Britishjournal of Dermatology (1979) 100, 459.
History of Dermatology
The history of dermatology in Belgium JEAN PI^RARD Avenue de Broqueville 127, 1200 Bruxelles, Belgium
MEDICAL EDUCATION IN BELGIUM
The problem of university teaching in Belgium, and the teaching of medicine in particular, has become singularly complicated since the last world war. Until almost twenty years ago there were four universities in the country: two state universities, Ghent and Liege, and two independent universities, Brussels and Louvain. When, after the last war, the linguistic problem became acute—the north of the country being Flemish-speaking and the south French-speaking—the two independent universities were each obliged to divide into two which resulted in the creation of two new essentially Flemish-speaking universities, the Catholic University of Louvain (KUL) and the Flemish University of Brussels (VUB). The latter coexists in that city with the ancient French-speaking Universite Libre of Brussels (ULB). But the situation at Louvain is different. There only the KUL remains whilst the secular French-speaking Catholic University (UCL) has found it expedient to emigrate to a French-speaking region and there establish a new town, Louvain-la-Neuve, some thirty kilometres from the capital. To ensure adequate working conditions for the faculty of medicine of the UCL, it was decided to locate it at Woluwe-St-Lambert, at the periphery of the Brussels conurbation. These divisions led to the establishment between i960 and 1970 of six tiniversities: three Frenchspeaking at Liege, Brussels (ULB) and Louvain (UCL), and three Flemish-speaking at Ghent, Brussels (VUB) and Louvain (KUL). But since then a new Flemish-speaking university centre has been formed at Antwerp (UIA) and a new French-speaking university is developing at Mons in Wallonia. Each of these universities has a medical faculty, with a seven year teaching programme. The first three years—the 'candidature'—are devoted to the basic sciences. In the next four years—the 'doctorat'—the student is introduced to pathology. In the last two of these years he is obliged to undertake practical work in the various clinical departments. Each year's work is consolidated and approved by an examination. After the seven years the student receives the title of'Doctor of medicine, surgery and obstetrics', and, after complying with certain administrative formalities, is authorized to practise. If the doctor then wishes to specialize he apphes once more to the utiiversity. According to the speciality he chooses he will be obliged to follow a theoretical and practical course lasting from three to six years, during which he will receive training in the clinical, therapeutic, surgical and laboratory aspects of his speciality. There are usually no annual examinations during this period of training but 0007-0963/79/0400-0459 S02.00
(• 1979 British Association of Dermatologists
459
460
J.Pierard
Professor Adrien Bayet, Brussels (1863-1935)
there may be one at its conclusion. On completing his prescribed training the candidate receives only a certificate recording his capabilities and the training he has received. He will then be in a position to practise his speciality, once he has secured the approval of a commission set up by the Ministry of Public Health. The training period in dermatology lasts four years. There are at present 324 dermatologists in Belgium for a population of nearly ten million inhabitants. DERMATOLOGY IN BELGIUM
Belgian dermatology, properly speaking, was born at the turn of the century, with the foundation of the Belgian Society of Dermatology and Syphiligraphy. This was created on 10 March 1901 on the initiative of Dr Emile Dubois-Havenith (1856-1918), who served as secretary until the First World War. From its foundation to the present day the Society has refiected dermatological activity in the country, gaining in importance both in the number of its members and in the quality of the work presented from its rostrum. This development was linked to that of the university departments. Until 1914 dermatology was not recognized as an autonomous speciality. This in no way implies any lack of interest in this branch of medicine but, in accordance with contemporary notions, it was most frequently associated with
Dermatology in Belgium
461
Professor Benoit Dujardin, Brussels (1884-1953)
