Edward Hand Medical Heritage Foundation
  THE HISTORY OF DERMATOLOGY IN LANCASTER COUNTY
 

 

 

Mary Kegel, M D

      Dermatology, the study of skin, hair, and nails, has been recognized as a subspecialty of medicine since ancient times. Medical records from 1500 to 1600 BC discuss skin conditions. Arsenic was used by the Egyptians to treat skin cancers. Just as it is today, cosmetic improvement of the texture and color of skin was of great importance to many ancient cultures. Egyptians used milk (lactic acid), salt, and alabaster; Greeks and Romans used pumice, frankincense, and myrhh; Indians used pumice and urine (urea).

    Two diseases in particular contributed to the medical profession's interest in dermatology; leprosy and syphilis.  Although early reports of leprosy may actually have been describing psoriasis, true leprosy became pandemic in medieval Europe from the 11th-15th centuries, originating in infected Crusaders returning from the East. The study of cutaneous leprosy contributed to the development of habits of careful observation and recording of signs and symptoms so crucial to any medical discipline.

     Syphilis appeared in Europe late in the 15th century. Columbus's sailors were felt to have brought the disease back from Haiti in 1493, and it quickly became the scourge of Europe. Rampant and incurable, estimates are that, at one point, 20% of the population was infected. Because of its many cutaneous manifestations, the study of syphilology was intimately linked to the study of dermatology, probably to the relief of other medical specialties.  Although Geronimo Mercuriali was the author of De Morbis Cutaneis (On Diseases of the Skin), in 1572, it is Jean Astruc who is felt to be the “father” of modern dermatology. He was a French professor of medicine who lived in the early 18th century and wrote the first great treatise on syphilis and venereal disease.

     Dermatology was a well established subspecialty of medicine in Europe by the early 19th century. The famous Hopital Saint-Louis was established in Paris in 1801 exclusively for the study and treatment of skin diseases. In America, the official organization of the specialty occurred about a century later. The nation's first dermatology department was established in 1874 by Dr. Louis Duhring at the University of Pennsylvania. The American Dermatological Association was formed by Dr. Duhring in 1876 at a meeting of the American Medical Association/International World Congress. The American Board of Dermatology/Syphilology, a national examining board, was established in 1931 and was one of four original sponsoring boards of the Advisory Board of Medical Specialties (along with the American Board of Ophthamology in 1917, the American Board of Otolaryngology in 1924, and the American Board of Obstetrics/ Gynecology in 1930). The American Academy of Dermatology/Syphilology was created in 1938. With the discovery of penicillin in the 1940's, the treatment of syphilis was no longer the exclusive domain of dermatology. The American Board of Dermatology and the American Academy of Dermatology officially eliminated “Syphilology” from their titles in 1955 and 1961, respectively.

In the early part of the 20th century, skin diseases in Lancaster County were addressed by nondermatologists, most commonly general practitioners.  Dr Paul Snoke, a WWI veteran and University of Pennsylvania medical school graduate as well as a radiologist by training, apparently treated a number of skin cancers with radiation therapy in the 1930's. Although this information is sketchy, the first two area practitioners dedicated to dermatology seem to be Dr. Lewis Johnson and Dr. Norman Goldsmith, both University of Pennsylvania medical school graduates. Dr. Johnson initially practiced general medicine in Intercourse PA. He received military training  and was listed in the Lancaster City and County Medical Society's 1944 Centennial Celebration program as “Major Johnson” on the roster of Lancaster physicians serving their country  “in this great war”. Dr. Johnson spent time with Dr. Carroll Wright, a leading Philadelphia dermatologist. His first listing as a dermatologist in the Lancaster telephone directory is in 1950. Prior to that, no designated specialty was included. Interestingly, not a single other physician in the 1950 Lancaster telephone directory identified himself as having a specialty, and only nine of the 109 physicians in the directory gave his telephone number. The majority merely included their office addresses. Not only did Dr. Johnson give his phone number, he was the only physician to provide his home number in the event there was no answer at the office. Dr. Johnson developed a flourishing dermatology practice at 203 North Lime Street. He was a large man with a large heart and was well liked. He admitted, however, that he had difficulty talking to patients and stated that “if you can talk to patients, you will be a great success.” Because of failing health, Dr. Johnson retired in 1964.

