H03: Avicenna: prince of physicians

Abstract

Avicenna: prince of physicians P. Arzpayma and P.D. Yesudian Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK Abu Ali Al-Hussein Ibn Abdullah Ibn Sina (980–1037 AD), known as Avicenna in the West, was born in Afshaneh, a village in the north-eastern part of medieval Persia. At the age of 10 years, he memorized the Koran and was proficient in the Arabic language and literature classics. Avicenna then immersed himself in philosophy and medicine, and by the age of 18 years, became a famous physician, well known in his country and beyond. He succeeded in treating the sultan of Bukhara and later cured the ruler of the Buyid Dynasty, becoming his private physician and prime minister. He wrote > 450 treatises on philosophy, logic, astronomy, alchemy, geology, mathematics, physics, poetry, psychology and medicine. In his most important medical manuscript, The Canon of Medicine, completed in 1025, he devoted a full chapter to dermatology. This book became one of the textbooks used for medical education in Europe from the twelfth to the seventeenth century, and went through 15 Latin editions. Avicenna defined a number of cutaneous conditions. Black baras (psoriasis) was described as roughness of skin, associated with shedding of large, round fish-like scales, which mainly occur in winter and is incurable once chronic. He suggested the application of topical oils and the avoidance of alcohol for its treatment. Black bahaq (tinea versicolor) was characterized as benign, smooth and superficial discoloured spots. He indicated that Wadah or white bahaq (vitiligo) manifested as nondepressed white spots of the skin with retention of original hair colour, and used the plant Acorus calamus in its treatment. Avicenna elucidated the symptoms, signs, complications and treatments of judham (lepromatous leprosy) in detail and called it the ‘leonine disease’. He highlighted hair and nail changes, ulceration/mutilation of extremities and change of facies seen in this condition, and considered it incurable. Avicenna suggested that sa’afa or quwaba (impetigo) was an ulcerating eruption that can form necrotizing ulcers with pus discharge. Avicenna dedicated a chapter on swellings and pustules in the fourth volume of Canon of Medicine. He described blistering skin diseases as hot swellings and alluded to a potential link between skin blisters and diet (onion, garlic, leeks, pepper, wine), now proven to have acantholytic potential. Avicenna’s birthday is celebrated as National Doctor’s Day in Iran to commemorate his invaluable contribution to medicine. He remained single throughout his life, dedicating his time to teaching and his profession. The wealth of information on various skin conditions mentioned in his textbook has served dermatologists well for many centuries. H04 Moulage: the forgotten art of dermatology? Z. Ali and M. Woyton Salford Royal Foundation Trust, Manchester, UK In 1889 the Hôpital Saint-Louis hosted the First International Congress of Dermatology and Syphilography. Visitors to this congress were met by the newly curated ‘Mus ee des Moulages’, an unrivalled collection of wax dermatological models. Moulage – wax models depicting three-dimensional representations of skin disease – first emerged in nineteenthcentury Europe. Early pioneers guarded their work jealously, refusing to take on apprentices and controlling the supply of moulage across Europe. Fortunately, this changed in 1863 when Charles Lailler, a French dermatologist employed at the Hôpital Saint-Louis, stumbled upon a promising papier-mach e artist named Jules Baretta. Together the pair revolutionized the art of moulage. Lailler sourced patients from his clinics and Baretta applied plaster to their lesions, pouring a mixture of beeswax and resin into the resulting casts. The hardened wax was then carefully and meticulously painted to create vividly life-like models of disease; offering an unrivalled opportunity to practice examinations of dermatological pathology. Lailler installed the collection in the Hôpital, and, once unveiled to the world, moulage exploded in popularity and orders were commissioned by hospitals and clinics across Europe and the USA. Over the next 50 years moulage was a highly effective clinical teaching model that brought dimension and texture to the classroom beyond what simple pencil drawings of lesions could achieve. Not unexpectedly, the growth of moulage paralleled the advancement of dermatology into an independent medical speciality. However, moulage was costly and timeconsuming to produce, thus limiting its supply to specialist centres. As colour photography advanced to make two-dimensional replicas of skin disease more accurate, moulage rapidly became a forgotten art; surviving works were banished from the classroom and confined to museums. Nevertheless, there have been stirrings of a revival of the practice, with pioneering educational centres beginning to look back through history and draw upon the lessons of early dermatologists to construct modern moulages for their students. A recent study compared the efficacy of silicon three-dimensional prosthetics of skin disease to standard photography in teaching lesion recognition and skin examination techniques to medical students. The group taught with three-dimensional models significantly outperformed the group taught with two-dimensional images when evaluating long-term retention of skills, and they also recorded higher levels of satisfaction and enjoyment from the teaching. Unlike other antiquated practices lost to time and modern advancements, moulage holds significant potential to reclaim its place at the heart of the dermatology teaching curriculum.