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Dr Geoffrey Barrow Dowling

Interviewed by Dr Victor Witten June 3 1960. London.

Dr Witten: I understand from every source that if there is anyone at all who can be held responsible for the advance and progress of Dermatology in England, that you're the one, that up until the War there wasn't much that one could say that here was a .... this is advance and so on that there were excellent Dermatologists.

Dr Dowling: No it's not really the case, my part in the concern has been simply to get the younger generation together into a big group, a very powerful group they are too. As we have what we call a travelling club. It travels and it reads Journals and meets once a month in a Pub and we go over the current literature and three times a year travel, once abroad and twice in England and it's interesting. All these chaps know each other and there are no hard words. They don't spare each other. They are perfectly frank.

Dr Witten: They don't in these Meetings.

Dr D: They do not.

Dr W: These are, what the younger men in London?

Dr D: All over the country.

Dr W: Who come here.

Dr D: Well no, the Londoners meet once a month you see and the travelling club has about 70-odd members but they are scattered about all over England. There are you see only about 170 or 180 Dermatologists in the whole country.

Dr W: Really.

Dr D: That's the total. We have a much smaller number here compared with size of the population than in any other country.

Dr W: We have more than that in New York City alone.

Dr D: Well the reason for it is. It's this old system we were talking about a minute ago. The General Practitioner has primary control of the patient and the Dermatologists are brought up, trained, to take on Hospital appointments, to take on Hospital departments. They earn the greater part of their money that way. They're quite well paid for their Sessions you know. They do 8 or 9 a week half-days, not quite half-days, but very nearly. And that's their main source of income. And that's the way the thing runs. They are scattered all over the country in different centres you know, scmetimes what you might call parochial centres, a town like Gloucester for example and Cheltenham, would be one, Exeter is another, Plymouth and surroundings and that sort of way and they are responsible for the dermatology of an area and of course so the number of Dermatologists corresponds to the number of parishes and centres.

Dr W: I see.

Dr D: In England exactly. There are no independent Dermatologists, They couldn't exist.

Dr W: This is now under the National Health.

Dr D: It's under the National Health. This is the result of the National Health. Before the National Health Service there were only about 60 or so active Dermatologists in Great Britain.

Dr W: Would you say that the calibre of Dermatology has been raised as a result of the insurance plan?

Dr D: It has. You see because there were so few recruits to dermatology in the old days. In the first place it wasn't very easy to earn a living at it. You had to have a substantial centre, you see, or you had to be on the Staff of a Teaching Hospital in London or the University Hospital say in the provinces, otherwise there wasn't a living in it. And of course, I always said if only the Dermatologists could be paid during their training period. We weren't in the old days, or very few were or paid so little as not to matter. They had to so to speak earn their living and learn the dermatology as well as they could. There was no training of Dermatologists in England between the Wars, practically none, and of course when the National Health Service came along the present system evolved and really, it's not bad.

Dr W: Well, let me go back, historically now. You began the practice of Dermatology when?

Dr D: Let's see, where are we I suppose somewhere ahout 39 years ago. And then Well, I was - I had a job I was Barber's Clinical Assistant, Chief Assistant at Guy's Hospital and I had a job in the Venereal Department for which I got paid, you see. And altogether I think I was paid £375 a year in those days which is a lot.

Dr W: Sounds like a lot.

Dr D: It was a lot compared with other places. They were very generous at Guy's Hospital and I was paid £375. a year which was enough. So I was able to go on like that you see, and really do nothing else. Well, that's exceptional.

Dr W: Well, now you did this and you came then to the First World War.

Dr D: Oh, that was after the First World War.

Dr W: This would be after, yes. And then, did Dermatology remain about the same in England until the termination of the Second World War?

Dr D: Pretty well. Yes.

Dr W: Pretty well. And at that time you went to St. John's, is that correct?

Dr D: Yes, I was at Guy's Hospital on the staff with Barber and I was on the staff there for about five or six years. Then an opening turned up at St. Thomas' Hospital so I changed from one to the other and St. John's was a kind of Hospital which nearly all of us belonged to, at least a number of us had a session there or two sessions.

Dr W: In other words its operation in the clinical respect has been the same for many years.

Dr D: Yes, it has, yes.

Dr W: And then?

