There could be little progress in dermatological affairs during the Second World War and in the immediate post-war years; doctors had left their practices to join the forces, teaching in medical schools was disrupted, and civilian healthcare became the responsibility of the Emergency Medical Service. Bombing of cities and industrial targets was anticipated, though surprisingly delayed; senior doctors emerged from retirement and the EMS shouldered this tremendous load with characteristic British resourcefulness. For administrative reasons London was divided into sectors, each with a teaching Hospital, usually adapted as a Casualty Reception Station, at its peak. Each zone, fanning out into the country, would take in local hospitals where Skin Clinics were to be conducted, so that one dermatologist might well serve several hospitals. Geoffrey Dowling, for example, used a motorcycle to get around his "parish"; in the winter and with the "blackout", this proved extremely taxing.
Some of the established consultants, especially those with administrative skills, had successful careers in the services, some had already been Territorial Officers or in the Reserve. John Ingram went to France early on, while the young Liverpool dermatologist, R M B MacKenna, then in practice with his father R W, moved to the War Office to become Adviser in Dermatology to the Army. These two men were able to upgrade the status of dermatology in the eyes of the military; furthermore skin patients were to be treated separately from those with venereal diseases, which naturally seem to flourish in times of war.
Unusual chemicals were introduced into military clothing and an outbreak of "khaki shirt" dermatitis51, with its purpuric features, caused interest and puzzlement. Dermatitis from military footwear was not uncommon but never assumed the dimensions of that which afflicted the Americans in Korea, or for that matter our own forces in the Falklands in more recent times. Therapeutic advances were notable: sulphonamides appeared in the early stages of the war, being used topically as well as systemically. As a result in North Africa, the Mediterranean sunlight provoked photosensitivity and other inflammatory patterns were also noted. Grant Peterkin of Edinburgh, serving in that theatre, wrote of his extensive experience of sulphonamide sensitivity. The first appearance of penicillin was as secret as it was exciting for it was prescribed for Winston Churchill's pneumonia; it was then to become available, most sparingly, for dermatological use. Its effects in the first place seemed nigh to miraculous and were reported by Hellier and Hodgson among others. DDT proved invaluable in eradicating the infestations which scourged so many prison camps. Malaria prophylaxis was vital to preserve a soldier's fighting capability; once this had been assured by the swallowing of a daily mepacrine pill, the improved performance of our forces in the tropics brought added kudos to the medical establishment. However the subsequent development of tropical lichenoid dermatosis caused concern, the American forces in the Pacific being more affected than the British. Chloroquine, mepacrine's successor, without its skin staining tendency, was better tolerated.
Once the American Forces had joined ours, military dermatologists soon got to know their counterparts, and friendships developed many of which survived long-term. American generosity is well known; their somewhat different approach to dermatology, as apparent then as now, depends on a training and education closer to the Continental pattern than that of Britain. Their social and their professional expectations are as different from ours as are their economic strengths. These newly acquired friendships were to prove a long-lasting bonus.
Some less fortunate individuals suffered the privations of incarceration: prisoners of War in the hands of the Japanese were ill-treated and Louis Sefton, who had trained at the London, wrote of his experiences52 in Singapore which he faced with detachment and bravery. He had charge of a hospital with at least a hundred "Skin" beds and recorded his observations over three years. He was puzzled and amused to report that the enigmatic "seborrhoeic dermatitis" disappeared after nine months of imprisonment. In his view this cast doubts on the various pathogenic theories then popular - vitamin deficiency, dietary imbalance and psychological stress; his patients had more than their fair share of each.
Regular meetings of the BAD, albeit in low-key, had continued throughout the war. The 25th in 1945 was held at the Royal Society of Medicine and "there was a good attendance of members and visitors". The special discussion was on "Penicillin in the Treatment of Skin Diseases" presented by R M B MacKenna, Adviser in Dermatology to the Army, and Frank Hellier - both were enthusiastic about their experiences. The concluding dinner at the Dorchester was gracious and "Formal Dress" was still de rigueur.
