William B. Ober, MD (1920-1993): humanist, humorist, historian, and histopathologist: recollections of his life and evaluation of his work

Seminars in Diagnostic Pathology (2008) 25, 202-229

William B. Ober, MD (1920-1993): humanist, humorist, historian, and histopathologist: recollections of his life and evaluation of his work Robert E. Scully, MD, Robert H. Young, MD From the James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Within the pantheon of pathologists, Dr. William B. (Bill) Ober (Figure 1) was a luminous figure with a unique combination of erudition, wit, and sporadic bizarre behavior. One of us (RES) was privileged to be among the many friends who were awed by his extensive knowledge and entertained by his keen, off-beat humor and occasional mischievous conduct. Both of us have found Dr. Ober’s original publications on pathology instructive and his many essays on nonpathology topics both educational and entertaining. Dr. Ober was born in 1920, the only child of Jewish parents who lived on a fashionable street in Brookline, Massachusetts. His father, Mr. Harry Ober, was a certified public accountant and his mother a homemaker. Bill adored his mother and grandmother, whose ancestors had emigrated from Russia, but he argued often and vociferously with his father. Bill graduated from Harvard College, magna cum laude, in 1941. Because of congenital amblyopia (dimness of vision without a detectable ocular lesion) and a spinal disorder of unknown type, he was deferred from military service during World War II. He graduated from Boston University Medical School in 1946. He interned at the Beth Israel Hospital in Boston under the celebrated cardiovascular pathologist Dr. Monroe J. Schlesinger, who gave him a thorough education in the clinicopathological features of coronary heart disease, and subsequently under the eminent obstetrical-and-gynecological pathologist Dr. Arthur T. Hertig, at the Boston-Lying-In Hospital (BLI) and

Address for correspondence: Robert H. Young, MD, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Warren 215, Boston, MA 02114.

0740-2570/$ -see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1053/j.semdp.2008.07.009

the Free Hospital for Women (FHW) in neighboring Brookline. RES met Bill as a coresident and “roommate” at the BLI. Bill did not sleep in our hospital room, however; he had a car, and his home was only a short drive from the hospital.

Figure 1

William B. Ober.

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William B. Ober, MD

The laboratory workload was unusually light, and Bill spent much of the day on the telephone. He talked often to one of his closest friends from college days, Howard Nemerov, who later became Poet Laureate of the United States and winner of both the National Book Award and the Pulitzer Prize for Literature. One morning, RES overheard Bill talking to Howard about recently issued European longplaying records and newly published British books that were scheduled to arrive at Boston Harbor. Bill drove his car there later in the day to obtain these treasures (including Evelyn Waugh’s witty The Loved One). There being only one outgoing telephone line in the small pathology department at the BLI, an annoyed Dr. Hertig remarked to RES on one occasion, “I haven’t been able to make any outside telephone calls since that damn Ober arrived.” Bill greatly enjoyed shocking people. For example, at a cocktail party, after having been introduced to a laywoman and asked by her, “What kind of a doctor are you?” he replied, “I’m a morbid anatomist; I cut up dead bodies!” A more bizarre episode of Oberian behavior occurred as Bill was driving RES up Louis Pasteur Avenue, a wide thoroughfare passing between the BLI and Vanderbilt Hall, the Harvard Medical School (HMS) student dormitory. We were traveling on slippery hardened snow at a brisk pace when Bill suddenly exclaimed, “Now watch this!” and made a rapid U-turn; the car swerved around like “the whip” in an amusement park. Miraculously, as Bill’s exhilaration continued, RES gradually recovered from momentary contemplation of his impending demise. Bill was an active member of the Handel and Haydn Society (at that time called the Haydn Society) during his Boston days. It was only years after he had left Boston that RES happened to purchase a long-playing recording of Mozart’s Great Mass in C-Minor, issued under the Society’s name, and found that the roughly 3500-word liner notes describing the historical background and musical features of the work in detail had been authored by Dr. William B. Ober (Figure 2). He had apparently heard the performance

Figure 2

203 of the work by the Vienna Symphony Orchestra and the Akademie Chorus of Vienna in Salzburg in 1946. Later, we learned that Bill’s career as a music critic had begun when he was an undergraduate at Harvard and reviewed local musical performances for the Boston Globe. He continued to write many reviews after leaving Boston, some of them for the New York Times and others for musical publications. On finishing his assignment at the BLI, Bill moved to the FHW for training in gynecological pathology. During his stay in Boston, he and RES became warm friends. RES saw him only occasionally thereafter, mostly at medical meetings, but they exchanged numerous letters (Figure 3) and telephone calls discussing histopathology, medical history, and personal activities throughout much of Bill’s remaining career. He also graciously sent RES reprints of many of his papers, as well as copies of his two books, which were mostly compilations of his essays: Boswell’s Clap & Other Essays: Medical Analyses of Literary Men’s Afflictions, and Bottom’s Up! A Pathologist’s Essays on Medicine and the Humanities. Dr. Ober moved to Washington, DC and environs in 1948 to continue his career in obstetrical-and-gynecological pathology, first as a Research Fellow at the National Cancer Institute (NCI) for 2 years under Dr. Harold Stewart. At that time Drs. M.C. Li and Roy Hertz, pioneers in the chemotherapy of trophoblastic disease, were at the Institute. Subsequently Bill became Assistant Pathologist and Assistant Chief of Gynecologic and Breast Pathology at the Armed Forces Institute of Pathology (AFIP) under Dr. Hugh G. Grady. In the latter role, Bill was considered a learned and inspiring teacher (Dr. Henry J. Norris, personal communication). In 1952, Dr. Ober began a 2-year stint as Chief of the Division of Research and Training at the American Registry of Pathology, where he had a role in editing some of the first series (1947-1968) of tumor fascicles of the AFIP. In 1952, Bill married Miss Rhoda Joyce Schott of New York City, an alumna of the University of Wisconsin, who was an adver-

Liner notes (written by Dr. Ober) for Mozart’s Great Mass in C-Minor.

