Adolpho Lutz and dermatology in historical perspective

_________.Vorschläge und Betrachtungen zur Frage der Trichinosistherapie und ihrer experimentellen Begründung von dr. Adolf Lutz in São Paulo in Brasilien. Deutsche Medizinal-Zeitung, Berlin, n.13, p.151-3, 13.fev.1888; n.15, p.175-6, 20.fev.1888e. [Trad. em português: Sugestões e considerações sobre a terapia da triquinose e suas fundamentações experimenatais pelo dr. Adolpho Lutz de São Paulo, Brasil.]

LUTZ, A. Weiteres zur Frage der Uebertragung des menschlichen Spulwurmes von Adolph Lutz. Centralblatt für Bakteriologie und Parasitenkunde, Jena, ano II, parte 1, v.3, n.9, p.265-8, 1888; parte 2 (final), n.10, p.297-9, 1888f. [Trad. em português: Acréscimo à questão da transmissão da solitária humana.]

_________.Zur Frage der Uebertragung des menschlichen Spulwurmes. Weitere Mittheilungen von dr. Adolpho Lutz in São Paulo. Centralblatt für Bakterologie und Parasitenkunde, ano II, v.3, n.14, p.425-8, 1888g. [Trad. em português: Sobre a questão da transmissão da solitária humana.]

_________.Zur Frage der Uebertragung von Taenia elliptica. Centralblatt für Bakteriologie und Parasitenkunde, Jena, ano II, v.3, n.16, p.489-90, 1888h. [Trad. em português: Sobre a questão da transmissão da Taenia elliptica.]

_________.Ueber ein Myxosporidium aus der Gallenblase brasilianischer Batrachier von dr. Adolph Lutz in São Paulo. Centralblatt für Bakterologie und Parasitenkunde, Jena, v.5, n.3, p.84-8, 1889. [Trad. em português: Sobre um mixosporídio da vesícula biliar de batráquios brasileiros.]

_________.Zur Kasuistik des Rhinoskleroms von dr. A. Lutz zur Zeit Honolulu. Monatshefte für Praktische Dermatologie, v.11, n.2, p.49-51, 15.jul.1890. [Trad. em português: Sobre a casuística do rinoscleroma.]

_________.Korrespondenz aus Honolulu. Monatshefte für Praktische Dermatologie, Hamburg, n.13, p.389-92 e 488-90, set. 1891; n.14, p.30-4 e 152-5, set. 1891); p.275-7 e 307-11, nov. 1891; n.15, p.382-9, 1891-1892. [Trad. em português: Correspondência de Honolulu.]

_________.Zur Behandlung der Atherome. Dermatologische Wochenschrift, p.505-6, 1891. [Trad. em português: Sobre o tratamento dos ateromas.]

_________.Observações sobre as molestias da cidade e do estado de São Paulo pelo dr. Adolpho Lutz, director do Instituto Bacteriologico de S. Paulo. São Paulo: Typographia Paulista, 1898. (Publicações da Revista Médica de São Paulo. Jornal Pratico de Medicina, Cirurgia e Hygiene, v.1, n.1, p.4-6; n.3, p.39-41; n.4, p.60-1; n.6, p.95-9. 1898.

_________.Um caso de myiase ou bicheira da garganta. Revista Médica de São Paulo. Jornal Pratico de Medicina, Cirurgia e Hygiene, v.2, n.8, p.215-9 (2 quadros), 1899.

_________.Uma mycose pseudococcidica localizada na bocca e observada no Brazil. Contribuição ao conhecimento das Hyphoblastomycoses americanas. Rio de Janeiro: Typ. Besnard Frères, 1908. (Publicações do Brazil-Medico). O Brazil-Medico, Revista Semanal de Medicina e Cirurgia, ano 22, n.13, p.121-4; n.15, p.141-4, 1908.

_________.A transmissão da lepra e suas indicações prophylaticas (Transmission of Leprosy and Prophylactic Indications). Memórias do Instituto Oswaldo Cruz, v.31, n.2, p.373-90, 1936.

_________.Relatório do dr. Lutz comunicado ao dr. Azevedo Lima. In: ARAÚJO, H.-C. de S. História da lepra no Brasil: períodos colonial e monárquico (1500-1889). Rio de Janeiro: Imprensa Nacional, v.I, p.491-3, 1946. (Extraído do Relatório do Hospital dos Lázaros do Rio de Janeiro, 4.jul.1887, p.24-32.)

LUTZ, A., MACHADO, A. Viagem pelo rio S. Francisco e por alguns dos seus afluentes entre Pirapora e Joazeiro. Estudos feitos a requisição da Inspetoria das Obras Contra a Secca, direção do dr. Arrojado Lisboa. Memórias do Instituto Oswaldo Cruz, t.7, n.1, p.5-50, 1915.

LUTZ, A., SPLENDORE, A. Sobre uma mycose observada em homens e ratos. Contribuição para o conhecimento das assim chamadas sporotrichoses. Memória apresentada ao Sexto Congresso Brasileiro de Medicina e Cirurgia. Revista Médica de São Paulo. Jornal Pratico de Medicina, Cirurgia e Hygiene, São Paulo, ano 10, n.21, p.443-50 (mais 4p. adicionais com 4 figuras), 1907.

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Notes

1 See, in Book 1 of this collection, correspondence sent from Rio de Janeiro in April, 1882 to Correspondenz-Blatt für Schweizer Aërzte (v.XII, n.7, p.210-4).

