Robert Willan – A true pioneer

EARLY LIFE

Robert Willan was born on November 12, 1757, at Hill, near Sedburgh, in Yorkshire, to a Quaker family. He attended medical school at the University of Edinburgh (one of the best medical schools of that time) from 1777 to 1780 and was an officer for both the Royal Medical Society and the Physical Society during that time. In 1780, he earned his MD on the basis of his thesis “On Inflammation of the Liver.”^[1]

MEDICAL CAREER

Willan worked as a physician at the Carey Street Dispensary in London from 1783 to 1803, spending much of his medical career caring for the poor and underprivileged. His practice there must have provided him with a plethora of dermatological conditions – proximity, filth, squalor, and the lack of baths or bathing leading to all types of dermatological diseases.^[3] He was also influenced by Andrew Duncan, who worked at the Public Dispensary in Edinburgh, who, in his records of his medical cases, published in 1777, highlighted the lack of satisfactory classification of cutaneous diseases.^[2]

CONTRIBUTIONS

Willan’s major contributions to dermatology can be grouped into two - he was the first to introduce a classification system for skin diseases and he was the first to give detailed clinical descriptions of many diseases. The classification system as well as the disease descriptions were mainly focused on morphology of lesions rather than on etiological or pathophysiological characteristics.^[1]

The classification system for cutaneous diseases, proposed by Wilan, was influenced by the Linnaean system of classification of the plant and animal kingdom (binomial system) and stands as testimony to his excellent observational skills.^[3]

His classification system was composed of eight orders: Papulae, squamae, exanthemata, bullae, pustulae, vesiculae, tubercula, and maculae. Orders were subdivided into genera, which were further subdivided into different species. For example, the squamae order included four genera: Lepra, psoriasis, pityriasis, and ichthyosis. The genus Pityriasis contains the species capitis, rubra, and versicolor (a Linnaean-based classification).^[3]

In 1808, Willan published “On Cutaneous Diseases, Vol. 1,” with a detailed description of the first four orders: The papulae, squamae, exanthemata, and bullae. It also included detailed illustrations of plates made from watercolor drawings, making him the first person to recognize the importance of illustrations in the description of skin disorders.^[3] He was the pioneer of clinical photography, something indispensable in our current day-to-day practice and academics.

Willan was the first person to give the correct and detailed clinical descriptions of many diseases such as prurigo, impetigo, and psoriasis. Willan’s description of psoriasis was highly accurate, but the claim that every recurrence was preceded by intolerable itching was rejected by later authors. He was the first to give a good medical account of psoriasis, calling it lepra graecorum, and recommended a local application of tar as its treatment. He observed that exposure to cold and wetness caused recurrences of the disease, especially in the spring and autumn.^[1]

He was also the author of the first atlas of skin diseases, containing colored pictures.^[4]

Willan intended to publish his second volume of “On Cutaneous Diseases,” which was to address his remaining four orders, but unfortunately, in 1811, he developed hemoptysis while caring for a patient and died on April 7, 1812, in Funchal, Portugal.^[3]

Fortunately, his legacy did not die with him; his mentee, Thomas Bateman, helped solidify his mentor’s legacy by successfully completing Willan’s “Cutaneous Diseases” in 1817. Bateman’s work, titled Delineations of Cutaneous Diseases, Exhibiting the Characteristic Appearances of the Principle Genera and Species, Comprised in the classification of the late Dr. Willan, which included the remaining 4 orders that Willan had not been able to complete himself, and incorporated illustrated plates from Willan’s own collection of watercolor drawings.^[3]

More than 200 years have passed since the landmark publication of Robert Willan’s Cutaneous Diseases, yet he is reverently remembered as the first prominent physician who gravitated toward the diagnosis and treatment of skin disease at a time when little attention was paid to the body’s largest organ. Having pioneered the descriptions of the morphology of skin diseases, his observations propelled the study of cutaneous medicine which led to the establishment of dermatology as a distinct discipline in the 19^th century.^[1]

As dermatologists of today, we will be forever grateful to this remarkable physician, for giving us the terminologies such as papules and macules that we cling to in our day to day practice, for giving us the importance of illustrations in learning and practicing dermatology and for being a benevolent doctor who went above and beyond to cater to the needs of the sick and indigent.