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Figure 3 Humorous letter from Dr. Ober to Dr. Scully. Dr. Emma Call of Newburyport, MA, was co-describer with Austrian physiologist, S. Exner, of microscopic fluid bodies in ovarian follicle; first female member of Massachusetts Medical Society and advocate of women in medicine.

tising copywriter. They had two children: Stephen, who was severely retarded, requiring hospitalization, and Elaine, who was bright and outgoing (she currently lives in Brookline, Massachusetts and is director of the editorial department of a publishing house). Rhoda, who had lived near her daughter and her family in recent years, died a few months ago. From 1953 to 1955, Bill had a second sojourn in Boston as Pathologist at the BLI. By that time, Dr. Hertig had become the Shattuck Professor of Pathology at HMS. RES was in the Army in Japan during the Korean conflict (19521954) and had almost no contact with Bill during that interval. From 1955 to the time of his death, Dr. Ober resided in New Jersey and worked as a pathologist in both New York City and New Jersey. During that period, however, he also traveled extensively in several continents, where he visited libraries and museums to conduct research for his historical writings. In New York, he was Director of Laboratories at the Knickerbocker Hospital (1957-1970), on the staff of Beth Israel Hospital (1972-1977), and had teaching appointments at several medical schools. In New Jersey, he practiced at the Hackensack Hospital (1955-1956) and later as Director of Pathology (1977-1982), and was Visiting Professor of Pathology at the New Jersey College of Medicine and Dentistry. He was also Assistant Medical Examiner of

Bergen County, New Jersey, where he reveled in battles with attorneys. In addition to being a member of many American medical societies, Dr. Ober was Chairman of the Library Committee of the New York Academy of Medicine from 1972 to 1974 and chairman of its publications subcommittee for many years. In the latter role, he described his work as “very time-consuming.” He was also a fellow of the Royal Society of Medicine, the Royal Microscopical Society of Great Britain and Ireland, and the Harvey Society of Great Britain. Bill’s monumental contributions to history and histopathology1-207 were made despite a life beset by problems. Although the bags under his eyes (Figure 1) might suggest that he was a poor sleeper, according to his daughter, his ability to sleep was the envy of his family, and the prominent lower lids had been inherited from his mother (hereditary ocular dermatochalasia: loss of elastic tissue and increase in collagen and muscle in the lower lids). In addition to the lifelong distress he suffered from having fathered a severely retarded son, his amblyopia, and spinal disorder, he also had hemorrhoids, which eventually caused so much pain that he required a hemorrhoidectomy. His most serious health problem was mid-life coronary heart disease with angina pectoris and three major myocardial infarcts. Dr. Victor Tchertkoff, a pathologist-friend in New York City,

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who wrote an affecting biography of Bill in the Journal of the American Medical Association,208 recounts an episode during which Bill had a severe anginal attack. As Victor was nervously driving him to a hospital, Bill began to fill the car with smoke. When reminded that smoking was bad for his angina, he replied, “I know, but I like to smoke.” The day after discharge from the hospital for treatment of his last major myocardial infarct, he and Rhoda and another couple traveled to Rio de Janeiro. Except for Bill’s attacks of angina, the trip was well tolerated. On April 27, 1993, Bill requested and received an invitation to an AFIP-staff dinner honoring his close friend, Dr. Henry Jason Norris, on the latter’s retirement. Bill drove alone from his home in New Jersey to Washington. He felt well on arrival but collapsed during the dinner. He was rushed by ambulance to the emergency ward of a nearby hospital. Still awake on arrival, he did not call Rhoda for fear of alarming her. His close friend and protégé, Dr. Robert J. (Bob) Kurman, who was also in attendance at the dinner along with his wife, phoned Bill at the hospital. Bill assured Bob that he did not have a myocardial infarct, and suggested that Bob and his wife enjoy their dinner and then visit him in the emergency ward. On arrival there, they became alarmed as they witnessed marked swelling of Bill’s abdomen because of a ruptured, rapidly fatal aortic aneurysm (of which there was a family history) while the unobserving attending physician was performing cardiac massage. Only Dr. Ober, the skilled cardiovascular diagnostician and master stylist, could have captured verbally the irony of his own tragic end. He had stated earlier to Bob Kurman that he wished he could supervise his own autopsy; he probably came closer to doing so than any other pathologist!

William B. Ober: the man Bill Ober was a conspicuous figure in any social gathering— nattily dressed, of average height, with a more than ample abdomen, a hint of a smirk on his face, a cigarette in a yellow holder protruding from his mouth, a string dangling from his neck suspending his glasses—fumbling now and then in his pocket for an antianginal pill. Bill had many friends, both among the intelligentsia and the less well-educated. Although he poked fun at some historical figures, and occasionally condemned them in his essays, he was remarkably loyal and kind to his friends. As a historian, he almost always followed in the footsteps of his physician-satirist hero, Dr. John Arbuthnot (1667-1735),71 about whose literary approach he commented, “Splenetic satire may make for better reading two centuries later when its objects have passed into the dust of history, but in its own time the gentle thrust is more likely to be effective than the envenomed quill.” RES was a victim of Bill’s charitable dissent on one occasion when, after writing a generally excellent review of

