Ohio History Journal

THE ESTABLISHMENT OF DERMATOLOGY AND SYPHILOL-

OGY AS MEDICAL SPECIALTIES IN NORTHERN OHIO1

Dr. William T. Corlett and the

"Renaissance" of the 1890's

by WILLARD L. MARMELZAT, M.D.

Department of Dermatology and Syphilology,

University Hospitals of Cleveland

The rise of dermatology as a medical specialty in Ohio is of

particular medico-historical interest, for the evolution of the treat-

ment of skin diseases with which this paper deals is not only of

local and regional interest, but indirectly had influences of an even

wider scope.

I have recently called attention to the neglected and almost

forgotten pioneer physician Noah Worcester, who, while at Cincin-

nati and Cleveland in the 1840's, introduced to the old West the

physical diagnostic methods of Laennec, and was the first physician

to bear the title "Professor of Physical Diagnosis" in the United

States, as well as the first lecturer on skin diseases in the Western

Reserve. His "Synopsis of the Symptoms, Diagnoses, and Treat-

ment of the More Common and Important Diseases of the Skin"

was the first American dermatology textbook.² But Worcester and

his book were some 35 years ahead of their time. Following his

untimely death in 1847, both were quickly forgotten.

Concerning the occurrence of skin ailments of the good citi-

zens of Ohio during the next four decades, one might almost para-

phrase Pliny's remark on the discrepancy between the practice of

physic and physicians during the first six hundred years of ancient

Rome by saying, "The people were not, indeed, without skin dis-

 

1 The data used in this study has been in large part derived from conversations

with Dr. William T. Corlett and from his charming autobiography, Early Reminiscences.

Dr. Frederick C. Waite's Western Reserve University. Centennial History of the

School of Medicine (Cleveland, 1946) has been of aid in following the fortunes

of the rival Cleveland medical schools in the late nineteenth century. I am indebted

to the Allen Memorial Library of Cleveland for making available to me papers and

documents to be found both in the Corlett Collection and in the general library.

2 Willard L. Marmelzat, "Noah Worcester, M.D.-The Forgotten Pioneer," in

Ohio State Medical Journal, XLIV (1948), 282-284.

378

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DERMATOLOGY AND SYPHILOLOGY              379

eases, but they were without dermatologists." The key to the prev-

alence of dermatological conditions among different occupations

and the refractoriness and seasonal incidence of these skin condi-

tions is to be found in the numerous popular names of the time.

The "prairie itch," the "grain itch," the "winter itch," the "lumber-

man's itch," and the "seven years itch" were only all too frequently

well known. It was early in the 1880's that there appeared on the

scene the doctor who was the first to break the necessary rocky

ground in establishing a new medical specialty-dermatology.

Dr. William Thomas Corlett had graduated at 23 from the

Wooster Medical College in 1877. Finding his youth a bar to

association with an older preceptor and his lack of political in-

fluence a bar to an appointment in the asylum for the insane, he

decided to open an "all night" office for general practice in the

heart of Cleveland. As an added source of revenue, he secured the

district physicianship of Whisky Island and Irish Town, two of the

toughest wards in the dock region, the astounding salary for the

position being 25 dollars per month, the doctor furnishing the

medicines. The ensuing eighteen months were, though not very

remunerative nor spent in the most "desirable" of environs, rich in

experience and the development of self-reliance. They were inter-

rupted only by two cruises to the upper Great Lakes as a ship

surgeon.

With his appointment as demonstrator of anatomy at his alma

mater in 1879, young Dr. Corlett seemed well on his way to estab-

lishing permanent professional roots in Cleveland, but other things

were in the offing. As a student at medical school he had suffered

a cutaneous eruption which had proved too much for the most

erudite of his professors. This had first served to direct his atten-

tion to the woeful inadequacy of the three or four desultory, didactic

lectures allocated to skin diseases in the curriculum. During his

year and a half of practice, time and again patients with skin

diseases of various sorts had put in an appearance in the new doc-

tor's office, patients who had "made the rounds" of the most learned

of the local Cleveland physicians. The two cruises had brought

Dr. Corlett in contact with the Indians of the upper Great Lakes

region, and he had been struck with the prevalence of syphilis and

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380   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

the havoc it had wrought with the tribes he had visited. As an

additional factor, there was the favorite uncle, after whom he had

been named, who had been forced to give up his parish work as a

clergyman because of an intractable skin disease of many years

duration. Apparently not only over-all "Misery" but its favorite

partner, "Itching," loves company, for this unfortunate uncle, it

seems, knew a number of prominent fellow unfortunates with skin

diseases whose pilgrimages near and far in search of relief had

proved fruitless.