external pathology, venereology or urology. Thus, at Liege, Professor Troisfontaines (1852-1925) was director of the section of uro-dermatology at the Hopital de Baviere. In Brussels, Dr Jean Thiry (1817-1896), surgeon to the Hopital St-Picrrc, was also head of a department of dermatovencorology and from 1850 onwards held open clinics in dermatology and venereology. His successor, Professor Edouard de Smet (1842-1925), taught hygiene and bacteriology, but his open clinics in dermatovenereology were well attended. At Ghent, at the civil hospital, Dr Leopold Cruyl (1957-1917) was responsible for the treatment of general medical cases, infectious diseases, skin diseases and syphilis. He established at Ghent a school for children with ringworm. At that period the interests of the heads of departments were directed mainly towards the study of venereal diseases. However, powerful personalities in other countries (such as Unna in Hamburg; Jadassohn in Breslau; Besnier, Vidal, Brocq and Darier in Paris; as well as the Vienna school) attracted Belgians wishing to specialize. Victor Lespinnc (1856-1937) had followed the teaching of Leloir at Lille. Cruyl had been to Paris to hear the masters of the day. Dubois-Havenith had attended the clinics of Paris, London, Vienna and Berlin; 'agrege' of the independent University of Brussels, after defending a thesis on lupus vulgaris, he became in 1899 the Secretary-General of the first international conference on the prophylaxis of syphilis and other venereal diseases, before devoting himself to the creation of the Belgian Society of Dermatology and Syphiligraphy. At this time new personalities made their appearance on the Belgian dermatological scene. In 1901 Adrien Bayet (1863-1935) succeeded De Smet in Brussels. It was the era of great discoveries in syphilis; in 1905 the demonstration of the Treponema by Schaudinn and Hoffmann, in 1906 the serological diagnosis of syphilis by the application of the complement fixation principle that Bordet
462
J.Pierard
Professor Achille Mirme, Ghent (1874-1960
had elucidated in 1900. With his pupils Jacque (1875-1961), Sluys (b. 1885), Dujardin (18841953) and Dcsneux (1885-1962), Professor Bayet played an active part in the developments in the medical world to which these discoveries gave rise. His efforts led to the foundation in 1922 of the 'Belgian National League against the Venereal Peril', followed by that of the 'International League against the Venereal Peril', of which he was the promoter. Having a sparkling intellect, lucid and elegant in his speech, he secured the acceptance of dermatosyphilology as a compulsory subject for students at Brussels from 1910. During the early years of the Society of Dermatology, the sessions were devoted to the presentation of clinical cases, and to discussion, principally concerned with syphilis. The members were few and the speakers almost always the same: Bayet, Cruyl, Dekeyser (1873-1956), Dubois-Havenith, Lespinne and Etienne Poirier (1869-1934). A little later other names appeared: Francois (18691936), Minne (1874-1960) and Halkin (1876-1945). Let us note in passing a few more important contributions: a paper by Poirier on the radiotherapy of cancer of the skin and of lupus vulgaris.
Dermatology in Belgium
463
Professor Henri Halkin Liege (1876-1945)
and one by Bayet and Jacque on Schaudinn's spirochaete (1905). Bayer later reported his 'Observations on 2,250 cases of syphilis seen at Brussels' and in 1909 was studying 'The practical value of serodiagnosis in syphilis'. Meanwhile Minne had published a paper on 'Telangiectatic naevi of the face, incorrectly called sebaceous adenomata', as well as studies of Microsporon audouini, and studies on 'Primary and secondary endolymphatic plexiform endotheliomas of the skin'. In 1909 Halkin returned to the subject of cutaneous endotheliomas, opposing Minne's concept. Finally Dujardin investigated the Wassermann reaction in the different stages of syphilis. After the 1914-18 war, dermatology received full recognition in our universities and professors with special responsibility for teaching it were appointed. From then on the Faculties became the main source of developments in dermatology, since the working conditions of the isolated practitioners were not conducive to scientific research. THE 'UNIVERSIT^S LIBRES'
