From the Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Historical articles published in Proceedings, including the history of anesthsiology published last issue) will be reprinted in the centennial history of Baylor University Medical Center, edited by H. Lawrence Wilsey and scheduled for publication in 2002. Readers who have any additional information, artifacts, photographs, or documents related to the historical articles are asked to forward such information to the Proceedings' editorial office for possible inclusion in the book version.

Corresponding author: M. Alan Menter, MD, 3600 Gaston Avenue, 651 Wadley, Dallas, Texas 75246.

Greek and Roman physicians endeavored to treat patients with skin disorders but with limited success. A Roman gentleman, Celsus, while not a physician, contributed to the understanding of skin disorders through his description and classification. The richness of the details he used is still reflected in our current dermatologic nomenclature (2).

As scientific advances were made in the late 1700s and 1800s, the causes and treatment of skin disorders became better understood. Lorry published a pioneering treatise on skin diseases in 1777. Jean Louis Alibert (1768-1837) is considered the founder of the discipline, but his system was superseded by that of the Englishman Robert Willan (1757-1812). Ferdinand von Hebra (1816-1880) introduced a pathological approach, and Raymond Sabouraud (1864-1938) and Paul Unna (1850-1929) discussed bacteriology's effects on dermatology (3).

Along with London and Paris, Vienna was prominent in the history of dermatology. In her book The Vienna Medical School of the Nineteenth Century, Ms. Erna Lensky reviews the career of Dr. Ferdinand von Hebra (4) (Figure 1). Dr. Hebra headed a department of dermatology at the Vienna Medical School in 1845 and was made a full professor in 1869. The book he published in 1844, Attempt at Classification of Skin Diseases on the Basis of Pathological Anatomy, served as a foundation for dermatology even into the 20th century. By the time Hebra died in 1880, the understanding of skin diseases was transformed: they were no longer viewed as “rashes from polluted humors” to be driven back into the body. Hebra's pupil, Dr. Moriz Kaposi, served as his successor in the Viennese school. Kaposi also described many new diseases, some of which bear his name today.

A number of physicians took Hebra's ideas to the USA, including J. C. White, S. Sherwell, H. G. Piffard, L. A. Duhring, and G. T. Jackson. Thus, much as Dr. Adolf Lorenz from the Vienna Medical School brought to Dallas the inspiration for development of “a great humanitarian hospital”--the Texas Baptist Memorial Sanitarium (TBMS), which metamorphosed into Baylor Hospital (BH), Baylor University Hospital (BUH), and Baylor University Medical Center (BUMC)--members of the Vienna medical faculty influenced the practice of dermatology in the USA in general and eventually at Baylor.

Dermatology was established as an independent specialty in the 1870s (5). The first international conference that included dermatology was held in 1889 (6). “Giants” of dermatology in the USA who helped establish American dermatology in the early 1900s--such as Dr. M. Sulzberger and Dr. W. Groeckerman--were trained in Europe, especially Vienna and Paris.

In Dallas and elsewhere in Texas in the 1800s, physicians generally cared for their patients as well as they could without the benefit of specialists in dermatology and other fields. The first dermatologist in Texas, Dr. Jesse Bedford Shelmire, came to Dallas in 1895. Since the beginning of the 20th century, BUMC and its predecessor hospitals have been privileged to have on staff world-class physicians in the field of dermatology.

DERMATOLOGY AT TBMS: 1903-1920

When TBMS opened in 1904, 22 physicians were chosen for the medical staff of the sanitarium. None was a specialist in dermatology, although Dr. A. F. Beddo was from 1901 to 1903 a professor of skin diseases as well as professor of diseases of children at the University of Dallas Medical Department, which in 1903 became Baylor University College of Medicine (BUCM). Dr. E. A. Blount, who had been professor of pathology at the University of Dallas Medical Department from 1902 to 1903, was professor of dermatology at BUCM from 1903 until 1908 as well as a member of the medical staff of TBMS during those years. These early faculty members probably considered skin diseases a secondary interest and did not qualify as true specialists in dermatology. Neither had the professional qualifications in dermatology possessed by Dr. Shelmire.

