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St Johns and the IOD

The Blackfriars Skin Hospital, for years the most important bastion of dermatology in London, was to close; St John's, by contrast, was set to grow. Its earliest days have been recorded by Russell56 and the more recent ones by Samman57. The wards in Shepherd's Bush had been destroyed in an air-raid. Outpatients moved from Leicester Square to a distinctive house in Lisle Street which was set in the red-light district of Soho. Lectures were given in an unstructured programme and teaching was largely restricted to the out-patient clinics.

St John's ran a busy service and a number of established London Consultants (Roxburgh and Goldsmith had recently resigned) were on its staff. Each would nominate their own clinical assistants; MacLeod had retired so Isaac Muende, his pupil and collaborator, was solely responsible for the histological reports. Basic and general pathology and all histological preparations, were in the hands of a dedicated laboratory technician, R C Syms. A mycological laboratory was founded and R W Riddell, micro-biologist at the Brompton Hospital, took charge; it was to prosper. A photographic unit, a library and a staff restaurant were all to appear as many postgraduates were around, not only our own demobilized men but several from the "old colonies", a number were to gravitate to the opposite camp in Edinburgh.

By 1948, with the introduction of a National Health Service, considerable increases in funds, staffing and facilities were apparent; not only were Honorary Consultants to be paid but the splendid idea of salaried Registrars was established. Three of senior grade were appointed at St John's but as yet no agreed pattern of training had been formulated.

The Institute of Dermatology, one of the Medical Postgraduate Schools of London University, had been founded as an administrative unit in 1945, with J E M Wigley as Dean. Naturally it was based at St John's but it remained for some years just as "a project for the future". Archibald Gray, who had originated the scheme, never lost the chance of pushing for its realisation.

In 1951 University recognition permitted the appointment of a Director as the first step before a Professorial Chair could be established. This followed the acquisition of more space so that wards, residents' accommodation, laboratories and an animal house could all be provided - essential requirements for an academic Institute. The Eastern Fever Hospital at Homerton, a relic of Victorian medicine, had many disused wards which were adapted and opened to signal the Institute's birth.

Geoffrey Dowling, already on the staff of St John's, was appointed Director in 1951; as a part-time post it fitted in with his commitment at St Thomas'. George Wells, after three years in Chicago, returned to be Senior Lecturer, he had earlier been Registrar to Professor de Wesselow in the Department of Medicine at St Thomas'. Wells had recently been working with Stephen Rothman (another emigrant from Nazi Europe), learning among other things, the wizardry of histochemistry; this he was able to import into the Institute, establishing his own histochemistry laboratory at Lisle Street. With Dowling and, since 1951 Wallace, both working at St John's, it was natural that many of the St Thomas' registrars would come across to the teaching sessions when possible.

In 1952 the 10th International Congress of Dermatology came to be held in London. Dowling, Mitchell-Heggs and Wigley, the Dean, were all heavily involved in its machinations; inevitably interest spilt over and minor involvement of the juniors gave a zest to life.

John Edwin Mackonachie Wigley (1892-1962) a past Secretary and President of the Association, was Dean of the London School before it became the Institute of Dermatology. The son of an Australian solicitor, he was born in Surrey though brought up in Australia. Graduating from Melbourne in 1915, he joined the RAMC serving in Egypt and then taking part in the Gallipoli landings; a devastating experience for any Australian soldier.

After postgraduate study at the London Hospital with Sequeira, he assisted MacLeod at the Charing Cross and it was he who stimulated further interest both in clinical work and histopathology; ultimately Wigley was to succeed him. In 1930 he was appointed to St John's. An excellent clinician and lucid teacher, he was active at clinical meetings and reported in 1945 the first example of facial granuloma. As Dean he was closely associated with Gray and Dowling in the early formative years, but he claimed to dislike paper work and administrators! For a University Dean that seemed curious. Physically he was a large man with a blunt wit, juniors were ever wary of crossing his path. Nevertheless "Wiggles" was unfailingly helpful to anyone from the "old colonies", and in his own home, a kindly host.

Growth of the Institute

Dowling retired from his short-lived Directorship in 1956, and the way had still to be cleared for the appointment of a full-time Professor. It was not until 1960 that the advertisement duly appeared in the Times, and it was hoped George Wells, heir apparent, would take over but this was not to be. In the next year another of Dowling's disciples was to be selected.

Charles Calnan was appointed in 1961. As Senior Registrar with R H Meara he had already established a patch-testing clinic at St John's and at this time had just returned from Pilsbury's unit in Philadelphia where he had worked with Albert Kligman and Walter Shelley; he had learnt that basic scientists are essential if fundamental advances are to be made in an up-to-date academic department.

Sam Shuster in Cardiff, a Lecturer in the Department of Medicine working with Professor Harold Scarborough, seemed to have the necessary qualities and was enticed to London. He immediately attracted other scientists to the Institute and promptly set to work studying acne, skin ageing, thermo-regulation and cutaneous metabolism - fields that he continued to explore in Newcastle, where he was later to move as Professor.

