Dr. James Clarke White was a man of firsts: first independent chair of dermatology, first full-professor of dermatology, the first President of the American Dermatological Association, and the first to describe keratosis follicularis, also known as “Darier-White Disease”. Dr. White wouldn’t really ever back down from something about which he had strong convictions.
It’s hard to realize that in the second half of the 1800’s, there were really no major divisions in medical specialty beyond medicine and surgery. Specialists didn’t really exist. Dr. White wrote in his memoir, “The schools had not begun to recognize the need of creating independent departments or of appointing special teachers of dermatology; the two divisions of hospital staffs were jealous of all efforts to establish separate wards for the care of skin diseases as likely to diminish the funds available for the support of the medical and surgical services.”
Dr. James White is also to whom we owe a fourth year of medical training, and obligatory testing as a mandatory part of medical curriculum. He also advocated for the establishment of a central authority to set a minimum curricular and examination requirement for all medical schools (early iteration of licensing examinations).
How he established the department of dermatology at Harvard was fascinating. He petitioned the Board of Trustees in a series of letters. He basically said that Harvard should provide means for giving greater clinical instruction in skin diseases at the Massachusetts General Hospital including creating an outpatient department and an inpatient ward for dermatology. He complained that all the hospital had done up until 1870 was to put all the patients with skin disease under his care without additional funding from the hospital.
Then he went on to say that he couldn’t possibly go on to care for so many patients and continue his teaching role as a “Visiting Physician to the Hospital”. He told the Board that he wanted to resign this position and be re-hired and appointed as “Physician to the Department of Skin Diseases” and then acknowledged that because no such department exists, that it should be formally created.
A lot of drama ensues, namely with opposition led by Dr. Henry J. Bigelow in the Department of Surgery who wrote a lot of disparaging remarks about patients with skin disease and how establishing a ward for skin disease would be a misallocation of resources. Things went back and forth, and ultimately Dr. White got his professorship, department and ward in 1870. However, by 1872, the surgeons were so vociferous in their protests that the hospital decided to close the inpatient skin ward. However, thirty years later, in 1903, a large donation from Dr. Charles G. Weld in recognition of Dr. White helped to establish a new 22-bed ward specifically for patients with skin disease.
Regarding keratosis follicularis, the disease is eponymously referred to as “Darier’s Disease” even though Darier described it three months after White. White refers to some of the thickened black scale as ‘ichthyose noire cornée” in his index case resembling Barretta’s Model No.4. Darier also thought that the rounded cells seen in the disease were parasitic bodies, some form of coccidiae. White was the one who established with his friend Dr. John T. Bowen, a dermatologist and pathologist that unless definitive evidence in the form of inoculation or culture was provided– that these did not look like parasitic bodies. Sadly, the moulages purchased and brought back to the United States for teaching purposes at Harvard were stored improperly and accidentally melted.