The origins LUCIO ANDREASSI As far back as Roman times, a number of naturalists and scholars of medicine had already dwelt on pathologies of dermatological interest, providing details that continue to be fascinating in terms of their precision and linguistic accuracy. An emblematic example is the description of alopecia areata furnished by Celsus in Book IV of the De re medica: «fit in capillo et in barba. Id vero quoad a serpentis similitudine appellatur, incipit ab occipitio». Outstanding in the mediaeval period are various figures from the Salerno School, foremost among them Trotula de Ruggiero. One of the most famous women in ancient medicine, Trotula was accredited with having laid the foundations for the disciplines of obstetrics and gynaecology, and collaterally of venereology. She also wrote a treatise on cosmetics which addressed the most important female imperfections, proposing a series of preparations and methods that continue to be intriguingly relevant today. At the beginning of the sixteenth century, Italian dermatology was dominated by the enormous interest aroused by the epidemic of what was then known as the “French disease” – linked to the invasion by Charles VIII – and the large number of writers attracted by this new disease. One of the most eminent among them was Girolamo Fracastoro (1478-1553), the erudite author of the epic poem in Latin «Syphilis, sive morbus gallicus», from which the modern name of the disease, syphilis, derives. Fracastoro also wrote other works of medicine, including the «De contagione et 1 contagiosis» in which he expounds a theory that is a precursor of modern bacteriology. It was a theory of vital germs, which he called “seeds of disease”, that could be transmitted from one individual to another and were broken down into «crassiora» and «subtiliora». It is also interesting to recall the ranks of less famous figures who exerted themselves to describe the “French disease” in the vernacular, sometimes even on the basis of personal experience. Among these we can mention Niccolò Campana, known as Strascino, whose light-hearted short poem about syphilis, composed in popular language, is marked by a distinctly satirical and goliardic flavour. In the Renaissance period we can mention the figures of Gabriele Falloppio (1523-1562), and Gerolamo Mercuriale (1530-1606). Falloppio, in addition to the significant advances he made in anatomical studies, also wrote the «Libelli duo, alter de ulceribus, alter de tumoribus praeter naturam», which recorded not only the opinions of the ancients but also his own acute and original observations such as those relating to the behaviour of small pieces of skin. When they are detached from the organism, fragments of the ear-lobe or the nose can be grafted back on again, as long as they are applied and sutured immediately. These observations appear to predict those of Tagliacozzi, Reverdin and Thiersch. Mercuriale was the author of the «De morbis cutanei et omnibus corporis humani excretionibus», the first treatise of a certain consistency devoted entirely to diseases of the skin, addressing diseases of the scalp, hair loss, alopecia, ophiasis, baldness, leucotrichia, pediculosis, pityriasis amiantacea, ringworm and sycosis. The seventeenth century, the century of the great anatomists such as Malpighi, Valsalva, and Morgagni, did not produce any works in the form of treatises devoted entirely to dermatology. Despite this, there was no shortage of observations and citations of interest to this discipline. We can mention Bartolomeo Buonaccorsi (1618-1656) author of the «De externis malis opusculum», with 46 chapters listing the dermatoses in alphabetical order, starting with «de achoribus» and ending with «de scloppis seu vesicis». Several passages of this latter chapter are of a staggering descriptive efficacy, such as «scloppae, vulgo schioppole, sunt 2 vesiculae quae per totum corpus spargi solent, rubicundae, humore turgentes», clearly referring to bullous impetigo and to smallpox. We should also recall Giovanni Cosimo Bonomo and Diacinto Cestoni, both pupils of Francesco Redi, for their contribution to the discovery of the acarus of scabies. Deserving mention in the eighteenth century are Bernardino Ramazzini (1633-1714), Francesco Frapoli and Vincenzio Chiarugi (1739-1820). Ramazzini wrote the «De morbis artificum diatriba», a work packed with profound observations regarding the dermopathies of workers, also indicating prophylactic and therapeutic methods, the first treatise of its kind in world literature. Frapoli provided an accurate description of the so-called «male della rosa», which he was the first to call pellagra, because in the registers of the Ospedale Maggiore in Milan it was recorded with the name of «pellarella». Finally we cannot forget the Florentine Vincenzio Chiarugi, author of the «Trattato sulle malattie cutanee sordide», and the first Italian to play an official role in dermatological training after obtaining the chair of “Cutaneous Diseases and Mental Disturbances”. Trotula de Ruggiero, a pioneer cosmetologist Trotula de Ruggiero, also known by the name of Trottula, lived in the eleventh century and was one of the most famous physicians of the School of Salerno. Attributed to her is a treatise that marked the birth of obstetrics and gynaecology, and another treatise on cosmetology containing a wealth of formulations and advice of enormous practical interest. The role of the “physician” Trotula in the history of medicine can be focused by recalling the legend of the emergence of the Salerno medical school, whereby its foundation is attributed to «four masters»: a Latin, a Greek, a Jew and a Turk, a tradition that underscores the atmosphere of syncretism in which the school developed. In reality, the origins of the Salerno Medical School are to be sought in the Benedictine monastery of Salerno, where ancient works on botany and medicine had been conserved since its 3 foundation in 794. The fame of the already renowned monastery increased further when, in 1070, it offered refuge to Constantine Africanus, who over a few years organised the works on medicine, many of which were translated from Arabic into Latin. In the same period Alphanus, archbishop of Salerno, had the Greek medical works translated into Latin and fostered the dissemination of Hebrew literature in the city of Naples. The Salerno Medical School, universally recognised as the first and most important medical institution in mediaeval Europe, grew and prospered in this atmosphere permeated by laicism. The School produced various medical works, the most famous of which consisted of a series of rules on how to maintain good health written in the form of a poem. This work, known as the “Regimen Sanitatis Salerni”, was so popular that it was translated into most of the European languages of the time. In the true spirit of the Salerno School, the works of Trotula – which comprise various aspects of dermatological interest – were of an extremely practical bent. Her principal work “De passionibus mulierum ante in et post partum”, which is also known as Trotula Major, was primarily focused on a knowledge of the female body, which was very limited among the medical class at the time. The work, traditionally attributed to Trotula, is actually largely composed of anonymous contributions, containing teachings that can be traced to Trotula, namely the Practica secundum Trotam. The book is composed of sixty-three chapters and provides information on the menstrual cycle, conception and childbirth, as well as the principal diseases affecting the female genital region and the possible remedies for the same, based on herbs, spices and extracts both animal and vegetable. In this respect, beyond its importance for obstetrics and gynaecology, the “De passionibus mulierum” also represents a compendium of rules for health and hygiene which is extremely interesting from a venereological aspect. The work also addresses the issue of conception, arriving at the conclusion that dysfunctions can be of both female and male origin, the latter being a hypothesis considered unacceptable at the time. Again, the “De passionibus mulierum” suggests the use of opiates to alleviate the suffering during labor and delivery, a measure that was in contrast with the teaching of the church 4 which held that women ought to bear the suffering of childbirth without any relief. Trotula’s other work, attributed in its entirety to the Salerno teacher, is the “De Ornatu Mulierum” also known as Trotula Minor. The “De Ornatu” is an authentic treatise on cosmetics, comprising an array of procedures and preparations most of which are recorded in the monograph volume on Trotula (Green M H, ed. The Trotula: a medieval compendium of women’s medicine. Philadelphia: University of Pennsylvania, 2001). The work provides instructions on how to take care of the skin, how to dye hair, how to whiten the teeth, how to eliminate bags under the eyes, how to apply make-up to the face and lips, how to cure wrinkles, how to eliminate superfluous hair and how to care for cracked skin. A number of the recipes and procedures recorded in the “De Ornatu” are indicated as customary practice among Turkish women, again underscoring the openness of the Salerno School towards all innovative experiences. Syphilis sive Morbus Gallicus When Girolamo Fracastoro had the idea of devoting himself to drafting a work that would address the problem of the “new disease” that was sweeping through Europe, he could certainly never have remotely imagined that he would have gone down in history for this very work and that from that time on the “French disease” would have been named Syphilis. Clearly, he had devoted much greater commitment to the “De contagione et contagiosis morbis”, which is considered to be a forerunner of modern pathology. Girolamo Fracastoro, physician, philosopher, astronomer, geographer, theologian and intellectual, was born into a noble family of Verona. In 1521 he began writing the “Syphilis sive Morbus Gallicus”, completing it the following year, although it was not delivered to Cardinal Pietro Bembo, to whom it was dedicated, until 1525 and was finally printed in 1530. Written in Latin, the poem is divided into three books of 469, 458 and 419 lines respectively (Fig. 1, Fig. 2). 5 In the first book, the author states with conviction that the new disease was introduced by the French army and that it then spread throughout Europe, clearly identifying the mechanism of transmission in sexual intercourse. In the second book Fracastoro addresses the issue of treatment, compiling an extensive list of recommendations regarding nutrition and hygiene and listing herbs and spices. Taking inspiration from the myth of the hunter Ilceus, punished by Diana for killing one of her deer by the infliction of a serious skin disease and cured after immersion in a river in which mercury flowed, Fracastoro then introduces the theme of treatment using mercury. He proposes a list of Galenic preparations containing mercury and instructions on how to use them. In the third book, Fracastoro describes the guaiacum tree, the places in which it grows, the procedures for processing the Fig. 1. – Girolamo Fracastoro (1476-1553). wood to extract the medicinal principle and the way in which it is used for treatment (Davalli R, Lo Scocco G. Girolamo Fracastoro. Publication reserved for ADOI members, 2005). Fracastoro then dwells on the adventures of Columbus’ men on the island of Ophyre (Haiti) and on the relations with the natives with whom the Spaniards had fraternised. These natives, who bore the signs of a serious skin disease, came together to offer sacrifices to the Sun god (Apollo) to expiate an ancient offence which had incurred the wrath of the god and led to the disease. The blame was to be attributed to the shepherd Syphilus, who had offended the 6 Fig. 2. – The frontispiece of “Syphilis sive Morbus Gallicus”, with dedication to Cardinal Bembo. god and was punished by the infliction of a terrible disease in which the body became covered in ulcers, and took from him the name of Syphilis. After this, the narration continues, everyone was struck with the disease; but they repented, raising even higher altars to Apollo and offering sacrifices to the Sun god, who finally took pity and sent them a wondrous cure in the form of the guaiacum tree. The origin of the name chosen by Fracastoro to define the disease has always been a source of lively interest. Various interpretations have been proposed, all more or less imaginative. In effect Fracastoro, who was an extremely cultured man with a profound knowledge of Greek mythology, drew inspiration from the story of Niobe and her numerous children, including her favourite Syphilus. The legend, recounted by Homer in the Iliad, describes the tragedy of Niobe who offended Diana and Apollo and was punished with the slaughter of almost all her children. In the sixteenth century the “new disease” was indicated by different names, such as the “French disease”, the “Neapolitan disease” and the “Great Pox”, all of which were replaced in the centuries that followed by the name “Syphilis”, which was adopted in all languages, testifying to the deserved recognition of the work of the great physician and intellectual of Verona. 