Bologna's Dermatological School Or-igins and devewpment oj Bowgna~ Dermatowgical School P.Moroni SUMM A R Y The first note on dermatology in Bologna goes back to the year 1200, when Taddeo degli Alderoni intro- duced the bedside teaching. At the tirne of the syphilis epidemic the hospital of Saint Job was estab- lished to care far these patients by the end of 15th century. During the following centuries many famous physicians were practising and teaching medicine, dermatology included. The greatest advancement of dermatology in Bologna was however in the 20th century. Among the prominent dermatologists at least a few deserved to be mentioned p. Gamberini, S. Giovannini, D. Majocchi and L. Martinotti. The oldest documents relating to dermatology in Bologna mention a famous clinical physician , Taddeo degli Alderotti , w ho was teaching at the end of 1200 (1) and w ho, unlike his colleagues, lecturers gave instrnc- tion at the beclside of his p atients clrawing, attention to the symptoms of the illness described in his writings , "Consilia Medicinalis", which inclucle numerous skin cliseases. The practical clinical scope of Tadcleo was fo llowed by his clisciples: Tommaso del Garbo , Gentile da Foligno and Bartolomeo da Varignana. In the following centuryTaddeo's methocl was aban- doned ancl there was a resurgence of the theoretical 1nethod whereby dermatology appeared only occasion- ally in the comments of Galen 's work "De Tumoribus praeter naturam"(2) , which was preferrecl by Celso. The perfection of Galen's language was causing major diffi- culties of interpretation Galen was also considered to be more of a scholar rather than a meclical practitioner. (2). During this period , however, Arab authors were highly appreciatecl and caute1y was in great vogue un- til Federico Borgognoni (3) restorecl the use of the scal- pel. The treatment of wounds was the prerogative of surgeons, supreme experts in the top ical interventions and use of medicines clesigned for external local app li- cation, so that the role of surgeons in the treatment of skin diseases became almost a matter ofthe past. (4) . With the advent of syphilis at the encl ofthe 15. cen- tury the aclministrators of the city of Bologna deserved well of their townspeople when they founcled a hospi- tal for patients stricken with syphilis . Thus they p ro- Hys to ry IK E y WORDS dermatologi- cal school, Jdevelopment, !Bologna, , Unniversity 68 --- - - - --- - - - ------------ - --- --- - --Acta Dermatoven APA Vol 10, 2001, No 2 Hystory vided assistance and treatment for the afflicted that wandered aimlessly about the city shunned by eve1y- body and removed even from hospitals. And so the Hospital of S. Job was established (5) on the premises of the Hospital of Santa Marina dei Guarini previously intended for the pilgrims (6). This hospital was accepting not only syphilitic pa- tients but also other sick persons afflicted by the so- called squalid diseases to be treated with mercurial unguents or with the resin of the Latin American tree Guaiacum o.fficinale or with the "holy wood" of Guai- acum sanctum applied in compresses and steam baths. The statutes of the hospital, that were very precise, clear and synthetic, especially those affecting the assistant personnel, made possible periods of treatment with the obligatory presence of a physiatrist to check urine and prescribe the diet, and of a treating surgeon as repre- sented ona woodcut by Bartholomeus Steber (7) . Since some physicians at the Hospital of S. Job were also lec- turers at the University, it is only natural that the Hospi- tal of S. Job became the teaching center for venereal and skin diseases. This was witnessed by frequent ap- pearances in hospital wards of numerous scholars and by annual teaching courses which up to the beginning of the 19. century included the reading and commen- tary of the works of Galen pertaining to Dermatology (2). Among the first surgeons performing operations at the Hospital of S. Job was the famous Berengario da Carpi, renowned for the use of mercurial ointment that he claimed to be his exclusive property. Thus he en- joyed a great income and was, in the words ofRamazzini at a more recent date, the only physician capable of transforming mercmy into gold (8). Undoubtedly, the widely spread ignorance together with bloated doctrine based largely on the most irrational and shaky empiri- cism favored the growth of his considerable prestige. This was confirmed by Leonardo Fioravanti (10), a noted Bologna physician in 1500, who also used printed ma- terial to advertise his professional capabilities. Dermatology excited great