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GIOVANCOSIMOBONOMO(16631696):Discovereroftheetiologyofscabies
InternationalJournalofDermatology199837(8):625630
MarciaRamoseSilva,MD,PhD
AssociateProfessorofDermatology
FromtheSchoolofMedicine,HUCFFUFRJ
UniversidadeFederaldoRiodeJaneiro,Brazil
PresentedattheSymposiumoftheHistoryofDermatologySociety
March201997,SanFrancisco,California,USA.
INTRODUCTION
Thehistoryofthediscoveryoftheagentofscabiesandofthediseaseitselfisfascinatingand
controversial.1Articleswithcompletelydifferentinterpretationsonthissubject,reportingconflicting
storiesandraisingquestionsarefoundintheliterature.
ThedrawingsmadebyBonomoin16872provethathedidactuallyobserveandstudytheagentof
scabiesbackintheseventeenthcentury,1(Figure1)butwhowasfirsttodescribetheparasitic
etiologyofscabies?WasitFrancescoRedi,GiovanCosimoBonomo,DiacintoCestonioreven
someonebeforethem?WereBonomoandCestonithesameperson?WasGiovanCosimoBonomoa
pseudonymforDiacintoCestoni?Didtheystudythemitetogetherorseparatelyalmostduringthe
sameperiod?

Figure1:Bonomo'sdrawings2
Thesequestionsandmanyothersaboutthediscoverersofthismitearestilldisagreedaboutand
somewillneverbesettledbecausetheexistingdocumentationiseitherincompleteorlost.
Althoughitsagentwasnotrecognizedanditscausewasattributedtoahumoralnature,scabies
wasprobablyalreadyknownbyAristotle(384322BC),whowasthefirsttousetheterm'akari'to
designateawooddwellingmite.Scabieswasmentionedbymanywritersindifferenttimes3anda
descriptionoftheconditionwasfoundinanArabianmanuscriptwrittenbyaphysiciancalledAbuel
HasanAhmedelTabari,ofTabaristan,wholivedaround970.4Inthetwelfthcentury,Saint
Hildegard(10981179),AbbessoftheRupertsbergConvent,nearBingen,wroteabooknamed
'Physika'whichincludesthefirstactualreferencetotheAcarusscabiei,andAvenzoar(10911162),
aMoorishphysicianpracticinginSpain,describedwhatwouldseemtobethemitebutdidnot
relateittotheitch.5,6
ScabieswasknowninEuropebyvariousnames.ItwasgalefortheFrench,itchfortheEnglish,and
KrtzefortheGerman.Inthosedays,itwaswidespread,speciallyamongpoorpeoplewithbad
hygiene,exactlyasitistoday,butevensomeimportantandwealthypersonsalsohadthe
disease.6,7ThiswasthecaseofNapoleonI,whoseemstohavesufferedfromtheitchduring
almosthiswholelife.7Oneoftheoldestacademicsocietiesintheworld,theCruscaAcademy,
foundedinFlorencein1582,defined'pellicello',atermusedforSarcoptesorAcarusscabiei,inthe
secondeditionofitsdictionary,publishedin1623,as'atinymitegeneratinginthescabridden
skin,thebitingofwhichproducesacuteitching'.8
AlthoughthemitewasknownlongbeforeBonomodescribedit,asiswidelydocumented,itwasnot
consideredthecauseofthediseasewhichwasbelievedtobeofhumoralnature.Galen(129200)
attributeditto'melancholicjuices'Avicenna(9801037)to'corruptblood'andVelamonteto
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'pungentferment'.Thosewhorecognizeditscontagiousnessexplaineditastheeffectofthehumors
andfermentsevaporatingfromthebody.6Duringthisperiodtherewasnodoubtaboutthedoctrine
ofspontaneousgeneration.Itwasaccepted,sincethetimeofAristotle,thatliceoriginatedfrom
meat,fleasfromfilth,andmothsfromwool,andthatthepresenceoftheacarusontheskinof
scabiespatientswasconsideredaproofofthecorruptionofthefleshandbloodcausedbyinternal
ailment.3,6
Theseventeenthcenturywascharacterizedbytwoopposingintellectualforces.Ononeside,a
culturethatwastheinspirationforaseriesofboldinnovatorsinthefieldsofscience,literature,
andart,andwhichgaveusatotallynewvisionoftheworld.ItwasthetimeofGalileo,
Campanella,Bruno,Caravaggio,Berniniandmanyothers.Ontheotherside,therewasaculture
whichrevolvedaroundtheChurchandassumedaseverelyintransigentandantagonistpositionwith
thefirst.6
Duringthesecondhalfoftheseventeenthcentury,empiricism,amethodcreatedbytheEnglish
philosopherFrancisBacon(15611626),wasusedforvariousstudies,speciallyinItalywhere
sciencewasparticularlyactive.Thismethodintroducedexperimentationasthefundamentalbasis
forscience.
