The study of skin through the centuries

Until recognized as a distinct medical specialty in the 18th and 19th centuries, the study of the skin received scant academic attention, says a recent review. It took the precise taxonomic classification system born during the second century BC, abetted by Enlightenmentera interest in science, for dermatology to begin receiving its due as a specialty. The review appeared in the August 2017 Medicina Historica.

Ancient Greek and Roman medicine considered the skin little more than a surface casing, as evidenced by the terms used to describe it, wrote review author Rosa Santoro, Ph.D., of the University of Messina, Italy. The Greek derma, for instance, originally meant animal hide or vegetable skin.

Rather than appreciating the skin per se, Greek-Roman medicine moreover viewed skin problems as outward representations of internal humoural imbalance. It was Greek medical pioneer Galen (A.D. 129-200) who first recognized the skin-particularly the smooth, hairless surface of the hands-as a tactile organ.

Santoro credits the Byzantines of the fourth through sixth centuries, and their influence on fledgling European universities of the 13th century, for revised interest in Galen’s teachings. This shift allowed human cadaver dissection to become an essential part of academic curricula. The key breakthrough, Santoro wrote, came with 16th-century Flemish physician Andreas van Wesel, who first analyzed the skin’s substance and constituent layers, identifying pores, fat and nerves.

Still, early publications regarding skin diseases focused largely on disfiguring but rarely deadly conditions whose nomenclature sometimes pointed fingers at outsiders for spreading these scourges-15th-century Italians called syphilis morbo gallico, for example, while the French called it mal napoletain. Santoro also details the circuitous routes by which labels including leprosy, scabies
and herpes evolved from their initial vagueness to characterize the specific conditions they now represent.

Generally, Santoro says, the words used to indicate skin diseases take wellknown terms from botany, agriculture or zoology and transform them through a process of metaphorization based on the similarity of the affected skin with objects from everyday life - the term chilblains chosen by Celsus, for example, links back to Cassius Felix’s perniones, which refers to “dried salt pork thigh.”

The cross-pollenization of Roman medicine and Greek influences during the second century BC amounted to an epistemological revolution, Santoro wrote. “In Celsus’ De medicina, the treatment of skin lesions of internal origin betrays the educational intention to transpose Greek knowledge rigorously and systematically, without however stifling the contribution of Latin lexical creativity.”

Much of modern medical terminology, then, marries Latin inventory and classification schemes based on empirical qualities (genre, form, color and seriousness) with authoritative Greek terms to indicate a condition’s degree of aggressiveness (e.g., agria/savage) or responsivity to treatment.

The modern emphasis on beauty and cosmetic skin improvement represents no less transformative a revolution. Ancient physicians were constantly concerned with restoring the body to its natural beauty. But in moralistic cultures that equated heavy makeup with lust and prostitution, early dermatological scholars focused largely on natural cures for specific conditions. Not until a growing chorus of female authors such as Trota of Salerno, who unapologetically offered Saracen beauty secrets to women of the Middle Ages, did aesthetic medicine begin to become a noble endeavor.

On the threshold of the 17th century, Gaspare Tagliacozzi in his 1597 De curtorum chirurgia resurrected Galen’s concept of beauty as a reflection of bodily health that should be pursued and restored by every means available. “Although from the Renaissance onwards scientific discoveries progressively saw a rise in specialist medical interest in dermatology,” Santoro wrote, “the greatest acknowledgment to the learning of the Ancients is the fact that the terminology for the classification of diseases remained almost intact.”

THE LANGUAGE OF THE SKIN

In Greek and Latin, the skin was thought of as “a surface casing that comes off easily,” a “surface envelope,” with “purely instrumental function” compared to other organs, reports Santoro. In fact, skin abnormalities were attributed to “an internal imbalance of the humours.”