7 The “Lament” of Niccolò Campana known as Strascino Fig. 3. – The frontispiece of “Lamento” by Nicolò Campana, which depicts the author over whom the devil is emptying a cornucopia of syphilitic papules. Niccolò Campana, known as “Strascino”, was born in Siena in 1478 and died in Rome in 1523. He belonged to the ranks of comedians who transformed into theatrical performances a rural culture that was an embodiment of popular folklore. These groups gravitating around popular theatre comprised some of the figures who, in 1531, founded in Siena the Congrega dei Rozzi, later transformed into the Accademia. The Congrega dei Rozzi was officially united around a statute; it was an association of humble workers who amused themselves in the literary production of popular compositions, a clear expression of the authors’ own position within the society of the time. The chronicles of the period record how several popular Sienese comedians were the channels through which the popular culture was translated into theatrical productions. In this way, from the beginning of the sixteenth century, they managed to spread this type of rustic erudition, even making it known in more illustrious settings, such as the papal court in Rome. This is the cultural backdrop to the work of the “Rozzo” Strascino, the author of several compositions, the most famous being the “Lamento”, printed in Venice in 1523 in a version in which the frontispiece portrays the author over whom the devil is emptying a cornucopia of syphilitic papules (Fig. 3). The “Lamento” consists of 168 verses in ottava rima, narrating in a popular, satirical style the clinical 8 condition and development of syphilis, which Strascino had had the misfortune of contracting. In the first part of the composition the author recounts his odyssey as a sufferer from the “French disease”, as a man who has lost all hope of a cure, allowing his distrust of official medicine to emerge. In the second part Strascino has the sensation that he has been cured, probably on account of the disappearance of the evidence on the skin, and he attributes the cure to treatment with an unguent based on mercury. This treatment must have been fairly common at the time, and was widely believed to be effective. The problem was related to the difficulty of defining and controlling the dosage, as suggested by the verses dealing with the physician “Simon da Ronciglioni” (Fig. 4). Another remedy upon which the syphilis sufferers pinned their hopes was the “holy wood”, guaiacum, a tree originating from Central America, which hence had to be imported. Vast fortunes were constructed on the trade of guaiacum, notably that of the Fugger family of Augsburg. The tragicomic aspect of this wonder cure was that it was entirely devoid of any therapeutic activity, as Fig. 4. – The verses in which the author seems to have sensed that the Mercurial therapy can produce benefits but also significant risks. 9 Fig. 5. – The verses dedicated to the wood of India against which the author shows a marked skepticism. was rigorously proven later. Strascino too had surmised as much, as he gives us to understand in other amusing verses (Fig. 5). A reading of the “Lamento” cannot fail to recall De Morbo Gallico written several years later. We do not know if Girolamo Fracastoro had read the composition of the Sienese “Rozzo”, but it certainly cannot be ruled out that some of the descriptions and sensations expressed in a dramatic manner in the “Lamento” may have been useful to the great Verona physician in his drafting of the poem that established the scientific name of the “French disease”. 10 Birth of the discipline LUCIO ANDREASSI In Europe, the foundations of the current discipline were laid between the end of the eighteenth and the beginning of the nineteenth century. Figures such as Robert Willan (1751-1812), author of a benchmark description and classification of skin diseases, and Louis Alibert (1768-1837), who held famous lessons at the Saint Louis Hospital, played a fundamental role. In these years dermatology was practised by generic physicians and surgeons. In fact we need to remember that outstanding physicians such as Wilson, Baker, Rosembach and Hutchinson, not to mention Paget, all of whom described diseases that are now known by their respective names, lent their services as generic physicians at the famous St. Bartholomew’s Hospital in London. In Italy this period coincided with the Napoleonic experience, which was more intense and prolonged here than elsewhere. In effect, the creation of the autonomous territories, which were later comprised in the Italian Republic (1802-1805) and subsequently transformed into the Kingdom of Italy (1805-1814), did not signify merely the construction of a strong and centred State with an efficient and well-prepared bureaucracy. It also entailed a new relationship with the intellectuals, who were called upon to marshal consensus around the new regime, and above all to furnish the new generations of officials, technicians and professionals, including the physicians. A number of Italian University Medical Schools were suppressed and the structures underwent significant charges, which largely remained in existence even after the restoration. 11 Dermatology had difficulty getting off the ground as an independent discipline, although certain hospitals such as San Gallicano in Rome and the Ospedale di Bonifazio in Florence were already devoted largely or entirely to the treatment of dermatological disease. History of the most significant pathologies treated in the Hospital of San Gallicano from its origins up to the mid twentieth century LUCA MUSCARDIN, LIANA TAVERNITI, ALDO DI CARLO San Gallicano, founded in 1725, is the first hospital in Europe to have been devoted specifically to the treatment of skin diseases. In effect, although the Hôpital Saint Louis in France was established in 1607, it became a dermatological hospital only much later, in 1801, for the treatment of “soit les maladies contagieuses comme la gale, la dartre, soit rebelles et cachetiques telles que scorbut, les viex ulcères e les écrouelles” (both contagious diseases such as scabies and pityriasis, and the refractory and cachetic diseases such as scurvy, chronic ulcers and scrofula). It is interesting to recall that, at the time it became a dermatology hospital, its name was changed to “Hospice du Nord” as a tribute to revolutionary principles. The Bull of Foundation of San Gallicano, which has been preserved, lists the institutional aims of the hospital, which were eminently charitable: “pro curandis pauperibus et miserabilibus” affected by: “lepra, scabie et tinea, seu prurigine in capite”. On the other hand, patients affected by “lepra et scabie venerea seu gallica” – that is, who were suffering from venereal diseases, which were already well known at the time – were not accepted but were referred to the Ospedale San Giacomo. In order to provide a historic framework for the terms used in the Bull, we need to remember that it is far from easy to furnish a precise definition of what was understood at the time by the word 12 “leprosy”, up to Hansen’s discovery of the mycobacterium in the nineteenth century. A brief overview of the origin of this term seems useful. In the Pentateuch the word “tsarath” is used to define a serious skin disease, which was probably contagious since it motivated the separation of the affected persons from the rest of the community. In the first Greek translation of the Bible, made in Alexandria in Egypt two centuries before Christ by the so-called “seventy interpreters”, this word was translated with the Greek term “lebbra”, etymologically “scaly, wrinkled, raw, rough”. Following this, the Biblical term was used to define all contagious skin diseases that affected visible areas of the skin and aroused fear of contagion and feelings of repulsion on account of the external appearance. In ancient Greek medicine (Hippocrates) the term was used in a more specific manner, signifying skin diseases characterised by scales. It is possible that it in fact referred to forms of psoriasis and other scaly skin diseases, while what is now called leprosy was known by the Greeks as “elephantiasis” a term which very probably described the lepromatous form. The term “scabies” too is of uncertain origin. The use of this term dates to the Latin period (the verb “scabere” means “to scratch”), while in the Greek world a contagious skin disease had already been described that was characterised by severe itching and was called “psora” (from the verb meaning “to scrape, scratch”). The link between a skin disease and an acarus infection may have already been suspected in the Greek world. In the eleventh century the Arab physician Avenzoar hypothesised such origin, and in Europe Guy de Chauliac (1300-1368), archiater of Avignon, was the first to link the term “scabies” with that of “mange” to describe an itchy disease caused by a parasite. In 1687, in a letter to Francesco Redi, the Livorno physician Cestoni confirmed the presence of small animals which he called “pellicelli” as the cause of scabies, but it was not until 1834 that the acarus was officially recognised as the agent causing scabies by the French physician of Corsican origin, Renucci of the Saint Louis of Paris. At the time when San Gallicano was opened, the official theory - also accepted by Lancisi - was that scabies had a “spontaneous generation in the organism” and it was hence treated with “depuratives”, “blood-letting” and other not better specified methods. 13 The name of the disease identified as “tinea” (also known as ringworm) may derive from the Arabic word “Alvathim”, which denoted a disease of the scalp, and in the Bible “tinea” is defined as “leprosy of the scalp and beard”. This referred merely to a specific localisation on the scalp, and was in no way connected with the presence of the fungi which were described by Linnaeus in 1753, and were not recognised as the cause of the disease until the nineteenth century. Returning to the Foundation Bull of 1725, in paragraph 6 we find an interesting statistic, namely the allocation in terms of beds in the men’s ward, which also enables us to see which of the diseases were most frequent at the time. In the early years in the life of the hospital, the allocation was as follows: 30 beds for “pruriginosis”, 3 beds for “pruriginosis febricitantibus”, 6 beds for “pruriginosis scabiosis”, 6 beds for “scabiosis in capite”, 9 beds for “leprosis”, 2 beds for “leprosis pruriginosis”, 4 beds for “leprosis non pestilentibus” and 5 beds for “leprosis pestilentibus”. The beds were similarly allocated in the women’s ward, albeit with the addition of a further 10 beds for the patients known as the “lancisiane”, following the bequest of the famous Roman physician Giovanni Maria Lancisi (1654-1720). Lancisi had in fact left a fund to cover the hospitalisation requirements of the women of the districts of “Borghi, Lungara, di Ponte, di strada Giulia e dell’Orso”, who were refused access to the nearby hospital of Santo Spirito and, in view of their particular conditions were unable to reach the more distant hospital of San Giovanni. Lancisi himself had remarked that “the poor fever-stricken women of these districts are constrained to die of privation in their own homes, or to have themselves transported with the greatest inconvenience and danger for a distance of three and more miles to the hospital of San Giovanni in Laterano”. Pope Benedict XIII utilised Lancisi’s legacy for the construction of San Gallicano, allocating 10 beds in it to the fever-stricken women originating from the districts close to Santo Spirito. In parallel with the wards, a clinic was also opened (paragraph 10 of the Bull) to deal with the medication of the poor of both sexes suffering from “scabbia” and “ulcuscula in cruris” or in other parts of the body, deriving from scabies, specifying that even if the scabies was not 14 localised on the head the treatment was to be performed anyway. It is interesting to note that separate mention is made of ulcers of the lower limbs, a pathology that was undoubtedly very frequent at that time, and even in our own clinics up to a few years ago before the advent of surgery reduced its incidence. Then we can also note the three types of “pruriginosis” one of them defined as simple (with the largest number of dedicated beds), one “feverish” and finally one defined by the use of the word “scabies” as an adjective. Then there is a “scabies” located on the head, which for two reasons can probably be identified with ringworm. Firstly because it is the only pathology in which the scalp – the characteristic location of ringworm – is specified, and secondly because ringworm is not mentioned in this list but does appear in other parts of the Bull, making it seem likely that the two terms were used synonymously, further confirming the generic use of the term “scabies” to refer to a number of diseases. Finally we have four types of “leprosy”, in two of which the adjective “pestilentibus” is used, possibly with the meaning of extremely severe or highly contagious. By order of Benedict XIV, on the first of July 1743 the so-called “rognosi febbricitanti” – up to then hospitalised at Santo Spirito – were transferred to San Gallicano. Two interesting manuscripts were published to mark the occasion: “Stabilimenti e regolamenti per il buon servizio de’ Rognosi Febbricitanti trasportati nell’Ospedale il primo luglio 1743 dal S. Spirito per ordine di Benedetto XIV”, which provide us with a realistic description of the daily life of the hospital. Different interpretations can be proposed for the definition of “rognosi febbricitanti”. The most plausible is that this definition may have generically included all four pathologies listed in the Bull where accompanied by a rise in temperature. However, considering that a raised temperature can be a concomitant phenomenon, it seems more likely that the epithet was applied to patients affected by extensive dermatosis, probably contagious and pruriginous, associated with more serious general conditions, who were traditionally admitted to Santo Spirito. In this case, the epithet “febbricitante” would indicate a decline in the general conditions rather than the fever phenomenon alone. 