The Early Days

The rich history of pathology at the Massachusetts General Hospital goes back to soon after the founding of the hospital in 1811 when limited autopsies were done by physicians and surgeons. Although some luminaries practiced pathology in significant manner at the hospital over the next 75 years, it was only upon the arrival of Dr. James Homer Wright, a native of Pittsburgh, who become the first full-time pathologist of the hospital in 1896, that pathology came upon the hospital stage as a major discipline and service. In the mid-1890’s the hospital trustees determined that a full-time pathologist was needed and recruited Dr. Wright, who had been working at the Boston City Hospital since 1893, to be Associate Pathologist and Director of the newly established clinico-pathologic laboratories. He took up this position on March 13, 1896 when still only 26-years-old. The new laboratory, on Allen Street, now the Western extension of Blossom Street was officially opened on October 16, 1896, the 50th anniversary of the hospital’s first public demonstration of the use of ether anesthesia.

Microscopists

Of those who preceded Dr. Wright, the most noteworthy individuals were Dr. John Barnard Sweet Jackson, an internist who was appointed “microscopist” at the hospital in 1847 and became the first Professor of Pathological Anatomy in the United States, holding this position at Harvard Medical School. Dr. Calvin W. Ellis was the first to significantly utilize the microscope in evaluating specimens. He also held the title of Professor of Pathological Anatomy and was succeeded in that position by Dr. Reginald Heber Fitz who, amongst other claims to fame, first elucidated the nature of appendicitis. Dr. John Collins Warren, one of many eminent members of a distinguished family of Boston physicians, after whom the building that houses the present day anatomic pathology laboratories is named, made important contributions to medicine, including pathology in the latter years of the 19th century. He was a surgeon who had studied under Virchow and Rokitansky. He may have been the first “pathologist” to utilize the frozen section technique and was a pioneer of needle biopsy evaluation of breast lesions. He also authored a major book “Surgical Pathology and Therapeutics”, one of the first texts emphasizing gross and microscopic pathology.

Dr. Wright's Contributions

Dr. Wright made many important contributions. He demonstrated that multiple myeloma is a tumor of plasma cells, that platelets arise from megakaryocytes, that spirochetes can be identified in syphilitic aneurysms of the aorta, and that neuroblastoma is of nerve cell lineage and contains what became famous as “Homer Wright” rosettes. He also wrote a classic paper on the pathology of actinomycosis, and described a modification of the Romanowsky stain of blood, that later became known as the “Wright stain” and is still widely used. He described an important modification of frozen section methodology, which became the most widely used technique in the United States until the advent of the cryostat. He wrote with Dr. Frank B. Mallory of the Boston City Hospital a book, “Pathological Technique”, which went through eight editions and was the most widely used book of its kind in American pathology laboratories for five decades.

A major development midway through Dr. Wright’s term as Chief of Pathology was the initiation of the clinicopathological conferences that became famous as “Case Records of the Massachusetts General Hospital”. These were begun in early 1910 by the famous internist, Dr. Richard C. Cabot, with Dr. Wright presenting the pathological findings. In 1915 Dr. Cabot began recording these exercises. In 1924 publication began in the Boston Medical and Surgical Journal (the predecessor of the New England Journal of Medicine) and it continues to this day.

During the Wright era physicians who primarily worked in other disciplines elsewhere in the hospital made significant contributions to the field of pathology. Dr. John T. Bowen, Professor of Dermatology and Syphilology, described the disease (in situ carcinoma of the skin) that bears his name. Dr. Ernest Amory Codman, a surgeon and co-founder of the American College of Surgeons, had a special interest in bone pathology. He co-founded the bone sarcoma registry, the first tumor registry in the United States with Dr. James Ewing of New York and Dr. Joseph Bloodgood of Baltimore. In 1935 he described the chondroblastoma (Codman’s tumor).

