Contemporaries Herman Beerman, A.B., M.D., Sc.D.(Med.), F.A.C.P.
With this issue, we begin a series titled "Contemporaries ." Prominent dermatologists prepare brief autobiographies emphasizing those accomplishments which they believe were important and also other significant occurrences during their carcers.-Editor What you do in this world is a matter of no consequence . The question is, what you can make people believe you have done. - A. COl/ali Doyle: A Study ill Searle/
Among 'the pleasures of being asked to write a few words about oneself is-the recollection or review of the many warm expressions of friends and the sense of importance one gets . Imagine anyone wanting to read about the so-called accomplishments of a 78-year-old person, who in 1919 came to Philadelphia from a small western Pennsylvania town (Johnstown) to the University of Pennsylvania to study arts and sciences. The interval between 1919 and 1980 has been spent in Philadelphia, but my tentacles have captured friends far and wide. It is difficult to write about oneself. If one regards an accomplishment as significant, he fears that he is immodest. It is also difficult for one to assess the importance of his own accomplishments. Therefore, it is necessary to a certain extent to rely on the evaluation of his efforts by his peers. At no time in my early life did I have any idea of becoming a physician . In fact , my intention was to become a zoologist with special interest in physiology. My first two papers (one with Leo Loeb) dealt with cell permeability and the effects of various ions on tissue. I spent the summer of 1923 in Woods Hole, at the Marine Biological Laboratory. Prior to going there, I had learned of a competitive examination for scholarships in the School of Med icine of the University of Pennsylvania. Two of my friends and I, for want of something better to do , took the examination. To our surprise all three of us won scholarships. I decided to accept 210
Herman Beerman, M.D. mine in spite of the displeasure of the head of Zoology, but I did not lose my interest in physiology, and the year I married my patient and longsuffering wife, Emma, I was assistant to Dr. Leo Loeb in Woods Hole (1924). I had no plans about my future activities in medicine until I met Dr. John H. Stokes. He fascinated me so much by his conduct in class and his marvelous diction that I said, " He is for me." After my internship I scouted around for a residency in dermatology with Dr. Stokes but there were no openings. I then turned to general practice, After some months of this, I was asked by Dr. Robert L. Gilman, of the University of Pennsylvania, in Dr. Stokes's absence in Europe, to 0190-9622/80/080210+04$00.40/0 © 1980 Am Acad Dcrrnatol
Volume 3 Number 2 Au!!ust. 1980
work as a volunteer in Pennsylvania Hospital. On his return, Dr. Stokes asked me to do more and to attend staff conferences at the hospital of the University of Pennsylvania. At that time, syphilis therapy required the use of sclerosing solutions of arsenicals and painful injections of bismuth. In order to save the patient from unnecessary pain , some means of teaching injection procedures were needed. Within a week I devised manikins for intravenous and intramuscular technics, which pleased Dr. Stokes immensely. Thus began my long-time association with Dr. Stokes and the University of Pennsylvania and the many affiliated hospitals, along with my passing through the various academic ranks. In 1949, I was made chairman of the Department of Dermatology in the Graduate School of Medicine of the University of Pennsylvania. During my tenure (to 1967), my staff and I had a hand in giving the basic year to hundreds of American dermatologists and numerous students from various parts of the world (notably Thailand). THE AMERICAN ACADEl\lY OF DERMATOLOGY CLINICOPATHOLOGIC CONFERENCE My contact with the American Academy of Dermatology began with the inaugural meeting in Detroit, Jan. 14 and 15, 1938, when I participated in the Syphilis Program at the request of Dr. Paul A. O'Leary. I was on the board of directors twice (1941-1948, 1962-1967); president (1965-1966); honorary member since 1971 . My most active teaching experience in the Academy was in the courses in dermatopathology and especially in the Clinicopathologic Conferences. I found my experiences with the Conference happy and instructive. I was a strict disciplinarian and often aroused my colleagues' ire . The Clinicopathologic Conference, which has been given annually for more than 30 years, has indeed played an important role in the Academy's program development and in my education specifically. It has been considered by many (Curth, Knox, et al) as an outstanding feature of the Academy meetings. Although the old masters, Diihring , Unna, Hutchinson, and others, had done much to advance the knowledge of pathology of the skin, and had even described much present
Herman Beerman
211
