Contemporaries

Marion B. Sulzberger, M.D. *

I was born in 1895 in New York City under alucky star.

In the early 1850s , as a penniless teenager, myfather had come from Germany to the UnitedStates and built up the third largest pork and beefpacking company in the world. He was patient andkind. My mother was an educated, loving South­ern gentlewoman.

In our home at 21 East 67th Street, there weremany children and three governesses-one Ger­man, one French, and one English. From earliestchildhood, I learned three languages.

In a New York private school , I was taught inthe classic tradition.

For a year and a half during my early teens, Iattended Pennsylvania Military College. Therigorous drilling and the paddling by the upperclass men further hardened my naturally toughbody-including my posterior.

Near the end of my freshman year, I leftHarvard-at a suggestion from the college, withwhich I heartily agreed . I was 17.

I worked my way around the world. My luckystars kept me from dying of heat exhaustion as acoal trimmer; from being thrown, dragged, andkilled by unbroken horses and mules or fromperishing of thirst in the Australian desert; fromdying of peritonitis during attacks of appendicitison a sheep station hundreds of miles from thenearest doctor; from starving to death or freezingwhen I had to sleep in Sydney's Domain Parkduring the bitter winter.

When I returned, I became a naval aviator inWorld War I, holding International SeaplaneLicense No. 74 and U.S. Naval Aviator's Cer­tificate No. 728. The appellation "safe" would bemost inappropriate for the rickety, underpowered,wooden and canvas planes r flew far out to sea onconvoys and patrols.

*Writing this sketch has been a most difficult assignment. I could nothave done it without the editorial assistance of my wife.

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Marion B. Sulzberger, M.D.

At the end of that war, rwent to South America.Timber cruising and assaying cattle lands in theParaguayan Chaco forests, I escaped death frominsects, snakes, crocodiles, and piranha fish.

Back in New York, I learned that my father wasvery ill and my mother, sister , and brother weremarooned in Geneva, Switzerland. I joined themthere to be of what help I could.

Then began the lucky chain of circumstancesthat led me into medicine and dermatology. My20-year-old sister, Dulcie, had a scarring facialacne and a mild radiodermatitis. She had gonefrom dermatologist to dermatologist for morex-ray treatments, denying to each that she had hadprevious radiation. I was shocked to see the scar­ring of both soma and psyche that acne hadwrought in this attractive, previously self-assured

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girl. Here may have been one of the influences thatled me to choose dermatology.

There was still enough of my father's di­minished fortune for my family to live well. Asshe emerged from her depression , my sister wasvivacious and charming . Invitations to my moth­er 's small tea and dinner parties were much soughtafter by young physicians in Geneva, Zurich, andenvirons. Among these was Dr. Ehrich Liebman,a professor of medicine at the University ofZurich. Noting my interest whenever the conver­sation turned to medicine, Liebman asked me whyI did not study it. I told him that I had no collegedegree. He said, "No matter-see whether yourrecords at Harvard won't suffice for you to enterthe Medical School of Geneva . "

My luck held . The authorities at the Universityof Geneva found my Harvard record sufficienr forentrance to their medical school.

Among the bachelors who came often with Dr.Liebman to see us was Julius Bloch, a highly re­spected industrialist of Zurich . He wooed my sis­ter and became my brother-in-law and friend.Though not related to him, Julius Bloch was aclose friend of Bruno Bloch , the already famousprofessor of dermatology at the University ofZurich. After meeting my family and me, Profes­sor Bloch offered me an assistantship on hisstaff, if and when I received my M.D. degree.

Because my family moved to Zurich, I trans­ferred there and completed the Swiss 6-year medi­cal curriculum, receiving my M.D. from the Uni­versity of Zurich in 1926. Then, I entered BrunoBloch's service of dermatology .

In 1926, there were no sulfonamides , antibi­otics, corticosteroids , or other modern systemicmedicaments; so our specialty was at a stage inwhich topical applications were the mainstay ofdermatologic therapy. I had to learn about topicalmeasures like six different tars , sulfur, quinolines ,mercurials, dyes, wet compresses, baths, bandag­ing, lengthy composite prescriptions , and the prop­erties of several dozen different vehicles . More­over, under Bloch 's oberarzt, Guido Miescher , Ilearned the safe and effective use of x-rays, grenzrays, radium, and ultraviolet light. And from Dr.Hans Stauffer I learned the complex, wearisomeand often cruel methods of treating venereal disease.