2 The articles by Adolpho Lutz on veterinary medicine will be published in Volume IV, Book 3, of this edition of his Obra Completa.

3 The articles by Adolpho Lutz on helminths will be included in Volume 5, Book 1 of this edition of his Obra Completa.

4 Translated to English by C. H. Fagge and published under the title On diseases of the skin, including the exanthemata. London, 1866-1880. New Sydenham Society (Series); v.30, 5v. illus (v.3-5 by F. Hebra and M. Kaposi). Atlas of portraits of diseases of the skin was published in London between 1860 and 1875.

5 Pathologie et traitement des maladies de la peau; leçons à l'usage des médicines praticients et des étudiants. Paris, Masson, 1891, 2.ed. française. The English edition is Pathology and treatment of diseases of the skin; for practitioners and students. London, Baillière, Tindall and Cox, 1895.

6 This physician organized in Munich the first medical-chemical laboratory associated with a hospital, Besides Handbuch der hautkrankheiten, 1881-1884, which was volume 14 (in 2 parts) of Handbuch der speciellen pathologie und therapie (Leipzig, 1874-84), there was the Handbuch der Krankheiten des Nervensystems (Leipzig: F. C. W. Vogel, 1878), in two volumes. The first was on diseases of the peripheral nervous system, and the second was about the diseases of the vasomotor system, epilepsy, eclampsia, tetanus, Parkinson's disease, hysteria and disorders of movement. In 1882, Hugo von Ziemssen, who was also well known as an electrotherapist, showed, for the first time in a living person, whose heart was visible following a surgical intervention in the thorax, that electrical impulses controlled ventricular activity.

7 "His treatise on syphilis is monumental" (Pusey, 1933, 111). He published an important study on senile skin in 1869 entitled Über die senilen Veränderungen der Haut des Menschen (Holubar, 1998).

8 This reference can be found in Olpp (1932). Hollander (1987) quotes what is probably an abstract, Archiv für Mikroskopische Anatomie (1876, v.12, p.665) published under the title "Beiträge zur Histologie und Entwicklungsgeschichte der menschlichen Oberhaut und ihrer Anhangsgebilde" (Contributions to the histology and embryology of human epidermis and its appendixes). Unna's original approach was severely criticized by Friedrich Daniel von Recklinghausen (1833-1910), who did not believe that scientifically valid conclusions could be obtained by using stains. The thesis had to be re-written before it was accepted, in 1875 (Olpp , 1932; Enersen, 1994-2001).

9 Besides Unna's text and an article by Auspitz on pathology and the therapeutics of the skin, mentioned above, the Handbuch der hautkrankheiten, published in English as Handbook of diseases of the skin (New York, W. Wood and Company, 1885), contained the following articles: Physiology, by H. Von Ziemssen; Hyperaemiae, anaemiae, and hemorrhages of the skin, by E. Schwimmer; Dermatitis superficiales, by T. Veiel; Acute deep-spreading inflammations, by E. Geber; Chronic deep-spreading inflammations, by E. Schwimmer; Anomalies of the epidermis; pt I by E. Lesser; pt. II by A. Weyl; Chronic infectious diseases of the skin, by A. Neisser; Neuroses of the skin, by E. Schwimmer; Anomalies in the growth and color of the hair, by P. Michelson; Anomalies in the color of the skin, by E. Lesser; Anomalies of the sebaceous glands, by E. Veiel; Acne rosacea and sycosis, by T. Veiel; Morbid changes of the nail and its bed, by E. Geber; Anomalies of the sudoriparous glands, by E. Geber; Parasitic diseases of the skin, by A. Weyland E. Geber; New formations of the skin, by E. Schwimmer and V. Babes, and Neuroma, adenoma, epithelioma molluscum, and carcinoma of the skin, by E. Geber.

10 Enersen's entry states that the clinic was founded in 1881.

11 This periodical was originally published monthly, and became weekly in 1912, when its name was changed to Dermatologische-Wochenschrift. It was published again as Dermatologische Monatsschrift, upon becoming the organ of the Society of Dermatology of the German Democratic Republic.

12 Only Hollander indicates the lapse of time between the new clinic and the activities of specialization. This author was the last living disciple of Unna when he presented his paper at the 17th International Congress of Dermatology, in 1987. Unna's letters to Lutz in the 1880s carry the letterhead of "Heilanstalt für Hautkranke von Dr. P. G. Unna. Eimsbüttel, Parkallée 13, bei Hamburg." The lapse of time might have been longer because, in a letter dated 10 August 1902, Unna comments that "You are probably aware of the intensification of my teaching activities, that were developing, little by little, from the founding of my dermatologicum and the two courses ... for doctors." On 1 September, 1904, he writes: "After the Dermatological Congress, that will begin 8 days from now in Berlin, my new dermatologicum will be set up. I myself built it and the first course there will be given in October." (BR. MN. Fundo Adolpho Lutz.)

13 Hansen worked at the hospital in Lungegaard as an assistant to Danielssen, whose daughter he later married (Obregon, 2002, p.129).

14 Baumgarten (1887, p.244, 251-252) states that, in Wiesbaden, Unna described the cure for a second case of tuberous leprosy using mainly salicylic acid plasters, creosote and chrysarobin, under which "the nodules visibly disappeared, partially through reabsorption, partially through exfoliation". Unna's article quoted in this work is Zur Histologie und Therapie der Lepra (Verhandlgn. des V Congresses f. innere Medicin zu Wiesbaden, p.277. Wiesvabden, Bergmann, 1886).

