The flowering of pathology as a medical discipline in Boston, 1892-c.1950: W.T. Councilman, FB Mallory, JH Wright, SB Wolbach and their descendants

Modern Pathology (2016) 29, 944–961 944 © 2016 USCAP, Inc All rights reserved 0893-3952/16 $32.00 The flowering of pathology as a medical discipline in Boston, 1892-c.1950: W.T. Councilman, FB Mallory, JH Wright, SB Wolbach and their descendants David N Louis1, Michael J O'Brien2 and Robert H Young1 1James Homer Wright Pathology Laboratories, Pathology Service, Massachusetts General Hospital and Department of Pathology, Harvard Medical School, Boston, MA, USA and 2Mallory Institute of Pathology, Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, MA, USA During most of the nineteenth century, the discipline of pathology in Boston made substantial strides as a result of physicians and surgeons who practiced pathology on a part-time basis. The present essay tells the subsequent story, beginning in 1892, when full-time pathologists begin to staff the medical schools and hospitals of Boston. Three individuals from this era deserve special mention: William T Councilman, Frank Burr Mallory and James Homer Wright, with Councilman remembered primarily as a visionary and teacher, Mallory as a trainer of many pathologists, and Wright as a scientist. Together with S Burt Wolbach in the early-to-mid-twentieth century, these pathologists went on to train the next generation of pathologists—a generation that then populated the various hospitals that were developed in Boston in the early 1900s. This group of seminal pathologists in turn formed the diagnostically strong, academically productive, pathology departments that grew in Boston over the remainder of the twentieth century. Modern Pathology (2016) 29, 944–961; doi:10.1038/modpathol.2016.91; published online 17 June 2016 The discipline of pathology in Boston has a rich history, extending from the early 19th century through the present day.1 Up to ~ 1950, the story can be divided roughly into three eras. The first begins with the founding in 1811 of the first full hospital in Boston, Massachusetts General Hospital (MGH), and features physicians and surgeons who practiced elements of pathology part-time; these included members of the Warren family as well as notables such as John Barnard Swett Jackson, the first professor of pathology in the United States, and Reginald Heber Fitz, the first person to have the title of ‘pathologist’ in Boston.2 The second era starts in 1892, when William T Councilman was recruited to Harvard Medical School (HMS) from Johns Hopkins University; Councilman in turn recommended the appointments of Frank Burr Mallory at the Boston Correspondence: Dr DN Louis, James Homer Wright Pathology Laboratories, Pathology Service, Massachusetts General Hospital, and Department of Pathology, Harvard Medical School, WRN225, 55 Fruit Street, Boston, MA 02114, USA. E-mail: Received 22 January 2016; revised 5 April 2016; accepted 7 April 2016; published online 17 June 2016 City Hospital (BCH) and James Homer Wright at the MGH—two pioneering full-time pathologists who, along with Councilman, set the stage for the further development of pathology in the city. The last part begins in the earlier decades of the 20th century and tells the story of Councilman and Mallory’s trainees, including S Burt Wolbach, who went on both to found and inspire the pathology departments of the many hospitals that had grown in Boston over the first half of the twentieth century (Figures 1 and 2). The 19th century and the era of physicianpathologists: the Warrens and their colleagues The first era of pathology extended from 1811 through 1892, and largely reflected the work of individuals who were primarily physicians and surgeons and who secondarily pursued studies in anatomical and clinical pathology, with much of the anatomic pathology directed toward education and research rather than clinical ends. This era featured the two founders of the MGH, the surgeon John www.modernpathology.org History of Boston pathology, 1892-c.1950 945 DN Louis et al Figure 1 Schematic illustrating that many of the pathologists who began the pathology departments at the Boston hospitals were the academic descendants of William T Councilman, Frank Burr Mallory, and S Burt Wolbach. Figure 2 Gathering of distinguished pathologists (and a few physicians) at the Mallory Institute of Pathology in the late 1940s. Back row, left to right: Drs Maxwell Finland, Shields Warren, unknown, Tracy B Mallory, William B Castle, Sidney Farber, Harold MacMahon, unknown, unknown; Front row, left to right: unknown, Drs G Kenneth Mallory, Timothy Leary, Frederic B Parker, Raymond D Adams, Arthur T Hertig. Modern Pathology (2016) 29, 944–961 History of Boston pathology, 1892-c.1950 946 DN Louis et al Figure 3 Dr William T Councilman. Courtesy of the Center for the History of Medicine, Francis A Countway Library of Medicine, Harvard Medical School. Collins Warren (1778–1856), and the physician James Jackson (1777–1867), as well as their relatives over the subsequent decades, particularly John Barnard Swett Jackson (1806–1879) and J Collins Warren (1842–1927). Other notables included the first individuals to introduce and implement microscopy at MGH and HMS, including Oliver Wendell Holmes (1809–1894) and Calvin Ellis (1826–1883), and the first to hold titles of Pathologist, Reginald Heber Fitz (1843–1918), and of Surgical Pathologist, William Fiske Whitney (1850–1921).1 The story of this first era is told in detail elsewhere.2 We concluded our essay on that period with the following comments, under the subtitle The End of the Beginning: 'William T Councilman arrived at HMS to succeed Fitz as Shattuck Professor of Pathological Anatomy in 1892. This augured a new era of pathology in Boston, reflecting the changing times...’ The present essay picks up the story in 1892 and continues it until about 1950. The turn of the last century and the transition to full-time pathologists: William Councilman, Frank Burr Mallory, and James Homer Wright The end of the nineteenth century was a critical period for American medicine. Systemic reform was needed if the United States was to participate in the great advances in medical discovery and practice that were occurring in Europe, particularly Modern Pathology (2016) 29, 944–961 in Germany.3 Pathology, a specialty that included the microscopic examination of diseased tissues and the new science of bacteriology, was seen as an important agent of medical progress. With an eye to this, HMS recruited, for the first time, a medical school professor who was not home-grown, William T Councilman, from Johns Hopkins (an institution that had pioneered in the establishment of pathology as a critical discipline), as the Shattuck Professor of Pathology (Pathological Anatomy).4 Councilman, in turn, placed two brilliant men in positions within his purview, Frank Burr Mallory at BCH and James Homer Wright at MGH.5 Together, these three men set the future trajectory of pathology in Boston and are often refer (...truncated)