The Warrens and Other Pioneering Clinician Pathologists of the Massachusetts General Hospital During its Early Years

An Appreciation on the 200th Anniversary of the Hospital Founding

Robert H Young; David N Louis

Disclosures

Mod Pathol. 2011;24(10):1285-1294. 

In This Article

Abstract and Introduction

Abstract

To celebrate the bicentennial of the 1811 charter to establish the Massachusetts General Hospital, we tell the stories of the physicians and surgeons of the hospital who practiced pathology until the discipline was more firmly established with the recruitment of James Homer Wright who became the first full-time pathologist at the hospital in 1896. One of the two co-founders of the hospital, John Collins Warren (famed primarily for being the surgeon at the first public demonstration of ether anesthesia) had a major interest in pathology; he published a book focused on gross pathology (1837) and began the important specimen collection subsequently known as the Warren Anatomical Museum at Harvard Medical School (HMS). An early physician, John Barnard Swett Jackson, became the first professor of pathology in the United States (1847) and was a noted collector whose specimens were added to the Warren Museum. Dr Jackson showed no interest in microscopy when it became available, but microscopy was promoted from circa the late 1840s at Harvard and likely at the hospital by Oliver Wendell Holmes, the famed essayist who was on the staff of the hospital and faculty at the medical school. Microscopy was probably first used at the Hospital with any frequency on examination of fluids by the first officially designated 'Microscopist,' John Bacon Jr, in 1851, and after the mid-1850s by Calvin Ellis on anatomic specimens; Ellis went on to pioneering reform of the HMS curriculum. Reginald Heber Fitz succeeded Ellis in 1871 and was the first to be officially designated as 'Pathologist' at the hospital. Fitz is remembered for two major contributions: his paper showing the nature of, and potential surgical cure for, the disease that he termed 'appendicitis'; and his description of acute pancreatitis. With the microscope now firmly entrenched and with the increase in surgery after Fitz's work on appendicitis, surgical pathology grew quickly. J Collins Warren, the grandson of the co-founder, had a major interest in pathology and in 1895 published an impressive volume entitled 'Surgical Pathology and Therapeutics.' Dr Warren had a major interest in breast disease and was a pioneer of needle biopsy in the evaluation of breast masses. In 1888, William Fiske Whitney joined the staff of the hospital and spent his nearly 30-year career practicing primarily as a surgical pathologist, making particular innovations in intraoperative consultation. The contributions of these individuals brought the field from a gross pathology-oriented discipline mostly oriented around teaching to a microscopy-dependent practice integral to patient care, and hence set the stage for the formal founding of the Pathology department in 1896.

Introduction

This year marks the 200th anniversary of the granting of the charter for the establishment of the Massachusetts General Hospital (MGH) (Figure 1). In commemoration of this anniversary, we have edited a book[1] telling the story of pathology at the hospital from its founding until today. As with many historical endeavors, it has uncovered much information about notable persons whose contributions deserve to be better remembered. We were well aware of the contributions of James Homer Wright,[2] the first 'full-time' pathologist at the hospital, appointed in 1896. Based on earlier work by Dr Robert E Scully and the late Dr Austin L Vickery Jr,[3] we also knew that pathology had been conducted at the hospital prior to the arrival of Dr Wright by a number of physicians and surgeons. However, our appreciation of their contributions was heightened considerably the more we read about them and we realized that most pathologists, even at our own hospital, were not aware of the extent of their contributions to pathology. In aggregate they solidified the importance of gross pathology, had a significant role in the early application of microscopic pathology, demonstrated the role of pathology in patient care, showed how pathology was central to clinical discoveries and also were active in using gross and microscopic specimens for medical student education (Table 1). Those considered herein laid a solid foundation for the development of anatomic pathology in the hospitals of Harvard Medical School (HMS) and their influence on the development of the field extended well beyond New England.

Figure 1.

Sketch of Bulfinch Building showing proximity to Charles River at the time the hospital admitted its first patient.

The origin of the MGH can be traced to the humanitarian motivations of a local clergyman, the Reverend John Bartlett, who was the Chaplain of the Almshouse in Boston from 1807 to 1811. His concern for the condition of the patients there prompted him to plan to develop an asylum in the city. His endeavor gathered steam when he invited the two most influential physicians in the city, Dr John Collins Warren and Dr James Jackson, to a meeting with other eminent citizens, including John Adams and John Quincy Adams, on March 8 1810. Drs Warren and Jackson expanded the plans of Reverend Bartlett to include a general hospital and, on 20 August 1810, circulated a letter appealing for funds to establish one. The hospital charter was granted the next year. However, the poor economy related to the War of 1812 delayed progress and the cornerstone of the initial hospital, the Bulfinch Building, was not laid until 4 July 1818. The hospital opened in 1821. More detailed discussion of the early days of the hospital can be found in the recent bicentennial book on the history of the MGH.[4]

The relationship of the MGH to HMS in the years encompassed by this essay changed. In the early years of the medical school at Harvard, students received relatively informal training on the Harvard College campus in Cambridge. The medical school moved from Cambridge to Boston in 1810. Then, after the MGH opened for patients in 1821 it was, until the opening of Boston City Hospital in 1864, the only hospital associated with the medical school. In 1847, HMS moved to North Grove Street, directly adjacent to the MGH (Figure 2), where it remained until 1883. When HMS was located on North Grove Street, the Pathology Department at the medical school and the MGH were likely essentially the same, even though there was a tiny room designated a 'laboratory' on the ground floor of the Bulfinch Building (Figure 3).

Figure 2.

The Bulfinch Building (left) and the adjacent Harvard Medical School on North Grove Street, 1853. The Charles River is in the foreground.

Figure 3.

Bulfinch Building floor plan, 1872, with the laboratory (C) highlighted.

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