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Into the 20th Century

The nation was soon to be preoccupied by war clouds gathering over Europe, carrying threats of chaos, death and economic ruin. No steps to foster dermatology could be taken, but some who had caught a glimpse of one of the great European Centres, must have been considering their own future and the future prospects of dermatology in Britain.

Archibald Gray (1880-1967), son of a country doctor, was born in Ottery St Mary in 1880; his grandfather had served as a naval surgeon at the battle of Trafalgar. He had been an outstanding student at University College Hospital where he won several prizes and became President of the Students' Union. It seems that from an early stage administration was to be his forte. Examinations held no terrors for him and after MRCP and FRCS he turned to gynaecology. Reputedly he was the first man in England to perform a Wertheim hysterectomy and he became an Examiner for the Midwives' Board. It was natural at that time for him to become involved with the management of syphilis, indeed he published articles on the therapeutic use of the new arsenical preparations that were becoming available.

When Radcliffe Crocker died in 1912 the Governing Board of University College Hospital looked around for a successor and alighted on Gray. The place of dermatology had already been established by Todd Thompson, William Jenner, and especially by Tilbury Fox. Gray was bright, ambitious and experienced in syphilology, in gynaecology and in paediatrics as well. After some consideration he finally accepted the offer and was off post-haste to study with the famous Joseph Jadassohn who had moved from Breslau to Bern. Such was the pattern of those days: once chosen the individual was often dispatched abroad to learn the craft.

In 1913 Gray, by that time an acknowledged syphilologist, was made Secretary of the Section of Dermatology at the XIIIth International Congress of Medicine held at the Albert Hall in London. There he met the famous professors, Darier and Neisser, also Jadassohn with whom he had recently studied in Bern. He must have been aware, as Hutchinson had been twenty years earlier, of the poor standing of dermatology in Britain and of the inadequate facilities available.

His appointment at UCH proved a productive one as Gray, who had remarkable organizational skills, was able to gain four inpatient wards as well as laboratory space in the School. Later he was joined by W N Goldsmith and later still, these two welcomed Walter Freudenthal the histopathologist, he had previously worked in Jadassohn's clinic in Breslau where he had become friendly with Goldsmith. Gray with his paediatric experience was soon appointed to the staff of the Childrens' Hospital at Great Ormond Street where his study of sclerema neonatorum proved to be his most distinguished work. By 1916 he was Editor of the British Journal of Dermatology, a post he was to hold for 14 years.

During the first world war Gray, who had been a keen member of the University Officers' Training Corps, eventually became a Lieutenant Colonel with the British Expeditionary Force. When the Official Medical History of the War came to be written he joined Arthur Whitfield to compile the dermatological section. It was during these war years that Gray began to ruminate over the foundation of an Association of Dermatologists. He had to travel around the various university hospitals and used the opportunity to visit dermatological colleagues working in the provinces. He found that many felt distanced from London, disadvantaged and very much the "poor relations". He was also aware that the Association of Physicians had been founded for similar reasons and was planning to rotate its meetings through a variety of provincial centres. Frustratingly, his "pipe-dream" had to be put in abeyance and could not begin to take shape until 1921, well after the armistice.

Back in civilian life, busy with hospital duties and practice, he continued to formulate his ideas about an association but this did not deter him from other activities such as becoming vice-dean of his medical school, and in the development of postgraduate education. With Francis Fraser he conceived the Federation of London University's Postgraduate Medical Institutes and the Institute of Dermatology was ever close to his heart. Jonathan Hutchinson would surely have approved.

Awards abounded - CBE in 1919 was followed by KBE in 1946 and KCVO in 1959. He gave the Malcolm Morris lecture in 1945, the Harveian - a rare honour for a dermatologist - in 1951, and the Prosser White in 1954. Perhaps his finest hour was in 1952 when he presided at the first post-war International Congress of Dermatology in London; there had been a long gap since Nekam's Budapest meeting of 1935. The London occasion was held in Bedford College, Regent's Park, a lady's establishment and part of London University, it was judged a great success.

It is not difficult to see how this intelligent man, dismayed by the low standing of dermatology in Britain at that time, should consider the formation of an Association of Specialists; the idea had been germinating throughout the long years of the war. He desperately wanted dermatology to be recognized and it is obvious, from the ultimate successes of the BAD, the Postgraduate Medical Federation and the Institute of Dermatology, that his dreams were finally fulfilled.

