By Karl H. Perzin, MD, Professor Emeritus of Clinical Surgical Pathology
In this report, I describe some of the major events that occurred during the years 1955-1987, before Dr. Shelanski became chairman. In speaking with various current members of our Department, I have found that most are unaware of these events. I will concentrate on the structure of Pathology services, especially on the major reorganization that occurred in 1960. I will also describe the changes that have occurred in the teaching of Surgical Pathology to our medical students. I also reminisce about several individualas I knew during this period, including Drs. Virginia Kneeland Franz, Arthur Purdy Stout, Raffaele Lattes, Nathan Lane and Donald West King.
I first came to the Medical Center in September, 1954 as a first year medical student. My first encounter with the Pathology Department was in September, 1955. The second year Pathology course consisted of lectures and laboratories, in which we studied glass slides. We also viewed photographs of gross specimens. On the first laboratory day, the Chairman of the Pathology Department, Dr. H. P. Smith, told us that we had to buy coloring pencils, smudge sticks, and an unlined notebook, into which we were to make, in each lab session, a drawing of something we examined from one of our slides. The drawings were part of our final grade. Many students were offended (imagine - a coloring book in medical school!) but, in retrospect, those exercises helped us to thoroughly and critically examine what we were supposed to be seeing through the microscope.
My first encounter with the Division of Surgical Pathology was in the Spring of the second year (1956), in a course called “Introduction to Surgery”, in which we were taught about granulation tissue and the principles of wound healing. At that time, the Division of Surgical Pathology was part of the Department of Surgery and my instructor in the lab was Dr. Virginia Kneeland Frantz, a Professor of Surgery.
My next encounter with Pathologists was in the third year. At P&S, the third year was a full 12 month year, without vacations. (Three months medicine, three months surgery, divided between General Surgery and Surgical Subspecialties, three months divided between Neurology and Psychiatry and three months divided between Pathology and Ob-Gyn). During the six week General Surgery rotation, students came to the Surgical Pathology Laboratory twice a week. There was a classroom where the Pathology Residents Room is now, with the blackboard wall facing the Humphreys Auditorium, and with five rows of benches containing cabinets in which we kept our microscopes. Each one of us was given a box of glass study slides. I remember being given a metal tray containing a formalin fixed gall bladder to examine. My instructor in the lab again was Dr. Virginia Kneeland Frantz.
In the third year, in addition to the Surgical Pathology Laboratory, there was a Surgical Pathology lecture course, which was given every Saturday morning, from 9 to 10:20am, starting in September and lasting until March. The setting was the Humphrey’s Auditorium, which was twice the size it is now, room enough for the entire class. The first part of each lecture consisted of a discussion of an entity by a surgeon, followed by a presentation of the pathologic findings by a Surgical Pathologist. One example was Crohn’s Disease with the surgeon Dr. Frank Gump, discussing its clinical aspect, and Dr. Raffaeale Lattes describing the pathologic features. The Surgical Pathology discussors were Drs. S. Frantz, Raphael Lattes, Nathan Lane and Luciano Ozzello. An examination was given at the end of the course, the grade being part of the Surgery grade. This course was ended in the late 1960’s. During the student rebellion years of that time, almost all Saturday teaching functions were terminated including the Surgical Pathology lecture course, Medical Group Clinic (10:30-11:45am) and others.
Before 1960, Pathology services were organized in a different manner. When the Columbia Presbyterian Medical Center was established in 1928, each Hospital or Division had its own pathologists. The Medical School had a Pathology Department. These pathologists did autopsies, taught the second year pathology course, conducted research, and participated in various conferences, such as the CPC (the clinico-pathologic conference, which was a major weekly event for many years). The Pathologist at Babies Hospital was Dr. Dorothy Andersen, who, I was told, first showed that Celiac Disease and Cystic Fibrosis were different entities. The Pathologist at the Neurologic Institute was Dr. Abner Wolff; at the New York Orthopedic Hospital was Dr. Zent Garber, at the Squire Urologic Clinic was Dr. Meyer Melicow, at the Sloan Hospital for Women was Dr. Engler, and at the Eye Institute was Dr. Al Reese. Surgical specimens removed by Surgeons in General Surgery (and ENT) were studied by the Pathologists in the Division of Surgical Pathology which was part of the Division of Surgery. In the late 1950’s, when I was a medical student, the Surgical Pathologists were Dr. Frantz, Dr. Lattes, and Dr. Lane. Dr. Arthur Purdy Stout had retired in about 1950, at the mandatory retirement age of 65, but he continued to act as consulting Pathologist until about 1968, when he died at age 83.
