Robert Willan Research Articles

Vitiligo in the 19<sup>th</sup>-century dermatological works of Vincenzo Chiarugi, Robert Willan, Jean-Louis Alibert, and Ferdinand von Hebra

Vitiligo is an iconic dermatological pathology as its clinical manifestations indelibly mark the patient through the appearance of white spots all over the body. The oldest written testimonies referring to vitiligo are: the first texts of Ayurveda, the Ebers Papyrus and the Leviticus of the Old Testament. During the Roman Empire, the doctors Aulus Cornelius Celsus and Galen, respectively in the I and II centuries AD, were the first to describe this skin disease and their statements were used by all subsequent authors. Hieronymus Mercurialis in the XVI century, Joseph Jakob Ritter Plenck in the XVIII century and Vincenzo Chiarugi again in the XIX century based their writings on the references of the two Roman doctors. After centuries of scientific inaction in the XIX century, there was an exponential increase in dermatological studies and the medical-scientific works produced in this period laid the foundations of modern dermatology. The nineteenth-century texts of Robert Willan and Thomas Bateman, Jean-Louis Alibert, Ferdinand von Hebra, and Moriz Kaposi proved fundamental for the study of skin pathologies, including vitiligo. The nineteenth-century medical-scientific vision and approach to vitiligo is shown in this work through the presentation of direct quotes extrapolated from the most important works of the authors mentioned above, this served to historically contextualize the gradual progress of medical study regarding this skin pathology.

H13 Leprosy and psoriasis: a heated controversy

Abstract In the Old Testament, the term ‘Lepra’ was used to describe many skin diseases, including psoriasis, eczema, vitiligo, alopecia areata and boils. The word ‘leprosy’ was derived from this and was previously used as a generic term that included multiple inflammatory dermatological diseases. It was a disorder of great religious significance during ancient times, with intense stigmatization—‘lepers’ were pronounced unclean by priests. Hippocrates (460–377 Bc), the Greek ‘father of medicine’, can be credited with being the first to separate medicine from religious superstition. However, there was little differentiation between leprosy and psoriasis, two distinct diseases we know today. He used the word ‘psora’ to describe itch, and ‘lopoi’ to describe the dry and scaly features of skin conditions, thus continuing the confusion between leprosy and psoriasis. The failure to differentiate psoriasis as its own clinical entity from leprosy meant that for many centuries, patients with psoriasis also suffered the same cruel fate as those with leprosy in society. Those suffering from leprosy were wrongly believed to be highly contagious and were forced to carry a bell or clapper to announce their approach to those who were considered healthy. They were required to wear distinctive clothing so that they were easy to recognize by the public, and were not permitted to talk to or even touch a healthy person. They were outcast in society and could only mix with other ‘lepers’. In 1313, Philip the Fair of France horrifically ordered all those outcasts to be burned at the stake. In 1809, Robert Willan (1757–1812), an English doctor, marvellously developed a simple classification of skin diseases that offered a clear description of the different types of psoriasis. This was a crucial milestone in the recognition of psoriasis as a separate skin disease from leprosy. However, while he was the first person to describe psoriasis as a separate condition, he failed to eliminate leprosy completely as an associated disease. He used the term ‘lepra vulgaris’ to discuss modern psoriasis, which once again further perpetuated the confusion between psoriasis and leprosy. Ultimately, it was Ferdinand von Hebra (1816–1880), an Austrian physician, who permanently shed the term ‘lepra’ from the description of psoriasis in the 1800s, finally allowing the two diseases to be separate.