Post-War Recovery and Development
At the end of the war, a Britain exhausted from prolonged privation, years of food rationing (nutritious but uninspiring), and a shortage of fuel and of clothing, had to cope with broken-down cities, factories, railways and docks. Concerns about the health of returning warriors and family estrangements, were borne with fortitude as optimism, nourished by the mighty American aid effort, began to return. Once victory was achieved, relief was overwhelming; Churchill's National Government, which had included representatives of the main political parties, was disbanded and a General Election was called. There was a widespread feeling that a change was needed, and an overt socialist campaign had latterly been run in the forces; it was not surprising that Clement Atlee's Labour party took over.
The new Government was occupied in demobilizing the services and in reconstruction, both of the environment and of the social fabric. The Emergency Medical Service had coped well during the war but there was no question of reverting to the pre-war pattern of medical care with Voluntary Hospitals and their Honorary staff on the high ground, and more modest Council Hospitals with paid staff elsewhere, while the Panel system dealt with general practice.
W H Beveridge, an enthusiastic social reformer, had met Churchill, then a Liberal, in 1907 to discuss ideas on national efficiency. Beveridge, as unpopular with the Unions as he was with the Labour movement, was then a Secretary at the Ministry of Food; later he became closely involved with the London School of Economics. Throughout his life he was obsessed by the social injustices in Britain and his inquiry into Social Service began in 1941 and was presented the following year; it was viewed with disquiet by the Churchill Government, but was widely acclaimed elsewhere. In 1943 it was agreed that his proposals could act as a "blue print" for a Welfare State with insurance against want, disease, ignorance, squalor and idleness.
Aneurin Bevan was Minister of Health in Atlee's post-war Socialist Government, a tough Welsh coal miner like his father before him; he possessed a sparkling intellect and was a brilliant orator. His National Health Act of 1946 promoted universal free medical and dental care, the nationalization of hospitals which were to be run by Regional Boards, the abolition of the sale of medical practices, universal education to the age of 15, and legal aid. All of these were to be funded from general taxation. It took two long years of negotiation with the medical profession: tempting carrots, such as part-time contracts and Merit Awards, had to be dangled to entice the influential and largely antagonistic hospital consultants to accept. But in 1948 the National Service became a fact and Bevan, an ever present thorn in Churchill's flesh, had won. He then set about repairing the country's war damaged houses, and erected thousands of ugly but practical "Prefabs".
Doctors were demobilized in an orderly fashion and soon large numbers of young, potential consultants were seeking hospital appointments and postgraduate training. In this way the "Demobilization Registrar" posts evolved, with a salary of between ,500-600 a year and the chance to settle into an educational environment. It proved an enlightened system. The London teaching hospitals combined to support these skin registrar posts, and St John's became a focus offering places for registrars and clinical assistants as well as courses of lectures and teaching in histopathology, mycology and radiotherapy. The Institute of Dermatology had yet to be launched. The Blackfriars Skin Hospital, still in operation but losing its appeal, was soon to close. In Scotland the departments both in Edinburgh and Glasgow provided posts and the former in particular attracted overseas students; G H Percival and Grant Peterkin were stimulating, both highly effective if contrasting teachers. In those days it was possible to obtain the Edinburgh Membership with dermatology as a special subject, and this encouraged a continuing supply of able postgraduates. Nothing comparable existed at that time in England where the greatest activity was in London, though Leeds, Sheffield and later other centres such as Newcastle, Bristol, Oxford and Cambridge were soon to play their part.
In London, prominent teachers included Thomson at King's, Roxburgh with Klaber at Bart's, O'Donovan at the London, Forman at Guy's where Barber, though still alive, restricted his attention to a favoured few. Goldsmith was at UCH with Freudenthal in the background, and Tom Brain was at the Royal Free and Great Ormond Street. At St Thomas' the knowledgeable but arcane genius of Geoffrey Dowling was revealed, interpreted by his shrewd junior colleague Hugh Wallace, to a number of men who were to become well-known in years to come. All of these teachers attracted lively groups and biographical notes follow.
Teachers in Post-War London
Matthew Sydney Thomson (1894-1969), a self-effacing man, had been Secretary of the BAD for three years from 1945. After Merchant Taylors and Downing College, Cambridge, he entered King's College Hospital Medical School where he proved a bright student winning the Burney Yeo Scholarship and coming under the eye of Arthur Whitfield. After House Appointments he became Medical Registrar, assisting in the Skin and V D Clinics. Having served as First Assistant to Whitfield he was finally put on the honorary staff in 1933; other appointments soon followed. Throughout the 1939-45 war, with Whitfield totally embroiled in medical outpatients, Thomson became Resident Casualty Officer at King's, and this work along with the routine Skin Clinics, provided a tremendous load; nevertheless his handwritten letters, were always promptly despatched.
