Two Hundred Years of Dermatology Services in London: an Overview.
H.J.M. Malhomme de la Roche, E.V.J. Edmonds, K. Agnew.
(Chelsea and Westminster Hospital)
Br J Derm. 2005; 153 (Suppl.): 53.
Patients have been admitted to the specialty of dermatology for over two hundred
years. The relationship between hospitals and medicine only began after 1795, as
previously hospitals had been shelters for the homeless.
Despite some opposition from general physicians and surgeons, by the 19th
century specialties were beginning to emerge. The specialty of dermatology
developed at this time through the work of the physicians Dr Robert Willan and his
successor Dr Thomas Bateman. Dr Willan is seen as the founder of modern British
dermatology through his systematic observation and classification of skin diseases,
and this was published by Bateman as: 'Practical Synopsis of Cutaneous Disease
according to the Arrangement of Dr Willan’ in 1813.
Dr Willan undertook study of skin at the Carey Street Dispensary in 1783, and in
1802 he opened the Fever Institution, later Hospital, on Grays Inn Road. Dr Bateman
was subsequently elected as the physician at the dispensary and at the Fever
Institution in 1804. The hospital had 15 beds and both Dr Willan and Dr Bateman
would have used their system of classification in the care and identification of disease
in patients with typhus, smallpox and scarlet fever. Dr Bateman also admitted
dermatological patients from the Dispensary to a House of Recovery, documented in
1808.
1802 onwards saw a steady rise in the availability of dermatological inpatient beds
in London. Institutions could be divided into three categories: the original voluntary
hospitals of London that became teaching hospitals, the special hospitals devoted
entirely to skin disease and the public dispensaries that were charitable institutions
catering for the sick poor.
The teaching hospital departments began with the establishment of the University
College Department by Sir William Jenner in 1859, followed in quick succession by
departments opening at Charing Cross Hospital (W. Tilbury Fox, 1860), the
Middlesex Hospital (Robert Lieving, 1879), St Mary's Hospital (Sir Malcolm Morris,
1882), The Westminster Hospital (T. Colcott Fox, 1883), St Thomas' Hospital (
Joseph F. Payne, 1884), King's College Hospital (Anthony Whitfield, 1899), St
George's Hospital (Wyndham Cottle, 1899), The London Hospital (James H.
Sequeira, 1902), Guy's Hospital (Sir Cooper Perry, 1907) and St Bartholomew's
Hospital (H.G. Adamson, 1908).
The special hospitals included The Hospital for the Disease of Skin in Blackfriars
(1841-1948) and, later, St John's Hospital for Diseases of the Skin (1863).
Dispensaries included that at Carey Street as well as the Western Dispensary for
Disease of the Skin (1852-1946).
1946 to the present day has seen a formalization in these practices with
considerable development in the structure of departments although with a notable
reduction in the number of inpatient beds. In the1960s St John's Hospital alone had
over 60 beds. In contrast, at the beginning of 2005 there are less than 50 designated
dermatology beds across the London area.