15 We can suspect that this group of dermatology patients included all the primary or secondary erythrodermic or sub-erythrodermic forms affecting vast areas of the integument (psoriasis, eczema, lymphomas, Norwegian scabies etc.). To take a closer look at the treatment of dermatological disease, it is interesting to record the treatment performed for ringworm of the scalp in 1753. In the first place the hair was almost completely shaved, after which “fresh or rancid butter” was applied to soften the scabs over which blotting paper was applied held in place with a linen cap until the softened scabs came away. After this the hair was completely shaved in the areas in which the disease was active, and incisions were made with a razor all over the head, (or over part of it depending on staunchly how the patient stood up to this treatment), with the patient keeping the head bent to favour the flow of blood until it stopped. After this the head was washed with cold water and the curative unguent was applied to the scars. This unguent (known as “nero da tagli”) was made up of fresh or rancid butter mixed with turpentine, lead, mercury, rose oil, rock salt and lemon juice, and acted as an irritant. To keep the unguent in contact with the infected scalp an ox bladder was used as a cap so as to achieve an occlusive skin treatment. The unguent was reapplied every day until the scabs healed, normally after 3-4 days. This treatment was continued for five or six months, during which time the hair that grew back was periodically pulled out and then anointed alternately with the black unguent and with oil. The purpose of this treatment was to produce an inflammation at the root of the hair so that it would be completely expelled, thus eliminating the infection. This type of treatment continued to be performed at length; in fact in his “Voyage en Italie” Ippolito di Taine (1828-1893) noted in 1864 that at the Ospedale San Gallicano incisions were made on the heads of people affected by ringworm, after which they were daubed with a liquid preparation using a paintbrush. The first period in the life of San Gallicano was characterised by the dominant care requirements for diseases that struck the poorest classes of the city, and hence nursing and social assistance took 16 precedence over the medical and scientific aspects; in effect there were more nursing staff than physicians. The shift from management of a religious kind, under the director of a “prior”, to lay management coincided in historical terms with the fall of the Papal State. When the hospital was no longer controlled by the ecclesiastical hierarchy, a greater aperture towards the medical science of the time emerged. In fact under the management of Manassei, the first lay director (1860-1867), the Ospedale San Gallicano opened up to the national and international scientific community, becoming an authentic clinical and scientific dermatological hospital and superseding the charitable connotations implicit in the Papal Bull through which it had been established (Fig. 6, Fig. 7, Fig. 8). As a further proof of the historic importance of San Gallicano, we can recall that in 1860 the first Chair of Dermatology in Rome was also entrusted to Manassei, who for a certain period maintained both positions, with the seat of the University chair at the hospital of San Gallicano. Then in 1866 he opted for the academic career, entrusting the direction of the hospital to Schilling. Casimiro Manassei was also the first Chairman of the Società Italiana di Dermatologia e Sifilografia founded in 1885. As mentioned above, the second director of the hospital was Schilling (1867-1893), during whose tenure the first patients affected by syphilis were accepted, who had up to then been treated at the Ospedale San Giacomo, known as the “Incurabili”. It was in this period that Maiocchi began his brilliant career as an intern assistant at San Gallicano, after which he was awarded the Chair of Dermatology first at Parma and later at Bologna. Under the direction of Ciarrocchi (1893-1925) venereal pathology came to be entirely comprised within the dermatological ambit, and the institute began to treat patients suffering from gonorrhoea. It was Ciarrocchi who introduced the Roentgen treatment for the cure of tinea, following original works by Sabouraud, and gave new impetus to dermatological treatment formulating new galenical preparations that are still featured in the textbooks (Fig. 9) The more recent history of San Gallicano is bound up with that of syphilis. In effect, in the first half of the last century dermatology was dominated by the social impact of venereology, and the scientific community engaged with dermatology and venereology 17 Fig. 6. – San Gallicano Hospital: anatomical theatre now houses the scientific direction. devoted much of its energy to fighting these venereal infections, the impact of which could be compared to that of AIDS in presentday society. At this time the San Gallicano Hospital was in the front line in the fight against syphilis, especially in the period before the discovery of penicillin after which it became an infectious disease like any other and its previous social significance dwindled. It was for this purpose that the “Sale Celtiche” were set up at the end of the nineteenth century (Crispi Decree), assigned to the treatment of women suffering from venereal disease (mainly syphilis and gonorrhoea) in the contagious phase, so as to eliminate the danger of infection. In practice the women taken into this section of the hospital were almost all prostitutes who, following periodical obligatory sanitary controls, proved to be suffering from a venereal disease in the contagious stage. Hence the Sale Celtiche represented the official health control of the problem of venereal disease, which was partially linked to the 18 Fig. 7. – San Gallicano Hospital: medallions depicting famous physicians located in the anatomical theatre. control of prostitution, considered to be the main cause of the diffusion of these diseases. The Sala Lancisi was in fact assigned to the hospitalisation of such women, who could receive visits from relatives only twice a week. Meineri (1934-1953) records the statistics of the patients admitted to San Gallicano, which show that between 1937 and 1944 the average number of admissions to the Sale Celtiche was 650 a year, with a staggering increase towards the end of the First World War (3,000 patients hospitalised in one year between 194445). The average period of hospitalisation varied from one to two months; in practice the primary luetic lesion and the blennorrhoea were cured within a month, while it took around two months for the contagious manifestations of syphilis to disappear. Both the number of controls and the number of cases were extremely high, and the statistics relating to San Gallicano for this period reflected the epidemiological trend at national level. It is also interesting to observe that Meineri’s interest was not restricted solely to the 19 Fig. 8. – San Gallicano Hospital: children hospitalised for ringworm in the early 900. medical aspect of the syphilitic infection; he also called attention to the social problem of prostitution as a source of the spread of the disease. His modern vision and pioneering approach fostered the development of a health policy that was not repressive but was built around an enhanced social commitment, aimed at encouraging the women to abandon prostitution and helping them to be reintegrated into society. In the age of antibiotics, San Gallicano abandoned the infectivological role endorsed by the principles of its foundation to become a modern dermatological hospital. It proceeded to establish and initially valorise radiation therapy for skin tumours and phototherapy for certain pathologies such as lupus and psoriasis. For this reason the hospital was separated from the Ospedali Riuniti di Santo Spirito, and in 1932 was transformed into a Hospital Institution of a Scientific Character. Dating to the time of its recognition as a scientific institute (IRCCS) is the formation of the Library which, in addition to modern journals and monographs, also comprises 2,063 humanistic texts (Fondo Agostani), 200 works of medical literature from the first half of the twentieth century and a collection of monographs on syphilis, such as Fournier’s famous treatise of 1924. The Pharmacy of San Gallicano, which is still in existence, was traditionally devoted to the 20 Fig. 9. – Professor Manassei and Professor Ciarrocchi of the San Gallicano hospital with other dermatologists at the World Congress of Dermatology. Paris 1889 preparation of galenicals, whereas it is now being transformed into a modern pharmaceutical enterprise engaged in the production of updated preparations for application in the field of dermatology. After the 1990s, with the establishment of the experimental laboratories (dealing respectively with Cutaneous Physiopathology, Dermatopathology, Biochemistry, Porphyrias and Microbiology), the transformation into a modern dermatology institute was completed under the management of able Directors and – in line with the mandate of Law 288/2003 governing the IRCCS – through the acquisition of new diagnostic techniques (electronic microscopy, telethermography), new clinics (allergology, paediatrics, oncology, plastic surgery), local structures for research and care (Psocare, Melanoma Unit) and new management approaches (week-hospital). References 01. De Angelis, P. L’Ospedale di Santa Maria e San Gallicano a Roma, Collana di studi storici sull’ospedale Santo Spirito in Saxia e sugli ospedali romani, 1966. 02. Agostani, M. Storia della scabbia nei rapporti coll’ospedale San Gallicano. Bollettino Dell’istituto Dermatologico San Gallicano, Vol V, p.57-68, 1968. 03. Argentieri, R., Biondi, S. Intuizione clinica e superstizione. Precetti morali e assistenza sanitaria nell’antico Regolamento dell’ospedale San Gallicano. Bollettino Dell’istituto Dermatologico San Gallicano, Vol. VI, p.85-90, 1970. 21 4. Meineri, P.A. Come si curava la tigna due secoli or sono in questo Ospedale. Ippolito di Taine e la cura della tigna in questo Ospedale. Bollettino Dell’istituto Dermatologico San Gallicano, Vol II, p. 94-96, 1952. 5. Meineri, P.A. Redenzione delle prostitute per mezzo del lavoro. Bollettino Dell’istituto Dermatologico San Gallicano, Vol I, p. 65-74, 1947. 6. Fortunato, M. Istituzione di un opera per la redenzione delle prostitute. Bollettino Dell’istituto Dermatologico San Gallicano, Vol I, p. 74-79, 1947. 7. Taverniti L, Di Carlo A. The first ‘rules’ of an ancient dermatologic hospital, the S. Gallicano Institute in Rome (1725). Int J Dermatol. 1998 Feb;37(2):150-5. The Hospital of Orbatello in Florence and the "Fotoradioterapico" Institute: five hundred years of history, eighty years of Dermatological Physiotherapy CARLO VALLECCHI, GIOVANNI MANTELLASSI (English translation of article published in “ Santa Maria Nuova in Firenze”, memories, testimonials, perspectives, the VII centenary of the foundation of the Hospital, proceedings of the days of celebration) In 1372, the Florentine banker Nicolò degli Alberti thought up and had Agnolo Gaddi build a great poorhouse or ospizio for destitute old women with neither relatives nor a home. “To do so”, wrote Passerini, “he built a large building above a garden in via della Pergola, at the place still called Canto alla Catena because of the coat of arms of the Alberti, wherein he had two hundred small rooms made, each separate from the other”.1 Thus began the story of the ospizio which was known for centuries as “di Orbatello”, a corruption perhaps of “Hortus Albertorum”, or perhaps of “Albertorum tellus”; or else it could come from the name of one its patrons, Albertello degli Alberti. For over three centuries, Orbatello stayed the way Nicolò had created it and as we can see it in the old map by Richa2: a poorhouse for the elderly, designed in an intelligent and very human way. It then became a Hospital, due to a unique sequence of events which began around the year 1700. In those days, there was widespread belief in Florence that unmarried women could interrupt a pregnancy “in order to safeguard their own honour and that of the family”. This precocious 22 campaign to legalize abortion called down on itself the wrath of Pope Innocent XI, who in 1679 anathematised the perverse doctrine and the errant women who had undergone an abortion.3 The papal decree opened a new chapter in the history of Orbatello: “Under Cosimo the Third”, wrote Bacciotti, “in 1704, the shameful pregnant women were brought in, whom the well deserving Father Filippo Franci had hitherto kept hidden in a place in Quarconia”.4 Quarconia was an almshouse for orphans in via de' Cimatori, where Franci secretly housed the “shameful pregnant” women until they had given birth. The frequent comings and goings in the night however fed many malicious rumours, so the Grand Duke put pressure on Franci to put an end to his initiative. Eventually convinced of Franci's innocence, however, he became a supporter of his and assigned part of the ospizio of Orbatello to him (cutting the rooms for the elderly women down to 54): an ideal place, far from the reach of town gossip, surrounded by walls, with a church5 to redeem the sinners, who could come there without being seen, thanks to a secret passage and a landing. In 1775, the Grand Duke entrusted management to the Commissioner for the Orphanage of the Innocenti, where between eighty and two hundred children born within the walls of Orbatello were taken every year.6 A new change took place in the 19th Century: in 1836, the Alberti Foundation having come to an end, the poor old women began to be sent away. A new role awaited the building, associated with the illustrious name of Vincenzo Chiarugi, who, since 1802, had been professor of “Skin Diseases and Intellectual Disorders” at the great Hospital of San Giovanni Battista or Bonifazio7 where patients affected by skin diseases were cared for. During a cholera epidemic, Nicolò Bruni (Chiarugi's second successor in the direction of the Hospital) had the skin patients moved to the nearby Hospital of Santa Lucia di Camporeggi, later demolished in a building gamble, together with that of Bonifazio and others in via San Gallo. In the meantime, cases of syphilis – which had begun to appear in Florence in the 15th Century8 – were growing in number, and patients were precariously assisted as “incurables” in various city hospitals, including that of Santa Lucia di Camporeggi. 