X. Sierra, MD
Read also The dermatological heritage in danger in Madrid by J. Calap
Dermatology in Spain did not have such an early awakening as in France, England, or Austria.
There had been some early work carried out in this field, such as that of Alfaro, who in 1840
published a book which basically followed Alibert's
ideas1 (although his classification is
closer to Rayer's2), but, in general, the attempts at
studying skin diseases had been timid and inconsistent.
olavide
The iconograghic atlas
The dermatologic ideas of Olavide
Etio-pathogenic thought
The "museum" of San Juan de Dios
Bibliography:
José Eugenio Olavide was born in Madrid in 1836. He studied medicine at the old San Carlos
Hospital, and, on finishing his studies, went to Paris, where for 2 years he worked with
eminent physicians, such as Alfred Velpeau, Armand Trousseau, and Jacques Maissonneuve.
On his return to Madrid, in 1860, he secured a place as doctor at the San Juan de Dios Hospital.
This old hospital of Madrid was founded in 1552 under the name of Antón Martín, with the aim of
serving "the wounded poor". Sufferers of skin diseases and venereal diseases were
confined here.3 This hospital was renowned for the
treatment of sexually transmitted diseases,
and the satirical poet Francisco Quevedo (17th century) made reference to it in this
sense in some of his poems. Olavide was in charge of 120 beds for cutaneous patients, fueling
his growing interest in dermatology, until then a neglected speciality in Spain.
Soon Olavide had at his disposal a group of associates, with whom he began classes or sessions
in the aforementioned hospital. This may be considered as the first educational activity in
dermatology that took place in Spain (1864). It is true, however, that some years before, in
1850, there had been a failed attempt to establish a Chair of Dermatology in Madrid, for which
Don José Calvo had been nominated, but this project only lasted a year and never came to
fruition.
The continuous observation of cutaneous diseases in the wards of San Juan de Dios Hospital, and
the need to retain in his memory the clinical details of the cases seen by him, led Olavide to
have illustrations made of skin diseases. His first intention was to keep the illustrations in
a kind of small private museum. He also made clinical annotations, helped by his associates
Hernando de Benito and Castelo. This is how he achieved a classification of dermatologic
diseases.
He then had the idea of publishing these experiences and teachings in the form of a book, which
would organize the material forthcoming from his personal observations with the aim of
contributing towards a better comprehension of dermatologic diseases. The treatise was entitled
"General Dermatology and Atlas of the Iconographic Clinic of Skin Diseases or
Dermatoses", and appeared in instalments between 1871 and 1880
4. This worthy piece of work,
which comprised two volumes, consisted of a text book and a rich iconographic atlas, and stands
out as one of the best publications of its time on the subject of clinical dermatology. The
illustrations, drawings and lithographs by Acevedo showed cutaneous injuries in detail and sith
accuracy. This iconographic richness and the large size of its pages (in folio)
substantially raised the price of this work, which made it impossible to acquire for many of
its potential readers, such as do students of medicine5.
Had it not been for the official
support of the Minister of Public Works and Economy, Ruiz Zorrilla, it would never have been
published. The instalments continued to appear, albeit at an irregular pace and with
interruptions, between 1871 and 1880. Although this book, because of its magnitude and
luxurious edition, met with certain difficulties in distribution, it became the most emblematic
work in Spanish dermatology and has been a compulsory point of reference since its
publication.
Olavide viewed dermatology as a branch of pathology which studied skin disorders, whether
produced by internal or external cause, and whether a local disorder or part of a systemic
disease. In Olavide's work, it is easy to recognize the influence of the French school of
Alibert and, above all, Bazin. He declared that the mere
description of symptoms was not enough and tried to explain the cause of the disease,
attempting to "link pathogenesis with the anatomy and pathologic physiology towards the
philosophic explanation of the symptoms".
Attention should be drawn to the consideration he gave to functional diseases and to disorders
which he called "sympathetic", in other words, those which coincided with localized
complaints in other organs. This set the precedent, in his time, of considering the cutaneous
expression of systemic pathology6, which corresponds
fully to the concept of diathesis defended
by Bazin and Hardy. He also considered some diseases without an objectifiable morphologic base
as is the case with sensitive or subjective disorders.