Marion B . Sultberger, M.D . 501

Like the other great institutes of dermatology onthe European continent, the Zurich DermatologicClinic possessed advantages that do not exist inour departments in the United States. They werehoused in their own large, specially designedbuildings with hundreds of beds . On every floor,special treatment rooms contained all availableforms of dermatologic therapeutic equipment. Asubstantial number of patients with inveteratedermatoses or venereal diseases were hospitalizedfor lengthy periods. These long-term patients weretaught the technics of applying shake lotions andcompresses , bandaging and bathing, treating ul­cers, putting on Unnas boot, etc. Each morningand evening, the patients carried out topical treat­ments on their fellows under the eyes of experi­enced dieners and the wholly dedicated Swissnuns who worked as trained nurses on the der­matologic service most of their lives.

The patients' treatment of one another was car­ried out to the accompaniment of lively conversa­tion. It combined many of the advantages of groupand occupational therapy and filled the patients'weary hospital stays with learning and purpose.

I began my studies in an era when few of themodem biochemical and laboratory procedureswere available. So 1had to learn to make gross andhistologic diagnoses by relying on experience,good sense, and my own senses.

Good fortune led me to Bloch when he was inthe heyday of his major contributions: patch test­ing; the immunology of fungal infections; the dis­tillation of coal tar into its carcinogenic fractions ;the isolation of the active polysaccharide allergensof trichophytin and the crystalline allergen ofPrimula obconica: the dopa reaction .

From something that befell Bloch, 1 learned alesson I will never forget. Bloch's monumentaldiscovery of the dopa reaction-the first methodfor demonstrating and locating a specific function­ing enzyme within the organelles of a cell-wasmade while he was at the University of Basel.When he carne to the University of Zurich, he andhis associates tried to repeat the dopa reaction. Formany months every attempt failed completely.Bloch was in despair , his magnum opus notconfirmable and his scientific reputation about tobe shattered. Then, as mysteriously as it had

502 Marion B. Sulzberger, M.D.

ceased to function, the dopa reaction began towork again-in Zurich as it had in Basel. No oneknew why. But from then on, the dopa reactionbecame a keystone to pigment research throughoutthe world.

If Bloch could not repeat his own work whentransferred to a new locale, should one be as­tonished when a later investigator cannot repeatthe work of an earlier one?

Later, in New York, I could not reproduce theskin sensitization of guinea pigs to neoarsphena­mine, at which Wilhelm Frei and I had succeededin J. Jadassohn's clinic in Breslau.

When I first returned from Europe to New Yorkin 1929, the great Karl Landsteiner greeted me atthe Rockefeller Institute saying, "Sulzberger,what nonsense have you and Frei been publishing?I've tried your technics here without sensitizinga single guinea pig to neoarsphenamine."

Landsteiner was right. Neoarsphenamine skinsensitization did not work at the Rockefeller Insti­tute. As Merrill Chase showed later, most of theguinea pigs of the strain then used at Rockefellerwere nonsensitizable. If I had not been luckyenough to work with Frei on a susceptible strain ofguinea pigs, I never would have stumbled acrossthe phenomena of specific, lasting refractorinessto sensitization-later so beautifully elucidated byMerrill Chase and still la.er, under the designationimmune tolerance, by Medawar and Burnet.Modem experiments with sensitization to simplechemicals that have yielded such valuable infor­mation concerning T cell functions and delayedhypersensitivity might have been retarded forquite a while had not chance introduced otherEuropean dermatologists and me to obligingfamilies of guinea pigs.

While I was an assistant of Bruno Bloch's,Werner Jadassohn was one of the staff. Wernerand his wife, Katy, became my lifelong friends,and Werner was my teacher and inspiration in thefield of dennatologic allergy and immunology.

It came about this way. One day Wernerbrought me an armful of reprints in the Englishlanguage. They were all by Arthur Coca and hiscollaborators and almost all dealt with varia­tions on passive transfer experiments with thePrausnitz-Kiistner technic. These were the phe-

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nomena that Werner Jadassohn had been studyingintensively for some time. It was essential thatWerner know what Coca and his group werefinding. Jadassohn's English was not quite goodenough to catch all the nuances of complex scien­tific reports. So he and I spent several eveningsevery week translating and analyzing the Cocareprints. This kindled in me a consuming fascina­tion with dermatologic allergy and immunologythat has lasted to this day.

