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An adventure in dermatology: A personal history
Clinics in Dermatology (2012) 30, 137–140
CLIO DERMATOLOGICA Edited by Mauricio Goihman-Yahr, MD, PhD
An adventure in dermatology: A personal history Bernard I. Gordon MD⁎ Emeritus, Clinical Professor of Dermatology, University of California School of Medicine, San Francisco, CA, USA; formerly Chief of Dermatology, Mt. Zion Hospital, San Francisco, CA, USA
Abstract This adventure in dermatology took place between 1960 and 1962. An immigration ruling forced Dr Bernard Gordon, a Canadian, to spend 2 years abroad before he could legally live and practice in the United States. Dr Gordon had just completed a 3-year residency at the New York University Skin and Cancer Unit. Dr Gordon met with his mentor, Dr Marion Sulzberger, for advice. This world-famous dermatologist took an interest in his situation and was able to arrive at an extraordinary solution. Dr Sulzberger consulted with his many dermatology colleagues and made arrangements for Dr Gordon to work abroad. He would spend 1 year in Caracas, Venezuela, teaching and conducting research in tropical skin diseases. The second year would be spent in Europe, beginning with 3 months in Madrid, Spain, followed by 3 months in Geneva, Switzerland, and concluding with 6 months at the Hôpital Saint Louis in Paris, France. Dr Gordon worked with the leading dermatologists at each hospital. These 2 years abroad led to a deeper understanding of world dermatology and lasting friendships.
Introduction In 1960, I finished a 3-year residency at the New York Skin and Cancer Unit of New York University. This was the year that Dr Marion Sulzberger retired after 13 years as chairman and professor of dermatology at the New York University School of Medicine. He was at the peak of his career. World renowned and named as “Mr. Dermatology” by the Journal of the American Medical Association, Dr Sulzberger had an insatiable intellectual curiosity and was a role model as a teacher and clinical investigator. He helped to bring the grand European tradition of experimental dermatology to the United States. The result became an extraordinary model for an academic department of dermatology promoting research, teaching, and clinical care. ⁎ Corresponding author. 239 Brannan St, Apt 17G, San Francisco, CA 94107. Tel.: +1 415 222 9966; fax: +1 415 348 0495. E-mail address: [email protected]. 0738-081X/$ – see front matter doi:10.1016/j.clindermatol.2011.05.003
I had an immigration problem. I was a Canadian attending school on a student visa. The law stated that upon finishing my training, I had to leave the United States for 2 years before I could return permanently. This law was passed at the request of many foreign countries to prevent the “brain drain.” Many students came to train in the United States and did not want to leave. I met with Dr Sulzberger and told him about my situation. A week later, he told me that he had a solution: I could go to Caracas, Venezuela, and work at the Vargas Hospital with Dr Francisco Kerdel-Vegas and Dr Jacinto Convit. They both had contacted Dr Sulzberger and wanted someone he could recommend to come and help teach and to conduct research in tropical dermatology. Both doctors had received a grant from the Creole Petroleum Corporation (Venezuela) to help pay for this position. Dr Kerdel-Vegas had trained at both Boston and the New York Skin and Cancer Unit and was on his way to a remarkable career. Dr Convit was conducting research in the immunology of leprosy, a disease in which he
138
B.I. Gordon
became an established authority. Before I left for Venezuela, I took some intensive Spanish language classes.
