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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
Dutch dermatologists and their working place Up until the 1960s, almost all dermatologists worked independently in extramural practices and less than 10% of them were women. Today, most work intramurally (often in a partnership), and in 2013 half of the 474 active dermatologists in the Netherlands were women. The field has also changed significantly in terms of content, which can be ascribed to the major economic, social, cultural and medical technological changes of the last 50 years. Since the emergence of the specialism in the second half of the 19th century, and well into the 20th century, it was not uncommon for dermatologists to run clinics in a separate part of their own home. The field was particularly suitable for this approach because the most important diagnostic measure was inspection with the naked eye, sometimes aided by a magnifying glass. For most patients, therapy consisted of nothing more than receiving a prescription, usually for a local treatment. Surgical procedures were kept to a minimum, including the diagnostic biopsy and excochleation and/or electrocoagulation of benign skin tumours and precancerous lesions. Basal cell carcinomas were treated with radiotherapy, also known as contact X-ray therapy, and almost any self-respecting dermatologist owned such a device which, incidentally, was also used for a variety of benign skin conditions. In the 1980s the use of contact X-ray therapy was fiercely debated with regard to therapy-resistant plantar warts. In the 1950s, liquid nitrogen treatment became popular, partly as an alternative to electrocoagulation. Patients with severe, extensive skin disorders such as generalised eczema or psoriasis could be hospitalised for weeks. Many dermatologists therefore had agreements with nearby hospitals, where beds were available. These patients were visited once or more times per week by the dermatologist in order to adjust the local therapy. The shift from solitary practice to hospital began in the 1960s, and continued towards the end of the 20th century. Dermatology had gradually become more complicated, not only through a deeper knowledge of the cause of disease which opened up new diagnostic possibilities, but also through the development of systemic therapies for chronic inflammatory skin diseases, the emer- gence of dermatosurgery, associated with the cancer epidemic and the development of phlebology and cosmetic dermatology. Moreover, dermatologists 18 Röntgen treatment from the early 20th century. BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:39 Pagina 18