interest due to the teach- ing of Gerolamo Mercuriale at the Bologna University (11). Among the physicians at the Hospital of S. Job who from its foundation up to its closure by a Napoleonic edict in 1800 conducted unofficial courses in skin and venereal diseases the following are remembered: Enea Vizzani, Flaminio Rota, Domenico Lanzoni, Francesco Muratori, Fabio Pellini, Omodio Dolci and Antonio Gaddi who was the last to conduct the course in sexual diseases. In the 17th century began the scientific research. Marcello Malpighi grasped the great possibilities cre- ated by the use of the microscope in the study of the Bologna 's Dermatological School Figure 1. Profesor Domenico Majocchi, Head of University Department of Dermatology, Bologna University, 1891-1925. organs and tissues of the human body, and in spite of various polemics at the Academy fuelled by his slan- derers ancl aclversaries his work ("De externo tactus organo") and other writings were fully vinclicatecl ancl acceptecl. This is clearly confirmed by the respective corresponclence (12) with the London Royal Academy and by the fact that he was electecl its fellow. In 1800 the Hospital of S. Job was closed down and its inmates were transferred to the Hospital of S. Orsola to be treated by the principal of the Department for chronic cliseases, Domenico Palazzi, who was a member of the Academy of Sciences at the University and conducted free courses in venereology. In 1843 he explainecl the aclvantages of the Hunter tube used in urethral stenosis. His successor, Ubaldo Daveri (13), abandoned the unita1y concept for the clualistic one. He was the first to use the potassium ancl soclium iodicle in tertiary syphi- lis. His culture, experiences, ancl the validity ofhis treat- ment attracted various Italian and foreign physicians Acta Dermatoven APA Vol 10, 2001, No 2 -------------------------- - -------- 69 Bologna 's Dermatological School who visited the wards of the department under his di- rection. His successful collaborator was Pietro Gambini who assisted him in publishing numerous clinical ob- servations 03). Among his assistants was not only Marco Paolini, noted for the research in Trichomonas vagina- lis, but also Michele Medici, Clodoveo Bigi, Francesco Ballotta , G. Battista Hercolani and Domenico Gualandi. They collaborated only a few years with Gamberini who in 1848 became head of the department. In fact , Gamberini did not unclerstand the importance of the means of study and research, alreacly generally recog- nizecl, but preferrecl a practical approach basecl on the observation of the patient Therefore his numerous pub- lications, inclucling those of a didactic nature, reveal the same characteristics (14). In 1860 the University in- troduced the subject of dermosyphilopathy as a regular course for the diploma and entrusted the chair to Pietro Gamberini. At the same tirne the Depaitment of sexual diseases at the Hospital of S. Orsa became the Royal Dermosyphilopathic clinic of the Bologna University. Figure 2. Profesor Leonardo Martinotti, Head of Department of Dermatology, Bologna University, 1925-1951. One of the disciples of the Gamberini school was Sebastiano Giovannini (15) who after his visits to the clinics in Paris and Vienna felt the need to finish the scientific preparations for the School of anatomic pa- thology of Professor Tizzoni. At a later date, after win- ning the competition, he was nominated head of the Dermosyphilopathic clinic at the University of Turin laying the founclations of the Dermatologic school in that city. In 1891 he abandonecl teaching due to o ld age. His successor became Domenico Majocchi, a Roman by origin as well as by cultural and scientific formation , former head of the dermosyphilopathic clinic at the Parma University. Majocchi renounced the invitation of the Medica! faculty at the Rome University and for the rest of his life remained in Bologna. He was the founder of the Bologna Dermatologic school and laicl the foun- dations for scientific activities: the laboratory for micros- copy, histology, bacteriology, chemistry, serology, as well as for practical activities: libra1y, X-ray-, radium-, photo- ancl cliathermoterapy, department for sexual dis- eases, antivenereal dispensary, photographic and cast- ing cabinets (16). He gave short shrift to the conven- tionalism preceding his term which he defined "expositive nosography", and founded his morphology on sound anatomo-pathological basis (16). His disciples were numerous and many became university teachers , some occupied university chairs. Among them were Pier Lodovico Bosellini in Rome, Giuseppe