Dermatology residency memories

By Arthur L. Norins, MD, July 1, 2021

DermWorld’s First Person column offers Academy members the opportunity to share their personal reflections about how dermatology is changing and how they’ve adapted. A condensed version appeared in print.

The American Academy of Dermatology meeting was scheduled in Chicago the first week of December 1956. The meeting was held at the Palmer House Hotel located just inside the downtown Loop. Northwestern University Medical School was not far from the hotel. The University allowed the Academy to have dermatopathology teaching sessions at the Medical School site. The facilities were excellent, including the availability of microscopes. The Northwestern residents gathered and set up the microscopes. I was one of those residents.

Earlier that year, I was a pediatric resident at the University of Michigan. We were allowed to take a one-month elective; I choose dermatology. It was an excellent month that gave me a quick look at the field; I attended rounds and clinics. During those years we had military obligations. I had enrolled in the Berry Plan which allowed me to take my pediatric residency before active duty. After much thought, I made a big decision to switch my career to dermatology, and hoped the Army would approve. After getting approval from Dr. Curtis to start in the Michigan dermatology program, I wrote to the Army to get their approval; the answer came quickly: “NO; you will get orders to report for active duty in July.” I finished my year in pediatrics and returned to my home in Chicago to await orders.

I had received my medical degree at Northwestern. There, I had taken a course in dermatology taught by Dr. Herbert Rattner, the dermatology program director. I told him of my interest in dermatology and asked if I could follow the residents around for the weeks before the Army called. During the second week of observing, I received a letter from the Army: “We are pleased to allow you to take a three-year residency in dermatology before active duty.” Dr. Rattner was very kind and let me officially join the Northwestern residency program.

The next couple of months were busy. Department meetings were exciting. Northwestern had no full-time faculty; but it did have a large clinical faculty that would come to help in the clinics. There were many excellent practitioners and willing teachers. There was a monthly department meeting. The room was always packed. Cases were discussed. Dr. Rattner was the editor of the AMA’s Journal of Dermatology and Syphilology. He would present many of the papers that had been submitted for publishing. At that time, it was the only dermatology journal. Each paper would get discussion from the group. That kept the department members about six months ahead of publication.

There was excitement in their talk of the upcoming Academy meeting. Northwestern was about a fifteen-minute bus ride from the Palmer House. It was convenient to have the dermatopathology meetings there in that the microscopes did not have to be transported to the hotel. Many of our faculty would be participating in courses and giving lectures at the meeting. All the residents were able to attend.

Dr. Rattner explained that there were many reasons for having a December meeting in Chicago each year. There was not much flying back then; most members came by train. A central location was desirable. The time, several weeks before Christmas, seemed strange. It proved to be excellent because of generally low patient office visits that made it conducive for most members to leave their practice. A high percentage of members who came actually spent their time in the meetings. The first winter storm of the year helped. Back then, most members were male; they were often joined by their wives. The wives were attracted to Marshall Fields, a large, well-known upscale department store just one block from the hotel. Much of their Christmas shopping took place then.

Most important, the meeting was valuable because of content; there were many small and specific topic breakout sessions as well as larger sessions devoted to current advancements. The Academy was proud that such a large percentage of the members throughout the country came to the meeting and actually attended the sessions. It was the envy of other medical societies. In later years in my residency, Dr. Rattner invited me and my wife to join him and his wife at the dinner dance that was a social highlight of the meeting. During the evening, the orchestra would play songs from the different states; the members from those states would stand, give a whoop, and wave their handkerchiefs. Importantly, the Academy was known to allow residents to attend the meeting and all the teaching sessions. Most programs allowed their senior year residents to attend. This created a solid bond between the Academy and future dermatologists. It was years later when the Academy voted to have the meeting at a different site, the Americana Hotel in Miami.

Those were the years when “preceptorships” were allowed in a resident’s third year. One would spend half of their time in the clinics at a university and the other half in one of the faculty member’s personal office. It was an honor to be invited into a preceptorship. One got to see what office practice was like. Dr. Rattner got approval from the Board for me to have my preceptorship start in his office in my second year. His office was on Michigan Avenue across the street from the Chicago Art Institute. When morning clinic at the university was over, I took the bus to the office. If there was a little time before office hours, I would spend it in the Art Institute. That was the best way to take in a wonderful museum — just one room at a time, not rushed — enjoying the artwork for 30 minutes. Then go across the street to the office. (Especially good, since the museum visit back then was free.) Next time, I got to visit another room, of a different period, and discover another artist.

