Online Exhibits@Yale

The Patients in the Drawings

"As specimens of untouched chromolithography some of our portraits are probably unequalled by anything of like kind either in this country or on the continent and during the last six years…"

So wrote Jonathan Hutchinson, the Society’s secretary, in his Descriptive Catalogue of The New Sydenham’s Society’s Atlas of Portraits of Diseases of the Skin published in 1869 and 1875.  The Catalogue contains case histories for the patients portrayed in the Atlas.

Plate 10-Leucoderma

Plate 10.  Leucoderma, 1864
Modern Term:  Leukoderma or hypopigmentation

Leukoderma, meaning “white skin”, describes a decrease in pigmentation of the skin. Two of the most common causes are post-inflammatory hypopigmentation (partial loss) and vitiligo (complete loss).

Hutchinson provides the case history for this patient, who has leukoderma, in the Descriptive Catalogue, p. 35, and excerpted below:

"W. Miles, aet. 12, well-grown, with jet black hair, and very dark eyes: sclerotics very dark. He has always had pretty good health since the age of four, before which he was 'very delicate, with tightness on his chest.'

His mother noticed the first white patch more than eight years ago. It was very small, the size of a sixpence, and on his chest, at a part where a blister had been applied. It was supposed to be a scar; it is still present, and looks like a very thin scar. From that time to the present the white patches have been gradually increasing in size and number.

"At first sight it might be supposed that the brown parts were the diseased ones, but it is clearly not so. His mother says that he was as brown as now before the white patches  showed themselves; and adds, further, that his sister (in perfect health) is as dark over the whole surface as he is on the non-decolorised parts..."

Plate 42-Lupus erythematosus

Pl. 42.  Lupus erythematosus, 1875

The three major types of cutaneous lupus are acute, subacute and chronic. This patient has the butterfly rash of acute lupus in which nearly all patients have systemic disease.

The Society continued to issue a fascicule, or installment, of three plates each year through 1875, the year of this plate.  The last fascicules were issued in 1882 and 1884.

In this case, described by Jonathan Hutchinson on p. 153-155 of the Descriptive Catalogue, the patient, John B., aged 16, "was a thin delicate lad of fair complexion and blue eyes in whom the disease had existed from six to twelve months.  His parents were living and they, as well as his brothers and sisters, were all healthy.  No skin-disease was known in the family...I have selected this portrait from a considerable number of original ones in my possession because it is one of the most purely erythematous that I have seen..."

Plate 33-Hydroa from iodide of potassium

Pl. 33.  Hydroa from iodide potassium, 1873
Modern Term:  iododerma, halogenoderma

Exposure to halogens, in particular iodides and bromides, can lead to dramatic vesiculobullous eruptions; the lesions may also contain pus but are sterile.

Hutchinson describes the term hydroa and provides a lengthy report on the patient in his Descriptive Catalogue, pp. 110-119. Her case begins below:

"J. C., aet. 50, married. This patient came to the London Hospital on July 5th, 1871, at a time when smallpox was rather prevalent in the metropolis, and the appearance of her face was so suggestive of that disease that she was detained by the gate-porter until she was seen by me. The condition of the face certainly justified the suspicion. Scattered over it were a number of papules of rather vivid red colour. They were most numerous in the central parts of the face (cheeks, upper lip, and nose), and at these parts several had coalesced so as to form patches. There was a similar papular eruption on the fronts and backs of both forearms and hands. There was no eruption on any other part of the skin. I made no note at the time, but my impression a few days after, when writing out the notes, was, that there were some raised red spots on the mucous membrane of the soft palate. The conjunctivae were injected and watery, and she complained of their being painful and of the nose being sore. She bad a good deal of frontal headache..."

Plate 7-Lupus vulgaris et serpiginosus.

Pl. 7.  Lupus vulgaris et serpiginosus (Hebra), 1862
Modern Term:  Cutaneous tuberculosis, lupus vulgaris variant

This variant of cutaneous TB is rare nowadays in high-income countries. Note the centrifugal spread with a serpiginous elevated border and residual central scarring.

Plate No. 7 was the last copied from Hebra’s atlas.

Anton Elfinger, who had trained both as an artist and as a physician, began making detailed drawings of Hebra’s patients in 1846.   His early death from tuberculosis impacted Hebra’s project.

This portrait epitomizes the artist’s careful attention to patient detail, including facial expression.

Two additional reports include a case of Pityriasis versicolor (tinea versicolor) found on p. 41, which gives the reader references to other atlases picturing the same disease, and Molluscum simplex seu fibrosum (Neurofibromatosis), on p. 58-60.

The Patients in the Drawings