Ferdinand Ritter von Hebra: Founder of modern dermatology

INTRODUCTION

Von Hebra (1816–1880) was rightfully called a founder of modern dermatology. He dedicated his life to studying and discovering various skin conditions even in the dark ages when there were many misconceptions about the pathology of skin diseases. He laid the foundation for present-day dermatology making it a separate branch of medicine. He established the Vienna school of medicine as a dermatology training and research center in Europe.^[1,2]

EARLY LIFE AND CAREER

Ferdinand von Hebra was born in the city of Brunn in Moravia, Austria on September 7, 1816 [Figure 1]. His father, Johannes, was a military official with the rank of an officer in the imperial army. He completed high school at Judenberg monastery in Styria and spent 2years in philosophical studies at the University of Graz in Styria. He graduated from the University of Vienna with a medical degree in the year 1841.^[1] He was appointed as an assistant in the department of medical jurisprudence under the guidance of Rokitansky, who taught pathology at the university. His keen observation and description of the postmortem examination enabled him to gain knowledge in pathology.^[2,3]

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Figure 1:

Ferdinand Ritter von Hebra (1816–1880).

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DERMATOLOGY BEFORE THE ERA OF VON HEBRA

Dermatology was practically non-existent before Hebra began his work in 1841. The prevailing knowledge of dermatology in the early part of the 19^th century was because of the brief interest in dermatopathology by the physicians and pathologists of Germany, England, and France, notably, Plenck, Willan, Bateman, Biette, Rayer, and Alibert. There was no effective communication and research based on critical observation and no attempt to modify the existing knowledge about skin diseases.^[1]

In the mid-19^th century, dermatological pathology was strongly influenced by humoral theory. This popular conception taught that there were four basic body fluids and imbalance in them would cause diseases in humans.^[1] Furthermore, skin diseases were not considered as separate entities but as cutaneous manifestations of internal diseases. This idea dominated the scientific world and was taught that the blood cleanses itself of its herpetic or scabious contamination. This was followed by the rejection of local skin therapy for the fear of damaging the internal organs. During this period, treatment of skin diseases included placing them in quarantine to avoid contagion. Both the patients and researchers involved in skin diseases were held in low esteem.^[1,4]

CONTRIBUTIONS, TITLES, AND HONORS

Joseph Skoda, the clinician, pathologist, and the chief of the chest disease clinic at Vienna General Hospital made Hebra his assistant and posted him in “Scabies station.” It was the first time Hebra came in contact with skin disease patients. During this time, Hebra developed an interest in dermatology and demonstrated his skills of critical observation and deduction. Skoda encouraged him to devote all his time and specialize in this field to develop the science of dermatology. He also made Hebra the head of “Scabies station” and provided him with all the resources required to improve his skills and guided him further.^[1,4]

Hebra, in the next few months, began his lectures on the explanation and presentation of skin disease classification to a group of interested physicians. Over years, his lectures gained popularity as they were practical, straightforward, and witty. Dermatology began to be recognized as a teaching specialty.^[1,2]

Hebra, after years of studying, research, and clinical observations achieved through the methods suggested by Skoda and Rokitansky has put forward the concept that all skin diseases are due to local irritants and suggested local remedies.^[2,4] He concluded that scabies was caused by a mite and rejected the humoral theory. He described several other skin conditions such as eczema, erythema exudativum multiform which is now called herpes-related erythema multiform, seborrhea congestive which he later discovered to be a form of lupus erythematous, and rhinoscleroma.^[1-4]

In the late 19^th century, Hebra used chemical peels for skin resurfacing and pigmentary concerns like freckles. He used croton oil, phenol, and nitric acid in various combinations. He repurposed the use of mercury for the treatment of syphilis.^[4]

Hebra had published many books and 32 articles in dermatology. Throughout his professional life, he received many titles and was knighted and honored [Table 1].

LATER YEARS AND SUCCESSOR OF HEBRA

Hebra suffered from chronic bronchiectasis since childhood. His health was complicated by cardiomegaly, congested liver, and kidneys. In the past weeks of his life, he suffered severe asthma and dropsy. He died on August 5, 1880, and was buried in Hernals, Austria next to Skoda and Rokitansky.^[1]

Hebra’s doctrines were succeeded by his son-in-law, Moritz Kaposi, who became the head of the dermatology department at the University of Vienna. Although not a pioneer by himself, he continued what was begun by von Hebra and was considered a cofounder of modern dermatology. He also made significant contributions to dermatology including the description of “Kaposi sarcoma.”^[3]

CONCLUSION

Hebra’s motto, “Never abandon a case as hopeless, but continue to study it based on knowledge of its pathology and etiology until you find some way to help”^[1] stands inspiring till date to all dermatologists. By shaping modern dermatology, he rightly deserves his place among the pioneers of dermatology.