15 At the time, Danielssen asked whether leprosy might not be a manifestation of tuberculosis. Besides the similarity of their respective bacilli, he often found both diseases in a single individual. He often observed that a pulmonary, abdominal or meningeal tuberculosis would arise when the nodes began to be reabsorbed. Danielssen believed that, in acute nodular eruptions of leprosy, the pathogenic agent was a poison produced by the bacilli, since there was as yet no proof of the their presence in the "fresh" eruptions or in the bloodstream (Baumgarten, 1887, p.257). When writing this comment, Baumgarten quotes the article of the Norwegian dermatologist: "Beretning om Lungegaardshopitalets Virksomhed i Treaaret 1883 bis 1885" (Sep.-A. Af N. Mag. f. Laegev. 1886, p.9).

16 Obregón (2002, 130) provides the following references: Gerhard Armauer Hansen, "Bacillus leprae," Virchow's Archiv, t. LXXIX, 1880, p.79; Nordiskt Medicinskt Arkiv, 1880, v.12, p.1-10; Quarterly Journal of Microscopical Science, 1880, 20 (Jan): p.92-102.

17 The stalk and roots of this plant have medicinal properties and the staining material containing hematoxilina is extracted from them.

18 Born in Dresden, Baumgarten had taken over that professorship in 1874, also becoming a professor of the same discipline in Tübingen in 1889. According to Bulloch (1938, p.351) he was one of the pioneers of bacteriology and did much for the progress of this science through his books and articles, especially through the book mentioned above, which Bulloch considers a very useful, precise and critical guide for bacteriologists. Also important among Baumgarten's writings was Lehrbuch der pathologischen Mykologie: Vorlesungen für Ärzte und Studirende. Braunschweig: Harald Bruhn, 1890. 2 volumes (the first was published in fascicles, and began circulating in 1886).

19 Baumgarten (1886, p.90-2; 1887, p.247-51); Unna's articles quoted by Baumgarten are "Die Bacillenklumpen in der Haut sind keine Zellen," Virshow's Archiv, Bd. CIII, 1886, p.553; and "Die Lepra-Bacillen in ihrem Verhältniss zum Hautgewebe," Dermatolog. Studien, Heft 1., Hamburg, Voss, 1886.

20 Baumgarten (1887, p.287). Hansen's article reviewed in this source is "Die Lage der Leprabacillen," Virshow's Archiv, Bd. CIII, 1886, p.388.

21 Baumgarten (1887, p.290). Neisser's article quoted by this commentator is "Histologische und bacteriologische Lepra – Untersuchungen," Virshow's Archiv, Bd. CIII, 1886, p.355.

22 Baumgarten (1887, p.293-6); this author comments on four articles by K. Touton: "Wo liegen die Leprabacillen?," Fortschr. d. Med., n.2, 1886; "Erwiderung auf Unna's: Wo liegen die Lepra bacillen?," Deutsche Med. Wochenschr., n.8, 1886; n.13, p.222; "Demonstration von Leprabacillen in Hautschnitten," Verhandlgn. d. V. Congresses f. innere Medicin zu Wiesbaden. Wiesbaden, Bergmann, 1886, p.242; lastly, "Zur Topographie der Bacillen in der Leprahaut," Virshow's Archiv, Bd. CIV, 1886, p.381.

23 Baumgarten (1889, p.218-23). The articles reviewed are "Bacillen der Lepra," Transact. Pathol. Soc. London, vol. XXXVIII, 1887, p.439; and "Berich über Züchtungsveruche mit dem Leprabacillus," Brit. Med. Journ., 1888, p.215, both by Beaven Rake; and "Beträge zur pathologischen Anatomie der Lepra. II. Veränderungen der Pacini'schen Körper, by J. Sudakewitsch," Beitr. Zur path. Anat. u. Phys. Von Ziegler u. Nauwerck Bd. II, p.327.

24 R. Campana's article, commented by Baumgarten (1887, p.255-57; 1888, p.218-20), is "Ancora della trapiantazione della lepra negli animali bruti," Bollet. Della reale Accademia medica di Genova, n.7, 1886; the article by J. L. Bidenkap is the same as that reviewed by Lutz (see Book 2 of this collection): "An abstract of lectures on Lepra," Christiania 1886 – Referat Fortsch. d. Med. 1886, n.24, p.806). H. Kuhne's observations are from two articles: "Zur pathologischen Anatomie der Lepra," Dermatolog. Studien, 1887, Heft 6, p.15; and "Demonstration von Leprapräparaten," Tagebl. d. 60. Versammi. Deutscher Naturf. u. Aerzte zu Wiesbaden 1887, p.340.

25 Referred to in by Brouardel, Gilbert and Girode in their widely respected treatise on medicine and therapeutics (1896, p.314), Lutz's article was reproduced almost in its entirety by Adrien Doyon (1886-1887) in the Annales de Dermatologie et de Syphiligraphie. It was also reviewed in Vierteljahrsschrift Derm. Syph. (v.18, p.331-4, 1886), Friedländer's Fortschritte der Medizen (Kokkothrix leprae, 1886) and in Baumgarten (1886, p.250-1).