He had been President of the BAD in 1939, having been Secretary, long-standing Editor and prudent Treasurer for 20 years. It can justifiably be said that he was not only our Founder, but for decades our very backbone.

Of diminutive stature, he tended latterly to be somewhat shabbily dressed. As a teaching hospital dermatologist Gray could hardly rank with Crocker, Colcott Fox, Whitfield, Barber or Dowling, as a pre-eminent "thinker", but all acknowledge his foresight, his persistence and his administrative skills. On October 13th 1967, this little old man died. He was 87.

Birth of the Association

Gray as Editor of the Journal in 1919 could use its secretariat as a launching pad for this new venture. The minutes of the Editorial Committee of 28th July, read36:-

"The Editor brought forward a suggestion that the guarantors should form themselves into an Association for the purpose of conducting the Journal and also for holding an annual congress, alternately in London and in a provincial centre, with the object of:-
i) promoting a free interchange of views between the London and the provincial dermatologists and
ii) dealing more with the academic side of dermatology and syphilis than was possible at the ordinary clinical meeting of the Dermatological Section of the Royal Society of Medicine."

This suggestion was then referred to a special subcommittee where the following was agreed:-

i) "To hold an annual meeting alternately in London and a provincial centre, lasting one to three days at which subjects of interest in dermatology and syphilology should be discussed
ii) To become the proprietor of the Journal at present owned by a number of guarantors."

It was also minuted that:-

"Such an Association would in no way interfere with the work of existing dermatological societies but would have the advantage
i) of bringing together London and provincial dermatologists at more regular intervals than has been possible in the past and
ii) of dealing with the academic side of dermatology and syphilology in a way that is not possible in existing societies, which are mainly clinical in type;
iii) of stimulating investigation into dermatological problems, and
iv) of increasing interest in and providing material for publication in the Journal, which is the sole organ of British dermatology and at present compares unfavourably with many foreign publications."

Gray, a natural administrator, defined the intentions of the Association clearly; he formulated outlines for membership, the appointment of officers and essential regulations. These, with certain modifications, were approved by the Editorial Committee in May 1921. The first meeting proper then followed on the 18th of November at the Royal Society of Medicine. An Executive Committee was then established, rules were agreed and our Association was launched. It was wryly noted that our founder, originally trained as an obstetrician, had proved an accomplished accoucheur.

The First Meeting in 1921, appropriately was in London and Morris, who had with Brooke founded the Journal, was the Association's first choice as President. The proceedings opened with a discussion on "Focal Infection in the Aetiology of Skin Diseases". H Leslie-Roberts, the first full-time appointee to Liverpool Royal Infirmary (in 1893), and an enthusiastic clinical mycologist, opened the discussion followed by H W Barber of Guy's. This was a concept then fashionable to explain the inexplicable (since supplanted by notions such as avitaminosis, disturbed immunity and stress, among others). J H Sequeira opened the second topic - "The Wassermann Reaction as a guide to the treatment of Syphilis". He was followed by the distinguished venereologist, Colonel L W Harrison, then in charge of that department at St Thomas' Hospital, quaintly known as Lydia Ward. Syphilis, like tuberculosis, played a large part in the work of any skin physician. Finally, a demonstration of clinical cases was arranged. Some 30 participants attended this first meeting, and it was regarded as a satisfactory beginning.

The Second Meeting in 1922 was a grander affair in Edinburgh, with Norman Walker an imposing President.

Norman Purves Walker (1862-1943), having graduated in Edinburgh, became the first full-time dermatologist in Scotland (Allan Jamieson was a "generalist"). He had studied with Kaposi in Vienna, with Pick in Prague and in Hamburg with Unna where reputedly he became his favourite pupil, translating the famous Die Histopathologie der Hautkrankheiten, a monument of intense research and precise observation. He had also translated Hansen and Looft's book on leprosy.

In Edinburgh44,45 Walker was an active teacher, but curiously, did not pursue the study of histopathology. His well illustrated Introduction to Dermatology ran to 13 editions, the last (1931) was in collaboration with G H Percival. His appetite for the subject may have waned, for committee rooms were proving attractive. The General Medical Council became his interest and he represented Scotland for thirty years before becoming President in 1931. In addition he advised the India Office on medical education and for this he was knighted; furthermore for 20 years he was Treasurer at Edinburgh's Royal College of Physicians.

The Edinburgh Department became divided, for half was to go to the long-serving Assistant, Frederick Gardiner, who due for promotion, was entitled to the charge of beds. Academic momentum understandably faltered.