First Residency Program

Dr. Wright was succeeded as Chief of Pathology by Dr. Tracy B. Mallory (a son of Dr. Frank B. Mallory) in 1926. One of Dr. Mallory’s first initiatives was to organize for the first time a residency training program in pathology. In 1935 Dr. Mallory succeeded Dr. Cabot as Editor of the Case Records of the Massachusetts General Hospital. In 1942 he formulated with Dr. Edward A. Gall, a widely used histological classification of lymphomas based on an analysis of 618 cases, and co-authored with his younger associate, Dr. Benjamin Castleman, numerous articles on diseases of the parathyroid gland. He also wrote an important paper on early carcinoma of the stomach. During World War II Dr. Mallory enlisted and became Chief Consultant in Pathology for the Mediterranean Theater. Classic papers on the pathology of acute tubular necrosis, traumatic shock, infectious hepatitis and other disorders related to war wounds emanated from this experience. During the Mallory years, Dr. Walter Lever, a dermatologist interested in pathology, wrote the first of numerous editions of his widely used book on dermatopathology.

Neuropathology Laboratory

During Dr. Mallory’s tenure, in 1927, Dr. James B. Ayer, Chief of the Neurology Service, recruited Dr. Charles S. Kubik to found the Neuropathology Laboratory. Dr. Kubik directed this Laboratory for many decades, closely integrating activities of the Pathology and Neurology Services, and it became one of the leading centers for neuropathology in the world. Dr. Kubik had wide interests in both neurology and neuropathology, and served as the Chief of the Neurology service from 1946 to 1951. Much later, in his honor, the Laboratory was named the C.S. Kubik Laboratory for Neuropathology. In 1949, Dr. E.P. Richardson, Jr., joined the Neuropathology Laboratory. Dr. Richardson, a wonderful teacher and expert diagnostician, led the Laboratory for almost four decades, a period that included neuropathological training of many of the current leaders in the fields of neurology and neuropathology. Dr. Richardson received strong support from Dr. Raymond Adams, Chief of the Neurology Service who had a remarkable dedication to neuropathology, particularly the study of muscle diseases. Dr. Richardson himself made many seminal contributions including the original description of progressive multifocal leukoencephalopathy and landmark clinicopathological studies of a number of entities. In 2001, the signout room in the renovated Neuropathology unit was dedicated to him, as the E.P. Richardson, Jr., Room for the Study of Neuropathology.

Post-War Era

In 1949 Dr. Austin L. Vickery, Jr., joined the staff. He authored many important papers on the pathology of the thyroid gland, including pioneering descriptions on needle biopsy diagnosis, radiation effects, thyroiditis and thyroid tumors over an illustrious 50 year career. He and his wife generously provided the funds for a Harvard Medical School Professor of Pathology, to be based at the Massachusetts General Hospital, in Dr. Vickery’s name.

Dr. Robert E. Scully joined the staff of the department in 1950 and has had a most distinguished career that still continues. Dr. Scully undertook important early studies of testicular tumors when knowledge of them was exceedingly limited and soon added to that interest one in gynecologic pathology, particularly ovarian pathology. He rapidly became known worldwide as an acknowledged authority in genital tract pathology and is widely acknowledged to be the preeminent gynecologic pathologist in the world. The classification of female genital tract tumors that is currently used is his creation and he has made numerous contributions to the literature in the form of description of new entitles. He is considered by most who have worked with him without peer as a diagnostic pathologist and despite his specialty interests in gynecologic and testicular pathology for most of his career was the last resort for challenging cases in many different areas. Dr. Scully has received numerous awards that reflect his stature in pathology including the Maude Abbott Lectureship and Distinguished Pathologist Awards of the United States-Canadian Academy of Pathology and an Honorary Fellowship of the Royal College of Pathologists of Great Britain. He succeeded Dr. Castleman as Editor of the Case Records of Massachusetts General Hospital in 1975 and carried out this obligation for a record 27 years.