I graduated from P&S in June 1958, and returned in July, 1961. I had a one year rotating clinical internship at the Jefferson Medical College Hospital in Philadelphia, from 1958-1959. From July 1959 to June 1961, I was in the United States Public Health Service. I had been deferred from military service during the Korean War, so I had to pay back the government for the deferral. For the first 18 months, the government sent me to Pittsburgh, PA, where I worked in the Pennsylvania State Health Department, and the Allegheny County Health Department. During the last 6 months, I was sent to Baltimore, MD, to work at the Johns Hopkins School of Public Health. While I was in Pittsburg, I enjoyed going to Pittsburgh Pirate Baseball games. I was there in 1960 when the Pirates won the famous World Series from the Yankees. In Pittsburgh, I became seriously interested in Pathology as a career. At the medical school, there was a Dr. Dixon who was doing pioneering pathologic studies on glomerular diseases of the kidneys (I said to myself, look at the interesting colors and patterns!).
I returned to P&S in July 1961. While I was gone, Dr. H. P. Smith retired as Chairman of the Pathology Department. Dr. Donald McKay was recruited from Boston to be the new Chairman, but he only came with the proviso that all the various Pathology Laboratories be unified into the Pathology Department. As far as I can remember, Dermatopathology and Eye Pathology remained separate entities. When I met Dr. McKay in the winter of 1960-61, he assured me that I could come here as a resident, since I had been a good P&S student.
I spent the first 6 months as a Pathology resident at the Francis Delafield Hospital doing autopsies and surgicals. The long yellow building at the South end of the parking lot was the Delafield Hospital, a New York City municipal cancer hospital. Delafield was finally shut down in the 1970’s, during one of New York City’s recurrent budget crises. The building is now used as a residence for elderly individuals. At Delafield, my mentor was Dr. Ralph Snyder, who had come from Boston with Dr. McKay. Ralph taught me how to process surgical specimens, to do frozen sections, and to do autopsies. The autopsies at Delafield were not easy; most patients had extensive spread of their cancers. I remember starting one autopsy at 8:30am and ending at 5:30pm. Ralph popped in every so often to help me, and at the end, congratulated me for having performed “the world’s longest running autopsy”. Ralph eventually came over to P&S for 2 years in the late 1960’s, and later went to Lenox Hill Hospital with other Delafield Pathologists, including Dr. Sheldon Sommers and Harry Juachim. Ralph became a long term friend, eventually returning to Florida in the mid-1980’s.
While at Delafield, I first met Dr. Arthur Purdy Stout, who has been called by many the “Father of Surgical Pathology” in the United States. Our Laboratory of Surgical Pathology is named for him, with a plaque on the wall of the 14th floor honoring his memory. In 1961, Dr. Stout was retired, but he came to P&S four days a week. At Delafield, he came at noon and was shown hospital cases in consultation. In addition, every day Dr Stout dropped off slides of a case, with a 3x5 card containing the clinical information concerning the case, similar to what we still do in our morning Surgical Pathology conferences. The next day, while sitting around a table, he asked each one of us our opinion. I usually managed to get a seat at the end of the circle, so that I would be the last to be asked.
Dr. Stout was trained as a surgeon, and served as a physician in Europe during the First World War. He was associated with the Surgery Department of the Presbyterian Hospital, which was then located on Madison Avenue, on the East side. On returning from Europe, he wrote a number of clinico-pathologic papers. At that time, the Columbia University College of Physicians and Surgeons was located on West 59th Street, across the street from the present Roosevelt Hospital. Dr. Stout related travelling frequently between the two institutions, either by foot, or by trolley. In the late 1920’s, the two institutions merged, and moved to its present site. Dr. Stout lived on the East side, and walked across Central Park every day, then taking the subway back and forth from the Medical Center. He did so even when he was in his early 80’s.
Dr. Stout was one of the founders of the Armed Forces Institute of Pathology Fascicles on various tumors. He wrote several of the books in the first series, published in the 1940’s and 50’s, including fascicles on Soft Tissue Tumors, Neurogenic Tumors, Tumors of the Stomach, and Tumors of the Esophagus. As a result, he received many cases in consultation.
Dr. Stout was a quiet, soft spoken gentleman with a droll sense of humor. He was once invited to give a talk in Albany, NY, by a former fellow, who picked up Dr. Stout at the train station driving a red two-seater MG sports car. The fellow proudly announced that he had an identical car at home, only in blue. Dr. Stout asked why he had two - was it for breeding purposes?”
