VIII Congreso Virtual Hispanoamericano http://conganat.cs.urjc.esde Anatomía Patológica – Octubre de 2006 Historia de la Medicina

João Carlos Prolla

M.D. F.I.A.C., Porto Alegre, RS, Brazi

Historia de la Patología y la Filatelia

Este trabajo revisa algunos marcos milenares en la historia de la Patología,desde la antigüedad hasta los tiempos modernos, como la filatelia losdocumenta. Existen centenas de estampillas postales conmemorativas dehechos, efemérides y protagonistas médicos. Algunas son verdaderas obrasde arte, y otras son simples documentos de interés histórico. Existe unproblema en seleccionar un panel amplio pero significativo del tópico“Patología y Filatelia.” En nuestro trabajo figuran estampillas postales enhomenaje a gigantes como Hipócrates, Avicena, Leonardo da Vinci,Vesalius, Virchow, e Papanicoloau. Pero figuras como Leeuwenhoek,Rokitansky, Zeiss, Abbe, Landsteiner, e muchos otros también han merecidoregistro. Un problema obvio es que muchísimos otros grandes nombres dela Patología moderna han sido ignorados por las autoridades filatélicasmundiales, tornando nuestra lista de marcos milenares muy fragmentaria yincompleta.

Palabras clave: historia de la patología; filatelia, teoría celular, Virchow,Papanicolaou

Some milestones in the history of Pathology illustrated byphilately

This paper deals with some of the milestones in the history ofpathology, from ancient times to molecular pathology as documentedby philately. There are hundreds of postal stamps commemoratingmedicine or pathology ephemeredes or their protagonists. Some arebeautiful works of art, others are simple documents of some historicalinterest. One problem is to select a wide but significant sample of thegeneral topic. We could not ignore giants like Hippocrates, Avicenna,Leonardo da Vinci, Vesalius, Virchow, and Papanicolaou. ButLeeuwenhoek, Zeiss, Abbe, Landsteiner and many others also meritregistration. One obvious problem is that philatelic authorities aroundthe world, making the milestone fragmentary, have ignored too manygreat names in medicine and modern pathology.

Keywords: pistory of pathology, philately, cellular theory, Virchow,Papanicolaou.

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INTRODUCCIÓN

“History recognizes many names and ignores evenmore. This fact is particularly true for philately. As aresult, a philatelic version of any aspect of the historyof medicine cannot be totally comprehensive. Theomission of any event or individual’s role in no waylessens the importance of the impact or contribution”(Erwin W. Ruggendorff, New York, N.Y., USA)available in: http://www.urologichistory.museum/museum/content/ about /resources/rugendorffmedstamps.htm

Using philatelic material one can provide some

insights into many major milestones of the history ofpathology and also to introduce the individualsinvolved. It is a tentative journey through medicalhistory from the antiquity to the present. Somecountries like Austria, Australia, and Argentina have atradition of honoring its leading citizens in medicine,while other countries rarely do so.

All the stamps shown here are from my collectionof digital images recovered through the Internet andfreely available for download. As E W Rugendorffsaid on his homepage (see above): “Deciding what toomit has been as difficult as deciding what to include.Though the resulting picture does not necessarilypresent continuity, it does emphasize certain peaksand memorable events in the evolvement of urology”.I would say the same only changing the word urologyfor pathology.

MATERIAL Y MÉTODOS

Using several search engines a detailed search inthe Internet was made, looking for images of postalstamps depicting the great names in medical history,and for web addresses of this topical philatelicinterest. A search for bibliography was made inPubMed, the most relevant articles were selected (1-7). The names and events are presented here inchronological order (preferably by the year of birth ofthe involved protagonists).

RESULTADOS

More than 200 images were identified, and analmost equal number of web addresses were visited.Using a personal criterium the, the most importantand interesting images and corresponding informationwere assembled in a coherent text, as follows, as adiscussion of the findings.

