Dreidimensionale Dokumente p.16
In the 20th century, dermatology changed from being a descriptive field to being one of the leading medical research fields. The skin is the human’s largest organ and protects us from environmental influences and pathogens. In this capacity, it influences the metabolism and plays an important role in communication. Diseases, test reactions and therapeutical effects are visible as well as palpable. Furthermore, skin samples are easy to obtain and evaluate under the microscope.
Bruno Bloch was the first professor for dermatology at the Clinic for Dermatology of the Kantonsspital Zürich (Hospital of the Canton of Zurich), which was founded 1916. He was one of the leading scientists who started to investigate the immunological reactions of the skin with functional experiments.
One of the published trial protocols was Bruno Bloch’s self-experiment which was also documented with the help of wax moulages.
These experiments were an important basis for further research. To continue research, it was important to find comparable results in animal experiments. In 1930, it was demonstrated that guinea pigs react the same way to primrose extract as humans. These experiments were also documented with moulages and some of them were used for illustrations in publications.
Experiment with primrose extract to trigger a contact-allergic eczema on a patient who made herself available as a proband.
Eczema experiment on the belly of a guinea pig.
Dreidimensionale Dokumente p.19
Aggressive substances will provoke toxic eczema on human skin. When somebody reacts with an eczema to an actually inoffensive substance, this is called an allergy (in the past this was called idiosyncrasy).
Bruno Bloch and his team tried to interpret this phenomenon from an immunobiological perspective. The appropriate experiments were patch tests, which Bruno Bloch took over from his teacher Josef Jadassohn in Bern.
Underneath fabric patches, various substances were tested on animals as well as on affected human probands. This way, allergic reactions were identified. Furthermore, it was possible to differentiate between toxic reactions and allergic eczemas by way of their appearance and the course of the skin’s changes.
Nowadays, the Patch Test is a modified version of the “Patch Test by Jadassohn”.
If a clinical picture indicates contact allergic eczema, the suspected allergens (allergens from professional activity and environment) are tested in a standardised procedure by taping them on the patient’s back. The small aluminium pads correlate with the 2-3 cm large linen rags.
The allergens are removed after 24 hours and the skin is observed three to four days.
A positive reaction, proofing an allergy, typically shows an increasing inflammation which spreads even beyond the testing area.
If the eczema gets better after two days and is limited to the testing area of the substance, a toxic reaction has to be assumed.
In case of a negative result, there is no skin reaction. With high probability, the patient is not allergic to the tested substance.
The most common contact allergies of our time are nickel (belt-buckle, piercings), scent mixtures and balsam of Peru (cosmetics). In professional life, contact eczemas by chromate (cement, but also leather) in construction workers are particularly problematic.
On the bottom of this showcase, you find the materials used in dermatological routine checkups today.
Bruno Bloch presented a few cases on allergy problematics at the fourth ordinary winter conference of Zurich physicians on December 1st 1927. Some of them have been documented with moulages.
Hatband eczema. Health record.
Toxic (not allergic) eczema reaction in answer to band-aid. patchesband-aid.
Allergic reaction in answer to cement (chromate is suspected).
Toxic (not allergic) reaction in answer to cement.
Feet Foot eczema, due in answer to upper leather of sandals. Health record.
Patch test on house dust (e.g.f.ex.respectively sick room dust) on patients with hand eczema (of the year 1922). This examination correlates with the rediscovered atopy -patch -test which tests patients with neurodermatitis patients wforon late-type-allergydelayed hypersensitivity reactions to acarodermatitishouse dust mites.
Patch T-test for the diagnosis of drug intolerance.
Further moulages onfor eczema research found on display on the left side of showcase 49.
Dreidimensionale Dokumente p. 23
Although fungal infections of the skin were held to be researched completely, Bruno Bloch wrote his postdoctoral qualification about mycosis. He tried a new approach and conducted functional experiments to examine the manner in which the body reacts to fungi.
Bruno Bloch and his assistants established the definition of Mycid as an allergic reaction of the body to mycosis of the skin. An analogous response was already known in tuberculous infections with tuberculides of the skin.
Consequently, it was supposed that an athlete’s foot might trigger an allergic hand eczema. Animal experiments succeeded in sensitising guinea pigs to fungi extracts (the guinea pigs developed an allergy). The next step was finding patients affected by athlete’s foot and at the same time by hand eczema. Testings with fungi extracts on these patients provided evidence of an allergy.
Finally, to verify experiments, healthy probands were intentionally infected with fungi in order to trigger an allergy.
Animal experiments on guinea pigs for testing allergic reactions to yeasts.
In 1929, patient Marta H., primarily hospitalised due to a sexually transmitted disease, participated in experiments by which allergic reactions to athlete’s foot were triggered.