PARASITICNATUREOFSCABIESANDBONOMO,CESTONIANDREDI
Usingtheempiricalmethod,FrancescoRedi(16261698)antagonizedthespontaneousgeneration
theorybydemonstratingthatfliesonlyappearonputridfleshifotherflieshadpreviouslydeposited
theireggs.RediwasthechiefphysicianofGrandDukeCosimoIIIandleaderofoneoftheschools
ofthoughtofthattime.HeandGiovanCosimoBonomo,ayoungnavalphysician,wereregular
visitorsofDiacintoCestoni'spharmacy,inLivorno,ameetingplaceformenoflettersandscience.6
Brumpt,inhisbookpublishedin1936,statesthattheetiologyofscabiesseemstohavebeen
discoveredbyRediin1687andthatitspathogenicrolewasevidentafterthestudiesofRenucci,in
1834.9
Nevertheless,itismostlikelythattherealdiscovereroftheparasiticnatureofscabieswasDr.
GiovanCosimoBonomowiththecollaborationoftheapothecaryandnaturalistDiacintoCestoni
bothofthemFrancescoRedi'sdisciples.3
From1685to1687,andprobablyattheSpaofthecityofLivorno,Italy,theystudiedthe
morphologyandphysiologyofSarcoptesscabies,explainedthecontagiousnatureofscabiesbythe
passageofthemitefrompersontoperson,suggestedmedications,andfinallydrewthemiteand
itseggsasobservedunderthemicroscope.
Lane,1in1928,statedthatitisgenerallyacceptedthattheletterwrittenbyBonomotoFrancesco
Redi2isthefirstaccuratedescriptionofthemiteandhasveryaccuratedrawingsofitsappearance.
Theoriginalandsoimportantletter(Figures2and3),writtenonJuly18,1687,isinArezzo,Italy,3
andadocumentofsuchgreatsignificancehastobementionedeverytimescabies'historyis
referred.1

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Figure2:FirstpageofBonomo'sletter3

Figure3:LastpageofBonomo'sletterwithhissignature3
ThediscoveryofSarcoptesscabieiwasannouncedinasmallbook,writtenbyFrancescoRedi,
entitled"Observationsaboutthe'pellicelli'ofthehumanbody,madebyGio.CosimoBonomoand
writtenbyhimwithotherobservationsinalettertoFrancescoRedi,Florence,1687".2(Figure4)In
thisbookRediexplainstheresearchesofBonomo,whoappearsasthesoleauthor,andCestoni,
whofiguresasacollaborator.3

Figure4:CoverofRedi'sbook2
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IntheEnglishmedicalliterature,thefirstnoticeofthisinvestigationappearsinanarticlewrittenby
Meadandpublishedin1703.10Thispaperhasgreathistoricalinterestandisanabstractofpartof
Bonomo'slettertoRedi2translatedintoEnglish.Themostimportantsubsequentpaper,stillbefore
thegeneralacceptanceoftheacarusoriginforscabies,wasthatofWichmann,11fromHannover,
Germany,in1786.Inthebookletcalled'Etiologyoftheitch',hecomparedhisowndrawingstothe
onescopiedbyMeadfromillustrationsinBonomo'sletter.1
BONOMO'SLETTERTOREDI
InthelettertoFrancescoRedi,2writtenin1687,astranslatedbyMead,10in1703,Bonomosays:
"havingfrequentlyobservedthatthepoorwomen,whentheirchildrenaretroubledwiththeitch,do
withthepointofapinpulloutofthescabbyskinlittlebladdersofwater,andcrackthemlikefleas
upontheirnailsandthatthescabbyslavesintheBagnoatLivornodooftenpracticethismutual
kindnessupononeanotheritcameintomymindtoexaminewhatthesebladdersmightreallybe.