DISCUSIÓN

1) Myth and Legend

Italy 1959

Despite its somewhat sinister appearance, the Staffof Asklepios (or Aesculapius) with its rod and anentwined snake has been an accepted symbol of themedical profession since its inception. Many academicand medical societies, including the World MedicalAssociation, the World Health Organization, theAmerican Medical Association, the American CancerSociety, and many others have this symbol in theirlogos. Asklepios was the God of the medicalprofession. He was the favorite son of Apollo, also aGod of medicine. Spain has three semi-postal stampshonoring Asklepios ( the extra charge in favor of anti-tuberculosis fight – see the Lorena cross in red):

2) Hippocratic medicine

Hippocrates (460-377 BC) separated medicinefrom religion and superstition. He is considered themost important physician of all times, and the oath ofHippocrates is still used in graduation ceremonies ofmany Medical schools throughout the world. Most ofthe earliest descriptions of diseases are from him. Hemade an almost unsurpassed clinical description oftuberculosis. He described the famous humoralpathology, a model to explain the origin of thediseases as a disturbance of the balance of the humors,that is the body fluids that survived for more than

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2,000 years, only being outdated by the cellularpathology of Virchow in the 19th century. Thehumoral pathology was taken over by theGreek/Roman physician Galen in the 2nd century AD.Galen exerted a very great influence over Arabic aswell as European medicine, and he was an importantauthority until the beginning of the 19th century.

Greece stamps honoring Hippocrates are several,and I choose only a few.The first one shows a bust ofHippocrates and the Oath in the background.

There is one Greek stamp depicting the famoustree under which he gave his teachings to hisdisciples:

3) Middle Ages

Avicenna (Ibn Sina)(980-1037), a Persianphysician, astronomer, and philosopher in his Canonof Medicine, combined the concepts of Hippocrates,Galen and Islamic principles with the medical practiceof his time. His book was widely used in medicineteaching up to around the mid of 17th century.Tunisia, France and Poland issued stamps depictingAvicenna:

The Arab Republic of Syria (1965) and Iran issuedstamps honoring both Hippocrates and Avicenna, andthe staff of Asklepios has wrongly two serpents (thisis a caduceus, the rod of Hermes, the Mercurialsymbol of commerce) (Wilcox and Whitham, 2003):

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Herophilus and Erasistratus were the only knownGreeks who dissected humans in antiquity. Anatomywas taught using Galen and Aristotle ideas until theRenaissance. Nearly 1800 years passed beforeLeonardo da Vinci and Andreas Vesalius (1514-1564) resumed the study of the human anatomy, in theItalian Renaissance. They deserve the honor of beingconsidered the fathers of the New Anatomy thatstarted a new era in western medicine. Vesalius´ DeHumani Corporis Fabrica is rightly considered one ofthe most important books in medicine.

Belgium stamps honoring Vesalius:

Monaco, Poland, and Macedonia besides manyother countries issued stamps honoring Leonardo:

5) Early microscopists

In the 17th century five great microscopists leftoutstanding achievements: Leeuwenhoek, Hooke,Nehemiah Grew, Marcello Malpighi (whosedescription of frog lung capillaries in 1661 started thediscipline of histology, and solved the problem ofHarvey´s circulation model), and Swarmmerdam.With their amazing simple microscopes (Demesianosfrom the Accademia dei Lincei had coined the word´microscopio´), they made several discoveries, andwith the posterior refinement of the instrument, led tothe cellular theory.

Antoni van Leeuwenhoek (1632-1723). Forexample, he was the first to see living protozoa,bacteria and spermatozoa (according to Rugendorff,they were observed for the first time by his disciple L.Hamm). He used an extremely simple microscope,built by himself, but was a well disciplined observerand made convincing drawings of his findings.

Holland and Antigua & Barbuda issued stampshonoring Leeuwenhoek and his microscope:

Robert Hooke (1635-1703) in his Micrographia(1665) used the word cell, describing the small poresor holes he saw in a thin piece of cork, andunknowingly started a medical revolution, he had noidea or conception of the cells as we have now. (Harris1999). His book had an enormous impact on his days,and besides this, he was a prolific scientist andinventor. He divided the podium, if you permit the

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metaphor, with his contemporary and contender, SirIsaac Newton.