Dr D: Well then, after the War, of course, there was a kind of special scheme for training ex-soldiers and medical officers in various specialties training them for Consultant work and paying them so much, you see,while they were having this training and that simply started the ball rolling and the influx into Dermatology became reasonable, substantial. The outcome of it is, we have trebled in number of Dermatologists in this country or we have certainly doubled the quality and the reputation of Dermatology has actually gone up in this country, a lot. It's treated with very much more respect than it used to be.

Dr W: It is that.

Dr D: Yes.

Dr W: And is this true for all of the Dermatologists,of course I know there are exceptions but you are now speaking of the specialty and overall the physician.

Dr D: Dermatologists, yes. They're very good you see and they have to compete for these posts. And they are very good. They are a very good lot.

Dr W: I've heard that when men graduate from medicine in England now they then compete for the Specialist or the specialistic training and in the beginning maybe only 10% in any one Examination will pass.

Dr D: Oh, that's the Membership, the MRCP it's a very difficult Examination which is,unfortunately,necessary for anybody going for Consultant medical work, they have to pass that MRCP Examination.

Dr W: What is that?

Dr D: It is Membership of the Royal College of Physicians and it's a very tough Examination indeed. There are about 300 go up for it four times a year and of that about 12% get through. And so you see it's a terrible hurdle but it's a hurdle which has got to be got over, because it is just a rule that's been made for a considerable number of years, even before the War, that anyone who is appointed as a Consultant to a Hospital, Consultant, Specialist or Physician or a Dermatologist or any other kind of Specialist, shall go through that Examination. They learn something about medicine in general.

Dr W: Well this Examination then occurs at the end of their completion of training in Dermatology.

Dr D: No. They don't start until they've got it.

Dr W: In other words, they must pass this before they go on to their Specialist training which in England you refer to as Consultant. The word Consultant means Specialist.

Dr D: Well, not quite, A Consultant is a person who is on the staff of a Hospital you see. Consultant is a rank, top rank of a Hospital clinical appointment.

Dr W: Now are all the Dermatologists Consultants?

Dr D: Yes. Must be.

Dr W: They all are. And they all have Hospital appointments.

Dr D: Have to have. They couldn't live otherwise.

Dr W: Today's plan. In other words he has no other place in which to have an assured income otherwise if he were to try to go out on his own the chances are that he couldn't make a go of it.

Dr D: He couldn't.

Dr W: The younger man is really dependent on the system today. What is his future, in the Department, he can work up.

Dr D: He's trained in a certain department. Say there are - London's a big place and there are 12 Teaching Hospitals, 12 Undergraduate Teaching Hospitals, there's St. John's and so the training of Dermatology is really rather good you know. I mean we are always having Meetings like the one we had yesterday which is all very entertaining and amusing and really good for people I think. And in London they're fairly well off. In the provinces, they are more dependent on their University Hospital. They have about 5 or 6 years training and then somebody either dies or is retired you see you have to retire at 65, and the Appointment is advertised and somebody who is ripe,you see,from one of these places, either London or the regional centres, a number of people apply. For example one came up in Nottingham the other day and so the ones,who are ready compete for it, one gets it you see and there will be another one turning up perhaps next year. But people are dependent entirely on those jobs.

Dr W: How are these Consultants in Dermatology looked upon by their fellow Physicians, the internist?

Dr D: Much better than they used to be. Out in the provinces they've got a very good reputation. It's the younger generation. They've been pretty good.

Dr W: Now tell me. I'm interested in knowing why now. You're still young in your thought why these men are so much better and have enhanced the reputation .

Dr D: Because they have had a very much better opportunity of training you see, they haven't had to scratch for a living. They are paid quite well from the moment they begin their training. A Registrar is a person who - a junior post - and he's paid.

Dr W: Like our resident.

Dr D: He's not a resident actually. But it's the equivalent of, and you have a Registrar for 2 years, perhaps 3, then a Senior Registrar for 2,3 or 4 years. That sort of period, before you can regard yourself as fit to take a job.

Dr W: Well now, let's think of the calibre of the young man who goes into Dermatology. We have the feeling in the States that its not always the highest calibre physician as he graduates Medical School, who selects Dermatology, either hecause he thinks easier, or because he does not have night hours or because he thinks it's going to be more lucrative or that his patients don't die, you know, all the old stories. Don't believe in this however. But we think that this is one of the failings today and why the reputation of Dermatology is not as good as it might be. Do you feel that here, that the calibre of the young men who come into Dermatology, is it an equal of the other Specialties?