H02 The Foundling-Chapel brawl 1804: Robert and Mary Willan, trial by social media

Abstract The social media of the late 18th and early 19th centuries was no less humorous, critical and potentially personally destructive than now, despite its form, distribution and time frame being quantitatively different. Cartoons and prints, broadsheets, leaflets and pamphlets were widely distributed by hand for sale cheaply, being passed on for maximal effect. Gillray, Rowlandson and the Cruikshanks were the masters of these media, but others were prolific and no less accomplished at targeting royalty, religions, politicians and individuals of particular merit, such as physicians. One such satirical caricaturist and pamphleteer was James Sayers (1748–1823), a favourite of Prime Minister William Pitt. In 1804, he wrote a verse satire, attacking Dr Robert Willan (1757–1812) and his wife Mary (1770–1844) after an incident in the Chapel at The Foundling Hospital (Nichols RH, Wray FA. History of the Foundling Hospital. Oxford: Oxford University Press, 1935), where his sister Elizabeth was in dispute with them over the occupancy of a pew (pews were rented by the hospital governors on an annual basis). They were both subjected to a clever—not always subtle—diatribe for some 2 years about their personal and professional integrity, including their religion. Willan was described as a ‘learned leech’, with the implication that this successful physician was not just bleeding patients therapeutically, but also financially. His patients were ‘scabby’ and therefore detestable, and he was a lesser man because he was no longer a Quaker. For Mary, there were intimations about her temperament, her motives for marriage and her personal hygiene. The recently married couple had moved from 14 Bloomsbury Square to nearby number 10, with her two daughters by her previous marriage. There, their son Richard was born in 1802. Robert Willan withdrew from his work at the Carey Street Dispensary in 1803. Re-reading this rare publication by Sayers, which may seem a negative satire, inadvertently provides clues to the personal and social context of the Willan’s early married life.

H08 The Crimson Chronicles of acne rosacea: a fascinating tale of medicine and culture

Abstract Acne rosacea is a common skin condition that affects people with Fitzpatrick skin types I–III and is characterized by flushing, erythema, telangiectasia, pustules, papules and phyma (Jansen T. Clinical presentations and classification of rosacea. Ann Dermatol Venereol 2011; 138:3). This condition has been around for centuries and is referred to in literature and art throughout history. The earliest reference to acne rosacea can be traced back to the third century Bc, where it was mentioned in the writings of Greek poet Theocritus. It has also been referred to in various forms of literature, including the character of Summoner in Chaucer’s Canterbury Tales and Bardolf in Shakespeare’s Henry VI (Cribier B. Histoires de visages rouges. Ann Dermatol Venereol 2011; 138:2). In art, the condition is famously depicted in Italian Renaissance painter Domenico Ghirlandaio’s ‘The Old Man and His Grandson’, now housed in the Louvre. The colour red, a prominent characteristic of acne rosacea, has had a significant role in literature, symbolizing everything from love and passion to anger and violence. French novelists Balzac and Proust used it as a motif in ‘The Red Face’ or ‘Le Visage Rouge’ to denote violence and as a marker of the working classes. In the 14th century, French surgeon Guy de Chauliac was the first to document clinically the condition, referring to it as goutterose or ‘pink droplet’. It was in the 18th and 19th centuries that significant strides were made in understanding the nature of acne rosacea. Dr Jean Astruc, known as the father of venereal diseases, characterized the condition as ‘erythematous, varicose and scaly’. In 1812, the official term ‘acne rosacea’ first appeared in a medical text by English dermatologist Dr Thomas Bateman. Further references to the condition can be found in the 1817 publication On Cutaneous Diseases by dermatology pioneer Dr Robert Willan. In 1834, physician Robert Macnish explicitly linked acne rosacea to alcohol consumption in his book Anatomy of Drunkenness. The differentiation between acne vulgaris and acne rosacea was firmly established following the work of Austrian dermatologist Hebra and French dermatologist Darier. In the past, treatments for acne rosacea included salves containing mercury, sulfur, bull’s blood, blood-letting and leeches. Today, topical and oral antibiotics are the standard treatments, a far cry from the remedies of yesteryear. In conclusion, the history of acne rosacea, which is so much more than just le visage rouge, is a captivating journey that spans centuries, from its earliest references in literature and art to the contemporary understanding and treatment of the condition.

