Reminiscence
MARION B. SULZBERGER: EXCERPTS FROM TAPED INTERVIEWS A N D TALKS* VICTOR H. WITTEN, M.D. From the Department of Dermato/ogy, University of Miami School ol Medicine, Miami, Florida
Nothing could bring me greater pleasure than to contribute to this Festschrift which honors my mentor — a person who has been more to me than partner or friend. 1 have reviewed my many hours of largely personally taped recordings of Marion B. Sulzberger made over the years; from these tens of thousands of words I have selected excerpts, each of which I believe has its own message. I present them here with only slight, nonsubstantive editorial changes.
A.D.A. Address From tbe Presidential Address at tbe American Dermato'.ogic Association, April 1960: "Dermatologists, like all others who are engaged in a high endeavor, must recognize some precise objectives and try to find effective means for achieving them. Let me say at once that I am not in accord with those who would change the name of our specialty from dermatology to cutaneous medicine. 1 say this not only because of the glorious past achievements connected with the name of dermatology but also because cutaneous medicine is much too narrow a Address for reprints: Victor H. Witten, M.D., Dermatology Foundation of Miami, 4901 Southwest 93rd Street, Miami, FL 33156. * Supported by grants from the Dermatology Foundation of Miami, Miami, Florida. 422
term, in my opinion. The suffix 'ology' is derived from logos, the word, what there was in the beginning, dynamic truth which has the power to create all knowledge, all science and all art. Dermatology, therefore, means much more to us than just medicine of the skin. It includes all the science and art that can be applied to the study of the skin and all the knowledge which has been, is being and will be garnered from the study of the skin. When we regard dermatology, in this wide and true sense, its major objectives can be expressed in the 2 following statements: First, to reduce the suffering caused by diseases principally affecting the skin or manifesting themselves principally in the skin; and second, to investigate the skin and all phenomena which may affect or which may be affected by skin — through every avenue which can lead not merely to a better understanding and conquest of skin diseases but also to the advancement of all medicine, of all biologic science and indeed, of all human progress. "The first thing that dermatologists must do when holding positions on medical faculties is to command respect of their colleagues by their clinical as well as basic scientific knowledge in their own field and by being well rounded and competent clinical teachers of their own specialty. Heads of clinical departments must also be In full possession of the ability to understand and stimulate scientific research in every way that it may be related to their clinical specialty. Moreover, like all leaders in clinical fields, dermatologists must always be alert for the first signs of disrespect for the clinical
No. 5
TAPES AND TALKS
aspects of their own specialty or for their clinical investigations and clinical teaching and join together to combat any such disrespect in the bud. Societies and associations of specialists, such as this one, can do even more than individuals and do it even more effectively. 1 therefore believe that our dermatologic societies must take vigorous stands against any encroachment upon the perogatives and respected position of the clinician and should formulate and publicize standards for university and hospital departments in our field, as, for example, was done by the American Academy of Dermatology in 1958. "Societies of dermatologists as well as those of other medical and surgical specialists should make it an inviolate rule to admit as members only and exclusively those who are truly specialists in their field. Moreover, societies should, in my opinion, embark actively in every form of dignified and proper public relations and adult education to inform both the lay public and other professional groups as to the nature, contribution, needs and potentialities of their particular specialty. It is for this reason that 1 suggested that this Association should consider appointing a committee on public relations." On Dermatology From a personal interview in Washington, D. C, April 1963: "1 think one has to regard the origin of specialties as Darwin thought of the origin of the species. What is it that forms a thing, an entity that is different from other entities and makes it continue to propagate itself with the differences preserved? There is no logic, there is no rational, intellectual reason for forming specialties, for classifying them, for separating them from each other that one can put on any sort of a logical table of organization, any system. The specialties
Witten
423
