Professional interest in dermatopathology of Stanisław Ostrowski – the only one State Polish President among physicians

Introduction

Stanisław Ostrowski (1892-1982) was an excellent dermatologist with detailed insight in diagnosis and treatment of skin disorders to obtain associate professorship of King John Casimir University of Lvov (Uniwersytet Jana Kazimierza we Lwowie – UJK) and later to become municipal president of Lvov and president of Polish Republic on Exile in London (Fig. 1) [1]. Stanisław Ostrowski was born on October 29, 1892 in Lemberg (Lvov) in Austro-Hungary and died in exile in London on November 22, 1982 [1, 2]. In the first half of his lifetime, his home town community experienced turbulent history. Namely, Lvov was occupied during World War I by troops of the Russian Empire for a year, to return under Austrian control in 1915 and to later become the arena Polish-Ukrainian fights in 1918 and 1919. Lvov stopped the offensive of the Red Army in 1920 on the outskirts of the city in heroic struggle of Polish municipal society. The military resistance of youngsters known as Lvovian Eaglets was remarkable against Ukrainian troops. So much instability has affected the fate of its inhabitants including Stanisław Ostrowski, who, having been appointed a physician, participated in all these battles as a military medical doctor and in this position he earned a deep respect and esteem, which helped him govern the city later on. Then, Lvov became the third largest city of the reborn Polish Republic, in which Ostrowski in 1934-1936 was vice president, and 1936-1939 president [1, 2] (Fig. 1). The interwar period was happy not only for the development of the city but also for professional development and stability in the personal life of Stanisław Ostrowski, who married Kamila and raised son Stanisław. In 1925-1927 Ostrowski worked in Warsaw with Prof. Franciszek Krzyształowicz. From 1927 he rejoined his Alma Mater of the King John Casimir University of Lvov where he obtained habilitation in 1930, and in 1931 he was employed in position of associate professor. His military service and loyal devotion closely associated him with the Marshall Józef Piłsudski with further implications on his political career. Ostrowski was conscientiously three times elected Member of Parliament (Polish: Sejm) in 1930, 1935 and 1938 [2]. In the lower chamber of Polish Parliament he was involved in public health and social security issues [2]. He also defended the rights of national minorities and was a supporter of Polish-Ukrainian reconciliation [2]. His accomplishments as a deputy include the work on the great social security reform in Poland, which resulted in the merger of five financially insufficient social insurance companies into one Social Insurance Institution (Polish: Zakład Ubezpieczeń Społecznych), which received solid organizational and financial foundations, to function in Poland (with a break for years Until 1955-1960) until now. The Social Security Act of 28 March 1933, which was construed partly by Stanisław Ostrowski, survived the constitutional changes and was abolished only on January 1, 1999 with further, possible, unwelcomed consequences for social insurances of retiring Polish citizens [3]. It is particularly interesting for the Readership of Polish Pathologists to note that in the parliamentary aspect, far-reaching analogies can be drawn up between a deputy of Polish Seym Stanisław Ostrowski and a celebrated, world famous pathologist, Rudolf Ludwig Karl Virchow (1821-1902) – a member of German Parliament (Reichstag) and a founder of the nursing school at Friedrichshain [4]. Namely, Stanisław Ostrowski might have been familiar with Virchow’ pioneer approach to the cooperation of medical doctors with nurses. Thanks to Ostrowski’s efforts, the Polish Sejm of the third term of office adopted the Nursing Act of 21 February 1935 [5], which defined the legal and organizational framework for the profession of the nurse in Poland for next 61 years. Therefore, his long-lasting merits as legislator should be recognized. In 1939, under the Ribbentrop-Molotov Pact, the Soviet Red Army started occupation of Lvov without warning and the president Stanisław Ostrowski was arrested, interrogated in the miserly prison of Lubyanka and Butyrki, and finally sentenced to 8 years in prison in a work camp. He was separated for 17 years from his wife and his only son was killed in wartime. In remote Siberia, he worked as a lumberjack and a camp physician saving the lives of his fellow prisoners. Released in 1941, he joined General Władysław Anders’ Army and once again became a military physician at the fighting route of Polish 2nd Corps through the Middle East and Italy. After the war he could not return to the USSR-dominated country and remained in exile in Great Britain. He remained a practicing, medical doctor there holding a position of head of the dermatology ward in hospital in Penley with his scientific activity becoming somewhat narrower, devoted primarily to social and organizational activities. After retiring in 1962, he became involved again in politics. Thanks to his unquestioned authority, he led the unification of the struggling parties of Polish emigration and became the President of the Republic of Poland in exile. The term of his office (1972-1979) was associated with the rebuilding of the authority of Polish government on exile, the promotion of the idea of human rights and the desire for harmonious cooperation with the representatives of the peoples of the enslaved-by-communists Central and Eastern Europe [1, 2] (Fig. 2).
On ground of medical profession, Stanisław Ostrowski followed a standard pathway of close co-operation between clinical dermatology and dermatopathology of his great tutor, professor in Cracow and Warsaw, Franciszek Krzyształowicz (1868-1931), who tested various histochemical techniques of staining dermal fibers particularly elastin and Professor of UJK, Jan Tadeusz Lenartowicz (1877-1959) who searched for new methods of microscopic detection of spirochetes in blood [6, 7]. Stanisław Ostrowski shared his masters’ interest in syphilis, skin inflammation and erythema and did not neglected microscopic studies of such lesions [1, 6, 7]. Lvov University was an excellent place for development of dermatopathological interests of Stanisław Ostrowski as the clinical laboratory of Dermatological Department of UJK was equipped with three Zeiss microscopes and the microtome in the early 20th century in Lvov [8].