At Walker's Edinburgh meeting "Allergy" was the main topic; Arthur Whitfield, now the BAD's first official Secretary, and Cranston Low, were the main speakers; both were widely regarded as two of the most thoughtful dermatologists around. At the formal dinner in the magnificent college hall, the tables were resplendent with thistles and roses tastefully arranged by Mrs Low. Next day, she with her husband Cranston, entertained the guests at a garden party, undoubtedly the social highlight of the meeting.

Norman Walker was to become a severe diabetic and reaching the last stages of emaciation, was one of the first to be rescued by the timely arrival of insulin from Canada.

Robert Cranston Low (1879-1949) went from Merchiston Castle School to Edinburgh University, graduating in 1900. He had been stimulated by Allan Jamieson, and, after house appointments was off to Breslau where Neisser, the micro-biologist, was using an experimental approach to immunology. This was to lead Low to his long-term interest in anaphylaxis. From Breslau he went on to Hamburg, and thence to Paris, before returning home after two most educative and stimulating years.

In Edinburgh he was awarded the Gold Medal for his thesis, later published as a monograph, on anaphylaxis. He was one of the earliest in Britain to venture into the minefields of allergy and idiosyncrasy, and certainly the first artificially to establish contact sensitivity to Primula obconica46 in both himself and his brother. He deduced that this reaction was unlike anaphylaxis as the state could not be passively transferred and the antibodies seemed cell-bound; it was also a different process from chemical irritation. Furthermore, he had already established that eczema from primary irritants was not an allergic phenomenon. Cranston Low seems to have been well ahead of his time.

He had learned the technique of moulage making from Baretta in Paris and with his innate artistry Low set about making his own wax models. His collection was displayed, along with those from other centres such as Vienna and Prague, at the 1939 International Congress of Medicine in London.

Low was appointed Assistant to Walker in 1906 but did not become the "Senior" until 1924, such were the hierarchical arrangements of those days. He was physically small, whereas Walker was tall, imposing and even austere, but intellectually Low was more than a match for his chief.

The Association's Growth

From 1922 until well after the second war47 the annual meetings meandered on gently in their regular if unexciting way. The format through which the venue rotated so that meetings in provincial centres would alternate with London (2:1) was maintained. Attendance was small, less than 60, for membership was closely guarded and indeed restricted; it was a cosy and elite affair, election being a formal process conducted by ballot. Blackballing was not unknown. The London Presidents rotated by seniority, the provincial centres chose their nominated leader to take the chair and some of their names are now unfamiliar.

Distinguished foreign visitors were invited to attend and Howard Fox from New York was an early guest; Svend Lomholt and Haxthausen were both to become lifelong friends. Likewise the Association arranged that a few British delegates should attend important International Congresses such as the brilliant one in Copenhagen in 1930 and Nekam's meeting in Budapest five years later. These made unforgettable impressions on a fortunate few.

The most prestigious President in those early years was at the Cambridge meeting of 1932 when Humphrey Rolleston, the Regius Professor of Physic, officiated. There had been a meeting in Oxford in 1928 but Cambridge had no pretensions to a skin department though Howard Whittle, then in pathology, was showing interest in the subject. In fact he served as the local secretary for this meeting.

How was it that such a busy and distinguished physician came to grace our small and relatively insignificant meeting? Rolleston had earlier been a friend and contemporary of Wilfrid Fox, the senior dermatologist at St George's, and both had to retire after 20 years service, a rule which could be devastating to anyone appointed early in professional life. Both had been educated at Marlborough before Cambridge and friendship may well have eased his Presidential appointment; blood is thicker than water. Furthermore, in 1924, Rolleston had revealed interest in matters dermatological with a paper on "Skin manifestations of leukaemia and allied conditions" at our London meeting.

Humphrey Rolleston (1864-1944) was the brilliant son of the Linacre Professor of Physiology at Oxford, and great nephew on his maternal side of Sir Humphrey Davy. After Cambridge, where he gained a double first in the Tripos, he entered St Bartholomew's as a clinical student. After the usual house appointments he demonstrated in pathology first at Bart's and then at Cambridge; as there were no immediate prospects of joining the staff at his own hospital he had to look elsewhere. In 1893 he was appointed first to the Metropolitan Hospital and then to St George's as Assistant Physician where he was nominated Curator of the museum which had been bequeathed to the hospital by Sir Benjamin Brodie; he became a full physician five years later.