evolve very much like species evolve. They evolve to fill certain needs and as long as they are adapted to their environment, they continue. Since the environment and the state of the art and the state of the knowledge are constantly changing, so specialties are constantly changing. "The big question in my mind about dermatology, to come back to our real subject, is if^ dermatology becomes more akin to all of the other fields in medicine, as I believe it is becoming, and as it uses more and more of the same approaches to therapy, to diagnosis, to study, to investigation, to management and as it becomes more Integrated with the academic family in the university, what will there be to differentiate the species from all the other species? What need will it fill which is its unique province and in the field of its unique capabilities? When this need is no longer there, will it survive as a specialty? Well, it will, certainly for a long time just by momentum, by those things which are operative against change per se. "It may also continue because a specialty may be created just because there is such a vast body of information from all different kinds of fields that someone must gather it together to focus it on a particular organ or on a particular problem. By that 1 mean biochemistry, for example, which applies to the skin particularly and not to other organs; someone must know that. At the same time, they must know the biophysics which applies to the skin and they must know something about the morphologic differentiation of the vascular system as it applies to the skin. So it is possible that even though their methods are not unique, the application of the methods and the knowledge will be sufficiently distinct and voluminous to make it necessary for some person or group of peo-
424
INTERNATIONAL JOURNAL OP DERMATOLOGY
pie to be repositories of all that information and in a position to use it on a particular organ even though they are the same methods and the same kind of information that other people are using on other organs. There may be a place for people who know how to apply this information and these particular methods to a particular organ." I then asked, "What do you consider to be the requisites for the head of a department of dermatology today?" "Well, very much like the requisites for the head of any other large department. I think the first thing is that he must be dedicated to medicine. By that I mean he must be dedicated to the relief of suffering and the correction of disfigurement and the alleviation of disability in patients who are alive today and to future ones; therefore, he must be interested in the three legs of the tripod: First, clinicai practice as it is now. Patient care has a very important part because people alive today deserve the best that can be given to them — the application of all the knowledge that is available. Second, he must be interested in spreading his knowledge by teaching, by writing and by encouraging others and teaching others how to teach and write. Third, he must be interested in creating new knowledge through research because only by trying to push back the borders of ignorance can one really be sure that one has complete command of what is known and the ability to teach it." And then I asked for any concluding comments for the day's interview. "I would like to say that I think one of the reasons why I am so likely to have bias or be vehement or may not be sufficiently objective about many of these problems is that I have a real love for this specialty. 1 think that this love is deserved because I think dermatology has made great contributions. 1 think it has tremendous problems (and you al-
June 1977
Vol. 16
ways love problem children). I don't know if I would love dermatology as much if 1 didn't think it was neglected or in some way handicapped. There wouldn't be as much to fight for. If you fight for a thing, you love it and you fight for it because you love it—so this is a self-perpetuating, self-fertilizing thing. And I think the amount of suffering that can be relieved with the specialty itself, in cutaneous disease itself, is way beyond that which most people imagine." Quotable Quotes From a personal interview in Atlantic City, June 1963: Sulzberger was speaking of Josef Jadassohn: "I learned from him true exactness, the exacting nature of the demands of any attempt to write up one's results, the need for certainty, never exaggerating, conservatism — saying less rather than more, by trying to overcome bias by the strongest possible controls, the strongest possible checks and balances, weighing things against one's bias and taking great care that way." From a personal interview in Coral Cables, Florida, May, 1969, just a glimpse of his sense of humor: "It started this way. When I put on this jacket I found the buttonhole is in the wrong place and I thought one of my shoulders had gotten higher than the other, but when I looked, Bobbie (his wife — Ed.) confirmed the fact that it was the button that was sewn wrong." In December 1959, be said tbe following at an informal talk at tbe Dermatology Researcb Club in Cbicago: "And then I think that one cannot direct research, one can only encourage or discourage it, one can only guide it and stimulate it, one can only shape it and give it different direction, one cannot actually direct it as a director would. 1 believe that we should bear in mind that our research problems should come from the skin and go back to the skin."