Dr D: Well, it's very had to say, isn't it. I think it's much better than it used to be.

Dr W: You do think that. What's created this? This is what we want to know. How can one create this?

Dr D: The structure created the function. You've had a system you see of years of training and nothing else to do but train, you see patients of course and have your duties and this training includes opportunities for doing research work. You see a person like Magnus for instance he goes off onto the chemical side and he's very good at it. But the ordinary training that they get is in clinical dermatology. They get a lot of that. And then histology of course was thrown in which is really only clinical dermatology when you think of it. And mycology and as I say, those who want to do some science can do it. But of course those are very few. I must admit even now the number of people who so to speak go in for strictly academic dermatology is still very small.

Dr W: But their income is low, isn't it. Those who are remaining strictly academic.

Dr D: Yes it is low. They have to agree to that to do what they want to do they have got to accept a lowish standard of living.

Dr W: What would it be in terms of a percentage? How much less would they get than the average successful young man in practice?

Dr D: Practice and Hospital together?

Dr W: Of course

Dr D: Well, I don't know. I don't know what peoples incomes are. But I would think that the whole-time academic man will be getting perhaps,say something of the order of £2300 - £2700 or £2800 and a successful practising Dermatologist ought to be able to do double that.

Dr W: This is the younger man.

Dr D: Relatively young. In their 40's I'd say. They ought to be able to make £3,OOO or £4,000 a year, more than that. They are not high incomes mind you, as incomes go. They are not really high. But they are higher than the whole-time academic person. We feel that the science side .. we've had the speculative approach you know. We had a lot of that between the Wars you know. The concepts. The focal sepsis, the psychosomatic and the other big concepts, what are the other ones?

Dr W: All the endocrinologic and the vitamin, is that what you mean?

Dr D: Well, the big concepts. When I was young it was focal sepsis, focal infection. Then psychosomatic and then this one of diathesis this wonderful 'stress adaptation syndrome'. And then the concept of seborrhoeic diathesis we've had, haven't we. That's a special dermatological one. And all those things. The boys feel that these things have failed them. And haven't really got them anywhere. So they think .. through science you see. There's little going on. Nothing very exciting. There's very much more going on in America. America approaches Dermatology through science like anything in these days. As far as I can see.

Dr W: You think you have the feeling that there is much more in the States.

Dr D: Well ahead. Well ahead in the World, I would have said. I mean judging by the publications.

Dr W: You said something then that the younger men aren't satisfied with the older concepts and that they therefore have gone ahead in the search ..

Dr D: Well, I don't say they've done much about it. They felt that that is the next step.

Dr W: Well, tell me something about your role in this. How you went about creating this at St, John's. How you began to build all of this. You're credited with all of this.

Dr D: Yes. I know. I daresay. But I don't think I'm really responsible at all. It's purely a natural phenomenon. The only part of..... I'm entirely in sympathy with it.

Dr W: That's important.

Dr D: I'm an elder. But they know very well that I'm entirely in sympathy with that sort of attitude. Let's be quite down to brass tacks the whole time.

Dr W: Now did you, when the young men came to you with concepts or research problems, you would say well, yes, go ahead with this or did you create a ...

Dr D: No, no no no. They don't, you know. If a young dermatologist wants to do anything they have got to think it out themselves. I don't think you can prescribe projects. I don't feel that you can. I think the thing has got to come from the chap and then he has to go to somebody who understands techniques and so on ..

Dr W: You were talking about your sympathy toward the . .

Dr D: Yes, yes. I think a sceptical outlook on clinical concepts is .. aetiological concepts,is right, I think they should face it the other way if they can. You know we had a Meeting 1958 in Cambridge, did you hear about that?

Dr W: Is this the one that's just recently published?

Dr D: Yes. Have you seen the book? Of course, it's rather interesting, you see. The difference between .. that's the first publication of that sort that's been produced here. It's rather a good publication though some of it isn't good but the great part of it is. Only six dermatological contributions in it, six out of 42 contributors I think altogether and six of them are dermatologists. Now in America, the greater number of those people would be dermatologists, wouldn't they,I mean Frish, Shelley, Kligman and all these people who keep on turning up, they are the Dermatologists. We could only produce you see, we have only about half a dozen laboratory dermatologists in this country.

Dr W: Of course, you are bringing up something that is important that in the States while there are many men who are Dermatologists and are very interested in basic science, that a great deal of the work that you see comes from men who only do basic science in Dermatologic Laboratories.