23 In 1869, the Regulation of the Ministry of the Interior on prostitution came into effect in Florence. On orders by Pietro Cipriani, at the time Superintendent of the Santa Maria Nuova Hospital, a first “sifilocomio” or syphilitics’ ward was set up at the same Hospital of Santa Lucia; then the Prefect ordered the “prompt takeover of the premises of Orbatello where the new syphilitics’ war must be set up”.9 The last old ladies were sent away, and the old Ospizio closed down. In 1861, part of its premises were set aside for a syphilitics' ward and Vigilance Office for prostitutes; all the skin patients left at Santa Lucia di Camporeggi were finally transferred to other, separate wards by order of the Superintendent of the Hospital of Santa Maria Nuova.10 It was October 11th, 1888. From that day on, then, Orbatello became the location of the Dermosyphilopathic Clinic of Florence, directed – at the end of the century – by a man of wide views and vast and eclectic culture: Celso Pellizzari. Those were years in which the progress of physical medicine began to open up new horisons for medicine. In 1895, Roentgen discovered X-rays and in 1898, Mr and Mrs Curie isolated Radium; soon after the effects of the new radiations on living tissues were discovered, also at the expense of Becquerel who was burned by them, and they began to be tested out in tumour therapy. In the meantime, phototherapy, especially using “actinic” or ultra-violet rays, began to be successfully adopted by Niel Finsen in the therapy of Lupus vulgaris, which at the time was a very frequent, devastating and diffusive form of skin tuberculosis. The Finsen-therapy, adopted on a large scale at the great Institute for Phototherapy of Copenhagen, attracted the attention of Celso Pellizzari, who spoke about it to the Florentine Committee of the Anti-Tuberculosis League. This was how the idea arose of creating an Institute for Phototherapy in Florence resembling the one in Copenhagen. If it were set up, the League promised to provide it immediately with a large Finsen apparatus.11 In January 1904, the idea took shape: a Committee was set up to gather funds. Its members were the Town Government, the Provincial Government, the Arcispedale di Santa Maria Nuova, the Anti-Tuberculosis League, the Savings Bank. Pellizzari, together with 24 his assistants Radaeli and Mazzoni, travelled unceasingly in order to gather information about the new therapies: he went to meet Finsen in Copenhagen, Lassar in Berlin, Schiff and Lang in Vienna, Neisser in Breslau. However, he did not neglect fund raising. He was greatly loved and respected by the Florentines, not only as a scientist, but also as a great connoisseur of arts and music: thanks to his personal prestige and enthusiasm, significant sums were collected from private citizens, and in a short time, the Committee had the fifty thousand lire it needed to start the project. Next to the Dermosyphilopathic Clinic, the ancient Ospizio of Orbatello began to undergo refurbishing of the ground floor, which had been left unused for a long time and was made available after a long and difficult struggle with the bureaucracy which administered state property. However, work was carried out in record time. Everybody, from the engineers to the labourers, took part with the enthusiasm of people who knew they were contributing to the birth of something new: the first public Phototherapy centre in Italy.12 The result was astonishing: by the end of 1904, less than a year after the idea was born and the Committee founded, the Florentine Institute for Phototherapy had been finished, equipped and was running. On May 11, 1905, it was officially inaugurated with the town authorities and a member of the royal family, and was already able to present the first results obtained thanks to the new therapies (Fig. 10). In his inauguration speech, Pellizzari also submitted his accounts: he had spent twenty four thousand lire to refurbish the building, twenty two thousand for the installations, equipment and furniture. Much less than he had expected. “During this first year”, he proudly said, “I know I can count on seven thousand lire”. The activity of the Institute, which began with Lupus therapy and the Finsen devices, soon expanded: in 1905, the first device for Roentgen dermatological therapy was installed, and various physical therapies which were the state of the art at the time were tried out, such as photochromotherapy, electrotherapy, high frequencies and Marconi therapy (Fig. 11). During his trip to Berlin in 1904, Pellizzari also gathered information on Lassar's first experience with skin tumour therapy using Radium applications. He had an intuition of the possibilities 25 Fig. 10. – Operating Finsentherapy equipment at “Fotoradioterapico” Institute in Florence in the early 900. Alinari Archivi Alinari archivio Alinari, Firenze afforded by this new concentrated and inexhaustible source of radiations, and as usual began to take action at once. In the whole world, there were only a few grams of Radium, fought over at a dear price by physicians and physicists, and nobody in Italy had any. In 1905, Pellizzari went to London, and purchased ten milligrams from W. Martindale, taking them personally to Florence “sealed in a small ebonite box”. If we think of the way they used to work in that age of pioneers, it is better not to ask oneself too many questions about this danger way of carrying it. In 1907, after a year of trials and study trips to Paris, the Florentine Institute for Phototherapy was the first in Italy to begin to use Radium systematically for contact therapy. In 1911, it was the first to propose a great novelty: intestitial therapy by fixing needles of Radium directly in neoplastic tissues, still used today. By then, newspapers were talking of the wonders of Radium and the new Florentine Institute: but Pellizzari was still forced to call on private donors to fund it and to increase the supply of Radium. Institutions, 26 Fig. 11. – Professor Pellizzari and his staff while the Finsen therapy equipment is operating at the Institute Fotoradioterapico - Alinari Archivi Alinari - archivio Alinari, Firenze in fact, were failing to comply with their promises: local governments had cut down contributions, and only in 1907 did the Government grant the paltry sum of three hundred lire, when a single tube of Radium cost eight thousand. Pellizzari, after a useless interview with Facta and other authorities in Rome, bitterly complained of the lack of material and moral contributions, which on one hand would have helped to develop free care and on the other hand would have made the Institute for Phototherapy an important centre for research on Physical Therapy. “Since this did not happen”, wrote Pellizzari in a report, “the publications and research carried out at the Institute are the result of the private initiative of assistants who took time away from their work”. Despite financial difficulties and the war which deprived him of all his staff, Pellizzari managed to make his Institute grow. The supply of Radium by now was more than one gram, subdivided into 88 preparations. 1923 saw the inauguration of the second floor, entirely given over to Roentgen therapy, provided with no less than 27 seven surface and in depth therapy units and one diagnostic unit. The balance-sheet of the radiotherapy activity was about four thousand cases of malignant tumours, with enough follow-up to allow one to speak of “positive” results. Carlo Pellizzari died on December 25, 1925. His successor, Jader Cappelli, said, “those who knew him will not forget what a genius he was, how honest and how straightforwardly involved in helping others. Those who were close to him will remember his wit and his multifarious and deep culture. Those who had him as their master will remember his persuasive teaching, his prompt replies, his endless goodness which he shared equally between his students and his patients”. Jader Cappelli and his assistant, Mario Scopesi, unforgettable friend and brilliant master of radiotherapy for the new generations, took the Institute through the many difficulties of the war. They even managed to hide the Radium from a written request by the German command to “borrow” it. During the academic year 1949-50, Jader Cappelli was succeeded by Enea G. Scolari. The Dermatology clinic had in the meantime been set up in via degli Alfani; but the new Director also devoted full care to radiotherapy and to physical therapy at the Centre in via della Pergola which, under the new name of “Celso Pellizzari Institute for Photoradiotherapy” was by then associated with the Dermosyphilopathic Clinic. Thanks to new allocations by the Ministry, the Radium supply soon reached four grams, subdivided into many hundreds of needles and tubes. Radiation protection measures were brought up to date; the Roentgen therapy equipment was renewed; a plastic and reconstruction surgery service was established. Scientific activity intensified, especially in the field of radiosensitizers; an original technique of hyperbaric oxygen radiotherapy was developed which soon drew the attention of radiotherapists from the USA. On November 4, 1966, the Institute was struck by the flood of the Arno river, which reached a level of two metres; effects on the ground floor, where the main activities were carried out, were devastating. While the small staff of the Institute was looking helplessly at the debris of furniture and equipment buried in the mud, a team of young volunteers appeared, asking whether any help was needed. The work of the Institute went on as well as possible on the upper floors, while 28 the volunteers made a miracle: they took away the wreckage, dried out and cleaned the rooms, and with infinite patience, they restored about one hundred thousand clinical records, an indispensable tool for radiotherapy. Radium was intact in its platinum and lead containers, but thousands of precious slides of clinical cases were lost forever. In 1972, Enea Scolari died. A disciple of his, Emiliano Panconesi, took up the heritage of Chiarugi and Pellizzari: it was thanks to his initiative that the Faculty of Medicine and Surgery of Florence, in 1982, was the first in Italy to introduce Dermatological Physiotherapy into its curriculum. The “Photoradiotherapy Centre” of via della Pergola today is a full part of the institute of Clinical Dermosyphilopathy, thus putting into practice Celso Pellizzari's wish to “see the importance which the Institute had by now acquired acknowledged”. Problems are not however over. In the past, the key point of the prestige of the Centre was Radium which today, though it has kept its therapeutic validity, has given way to more practical artificial radionuclides and accelerated electrons; non-ionizing radiation physiotherapy has been enriched with important new means, including Laser; modern teaching needs are associated with the development of scientific activity, especially in the field of radiobiology and photobiology. These new and urgent needs for updating bring up the same problems today as had so embittered Pellizzari. They also bring up a new one: the slowness of public structures often leads to the use, and sometimes misuse, of techniques of Dermatological Physiotherapy, by private structures, for purely commercial purposes. References 01. Passerini L. Storia degli Stabilimenti di Beneficienza della Città di Firenze, Le Monnier, 1853. 02. Richa G., Notizie sulle Chiese Fiorentine, 1754. 03. Passerini, op. Cit. 04. Baciotti E., Firenze Illustrata, Florence, 1886. 05. The church, built at the same time as the Ospizio, has been restored and now hosts the University library of History of Art. One can still see the beautiful 14th century portal surmounted by a fresco of the school of Il Ghirlandaio; inside, there is still a landing where the secret passage started. 06. There is mention of the existence of an underground passage which directly connected. Orbatello to the nearby Ospizio degli Innocenti, making it possible to transfer newborn children with discretion. We are not aware of any studies on this, however it is well known that secret underground passages were in rather wide use at the time. 29 7. This Hospital was located in Via San Gallo where the Police Headquarters stands today, and was called “Hospital of San Bonifazio” by the people. It was founded in 1376 by Bonifazio Ugone de' Lupi, marquis of Soragna, who was not a saint, but a fearsome leader of mercenaries from Parma, who became a citizen of Florence. 8. On May 28, 1496, the “bolle franciose” or “French bubbles” were discovered in Florence, as the chronicler Luca Landucci tells us. 9. A.S.F. Fondo Ospedale S.M. Nuova, Copia degli Ordini allo Spedale di Bonifazio e S. Lucia, 1852-1890, Volume No. 4134. 10. The letter is dated October 10 (A.S.F. Fondo Ospedale S.M. Nuova, Affari d'Ufizio, anno 1888, filza No. 4158). 11. The Finsen, Finsen-Reyn and similar devices used the germ killing action of short wave UV rays produced by an arc lamp and concentrated on the lesion (ischemicized by compression) using a quartz lens optical system. 12. A small private centre had already been running in Milan since 1903, directed by a disciple of Celso Pellizzari, Angelo Bellini, who already employed Finsen therapy with Lupus and was trying out Roentgen therapy for some benign forms, especially with hypertrichosis. It was only in 1906, thanks to the initiative of Francesco Bertarelli, that the “Finsen Radiotherapy section” was set up at the Ospedale Maggiore in Milan. The first hundred years of the “Fotoradioterapico” Institute In 2005 Prof. Torello Lotti, Chairman of the University Unit of Dermatological Physiotherapy (Fotoradioterapico Institute) in Florence has solemny commemorated in the Aula Magna of the University the first hundred years of the activity of “Fotoradioterapico” Institute / Dermatological Physiotherapy Unit (Fig. 12). Prof. Torello Lotti with Drs Riccardo Rossi and Pietro Campolmi in the Giornale Italiano di Dermatologia e Venereologia” (Lotti T, Rossi R, Campolmi P. Dermatologic radiotherapy from the Florentine Pioneers to an urbi et orbi message – Giorn It Dermatol Venereol 2006;141:1-4) reported on the celebration day of 23 november 2005 and after commenting on the past, proposed their ideas for the future management of the Fototerapico Institute of the Florence University. Fig. 12. – The poster of commemoration of the first 100 years of the “Fotoradioterapico” Institute, held in Florence in 2005. 