Dr. Rattner’s office had a small waiting room, a small adjoining room for a receptionist, an exam room with X-ray equipment, another exam room, an office for me with exam facilities, and Dr. Rattner’s more formal office lined with bookshelves where he could speak with patients. It was Dr. Rattner’s custom to wear a fresh short gray medical jacket while seeing patients. There was one for me too. The usual routine was for me to see a patient first and then I would discuss the case with Dr. Rattner in his office before he saw the patient. Many of the patients were physician’s family, clergy, and well-known Chicagoans.

In those days, he used superficial radiation, radium plaques, and cold quartz UV. He was one of the early dermatologists to perform dermabrasion. Grenz ray therapy was just coming into vogue but he had not made that acquisition yet. I got firsthand instruction on the use of all the equipment. At that time, downtown Chicago was on direct current (DC) electricity. One had to be certain that electrical equipment was adaptable. Edison had sponsored DC and Westinghouse alternating current (AC). Fortunately, Westinghouse won, and the country went AC; there were a few late holdouts including downtown Chicago. Chicagoans were aware of the situation, but many visitors came and plugged in their electric razor – BANG. They went without “a shave” that day.

We had many “detail” people from the pharmaceutical and cosmetic industry visit the office. From my first day, Dr. Rattner made it clear that he had strict rules about taking gifts regardless of value. “Never, never take anything…unless they offer you a million dollars, then take it and quit practice.” We had one receptionist who greeted patients, made appointments over the phone, collected fees, and kept the “books.” There was little insurance. In addition, he had a young woman, high school graduate, who was capable and very pleasant with patients. She took them to the exam room, appropriately gowned them and made them comfortable, especially important with the older patients. She had been trained by Dr. Rattner on simple procedures and how to help with the minor surgeries. She did the sterilization of instruments. In those years we seldom put on gloves. That was it. Everything ran simply and efficiently.

After office hours, we would often walk home from the office. Dr. Rattner lived in the new glass building near the medical school. My wife and I had an apartment in one of the student nurses dorms. Those walks were very special. I finally became able to say Dr. R, I never could call him Herb as he later suggested. Dr. R would tell stories of past times. As we walked along Michigan Avenue, many policemen would say, “Hi, Doctor.” He had walked that route many times over many years. Some of his stories were about a Dr. Pusey. Dr. R had left these stories out of a book he had written about Dr. Pusey. Dr. R worked in Dr. Pusey’s office much as I was working with Dr. R, Dr. Pusey was very well known nationally. He was elected President of the AMA. His office had two waiting rooms. One was very elegant for the special wealthy ladies who were patients. That room had a maid in uniform and who wore a cap. She would serve tea and attend to their wraps. The other waiting room was for “ordinary” patients. Dr. Pusey was short and a bit pudgy. His chair had an extra thick cushion. The patient’s chair had its legs shortened; Dr. Pusey would sit high and look down on the patient. Their chair was uncomfortable, patients did not prolong conversation. Not long before, the role of bacteria in disease had become evident; Dr. Pusey always wore gloves when he left the office. He had a large car and chauffer that would park outside the office; imagine downtown Chicago. Mrs. Potter Palmer, famous in society circles and very well-to-do lived in a mansion on Lake Shore Drive facing lake Michigan. Dr. Pusey went to her home for professional visits; on one visit he diagnosed an early skin cancer. X-ray had just become popular for treating skin cancer. She had heard of it and wanted X-ray treatment. However, she did not want to go to the office for treatment. Dr. Pusey knew who to contact at Commonwealth Edison and had appropriate electric wires connected from across the street to her home and the X-ray machine was set in place. She was treated at home. By the way, the Palmer House hotel where we had the American Academy meeting was owned by the same Palmer.

On another afternoon walk, I told Dr R. that the residents took his advice and traveled to the south side of Chicago, to the University of Chicago, to take in a lecture by his good friend Dr. Stephan Rothman. Dr. Rothman was the chairman of dermatology. I told Dr. R about how great the student lecture was. The lecture hall was packed. A highlight was when Dr. Rothman was discussing psoriasis, he stopped, walked over to one of the students and asked, “From last week’s lecture, do you remember what causes psoriasis?” Pause. “No, sir, I forget.” Dr. Rothman looked up to the audience and seriously said, “For years we have studied and looked for the cause of psoriasis, this gentleman knew the cause — and forgot.” Of course, there was great laughter and Dr. Rothman made sure that the student was not embarrassed. Then Dr. Rattner told me a story about how Dr. Rothman came to Chicago. Before the Second World War, it was becoming evident that the Hitler regime was causing problems for the Jewish population in Europe including physicians. A group of Chicago dermatologists knew and had become friends with Dr. Rothman, who was in Hungary. In those years, many had trained in Europe and had attended European meetings. They suggested he leave Hungary and come to Chicago to practice.

