In Memoriam
Dr. Marsden Scott Blois, Jr.
1919-1988
UCSF Professor of Medicine

At the time of his death, Scott Blois was 69 years of age and was Professor and Chairman of the Section on Medical Information Science at the University of California in San Francisco. He was also Professor of Dermatology and founder and Director of the Melanoma Clinic there. It is difficult to imagine the breadth of contributions in such a personable and humble man, but the events following his death have taught us that no one person can accurately summarize all the facts. The following information has been compiled with the help of David Sherertz and Mark Tuttle in the Section on Medical Information Science, and Phillip Banda in the Department of Chemistry at San Jose State University. Although I myself have worked with Scott since the founding of the UCSF Melanoma Clinic in 1971, I was unaware of many areas of his earlier scientific career.

Scott was born in San Antonio, Texas, January 5, 1919. He lived in various areas of California during his early schooling, including the Central Valley and San Francisco. He enrolled in the United States Naval Academy in 1938. His class at Annapolis was accelerated because of World War II and he graduated a year early in 1941. He was immediately assigned as a line officer on a destroyer escort in the South Pacific. On rare occasions he would relate his war experiences, including the time that his ship sank during fierce combat, forcing him and other crew members to spend hours treading shark-infested waters.

Following this unusual preparation for a scientific career, Scott spent the remaining years of the war conducting classified work for what was to become the Office of Naval Research (ONR) in Washington, D.C. Scott continued to carry out research in the Navy, and was Director of Research at the naval facilities in Corona, California, until the late 1940s when he resigned from the Navy to begin graduate studies in physics at Stanford University. He worked under Professor Paul Kirkpatrick on the physical and magnetic properties of deposited metallic thin films. He received his Ph.D. in physics from Stanford in 1952. Along with most world War II veterans, Scott had a growing family to provide for during his graduate schooling.

While in graduate school at Stanford, Scott developed an interest in applying physical methods to the study of biological problems. After receiving his degree in physics, Scott joined with some other physics graduates interested in physical approaches to biology, to help found the Biophysics Laboratory on the Stanford campus as part of the Hansen Laboratories of Applied Physics. Scott later served as Director of the Biophysics Graduate Program, while developing his research on the electron spin resonance of biopolymers, including melanins.

He observed the presence of free radicals trapped in melanin, and was one of the first investigators to suggest that free radicals were an integral part of biological systems. This occurred at a time when free radicals were considered far too reactive to be associated with living systems. Research over the intervening years has long since confirmed the presence and importance of free radical reactions in living systems. Scott's interest in melanin as a unique biopolymer carried him to the study of melanin production in vivo, its aberrant production in melanoma tissue, and eventually to pursue a research and clinical career in dermatology.

Scott began his medical studies at Stanford Medical School while he was Director of the Biophysics Laboratory, a position he left to begin a dermatology residency. Dr. Eugene Farber, then Chair of Dermatology at Stanford, tells of the years when Scott as a resident would work in the morning and afternoon clinics and then devote lunch hours and evenings to his research lab.

The Melanoma Clinic at UCSF began because of Scott's recognition of the fragmentation of care for melanoma patients. In 1971 dermatologists and family physicians were seeing the initial lesions, and surgeons were rather radically performing "definitive therapy." At that point many patients were left on their own without any coherent or recognizable followup. Together with physicians at Temple University (Dr. Wallace H. Clark Jr.), New York University (Dr. Alfred Kopf) and Massachusetts General Hospital (Dr. Thomas B. Fitzpatrick), Scott organized the Melanoma Clinical Cooperative Group, with the purpose of assembling a data base of clinical information to follow what Dr. Clark called the "natural history of neoplasia." Unlike the situation today, when powerful and user-friendly computing resources support clinic data management, the early attempts to collect large numbers of attributes were fraught with frustrations. After a period of several years the Melanoma Cooperative Group was no longer funded, but the institutions continued on their own. At UCSF, because of Dr. Blois' expertise in medical computing as well as his interest in patient care, the Melanoma Data Base grew and the computer science prospered. It was my privilege to be able to follow some of this development as well as to watch Scott Blois treat patients on an individual basis. His kind and gentle manner may well have derived from his upbringing in rural areas of California, including its Central Valley. He had a friendly way of speaking to patients, who were referred to the Melanoma Clinic from similar regions of the Western U.S. That calmed their fears and anxieties. His natural ability to interact with patients at this metaphysical level was greatly respected by other physicians. It led to an early recognition that clinical psychology and clinical psychologists could play an important role in helping us understand the response of patients to their disease, as well as to learn the effect that the disease had on their personal and professional lives. Since 1973, Scott Blois did all this despite his own diagnosis of malignant lymphoma which necessitated a series of debilitating and painful therapies. His selfless attitude toward patients never varied and his energy toward pursuing expertise and excellence in the clinic as well as in his research work never faltered.