30 Angelo Scarenzio CORRADO DEL FORNO The first university professor to occupy the chair of Dermatology and Syphilology in Pavia was Angelo Scarenzio, who became internationally famous in the field of venereology for his pioneering treatment of syphilis via subcutaneous injection of calomel, or mercury chloride. Scarenzio was born in Pavia on 1 February 1831 and graduated very young in 1854, with a degree thesis on “Progressive general paralysis among the non mentally ill”. He began his professional career in the field of surgery, under the guidance of the great surgeon Porta, and every soon became a surgeon at Mantua and was twice appointed as assistant professor of Clinical Surgery at the University of Pavia. Even after he moved on to the area of Dermatology and Syphilology, in his heart and practis he remained a skilful and impassioned surgeon. He continued to publish numerous works on surgical arguments and was frequently engaged in surgical teaching in the Faculty of Medicine at Pavia. He devoted himself with great success to plastic surgery, and in 1894 at the Hygiene Exhibition of the International Medical Congress in Rome, the King of Italy Umberto I stopped to examine what we would now call the “poster” of the rhinoplasties performed by Scarenzio and commented “I am delighted to be able to admire such fine results produced by an Italian surgeon.” In 1861 Angelo Scarenzio was appointed to the newly-established Chair of Dermatology and Syphilology at the University of Pavia, and he continued to be a professor in this discipline for 43 years up 31 to his death in 1904. In Scarenzio’s time the Dermatology and Syphilology Department was housed in the poky and dilapidated premises of the part of the Ospedale San Matteo known as “Casa Ghislanzoni”, located in the former church of Sant’Eusebio, and demolished at the beginning of the twentieth century to make room for the present “Palazzo della Posta Centrale”. There was an annexe to the Department (a ward for those suffering from venereal diseases) in the “Palazzo del Maino”, which then became the premises of the management offices of the Ospedale San Matteo when the new Polyclinic was created. The majority of the patients treated at the Dermatology and Syphilology Department were suffering from venereal disease. In the second half of the nineteenth century syphilis was very widespread in the city and in the provincial area of Pavia, and there were numerous patients hospitalised even for long periods in the ward. The Department was also the premises of the State “Celtic Dispensary” a type of specialist syphilis clinic, which was also managed by Scarenzio. This dispensary had been set up following the promulgation of the Crispi Law for the prophylaxis and treatment of syphilitic disease, and was for many years the only actual clinic within the institution. In fact, the Clinic for skin diseases was not opened until 1900 on the initiative of Professor Truffi, pupil and at the time assistant to Scarenzio. Consequently, it is not surprising that between dermatology and syphilology, Scarenzio tended to be more interested by the latter. The destructive lesions caused by the later stages of syphilis, moreover, offered him the opportunity to exploit his skills as a surgeon, as in the case of rhinoplasty for nodular syphilids of the nose. Scarenzio published around 150 scientific works, 50 of them on venereological topics. He also set up – at his own expense, endowing it with an annual budget of 200 lire – a Dermatology and Syphilology Museum which comprised a number of wax models (“moulages” of dermatological diseases), illustrated plates, pathological items and in particular an important collection of skeletons and brains of prostitutes and ruffians, a collection that was defined by Truffi as “of notable value for anthropological science”. The collection illustrated Scarenzio’s particular interest in the syphilis of the nervous system, which was the subject of his first publications on venerological topics dating to the 1860s, after he 32 had been appointed to the Chair. Scarenzio was a gentle and courteous man, a scrupulous teacher greatly loved by his students, and a citizen actively engaged in public life: he held the positions of town councillor and provincial councillor and was a member of the Provincial Health Board etc. In the history of medicine, Scarenzio’s name is still linked to the treatment of syphilis via subcutaneous injection of calomel, or mercury chloride. In the nineteenth century mercury, for topical use (mercurial unguent or, as Scarenzio himself called it “Neapolitan unguent”) or taken by mouth (in the form of pills of red precipitate or mercuric chloride), was the treatment most commonly used in the treatment of syphilis, but it featured a number of inconveniences in terms of absorption, with an extremely variable efficacy and a notable frequency of undesirable side effects. In 1864, and more precisely on 7 April 1864, Scarenzio administered subcutaneously 20 centigrams of calomel held in suspension by glycerine to a patient affected by a serious secondary syphilitic infection with destructive ulceration of the face. She was a woman of 30 years old, eight months pregnant, who had contracted the infection by breast-feeding on payment, acting as wet nurse to a child affected by congenital syphilis. This mode of contagion was anything but rare at the time, in view of the frequency of the congenital forms and the widespread practice of sending city infants to be breast-fed by wet nurses in the countryside or the surrounding hills. The injection of the dose of calomel was repeated the following day. In two weeks the cutaneous manifestations began to improve, and after about a month the patient, who in the interim had given birth to a baby boy who had died after 15 days as a consequence of syphilis infection, proved to be in good general conditions of health, the skin ulcers having healed although not without a significant mutilation of the nose. In this case Scarenzio chose to resort to an artificial nose rather than undertaking rhinoplasty. The second patient treated with subcutaneous injections of calomel in June 1864 was a 35 year-old man “a polisher by trade, dwarfed, hunchbacked, lame and ill-tempered, who had already fallen ill from primary syphilis several times”. This patient too was completely cured of a serious form of secondary syphilis within a month. 33 Scarenzio experimented subcutaneous treatment with calomel on 8 patients in all, and the positive results were published in the August-September 1864 issue of the Annali Universali di Medicina in an article entitled “First attempts at the treatment of constitutional syphilis via subcutaneous injection of a preparation of mercury”. For many years Scarenzio’s method remained little known, and was adopted only by a small group of Italian dermatologistsvenereologists, particularly those of the Pavia School. Even the coveted prize of the gold medal that was awarded at the end of the 1860s to Scarenzio and his colleague Ricordi by the Royal Society of Medical and Natural Sciences of Brussels failed to disseminate the method at international level. In the study published in the Journal of the Belgian Royal Society, Scarenzio and Ricordi presented 85 cases treated with subcutaneous calomel, in 79 of which there had been rapid healing. There was, however, the constant side effect of the treatment in the form of an abscess at the site of injection, in the arm, which probably represented a deterrent to the adoption of Scarenzio’s method. Then, in the early 1880s, a Finnish syphilologist Giorgio Smirnoff, began to utilise the calomel treatment on a vast scale, injecting the dose in a suitable site (the lower buttocks), and succeeded in reducing the frequency of the abscesses to 35%, with a simultaneous notable reduction in the gravity of the suppuration phenomenon. Smirnoff’s modification, which when lower doses of calomel were used rendered the incidence of abscesses negligible, generated new interest in Scarenzio’s method on the part of syphilologists all over the world, and it was presented and discussed at the most important international medical congresses in Copenhagen, Paris, London, Rome, etc. Another three leading figures in the world of venereology contributed to its success: Balzer in France and Neisser in Germany proposed using oily substances (the former vaseline oil and the latter olive oil) as a vehicle for the calomel instead of glycerine, or the gum arabic mucilage subsequently suggested by Scarenzio. This made it possible to create stable suspensions that were sterile and nonirritant. In France, Jullien became an enthusiastic and efficacious supporter and disseminator of the method, convincing numerous physicians in his own country and elsewhere to adopt it on a wide scale. 34 In Pavia, Scarenzio himself introduced improvements in the treatment technique, adopting the intramuscular route and reducing the dose of the injections from 20 to 10 or 5 centigrams in the adult. He converted to an oily vehicle, using oil of vaseline as a suspension for the calomel prepared in contact with steam, finely porphyrised and washed with boiling alcohol; this suspension was packed in glass vials supplied by the Bertolini pharmacy of Pavia, which were then sterilised and sealed using a lamp. In Italy too all the University Dermatology Schools now accepted without reservations the therapeutic method of the Pavia master: Maiocchi in Bologna, Mibelli in Parma, Pellizzari in Florence – to name but a few of the luminaries of the Italian world of dermatology and syphilology in the nineteenth century – acknowledged the validity of calomel in the treatment of syphilis. Consequently, by the last decade of the century Scarenzio’s method had become consolidated all over the world. Many years had passed since the April of 1864 when in the antiquated rooms of the Ospedale San Matteo between Sant’Eusebio and Palazzo del Maino Scarenzio had begun his struggle against the terrible disease. In the early years of the new century, two of his most devoted students, Truffi and Bertarelli, rightly thought of organising a major and well-deserved ceremony in honour of the master, taking as the occasion the fortieth anniversary of the first injection of calomel. Ambrogio Bertarelli was the Secretary of the Committee for Public Tribute to Professor Scarenzio. Bertarelli, who came from a wealthy Milanese family, graduated in Medical Surgery in Milan, where he began his professional career working in the Municipal Celtic Dispensary of Milan under the guidance of Dr. Soresina. After 12 years he was appointed as director of the State Venereal Disease Hospital (Sifilicomio) and later in 1885 as Chief Physician of the Dermatology and Syphilology department of the Ospedale Maggiore of Milan, taking over from the great Forlanini, the phthisiologist from Pavia who before launching on a brilliant university career had devoted himself temporarily to dermatology within the hospital. Bertarelli continued for 30 years as Chief Physician at the Ospedale Maggiore, becoming known and 35 esteemed in Italy and all over the world for his assiduous presence at national and international conferences where he always took a very active part in the works and the discussions. Abroad in particular, as an official representative of International Dermatology at numerous congresses, he succeeded in establishing a network of amicable relations and precious contacts with the most important professors of the period. However, his greatest merit was the editing of the Giornale Italiano delle Malattie veneree e della pelle, the oldest journal in the world dealing with this specialisation, which he took over from Soresina in 1883. Under his editorship, the Giornale Italiano became one of the most esteemed journals in Italy and abroad. Bertarelli was a skilled physician and an illuminated philanthropist, and he injected hefty funds into the enlargement and transformation of the hospital structures into a University Department when the University of Milan was set up in 1923, after which his former student Professor Pasini became the first to hold the Chair of Dermatology and Syphilology in the Lombardy metropolis. An able organiser and great communicator, thanks to his friendships and connections in the dermatology field both in Italy and abroad, for the celebrations of the fortieth anniversary of Scarenzio’s pioneering treatment Bertarelli managed to bring together contributions from numerous leading dermatologists and venereologists, which were published in a volume dedicated to Scarenzio that was issued as an appendix to Giornale Italiano delle malattie veneree e della pelle. The ceremony in honour of Angelo Scarenzio was held with great pomp on the afternoon of 7 April 1904, exactly 40 years after the first injection of calomel. Scarenzio entered the General Pathology classroom of Palazzo Botta to loud and prolonged applause, accompanied by Professor Maiocchi of Bologna, President of the Italian Society of Dermatology and Chairman of the Committee, and by Professor Golgi, Vice Chancellor of the University of Pavia and Honorary Chairman of the Committee. The classroom was packed with students, physicians and illustrious figures, including the Dean of the Faculty Professor Falchi, an oculist, the Honourable Montemartini, Chairman of the Board of Directors of the Ospedale San Matteo, and the dermatology and syphilology professors Mazza, Mibelli and Respighi. 