Changes in color of the skin and systemic disease

When looking for diseases of the skin, this is usually done in a holistic way, automatically and unconsciously, by recognizing localization, distribution, and appearance of the primary or secondary skin lesions. When Robert Willan (1757-1812) introduced the concept of morphology of skin lesions, it became the basis for the classification of dermatoses. Apart from ethnic factors, the various dermatoses comprise a rainbow of colors ranging from the most common red color to yellow, blue, brown, silver, green, black, and white.

Dermatite atopíque : images hístoriques: Historical images of atopic dermatitis

Atopic dermatitis has been described under many names before the XXth century, and first illustrated in the early XIXth century. This article presents historical images from the first volumes of Robert Willan to the Pratique dermatologique, the first encyclopedy published in 1900. Many accurate clinical descriptions of the disease can be found in the early treaties of dermatology, including the one published by Thomas Carrere in 1740. Since then, Alibert and Rayer in France, Hebra and Neumann in Vienna and Duhring and Fox in the USA illustrated their atlases with spectacular images of adults or children suffering from AD, or from other diseases that might have been considered as eczema infantile. Color engravings, color lithographs and black and white photographs showed with an increasing precision the semiology of AD, in the context of artistic representations of high quality, that have not been surpassed by modern photographs. At the beginning of the XXth century the clinical presentation, the course and heredity of the disease were perfectly established, introducing a new era of research in physiopathology and treatment in the following decades.

On the History of Classification in Dermatology.

Since the early days of cutaneous medicine, naming of the entities had remained a confusing subject. Earlier texts of all ancient civilisations are almost similar in this topic The Biblical controversy regarding the actual translational meaning of the original Hebrew term Zara ‘at has become a centre of controversy amongst many research scholars of the medical history. Similar debate exists about the Ayurvedic term Kustha---- whether it meant leprosy or stood for a number of skin affliction is a matter of controversy. A scientific and rational classification system was, therefore needed. The process started with Galen and traversed a long path and ultimately with the eight orders classification system proposed by Robert Willan in the early part of the nineteenth century resolved the issue. This whole journey was eventful….almost all the great doyens of dermatology directly or indirectly contributed to this process. This overview will focus on the main such events of the medical history in nutshell.

A tribute to Robert Willan in Bloomsbury Square

Robert Willan is commemorated by a blue plaque on the house in which he lived in Bloomsbury Square in London. He lived there during a productive period of his career, until ill-health caused him to travel to Madeira, where he died. This fitting tribute to Willan is the result of the efforts of Dr. Henry MacCormac, himself an eminent British dermatologist of the first half of the 20th century.

Robert Willan: Pioneer in morphology

Robert Willan (1757-1812), a 1780 graduate in medicine from the University of Edinburgh, spent most of his professional life in London. He worked at the Carey Street Public Dispensary, which was also staffed mainly by such graduates from Edinburgh as Thomas Bateman, Richard Bright, and Thomas Addison. Willan's major dermatology works can be categorized into two groups: an introduction of the first classification of skin diseases, and the correct clinical descriptions of many diseases. Both were based predominantly on morphologic features rather than on the etiologic or pathophysiologic characteristics of a disease. Between 1798 and 1808, Willan published a four-part work, Cutaneous Diseases, in which he developed a classification of skin diseases according to the form of their pathologic products. Willan was also the first to recognize the importance of illustrations in the description of skin disorders and to create the first atlas of skin diseases containing color pictures.

Robert Willan – a versatile physician and scholar

Robert Willan – a versatile physician and scholar

Psoriasis

Psoriasis (derived from the Greek word psora meaning to itch) is a common immune-mediated papulosquamous skin disease. First recognized as an independent condition by English dermatologist Robert Willan in 1798, the term is now used to include a variety of clinical appearances with different morphology, distribution, severity and course. Although common, the pathogenesis of psoriasis is not well understood and involves a multitude of genetic and environmental factors. Management of psoriasis includes controlling the extent and severity of disease and its complications, improving the patient's quality of life while minimizing potentially toxic side effects of treatments. This review aims to provide an overview of this complex condition, from its presentation, diagnosis, management in primary care and the referral criteria to secondary care.

