Dres Fox and Fordyce—A biographical note

Apr – Jun 2004 | Vol. 10, No. 2
Böer, Almut

The problem

Fox-Fordyce disease is named for the two authors of the first report about that condition. They are known to some American dermatologists but are unfamiliar to colleagues outside the United States. The paragraphs that follow are an attempt to rectify that situation.

George Henry Fox

George Henry Fox (Fig. 1) was born on October 8th, 1846 in Ballston Spa, New York. He obtained a Bachelor of Arts degree from the University of Rochester in 1867 and received his doctorate in medicine at the University of Pennsylvania in 1869 [1 ]. As was common at that time, he travelled to Europe in order to learn dermatology. He met Rudolf Virchow in Berlin, Ferdinand Hebra in Vienna, Jonathan Hutchinson and Tilbury Fox in London, and Bazin, Hardy, and Vidal in Paris [2 ]. In 1873 he began practice in New York City and, soon thereafter, was appointed physician to the department of dermatology of the Northwestern Dispensary and then to the New York Dispensary. In short succession he became professor of dermatology at Women’s Medical College, professor at Starling Medical College, and, concurrently, chairman of the New York Post-Graduate School. In 1880 he was appointed professor of dermatology at the College of Physicians and Surgeons of Columbia University in New York City, where he remained for 26 years, resigning long before his age of retirement in order that his associate, Dr. George T. Jackson, might become his successor.

Fig. 1

George Henry Fox (1846-1937).

One of the most important contributions of George Henry Fox was his atlas devoted to “Photographic Illustrations of Skin Diseases” published in 1880 [3 ], which was the first atlas of dermatology illustrated by actual photographs and for which he achieved fame widely. The atlas contained about 100 photographs of lesions of diseases of the skin, all photographs being colored by hand. A second edition was published in 1889, and other editions followed until 1905. An atlas of photographs of cutaneous manifestations of syphilis was completed by him in 1885, and a volume dedicated to pediatric dermatology came out in 1897. Not so commonly known is that a second interest of George Henry Fox was genealogy. For 25 years he was president of the Society of the Descendents of Norman Fox, and he authorized a work titled “The Lineage of One Hundred American Physicians Named Fox.”

George Henry Fox was appreciated for his commitment to the teaching of dermatology. He was one of the six founders of the American Dermatological Association, of which he was president in 1892 and 1893. He died in 1937, at the age of 91, in New York City. In an obituary published in the Archives of Dermatology and Syphilis, William Allan Pusey wrote about him that “[Fox] was an able practitioner, an accurate observer whose records have added to present knowledge of dermatology, and an excellent teacher.” And he proceeded to say, “Not the least of Dr. Fox’s admirable qualities was his personality . . . He looked the scholar and man of dignity, but without a trace of self importance. Friendly, sociable, easy, and jovial, he was a most agreeable person.” Pusey ended the obituary with a quote from a biographical sketch by one of Fox’s former students at a meeting of the American Dermatological Association that read as follows: “George Henry Fox occupied a unique position in American dermatology. It was not only his position as one of the foremost specialists of his time that earned for him the respect and affection which marked his closing years; it was the realization that we were privileged to have among us a gentleman whose attainments were of the highest type and whose human kindness was of the most sympathetic type” [4 ].

John Addison Fordyce

John Addison Fordyce (Fig. 2) was born on February 16, 1858, in Guernsey County, Ohio [5 ]. He studied medicine at Chicago Medical College and graduated in 1881, after which he served as an intern at Cook County Hospital in Chicago. Until 1886 he worked as a general practitioner in Hot Springs, Arkansas. Just as George Henry Fox had travelled to Europe for further study, so, too, did John Addison Fordyce, from 1886 through 1888. He attended courses in bacteriology given by Robert Koch and was a pupil of Lassar and Behrend; he received his doctorate of medicine from the University of Berlin in 1888. He went on to study dermatology with Moritz Kaposi in Vienna, where he was engaged especially in dermatopathology. Last, he spent time at the Hospital St. Luis in Paris, where he studied under Ernest Henri Besnier, Jean Baptist Emil Vidal, and Jean Alfred Fournier [2 ]. After his return to the United States, he decided to become a dermatologist in New York City. He became assistant professor at the New York Polyclinic and later he worked as a professor at Bellevue Hospital College and at the College of Physicians and Surgeons. In 1889, he joined Dr. P. A. Morrow as editor of the Journal of Cutaneous and Genito-Urinary Diseases (later to be designated the Journal of Cutaneous Diseases including Syphilis and subsequently the Archives of Dermatology and Syphilology), a position he resigned from in 1897.

Fig. 2

John Addison Fordyce (1858-1925).