The Catholic University of Louvain—French-speaking (UCL) Let us give honour to whom honour is due. If we begin this historical review with the University of Louvain, it is because it is the most ancient and the most celebrated in Belgium, having been founded four centuries before the other three. The charter of foundation is indeed dated 9 December 1425. The 'Studium Generale' was created by pope Martin V at the instigation of the Duke of Brabant, John IV. The university then consisted of four faculties: Theology, Law, Arts and Medicine. Associated with the university were such
464
J. Pierard
prestigious Renaissance names as Erasmus, Vesalius and Bushleyden, the founder of the College of the Three Languages (Latin, Greek, Hebrew). But at the end of the War of the Spanish Succession the university showed signs of decadence. Under the Directory it was closed and it remained closed during the Consulate and the Empire. An attempt to re-establish the university in 1814 failed, but in September 1816, William I, King of the Netherlands, created three universities in the Southern Provinces, at Ghent, Louvain and Liege. However, soon after 1830, Belgium having become independent, the University of Louvain was taken over once more by the religious authorities. Schwann held the chair of anatomy. Until the war of 1914-18, dermatology was taught by the professor of external pathology. At the beginning of the present century this ofhcc was held by L.Dandois (1853-1920). It was AimeMorelle (1869-1926) who in 1920 first occupied the chair of dermatology. He had received his training in dermatology at the Hopital Saint-Louis, but he also practised urology and radiotherapy. He founded a museum of moulages. His university career was brief, for he died prematurely in 1926. He was succeeded in the same year by Professor Nestor Yernaux (1883-1958) who had trained in Berlin, Paris and Vienna. Well informed in pharmacodynamics, and a good clinician, he was greatly interested in the treatment of syphilis, expressing a preference for his technique of 'Continuous Bismuth Therapy'. He also published articles on hypertrichosis and on urological subjects. He remained in office until 1955. The chair then passed to Adolphe Dupont (b. 1898) and immediately acquired a brilliant reputation. Dupont had been the pupil of Pautricr in Strasbourg and of A.Civatte in Paris. An excellent histopathoiogist, he has published studies on tumours of sweat glands, the bullous dermatoses, squamous cell epithelioma and keratoacanthoma, as well as the first account of what is now known as lymphomatoid papulosis. His aggregation thesis on 'Cutaneous angioreticulomatosis (multiple pigmented angiopathic sarcoma of Kaposi)' was the culmination of a series of works already devoted to this lesion. His studies on the histology and the histopathology of the cutaneous nervous system enabled him to bring together, at a special meeting in Louvain, the leading European authorities in this field. Dupont trained several pupils who have made a name for themselves. We may mention, among others, Michel Aupaix (b. 1931) and Pierre Van Caneghem (b. 1923), formerly assistant to Professor Yernaux, as well as A.Bourlond and J.-M.Lachapelle, who have achieved professorial status. Dupont retired in 1968 and was succeeded by Andre Bourlond (b. 1933). Trained at Louvain and then in the United States, where he was the pupil of Winkelmann, he is the author of a very interesting thesis on 'Cutaneous Innervation'. A good clinician and a competent light and electron microscopist, he now teaches in the Brussels conurbation (see above). Jean-Marie Lachapelle (b. 1937) is the author of a thesis on 'The radio-autographic study of the in vitro incorporation of tritiated thymidine in normal human skin and in certain proliferative conditions of the epidermis' (1970). He began his specialist training with A.Dupont and continued it at Cambridge, in Arthur Rook's department. A lively intellect, with a capacity for expounding complicated concepts clearly, J.-M.Lachapelle is at present in charge of the Department of Occupational Dermatology at the UCL. The Catholic University of Louvain—Flemish-speaking (KUL) We have already seen how Belgium's most ancient university was affected by the linguistic conflict which shook the country. About forty years ago, teaching at Louvain was duplicated by the formation of French and Flemish-speaking sections; and Eugene Haven (1901-1973) was made responsible for giving in Flemish the course given in French by Yernaux, who remained titular professor. However, after the war, Dr Haven was put in charge of the course and then appointed professor, with an autono-