Having once decided that further study in some of the large

clinics and hospitals of Europe which gave much attention to skin

diseases was the sole means to become thoroughly and liberally

prepared, and having faith in his ability to do better work with

such training, the die was cast. Despite the widespread forebodings

expressed at the prospect of a young doctor's resigning a university

position and giving up a practice in which, in eighteen months, he

had made such a good start, Dr. Corlett made these precise moves

and began his journey to Europe for that which America of the

1880's could not offer. The next two years were pleasant, broad-

ening, and fruitful ones. During this course of time the young

American worked hard and eventually became a Fellow of the Royal

College of Medicine after having started all over as an under-

graduate student. Much of the time, as might be expected, he

cultivated his special interest in diseases of the skin and sought

out and learned much from the truly great dermatologists and

syphilologists in London and Paris-Erasmus Wilson, Jonathan

Hutchinson, Stephen Mackenzie, Malcolm Morris, Ernest Besnier,

Albert Fournier, and many others of the outstanding men of their

century. He was an especial favorite of Stephen Mackenzie who

presented his departing American protege with the following letter:

London, 26 Finsbury Square, E. C.

August 8th, 1881.

I have known Dr. William Corlett throughout his stay in England. Dr.

Corlett has worked much with me, especially in the Skin Department of the

London Hospital. I have found Dr. Corlett extensively read in the literature

of Dermatology and to have had great practical experience in Skin Diseases.

I have been glad to avail myself of Dr. Corlett's assistance in seeing my

patients on several occasions.

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DERMATOLOGY AND SYPHILOLOGY                 381

 

In conclusion I may state that I regard Dr. Corlett as a skillful physi-

cian, with extensive knowledge and practical experience in Diseases of the

Skin, and have every confidence in recommending him for the appointment of

head of a Skin Department in a University or Hospital.

Stephen Mackenzie, M.D., F.R.C.P.

Physician to the London Hospital, Lecturer on Medicine,

Physician to the Skin Department, etc., etc.

Coming back to his native Cleveland in 1881, having deter-

mined to devote himself primarily to skin diseases and syphilology,

the resolute physician was quick to encounter those obstacles en-

demic in all would-be medical innovations. Wise, well-meaning

older medical friends were quick to point out the foolhardiness in

trying to eke out a living from an unknown specialty when one

was exceptionally well trained in general medicine and surgery.

While considering his situation, there came an announcement from

Chicago of a new medical school which was in the formative stage.

This was to be called the College of Physicians and Surgeons of

Chicago, and the proposed curriculum  and requirements for ad-

mission would far excel those of any other existing medical school.

In the winter of 1881, having been invited to appear in Chicago

before the organization committee, Dr. Corlett did so and gave a

talk on eczema. The next day he was offered the position of pro-

fessor of dermatology of the new school-with the proviso that he

subscribe to $2,000 worth of the college stock. The European

junket made the latter condition financially unfeasible. Except for

this, there is little doubt that Ohio would have lost its first der-

matological specialist-to-be.

Hoping that in time he might specialize, and that by teaching in

a local medical school, traveling to such diverse points as Buffalo,

Columbus, Detroit, and Ann Arbor for lectures, demonstrations,

and consultations with doctors and patients he could find sufficient

work to fill his time, Dr. Corlett settled down in Cleveland. Early

in 1882 he was appointed lecturer on skin and genito-urinary

diseases in the medical department of Wooster University, the

planned merger of this school with the Cleveland Medical College

having just failed. In this year he opened a free clinic for skin

and venereal diseases. This was the first such clinic for the indigent

poor to be established in northern Ohio and the surrounding area.

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382   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

Development was understandably slow, for physicians were reluc-

tant to recognize divisions in medical practice in hospitals and

clinics. Yet, in 1883 there appeared in the October issue of the

Columbus Medical Journal a "Report of Ninety Consecutive Cases

of Skin Diseases Treated at the Dermatological Clinic of Wooster

University." This marked a definite starting point in the appear-

ance of dermatological articles at occasional intervals in the medi-

cal literature of the state. This year, Dr. Corlett, after many

visits to the powers that be and many persuasive arguments, be-

came a member of the board of health so that he could make

official visits to the public schools for the purpose of making

needed corrections. His experience with infectious diseases served

him in good stead, and yet there was much opposition to this new

department and the "meddlesome" doctor who came regularly to

supervise Cleveland school children, his sole material compensa-

tion being free streetcar tickets and the privilege of wearing a

large gold star as a badge of office. This was the beginning of

what has now grown into the excellent present-day medical super-

vision in schools.