"Iquicklyfoundanitchyperson,andaskinghimwherehefeltthegreatestandmostacuteitching,
hepointedtoagreatmanylittlepustulesnotyetscabbedover,ofwhichpickingoutonewitha
veryfineneedle,andsqueezingfromitathinwater,Itookoutaverysmallwhiteglobulescarcely
discernible:observingthiswithamicroscope,Ifoundittobeaveryminutelivingcreature,in
shaperesemblingatortoiseofwhitishcolor,alittledarkupontheback,withsomethinandlong
hairs,ofnimblemotion,withsixfeet,asharphead,withtwolittlehornsattheendofthesnout."
InthispartofhisletterBonomomadeanaccuratedescriptionofthesixleggedlarvawithitsrapid
movementsandnotofanadultwhichhaseightlegs.
"Notsatisfiedwiththefirstdiscovery,Irepeatedthesearchinseveralitchypersons,ofdifferent
age,complexionandsex,andatdifferentseasonsoftheyear,andinallfoundthesameanimals
andthatinmostofthewaterypustules,fornowandtheninsomefew,Icouldnotseeany.
"Andthoughbyreasonoftheirminuteness,andcolorthesamewiththeskin,itishardtodiscern
thesecreaturesuponthesurfaceofthebody,neverthelessIhavesometimesseenthemuponthe
jointsofthefingersinthelittlefurrowsofthecuticula,wherewiththeirsharpheadtheyfirstbegin
toenter,andbythisgnawingandworkinginwiththeirbody,theycauseamosttroublesome
itching,tilltheyaregotquiteunderthecuticula,andthenitiseasytoseehowtheymakeways
fromplacetoplacebytheirbitingandeating,onesingleonehappeningsometimestomakeseveral
pustules,ofwhichIhaveoftenfoundtwoorthreetogether,andforthemostpartveryneartoone
another.
"WithgreatearnestnessIexaminedwhetherornottheseanimalculeslaideggs,andaftermany
inquiries,atlastbygoodfortunewhileIwasdrawingthefigureofoneofthembyamicroscope,
fromthehinderpartIsawdropaverysmallandscarcelyvisiblewhiteegg,almosttransparentand
oblong,liketotheseedofapineapple.
"Ioftentimesfoundtheseeggsafterwards,fromwhichnodoubtthesecreaturesaregenerated,as
allothersare,thatisfromamaleandfemale,thoughIhavenotyetbeenablebyanydifferenceof
figuretodistinguishthesexoftheseanimals."
FromwhatBonomowroteinthesetwolastparagraphsheactuallysawafemalelayinganeggand
statedthatreproductionwascarriedoutbythematingofamaleandafemale,althoughhecould
notseetheirsexualdifferences.Hewasmuchaheadofhistimebecausespontaneousgeneration
wastheprevailingtheory.
"Fromthisdiscoveryitmaybenodifficultmattertogiveamorerationalaccountoftheitch,than
authorshavehithertodeliveredus.Itbeingveryprobablethatthiscontagiousdiseaseowesits
originneithertothemelancholyhumorofGalen,northecorrosiveacidofSylvius,northe
particularfermentofvanHelmont,northeirritatingsaltsintheserumorlymphaofthemoderns,
butisnootherthanthecontinualbitingoftheseanimalculesintheskin,bymeansofwhichsome
portionoftheserumoozingoutthroughthesmallaperturesofthecutis,littlewaterybladdersare
made,withinwhichtheinsectscontinuingtognaw,theinfectedareforcedtoscratch,andby
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scratchingincreasethemischief,andthusrenewthetroublesomework,breakingnotonlythelittle
pustules,buttheskintoo,andsomelittlebloodvessels,andtomakingscabs,crustysores,and
suchlikefilthysymptoms."
