Vol 54 No 3 2013


Vol 54 No 3 2013

History of Johns Hopkins Medical Institutions

The IAP in Action: Meetings in Cambodia and Mexico

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INTERNATIONAL PATHOLOGY (ISSN 0020-8205)published quarterly by the International Academyof Pathology.Circulation 23,000 worldwide.IAP WEBSITEhttp://www.iaphomepage.orgPRESIDENTSamir S. Amr,Chairman, Dept of Pathology and LaboratoryMedicine,King Fahad Specialist Hospital,Dammam, Saudi ArabiaEmail: samir.amr48@gmail.comSECRETARYDavid F. HardwickUniversity of British Columbia Faculty of MedicineVancouver, CanadaEmail: iap.secretary@ubc.caTREASURERJ. Allan TuckerLouise Lenoir Locke ProfessorUniversity of South AlabamaMobile, USAEmail: atucker@usouthal.eduEDITORRobin A. CookeMayne Medical School, University of Queenslandand Pathology QueenslandBrisbane, AustraliaE-mail: cooker@ozemail.com.auDESIGNLuke Perkins GraphicsBrisbane, AustraliaEmail: l.perkins@bigpond.comVol 54 No 3 2013The University was established in 1876 withmoney bequeathed in the will of Johns Hopkins(1795-1873). Johns, who got his name fromhis maternal great grandmother who was a MissJohns, became wealthy as a result of his many businessventures. He regarded himself as a custodian ofmoney, and became a great philanthropist later inhis life. His most enduring philanthropy was a largebequest in his will to found a University, MedicalSchool and Hospital. Hence the name Johns HopkinsMedical Institutions. They continue to operateas a not for profit Private Institution.The Institutions now occupy a few blocks in EastBaltimore that radiate from the original Hospitalbuilding that was designed by the surgeon, John S.Billings (1838 - 1913).Billings was a multifaceted genius. As well asbeing an accomplished surgeon he won a competitionto design a Hospital. The Trustees of theHopkins will also enlisted Billings to recruit thefirst Professors. He picked up on the wording inJohns Hopkins’ will and promulgated the idea ofScientific Medicine by appointing staff who wouldincorporate research, teaching and service; and thusbegan the first truly scientific medical school in theUnited States.The appointments of the early faculty proved tobe spectacularly successful in establishing a MedicalSchool that still rates amongst the leading Schoolsin the USA.The first Director of the University, Daniel ColtGilman (1831-1908) was recruited from beingDirector of the University of California. He was aneducationist and an organiser.The founding Professors were:William Osler (1849-1919) Professor of Medicine;William S. Halsted (1852-1922) Professor of Surgery;Howard A. Kelly (1858-1943) Professor of Gynaecology;William H. Welch (1850-1934) Professorof Pathology; Franklin Mall (1862-1917) Professorof Anatomy; John J. Abell (1857-1938) Professor ofThe History of Johns Hopkins Medical InstitutionsBaltimore, USAAbove: Johns Hopkins (1705 - 1873). Portrait in the entrance foyerto the old hospital building. He donated the money to establish theHospital and Medical School.The four Professors: Welch, Halsted, Osler, Kelly. Painting by JohnSinger Sargent hanging in the Journal Library of Johns HopkinsHistory of Medicine Building.Mary Elizabeth Garrett.(1854-1915) A philanthropist whoinherited a fortune from her father who was the President of theBaltimore and Ohio Railroad. She was a champion of women’srights, and used her fortune to further this cause.Pharmacology.All of these men became famous, each in theirown right, and Osler, Halsted, Kelly and Welch wereimmortalized in John Singer Sargent’s famous “FourDoctors” painting.The Hospital opened in 1889 and the MedicalSchool opened in 1893. It was the first MedicalSchool to require entrants to already have a degree.From its inception it accepted women on an equalbasis to men. Both of these milestones were the productof the philanthropy of Mary Elizabeth Garrett.The University was running out of money neededto establish the Medical School and Mary ElizabethGarrett offered them a large sum to get them out oftheir difficulties. Among the conditions she stipulatedfor giving them the money they needed was thatwomen would be accepted on an equal basis to men,Left: Max Brödel in his studio 1917 (Known asthe Valentines Photo because the calendar showsFebruary 14, 1917 - Valentine’s Day).Below: Street banner outside one of the Hospitalbuildings advertising the 100th year celebrationof the founding of the Department of Art asApplied to Medicine in 2011.Left: Johns Billings (1838 - 1913)Portrait in the entrance foyer to theold hospital building. He designedthis building which is now called theBillings Building.Right: William Osler PortraitBelow: William Osler at his deskand the library in which he wrotehis books.Johns Hopkins Hospital: entrance to the original Hospitalbuilding.The Welch Medical library and the History of Medicine building.the Medical School would be only a graduateschool and that it would observe high admissionstandards.For the first 50 or so years, a Pathology Museumthat contained over 2000 specimens was the mostimportant teaching aid in the Medical School. Thiscoincided with the end of WW2 when there wasa need for space to house the newer disciplines