26 In a paper presented at the 5th Congress of Internal Medicine, in Wiesbaden ("Zur Histologie und Therapie der Lepra", 1886), Unna said had he had arrived at conclusions similar to those of Lutz on the morphology of leprosy microbes. He had studied what chemical factors of "Lutz-Unna method" were involved in the dissolution of the leprosy bacilli into rows of cocci and came to the conclusion that the predominant factor was iodine (Baumgarten, 1887, p.251-2). Campana (Baumgarten, 1887, 251-52) found Coccothrix leprae only in older nodes, whereas the rows of small colored spheres were found in the cells. This led him to believe that the Coccothrix formations were residues of old bacilli.

27 Baumgarten (1887, p.259-60) comments on the work of this author entitled "Ueber Bacillen bei Syphillis," Mittheil. a d. med. Klinik d. Univ. Würzburg. Wiesbaden, Bergmann, 1886.

28 Lutz had not yet mentioned the hematozoan discovered in 1880 in Algeria by the French military physician Charles Louis Alphonse Laveran. Oscillaria malariae (later called Plasmodium) was a protozoan and, even though the dysentery and surra had already been associated with this unicellular animal, there had not yet been any conclusive proof that it caused any significant human disease. The demonstration of an etiology of this nature was made difficult by the complexity of the life cycles of the animals in this sub-kingdom, by the absence of any precise system of classification and by the difficulty in obtaining artificial means for growing them in cultures. This contributed to the fact that Laveran's discovery remained in the shadows of the bacillus of Klebs and Tommasi Crudelli for several years. Laveran published his discovery in 1880 in the Annales de dermatologie (.1, p.173) and in the Bulletin de l'Academie de Medecine de Paris (v.44, 2ème série, n.9, p.1346). In this regard, see Busvine (1993, p.18-20).

29 See Théodoridès (1984, p.39-40); Bulloch (1938, p.171-5) and Encyclopaedia Britannica (v.20, p.109; v.23, p.178-9).

30 Stanier and Lwoff (Bulloch, p.1192). Haeckel (1834-1919), an enthusiastic disciple of Darwin, formulated the "biogenetic law," according to which ontogenesis (development of the individual from fecundation to maturity) is a recapitulation of phylogenesis (succession of previous evolutionary phases). His main works are Natürliche Schöpfungsgechichte (Natural history of creation, 1868) and Prinzipien der generellen Morphologie der Organismen (Principle of the general morphology of organisms, 1906). Die Welträtsel (The mysteries of the universe, 1889) was, for a long period, a manual for materialists.

31 Cohn had already called attention to the co-existence in the writings of Pasteur, almost as synonyms, of microscopic cryptogamous plants, animalcules, mushrooms, Infusoria, toruláceas, bacteria, vibriones, monads, mucedíneas, yeast, etc. (Bulloch, 1938, p.187). Stanier and Lwoff (ibid., 1938, p.1191) confirm that: "For Pasteur, the concept of microorganism as an object of biology remained quite vague. It was the activity that counted, and not the taxionomic position."

32 The complete reference given by Mazumdar (1994, p.426) is Grundzüge der wissenschaftliche Botanik, nebst einer methodologischen Einleitung, als Einletung zum Studium der Pflanze, Leipzig, Engelmann, 1842-1843. It was translated into English by Edwin Ray Lankaster under the title of Principles of Scientific Botany, or Botany as an Inductive Science, London, Longmans 1849.

33 This quote can be found in Mazumdar (1994, p.37) who gives the complete bibliographic references (p.417): Mechanisch-physiologische Theorie der Abstammungslehre, mit einem Anhang: 1. Die Schanken der naturwissenschaftlichen Erkenntniss. 2. Kräfte und Gestaltlungen im molecularen Gebiet. Munich, Oldenbourg, 1884.

34 Especially "Die neueren Algensysteme und Versuch zur Begrünung eines Eigenen Systems der Algens und Florideen," Neue Denksch. der Scweizer naturforschende Gesellsch., 9, 1847 (reference in Mazumdar, 1994, p.417).

35 Die niederen Pilze in ihren Beziehungen zu den Infektionskrankheitenund der Gesundheitspflege, Munich, Oldenbourg, 1877. Nägelli had already given up the idea that fungi were generated spontaneously, but denied the existence of genera and species among microorganisms that acquired diversified forms and functions as they adapted to external conditions. Opposing both Cohn's classification and Pasteur's specific fermentations, he argued that a single bacteria transplanted to different environments, could "successively, from one generation to another, produce in one place the acidity of milk or butyric fermentation, or changes in wine, or the putrefaction of albuminoidal material, or the destruction of urea... and somewhere else generate diphtheria or typhus, or relapsing fever or cholera" (Wasserzug, 1888, p.76-7, 157).

36 Bulloch (1938, 186-7) indicates the following as representatives of the era of fungi, Klob (1867) and Thomé (1867), who found them in cholera, and Letzerich (1869, 1873) and Talomon (1881), who attributed diphtheria to them. From 1867 to 1877, micrococci were described in cases of diphtheria (Buhl, 1867; Tommasi and Hueter, 1868; Oertel, 1868; Nassiloff, 1870; Eberth, 1872); endocarditis (Winge, 1870; Waldeyer, 1872; Heiberg, 1872; Eberth, 1872, 1875, 1878); and in septic and putrid infections (Leyden and Jaffe, 1867; Hueter, 1868; von Recklinghausen, 1871; Cohn, 1872; Klebs, 1873; Weigert, 1876). Bulloch makes no reference to polymorphous fungi and algae associated with yellow fever in the 1880s (see Benchimol, 1999) but, to show how naive the followers of these theories were, he goes on at length to describe Gemiasma (miasma of the earth), fungus captured in malaric swamps by J. H. Salisbury (1862-1866).

