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Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e31827472ae
Book Review

Keen Minds to Explore the Dark Continents of Disease: A History of the Pathology Services at the Massachusetts General Hospital

Ulbright, Thomas M. MD

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Author Information

Department of Pathology, Indiana University School of Medicine Indianapolis, IN

The author has no funding or conflicts of interest to disclose.

History is the essence of innumerable biographies. Thomas Carlisle.

This work, coedited by 2 long-standing faculty members at the Massachusetts General Hospital (MGH), is a comprehensive history of the Pathology Services at that institution. It takes its title from a history of the MGH written by John Garland upon the sesquicentennial of the hospital; he commented that the partnership between the MGH and Harvard Medical School had “created an atmosphere that excites keen minds to explore the dark continents of disease.” The authors have provided us a privileged glimpse into some of these minds. The only somewhat comparable work that comes to mind is the one edited by Dr Juan Rosai, Guiding the Surgeon’s Hand: The History of American Surgical Pathology (Washington, DC: American Registry of Pathology, 1997). The focus of that work is simultaneously broader, dealing with several institutions, and more narrowly focused, dealing exclusively with the discipline of surgical pathology.

The book is divided into 25 separate chapters that are written by current and past members of the Department. Six are relatively broad overviews of periods of development of Pathology at the MGH from its essential nonexistence in the early days of the hospital, which admitted its first patient in 1821, to the sophisticated and subspecialized entity that exists today. This institutional history provides great insight and historical perspective in a broader sense concerning how our discipline arrived where we now find it. Among these chapters, we learn that the first physician to focus on pathology was John Barnard Swett Jackson, who became the first professor of pathology in the United States in 1847 and solely used macroscopic observations for his diagnoses. Four of the chapters document the progressive changes that occurred under the leadership of 4 remarkable individuals, James Homer Wright, Tracy B. Mallory, Benjamin Castleman, and Robert T. McCluskey. Each of these chapters is followed by biographically oriented chapters devoted to these luminaries that provide fascinating insights into their personalities. The remaining chapters are either biographical concerning various faculty members or are focused on the history of a particular discipline, such as the Autopsy Service, Surgical Pathology, Microbiology, or the Blood Transfusion Service, among others. In addition, there is a separate chapter concerning the history of the clinical pathologic conferences at the MGH, the records of which have remained a fixture in The New England Journal of Medicine for over 80 years.

All of the chapters are replete with excellently reproduced black and white photographs, mostly devoted to the numerous personalities that helped turn Pathology at the MGH into the leader it is today. Individual pictures are supplemented by group photographs and occasional spur-of-the-moment images. Original documents, some handwritten, are illustrated in a number of the chapters, which are also filled with quotations from primary sources or personally recollected conversations. A comprehensive index is provided so that an interested reader can easily locate those pages dealing with certain topics or people. The price of this book, as listed on the dust jacket, is $35, which is an incredible bargain, given the high-quality glossy paper and the excellent reproductions. Pretty clearly the book has been subsidized by the publisher, which is the MGH.

Although there is much to be commended in this volume, what I found most appealing were the biographical chapters that provided insights into the traits of many of these “pathology heroes.” These include chapters devoted to the 4 individuals already mentioned and also to Drs Reginald Heber Fitz, Austin L. Vickery Jr, Robert E. Scully, Edward P. Richardson Jr, and Walter G. J. Putschar. Among these, we learn that Dr Castleman took great pride in concocting the annual Christmas holiday punch and hated relinquishing that responsibility at his retirement. We gain insight not only concerning the remarkable diagnostic abilities of Dr Robert Scully but also his patience and generosity with trainees; for those of us whose offices are not perfectly ordered, we can take comfort in a photograph of Dr Scully at his office microscope with several feet of stacked journals hovering precariously above his head. We learn of the excellent 25-cent dry martinis enjoyed by Drs Vickery and Scully while in military service in Japan during the Korean War and are once again reminded of the importance of Dr Vickery’s landmark paper supporting conservative management of intrathyroidal papillary carcinoma (Cancer 1987;60:2587–2595), perhaps one that should be required reading for surgeons operating on the thyroid. An incident concerning Dr Walter Putschar is priceless. As he dissected a knee, an imperious rheumatologist asked him if he was familiar with the description of the knee in the Henke-Lubarsch reference textbook. Dr Putschar’s brief response was, “I wrote it.” For those of us who feel lack of institutional support, we can take some solace in the experience of Dr Charles Kubik, the first Director of Neuropathology, who only acquired a microtome by finding an abandoned one under the seats of the old Pathology Amphitheater and who had to cut and stain his own tissue sections. We also get to know something of Dr E.P. Richardson Jr, a preeminent neuropathologist and long-standing Director of Neuropathology, who, upon being asked how long he had been at the MGH replied, “Well… I was born here.” There are too many such anecdotes but to briefly mention a few here. This work certainly justifies Carlisle’s dictum, quoted at the beginning of this review, and makes the correlate that an exceptional department is made by exceptional people.

I recommend this book to anyone who has an interest in the history of pathology. It will be of particular appeal to the many who have been associated with the MGH Pathology Service. Virtually anyone who has ever spent a meaningful amount of time there is likely to be mentioned and very likely to be pictured in a photograph. It will also interest those of you who, like me, have neither trained nor worked at the MGH but who enjoy learning about those who have contributed so much to our profession. The wisdom of past generations becomes available to us through work such as this. As most of us struggle with the ongoing push to provide the most rapid turnaround time possible, we should remember the wisdom of Dr Tracy B. Mallory, whose 1935 observation is quoted in the book: “Satisfactory relationships…demand…a working compromise between maximal accuracy and reasonable speed.” “…[yet] many patients present problems of special interest or difficulty requiring individual, and consequently time-consuming attention. Yet it is through the results of this type of examination that the influence of the laboratory upon the hospital is particularly felt.”

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Thomas M. Ulbright, MD

Department of Pathology, Indiana University School of Medicine, Indianapolis, IN

© 2012 Lippincott Williams & Wilkins, Inc.

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