Dermatology in Belgium
AC
History of Dermatology
The history of dermatology in Belgium JEAN PI^RARD Avenue de Broqueville 127, 1200 Bruxelles, Belgium
MEDICAL EDUCATION IN BELGIUM
The problem of university teaching in Belgium, and the teaching of medicine in particular, has become singularly complicated since the last world war. Until almost twenty years ago there were four universities in the country: two state universities, Ghent and Liege, and two independent universities, Brussels and Louvain. When, after the last war, the linguistic problem became acute—the north of the country being Flemish-speaking and the south French-speaking—the two independent universities were each obliged to divide into two which resulted in the creation of two new essentially Flemish-speaking universities, the Catholic University of Louvain (KUL) and the Flemish University of Brussels (VUB). The latter coexists in that city with the ancient French-speaking Universite Libre of Brussels (ULB). But the situation at Louvain is different. There only the KUL remains whilst the secular French-speaking Catholic University (UCL) has found it expedient to emigrate to a French-speaking region and there establish a new town, Louvain-la-Neuve, some thirty kilometres from the capital. To ensure adequate working conditions for the faculty of medicine of the UCL, it was decided to locate it at Woluwe-St-Lambert, at the periphery of the Brussels conurbation. These divisions led to the establishment between i960 and 1970 of six tiniversities: three Frenchspeaking at Liege, Brussels (ULB) and Louvain (UCL), and three Flemish-speaking at Ghent, Brussels (VUB) and Louvain (KUL). But since then a new Flemish-speaking university centre has been formed at Antwerp (UIA) and a new French-speaking university is developing at Mons in Wallonia. Each of these universities has a medical faculty, with a seven year teaching programme. The first three years—the 'candidature'—are devoted to the basic sciences. In the next four years—the 'doctorat'—the student is introduced to pathology. In the last two of these years he is obliged to undertake practical work in the various clinical departments. Each year's work is consolidated and approved by an examination. After the seven years the student receives the title of'Doctor of medicine, surgery and obstetrics', and, after complying with certain administrative formalities, is authorized to practise. If the doctor then wishes to specialize he apphes once more to the utiiversity. According to the speciality he chooses he will be obliged to follow a theoretical and practical course lasting from three to six years, during which he will receive training in the clinical, therapeutic, surgical and laboratory aspects of his speciality. There are usually no annual examinations during this period of training but 0007-0963/79/0400-0459 S02.00
(• 1979 British Association of Dermatologists
459
460
J.Pierard
Professor Adrien Bayet, Brussels (1863-1935)
there may be one at its conclusion. On completing his prescribed training the candidate receives only a certificate recording his capabilities and the training he has received. He will then be in a position to practise his speciality, once he has secured the approval of a commission set up by the Ministry of Public Health. The training period in dermatology lasts four years. There are at present 324 dermatologists in Belgium for a population of nearly ten million inhabitants. DERMATOLOGY IN BELGIUM
Belgian dermatology, properly speaking, was born at the turn of the century, with the foundation of the Belgian Society of Dermatology and Syphiligraphy. This was created on 10 March 1901 on the initiative of Dr Emile Dubois-Havenith (1856-1918), who served as secretary until the First World War. From its foundation to the present day the Society has refiected dermatological activity in the country, gaining in importance both in the number of its members and in the quality of the work presented from its rostrum. This development was linked to that of the university departments. Until 1914 dermatology was not recognized as an autonomous speciality. This in no way implies any lack of interest in this branch of medicine but, in accordance with contemporary notions, it was most frequently associated with
Dermatology in Belgium
461
Professor Benoit Dujardin, Brussels (1884-1953)