Skin reactions as a result of experiments on probands to provide evidence for allergies to yeasts and athlete’s foot.
Allergic reaction of a female patient caused by yeast (candida albicans) and corresponding allergy testing.
Allergic test reaction on fungi extract. The moulage was used to illustrate the chapter on the biology of fungal infections in the “Dermatology Handbook” of 1928 by Josef Jadassohn.
Dreidimensionale Dokumente p. 34
Electromagnetic radiation of various wavelength is commonly used for therapy in dermatology. The improvement of the selection of desired UV-wavelengths and the development of laser in the range of visual light initiated the revival of the current dermatological radiation therapy. X-ray therapy still represents an excellent possibility for skin cancer treatment. Nowadays, inflammatory changes are not treated with X-rays anymore.
During the first half of the 20th century, the department for radiation therapy consisted of the X-ray department, a department for radium therapy and a department for light therapy. The following photos were taken in 1926.
The X-ray department consisted of a spacious “Schaltzimmer”, two therapy rooms and a machinery room.
The clinic was in possession of a radium element which had to be bought by Bruno Bloch personally. The radioactive elements were stored in a specially constructed leaden safe.
The light department included various UV-lamps (Finsen-Reyn, Kromayer, Bach, Jesionek) and other physical machines, e.g. for diathermy and high frequency treatment. Additionally, the light department contained an air- and sunbath on top of the clinic’s roof.
X-ray biology and X-ray therapy were the main research fields of Guido Miescher, senior physician under Bruno Bloch’s lead and his successor as director of Zurich’s Dermatology Clinic.
On the occasion of the 33rd annual convention of Swiss Dermatologists in Bern 1951, Guido Miescher presented the late outcome of the X-ray treatment via moulages.
The moulage shows the tumor before X-ray therapy.
19 years later, the patient was still without complaints and fully cured.
Black skin cancer (melanoma) was rarely found in earlier times and was known to be incurable. Over a timeline of 13 years, Zurich dermatologists and surgeons reached a cure percentage of 30 percent in 35 patients treated with X-rays and surgery. Several cases were documented with moulages.
X-ray therapy of a basal cell carcinoma. The moulage of the treatment result shows the impressive success in comparison to the primary diagnostic findings on the photo.
Extensive white skin cancer of the face, before and after X-ray therapy.
Moulages 524, 524a, c, d
A documentation of the success of X-ray therapy of white skin cancer (spinocellular carcinoma), spanning more than 13 years.
Dreidimensionale Dokumente p.23
Guido Miescher was senior physician under Bruno Bloch’s lead and his successor as director of Zurich’s Clinic for Dermatology in 1933. He was especially interested in the biological impact of X-rays on the skin.
With radiation experiments he proved the wave-shaped development of redness and the different responses of the skin caused by X-rays. This way he disproved any assumption of hypersensitivity reactions to X-rays.
This experiment required a long observation period. The probands were “female residents of our venereal ward” between 18 and 30 years old. Nowadays, based on ethical and judicial criteria, such experiments on women who were often hospitalised against their will would of course no longer be allowed.
Determination of the therapeutic X-ray dosing with the aid of X-ray erythema.
Initially, it was unclear which would be preferable: a single radiant exposure with a highly dosed rate or a fractioned, low dose radiant exposure over several days.
The moulage shows a comparative experiment on a patient with facial dermal cylindromas with Spiegler-Brook-Syndrome.
Since the 18th century, animal testing preceded experiments on human beings. The experiments with primrose extract in the Clinic for Dermatology Zurich are a peculiarity. Suitable testing animals were looked for only after the importance of the findings of the self-experiments and experiments on voluntary probands became apparent. (cf. Showcase 1)
In order to compare the effects on humans and animals, the animal has to react in exactly the same way as the human. Therefore, the choice of a suitable testing animal is essential. X-ray induced cancer could be triggered on rabbits, but not on mice. Guinea pigs were found to be ideal for eczema research. On the other hand, guinea pigs were resistant to triggering cancer by coal tar.
Dreidimensionale Dokumente p. 10
By experimenting on white mice, the cancer triggering components of coal tar could be determined. The skin of the mice was brushed regularly with the substances. After one week, the mice showed loss of hair, and after an average of five months, various skin cancers developed on the the animals’ backs.
Dreidimensionale Dokumente p. 9
Before penicillin became available in 1946, the arsenic derivative Salvarsan was the best available remedy for the therapy of syphilis.
Some patients responded to Salvarsan with an intolerance. This allergic reaction could progress rapidly and severely and was dreaded accordingly.
The American guest physician Marion Sulzberger examined immunobiological reactions to different forms of Salvarsan in animal testing.
The X-Ray Carcinoma
Not until 25 years after the discovery of X-rays in 1895, their carcinogenic properties were determined as a long-term consequence for radiographers, physicians and irradiated patients. In animal testing on rabbits, Bruno Bloch was first to prove the triggering of carcinoma by X-rays.
