History of Pathology

History of Pathology at Mass General

The rich history of pathology at Massachusetts General Hospital goes back to soon after the founding of the hospital in 1811 and continues to the present day. The history of the department has been the subject of articles and a book, and those interested are referred to the references at the end of this brief summary for more information. In addition, chapters from Keen Minds to Explore the Dark Continents of Disease, a book on the history of the department that was published in 2011, are now available for download in PDF format.

The Early Days of the Physician/Surgeon-Pathologists, Chemists, Curators and Microscopists

Autopsies were undertaken by physicians and surgeons from the earliest days of the hospital. The most noteworthy individuals in the first half century of pathology at Mas General included Dr. John Collin Warren, one of the founders of the hospital who wrote a book on gross pathology, and Dr. John Barnard Sweet Jackson, an internist at Mass General who became the first Professor of Pathological Anatomy in the United States, holding this position at Harvard Medical School (HMS). Dr. Jackson and others were major contributors to teaching collections at Mass General and HMS, and held positions such as “Curator of the Pathological Cabinet” at Mass General and curator of the Warren Anatomical Museum at HMS. Clinical activities in chemistry and microscopy grew at MGH after 1851, with the appointment of the first Microscopist and Chemist (Dr. John Bacon) in that year.  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, among other claims to fame, first elucidated the nature of appendicitis. Dr. J. Collins Warren (grandson of the aforementioned Dr. Warren and member of the distinguished family of Boston physicians after whom the building that houses the present day anatomic pathology laboratories is named) made important contributions to 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.

The Wright Era, the Emergence of Clinical Chemistry and Microbiology, and the Start of the CPCs

In the mid-1890s the hospital trustees determined that a full-time pathologist was needed and recruited Dr. James Homer Wright, who had been working at the Boston City Hospital since 1893, to be Associate Pathologist and Director of the newly established clinicopathologic laboratories. He took up this position as the first full-time pathologist at the hospital 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.

It was only upon the arrival of Dr. Wright that pathology came upon the hospital stage as a distinct discipline and service. 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 blood stain 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.

In addition to his investigative work in bacteriology, Dr. Wright was instrumental in the development of clinical bacteriology at the hospital. He oversaw tremendous growth in this area, setting the stage for the arrival of Dr. Louis Dienes in 1930; Dr. Dienes did investigative work in microbiology for many decades at Mass General, including the discovery of Mycoplasma, and oversaw major expansion of the clinical microbiology laboratories in the 1930s and 1940s. In 1952, Microbiology left Pathology and became part of Infectious Disease; it was led by Dr. Lawrence Kunz during the 1950s, 1960s and 1970s.

Another area that was fostered by Dr. Wright was clinica chemistry, led in the 1910s by the team of Drs. Otto Folin (who developed quantitative approaches such as the Folin-Wu method for determining blood glucose) and Willey Denis (the first woman faculty member at Mass General). As clinical chemistry became more specialized over the next few decades, specialty laboratories grew up in association with the respective divisions of the Medicine department at MGH, e.g., endocrinology.

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).

The Mallory Era, the First Residency Program and the Start of Dermatopathology, Neuropathology and the Blood Bank

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. (Dr. Benjamin Castleman, who became the fourth Chief of Pathology in 1952, was the first resident in the program.) 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. He also worked with Castleman on diseases of the parathyroid gland, and 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.

In 1927, Dr. Mallory and 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.

Although pioneering work on blood storage and transfusion has been done by MGH physicians during World War I, the Blood Bank began later at Mass General, in 1942, and played a role in managing patients involved in the Cocoanut Grove nightclub fire in the year. The Bank developed in the Surgical Service, in collaboration with Pathology, with the initial director being Dr. Lamar Soutter. The subsequent directors of the Blood Bank and Blood Transfusion Service from the 1950s through the 1980s, Drs. Morten Grove-Rasmussen and Charles Huggins, also made major contributions to the field.

