Microbiology Mary Jane Ferraro and Robert C

Chapter Microbiology Mary Jane Ferraro and Robert C. Moellering Jr. he history of Microbiology (or Bacte- abrupt departure the following year, Dr. Law- Triology, as it was originally known) at the rence Kunz, who had come to the MGH as an Massachusetts General Hospital (MGH) is a Assistant Bacteriologist in 1952, assumed de facto complex one. Although Dr. Reginald Heber responsibility for the laboratory until he was offi - Fitz’s pioneering work established the pathogen- cially appointed chief in 1956. During his tenure esis of appendicitis in 1886 (15, 41; and see chapter the Department of Bacteriology developed close 2), the laboratory specialty of microbiology owes ties with the Infectious Diseases Division and the its origins to Dr. James Homer Wright, who was Department of Medicine. Th is was also a time appointed Pathologist at MGH in 1896. Wright during which a number of “boutique” clinical was involved in a number of landmark studies laboratories sprang up throughout the hospital. in the etiology of parasitic and other infections, Microbiology and Infectious Diseases were no established the fi rst diagnostic bacteriology labo- exception, and in rapid order independent laboratory functions at the MGH, and hired several ratories of Antibiotic Blood Levels, Parasitology, physicians to undertake bacteriological work in and Virology were established in the Infectious the department. In 1925, just before the end of Dr. Diseases Unit. All these had close relationships Wright’s tenure as chief, the offi cial position of with the Bacteriology Laboratory as well. In 1989 Bacteriologist was established in the Department the activities of the Bacteriology/Clinical Micro- of Pathology, and this was held in succession by biology Laboratory were once again returned to Drs. George Lawson and Merrill King over the Pathology under Clinical Pathology. With the next several years. In 1930 Dr. Louis Dienes was consolidation of laboratories in the early 1990s, appointed Bacteriologist, a position he held until the activities in all these specialized infectious 1952. Under his direction the fi eld of bacteriology diseases laboratories were ultimately incorpo- began to fl ourish and the number of diagnostic rated under Bacteriology to make it a true Clini- studies carried out in the Clinical Bacteriology cal Microbiology Laboratory. Before this, how- Laboratory increased dramatically. After Dr. ever, Dr. Kunz had retired in 1982 and Dr. Mary Dienes’s retirement in 1952, Th omas Fite Paine Jane Ferraro had been appointed his successor. Jr. was appointed Chief of Bacteriology, and a She has maintained leadership of the Clini- separate department was established, beginning cal Microbiology Laboratories until the present a nearly four-decade period (1952–1989) in which time. Th us, in a period of just less than a century, clinical microbiological studies were performed Clinical Microbiology at the MGH evolved from outside the Pathology department. Upon Paine’s a nascent discipline in Pathology to a separate 303 pathology_chap21.indd 303 8/16/11 10:24 AM Keen Minds to Explore the Dark Continents of Disease Department of Bacteriology, which ultimately leishmaniasis. Dr. Wright’s monograph entitled became a full-fl edged Division of Clinical Micro- “Th e Biology of the Microorganism of Acti- biology, and was returned to its original roots in nomycosis” led to his receipt of the Samuel D. Pathology, where it now resides as a fl ourishing Gross Prize (53). During Dr. Wright’s tenure, lab- clinical, research, and teaching operation. oratory testing for infectious diseases was estab- During the fi rst hundred years of Bacteriol- lished in Pathology, although the number of tests ogy/Clinical Microbiology at the MGH, the lab- carried out was relatively modest by today’s stan- oratory occupied a number of diff erent venues. It dards. Initial tests involved studies of blood and began its existence under Dr. Wright in the Allen urine but were expanded to include cerebrospi- Street Building. By the 1930s bacteriology was nal fl uid before Wright retired (1). After visiting carried out in a building adjacent to the Allen a laboratory in Germany, Wright commissioned Street Building (see below). In the early 1950s the the building of the fi rst water-jacketed incuba- laboratory was relocated to the fourth fl oor of tor in the United States (fi gure 21.1), which was the Domestic Building, where it remained until built by a Boston coppersmith named Peter Gray. it was moved to a temporary building erected Th is gas-powered incubator served to provide the on the lawn in front of the Bulfi nch Building to appropriate environment for early bacterial cul- enable the destruction of the Domestic Building tures at the institution. It was placed on display and construction of the Gray Building. In 1968 in the MGH Ether Dome after its utility in the the laboratory moved into