Dr. Jesse B. Shelmire (1858-1931; Figure 2), the son of a Louisiana farmer, graduated from Tulane University School of Medicine in 1883. Subsequently, he gained clinical experience at the Skin and Cancer Hospital in New York City. He arrived in Dallas in 1895, becoming the first fully trained dermatologist south of St. Louis and west of New Orleans. He was truly the father of dermatology in Texas. When he began practice in Dallas, he possessed the first microscope in the city and often did microscopic examinations for other physicians.

Dr. Shelmire, like leading clinicians in other specialties, took an active interest in teaching and research as well as in his growing practice. In 1903, he taught dermatology at Southwestern University Medical College until it became Southern Methodist University Medical Department in 1911. He then taught at Southern Methodist University Medical Department from 1911 until it closed in 1915. Dr. Shelmire practiced at TBMS and BH and was a member of the faculty of BUCM: as professor of dermatology from 1911 to 1913 and from 1914 to 1920, professor of dermatology and syphilology from 1920 to 1928, and emeritus professor from 1929 to 1931.

Dr. Shelmire developed major clinical and research interests while practicing in Dallas. He published many papers on various aspects of dermatology, including fungal infections such as actinomycosis and nail fungus, bacterial infections such as syphilis, and the response of the skin to allergens.

DERMATOLOGY AT BH AND BUH: 1920-1950

In 1921, the year after TBMS was renamed BH, Dr. Jesse B. Shelmire helped form the first organization dedicated to dermatology, which in 1928 became the Texas Dermatology Society. By June 1927 the society had 11 members, which grew to 225 members by 1975 and close to 500 members today. Thus, it can be said that organized dermatology in Texas had its origins not only in Dallas, but at the institution that is now BUMC.

In 1924, Dr. Jesse B. Shelmire was joined by his son, Dr. J. Bedford Shelmire, Jr. (Figure 3), in the practice of dermatology. The younger Dr. Shelmire was a student at the University of Texas before going to the Columbia College of Physicians and Surgeons. He trained abroad, both in Paris and Vienna, as well as in New York. He returned to Dallas to join his father in practice. As mentioned by Dr. Coleman Jacobson, Dr. J. Bedford Shelmire was “the best trained dermatologist in the South” (7).

Like his father, Dr. J. Bedford Shelmire published extensively. In fact, he was awarded a silver medal from the American Medical Association for his work on endemic typhus fever associated with rat bites. He is particularly remembered for his work on poison ivy-type dermatitis. Many people living today in the Highland Park area were included by Dr. Shelmire in his testing program for this disease, and his work is still quoted in professional publications. In addition to his active dermatology practice and his clinical research, Dr. Bedford Shelmire was highly sought as a speaker nationwide. He received many honors, including serving on the American Board of Dermatology and being president of the prestigious Society of Investigative Dermatology, the premier dermatology research organization in the USA.

Dr. J. Bedford Shelmire followed his father as professor of dermatology at BUCM from 1927 until BUCM moved to Houston in 1943. Thereafter, Dr. J. Bedford Shelmire became the first professor of dermatology at Southwestern Medical School of Southwestern Medical Foundation, which became the University of Texas Southwestern Medical School (UT Southwestern), until his retirement from active teaching in 1950.

The Shelmire legacy in dermatology in Dallas and at Baylor was continued by the 2 sons of Dr. J. Bedford Shelmire, Jr., Dr. J. Bedford Shelmire III, and Dr. David Sutton Shelmire. The Shelmires maintained an active practice at the Medical Arts Building in downtown Dallas before it was demolished in the mid 1960s, after which they moved to the BUH campus. Dr. J. Bedford Shelmire III was frequently joined by his father in his later years, even when the senior Dr. Shelmire was almost blind because of long-standing retinopathy. Tragically, Dr. J. Bedford Shelmire III died prematurely. Dr. David Shelmire still practices in Dallas (Figure 4).

In the early days of dermatology in Dallas and at BH, many dermatologists were trained using the old preceptorship model. Two who became giants of dermatology arrived in Dallas in 1931: Dr. Arthur Schoch and Dr. Everett C. Fox. Both these nationally renowned dermatologists became active at BH and BUH as well as in the Dallas community. Along with other dermatology luminaries, including Dr. Eugene Wasserman, Dr. Earl Loftis, and Dr. Harry Spence, they opened the Dallas Syphilis and Venereal Disease Clinic at Parkland Hospital in January 1937, with Dr. Schoch as director. Dr. Schoch and Dr. Lee Alexander also worked with protocols for the rapid treatment of syphilis during World War II, when arsenic and bismuth were the only medications available (8).

