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From Brown to Green: Origins of the Montagna Symposium on the Biology of the Skin

      Recipient of Founding Member Award, Montagna Symposium on The Biology of The Skin
      To tell you about the beginning of this wonderful Symposium, I must first tell you a little about dermatology's past and then about how and why William Montagna came to Oregon.
      In the 1930s and 1940s, Clinical Dermatology was content to give its diseases descriptive names and let it go at that. A rose, regardless of its variations, always looks like a rose and psoriasis always looks like psoriasis.
      During the 1930s and 1940s, the science of Dermatology, like Medicine as a whole, was mired in descriptive gross and microscopic pathology without the tools to feed curiosity about the dynamic structure and function of skin or the mechanisms and pathways that made the skin sick.
      Let me give you an example of what we faced day in and day out. In the early 1940s when I was a Fellow at the Mayo Clinic, being trained in Dermatology, we had a patient who had a purulent infection on his right ankle. The treatment of the day was sulfathiazole ointment. Antibiotics had yet to be discovered and invented. We put sulfathiazole ointment on a gauze square over the infection and it cured it. However, as often happened, the patient developed a contact allergic eczematous dermatitis to the sulfathiazole, limited just to the size and shape of the square of gauze. That too was recognized for what it was and was cured. After 3 years, the patient returned with a bladder infection for which he was given sulfathiazole by mouth and his right ankle broke out in an eczematous dermatitis, limited exactly in size and shape to the gauze square and only to that square.
      Where was the memory? We knew that the same epidermal cells that were involved 3 years earlier were long gone and had been replaced every several weeks for 3 years with new ones. Langerhans cells? We could recognize them, but thought that they were effete melanocytes without pigment. It would be another 25 years before their function would be known.
      Let me remind you, too, that Clinical Dermatology in the 1940s was a medical subspecialty and, to give it credit, Dermatology was trying to find a new niche for itself by discovering and correlating what went wrong inside the body with what was heralded and mirrored on the surface skin, for example, pyoderma gangrenosum on the skin associated with chronic ulcerative colitis in the gut; necrobiosis lipoidica on the skin, diabetes mellitus inside; erythema nodosum (hot tender nodules) on the upper shins, rheumatic fever. These are short cuts to diagnosing diseases of Internal Medicine, and this discipline furnished the diagnostician with the tools of one-up-man-ship. And it was fun. It was a good era.
      However, there was in those early 1940s a small group of young dermatologists who were curious about the skin itself. They fell in love with this huge, complex organ, which was so visible, so available, so reproducibly patterned in its diseases. Me? I was a patient. During my first year in medical school, I developed generalized scleroderma of the morphea type, was hospitalized in bed for a year and half, and then convalesced another year and a half before returning to Medical School at the University of Cincinnati.
      These young dermatologists had nowhere within dermatology to turn. The leather industry knew more about the dermis than did we. The wool industry knew more about hair and sebum. The cosmetic industry knew more about nails, keratin, oil, and sweating. The soap and chemical industries knew more about contact irritant and contact allergic dermatitis than did we. And those were the places that we turned to for basic information.
      In the late 1940s, a “happening” occurred. It was unpredictable, simultaneous, and for totally different reasons. A few of the young dermatologists independently found William Montagna, PhD, a comparative cutaneous biologist and primatologist in the Biology Department of Brown University in Providence, Rhode Island.
      I found Bill Montagna because of my need to know the microscopic structure of the external one-third of the human ear canal, because that area of skin was developing deafening, crippling eczematous dermatitis much like the seborrheic dermatitis of the axilla. Of course, I knew there were wax glands somewhere in there, but I did not know that they were apocrine glands like the scent glands in our armpits and groin. Finding nothing in the ear, nose, and throat literature, I finally found what I needed in a small, obscure anatomy journal in an article written by Montagna at Brown University.
      I was at Dartmouth Medical School and its Hitchcock Clinic in Hanover, New Hampshire at that time. I phoned this Montagna who was immediately cordial, enthusiastic, cooperative, and sent me his original slides for microscopic study. And thus began a friendship and collaboration for the decades that followed. We, in Dermatology, who found Bill Montagna were: Albert Kligman, MD, PhD, mycologist turned dermatologist at the University of Pennsylvania in Philadelphia, PA (Al was here with you last year and spoke to you); Irvin Blank, PhD, physical chemist, in Harvard's Department of Dermatology, Boston, MA; Raymond Suskind, MD, dermatologist and occupational and public health authority at the College of Medicine of the University of Cincinnati, OH; Harvey Blank, MD, PhD, dermatologist interested in pharmacology, also from the University of Pennsylvania, Philadelphia, PA; Fred Urbach, MD, dermatologist interested in sunlight and melanin, Temple University Medical School, Philadelphia, PA; Herbert Mescon, MD, dermatologist and dermatopathologist, Boston University Medical School, Boston, MA; Herman Pinkus, MD, dermatologist and dermatopathologist, Wayne State University School of Medicine, Detroit, MI; and Walter Lobitz, MD, dermatologist interested in atopy, atopic dermatitis, and the eccrine sweat gland, Dartmouth Medical School and Hitchcock Clinic, Hanover, NH.