AtthispointBonomodisagreedwiththehumoralandspontaneousgenerationtheoryacceptedat
thattimeandstatedthatthepassageandbitingoftheskinbytheacaruswasthecauseofthe
pruritus.Aboveall,hedescribedwithgreataccuracytheetiopathogenicmechanismoflesions
formationinscabies.
"Fromhencewecometounderstandhowtheitchprovestobeadistempersoverycatching,since
thesecreaturesbysimplecontactcaneasilypassfromonebodytoanother,theirmotionbeing,
wonderfullyswift,andtheyaswellcrawlinguponthesurfaceofthebodyasunderthecuticula,
beingveryapttosticktoeverythingthattouchesthem,andaveryfewofthem,beingonce
lodged,theymultiplyapacebytheeggswhichtheylay.
"Neitherisitanywonderifthisinfectionbepropagatedbythemeansofsheets,towels,
handkerchiefs,gloves,etc.,usedbyitchypersons,itbeingeasyenoughforsomeofthesecreepers
tobelodgedinsuchthingsasthose,andindeedIhaveobservedthattheywillliveoutthebody2
or3days."
InhisletterBonomostatedthatSarcoptesscabieicouldbetransmittedbydirectcontact,andthatit
stickedtoalmosteverything,sotransmissionalsooccurthroughclothesandotherfomites.Inhis
experimentshealsoobservedthatthemitecouldliveoutofthebodyforsomedays.
"Norinthelastplaceshallwebeatalosstoknowthereasonofthecureofthismaladybylixivial
washes,bathsandointmentsmadeupwithsalt,sulphurs,vitriols,mercury's,simple,precipitateor
sublimate,andsuchsortofcorrosiveandpenetratingmedicines.Thesebeinginfalliblypowerfulto
killtheverminlodgedinthecavitiesoftheskin,whichscratchingwillneverdo,partlybyreasonof
theirhardness,andpartlybecausetheyaretoominuteasscarcelytobefoundbythenails.
"Neitherdoinwardmedicinesperformanyrealserviceinthiscase,itbeingalwaysnecessaryafter
atedioususeofthesetohaverecoursetothoseexternalalreadymentioned.Andifinpracticewe
oftentimesexperiencethatthisdisease,whenwethinkitisquitecuredbyunction,does
neverthelessinashorttimereturnagain,thisisnotstrange,sincethoughtheointmentmayhave
killedallthelivingcreature,yetitmaynotprobablyhavedestroyedalltheireggs,laidasitwerein
thenestsoftheskin,fromwhichthemayafterwardsbreedagainandrenewthedistemper.And
uponthisaccount,itisveryadvisableafterthecureisonceperformed,stilltocontinuetheointing
foradayortwomorewhichistheeasiertodo,becausetheselinimentsmaybemadeagreeable
enough,andofagoodsmell,asparticularlyisthatcompoundedoftheointmentoforangeflowers
orroses,andasmallquantityofredprecipitate."2
TofinishhissocompleteandexcitingobservationsBonomosuggestedthatthecureoftheitch
couldbeaccomplishedbytheuseoflocaltherapy,assulphur,whichisuseduntilnow.Hestated
thatinternaldrugswerenoteffectiveandlocaltreatmenthadtogoonfortwoorthreemoredays
afterthecureoftheitch.Thistimewouldbenecessarytopreventrelapsesbecauseofthepresence
ofeggsthat,afterhatching,couldthenstartanewbiologicalcycleoftheparasite.