37 Lister described changes in the forms of bacteria due to the effect of nutritional variations. For Huxley, they were the simplest stage in the development of fungi. For the Viennese surgeon Theodor Billroth, the forms found in putrid infusions, surgical infections and cadavers were no more than stages of the Coccobacteria septica. Names invented by him survived the refutation of his ideas. He called the smallest forms of this alga cocci (from the Greek kókkos, meaning seed), classifying them according to their size or arrangement: micrococci, diplococci, streptococci, etc. After Cohn's classification, the English zoologist Ray Edwin Lankester studied a colored microbe, Bacterium rubescens, that presented the four fixed forms in that system as stages in its development (1873-1876). The connection among them could be authenticated by staining material specific to the microbe. Cohn tried to show that the forms corresponded to the different species (Bulloch, 1938, p.196-200).

38 Mazumdar (1994, p.52-5). The reference provided by this author is: "Conspectus familiarum crytogamarum secundum methodum naturalem dispositarum auctore Ferdinand Cohn," Hedwigia, v.11, p.17-20, 1872.

39 He defined bacteria as cells without chlorophyll, but with certain determinable forms, which reproduced exclusively by cell division and lived in isolation or in families of cells. According to Cohn, although characterized by the absence of color, bacteria had similarities with cianofíceas, a class of unicellular or filamentous algae having a simple structure and blue-green pigments. Reproduction took place by binary division in both "blue algae" and bacteria. Bacterial cells always looked uniform, without internal differentiation, which was also a noticeable characteristic of blue algae, where no chloroplasts could be discerned, although these latter had abready been recognized as the seat of photosynthetic pigments in vascular plants and in all other algae. Cohn therefore proposed to join together in a single classification, which he called Schizophytae, belonging to the plant kingdom, the two groups of microbes comprising the simplest forms of living beings.

40 "Untersuchung über Bacterien," Beiträge zur Biologie der Pflanzen, v.1, p.127-222, 1875; v.1877, p.249-76. By Ferdinand Julius Cohn, see also Bacteria, the smallest of living organisms. Baltimore, Johns Hopkins Press, 1939. Translated from Ueber die Bacterien, die kleinsten lebenden Wesen (1872) by Charles S. Dolley (1881). Cohn's bibliography is on p.40-4. The English translation also published in Bulletin of the history of medicine, v.VII, n.1, Jan.1939.

41 Tribus I: Sphaerobacteria – Genus I: Micrococcus. Tribus II: Microbacteria – Genus 2: Bacterium. Tribus III: Desmobacteria – Genus 3: Bacillus; Genus 4: Vibrio. Tribus IV: Spirobacteria. Genus 5: Spirillum; Genus 6: Spirochaete. Among the round bacteria (Sphaerobacteria) he distinguished cromógenas (they color the environment where they are found), zimogenic (produce chemical fermentation) and pathogenic species.

42 According to the manuals of bacteriology at the end of the 19th century, bacilli were bacteria in the form of straight or curved rods of sizes varying from 30u to 0.4u in length (1u = one one-thousandth of one millimeter). Cocci were spherical or rounded bodies with diameters that varied from approximately 0.3u to that of a yeast cell (ca. 3u). They divide in one or more directions and not always on the same plane, and produce characteristic arrangements. The spherical cocci were called diplococci, joined two by two; tetrad are groupings of four; sarcina, of eight. When in the form of a string of beads or a long series, they were called streptococci. Staphylococci appeared in bunches, like grapes. Zoogleia are amorphous clumps of bacteria. The bacilli could also be aligned at their extremities (artrobacterias) If the cylinders of filaments were straight, they were called Leptotrix; the sinuous type were Streptotrix. The genus Crenothrix designated the filamentous and rounded forms surrounded by a gelatinous sheath; and Cladothrix designated the joining of segments, not in a straight line but laterally, forming false branches. When the filaments were grouped into the form of a cauliflower, they belonged to the Beggiatoa. Finally, microbes joined into long flexible threads were called spirochetes (Galvão, 1901, p.173; Bulloch, 1938, p.193-5).

43 Excerpt quoted by Mazumdar (1994, p.66), from Robert Koch, Investigations into the Etiology of Traumatic Infective Disease, London, New Sydenham Society, 1880, p.65. English translation by W. Watson Cheyne, of Untersuchungen über die Aetiologie der Wundinfektionskrankheiten, Leipzig, Vogel, 1878.

44 Cuvier's dictionary (1867, p.138, 203) has an entry on Coccotrichum, indicated as a synonym for Collarium, a genus of mushrooms in the order of hyphomycites (Sépédoniées), a term coined by Link to refer to microscopic plants with closely joined, branched and sporous filaments grouped into small agglomerations on the filaments. Link described two species, C. Nigrispermum, that grew on dry cola, and C. Fructigerum, on rotten apples.

45 Neumann was a teacher at the University of Heidelberg and associated to the Seemannskrankenhause (Sailors' Hospital) and to Institut für Schiffs und Tropenkrankheiten (Institute for Naval and Tropical Diseases), in Hamburg. He traveled to Brazil with M. Otto in the summer of 1904 to study yellow fever, and then published Studien über das Gelbe Fieber in Brasilien (Leipzig, 1906).