Dr. Sam Becker Sr., among the others was most helpful to set up an office; Dr. Rothman came to Chicago. Each of the dermatologists directed patients to his new office. He had been a very famous professor in Hungary, and it was felt it would not take long to establish a practice; it did not happen. It was not enjoyable to him and the practice never caught on. The group had also arranged to establish a faculty appointment, with a small laboratory, at the University of Chicago. This was going well. Dr. Rothman never knew; the group had contributed funds for not only the laboratory, but a small stipend for him. He left the practice and went on to become professor at the university. He became one of the most important investigative dermatologists in the world. In later years, we had a meeting on Keratinization at Lake Arrowhead outside of Los Angeles. Dr. Rothman had retired, but as an honor he was asked to attend. I have never forgotten how he discussed almost every paper that was given with his great knowledge and incite. Then in the evening many who knew another of his talents, asked him to play piano. His performance of Schumann was outstanding. What a great person.

During the third year of our residency, the residents were invited to spend afternoons in the offices of other faculty members in addition to the preceptorships. During those visits, you were very aware of the differences in the way each practice was organized. At each office there was something to learn. Each faculty member had their own personality which could be seen in their practice. We had many unique experiences.

Dr. Zakon had his office on the west side of Chicago. He had a huge practice, often seeing 100 patients a day. Many exam rooms circled the patient waiting area. The nurses called the patients into the room and had them properly draped. Dr. Zakon moved from one patient to the next, extremely well organized; one nurse made the notes he dictated and filled out the prescriptions. On occasion he would dramatically tell a demanding patient to leave, “out out,” in front of all the waiting patients. Invariably the patient would say they were sorry. “I won’t say another word.” “Then go back in the room.” Obviously, he knew his patients — in other practices that would be disastrous. He was an excellent physician; we learned a lot about disease, diagnosis, therapy, and efficiency. At the end of the session, I was exhausted; I don’t know how he did it. When cortisone first became available, he told the residents, “Boys, be careful. It ain’t candy.”

During my residency, one of our faculty was elected president of the Academy, Dr. Jim Webster. He always had something important to contribute at our faculty meetings. One of our senior residents went to his office for his preceptorship. The resident had been in family practice for years in Wisconsin and was quite knowledgeable on how to run a practice. After several weeks, he came back to tell how great it was to watch Dr. Webster practice and how much he had learned. Then said, he had to tell Dr. Webster how to handle office charges. Most times the charge was far below what it should have been and often that would be “NC’d” = No Charge. He said, “Dr. Webster you will not be able to send your kids to college if you do not charge appropriately.” Those kids did get to college, and one became a dermatologist, Dr. Steve Webster, who also became president of the Academy years later. Steve and I are good friends and I told him the story of the “charging.” I was able to fill it in further when I told him my wife, Mona, had been a patient of his father. My wife knew that Dr. Webster had her dad speak German to him during visits; Dr. Webster had studied in Europe and said he wanted to brush up on his German. He used the “lessons” as an excuse to offset the visit charge. Steve got a real laugh and some tears out of the stories.

During my third year of residency Dr. R suffered a heart attack. Soon after I visited him in the hospital. He said I knew most of the patients and I should continue seeing them after I told them the circumstances. New patients were also informed and given the name of other dermatologists. Most elected to have their visit. We had a towel uniform service. After several weeks, I noted the office was charged for more towels than we received. The towel man was a nice older man who I had gotten to know. I told him of the mischarge and that if it continued, we might have to switch services. He put his arm on my shoulder and in very fatherly fashion explained that I could not switch. He tried to find a proper word but then said the “mob” was in charge of all the towel services. Then I caught on. That evening, during my hospital visit, I told Dr. R what had occurred. It was the first time in several weeks that he really had laughed. That probably shortened his hospitalization. He said, “you just learned more about big city life than I could teach you.”

Not long after, I took the train to San Antonio, Texas and reported for active duty at Fort Sam Houston. All new Army physicians went there first. I remembered that my draft board got to know me; I had to check in every year that I was deferred. There were long sheets on the wall with the names of those who were due to go in. My name gradually moved to the top of the list. One on the draft board said we will be getting you soon — they did.

Dr. Norins currently resides in Cupertino, California.

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