Camille Melchoir Gibert (1797-1866): Pityriasis rosea and beyond

The early days

Camille Melchoir Gibert was born in Paris on 18^th August, 1797.³ Between 1818-1819, Gibert worked under Laurent Théodore Biett (1781-1840), an excellent but strict teacher at l’Hôpital Saint-Louis in Paris.⁴ On 7^th May 1822, he obtained his doctoral degree on Quelques réflexions sur la médecine moderne [Figure 2a] and in 1825 was bestowed with a gold medal by the Société de Médicine Pratique for a work entitled Existe-t-il toujours des traces d’inflammation dans les viscères abdominaux près les fièvres putride et maligne? Cette inflammation est-elle cause, effet ou complication de la fièvre? [Figure 2b].²

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Figure 2:

(a). Title page of Quelques réflexions sur la médecine moderne (1822) –the doctoral thesis of Gibert. (Public domain. Credit: books.google.co.in) (b). Title page of Existe-t-il toujours des traces d’inflammation dans les viscères abdominaux près les fièvres putride et maligne? Cette inflammation est-elle cause, effet ou complication de la fièvre? (1825) – the topic on which Gibert was; awarded a gold medal. (Public domain. Credit: gallica.bnf.Fr/Bibliothèque nationale de France).

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Gibert in profession

Gibert appeared for the Competition ad Aggregationem, a challenging and prestigious examination, in 1824 and 1826. He successfully cleared the agrégation, which enabled him to become Professeur agrégé. In 1826, he secured first place, defeating Armand Trousseau (1801-1867), the famous physician of later years.² The topics of the competitions were “Suntne inter hydrothoracem et pleuritidem chronicam certa discrimina quibus dignosci possint?” (1824) and “Sunt-ne cerebri et medullae spinalis nervoses, ab inflammationibus, aliisve organorum laesionibus dignoscendae?” (1826). The first one focused on the clinico-pathological differentiation between pleural fluid and inflammation, and the other on the problem related to the brain and spinal cord.^4,5

From 1831 to 1835, Gibert visited the Department of Dermatology of Hôpital Saint Louis to work as a replacement for Laurent Théodore Biett (1781-1840), Jean Guillaume Auguste Lugol (1786-1851), and Jean Manry (1783-1840).² On 28 January 1836, l’hôpital de Lourcine was inaugurated, and Gibert joined as a physician, working there until 1840.⁶ After Manry, he headed the Hôpital Saint Louis in 1840 and remained there until his retirement in 1863.²

In academia

Gibert began teaching dermatology in 1827 in a private amphitheatre and later at the faculty’s hospice.² After he took up his position at Hôpital Saint Louis in 1840, he followed the footsteps of Jean Louis Alibert (1768-1837) by continuing open-air clinics and teaching in Alibert’s style. Gibert adhered to the Willan school, possibly reflecting the influence of Biett and Pierre Louis Alphée Cazenave (1795-1877). Noah Worcester (1812-1847), who wrote the first American textbook on dermatology, and Henry Daggett Bulkley (1803-1872), another pioneer in American dermatology, were two of his most prominent students. Gibert was renowned for his eloquence and his ability to present difficult topics with utmost clarity. In 1847, he became a member of the Académie de médecine.³

Gibert was a prolific writer, careful, didactic, accurate, and precise in his work. His interest in various subjects within medicine led to the publication of many important works across diverse medical fields [Table 1]. Gibert had a significant opportunity to work on venereal diseases at L’hôpital de Lourcine, which resulted in his very first book, Manuel des maladies vénériennes, published in 1836 [Figure 3]. His most famous work on dermatology was the two-volume Traité pratique des maladies de la peau et de la syphilis, published in 1839 and subsequently edited twice (1840 and 1860).¹

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Figure 3:

Title page of Manuel des maladies vénériennes (1836) by Gibert. (Public domain. Credit: Bibliothèque nationale de France, département Sciences et techniques).

