The First Cellular Pathologists

Annals of Clinical & Laboratory Science, vol. 34, no. 4, 2004 481

A Note from History: The First Cellular Pathologists

Steven I. Hajdu

Keywords: History of pathology, history of cytology, Hermann Lebert, Julius Vogel

By all rights, Julius Vogel (1814-1880) and Hermann Lebert (1813-1878) should be household names to pathologists, cytologists, and all who are interested in the history of science and medicine. But, due to gross neglect by historians, Vogel’s and Lebert’s major contributions to laboratory science and medicine have remained largely unappreciated for 150 years. Readers of the Annals may find it disappointing, as I did, to observe that Morton’s monumental Medical Bibliography does not include either Vogel or Lebert among the >7000 entries [1]. Julius Vogel, a disciple of Johannes Müller, was professor of pathology at Göttingen in Germany. He was a skillful microscopist and was expert in basic sciences as well as anatomic and clinical pathology. He was one of the first to attempt grafting tumors in animals. Within 5 years after Theodor Schwann (1810-1882) and Matthias Schleiden (1804-1881) announced the cell theory and Johannes Müller (1801-1858) finished his monograph on cancer, Julius Vogel’s pioneering book on Pathological Anatomy was published in Berlin. Vogel’s text was rapidly translated from German into English and was published in London and Philadelphia in 1847 [2]. George E. Day, the translator, wrote that the laborious translation had been undertaken because of the lack of any book in English that embraced Fig. 1. Plate VIII from Vogel’s Pathological Anatomy of the the recent discoveries in chemistry and pathology. Human Body [2] (For descriptions of the figures, see the text.) Vogel’s Pathological Anatomy [2] was the earliest comprehensive pathology text that contained macroscopic, histopathologic, and cytopathologic illustrations. The book consists of 482 pages of text, Address correspondence to Steven I. Hajdu, M.D., 1759 10 plates of illustrations with >100 figures; and 42 Drumcliff Court, Westlake Village, CA 91361-1636, USA; tel pages of legends for the figures. In addition to a 805 496 0691; fax 805 496 0620 dozen illustrations of surgical specimens, histologic

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sections, concretions, and crystals, the bulk of the figures show benign and malignant cells. Among the figures are cells from tuberculous granuloma, cirrhotic and fatty liver, granulation tissue, gangrene of the foot, blood and blood clot, hyperplastic lymph nodes, nasal polyp, parotid tumor, enchondroma, papillary tumor of the bladder, polypoid tumor of the uterus, lipoma, and carcinomas of the breast, lung, uterus, and testis. Vogel also included cells from sputum in cases of pneumonia, bronchitis, and tracheitis and cells from pleural and pericardial effusions. The 11 figures on Plate VIII (Fig. 1) are printed with 9 pages of detailed microscopic descriptions. Vogel’s legends state that Figs. 1-3 show carcinoma of the testis (malignant germ cell tumor). The cells are variable in size and form, with round (a), oval (b), candate (f), and entirely irregular forms. In some nuclei, big nucleoli are visible (c, h). Fig. 2 shows fibers that remained after sections were treated with acetic acid. Figs. 3 (a) and (b) show tumor cells inside a capsule (seminoma?). Figs 4 and 5 are from a 14- pound carcinoma of the liver (hepatoma?). Figs. 6 and 7 illustrate a soft cancer of the knee joint of a young man (giant cell tumor?). Fig. 8 shows cancer cells from a scirrhus carcinoma of the breast (infiltrating duct carcinoma) and Fig. 9 shows tumor cells from retroperitoneal and pulmonary metastases of the testicular primary tumor illustrated in Figs. Fig. 2. Plate XIX from Lebert’s Physiologie Pathologique [3] (For descriptions of figures, see the text.) 1-3. Vogel gives credit to Johannes Müller for Fig. 10, which shows the reticular stroma of a breast under the microscope. The most notable illustrations carcinoma, and Fig. 11, which shows an alveolar in the atlas are brain abscess, tuberculous granuloma carcinoma (adenocarcinoma) of the stomach. in the brain, tuberculous lymphadenitis, sebaceous The other forgotten pathologist is Hermann cysts, cholesteatoma, melanosis coli, echinococcus Lebert. He was born in Germany but did most of in the liver (with hooklets and all), and ciliated and his clinical work, writing, and teaching while he was non-ciliated (metaplastic) cells in sputum. The Professor of Pathology in Paris and later in Zurich. figures of tumors include cells from squamous Lebert lectured and wrote in French. His three papilloma and condyloma, pulmonary chondroid landmark books were published in Paris from 1845 lesions (chondroid hamartoma?), fibroadenoma and to 1857 [3-5]. phyllodes tumor of the breast, chondromatosis of Lebert’s Physiologie Pathologique [3] contains the fingers, dermoid cyst of the ovary, meningioma, >1000 pages and an atlas with 249 figures (some fibroma of the skin (dermatofibrosarcoma), tumor hand colored) on 22 page-size plates. The legends of the knee joint (villonodular synovitis), post- for the figures are very detailed and occupy 33 pages. amputation tumor (amputation neuroma), cancer The text and figures are almost equally devoted to of the uterine cervix (squamous carcinoma), cancer inflammatory changes, infectious lesions, benign of the colon (adenocarcinoma), cancers of the tumors, and cancers, as seen with the naked eye and maxilla, lung, and buccal mucosa, metastatic gastric

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cancer in the liver, sarcoma of the uterus, and spindle pages and discusses the dietary, surgical, and medical cell sarcoma of soft tissues. treatment of cancer. In 1857, Lebert [5] published Fig. 2 of this commentary (Plate XIX from a comprehensive pathology text in two volumes that Lebert’s Physiologie Pathologique [3]) shows a covered everything that was known at that time combination of histologic sections and isolated cells about anatomic pathology, as well as discussions on in 11 drawings that are identified as Figs. 1 to 11. clinical pathology. In the plate, Figs. 1 and 3 to 6 show histologic It is fitting to emphasize the crucial importance sections and cells of breast cancer. Fig. 2 shows of Vogel’s and Lebert’s roles in developing the crystals from a breast cancer. The legend calls concepts of cellular pathology. Vogel and Lebert attention, in Fig. 6, to enlarged nuclei (b), macro- established the solid basis on which Rudolph nucleoli (c), and cancer cells infiltrating fat (e and Virchow, in the 1860s, built his general theory about f). Figs. 7-11 show histologic sections and cells of cells. an encephaloid tumor (germ cell tumor) of the testis. Giant cells are shown in Figs. 10 and 11. References For their microscopic examinations, Vogel and Lebert sliced fresh tissues with a razor-like knife and 1. Norman JM. Morton’s Medical Bibliography. University Press, Cambridge, 1991. prepared cell samples (smears) by scraping, washing, 2. Vogel J. The Pathological Anatomy of the Human Body. or by squeezing the tissue slices. Samples from fluids (Translated from German by George E. Day.) Lea and were placed on glass slides without preservatives. Blanchard, Philadelphia, 1847. Most microscopic preparations were unstained, but 3. Lebert H. Physiologie Pathologique ou Récherches Clinique, Experimentales et Microscopiques. Bailliére, Paris, 1845. occasionally a drop of iodine was applied as a stain. 4. Lebert H. Traité Pratique des Maladies Cancéreuses et des In his text on cancer (1851), Lebert [4] gave Affections Curables Confondues aver le Cancer. Bailliére, concise summaries and organ specific descriptions Paris, 1851. of all forms of tumors. The book consists of 885 5. Lebert H. Traité d´Anatomie Pathologique Générale et Spéciale. Bailliére, Paris, 1857.

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