In 1884 Dr. Corlett was advanced to the position of professor

of diseases of the skin at Wooster, which position he was to hold

for two years, and became dermatologist to the Charity Hospital,

We may note with interest that when, the following year (1885).

he was selected to give the opening address at the summer session

of the Wooster medical school, he took as his subject, "Defeat

and Disappointment Necessary to Success-Life's Shadows and their

Meanings."

In 1887 the rival Cleveland Medical College, now the medical

department of Western Reserve University, having completed a

fine new building, determined to improve clinical teaching by the

establishment of a daily polyclinic (dispensary), staffed by prom-

ising young part-time men. Medicine, surgery, ophthalmology,

and otorhinolaryngology had been well recognized as specialties.

However, in addition to these, for the first time, the following new

special departments were added: neurology, gynecology, pediatrics,

and dermatology, which at first included genito-urinary diseases.

Aggressive young men were selected, each of whom attempted to

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DERMATOLOGY AND SYPHILOLOGY              383

bring general recognition to his specialty. As might be expected,

attracted by the opportunities to establish better the teaching

aspects of the specialty and raise the level of medical teaching

in general, Dr. Corlett, now 32 years old, resigned his professor-

ship at Wooster for an indefinite teaching appointment at Western

Reserve with the nebulous title "Chief of Clinic." Having com-

menced his new teaching career at Western Reserve without formal

faculty status, in January of the following year, 1888, he was

appointed lecturer on dermatology with a seat and vote in the

faculty. When the modern type of regulated graded course was

adopted in the 1888-89 session, dermatology was allotted 24 teach-

ing hours in the senior year.

In 1890 Dr. Corlett was named acting professor of dermatology

in the university. The following year he was asked to contribute

five sections to the monumental work on genito-urinary diseases,

dermatology, and syphilology edited by Prince A. Morrow. It would

seem as though everything was progressing beautifully, but if we

turn our attention to another facet of this ten-year period, we may

get an inkling as to why "adversity" may have been chosen as a

theme for the medical students at Wooster.

Turning for a moment toward the matter of the private prac-

tice of a new specialty, we find that during the early years patients

did put in an appearance at the new dermatologist's office, but al-

most invariably these were physicians and their families and clergy-

men and their families-all by custom immune from fees. As

Dr. Corlett graphically puts it: "At this time a pay patient seemed

like an oasis in a desert, which offers temporary relief and encour-

ages the weary traveler to happy anticipation of better things

beyond." He attributes this dearth of pay patients and long delay in

receiving profitable recognition not only to the fact that he was

attempting to plant a new seed in uncultivated soil, but also to

another which all his friends predicted would be his certain

ruination-he was charging a higher fee for consultation than

had ever been asked in Cleveland. It is intriguing to note that

Cleveland doctors of the 1880's and 1890's customarily charged

fifty cents to one dollar for office consultations, one and a half

dollars for house visits, and three dollars for night calls. Gonor-

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384    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

rhea was treated for a lump sum of ten dollars, and syphilis for

a lump sum of thirty to fifty dollars, the period of treatment

usually taking three years.   Dr. Corlett's "exorbitant" fees were

five dollars for a first visit, two dollars for subsequent visits and

ten dollars for consultation with another physician. Nonetheless,

despite the long probationary and at times seemingly interminable

period of waiting, toward the end of the decade the pay patients

commenced to put in an appearance and the first monetary fruits

of labor were coming to be realized.

In June 1893 Dr. Corlett was advanced to professor of der-

matology and venereal and genito-urinary diseases at Western

Reserve. The impress of a second European trip by Dr. Corlett

to the Viennese and French schools of dermatology can be seen

by the announcement of the medical school for this period. Con-

cerning the course of dermatological and syphilological instruction

we find:

DERMATOLOGY AND SYPHILOLOGY. Instruction is given by the

presentation of clinical cases which are classified so as to impress the student

with the different varieties and places each disease may assume. In this way

the common diseases of the skin, as well as many of the more rare forms are

studied, the progress under treatment noted in a way that can be done only

where more ample clinical material is furnished. As accessories to clinical

instruction the microscope is used to demonstrate the various pathological

conditions met with, together with colored life-size plates, wax models and

charts illustrating normal and pathological conditions of the skin. During the

year each student is called upon to make diagnoses and outline courses of

treatment under the immediate supervision of the professor.8

Oddly enough, although suggested textbooks are listed in all

other subjects, none on skin diseases are listed in the catalogs for

this period.

With the assumption of the professorship also came the posi-

tion of dermatologist to the City Hospital, which theoretically

should have meant a wealth of additional material. It would seem

from all this as though full local recognition of this specialty had

been achieved. But such was far from the case. Only too often

during the 1890's it seemed as though the battle was just beginning.