Dr D: I know. That's the difference you see.

Dr W: And have no real contact with dermatology. This is of extreme importance. Is this the right direction? Is it good for dermatology?

Dr D: It may be, or may not be. How are we going to know? You have to wait 30 years or so. And look back. That is the present day approach, isn't it. You see, so far as I can see in the States you can employ these laboratory people in Dermatology. We can't do that. Not much at any rate.

Dr W: Well now, this brings up .. let me telI you what is happening in this regard. We see that the medical student as a result of the Heads of the Department and their inclinations are leaning more toward the scientific. They have honour programmes to interest these men in the scientific. And as some of the students said to me we can tell you all about allergy in a guineapig, but I wouldn't know how to treat a patient. Now -what do you think of this trend. Suppose this were to happen in your Schools or is it?

Dr D: It's not happening yet.

Dr W: It's not.

Dr D: No. It is a trend obviously and it hasn't gone far enough in this country yet. I mean I think we ought to go further along the basic science pathway to get more people in Dermatology doing actually research work, but along with them a lot of the Dermatologists are clinicians and they will probably stick to clinical dermatology, and just try and learn something of the language of the other side but not attempt to enter into it themselves.

Dr W: Now supposing a .. a department, say St. John's if you wish, that you began to get biologists, physiologists, biochemists , Ph.D's, not Dermatologists who come in to do work in this field and gradually you have more and more basic science being done there. You find that your Dermatologists who somewhat have a particular bent, as Magnus and George Wells, and others , have in basic science and this becomes a predominant part of their activity , the next thing you find is in a search for a Head of the Department that instead of selecting a clinician who has some leanings toward the science, you select the scientist who has some leanings toward the clinical. What do you think this will do to Dermatology locally?

Dr D: I just don't know. Truthfully, we haven't really started on that system yet. You see we have just appointed somebody at St. John's, I don't know who, at least somebody will be appointed shortly as Professor there, Professor of Dermatology at St. John's the Institute of Dermatology, and they have had to choose, they wanted several things. They want a scientist, they want a clinician, they want a teacher, they want an organiser, administrator and he must be a nice chap. They want all that, you see. Obviously, they can't have it all. So the choice has to be between somebody who is predominantly scientific, say like Magnus, and somebody who is primarily a clinician and whatever investigations he does would be in the clinical direction. So I just don't know which in fact .. you see,Wells combines the two things he is a first class clinician and he is also a laboratory worker, he's got the two things, but its awfully hard to find this in the same chap. I think you've got this in America, haven't you, got some people like Shelley who have got a foot really in both camps.

Dr W: I think so.

Dr D: Obviously you've got them there. We've got so very few here. We feel that as a breed ought to be encouraged that we ought to have a round dozen or so of these doubly qualified people. People who understand basic science and who also are good clinical Dermatologists.

Dr W: Well, Dr. Dowling I think we have only a few of them in the States too. The scientist finds his niche very easily because it's so broad he can just work on one aspect of chemistry and become an expert. The clinician however is quite a different story. Quite different, and when I speak of the clinician I speak of all those things that are important, diagnosis, and I don't mean the true morphologist as the French still are.

Dr D: Yes, indeed, they are.

Dr W: But the therapy, understanding mechanisms of disease, as much as there is known. I wonder how much of this really exists today. Now, I wonder about this everywhere. Because I have been impressed by the true clinician or the elders. Now as therapy comes into it, here it's I think on the agility of mind of the particular elder. Now how much of this has been passed on to the younger men today. The real clinical.

Dr D: Oh. I think a lot.

Dr W: You do.

Dr D: Here you see we haven't really got into the science yet. We are trying to become more scientific. The value of the scientific approach or the attempt to approach Dermatology scientifically is we think, or some people think at any rate, that it demands better criteria, it gets rid of a certain amount of slovenly thinking. You know, some people are prepared to say that this disease is so and so .. and in fact lay down the law about it, and the people who have had some scientific training know perfectly well that it just doesn't hold water. We're just using a lot of words. I think the feeling is that the younger men would like to think like scientists, although they don' t want to do any scientific work themselves, you know, they want to understand their language.

Dr W: Yes. Well l've been listening to what you've said I want to summarize something. So we can go on from there. That since the War the stature cf the Dermatologist and Dermatology in England is definitely better.

Dr D: I am sure of that.