205 the former’s AFIP fascicle on Tumors of the Ovary and Maldeveloped Gonads, Bill added that some of the color plates suggested “the palette of a sunset by Turner, even perhaps a baboon’s behind” but that “surely the psychedelic colors reflected” the 1970s (when this fascicle was in preparation) by “causing a heightening of visual experience, more real than real.” Bill did not accept outspoken criticism of his own views graciously, however. According to Dr. Stephen A. Geller, a good friend, “Bill had a gift for painful sarcasm, which he could not easily control and managed to simultaneously impress and irritate people” (personal communication to RHY). Bill’s stated goal in life was to direct his prodigious talents toward the improvement of mankind. In the preface to Bottoms Up,200 he characterized himself as a “practicing medical humanist” following the examples of Drs. Edmund Pellegrino (Professor of Medical Ethics, Georgetown University) and Lewis Thomas (Professor of Pathology, New York University School of Medicine). Bill admitted, however, that there was no proof that humanism makes one a better doctor—a premise that he accepted on faith alone. In his pathology practice, he confessed that he heeded the advice of Emily Dickinson: Faith is a fine invention When Gentlemen can see But Microscopes are prudent In an Emergency. Bill was particularly supportive of trainees under his tutelage. Ignoring his own significant contributions to obstetrical and gynecological pathology, he insisted that his legacy in that area would be based on his guiding the career of Dr. Kurman, who is presently the Richard W. TeLinde Distinguished Professor of Gynecology, Obstetrics and Pathology at The Johns Hopkins University School of Medicine. Bob was inspired by Bill to enter the field of pathology when he was an impressionable third-year medical student in New York. He was later persuaded by Bill to train under RES and was continually encouraged by Bill during the later years of his illustrious career. Dr. Ralph M. Wynn, Professor of Obstetrics and Gynecology and Pathology at the State University of New York Health Services Center at Brooklyn, another close friend and fellow humanist, although not a trainee, also ascribed his choice of a career to the inspiration of Dr. Ober. Ralph had met Bill at the BLI, as he was examining a tray of slides, which lay next to notes being prepared for a local symphony concert. Bill was entertaining as a lecturer, and even more so as chairman of a discussion group. RES attended a gynecological meeting in Cleveland at which a well-known gynecologist who worked closely with Dr. Hertig at the FHW gave the first presentation (on the therapy of “endometrial carcinoma in situ”) showing color illustrations of that lesion before and after progestational treatment. As soon as the first (pretreatment) picture appeared, Chairman Ober rose

206 from his chair at the right of the speaker, approached the screen, whipped off his glasses, and stared at the image, almost touching the screen with his eyes. He then abruptly swung around to face the audience, shaking his head vigorously in denial. Bill’s risqué remark at the end of the last presentation (on new approaches to female contraception) is best left to the imagination of the reader. Bill’s irreverent approach to life was also reflected in an infamous Letter to the Editor published in the New England Journal of Medicine in response to an article on “syncope following micturition,” which had been submitted by a US Army installation. Bill, reacting to the indigestible title of the paper, suggested that the Journal conduct a limerick contest for the readers, beginning, for example: “There was a young man from Fort Lee, who would faint whenever he’d —”; or “There was a young man from Fort Bliss, etc.” There was no response to Bill’s challenge. Bill had a great love of literature, which consumed him in his later years. Just as he had a precocious mastery of music, his superior knowledge of literature was already evident in his undergraduate days at Harvard. In the preface to Bottoms Up, he mentions that, during his college years, he was familiar with traditional French poetry and intoxicated with later, erotic French poetry, such as that of Beaudelaire, Verlaine, and Rimbaud. He would write psychobiographies of the latter two poets many years later.193 Bill spoke English and Yiddish fluently and was familiar with French and German, according to his daughter. Although he stated that the practice of histopathology was his vocation, and history his avocation, the reverse was true in his later years, when he confessed that his happiest days were spent in the British Library with his “nostrils filled with the dust” of old volumes. Bill’s writings were not confined to his many essays, but included as well: invited reviews of medical fiction and nonfiction in major journals and newspapers; Letters to the Editor of the New York Times berating the Nixon administration, criticizing a decision of the Warren Supreme Court, and castigating New York Mayor Koch for not filling potholes on city roads; and a long article favoring a woman’s freedom of choice of abortion in the Saturday Evening Post. Despite his obvious love of music, art, and poetry, Bill did not play a musical instrument, paint, or submit any poetry for publication. He was an avid fan of local baseball and American-football teams. Dr. Ober had so great a command of English that he often typed an essay using four fingers on an old manual typewriter, and the product required little or no proofreading. In the remainder of this essay, we shall summarize and attempt to evaluate Dr. Ober’s work critically by presenting reviews of selected examples of three overlapping categories of his publications: those dealing with histopathology and the history of pathology and other medical disciplines; biographies of physicians more famous for their nonmedical than medical activities; and psychobiographies of well-

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 known figures in literary and artistic fields, most of them having little or no connection with medicine. Finally, we shall comment on Dr. Ober’s two books, Boswell’s Clap and Bottoms Up! We shall treat Dr. Ober as a recent historical figure, and whenever appropriate, review his conclusions in the light of current knowledge (the essays so analyzed account for less than one-quarter of Dr. Ober’s publications). We attempt all these evaluations humbly with the assurance that Dr. Ober can no longer subject them to his skillful scrutiny.

