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.