Reminiscence
PEDIATRIC DERMATOLOGY IN ANTIQUITY: PART Ill SAMUEL X. RADBILL, M.D.
Dioscorides (40-90 AD) Pedanius Dioscorides of Anazarba, a town in Cilicia, Asia Minor, was a contemporary of Pliny. In 63 AD, just about the time his native province became a part of the Roman Empire, he compiled a Greek herbal in which he gathered the entire materia medica known up to his time. This great herbal formed the basis of botanical knowledge throughout the ensuing centurie s and was the forerunner of all future galenicals. Dioscorides named and described each plant systematically, and enumerated medicines compounded from it. He named conditions in which the medicinal element was useful either alone or in combination with other substances, explained its mode of action and detailed its pharmaceutical preparation. He also included in this pharmacopoeia remedies derived from animal and mineral sources. His physiology was based upon the four humors and his pharmacognosy upon the theory of natural faculties of drugs. He inferred that each plant was endowed with certain physiologic actions or qualities such as heating, cooling, wetting, drying, mollifying, resolving, dissolving, dispersing, exulcerating, caustic, binding, astringent, cleansing, drawing out, driving out, putrifying, cicaPart I appeared in June 1975 14:363. Part 11 appeared in May 1976 15 : 30 3.
Honorary Librarian , The College of Physicians of Philadelphia, Philadelphia , Pennsylvania
trizing and other properties. Internal medications had many of these modifying propensities as well as purging, diaphoretic, diuretic and such like qualities. While the skin was p~imarily a surface structure upon which topical therapy was the usual resort in healing, it was also looked upon as an excretory organ. It had pores through which the imbalanced humors could emit corrupt fluids from inside the body. For this reason hygienic regimen and diet were always important elements of treatment. Reasoning along these lines, for example, Dioscorides explained that juice of wild and sative figs, in making the body break out in boils and opening the pores of the skin for increased perspiration, cleansed the blood of its corruptions and so purified it. But Dioscorides did not delve deeply into physiologic or pathologic detail. That remained for Galen to elaborate a century later. Descriptive Terms In naming conditions for which the various medicaments were best suited by their natural faculties, Dioscorides presented us with an extensive nosology. His terminology, like that of Celsus, de-
00 11-9059-7 8-0600-04 27-008 5 © Intern ati onal Soc iety o f Tropi ca l Derm atology, Inc.
427
428
INTERNATIONAL JOURNAL OF DERMATOLOGY
pended upon Hippocrates. Since the skin is so accessible, almost all his drugs found some use in cutaneous medicine. We find a wide array of dermatologic terms, most of them applicable to children as well as to adults, although children specifically were rarely mentioned . There is a 17th century English translation recently reprinted 1 which enriches the medical vocabulary while expanding the descriptive terminology of the Greeks. Thus, the word originally used in Greek or Latin for ulcer, which could indicate almost any kind of a sore, was here translated not only as ulcer in English but as sore, eruption and other terms. In addition, there were characterizing terms such as malignant, phagedenic, wild, savage, fretting, old, recent. hot, inflamed, deep, running, scabby, creeping and so on. When we read in 17th century English of "scald sores of the head" we can visualize the "scabby or scurfy" erup tions once so common on children's scalps. This lesion was called crusta lactea, milk crust or milk scab because it was attributed to milk sucked by the infant from its mother or nurse. Achora of the Roman Dioscorides could be '·running sores of the head" in 17th century English, but it could also include such conditions as we now call seborrheic dermatitis and tinea capitis . Favus, kerion to the Greeks, both words meaning honeycomb, recalled the oozing honeylike exudate that crusted children ' s scalps when it dried. Because of the sympathetic magic of words and the theory of like cures like, .. honey was incorporated into many prescriptions for this condition by Dioscorides. Sebaceous cysts, also related to honey by the image of the secretion, were called melicerides. Hair dyes such as henna which were used on children sometimes ran down
June 1978
Vol. 17
their faces and caused dermatitis. 2 Children were also very prone to chilblains (perniones) from chilling, this is repeatedly encountered in listings of the uses of various medicines. Also warts, moles and skin blemishes of various sorts are recorded . A number of varieties of warts were distinguished. Thymia were small warts on the skin while formica or formicose warts caused a biting sensation like that caused by ants. There were flat warts and there were hanging warts, which we describe as pedunculated. Scabies
