Lives of the fellows

Geoffrey Barrow Dowling

b.9 August 1891 d.1 June 1976
MB BS Lond(1920) MRCP(1921) MD(1921) FRCP(1933)†

GB Dowling, consulting physician to the department for skin diseases at St Thomas’s Hospital and to St John’s Hospital for Diseases of the Skin, died peacefully at St Thomas’s Hospital at the age of 84. He had long been an internationally revered authority on his specialty and the doyen of British dermatologists. He had been in failing health for several months, happily without lessening of his intellect, humour or courage. In the month before his death he attended, with obvious enjoyment, the annual oration and dinner of the club which bears his name, and also a dinner to mark the 250th anniversary of the founding of Guy’s Hospital.

Geoffrey Barrow Dowling was born in Cape Town, where his father was first organist of the cathedral and a leading figure in the musical life of Cape Province. Educated at the Diocesan College in Cape Town, at Exeter Cathedral Choir School, Dulwich College and Guy’s Hospital, his medical training was interrupted by two years’ service as a cavalry trooper in the first world war. In 1920 he graduated MB BS with honours in medicine and soon became MRCP. At Guy’s he held several house officer and registrar appointments in medicine and pathology, and his outstanding ability was soon recognized. His decision to specialize in dermatology owed much to the influence of HW Barber.

In 1926 Dowling was appointed physician to St John’s Hospital for Diseases of the Skin, a post to which later was added the charge of the Goldie Leigh Hospital for the treatment of skin diseases in children, including fungus scalp infections. In 1927 he was appointed assistant physician to the skin department at Guy’s. He was also in charge of the skin department of the West London Hospital, resigning these two latter posts on his appointment to St Thomas’s Hospital in 1933. In addition, he was civilian consultant in dermatology to the Royal Air Force.

Dowling was largely responsible for the renaissance of dermatology in the United Kingdom, and many would hold that his influence has been unequalled in the past century. He was a superb clinician with an exceptional talent for distinguishing between the significant and the irrelevant. He realized the importance of exact observation and description, and in this respect perhaps the French school ranked highest in his esteem. To an even greater degree his influence was manifest in the clarity of his thinking, whether in individual diagnosis or in investigative studies, which were at that time predominantly clinical.

With his formidable and occasionally devastating critical faculty he drew a sharp distinction between speculative theory and proven fact, while appreciating that some well tested empirical observations would have to await a rational explanation. With his keen and enquiring mind he perceived that in many fields further advances would have to rely on experimental investigation, which at that time was in its infancy and limited to a few brilliant workers such as Haxthausen, for whom he had a lasting respect and affection.

His early experience in pathology led him to encourage the study of the histopathology of the skin. This encouragement was within a few years to ensure its pre-eminence in this country. When, in 1952, Dowling was appointed the first director of medical studies at the Institute of Dermatology, he greatly encouraged investigative studies particularly in photobiology and in contact sensitivity, the results of which were to achieve world wide fame.

His original contributions were outstanding. They began with the investigations which he carried out with JHH Macleod on the role of Pityrosporon ovale in seborrhoeic dermatitis. Later, in conjunction with Freudenthal, he became interested in the relationship between dermatomyositis and scleroderma. This culminated in his authoritative Watson-Smith lecture to the Royal College of Physicians in 1953. His greatest contribution was the demonstration in 1945 of the efficacy of massive doses of calciferol in the treatment of lupus vulgaris. This was no chance discovery but the outcome of simple and logical deduction from the knowledge that the only previously significant treatment had been concentrated ultraviolet rays, a technique devised by Finsen, very time consuming and available to few. The same therapeutic advance was introduced independently and simultaneously by Charpy in France, but neither knew of the other’s work until after the war.

Although calciferol was soon superceded by other anti-tuberculous drugs, Dowling’s treatment gave the first hope for the majority of sufferers from this age old and often grossly disfiguring disease, which at that time was still not uncommon. His colleagues deeply regretted that he did not receive the public honour which he so justly merited.

His retirement from his hospital appointments in 1956 signalled the beginning of a second period of unrelenting professional activity, during which he became an almost legendary figure. For many years he gave invaluable service as a locum consultant, with very busy clinics at Lewisham General Hospital and at Farnham Hospital in Surrey. For him the enjoyment of the work more than compensated for the difficulties of public transport, often having to leave his house before dawn. Even in his late seventies he retained an undiminished interest in dermatology, continuing to make valuable and often original contributions.