external pathology, venereology or urology. Thus, at Liege, Professor Troisfontaines (1852-1925) was director of the section of uro-dermatology at the Hopital de Baviere. In Brussels, Dr Jean Thiry (1817-1896), surgeon to the Hopital St-Picrrc, was also head of a department of dermatovencorology and from 1850 onwards held open clinics in dermatology and venereology. His successor, Professor Edouard de Smet (1842-1925), taught hygiene and bacteriology, but his open clinics in dermatovenereology were well attended. At Ghent, at the civil hospital, Dr Leopold Cruyl (1957-1917) was responsible for the treatment of general medical cases, infectious diseases, skin diseases and syphilis. He established at Ghent a school for children with ringworm. At that period the interests of the heads of departments were directed mainly towards the study of venereal diseases. However, powerful personalities in other countries (such as Unna in Hamburg; Jadassohn in Breslau; Besnier, Vidal, Brocq and Darier in Paris; as well as the Vienna school) attracted Belgians wishing to specialize. Victor Lespinnc (1856-1937) had followed the teaching of Leloir at Lille. Cruyl had been to Paris to hear the masters of the day. Dubois-Havenith had attended the clinics of Paris, London, Vienna and Berlin; 'agrege' of the independent University of Brussels, after defending a thesis on lupus vulgaris, he became in 1899 the Secretary-General of the first international conference on the prophylaxis of syphilis and other venereal diseases, before devoting himself to the creation of the Belgian Society of Dermatology and Syphiligraphy. At this time new personalities made their appearance on the Belgian dermatological scene. In 1901 Adrien Bayet (1863-1935) succeeded De Smet in Brussels. It was the era of great discoveries in syphilis; in 1905 the demonstration of the Treponema by Schaudinn and Hoffmann, in 1906 the serological diagnosis of syphilis by the application of the complement fixation principle that Bordet
462
J.Pierard
Professor Achille Mirme, Ghent (1874-1960
had elucidated in 1900. With his pupils Jacque (1875-1961), Sluys (b. 1885), Dujardin (18841953) and Dcsneux (1885-1962), Professor Bayet played an active part in the developments in the medical world to which these discoveries gave rise. His efforts led to the foundation in 1922 of the 'Belgian National League against the Venereal Peril', followed by that of the 'International League against the Venereal Peril', of which he was the promoter. Having a sparkling intellect, lucid and elegant in his speech, he secured the acceptance of dermatosyphilology as a compulsory subject for students at Brussels from 1910. During the early years of the Society of Dermatology, the sessions were devoted to the presentation of clinical cases, and to discussion, principally concerned with syphilis. The members were few and the speakers almost always the same: Bayet, Cruyl, Dekeyser (1873-1956), Dubois-Havenith, Lespinne and Etienne Poirier (1869-1934). A little later other names appeared: Francois (18691936), Minne (1874-1960) and Halkin (1876-1945). Let us note in passing a few more important contributions: a paper by Poirier on the radiotherapy of cancer of the skin and of lupus vulgaris.
Dermatology in Belgium
463
Professor Henri Halkin Liege (1876-1945)
and one by Bayet and Jacque on Schaudinn's spirochaete (1905). Bayer later reported his 'Observations on 2,250 cases of syphilis seen at Brussels' and in 1909 was studying 'The practical value of serodiagnosis in syphilis'. Meanwhile Minne had published a paper on 'Telangiectatic naevi of the face, incorrectly called sebaceous adenomata', as well as studies of Microsporon audouini, and studies on 'Primary and secondary endolymphatic plexiform endotheliomas of the skin'. In 1909 Halkin returned to the subject of cutaneous endotheliomas, opposing Minne's concept. Finally Dujardin investigated the Wassermann reaction in the different stages of syphilis. After the 1914-18 war, dermatology received full recognition in our universities and professors with special responsibility for teaching it were appointed. From then on the Faculties became the main source of developments in dermatology, since the working conditions of the isolated practitioners were not conducive to scientific research. THE 'UNIVERSIT^S LIBRES'