Benjamin Castleman, Austin Vickery, Robert Scully and the Growth of Surgical Pathology and Cytopathology

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 also had a most distinguished career, spanning 55 years. Dr. Scully undertook important studies of testicular tumors and in gynecologic pathology, particularly ovarian pathology. He rapidly became known worldwide as an acknowledged authority in genital tract pathology. The classification of female genital tract tumors that is currently used is based on his formulations and he has made numerous contributions to the literature in the form of description of new entitles. Dr. Scully succeeded Dr. Castleman as Editor of the Case Records of Massachusetts General Hospital in 1975 and carried out this role for a record 27 years.

In 1952 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 1950s 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.

One of the first resident recruits of Dr. Castleman was Dr. Leonard Atkins. Dr. Atkins was one of the first to undertake serious investigation of chromosomal abnormalities in human disease and was the first director of the Cytogenetics Unit, which was the largest in New England for many years. Another important development in the mid 1950s was the move of the cytology laboratory of the hospital from the Vincent Memorial service of Gynecology to Pathology in 1956. Dr. Priscilla Dienes Taft was the first pathologist to practice cytopathology exclusively and directed Cytopathology for over 30 years.

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. From the 1920s until the 1970s, most of the clinical laboratories had been individual laboratories, often run by clinicians, and without any specific linkage with Pathology. 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. 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, 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. 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.

Dr. Colvin's stewardship saw a major increase in the clinical services of the department because of continued hospital expansion. With increased complexity of reporting in the modern era, Dr. Colvin approved (in 1996), a change to full 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 capitalized on the accomplishments of Dr. Colvin's tenure by utilizing departmental as well as hospital strengths to set directions for further departmental growth and development. He began programs to unify the department into a single operational unit and to develop the three key areas of molecular diagnostic pathology, molecular pathology research and pathology informatics — believing that these three areas represented the directions that the field was taking, and that MGH Pathology was well-positioned to lead the way in these areas.

As a result, the department has developed many new initiatives to move the department and field forward. For example, we have:

• Restructured the department in a mission-driven manner, administratively unifying the diverse laboratories so that the emphasis is on unified, cross-cutting clinical services, teaching and research — rather than on the more historically based silos of anatomical pathology, clinical pathology and pathology research
• Begun new divisions, one focused on Pathology Informatics (already with a successful fellowship and a considerable research portfolio) and a second on Quality and Safety — each led by a nationally known pathologist recruited to the department
• Invigorated the research program, with tremendous growth recognized by increases in research faculty, grant funding, research space and Harvard graduate students; by appointments to the Howard Hughes Medical Institute and to the Broad Institute of Harvard and MIT; and by scientific publications and national recognition such as advanced cancer molecular diagnostic breakthroughs (see our Pathology News in the Media.)
• Restructured and expanded the residency and fellowship programs to customize, and facilitate careers in academic pathology for our trainees
• Invested in many clinical areas of the department, notably in recruitment of new clinical faculty and in molecular diagnostics, and with completed plans for major infrastructure updates across the clinical laboratories

Today, the department has about 90 faculty, 800 employees and approximately 50 residents and clinical fellows; a budget of over $125 million per year; and test volumes that exceed 10 million clinical laboratory tests, 80,000 surgical specimens, 60,000 cytopathology specimens and 35,000 red cell transfusions each year. The current department is completely subspecialized, so that each organ system has its dedicated pathology team of specialists, in many cases combining clinical and research interests. We are structured this way to optimize clinical expertise, teaching and research productivity over a large department and within a dynamic set of institutions.

The remarkable strengths and traditions that have long made Mass General Pathology a leader in the field now allow the department to continue its role of advancing diagnosis and discovery.

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

In 2011, for the 200th anniversary of the hospital’s founding, the Pathology Service published a book entitled Keen Minds to Explore the Dark Continents of Disease: A History of the Pathology Services at the Massachusetts General Hospital. Edited by Drs. David N. Louis and Robert H. Young, the book tells the stories of the pathologists and the Pathology laboratories at the Mass General, bringing notable events, discoveries, and individuals to life in print for the first time.