In 1951 Dr. Benjamin Castleman, a graduate of Yale University, succeeded Dr. Mallory as Chief of Pathology and Editor of the Case Records of the Massachusetts General Hospital. He continued his investigations of parathyroid disease, and wrote numerous important papers on diseases of the thymus and mediastinum, including Castleman’s disease of lymph nodes. He also authored or co-authored many papers on the pathology of a variety of diseases as well as Armed Forces Institute of Pathology fascicles on tumors of the thymus and parathyroid glands. Dr. Castleman’s former residents created the Benjamin Castleman Award, which is presented annually at the meeting of the United-States-Canadian Division of the International Academy of Pathology to a young pathologist who has performed outstanding research. Additionally, in 1982 funds provided by Dr. Castleman’s family, students, colleagues and friends enabled the endowment of the Benjamin Castleman Chair of Pathology at Harvard Medical School, the first occupant of which was Robert Timmons McCluskey who succeeded Dr. Castleman as Chief of Pathology in 1974. Two weeks before his death Dr. Castleman was present at a ceremony at which this title was awarded to his successor.

Until the early years of Dr. Castleman’s tenure, the pathology department had been housed in an old building on Allen Street and had outgrown its outdated facilities. When the Warren Building was built in the early 1950’s Dr. Castleman was able to get substantial space within it for pathology and in 1956 the laboratories moved to that building and have occupied the entire first three floors and part or all of other floors since that time. Dr. Castleman’s admiration for the seminal contributions of Dr. Wright led him to suggest that the new laboratories in the Warren Building be named the “James Homer Wright Pathology Laboratories”. This suggestion was approved by the hospital trustees. The building was dedicated at a ceremony on December 15, 1956 . Many visiting dignitaries, including Dr. Wright’s sister and two eminent pathologists, Dr. Fred W. Stewart, Chief of Pathology at Memorial Sloan-Kettering cancer Center and Dr. William Boyd author of numerous pathology textbooks, participated in the ceremony. During the “Castleman Era” Dr. Ronald C. Sniffen, a Canadian who had been a resident in the 1940’s during Dr. Mallory’s era wrote extensively on normal and abnormal testicular development. He classified various types of pathological lesions in testicular biopsy specimens from infertile men and sexually precocious boys. One of the first resident recruits of Dr. Castleman was Dr. Leonard Atkins who began his training in 1951 and ended up spending over 50 years in the department with the exception of one year studying abroad. He was one of the first to undertake serious investigation of chromosomal abnormalities in human disease and was the first director of the cytogenetics unit of the hospital and served in that capacity for 36 years before the cytogenetics laboratory was merged with that of the Brigham and Women’s Hospital and located at the latter institution. Dr. Atkins participated in many important papers on cytogenetics and was also a medical examiner for many years.

Cytopathology & Dermatopathology

An important development in the mid 1950’s was the move of the cytology laboratory of the hospital from the Vincent Memorial service of gynecology to the pathology department in 1956. Dr. Priscilla Dienes Taft was the first pathologist to practice cytopathology exclusively and directed the cytopathology unit for over 30 years. Her husband, Dr. Edgar Taft, was also on the faculty for several decades.

Notable Appointees

In 1959 Dr. Castleman recruited Dr. Walter G.J. Putschar an Austrian pathologist with special interest in diseases of the musculoskeletal system and Consultant at the Armed Forces Institute of Pathology, to join the staff. He continued to make contributions to the pathology of bone and joint and other diseases, co-authored a book on paleopathology, and was an inspiring teacher. After his death Dr. Putschar’s colleagues and students funded an annual visiting lectureship in his name, a highlight of the academic year of the department. Illustrious pathologists from others institution visit for two days to give lectures and slide seminars. The major department conference room is named after Dr. Putschar.

In 1962 Dr. Castleman recruited Dr. Wallace H. Clark, at the time Professor of Pathology at Tulane University, to join the department and head up Dermatopathology. During the next seven years Dr. Clark conducted a number of major studies on malignant melanoma and developed a prognostically important way of subcategorizing the depth of invasion of melanoma, which is widely known as “Clark’s levels”. A major collaborator in this work was Dr. Martin C. Mihm Jr. who succeeded Dr. Clark as chief of dermatopathology and like him became internationally known for his work on skin pathology, particularly melanoma.