Scabies indicated excoriations from scratching. Vari, the Latin equivalent of Greek ionthoi, included the pimple of facial acne. Lice and nits, constant companions of mankind, were troublesome. Many plants were said to be effective against them as well as against other verminous pests. Eating snakes, some people said, breeds lice, but Dioscorides said this is a lie. A universal disease until quite recently, pediculosis is still bothersome to school children and their teachers. A curious diagnosis mentioned by Dioscorides was the "chironian. " Robert Hooper in 1543.1 defined chirones as small pustules on the hands and feet which contain a troublesome worm. This is a neat description of scabies in infancy. Dioscorides mentioned lesions which the 17th century English translator called " creeks." In old English this meant a cleft or crevise; I suspect that he was referring to the burrows of scabies. Until Renucci in Alibert's Parisian clinic in 1834 showed doctors how to find the itch mite for diagnosis, the humoralists held that scabies and scabby diseases in general were all due to an acrimonia sanguinis or acrimony of the blood. But the common people were well aware of the presence of the mite by
No . .5
PEDIATRIC DERMATOLOGY
the 18th century, for they extracted them with little needles. The contagionists at that time maintained that this mite was the cause of the disease and not just an adventitious parasite. The parasites were called "sirones" and "cirones," obviously a variation of chironian. The Germans called the extr2cting maneuver "seuren graben," digging for the cirones. When Bonomo, using a microscope, drew a picture of the mite in '1687, it was the first time any living organism had been demonstrated by microscope to be a specific cause of a single disease. Whether or not Dioscorides realized its connection with scabies, the word cirones is certainly etymologically connected with his chironian. 4 Under the term impetigines, Dioscorides classified a variety of swellings, nodules, tumors or eruptions which he looked upon as outbreaks on the skin caused from within. Carcinom;:ita, meaning crabs, were so named because they had large, blue veins that made the growth look like crabs' claws. The Romans also called them lupus (wolf) because they ate away the flesh like a wolf. Bernard de Gordon in his Lilium Medicinae published in 1305 equated herpes esthiomenos, corrosive ulcers, with lupus.
Sensitizing Materials Dioscorides also described dermatitis venenata caused by ruta montan;:i, mountain rue or hilly rue, which was gathered at flowering time for picklings. It made the skin redden and puff up with itching and widespread extreme infl;:imm
PEDIATRIC DERMATOLOGY IN ANTIQUITY: PART Ill SAMUEL X. RADBILL, M.D.
Dioscorides (40-90 AD) Pedanius Dioscorides of Anazarba, a town in Cilicia, Asia Minor, was a contemporary of Pliny. In 63 AD, just about the time his native province became a part of the Roman Empire, he compiled a Greek herbal in which he gathered the entire materia medica known up to his time. This great herbal formed the basis of botanical knowledge throughout the ensuing centurie s and was the forerunner of all future galenicals. Dioscorides named and described each plant systematically, and enumerated medicines compounded from it. He named conditions in which the medicinal element was useful either alone or in combination with other substances, explained its mode of action and detailed its pharmaceutical preparation. He also included in this pharmacopoeia remedies derived from animal and mineral sources. His physiology was based upon the four humors and his pharmacognosy upon the theory of natural faculties of drugs. He inferred that each plant was endowed with certain physiologic actions or qualities such as heating, cooling, wetting, drying, mollifying, resolving, dissolving, dispersing, exulcerating, caustic, binding, astringent, cleansing, drawing out, driving out, putrifying, cicaPart I appeared in June 1975 14:363. Part 11 appeared in May 1976 15 : 30 3.
Honorary Librarian , The College of Physicians of Philadelphia, Philadelphia , Pennsylvania
trizing and other properties. Internal medications had many of these modifying propensities as well as purging, diaphoretic, diuretic and such like qualities. While the skin was p~imarily a surface structure upon which topical therapy was the usual resort in healing, it was also looked upon as an excretory organ. It had pores through which the imbalanced humors could emit corrupt fluids from inside the body. For this reason hygienic regimen and diet were always important elements of treatment. Reasoning along these lines, for example, Dioscorides explained that juice of wild and sative figs, in making the body break out in boils and opening the pores of the skin for increased perspiration, cleansed the blood of its corruptions and so purified it. But Dioscorides did not delve deeply into physiologic or pathologic detail. That remained for Galen to elaborate a century later. Descriptive Terms In naming conditions for which the various medicaments were best suited by their natural faculties, Dioscorides presented us with an extensive nosology. His terminology, like that of Celsus, de-
00 11-9059-7 8-0600-04 27-008 5 © Intern ati onal Soc iety o f Tropi ca l Derm atology, Inc.
