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Notable Notes
April 2017

Oribasius—Pediatric Skin Eruptions and the Origins of the Allergic Reaction to Breast Milk

Author Affiliations
  • 1Department of Anatomy & History of Medicine, University of Thessaly, Larissa, Greece
JAMA Dermatol. 2017;153(4):303. doi:10.1001/jamadermatol.2016.0531

Oribasius (circa ad 325-403) was born in the Kingdom of Pergamon and studied medicine at the Alexandrian School in Egypt under Zeno of Cyprus. He practiced in Asia Minor and gained the reputation of an expert before he became the personal physician of the emperor Julian (ad 330-363). He was interested in pediatric diseases and was the first to recognize skin eruptions after breastfeeding as a common allergy among newborn infants. He knew that every woman's milk should be tested for its quality and for conditions that would be pathological for the newborns.1 He proposed several methods to test the milk, such as the “seashell-fat formation,” in which the milk rested inside a seashell for 1 day and a fatty crust appeared, or the same test but with a clay vase, named “cream-judger” (Greek: κρεματοκρίτης).1,2 Both tests assessed the flavor, odor, and hue. He noted “… for rashes presenting on the baby's skin, most are due to poor quality of the maternal milk, or when the newborn's organisms could not properly digest the milk, or sometimes the skin's maleficence begins intrauterine. Mothers or wet nurses (Greek: τροφóς, τίτθη, a nurse that breastfeeds another woman's newborn) must therefore both let it manifest itself, as this is the only way to redemption from greatest evils that could happen to the baby. If you don't allow rashes to fully grow, they could be really dangerous. You should begin the treatment when the rashes are in exultation, only then you could heal them, by applying a water solution with myrtle (myrtus), or schinus. The best way is for the woman to be fed as gently as possible, and as for the baby, it must live daily without an overfilled stomach, so that it could better digest the milk, and avoid the unpleasant feeling of a poor mood.”3 Oribasius clearly understood that this was a congenital or acquired disorder related to milk's digestion. Although he did not observe a fully oral allergy syndrome, but only a skin anaphylaxis, he gave specific instructions to minimize the fatality of the disease.1

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