Olavide would have preferred to disregard the elemental lesions described by Willan, although
that was not entirely possible. For this reason, he tried to make his own classification of
elemental lesions, insisting that these may superimpose themselves or coincide, a dynamic
concept, considering the epoch, similar to that proposed later by
Devergie.
The treatise classified dermatoses into three large groups: parasitic diseases, natural
diseases, and artificial diseases.
The parasitic diseases, which were contagious, were produced by external agents, such as
animals (lice, scabies) or cryptogams (tinea). Amongst the latter, he also included chloasma
and pityriasis.
Those which he called natural diseases were local, general, or constitutional deformities.
Olavide here included complaints of the following types: syphilitic, herpetic, rheumatic,
scrofulous, scurbutic, leprous, pellagrous, glanderous, carbuncular, tuberculous, fibroid, and
cancerous. This is where we can most clearly see the influence of Bazin and his theory of
diathesis, in which the personal factor is essential and explains the constitutional
predisposition of an individual towards suffering from the disease.
Finally, he considered the artificial diseases which were caused directly or indirectly.
As can be seen, the "more botánico"*
classifications of notorious influence in European
dermatology had no such effect on Olavide, probably due to his readings and almost exclusive
relations with the French school. Olavide did not know the work of Hebra, since he did not
speak German. It is also unlikely that he knew the work of other schools, which had made little
impact in Spain. We should also remember that the works of Willan and Bateman were not
translated into Spanish, nor that of Rayer; Plenck's work was, but very belatedly; Biett's work
archieved only a sparse distribution7.
The causes of diseases were also of interest to Olavide. In the line of etio-pathogenic
thought, he suggested five causes of dermatosis: contagion, heredity, internal constitutional
diseases, exterior influences, and causes through individual predisposition. He defined three
types of contagion: the parasitic (scabies, phytoparasitic), the miasmatic (ferments), and the
virulent (purulent or serous liquids).
Olavide was as a strong supporter of the microscope as a means of research and diagnosis. A
display of his early interest in microbiology was the study in 1872 of the ambient air of the
hospital service, conducted by Ezequiel Martín de Pedro, with the aim of examining the germs
found there. Three years later, in 1875, Olavide gave a speech before the Royal Academy of
Medicine of Madrid entitled "Parasitism or vegetable morbidity before reason and the
facts". A little later he published a similar pamphlet
8. In these works, he considered
cutaneous parasitism, parasitism of mucous membranes, and also parasitism in a general
sense.
The presence of microscopic plant matter on the skin was generally accepted in these times, but
its etiologic role was more debatable. It is true that Remack and Schönlein had already
described the producing agent of favus, which they called Achorion schönleinii (today
Trichophyton schönleinii), Gruby had carried out many demonstrations of fungal producers
of diseases, and the producing agent of pityriasis versicolor had already been described
(Eichstedt, 1846); however, the role of microscopic fungi as etiologic agents was still not
universally accepted. Admitted by some, as was the case with Bazin and Hardy, it was still
disputed by others, such as Cazenave, who maintained that
fungi "were no more than ilusions of micrography". The skepticism of this prestigious
dermatologist doubtless influenced the opinion of a large number of doctors of the epoch.
In spite of this controversy, Olavide clearly defended the etiologic role of fungi in the case
of transmissible dermatosis, rebuffing those who considered parasites to be mere co-adjutants
in the production of diseases:
"In spite of how irrational the idea may be, there have been and there still are men of
science who are not content to look on diseases as the accidental cause of the production and
the development of parasites, but rather they consider them to be an efficient cause, which
has been mistakenly called spontaneous generation (...) we must distinguish between those cases
in which the parasites are the cause of the disease and others in which they are a coincidence
or complication".
This was a disguised allusion to opinions such as a those of
Cazenave or Devergie,
who showed themselves unwilling to recognize the etiologic role of fungi. Olavide considered
contagion to be a seed and the individual to be the land in which it was sown
9,
recognizing these disorders within the phytoparasitic group: thrush, favus, herpes, alopecia
areata, and pityriasis versicolor. He appeared very keen to explain the different forms of
contagion considering them to be direct or mediate, by air and by transplantation. The latter
form of contagion gave cause for various experimental works:
"In this way we have transplanted tinea from man to various animals".
Some of the illustrations of his book attested to he results of various studies of
experimental dermatology: tinea reproduced in dogs and carts, rats, cockerels, etc.
