Cutaneous Infections and
Infestations in Historical
(Iconographic) Perspective
From Variola to AIDS
STELLA FATOVIC
´
-FERENC
˘
IC
´
, MD, PhD
KARL HOLUBAR, MD, FRCP
H
ardly any group of diseases caused so many
fantasies and so much fear, pain, and death
throughout history as did epidemics of infec-
tious diseases, leaving profound marks in human mem-
ory. A variety and diversity of testimonies about count-
less epidemics of the past were recorded: holy
scriptures, chronicles, travelers’ reports, literary and art
works, etc. Although narratives are a valuable source of
historical data and (retrospective) epidemiology, art is a
much more expressive vehicle for demonstrating dis-
ease, malformation, and death. Albeit rare, illustrations
to medical texts paralleled the written word on a small
scale, and they are almost as old as texts themselves.
Furthermore, illustrations could also be understood
over the centuries by the illiterate.
Thomas Sydenham (1624–1689) and Giorgio Armeno
Baglivi (1668–1707) introduced the concept of disease
entities in the mid-1700s, and it took another century
until diseases were categorized by Franc¸ois Boissier de
Sauvages (1706 –1767) into 10 classes. When Agostino
Bassi of Lodi in the early 19th century linked the disease
of silkworms to a fungal parasite (Botrytis cinerea; orig-
inally, Bassiana), it encouraged others to speculate that
contagious diseases, viz, smallpox, plague, cholera, etc
were also due to living organisms. Although theories of
contagion were largely motivated by syphilis up to the
early 19th century, other causes were increasingly being
considered and discovered with the propagation of the
germ theory.
Over many centuries, anatomicosurgical details
about the buildup of the human body prevailed in
medical illustration side by side with malformations
and monstrous appearances, ie, anything impressive by
sheer visibility. Vesalius’ anatomy is a perennial re-
minder of what Renaissance artists could produce.
Eventually, the focus of attention was widened, and not
only were frightening malformations or giant aberra-
tions depicted but also minute skin lesions, conceived
to be typical, appeared in various illustrations. The first
depictions of skin lesions in color appeared in a post-
humous edition of Sauvages, by Christoph Friedrich
Daniel, in Leipzig, Germany (1790–1797).
1
For the purpose of this article, we have screened
hundreds of medical illustrations in contemporary pub-
lications from the late 18th to the late 20th century. This
period seems to be one with striking changes in nosol-
ogy of skin eruptions. We analyzed a series of illustra-
tions ranging from that point of time until recently
(1983–1998). The edition of Willan’s
2
copper plates in
and after 1798 and Alibert’s
3
atlas in and after 1806 are
master examples of dermatologic illustrations to this
day. In addition, the atlases of, eg, Pierre Rayer (1836),
4
Marie-Nicolas Devergie (1826 and 1833),
5
Erasmus Wil-
son (1855),
6
Pierre-Louis-Alphe´e Cazenave (1856),
7
and
Ferdinand Hebra (1856),
8
in addition to others from
across the Atlantic and Japan,
9
document a high artistic
level. To a considerable extent we have also drawn on
the material in the vaults of the Vienna Institute, ie,
original watercolors, drawings, and lithographs by Drs.
Georg Joseph Beer, Friedrich and Eduard Jaeger (father
and son), Anton Elfinger, and Carl and Julius Heitz-
mann (brothers). As a modern token of relevance, we
looked into the color atlas of clinical dermatology by
Fitzpatrick et al, first edited in 1983, the most recent
German edition printed in 1998.
10
Historical Color Illustrations of Skin Diseases,
Infectious Versus Noninfectious
Atlases (Table 1) often did not appear at one time but in
several installments. The figures numbering the infec-
tious diseases depicted and referred to in the above
table relate to the complete editions of the oeuvres and
also because the first editions may not have been avail-
able in all cases. This discrepancy should be kept in
mind as much as the fact that different editions may
have different numbers of plates, paintings, etc. (In the
From the Department for the History of Medicine, Croatian Academy of
Sciences and Arts, Zagreb, Croatia, and the Institute for the History of
Medicine, University of Vienna, Vienna, Austria.
Address correspondence to Stella Fatovic´-Ferenc˘ic´, MD, PhD, Depart-
ment for the History of Medicine, Croatian Academy of Sciences and Arts,
Demetrova 18, HR-10000 Zagreb, Croatia.
E-mail address: stella@hazu.hr.
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