Miroslav Ž. Dinić, Lidija Kandolf-Sekulović and Radoš D. Zečević
One hundred years of dermatovenereology of the Serbian Army was celebrated on November 7, 2009, in the amphitheatre of the Military Medical Academy (MMA). The oldest document in possession of the Serbian Armed ForcesMedical Services is dated on St. George’s Day, May 6th, 1869 and represents a “Daily report of military hospitals”. This document clearly shows the number of patients, and what they suffered from. Moreover, this document shows, among other things, how many patients were suffering from “venereal diseases, red wind, mechanical injuries, base wounds, ulcers, lichen and mange“. Until 1909, the Department of Dermatovenereology did not exist as an independent. Today, the Clinic has 2 divisions (a total of 36 beds), as well as the Laboratory for immunodermatology, Surgical unit, GeneralDermatology Outpatient Clinic, Allergology Section, Phototherapy Section, Dermoscopy and Melanoma Outpatient Clinic. The Clinic is the leader in the treatment of psoriasis, autoimmune skin diseases (pemphigus, pemphigoid), severe forms of atopic dermatitis, erythroderma, skin lymphomas and cutaneous manifestations of connective tissue diseases (lupus, dermatomyositis, sclerodermia), and a dermatologic oncology section is being developed, where systemic therapy of melanoma and follow-up of these patients will be done. Regarding the vision of the future, the main task of the Clinic is to ensure continuous improvement in the field of dermatology in Serbia. The plan is to develop the area of photodiagnostics and phototherapy, which are insufficient in the region. Also, further development of dermatological surgery is planned. Further development of Allergology Service is mandatory, as well as establishment of Pediatric Dermatology, Phlebology and Trichology Outpatient Clinic. Continued scientific research is essential for the development of an academic institution and a prerequisite for continuous diagnostic and therapeutic progress, and a permanent pursuit.
In the early 19th century, after several centuries of slavery, Serbia was liberated and along with the overall organization of the country, health services were formed. The first specialists appeared at the end of the century, among them our first dermatovenereologist, Dr. Jevrem Žujović. He was born in 1860 in Belgrade. He attended high school in Belgrade and in 1885 he graduated from School of Medicine in Paris. Dr. Žujović specialized in dermatovenereology in Paris, with Prof. Fournier as his mentor. He was the first Head of the Department of Skin Diseases and Syphilis at the General Public Hospital since 1889. He organized specialized services all over Serbia. His activity in the work of the Serbian Medical Society was very appreciated. Dr. Žujović studied endemic syphilis and leprosy, and translated A. Fournier’s book “Syphilis and Marriage”, and Loraine’s “Prostitution and Degeneration”. Together with M. Jovanović-Batut, he wrote “Instructions on Syphilis”.
As an Army Medical Officer, Dr. Žujović participated in the Serbo-Bulgarian war (1885), the First and the Second Balkan War and in the First World War (1912 - 1918). He was the vice-president of the Society of the Red Cross of the Kingdom of Yugoslavia, and the first president of the newly-founded Association of Dermatovenereologists of Yugoslavia. He was a recipient of many awards and decorations. Jevrem Žujović retired in 1927, and passed away in 1944.
During the multi-century Ottoman rule, there were no educated physicians in Serbia, and “folk healers” used to treat the sick. Just after the 3rd decade of the 19th century, when the first educated physicians came to Serbia, we can also speak about quackery. At that time, syphilis started spreading and some quacks became “specialists for syphilis”. They were most numerous in the North-East Serbia in the 4th and 5th decades of the 19th century. They represented a major problem, because people believed them more than they believed physicians, while the state authorities of just liberated country, tolerated them. The quacks were not familiar with the clinical features of syphilis, and mostly used mercury to treat it by fumigation and inhalation, rubbing it into the skin, proscribing mercury pills, while symptoms of severe, sometimes lethal intoxication were signs of successful treatment. They also used sarsaparilla. Authorities of the new Government often issued them permission to work, whereas professional control and prohibition of such treatment began in 1839, when the Health Department of the Ministry of Internal Affairs was established.
The most famous quack, “specialist for syphilis”, was Gojko Marković, who was also a “physician” and the first director of the Hospital for the treatment of syphilis in Serbia during a certain period. A married couple, Gaja and Kita Savković, were also well known, as well as Stojan Milenković, a young man in the service of Prince Miloš. There were, of course, many adventurers, imposters, travelling Turkish and Greek physicians, Gipsies, fortune-tellers, old women, and ignorant people of various professions. Their work was banned by the Government.