X-ray carcinoma on rabbit ears.
Chronic inflammation with a non-healing wound: typical occupational disease of a radiographer as a long-term consequence of massive radiation exposure.
This patient was treated regularly with X-rays for Psoriasis. In 1921, due to X-ray burning, slow-healing wounds developed (Moulage 187). A few years later, skin cancer evolved on this spot (Moulage 551).
Research on the skin is especially suitable for the study of intolerance reactions, as skin is often affected, easy to evaluate, and accessible. The scientific findings of Bruno Bloch and his team on eczema and the immunological reactions to fungi were transferable to drug intolerance. With the growing amount of effective pharmacological therapies, intolerance reactions became more and more frequent, sometimes even life-threatening.
During a trip to the USA in 1928, Bruno Bloch gave various guest lectures. In front of the American Dermatological Association in Washington, he presented a few cases of intolerance reactions, among them a massive quinine-triggered eczema, documented with moulage 342. Moulage 343 shows a reaction to a quinine injection on the upper arm and moulage 344 shows a typical eczema response after conducting the patch test.
In another patient, an allergic reaction to quinine in hair tonic, resulting in chronical eczema of the scalp, was found with the aid of skin testing.
Independent of the location of the infection, the intolerance reactions to fungi showed specific distribution patterns on the skin. Scientists expected a distribution of fungi particles throughout the body by way of the bloodstream. This assumption was reproduced in animal experiments with intracardial injections (shots into the heart) of fungi substrates. The reactions were only visible on the skin (dermatotrophy) and not in other organs.
The questions around the cause of eczematous reactions remained one of the main research topics for Guido Miescher and his successor Hans Storck in Zurich.
Pus bacteria, especially staphylococcus, appeared to change an already existing eczema for the worse. As seen on this moulage, this was shown by patch testing with bacterial components directly on the eczema. Especially patients with “nummulary” and “seborrheic” eczema reacted very distinctly in comparison to patients with neurodermatitis or child’s eczema.
In eczematous skin, pathogenic (morbid) bacteria were found more often than on healthy skin next to the eczema. The identified bacteria and fungi were isolated, cultured and finally used for further testing. The results showed that some probands had a more intense intolerance reaction to fungi- and bacteria bouillons than others.
Some of those test results were documented with moulages. With the aid of those moulages, the test results were presented and discussed on the Swiss Dermatology Congress in 1946.
Although the results gave a clear picture, definitive classifications were not possible. Disinfectant therapies were helpful but did not bring the breakthrough that was hoped for. It appeared that the effect of bacteria on skin was only one of many factors in the development of eczema.
As a result of various experiments, skin reactions in infections (tuberculosis, mycosis) as well as eczema on primrose extract were defined as hypersensitivity reactions. Further examination identified urticaria, runny nose, burning eyes and asthma as allergic reactions to different elicitors.
For his doctoral thesis, a medical student investigated the roundworm (Ascaris), a parasite who also afflicts human beings. The student suffered from a chronic cold, eye burning and urticaria. When his father visited him in his laboratory, he suffered an asthma attack. This was the trigger for Werner Jadassohn – at the time assistant medical doctor in Zurich, later director of the Dermatology Clinic in Geneva – to start experiments on affected people, eventually on over 60 voluntary probands (mostly patients from the clinic). The experiments showed that all of the symptoms were allergic reactions to the roundworm.
To verify the existence of allergenic “regaines” in the blood (today called IgE-antibodies), the Prausnitz-Küstner-experiment was used:
The bloodserum of an allergic person was injected into the proband’s skin. After 24 hours, the allergenic substance was applied to the same skin patch. If “regaines” were a component of the injected serum, the skin responded with swelling and redness. If the serum of a non-allergic person was injected, the response was much weaker.
Yperite (mustard gas, Lost) was used for the first time as a chemical weapon during the First World War. Any contact with Yperite causes massive chemical burns and the destruction of the lungs upon inhalation. Its use has been prohibited since 1925. During the Second World War, the Clinic for Dermatology in Zurich conducted research on the prevention and therapy of Yperite burns.
People who were exposed to Yperite in forensic laboratories developed stronger skin reactions over the course of time. An allergic reaction was assumed. Later on, the indications were verified on rabbits and guinea pigs.
The prevention and therapy of Yperite burns was problematic. Protection ointments proved to be counterproductive, because they increased the damaging influence of the liposoluble Yperite. Various substances were tested for detoxification after contact with Yperite, as documented on this moulage. The experiments have never been published.
The moulages present chemical burns induced by Yperite. They were probably produced in 1940 by Lotte Volger. During the Second World War, the chemical weapon was no longer used, and in Switzerland, there were no known cases of Yperite injuries.