His wide-ranging knowledge was to revolutionise pathology at St George's where his erudition, wisdom and experience were readily acknowledged; furthermore an interest in the skin manifestations of general disease is apparent in several of his papers. His first important publication in 1905 wasDisease of the Liver, Gall Bladder and Bile ducts his last - The endocrine organs in Health and Disease with an Historical Review appeared in 1936.

A lifelong association with Clifford Allbutt, with whom he collaborated over the massive "System of Medicine", was more than rewarding. He was to follow him as Regius Professor in Cambridge for seven years from 1925. At the College of Physicians he gave numerous eponymous lectures including the Harveian, and he was Senior Censor and President from 1922-26. Many other appointments and accolades came his way. He supported Lord Dawson during the terminal illnesses of King George V, and was awarded a KCB, then a baronetcy and finally the GCVO.

Humphrey Rolleston was a quiet, self-effacing man. He was characterised by his industry and by his infinite care and accuracy over the written word though he was a prolific writer. His immense knowledge of the rare and the obscure allowed him to approach that pinnacle occupied by the one and only Frederick Parkes-Weber.

S E Dore's London meeting in 1933, broke the usual mould by being devoted to an historical survey with three papers on Robert Willan by MacCormac, by J D Rolleston and by Haldin-Davis; one on "Erasmus Wilson, his predecessors and contemporaries" by H G Adamson and "British Dermatology in the eighties" by Whitfield. Scottish dermatology was covered by Norman Walker and Percival. These papers are to be found in the Journal of 1933. The price of the dinner at Claridge's hotel seems to have been a bargain at a guinea a head inclusive of all wines.

During the 1939-45 war the Association's depleted meetings were held in London and at the one in 1943 Robert Klaber suggested that careful thought should be given to the post-war status of dermatology, its teaching, its training and the facilities required. Though the idea was widely supported, the ultimate outcome of the war was far from certain, and it was felt that this was not the time for prolonged and detailed planning. By 1944 membership had increased to 80, the Journal was making a profit, and a modest investment was made in War Bonds. Latterly military dermatologists, such as R M B MacKenna and Frank Hellier, and even Donald Pillsbury, Consultant to the American forces, had been invited to present observations of current interest on subjects such as khaki dermatitis, the introduction of DDT, and dimercaprol (BAL), and then later on the use of sulphonamides and penicillin.

Foreign members were now introduced, first as "Corresponding", and later as "Honorary" members. Our relations with colleagues from Canada and South Africa were particularly close and members of the affiliated branches in New Zealand and Australia could participate in our meetings. By 1949 the home membership was up to 120, a figure which was, for the time being regarded as a "ceiling". The subscription was still one guinea a year. It was not until 1964 that the abolition of restricted membership became accepted, it had been championed by both Ingram and Dowling, though a number of "backwoodsmen" seemed keen to cling on to their privileged and exclusive club.

The Scottish Dermatological Society

The origins, evolution and development of the Scottish Dermatological Society have been recorded by Gordon Fraser48. It first met in 1924 having been instigated by Norman Walker, fresh from his Presidency of the BAD's highly successful meeting in Edinburgh two years earlier.

Thirteen dermatologists from Glasgow, Edinburgh, Dundee and Aberdeen were joined by Robert Bolam of Newcastle, a crony of Norman Walker, and they were both to become actively involved with the General Medical Council. Originally it was known as the North British Association, in deference to Bolam; the designation hardly surprisingly proved unpopular and was later changed to its present more acceptable form. Meetings were held three times a year, one in Edinburgh, one in Glasgow and a third rotating between the other centres. These were informal clinical affairs without papers, indeed for some years minutes were not kept and subscriptions were not required. Qualifications for joining were not defined at first but until the 1939 war, only senior dermatologists were proposed. Attendance was sometimes low, occasionally even in single figures. In Aberdeen in 1936 but three supported Tom Anderson, the host.

After the war, and the launch of the National Health Service, the Society inevitably became transformed, losing something of its friendly informality; with the changing medico-political scene, involvement with education and training had now to be considered. A new Constitution evolved in 1968, with a wider membership and a new pattern of meetings; formal papers were included, the duration was extended and visiting guest speakers were to be invited.

The Scottish Dermatological Society is now a force to be reckoned with in the modern arena, proudly asserting its place in dermatology and pointing to Willan, Bateman and to Addison, to her own heroes, and to the many adventurous sons who migrated South such as Pringle, MacLeod, Mackenzie, MacCormac and Galloway.

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