The greatest opposition often came in the failure of other medical

colleagues to cooperate in assigning cases to the special depart-

 

8 The Medical Department of Western Reserve University, Announcement for

the Session of 1894-95.

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DERMATOLOGY AND SYPHILOLOGY                      385

 

ment which was dependent upon them for clinical material. This

lack of cooperation was to prove a constant stumbling block which

sometimes took dramatic turns. We may take, for instance, an

occasion when, upon going through the surgical wards of the City

Hospital, Dr. Corlett spotted a case of leprosy which had lain

there for months undiagnosed while the surgeons removed one

leprous nodule at a time trying to fathom meanwhile the possible

significance of the multiple tumors. A delightful reconstruction

of the scene has been related:

Chart No.  Progress Note: "This pt. has been here for many

months undiagnosed. Today Dr. Corlett made rounds and recognized the case

as one of leprosy." Conjure up the picture on that distant Sunday morning:

A flurry of bed-fixing, face-washing and hair-combing among patients and

nurses, for the weekly ceremonial. Visualize the pontifical procession of visit-

ing chiefs, assistants, associates and residents, internes, and finally the nurses

in the rear with ready tongue blades and paper bags. Dr. Corlett, just home

from a foray into sub-tropical diseases, looks casually at the patient who is

sitting up in bed eating of his Sunday dinner. "I see you have a case of

leprosy here."  Immediate petrification of the parade!  A stampede toward

the startled patient, a biopsy and a frozen section stained for Hansen's bacilli!

Diagnosis confirmed! City Hospital in the headlines; curious but cautious

reporters poking their faces through the iron fence on Scranton Road, beck-

oning frantically to housemen to come out and give them the gruesome details!

The clamor of other patients for immediate discharge and hasty resignations

by tremorous attendants. A bewildered leper riding across the country toward

Hawaii in an elaborately equipped horse-car in company with a lot of canned

goods and a gleeful interne.4

Thus we see that then, as now, newspapers were only too

glad to procure sensational medical copy. On some occasions such

as this they possibly served a useful function.

With regard to the disease syphilis, we find that there existed

a much different situation. A forbidden subject in the press and

in polite society conversation, private hospital authorities also had

obfuscated ideas on the subject and considered it a disgrace to

have such cases in their institutions. With Ehrlich's 606 and the

Wasserman serological test still ten years in the offing, and in a

period when actually reporting a venereal disease was incredible

and doubtless considered a shameful breach in doctor-patient rela-

 

4 Louis J. Karnosh, "A Hundred Years of City Hospital," in Clinical Bulletin of

the School of Medicine of Western Reserve University and Its Associated Hospitals,

1 (1937), 16.

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386   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

tionships, we can well imagine the subterfuge often resorted to by

doctors who treated the disease under various names. The new

Lakeside Hospital, opened in 1898, actually forbade the admittance

of syphilitic patients through its doors. It was in large measure

due to Dr. Corlett's repeated advocacy of a sane attitude toward the

diseases, which called for placing patients in hospitals where they

belonged and thus giving them the best available therapy, that

eventually such restrictions were revoked. But it was only after

a long, hard battle over fifteen years with numerous incidents and

skirmishes, each of which had to be properly seized upon and

capitalized to the utmost, that the demand for considering syphilis

in a truly scientific light was finally achieved.

During the period 1860-73, smallpox, most dreaded of infec-

tious diseases, had been rife in Cleveland. Since that time the city

had been remarkably free from any large number of cases. But

in 1900 cases suddenly began to appear in all parts of the city in

epidemic proportions, and the special smallpox hospital (more

popularly designated "pest-house") became quite filled with pa-

tients, these correctly diagnosed patients quite properly not being

admitted to the other hospitals.⁵ Great controversy raged in the

press, both lay and medical, concerning the relative value of small-

pox vaccination. (Compulsory vaccination was still two years in

the future.) During this epidemic, which carried over into 1901,

the professor of dermatology was by chance asked to see a patient

on the medical service of the Lakeside Hospital who for some days

had been lying on the open ward with a supposed case of an

"iodide drug eruption." Dr. Corlett's nonchalant diagnosis, "an

excellent case of small-pox," immediately threw the hospital into

turmoil. Emergency meetings were held, explanations demanded.

Why had not the man specially trained in diseases of the skin been

called to see the case sooner? Why not first? The obvious answers

were not readily forthcoming. This marked the last turning point.

The requisite rules were immediately passed by the powers that be.

Henceforth all patients with eruptions of the skin were to be seen

and diagnosed by the dermatologist before admission to the hospital

wards. Dermatology as a full-fledged specialty had arrived.

 

5 M. F. Friedrich, "Smallpox of the Present Epidemic," in Cleveland Journal of

Medicine, V (1900), 551.

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