ofMedicine, and when Professors of Pathology werenot necessarily primarily Anatomic Pathologists.Since then the Museum has been dispersed, andpathology staff now use only a small number ofspecimens in the teaching of pathology.Rather than rejuvenating their old museum,teachers are relying on the use of electronic teachingaids. Staff members are enlisting the services of theDepartment of Art as Applied to Medicine that wasestablished in the earliest days of the Medical Schoolto help them design these aids.For example, Ralph Hruban, in collaboration withBona Kim and Corrine Sandone in the Departmentof Art as Applied to Medicine, developed a noveliPAD application to teach advanced pancreaticpathology to residents, fellows and practisingpathologists. The Johns Hopkins Atlas of PancreaticPathology has sold over 14,000 copies in 82 countries.It won a Frank Netter Award for Special Contributionsto Medical Education and it has featuredin the iTunes store.(http://www.youtube.com/watch?v=R9VRlssTnJU).Department of Art as Applied to MedicineMax Brödel (1870-1941), a brilliant German artistfrom Leipzig met Drs. Welch, Kelly and Mall whileillustrating for Dr. Carl Ludwig, director of thePhysiological Institute of Leipzig. Mall recognizedBrödel’s potential and recruited him to Johns Hopkinsin 1894. When he arrived at Hopkins, Mallwas busy teaching anatomy but Howard Kelly theProfessor of Gynaecology, ‘commandeered’ Brödelto illustrate a 2 volume textbook on OperativeGynaecology that he was compiling. Brödel quicklyRight above: The Johns Hopkins Atlas of Pancreatic Pathology designedto teach residents, fellows and practising pathologists advanced pancreaticpathology. The Image Atlas contains over 1400 high resolution colorimages.Left above: Harvey Cushing - approach to the pituitary gland.Above: William S. Halsted - approach to an arterio-venous fistula in theneck.Bottom: The journal library with no books. Students are studying fromtheir computers. (I wonder what William Osler would have thought aboutthis? When he moved to Oxford in England, he had a large truckload ofbooks.)Below right: Artists practising sculpting in the Department of Art asApplied to Medicine.Below: Ralph Hruban with a sculpture that was done by a student forpractice.4emerged as one of the greatest medical illustratorswho ever lived, and for decades his illustrationshelped promulgate the surgical accomplishmentsdeveloped at Hopkins.Attempts were made to recruit Brödel away fromHopkins but Dr. Thomas Cullen, Kelly’s successor asProfessor of Gynaecology, led a search for funding.He was successful and the Department of Art as Appliedto Medicine was established at Hopkins to keepBrödel in Baltimore. Henry Walters, a Baltimorefinancier, philanthropist, and art collector, agreedto provide an Endowment to allow the creation ofthe first Department of its kind in 1911 with MaxBrödel as its Director.The Department has been teaching medical illustrationcontinuously since then and it celebratedits 100th anniversary in 2011. In 1959, the JohnsHopkins University approved a two-year graduateprogramme leading to the degree of Master of Artsin Medical and Biological Illustration.The course has an average of 6 students in eachyear in the two year graduate program. Some of thesubjects taught are as follows:• Human Anatomy, Biophysics, Cell Physiologyand Comparative Pathology• Line, Tone and Colour Illustration• Digital Imaging• Graphic DesignAt the time of its creation 58 years ago,and for several decades, the MexicanAssociation of Pathologists (AMP) servedas the national representative body of theguild of pathologists, most of the Mexicanpathologists worked in Mexico City, in theFederal District and there were very fewpathologists elsewhere in the country. Inaddition, the main medical institutions,with sufficient economic and human resourceswere also located in Mexico City.In this situation, it was entirely logicalthat most of the academic activities wereheld in Mexico City and that the board ofdirectors, (with a few exceptions) was onlycomposed of Pathologists of the FederalDistrict.For the last several years, the conditionshave changed, and nowadays many morepathologists work and have academicactivities in the states of the MexicanRepublic.Many pathology laboratories outside thefederal district have immunohistochemistrysections and in several places suchas Monterrey, Puebla, Aguascalientes AGS,Leon Gto, there are laboratories of molecularpathology as well. There are residencytraining programs in MonterreyNL. Guadalajara Jal, San Luis Potosi, SLP,Hermosillo Son.Therefore, it became imperative to createan association to represent the entirecommunity of Mexican pathologists; includingthe ones working in Mexico Cityand nearby metropolitan areas, essentiallyrepresented by the original AMP.The idea of creating a Federation to coordinatethe different groupings of pathologiststhat had arisen was raised for the firsttime in 1979 by Dr. Ruy Pérez Tamayo andDr. Cecilia Ridaura Sanz, in the context ofthe 25th anniversary of the Mexican Associationof pathologists. This idea was occasionallycommented upon by membersof the AMP in the next 20 years, but it wasnot until a National Congress held