"Tommy", a popular member of staff, was to become well disposed to the newly demobilized King's men; in fact he taught many, directing a number to distinguished careers. He published several papers, but his report of Poikiloderma congenitale (Rothmund-Thomson) in 1923 ensured lasting fame. In 1958 he retired to the coast, cutting himself off from London, to tend his garden and stamp collection.
Robert Klaber (1900-1946), was Roxburgh's Chief Assistant at St Bartholomew's from 1933, displaying natural teaching ability and wide erudition. At the Prince of Wales' and the Haymeads Hospital in Bishops Stortford he developed excellent units within the Emergency Medical Service but his life was to end abruptly and prematurely.
After his house appointments he had enjoyed a period in Vienna before returning to Bart's as a demonstrator in pathology and a Clinical Assistant in the Skin Department, a combined arrangement which provided an ideal base for his future career. He published some excellent papers - observations on contact sensitivity, particularly phytophoto-dermatitis from meadow grass and the puzzling, even though self-acquired, phosphorus sensitivity from red-headed matches (he was an inveterate smoker). Other studies such as on glomangioma, necrobiosis lipoidica and erythema gyratum perstans revealed his wide reading and a mature understanding of skin pathology.
He amassed a large collection of histological specimens at St Bartholomew's Hospital and gained something of a personal reputation as a dermatopathologist, at a time when these were few and far between.
It should be remembered that in the early part of this century responsibility for venereal disease was the lot of the dermatologist. Syphilis was being treated with the arsenicals, which, with the new serological tests, were to bring special interest to the study - and generated respect for the specialists. It was for this reason that the Continental clinics achieved such standing with their lavish departmental space, central funding and high academic status. In London Macormac and Gray both gained generous allocation of beds.
William James O'Donovan (1886-1955), the eldest of a large Irish Catholic family, was educated privately before entering the London Hospital in 1909. He was attracted to pathology eventually becoming Junior Assistant to the Director. This led to his appointment as CMO at the Ministry of Munitions in the 1914-18 War, the acquisition of an interest in industrial skin disease, and the receipt of an OBE. Sequeira took him into the skin clinic, first as an assistant and finally appointing him to the full staff in 1926. Like his teacher he became an expert syphilologist.
"O'D" did not conform to the mould of a conventional consultant - far from it. As colourful as he was eccentric, he continued to be a Coroner's pathologist. With his morning coat and top-hat, a monocle firmly fixed in his eye, he made a striking and unforgettable figure. His Irish brogue and quick repartee caused him to be revered (and feared) in the London Hospital Clinics. In 1927 he wrote his own book - "Dermatological Neuroses". It was hardly surprising that the large Irish community, bemused by his wit and badinage, and the fact that he was now a Papal Count, elected him as their Member of Parliament for Mile End - a seat he held for five years.
O'Donovan's fame in the hospital was based on his personality but he was not accepted by many of the more established and conventional of his colleagues; some may have been fearful of his acid tongue and some incensed that he continued to work for a Coroner's court. He did not become a member of our Association for many years and was never elected a Fellow of the Royal College of Physicians. At the London he was in control of a busy clinic, where his teaching sessions proved magnetic to the students. An expert syphilologist, he remained in total charge until the formation of the Whitechapel Clinic in 1930. In the 1940s he found himself in Egypt, dressed in army uniform, as Adviser in Dermatology; there he astounded all with his caustic wit but particularly with his thoroughly unmilitary behaviour.
William Noel Goldsmith (1893-1975) edited the British Journal of Dermatology for 10 years, taking over from Roxburgh. He coped single-handed during the difficult days of war-time restrictions in London and virtually saved the journal from oblivion.
His father had come to England and founded the London Metal exchange, his uncle Viktor had been Professor of Mineralogy at Heidelberg University. William was born in Kensington and after Rugby and Pembroke College, Cambridge entered UCH Medical School, qualifying in 1918.