Caracas, Venezuela The Vargas Hospital was a busy teaching hospital filled with dermatologic cases from all over the country. The dermatology wards included patients with leprosy, cutaneous tuberculosis, nocardiosis, chromoblastomycoses, sporotrichosis, and rhinoscleroma, as well as skin tumors of all kinds. It was a scene straight out of a dermatologic textbook on tropical diseases. I was overwhelmed with the variety of skin diseases. The Department of Dermatology consisted of six members and two residents, Dr Mauricio Goihman and Dr Eduardo Perera. We all worked together to organize and function as a teaching and research facility. I realized that dermatopathology was one feature that needed attention. We invited Dr Walter Lever, the renowned dermatopathologist from Boston, to come and lecture. We invited all the dermatologists in Venezuela to attend. It was a very successful event. I was so impressed that I wrote a letter to the editor of the Archives of Dermatology. I encouraged young doctors, upon finishing their training in the United States, to spend time abroad working in foreign environments to enrich their medical knowledge. Our research revealed that 25% of all cases of rhinoscleroma came from the District of Bocono, an area in the Andes Mountains in the state of Trujillo. Rhinoscleroma is an infectious disease of the respiratory tract that forms granulomatous tissue with a characteristic pathologic structure in the nose and upper lip. If left untreated, it can lead to death. We formed a group of dermatologists and otolaryngologists and made two trips, visiting the homes of natives living in Bocono and other communities. We came equipped to take cultures and biopsy specimens and were able to identify and treat five new cases. The success of these two field trips and the information that we gathered led to the writing of a monograph on all 30 cases of rhinoscleroma.1 It was published by Charles C Thomas in 1963 and was later revised and translated into Spanish in 1966. The authors of the monograph included myself, Dr Kerdel-Vegas, Dr Convit, and Dr Goihman. Dr Sulzberger wrote the foreword. Our goal was to write a monograph on every tropical skin disease. Unfortunately, this never materialized. We also published two papers. The first was on a case of disseminated anergic cutaneous leishmaniasis in the British Journal of Dermatology in 1962.2 The second was on a case of poikiloderma congenitale in Dermatologica, also in 1962.3 Toward the end of 1961, Dr. Sulzberger was invited to receive an honorary Doctorate from the Central University of Venezuela (Figure 1). When he arrived, it was front-page news all over Venezuela. He was treated like a “superstar.”
Fig. 1 Dr Marion Sulzberger (left) and Dr Bernard Gordon (right) stand in front of the statue of Jose Maria Vargas at the Vargas Hospital, Caracas, Venezuela, 1961.
He toured the country and was impressed with our work. He received many letters from patients with chronic diseases asking him for help. He was gracious and understanding. He read all of the letters with me and asked me to do him a favor. Would I respond to all of the letters on his behalf? Of course, I did. I referred these cases to the dermatologic clinic at the Vargas Hospital where we would do our best to help them. I left Caracas at the end of 1961. Dr Kerdel-Vegas became a renowned teacher and lecturer. He later was appointed the Venezuelan Ambassador to England (Saint James) and the Venezuelan Representative (or Ambassador) to United Nations Educational, Scientific and Cultural Organization (UNESCO). Dr Goihman came to the United States to Stanford, where he finished his dermatology residency. He then worked with the eminent Stanford microbiologist, Dr Sidney Raffel. He obtained his PhD and later returned to Caracas, where he started a research immunology and microbiology laboratory as well as a private practice. He remains a prolific medical writer and a good friend. I told Dr Sulzberger that I had never been to Europe and that I would like to visit and work with the great European
An adventure in dermatology dermatologists. They were his colleagues. He wrote three letters of introduction. The first was to Dr Gay Prieto, chief of dermatology at the San Juan de Dios Hospital in Madrid, the second was to Dr Werner Jadassohn in Geneva, and the third was to Dr Robert Degos in Paris.
Madrid, Spain Dr Gay Prieto was the director of the leprosy program for the World Health Organization and helped found the International Society of Dermatology. (His son, Carlos Gay, was a resident with me in New York.) Every morning at 8:00, we conducted rounds at the hospital with his father. Patients came from all over Spain and Northern Africa. The European teaching tradition was to listen to the chief and obey his instructions. There was little discussion. This experience was prevalent all over Europe during this time. I had to be very careful and diplomatic. It was not a good idea for me to say that some of these diseases were treated differently in the United States. I could suggest some new types of therapy, as new drugs were becoming publicly available. This was the time when steroids and new antibiotics were playing a larger role. I spent 3 months in Madrid during the Franco regime. I did not get the opportunity to work on any research projects but was introduced to clinical dermatology in the European style.