36 Bertarelli and Truffi were the first to take the floor, referring the extensive congratulations and messages of support from all over the world, after which they presented to Scarenzio the silver seal sent as a gift from Jullien in Paris. The seal was engraved with the image of a phoenix emerging from the flames, accompanied by these noble words: “Le feu purificateur, allumé par Scarenzio, sauve le syphilitique qui, comme le phénix, renait de ses cendres”. After them, Golgi took the floor and presented the volume of scientific works published in honour of Scarenzio, recalling in moved tones his scientific and humanitarian merits in the struggle against the terrible disease. He then added a personal reason for his affection for the leading light of dermatology and syphilology in Pavia, which most of those in attendance were unaware of, explaining that he had taken the first steps along his academic career as Scarenzio’s assistant. Maiocchi then took over from Golgi, presenting a gold medal on behalf of the Committee. The medal bore on one side the effigy of Scarenzio and on the other a legend in Latin recording the historic event: “Angelo Scarentio. Athenaei ticinensis. Magistro Syphylopathiae perinsigni. Qui in lue gallica curanda. Photochloruretum hydrargyrium. Subter cutem primus injecit. VII ID. APR. MD CCC LXIV. Collegae et sodales. Ingenium viri et sollertiam admirantes. Die Eius inventi anniversario. A. MDC CCCIV”. After other celebratory addresses, the representative of the sixthyear medical students, Colombo, presented Scarenzio with the gift of an artistic parchment bearing a Latin epigraph. Scarenzio, visibly moved, thanked all those present, recalling how 40 years earlier he had been practically forced to opt for a new mode of treatment, given the grievous clinical conditions of the first patient which did not permit the administration of mercury by mouth or application on the skin. As luck would have it, the subcutaneous calomel proved to act rapidly but with lasting effects, an indispensable quality for fighting syphilis. His perseverance and that of his colleagues who had experimented and improved the method had then prevented the new treatment from running aground. This ceremony marked the glorious conclusion of the scientific and academic career of Angelo Scarenzio, preceding by just a few 37 months the end of his earthly adventure. He died in fact in the summer of 1904. After 43 years, the Dermatology and Syphilology department of the Ospedale San Matteo and the University Dermatology and Syphilology Clinic were left without the guidance of their master. His favourite student, Professor Truffi, who was at the time Assistant in the Clinic, was temporarily assigned to take his place. Truffi was one of the major exponents of Italian dermatology in the first half of the twentieth century; in the field of venereology he became famous above all for his studies on experimental syphilis in the rabbit, which made a fundamental contribution to the progress of antiluetic treatment, and above all to the use of arsenobenzols. Mario Truffi was born on 4 April 1872 in Casteggio, in Oltrepò Pavese. He always maintained the links with his homeland, just as he displayed its characteristic temperament: a gruff exterior concealing a core of warm humanity, a love of life, stinging and brilliant irony, and a tireless capacity and desire to work. He died in Casteggio aged over ninety in 1963 and was deeply mourned by his fellow citizens: the pavilion that every summer hosts the show of the famous wines of Oltrepò Pavese bears his name. Truffi attended the University of Pavia and graduated at the age of 24, in 1896. During his course of studies he frequented Golgi’s General Pathology laboratory and the medical clinic run by Orsi as an intern. Truffi’s passion for dermatology and venereology came to light even before he had taken his degree; during his fourth year as a medical student he did military service as a health assistant in a “dermoceltic” care centre and was immediately attracted by this specialisation. He began to study on his own account, supplementing his academic reading with his daily observation of the sick. This meant that in his sixth year, during the clinical dermatology and syphilology course, he was immediately able to attract the attention and approval of Scarenzio, who as soon as he had graduated took him on as his assistant in the Clinic. In the early years of his university career Truffi felt the need to complete his clinical and scientific training by frequenting the Pathological Anatomy laboratory of the University of Pavia run by Professor Monti, and maintaining intensive contacts with the leading lights of Italian dermatology, in particular Majocchi and 38 Mibelli, who looked kindly upon him as a disciple. His yearning to learn also drove him abroad, and in 1899 he was in Paris in the famous Hôpital Saint Louis, where he worked in the laboratory of the great Sabouraud, acknowledged master of mycology. This experience left Truffi with an enduring passion for the study of fungal infections of the skin, and among his most important works we can mention those on ringworm and trichophyton. In 1901, at the age of just 29, he brilliantly passed his examination for qualification as a university teacher before a Board made up of eminent clinicians and scientists including Golgi, Forlanini, Mangiagalli, Maiocchi and Breda. By now the path towards a rapid ascent to the university chair appeared to be in sight, but Scarenzio’s death brought Truffi’s career to a swift standstill. The management of the hospital was entrusted to him in July 1904, and that of the university in December of the same year. Truffi performed his duties with competence and commitment up to January 1906, winning the esteem of the Faculty and the hospital administration. In the meantime, academic manoeuvres for the succession to Scarenzio in the Pavia chair were under way. It was a coveted position and, although the young Truffi was known and esteemed, he lacked sufficient academic qualifications. The Faculty of Medicine of Pavia instead decided to offer the position to Professor Mantegazza, who was Director of the Dermatology and Syphilology Department at the University of Cagliari. Umberto Mantegazza was a native of Vigevano and had graduated at Pavia: consequently his specialist training had not taken place under Scarenzio but in the Florentine school of Celso Pellizzari. Mantegazza founded his own school in Pavia from which the present institution directly descends, and many of his students went on to occupy the Chair: Mariani, Falchi, Flarer, Casazza, Baccaredda Boy, Cottini, etc. Relations between Mantegazza and Truffi were far from idyllic, and the coexistence rapidly became intolerable; in 1906 Truffi found himself forced to leave the Dermatology and Syphilology Clinic. After this he turned initially to practicing as a freelance professional, but he felt dissatisfied and the call of scientific research was irresistible. Consequently he accepted the generous hospitality 39 offered first by Professor Devoto and later by Professor Ascoli in the research laboratory of the Institute of Medical Pathology at the University of Pavia. It was here that Truffi’s most important research in the field of syphilis began. Both in Italy and in the rest of the world, the early years of the century were marked by a spurt of studies on the transmissibility of syphilis to animals. Bertarelli had been the first, in 1906, to demonstrate that Treponema pallidum could be inoculated into the cornea of the rabbit, obtaining characteristic keratotic lesions with material collected from human syphiloma, and had managed to serially transmit the infection to other rabbits. At the Dermatology and Syphilology Clinic of Pavia, under the new direction of Mantegazza, a brilliant researcher called Silvio Ossola conducted scrupulous studies on experimental syphilis in the rabbit. In the Medical Pathology laboratory Truffi too devoted himself to research into syphilis in the rabbit. The climate of competition that was thus set up resulted, in 1908, in the two researchers almost simultaneously demonstrating the possibility of inoculating syphilis into the testicles of the rabbit. Ossola was the first to provoke the appearance of a typical syphiloma in the skin of the scrotum by inoculating fragments of cornea of a rabbit affected by syphilitic keratitis into the testicular vaginal tunic, while shortly afterwards Truffi obtained a scrotal syphiloma by injecting the serum from a human syphiloma into the testicle. Later, again in 1908, the two Pavia dermatologists demonstrated the possibility of serially transmitting the scrotal syphiloma from one rabbit to another with a progressive reduction of the period of incubation of the infection, and illustrated the spread of the spirochetes to the lymph nodes. The results of Truffi’s investigations were published in German journals and raised a stir in international scientific circles. In 1909 Ossola and Truffi demonstrated the appearance in the rabbit of syphilitic manifestations in sites distant from the point of inoculation and the positivity of the Wassermann test. However, further studies conducted by Truffi reappraised the importance of the serological reactions in the rabbit, demonstrating that positive results to the Wassermann test could be observed even in healthy rabbits. Hence, in the course of these fundamental studies Truffi had obtained a strain of Treponema pallidum that was highly virulent for the rabbit. The “Truffi strain” was the first laboratory strain in the world to be 40 isolated and, on a par with other famous strains such as those of Nichols, Mulzer and Kuznitsky, it became widely diffused in international research centres. It was precisely the Truffi strain that made a decisive contribution to the conclusive studies that led to the introduction of Salvarsan or 606 in the treatment of syphilis. Paul Ehrlich had been directly informed of Truffi’s studies by Professor Ascoli, the Pavia medical pathologist who had worked under him at length on the treatment of syphilis in the Speyerhaus laboratory of Frankfurt, and decided to send to Pavia his trusted Japanese collaborator Hata. Truffi showed the latter the infected animals, and explained the techniques adopted in minute detail. Hata listened attentively and carried out inoculations himself under the guidance of Truffi, after which he rapidly set off for Frankfurt again with three rabbits which he got across the border without difficulty and were subsequently utilised for the indispensable animal experiments that preceded the experimentation on man. Ehrlich was grateful to Truffi and sent him the first vials of Salvarsan so that he could appraise its therapeutic effect on man. Thus it turned out that, on Christmas Eve 1909, Truffi with great trepidation injected 2.5 centigrams of Salvarsan into a patient suffering from primary syphilis: the result was nothing short of brilliant. Truffi was the first doctor in Italy and one of the first in the world to experiment this treatment. However, the first Italian injection of Salvarsan was not carried out in Pavia but in Savona. In the meantime, in fact, Truffi’s long and troubled professional career had continued to unfurl, leading him to abandon Pavia for good. In 1908 he had won a competition for the position of Chief Physician at the Pammatone Hospital in Genoa, but was then not assigned the post. After another competition, in March 1909 he became the Chief Dermatologist at Ospedale San Paolo of Savona, and also director of the Dispensario Celtico, or syphilis clinic, of the same city. In Savona he set up a laboratory which enabled him to continue his scientific research, especially in the field of venereology. The Truffi strain was also used by Levaditi for the pharmacological experimentation of bismuth, and Truffi was the first in Italy to use bismuth experimentally in the treatment of human syphilis. 41 Truffi held the position of Chief Physician in Savona for 13 years, earning the greatest esteem, but his dream continued to reside in a university career as the just reward for his gifts as a researcher and his long years of impassioned commitment. In 1911 he took part in a competition for the Chair of Clinical Dermatology and Syphilology at Sassari and in 1921 in that for the Chair at Cagliari. Finally, in 1922, he was offered the management of the Dermatology and Syphilology Clinic of Messina, which he enthusiastically accepted. From this moment on, albeit at the late age of fifty, a new phase in his brilliant university career began, which brought him the following year to Catania, initially as lecturer and later, after winning the competition in 1925, as professor. In the course of 1925 he was summoned to direct the Siena Clinic and subsequently the prestigious Clinic of Padua, where he took up his position in the autumn. In his opening lecture, given on 23 November 1925, he recalled with emotion his master Scarenzio and underscored how the two glorious Faculties of Pavia and Padua were bound together by the links between their scientific schools. As examples of this he cited the presence among the Paduan lecturers of two famous professors of Pavian origin: the great surgeon Bassini, former student of Porta, and the medical clinician De Giovanni, former student of Orsi. Truffi held the chair at Padua for 17 years up to 1942. However, even after he retired he did not abandon his studies and his scientific works: his last publication dates to 1959, and the venerable age of 87. It is a historic work marking the fiftieth anniversary of the discovery of Salvarsan, in which he recalls with lucid precision and irony the events in which he played such a prominent part. Mario Truffi ended his days in his home town of Casteggio on 8 November 1963. 42 Contribution to the history of the teaching of Dermatology and Venereology at Italian Universities (1860-2010) DECIO CERIMELE The teaching of dermatology had a few precursors such as Vincenzio Chiarugi who taught dermatology and psychiatry in Florence at the end of the 18th century. In fact, the teaching of, at first, syphilography, and later, dermatology started almost simultaneously at the most important universities, in hospitals (Ospedale San Gallicano in Rome, Ospedale Gesù e Maria in Naples, Ospedale Maggiore in Milan), and in some specialised clinics (the Istituto Superiore di Studi Pratici e di Perfezionamento in Florence) just after the Italian Unification in the years 1859-1861. The Casati law concerning public education is dated 13 November 1959, and the faculty of medicine regulation establishing that at least one of the 24 mandatory teaching subjects must be “Clinica Dermosifilopatica” is dated 13 September 1862. The first syphilographists came from a background in surgery whereas dermatologists had a background in internal medicine. Casimiro Manassei started the teaching of dermatology at the San Gallicano hospital in Rome (which at that time was still a Papal State), Augusto Michelacci in Florence in 1859, and Pietro Gamberini in Bologna in 1860. Angelo Scarenzio began teaching venereology in Pavia in 1861. Two important moments in the history of Italian dermatology were the founding of the Italian Journal of Venereal and Skin Diseases which was started by G. B. Soresina in Milan in 1866 and the foundation of the Society of Dermatology and Syphilography in Perugia in 1885. 