He also extensively considered scabies, to which he had already dedicated other studies
10. He defined it as:
"a parasitic disease and therefore contagious, produced by an arachnid..., called Sarcoptes
hominis".
He then went on to defend the concept that all parasitic diseases have existed since time
immemorial, although they have been confused with other diseases, such as syphilis and leprosy.
After describing in detail the acarus, he refuted the idea of spontaneous generation and
scabious predisposition. As treatment, he suggested the use of creosote and phenic acid.
Although he made some errors, such as denying the contagiousness of leprosy, he showed himself
to be farsighted in other senses. It is surprising, for example, to note his conviction that
syphilis would one day be explained as a "parasitism".
As can be seen, Olavide fully accepted the concept of etiology. As a consequence of this
etio-pathogenic mentality, in 1881 he created a micrographic laboratory in the hospital under
the direction of his associate Antonio Mendoza. Here, histologic and microbiologic work and
research were carried out lending their efforts a special scientific rigor.
Olavide was also the founder of a museum of wax moulages in which, in some way, his
initial idea of collecting clinical illustrations survived, and from which his treatise finally
came forth. The wax moulages allowed the reproduction, in three dimensions and in a form
quite similar to the original, of the various pathologic alterations of the skin, and
constituted a regular recourse in the larger educational centers of the era, until the
introduction of photography made them unnecessary. In this sense, we should recall the wax
museum of the Saint-Louis Hospital in Madrid. Now, San Juan de Dios Hospital no longer exists;
it disappeared in 1965. Its heir, the existing Gregorio Marañón Hospital, Madrid, preserves
the wax moulages of Olavide's museum in boxes in a store-room, and lamentably they
cannot be seen by the public. Let us hope that, in the near future, this anomalous situation
will be rectified.
All things considered, José Eugenio Olavide deserves to be recognized as the founder and
instigator of Spanish dermatology. On his death, in 1901, his book survived in
Madrid with his followers, amongst whom Juan de Azúa (1858-1992) stands out. Olavide's
influence in Barcelona was well known, especially on Joan Giné i Partagàs (1836-1903), who
recognized Olavide in his book11. Olavide's treatise, a
true banner of Spanish dermatology,
marks its starting point, and can be considered the solemn consecration of this medical
speciality in Spain, comparable with the works of Alibert in
France, Willan in England or Hebra in Austria.
^ 1 Alfaro N. Tratado Teórico Práctico de Enfermedades Cutáneas.
Madrid: Yenes, 1840.
^ 2 Bloch I. Geschichte der Hautkrankheiten in der neuren Zeit. In:
Puschmann T, Pagel J, eds. Handbuch der Geschichte der Medizin. New York: GO Verlag
(reimpression), 1971
^ 3 García-Pérez A. Enfermedades de Transmisión Sexual. Madrid:
Eudema, 1992
^ 4 Olavide JE. Dermatología General y Atlas de Clínica Iconográfica
de Enfermedades de la Piel o Dermatosis. Madrid: T. Fortanet, 1871.
^ 5 Sierra X. Historia de la Dermatología. Barcelona: Mra, 1994.
^ 6 Gómez-Orbaneja J. Historia de la dermatología en Madrid, en el
siglo XIX y primer tercio del XX. In: Calap J, Rodríguez-Murillo JA, eds. Aspectos Históricos
de la Dermatología Médico-Quirúrgica y Venereología Española. Barcelona: Isdin, 1985.
^ 7 Lázaro P. El nacimiento de la dermatología: clasificiaciones
"more botánico". Tesis doctoral 30/86. Madrid: Univ. Complutense, 1986.
^ 8 Olavide JE. De las Enfermedades Cutáneas Producidas por Vegetales
Parásitos. Madrid: Oficina Tipográfica del Hospicio, 1878.
^ 9 Báguena MJ. El parasitismo en la obra de José Eugenio Olavide:
dermatología general y clínica iconográfica de enfermedades de la piel o dermatosis (1871).
Dynamis 1985; 5: 259-267.
^ 10 Olavide JE. De la Sarna. Madrid: Labajos, 1874.
^ 11 Giné i Partagàs J. Tratado Clínico-Iconografico de
Dermatología Quirúrgica. Barcelona, 1880.
^ * "more botánico". Latin phrase used in the early 19th century
referring to the medical classification of skin diseases, as had been performed previously by
botanists when classifying plants (e.g. linneus).