knowledge (e.g., Hutchinson: keratoacanthoma; toxic epidermal necrolysis; and sweat duct blockage in miliaria), only recently "rediscovered," there were no real platforms for discussion of dermatopathology in the United States. There were some dermatologists who promoted interest in this field, Piffard , Politzer, James C. White, Hartzell, Weidman and Montgomery, S. W. Becker, Sr., and Ash, to mention some of the prominent ones. Up to about 1930, at meetings of local dermatologic societies of the United States, nearly all patients were presented without microscopic data. It is possible that the recent increase in interest in this field was due to improved technology and the discovery by the American Board of Dermatology of how little competence candidates for certification had in the pathology of cutaneous diseases. The Academy, shortly after its organization in 1938, stepped into the breech when Dr. Fred D. Weidman conducted the Clinicopathologic Conference. I assisted in the first of the long series of sessions subsequently headed by Marcus R. Caro, Beerman, Knox, Winkelmann, Ackerman, and others. Numerous younger participants added much. My efforts were underpinned by my long-time colleague, Dr. Margaret Gray Wood . My tenure of 19 years convinced me of how influential the Academy's conference was in spreading the gospel of dermatopathology. It stimulated the development of local conferences (Pacific Dermatological-Zola Cooper and the like) . It has offered a forum where those interested in dermatopathology could meet on equal terms with general pathologists. This has, I am certain, been a factor in stimulating the creation of the board certification of dermatologists' and pathologists' competence in this field by the American Boards of Dermatology and Pathology. It also may have stimulated the creation of the American Society of Dermatopathology. The Conference afforded the panel, as well as others, an extraordinary opportunity to try out methods of teaching and stimulated study of new problems . It was an exhibit forum for newly discovered conditions where these diseases were discussed for the first time (keratoacanthoma; certain Pinkus processes (poroma, alopecia mucinosa, etc.) The format of the Conference notably permitted
Journal of the American Academy of Dermatology
212 Herman Beerman the panel to talk but encouraged audience participation. This became an important part of the exercise. Younger members had an opportunity to hear the opinions of the leaders in this discipline. The Conference still, with continuing changes in format, carries on the spirit which we had engendered in the past. THE SOCIETY FOR INVESTIGATIVE DERMATOLOGY
The Society for Investigative Dermatology has played a prominent role in my professional life. I was a member from its inception, a member of the editorial board of the Journal of Investigative Dermatology, vice-president in 1946, and president in 1947. Out of a clear sky in 1950, when I missed a meeting, I found myself the new secretary-treasurer, an office I held for 15 years. I had the satisfaction of seeing the Society grow from a membership of about 500 at the time of its founding to the present dues-paying membership of more than 1,300. There was also a concomitant growth in financial resources and activities. My 15year report in 1965 reflects this growth. I felt that "Again it is desirable to point out that mere growth in size and financial resources is not enough to measure the degree to which the organization is fulfilling its objectives. These items are, however, necessary for insurance of continued development. " The Society has done more than attain increase in membership and fiscal security. The Society has been more than kind to me personally, with an annual lectureship, a festschrift, honorary membership, and treasured citations. OTHER SOCIETIES
Other American organizations, as well as foreign ones, have meant much to me. In their accepting me as a member or officer, I have been the gainer. Among these are the American Dermatological Association, the American Society of Dermatopathology, the Association of Professors of Dermatology, and the Philadelphia Dermatological Society; for all of these societies I have served as president. The Institute for Dermatologic Communication and Education and the Dermatology Foundation have honored me with membership on the board of directors. Numerous domestic and foreign societies have placed me in
their ranks and have asked me to give named lectures. STUDIES
My studies and publications have dealt with a variety of topics ranging from a case report and numerous critical and comprehensive reviews of dermatologic subjects to a 9V2-year study of treatment-resistant spirochetes. My reports were concerned with the introduction of drugs, including anthralin, description of the first American case of solitary keratoacanthoma, and the description of ocular lesions in nevoxanthoendothelioma (xanthogranuloma). Dermatopathology, dermatologic history, and Sherlock Holmes in dermatology engaged some of my attention. But by far the most of my studies dealt with various aspects of syphilis: diagnosis, clinical studies, pathogenesis, and treatment. The value of most of my earlier (pre-1944) syphilis therapeutic reports was wiped out in one fell swoop by the introduction of penicillin by Mahoney and his co-workers. They showed that penicillin was effective in the treatment of syphilis in the rabbit and man. It was a superior, nontoxic, curative agent in early syphilis when administered in the short space of 8 days. Our group at the University of Pennsylvania was fortunate, however, in being among the early students of this drug. Because of the war, the problem of early syphilis was of great importance to the armed forces. In order to determine quickly the best method for