Be1taccini in Bari, Leonardo Martinotti in Bologna. He published many original scientific works , including the "purpura teleangiectocles" linked with his name. He was a hu- manist and also took an interese in the history of medi- cine with an acute critical sense. He also conducted archival research. In 1925, relieved from the duty of teaching because of old age, he was succeeded by his disciple, Leonardo Martinotti, who hacl obtained his university chair as a lecturer in Modena and then as assistant professor in Siena. Martinotti completed his studies in Wroclaw at the school of Jadasshon and then at S. Luis (Paris). He was not only a diligent and painstaking clinician, sup- ported by the most updatecl bibliography, but also an excellent and expert dermopathologist who devoted himself primarily to the histochemistry ancl afte1wards to the immunohistochemistry. He was engaged in highly original research (1914) in keratohyaline and eleidine (17,18) . Afteroccupying his chair in Bologna he founded in 1925 the scientific review of the School, "Archivio Italiano di Dermatologia e Venereologia" that was sus- pended by Andrea Montagnani in 1978. Moreover, he established the School for Specialization in Dermatol- ogy ancl Venereology at the Bologna University attended by physicians from Italy and also from abroad. In 1938, H ystory 70 ------ ----------------------------- Acta Dermatoven APA Vol 10, 2001, No 2 Hystor y Bologna's Dermatological School Figure 3. Professor Martinotti examining a temale patient. Allegoric drawing by doctor Mari, 1935. in his capacity as Chairman of the Italian Society for Dermatology ancl Syphilography, he organizecl an in- ternational Congress on Cutaneous Tuberculosis at- tenclecl by numerous foreign scientists. Among them Domagk who by orcler of the Nazi government refusecl to accept in 1939 the Nobel Prize awarclecl to him for having cliscoverecl in 1932 the antibacterial properties of sulphaclecliaminoazobenzene, the first sulphamiclic compouncl introclucecl in therapy. In 1948 he aclclecl the antibacterial effects of thiosemicarbazons. Martinotti hacl publishecl numerous original works on important sub- jects in skin pathology. There were many clisciples who became lecturers ancl heacl physicians, inclucling Arrigo Bergamasco, the principal in Venice, who completecl his scientific clinical stuclies at the Miescher school in Zurich, ancl who, following the suggestion of his teacher, clevotecl himself to virologic research ancl consequently to the attempts at vaccinal therapy in serious clermato- logic pathologies. Moreover, Unita Silvestri shoulcl be mentionecl too. She occupiecl the seconcl teaching chair from 1968 until 1978. In 1945 Martinotti was suspenclecl from teaching for political reasons, but was recallecl in 1949. During this period various young physicians frequentecl the Insti- tute , inclucling Arturo Longhi, Paolo Morani , Luigi Rasponi ancl others who coulcl meet ancl esteem the teacher while actively collaborating with him. They owecl him their professional formation ancl eclucation. Unfortunately, this lastecl only a few years because in 1951 Martinotti gave up teaching clue to olcl age. The faculty callecl Gilberto Manganotti of the Florentine school, the former heacl of the Dermatologic Clinic at the Siena University. The above mentionecl clisciples of Martinotti together ancl others collaboratecl with Martinotti in research concluctecl by the School: senescence, photodermatosis, autoimmune psychoso- matic diseases , and neoplasias. Consequently they be- came principals at the hospitals in Bologna, Ravenna, Reggio Emilia, thus continuing their teaching at the School for Specialization in Dermatology at the Univer- sity. One of the young physicians attencling the Clinic cluring the last years uncler the leadership of Manganotti was Clauclio Varotti who had prč:viously clevoted him- self to Dermohistopathology, and who is now the head of the Clinic after having substituted in teaching Unita Silvestri ancl subsequently his teacher, Anclrea Montagnani, Manganotti's successor. The School con- tinues its mission supported by numer(?US and capable disciples under the positive guidance of Claudio Marotti accompanied by Antonella Tosti, primarily engaged in the stucly of cutaneous problems, whose scientific ac- tivity keeps alive the memory of her famous teacher of the Italian clermatology, Antonio Tosti. Acta Dermatoven APA Vol 10, 2001, No 2 ----------------------------------- 71 Hys to r y R E F. ·1? R ·1i' ·Nr C ·r;, s·, . . . _-_j .. .:.; J. 1:; l.... AUTHOR'S ADDRESS Bologna's Dermatological School 1. Gelmetti P. Taddeo