43 The development of Italian dermatology at the end of the 19th century and at the start of the 20th century owes a great deal to two important figures: Celso Pellizzari who taught dermatology and syphilography in Florence from 1892 to 1925 and Tommaso De Amicis who taught in Naples from 1880 to 1914. Francesco Radaeli, Vittorio Mibelli, Amedeo Marianelli, Umberto Mantegazza, Agostino Mibelli and Jader Cappelli were pupils of Pellizzari; Augusto Ducrey, Rodolfo Stanziale, Giuseppe Verrotti and Lodovico Tommasi were pupils of De Amicis. In 1905 Pellizzari set up the Fotoradioterapico Institute in Florence for the treatment of skin diseases using ultraviolet rays and x-rays. In order to illustrate just how Pellizzari was ahead of his time it is enough to point out that Rontgen had won the Nobel prize for physics in 1901 and Finsen the Nobel for medicine in 1903. The Italian Society organised two International Congresses of Dermatology, in 1912 the 7th in Rome (De Amicis chairman, Ciarrocchi secretary) and in 1972 the 14th in Padua-Venice (Flarer chairman, Serri secretary). In this research project the chronology of the teaching of dermatology and venereology at the main Italian universities has been reconstructed. Chronological list of Professors of Dermatology grouped by University University of Turin Professor Period Trained at Teacher Sperino Casimiro (Syph.) 1859… Gibello Giacomo (Derm.) 1859… Giovannini Sebastiano 1891-1920 Bologna Gamberini Pietro Fontana Arturo (In charge) 1921-1922 Turin Cappelli Jader 1922-1926 Florence Pellizzari Celso Bizzozzero Enzo 1926-1952 Turin Midana Alberto 1952-1972 Turin Bizzozzero Enzo Zina Giuseppe 1972-1992 Turin Midana Alberto Pippione Mario 1985-2009 Turin Zina Giuseppe Bernengo Maria Grazia 1990… Turin Zina Giuseppe 44 University of Eastern Piemonte (Novara) Professor Period Trained at Teacher Leigheb Giorgio 1997-2009 Turin-Sassari Zina Giuseppe Colombo Enrico 2009… Novara Leigheb Giorgio Professor Period Granara Romolo (Syph.) 1866 Orsi Francesco (Derm.) 1866 University of Genoa Trained at Teacher Genoa Internal Med. Profeta Giuseppe Campana Roberto 1878-1893 Naples Tanturri Vincenzo Ducrey Augusto 1911-1919 Naples De Amicis Tommaso Radaeli Francesco 1919-1936 Florence Pellizzari Celso Mariani Giuseppe 1937-1954 Pavia Mantegazza Umberto Baccaredda-Boy Aldo 1955-1972 Pavia Mariani Giuseppe Moretti Giuseppe 1972-1982 Genoa Baccaredda-Boy Aldo Rebora Alfredo 1982-2004 Genoa Moretti Giuseppe Nunzi Enrico 1985… Genoa Moretti Giuseppe Parodi Aurora 2004… Genoa Rebora Alfredo University of Pavia Professor Period Trained at Scarenzio Angelo 1861-1904 Pavia Teacher Truffi Mario (In charge) 1904-1906 Pavia Scarenzio Angelo Mantegazza Umberto 1906-1935 Pavia-Florence Scarenzio-Pellizzari Mariani Giuseppe 1935-1937 Pavia-Bari Mantegazza Umberto Falchi Giorgio 1937-1965 Pavia-Siena Mantegazza Umberto Serri Ferdinando 1965-1977 Pavia-Sassari Falchi Giorgio Rabbiosi Giacomo 1977-1999 Pavia-Sassari Falchi-Serri Borroni Giacomo 1999… Pavia Rabbiosi Giacomo 45 University of Milan “Statale” Professor Period Trained at Dubini Angelo (Hosp-Dept Chief) 1861-1883 Forlanini Carlo (Hosp-Dept Chief) 1883-1885 Teacher Bertarelli Ambrogio (Hosp-Dept Chief) 1885-1924 Pasini Agostino 1924-1944 Milan Crosti Agostino 1945-1966 Milan Pasini Agostino Puccinelli Vittorio 1966-1981 Milan Crosti Agostino Gianotti Ferdinando 1981-1984 Milan Crosti Agostino Caputo Ruggero 1984-2007 Milan Puccinelli Vittorio Alessi Elvio 1985-2008 Milan Puccinelli Vittorio Crosti Carlo 2007… Milan Caputo Ruggero Gelmetti Carlo 2007... Milan Caputo Ruggero University of Milano II Professor Period Trained at Teacher Caccialanza Piero 1971-1982 Milan Crosti Agostino Finzi Aldo 1982-2002 Milan II Caccialanza Piero Altomare Gianfranco 2002… Milan II Finzi Aldo University of Milan Bicocca Professor Period Trained at Teacher Cainelli Tullio 1999-2007 Milan Caputo Ruggero Berti Emilio 2007… Milan Caputo Ruggero University of Brescia Professor Period Trained at Teacher Marini Dario 1986-2001 Milan Caputo Ruggero Allegra Fulvio De Panfilis Giuseppe 2001-2004 Parma Calzavara-Pinton Pier Giacomo 2004… Brescia 46 University of Verona Professor Period Trained at Teacher Rabito Calogero 1969-1970 Padua Flarer Franco Sapuppo Antonio 1971-1982 Catania Flarer-Mezzadra Chieregato Giancarlo 1982-2002 Padua Flarer Franco Girolomoni Giampiero 2003… Modena Giannetti Alberto Professor Period Rosanelli Carlo Sovrintendente 1873-1878 Breda Achille 1878-1925 Padua Truffi Mario 1925-1942 Pavia Scarenzio Angelo University of Padua Trained at Teacher Flarer Franco 1942-1970 Pavia-Catania Mantegazza Umberto Rabito Calogero 1970-1990 Padua Flarer Franco Peserico Andrea 1990… Padua Flarer-Rabito University of Udine Professor Period Trained at Teacher Patrone Pasquale 1991… Bologna Montagnani Andrea University of Trieste Professor Period Trained at Teacher Montagnani Andrea 1969-1971 Naples Cerutti Pietro Scarpa Carmelo 1971-1993 Rome-Sassari Monacelli Mario Trevisan Giusto 1993… Trieste Scarpa Carmelo University of Parma Professor Period Trained at Teacher Maiocchi Domenico 1880-1891 Rome-San Gallicano Schilling Pietro Mibelli Vittorio 1892-1910 Siena/ Florence Barduzzi/Pellizzari Pelagatti Mario 1910-1939 Casazza Roberto 1939-1944 Pavia Mantegazza Umberto Tamponi Mario 1944-1973 Parma Casazza Roberto Allegra Fulvio 1973-2001 Parma Tamponi Mario De Panfilis Giuseppe 2002… Parma Allegra Fulvio 47 University of Modena Professor Period Casarini Giuseppe 1876-1890 Giovannini Sebastiano 1890-1891 Tommasoli Pierleone 1891-1894 Trained at Teacher Bologna Gamberini Pietro Casarini Giuseppe 1894-1895 Marianelli Amedeo 1895-1898 Pisa Pellizzari Celso Mazza Giuseppe 1898-1911 Pavia-Cagliari Scarenzio Angelo Colombini Pio 1911-1935 Cagliari Barduzzi Domenico Ciambellotti Edoardo 1935-1938 Florence Cappelli Jader Comel Marcello 1938-1946 Milan Pasini Agostino Cerutti Pietro 1946-1950 Padua Flarer Franco Boncinelli Umberto 1952-1975 Florence Cappelli Jader Vaccari Riccardo (In charge) 1975-1985 Modena Boncinelli Umberto Giannetti Alberto 1986… Pavia Serri Ferdinando University of Bologna Professor Period Trained at Gamberini Pietro 1860-1890 Teacher Maiocchi Domenico 1890-1924 Rome-Parma Schilling Pietro Martinotti Leonardo 1924-1950 Bologna Maiocchi Domenico Manganotti Gilberto 1951-1971 Florence-Siena Cappelli Jader Montagnani Andrea 1971-1990 Naples Cerutti Pietro Varotti Claudio 1990-2007 Bologna Montagnani Andrea Tosti Antonella 2001… Bologna Varotti Claudio Patrizi Annalisa 2007… Bologna Varotti Claudio Professor Period Trained at Teacher Puccinelli Vittorio 1955-1962 Milan Crosti Agostino Mezzadra Giuseppe 1962-1966 Padua Flarer Franco Caccialanza Piero 1966-1971 Perugia Crosti Agostino Califano Adalberto 1971-2002 Milan Puccinelli Vittorio Virgili Annarosa 2002… Ferrara Califano Alberto University of Ferrara 48 University of Ancona Professor Period Trained at Teacher Bossi Guido 1975-2001 Rome Cattolica Ormea Ferdinando Offidani Anna Maria 2001… Ancona Bossi Guido University of Pisa Professor Period Trained at Teacher Barduzzi Domenico (In charge) 1883-1884 Florence Michelacci Augusto Pellizzari Celso 1884-1892 Florence Michelacci Augusto Ducrey Augusto 1894-1911 Naples De Amicis Tommaso Mazza Giuseppe 1912-1922 Pavia Bosellini Pier Ludovico 1922-1923 Bologna Maiocchi Domenico Lombardo Cosimo 1923-1945 Modena Mazza Giuseppe Comel Marcello 1946-1972 Milan Pasini Agostino Mian Eneo 1972-1996 Pisa Comel Marcello Barachini Paolo 1996… Pisa Mian Eneo University of Siena Professor Period Trained at Teacher Pellizzari Celso 1883-1884 Florence Michelacci Augusto Barduzzi Domenico 1884-1922 Pisa Michelacci Augusto Martinotti Leonardo 1922-1924 Bologna Maiocchi Domenico Truffi Mario 1925 Pavia Tommasi Lodovico 1925-1930 Naples Maccari Ferdinando (In charge) 1930-1931 Siena Bertaccini Giuseppe 1931-1935 Florence Cappelli Jader Falchi Giorgio 1935-1937 Pavia-Sassari Mantegazza Umberto Casazza Roberto 1937-1939 Pavia-Sassari Mantegazza Umberto Cappelli Jader Manganotti Gilberto 1939-1944 Florence Agostini Adolfo (In charge 1944-1945 Siena Ciambellotti Edoardo (In charge) 1945 Agostini Adolfo (In charge) 1946-1947 Manganotti Gilberto 1947-1952 De Amicis Tommaso Siena Cerutti Pietro 1952-1956 Padua-Modena Flarer Franco Ottolenghi-Lodigiani Franco 1956-1978 Florence Scolari Enea Andreassi Lucio 1978-2006 Siena Ottolenghi Franco Fimiani Michele 2004… Siena Andreassi Lucio 49 University of Florence Professor Period Trained at Teacher Michelacci Augusto (Derm.) 1859-1888 Pellizzari Pietro (Syph.) 1859-1892 Pellizzari Celso 1892-1926 Florence Michelacci Augusto Cappelli Jader 1926-1947 Florence Pellizzari Celso Scolari Enea 1947-1972 Milan Pasini Agostino Panconesi Emiliano 1973-1993 Florence Scolari Enea Giannotti Benvenuto 1993-2006 Florence Scolari Enea Fabbri Paolo 1989… Florence Panconesi Emiliano Lotti Torello 2006… Florence Panconesi Emiliano Professor Period Trained at Teacher Bertaccini Giuseppe 1928-1930 Florence Cappelli Jader Crosti Agostino 1930-1939 Milan Pasini Agostino Lisi Francesco (In charge) 1939-1948 Perugia Crosti Agostino University of Perugia Bosco Isidoro 1948-1955 Rome-Palermo Tommasi Lodovico Caccialanza Piero 1955-1966 Milan Crosti Agostino Binazzi Maurizio 1966-1988 Perugia Bosco Isidoro Calandra Paolo 1988-2002 Perugia Binazzi Maurizio Lisi Paolo 2002… Perugia Binazzi Maurizio University of Rome La Sapienza Professor Period Manassei Casimiro 1859-1892 Trained at Teacher Campana Roberto 1892-1918 Naples Tanturri Vincenzo Ducrey Augusto 1919-1923 Naples De Amicis Tommaso Bosellini Pier Ludovico 1923-1943 Bologna Maiocchi Domenico Tarantelli Eugenio (In charge) 1943-1945 Rome Tommasi Lodovico 1946-1955 Naples De Amicis Tommaso Monacelli Mario 1955-1970 Rome-Naples Bosellini Pier Ludovico Ribuffo Antonio 1970-1985 Rome Monacelli Mario Carlesimo Onorio 1985-1995 Rome Ribuffo Antonio Calvieri Stefano 1995… Rome Ribuffo Antonio 50 University of Rome Cattolica Professor Period Trained at Teacher Ormea Ferdinando 1965-1977 Turin Midana Alberto Serri Ferdinando 1977-1987 Pavia Falchi Giorgio Cerimele Decio 1987-1998 Pavia-Sassari Serri Ferdinando Amerio Pierluigi 1998… Rome Cattolica Ormea Ferdinando Professor Period Trained at Teacher Nini Gabriele 1987-1997 Rome Ribuffo Antonio Chimenti Sergio 1997… Rome Ribuffo Antonio Professor Period Trained at Teacher Chimenti Sergio 1987-1997 Rome Ribuffo Antonio Peris Ketty 1997 L’Aquila Chimenti Sergio University of Rome Tor Vergata University of L’Aquila University of Chieti Professor Period Trained at Teacher Bossi Guido 1973-1975 Rome Cattolica Ormea Ferdinando Amerio Pierluigi 1975-1998 Rome Cattolica Ormea Ferdinando Tulli Antonello 1999… Rome Cattolica Amerio Pierluigi Professor Period Patamia Carmelo (Syph.) 1866 Tanturri Vincenzo 1864-1880 De Amicis Tommaso 1880-1919 University of Naples Trained at Teacher Naples Stanziale Rodolfo 1920-1934 Naples De Amicis Tommaso Verrotti Giuseppe 1934-1939 Naples De Amicis Tommaso Tommasi Lodovico 1939-1945 Palermo De Amicis Tommaso Monacelli Mario 1945-1955 Messina Bosellini Pier Ludovico Cerutti Pietro 1955-1975 Padua Flarer Franco 51 University of Naples Federico II Professor Period Trained at Teacher Santoianni Pietro 1975-2002 Naples Cerutti Pietro Ayala Fabio 1994… Naples Federico II Santoianni Pietro Monfrecola Giuseppe 2003… Naples Federico II Santoianni Pietro University of Naples Seconda Università (SUN) Professor Period Trained at Teacher Pisani Marco 1975-1992 Naples Cerutti Pietro Ruocco Vincenzo 1992… Naples 1st Faculty Pisani marco University of Bari Professor Period Trained at Teacher Mariani Giuseppe 1924-1935 Pavia Mantegazza Umberto Bertaccini Giuseppe 1935-1962 Florence Cappelli Jader Puccinelli Vittorio 1962-1966 Milan Crosti Agostino Meneghini Carlo 1966-1988 Milan Crosti Agostino Rantuccio Francesco 1988-2001 Milan Meneghini Carlo Angelini Giovanni 1990… Bari Meneghini Carlo Vena Gino Antonio 1994… Bari Meneghini Carlo University of Messina Professor Period Trained at Teacher Ziino Giuseppe 1881-1884 Mazzitelli Pietro 1886-1894 Melle Giovanni 1895-1908 Stanziale Rodolfo 1913-1914 Naples De Amicis Tommaso Bosellini Pier Ludovico 1921-1922 Bologna Maiocchi Domenico Pavia Scarenzio Angelo Truffi Mario 1922-1923 Barbaglia Vincenzo 1924-1925 Mibelli Agostino 1926-1930 Flarer Franco 1930-1934 Pavia Mantegazza Umberto Monacelli Mario 1934-1947 Rome Bosellini Pier Ludovico Pellizzari Celso Pisacane Carlo 1948-1971 Messina Monacelli Mario Ciaccio Ivan 1971-1982 Messina Monacelli Mario Guarneri Biagio 1982… Catania Mezzadra Giuseppe Cannavò Serafinella 2002… Messina Guarneri Biagio 52 University of Catanzaro Professor Period Trained at Teacher Ayala Fabio 1990-1994 Naples Santoianni Pietro Micali Giuseppe 1994-1996 Catania Sapuppo Antonio Delfino Mario 1996-2003 Naples Santoianni Pietro Bottoni Ugo 2003… Rome Calvieri Stefano University of Palermo Professor Period Monteforte Gaetano (Syph.) 1866 Trained at Teacher Profeta Giuseppe 1867… Tommasoli Pierleone 1894-1903 Modena Unna Philippson Luigi 1903-1929 Palermo Unna-Tommasoli Tommasi Lodovico 1930-1938 Naples-Siena De Amicis Tommaso Crosti Agostino 1939-1945 Milan Pasini Agostino Scolari Enea 1945-1947 Milan Pasini Agostino Baccaredda Boy Aldo 1948-1955 Genoa Mariani Giuseppe Bosco Isidoro 1955-1970 Palermo Tommasi Lodovico Tosti Antonio 1970-1988 Palermo Bosco Isidoro Grana Adalberto (Experimental Derm.) 1967-1987 Palermo Tosti Antonio Fazzini Maria Teresa 1988-2001 Palermo Tosti Antonio Aricò Mario 1993… Palermo Bosco Isidoro University of Catania Professor Period Trained at Teacher De Amicis Tommaso 1880 Naples Tanturri Vincenzo De Luca Rocco 1912-1919 Truffi Mario 1923-1925 Pavia Scarenzio Angelo Verrotti Giuseppe 1934 Naples De Amicis Tommaso Flarer Franco 1934-1942 Pavia Mantegazza Umberto Scolari Enea 1942-1944 Milan Pasini Agostino Cottini Giambattista 1944-1966 Pavia Flarer Franco Mezzadra Giuseppe 1966-1982 Padua Flarer Franco Sapuppo Antonio 1982-1996 Catania Mezzadra Giuseppe Micali Giuseppe 1996… Catania Sapuppo Antonio 53 University of Cagliari Professor Period Trained at Teacher Manca Gaetano (Syph.) 1865- Cagliari - Surgery Mibelli Vittorio 1890-1892 Siena/ Florence Barduzzi/Pellizzari Mazza Giusepe 1892-1898 Pavia Scarenzio Angelo Mantegazza Umberto 1898-1905 Florence Pellizzari Celso Colombini Pio 1905-1912 Siena-Sassari Barduzzi Domenico Radaeli Francesco 1912-1919 Florence Pellizzari Celso Bosellini Pier Ludovico 1919-1921 Modena-Bologna Maiocchi Domenico Serra Alberto (In charge) 1920-1921 Cagliari Mantegazza Umberto Cappelli Jader 1921-1922 Florence Pellizzari Carlo Mariani Giuseppe 1922-1924 Pavia Mantegazza Umberto Serra Alberto 1924-1945 Cagliari Mantegazza Umberto Pinetti Pino 1945-1974 Cagliari Falchi Giorgio Orrù Antonio 1974-1984 Cagliari Pinetti Pino Biggio Pietro 1984-2005 Cagliari Pinetti Pino Aste Nicola 2005… Cagliari Biggio Pietro University of Sassari Professor Period Trained at Piga Pasquale 1885-1887 Sassari - Surgery Rattone Giorgio 