The seven years’ war (1912 - 1918) and epidemics of infectious diseases, led to a great loss of lives and medical corps of Serbia. As already stated, venereal and skin diseases were spreading in the postwar period that can be seen from medical reports of dermatovenereology institutions. They contain appropriate pathologies and some specific conditions under which they developed. In dermatovenereal pathology, venereal diseases were still dominating. In the outpatientClinic for Skin and Venereal Diseases, 10.000 patients were examined during the period from 1919 to 1921, venereal diseases accounted for 73.13%, whereas skin diseases accounted for 26.87% of all established diagnoses. A similar distribution existed at the territory of Serbia (Belgrade excluded) in 1931: venereal diseases accounted for 73.4%, and skin diseases for 26.6%; moreover, in Belgrade, the situation was even more drastic: venereal diseases accounted for 84.7%, and skin diseases for 15.3%. However, in the student population, the distribution was reversed: 43% and 57%, respectively. In regard to venereal diseases, in the series from 1919 to 1921, non-endemic syphilis was the most common disease, if serologically positive cases (latent syphilis) were added up to the clinically manifested cases. In the same series of patients, syphilis was staged as follows: syphilis I in 10%, syphilis II in 29.3%, syphilis III in 1.7%, tabes dorsalis in 0.8%, and latent syphilis in 56% of patients. In regions with endemic syphilis, from 1921 to 1925, the distribution was as follows: syphilis I in 4%, syphilis II in 49.8%, syphilis III in 18.3%, hereditary syphilis in 1.3%, and latent syphilis in 26.5% of patients. In patients suffering from gonorrhea, balanitis was found in 4.5%, and arthritis in 0.43% of cases. Generally, spreading of prostitution had a significant role, and its abolition was an important preventive action. In regard to skin diseases, in the above-mentioned series of patients, treated at the Outpatient Clinic for Skin andVenereal Diseases (1919 - 1921), scabies was the commonest skin disease (26.7%), eczemas were the second most common (21.8%), followed by pyococcal diseases (20.4%), while fungal diseases (4.5%) and skin tuberculosis (1.9%) were considerably less frequent.
This is the final report about the foundation of modern dermatovenereology in Serbia.
The Pan-Slavic Association of Dermatovenereologists (PSADVs) was founded in May 1928, and it included dermatologic associations of Bulgaria, Czechoslovakia, Poland and Yugoslavia. Its president was Prof. Krzysztalowicz from Poland. The 1st Congress of this association was held in Warsaw in 1929, and the 2nd Congress was organized by the Association of Dermatovenereologists of Yugoslavia (ADVY), in Belgrade in 1931. The president of the Organizing Committee was Prof. Đorđe Đorđevic, and the secretary Assoc. Prof. Milan Kićevac from the Clinic of Dermatovenereology in Belgrade. The Congress was attended by representatives of Slavic national associations, as well as by representatives of French, Romanian, Greek and Turkish dermatology. The number of participants amounted to 160 physicians and 60 members of their families.
According to the report of Ilić S., 104 papers had been presented: 48 from Yugoslavia (37 from Serbia, 3 from Croatia, 3 from Macedonia, and 5 from Bosnia), 23 from Czechoslovakia, 18 from Poland, 8 from France, 5 from Romania, 1 from Turkey, and 1 from Greece.
Most papers were from the area of sexually transmitted diseases: 43 papers (41.35% of the total number). Out of these, 27 papers were on syphilis, followed by gonorrhea with 9 papers. There were both research and experimental papers. The authors insisted on assessing diagnostic and therapeutic issues, as well as disease prevention.
The second most frequent group of diseases accounted for eczema. The problem included the defi nition and pathogenesis of the disease. The third group of diseases was tuberculosis. The results of experiments on animals were studied pointing out the need for reclassifi cation of skin tuberculosis in relation to internal tuberculosis.
A small number of papers were on other infections of the skin and genitals, as well as individual cases of various dermatoses. During the Congress, social events were also organized, as well as a banquet on the ship Alexander I cruising on the Danube and Sava. Optional travel tours to all parts of Yugoslavia were also offered.
Soon after the Congress, foreign journals published reports on its high professional level and the entire organization.
Đorđe Đorđević, a Serb from Croatia, was born in Grubišno polje (Croatia) on April 22, 1885. He studied medicine in Vienna and graduated in 1909. Till 1912, he advanced his knowledge working at dermatology clinics with Prof. Finger and Prof. Arning, as well as with Prof. Weichselbaum, professor of pathological anatomy and bacteriology. From 1912 he worked in Zagreb, at the Dermatology Department of the Brothers of Mercy Hospital, and during World War I as a military doctor at the Dermatology Department and the Zagreb Outpatient Department (Second kolodvor). After the war, in 1918, he moved to Belgrade, where he was the Head of the Polyclinic for Skin and Venereal Diseases, and in 1922 he became an Assistant Professor of Dermatology at the School of Medicine in Belgrade. In the same year, he founded the Department of Dermatovenereology at the School of Medicine in Belgrade and the Clinic for Skin and Venereal Diseases, of which he was also the Head. In 1923, he became an Associate Professor, and in 1934 a Full Professor. He is given credit for passing legislation on prostitution and banning brothels.
The professional work of Prof. Đorđe Đorđević encompasses all areas of dermatology, including his special interest in experimental studies in the field of venereology. He organized medical-research trips to study people’s health status, and his teams visited the South Serbia (today Macedonia), Sandžak and Montenegro. In 1927, he founded the Dermatovenereology Section of the Serbian Medical Society (19) and the Association of Dermatovenereologists of Yugoslavia. He was the chairman of the I, II and III Yugoslav Congress of Dermatology in Belgrade, and of the II Congress of the Pan-Slavic Association of Dermatovenereologists with international participation. He was an honorary member of the Bulgarian, Czechoslovakian, Polish and Danish Dermatological Societies, as well as a regular member of the Association of French Speaking Dermatologists, and of French, German and Biology Society. He was the Vice dean of the School of Medicine.
He died suddenly on April 27, 1935, shortly after his 50th birthday, and was mourned by colleagues, friends and students.
On the first anniversary of his death, his family, friends and colleagues established a ”Foundation of Dr. Đorđe-Đurica Đorđević” meant for ”doctors and health workers”. Unfortunately, the foundation was disestablished in the early eighties of the 20th century.