Die Psoriasis: Geschichte und Therapie vom Altertum bis zur Gegenwart (review)

Gerhard Saalmann and Heinrich Schlange-Schöningen. Die Psoriasis: Geschichte und Therapie vom Altertum bis zur Gegenwart. Herford, Germany: Verlag G. Saalmann, 1998. 168 pp. Ill. DM 39.00 (3-980063-1-X).

The authors of this book are a historian and a sufferer from psoriasis who is an industrialist manufacturer of light bulbs for phototherapy. They are joined by one of the champions of phototherapy in Germany, the dermatologist Professor Hagen Tronnier, who has written the preface. The book's five chapters present the therapy of psoriasis chronologically; classical citations are used as headings within the chapters and discussed in the text.

The historical references are well elaborated, documenting chronic skin disease over the centuries. Yet the authors fail to support the book's subtitle, which implies that psoriasis can be identified specifically from antiquity to the present. They repeatedly state that it is difficult to apply the label of "psoriasis" to skin diseases mentioned in biblical and later texts. Indeed, the Greek word psora is an inclusive term, and we cannot say today what was labeled as such. Yet the authors incorrectly identify the biblical expressions of zara'ath or shechin with either leprosy or other medical diagnoses of today; these are inclusive terms and may mean anything from leprosy to psoriasis to chronic eczema to neurodermatitis to ulcers from various sources. In the same way, the quotation from 3 Mose (Leviticus) 13: 10, "wildes Fleisch" (that is, w(u)-mechiat basar chai in the original Hebrew), cannot be assumed to refer to an elephantiastic thickening (p. 16). Similarly, while a figure in a della Robbia relief appears to be suffering from a disease of the scalp, there is no evidence whatsoever that the disease is psoriasis. Indeed, the diagnosis of psoriasis cannot be substantiated until after the nineteenth century. For this reason, the authors would have done better to call the book "A History of Chronic Skin Disease" and to offer possible diagnoses in parentheses.

Further difficulties of interpretation emerge in Mr. Schlange-Schöningen's personal memories of heated discussions between the Viennese and German schools, both of which claimed priority for their treatment of psoriasis. He does not delve into the background or motivations behind this conflict, presenting only a superficial version of the dispute.

In addition, the book is littered with factual and editorial mistakes. A few examples: Joseph Plenck was born in 1735, not 1732 (p. 90); Erasmus Wilson, who was seven years older than Hebra, cannot be called his pupil--the two men were colleagues (p. 97); the Köbner phenomenon was described by Heinrich Köbner in 1872, whereas the Auspitz phenomenon was named after Auspitz but described earlier, by several other physicians (p. 97); the epidermis is renewed in less than the twenty-eight days asserted (p. 105); only one of the two subtypes of psoriasis is mentioned (p. 98); "meladenine" is spelled incorrectly (p. 120).

While the illustrations do not contribute substantially, the text could be useful for readers interested in the history of skin disease, especially the chronic types. It does contain a wealth of clinical information on a relatively rare subject.

 

Karl Holubar
Institut für Geschichte der Medizin der Universität Wien

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