After Delafield, I spent the next 6 months at Presbyterian Hospital doing autopsies. In my second year, I spent the first 3 months in Neuropathology, the next 3 in Ob-Gyn Pathology and the following 7 months in Pediatric Pathology. Between Ob-Gyn and Pediatric Pathology, I became the subject of a tug of war between Dr. Ralph Richart who had just arrived at P&S, and Dr. William Blanc who was in charge of Pediatric Pathology. Dr. McKay, the Chairman, decided that I should go to Pediatric Pathology as originally scheduled, because Dr. Dorothy Andersen was dying at that time, and Dr. Blanc needed help.
Dr. William Blanc was a very knowledgeable Pediatric Pathologist. A good looking, well dressed, suave, debonaire gentleman. He originally came from the French speaking area of Switzerland, Geneva. He had a distinct French accent. Once, while I was showing a case to a pediatrician, the clinician said to me that he thought Dr. Blanc probably spent at least half an hour at night before his bathroom mirror practicing his French accent. Dr. Blanc eventually retired to Geneva.
I next joined Surgical Pathology, where I worked for the next 11 months (1963-4). At that time, the Surgical Pathologists were Dr. Lattes, Dr. Nathan Lane and Dr. Luciano Ozzello. Dr. Stout was available for consultation. Dr. Meyer Melicow examined specimens from the Urology Department, but he soon retired. Dr. Frantz was ill, and only occasionally came to the laboratory. During the year, they gave me increasing responsibilities.
Dr. Frantz was the first woman surgery house officer (resident) in the history of Presbyterian Hospital when it was still downtown. She developed an interest in Pathology, and joined Dr. Stout when the Medical center was established. The Presbyterian Hospital was a center fro the treatment of thyroid diseases and had outstanding thyroid surgeons. Dr. Frantz specialized in the pathology of thyroid diseases, and attended they thyroid clinic and conferences, frequently criticizing clinicians during the conferences. She was no shrinking violet. She published several studies on thyroid cancer. During the 1930’s and 40’s, Dr, Frantz also worked with Dr. Alan Whipple (of Whipple’s pancreatoduodenectomy fame). She was the first to describe the solid pseudopapillary tumor of the pancreas (once known as the Frantz tumor of the pancreas). Dr. Frantz came from an old line well-to-do family, and lived in a duplex apartment on Park Avenue. Dr. Lattes told me that Dr. Frantz once joked that her salary from Columbia was enough to pay for one of her maids. When she died, I had a fellowship in Surgical Pathology. Dr. Lattes gave me her office, asked me to finish her unfinished cases, and decreed that I was to become the thyroid specialist following Dr. Frantz.
When I arrived in Surgical Pathology in 1963, there was a regular Saturday Surgical Operating Room Schedule, something that had been in place for many years. All Surgical Pathology attendings and residents came to work until noon on Saturdays. After noon, one attending and one resident stayed until 5pm, and were on call for the rest of the weekend. We did many frozen sections on Saturdays, especially breast cases. The regular Saturday operating schedule was ended in the late 1960’s, as was the Surgical Pathology third year course.
After my year in Surgical Pathology, I was named Chief Resident in pathology (1964-65). Technically, that was a year of Clinical pathology, to be followed by another year of Clinical pathology at an associated hospital, such as Hackensack Hospital, so that I could get my boards in both Anatomic and Clinical Pathology. But during the year, Dr. Lattes frequently asked me to help out in Surgical Pathology because of the heavy workload. Dr. Lattes helped me obtain a National Cancer Institute Fellowship for the next two years (1965-67) during which I basically functioned as an attending in Surgical Pathology. I was given my first medical school appointment in 1967, as an assistant in Pathology. Over the next two years, I was promoted to Assistant Professor, the Associate Professor and finally, Professor of Clinical Surgical Pathology in 1979.
Dr. Raffaele Lattes came to the United States in 1940 from Italy with his wife and son Conrad, fleeing the fascists. Dr. Lattes was trained as a general surgeon and had a number of positions in the United States before joining Dr. Stout during World War II as a fellow in Surgical Pathology. Dr. Lattes became an outstanding Surgical Pathologist, eventually succeeding Dr. Stout as Director of Surgical Pathology. He was a leading expert on mesenchymal tumors and wrote several AFIP Fascicles. He was a friendly person who frequently told jokes, many transmitted to him by his friend in the Department of Radiology, Dr. Ralph Schlaeger. Both his sons, Conrad and Robert, graduated from P&S. Conrad became a well-respected general surgeon at St. Lukes-Roosevelt. I still remember the anguished telephone call I received from Dr. Lattes on a Sunday morning (Circa 1988). He told me that the worst thing that had ever happened to him, occurred the previous night. His son, Conrad, only 50 years of age, had died the night before. Conrad had performed a kidney transplant, had felt tired after the operation, and elected to stay in the on-call room overnight. When he didn’t return home the next morning, his wife called the hospital. Another surgeon found him dead in the on-call room. He had mild coronary artery disease, and it is presumed that he had a cardiac arrhythmia.
