Papillary tip bleeding or the Auspitz phenomenon: a hero wrongly credited and a misnomer resolved.

H istoric investigation can unearth facts that invalidate details of teaching in medical schools and residency programs. The socalled Auspitz phenomenon is a good example; it is a misnomer. Heinrich Auspitz (1835-1886) was the early star among Ferdinand Ritter von Hebra’s pupils. Two years older than Moritz Kaposi (Kohn), dealing with histopathology and systematization earlier on, and editor (with Filipp Josef Pick) of the Archiv fur Dermatologie und Syphilis in 1869, he dropped out of Vienna University only in 1872 when he founded the Wiener Allgemeine Poliklinik and put himself in juxtaposition with Hebra (and Kaposi). Some time ago, while still in Jerusalem (K.H.), the centenary of his demise was addressed.1 Thoughts relating to this clinical sign, eponymously termed “Auspitz,” surfaced then but remained unpublished and have not been pursued until now. Major current texts such as Fitzpatrick’s DIGM2; the volumes by Rook et al (Champion et al3); Ackerman’s dermatopathology text4; Leider and Rosenblum’s dictionary,5 including Carter’s edition of 19926; and recent reports7,8 associate the papillary tip bleeding that occurs after scratching off the scales of a psoriatic papule with Auspitz’s name. However, the French Dermatologie et Venereologie of Saurat et al9 and, most remarkably, the (Austrian-only) volume by Fuhs and Kumer10 do not. Teachings in medical school and during residency in Vienna, Austria, where Auspitz lived, worked, and died do not mention any Auspitz phenomenon. “Why? ” one might ask. Auspitz and Kaposi, two of the many Jewish assistants Hebra had in his fold, obviously were not the best of friends but, rather, emotional competitors. Kaposi,11 in the hailed, second French translation of his textbook, mentions the capillary tip bleeding but makes no relation to Auspitz. In a footnote by the translators Adrien Doyon and Ernest Besnier, the fact is addressed that both Devergie jeune and Hebra (eg, in 186012 and 184513) had observed this clinical sign earlier. We could not find evidence of this in Devergie’s textbook, but had no access to his extended bibliography. Going back in time, one may find that, surprisingly, Robert Willan14 already addressed this fact while writing on psoriasis (“. . .should any portion of the diseased surface be forcibly excoriated, there issues out a thin lymph, mixed with some drops of blood*. . .”). Even more interestingly, the asterisk points to a reference of Joseph Plenck15 in Vienna, Austria, which reads: “. squamae. quae tam digitis aufferi possunt, quam per sudores decidunt, quibus demptis profluit sanguis. ” Going further back in time, one arrives at Daniel Turner’s treatise16 (“. . .as to the Strata above-mentioned, I had lately an Opportunity of remarking them, in an Elephantiatical Patient, on the Inside of whose Knee a large Lichen, or impetiginous Eruption, was seated, accompanied with great itching: Whence, upon rubbing, a Scale should throw off, and a fresh one regenerate in few Days. For curiosity sake, I raised one of these, near the Compass of an half Crown; in one Part it adhered to that subjacent, and forcing the same off with the Edge of my Spathula, several small Specks of Blood appeared underneath;. . .”). At this point in time and in historical investigation an additional difficulty emerged, which, so far, has not been overcome. Before Willan (the first printing of the first order of his textbook was in 1798), there is no dermatology in the modern sense. Sifting From the Institute for the History of Medicine at University of Vienna and Croatian Academy of Sciences and Arts, Zagreb. Funding sources: None. Conflict of interest: None identified. Reprint requests: Karl Holubar, MD, FRCP, Institute for the History of Medicine, University of Vienna, Wahringer Str 25, A-1090 Vienna, Austria. E-mail: KH.histmed@univie.ac. at. J Am Acad Dermatol 2003;48:263-4. Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 0 doi:10.1067/mjd.2003. 89