Geneva, Switzerland Dr Werner Jadassohn was chief at the hospital Cantonal in Geneva. He and Dr Sulzberger were residents under Dr Bruno Bloch. Dr Jadassohn was the son of the famous European dermatologist, Dr Joseph Jadassohn. The dermatology department was well organized, with residents, research fellows, and foreign doctors visiting for short periods. I was given an active role. I helped to teach students, gave lectures, took part in grand rounds, and was given a research project. I spent time in the laboratory with an Italian doctor conducting experiments on radiation protection in rats. Dr Jadassohn’s specialty was allergy and dermatoimmunology. During grand rounds, he would turn to me after a difficult case and say, “Quel serait le traitement en Amerique?” (“What would be the treatment in America?”) I also made a life-long friendship with Dr Ulrich Schmid, a hospital resident. He later worked in private practice in Vevey, Switzerland.
139 King Henri IV to care for victims of the plague. During its more than 400 years of service, it has been the main bastion for treatment of every major epidemic in France. In 1803, it became “a temple of dermatology.” It handled all of the skin diseases from all over Europe and Africa. Separate buildings were devoted to the plague, venereal disease, psoriasis, fungal diseases, leprosy, and tropical skin diseases. One building was devoted to bath therapy for chronic skin diseases. French dermatologists spent time at the Hôpital Saint Louis researching cures for these diseases. When I arrived in 1962, there were five department chiefs, one for every day of the week. The main chief was Dr Robert Degos. He was the author of a prominent textbook on dermatology in France. Here again, the teaching was strictly in the European style, with little exchange between students and professors. His breadth of dermatologic knowledge and experience impressed and attracted many visiting physicians. I spent much of my time with a younger chief, by the name of Dr Charles Grupper. He was a dynamic chief. He loved the American style of teaching, and traveled with his residents to every academy meeting in the United States. He was fluent in English and made many friends abroad. He wrote numerous papers and later became the head of the Dermatology Unit at the Rothschild Institute. I attended the clinics every morning and spent time in the afternoon in the library exploring the famous “Musée des Moulages.” This is an astounding museum, filled to overflowing with exquisite antique dermatologic moulages (wax models of skin diseases). There are nearly 5000 displayed in wood and glass cases. It is the largest collection of its kind in the world. Incredibly, 2000 of the moulages are the work of a single man, Jules Baretta. This museum is open to the public (photos can be found on the Internet). During my time in Paris, Dr Albert Kligman came to the hospital and gave a well-received lecture. Dr Sulzberger came to Paris to receive an honor at the Pasteur Institute. I invited him to grand rounds to hear his friend, Dr Degos. After his presentation of a very complex dermatologic problem, Dr Degos asked if we would express our views on the case. Dr Sulzberger gave an excellent review in fluent French. It was a moment that I cherished. Dr Sulzberger spoke four languages: English, French, Spanish, and German. Today the Hôpital Saint Louis has changed and is now a “specialty hospital” and medical school. Alongside dermatology, there are hematology, oncology, plastic surgery, and organ transplantation departments, and a burn center.
San Francisco, CA, USA Paris, France My next 6 months were spent in Paris at the famous Hôpital Saint Louis. This hospital was founded in 1607 by
At the end of my 2 years abroad, I decided to return to the United States. I married a beautiful and cosmopolitan Parisian woman that I had met during my stay in Caracas. We married in Paris. We both immigrated to the United
140 States and settled in San Francisco. I started teaching at the University of California, San Francisco (UCSF) in 1963 and also opened a private practice. Dr Sulzberger moved to San Francisco and became technical director of research for the United States Armed Forces. He was the principal advisor on all scientific and technical matters related to medical research and development. During the Vietnam War, I had a research laboratory at UCSF doing research on sweat disorders that was funded by the United States Army. In 1981, I became chief of dermatology at Mt. Zion Hospital/UCSF and served in that capacity for 18 years. After 45 years of practicing medicine, I retired in 2007. The 2 years I spent abroad were catalysts in my development as a professional dermatologist. My time spent in Caracas and Europe opened my eyes to the larger medical community outside of the United States and I benefited. Extremely bright and learned physicians are everywhere, and there is much to learn from them. I highly recommend that when a resident finishes training, he or she spend some time abroad. It is a unique experience that provides the physician with a deeper understanding of the world.