46 Lessel Jr. lists quite a number of microbiologists who incorrectly used Coccothrix tüberculosis Lutz or Coccothrix leprae Lutz: Unna (1887, p.11); Toni and Trevisan (1889, p.943-4); Vuillemin (1913, p.527); Buchanan (1925, p.275); Bergey et al. (1934, p.536); Hauduroy et al. (1937, p.291; 1953, p.327, 335); Reed (1939, p.810; 1948, p.877); Krassilnikov (1941, p.107, 109; 1949, p.179-80); and Hanks (1948, p.882). According to the International Code of Nomenclature of Bacteria, the species Mycobacterium leprae Lehmann & Neumann are synonymous with Bacillus leprae Hansen 1874, Coccothrix leprae Lutz 1886, Discomyces leprae Neveu-Lemaire 1921, Mycobacterium leprae hominis Lowe 1937, Mycobacterium Leprosy bacillus Hansen 1880, and Sclerothrix

leprae Vuillemin 1921. (www.dsmz.de/bactnom/bactname.htm, 2000).

47 Excerpt of a letter from Altersdorf on 6 June, 1906 (BR. MN. Fundo Adolpho Lutz).

48 Excerpts of a letter from Unna to Lutz, dated 3 Jannary, 1887 (BR. MN. Fundo Adolpho Lutz).

49 Monatshefte für Praktsche Dermatologie (1887, v.13, p.596-7) published a letter written by Azevedo Lima, the director of the hospital and Guedes de Mello, translated from Portuguese into German by Adolpho Lutz. The letter was entitled "Über das Vorkommen der einzelnen Lepraformen, sowie der Erscheinungen an Augen, Nase un Ohren," and contained clinical observations on leprosy, especially on lesions on the nose, eyes and ears. Another issue of the same periodical (v.6, p.237) published another article by Azevedo Lima, "Mittheilungen über das Lepra-Hospital in Rio de Janeiro." It also may have been translated by Lutz. Both articles were reviewed in Baumgarten (1888, p.231).

50 Hebra described Rhinoscleroma in 1870 in Wiener Med. Wshschr (v.21, n.1). The description of scrofulous lichen (1874) can be found in Maladies de la peau (p.456), a book written by Hebra and translated by Doyon. These references can be found in Tilles (1989, p.125-7), who provides a very interesting list of the "main skin diseases described between 1780 and 1880."

51 See Crissey, Parish & Holubar (2002) and Direction de la Communication de l'AP-HP, site internet institutionnel de l'Assistance

Publique – Hôpitaux de Paris: www.ap-hp.fr (consulted on 22 February, 2004).

52 There were already similar societies in the United States, Germany, Italy, and England. From 1890 to 1987, the monthly meetings of the French society were held at the museum of St. Louis Hospital. According to Tilles (2002), the inclinations of its founders combined the tradition of the French school (Ricord, Hardy), with their openness to new ideas (Besnier), and the important place given to syphilis in this specialty (Fournier).

53 Doyon had been in Germany and Austria, knew the language very well, and maintained close relationships with Hebra, Neisser, Auspitz and Kaposi. An intern at hospitals in Lyons in 1848, he soon after worked as a physician at the Hospice de l'Antiquaille. Among his teachers were Rollet and Diday, well-known dermatologists and specialists in syphilis. With Diday he published several articles on genital herpes, the treatment of dermatoses and the teaching of the dermatology and venereology. He moved to Uriage in 1858 and participated in the founding of that spa where he served as inspecting physician until his death, there, on 21 September, 1907. Doyon was an official of the Legion of Honor and Associate Member of the Academy of Medicine. In cooperation with E. Besnier, he translated Leçons sur les maladies de la peau, by M. Kaposi. Many detailed notes describing certain points of disagreement between the French and the Viennese schools were added to the 1881 edition.

54 Une to the importance he gave to syphilis, he proposed that the course be divided and that syphilography be moved to the hospital in Midi. The proposal was rejected at a professors' meeting on 19 May, 1881. Gauchier succeeded Fournier in 1902. Later Jeanselme occupied the professorship as of 1918 and was succeeded by Gougerot in 1928. Only in 1953 a professorship specialized in clinical dermatology was created at the Paris Medical School.

55 See, in Book 1 of this collection, the letter published in April, 1882 in Correspondenz-Blatt für Schweize Aerzte (v.XII, n.7, p.210-4).

56 This Polyclinic was intended as an institution to provide "free treatment for poor patients ... and for the teaching of medical and surgical specialties, as well as all work of investigation related to ... experimental medicine." It was opened on 28 June, 1882 in the modest two-story house of the Public Archive, on Rua dos Ourives No 1. Next door, on the second floor, was the Imperial Academy of Medicine. During the urban reform of Rio de Janeiro it was transfered to Avenida Central. The first defender of the fouding of polyclinics in Brazil was Pacífico Pereira, professor at the Medical School of Bahia. From the beginning, the idea was associated with a project to modernize the teaching of medicine. In 1877, Pereira published several articles in Gazeta Médica da Bahia on the usefulness of the Viennese institution. In Rio de Janeiro the project was defended by Dr. Moncorvo de Figueiredo in his book Do exercício e ensino médico no Brasil, and by a group of clinicians that included Ramiz Galvão, Hilário de Gouveia and Nuno de Andrade. Several important members of the elite of Rio de Janeiro society were also called in as sponsors to sign the Act of Founding of the Polyclinic, on 10 December, 1881, including Visconde de Figueiredo (Benchimol, 1990).