DISPUTEANDCONTROVERSY
ImmediatelyaftertheletterofBonomoandpublicationofRedi'sbook,2thePope'schiefphysician,
GiovanniMariaLancisi(16541720)beganadisputewithBonomo.Lancisithoughtscabieshada
humoraloriginthatprecededtheproliferationoftheacarus,and,althoughherecognizedthe
presenceoftheparasite,hediscardeditasthesinglecauseofthedisease.Inthecourseofthis
dispute,becauseofLancisi'spositionasthePope'schiefphysician,thefactthatheinvokedthe
Scriptures,andthefateofpreviousscientistsasGalileoBonomowaspersuadednottocontinue
thedebate.Hisdiscoverywasthencompletelyforgotten.6AsErnestBesnierandAdrianDoyonsaid
laterandverypertinently,itwasatimewhenthemedicalbrainwasnotyetpreparedtoacceptthis
discovery.12
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ItiseasytoattributethepaternityofthediscoveryoftheparasiticoriginoftheitchtoBonomoand
nottoRedi.ThefirstaffirmedandafterwardssustaineditinapolemicwithLancisi,whileRedi
showedsomehesitationinacceptingsuchasubvertingidea,besidesthefactthatRedihimself
admittedhewaspublishingtheresultsofBonomo'sinvestigation.3
ItisdifficulttoestablishwithprecisionandcertaintyhowmuchisowedtoBonomoandCestoni.3
Usuallytheirnamesarereferredtoastwodistinctpersonswhoworkedtogether,butthereare
someauthors,asRaspailandDevergie,thatclaimtheyarethesameperson.Raspailstatedthat
Cestoni,apharmacistofLivorno,Italy,wrotealettertothecelebratedItaliannaturalist,Francesco
Redi,in1687,underthepseudonymofGiovanCosimoBonomobecausehefearedpersecution,
sincehisideasrelatedtoscabieswereopposedtothespontaneousgenerationtheories.5InJanuary
15,1710,thustwentythreeyearsafterBonomohadwrittenhisexperiencestoRedi,Cestoniwrote
alettertoAntonioVallisnieri,repudiatingtheoriginaloneandclaimingtheentirecreditforthe
discoveryofacarus,whichappearedjustunderBonomo'sname,forhimself.13
MostoftheauthorsonthesubjectbelievethatBonomoandCestoniweredifferentpersonsamong
themareFrstenbergandHebra,whosecarefulresearchesintothehistoricalandotheraspectsof
thismattergavemuchweighttotheirviewsandestablishedBonomo'sexistence.5,6Verylittleis
knownabouthim,speciallybeforeandafterhelivedinthecityofLivornoinItaly.Mostinformation
wasobtainedfromletterswrittenbyhimortohim.HisfatherwasaFrenchpharmacistnamed
Stefan,whodiedinLivornoin1684,wherehismotherwasstilllivingin1690.Itisknownthathe
wasaregularvisitorofCestoni'spharmacyandreceivedtheLivornocitizenshipin1690,asapublic
andsolemnrecognition.HestudiedscabiesanditsagentwithCestoniprobablyattheLivornospa,
builtin1602byFerdinandI.In1691hewasdesignatedasthephysicianofAnnaMaria,daughterof
theGrandDukeCosimoIII,wifeofGiovanniGuglielmo,representativeinGermany.Hewentto
NeuburgandlatertoDsseldorf.Unfortunately,afterthisperiodwhichisthoughttohavebeenthe
mosthappypartofhislife,verylittlewasheardofhimagain.3Bonomoprobablydiedin1696in
Florenceattheearlyageof33.14
ItisbelievedthatCestoni,probablyknowingthedestinyofhisformercollaboratorandthatRedi
hadalreadydied,claimedthecreditbecausenobodywouldquestionhim.3,13Inhisoriginalletter2
BonomosaidthatDiacintoCestonihadassuredhimthathehadmanytimesseenoldwomen
extractingsomethingonthepointofaneedlethathadbeenintroducedundertheskinofchildren
affectedwithscabies.5Faucci3statesthatprobablythenaturalisticstudyoftheacarusisdueto
Cestoni,averycleverresearcher,whileBonomo,averykeennavalphysician,isresponsiblefor
theobservationsregardingtotheexternalcureofscabies.Theresultofhisinvestigationsledhim
tousetheresoluteexpressionscontainedinhisautographedletter,revealinghowabsolutehis
convictionwasaboutthecauseofthedisease.TherewasnodoubtthatDiacintoCestoniwasan