Conclusions My adventure in dermatology took place in the early 1960s. This was a time when the United States was a leader in so many fields, and American dermatology was no exception. Heads of dermatology units became famous and renowned. It was an honor for an American physician to
B.I. Gordon work or study abroad. Today, all has changed. We live in a globalized world. The advent of the Internet now makes available a large volume of medical information to the general consumer that was not previously available. Treatment of diseases and the latest research results are easy to obtain. But human relationships are forged by person-to-person involvements. Working abroad is an adventure that leads to new friendships. This broadens our understanding of other cultures. Political and economic crises continue to change the complexity of medical care in many countries. For example, after 40 years of blossoming, Venezuelan dermatology and research are in decline. It is now up to the next generation to restore what has been lost. Emerging democracies could help the situation. Countries that wish to lead in medical advancements must support an environment for a vibrant, professional network of medical practitioners and specialists to flourish. The opinions expressed here are my personal points of view and not those of the University of California at San Francisco, Department of Dermatology.
References 1. Kerdel-Vegas F, Convit J, Gordon B, Goihman M. Rhinoscleroma. Monograph in the American Lecture Series of Dermatology. Springfield (Ill): Charles C Thomas; 1963. 2. Convit J, Kerdel-Vegas F, Gordon B. Disseminated anergic cutaneous leishmaniasis. Br J Dermatol 1962;274:132-5. 3. Kerdel-Vegas F, Gordon B. Poikiloderma congenitale. Dermatologica 1962;125:155-60.
CLIO DERMATOLOGICA Edited by Mauricio Goihman-Yahr, MD, PhD
An adventure in dermatology: A personal history Bernard I. Gordon MD⁎ Emeritus, Clinical Professor of Dermatology, University of California School of Medicine, San Francisco, CA, USA; formerly Chief of Dermatology, Mt. Zion Hospital, San Francisco, CA, USA
Abstract This adventure in dermatology took place between 1960 and 1962. An immigration ruling forced Dr Bernard Gordon, a Canadian, to spend 2 years abroad before he could legally live and practice in the United States. Dr Gordon had just completed a 3-year residency at the New York University Skin and Cancer Unit. Dr Gordon met with his mentor, Dr Marion Sulzberger, for advice. This world-famous dermatologist took an interest in his situation and was able to arrive at an extraordinary solution. Dr Sulzberger consulted with his many dermatology colleagues and made arrangements for Dr Gordon to work abroad. He would spend 1 year in Caracas, Venezuela, teaching and conducting research in tropical skin diseases. The second year would be spent in Europe, beginning with 3 months in Madrid, Spain, followed by 3 months in Geneva, Switzerland, and concluding with 6 months at the Hôpital Saint Louis in Paris, France. Dr Gordon worked with the leading dermatologists at each hospital. These 2 years abroad led to a deeper understanding of world dermatology and lasting friendships.