By the 1930s, dermatologists studying skin al­lergy foresaw much of the central role immunol­ogy would play in almost every branch ofmedicine. With Naomi Kanof's assistance, I as­sembled my lectures in the textbook entitled Der­matologic Allergy. Of course, I knew nothing ofthe coming of T and B cells, suppressors, helpers,and killers. But we did differentiate sharply be­tween circulating, antibody-mediated, immediate,wheal-type hypersensitivity on the one hand anddelayed, tuberculin-type, and eczematous contacttype hypersensitivity on the other. And we didrecognize the pathogenetic mechanism of autoag­gression in certain diseases that are now so mis­leadingly dubbed "autoimmune" diseases.

Earlier, Werner Jadassohn and Bloch had intro­duced me to Werner's father, the great JosephJadassohn. Thus, I was granted the opportunity ofworking at the renowned Breslau Clinic where J.Jadassohn was Albert Neisser's successor.

At the Breslau Clinic, I worked with and be­came the friend of many top dermatologists andother scientists, including Wilhelm Frei , MaxJessner, Hans Biberstein, Rudolf L. Mayer, Wal­ter Freudenthal, Felix and Hermann Pinkus.Prausnitz and Kiistner were both on the Breslaufaculty, then.

One of the most valuable lessons I learned fromGeheimrat Jadassohn was the ultraconscientious­ness required in scientific research and scientificwriting. When Joseph Jadassohn corrected theprinter's proofs of his reports, he often changedprobably to possibly and expressed those findingshe believed to be certain with the phrase, "a prob­ability that approaches a certainty. "

Joseph Jadassohn was a superb investigator anda humane, patient, skillful practitioner and healer.I learned much from him.

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Professor Jadassohn and his son Werner wereinvited to tour the United States as guests of sev­eral dermatologic societies. So was Bruno Bloch.On each trip, I came along as interpreter and friendof the invited speakers . In this way, I met FredWise and George Miller MacKee, among manydistinguished American dermatologists. Jadassohnand Bloch made such a good impression that Wiseand MacKee decided that a protege of theirs mustbe worthy of a position at the New York Skin andCancer Unit. Fred Wise even asked me to becomethe junior partner in his practice.

Fate granted me two more great favors: first, theopportunity to work with competent, noble FredWise and intelligent, just, unbiased George MillerMacKee and then to occupy first the Chair thatbears McKee's name.

In 1938, dermatologic laboratory research wasgetting a big push from governmental and otherfunds. The time was ripe for the founding of theSociety for Investigative Dermatology and itsjournal. I was available at the right moment tobecome one of the founders of the Society and thefirst editor of its journal for 10 years .

At another fortunate moment, Fred Wise be­came editor of the Year Book ofDermatology andasked me to be his co-editor. I remained co-editorand then editor-in-chief of the year books from1932 through 1955, first with Rudolf Baer andlater with Victor H. Witten as associate editors.

As a result of my succession to the private prac­tices of both MacKee and Wise, my own practiceattracted glamorous personalities as well as poorand desperate patients. And during practice, Vic­tor H. Witten and I were the first to demonstratethe effectiveness of topical steroids and of occlu­sive dressings.

Furthermore, at the New York Skin and CancerUnit , I was privileged to help many German andEuropean dermatologists find new places in Amer­ica when they fled from Hitler's persecution.American dermatology was thus enriched by thetalents of such men as Rudolf Baer, Stephan Ep­stein, Franz Herrmann, Max Jessner, Rudolf L.Mayer, Hermann Pinkus, and Stephen Rothman.

Good fortune put me on the first Board of Direc­tors of the American Academy of Dermatologyand of the Dermatology Foundation and made me

Marion B . Sulrberger, M.D. 503

one of the presidents of the American Dermatolog­ical Association . From dermatology, I have re­ceived more than my share of honors: the GoldMedal of the Academy; the presidency and theStephen Rothman Medal of the Society for Inves­tigative Dermatology; a lectureship in my namefrom the American Dermatological Society of Al­lergy and Immunology; the Alfred MarchioniGold Medal; and honorary memberships here andabroad.