Dr W: And that the respect of the Dermatologist is distinctly increased.

Dr D: Yes.

Dr W: It seemed to me that important .... only a very selected group may go into a Specialty and that among these a certain number select Dermatology. Do you have any idea what percentage that is.

Dr D: Oh it's comparatively small. It doesn't attract a great number.

Dr W: It doesn't. Well let's come back to why it does not attract a great number. Because this is important. Now once these men come into Dermatology they go through good training because its available to them here in England, as yet that training is primarily clinical and the scientific is coming into it more and more. They are taught whatever is known about the scientific ..

Dr D: The scientific side is not coming in all that fast.

Dr W: No, but slowly. Well, the question is whether this may not still be good and that when one gets to a certain point as the scientific increases it may soon become overweighed with the scientific, at that point maybe the quality of the Dermatologist will go down and so will the reputation of the Specialty. The question is whether this is happening, elsewhere.

Dr D: I dont think its happened here because we've got so few you see. I don't think it can get like that either.

Dr W: Why is that?

Dr D: Well you know, a good clinician has got a lot to learn hasn't he. I mean, you know, there is a very great deal to learn, clinical medicine, handling of patients all this. It's a very difficult job. And the scientific fellow whose bent is to go along a very narrow path indeed very often he is just not capable of doing that work. I hope that we shall have more of that sort of work going on. And we shall try and keep pace with some of the scientific developments, understand their language and perhaps even take some part in initiating progress in this and that aspect of dermatology. But I don't think that in this country the clinician will be submerged by the scientist. I'd prefer it the other way. I'd rather have say 80% of really well developed clinicians and being helped by 20% of scientific people working on dermatological problems.

Dr W: Suppose that just by chance someone particularly interested in the scientific whose interest in the clinical had waned, would have become the Head of a Department of Dermatology in a Hospital and because of this he built up the Laboratory and surrounded himself by scientific personnel and he allowed the clinical aspects only to remain in the hands of the clinicians over whom he had no real interest and therefore didn't attempt to direct them. What do you think would happen to such a Department?

Dr D: I think .. if the Department under the strict control of the pure scientist who had a number of people working around him on isotopes and something else and so on all working along those little channels, another one would be working with some electronic device like this thing here, well,I don't think that would bevery healthy. I don't think that would be a very good thing atall. My feeling about Dermatology is this, that it's absolutely necessary, the person in charge shall be a Dermatologist. He must know the clinical work. I don't say he need know it quite as well as the top-class clinician but he must know it well. You couldn't run a Department successfully with a collection of Ph. D's. There's no particular knowledge whatever. They would be in the hands of the clinicians in the first place. They wouldn't speak the same language and well, my feeling is that then, it's absolutely necessary that the Heads of the Departments should be primarily clinical Dermatologists.

Dr W: Well, I can tell you that your attitude is shared by most of the elders, I think. Everywhere.

Dr D: Is that so. You see Tom Fitzpatrick for example, he's got most things. You know when he talks clinical medicine, clinical dermatology, he's good. You know that he's talking sense. He's very well equipped with clinical knowledge and experience and he's got this pigment research. Well that's fine. I suppose he's an exceptional person even in America. Is he?

Dr W: Well. He is. There's controversy about Tom. Actually. As there is about some of the others .. I don't think that I'm in a position to tell you exactly, where they stand. I'd like to come back to your statement we were talking about, the percentage of those who passed their Examinations who go into Dermatology. You said that it is small. And I'm interested in in why it's small. Why Dermatology doesn't attract more men. Even here.

Dr D: I don't know why it is. I think it's partly because it's away from the main fields and from the main course of their training. The remedy, I would think, might be to have more Dermatology taught in the undergraduate period. You get a certain number of people who think this is very interesting, it does seem a little remote, its a rather botanical subject to the ordinary medical student looking at the skin and saying what it's called and what to do about it, it all seems a little remote from the important stuff. The thing I think is to alter the curriculum a little bit to put more emphasis on Dermatology if possible during the course of training. Make it absolutely necessary for students to learn some Dermatology during the course of their training and not just put in a few appearances and hope for the best. And particularly to set the Examination question. I think that if more people were obliged to do some Dermatology in the course of their normal training the number, of course, might be greater.

Dr W: Why can't this be achieved in the undergraduate level?

Dr D: Well, I think it's a question of time. I think they are doing something towards it. I think there will probably be some change. We hope so, at any rate.