427
428
INTERNATIONAL JOURNAL OF DERMATOLOGY
pended upon Hippocrates. Since the skin is so accessible, almost all his drugs found some use in cutaneous medicine. We find a wide array of dermatologic terms, most of them applicable to children as well as to adults, although children specifically were rarely mentioned . There is a 17th century English translation recently reprinted 1 which enriches the medical vocabulary while expanding the descriptive terminology of the Greeks. Thus, the word originally used in Greek or Latin for ulcer, which could indicate almost any kind of a sore, was here translated not only as ulcer in English but as sore, eruption and other terms. In addition, there were characterizing terms such as malignant, phagedenic, wild, savage, fretting, old, recent. hot, inflamed, deep, running, scabby, creeping and so on. When we read in 17th century English of "scald sores of the head" we can visualize the "scabby or scurfy" erup tions once so common on children's scalps. This lesion was called crusta lactea, milk crust or milk scab because it was attributed to milk sucked by the infant from its mother or nurse. Achora of the Roman Dioscorides could be '·running sores of the head" in 17th century English, but it could also include such conditions as we now call seborrheic dermatitis and tinea capitis . Favus, kerion to the Greeks, both words meaning honeycomb, recalled the oozing honeylike exudate that crusted children ' s scalps when it dried. Because of the sympathetic magic of words and the theory of like cures like, .. honey was incorporated into many prescriptions for this condition by Dioscorides. Sebaceous cysts, also related to honey by the image of the secretion, were called melicerides. Hair dyes such as henna which were used on children sometimes ran down
June 1978
Vol. 17
their faces and caused dermatitis. 2 Children were also very prone to chilblains (perniones) from chilling, this is repeatedly encountered in listings of the uses of various medicines. Also warts, moles and skin blemishes of various sorts are recorded . A number of varieties of warts were distinguished. Thymia were small warts on the skin while formica or formicose warts caused a biting sensation like that caused by ants. There were flat warts and there were hanging warts, which we describe as pedunculated. Scabies
Scabies indicated excoriations from scratching. Vari, the Latin equivalent of Greek ionthoi, included the pimple of facial acne. Lice and nits, constant companions of mankind, were troublesome. Many plants were said to be effective against them as well as against other verminous pests. Eating snakes, some people said, breeds lice, but Dioscorides said this is a lie. A universal disease until quite recently, pediculosis is still bothersome to school children and their teachers. A curious diagnosis mentioned by Dioscorides was the "chironian. " Robert Hooper in 1543.1 defined chirones as small pustules on the hands and feet which contain a troublesome worm. This is a neat description of scabies in infancy. Dioscorides mentioned lesions which the 17th century English translator called " creeks." In old English this meant a cleft or crevise; I suspect that he was referring to the burrows of scabies. Until Renucci in Alibert's Parisian clinic in 1834 showed doctors how to find the itch mite for diagnosis, the humoralists held that scabies and scabby diseases in general were all due to an acrimonia sanguinis or acrimony of the blood. But the common people were well aware of the presence of the mite by
No . .5
PEDIATRIC DERMATOLOGY
the 18th century, for they extracted them with little needles. The contagionists at that time maintained that this mite was the cause of the disease and not just an adventitious parasite. The parasites were called "sirones" and "cirones," obviously a variation of chironian. The Germans called the extr2cting maneuver "seuren graben," digging for the cirones. When Bonomo, using a microscope, drew a picture of the mite in '1687, it was the first time any living organism had been demonstrated by microscope to be a specific cause of a single disease. Whether or not Dioscorides realized its connection with scabies, the word cirones is certainly etymologically connected with his chironian. 4 Under the term impetigines, Dioscorides classified a variety of swellings, nodules, tumors or eruptions which he looked upon as outbreaks on the skin caused from within. Carcinom;:ita, meaning crabs, were so named because they had large, blue veins that made the growth look like crabs' claws. The Romans also called them lupus (wolf) because they ate away the flesh like a wolf. Bernard de Gordon in his Lilium Medicinae published in 1305 equated herpes esthiomenos, corrosive ulcers, with lupus.
Sensitizing Materials Dioscorides also described dermatitis venenata caused by ruta montan;:i, mountain rue or hilly rue, which was gathered at flowering time for picklings. It made the skin redden and puff up with itching and widespread extreme infl;:imm
