Irwin Freedberg: the early years at Harvard.

In 1959 Irwin Freedberg, after four years at Harvard Medical School and three years of residency at Beth Israel Hospital, arrived at Massachusetts General Hospital to begin his residency in dermatology. I, by chance, arrived at the same time, having attended the same medical school, interned at the old Peter Bent Brigham Hospital, and served as a medical officer in the field artillery during the Cold War. By the time our new chief, Thomas B. Fitzpatrick, arrived, we had already managed to shake up what had been a slightly complacent department because the previous chairman had been ill for a number of years. Irwin’s and my first encounter with TBF was at skin rounds. This guy with a hand lens elbowed his way in and we elbowed him out in trying to examine a patient. At the end of rounds Tom was introduced as our new chief, and we both thought about looking for a new job. We spent two years learning the names of diseases and the limited therapies available. The clinic was a relatively easy rotation, because a number of part-time faculty also saw patients. The inpatient service was busier, because about 30 patients with extensive disease were managed by one first-year resident with limited experience and therapeutic options. As in all things that crossed Irwin’s path, he did remarkably well. There were four residents, and we made consult rounds every Friday with Tom. At that time he repeatedly announced that we should work on the epidermis to balance his long-standing work on melanocytes, so really that is how it began. I still am not sure why, but Tom could not keep our names straight until after Irwin left. Irwin thought we should begin a research career during our residency, and we decided to study the metabolic response to exfoliation; this was made possible by a metabolic ward, funded by the National Institutes of Health, at Massachusetts General Hospital. Fortunately the other residents were more experienced and could manage patients in greater numbers, so our occasional absences from the clinic were noticed but not a problem in terms of patient care. We had no difficulty finding patients with almost total-body psoriasis and made a suit, demonstrated in Figure 1 by Irwin, to collect scales. We spent part of every weekend aliquoting the stool collections, because that was not one of the core activities of the ward, and it was not a pleasant task. One good fallout of that project was that one of the nurses became interested in dermatology and worked on our White 8 Skin Service inpatient skin service for many years. It was clear at the end of our first year that we needed training in basic science, and after reviewing all the programs in the Boston area, we decided to go to Brandeis, where Nate Kaplan had a program in biochemistry to train MDs in basic science without their having to go the PhD route. Fortunately there were training grants to fund our fellowship, since at that time we each had two kids to support. It was a turning point in our careers. Many others with a clinical background followed us, including residents from our own program. Although we continued to work on the epidermis together, our professional careers began to diverge. Irwin’s exceptional personal skills became apparent, and his plans for the future were forming. After completing the fellowship, Irwin returned to Beth Israel. Over the years we continued to interact with our earlier mentors, and we were members of the Brandeis Club. Irwin started a clinical and research program, the first in dermatology separate from Massachusetts General Hospital, at Beth Israel. He attracted additional outstanding faculty, both in the clinical area and in research, who built strong programs of their own under his mentorship. In 1969 he was awarded a John Guggenheim Memorial Foundation Fellowship at the Department of Biophysics of Weizmann Institute of Science, with the renowned protein chemist Ephraim Katchalski-Katzir, to enhance his research skills. He became head of the department at Beth Israel and a tenured professor at Harvard Medical School. 1Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, MA, USA