General aspects of Dr. Ober’s publications These vary considerably in their content and approach. Some are serious, whereas others are remarkably witty. All of them reflect a mastery of their subject matter, whether it be history, the arts, or the sciences. Some historical articles include information in previously unreleased documents obtained by Dr. Ober. The focus of each article is on the author’s expert analysis. Some essays are irreverently shocking because they deal with a scatological subject or deviant sexual behavior. Bill believed that “the seamy side of life” was an integral part of the human experience and that it was being sheepishly ignored by chaste contemporary authors. Dr. Wynn stated that Bill fulfilled H.L. Mencken’s definition of a great writer, who “is never a Puritan and seldom even ordinarily respectable” (Memorial Minute on Dr. Ober, New York Obstetrical Society). The pathological and history-of-pathology papers obviously will be difficult for nonmedical readers. The enjoyment of reading Dr. Ober’s other publications will depend on where one lies on the gradual slope from a Renaissance man to a Philistine. The author often quotes the poems and prose of foreign writers in their native languages, and sometimes inserts foreign phrases in his own text as well. Also, he has a vast English vocabulary. Therefore, it may be necessary to have comprehensive dictionaries (English and/or Latin, French, Italian, Spanish, German, Yiddish) for complete understanding of individual essays. Despite these problems, no reader of Dr. Ober’s works will fail to be educated and grow as a humanist.

Histopathology papers In his preface to Boswell’s Clap, Dr. Ober presents his concept of the role of the histopathologist in patient care: “No sensible pathologist believes that his microscopic examination tells him everything he needs to know about a specific patient or a specific disease. He has to take into account the patient’s personal history, the sequence of events, and to apply evidence from other disciplines such as physiology, biochemistry, and the like, to produce a rounded view of the problem at issue.” Unfortunately, some

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Table 1 Findings in neonatal endometrium (left) and ovaries (right)12 169 cases*

73 cases†

Proliferative 116 (68%) Secretory, predecidual 45 (27%) Decidual or menstrual 8 (5%)

Granulosa cell proliferation 70 (96%) Antrum formation 64 (88%) Theca interna proliferation 66 (90%) Theca congestion and hemorrhage 47 (64%) Multiple cysts 5 (7%) Atretic follicles 7 (10%)

*Simplified version of authors’ table. †Slightly modified from authors’ table.

modern clinicians are unaware of the “sensible pathologist’s” role in patient care, to the detriment of their patients. In the 1950s, Dr. Ober and his colleagues wrote six overall excellent papers on sarcomas of the female genital tract,5-7,21-23 which combined thorough reviews of the literature and reports of original cases. These articles were based on the diagnostic methodology of the time, stressed histogenesis, and reflected limited experience with unusual cases. Genetic investigations, electron microscopy, and especially immunohistochemistry have subsequently greatly expanded knowledge of these tumors. An example of inadequate exposure to rare lesions is a report of two cases of “congenital sarcoma botryoides” of the vagina by Ober and coworkers.21 The lesions were characterized by an edematous or highly cellular stroma containing multipolar to bipolar cells, some of which had abundant cytoplasm and formed strap cells; the cells, however, had no cross-striations and did not invade the overlying epithelium. The current interpretation of these two lesions is fibroepithelial polyps of the pseudosarcoma type.209 In 1955, Ober and Black9 introduced the concept of “neoplasms of the subcoelomic mesenchyme” to explain the histogenesis of a variety of tumors involving the peritoneum. Most of these tumors are of Müllerian type and were later designated by S.C. Lauchlan “tumors of the secondary müllerian system.”210 Subsequently described peritoneal tumors or tumor-like lesions derivable from the subcoelomic mesothelium include disseminated leiomyomatosis peritonealis211 and sclerosing peritonitis associated with ovarian luteinized thecomas.212 Another tumor of probably similar derivation, so-called fibrous mesothelioma of the abdominal cavity,213,214 had previously been described by Drs. A.P. Stout and M. Murray213 and is now generally referred to as “solitary” fibrous tumor. From 1968 to 1973, Dr. Ober was consulting pathologist at the Margaret Sanger Research Bureau, and from 1961 to 1972, at the New York Fertility Institute. During those periods, many contraceptive drugs and devices were being investigated by gynecologists, endocrinologists, and pathologists, resulting in the publication of 15 articles, of which

207 Dr. Ober was the sole or major author. Almost all of the papers contain numerous illustrations of the changes in the endometrium, which varied depending on the timing and dosage of the drugs and the types of devices. Special emphasis was placed on two mechanisms of bleeding: venous sinusoidal dilation and thrombosis, a very early estrogenic effect, and arteriolar rupture, a common sequel to progesterone administration. Unfortunately, many modern pathologists remain unaware of this important distinction. Dr. Ober also discusses and illustrates atypical but benign changes that may occur in endometrial glands and stroma and in leiomyomas, and microglandular hyperplasia of the cervix, which may be associated with the administration of certain oral contraceptive agents. In “Observations on the endometrium and ovary in the newborn,” Dr. Ober and Dr. J. Bernstein12 review the literature on the subject and present their findings in the endometrium of 169 neonates and in the ovary of 73 (Table 1). The authors agreed with a previous investigator that the changes in the ovary and endometrium are independent of one another, with those in the former being caused by chorionic or pituitary-gonadotropic stimulation, and those in the latter by steroid hormones, probably of either placental or iatrogenic origin. Subsequent to publication of this article, corpus luteum formation has been observed in the neonatal ovary.215 Dr. Ober and Dr. Hugh Grady wrote an excellent essay on subinvolution of the placental site,35 and the former authored several thoughtful papers on the pathogenesis and nature of endometrial carcinoma.138,164 In those essays, he argues against the concept of adenocarcinoma in situ as defined at that time by his former mentor, Dr. Hertig. Also, it is not generally known that Dr. Ober was the first to suggest to Dr. George N. Papanicolaou usage of the term “dysplasia” for precarcinomatous squamous lesions of the uterine cervix.184 Although “dysplasia” is an imperfect choice, in our opinion it is preferable to the vague alternative designation “intraepithelial lesion.” In 1971, Dr. Ober and coauthors125 wrote a 127-page review of the pathology of 100 choriocarcinomas studied microscopically and recorded in the files of the National Institutes of Health during a 10-year period following the institution of chemotherapy (Table 2). The text, including references, is 33 pages long; there are 36 pages of detailed clinicopathological data in fine print, and 69 pages containing microphotographs. The latter illustrate the appearances

Table 2 1. 2. 3. 4. 5.