In 1960 there had been a record number of students at the Institute and the effect that Shuster's arrival had was inestimable. Teaching had previously been concentrated in the clinics and wards, the evenings being given over to histopathology. The programme was now supplemented by Grand Rounds, seminars, and journal clubs, while the popular Friday evening clinical "exhibition" continued to attract many of the other London registrars.

The excellent Department of Illustration, developed by R J Lunnon, was to gain University approval; it was supplemented by the elegant work of Alice Gretener, a Swiss immigrant who, like Cranston Low, had acquired skills of moulage making. (Wax models provided useful teaching aids before the era of modern colour photography).

Calnan now introduced other scientists notably J L Turk an immunolologist, Y M Clayton came in to join Riddell's department of mycology, W C Noble a microbiologist, later to gain professor status, and R S Wells turning his attention to the genodermatoses. Photobiology, which had started with Arthur Porter's monochromator was now in the hands of Ian Magnus, who with his colleagues was to define erythropoietic protoporphyria.

Peter Derrick Samman (1914-1992) was an enlightened Dean for five years but also made his mark as a meticulous clinical observer.

From King's he had gone into the RAF, returning as a Squadron Leader to Sidney Thomson's group. He soon moved to Bristol as Registrar and Clinical Tutor in Dermatology; in fact he expected to stay there as successor to Kenneth Wills but his plans went awry and so he came back to London as one of the first Senior Registrars at St John's. After his appointment as Consultant first to St John's and then to the Westminster he managed to arrange a six month visit to Pilsbury's department in Philadelphia.

At Bristol he had become intrigued with the patterns of skin involvement seen in Hodgkin's and related diseases; this provided the core of his MD. In London he started his survey of lichen planus, while his Nail Clinic enabled him to amass information which he could use for his textbook. His observations on the "yellow nail syndrome" were mostly made at the Westminster Hospital. At St John's he continued to study the skin lymphomas and was able to persuade his clinical colleagues to refer their patients for assessment and follow-up at a time when many guarded their clinical material as if it was personal property. Samman's quiet and modest approach dispelled all anxieties. This long-term survey of the cutaneous aspects of lymphoproliferative disease was carried out in conjunction with the pathologists and two oncologists, first Leon Szur and then Margaret Spittle. The study is still on-going, an object lesson in accurate and patient observation and recording; it provided the substance of his Parkes Weber lecture in 1976.

There were then many personalities at the Institute to promote a climate of enthusiasm amongst the trainees. An inpatient department of 70 beds, the monochromator, the contact clinic, the mycology department which was always involved in research projects, and histopathology provided the registrars with an array of interests over and above the essential study of clinical dermatology which continued to be "celebrated" at the weekly registrar clinics, where Dowling even after retirement, continued to take his usual "back seat". It was the highlight of the week.

As important as cutaneous morphology was the study of the skin's microscopical features. Isaac Muende, responsible for routine reporting, had been discouraged from formal teaching but now the way became clear both for Wells and for Haber.

Henry Haber (1901-1962) arrived in England in 1939, having earlier studied dermatology in Prague with Professor Kreibich. After the RAMC, and he was a peculiarly unmilitary figure, he arrived at St John's as a Clinical Assistant. He was immediately recognized for his zest and unusual flair, and though an experienced clinician, histopathology became his forte, self-taught he claimed. He was to make a considerable reputation lecturing at St John's for he could always enthuse students, young and old with his teaching. His memory was formidable; he seemed able to call on the vast experience of clinical and pathological data that had previously come his way, so that at meetings he could be relied upon to throw light on many an obscure problem. With his personality, warmth and charm he was much loved; his early and unexpected death was a tragedy.

While George Wells was developing histo-chemistry, in his words "applying Mrs Beeton's culinary skills" to cutaneous pathology; electron-microscopy, cyto-chemistry and immuno-pathology were also being explored and the reputation of the Institute was to attract many visitors from overseas. The Diploma course which had started in 1967, initially for 12 postgraduates though later for 24, was running regularly and successfully. Individual students came from Europe, the United States, Canada and the Commonwealth to work alongside the Institute's own experts, e.g.. contact dermatitis in which Charles Calnan and Etain Cronin were achieving wide recognition. A unique accolade was awarded by the American "Boards" in their recognition that time spent in London would be acceptable towards their training programme.

However the long-term prospects of the Institute never seemed secure, and from the 1970's political and economic factors troubled the planners of postgraduate medical teaching in London. At least three schemes had been put forward to link the Institute with other hospitals and medical schools. The small houses in Lisle and Gerrard Streets provided only cramped accommodation; the inpatient department at Homerton was an inconvenient eight miles away. In spite of these uncertainties the clinical standards and teaching at the Institute was of the highest order, and adding further lustre, Edward Wilson-Jones and Malcolm Greaves were to bring their own special expertise. Many of today's consultants happily spent some of their formative years cutting their dermatological teeth in London.

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