After a spell in the RAMC he returned to London, passed the outstanding exams and worked with Archibald Gray in the Skin Department as his Assistant. This led to a year of travel, thanks to the Radcliffe Crocker scholarship in the gift of the Medical School. He spent most of his time in Breslau12 with Joseph Jadassohn working with Frei, the bacteriologist. "The staphylococci in acne vulgaris" was the subject of his MD thesis. In the department were Jessner, Biberstein and Freudenthal, the latter being particularly friendly and this friendship was to be repaid in later years.
In 1928 he achieved a consultancy at St John's for one weekly outpatient clinic. In 1932 he was appointed Assistant Physician to the Skin Department; now a full blooded "Honorary", at UCH, he assumed charge on Gray's retirement in 1946.
Goldsmith (the name had changed) was a hybrid. Genetically he was of middle-European Jewish stock, with high-achieving intellectual parents, but was sent to a superior English public school, and then Cambridge, before entering a conventional London Medical School. Conscientious to a degree, the epitome of industry and learning, the studies he published, and there were many, were undertaken with exquisite care. He decided, at considerable cost to his energies and time to edit the first "Recent Advances in Dermatology" which appeared in 1936, recounting worldwide developments over the previous 20 years. Later he helped R M B MacKenna to compile the Dermatology Section of the "Nomencature of Disease" promoted by the Joint Committee of the Royal College of Physicians.
In the clinic he was the essence of kindness to his patients, but his manner was ponderous, and his students had been known to shut an eye during some of the longer sessions; more noteworthy was the senior registrar who took a shooting stick on one of his ward rounds. He often chose to examine the patient before embarking on the history and of course insisted on precise morphological detail. P J Hare noted53 that it was easy to misjudge Goldsmith's solemn expression, likening it to Roman gravitas. Though of exceptional erudition, he was not pompous but basically a humble, shy man who enjoyed fun. He gained great pleasure from his music and his vast record collection; he also followed the fortunes of the English ballet and was no mean performer on the dance floor himself - he was said to find the Charleston intoxicating!
Goldsmith knew everyone who was anyone in world dermatology. His genius for friendship was remarkable and he was a loveable man. Many of similar ethnic background had emigrated to the USA giving a powerful and vital thrust to American dermatology; such contacts later proved useful to the travelling young.
Walter Freudenthal (1894-1952), an erstwhile Breslau colleague of Goldsmith, arrived at UCH in 1933 bringing his expertise in dermatopathology. He co-operated with Dowling who came to admire his unusual talents, he even encouraged his own students to attend Freudenthal's teaching sessions. London University honoured him with the first Readership of Dermatological Histology.
Louis Forman (1901-1989) had been President of the BAD in 1960, and was, after Dowling retired, the doyen at St John's, the Dowling Club and the RSM section. Deservedly he was awarded the Society's Honorary Fellowship.
Entering Guy's54 in 1918, this brilliant student carried off many prizes and distinctions. After qualifying in 1923 he served some of the famous Guy's physicians as houseman, then for four years worked as a general physician at St Olave's Hospital where Geoffrey Dowling was the visiting dermatologist. This proved opportune, for Forman was smitten by the magic of dermatology and returned to Guy's in 1930 as Skin Registrar. When Dowling moved to St Thomas' in 1932, Forman was appointed Assistant Physician, joining Barber in the Guy's Department; in 1935 he joined the staff of St John's.
War-time for Louis Forman was exhausting. As Consultant to the South East Sector of the EMS he had to travel around many hospitals giving a clinical service as well as still teaching the students; he was also Sub-Dean of the medical school which was then based in Farnborough. After 1945, with the influx of demobilised registrars to the department, Forman became their "Director" for Barber was nearing retirement. Histopathology of the skin, still a Cinderella subject, was keenly studied and discussed, indeed Forman was ready to consider any problem presented. His clinical memory was remarkable and invaluable.
His study of erythema nodosum appeared in 1946 but it was the relationship of bowel and skin, an early interest of Barber and others at Guy's, which continued to fascinate him. He was conscious of his predecessors and proud of his Guy's lineage. His Prosser-White Oration "The Skin and the Colon" revealed deep understanding of a complex field; throughout his life he maintained an intense interest in any disease process affecting the oral mucosa.
