For forty years of his life Leonard Loewenthal devoted his energies to the furtherance of dermatology in Africa. No one else brought such dedication and intellectual brilliance to this field of African medicine. With no medical libraries, no expensive equipment, no academic associates and no comfortable appointments, he possessed both the gifts and the discipline to achieve a position at the forefront of his profession. Starting in 1931, in Uganda, with studies on tropical ulcer and vitamin A deficiency, he ended his career in Johannesburg forty years later with investigations on the skin of miners.
Loewenthal was both a retiring, asocial and industrious scholar-student and a dazzling entertainer in the social and medical limelight. He allowed his learning to find an outlet in writing, teaching and conversation. He had a fine natural wit which was guaranteed to enliven the dullest company, and a stylistic elegance in writing and speaking which was partly attributable to his aptitude for classical studies. His confident, authoritative style earned him the nickname of ‘King Alphonse’ for at times he reached the absurd majesty of a nobleman in comic opera. He had an avid grasp of facts, a clear understanding and excellent memory, which assured him a distinguished student career and a successful and multi-faceted life which falls naturally into five main phases: England and Europe until the age of 28; followed by ten years in the colonial medical service in Uganda; five years service in the Army during the second world war; twenty-five years in Johannesburg and, finally, eleven years in Spain.
Alphonse was born in Liverpool where his father, Max Sally Loewenthal, was a respected physician who had come from Europe and settled down in Princes Road. His mother, Amanda, was the daughter of Joseph Kehr, a banker. He was educated at St Christopher’s Preparatory School and Malvern College, where he matriculated, passing all his subjects with distinction and being the first recipient of the Moore-Bayley prize for Greek, an award which still exists. He went on to study medicine at Liverpool University where he graduated with honours in July 1925. From 1926 to 1929 he acted as clinical assistant to the skin department at the Royal Infirmary, and as assistant dermatologist at the Liverpool Hospital for Cancer and Skin Diseases. During this period he also spent a year doing research in pathology, and visited Paul Gerson Unna in Hamburg where he spent some time cutting and staining skin sections. In 1930 he registered as a Colonial Office student, acquired the DTM&H, and was sent to Uganda. Those who knew how much work he accomplished during the next ten years in the tropics might not realize how broad and general were his duties at that time: clearing swamps, lecturing to orderlies, doing midwifery in the bush, making jail inspections, attending to hospital work, practising ophthalmology — all these tasks were part of the daily round but he never allowed them to interfere with his dermatological responsibility. Within the first two years he had fully grasped the role that poor nutrition played in producing tropical ulcer, and he discovered that distinctive skin lesions result from vitamin A deficiency. By comparing different classes of negroes with different eating habits, he saw that the high incidence of tropical ulcer was confined to groups with poor nutrition. If infection was the precipitating cause, predisposition was even more necessary in allowing the disease to occur. Tropical ulcer continued to engage his attention until he produced his last and most comprehensive paper on the subject in 1968.
In 1933, in Kampala, he described the follicular signs of vitamin A deficiency. It was an original piece of research, independent of the two similar discoveries made by Lucius Nicholls in Ceylon and Chester Frazier in China. He submitted an MD thesis to Liverpool University, in 1934, on lymph stasis in the skin. It covered the role of onchocerciasis, Bancroftian filariasis, chromoblastomycosis, chronic ulcers and allied conditions in producing ‘mossy foot’. That same year he passed the membership examination of the College. His pace did not slacken: between 1936 and 1939 he published in serial form a contribution in fifteen parts on diseases of the skin in negroes in the Journal of Tropical Medicine and Hygiene, and also placed Kaposi’s sarcoma and xeroderma pigmentosum firmly on the African dermatological map. Ignorance, and the apparent rarity of these diseases, he rightly concluded, ‘may be due to the lack of skilled dermatologists in the greater part of Africa’.
On the outbreak of war Alphonse wished to join the armed forces, but the Colonial Office refused to release him. So he released himself instead, went to South Africa, registered as a dermatologist with the Medical Council, and enlisted in the South African Medical Corps. He saw service in North Africa and Italy, rose to the rank of lieutenant colonel, became area dermatologist in Tripolitania, read Greek, learned Italian, sang operatic arias, wrote dermatological papers, and went escapading. While on active service he published three papers: one on the causation of lichenification in onchocerciasis, in which the microfilariae were held responsible and not the fly bites by Simulium; another dealt with the relationship between xanthism in Nigerian negroes and albinism; the last concerned the prophylactic antimalarial in the production of tropical lichenoid dermatitis, a relevant subject with troops in malarious areas.
