Review by Vincent A. Cipollaro from the International Journal of Dermatology

Anyone who knows Terence Ryan will want to read his revealingly candid autobiography. To those not familiar with the making of a British doctor, his personal story will be a revelation as well as a history of the evolution of modern dermatology in Great Britain and an encyclopedia not only of Terence’s professional and social experiences but also those of his numerous peers not only in Great Britain but throughout the world. 

It is doubtful if any single living dermatologist or any other physician has had the international influence and impact on medicinal education that Professor Ryan has had, and this is illustrated in the voyage through his autobiography and history of modern British and international dermatological education. 

Terence is the unlikely belated product of often absent parents. Based on his family genealogy and birth in India, he must have genes directing him toward a life of exotic medicine. He reveals a rather unhappy childhood and family environment which, how- ever, was followed by an enjoyable productive medical education and military experience. Those who do not know Terence will find that he modestly reveals himself to be multitalented, especially artistically as a musician, performer, painter, and in his youth, as 

a prankster. The book is interspersed with humorous anecdotes to be enjoyed by all. While his chosen field of expertise and inter- est is the microcirculation and lymphatics, his experiences extend far beyond dermatology into the field of public health and education, especially of the poorest and neediest of people. 

Aside from Terence’s extensive travels to all corners of the earth, he describes his community duties as commissioner and commander of St. John Ambulance Brigade, responsible for not only the planning and teaching for local disaster response, particularly in case of nuclear attack, but also to manage domestic medical emergencies. This turned out be a 20-year service which was not only domestic but took Terence to faraway places such as Singapore, Australia, Fiji, Israel, and Malta and earned Terence the title of “The Order of St. John,” “commander of St. John,” and “Knight of the Order of St. John.” 

Professor Ryan’s charitable service with St. John ambulance turned out to be most enjoyable, enabling him to learn and to teach as well as to administer emergency care ordinarily beyond the scope of dermatology on numerous occasions. It proved to be a useful model for later organizing the teaching of diverse groups of African students. Professor Ryan, in describing the ascensions of his career from medical student to professorship, takes us through a comprehensive listing of existing and newly created medical and especially dermatologic organizations in which he played significant roles as a member creator and organizer. His interest extended beyond the fields of education and clinical care into his much promoted and necessary campaign for the creation of programs of “Healthy Skin for All” and “Skin Care for All,” created by him under the Auspices of the “World Health Organization,” “UNESCO,” and the “International Foundation for Dermatology” (IFD) which was adopted by the “International Committee of Dermatology” of which he was elected president. Through this concept of “Skin- care for All”, Terence was able to guide the expansion of care to nurses, traditional health practitioners, village doctors, wound healing, and therapies including yoga and herbals as well as much needed care for leprosy. While Terence always had an inclination toward a humanistic approach to medicine, he was encouraged to pursue these goals by the influence of great teachers. 

In addition to his indefatigable organizational skills in clinical and academic medicine and socio-environmental accomplishments, Terence also shows his leadership in preserving much of the great historical legacy of Oxfordian medicine which had been surprisingly neglected. He also set up the “Oxford Medical Alumni Association” to record the accomplishments of Oxford medical faculty and students, and the raising of funds for the preservation of Oxford history and support of such organizations as the Osler societies. 

In retirement, Terence has kept up his interest in preserving Oxford’s reputation as a world leader of medicinal sciences, clinical research, and the Oslerian ethics of medicine and civil- ity. For those interested in the history of medicine, they may visit Terence, who in his retirement is Curator of Osler’s home. 

As a result of Terence’s program of “Skin care for all,” one of his most ambitious and difficult human health projects came to fruition under the Auspice of “The International Foundation of the Regional Dermatological Training Center in Tanzania” (RDTC). This great educational and clinical project required raising large sums of money from private and public sources. The details of the fundraising efforts and the generosity and at times failed generosity of projected donors is fully described along with the relationship of the training center to the pre-existing hospital, nursing and health facilities, including facilities for leprosy training. The training center also provided a much needed ambitious program for the treatment and preventive education of HIV-AIDS and of serious skin cancer in a large Albino population. Terence does not fail to acknowledge the super-humanitarian contribution of the German missionary couple Henning and Herma Grossman to the success of the RDTC. Henning was a trained dermatologist and long-time director of the RDTC, and his wife Herma was an internationally recognized occupational therapist. 

Not all of Terence’s humanitarian projects ended as hoped for. Efforts to establish an RDTC in Guatemala, designed to 

educate nurses to work in rural areas, despite brief success met with obstruction from local professional groups because of jealousies and fear of competition as well as government apathy and political unrest. The project was terminated after consider- able expenditure of funds and manpower. Also, similar efforts in Mali failed mostly because of nationalistic jealousies and lack of cooperation. Larger projected efforts to meet the goals of “Skin Care for All” for the largest population in the world, China, were also exerted. A very complex and ambitious plan was set up to bring improved public health education and care to the millions of poor in far western rural China and Tibet. Unfortunately, years of expenditure of funds and preparation of the building of a China project were met with the resistance and subsequent loss of interest by the IFD, and the project died, a great disappointment to Terence. 

Upon retirement Terence decided to concentrate his interest on the study of lymphatics and the problem of lymphedema especially in relation to the suffering of millions of barefoot subjects in devolving countries. This was accomplished by the formation of a new international branch of “Community Dermatology” chaired by Terence. His interest in the association of skin ulcers with lymphedema led to his writing four chapters in a book entitled “Wounds and Lymphoedema Management.” 

Terence finished his autobiography by confirming his sup- port of the importance of cosmetic dermatology for body image and his support of traditional and alternative medicine. Ryan’s final message is an appeal for the universal humanism and affordability of community healthcare services and cooperation and coordination of public healthcare services between professional medical personnel and voluntary lay personnel as he describes the differentiation which led to the lack of such coordination.