1885-1886 Sassari - Pathology Fiori Giovanni Maria 1886-1898 Sassari - Internal Med. Colombini Pio 1898-1905 Siena Zagari Giuseppe 1906-1907 Pelagatti Mario 1907-1910 Teacher Barduzzi Domenico Radaeli Francesco 1911-1912 Florence Pellizzari Celso Bosellini Pier Ludovico 1912-1919 Bologna Maiocchi Domenico Lombardo Cosimo 1919-1923 Barbaglia Vittorio 1927-1929 Pisa Mazza Tommasi Lodovico 1929 Siena Falchi Giorgio 1930-1935 Pavia Mantegazza Umberto Casazza Roberto 1935-1937 Pavia Mantegazza Umberto Manganotti Gilberto 1938-1939 Florence Cappelli Jader Scolari Enea 1939-1942 Milan Pasini Agostino Cottini Giambattista 1942-1944 Pavia-Catania Flarer Franco 54 Professor Period Trained at Teacher Manca Vincenzo 1944-1948 Sassari Lisi Francesco 1948-1959 Perugia Cerutti Pietro 1950-1951 Modena Midana Alberto 1951-1952 Turin Bizzozzero Enzo Puccinelli Vittorio 1952-1955 Milan Crosti Agostino Crosti Agostino Mezzadra Giuseppe 1955-1962 Padua Flarer Franco Serri Ferdinando 1962-1965 Pavia Falchi Giorgio Ribuffo Antonio 1965-1970 Rome Monacelli Mario Scarpa Carmelo 1970-1972 Rome Monacelli Mario Rabbiosi Giacomo 1973-1977 Pavia Serri Ferdinando Cerimele Decio 1977-1987 Pavia Serri Ferdinando Fabbri Paolo 1987-1989 Florence Panconesi Emiliano Cottoni Francesca 1989-1993 Sassari Cerimele Decio Leigheb Giorgio 1993-1997 Turin-Novara Zina Giuseppe Cottoni Francesca 1997-1998 Sassari Cerimele Decio Cerimele Decio 1998-2995 Rome Cattolica Ferdinando Serri Cottoni Francesca 2005… Sassari Cerimele Decio Fig. 13. – Domenico Barduzzi. Domenico Barduzzi, was born in Brisighella (Ravenna) in 1847 and died in Siena in 1929. In 1872 he graduated from the University of Pisa with a degree in medicine and in 1876 obtained qualification to practice medicine at the Florence Istituto Superiore where, under the guidance of Augusto Michelacci, he started learning about dermatology. From 1876 to 1882 he acted as assistant at the Pisa Clinic of Surgery, directed by Prof. P. Landi. In 1882 he obtained the teaching qualification in Clinical Dermatology and Venereology at the University of Modena. In 1886 he became a professor of dermatology at the University of Siena and director of the annexed Gabinetto which later became the Department of Dermatology and Venereology. In 1891 he was elected Dean of the Faculty of Medicine and in 1892 University Rector, an office which he held for several years. In 1885 he served as secretary of the promotional committee of the Italian Dermatology Society, founded in Perugia, and between 1909 and 1911 he became President of the same. He had the satisfaction of seeing two of his pupils reach the height of their university career: Vittorio Mibelli and Pio Colombini. The former, after having started his training with Celso Pellizzari, was assistant to Barduzzi and became a full professor in Cagliari and eventually in Parma. The latter was professor in Sassari and subsequently in Cagliari and Modena (Fig. 13). 55 Fig. 14. – Ruggero Caputo with Ferdinando Gianotti. Fig. 15. – Vincenzio Chiarugi. Ruggero Caputo died unexpectedly on 24 May 2007 leaving behind an immense gap not only in the dermatological community, but also in the whole scientific and academic world. When he was very young, after having attended the Engineering Faculty for a few months, Caputo realized he was not made for that subject, feeling that his vocation lay in Medicine, and especially Dermatology, a discipline which he fell in love with – so much so that he was still a student when he began regularly to visit the Dermatological Clinic in Via Pace in Milano. In this immense scientific and professional testing ground, Caputo had the good luck of having as his masters Agostino Crosti, Vittorio Puccinelli, and especially Ferdinando Gianotti, with whom he established a profound friendship which lasted until the early death of the great Master, famous around the world for having tied his name to a new skin disease. In 1980 he became Full Professor of Dermatology and four years later was summoned to teach at the First Dermatological Clinic of the University of Milan, a chair he would keep until he died. Ruggero Caputo’s scientific merits are enormous and would need much more space than we have here. However, we should remember that Caputo was a great researcher in the field of electronic microscopy and skin immunopathology applied to the study of dermatology. He wrote a much appreciated four volume work on paediatric dermatology (Pediatric Dermatology and Dermatopathology). He was a member of the editorial board of the most important international scientific journals of dermatology. For 15 years, he was a member of the steering committee of the International League of Dermatological Societies. Among his pupils were Tullio Cainelli, Carlo Crosti, Emilio Berti, Silvano Menni and Carlo Gelmetti (Fig. 14). Vincenzio Chiarugi, (1759-1820). Born in Empoli into a family from Prato (his father was a surgeon), he earned his university degree in Pisa in 1779 and was authorized to practice medicine in 1780. In 1782, he was appointed Assistant at the Hospital of Santa Maria Nuova in Florence and, six months later, “Infirmarius”, that is Head Physician of a male ward (Marri Malacrida L., Panconesi E. Vincenzio Chiarugi, i suoi tempi, il suo libro su le malattie cutanee sordide. ERS, Florence 1989). During those years, other hospitals were added to “Santa Maria Nuova” including the Hospital of Bonifazio, made to receive the mentally ill and skin patients. Chiarugi worked there as “Primus Infirmarius”, that is Head Physician and Director. He then obtained his diploma in surgery and was also appointed to work on surgical illnesses. At the Hospital of Bonifazio, patients were divided into groups, including the “incurable”, that is venereal illnesses which Chiarugi called aphrodisiac (especially syphilis), the “invalids”, the “demented” and the “skin diseased”. With such a wide and complex range of cases, Chiarugi developed a vast clinical experience which allowed him to write various, highly appreciated texts, among which his “Theoretical-practical 56 essay on sordid skin diseases observed at the Royal Hospital of Bonifazio in Florence” (“Saggio teorico-pratico sulle malattie cutanee sordide osservate nel R. Ospedale di Bonifazio di Firenze” ) and his “Essay of researches on pellagra” (“Saggio di ricerche sulla pellagra”). The latter contains a pathogenetic interpretation of pellagra,which he associated with a poor diet almost entirely based on maize. Chiarugi’s reputation grew. He was called in and appreciated throughout Tuscany, and became a member of the most celebrated Academies. He received very prestigious public charges, and in 1805 he was appointed professor at the University of Pisa, with the obligation of “lecturing in Florence”. Thus began his lessons on “Sordid cutaneous diseases and intellectual perturbation”. This was a semester course at the Graduation Course in Medicine, which had been set up in Florence during the fleeting reign of Maria Anna Bonaparte. Several years later (1819), he was appointed Dean of all Medical Studies in Florence, and wrote the “Regulation for the examinations of students of medicine, surgery and pharmacy”. Vincenzio Chiarugi died in his home in Florence December 22, 1820 (Fig. 15). Pio Colombini (1865-1935). Born in Montalcino in 1865, he was a pupil of Barduzzi in Siena. In 1898 he won the professorship of clinical dermatology and syphilology in Sassari where he remained until 1905. He founded the Sassari Department of Dermatology at the start of the 20th century. In 1905 he moved to Cagliari and in 1910 became University Rector. In 1907 he proved the connection between gonorrhea and gonococcal arthritis. In 1911 he transferred to the University of Modena where he remained until 1935, year of his death. From 1916 to 1932 he also held the office of University Rector in Modena. He died in Montalcino in 1935. Agostino Crosti (1896-1988). A graduate from Milan University, he got his training at the Pasini school. In 1930 he won the professorship of Clinical Dermatology and Syphilology at the University of Perugia, where he remained until 1939. From 1939 to 1945 he was based at the University of Palermo. In 1945 he was called to the University of Milan to take the place of Pasini and he remained there until 1966. In 1951 he described reticulohistiocytoma of the back, subsequently called Crosti syndrome, and, in 1957, with Gianotti, acral dermatitis caused by a viral infection which later became known as papular acrodermatitis of childhood or Gianotti-Crosti syndrome. Among his pupils were Francesco Lisi, his successor in Perugia who died prematurely, Vittorio Amedeo Puccinelli and Ruggero Caputo who succeeded him in Milan, Piero Caccialanza who took over the professorship in Milan, Elvio Alessi, director of the Milan anti-venereal disease centre, Carlo Ludovico Meneghini who finished his career in Bari, and Ferdinando Gianotti, who started paediatric dermatology in Milan. 57 Francesco Flarer, born in Pavia in 1899, he was a pupil of Mantegazza in Pavia. In 1930 he became director of the Messina Department of Dermatology where he remained until 1934. From 1934 to 1942 he was based at the University of Catania. In 1942 he transferred to the University of Padua where he remained until 1970. From 1957 to 1972 he was a member of the International Committee of Dermatology. In 1972 he was chairman of the 14th International Congress of Padua-Venice. Of particular importance were his studies on hematologic alterations in the course of lupus eritematoso of the skin. Among his pupils were Cottini who ran the Catania Department, Cerutti who ran the Naples Department, Mezzadra who ran the Catania Department, Rabito who succeeded him in Padua, and Chieregato who founded the Verona Dermatology Department. He was also a much appreciated painter. Fig. 16. – Cosimo Lombardo. Fig. 17. – Domenico Maiocchi. Cosimo Lombardo (1875-1945). He was born in Sassari in 1875 and graduated in Turin in 1900. From 1900 to 1902 he worked at the Turin syphilis ward directed by Prof. Saltotto. From 1902 to 1903 he gained experience at the Paris Clinic of Prof. Gaucher, the laboratory of Dr. Gastou and the laboratory specialised in ringworm run by Prof. Sabouraud. From 1903 to 1911 he was a pupil of Prof. Mazza. In 1905 he attended the dermatology Department of Bern run by Prof. Jadasshon and in 1907 he presented a report at the VI International Congress in New York. From 1911 to 1919 he transferred to Pisa following Prof. Mazza. In 1919 he won the professorship of clinical dermatology at the University of Sassari where he remained until 1923. During this period he organised an efficient physiotherapy centre for the treatment of ringworm, a disease which at that time was endemic in Sardinia. In 1923 he moved to Pisa where he remained until 1945, year of his death. In 1937 in Livorno he organised an important congress to celebrate the 250th anniversary of the discovery of itch mites by Gian Cosimo Bonomo and Giacinto Cestoni (Fig. 16). Domenico Maiocchi was born in Roccalvecce (province of Viterbo) on 5 August 1849. He obtained a degree in Medicine on 11 August 1973 at the University of Rome. He won a position at the San Gallicano Hospital where he studied various forms of tertiary syphilis. In 1880 he won the professorship of Clinical Dermatology and Syphilology at the University of Parma where he remained for 11 years. During this period he described granuloma trichophyticum which eventually was named after him. In 1885 he participated in the foundation of the Italian Society of Dermatology and Syphilology. From 1892 to 1924 he taught at the University of Bologna. In 1896 he described the condition of purpura annularis telangiectodes which also eventually was named after him. He was an active participant in the cultural life of Bologna, a friend of Carducci’s, as well as of Severino Ferrari, Guerrini and Panzacchi. 58 In 1912 at the VII International Congress of Dermatology in Rome he held an exemplar lesson on granuloma trichophyticum. His pupils Pier Ludovico Bosellini and Leonardo Martinotti both won professorships at university and taught respectively at the University of Rome and the University of Bologna. At dawn on 7 March 1929 Maiocchi died in Bologna (Fig. 17). Umberto Mantegazza (1863-1948). After graduating from Pavia he perfected his knowledge in Florence under the guidance of Pellizzari. He was a professor in Cagliari from 1898 to 1905 and in Pavia from 1905 to 1935. His Fig. 18. – Commemorative plaque in memory of Umberto Mantegazza, University of Pavia. Fig. 19. – The Dermatology School of Pavia (drawing by Francesco Randazzo 1994). 59 most important studies were on hystopathology of psoriasis. He described the intraepidermic collection of neutrophils (the microabscesses of MunroMantegazza-Sabouraud). Mantegazza gave way to a productive school of dermatology. Mariani finished his career in Genoa and Falchi succeeded him in Pavia, Flarer ended his career in Padua, Casazza prematurely finished his career under the bombings in Parma (Figg.18, 19, 20). Fig. 20. – Dermatology School of Pavia in May 1970 at the retirement of Prof Falchi. From left: Giacomo Rabbiosi, Mario Tamponi, Pino Pinetti, Luigi Bruni, Giorgio Falchi, Decio Cerimele, Ferdinando Serri, Severino Sacchi. Vittorio Mibelli (1860-1910). A graduate from Siena in 1881 at the age of 21, he attended the Istituto Superiore in Florence for 2 years which was then run by Michelacci. In 1887 he returned to the Dermatology Department of Siena run by Domenico Barduzzi, initially as assistant volunteer, then as assistant, and finally as assistant professor. In 1889 he described an angiokeratoma which was then named after him. In 1890 he won a position at the Dermatology Department of the University of Cagliari where he remained for 2 years. In 1892 he moved to the Dermatology Department of the University of Parma where he stayed until 1910, year of his death. In 1893 he described porokeratosis which was then named after him (Figg. 21, 22). Fig. 21. – Vittorio Mibelli. Fig. 22. – Commemorative plaque in memory of Vittorio Mibelli, University of Parma. 60 Agostino Pasini (18751944). A graduate from Pavia in 1900, he was a professor in Milan from 1922 to 1944. He described a progressive disease characterised by bluish or
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