Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter I
CHAPTER I
The Institute and Its Ancestry
On 21 May 1962, the Armed Forces Institute of Pathology entered upon the second century of its life. It had started one hundred years before as an item in Circular No. 2, of the Surgeon General's Office, in which Brig. Gen. William Alexander Hammond, The Surgeon General, announced his intention to establish an Army Medical Museum, for which medical officers were directed to collect specimens of morbid anatomy.
The collections with which the Museum started consisted of three dried and varnished bones resting on a little shelf above the inkstand on the desk of Brigade Surgeon John Hill Brinton, the young medical officer who was to become the first curator of the Museum which was to be established.
The Museum thus launched evolved into the Army Institute of Pathology which became the Armed Forces Institute of Pathology—a veritable treasure house of medical knowledge and an active center for consultation, research, and education in the effects of disease and injury upon the form and function of living cells and tissue.
For back of the announcement in Circular No. 2 was an idea—the idea that by careful collection, comparison, and study of the anatomical wreckage of the great war in which the United States and the Confederate States were then engaged, there might emerge a body of knowledge and understanding which would, in time, lead to the lessening of human suffering and the saving of human life.
To that end, the Museum and its successor Institutes have followed General Hammond's admonition, "diligently to collect" specimens of morbid anatomy and other materials of value and interest to the study of military medicine or surgery until, at the opening of the second century of its life, the Institute had in its collections more than 1,000,000 specimens—and is continuing to receive such specimens at the rate of 200 per day.
The Threefold Mission
The institution which has grown to such proportions in its first century is unique in its organization and mission. It was founded and for 87 years existed as an Army installation, and still is administered under the authority of the Secretary of the Department of the Army, acting through The Surgeon General of that Department, but it is not now an organization of and for the Army alone. It is truly a triservice organization, established as such by the joint action of the Department of Defense and the Departments of the Army, the Navy, and the Air Force, with its broad policies determined by a Board of Governors, the members of which are the Surgeons General of the three Armed Forces.
It is thus a military organization, but one with so strong an infusion of the civilian in its makeup and mission that the medical profession—the term "medical" as here used being broad enough to include the dental and veterinary professions as well—has come to accept and rely upon the Institute's work and findings as a distinct, indeed a unique, contribution to the advancement of medical science and practice, civilian as well as military, throughout the Nation.
Nor are the services of the Museum-Institute limited to the boundaries of the United States, for they have followed wherever the American soldier, sailor, and airman have gone—to the western plains in the 19th century Indian campaigns; to Cuba, Puerto Rico, the Philippines, and the Canal Zone at the turn of the century; to Europe in the first war, known simply as the World War until a second world war of even greater dimensions took the American forces back to Europe, and to the continents of Africa, Australia, and Asia, to Japan, and the islands of the Pacific; and, at the halfway mark of the 20th century, to Korea.
From all these campaigns, as well as from the American Civil War during which the Museum was founded, lessons learned in the diagnosis and treatment of disease and trauma have been reported to the Museum-Institute in the form, principally, of specimens taken from surgical operations and from autopsies, together with the relevant medical history and records of each case.
The American Registry of Pathology
In addition to this flow of materials from military installations in all parts of the world, the Institute receives the organized cooperation of civilian medicine, acting through the American Registry of Pathology, an arm of the National Research Council of the National Academy of Sciences. The American Registry of Pathology, which now includes 27 constituent registries sponsored by the appropriate national societies of the various medical specialties, is both an arm of the National Research Council and also one of the four main operating departments of the Armed Forces Institute of Pathology. Thus, the Registry constitutes a living link between the operations of the Institute and civilian practitioners in regard to matters of pathology.
Pathology has been defined "as that specialty of the practice of medicine dealing with the causes and nature of disease, which contributes to diagnosis, prognosis and treatment through knowledge gained by laboratory applications of the biologic, chemical or physical sciences to man, or material obtained from man."[1]
Broad as it is, the definition is not broad enough to cover all the activities and contributions of the Institute. Being limited to man, it does not cover the work of the Institute in veterinary science, a field in which what is probably the largest staff of veterinary scientists in the country is engaged. Nor does it cover much of the work of the Medical Illustration Service, one of the four departments which make up the Institute, and one which is called upon for many services outside the perimeter of pathology.
