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

The First 'Pathologist' at the MGH: Reginald Heber Fitz

Dr Reginald Heber Fitz (1843–1918) (Figure 9) succeeded Dr Ellis as Microscopist and Curator of the Pathological Cabinet at the MGH in 1871.[11] During his time as a microscopist, in 1874, the first significant pathology facilities were built at the MGH, on Allen Street, where they remained through 1956 when the Warren Building opened. He was the first physician to be designated Pathologist at the hospital. Fitz's first love had been business, but after a brief time working in a copper mine in Michigan, he realized his true vocation vowing to 'become an honorable practitioner respected by my brethren in the profession.' He graduated from HMS in 1868 and then trained with Rokitansky, Virchow and the latter's student, Orth, in Germany. When Orth's book 'A Compend of Diagnosis in Pathological Anatomy' was translated into English by Frederick Shattuck and George Sabine, Fitz had a role in enhancing the English translation by being the reviser of the work. Fitz has been remembered 'as using the methodical German technique at autopsies, which was a revelation to house officers' and was noted for his clear-cut concise description of pathological changes. Fitz became the head of the HMS Pathology Department in 1879 (upon the death of Dr JBS Jackson), as the third Shattuck Professor. He made outstanding contributions, the most notable being in 1886 in his paper entitled 'Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment'[12] (Figure 9). He showed that acute inflammation, abscess formation and bowel perforation in the cecal region were almost always secondary to a disease he designated 'appendicitis.' Although others had made contributions concerning this condition previously, Fitz's study was more significant in that it included a plea for appendectomy as the appropriate treatment. This was contrary to the generally prevailing opinion that the acute inflammatory condition in these cases arose in the cecum (typhlitis or perityphlitis) with secondary involvement of the appendix. The late Dr William B Ober, a pathologist and noted medical historian, stated that a case can be made for Fitz's investigation of appendicitis as marking the beginning of surgical pathology in North America.[13]

Figure 9.

(Left) Dr Reginald Heber Fitz. (Right) Frontispiece of Dr Fitz's paper on appendicitis.

Another major contribution by Dr Fitz was his 1889 paper on acute pancreatitis.[14] He first delivered his findings when he gave the Middleton-Goldsmith lecture to the New York Pathological Society on 16 February 1889, and his findings were published shortly afterwards in the Boston Medical and Surgical Journal. In his report Fitz reviews in detail the literature on the pancreas and many of its disorders. He then notes that his own interest was stimulated by an autopsy he had performed in 1876 of a patient who died of pancreatitis. He then studied further pancreatic specimens, getting significant help from Dr William Fiske Whitney (see below). Dr Fitz discusses pancreatic hemorrhage, the association of hemorrhage with acute pancreatitis, pancreatitis occurring without hemorrhage and the relation of acute pancreatitis to fat necrosis. Dr HR Viets, when he discussed what he thought were the 20 most significant papers published in the first 150 years of the New England Journal of Medicine, stated that 'The report by Fitz is a model of completeness, putting the disease in a new setting, with an authority that could come only from long continued study of the basic pathology'.[15] In 1892, Dr Fitz relinquished the chair of pathology to become the Hersey Professor of Theory and Practice of Physic.

During the busy years of the 1880s, when Dr Fitz was doing research and reporting his findings widely, he was helped by Dr William Whitworth Gannett. Dr Gannett was appointed Assistant in Pathology in 1882 and had a liking for autopsy pathology, humorously leading to him being known as 'Buzz' because, as remarked in an obituary,[16] 'like the buzzard, he was noted for his fondness for post-mortem material.' Dr Gannett went on to serve as a pathologist for a number of hospitals in the Boston area.

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