The Melanoma Clinic grew from seeing a handful of patients in the first year to more than 250 per year at the time of his death. He established a non-profit organization, The Melanoma Foundation, to further the teaching, research and service aspects of patients with melanoma. At the time of his death, he had plans to merge several U.S. and European melanoma data bases. Scott could not attend a meeting in Germany, scheduled shortly before his death, to go over the details of that country's participation. It was his intent to use the resulting greatly enlarged data set to answer questions about the natural history of melanoma and to resolve the apparent differences between the U.S. and European experiences. In honor of these and his many other efforts, the UCSF Melanoma Clinic has been renamed the Marsden Scott Blois Jr. Melanoma Clinic.

Despite his considerable clinical responsibilities during the 1970s and early 80s, Scott made fundamental contributions to the evolving field of Medical Informatics during this period. He founded and chaired the Section on Medical Information Science at UCSF, a department among the first of such programs to receive a training grant from the National Library of Medicine. This began a long relationship with the NLM which Scott continued until his death. One of Scott's early successes in medical computing was the development and evaluation of the diagnostic prompting program called RECONSIDER. Concerned that then exemplary programs in medical computing contained "knowledge" which was not understandable by physicians, Scott proposed to develop "prompting" programs based on the notion of structured text. Structured text was simply text which was easier to process computationally than narrative text, but which was still easily understood by people.

Later, with support from a writing grant from NLM, Scott wrote the landmark volume entitled Information and Medicine; The Nature of Medical Descriptions. A sequel to some of the ideas in this book appeared recently.

At the time of his death, Scott's Informatics research was supported by both a grant (the "Lexicon Grant") and a contract (the "UMLS Project") from the NLM. Both awards were fitting recognition of work begun more than 15 years before on medical informatics.

Scott has received both national and world-wide recognition for the work that has come from his establishment of the Melanoma Clinic and the Medical Information Science program at the University of California. However, it should not be forgotten that he also had a distinguished career at Stanford, and that his early work on the magnetic properties of metallic thin films, i.e. information storage, which resulted in a U.S. patent, and on free radicals in biological systems, was in each case years ahead of the field. Scott's interest in metallic thin films arose from his recognition of their potential for information and data storage, which he viewed to be a major problem during his war years in the Navy. Scott's early interest in information processing and storage was a contributing factor in his selection to head the Medical Information Sciences Section at UCSF. His continued interest in information processing and tireless efforts for the National Library of Medicine (NLM) led to his election as Chairman of the NLM's Biomedical Library Review Committee a few months before his death.

Scott will be deservedly remembered as an individual, a melanoma clinician, and a program director in medical informatics, but it should not be forgotten that he was an excellent laboratory research scientist with a keen sense for fundamental problems. Scott was a very intellectual being--searching for what he half-jokingly termed "ultimate clarity"--but this was never a barrier in discussions with patients and colleagues. Though his lymphoma and its therapy was painful and caused a tremendous drain of his energy, he was always willing to help any patient or relative when they asked. His illness itself seemed to make him a more compassionate doctor--"only the wounded physician heals."

It has been a real privilege to work with a man of this stature, and all the while collaborating with him on a day-to-day basis, thinking of him as merely another colleague and friend, admiring his gentleness toward patients and even towards administrative problems, and somehow never quite recognizing the magnitude in importance of all the various facets of his life and work put together -- until perhaps now.