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26 Department of Pathology WHEN THE JEWS’ Hospital opened its doors in 1855, pathology and laboratory services were essentially nonexistent. The need for such facilities , however, became apparent when, six months after the opening of the Hospital, Mark Blumenthal, the Resident and Attending Physician , requested permission to perform an autopsy on one of his patients to “justify himself and his reputation concerning the cause of death of the patient.”1 Permission was granted by the Directors by a single-vote margin (four to three). The following month, John Hart, the President of the Hospital, introduced a resolution “that there be no postmortems in the hospital under any circumstances whatsoever unless required by law since such examinations were entirely contrary to Jewish law.”2 This resolution passed. The Chief Rabbi of London was consulted, and, when he responded that autopsies were desecrations and could be performed only in cases of suspected murder or when the cause of death was unknown and there were other patients in the Hospital with the same disease, these very stringent regulations remained in effect. Nevertheless , when it was deemed necessary, the Directors did give their approval. These autopsies were performed by the clinicians and consisted of gross examinations only. By the last decade of the nineteenth century, the development of research medicine made the need for laboratory services self-evident. Also, the intellectual needs of the physicians to know the cause of death and to determine where they might have made errors in diagnosis led to a gradual increase in the number of autopsies requested and permissions granted. In a move spurred by the clinicians and readily accepted by the Directors, the Hospital established a laboratory in 1893 on the second floor of the Lexington Avenue building in a small corner room. Henry N. Heineman, a member of the medical staff since 1880, was named the first Pathologist. Helping to supply the laboratory with his own funds, Heineman also appointed Frederick S. Mandlebaum his Assistant and sent the latter to Europe for further study. Shortly after Man286 dlebaum’s return, Heineman resigned, and Mandlebaum was appointed as the first full-time Pathologist in the institution. At first, the laboratory was open only a few hours a day, and Mandlebaum’s salary was five hundred dollars per year.3 Mandlebaum would direct pathology and laboratory services for thirty years. A meticulous and tireless worker, he not only studied all of the pathology specimens and directed research in the laboratory but also cleaned the test tubes, the instruments, and often the floor. Allergic to formalin, Mandlebaum delegated the performance of autopsies to Emanuel Libman and then to George Baehr. Mandlebaum’s accomplishments were many, both as a pathologist and as an administrator. He was the first to develop the technique of identifying malignant cells in tissue fluids.4 His studies on Gaucher’s disease over a period of many years, often in collaboration with Nathan Brill, paved the way for a century of interest in this genetic disorder on the part of many of Mount Sinai’s staff. Mandlebaum appointed Charles A. Elsberg his first Assistant in Pathology in 1896. Elsberg published his first paper on the serum diagnosis of typhoid fever one year later.5 This seminal study on the Widal reaction later allowed the Hospital to trace an epidemic of typhoid in the Nurses Training School to an employee who was probably a typhoid carrier. Elsberg also published the results of the first animal experimental study performed in the laboratory on the repair of wounds of the heart.6 Elsberg’s paper was the first of thousands of publications to result from experimental work at the laboratories of The Mount Sinai Hospital. As with so many of the physicians who were Assistants or Volunteers in pathology, Elsberg would go on to great fame in his chosen field, in his case neurosurgery.7 In 1910, Elsberg would also be responsible for the introduction of intratracheal anesthesia.8 Elsberg tells a delightful story about the early days of the laboratory: White mice, rabbits and guinea-pigs were kept in a cage in the subbasement of the hospital. In the daytime the cage was rolled out into the hospital yard and at night was kept in one of the corridors. If one can apply the term to an animal cage, this cage had a checkered career. One day a grocery wagon upset the cage and the guinea-pigs and mice escaped and frightened convalescent patients who were sitting in...

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