Little local information could be found about Dr. Goldsmith. After graduating from medical school, he completed his dermatology training at Pittsburgh Skin and Cancer in the mid 1930's. He then worked as an assistant to Drs. Marion Sulzberger and Rudolph Baer in New York in the early 40's. Locally, Dr. Goldsmith was apparently on staff at St. Joseph Hospital, but the amount of time he lived and worked in Lancaster is unknown. Dr. Goldsmith authored a number of medical papers related to dermatology as well as a book entitled “You and Your Skin”, published in 1953. Written for the general public, this book of information and advice offers a fascinating glimpse into mid-century dermatology. Although many of the scientific principles are sound, some of Dr. Goldsmith's statements are based on tenets that have changed significantly; “the secret of avoiding sunburn is to get exposure gradually. If you do this your skin will become accustomed to the effect of the sun's rays. Your body will form pigment which you call tanning and prevent a severe burn. Then at the end of the summer you may have that gorgeous bronze, the envy of so many” (Goldsmith, 1953).

Solo dermatology practices were the mid century norm in Lancaster. Dr. William Sigmund, a University of Pennsylvania graduate, established an office on Duke Street beginning in the late 1940's. Later he moved to Lititz, where he practiced for the rest of his career.

Dr. Walter Hassel came to Lancaster in 1958 after completing a dermatology residency at the Mayo Clinic in Rochester, Minnesota. He was encouraged to come to Lancaster by Dr. Sol Pontius of Lancaster, also a Mayo Clinic fellow, who had traveled to Rochester in 1957 with the specific intention of bringing more Mayo trained physicians to this area. In addition to his solo practice, Dr. Hassel volunteered on a weekly basis at Temple Skin and Cancer in Philadelphia for several years. He also often volunteered to teach family practice residents in the dermatology clinic at Lancaster General Hospital. Dr. Hassel retired in 1990.

Dr. Robert Roschel, also a graduate of the distinguished Penn dermatology residency program,returned to his Lancaster roots and took over Dr. Johnson's practice in 1964. The practice expanded in 1978 with the addition of Dr. Richard Herschaft, a native of New York City with credentials from the Medical College of Virginia and Temple Skin and Cancer Hospital. Partnerships at that time were relatively rare, but the practice continued to grow and an additional office was opened. Dr. George Groleau, who did his medical and dermatology training at the University of Maryland, joined the group in 1986. Dr. John Legere, a graduate of West Point Military Academy and the Philadelphia College of Osteopathic Medicine, joined the practice in 1991 after completing service for the Strategic Air Command/United States Air Force. Dr. Marissa Baldassano, a dermatopathologist and associate professor at Drexel Medical College, joined the group in 2005 when a dermatopathology laboratory was added to the practice.  Dr. Baldassano completed an internal medicine residency at Duke University as well as an anatomic pathology residency at Massachusetts General Hospital and a dermatopathology fellowship at New York University. Expansion continued with the integration of a Laser and Skin Care Center into the practice. Dr. William Groff, a Lancaster native and prominent laser surgeon on the West coast, was engaged in 2011 to head up that facility. Dr. Groff is a graduate of the Philadelphia College of Osteopathic Medicine who received much of his training and experience in the United States Navy. Dermatology Physicians has had a long standing presence in Lancaster County. Dr. Roschel, as of this publication, will be celebrating his 50th year of patient care. Their main office at 203 North Lime Street, originally Dr. Lewis Johnson's office, has been the site of continuous dermatologic care for sixty four years.

Dr. Monte Courter came to Lancaster from the University of Michigan in 1973; while driving through the area, he and his wife fell in love with Lancaster County. He had a solo dermatology practice at 1903 Lititz Pike until he recruited another University of Michigan alumnus, Dr. Patrick Feehan, in 1976, and created Dermatology Associates of Lancaster.  Dr. Feehan was instrumental in developing the teaching program for family practice residents at Lancaster General Hospital. Dr. Mary Kegel, a graduate of Jefferson Medical College and Brown University, arrived back in her native Lancaster in 1986. Expansion continued, welcoming Dr. Sherri Vazales in 1988, Dr. Bruce Brod in 1994 , and Dr. Sameh Hanna in 1991. Dr. Vazales and Dr. Hanna subsequently moved out of the area. Dr. Brod, a University of Pennsylvania graduate and clinical professor with an expertise in contact dermatitis, has twice been voted “Dermatologist of the Year” by the Pennsylvania Academy of Dermatology and Dermatologic Surgery for his contributions to state and national dermatology affairs, including the passage of a PA state bill regulating tanning bed usage. The scope of the practice continued to grow in 2006 with the addition of two physicians;  Dr. Jennifer Sceppa, a graduate of the University of Pennsylvania School of Medicine, is a dermatologist/dermatopathologist who trained in dermatology at Penn State University and dermatopathology at the Ackerman Academy/State University of New York Downstate. Native Lancastrian Dr. Jeanette Hebel is a Mohs surgeon who was a commander in the US Navy for 13 years. She trained at the Naval Medical Center in San Diego and the Skin and Surgery Center in Winston-Salem. Dr. Jennifer Mueller, a graduate of Eastern Virginia Medical College and Drexel University, arrived in 2009 and has expertise in surgical and cosmetic/laser dermatology.  Dr. Mark Gibbs, a University of Michigan graduate and previous University of Pittsburgh assistant professor of dermatology, joined the practice in 2011. Dr. Sara Heilig, a graduate of Penn State University College of Medicine, was welcomed in 2014, returning to her Lancaster roots from a practicing dermatology position in Seattle.