57 Carrara (1996, p.83-4). Chaves was trained in Bahia and published his doctoral thesis in 1887 on "Mercury and its compounds," indicating it as a treatment for syphilis. Summaries of the thesis were published in the Medical and Surgical Reporter, of Philadelphia, and the Annales de Dermatologie e de Syphiligraphie. For this reason, he was named a foreign member of the French Society of Dermatology and Syphilography. He was already living in Pelotas when he traveled to Paris (Carneiro, 2002, p.44).

58 Due to his intense activity, he became First Secretary in 1889, President in 1897 and, later, Perpetual President. He was also responsible for setting up the Museum of the National Academy of Medicine. (Azulay, 1974, p.221).

59 "Je désire faire une remarque à propos de la propagation de la trichophytie: elle debute souvent par les chiens et il arrive très fréquemment qu'elle attient un enfant qui joue avec un chien, puis qu'elle se propage de cet enfant à d'autres enfants de la même famille. Aussi est-il indispensable, dans les familles, où on rencontre un enfant trichophytique, d'examinar les chiens qui vivent dans la maison, car s'ils sont trichophytiques, ils peuvent encore transmettre la maladie à des enfants restés indemnes ou, par des reinoculations successives, prolonger la durée de la maladie chez ceux qui etaient dejà atteints."

60 "J'ai observé la lèpre à Rio de Janeiro e à Saint-Paul au Brésil, et j'ai pu constater qu'elle n'etait pas une maladie des villes. La misère n'en est pas non plus la cause sine qua non, et des gens qui vivent bien peuvent parfaitemente en être attients."

61 "Quand on voit se résoudre un tubercule lépreux, il faut toujours craindre qu'un autre ne survienne. Il semble se faire de veritables embolies lépreuses. Aussi la médication interne est-elle préférable au traitement externe, pour empêcher des faits de cet ordre."

62 His speech is transcribed below in this same volume. Ricord and Hardy, presidents of the congress, also spoke, as well as Henri Feular, its secretary. Other speakers were Kaposi, the delegate from Vienna; Malcolm-Morris, from London; Mansouroff, from Moscow; De Amicis, from Naples; Unna, from Hamburg; Wetraszewski, from Warsaw; Olavide, from Madrid; Zambaco-Pacha, from Constantinople; and Kalindero, from Bucharest.

63 BR. MN. Fundo Adolpho Lutz, caixa 21, pasta 254, maço 3.

64 The other correspondents were Drs. H. G. Brooke, in Manchester; Dubois-Havenith, in Brussels; E. von Düring, in Constantinople; Henri Fournier, in Paris; Funk in Warsaw; Emil Kroug, in Hungerburg bei Narwa; E. Pontoppidan, in Copenhagen; S. Róna, in Budapeste and P. Tommasoli, in Modena.

65 These articles were the object of a brief commentary by Unna in a review that focused more on articles about the influence of tuberculine on leprosy, published in the Journal of the Leprosy Investigations Committee. About Lutz, Unna only said that he "discussed some interesting complications of leprosy, especially syphilis. Leprous and syphilitic eruptions are easily diagnosed in the patient. The case of a patient with a cancroid on a leprous base is also discussed" (Baumgarten, 1893, p.271).

66 Zilberberg (1938), the main source used here, was assistant physician at the 3rd dermo-syphillographic clinic of Santo Amaro Hospital in Recife. He refers to the dissertation on the disease defended by Flaviano Silva at the Medical School of Bahia, describing six cases. On Lutz-Jeanselme nodules, see also Portugal (1944).

67 Zilberberg (1938) affirmed that a great deal of research was being done in Brazil in order to discover the parasite responsible for the syndrome. He himself tried, unsuccessfully, to cultivate material from a node. He believed that the nodules had a fungal origin, but only in a minimal percentage; syphillis and bubba were, in his view, more responsible for their etiology. Pinoy, Le Dantec and other authors questioned the existence of a pathogenic fungus. Le Dantec agreed on an etiology where syphillis was responsible together with other affections: mycoses, bubba, filariasis, etc.

68 These subjects will be examined in detail in the books of this collection dedicated to Lutz's work in entomology and helminthology (Volume II, Books 2 and 3) and as director of the Bacteriological Institute of São Paulo (Volume IV, Book 1).

69 Walter Seng was born on 23 May 1873 in Vienna, Austria, and died on 28 June 1931 in São Paulo, SP. He married Mercedes Lisboa there on 26 October 1901. He is considered a pioneer of neurosurgery in São Paulo and was the first clinical director of Santa Catarina Sanitarium, the city's oldest private hospital. Rua Dr. Seng, in Bela Vista neighborhood, is named after him.

70 He taught General and Special Zootechnics and Veterinary Medicine and Hygiene of Domestic Animals in the agronomy course. When the course was closed, Hottinger began to teach Biochemistry, Physical Chemistry and Electrochemistry in the Chemical Engineering course. "He was particularly concerned with the study of general processes to combat illnesses typical of our environment. Among his discoveries, the best known among us is the use of oligodynamic action of metals, with the use of coloidal silver to sterilize water. This discovery became kown as the Salus sterilization process." (Webpage of the Polytechnic School of São Paulo, consulted on 27 Feb. 2004:

www.poli.usp.br/Organizacao/Historia/Historico/1893-1900.asp.)

71 Lutz (1908, p.24) mentions cases observed by Splendore, of which more will be said; one described by Breda, who only knew the literature indirectly; and a case presented by Dr. Baldomero Summer at the Second Latin American Medical Congress (Buenos Aires, 1904) with a probable diagnosis of bubba, "a word that designates a tropical raspberry or yaw… mistakenly taken as a synonym for syphillis."