Dr W: With the increase in knowledge and the biochemistry and physiology of the skin, why can't this become an integral part of the general physiology and biochemistry and be taught by the Dermatologist?

Dr D: Yes, that's right. There is a Dermatological Committee of the Royal College of Physicians which has, but I haven't got a copy of it here, but they have made out a report on making suggestions like that, you see. That students should be shown skin and at a very early stage in their career.

Dr W: Why do you think its been so difficult to get this into their curriculum?

Dr D: Well, how do the Americans..

Dr W: Well, very difficult.

Dr D: Just the same.

Dr W: Very. 15% of the Americans practice, General Practitioners practise in the skin, probably less than 1% of his teaching in Dermatology.

Dr D: Well. You have the same difficulty then.

Dr W: Very definitely.

Dr D: And do you think that is the remedy to introduce the subject to students at an earlier stage and especially on the physiological level and the biochemical level. If you could?

Dr W: I believe very strongly that if Dermatology could be made more a part where they begin to know the language so they don't talk about these peculiar names of ours, they're no more peculiar than the other ones they learn. Where they can learn the biochemistry, the physiology of the skin which is its greatest organ of the body, they can see more clinical Dermatology, that the Dermatologists are there to teach it, take an active role in clinical teaching, I think the respect of the student will increase, the respect of the Faculty will increase and, in turn, the respect of Physicians everywhere and eventually the patient will increase.

Dr D: Yes. I think it's quite true. You want to start very early and you really want to emphasize the scientific side of it in the training period, in the early training period, because there's a lot of physiology to be learnt from the skin, only of course very few Dermatologists know how to teach it. It's going to be difficult to find the right sort of person.

Dr W: Well, I think this is true in all of medicine.

Dr D: Yes. To impart knowledge, say, of microcirculation of the skin and that sort of thing. And all those kind of things, the physiological side could be taught at an early stage and I think that would bring the recruits in. Do you think there is something in that?

Dr W: I think that if the Head of the Department some place, or men in key positions at the graduate level like at St. John's, had an active role in the teaching of the undergraduate and because of their very personality, because of their very contact with the patient, because of their assigning to the teaching, men in Dermatology who knew their subjects well at the basic level and clinically that they would be able to stimulate young men to want to go into Dermatology. This is really where it has to begin.

Dr D: Oh. I think so, yes. You've got to have rather high class Dermatologists to be able to function in that way to be able to teach physiology of the skin and chemistry and all that.

Dr W: This is true. I think he has to surround himself with the proper men. This, Dr. Dowling, is the reason why I, and others, feel that the Head of the Department must be one who knows well all the problems of Dermatology, clinical and at the basic level, because otherwise he will never be able to represent dermatology.

Dr D: That's quite right. Yes.

Dr W: This is really the crux of what I'm trying to find from you and I must tell you that I have gleaned more from my interview with you than I have with others because you seem to have the heart of the problem in your hand.

Dr D: Oh, well. I don't know. I don't think I should be very much good at administering a department. I think I know pretty well what's what as a matter of fact. You must have in any Dermatological Department nowadays, any good one, you must have some research going on. You must have somebody who knows that language and can teach it. It need not be the clinician although he ought to learn the language as far as he possibly can of the other people, and I feel that he ought to make that effort. I suppose,for example, there's an elder Dermatologist, Pillsbury as an example of that sort of person, isn't he. He's not a scientist really, he was a biochemist I believe, but he is not a research man, you see. He doesn't actually do laboratory work but he certainly understands the language and he stimulates. He's got a good department, I gather, and he stimulates the interest in it. Rothman of course, again he's a man who, if anything, is more laboratory minded I suppose than clinical perhaps. I don't know that he does any laboratory work but he certainly understands whet 's going on.

Dr W: Oh. Very well.

Dr D: You can see from reading his comments of some of these very obscure papers that he can follow the whole thing. He has an enormous knowledge. I think we owe Rothman a lot. I think that book you know,was an enormous stimulus, to the scientific approach to Dermatology. It's something that has been going along quietly and then along comes this book .. I think he's done more in a general way to improve the standing of Dermatologists than anybody. He is a remarkable man.

Dr W: There's some, Dr. Dowling, who feel that you should still be the Dean. That you are too young a man to retire. That's right?

Dr D: Yes, well there it is.

Dr W: I thank you. I thank you very much

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