"Lolly" was approachable, patient and tolerant. His unworldly air and ability to disregard what was currently in hand, led to slow consultations with his clinics regularly over-running their allotted span; he was generally seen to be deep in thought even thinking aloud between prolonged silences. Unmarried, he lived in comfort and had countless friends. Tennis and his piano had given him pleasure, even the tragedy of failing vision seemed not to dampen his enthusiasm. He was popular, generous and greatly respected. Dermatology had been his life's interest and his love.
Reginald Thomas Brain (1894-1972), had been a pupil of Sequeira at the London Hospital along with O'Donovan, Ingram and Arthur Burrows; he came to be treated by them as a father figure for he was older and seemed worldly-wise.
During the 1914-18 war he had served for five years in the Army Medical Service acquiring skills in laboratory work so, when installed at the London, he was able to develop this interest, becoming an expert in handling viruses, especially herpes simplex. This experience served him as the basis for his Watson Smith Lecture, and probably influenced his appointments to the Royal Free, the Hospital for Sick Children at Great Ormond Street and even St John's. At the latter, apart from clinical work, he took over radiotherapy, an interest he had acquired from Sequeira; his dosages by modern standards may now seem somewhat cavalier.
Tom Brain was no great contributor to the literature, but having been Sequeira's First Assistant, he participated in the later editions of his textbook. With Northern accent, bald pate, and blunt manner he was at home with children, their parents and their diseases; his down-to-earth teaching was ever popular. Individual in his style he may have been, but he was also much loved and respected.
St Thomas' Hospital it was Hugh Wallace who identified and exploited the peculiar talents of Geoffrey Dowling as a postgraduate teacher. In the Surrey Sector hospitals they served there were plentiful clinical slots where the ex-service registrars could be placed to gain practical experience, providing scope to nourish what proved to be an impressive cohort. Those to enlist and train at St Thomas' over these years included many of our future leaders - Wells, Rook, Sweet, Wilkinson, and Lyell to name but a few. During the war years Robert Bowers had been Registrar with E W Prosser-Thomas Chief Assistant; soon Ian Whimster arrived in the pathology department, and, encouraged and stimulated by Dowling, was developing more than a passing interest in the vagaries of skin behaviour.
Dowling tended to make friends at St Thomas' with the less conventional of his colleagues as he was not at ease with the "establishment" figures, and they abounded there. He was thought at one time to harbour left wing ideas, for there was indeed a coterie (mostly ensconced in various laboratories) of such around; in fact, though he was a thinking, caring man, brought up in the liberal Anglican society of Cape Town, these suspicions were not far off the mark. Quiet, shy and seemingly gruff with little appeal for the uninitiated student he came to be regarded as a "character" in the Medical School. His musical interests led him to the Hospital Choral Society then run by Wilfred Dykes-Bower, a Thomas'-trained GP, brother of John the organist and Stephen the architect. This musical interest brought Dowling much joy, later he became President of the Society. In 1938 Renwick Vickers paid a short visit to look around the London Hospitals and he found his reception by Dowling unusually warm, a common devotion to choral music cemented their friendship over the years.
During and immediately after the war Dowling developed an interest in treating patients with lupus vulgaris. Finsen's actino-therapy, as used at the London Hospital, had become more popular than the earlier methods of chemical or thermal destruction. Dowling deduced that administration of calciferol, (high potency Vitamin D) might benefit patients with long-term tuberculous infections. With K M Tomlinson as his assistant, his own observations confirmed this idea, and in 1945 he was able to demonstrate a selection of his cases at the Royal Society of Medicine. (Similar observations were being made in France by Professor Jacques Charpy). The impact was short-lived for the specific anti-tuberculous drugs were soon to become available.
With Walter Freudenthal settled in his laboratory at University College Hospital, Dowling became aware, as never before, of the potential of such a superb histopathologist; the two formed a friendship based on a mutual respect of each other's expertise. This led in 1938 to a joint study of the muscle changes in systemic sclerosis, and then to a review of scleroderma and dermatomyositis which formed the basis of his Watson-Smith Lecture.