DERMATOLOGY BUH AND BUMC: 1950-1980

Between 1950 and 1980, BUH continued to develop as a major community hospital and as a graduate-level teaching hospital sponsoring a growing number of internships and residencies. In some instances the residencies were developed in affiliation with UT Southwestern. In most instances, however, the programs were sponsored by the hospital alone, and UT Southwestern and Parkland Hospital or Children's Hospital developed parallel residencies. In the late 1970s, dermatology residents from UT Southwestern spent several months in rotation at Baylor, mainly in the private offices of Drs. Jacobson, Howell, Menter, and Whiting. This close relationship between the dermatologists at BUMC and UT Southwestern continues today.

Dr. Everett C. Fox

One of Dallas' leading dermatologists active at Baylor and UT Southwestern, Dr. Everett C. Fox (Figure 5), was born in Italy, Texas, in 1902. Dr. Fox graduated from BUCM in 1928. After specialty training in New York, he returned to Dallas, worked for some time in Dr. J. Bedford Shelmire's office, and then opened a private practice in Dallas in 1932. He continued in practice until he retired in 1975. He taught clinical dermatology and syphilology at BUCM from 1935 until 1943 and subsequently at UT Southwestern. He served in the US Navy during World War II and was discharged as a captain in 1945.

Dr. Fox was a leader not only in dermatology but also in Dallas civic affairs. He served as a director of the Dallas Health Museum in 1946 and 1948 and as secretary of Blue Cross Blue Shield of Texas from 1957 to 1972. He directed the Blue Shield Medical Care plans from 1959 to 1962. He was a wonderful teacher and clinician, respected by patients and colleagues alike. He was a man of great principle who insisted on punctuality. In addition to his achievements at Baylor and in Dallas, he was president of the Texas Dermatology Society in 1934. He was vice president of the American Academy of Dermatology in 1941 and served multiple years on the academy's board of directors. He was a member of the House of Delegates to the American Medical Association as well as president of the Dallas County Medical Society in 1946. He received the national Clark W. Finnerud Award for Meritorious Service in the practice and teaching of dermatology in 1975. At each annual meeting of the American Academy of Dermatology, there is an Everett C. Fox Memorial Lecture, funded by proceeds from a bequest by Dr. Fox.

Dr. J. B. Howell

Dr. J. B. Howell (Figure 6) was the first new dermatologist to open an office in Dallas after World War II. Dr. Howell, the “grand old man” of Dallas dermatology, was born in Winnsboro, Texas, on September 9, 1914. He graduated from Baylor University in 1935 and from BUCM in 1939. Afterward, he worked in the office of Dr. J. Bedford Shelmire and in the dermatology and syphilology clinic at Parkland Hospital. Thereafter, he spent a year at the New York Postgraduate School and Cancer Unit, as well as with 2 leaders in dermatology, Dr. Sulzberger and Dr. Baer. He also spent 6 weeks at the Mayo Clinic in Rochester, Minnesota.

He returned to Texas in 1946 and commenced private practice in Dallas. Dr. Howell continued in practice for 53 years prior to his recent retirement. He received many awards in his career, not the least of which was for founding the Dallas Dermatology Society in 1947. In addition, he was president of the Texas Dermatological Society in 1978 and a member of the board of directors for the American Academy of Dermatology on 2 occasions (in 1964 and from 1974 until 1976). He has been made an honorary member of the British Association of Dermatology as well as the French and Irish dermatological societies.

In 1987, Dr. Howell was presented the Practitioner of the Year Award by the Dermatology Foundation, an award given to 1 dermatologist each year for outstanding treatment in dermatology and clinical practice. Dr. Howell took a leading role nationally in skin cancer and melanoma prevention, campaigning tirelessly to promote public awareness of melanoma and skin cancer and to reduce mortality through detection and removal of early melanoma. Due to his efforts, this has been made an annual project of the American Academy of Dermatology. He is responsible for many related publications, such as the melanoma bookmark and booklets for the American Academy of Dermatology and American Cancer Society.

Dr. J. B. Howell has been a prolific writer, with his first publication in 1941 on poison ivy and his 61st and most recent publication in 1999, an editorial. He still attends dermatology meetings around the country and abroad as well as skin cancer meetings at BUMC.