Methods

In this current study we collected and analyzed original resources, which mainly are the reports of his own authorship that refer directly to histopathology of skin lesions. Original works by Stanisław Ostrowski were provided from private collections of the authors of this paper, international repositories, Warsaw University Library, National Library in Warsaw and Section of Special Collection, Stanisław Konopka Main Medical Library Warsaw Jazdów 1A street, 00-467 Warsaw [Główna Biblioteka Lekarska im. Stanisława Konopki Dział Zbiorów Specjalnych, ul. Jazdów 1A, 00-467 Warszawa]. Online catalog of 1901-1939 publications on http://195.187.98.5/].

Results – dematopathological evalutions of Stanisław Ostrowski

In Warsaw and Lvov Stanisław Ostrowski became a meticulous dermatologist who was greatly interested in histopathology of cutaneous manifestations of diseases or skin reactions to various modes of therapy [1]. Antituberculous gold therapy gained popularity thanks to Danish physicians after Robert Koch noted limited effectiveness of gold cyanide against cultures of Mycobacterium tuberculosis [9, 10, 11]. In 1924, Moellegaard from Copenhagen introduced a new therapuetic gold agent sanocryzine. Ostrowski used Aurosan Spiess identical to sanocryzine [11, 12, 13]. He examined skin lesions in response to injection treatment of tuberculosis with gold preparations like Aurosan, administered intravenously and intramuscularly to 50 patients [12]. He noted that almost 30% of his patients developed side-effect symptoms of toxic allergic dermatitis in the form of skin eruptions like erythemas, papules and rarely vesicles. He observed toxic, exfoliative dermatitis with aurokeratosis, eczema skin rash and discoloration predominantly on extremities [12]. In cooperation with Associate Professor Helena Schuster (1884-1949) from Institute of Anatomical Pathology headed by Professor Witold Nowicki (1878-1941) Stanisław Ostrowski reported following microscopical findings: epidermal thickness, hyperkeratosis with keratocysts (Fig. 3) at the top of hair follicles with elongation of epidermal ridges and broadening and elongation of dermal papillae, oedema and vacuolization of keratinocytes with spongiosis and retention of melanin. In addition he noted lymphocytic infiltration of dermis in vicinity of hyperemic blood vessels [12]. He categorized these findings as an reactive changes in course of toxic dermatitis [12]. Doing so, Ostrowski examined eventual toxicity of gold injection preparations, which were finally withdrawn from its therapeutical use due to outweigh of its unwelcomed, side effects over its antimicrobial benefit [10, 12, 13].
Next on the basis of his close cooperation with from Institute of Anatomical Pathology headed by Professor Witold Nowicki Stanisław Ostrowski focused on histopatological evaluation of skin sebaceous lesions at the time when no Polish officially recognized nomenclature existed for such cutaneous tumors [14]. In consequence, he correctly diagnosed one of such tumors as naevus epitheliomatosus sebaceus Wolters-Friboes, but erroneously he make the Latin name of the lesion consistent with Polish equivalent of sebaceous adenoma in his Polish paper in “Dermatological Review” (“Przegląd Dermatologiczny” [14]. However, in his German-written paper which was published by “Acta Dermato-Venerologica”, in Stockholm, in 1928 on the same topic, he correctly preserved only the latin term naevus (epitheliomatosus) sebaceus unilateralis capitis [15]. This latter paper of his authorship merited such an recognition that it was cited in a renowned dermatopathology handbook titled: Histologie der Hautkrankheiten written by Frankfurt-am-Main University Professors Oscar Gans and Gerd-Klaus Steigleder and published by Springer Verlag in 1957 as well as by Professor Peter Wodniansky from Vienna in a book entitled: Nicht Entzündliche Dermatosen III by Springer Verlag in 1975 [16, 17]. Ostrowski justified his study of naevus sebaceus due to rarity and variation of microscopic appearance in spite of similarity of clinical picture of lesions of sebaceous nature [14, 15]. Namely he described 4 × 1.5 cm large elevated pink-yellowish, hairless, itching lesion, studded with hair pits of 33-year old man. He found tumor-like mass of enlarged benign sebaceous glands that consisted with mature sebocytes