The title of the book comes from a 1961 history of Mass General by Joseph Garland, in which he wrote that the partnership between the Mass General and Harvard “has created an atmosphere that excites keen minds to explore the dark continents of disease.” The phrase captures the story told in the history of MGH Pathology: many keen pathologists at MGH have worked toward a better understanding of disease in order to improve diagnosis and treatment for patients worldwide. 

The book features 25 chapters and about 200 black-and-white photographs, and covers:

• The various eras of the Mass General Pathology, from the early surgeons and physicians who practiced pathology to the highly subspecialized pathology department of the present day
• Biographies of Reginald Heber Fitz, James Homer Wright, Tracy Burr Mallory, Benjamin Castleman, Austin L. Vickery, Jr., Robert E. Scully, E.P. Richardson, Jr., Walter G.J. Putschar and Robert T. McCluskey
• The disciplines of autopsy pathology, surgical pathology, neuropathology, dermatopathology, cytopathology, clinical chemistry, hematology, microbiology, blood transfusion and immunopathology
• The Case Records of the Massachusetts General Hospital
• Classical descriptions of acute appendicitis, acute pancreatitis, neuroblastoma, the origins of platelets, Castleman’s disease, mycoplasma, parathyroid hyperplasias and neoplasias, various ovarian tumors, neurological diseases, melanoma progression
• Early residency programs in Pathology that trained generations of leaders in pathology in North America and abroad
• Many major textbooks in the field, including World Health Organization classifications and Armed Forces Institute of Pathology fascicles

To order the hardcover book, please download and fill out the MGH Pathology history book order form (PDF). 
Make your check payable to "Mass General Physician's Organization", and mail it with your order form to:

Attn: William M. Hynes 
Mailcode: WRN-225 
Massachusetts General Hospital 
55 Fruit Street 
Boston, MA 02114

Chapters from Keen Minds to Explore the Dark Continents of Disease

Chapters are available to read online or download in PDF format.

Table of Contents, Contributors, and Preface

1. The Early Years (1811-1896) - Dr. Louis, and Dr. Young
2. Reginald Heber Fitz - Dr. Young
3. The Wright Era (1896-1926) - Dr. Louis, and Dr. Young
4. James Homer Wright - Dr. Young, and Dr. Lee
5. The Mallory Era (1926-1951) - Dr. Louis, and Dr. Young
6. Tracy B. Mallory -  Dr. Young, Dr. Mallory, and Dr. Scully
7. The Castleman Era (1952-1974) - Dr. Louis, and Dr. Young
8. Benjamin Castleman - Dr. Scully
9. Austin L. Vickery, Jr. - Dr. Scully
10. Robert E. Scully - Dr. Young
11. E. P. Richardson, Jr. - Dr. De Girolami, Dr. Hedley-Whyte, and Dr. Louis
12. Walter G. J. Putschar - Dr. Rosenberg, Dr. Ragsdale, and Dr. Ortner
13. The McCluskey Era (1974-1991) - Dr. Louis, and Dr. Young
14. Robert T. McCluskey - Dr. Colvin
15. The Autopsy Service - Dr. Mark, Dr. Young
16. Surgical Pathology - Dr. Mark, Dr. Louis, and Dr. Young
17. Neuropathology - Dr. Hedley-Whyte, Dr. Louis, Dr. DeGirolami, and Dr. Frosch
18. Dermatopathology - Dr. Mihm, and Dr. Duncan
19. Cytopathology - Dr. Wilbur
20. Clinical Laboratories - Ms. Macmillan, and Dr. Lewandrowski
21. Microbiology - Dr. Ferraro, and Dr. Moellering
22. The Blood Transfusion Service - Dr. Umlas, Dr. Stowell
23. Immunopathology - Dr. Bhan, Colvin, and Dr. Dvorak
24. The CPCs - Dr. Harris, and Dr. Scully
25. The Later Years (1991-2011) - Dr. Colvin, and Dr. Louis

Appendix