Introduction In 1960, I finished a 3-year residency at the New York Skin and Cancer Unit of New York University. This was the year that Dr Marion Sulzberger retired after 13 years as chairman and professor of dermatology at the New York University School of Medicine. He was at the peak of his career. World renowned and named as “Mr. Dermatology” by the Journal of the American Medical Association, Dr Sulzberger had an insatiable intellectual curiosity and was a role model as a teacher and clinical investigator. He helped to bring the grand European tradition of experimental dermatology to the United States. The result became an extraordinary model for an academic department of dermatology promoting research, teaching, and clinical care. ⁎ Corresponding author. 239 Brannan St, Apt 17G, San Francisco, CA 94107. Tel.: +1 415 222 9966; fax: +1 415 348 0495. E-mail address: [email protected]. 0738-081X/$ – see front matter doi:10.1016/j.clindermatol.2011.05.003
I had an immigration problem. I was a Canadian attending school on a student visa. The law stated that upon finishing my training, I had to leave the United States for 2 years before I could return permanently. This law was passed at the request of many foreign countries to prevent the “brain drain.” Many students came to train in the United States and did not want to leave. I met with Dr Sulzberger and told him about my situation. A week later, he told me that he had a solution: I could go to Caracas, Venezuela, and work at the Vargas Hospital with Dr Francisco Kerdel-Vegas and Dr Jacinto Convit. They both had contacted Dr Sulzberger and wanted someone he could recommend to come and help teach and to conduct research in tropical dermatology. Both doctors had received a grant from the Creole Petroleum Corporation (Venezuela) to help pay for this position. Dr Kerdel-Vegas had trained at both Boston and the New York Skin and Cancer Unit and was on his way to a remarkable career. Dr Convit was conducting research in the immunology of leprosy, a disease in which he
138
B.I. Gordon
became an established authority. Before I left for Venezuela, I took some intensive Spanish language classes.
Caracas, Venezuela The Vargas Hospital was a busy teaching hospital filled with dermatologic cases from all over the country. The dermatology wards included patients with leprosy, cutaneous tuberculosis, nocardiosis, chromoblastomycoses, sporotrichosis, and rhinoscleroma, as well as skin tumors of all kinds. It was a scene straight out of a dermatologic textbook on tropical diseases. I was overwhelmed with the variety of skin diseases. The Department of Dermatology consisted of six members and two residents, Dr Mauricio Goihman and Dr Eduardo Perera. We all worked together to organize and function as a teaching and research facility. I realized that dermatopathology was one feature that needed attention. We invited Dr Walter Lever, the renowned dermatopathologist from Boston, to come and lecture. We invited all the dermatologists in Venezuela to attend. It was a very successful event. I was so impressed that I wrote a letter to the editor of the Archives of Dermatology. I encouraged young doctors, upon finishing their training in the United States, to spend time abroad working in foreign environments to enrich their medical knowledge. Our research revealed that 25% of all cases of rhinoscleroma came from the District of Bocono, an area in the Andes Mountains in the state of Trujillo. Rhinoscleroma is an infectious disease of the respiratory tract that forms granulomatous tissue with a characteristic pathologic structure in the nose and upper lip. If left untreated, it can lead to death. We formed a group of dermatologists and otolaryngologists and made two trips, visiting the homes of natives living in Bocono and other communities. We came equipped to take cultures and biopsy specimens and were able to identify and treat five new cases. The success of these two field trips and the information that we gathered led to the writing of a monograph on all 30 cases of rhinoscleroma.1 It was published by Charles C Thomas in 1963 and was later revised and translated into Spanish in 1966. The authors of the monograph included myself, Dr Kerdel-Vegas, Dr Convit, and Dr Goihman. Dr Sulzberger wrote the foreword. Our goal was to write a monograph on every tropical skin disease. Unfortunately, this never materialized. We also published two papers. The first was on a case of disseminated anergic cutaneous leishmaniasis in the British Journal of Dermatology in 1962.2 The second was on a case of poikiloderma congenitale in Dermatologica, also in 1962.3 Toward the end of 1961, Dr. Sulzberger was invited to receive an honorary Doctorate from the Central University of Venezuela (Figure 1). When he arrived, it was front-page news all over Venezuela. He was treated like a “superstar.”
Fig. 1 Dr Marion Sulzberger (left) and Dr Bernard Gordon (right) stand in front of the statue of Jose Maria Vargas at the Vargas Hospital, Caracas, Venezuela, 1961.