Other prominent dermatologists

In 1954, Dr. Donald Brooking (Figure 7) joined Dr. J. B. Howell in clinical practice. He still practices at BUMC today, 45 years later.

In 1953, Dr. Coleman Jacobson (Figure 7) arrived in Dallas and soon developed a thriving and nationally renowned clinical dermatology practice. In addition to his practice, based at BUMC, Dr. Jacobson has been active in multiple organizations, nationally and internationally. He was one of the founders of the Dermatology Foundation, which is dedicated to fund-raising for dermatological research. Like Dr. Howell, he received the Practitioner of the Year Award from this foundation. Today at age 78, he remains active at BUMC.

Another “grand old man” of Dallas dermatology, Dr. William N. New, is still active and living in Dallas at the age of 91. He is a renowned dermatologist and US Navy physician, having been chief of medical operations for the Pacific Fleet during World War II with the rank of rear admiral. He also served in China and in the dermatology clinic at Walter Reed Hospital. He came to the Dallas Medical and Surgical Clinic after retiring from the navy and spent his time in active dermatology practice as well as in consulting for the cosmetic industry.

Dr. David McCaffree (Figure 7)arrived in Dallas in 1960 from his beloved Michigan State University (where his father was a renowned swimming coach) to practice dermatology. Unbeknownst to many, he, along with Dr. R. Neal Schneiderman, faithfully served in the BUMC clinic, giving of his time in treating skin problems and educating interns and residents. Today, while partially retired, he serves the American Academy of Dermatology as a leading expert in dermatology coding and interaction with the Health Care Financing Administration.

Dr. R. Neal Schneiderman (Figure 7) maintained an active and busy practice at BUMC for >20 years until his untimely death in 1985 from amyotrophic lateral sclerosis. He was beloved by his patients and was a man of multiple interests. There is now a lectureship in Dr. Schneiderman's name at the annual meeting of the American Academy of Dermatology.

Dr. Marcia Glass (Figure 7), originally from Australia, completed her fellowship training at UT Southwestern and with Dr. Alan Menter and has played a prominent role in Baylor College of Dentistry's mouth (stomatology) disease clinic.

Dr. Roberta Simon (Figure 7) arrived in Dallas in 1977, completed her residency at UT Southwestern, and then commenced practice at BUMC, maintaining an office with her husband, Dr. Herbert I. Leiman, a neurologist. She remains active in the dermatology community in Dallas, where she is well respected for her clinical expertise.

Dr. M. Alan Menter (Figure 7, born in England and a graduate of the medical school of the University of Witwatersrand, completed his dermatology residency at Pretoria General Hospital and fellowships at Guys Hospital, London, and UT Southwestern. He joined the BUMC medical staff in 1975. In addition to his involvement in psoriasis treatment and research, Dr. Menter has been active in dermatology organizations. He served as president of the Texas Dermatological Society in 1995 and as a member of the board of directors of the American Academy of Dermatology from 1995 until 1997. His current resume lists some 91 publications as well as multiple book chapters.

The commitment to clinical excellence established by the early dermatologists at BH, BUH, and BUMC has continued up to the present and has been supplemented by excellent clinical and investigative research during the past 20 years.

Psoriasis Center

Dr. Menter, with his long-standing interest in psoriasis--and with the active support of Drs. J. B. Howell and Coleman Jacobson--convinced Mr. Boone Powell, Sr., executive director of BUMC, and BUMC's administration of the need for a psoriasis center at BUMC. Since its opening in 1979, the psoriasis clinic and research center has grown to be one of the largest in the USA, with routine referrals from a 5-state area.

Approximately 4000 patients visit the clinic each year. Patients of all ages, including a 3-month-old baby with total body psoriasis, have been served. Complementing the clinic visits and the systemic medications, thousands of light treatments using sophisticated ultraviolet units are given annually.

In addition to providing clinical services, the clinic has a major commitment to research. The significance and effectiveness of this research resulted in the psoriasis center being awarded the National Gene Bank for Psoriasis by the National Psoriasis Foundation in 1994. Thereafter, in collaboration with Dr. Anne Bowcock, then at UT Southwestern, the first gene for psoriasis was found and the results published in Science in 1995. Multiple investigative research studies continue to be performed at the center, including the use of systemic immune-modulating drugs likely to revolutionize the therapy of psoriasis in the years ahead.