Henry Harris in his excellent book The Birth ofthe Cell says: “There is, in my view, no convincingevidence that he saw individual living cells in anyother tissue”.

The polymath Hooke deserves a visit to the website dedicated to him:

http://www.roberthooke.org.uk/intro.htm

The German Democratic Republic issued in 1980a series of four stamps depicting early compoundmicroscopes, and UK issued in 1989 beautiful stampson the 150th year of the foundation of the RoyalMicroscopical Society of London (Evennett, 1989,Quekett 1997, Wergin,1990):

The 18th century saw almost no great progress, forwant of better instruments, but the first half of the19th century saw many contributions from scientists

now using better built microscopes, including the useof the solar light as illumination (W F Gleichen): B CDumorthier, Jan Purkine, Robert Brown, C GEhrenberg, A H Hassal, Otto Bütschli, G G Valentin,R Remak, M Raspail, etc, culminating with the “CellTheory” commonly attributed to Theodor Schwannand Matthias Schleiden in 1838~1839. All wereignored by world philately.

Henry Harris in his above mentioned book,laments the great rivalry between Germany and othernations, creating a reciprocal nationalistic bias in theirrespective publications, resulting in the usual omissionof Purkine as an equal contributor to the formulationof the Cell Theory; actually he preceded them in 1837:in a public lecture given in Prague. In his workPurkine was the first to use a microtome, a mechanicaldevice for slicing thin tissue sections for microscopicexamination. He used glacial acetic acid, potassiumbichromate in his pathological or anatomicalpreparations, and also became the first to use glass-slide preparations with balsam as a mounting medium.

It is worth of note that the first largely availablemicrotome was developed by Zeiss in 1880, and thatthe “apochromatic” oil-immersion objective lenses ofAbbe were first constructed in 1870. Great progresswas also made in fixing and staining of tissues. Thesecond half of the 19th century saw the establishmentof chairs of pathological anatomy in all medicalschools. Those achievements led to modernPathology.

6) Modern Pathology

Karl Freiherr von Rokitansky (1804-1878), thefounder of the anatomo-pathological school of Vienna,who in a period of 40 years personally performedmore than 30,000 autopsies, and was criticized byVirchow as being not objective and mainly based onthe humoral theory of diseases was honored byAustria with two stamps:

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R-T-H Laënnec (1781-1826) in France describedin detail the morbid anatomy of tuberculosis.“Laënnec's studies on tuberculosis were monumental.He first recognized the unity of this condition, whichhad previously been thought to be a number ofdifferent diseases. He wrote the first descriptions ofbronchiectasis and cirrhosis, and classified pulmonaryconditions.

He is also famous for the invention of thestethoscope: he introduced many terms still usedtoday in auscultation: for example, pectoriloquy, ralesand aegophony, and described bronchial and vesicularbreathing. He also described “cirrhosis” of the liver.

France honored him with a stamp:

Pierre F. Bretonneau (1788-1862) made thefundamental studies on typhoid fever based onautopsy findings in 120 patients dying from it. He alsopublished a treatise on diphtheria (Traité de laDiphthérie). France honored him with a stamp (withhis beloved Tours in the background):

Carl Zeiss (1816-1888) and Ernst Abbe (1840-1905) made great contributions in the development ofthe modern microscopes used in everyday pathology.German Democratic Republic (DDR) honored both,and the Zeiss fabric in Jena:

Rudolf L.K. Virchow (1821-1902)

(Born October 13, 1821 in Pomerania, diedSeptember 5, 1902, in Berlin) He was the mostprominent German pathologist, and also a brilliantbiologist and politician.

Virchow studied medicine in Berlin at the KaiserWilhelm Academy of Prussia, and in 1843 graduatedat the University of Berlin. In 1847 he was appointedPrivatdozent in Pathology.

