The Department of Dermatology, Kyushu University was founded more than a century ago, in 1906. Dermatology is a medical science to provide diagnosis and treatment by keeping track of the changes on the body surface. The body surface is subject to various influences such as the lifestyle and living environment of individuals, which is why the visual appearance of the same skin disease differs greatly from patient to patient. The key component of dermatology education is to make the students fully understand diagnosis and treatment by scrupulously describing the skin condition such as rashes, while taking into consideration such inter-individual differences. Today, thanks to advances in computer technology, it is possible to give lectures using vivid color images. But such technologies did not exist in the early 20th century, and so physicians asked their patients to allow students to attend when examining the skin condition just for educational purposes. When patients with rare skin diseases were not available, drawings were used to teach students about the rashes of such diseases. Nevertheless, low-resolution, two-dimensional drawings could not convey the delicate nuances of rashes, and so moulages of skin diseases were created and used for lectures.
A moulage is a wax model, and was indispensable for dermatology lecturers in the days when modern slides were not available. For dermatologists, the word ﾒmoulageﾓ has a familiar historical ring to it.
The Department of Dermatology, Kyushu University now has about 200 moulages. Isaburo (Shouhu) Niijima, who established the Fukuoka Art Association, reportedly crafted about 700 moulage models (Kyushu University Historical Monographs No. 8, p. 63). Fortunately, many of them are preserved in good condition. They are so exquisitely crafted that they can guide us from the initial visual differential diagnosis to the final diagnostic conclusion. Whenever I have time, I bring moulages into the classroom, as their sophisticated construction can fully meet the requirements of modern education. Clinical presentations of skin diseases are diverse, ranging from basal cell carcinoma to herpes zoster and syphilis. The students are first instructed to describe the disease presented by the moulage, and then to give a differential diagnosis and explain the rationale for reaching the final diagnosis. They are instructed to guess, from the moulage, even the age and occupation of the patient, and to consider the cause of disease, pathology, primary disease and treatment method. I can feel and enjoy the history of Kyushu University while delivering these lectures.
Three labels are attached to the wooden frame of the supporting pedestal beneath the moulage. The name of the university (Faculty of Dermatology and Urology, Kyushu Imperial University) and the name of the craftsman are on the left label, the diagnosis of the disease is on the central label, and the name of the professor (Prof. K. Asahi: first professor) is on the right label. These moulage models, first crafted in about 1910, have seen almost the entire 100-year history of the Department of Dermatology, Kyushu University. With the advancement of medical science, the causes of diseases and pathologies have been increasingly elucidated, and some diagnostic terms have changed.
In universities and hospitals with a long history, particularly in Europe, many moulages are preserved, and there are also a number of museums dedicated to moulages. In Japan, too, moulages were made for imperial universities and other universities with a long history, but most have deteriorated or been lost over the years. There are few moulages that have been preserved in such good condition as those at Kyushu University. The collection includes a moulage for noma, a social skin disease that no longer occurs in recent Japan. Moulages remind us of the importance of having a firsthand knowledge of history. I cannot but admire the artistry and craftsmanship of those proud artisans. Moulages are a true treasure worthy of the 100-year history of Kyushu University considering the fact that these moulages of Japanese patients were created by Japanese craftsmen for Japanese medical students, and have been continuously used for so many years.
Lastly, I would like to mention just one point. The diagnostic terms on the labels remain as they were, but I use the current terms of diseases when explaining each moulage. Some labeled terms are wrong in the light of modern dermatology knowledge. In such cases, I use the diagnostic terms that are correct in my opinion, as I feel obligated to fulfill my responsibility as 6th professor of dermatology. I only hope that my diagnostic judgments are correct. I am able to make correct diagnoses many years after the moulage was made, simply because of the faithful reproduction of skin condition on moulage. I stand in awe of the ingenuity of moulage creators.
Isaburo (Shouhu) Niijima, who established the Fukuoka Art Association, reportedly crafted about 700 moulage models (Kyushu University Historical Monographs No. 8, p. 63).