Mohs micrographic surgery was introduced to the county by Dr. Mark Hassel in 1991.  Walter Hassel's son and a Lancaster native, he was trained in dermatology at the Medical College of Georgia and completed a fellowship in Mohs surgery and laser surgery at NYU Medical Center. The medical community was devastated by his untimely death from stomach cancer In 2007 at the age of 47.  Dr. Teri McGillis, a Mohs surgeon and former clinical professor of dermatology at the Cleveland Clinic, has taken over Dr. Hassel's practice.

  Dr. William Andersen is a triple board certified anatomic pathologist, dermatopathologist, and dermatologist. He came to Lancaster  in 1997, after having served as Assistant Professor of Dermatology at Boston University.  Dr. Stephanie Mackey, a  Penn State medical school alumnus, began her dermatology career at Dermatology Associates of Lancaster but struck out on her own in 1999. Dr. Mackey also enjoys teaching and has the Lancaster General Hospital family practice residents rotate through her office on a monthly basis.  Both Dr. Mackey and Dr. Andersen continue with thriving solo practices today.

Present day dermatology has evolved into a complex specialty; it is necessary for a general dermatologist to have a firm grasp of basic science, immunology, dermatopathology and dermatologic surgery. The last thirty years have been an exciting time. Basic science research in many of the dermatologic subspecialties exploded, segueing into new diagnostic and therapeutic developments in the fields of immunology, dermatologic surgery, phototherapy, laser therapy, and skin oncology.

Immunotherapy, involving both topical and systemic immune response modifiers, is frequently utilized in the treatment of both melanoma and  nonmelanoma skin cancers. Mohs micrographic surgery is often the treatment of choice for many nonmelanoma skin cancers, such as facial, ill defined, large, or recurrent tumors. Layered surgical removal of diseased tissue with concurrent evaluation of surgical margins promotes high cure rates and good cosmetic outcome. Phototherapy traditionally has been an effective therapeutic modality for many skin diseases, but not without risks and side effects. Narrow band UVB utilizes the most efficacious wavelengths in the UVB range, thereby resulting in less exposure and less risk. Photodynamic therapy is now a well established therapy for some cutaneous malignancies and premalignancies. Exposure to a specific wavelength of light after application of a photosensitizing agent results in free radical formation and cell death. Laser therapy is a constantly evolving subset of the dermatologic therapeutic armamentarium; lasers are commonly used for cutaneous resurfacing, tattoo removal, epilation, and treatment of some vascular and pigmented lesions. Therapeutic options for advanced/metastatic melanoma continue to expand. Surgical resection remains first line therapy for early disease, but the prognosis for metastatic disease has notoriously been poor. Advances utilizing immunomodulators and targeted therapy continue to brighten the outlook for disease free as well as overall survival of advanced melanoma. Keeping abreast of these advances is an ongoing goal of our local dermatology community in order to continue to offer our patients care of the highest quality. We've come long way from this remedy for warts found in a 19th century Lancaster almanac:

“Roast chicken feet and rub warts with them, then bury them under the eaves” (Hohman, 1877).

References

     Hohman, John George. The Long Lost Friend: Containing Mysterious and Invaluable Arts and Remedies for Man as well as Animals. Lancaster PA. 1877.

     Goldsmith, Norman R., MD. You and Your Skin. Charles C. Thomas, Springfield, Illinois. 1953.

     Fitzpatrick's Dermatology in General Medicine, 5th edition. Editor Freedberg, Irwin M., MD. McGraw-Hill, New York. 1999.

     Crissey, John Thorne, MD; Parish, Lawrence Charles, MD; Holubar, Karl, MD. Historical Atlas of Dermatology and Dermatologists. Parthenon Publishing Group, New York. 2002.