John Addison Fordyce not only continued to have his own practice of dermatology but he also was absorbed academically. Among his contributions are “A Peculiar Affection of the Mucous Membrane of the Lips [Fordyce’s disease] (1896),” “The vessel changes and other histologic features in cutaneous syphilis (1907),” and “The importance of recognizing and treating neurosyphilis in the early period of infection (1921).” He specialized in syphilology and dermatopathology, the total number of his publications being more than 100. He established one of the largest and best-equipped centers for dermatology and syphilology in the country. Under his supervision, the department of dermatology at Columbia University developed rapidly. Before he galvanized that department, most dermatologists received their training abroad, but with the advent of Fordyce’s chairmanship, many young physicians did their entire training in dermatology at Columbia University. It was Fordyce’s idea to train postgraduate students in every possible phase of dermatology and syphilology, and to do that in a single department. He trained more than 150 physicians in dermatology, many of whom became leading persons in the discipline. Contemporaries described his efforts pedagogically as one of the major reasons why dermatology developed so dramatically during these years.

Fordyce died suddenly from appendicitis, in 1925. At the time of his death, he was an active member of the New York Academy of Medicine, the New York State Medical Society, the American Medical Association, the American Dermatological Association, and the New York Dermatological Society. In an obituary published in the Archives of Dermatology and Syphilis, George M. MacKee wrote about him thus: “From the beginning of his professional life until his fatal illness, Dr. Fordyce was an inordinate worker. No medical specialist was ever more faithful to his office, to his professional duties, or ever devoted more time or gave more of himself to his patients.” He said, too, that Fordyce “never permitted handicaps and unfavorable conditions to prevent accomplishment” and that “without hospital ward or budget [his department] became a leader in the field.” MacKee described Fordyce’s personal life in these words: “He lived in an atmosphere of culture and refinement surrounded by etchings and paintings and a voluminous and varied library, all of which were very dear to him . . . He enjoyed good music, humor, high class theatrical productions, literature, history and most of the things that are conducive to the happiness of educated and cultured persons . . . Dr Fordyce indulged in several hobbies, among which was photography. His photographs of landscapes, human characters, and quaint scenes show both photographic and artistic skill . . . Dr. Fordyce was very human, and this was probably the basis for his ability to understand and to respect the point of view held by other persons. He was lenient and tolerant, and he was especially kind to the younger men” [6 ].

Fox-Fordyce disease

When, in 1902, George Henry Fox and John Addison Fordyce published their report on “Two cases of a rare papular disease affecting the axillary region,” Fox was 56 and Fordyce 44 years old, and both were working in New York City as professors at departments of dermatology. Although their conclusion that the condition they brought to attention might be related to neurosis and to neurodermatitis was wrong, their observation that individual lesions of the condition named eponymically for them looked, at times, similar to keratosis pilaris was correct. Whereas many other designations eponymically credit the wrong person (e.g., Merkel cell carcinoma is not named for Toker who was the first to describe it as “trabecular carcinoma,” or Pautrier’s microabscess not for Darier, who described them), the appelation Fox-Fordyce disease is justified because those two colleagues really were the first to recognize the uniqueness of the disease named for them.

G. H. Fox and J. A. Fordyce, kindred spirits

The curriculum vita of Fox and Fordyce is similar, particularly in regard to three aspects. Both men decided to study dermatology abroad in order to widen their horizons, both later in their careers were devoted with ardor to teaching dermatology, and both were perceived by their coworkers as being versatile, evenly tempered, friendly persons. At the time they did their training, no program for teaching dermatology existed in the United States, a reality that led those two colleagues to conclude that establishment of good teaching of the discipline in their own country was needed desperately. They shared the view that support of a next generation of young dermatologists is essential to the viability of the speciality. For their entire professional lives, both continued to take care of patients themselves, reminding that the patient is, and remains, the ultimate purpose of all efforts of a physician. From all that is known about Fox and Fordyce it seems that they serve, even to this day, as excellent models for those who truly would be academic dermatologists.

Almut Böer, M.D., is a dermatopathologist at the Dermatologikum in Hamburg, Germany. Contact corresponding author via email: almut@derm101.com.

References

1. George Henry Fox. Available at www.whonamedit.com.

2. Shelly WB, Crissey JT, Stokes JH. Classics in Dermaology. Springfield: Charles C. Thomas Publisher, 1953.

3. George Henry Fox. Photographic Illustrations of Skin Diseases. New York, E.B. Treat, 1880.

4. Pusey W. George Henry Fox. Arch Dermatol Syph 1937;36:361.

5. John Addison Fordyce. Available at www.whonamedit.com.

6. MacKee G. John Addison Fordyce. Arch Dermat Syph 1925;12:268.

7. Fox G, Fordyce J. Two Cases of a Rare Papular Disease Affecting the Axillary Region. J Cutan Genit Dis 1902;20:1-5.