without notable rate of basaloid cells within periphery of glands in close proximity of hair follicles accompanied with accumulation of dilated sweat glands (Fig. 4). Overlying epidermis was thickened and presented with papilomatosis [14, 15] (Fig. 4). These features favor diagnosis of sebaceous nevus over sebaceous adenoma or sebaceous hyperplasia [18, 19]. Thus, based on the provided description and microscopic illustration of the lesion, the tumor was precisely sebaceous nevus according to current classification as the Latin term he used [14, 15, 16, 17, 18, 19]. Actually as Ostrowski’s publication on sebaceous nevus was cited in handbooks [16, 17], it can be presumed that Stanisław Ostrowski contributed to recognition of this entity on international scale. It is remarkable that Stanisław Ostrowski wrote that he preformed technical processing and staining of the material for microscopic evaluation in following way in his report on neavus sebaceous in Dermatological Review: “I sliced the sample in celloidine, then stained with haematoxylin-eosin, methylene blue and Papenheim stain, orcein for visualisation of elastin fibers and Sudan III for staining of fat tissue” [14].
Among quite numerous of his publications Stanisław Ostrowski together with Tadeusz Chorążak provided detailed description of Fox-Fordyce disease (apocrine miliaria) both on macroscopic and microscopic level for Polish readership before World War Two [20]. Actually, the publication titled “Fox-Fordyce’sche Krankheit mit eigenartigem Verhalten des Vegetativen System”, was originally published in “Acta Dermato-Venereologica” in Stockholm in 1928 and then was translated into Polish and the following year appeared in the “Dermatological Review” [21]. He illustrated cases of nodular exanthema in axillary region with strong pruritus causing deprivation of dream in female population [20]. Histologically, he reported accumulation of sweat glands of distended excretory ducts with its content with fine and exhaustive description of ecrine and apocrine sweat glands of skin with a fine photographic illustration provided by Helena Schuster (Fig. 5). Overlying epidermis was characterized with acanthosis and focal parakeratosis and keratin plugs in orifices of glands that were hyperactivated and simply dilated with extended production of excretion. The presented descriptions of dermatological entities are concise, easy-to-read and accompanied by microscopic illustrations [8, 14, 15, 20, 21] pointing at Ostrowski’s high academic skills.
Thus, Stanisław Ostrowski closely cooperated with Henryk Hilarowicz whose admiration for tissue structure was characteristic in his family- and pathologists like Helena Schuster and Witold Nowicki to provide the best clinic-pathological approach to skin lesions [8, 14, 20]. Stanisław Ostrowski frequently benefited from the hospitality of the Department of Pathology. Memories of Stanisław Ostrowski’s colleague from that period, future professor Henryk Mierzecki (1891-1977), are the best documentation of such an collaboration [22]. Not only Nowicki worked in one Faculty with Stanisław Ostrowski, but also was a Prosector of the State General Hospital in Lvov, where Ostrowski was a head of the department of the Skin and veneral disease. Thanks to the courtesy of Professor Witold Nowicki, the clinical assistants (including Stanisław Ostrowski) were able to participate in all body dissections, including: autopsies of patients treated with arsenobenzoles, which resulted in numerous publications of the future President of Poland [23, 24, 25]. This cooperation was also eased by proximity of academic institutions. Namely, the Institute of Pathological Anatomy which gathered open-minded academic workers at the King John Casimir University in Lvov was located on Piekarska Street 52 opposite the department of Dermatology, where Ostrowski worked, located at Piekarska Street 69. In the histological section of Department of Pathology there were besides photographic darkroom and laboratory for histopathology three offices for guest assistants of other research institutions and volunteers. Integration of community of academic employees determined common scientific interests of the staff and favored intensive cooperation thus being indeed much more important than comfortable proximity of neighboring university buildings [22].

