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The Role of Syphilis in the Establishment of the Specialty of Dermatology

The Role of Syphilis in the Establishment of the Specialty of Dermatology While today the term “dermatologist” may conjure up images of celebrities and Botox, the field's early history is much less glamorous. In fact, venereal diseases, especially syphilis, figure prominently in the field's development as distinct from general medicine. Although the discussion of venereal disease was considered clandestine, the public health risks of syphilis in the late 1800s demanded attention. Dermatologists rose to the task of caring for these underserved patients, who were cloaked with a “stigma of disrepute.”1 This expertise in syphilis, a disease to be “mentioned in whispers only”1(p519) actually helped to establish dermatology as a legitimate medical specialty. The unique pathologic characteristics of syphilis allowed dermatologists to emphasize the relationships between cutaneous manifestations and systemic disease. By illustrating the effects of syphilis on other organs, dermatologists highlighted the relationship of skin diseases to the rest of the body, which deepened the relationship between dermatology and internal medicine. Like syphilis, diabetes mellitus, tuberculosis, and erythema multiforme were other skin conditions with systemic manifestations that provided “ample justification for an internist to be interested in skin disorders.”1(p520) Thus, syphilis shaped the way that dermatologists would explain the importance of dermatology as a field in relation to general medicine. Syphilis was not only an intellectual matter between physicians, of course; its epidemiology and treatment was wrought with ethical dilemmas. Did physicians have an ethical obligation to inform patients' wives about their diagnosis or “shall we make ourselves accomplices of the man in order to shield him?”2 Did those with syphilis get what they deserved since “the wages of sin is death,” or did “[syphilis have] no more right of existence than plague and yellow fever”?2(pp777-778) These were the topics that led to heated discussions behind closed doors in every house and to headlines in newspapers and magazines across the country. As a result, dermatologists found themselves center stage in a public debate over moral decency and the role of the government. In 1878, at the first annual American Association of Dermatology meeting, the president, James C. White, MD, proclaimed “This meetings marks an important era in American dermatology—that of its fully recognized, independent position.”3(p1) However, the reality was far different. While dermatology at this time may have been “independent,” it was not “fully recognized” as a specialty. White himself admitted as much saying later in the same speech, “The hostility which at first existed against [dermatology] . . . has not yet wholly subsided.”3(p1) He could not have imagined that the road to legitimization of the specialty was through the proficiency in “venereal diseases.”3 Back to top Article Information Contact Dr Chu at the Department of Dermatology, St Louis University, 1402 S Grand Blvd, Fourth Floor, St Louis, MO 63104 (chumb@slu.edu). References 1. Schalek A. Prophylaxis of syphilis and professional ethics. Urol Cutaneous Rev. 1913;17(10):519-521Google Scholar 2. Scholtz M. The trend of modern dermatological research and its bearing on general medicine. N Y Med J. 1918;775-780Google Scholar 3. White JC. Dermatology in America: President's address delivered at the first annual meeting of the American Dermatological Association at Niagara, September 4th, 1877. Arch Dermatol. 1878;4:1Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

The Role of Syphilis in the Establishment of the Specialty of Dermatology

JAMA Dermatology , Volume 149 (4) – Apr 1, 2013

The Role of Syphilis in the Establishment of the Specialty of Dermatology

Abstract

While today the term “dermatologist” may conjure up images of celebrities and Botox, the field's early history is much less glamorous. In fact, venereal diseases, especially syphilis, figure prominently in the field's development as distinct from general medicine. Although the discussion of venereal disease was considered clandestine, the public health risks of syphilis in the late 1800s demanded attention. Dermatologists rose to the task of caring for these underserved...
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Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2013.3159
Publisher site
See Article on Publisher Site

Abstract

While today the term “dermatologist” may conjure up images of celebrities and Botox, the field's early history is much less glamorous. In fact, venereal diseases, especially syphilis, figure prominently in the field's development as distinct from general medicine. Although the discussion of venereal disease was considered clandestine, the public health risks of syphilis in the late 1800s demanded attention. Dermatologists rose to the task of caring for these underserved patients, who were cloaked with a “stigma of disrepute.”1 This expertise in syphilis, a disease to be “mentioned in whispers only”1(p519) actually helped to establish dermatology as a legitimate medical specialty. The unique pathologic characteristics of syphilis allowed dermatologists to emphasize the relationships between cutaneous manifestations and systemic disease. By illustrating the effects of syphilis on other organs, dermatologists highlighted the relationship of skin diseases to the rest of the body, which deepened the relationship between dermatology and internal medicine. Like syphilis, diabetes mellitus, tuberculosis, and erythema multiforme were other skin conditions with systemic manifestations that provided “ample justification for an internist to be interested in skin disorders.”1(p520) Thus, syphilis shaped the way that dermatologists would explain the importance of dermatology as a field in relation to general medicine. Syphilis was not only an intellectual matter between physicians, of course; its epidemiology and treatment was wrought with ethical dilemmas. Did physicians have an ethical obligation to inform patients' wives about their diagnosis or “shall we make ourselves accomplices of the man in order to shield him?”2 Did those with syphilis get what they deserved since “the wages of sin is death,” or did “[syphilis have] no more right of existence than plague and yellow fever”?2(pp777-778) These were the topics that led to heated discussions behind closed doors in every house and to headlines in newspapers and magazines across the country. As a result, dermatologists found themselves center stage in a public debate over moral decency and the role of the government. In 1878, at the first annual American Association of Dermatology meeting, the president, James C. White, MD, proclaimed “This meetings marks an important era in American dermatology—that of its fully recognized, independent position.”3(p1) However, the reality was far different. While dermatology at this time may have been “independent,” it was not “fully recognized” as a specialty. White himself admitted as much saying later in the same speech, “The hostility which at first existed against [dermatology] . . . has not yet wholly subsided.”3(p1) He could not have imagined that the road to legitimization of the specialty was through the proficiency in “venereal diseases.”3 Back to top Article Information Contact Dr Chu at the Department of Dermatology, St Louis University, 1402 S Grand Blvd, Fourth Floor, St Louis, MO 63104 (chumb@slu.edu). References 1. Schalek A. Prophylaxis of syphilis and professional ethics. Urol Cutaneous Rev. 1913;17(10):519-521Google Scholar 2. Scholtz M. The trend of modern dermatological research and its bearing on general medicine. N Y Med J. 1918;775-780Google Scholar 3. White JC. Dermatology in America: President's address delivered at the first annual meeting of the American Dermatological Association at Niagara, September 4th, 1877. Arch Dermatol. 1878;4:1Google Scholar

Journal

JAMA DermatologyAmerican Medical Association

Published: Apr 1, 2013

Keywords: dermatology,syphilis

References