The heart and core of the Institute is in its work of consultation, research, and education, carried on largely by its Department of Pathology. To this Department goes the daily intake of specimens sent in by medical officers in the field, pathologists at military hospitals, and civilian practitioners seeking light on some puzzling piece of pathological material. No matter whence it comes, the sender is asked to designate the degree of urgency which attends its sending by the use of code words which tell the staff at the Institute whether the utmost in expedition is required, or whether the specimen may safely be given ordinary expedited attention, or if it may go into the backlog of cases awaiting opportunity to be worked over by the Institute's pathologists.
In numerous instances, review of the original diagnosis by the Institute has profoundly altered the therapy applied. In other instances, materials have been submitted to the Institute too late for treatment to be affected by the revised diagnosis. Such was the case of a 22-year-old air cadet who developed a growth, upon an eye, which though actually benign was mistakenly diagnosed in the first instance as "malignant melanoma." The eye was removed, and the enucleated eye, along with the benign nevus, was sent to the Institute—too late to save the young cadet's eye. More fortunate in its outcome was a similar case in which the nevus, mistakenly diagnosed as malignant, was submitted to the Institute in time for a telegraphic report to save the patient's eye from enucleation.
Review of diagnoses by the Institute staff has prevented unnecessary operations, including amputations of limbs, in a number of cases. Such cases are an infinitesimal percentage of all cases reviewed, but to the individual whose limb or whose sight is saved or lost, nothing could be more important.
Institute review of diagnosis is important, also, in preventing possible imposition on the Government or injustice to the serviceman in cases involving line-of-duty questions as to responsibility for death or disablement. Thus, Institute review has forestalled the collection of compensation for nonexistent disease and, on the other hand, has altered erroneous diagnoses of the causes of deaths which, if allowed to stand, would have denied benefits due the serviceman's family.
To many, and perhaps to most, of those outside medical circles, pathology is vaguely recognized as a special sort of medical activity, and the pathologist is a dim and remote background figure. This attitude was reflected in an aside from President Dwight D. Eisenhower when he was called upon to dedicate the new building of the Institute in May 1955. Turning to his friend and physician, Lt. Gen. Leonard D. Heaton, just before making the dedicatory address, the President said, "Leonard, what am I doing getting up to dedicate a building for pathology, when I don't even know what pathology is?"
In telling of the incident, General Heaton adds the comment that however little the President knew then what pathology is, "he would soon know"—having in mind the medical and surgical experiences that lay ahead of him. President Eisenhower, indeed, began to learn about pathology that same afternoon of the dedication, "For the enlightenment of this audience," he said in his opening remarks, "it is indeed fortunate that Dr. [Brig. Gen. Elbert] DeCoursey saw fit (in his address of welcome) to tell us about pathology. Because for myself, I can assure you that I have learned more in the last 5 minutes than I knew in my entire life before."
The most common picture of the pathologist in the popular mind—insofar as there is such a picture—is probably that of the specialist who advises the surgeon as to whether the tissues to be removed are, or are not, malignant. That, indeed, is an important part of what the specialist in pathology does, but it is, after all, a part only.