Galen did identify skin as the organ of touch-especially skin of the hand. Santoro notes that in the early 1300s, physicians cut through skin during autopsy, raised it and moved it aside to access internal organs. In the 1500s, the Flemish doctor, Andreas van Wesel, concentrated on analyzing skin’s substance and layers, and hailed it as the “first barrier” to be incised during dissection. This seemed to confirm that skin had been recognized on its own merit and laid the foundation for future scientific research.

PATHOLOGY

Pliny the Elder (23 A.D. – 79 A.D.) noted that facial diseases, while not painful or fatal, were horribly disfiguring, with those suffering being shunned. The artist and scientific communities were, however, intrigued by them.

Galen is credited with developing “the language of dermatology” as well as of technical medicine in general, which was then annotated and extended by Latin authors. Santoro writes that the Greeks and Romans did try “to develop and differentiate the dictionary of skin diseases.” Alas, they didn’t achieve their goals, instead coming up with “generic and vague” terms for conditions including leprosy, scabies and herpes.

a) Leprosy as we know it today was actually called elephantiasis in the ancient world, which was both serious and fatal. Modern medicine defines the latter condition as a lympathic condition causing roughness of the tegument caused by infestation of nematode worms from warm regions.

b) Scabies in current terms is contagious, infectious, and caused by the itch-mite Sarcoptes scabiei, replete with itching and skin tunnels. The Latin refers to a “disease that makes you scratch.” Due to a lack of what Santoro calls “distinctive peculiarities,” she notes that recent studies have indicated that “precisely identifying” the scabies of antiquity with modern scabies is basically impossible.

c) Herpes had multiple meanings in ancient medicine. Santoro reports that today, herpes generally indicates “widespread and ulcerative skin lesions rather than a single, specific condition.” A review of documents of the ancients, and of medieval times finds, “a single denomination” for various unrelated diseases.

d) Syphilis was identified in the early 20th century, named for a young shepherd in a Latin poem. In fact, when it comes to the names of skin diseases, “the influence of classical authors has been constant.” From the late 15th century, syphilis spread “like wildfire all over Europe,” (replete with sores, abscesses and ulcers).

COSMETICS

“In the cultural imaginary of every period, attention to skin care and the beauty of the body has represented a form of externalization of the self, through the construction of a bodily image in line with the dominant aesthetic and health parameters,” Santoro says. “Medicine’s interest in beauty finds in cosmetics a legitimate epistemological justification.”

Byzantine (330 A.D – 1453 A.D.) medicine was aware of society’s penchant for “physical appearance and aesthetic values.” Santoro cites cosmetics applications for wrinkle, stain and hair elimination, along with hair and eyebrow thickening and dying.

Greek female physician Metrodora (200 A.D. – 400 A.D.) wrote about hair removal, facial toning lotions and perfume recipes. Santoro confirms the existence, from the Middle Ages to the Renaissance, of “beauty recipes, essential remedies for blemishes caused by skin diseases.”

In the 16th century, medical cosmetics “passed new milestones.”

In fact, “from the Renaissance onwards, scientific discoveries progressively saw a rise in specialist medical interest in dermatology.” Kudos to the ancients, she says, as “terminology for the classification of diseases remained almost intact. Still today we preserve the same lexical variety that Greek-Roman medicine had adopted and divulged.”

In conclusion, her study “reveals interesting social implications,” she says. Remember the repulsion of ancient dermatological diseases that “heightened the sensitivity of physicians” to cosmetics and aesthetic medicine. Now we achieve results that ancient civilizations could never imagine. And don’t forget the evolution of “the emancipation of women” that care for and respect their bodies.

A final thought: If the study of skin was tardy in achieving specialization, albeit not until the 18th and 19th centuries, the dizzying rate of scientific advances, combined with the extraordinary popularity of elective aesthetic skin procedures, has undeniably picked up the slack for dermatology in 2019. ƒ
 

References:

Rosa Santoro PhD. Skin over the Centuries: a Short History of Dermatology: Physiology, Pathology and Cosmetics,” Medicina Historica. August 2017.