By the mid-1950s over half the dermatological consultants appointed in the United Kingdom during the previous decade had been trained by him. Many of the papers written by his registrars, some attaining international recognition, derived from Dowling’s suggestions and help. His reputation also attracted first class postgraduates from overseas, particularly from Australia and South Africa. It was also characteristic of Dowling that he did not restrict his help to his own registrars. He initiated the regular Saturday morning meetings at St John’s Hospital for Diseases of the Skin, open to all junior dermatologists, which now enjoy an international reputation.

Much of the immense influence that he was to have on dermatology in this country and overseas began in 1948, when he started an informal journal and travelling club which was later to bear his name. The object of the club has always been to promote knowledge and friendship among younger dermatologists and it now includes members from most European countries, the Middle East, Africa, North and South America. To commemorate the great service rendered by its founder, the club contributed generously to a fund to establish an annual Dowling oration. The British Association of Dermatology also paid him the unique tribute of founding a Dowling Fellowship for young dermatologists to undertake research projects for upwards of a year.

In his earlier years it was not always easy to the newcomer to detect the qualities which made him so pre-eminent and beloved. His kindly and scholarly bearing were obvious to all, but modesty and intense concentration sometimes made him appear preoccupied, an appearance enhanced in the clinic by a magnifying visor which temporarily rendered him incommunicado. His abhorrence of appearing to patronize often led him to overestimate the erudition of his audience, and with a less than perfect enunciation his observations were not always clear to the uninitiated. For these reasons he was perhaps less than successful as a teacher of undergraduates, to whom he nonetheless endeared himself by his great kindness and occasional mannerisms.

In middle life Dowling appeared older than his contemporaries and to generations at St Thomas’s he was affectionately known as ‘Daddy Dowling’. With a great appreciation of music, his interest in the students’ welfare found a happy expression when he became president of the St Thomas’s Hospital Musical Society, which was actively sponsored for many years by Ralph Vaughan Williams who dedicated a composition to the Society.

The tolerance that he showed to his juniors did not always extend to his contemporaries, and occasionally his judgements were less than fair. He had a very keen sense of humour but on occasion he was known to mistake the friendly badinage of a colleague for an attack on dermatology itself. The occasion when a new nurse mistook him for the barber caused him much amusement as it embarrassed the present writer, then his house physician. The friendly title of ‘Headmaster’ which he soon acquired after the founding of the Dowling Club initially gave him some misgivings, until he realized it was a token of affection. In committees, which he greatly disliked and avoided if possible, he was not very successful, and he had no taste for intrigue.

Dowling was a man of wide culture with an extensive knowledge and appreciation of literature, music and painting; his interest in the latter being greatly stimulated by the accomplishments of his family. He was very interested in many branches of sport. In his youth he was no mean rugby player and later became a competent golfer. The motorcar held little attraction for him except as a means of transport. His style of driving was unorthodox and perhaps, on occasion, perilous but accidents were few and trivial. In his seventies he became an enthusiastic and proficient cook, a hobby which afforded him much pleasure.

Socially, his gentle and benevolent charm at once endeared him to the newcomer and to his friends of all ages and all nationalities. His gregarious habits and sense of fun astonished the stranger as much as they delighted his friends. The prodigious stamina that was such a feature in his professional life extended also to his social activities.

Many professional honours came to him. He was president of the British Association of Dermatology and was later made an honorary member. He was president of the dermatological section of the Royal Society of Medicine and was later elected honorary fellow of the Society. All the major dermatological societies of the world conferred on him their honorary fellowships. He was president of St John’s Dermatological Society and gave the Prosser White oration in 1958. An honorary doctorate of medicine was conferred on him by the University of Utrecht in 1957 and, in 1959, he received an honorary doctorate of medicine from the University of Pretoria. In 1972 he was awarded the Alfred Marchionini gold medal.

He married, in 1923, Mary Elizabeth Kelly, who died in 1965. They had two sons and two daughters.

† The list of honorary degrees is too lengthy to include in entirety

[, 1976, 1, 1474; Lancet, 1976, 1, 1359; Times, 3 June 1976; Brit.J.Derm., 1976, 95, 677]

(Volume VII, page 163)

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