72 According to Fialho (1946, p.12), Buschke (1927) attributes the invention of the term to Naegeli, and Floriano de Almeida (1939) to Frank.

73 "The first human case of sporotrichosis was described in 1898 in the United States, by Schenk; two years later, L. Hetkoen and C. F. Perkins established a species now known under the name Sporotrichum schenckii" (Fonseca Filho, 1974, p.80).

74 Busse, O. "Über parasitäre Zeleinschlüsse", Centralblatt für Bakteriologie und Parasitenkunde, 1894, p.16.; and, by the same author, "Über Saccharomycosis homins", Virchows Archiv. F. Path Ant., 1896, p.146. Buschke, for his part, published "Über Saccharomycosis", Virchow Arch., v.41, 1896; and Die Blastomikose. Biblioteca Médica, Stuttgart, 1902. References provided by Fialho (1946, p.17-8, 235).

75 In Wernicke's laboratory, Posadas became skilled in pathology and microbiology. Posadas and Wernicke were the first to record a case of rhinosporidiosis, whose etiological agent is still uncertain.

76 Eliseo Canton proposed that the microorganism be called Posadasia esferiforme, but the name did not hold because of the work done by US researchers during the same period (Fialho, 1946, p.13).

77 Fialho (1946, p.15-6). In a retrospective study quoted by Fialho, Rixford (1931) said that, at that time, in São Francisco, only two physicians were equipped to do bacteriological research: Mouser and Douglas Montgomery. Both examined materials from his case. The cultures remained sterile and a fungus grew in Montgomery's tubes that he threw away as a contaminant, though it was a Coccidioides. Rixford and another Californian doctor, Dr. Thome, thought the agent of the mysterious disease was a protozoan and sent materials extracted from their patients to a well-known protozoologist in Washington, Dr. Charles W. Stiles, who suggested to Rixford and Gilchrist that they call their supposed protozoan Coccidioides immitis; Stiles called Thome's Coccidioides piogenes. (Fialho, 1946, p.13; Fonseca Filho, 1974, p.80).

78 Oidium coccidioides, according to Fialho (1946, p.15).

79 Fialho (1946, p.15-6). According to Jacobson (1932), by 1932 about 200 cases had been diagnosed and studied. Other articles were later published on the subject, such as A. M. Stober, "Systematic blastomicosis. A report of its pathological, bacteriological and clinical features", Arch. Int. Med., v.13, p.509-56, 1914; S. Snow Miller, "The reticulum of the lung. V. – Its similarity in blastomycosis to that in tuberculosis", American Journal of Pathology, v.3, p.316-20, 1927; and Medlar, "A cutaneous infection caused by a new fungus Phyalophora verrucosa, with a study of the fungus", J. Med. Res., v.32, p.507-21, 1915 (references supplied by Fialho, 1946, p.242, 239). In 1940, Conant and Howel demonstrated a "close parallel" between the agent of Gilchrist's disease and of Lutz's disease and called the agent of South American blastomycosis Blastomyces brasiliensis (Langeron & Vanbreuseghem, 1952).

80 Fialho (1946, p.41) considers this paper confusing, with traces of bad quality, because of the contamination of Splendore's cultures, at least the one that looked like Oidia. His opinion contrasts with that of Lacaz (1960, p.242), who considers all of Splendore's work "very well documented."

81 His interest was so great, Fonseca Filho (1974, p.91) recalls, "that he even taught a course on it in 1914, to a small group of students I was privileged to be part of, in the 19th infirmary of the General Hospital of Santa Casa de Misericórdia do Rio de Janeiro, which held the chair of Dermatology of the Faculty of Medicine."

82 He had not seen the gemmulation that Vianna had observed in pus, making chains of 4 to 5 individuals (Fialho, p.44). According to Fialho, Gaspar Vianna was right.

83 When the First World War broke out, Ficker had to return to Europe The crisis of the Bacteriological Institute culminated in its closure by decree 3.876, of 11 July 1925 (Lemos, 1954; Stepan, 1976, p.142-3). We return to this subject in Volume IV, Book 1, of the Obra Completa de Adolpho Lutz.

84 Almeida took his degree in 1924 from the Faculty of Medicine and Surgery founded in São Paulo in December 1912. Supervised by Ernesto de Souza Campos, chaired professor of microbiology and immunology, he was an intern with Fonseca Filho at Instituto Oswaldo Cruz, and when he left he took fungus cultures to teach medical mycology at the Faculty in São Paulo. He then began to study the etiological agent of Lutz's disease, with Souza Campos (Lacaz, 1983, p.266; on the Medical Faculty see Casa de Oswaldo

Cruz, www.dichistoriasaude.coc.fiocruz.br).

85 Fonseca Filho (1974, p.83-8). According to Lacaz (1983, p.265), it was first described by the German physician Max Rudolph, under the name Figueira.

86 Fifty-two were from the Federal District, 13 from Minas Gerais, 8 from São Paulo, 2 from Bahia, and one each from Rio Grande do Sul and Espírito Santo. Physicians from the city and state of Rio de Janeiro remained a majority until the 1970s (Carneiro, 2002, p.55-6).

87 The report on this trip will be reproduced in another book of the Obra Completa de Adolpho Lutz.

88 Hugo de Sousa Lopes, p.14, tape 1, side B, 1st interview. Departament of Archives and Documentation of Casa de Oswaldo Cruz/Fiocruz.