Discussion

Scrutiny of Stanisław Ostrowski is evidenced in detailed, dermatopathological evaluations in his several reports [8, 14, 15, 20, 21] that were preformed in close cooperation with Institute of Anatomical Pathology of Lvov University. With similar precision he put in order the municipal administration of Lvov, holding an office of president of the city from 1936-1939 [1]. Lvov municipal investments of the presidency of Stanisław Ostrowski resembled priority projects implemented in Berlin thanks to the involvement of the German pathologist Rudolf Ludwig Karl Virchow (1821-1902), who was extremely popular Berlin councilor continuously for 43 years [26]. The similarity between the social programs implemented in the self-government practice by both outstanding physicians is striking. According to one vice-presidents of Lvov at the time of presidency of Stanisław Ostrowski, philanthropist, banker, social and cultural activist, victim of the Katyń Crime, Wiktor (Wigder) Chajes (1875-1940) (whose financial genius enabled modernizing city investments and sanitation of municipal finances), Lvov of the early 30s did not resemble in the contemporary daily press anything of the idealized image of Lvov in the later reminiscences of Polish repatriates [27]. Extremely high unemployment, the associated riots and demonstrations brutally pacified by the police, and the very low standard of living of the labor workers were symptoms of severe economical crisis [27]. Fortunately, “Professor Stanisław Ostrowski knew how to live not only with Poles of other political backgrounds, but also with all Polish citizens of other nationalities or religions, and was able to find a common language for solving serious public affairs” – it was invaluable in the interwar Lvov and among the disintegrated emigration in London [28]. Ostrowski saw the possibility of reducing unemployment through the widespread employment of the unemployed people in public works for the benefit of development of the city and the region [29]. They worked on repairs, rebuilding of street surfaces, repairs of urban sewage, urban greens and earthworks [29]. Exhibition halls were built to maintain small trade in hygienic conditions. In case of the inevitable outbreak of war, the administration of President Ostrowski also invested in communal blocks of flats, building of public baths connected to the shelters, development of water supply system and the network of public toilets. He developed public city transportation with reconstruction of the existing network and construction of new lines as well as the purchase of new trams. He initiated a foundation of a large hospital for terminally ill people as well as the construction of further schools and kindergartens. His presidency was a also time for starting a project of modern bus station of Lvov [29]. Achievements of Stanisław Ostrowski are provided here as examples of deep integrating scope of actions of this excellent observer and diagnostician of public life in the city of Lvov. The organizational success required detailed diagnosis harmoniously grounded on wise selection of variation of numerous factors both in work of Lvov municipal president and dermatologist with such a dermatopathological scrutiny. As sometimes dermatopathological evaluation is associated with high demands of discipline and patience, his calm nature enabled him to unite divided political elite in London under his authority as a President of Polish Republic on Exile [1]. Stanisław Ostrowski was censored in the Polish People’s Republic (Polish: Polska Rzeczpospolita Ludowa) until 1989 due to political background of the interwar period: membership of “bourgeois” parliament and municipal city council and president of the largest city of the Second Polish Republic seized by the USSR, and above all, holding the position of President of Polish Republic on Exile (1972-1977). His publications, which were cited mainly by notable West-European, German-speaking dermatologists in the second half of twentieth century, were not propagated in Poland or even recognized. The restoration of the memory of Stanisław Ostrowski is of great advantage for consciousness of Polish community, not exclusively for Polish Pathologists, but for the whole Nation, who is left without such a great statesman, a truly healing physician of Polish State as Stanisław Ostrowski was.

Conclusions

Stanisław Ostrowski is a great example of soldier, dermatologist with close cooperation with dermatopathologists and a statesman of extraordinary peace of mind that helped him to harmonize with conflicted society of pre-war Lvov, to survive Soviet imprisonment and military campaigns of both of World Wars and in last to achieve an political agreement among antagonized Polish emigrants in London.

M.W. and P.W. are greatly indebted to Professor of history at Warsaw University, Andrzej Woltanowski (1942-1996), a close Tutor that grounded his publications on primary original resources with heroic effort in search of archives in pre-internet era, for all lessons of academic honesty and devotion to historical truth.
The authors declare no conflict of interest.

References

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Address for correspondence

Andrzej Wincewicz MD, PhD, FEBP
(Professor of UJK from 2013 to 2016)
Non-Public Health Care Unit
(NZOZ Zakład Patologii Sp. z o.o.)
Jagiellońska 70
25-734 Kielce, Poland
e-mail: andwinc@gmail.com