He toured the country and was impressed with our work. He received many letters from patients with chronic diseases asking him for help. He was gracious and understanding. He read all of the letters with me and asked me to do him a favor. Would I respond to all of the letters on his behalf? Of course, I did. I referred these cases to the dermatologic clinic at the Vargas Hospital where we would do our best to help them. I left Caracas at the end of 1961. Dr Kerdel-Vegas became a renowned teacher and lecturer. He later was appointed the Venezuelan Ambassador to England (Saint James) and the Venezuelan Representative (or Ambassador) to United Nations Educational, Scientific and Cultural Organization (UNESCO). Dr Goihman came to the United States to Stanford, where he finished his dermatology residency. He then worked with the eminent Stanford microbiologist, Dr Sidney Raffel. He obtained his PhD and later returned to Caracas, where he started a research immunology and microbiology laboratory as well as a private practice. He remains a prolific medical writer and a good friend. I told Dr Sulzberger that I had never been to Europe and that I would like to visit and work with the great European
An adventure in dermatology dermatologists. They were his colleagues. He wrote three letters of introduction. The first was to Dr Gay Prieto, chief of dermatology at the San Juan de Dios Hospital in Madrid, the second was to Dr Werner Jadassohn in Geneva, and the third was to Dr Robert Degos in Paris.
Madrid, Spain Dr Gay Prieto was the director of the leprosy program for the World Health Organization and helped found the International Society of Dermatology. (His son, Carlos Gay, was a resident with me in New York.) Every morning at 8:00, we conducted rounds at the hospital with his father. Patients came from all over Spain and Northern Africa. The European teaching tradition was to listen to the chief and obey his instructions. There was little discussion. This experience was prevalent all over Europe during this time. I had to be very careful and diplomatic. It was not a good idea for me to say that some of these diseases were treated differently in the United States. I could suggest some new types of therapy, as new drugs were becoming publicly available. This was the time when steroids and new antibiotics were playing a larger role. I spent 3 months in Madrid during the Franco regime. I did not get the opportunity to work on any research projects but was introduced to clinical dermatology in the European style.
Geneva, Switzerland Dr Werner Jadassohn was chief at the hospital Cantonal in Geneva. He and Dr Sulzberger were residents under Dr Bruno Bloch. Dr Jadassohn was the son of the famous European dermatologist, Dr Joseph Jadassohn. The dermatology department was well organized, with residents, research fellows, and foreign doctors visiting for short periods. I was given an active role. I helped to teach students, gave lectures, took part in grand rounds, and was given a research project. I spent time in the laboratory with an Italian doctor conducting experiments on radiation protection in rats. Dr Jadassohn’s specialty was allergy and dermatoimmunology. During grand rounds, he would turn to me after a difficult case and say, “Quel serait le traitement en Amerique?” (“What would be the treatment in America?”) I also made a life-long friendship with Dr Ulrich Schmid, a hospital resident. He later worked in private practice in Vevey, Switzerland.