Robert Willan and the Age of Enlightenment

Robert Willan and the Age of Enlightenment

The History of Lupus Erythematosus

This article explores the history of lupus erythematosus from the origins of the name to the most modern therapeutic advances. The review includes information about the origin of the name "lupus," the first clear description of the skin lesions, the discovery of the systemic and discoid forms, and further advances which define our current view of this illness. The classical descriptions of Hippocrates, Paracelsus, Manardi, Rudolph Virchow, Cazenave, Robert Willan, and Moritz Kaposi are chronologically described. Later, the contributions of Sir William Osler, Jonathan Hutchinson, Sequira and Balean, Kraus and Bohac, Libman and Sacks, Malcolm Hargraves, and Edmund L. Dubois are highlighted. The major breakthroughs of the modern period, including the diagnostic tests, animal models, and genetics, are briefly described. The article ends with the history of drug-induced lupus, diagnostic criteria, and the history of the therapy of lupus erythematosus. With modern therapeutic advances, the mortality rate from lupus erythematosus has decreased substantially. It is hoped that current research will further improve the prognosis of this disease in the near future.

The origins of Robert Willan's On Cutaneous Disease

The origins of Robert Willan's On Cutaneous Disease

Willan's itch and other causes of pruritus in the elderly

Itch in the elderly presents a diagnostic and therapeutic challenge. A thorough history, review of systems, and physical examination are critical to determining its cause. Examination of the skin may be misleading. There are frequently only secondary lesions, eczematous changes, lichenification, and excoriation, which may be misdiagnosed as a primary dermatitis. Xerosis may be the cause, but it is sometimes merely coincidental. If primary lesions are present, a skin biopsy can enable a diagnosis to be made. Systemic causes of itch, such as cholestasis, uremia, hyperthyroidism, medications, or lymphoma, must be considered. If the cause remains elusive, idiopathic itching of the elderly or so-called "senile pruritus" may be considered. However, we propose to discard the term "senile pruritus", which can be offensive and frightening. We propose to replace it with "Willan's itch". Robert Willan (1757-1812) is honored as one of the founders of modern dermatology thanks to his book, On Cutaneous Diseases, and its morphological approach to skin disease. He was probably the first to give a good clinical description of itching in the elderly. The diagnosis of Willan's itch should be reserved for generalized pruritus in the absence of xerosis or other recognizable cause. The pathophysiology of this form of pruritus is poorly understood, but it is likely that age-related changes of the skin, cutaneous nerves, and other parts of the nervous system play a role. Anecdotal and limited data suggest that gabapentin, cutaneous field stimulation, serotonin antagonists, and ultraviolet B phototherapy may attenuate itch in some of these patients.

Classics in Clinical Dermatology with Biographical Sketches: 50th Anniversary 2nd Edition