It would be remiss not to mention the fine col­laboration the Academy has given to the Institutefor Dermatologic Communication and Education,a nonprofit foundation, incorporated in 1962,through whose trustees* and collaborating pre­senters Roberta Sulzberger and I have been able toproduce audiovisual teaching aids about the skin.

As a member of the International Committee ofDermatology from 1957 to the present and its pres­ident from 1957 to 1962, I developed lastingfriendships with families of dermatologists frommany nations. t

This is not the place to expand on my goodfortune in being the senior dermatologist in theNavy and an investigator for the National Re­search Council and for Naval Medical ResearchUnit No .2 on Guam during World War II. Norshall I here describe my stimulating years asTechnical Director of Research in the Army'sOffice of the Surgeon General from 1961 to 1964and as the first chief of dermatology at LettermanArmy Institute of Research in San Francisco. Noris it the place to enumerate decorations receivedfrom the U.S . Army and Navy and the Frenchgovernment.

But it is the place to say that on Guam we beganto study the profound systemic disturbances mili­aria can cause by producing sweat retention andheat exhaustion-work that I continued withFranz Herrmann at The New York Skin andCancer Unit and with Hugh Wiley, William Ak-

*Trustees: Herman Beerman, Coleman Jacobson, Frederick A. 1.Kingery, Alfred W. Kopf, Clarence S. Livingood , Frederick D.Malkinson, J. Louis Pipkin, and Rees B. Rees .

t Members International Committee of Dermatology during my pres­idency: L. A. Brunsting, R. Degos, F. Flarer, C. H. Floden, J.Gay Prieto, S. Hellerstrom, W. Jadassohn, S. Kogoj, S. Lapiere,C. S. Livingood, A. Marchionini, G. B. Mitchell-Heggs, D. M.Pillsbury, and M. I. Quiroga.

504 Marion B. Sulzberger, M.D.

ers , David Harris, Tommy Griffin, and others atLetterman Army Institute of Research.

I cannot deny my gratification that, at lastcount, eighteen students I have helped to trainhave occupied chairs of dermatology in the UnitedStates and throughout the world and that, as Iwrite, five of the departments of dermatology inleading universities in greater New York areheaded by five students of my school: Rudolf Baerat New York University; Leonard Harber at Co­lumbia; Raul Fleischmajer at Mt. Sinai; AlanShalita at New York Downstate Medical Center;and Edward Mandel at Flower Fifth Avenue Hos­pital.

In 1961, I was made Doctor Honoris Causa bythe University of Venezuela at the strong urging ofFrancisco Kerdel- Vegas and others of my formerstudents then in Caracas. Today I have the honorto be professor emeritus, New York University(1961) and emeritus clinical professor, the Uni­versity of California, San Francisco (1980), anappointment made at the urging of William Ep­stein, Rees B. Rees, and Dean Julius Krevans.

I have been lucky to live through a period ofrevolutionary advances in the sciences and inmedicine and to have met and worked with giftedleaders. Thus, I have been privileged to participate

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in the development of dennatologic allergy andimmunology and to stumble by pure chance uponthe discovery of refractoriness to sensitization.

I am most proud that I was able to transmit fromBloch, the Jadassohns, Wise, and MacKee ateaching philosophy and a form of dennato­logic practice to hundreds of younger colleaguesthroughout the world.

In short, I was endowed with good genes, fam­ily, and opportunities. I acquired three lovingwives and a devoted daughter and son-in-law.Who but Lady Luck could have given me friendsso loyal and so numerous that I dare not try toname them. But I can thank them, for theirconfidence has helped to allay, to some degree,my chronic, recurrent convictions of inadequacy.

Marion B. Sulzberger, M.D.San Francisco, CA

REFERENCESI. Sulzberger MB: Dermatologic allergy. Springfield, IL,

1940, Charles C Thomas, Publisher.2. Adamic L: From many lands, Dr. Eliot Steinberger, 5 to

52. New York, 1940, Harper & Row, Publishers, Inc.3. Issue in honor of Marion B. Sulzberger. J Invest Dermatol

24:141-373, 1955.4. Festschrift for Marion B. Sulzberger. Int J Dermatol

16:305, 440, 1977.