139 King Henri IV to care for victims of the plague. During its more than 400 years of service, it has been the main bastion for treatment of every major epidemic in France. In 1803, it became “a temple of dermatology.” It handled all of the skin diseases from all over Europe and Africa. Separate buildings were devoted to the plague, venereal disease, psoriasis, fungal diseases, leprosy, and tropical skin diseases. One building was devoted to bath therapy for chronic skin diseases. French dermatologists spent time at the Hôpital Saint Louis researching cures for these diseases. When I arrived in 1962, there were five department chiefs, one for every day of the week. The main chief was Dr Robert Degos. He was the author of a prominent textbook on dermatology in France. Here again, the teaching was strictly in the European style, with little exchange between students and professors. His breadth of dermatologic knowledge and experience impressed and attracted many visiting physicians. I spent much of my time with a younger chief, by the name of Dr Charles Grupper. He was a dynamic chief. He loved the American style of teaching, and traveled with his residents to every academy meeting in the United States. He was fluent in English and made many friends abroad. He wrote numerous papers and later became the head of the Dermatology Unit at the Rothschild Institute. I attended the clinics every morning and spent time in the afternoon in the library exploring the famous “Musée des Moulages.” This is an astounding museum, filled to overflowing with exquisite antique dermatologic moulages (wax models of skin diseases). There are nearly 5000 displayed in wood and glass cases. It is the largest collection of its kind in the world. Incredibly, 2000 of the moulages are the work of a single man, Jules Baretta. This museum is open to the public (photos can be found on the Internet). During my time in Paris, Dr Albert Kligman came to the hospital and gave a well-received lecture. Dr Sulzberger came to Paris to receive an honor at the Pasteur Institute. I invited him to grand rounds to hear his friend, Dr Degos. After his presentation of a very complex dermatologic problem, Dr Degos asked if we would express our views on the case. Dr Sulzberger gave an excellent review in fluent French. It was a moment that I cherished. Dr Sulzberger spoke four languages: English, French, Spanish, and German. Today the Hôpital Saint Louis has changed and is now a “specialty hospital” and medical school. Alongside dermatology, there are hematology, oncology, plastic surgery, and organ transplantation departments, and a burn center.
San Francisco, CA, USA Paris, France My next 6 months were spent in Paris at the famous Hôpital Saint Louis. This hospital was founded in 1607 by
At the end of my 2 years abroad, I decided to return to the United States. I married a beautiful and cosmopolitan Parisian woman that I had met during my stay in Caracas. We married in Paris. We both immigrated to the United
140 States and settled in San Francisco. I started teaching at the University of California, San Francisco (UCSF) in 1963 and also opened a private practice. Dr Sulzberger moved to San Francisco and became technical director of research for the United States Armed Forces. He was the principal advisor on all scientific and technical matters related to medical research and development. During the Vietnam War, I had a research laboratory at UCSF doing research on sweat disorders that was funded by the United States Army. In 1981, I became chief of dermatology at Mt. Zion Hospital/UCSF and served in that capacity for 18 years. After 45 years of practicing medicine, I retired in 2007. The 2 years I spent abroad were catalysts in my development as a professional dermatologist. My time spent in Caracas and Europe opened my eyes to the larger medical community outside of the United States and I benefited. Extremely bright and learned physicians are everywhere, and there is much to learn from them. I highly recommend that when a resident finishes training, he or she spend some time abroad. It is a unique experience that provides the physician with a deeper understanding of the world.
Conclusions My adventure in dermatology took place in the early 1960s. This was a time when the United States was a leader in so many fields, and American dermatology was no exception. Heads of dermatology units became famous and renowned. It was an honor for an American physician to
B.I. Gordon work or study abroad. Today, all has changed. We live in a globalized world. The advent of the Internet now makes available a large volume of medical information to the general consumer that was not previously available. Treatment of diseases and the latest research results are easy to obtain. But human relationships are forged by person-to-person involvements. Working abroad is an adventure that leads to new friendships. This broadens our understanding of other cultures. Political and economic crises continue to change the complexity of medical care in many countries. For example, after 40 years of blossoming, Venezuelan dermatology and research are in decline. It is now up to the next generation to restore what has been lost. Emerging democracies could help the situation. Countries that wish to lead in medical advancements must support an environment for a vibrant, professional network of medical practitioners and specialists to flourish. The opinions expressed here are my personal points of view and not those of the University of California at San Francisco, Department of Dermatology.
References 1. Kerdel-Vegas F, Convit J, Gordon B, Goihman M. Rhinoscleroma. Monograph in the American Lecture Series of Dermatology. Springfield (Ill): Charles C Thomas; 1963. 2. Convit J, Kerdel-Vegas F, Gordon B. Disseminated anergic cutaneous leishmaniasis. Br J Dermatol 1962;274:132-5. 3. Kerdel-Vegas F, Gordon B. Poikiloderma congenitale. Dermatologica 1962;125:155-60.