The Catholic University of Louvain—French-speaking (UCL) Let us give honour to whom honour is due. If we begin this historical review with the University of Louvain, it is because it is the most ancient and the most celebrated in Belgium, having been founded four centuries before the other three. The charter of foundation is indeed dated 9 December 1425. The 'Studium Generale' was created by pope Martin V at the instigation of the Duke of Brabant, John IV. The university then consisted of four faculties: Theology, Law, Arts and Medicine. Associated with the university were such
464
J. Pierard
prestigious Renaissance names as Erasmus, Vesalius and Bushleyden, the founder of the College of the Three Languages (Latin, Greek, Hebrew). But at the end of the War of the Spanish Succession the university showed signs of decadence. Under the Directory it was closed and it remained closed during the Consulate and the Empire. An attempt to re-establish the university in 1814 failed, but in September 1816, William I, King of the Netherlands, created three universities in the Southern Provinces, at Ghent, Louvain and Liege. However, soon after 1830, Belgium having become independent, the University of Louvain was taken over once more by the religious authorities. Schwann held the chair of anatomy. Until the war of 1914-18, dermatology was taught by the professor of external pathology. At the beginning of the present century this ofhcc was held by L.Dandois (1853-1920). It was AimeMorelle (1869-1926) who in 1920 first occupied the chair of dermatology. He had received his training in dermatology at the Hopital Saint-Louis, but he also practised urology and radiotherapy. He founded a museum of moulages. His university career was brief, for he died prematurely in 1926. He was succeeded in the same year by Professor Nestor Yernaux (1883-1958) who had trained in Berlin, Paris and Vienna. Well informed in pharmacodynamics, and a good clinician, he was greatly interested in the treatment of syphilis, expressing a preference for his technique of 'Continuous Bismuth Therapy'. He also published articles on hypertrichosis and on urological subjects. He remained in office until 1955. The chair then passed to Adolphe Dupont (b. 1898) and immediately acquired a brilliant reputation. Dupont had been the pupil of Pautricr in Strasbourg and of A.Civatte in Paris. An excellent histopathoiogist, he has published studies on tumours of sweat glands, the bullous dermatoses, squamous cell epithelioma and keratoacanthoma, as well as the first account of what is now known as lymphomatoid papulosis. His aggregation thesis on 'Cutaneous angioreticulomatosis (multiple pigmented angiopathic sarcoma of Kaposi)' was the culmination of a series of works already devoted to this lesion. His studies on the histology and the histopathology of the cutaneous nervous system enabled him to bring together, at a special meeting in Louvain, the leading European authorities in this field. Dupont trained several pupils who have made a name for themselves. We may mention, among others, Michel Aupaix (b. 1931) and Pierre Van Caneghem (b. 1923), formerly assistant to Professor Yernaux, as well as A.Bourlond and J.-M.Lachapelle, who have achieved professorial status. Dupont retired in 1968 and was succeeded by Andre Bourlond (b. 1933). Trained at Louvain and then in the United States, where he was the pupil of Winkelmann, he is the author of a very interesting thesis on 'Cutaneous Innervation'. A good clinician and a competent light and electron microscopist, he now teaches in the Brussels conurbation (see above). Jean-Marie Lachapelle (b. 1937) is the author of a thesis on 'The radio-autographic study of the in vitro incorporation of tritiated thymidine in normal human skin and in certain proliferative conditions of the epidermis' (1970). He began his specialist training with A.Dupont and continued it at Cambridge, in Arthur Rook's department. A lively intellect, with a capacity for expounding complicated concepts clearly, J.-M.Lachapelle is at present in charge of the Department of Occupational Dermatology at the UCL. The Catholic University of Louvain—Flemish-speaking (KUL) We have already seen how Belgium's most ancient university was affected by the linguistic conflict which shook the country. About forty years ago, teaching at Louvain was duplicated by the formation of French and Flemish-speaking sections; and Eugene Haven (1901-1973) was made responsible for giving in Flemish the course given in French by Yernaux, who remained titular professor. However, after the war, Dr Haven was put in charge of the course and then appointed professor, with an autono-
Dermatology in Belgium
AC