After he retired in 1978, Dr. Lattes continued to work in Surgical Pathology as a consulting pathologist. He received many cases from the outside. Once a week, we had Dr. Lattes’ “Black Tray” conference. He put out on the “black tray” a number of cases as unknowns. We had the opportunity to examine these cases before the black tray conference. The slides were shown on a screen. Later Dr. Lattes asked each one of us, attendings and residents, in order of seniority, our opinions. These were excellent learning experiences. After Mrs. Lattes became ill, these conferences were ended. After Mrs. Lattes died, Dr. Lattes returned to Italy where he died at the age of 93.
Dr. Lattes was Director of Surgical Pathology from the time Dr. Stout retired (1950) until 1978, at which time he was succeeded by Co-Directors, Dr. Nathan Lane, in charge of Surgical Pathology Services, and Dr. Cecilia Fenoglio, in charge of Administration and Research. After one year, in June 1979, Dr. Lane announced that he would retire in three months. Years later, he told me that he thought the Division of Surgical Pathology would be in good hands after he retired, given the combination of experienced senior pathologists (including me) and bright, young, talented individuals, including Cecilia Fenoglio, Daniel Knowles and John Fenoglio.
Dr. Lane was best known for his landmark study showing that adenomas of the colon are precancerous lesions. He showed that intramucosal and invasive carcinomas increased with increasing size in adenomas. His landmark study was rejected for publication by the editor of the journal Cancer because the editor didn’t believe that adenomas gave rise to cancer. The study was finally published in the journal SG&O (Surgery, Gynecology and Obstetrics).
As described previously, for many years there was a Surgical Pathology Laboratory for third year P&S students as part of their surgery rotation. During their 6 weeks in Surgery, students came to our laboratory three times a week for 2 hour periods, for a total of 36 hours. Eight different groups came during the academic year. I started to teach in this laboratory in 1967, taking 4 of the 8 groups. During the decade of the 1970’s, Dr. Marianne Wolff, who joined Surgical Pathology when Dr. Snyder left and I each did of the laboratory teaching. These laboratories consisted of gross demonstrations of surgical specimens and discussions of various surgical diseases for which the Surgical Pathology Lab received specimens. Each of the 18-20 students was assigned an entity to discuss. This course was formally ended in 1983. Dr. Cecilia Fenoglio and I met with the third year Curriculum Committee and asked that the course be terminated because we no longer had sufficient staff to continue the course. The course was officially “suspended”. After that time, various individuals, such as Dr. Jay Lefkowitch, have taken the third year students to the gross room to demonstrate specimens, but the formal course, as previously organized was ended in 1983.
After Dr. McKay departed as Chairman, he was replaced by Dr. Donald West King who came from Colorado, where he was Chairman. Dr. King was a friendly, laid-back, benevolent chairman who was extremely supportive of everyone in the Department. Dr. King had been a resident in the Pathology Department at P&S during the tenure of Dr. H. P. Smith. As discussed previously, the Laboratory of Surgical Pathology was part of the Department of Surgery before 1960, and the trainees and fellows in the Surgical Pathology Lab were hired through the Department of Surgery. Pathology residents at P&S did not rotate through the Surgical Pathology Laboratory. Dr. King once told me that he had asked Dr. H. P. Smith when the pathology residents were supposed to learn Surgical Pathology. Dr. Smith told Dr. King not to worry, he could easily learn Surgical Pathology in 3 or 4 weeks.
After Dr. King departed to become Dean of the University of Chicago Medical School, he was followed by acting chairmen, first, Dr. Phillip Duffy, Director of Neuropathology, who was instrumental in establishing the Fee for Service Billing system we now have in Pathology, and later by Dr. John Fenoglio, who was followed by Dr. Shelanski.My purpose in writing this essay was to describe some of the events that occurred in the Department of Pathology before Dr. Shelanski became Chairman, and to write about some of the pathologists I knew during my long association with the Pathology Department.