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Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 563-567
On the Scheme for Obtaining a Better Knowledge of Endemic Skin Diseases of India by Tilbury Fox (1836–1879): A Medico-Historical Overview

Department of Dermatology, “Pranab”, Ismile, Asansol, West Bengal, India

Date of Web Publication29-Dec-2022

Correspondence Address:
Amiya K Mukhopadhyay
Department of Dermatology, “Pranab”, Ismile, Asansol - 713 301, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijd.ijd_565_21

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With the presence of western nations in India, a change started appearing in the medical scenario. The civilians and soldiers had to suffer from many endemic diseases like fever, cholera, plague, small pox etc. prevalent in India and it caused great loss to the new comers. To protect the life and properties and to gain a firm ground in the Indian soil, Europeans established various medical institutions that provided western medical care. In the course of time British got hold of the power in most part of this country. As the administrators were more engaged with the fatal endemic diseases, cutaneous disorders with lower mortality got less importance. Tilbury Fox, a distinguished British physician accompanied the Earl of Hopetoun in a tour to the East and reached India in 1864. Fox noticed the chaotic situation in the systematic study of dermatological disorders. He proposed a scheme to study the proper situation in this country which laid the beginning of systematic study of dermatology in India. Though his study was the steppingstone of Indian dermatology, but Fox got little attention in the history of dermatology in India. This article discusses about a brief overview of the scheme and the contribution of Tilbury fox.

Keywords: History of dermatology, Indian dermatology, tilbury fox

How to cite this article:
Mukhopadhyay AK. On the Scheme for Obtaining a Better Knowledge of Endemic Skin Diseases of India by Tilbury Fox (1836–1879): A Medico-Historical Overview. Indian J Dermatol 2022;67:563-7

How to cite this URL:
Mukhopadhyay AK. On the Scheme for Obtaining a Better Knowledge of Endemic Skin Diseases of India by Tilbury Fox (1836–1879): A Medico-Historical Overview. Indian J Dermatol [serial online] 2022 [cited 2023 Jan 31];67:563-7. Available from:

   Introduction Top

The year 2022 is the sesquicentennial year of publication of the Scheme for obtaining a better knowledge of endemic skin diseases of India (hereafter designated as Scheme). Such schemes and reports on various medical aspects were ordered during the rule of the British Crown with an aim of welfare for Indians after the Proclamation was declared in 1858 and the Government of India Act along with An Act for the Better Governance of India were promulgated on 2 August 1858 in the British Parliament. This promised an equal status to its Indian subjects as enjoyed by others in the British Empire.[1] Amongst various surveys and reports, the aforementioned Scheme is considered exceptional as it can be marked as a steppingstone in the history of modern Indian dermatology. Before elaborating further, a brief discussion is deemed appropriate for better discernment about the poor status of dermatology in the backdrop of other ailments in India prior to the Scheme.

Position of dermatology in pre-colonial period (1498–1858)

Alfonso de Albuquerque, the governor of Portuguese India (1509–1515) and the first duke of Goa, perceived that to make firm ground in this country proper medical facility for its subjects was of utmost necessity. Accordingly, he established the Royal Portuguese Hospital, the first European hospital in India, in Goa in 1510. Subsequently the first British hospital was established in Madras in 1664.[2] In the beginning, most of the medical institutions were engaged in serving the European people in India and their troops.[3] Amongst the British fever, dysentery, diarrhoea, cholera, plague, malaria, and other endemic diseases took the life of a considerable number of people.[4],[5] In 1817–1831, there were eight million deaths from cholera alone. The situation was such that a majority of soldiers died of improper sanitary conditions and diseases rather than in the war.[6],[7]

The rulers were more concerned with these major deadly diseases, and hence skin diseases with low mortality unsurprisingly received less attention, though skin diseases were a common affair.[8] In this scenario, a tour of the Earl of Hopetoun in 1864 laid the foundation of modern dermatology in India.