Subgroups of choriocarcinoma*,125

Gestational choriocarcinoma, fatal, with autopsy Gestational choriocarcinoma, fatal, without autopsy Choriocarcinoma of germ cell origin, with autopsy Gestational choriocarcinoma, nonfatal Probable gestational carcinoma, nonfatal *Slight modification of original table.

44 6 4 42 4

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of the tumors before and after chemotherapy; the toxic effects of the therapy on normal tissues; and the changes in the female genital tract, endocrine glands, and their endorgans caused by hormones secreted by the trophoblastic tumors—a prodigious piece of work. One tumor in Category 4 (case 98) and another in Category 5 (case 84) appear more likely on the basis of current knowledge to be examples of placental-site trophoblastic tumor rather than choriocarcinoma. The placental-site trophoblastic tumor was almost invariably misdiagnosed as another type of tumor, even by experts in trophoblastic disease, until Kurman, Scully, and Norris216 described its microscopical features in a small series of cases in 1976. The outcome was benign in those cases with follow-up data, leading the authors to assign the lesion a tentative designation of “placental-site pseudotumor.” By 1981, however, several malignant examples had appeared, resulting in a change of terminology to “placental-site trophoblastic tumor.”217 Subsequently, the tumor was demonstrated by Kurman218 to arise from intermediate trophoblast. A clinicopathological analysis of a large series of cases was recently published.219 Dr. Ober and two of his colleagues reported a series of five cases exemplifying three disorders of the esophagus and stomach: acute rupture of the esophagus, the MalloryWeiss syndrome (gastroesophageal lacerations with hematemesis), and gastric rupture.55 The authors emphasized the importance of distinguishing among these disorders, which differ in clinical presentation, treatment, and prognosis. In this paper and an invited editorial the same year by Dr. Ober,56 the name “Boerhaave’s syndrome” was created for esophageal rupture to honor the great Dutch physician, Hermann Boerhaave (1668-1738) (Figure 4). The latter’s report, characterized by the authors as “a clinicopathological masterpiece,” involved the case of Baron von Wassenaar, an admiral of the Dutch fleet. He was a corpulent gourmand who tried to induce vomiting after overindulging, suffered excruciating pain, and died in shock 18 hours later; autopsy revealed rupture of the esophagus into the mediastinum.

Histopathological-history papers The most ambitious of Dr. Ober’s historical publications are two papers reviewing the early development of pathology in the 19th century in the United States. In the first,150 he describes in detail how this country lagged far behind Europe in the evolution of this discipline, with American pioneers depending on their training in Europe, reading English translations of foreign-language pathology publications, or both. The second paper174 begins with a tedious, philosophical discussion and ends with more pertinent evaluations of Theodor Bilroth (1829-1894), a leading surgeon of his era in Europe and an advocate of the epistemic (deductive) ap-

Figure 4 Hermann Boerhaave (courtesy of the New York Academy of Medicine Library).

proach to practice, and Reginald Fitz (1843-1913), an HMS clinician, who used empirical (inductive) reasoning to establish for the first time the diagnostic and therapeutic approaches to appendicitis. A number of doctors, including Thomas Hodgkin, had previously identified the pathology of the disease but had not progressed further to inductive reasoning. Dr. Ober’s essays are complemented in great detail in several English language books, including those by Drs. Henry E. Sigerist,220 Sherwin B. Nuland,221 and Philip Rhodes.222 Although those works emphasize clinical advances, they include progress in pathology as well. Two profusely illustrated reviews of the development of knowledge of trophoblastic disease by Dr. Ober were published in 195926 and 1961.32 In the first essay, early historical landmarks, most of which are listed in Table 3, were noted. The second Ober essay32 overlaps the first. Among many other investigators, the author includes J.H. Teacher226 for elaborate studies confirming the concepts of Felix Marchand227; James Ewing228 for expanding the number of chorionic lesions, classifying them and correlating them with prognosis; and A.T. Hertig and H. Edmonds229 for investigating the genesis of hydatidiform moles. The controversy between the A.T. Hertig and Emil Novak schools about

Scully and Young Table 3 1. 2. 3. 4.

5. 6. 7. 8. 9.

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209

Trophoblastic disease: historical events*

Hippocrates and pupil Diocles (5th century BC): “degeneration of membranes” (?mole) causes abortion. Aetius of Amida, Greece (now in Turkey), 6th century: coined term “hydatid” (drop-like) for mole. Countess of Henneberg (now in the Hague) delivered 365 “children” in 1276; each vesicle was baptized by a midwife. First recorded case of hydatidiform mole in America passed by Anne Hutchinson in 1637. (According to a recent book by one of her descendants,225 Anne was an advocate of women’s rights and religious freedom in Boston. Refusing to accept the Puritan government’s First Church of Christ teachings, she was accused of heresy and banished from Massachusetts Bay Colony in 1637. She then joined Rev. Roger Williams to cofound Rhode Island. After having had 15 pregnancies in Boston, she passed a hydatidiform mole in Rhode Island at the age of 46. Massachusetts politicians and ministers considered the event a punishment by God, and proof of her having been in league with the devil. At the age of 52, after the death of her husband and the development of religious intolerance in Rhode Island, Anne moved to the Dutch Colony of New Amsterdam (now New York City) with her children. There, she and 5 of her 11 children were scalped by Siwaney Indians. Years later, the Hutchinson River and the Hutchinson River Parkway were named in her honor. In 1923, a bronze statute in her memory was erected in front of the Massachusetts State House, and in 1987, she was officially pardoned by Governor M. Dukakis.) J.B. Bremser, Vienna: introduced the term “hydatidiform” to modify “mole” because of its resemblance to the hydatids of echinococcal cysts, 1819. William Wilton, Brighton, England: first described chorioadenoma destruens, 1840. Hans Chiari, Vienna: first reported a choriocarcinoma, 1877. Max Sänger, Germany: misnamed choriocarcinoma “malignant deciduoma,” 1889. Felix Marchand, Marburg, Germany: coined the term “chorioepithelioma,” 1898. *Modified slightly on the basis of subsequent reviews.223,224