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The pityriasis story

Historically, many authors are believed to have described PR before Gibert. In 1798, Robert Willan (1757-1812) described roseola annulata, Pierre François Oliv Rayer (1793-1867) designated it as erythema annulatum (1828), and Erasmus Wilson (1809-1884) described a probably similar condition, as lichen annulatus (1857).^7,8 However, before Gibert’s accurate description, which recognised PR as a distinct disease in its own right, it was considered merely a morbid entity. In the third edition (1860) of his book [Figures 4a and b], while discussing different varieties of Pityriasis, Gibert wrote:⁹

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Figure 4:

(a). Cover page of Gibert’s Traité pratique des maladies de la peau et de la syphilis. (1860) (b). The page of Traité pratique des maladies de la peau et de la syphilis that first named and described pityriasis rosea. (Public domain. Credit: books.google.co.in and Bibliothèque nationale de France, département Sciences et techniques).

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Another variety that could be referred to as pityriasis rosé, and which offers the following characters: small furfuraceous spots very-slightly coloured, irregular, of an extent that hardly exceeds that of the nail, numerous and close together, although always separated by some interval of healthy, pruritic skin, which spread over the upper parts of the body, from the neck, the upper chest, the upper arms, but can successively spread from top to bottom, down to the thighs, so that the total duration of the operation, which gradually fades into the parts it had initially occupied, as it descends lower down, is quite ordinarily extended for six weeks or two months.

This clear and accurate description was the beginning of PR, and in no time, the entity was termed Pityriasis rosé de Gibert or Gibert’s disease.

The experiment that cleared the doubt and created the controversy

Syphilis was a major health issue in 19^th-century France. Philippe Ricord (1800-1889) was a renowned syphilologist who worked at Hôpital du Midi, a hospital specialising in the treatment of venereal diseases. He conclusively proved that gonorrhoea and syphilis are two different diseases, as was advocated by John Hunter (1728-1793), and this remained uncontested for over 50 years. Ricord, however, believed that inoculating material from the ulcers of secondary syphilis would not cause infection.^13,14 This was challenged by his arch-rival Joseph Alexandre Auzias-Turenne (1812-1870). On 12^th October, 1858, in a letter to the Minister of Agriculture, Commerce, and Public Works, Auzias-Turenne appealed to investigate the controversy.¹⁵ A commission was formed, and Gibert was tasked with reporting its findings. Gibert and Auzias-Turenne inoculated four subjects suffering from lupus but without any syphilitic infection, using purulent matter collected from mucous lesions of a patient with secondary syphilis in its secondary phase. All four subjects developed signs of syphilis, and Gibert reported the results on 24th May 1859. This demonstrated that the secondary stage of syphilis was contagious, disproving Ricord’s argument.¹¹

This experiment caused an uproar in the medical world over its ethical implications. The medical community and media in France deemed it highly unacceptable according to current ethical standards and voiced their opposition to this experiment, which they regarded as morally and ethically wrong.^11,16

Gibert: A man misunderstood?

Gibert was one of the brilliant dermatologists produced by the Hôpital Saint Louis. Ernest Henri Besnier (1831-1909) and Philippe Charles Ernest Gaucher (1854-1918) held him in high esteem for his contribution to therapeutics.² He had a unique personality that led to differences of opinion among his friends and foes. He did not hesitate to follow the English way (of Willan) of classifying skin diseases in the French kingdom of Alibert, but at the same time, he was not an avid follower of the famous French dermatologist Rayer’s method either.^2,3 When we examine his persona, Gibert is portrayed as a proud, unemotional person. In a letter (18^th December,1827) to his teacher Pierre-Fidèle Bretonneau (1778-1862), Trousseau, a brilliant competitor of Gibert, wrote:¹⁷

He is a young man who does not know pathologic anatomy and who has an extreme dread of hospitals and amphitheatres, but he speaks easily and with extraordinary charm. I have not heard of anyone who starts so well as he. He has but one fault, and I already know that it is a capital one: he is cold.

To some, Gibert was a jealous man who tended to harbour animosity toward anyone who offended him. The rivalry with Ricord supports this view. One researcher even believed that this experiment was conducted to defame Ricord. However, in the same article, the author noted Gibert’s regret, as he (Gibert) warned his students against such experiments that conflicted with morality.¹⁶ Although he has been described as cold and harsh in manner, his eloquence and innate ability to present even the most complex issues in an easily understandable way made him a great teacher.¹⁸ Even his arch-rival, like Trousseau, had to admit this.¹⁷