Virchow is credited with multiple significantdiscoveries. He was the first to recognize leukemia asa disease. His method of making autopsy is still astandard one. However, he is perhaps best known forhis law Omnis cellula a cellula ("every cell originatesfrom another cell") which he published in 1855. (Themotto was actually coined by François-VincentRaspail but popularized by Virchow). Virchow is alsofamous for elucidating the mechanism of pulmonarythromboembolism, thus coining the term embolism.Virchow is considered the most prominent Germanphysician of the 19th century, his long and successfulcareer reflecting the ascendancy of German medicineafter 1840. Virchow pioneered the modern concept ofpathological processes by his application of the celltheory to explain the effects of disease in the organsand tissues of the body. He emphasized that diseasesarose, not in organs or tissues in general, but primarily

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in their individual cells. Virchow founded the medicaldisciplines of cellular pathology, comparativepathology, and anthropology.

His Die Cellular-pathologie, 1858, probably themost influential book ever written on medicine, was acompilation of previous lectures and formal scientificpapers, and incorporated Robert Remak (1815-1865)views that every animal cell originated from aprevious animal cell, a position never adopted bySchwann,

7) Virchow’s Archiv

Dissatisfied with the editors of journals thatrefused to accept some of his papers, Virchow, withhis friend Benno Ernst Heinrich Reinhardt (1819-1852), in 1846 founded a new journal, Archiv fürpathologische Anatomie und Physiologie und fürklinische Medizin ("Archives of PathologicalAnatomy and Physiology and of Clinical Medicine").He wrote that the aim of the journal was a close unionof clinical medicine, pathological anatomy andphysiology and this remained his lifetime objective.He strongly propounded the concept that unprovedhypothesis is an anathema for the practice of medicineand that no man could be regarded as infallible withregard to knowledge, judgment or supposition.

This journal became one of the most prominentmedical periodicals of the time. After Reinhardt'sdeath in 1852, Virchow continued as sole editor, nowknown as Virchows Archiv. In 1856 Virchowaccepted an invitation to return to the University ofBerlin as professor of anatomy, general pathology,and therapy, as well as director of the newly createdPathological Institute at the famous Charité Hospitalin Berlin. The stamp of DDR (DeutscheDemokkratische Republik) honoring the 250th year offoundation of Charité has his effigy.

Robert Koch (1843-1910), in 1882, isolated thetubercle bacillus and developed a staining method todemonstrate it in tissues. Tuberculosis was starting tobe defeated as one of the major killers of humankind.Many countries with dozens of stamps have honoredhim. Here we demonstrate only six of them.

A very interesting stamp from Rwanda,commemorating the 100th year of the discovery of thetuberculosis bacillus by Koch, shows what was to be amicroscopical field depicting a histological section of

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a lung with tuberculosis, but actually looks more atangle of blood vessels.

Paul Ehrlich (1854-1915), won the Nobel Prize inMedicine or Physiology in 1908, together with IlyaIlyich Mechnikov, in recognition for their work inimmunity. But while still a student of medicine and inhis early career he made very important contributionsin staining cells and tissues, working mainly withaniline dyes, In 1878 he obtained his doctorate ofmedicine by means of a dissertation on the theory andpractice of staining animal tissues. He has beenhonored with many stamps, specially because he isconsidered the father of modern chemotherapy ofpathogenic microorganisms, in special of syphilis.Ghana commemorating the 100th anniversary of theNobel Prize issued a stamp honoring Ehrlich:

Karl Landsteiner (1868-1943), who received the1930 Nobel Prize in Medicine or Physiology inrecognition for his discovery of blood groups in man,and whose research with Alexander S. Wiener led tothe discovery of the Rhesus (Rh) factor in 1940,introduced the dark-field microscopy for the diagnosisof primary syphilis. Previously, spirochetes could beseen only in stained sections of tissue.

Karl Landsteiner

Frits (“Frederyk”) Zernike (1898-1966), Dutchphysicist, in early 1930 discovered the phase contrastphenomenon in his optical laboratory and laterinvented the phase contrast microscope. He haddifficulties in convincing the Zeiss industry to makecommercially available phase microscopes. Today thestudy of living organisms and cells are unthinkablewithout the help of phase microscope. He wasawarded the Nobel Prize in Physics “for hisdemonstration of the phase contrast method,especially for his invention of the phase contrastmicroscope” in 1953.