It was indeed fortunate that Wallace recognized the unique qualities of Dowling - the clear thinking and an ability to distinguish between the significant and the irrelevant. He knew of Dowling's humility and inability to contradict, his difficulty in explaining his essential diagnostic "steps", and particularly in communicating with undergraduate students. However, with his remarkable memory and such critical faculties he was the complete clinician, who could stimulate and enthral his group of enthusiastic registrars without any hint of patronage or deference. Wallace, understanding this quiet observer, could act as interpreter; he planned that Dowling should play a "Professorial" role.
Hugh John Wallace (1909-1985) from Bedford School and King's College Cambridge moved to St Thomas' Hospital Medical School for his clinical training. It became his second home. As house physician he had served Geoffrey Dowling and marvelled at the wisdom of this unassuming man.
His war years were spent as Superintendent of the "Woking War", a disused railway orphanage then a hospital, as administrator and physician; he undertook the teaching of the undergraduate students and Membership candidates with skill and good humour. His curious short stature, the result of some vertebral anomaly, his muscular frame, bald head and delightful countenance presented an unusual appearance. An impish humour with a penchant for the absurd made him good company - often outrageous and always entertaining.
In the early days he had considered a career in paediatrics, but from 1939 he had worked in various skin clinics with Dowling as his Assistant, and in 1946 he was on the staff of St Thomas' continuing to serve a number of other hospitals in the Sector. From these he could refer to the parent Hospital patients of interest for investigation and teaching. Thus the scene was set for reception of the demobilized doctors joining the St Thomas's team, to work in the Sector hospitals and to benefit from the "Headmaster's" guidance and teaching. Without doubt it was Wallace's vision, friendliness and clever assessment of this potential, that was to lay the foundation for a high calibre "production line". The outcome was an élite group soon to be responsible for an upturn of our dermatological fortunes - a renaissance, no less. Hugh Wallace himself was a gifted teacher, a wise physician and an astute dermatologist, popular at St Thomas' and St John's to which he was appointed in 1951.
His most important project, prompted by Dowling, was to elucidate the status of lichen sclerosus et atrophicus, a condition which had been befogged by a particularly clumsy gynaecological jargon, and to clarify its position vis-à-vis leucoplakia and carcinoma of the vulva. His exposition was later to be accepted by most pathologists and any clinician who favoured the use of a microscope; it formed the basis of his Prosser-White Oration.
His other main study concerned a family with angioma corporis diffusum - Anderson-Fabry disease and he was delighted to find that the St Thomas' surgeon, William Anderson, had recognized it ahead of Fabry. He identified the precise nature of the dyslipoidosis and established its mode of inheritance, it was the basis of his Watson-Smith Lecture.
Articulate speech was not his forte; a series of grunts, pauses, winks and innuendoes could make his train of thought difficult to follow: some felt that he could imply intemperate ideas without actually declaring them. He was our representative at the International Congresses of Dermatology and as a keen traveller was sought after at many meetings; he was informative and an entertaining speaker. A great protagonist of Anglo-French cordiality, as President of the BAD in 1974 he hosted the Reunion and was able to exercise his linguistic skills.
Hugh Wallace endeared himself to all but not least to his patients who, aware of his professional skill, were enchanted by his personality.
Ian Whimster (1924-1979) volunteered as a young doctor to go and work in Belsen before returning to pathology at St Thomas'; he acquired an interest in the skin which Dowling was able to support and strengthen. Whimster acquired fame for his work with Rook on keratoacanthoma and on the site of cell cleavage in the bullous eruptions. With Wallace he studied lichen sclerosus and vulval leucoplakia but it was his experimentation on reptilian pigment systems that ensured world-wide recognition55.
Birmingham and the MRC Unit
When the Medical Research Council became concerned about a widespread ignorance of the skin's role following burns, the only academic dermatological unit in Britain was the one in Edinburgh, the chair being endowed there in 1946. Burns had been a major problem throughout the war, affecting all the services; plastic surgeons had developed remarkable reparative skills but little was known of the skin's natural ability to protect or disinfect itself; death from circulatory failure after severe burning was commonplace and the choice of suitable local dressings always posed problems. Research activities in the United States and elsewhere convinced the Council that it should set up a British Unit for Experimental Pathology of the Skin, and the Birmingham Accident Hospital seemed to provide a suitable centre.