grading of moles is discussed, as well as the pioneering introduction of chemotherapy for choriocarcinoma by M.C. Li, R. Hertz, and their associates (1956). Many other contributions to the knowledge of trophoblastic disease too numerous to review have been made since Dr. Ober’s time. In his 1959 essay, Dr. Ober also noted that trophoblastic tumors had not been reported in animals other than humans, an observation that led him to the later publication of two of his most amusing articles in 196892 and 1979.171 In the first paper, “in a Swiftian satire” he makes “a modest proposal” that “the human female might prevent choriocarcinoma by emulating placentophagus viviparous mammals that eat the placenta.” He proceeds with a witty account of this generally unfamiliar gastronomic experience, ending with: the placenta “is best eaten as placenta tartare, minced to a coarse consistency, served with a raw egg, freshly ground black pepper, and salt ad libitum.” By the time of the second paper, 11 years later, he had accumulated additional information on documented and putative cases of human placentophagy and reviewed the history of the placenta as recorded in writings and portrayed in art.171 One of Dr. Ober’s most impressive historical essays is “Stilbestrol: a pathologist’s view.”155 Although he apologizes for the brevity of the review, one of us (RES), as an investigator of the diethylstilbestrol (DES) role in producing vaginal and cervical carcinoma and other changes in the lower genital tract of young females, can attest that this essay is the most thorough and useful brief review of the subject of which he is aware. It discusses in order: the synthesis of the compound and its chemical properties; its many usages in males and females; its role in producing carcinoma and other changes in the genital tract in young women exposed to the drug during pregnancy; and the role

of government in determining the allowable concentration of DES in animal foods consumed by humans, which remains a concern to physicians familiar with the DES-genital cancer linkage in the offspring of DES-exposed mothers. Dr. Ober enjoyed writing biographical essays about eponymous medical authors.166,173,176,180,183 In “History of the Brenner tumor of the ovary,”173 Dr. Ober traces the tortured evolution of knowledge of this neoplasm, its differentiation from the granulosa cell tumor, and the erroneous diagnosis Dr. Brenner (Figure 5) assigned it (oophoroma folliculare), ie, granulosa cell tumor, when he described it in 1907. Dr. Ober proceeds to record cases of typical Brenner tumor that had appeared in the literature before Dr. Brenner’s description in 1907. The first report was by a prominent Irish surgeon and author of textbooks of gynecology and otolaryngology, Dr. Henry MacNaughton-Jones. He illustrated an acceptable Brenner tumor in 1898 but assigned it the noncommittal name “anomalous ovarian tumor.”230 A number of other cases that antedated Brenner’s report had also appeared in both the British and the German literature. After those publications, German pathologists began to designate the two tumors Brenner illustrated in most of his figures as ovarian tumors of the Brenner type, and true granulosa cell tumors as folliculomas of the von Kahlden type. The latter designation was after Dr. Clemens von Kahlden, who is credited with the first description of the granulosa cell tumor in 1895. A modern interpretation of that tumor, however, is a mixed granulosa cell tumor with a trabecular pattern and sex cord tumor with annular tubules.231 It was not until 1932 that the renowned Dr. Robert Meyer232 assigned the name “Brenner” to the tumor that Brenner had incorrectly interpreted and clearly distin-

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Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 The most witty of Dr. Ober’s essays on eponymous authors is “Leydig, Sertoli, and Reinke: three anatomists who were on the ball.”176 Franz von Leydig, a German comparative anatomist (1821-1908), pictured as a stern elderly man with a long white beard and marked frontal balding (Figure 6) suggesting that he had an abundance of his own cells, made his observations with a primitive microscope, the sun for illumination, and a fat stain. Enrico Sertoli (1841-1910), an Italian contemporary of Leydig, similarly handicapped by a primitive microscope, made remarkable drawings of unstained testicular tubules (Figure 7), in which he identified and labeled all of the cell types directly involved in spermatogenesis as well as the cells that bear his name. Friedrich Reinke (1862-1919) took advantage of the development of staining that was available in his later years to illustrate his crystals in color (Figure 8). A less obvious humorous aspect of this essay is the name of its fictional coauthor, Che Sciagura, D. Phil. One of us (RHY) was told by Dr. Ober that, if he could identify the coauthor, he would receive the “Gold Medal of the Meconium Society.” Dr. Juan Rosai has recently informed us that “Che Sciagura” means “what a calamity” in Italian and was often identified with “being without testes.” Dr. Rosai cites a passage in Voltaire’s Candide, Chapter 11 “The History of the Old Woman” as an example of this usage. In the table of contents of the volume in which Dr. Ober’s essay appears, Dr. Sciagura is further identified as “Professor of Tautology” (needless repetition of an idea, statement, or word) at the Sacred Heart Institute of Theology, Siena, Italy. Figure 5

Fritz Brenner in his later years.

guished it from a granulosa cell tumor. Dr. Ober criticizes Dr. Brenner for his failure to review the German literature before reporting his cases and Dr. Meyer, even more so, for his disregard of both the German and English literature in assigning an eponym to Brenner. Although Dr. Ober believes that Dr. MacNaughton-Jones should have received the eponym instead of Dr. Brenner, our opinion is that the former’s ignorance of the nature of the tumor he illustrated disqualifies him. Dr. Meyer, himself, is most deserving of the eponym for first clearly identifying the tumor as being of transitional cell type and distinguishing it from a granulosa cell tumor, but the designation “Brenner tumor” is ingrained in the literature. Dr. Ober speculates that Dr. Brenner was unable to find a position in academic medicine in Germany after publication of his paper and the death of his chief. He entered the military, migrating in 1910 to Southwest Africa (now Namibia) in the colonial service.233 He became a general practitioner, moving to Johannesburg in 1935. One day there, in 1956, a “little old man” by the name of Brenner brought a few nevi to the University of Witwatersrand Hospital Pathology Laboratory for examination, and was asked if he was possibly related to the pathologist who had described the Brenner tumor (personal communication to RES from Dr. S. Shippel). He was astounded on hearing of the eponymic designation of the tumor he had once described.