He was honored by his native Netherlands and bythe Republic of Guinea:

8) Cytopathology

Johannes Peter Muller in Germany (1838) andAlfred François Donné in France (1845) areconsidered the pioneers in using cytological criteriaand to study and diagnose diseases, in specialmalignant tumors. Donné first described Trichomonasvaginalis. He was a pioneer in the use ofphotomicrography in documenting cytology with hisAtlas du cours de microscopie exécuté d’après natureau microscope daguerreotype avec M. Léon Foucault,1845. The atlas includes the first engravings fromphotomicrographs, in this case, daguerreotypes. The

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interested reader should consult the History ofClinical Cytology (Grunze and Sppriggs, 1980) forthe details of their contributions. Both men wereignored by the postal authorities of their countries.

George N. Papanicolaou (1883-1962), the fatherof cytopathology was honored by stamps issued bythe USA, where he developed the method, by hisnative country Greece, and by Cyprus. Greece alsohad his image on a 10,000 dracma bill (Wilcox andWhitham, 2005).

He studied at the University of Athens where hereceived his medical degree in 1904. Six years later hereceived his Ph.D. from the University of Munich,Germany. In 1913 he emigrated to the U.S.A. inorder to work in the department of Pathology of NewYork Hospital and in the Department of Anatomy ofthe Cornell University. He first reported that uterinecancer could be diagnosed by means of a vaginalsmear in 1928, but the importance of his work was notrecognized until the publication, together with HTraut, of 'Diagnosis of Uterine Cancer by the VaginalSmear' in 1943. He thus became known for hisinvention of Papanicolaou's test, which is usedworldwide for the detection and prevention of cervicalcancer and other cytologic diseases of the femalereprodutive system. Since the introduction of the Paptest after 1950, the death rate from cervical cancer hasdecreased by nearly 70 percent, in countries likeCanada, USA, and Sweden, where effective use of thetest has been accomplished. It is without doubt themost effective secondary preventive medical strategyever devised.

The USA issued in 1965 the stamp “FightingCancer with Microscope and Stethoscope”, andemphasizing its early diagnosis, and a first day ofissue cover shows the Pap smear being fixed with adrop of cytological fixative.

In 1996 the Republic of Croatia issued a stampfor the awareness of the Pap test in prevention ofcancer of the uterus, and in 2004, Argentina alsoissued a stamp with similar purpose:

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9) Molecular Pathology

César Milstein (1927- ), an Argentinean scientist,shared the 1984 Nobel Prize in Medicine withGeorges J. F. Köhler (1946- ), and Nils K. Jerne fortheories concerning the specificity in developmentand control of the immune system and the discoveryof the principle for production of monoclonalantibodies. Monoclonal antibodies are used indiagnostic testing, specially immune-histochemistryin pathology, for the development of drugs, vaccinesand hormones, and for cancer therapy. Argentinahonored his native scientist with a stamp in 2005.

DNA double helix and the biotechnology revolution

Several countries issued commemorative stampsfor the 50th year of the discovery of the DNA doublehelix structure, and the advent of molecular biology(and its by-product molecular pathology):

REFERENCIAS

1. Anand A, Singh VP, Anand KP. Medical philately(medical personalities on stamps)—George NicholasPapanicolaou. J Assoc Physicians India. 2005;53:126.

2. Evennett P. The Royal Microscopical Society Stamps.Proceedings RMS, 1989; 24:231-237.

3. Grunze H and Spriggs AI. History of Clinical Cytology.1980 G-I-T Verlag Ernst Griebeler, Darmstadt.

4. Harris H. – The Birth of the Cell – 1999, YaleUniversity Press.

5. Quekett WH: Microscopes on Stamps: A Checklist to1996. Journal of Microscopy, 1997; 38:37-47.

6. Wergin WP. Microscopes and Postage Stamps.Proceedings RMS, 1990, volume 25, pages 115-121,212-214, 249-253, 324-327,416-422.

7. Wilcox, R A and Whitham, E M. "The Symbol ofModern Medicine: Why One Snake Is More Than Two"Ann Intern Med. 2003;138:673-677.

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