From Brown to Green: Origins of the Montagna Symposium on the Biology of the Skin

Abstract

To tell you about the beginning of this wonderful Symposium, I must first tell you a little about dermatology’s past and then about how and why William Montagna came to Oregon. In the 1930s and 1940s, Clinical Dermatology was content to give its diseases descriptive names and let it go at that. A rose, regardless of its variations, always looks like a rose and psoriasis always looks like psoriasis. During the 1930s and 1940s, the science of Dermatology, like Medicine as a whole, was mired in descriptive gross and microscopic pathology without the tools to feed curiosity about the dynamic structure and function of skin or the mechanisms and pathways that made the skin sick. Let me give you an example of what we faced day in and day out. In the early 1940s when I was a Fellow at the Mayo Clinic, being trained in Dermatology, we had a patient who had a purulent infection on his right ankle. The treatment of the day was sulfathiazole ointment. Antibiotics had yet to be discovered and invented. We put sulfathiazole ointment on a gauze square over the infection and it cured it. However, as often happened, the patient developed a contact allergic eczematous dermatitis to the sulfathiazole, limited just to the size and shape of the square of gauze. That too was recognized for what it was and was cured. After 3 years, the patient returned with a bladder infection for which he was given sulfathiazole by mouth and his right ankle broke out in an eczematous dermatitis, limited exactly in size and shape to the gauze square and only to that square. Where was the memory? We knew that the same epidermal cells that were involved 3 years earlier were long gone and had been replaced every several weeks for 3 years with new ones. Langerhans cells? We could recognize them, but thought that they were effete melanocytes without pigment. It would be another 25 years before their function would be known. Let me remind you, too, that Clinical Dermatology in the 1940s was a medical subspecialty and, to give it credit, Dermatology was trying to find a new niche for itself by discovering and correlating what went wrong inside the body with what was heralded and mirrored on the surface skin, for example, pyoderma gangrenosum on the skin associated with chronic ulcerative colitis in the gut; necrobiosis lipoidica on the skin, diabetes mellitus inside; erythema nodosum (hot tender nodules) on the upper shins, rheumatic fever. These are short cuts to diagnosing diseases of Internal Medicine, and this discipline furnished the diagnostician with the tools of one-up-man-ship. And it was fun. It was a good era. However, there was in those early 1940s a small group of young dermatologists who were curious about the skin itself. They fell in love with this huge, complex organ, which was so visible, so available, so reproducibly patterned in its diseases. Me? I was a patient. During my first year in medical school, I developed generalized scleroderma of the morphea type, was hospitalized in bed for a year and half, and then convalesced another year and a half before returning to Medical School at the University of Cincinnati. These young dermatologists had nowhere within dermatology to turn. The leather industry knew more about the dermis than did we. The wool industry knew more about hair and sebum. The cosmetic industry knew more about nails, keratin, oil, and sweating. The soap and chemical industries knew more about contact irritant and contact allergic dermatitis than did we. And those were the places that we turned to for basic information. In the late 1940s, a ‘‘happening’’ occurred. It was unpredictable, simultaneous, and for totally different reasons. A few of the young dermatologists independently found William Montagna, PhD, a comparative cutaneous biologist and primatologist in the Biology Department of Brown University in Providence, Rhode Island. I found Bill Montagna because of my need to know the microscopic structure of the external one-third of the human ear canal, because that area of skin was developing deafening, crippling eczematous dermatitis much like the seborrheic dermatitis of the axilla. Of course, I knew there were wax glands somewhere in there, but I did not know that they were apocrine glands like the scent glands in our armpits and groin. Finding nothing in the ear, nose, and throat literature, I finally found what I needed in a small, obscure anatomy journal in an article written by Montagna at Brown University. I was at Dartmouth Medical School and its Hitchcock Clinic in Hanover, New Hampshire at that time. I phoned this