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
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
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.
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.
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
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-
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.
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.
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.