in Veracruzin May 1998 that action was taken.Pathologists from several parts of thecountry, coordinated by Doctors EduardoLópez Corella, Jose de Jesus Curiel Valdésand Fernando E. De la Torre Rendón, proposedthe creation of an organization thatcould negotiate with the legal, income taxand health authorities, defend commoninterests with other medical associationsand mediate internal conflicts.This proposal did not fall on deaf ears. InFebruary 1999, a group of pathologistswho were attending a workshop of surgicalpathology in Monterrey, NL, discussedthe advisability of creating a Federationof groups of pathologists. They issued aformal invitation to the pathologists ofMexico to constitute The Mexican Federationof Anatomic Pathology.That invitation stressed the need to createthis organization, due to the increasingnumber of pathologists in the country,the diversity of activities of the specialty,the existence of numerous groupings andthe need for interaction, so the formationof a Federation of groups of pathologistsseemed to be the most viable option.The announcement of the creation of theFederation of groupings of Pathologistsof the Mexican Republic was read in thegeneral Assembly of the AMP at the XLIICongress (May 1999, Chihuahua, Chih.),and published in the Bulletin of the AMP, n° 55, July 1999.There was quite a deal of disagreement betweenthis organisation and the AMP overthe ensuing years. In 2004, the AMP decidedno longer to be a part of the Federation.The Federation of Anatomic Pathology ofthe Mexican Republic continued to operateand on October 2, 2010 it joined theInternational Academy of Pathology asthe Mexican Division of the IAP. The applicationto belong to the IAP was approvedin the International Congress of theIAP held in Sao Paulo, Brazil, October10–15, 2010.History ofthe MexicanFederation ofAnatomic Pathology,which is also theMexican Divisionof the InternationalAcademy ofPathology in theacademic andprofessional activityof Pathologists inMexico.Continued page 6 Continued page 6Above: Max Brödel drawing of his Canadian holiday home drawn ona tree fungus.Below: Original journals stored in compactus units.Report on ameeting heldin Cambodia inOctober 2012This meeting was sponsored bythe IAP Education Committeewith a grant of $5,000. Overseaslecturers included the Presidentof the IAP, Samir Amr (SaudiaArabia), the Chairman of the EducationCommittee, HK Ng (HongKong), Claude Cuvelier (a formerPresident of the British Divisionof the IAP).The detailed arrangements weremade by the young Cambodianpathologist, Monirath Hav. Monirathspent a few years in Ghentwith Prof Claude Cuvalier andobtained a Ph. D. degree whileshe was there.There are only 6 pathologists inCambodia and a few trainees.However there was an attendanceof over 180 delegates.These included gynaecologists,surgeons, oncologists and medicalstudents.The meeting was opened by theThe IAP in ActionMinister of Health, Mr. MamBunheng. In his speech, theMinister said that he wasvery pleased to be havingthis meeting in Cambodia.It was the first Internationalmeeting of its kind to beheld in his country and hehoped it would open doorsfor future educational opportunities.Information and images for thisreport were provided by Samir Amrand HK Ng.Above: Some of the International speakers at theOpening ceremony with Cambodian Minister of Healthbetween Samir Amr (Pres of IAP) second from the right,and the conference organiser Dr. Monirath (black andwhite striped jacket)Above: Drs Amr and Monirath chairing a sessionBelow: Conference brochureBelow left: Cambodian dancers at the Gala Dinner.WHO TumourSeries Books:Covers ofRecent EditionsAbove: Question and answer sessionTop: Participants at the conference• Presentation Visuals• 3D modeling and Animation• Surgical, Editorial, and Biological IllustrationPhotography• Medical Sculpture and Facial Prosthetics (such asreplacement eyes).The Max Brödel Archives contain the largest collectionof 20th century medical art. In addition to theillustrations for the Kelly and Cullen books and the 989illustrations in the Walters Collection by Brödel from1911 to 1940, it houses over 3000 illustrations by Brödelgraduates. The Archives are utilized by students in thegraduate program and they are available for study byanyone interested in the history of medicine or medicalillustration. Gary P. Lees is the fourth Director of thisDepartment.The information for this article was provided byRalph Hruban and Gary Lees. They kindly allowedthe author to take pictures in the Hospital, and Garyprovided the illustrations of Max Brödel.The Federation of Anatomic Pathologyof the Mexican Republic / MexicanDivision of the IAP at the presenttime is composed by 14 associationsof pathologists throughout the country.Ten annual meetings have takenplace in different cities of the republicand it organized the 11th annualmeeting held in Mexico City in 2012.The Two Mexican pathology organisationsare planning a joint Nationalmeeting for 2014.Dr. Eduardo Luevano FloresPresident of The Federation of AnatomicPathology of the Mexican Republic/ Mexican Division of the IAP.Mexico report continuedJohns Hopkins continued



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