Dermatology fellowship

The first full fellowship in dermatology was established by Dr. Alan Menter, with the help of funding from the Baylor Health Care System Foundation. Multiple graduates from this program have gone on to successful careers in dermatology, including academic practice.

DERMATOLOGY AT BUMC AND WITHIN BHCS: 1980-2000

In the early 1980s, building on the strength and national reputation of BUMC, the Baylor Health Care System (BHCS) was established. With BUMC as the nucleus, BHCS has affiliated with or acquired a variety of community medical centers in the Dallas region, established specialized institutions on the Dallas campus, and entered into joint ventures with physicians and other institutions. These developments have enabled BHCS and members of BUMC's medical staff to expand their service and practice. Dermatology clinics were established by BHCS and Dr. Alan Menter in several of these communities with the subsequent development of successful full-time practices, for example, by Dr. Jamie Bond in Grapevine.

Clinical Research Hair Center

After the psoriasis center opened, another clinic for specialized care was developed at BUMC: the Clinical Research Hair Center, established in 1982 by Drs. Coleman Jacobson and David Whiting. This has developed into a major referral center for the study and treatment of hair diseases in the USA. One of a few specialty hair clinics in the country, this center provides diagnosis, treatment, and hair transplants for patients of all ages.

Dr. David Whiting

Dr. David Whiting (Figure 7), a native of South Africa, came to BUMC in 1979 from UT Southwestern, where he was active in clinical teaching and at the Veterans Administration hospital. He is a much-sought-after speaker, nationally and internationally, because of his expertise in hair disease. He has been actively involved in diagnosing and classifying hair disorders, as well as in developing new treatments. He continues to play a major role in this research. Dr. Whiting has written 72 general publications as well as multiple book chapters. In addition, his Atlas of Hair Disease is beautifully illustrated and highly regarded among dermatologists and other physicians.

Honors in dermatology

Baylor has played a prominent role in dermatology in Texas and nationally. The Baylor institutions have provided multiple presidents of the Texas Dermatology Society since the establishment of the society by Dr. Jesse B. Shelmire in 1928. These have included Dr. Everett C. Fox in 1934, Dr. Eugene Schoch in 1949, Dr. Gilmore Brau in 1950, Dr. Coleman Jacobson in 1971, Dr.
J. B. Howell in 1978, and Dr. Alan Menter in 1995. The national and international achievements and awards achieved by dermatologists at BUMC have been gratifying.

With BUMC's record in dermatology stretching back to the beginning of the 20th century, achievements in patient care, teaching, and research have been truly remarkable. The 21st century opened with 29 dermatologists on BUMC's medical staff and 8 dermatologists on the medical staffs of BHCS's community medical centers. Among the exceptionally well trained dermatologists added to BUMC's medical staff in the past decade are Drs. William Abramovits, Christine D. Brown, Jennifer Cather, Chris W. Crawford, Mary Fleischli, Laura Sears, and Jerald L. Sklar. With BHCS's highly qualified staff of dermatologists and its specialized psoriasis and hair centers, the quality of Baylor-provided dermatology care in the new millennium is assured.

DERMATOLOGY IN THE 21ST CENTURY: THE CHALLENGE AHEAD

Dermatology, like medicine in general, faces many challenges. In its formative years, organized dermatology encompassed all aspects of medical dermatology, surgical dermatology (particularly the treatment of skin cancers), radiation therapy for skin cancers and chronic skin conditions, and infectious diseases (syphilology). Most recently the training and practice of dermatology has taken a decided surgical bent, as dermatologists cater to the needs of the aging (and not-so-aging) community. Thus, dermatologists have been in the forefront in the development of all the laser systems currently used for cosmetic and surgical purposes. How dermatology marries the more cosmetic aspects to its traditional medical and surgical expertise will be interesting in the years ahead. Fortunately the excellent relationship existing at BUMC between dermatologists and their colleagues in internal medicine and subspecialties such as oncology, rheumatology, gastroenterology, nephrology, and infectious diseases plus surgical specialties such as plastic surgery and otolaryngology and the Baylor College of Dentistry will allow for patients of all ages at BUMC and BHCS to receive the highest quality of dermatological care.

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