the application of penicillin to syphilotherapy, a study was organized through the cooperation of the United States Army, Navy, and Public Health Service, and the Committee on Medical Research of the office of Scientific Research and Development, under the general auspices of a penicillin panel appointed by the Subcommittee on Venereal Diseases, National Research Council. This committee, in conjunction with the participation of twenty-three civilian clinics, the armed forces, and four laboratories, illustrates how concerted action in a very short time may answer questions regarding treatment of early and late syphilis. Individual effort might not effect such an answer in a lifetime. The spectacular reduction in the incidence of syphilis after the introduction of penicillin (the rate of this disease fell from 75.6 to 3.8 of re-
Volume 3 Number 2 August, 1980
ported cases per hundred thousand population) induced the Government to slash funds and to reduce government and private publication dealing with venereal disease. From 1950 to 1962, my colleagues and I reviewed the annual production of literature dealing with syphilis for the Archives of Internal Medicine. In these reviews, we were able to trace the gradual lack of interest in syphilis by physicians, the public, and the Government. Actually, in 1950 there was some affirmation that syphilis was still "rearing its ugly head. " Gradually there was an apparent increase in the incidence rate of syphilis, so that by 1962 the United States Public Health Service reported that there had been 174% increase in primary and secondary syphilis in the United States from 1957 to 1961. Britain reported a 73% increase in 1958, and France 147% since 1957. Decline, if not complete abolition, of medical student teaching about venereal diseases was an important factor in their spread. The situation was so bad in 1951 that the great Udo J. Wile, University of Michigan, had already urged that' 'syphilis in all its manifestations should be taught to the medical student, precisely as we still teach all that is known of typhoid, diphtheria and smallpox, although a medical student may well go through his whole course of study without ever seeing a case demonstrated to him. " The Government in,l961, under Surgeon General Luther L. Terry, appointed a task force to survey the problem and make recommendations. Apparently, for whatever reasons, the incidence of syphilis and gonorrhea is now somewhat less of a problem each year. Throughout my long teaching experience I have been impres sed with the importance of preceptstudying the example of my predecessors. This has led to an intense interest in the history of dermatology. As a result, when I became chairman of Dermatology in the Graduate School of Medicine, University of Pennsylvania, I incorporated a series of lectures on the history of dermatology and syphilology in the regular course of study. Each presentation was made by a different lecturer who covered a special historic topic in which he was particularly well versed. Parallel to my interest in the past of dermatology and syphilology was my interest in people. I
Herman Beerman
213
have , because of my long professional career, benefited from my contact with most of the "greats " in dermatology, both American and foreign. To mention each one would require more space than I am allowed for all my remarks. Yet, I must single out some who were especially close: Donald M . Pillsbury, Marion B. Sulzberger, Louis Forman, and Alfred Hollander. Each of these has added much to my development-Pillsbury's administration, Sulzberger's friendship and attention to detail, Forman's correlation of the internal medical aspects of dermatology, and Hollander's masterful therapy. However, my two teachers for many years, Drs. John H. Stokes and Fred D. Weidman, stand as the keystone of my career. I have written much about these two mentors in a number of presentations. To reconstruct their contributions to syphilology and cutaneous pathology, respectively, would be to write the modern history of syphilology and cutaneous pathology. This I have already done elsewhere. My retirement has been made pleasant and continuously productive through the efforts of Walter B. Shelley, chairman of the Department of Dermatology, School of Medicine, University of Pennsylvania. Now that I have detailed some of my accomplishments, I cannot agree with those who rank modesty among the virtues. To a logician all things should be seen exactly as they are, and to underestimate oneself is as much a departure from truth as to exaggerate one's own powers . -A. Conan Doyle: The Greek Interpreter
Herman Beerman, M.D. Philadelphia, PA BIBLIOGRAPHY I. Stokes JH , Beerman H: Manikins for teaching intravenous and intramuscular injection technics . JAMA 94: 16581660, 1930. 2. Pillsbury DM, Beerman H: John Hinchman Stokes, M.D . Arch Dermatol 84:325 -328, 1961. 3. Beerman H: Frederick Deforest Weidman, 1881-1956. Arch Dermatol 75:276 -279, 1957. 4. Beerman H: Cutaneous pathology. A historical view. J Cutan Pathol 13:93-95;118-122; 127-130, 1974. 5. Beerman H: My half century in dermatopathology. J Dermatopathol 1:237-243, 1979. 6. Beerman H: The rise of dermatology in Philadelphia . Trans Stud ColI Physicians Phila 40:39-54, 1972. 7. Beerman, H: 100 years of dermatology in Pennsylvania . Int J DermatoI18:232-239; 311-318,1979.