John Squire, a capable and highly experienced research worker, had been a protégé of Sir Thomas Lewis. He was appointed to the Leith Chair of Experimental Pathology in Birmingham and took on Directorship of this Unit, but he had other responsibilities, notably overall charge of three distinct and separate research projects - those considering renal disease, immunological chemistry and connective tissue disorders. His part in the identification of benzpyrene as the carcinogenic factor in the mineral oils then used as industrial coolants had been of particular interest to dermatologists. This seemed to be responsible for occupational scrotal cancer and its subsequent exclusion was to prove totally effective.
Squire recruited two other capable scientists, C N D Cruikshank, a biochemist who was to take over control after the Director's early and unexpected death and M D Trotter, who had gained a considerable reputation at the Chemical Warfare Unit at Porton Down for his study on the penetration and absorption of chemicals by the skin.
With hindsight there seems to have been little consistent or satisfactory liaison between the scientists and local clinicians though E A Fairburn, Roy Summerly and Stanley Wood for a time joined in the activities. With Cruikshank's retirement the Unit was disbanded but by then the Institute of Dermatology in London was expanding under Professor Charles Calnan and dermatological research was beginning to develop in other areas.
* * *
The 10th International Congress of Dermatology had been planned for 1940 in New York, but it was not to be. So, 15 years after Nekam's Budapest meeting, universal admiration for Britain's brave survival and more practically, the potential currency difficulties for any European visiting the United States, determined that London should be the centre.
The British Association undertook to arrange the Congress and Archibald Gray, our founder and currently the Harveian Orator, was naturally President. Gordon Mitchell-Heggs, fresh from running a large Military Hospital and destined to be Dean of St Mary's Medical School, was an efficient and business-like Secretary. Following the Royal opening by King George's brother, the Duke of Gloucester, Bedford College, then a ladies' enclave in Regent's Park, provided a tranquil rural venue. The "Museum Exhibition" featured more than 40 items and the presence of pharmaceutical firms broke fresh ground for conservative Britain; a number of educational films were shown.
The first somewhat daunting subject for consideration was the pathogenesis of eczema, but it did not deter John Belisario from Sydney, who was followed by Oscar Gans from Frankfurt, Jean Gaté from Lyons and Donald Pillsbury of Philadelphia; the latter enlivened a somewhat indigestible session with delightful illustrations. Guido Miescher of Zürich followed with a histological study and finally R T Brain, from London's Great Ormond Street Hospital, recounted his experiences with infantile eczema.
The second topic concerned the exciting advent of Cortisone and Corticotrophin (ACTH) and their effects on the skin. The main contributors were American, Louis Brunsting from the Mayo Clinic, Lemuel Eraux of Montreal and Marion Sulzberger from New York were able to tell of their three years of experience. F T G Prunty, from Britain, with his St Thomas' collaborators presented early data on the treatment of systemic lupus erythematosus and dermatomyositis. This topic was to stimulate numerous, often over-excited delegates to take the floor.
The third subject was the treatment of cutaneous tuberculosis and allied infections. Geoffrey Dowling, who had reported earlier the results of calciferol treatment in patients with lupus vulgaris, opened the proceedings. He was followed by Professor J Charpy from Marseilles who had been pursuing the same course independently since 1940. Next Poul Marcussen with Arne Nielsen from Copenhagen compared the results of this method with those of conventional actinotherapy, a treatment originating in Scandinavia. From Madrid, Sainz de Aja reported on his experiences, followed by Gustav Riehl, a revered figure who had been secretary of the International Congress in Vienna 60 years earlier. There then followed a group from Belgium, and finally, from St Thomas', Wetherley-Mein considered the metabolic effects which might follow calciferol treatment. These findings are only of historical interest, as anti-tuberculous drugs were about to appear on the scene.
One hundred and fifty short papers were given over the five days and 140 cases were demonstrated at the Clinical Section which was held in the Military Hospital, Millbank on the final day. Bearing in mind the difficulties in mounting such an event so soon after the war we could feel justifiably proud over the outcome. Furthermore, a financial surplus was passed to our Association and then, via Sir Archibald Gray, to the College of Physicians at the time of its move from Pall Mall East to Regent's Park. The Willan Room was the outcome.