The war over, Loewenthal set up as a dermatologist in Johannesburg. He was given a few sessions at the skin department of Johannesburg General Hospital where, as he was apt to say, the ‘specialized equipment consisted of a piece of cotton wool and a bent pin’. His first appearance caused some astonishment: it was in 1945 and some colourless character was mumbling away about lupus erythematosus when suddenly this well-spoken, loud-voiced man swaggered in, slender, nattily dressed, bald, with an olive complexion and grey-blue eyes, a blue cloth suit and a gold cigarette case. He took over the discussion, digressing freely on HW Barber’s views on the sulphonamides in lupus erythematosus at a time when no Johannesburg dermatologist ever quoted articles or overseas experts. Forthwith, he began to drag dermatology in Johannesburg out of the shadows. In the outpatient department, in the wards, and at his house in Bergvlei, topics of current interest would come under discussion. The result was a significant heightening of general awareness; few of his enthusiasms were lasting but his latest ideas were most stimulating at the time. Awareness and current relevance — these were Loewenthal's great offerings. Falsehood, both popular and professional, he detested. If somebody claimed that acne was cured by marriage, he wanted to know if a civil or religious ceremony was better. ‘Education’, he once said, ‘is impracticable if the charlatan is allowed to advertize’. During his Johannesburg period he made two substantial contributions: an account of itching purpura, and his treatment of eczemas resembling dermatitis herpetiformis with sulphones. Long drawn out struggles were not in his line though he was engaged on two battlefronts, concerning the respective places of skin radiotherapy and skin histopathology in dermatological practice. It was the old story of a claim over a method v ability to use it judiciously - a source of much fruitless argumentation.
Loewenthal was a prolific writer: the Index Medicus lists over one hundred of his papers, a mere fraction of what he wrote. Noteworthy among his medical publications are The Eczemas (1954), three chapters in Mitchell-Hegg’s Modern Practice in Dermatology (1950), a WHO monograph on Differential diagnosis of yaws (1960) with CJ Hackett, and a massive chapter on ethnology and dermatology in Jadassohn's Handbuch: Ergänzungsband 8, ed. HA Gottron (1967).
Loewenthal was often humorously disrespectful; under cover of great mirth he could deliver some sharp truths. He was also capable of being unnecessarily harsh for the sake of a laugh. Not surprising, therefore, that his humour did not appeal to everybody. At a meeting where he had almost been pushed off the programme by other speakers exceeding their time, the chairman said: ‘Now Dr Loewenthal will give you his address’. Alphonse stood up, said, ‘1 Smits Road, Dunkeld’, and sat down again. Once, when meeting his cousin Harry at a medical meeting, Alphonse asked him: ‘Want to hear a good lecture, Harry?’ ‘Well, it depends who’s giving it’. ‘I am, of course’. ‘In that case I don’t think I’ll come’. Leaping back in mock horror Alphonse exclaimed ‘Who would think that the blood of the Loewenthal's courses through his variocele’. Again, when chairing a discussion on the tuberculides, a Jewish dermatologist asked Alphonse: ‘Why do we hear nothing these days about the rosacea-like tuberculide of Lewandowsky?’ ‘Pure anti-semitism,’ he replied.
In the 1960s, during his last decade in Johannesburg, he was invited to study the skin rashes of miners in relation to acclimatization. This was perhaps the only piece of sponsored skin research he ever did. A number of studies appeared on the subject of sweat gland function and eczema, and he came up with some interesting answers.
His association with Spain began while he was still at school; during a summer vacation he tramped across the country with a friend and learned the language. It seems that he urgently needed to get away from both his father’s anger and the Liverpool police: he had crashed his father’s car (borrowed without permission) into a municipal bus. He survived in Spain by taking odd jobs, the most appealing being in a circus where he held the flaming hoop for a wild boar to jump through. He continued building his relationship with the country during each period of leave, and in 1970 he resigned from all his dermatological appointments and retired to Spain to write books. He dropped his titles, stopped practising medicine, and took up residence at San Pedro de Ribas (Barcelona) where he became known as a writer - Alfonso Lowe, correrspondent of the Royal Academy of Cordoba. A remarkable series of smoothly written and fastidiously prepared volumes on Spain and Italy marked the last decade of his life. These include The Catalan Vengeance (1972); The Barrier and the Bridge, an historical guidebook; Companion Guide to Southern Spain (1973), probably the best guidebook to date on this region of Spain; La Serenissima: The Last Flowering of the Venetian Republic (1974), and his last published book The Culture and History of the Spanish (1975).
Loewenthal’s first wife, Kathleen Richardson, died in the 1940s and he married Stella Regina, daughter of William Herzfeld, in 1950. There were two sons and a daughter of the first marriage. In Spain, in the middle of 1981, Stella was killed in a motor accident and Alphonse was badly shaken and rapidly declined to become a near total invalid. He remained witty and uncomplaining, in spite of growing and embarrassing disability. Faltering as he was, he ensured that his companionship remained agreeable. He returned to Africa for the last months of his life and died in Cape Town. Towards the end, his son Richard asked him if he would have preferred another life or career. ‘Never. I loved it all’, was Alphonse’s reply.
GH Findlay
CJ Hackett
Sir Gordon Wolstenholme
Valérie Luniewska
[SA med. J., 1983, 64, 1064-1067]