In 1953, two young American dermatologists, Shelley and Crissey, produced a work entitled Classics in Clinical Dermatology, containing the original descriptions of 143 dermatological disorders, with brief biographical notes on the ninety-four men and one woman who had written them. The chronology extended from Robert Willan's first descriptions of psoriasis and erythema nodosum in 1808, to Sophie Spitz's recognition of melanoma of childhood in 1948. This book has long been out of print, but after a lapse of half a century the same two authors, both now retired after long and distinguished careers, have produced a second edition, adding 46 original descriptions by a further thirty-one men and one woman. The choice of subjects is deliberately eclectic, encompassing the grave (Kaposi's sarcoma, Wegener's granulomatosis, mycosis fungoides), the commonplace (acne vulgaris, seborrhoeic dermatitis, pityriasis rosea) and the obscure (rhinoscleroma, hydroa vacciniforme). Likewise, some of those commemorated are very well known (Parkes Weber, Jonathan Hutchinson), others familiar only through the name of the disorder that they described (Behcet, Bowen, Paget, Darier). Many of the original descriptions are delightful to read, surpassing anything that would be written nowadays in both the elegance of the language and the precision of clinical observation. Erasmus Wilson, for example, in describing spider naevi, talks of a publican who had ‘yielded to the temptation of his calling’, whilst Willan's observation of the sequence of evolution of the morphological changes in chronic plaque psoriasis could not be improved upon. The modern additions offer reassurance that original clinical observations continue to be made by dermatologists in routine practice (Sweet, Wilkinson, Grover). It is also pleasing to discover that the fact that the original description of Kawasaki disease was in Japanese did not prevent its general recognition and the correct eponymous attribution. The inclusion of the biographical sketches is an important element of the work; an eponym becomes rather pointless if the person concerned has vanished into obscurity. A point of interest is that many original observations of skin disease were made by surgeons or physicians; in an age when clinical practice is becoming increasingly compartmentalized it is salutary to read of those such as Paget and Hutchinson whose clinical practice and contributions ranged over almost the entire spectrum of medicine. The earlier biographies, whilst brief, do not lack colour; one individual is said to have been ‘totally devoid of any sense of humour’, whilst another is said to have had ‘a certain abruptness of manner’. By contrast, those added to the second edition are in some instances overladen with sycophancy; no doubt Shelley and Crissey have mellowed with the passing of the years. The new edition of Classics in Dermatology will certainly appeal to anyone with an interest in how our understanding of skin disease has evolved. Nor is its appeal confined to the specialist. Many of the conditions described are of general medical importance—dermatomyositis, pyoderma gang-renosum, dermatitis herpetiformis. Perhaps most important of all, this splendid book will encourage readers, from whatever clinical specialty, to rediscover the dying art of precise clinical observation and clear description.

Los tres grandes. Primera parte: Robert Willan (1757-1812)

Abstract.—Robert Willan was the founder of Dermatology in Great Britain. Because Willan's family was quaker, he was graduated at Edinburg University. He was physician to the Carey Street Dispensary of London. His classification of cutaneous diseases was based on an arragement similar to that of botanic. His pupil, Dr. Thomas Beteman, became his posthumous advocate and supporter.

Thomas Bateman MD FLS 1778-1821.

Thomas Bateman was a physician to the Carey Street Public Dispensary with Robert Willan in the first decade of the nineteenth century when the latter was developing the classification that would act as a foundation for modern dermatology. Following Willan's death with his work still incomplete, Bateman published a book, as an abstract of Willan's full concept, which was probably the most influential dermatology text of the nineteenth century. This was the first classification of dermatology that precisely defined the terms used and fitted individual diseases into a single class, rather than considering different stages of the same disease as maladies that belonged in different classes. This was the first attempt to link treatment to the disease process rather than to the clinical appearances and thus represents the origin of modern scientific clinical dermatology.

Robert Willan and the French Willanists.

In 1798, Robert Willan published the founding textbook of British dermatology. In adopting the elementary lesions principle previously described by Josef Plenck and improving the nomenclature of the skin diseases, Willan established a method for the diagnosis and a doctrine for the nosology of the cutaneous diseases. Introduced into France by Biett in the 1810s, the Willanist method, which allowed diagnosis on the basis of objective criteria, was adopted by the majority of the dermatological community. However, as a doctrine, Willanism, the use of elementary lesions as a framework for classifying diseases, became the subject of lasting debate. In fact, apart from a few, most leading French dermatologists did not accept Willan's doctrine and preferred classifications according to systems which were supposed to reflect the best understanding of the cutaneous diseases: physiological, aetiological and pathological. Willanism is still used by every dermatologist as a method for recognizing skin diseases. It constitutes a firm link to the founding period of modern dermatology and remains a bastion against uncertain hypotheses.

Robert Willan MD FRS (1757-1812): dermatologist of the millennium.

Robert Willan MD FRS (1757-1812): dermatologist of the millennium.