Figure 6

Franz von Leydig.

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211 neoplasia (MEN) Type 2 (bilateral adrenal pheochromocytomas and medullary carcinoma(s) of the thyroid gland), an association first described by Dr. E.D. Williams in 1965.235 Review of the patient’s autopsy report indicated that she had a goiter, which was not sampled for microscopical examination. Several nieces and nephews and later-generation members of her family, however, had bilateral pheochromocytomas with or without medullary thyroid carcinoma; four had a mutation in the RET gene characteristic of MEN Type 2; none had a mutation in the gene responsible for von Hippel-Lindau disease, which is relatively common in patients in the Black Forest area, where Fraenkel’s patient had been born. In 1973, Dr. Ober, as Chairman of the Publications Committee of the New York Academy of Medicine, collected an anthology of original works of nine great men of Guy’s Hospital of London during the 19th century (Figure 10). In his introduction to the collection,143 he presents brief biographies of Thomas Guy and the nine physicians, evaluating the significance of their contributions. The physicians included Thomas Addison, Richard Bright, Thomas Hodgkin, and Thomas Williams. Thomas Guy (1644-1725), a bookseller and philanthropist, founded Guy’s Hospital, which opened on January 6, 1725, the day after his funeral.236 In 1836, the hospital

Figure 7 Drawing of testicular tubules by Enrico Sertoli containing Sertoli and spermatogenic cells.

In “Emil Zuckerkandl and his delightful little organ,”180 Dr. Ober presents a thoroughly investigated case of pheochromocytoma (now preferably called paraganglioma) of that organ, reviews both the early history and the later literature about tumors of medullary tissues, and provides a biography of Dr. Zuckerkandl (1849-1910; Figure 9). Best known now for his extensive embryological and pathological investigations of the organ that bears his name, Dr. Zuckerkandl was one of a team of Viennese anatomists who believed that anatomy should be related to patient care by being a guide for the surgeon. His major contribution to medicine was his four-volume “Atlas of Human Topographic Anatomy,” which was a “war map” for surgeons working in operable sites in the body. Dr. Zuckerkandl was also considered one of the intellectuals of the University of Vienna. His wife was a well-known artist, and Gustav Mahler was a close friend. Dr. Ober credits Felix Fraenkel with the first report of a pheochromocytoma in 1886, based on his microscopical description of bilateral adrenal tumors in an autopsy on an 18-year-old girl with paroxysmal tachycardia, headache, severe albuminuria, and retinal exudates. Fraenkel’s report was an accurate description, but it led him to a misdiagnosis of “bilateral adrenal sarcomas”; no illustrations were published. A recent example of masterful detective work234 demonstrated that the above patient had multiple endocrine

Figure 8

Crystals of Reinke as illustrated by Reinke in his paper.

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Figure 9

Emil Zuckerkandl.

physicians began an excellent journal, Guy’s Hospital Reports, which continued to be published until 1974. Thomas Addison (1793-1860; Figure 11a) is included among the great men, not only for describing the clinicopathological features of adrenal hypocorticalism, but also those of pneumonia. In his essay on the latter, Addison disagreed with Laennec, who had written that the fluid in the

lungs in lobar pneumonia was interstitial rather than intraalveolar. Dr. Addison had a dour personality but was considered an excellent lecturer. Richard Bright (1789-1858; Figure 11b) was an astute observer of the clinicopathological aspects of renal disease. Although not the first to relate dropsy to renal disease, he initially reported the presence of albuminuria in cases of dropsy. Of Bright’s cases in which autopsies were done and microscopical examination of the kidneys was performed, slides were available for modern review in only three; the diagnoses, according to Dr. Ober, were membranoproliferative glomerulonephritis in two cases and amyloidosis in one. The kidneys had not been examined routinely at autopsy before Bright’s reports were published because most physicians were unaware that they had any important function. Although Bright is remembered most for his publications on renal disease, he wrote on many other topics, including ovarian tumors.237 Unlike Dr. Addison, he was outgoing, but his lectures were considered mediocre compared with those of the former. Thomas Hodgkin (1798-1866; Figure 11c) was not only an accomplished clinician-pathologist, but also a humanitarian who believed in equal opportunity for all people. His views alienated almost all of his colleagues, leading him to abandon medicine for humanitarian activities in his later years. Thomas Williams is of particular interest to microscopical pathologists because of his article “On the pathology of cells”238 (inspired, at least to some extent, by the pioneering work of Theodor Schwann), which preceded the later more definitive studies of Rudolf Virchow (1821-1902). Williams suffered from “Bright’s disease” and described in the literature his own illness, which presumably caused his death at the age of 46. In addition to his brief history of Dr. Hodgkin’s life, in “Great men of Guy’s,” Dr. Ober presents a more detailed

Figure 10 Great Men of Guy’s: Thomas Addison (left), Richard Bright (middle), and Thomas Hodgkin (right). (All pictures are courtesy of the New York Academy of Medicine Library.)

