Guiding the Surgeon's Hand: The History of American Surgical Pathology (review)

In the nineteenth century, pathology was a basic science with little direct involvement in patient care; in the early to mid-twentieth century, its emphasis became clinical, and surgical pathology was at the forefront of this transition. Guiding the Surgeon’s Hand, edited by the eminent surgical pathologist Juan Rosai, chronicles the development of this field in the United States. Although now an integral part of pathology, surgical pathology arose estranged from pathology in departments of surgery at a handful of premier American hospitals in the early twentieth century. The first chapter briefly describes various paradigm shifts in pathology from the Middle Ages to the present, thus setting the context for the rest of the book. The second chapter provides a well-written, accurate overview of the events promoting the development of surgical pathology, as well as describing some of the players.

The next six chapters chronicle the development of university/hospital departments of surgical pathology at Johns Hopkins, Columbia, Memorial Sloan-Kettering, Harvard, Barnes Hospital/Washington University, and the Mayo Clinic. Rosai selected these six institutions as having had the greatest overall impact on the development of the specialty, and one could hardly fault his choices. The need for surgical pathologists developed acutely, and these six great training programs were forged around one or more founding fathers who recognized and filled this niche. The founders disseminated their gospel through their trainees, who quickly filled academic surgical pathology positions across the country. As a result, most American surgical pathologists, regardless of where they trained, can trace their roots through their own mentors to one or more of these programs.

These six chapters were written by distinguished, senior surgical pathologists. Although none of the authors is a trained historian, they know whereof they write, for most were direct trainees of the great ones. These disciples discuss the colorful people and events that they observed during the very early parts of their careers, or that were described to them by their mentors, their mentors’ colleagues, or other trainees. Although the writing style varies dramatically from chapter to chapter, and there is sometimes a tendency to provide glowing, noncritical descriptions of people and events, the factual framework of names, dates, and previously unpublished photographs is invaluable. Some chapters are chronologies, while others focus on a few famous individuals; however, they all successfully articulate why the program in which each author trained was so influential.

There is also a chapter on the history of the Armed Forces Institute of Pathology (AFIP), a national referral center that provides diagnostic consultation and educational services (and which, incidentally, both funded and published this book as part of its series of fascicles on tumor pathology). Unfortunately, this chapter is disappointing because the author focuses on the administrative structure of the AFIP, rather than the accomplishments of its outstanding surgical pathologists. Much of the chapter reads like an advertisement for the current services provided by the AFIP.

Finally, the book includes previously unpublished autobiographical data on two of the most important of the founding surgical pathologists: Dr. Arthur Purdy Stout, former director of Surgical Pathology at the College of Physicians and Surgeons of Columbia University, and Dr. Lauren V. Ackerman, former director of Surgical Pathology at Barnes Hospital. While the six previously mentioned chapters outline the ontogeny of the specialty, these two autobiographies recapitulate its soul. The seventy-seven-page autobiography of Stout was written, according to its author, “solely for my own amusement” (p. 197), and the only known copy was in the possession of one of his favored trainees. It was apparently written while on summer vacation in 1950 and 1951 immediately prior to his forced retirement from Columbia at age sixty-five, and was updated occasionally thereafter until 1955, when he...