In the “Guideline for Pathology and Therapy of Warfare Agent Illnesses” by Otto Muntsch (Leipzig, 1932 to 1944) there is a colored drawing with an almost identical moulage of chemical burns on a foot. Presumably, the moulages in our collection are duplicates of moulages which were used for education in the army or in public in Germany.
Catalogue p. 87
It remains unclear when smallpox was described for the first time and when the first useful strategy against it, the variolation, was implemented. Without vaccination, smallpox took a lethal course in up to 20% of the cases.
Variolation signifies the artificial infection with the smallpox virus, which induces a gentle progression of the illness and at the same time immunizes the vaccinated person against wild pox. This way of immunizing, however, still had a mortality rate of 2%.
In Western Europe, the variolation was started in the 18th century. By the end of the 18th century, an English country doctor named Edward Jenner did research on the popular knowledge that a harmless infection with “cowpox” could protect people against a smallpox infection. Thanks to his activites, the smallpox vaccination (lat. vacca = cow) was established. The inoculation of infants was carried out by brushing alleviated cowpox vaccine on two small incisions in the skin’s surface. In this area, a pustule developed and healed with a scar.
Complications were necrosis of the inoculation response, spreading through satellite pustules or transferring to non-vaccinated people or other body parts by smear infection (moulage 43 and moulage of Vogelbacher).
Last smallpox epidemic in Zurich (moulages 295, 296 and 297).
Smallpox demands one million casualties in India alone.
Smallpox is still a threat to about 60% of the world population. The WHO starts the worldwide extermination campaign against the smallpox virus. At this time, the smallpox virus is domestic in 31 countries.
October: The WHO informs about the last natural case of smallpox in Somalia. An emergency program stops the short-term eruption of the epidemic.
In August, a laboratory accident in Birmingham, England causes two further smallpox cases. One patient dies.
December 9th: A certificate of the WHO documents the worldwide extermination of smallpox.
The smallpox genome is sequenced.
The WHO proposes the deliberate extermination of one species through another and the total devastation of the variola virus for the first time in history. Various members of WHO vetoed this proposal. To this day, the smallpox virus is kept in high security laboratories.
Catalogue p. 89
In German, “Grind” means pustule, bark, or scab, and was a general expression for a scabby skin disease. The meaning of “erben” in German was to transfer, to infect, however not in the narrower genetic sense of nowadays. “Erbgrind” was a scaly, scabby, partly purulent clinical picture of the hairy head. According to contemporary knowledge, “Erbgrind” corresponds to a mycosis of the hairy head, favus (moulage 206).
The disease was also named “Kopfgrind” (Kopf = head). In contemporary Swiss German, the meaning of “Grind” is equal to “head”, dating back to the clinical picture described before, and referring to the high occurrence of the problem in the past.
The deep infection with fungi leads to pustules and purulent knots. The formerly used term for this disease is “Kerion celsi”, deduced from kerion = honeycomb.
Typical for favus (apart from it smelling of mice urine) are tag-formed sheds (Scutula).
Without any concept of infectious agents, the formerly frequent problem was not perceived as a fungal infection. “Lack of hygiene, dissoluteness, and excessive activities” were seen as the cause of the disease. The unaesthetic clinical picture lead to social exclusion, and according to some physicians, the disease lead to “stultification”.
The scalp was formerly known as a purification organ. Inflammations, scabs and pustules were testimony of bad juices being released. Therefore, a fast healing process seemed to impede these “healing secretions”, and increase the danger for precarious inner medical conditions.
In 1939, Johann Lucas Schönlein in Zurich was the first to publish the idea that “Erbgrind” could be caused by fungi (view copy of the whole article at the bottom of the showcase).
He was the first director of the medical clinic at the new Kantonsspital (Hospital of the Canton of Zurich), founded in 1833, and was one of the most important physicians of his time to patronize the development of medicine in Europe.
However, this was not due to his publications – which consisted of two papers on a total of three pages – but because of his work as a reformer of clinical lectures and bedside teaching. In his opinion, clinical examination was the right way to a correct diagnosis, to finding the source of a disease as well as the therapy thereof. Thus he seceded himself from old theories that contradicted the diagnostic findings.
Although fungi were subsequently found on many skin phenomenona, it took decades until this theory was accepted universally.
The idea of living organisms as the cause for disease did not match the established concepts. The idea that the fungi were produced by bad juices and released via the skin seemed more plausible. Only once the science of bacteriology was founded thanks to the works of Pasteur and Koch, the idea of mycosis became more established.
Superficial mycotic infection by trichophyton fungi. The pathogen is not identifiable without further inspection of microbiological cultures.
Without further therapy, the infection may subside at the centre but simultaneously progress at the outer edges, resulting in annular redness.