No. 5
TAPES AND TALKS
In April 1970, he spoke on "Perspectives in Dermatology" at the 40th Anniversary of Skin & Cancer Hospital of Philadelphia, entitling his paper, "Strong Swimmers on a Swelling Sea — And How I Floated Alongside": "I've heard Dr. Robert Oppenheimer quoted as saying that it is more the business of science to find questions to answer than it is to find answers to questions. Certainly by this criterion dermatology has always been and remains a king among medical sciences. For nowhere else in medicine and in no tissue other than the skin can one so readily find so many fundamental and accessible questions to answer. Nowhere else are there so many questions that can — in every period and in every age — be approached by the then available methods of scientific investigation. 1 predict that we are right now on a new floodtide, on a new swelling sea of dermatologic discoveries and that many of its strongest swimmers may be here with us — in this very audience today." From an interview in August 1970, in Coral Cables, Florida: "One of the greatest satisfactions that I have had in my professional life was when I did a piece of work, one of the first papers that I wrote, the first piece of experimental work that 1 did and when my teacher, Bloch, whom I respected greatly, said to me, "Now you have seen something that no human being has seen before and you are like a discoverer who finds a mountain peak that has never been climbed before and you will always feel this joy of discovery." That was a very great satisfaction to me because I got that feeling — to think that it was a phenomenon that no one else had seen before." And speaking very personally, he said: "1 didn't want to have a big practice, I didn't want to make a lot of money out of practice, I didn't want to do anything of that kind but I really wanted to feel
Witten
42S
that when patients came to me I was going to do everything in my power to help them. "Every discourse should have a summation and a recapitulation. I will say three things: one is discovery — finding something new and true. The second one is helping human beings and the third one is helping young men, younger men, training them to help human beings or to discover things. This is really the summation of the whole thing. What else is there? Those are the only satisfactions that one can get out of medicine." In 1956 when I became the co-editor of The Yearbook of Dermatology with Rudolf Baer, Sulzberger made the following remarks while discussing with me the writing of the editorial comments which he had introduced in the Yearbook many years before. He advised me that it was just as much a fault to let false or questionable articles go by without an editorial as it was to write a false or questionable editorial about an article. He reminded me that an editorial comment, once published, was the "last w o r d " as it did not permit the author of the article to present a rebuttal. And last, for this very brief review, in December 1975, while attending the American Academy of Dermatology Meeting in San Francisco, Sulzberger wrote the following to me on a card he took from his pocket (he always carries 3" X 5" cards) because he had laryngitis and could not speak: "The specialty of dermatology is going to be relegated to a third class specialty unless the leaders recognize what they must do nowl Get influential laymen and lawmakers to take up the cause on account of the cost of skin disease to industry, military and the country." Thus this Festschrift to a man who not only was, but remains inquisitive, imaginative, creative, original, productive, provocative and, yes, even controversial. 1 admire and deeply respect him!
MARION B. SULZBERGER: EXCERPTS FROM TAPED INTERVIEWS A N D TALKS* VICTOR H. WITTEN, M.D. From the Department of Dermato/ogy, University of Miami School ol Medicine, Miami, Florida
Nothing could bring me greater pleasure than to contribute to this Festschrift which honors my mentor — a person who has been more to me than partner or friend. 1 have reviewed my many hours of largely personally taped recordings of Marion B. Sulzberger made over the years; from these tens of thousands of words I have selected excerpts, each of which I believe has its own message. I present them here with only slight, nonsubstantive editorial changes.
A.D.A. Address From tbe Presidential Address at tbe American Dermato'.ogic Association, April 1960: "Dermatologists, like all others who are engaged in a high endeavor, must recognize some precise objectives and try to find effective means for achieving them. Let me say at once that I am not in accord with those who would change the name of our specialty from dermatology to cutaneous medicine. 1 say this not only because of the glorious past achievements connected with the name of dermatology but also because cutaneous medicine is much too narrow a Address for reprints: Victor H. Witten, M.D., Dermatology Foundation of Miami, 4901 Southwest 93rd Street, Miami, FL 33156. * Supported by grants from the Dermatology Foundation of Miami, Miami, Florida. 422
term, in my opinion. The suffix 'ology' is derived from logos, the word, what there was in the beginning, dynamic truth which has the power to create all knowledge, all science and all art. Dermatology, therefore, means much more to us than just medicine of the skin. It includes all the science and art that can be applied to the study of the skin and all the knowledge which has been, is being and will be garnered from the study of the skin. When we regard dermatology, in this wide and true sense, its major objectives can be expressed in the 2 following statements: First, to reduce the suffering caused by diseases principally affecting the skin or manifesting themselves principally in the skin; and second, to investigate the skin and all phenomena which may affect or which may be affected by skin — through every avenue which can lead not merely to a better understanding and conquest of skin diseases but also to the advancement of all medicine, of all biologic science and indeed, of all human progress. "The first thing that dermatologists must do when holding positions on medical faculties is to command respect of their colleagues by their clinical as well as basic scientific knowledge in their own field and by being well rounded and competent clinical teachers of their own specialty. Heads of clinical departments must also be In full possession of the ability to understand and stimulate scientific research in every way that it may be related to their clinical specialty. Moreover, like all leaders in clinical fields, dermatologists must always be alert for the first signs of disrespect for the clinical