exampleofhonesty,asrecognizedbyall.Havingtoreconcilehistruehonestywithhisconducton
theauthorshipvindication,Fauccisuggestswhathecalleda'retrospectiveillusion':thelongperiod
aftertheresearchesandthedistantmemoriesinCestoni'smindslowlychanged,transforminghis
partofthediscoveriesintotheessentialpartoftheworkincommon,andmakingBonomo's
cooperationinsignificantandnegligiblethereforeheconvincedhimselftoclaimallthecreditfor
thediscovery,besidesthefactthatitwasalwaysquotedsolelyunderBonomo'sname.3
Itwasonlyin1834,almosttwocenturieslater,thatRenucci,ayoungstudent,reestablishedthe
factthattheacaruswasthecauseofscabies.15Afterthis,aperiodofintenseinvestigationson
scabiesbegan,andFerdinandHebra(181680),byparticularselfexperiments,wastheonethatdid
themosttosettleonceandforalltheproblemofscabies.Hepublishedhisviewsondiagnosis,
etiology,andtreatmentofthisdiseasein1844andmadeaneulogyofBonomo'sandCestoni's
work.16
HebraalsostatedthatGiovanniCinelliCalvoli,in1689,claimedtohaveseentheacarustenyears
beforeCestoni.CalvolideclaredthatacertainProtasioFeliceSalvetti,whomhehademployedto
makedrawings,hadrevealedhisresearchestoBonomoandCestoni.Despitehisclaimstopriority
inthediscoveryoftheitchmite,Calvoli,itissaid,didnotregarditasthecauseofscabies.Itis
alsoclaimedthat,beforeBonomoandCestoni,Scaliger,in1557,Joubertus,in1577,Fallopius,in
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1584,Rondelet,in1592,Vidius,in1586,andSchenck,in1600,knewandwroteaboutacarus.Some
oftheseauthorshoweverconfuseditwithlice,whichwasnotanuncommonerroratthattimeor
evenlater.5
Favarielle,inathesisonscabies,writteninParisin1805,stillaffirmeditwasproducedbya
syphiliticorascorbuticinfectionofthehumorsandbyadegenerationofthetranspiration.5
ItwasCumston,in1924,whocreditedBonomoforthediscoveryandfirstdescriptionofSarcoptes
scabiei,5and,finallyin1927,RazzauticameacrossBonomo'ssignedletterwhichhadbeen
preservedintheLibraryofFraternitdiS.MariaofArezzo.14Itspublicationthatyearprovedthat,
infact,thediscoveryoftheacarianoriginofscabiesprecededRenucci'spaperanditsofficial
scientificrecognitionby150years.3
CONCLUSION
ItiscontrarytohistoricalprooftoascribetoothersthanBonomoandCestonithediscoveryofthe
parasiticoriginoftheitch.FrancescoRedi,however,althoughnotactingdirectlyinthediscovery,
mustbehonoredforbeingBonomoandCestoni'sMaster,inthewidestsenseoftheword.Withhis
admirableexampleheshowedthemthewaytobefollowed,alwaysstimulatedtheirwork,guidedit
withhiswiseadviceandgavethemduringandaftertheirinvestigationalltheneededhelp,sothat
itmightbeaccomplishedandthereforeknownandspread.3
GiovanCosimoBonomo,incollaborationwithDiacintoCestoni,discoveredtheetiologicagent,
statedthatitreproducedthroughtheunionofamaleandafemale,affirmeditlaideggs(Bonomo
actuallysawthemitelayinganegg),suggesteditstransmissionbyclothesandfomites,and
speculatedaboutthereasonssomelocaltreatmentswereeffectiveandsomesystemicwerenot.
Thatwasin1687,2threehundredand10yearsagoandtheirstudy,eventhoughnotimmediately
recognized,markedthefirstnoticeoftheparasitictheoryofinfectiousdiseasesdemonstratingfor
thefirsttimethatamicroscopicorganismcouldbethecauseofadisease.Itmayevenbesaid
withoutdoubtthatBonomo'sandCestoni'sdiscoveryinitiatedanewerainMedicine.6
Acknowledgement:TheauthorwishestothankDr.TorelloLotti,Montecatini,ItalyDr.Carlos
Lacaz,SoPaulo,BrazilDr.StephenGreenbergandthestaffoftheNationalLibraryofMedicine,
Washington,DC.,UnitedStatesfortheirhelpinobtainingsomeoftheancientdocumentsusedin
thispaper.
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