Tour of Hopetoun and Tilbury Fox

In 1864, William Tilbury Fox (1836–1879) [Figure 1] accompanied the Earl of Hopetoun in a travel appointment on a trip to the east and came to India. Fox graduated from the University College, London, in 1857 with honours in surgery and the gold medal and scholarship in medicine, and worked under Edward Jenner, the inventor of the smallpox vaccine. Later, he started general practice in Bayswater and decided to take a career in midwifery, but with time Fox became interested in the fungal infection of the skin and hairs. This resulted in the publication of his Skin diseases of Parasitic Origin in 1863 and Treatise on skin diseases in 1864. His keen observation of the diseases prevalent in the east during the tour (1864) resulted in the publication of pamphlets on various subjects. His perception of the lack of any organized study on skin diseases in India led him to formulate a plan for a systematic study.[9],[10],[11] Prior to his work, all endeavours of the British Empire on cutaneous disorders was confined mainly to the reports about small pox and leprosy. The Scheme drawn for the India Office was the first published step towards the beginning of a systematic study of modern dermatology in India.
Figure 1: William Tilbury Fox (1836–1879). Colour lithograph by Beynon and Company. (Credit: Wellcome Collection. Public Domain Mark 4.0)

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The Scheme

The Scheme [Figure 2] was published for the India Office of the British Crown by Tilbury Fox, the then physician to the department for diseases of the skin at the University College Hospital, London, along with the retired surgeon major H.M.S, of the Bengal Medical Service Dr Thomas Farquhar in the year 1872. This was a pamphlet of 36 pages with multiple illustrations and a number of tables for enumeration and taking notes on various diseases.[12] An overview of the Scheme is presented below:
Figure 2: Title page of Fox's Scheme for obtaining a better knowledge of endemic skin diseases of India (1872). (Credit:

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Under the heading 'General remarks', the document is divided into two sections:

In section A titled 'Objective and the mode of inquiry', two main objectives are proposed:

  1. 'To obtain and then to circulate a better knowledge of the more important endemic skin diseases of India, or such as principally attack the skin; and thereby
  2. To bring about an agreement, which is far from existing at present, between the profession in India and in England as to the nomenclature, the typical character, the varieties, and the probable or demonstrated causes of the diseases in question'.

The aim was to

  1. Ascertain uniformity of terms regarding any specific disease to mitigate confusion regarding communication and research;
  2. Aim to educate those who are in training for Indian Medical Service so that they can attain some preliminary knowledge about skin diseases before they come to India;
  3. Acquire knowledge about skin diseases unique to India with different climate, social system, etc.;
  4. Study the influence of the climate on skin diseases leading to different clinical presentations in Europe and India;
  5. Alleviate the difficulties faced by doctors in India while investigating the nature and cause of a disease. He also took care of the scarcity of academic and technical support to carry out modern western investigative techniques;
  6. Minimize the time and difficulties faced by Indian doctors in managing skin diseases.

Fox stressed that the study of endemic cutaneous diseases in India deserved attention because these diseases were the cause of great sufferings, and many of these could be prevented.

He also maintained that the indigenous medicine prescribed by hakeems might contain some inert or dangerous substance and the actual active ingredient was difficult to identify from their lengthy prescription. Many good drugs prescribed but kept secret by the native practitioners were to be identified.

In section B, Fox discussed about the scheme of inquiry.

Following queries were advised to be made:

  1. To observe the diseases carefully and to enquire about the origin and their microscopic study;
  2. Climatic influence on the genesis of diseases in India and prevalence of a particular disease in a particular locality or tribe. Effects of food, clothing, and geographical localization and nature on various endemic diseases are to be enquired.
  3. The influence of skin colour to be studied. To see the course of a particular ailment in darker skin of the native and Europeans and the difference in the nature of same diseases in Europe and India.

Thereafter, Fox discussed about fourteen diseases: 1. Morphoea; 2. Scleroderma; 3. Framboisia; 4. Delhi sore; 5. Keloid [Figure 3]; 6. Fibroma [Figure 4]; 7. The Elephant leg; 8. The Madura foot; 9. The true Leprosy; 10. Leucoderma; 11. Pityriasis versicolor in unusual forms; 12. Burmese ringworm; 13. Malabar itch; 14. Lichen tropicus or prickly heat. He discussed them in brief and included an introduction, explanation of the nomenclature, features and nature of the disease, locality of occurrence, pathological nature, differential diagnoses, and some suggested questions along with a plan for note-taking and tabulation.
Figure 3: Keloid (Traumatic) in Fox's Scheme for obtaining a better knowledge of endemic skin diseases of India (1872). (Credit:

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Figure 4: Fibroma in Fox's Scheme for obtaining a better knowledge of endemic skin diseases of India (1872). (Credit:

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Impact of Scheme on further dermatological study

The Scheme had initiated a process of study on skin diseases, not only in India but in other countries with a hot climate. The data collected resulted in a detailed discussion in the form of a book entitled On certain endemic skin and other diseases of India and hot climates generally [Figure 5]. The Duke of Argyll ordered in 1872 that copies of the Scheme be distributed to the medical officers in India for study and further information. Afterwards, Lord Granville, Lord Kimberly, and Sir Alexander Armstrong recommended it to colonies, foreign offices, and the navy. The data collected from the scheme was bulky and Fox believed that '[the study would] come to be regarded as a really solid and valuable contribution to medical science'. The reality in Fox's avowal can be evidenced from an official communication of the inspector-general of hospitals in the Indian Medical Department, dated 18 February 1873, where he observed that 'the circulation of the paper has undoubtedly done good by informing medical officers regarding previous work, and placing the present state of knowledge on the subjects embraced in it before them in a concise form.'[9],[13]
Figure 5: Title page of Fox, Farquhar and Carters' On certain endemic skin and other diseases of India and hot climates generally (1876). (Credit

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   Conclusion Top

Tilbury Fox never held any position in the Indian Medical Service, but he could recognize the importance of skin diseases in India. The design of the study in the Scheme published about one-and-a-half century ago is surprisingly relevant even today. Fox foresaw the significance of his work and hence commented, 'Doubtless other skin diseases that are considered peculiar to India find no place in this document. It will be a matter of much satisfaction if the circulation of this paper should be the means of eliciting information relative to such diseases, to the benefit of medical science generally and dermatology in particular.'[12] His work had influenced future dermatology not only in India but in regions that had a hot and tropical climate. The Scheme laid the foundation for the present-day modern dermatology in India. Indian dermatology is indebted enormously to Tilbury Fox for his contribution, but he is yet to receive his appropriate place in the history of dermatology in India. The year 2022 is the sesquicentennial year of publication of the Scheme for obtaining a better knowledge of endemic skin diseases of India. It is an appropriate occasion to commemorate this 150th anniversary of the Scheme and pay tribute to Tilbury Fox, the forgotten figure of Indian dermatology of the colonial era.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Anonymous. Proclamation by the Queen in Council to the Princes, Chiefs, and People of India. Allahabad: Governor General; 1858.  Back to cited text no. 1
Jaggi OP. Medicine in India: Modern period. In: Chattopadhyaya DP, editor. History of Science, Philosophy and Culture in Indian Civilization. New Delhi: Oxford University Press; 2007. p. 74-7.  Back to cited text no. 2
Arnold D. the rise of western medicine in India. Lancet 1996;348:1075-8.  Back to cited text no. 3
Twining W. Clinical Illustrations of the More Important Diseases of Bengal. Calcutta: The Baptist Mission Press; 1832.  Back to cited text no. 4
Anonymous. Report of the Commissioners Appointed to Inquire into the Sanitary State of the Army in India. London: Stationery Office; 1863.  Back to cited text no. 5
Arnold D. Cholera and colonialism in British India. Past Present 1986;113:118-51.  Back to cited text no. 6
Harrison M. Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914. Cambridge: Cambridge University Press; 1994.  Back to cited text no. 7
Martin RM. The Indian Empire: History, Topography, Geology, Climate, Population, Chief Cities and Provinces; Tributary and Protected States; Military Power and Resources; Religion, Education, Crime; Land Tenures; Staple Products; Government, Finance, and Commerce. Vol 1. London: The London Printing and Publishing Company Ltd; 1858. p. 491.  Back to cited text no. 8
Rook A. Tibury Fox (1836-1879). His contribution to tropical dermatology. Int J Dermatol 1981;20:140-2.  Back to cited text no. 9
Findlay GH. William Tilbury Fox (1836-1879): His contribution to British dermatology. Br J Dermatol Syphil 1950;62:221-5.  Back to cited text no. 10
Obituary. Tilbury fox. Br Med J 1879;1:915.  Back to cited text no. 11
Fox T, Farquhar T. Scheme for Obtaining a Better Knowledge of Endemic Skin Diseases in India London: Stationery Office; 1872.  Back to cited text no. 12
Fox T, Farquhar T, Carter HV. On Certain Endemic Skin and Other Diseases of India and Hot Climates Generally. London: J & A Churchill; 1876.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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