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
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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
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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
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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).
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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
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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.
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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
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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.
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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”.
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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.
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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
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“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.
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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
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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.
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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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