As Dr. James Milton Robb, of Detroit—not himself a pathologist—put it in his presidential address before the American Academy of Ophthalmology and Otolaryngology, in 1952:
* * * the study of pathology in its relatively short life has grown from an investigation or the changes found in the human body after death and their correlation with the signs of disease which had been observed during life to include almost anything which had to do with disease, etiology, pathogenesis, morbid anatomy, microscopic histology, parasitology, functional changes, chemical alterations, indeed any topic except treatment.[2]
Or, to put it more briefly and even more broadly, Dr. Esmond R. Long, practitioner and historian of pathology, describes pathology as "the basic informational science in the understanding of disease" and "a science that makes use of all other biological and medical disciplines in its development."[3]
In arriving at this broader concept of pathology and the place of the pathologist in the scheme of things medical, the Institute has played a major part. During the first half-century of its life, while it still was the Army Medical Museum, it contributed to medical research and education through compiling and publishing the massive "Medical and Surgical History of the War of the Rebellion," and through the introduction and development of such techniques as photomicrography and the use of aniline dyes in staining slides for microscopic study. Through its Curator, Maj. Walter Reed, it contributed to the conquest of yellow fever, and through another curator, Maj. Frederick Fuller Russell, it helped mightily in stamping out typhoid fever. Under the curatorship of Maj. George Russell Callender, the Museum broadened its work of education and research through its linkage with civilian medicine in the Registry movement.
Through the work of more recent curators, the Museum, while retaining its distinctive character as a place for exhibition of medical lore and historic materials to a large and increasing number of visitors, has had its greatest growth through the enlargement of its services of education and, increasingly of late years, of research.
Unique in the World
Writing in 1946, when the Institute was still an Army organization and had not taken on its triservice character, Dr. Howard T. Karsner, then of Western Reserve University, described it as "unique in the world." He continued:[4]
* * * Nowhere else has there ever been a concentration of pathological specimens that is comparable. Nowhere else is the pathology of the entire Army of a great country so concentrated. Nowhere else have the civilian pathologists and other interested physicians taken such a great part in organization and operation. Nowhere else has there been, as continues to be true, such a close scientific liaison between medical officer and civilian doctor.
In the years since this was written, the Institute has not only taken on its triservice character; it has also become the central laboratory of pathology for the Veterans' Administration, the Atomic Energy Commission, and the U.S. Public Health Service, and has furnished informal consultation to the Civil Aeronautics Board and the Federal Aviation Agency.
All in all, as Dr. Esmond R. Long says in his recent (1962) book, "A History of American Pathology," the Armed Forces Institute of Pathology has "become in fact the hub of activities in the nation's pathology," in a period of activity since 1949 that "has never been matched by any organization for research and instruction in pathology."[5]
The sweep and scope of these activities of the Institute are indicated by the fact that its latest annual report, that for the last year of the first century of its life, requires 254 pages in order to outline the working organization and list in briefest form the activities undertaken and carried forward during the year. These activities included 194 registered research projects, 91 publications by staff members, n postgraduate courses with an attendance of 1,105, the distribution of 27,000 copies of fascicles published as part of the "Atlas of Tumor Pathology," and the creation of 55 new visual exhibits—to mention but a few items of work done in but one year out of the one hundred years of the life of the Museum-Institute.
In the opening years of the second century of its life, the Institute is carrying forward studies that range from the nature and behavior of the infinitesimally small subcellular particles that are revealed only in the stream of electronic waves of the electron microscope to the inconceivable vastness of outer space. For wherever man may go, and whatever he may see, pathology—the scientific cornerstone of medicine—goes with him, and its evidences are to be seen.
This volume does not undertake to treat in detail the history of the first century of the Museum and its offspring, the Institute—a multi-volume task —but seeks to tell in brief compass the story of the soil and the seed from which a great medical service has grown, with some account of the men and women who have made great the century-old Armed Forces Institute of Pathology.
- ↑ Directory of Medical Specialists. Chicago: Marquis-Who's Who, Inc., 1961 vo1. X, p. 823.
- ↑ Transactions of the American Academy of Ophthalmology and Otolaryngology, September-October 1952, p. 715.
- ↑ Long, Esmond R.: A History of American Pathology. Springfield, 111.: Charles C Thomas, Publisher, 1962, pp. 133, 147.
- ↑ Karsner, Howard T.: The American Registry of Pathology and Its Relation to the Army Institute of Pathology. The Military Surgeon 99: 368-369, November 1946.
- ↑ Long, op. cit., pp. 379, 381.