No. 5
TAPES AND TALKS
aspects of their own specialty or for their clinical investigations and clinical teaching and join together to combat any such disrespect in the bud. Societies and associations of specialists, such as this one, can do even more than individuals and do it even more effectively. 1 therefore believe that our dermatologic societies must take vigorous stands against any encroachment upon the perogatives and respected position of the clinician and should formulate and publicize standards for university and hospital departments in our field, as, for example, was done by the American Academy of Dermatology in 1958. "Societies of dermatologists as well as those of other medical and surgical specialists should make it an inviolate rule to admit as members only and exclusively those who are truly specialists in their field. Moreover, societies should, in my opinion, embark actively in every form of dignified and proper public relations and adult education to inform both the lay public and other professional groups as to the nature, contribution, needs and potentialities of their particular specialty. It is for this reason that 1 suggested that this Association should consider appointing a committee on public relations." On Dermatology From a personal interview in Washington, D. C, April 1963: "1 think one has to regard the origin of specialties as Darwin thought of the origin of the species. What is it that forms a thing, an entity that is different from other entities and makes it continue to propagate itself with the differences preserved? There is no logic, there is no rational, intellectual reason for forming specialties, for classifying them, for separating them from each other that one can put on any sort of a logical table of organization, any system. The specialties
Witten
423
evolve very much like species evolve. They evolve to fill certain needs and as long as they are adapted to their environment, they continue. Since the environment and the state of the art and the state of the knowledge are constantly changing, so specialties are constantly changing. "The big question in my mind about dermatology, to come back to our real subject, is if^ dermatology becomes more akin to all of the other fields in medicine, as I believe it is becoming, and as it uses more and more of the same approaches to therapy, to diagnosis, to study, to investigation, to management and as it becomes more Integrated with the academic family in the university, what will there be to differentiate the species from all the other species? What need will it fill which is its unique province and in the field of its unique capabilities? When this need is no longer there, will it survive as a specialty? Well, it will, certainly for a long time just by momentum, by those things which are operative against change per se. "It may also continue because a specialty may be created just because there is such a vast body of information from all different kinds of fields that someone must gather it together to focus it on a particular organ or on a particular problem. By that 1 mean biochemistry, for example, which applies to the skin particularly and not to other organs; someone must know that. At the same time, they must know the biophysics which applies to the skin and they must know something about the morphologic differentiation of the vascular system as it applies to the skin. So it is possible that even though their methods are not unique, the application of the methods and the knowledge will be sufficiently distinct and voluminous to make it necessary for some person or group of peo-
424
INTERNATIONAL JOURNAL OP DERMATOLOGY
pie to be repositories of all that information and in a position to use it on a particular organ even though they are the same methods and the same kind of information that other people are using on other organs. There may be a place for people who know how to apply this information and these particular methods to a particular organ." I then asked, "What do you consider to be the requisites for the head of a department of dermatology today?" "Well, very much like the requisites for the head of any other large department. I think the first thing is that he must be dedicated to medicine. By that I mean he must be dedicated to the relief of suffering and the correction of disfigurement and the alleviation of disability in patients who are alive today and to future ones; therefore, he must be interested in the three legs of the tripod: First, clinicai practice as it is now. Patient care has a very important part because people alive today deserve the best that can be given to them — the application of all the knowledge that is available. Second, he must be interested in spreading his knowledge by teaching, by writing and by encouraging others and teaching others how to teach and write. Third, he must be interested in creating new knowledge through research because only by trying to push back the borders of ignorance can one really be sure that one has complete command of what is known and the ability to teach it." And then I asked for any concluding comments for the day's interview. "I would like to say that I think one of the reasons why I am so likely to have bias or be vehement or may not be sufficiently objective about many of these problems is that I have a real love for this specialty. 1 think that this love is deserved because I think dermatology has made great contributions. 1 think it has tremendous problems (and you al-