new quarters on the Bacteriology Laboratory ended. fourth fl oor of the Gray Building, which had A review of the annual reports of the Depart- been made possible through a bequest from the ment of Pathology to the MGH Board of Trustees estate of Mrs. Stephen S. Fitzgerald, in memory provides an interesting insight into the microbi- of her father, Francis Blake. Blake was the inven- ology activities carried out in Pathology during tor of the Blake transmitter, which was developed the Wright era (1). As early as 1898, Dr. Wright for the Bell Telephone Company, and was once a reported that Pathology was involved in the Trustee of the MGH. Th e Francis Blake Bacteri- “application of bacterial culture tests in cases of ology Laboratories provided much-needed space suspected diphtheria in the hospital wards” and and facilities for the growing activities of the Bac- “the testing of tissues and fl uids for the presence of teriology/Microbiology Laboratory. the bacillus of tuberculosis.” His 1899 report notes that Pathology had begun “examination of spu- The Wright Era tum for tuberculosis bacillus” and also observes Dr. James Homer Wright (chapter 4) served as that the laboratory was carrying out examinations Chief of the Department of Pathology at MGH of blood for the “malaria parasite.” He then went from 1896 until 1926. In the early 1900s, Dr. on to describe an interesting test for typhoid fever Wright authored sections titled “Actinomyco- that was employed in 1899 but is not mentioned sis” and “Diseases Due to Vegetable Parasites in subsequent reports: “In typhoid fever the blood Other Th an Bacteria” for Dr. William Osler’s test is of greatest value confi rming the diagnosis. textbook Modern Medicine, evidence of his grow- Th e test consisted of a drop of blood from earlobe ing interest in infectious diseases (28). In 1903 or fi nger-tip mixed with a few drops of bouillon he reported on the discovery of a protozoan in containing living typhoid bacilli, which caused the a tropical ulcer, but, although this was an inde- bacilli to gather together as clumps or groups.” He pendent observation, Dr. Wright was six months also noted that the laboratory was doing throat later than Charles Donovan in what turned out cultures for diphtheria and stated that the labora- to be the discovery of the causative organism of tory was beginning to study methods to cultivate 304 pathology_chap21.indd 304 8/16/11 10:24 AM Microbiology Figure 21.1 James Homer Wright (left) in his laboratory with the fi rst water-jacketed incubator (far right) in the United States. Th e person standing at the bench at the back of the laboratory is most likely Louis Brown. bacteria in the absence of oxygen “with special ref- prolifi c in this area, publishing eight articles on erence to the bacillus of tetanus or ‘lockjaw’ ”; and the subject in 1897 and 1898 alone. He went on to in 1900 he published a paper describing a rather serve on the board of public health and published crude but eff ective method for culturing anaero- on inoculation against typhoid fever. Dr. Steele bic bacteria (57). It was at this time that he also served as Assistant in Clinical Bacteriology from began his own personal studies of actinomycosis 1910 through 1926. He had trained at Boston (fi gure 21.2). Th ese were remarkably pioneering City Hospital and at MGH. In MGH Pathology eff orts in early bacteriology, especially given the he played a major role in the therapeutic use of fact that they took place less than a quarter cen- killed bacteria. tury after the establishment of the microbial basis In 1907 the Pathology Department began to for bacterial infections by Robert Koch and Louis treat “certain bacterial diseases by subcutane- Pasteur. ous injections of killed cultures of the infecting Wright’s diagnostic eff orts and research studies organism” (1). Hundreds of patients received in bacteriology were supported by several other this therapy on the wards and in two separate physicians working in the Pathology department, rooms in the Pathology Department. Indeed, including Drs. Mark Wyman Richardson and 500 patients were treated in 1908, with “very Albert E. Steele. Richardson did pioneering work satisfactory results.” It should be noted that this on methods for diagnosing typhoid fever and was type of therapy was carried out in Pathology for 305 pathology_chap21.indd 305 8/16/11 10:24 AM Keen Minds to Explore the Dark Continents of Disease appointed Bacteriologist in his place, but he left in 1930 after a brief tenure to enter a career in ophthalmology, which led to the appointment of Dr. Louis Dienes (53). The Dienes Era Dr. Louis Dienes (fi gure 21.3) was appointed Bacteriologist in the Department of Pathology in 1930, a position he held until his retirement in 1952 (53). Dienes was born in Tokay, Hungary, in 1885 and received a medical degree from the University of Budapest in 1908.

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