The later 20th century: Clinical Laboratories and Research

In 1974 Dr. Castleman was succeeded as Chief of Pathology by Dr. Robert T. McCluskey. He was a pioneer in the study of mechanisms of inflammation and use of immunofluorescence as an investigative tool in delineating the nature of glomerular diseases and as an aid in the differential diagnosis of renal disorders. He also did research on pathogenetic factors in renal disease and vasculitis, including Wegener’s granulomatosis. A major development during Dr. McCluskey’s tenure was the bringing into the pathology department of the various clinical laboratories of the hospital. This was much needed and appropriate inasmuch as the first full-time pathologist, Dr. Wright, had himself had strong interests in laboratory medicine, particularly microbiology. However, until the 1970s the clinical laboratories had been individual laboratories, often run by clinicians, and without any specific linkage with the pathology department. Toward the end of Dr. McCluskey’s tenure as Chief, the laboratories were begun to be brought together within a division of Laboratory Medicine within the Department of Pathology, a structure that existed until late in 2006.

Another important development brought about by Dr. McCluskey was a marked expansion of research space within the department. This led to the creation of an entire floor of the Cox Building devoted to investigative pathology, relocated later to the 5th floor of the Warren Building, closer to the spiritual home of the department. By the end of Dr. McCluskey’s term as Chief, the department was strong in all three branches of pathology, anatomic pathology, laboratory medicine, and investigative pathology.

In 1991 Dr. McCluskey was succeeded as Chief of Pathology by Dr. Robert B. Colvin. He is also an authority on renal diseases, as well as flow cytometry and has a major interest in immunological mechanisms of disease.  Dr. Colvin continued the integration of the clinical laboratories, with this process largely completed by the mid-1990s.  Dr. Colvin also continued the research expansion of the department, primarily through development of the research laboratories in Building 149 of the Charlestown Navy Yard.  Initially, the research group focused on immunopathology.  In 2001, Dr. Colvin appointed Dr. David Louis as founding director of a new departmental division, the Division of Molecular Pathology and Research.  Under Dr. Louis, the Molecular Pathology Unit in Charlestown took a new direction, with an emphasis on cancer research, and begun a comprehensive series of basic science recruits that continues to this day.

In 1996, the department celebrated its 100th anniversary. In recognition of the glorious past of the department, Dr. Colvin commissioned a Centennial Celebration that was held during the Columbus Day weekend of 1996. Over 200 current and former members of the department convened to hear a series of historical and scientific talks that had been jointly organized by Dr. Vickery and Dr. Scully.

During the decade of Dr. Colvin’s stewardship there has been a major increase in the clinical service of the department because of continued hospital expansion. To address this, and the increased complexity of reporting in the modern era, Dr. Colvin approved (in 1996), a change to complete subspecialty signout rotations for the staff pathologists. The department was the first to take this approach, which has proved successful, and is serving as a model for others.

Pathology Today

In 2006 Dr. Colvin was succeeded as Chief of Pathology by Dr. David N. Louis, an authority on the molecular genetics and pathology of nervous system tumors.  Dr. Louis undertook a reorganization of the department, unifying the three divisions of Anatomic Pathology, Laboratory Medicine and Molecular Pathology and Research into a single departmental structure, with mission-based clinical service, teaching and research programs that overlap the old divisions.  The department is currently continuing the expansion of departmental research, with an emphasis on the cancer biology program in Charlestown, and is beginning an entire department-wide program in pathology informatics.  Today the department continues to thrive with superior clinical diagnostic experience, leading edge research and a residency training program that is among the best in the world.

Notes:

1. Scully RE, Vickery AL Jr. Surgical pathology at the hospitals of Harvard Medical School. Chapter 6 in Rosai J, ed. Guiding the Surgeon's Hand, The History of American Surgical Pathology. Armed Forces Institute of Pathology, Washington, DC, 1997.

2. Lee RE, Young RH, Castleman B. James Homer Wright. A Biography of the Enigmatic Creator of the Wright Stain on the Occasion of Its Centennial. Am J Surg Pathol 26:88-96, 2002.

3. Richardson, EP Jr., Astrom KE, Kleihues P. The Development of Neuropathology at the Massachusetts General Hospital and Harvard Medical School. Brain Pathol 4:181-195, 1994.