      We all found Bill Montagna and that was the way this began in 1950, because almost immediately this small group decided it was a good idea to sit down together and just talk about the skin. So during winter semester break at Brown, for the first time, this group of eight plus three from Brown's Biology Department, Herman Chase, Gideon Matoltsy, and its chairman, J Walter Wilson, met. There were no prepared talks and no selected subjects, we just sat together for a weekend and picked each other's brains. And it worked!
      Beginning the following year, we selected just one skin structure to talk about, and each year it got better and better and bigger with more invited participants and speakers. And, of course, we called it the Brown Conference.
      But how did the Brown Conference get to Oregon and to this wonderful place called Salishan? A series of unpredictable, unconnected events occurred to make it happen.
      In 1959, I moved from Dartmouth to the University of Oregon Medical School in Portland, Oregon (now Oregon Health and Science University, OHSU, and still the only medical school in Oregon). Within a year or two, Dobson, a former fellow of mine then at the University of North Carolina Medical School, joined me, as did Suskind from Cincinnati's College of Medicine, Halprin and Nicolaides (a lipid chemist) from the University of Chicago, and Kellum from the Cleveland Clinic. We all loved Bill Montagna and with all the others faithfully attended the Brown Conference every year in Providence, Rhode Island. It was a highlight for us!
      Now, another important and unpredictable coincidence occurred. J Walter Wilson, the Chairman of Brown's Biology Department, decided to retire and Bill Montagna was one of two candidates for that Chair. Bill did not get it. To hold onto him, Brown created an endowed professorship for life just for Bill. We thought that was truly a great thing for Bill and told him so, but Bill's feathers were ruffled, so we all started to consider: How could we get Bill to fly from Brown to Oregon?
      You should know that at that time, and up until the late 1960s, the University of Oregon Medical School in Portland was a college of the University of Oregon 90 miles south in Eugene, where administration and the basic science departments of the University were located. We really needed a Basic Science Department on our own campus in Portland to confer and collaborate with us. The Dean recognized this need and asked Bill Montagna to Chair the Basic Sciences, and Bill accepted.
      However, before Bill Montagna could arrive in Portland, another unforeseen, but very pertinent event was happening here in Portland. In the early 1960s, the National Institute of Health was beginning to establish Regional Primate Research Centers throughout the country. And the National Institute of Health decided to grant, through the Medical Research Foundation of Oregon and the Dean's office, one of these Centers to Oregon because a Professor of Pediatrics already had a small macaque monkey colony here in Portland. But after getting the grant and building the Center, it became necessary to find new leadership. The Dean was in a difficult position, until it was pointed out to him that he already had on his faculty a leading Comparative Primatologist called William Montagna who could take over and run that show. The Dean bought that idea and so did the National Institute of Health, but Bill had some reservations.
      Bill pointed out that having Primate Centers limited to one species (e.g., a chimp center, a gorilla center, and a macaque monkey center) made as much sense as having a rat center, or a hamster center, or a rabbit center. But if the National Institute of Health wanted a Primate Center that could comparatively study primates from the lowly pro-simians (e.g., pottos and lemurs) up through various monkey species (old-world macaques, Japanese stump tails, and new-world greens), Celebes apes, and so on, he would be glad to take that over and run it.
      The National Institute of Health eagerly accepted the idea. The grants were rewritten accordingly, and that is what brought the great Dr William Montagna from Brown University to Oregon. And, as you know, Bill's Primate Center became deservingly famous and world-renowned, as did Bill himself. And it was great for Oregon Dermatology, too! Our staffs functioned as a team.
      The one thing we all decided immediately, even before Bill arrived here, was that the Biology of the Skin Seminars, the Brown Conference, must be continued and moved to Portland. My wife, Betty (recognizing the luxurious result of Oregon precipitation) recommended that we change its name from the Brown Conference to the Green Conference.
      When John Gray hired the late, great architect, John Storrs (the husband of OHSU dermatology's and Oregon's famous contact dermatitis expert Dr Frances Storrs) to create Salishan, the die was cast. Bill moved the meetings here to this halcyon setting where they flourished. In 1975, we celebrated the 25th anniversary of this Symposium.
      After Bill Montagna's retirement, he handed over the reins to Kurt Wuepper, then the director of research in my department, OHSU Dermatology. The rest of the story you know better than I. David Norris kept it alive at Snowmass in Colorado and then last year Molly Kulesz-Martin and Jackie Bickenbach brought it back to Oregon. I join all in shouting our thanks to you both for bringing the old Brown-Green Conference back home to Salishan.