June 1977
Vol. 16
ways love problem children). I don't know if I would love dermatology as much if 1 didn't think it was neglected or in some way handicapped. There wouldn't be as much to fight for. If you fight for a thing, you love it and you fight for it because you love it—so this is a self-perpetuating, self-fertilizing thing. And I think the amount of suffering that can be relieved with the specialty itself, in cutaneous disease itself, is way beyond that which most people imagine." Quotable Quotes From a personal interview in Atlantic City, June 1963: Sulzberger was speaking of Josef Jadassohn: "I learned from him true exactness, the exacting nature of the demands of any attempt to write up one's results, the need for certainty, never exaggerating, conservatism — saying less rather than more, by trying to overcome bias by the strongest possible controls, the strongest possible checks and balances, weighing things against one's bias and taking great care that way." From a personal interview in Coral Cables, Florida, May, 1969, just a glimpse of his sense of humor: "It started this way. When I put on this jacket I found the buttonhole is in the wrong place and I thought one of my shoulders had gotten higher than the other, but when I looked, Bobbie (his wife — Ed.) confirmed the fact that it was the button that was sewn wrong." In December 1959, be said tbe following at an informal talk at tbe Dermatology Researcb Club in Cbicago: "And then I think that one cannot direct research, one can only encourage or discourage it, one can only guide it and stimulate it, one can only shape it and give it different direction, one cannot actually direct it as a director would. 1 believe that we should bear in mind that our research problems should come from the skin and go back to the skin."
No. 5
TAPES AND TALKS
In April 1970, he spoke on "Perspectives in Dermatology" at the 40th Anniversary of Skin & Cancer Hospital of Philadelphia, entitling his paper, "Strong Swimmers on a Swelling Sea — And How I Floated Alongside": "I've heard Dr. Robert Oppenheimer quoted as saying that it is more the business of science to find questions to answer than it is to find answers to questions. Certainly by this criterion dermatology has always been and remains a king among medical sciences. For nowhere else in medicine and in no tissue other than the skin can one so readily find so many fundamental and accessible questions to answer. Nowhere else are there so many questions that can — in every period and in every age — be approached by the then available methods of scientific investigation. 1 predict that we are right now on a new floodtide, on a new swelling sea of dermatologic discoveries and that many of its strongest swimmers may be here with us — in this very audience today." From an interview in August 1970, in Coral Cables, Florida: "One of the greatest satisfactions that I have had in my professional life was when I did a piece of work, one of the first papers that I wrote, the first piece of experimental work that 1 did and when my teacher, Bloch, whom I respected greatly, said to me, "Now you have seen something that no human being has seen before and you are like a discoverer who finds a mountain peak that has never been climbed before and you will always feel this joy of discovery." That was a very great satisfaction to me because I got that feeling — to think that it was a phenomenon that no one else had seen before." And speaking very personally, he said: "1 didn't want to have a big practice, I didn't want to make a lot of money out of practice, I didn't want to do anything of that kind but I really wanted to feel
Witten
42S
that when patients came to me I was going to do everything in my power to help them. "Every discourse should have a summation and a recapitulation. I will say three things: one is discovery — finding something new and true. The second one is helping human beings and the third one is helping young men, younger men, training them to help human beings or to discover things. This is really the summation of the whole thing. What else is there? Those are the only satisfactions that one can get out of medicine." In 1956 when I became the co-editor of The Yearbook of Dermatology with Rudolf Baer, Sulzberger made the following remarks while discussing with me the writing of the editorial comments which he had introduced in the Yearbook many years before. He advised me that it was just as much a fault to let false or questionable articles go by without an editorial as it was to write a false or questionable editorial about an article. He reminded me that an editorial comment, once published, was the "last w o r d " as it did not permit the author of the article to present a rebuttal. And last, for this very brief review, in December 1975, while attending the American Academy of Dermatology Meeting in San Francisco, Sulzberger wrote the following to me on a card he took from his pocket (he always carries 3" X 5" cards) because he had laryngitis and could not speak: "The specialty of dermatology is going to be relegated to a third class specialty unless the leaders recognize what they must do nowl Get influential laymen and lawmakers to take up the cause on account of the cost of skin disease to industry, military and the country." Thus this Festschrift to a man who not only was, but remains inquisitive, imaginative, creative, original, productive, provocative and, yes, even controversial. 1 admire and deeply respect him!