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account of Hodgkin’s career in “Hodgkin’s disease: historical notes.”157 There, the author reminds us that, in the era during which Hodgkin practiced, pathological articles were almost all written by clinicians evaluating clinical findings and correlating them with gross-pathological observations. It was not until 1926 that Dr. H. Fox239 examined tissue from three of Hodgkin’s seven cases; two were Hodgkin’s disease histologically, and one was a nonHodgkin lymphoma. In the other cases, the patients had clinical evidence of tuberculosis or syphilis, but Hodgkin, although aware of their presence, thought that the gross appearance of the nodes was still more compatible with his disease. In addition to having reported seven cases of his disease, Hodgkin wrote a long and instructive article on the value of autopsies in explaining the mechanics of various diseases, described the valvular changes that resulted in aortic insufficiency 5 years before the Irish physician Dominic J. Corrigan, and wrote papers on ovarian tumors, which were praised by Sir James Paget.240 The major portion of Dr. Ober’s article is devoted to a thorough review of progress in Hodgkin’s disease, including advances in pathological diagnosis, classification, staging, epidemiology, treatment, and prognosis. He also includes in his paper a detailed biography of Dr. Dorothy Reed (Figure 11). She was a graduate of Smith College and Johns Hopkins Medical School. After being refused an internship in pediatrics at Hopkins, she settled for a year of training in pathology, during which she described and illus-

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Figure 12 William MacCallum (courtesy of the New York Academy of Medicine Library).

trated the Reed-Sternberg cells diagnostic of Hodgkins’ disease—a multinuclear cell whose large nuclei contain prominent (eosinophilic) nucleoli.241 Many pathologists had previously described the cells of Hodgkin’s disease; Dr. Carl Sternberg was the first to describe them accurately but had poor illustrations. After the year at Hopkins, Dr. Reed left to become trained in pediatrics elsewhere. She spent most of her subsequent career in Madison, Wisconsin as a professor of pediatrics, married to a physics professor. She was an ardent crusader for children’s health and for the entry of women into medicine and other professions. Dr. Ober, who described Dr. Reed as “a woman of great determination and force of character,” would have been interested, but probably not surprised, to learn of more recently published evidence that she had been secretly engaged to, but reluctant to marry, Dr. William MacCallum, (Figure 12), who was then a junior staff member in pathology at Hopkins.242 In all probability, he had helped to immortalize her as a pathologist. Later, he became a celebrated Chief of Pathology at Hopkins and writer of a widely used textbook of pathology; Dorothy’s love of “William,” however, continued until her death at the age of 90.242 Figure 11 Dorothy Reed (photograph by A. Pearsall, courtesy of Alan Mason Chesney Archives of Johns Hopkins Medical School).

The essay entitled “Kaposi: the man and the sarcoma”201 is an exceptional one in which Dr. Ober not only praises his subject for the initial clinical and pathological description of the tumor that bears his name, but also condemns him as an

214 insincere apostate from the Jewish faith, for whom social climbing was the motivation of his conversion to Roman Catholicism. After bringing the reader up-to-date on knowledge of the clinicopathological aspects of Kaposi’s sarcoma, Dr. Ober embarks on a judgmental discussion of apostasy in general. He disapproved the conversion of John Donne (1573-1631), a favorite author of his, who switched from the Roman Catholic to the Anglican faith in the 18th century to avoid the imprisonment and martyrdom suffered by many members of his family. Dr. Ober agreed with Lytton Strachey243 that the “Eminent Victorian,” Cardinal Manning’s conversion from Anglicanism to Catholicism in the 19th century was opportunistic, but that Cardinal Newman’s apostasy in the same direction was genuine. The champion of insincere apostates was the composer Johann Christian Bach (the youngest son of Johann Sebastian), who switched from Lutheran to Roman Catholic and finally Anglican to promote his career as he moved from Leipzig to Milan to London in the 18th century. Kaposi (Figure 13) was an Orthodox Jew by the name of Moritz Kohn, born in 1837 in Kaposvar, a small town in Southern Hungary. He graduated from the University of Vienna Medical School with specialty training in dermatology and finally joined the department of Dr. Ferdinand von Hebra as an Associate Professor in Dermatology. Von He-

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 bra was the founder of Viennese dermatology and a Roman Catholic. Kohn soon fell in love with von Hebra’s daughter, Martha, and married her as his career began to blossom. As Dr. Ober states, “One is inevitably suspicious of the young man from the sticks who comes to the big city and marries the boss’s daughter.” He concedes that the wedding may have been based on true love, but doubts that Kohn’s conversion to Catholicism was genuine. There was no evidence that he was particularly religious, and he also changed his name to Kaposi after his birthplace, Kaposvar, 2 years after his marriage. In “John Donne (1573-1631) as a patient: devotions on emergent occasions,”204 Dr. Ober recounts Donne’s career and literary reputation during the years that followed his apostasy from the Roman Catholic faith. He married and had 7 children, and lived from hand to mouth until the King insisted he take holy orders in 1615. He became Dean of St. Paul’s Cathedral 6 years later. He was famous for his sermons, 164 of which were published, along with many of his lyric poems, by his son after his death. Donne’s most widely known literary achievement was his “Devotions On Emergent Occasions,” written during convalescence from an acute febrile, life-threatening infectious illness of still uncertain type, which occurred 2 years after he had become Dean of St. Paul’s. Donne believed that the illness was God’s preparation of him for his death, but he unexpectedly survived. The Devotions ended with the immortal passage written as he listened to the bells of St. Paul’s ringing during his convalescence: “. . . no man is an island . . . any man’s death diminishes me because I am involved in mankind, and therefore, never send to know for whom the bell tolls; it tolls for thee.” Donne’s works were not considered great literature by most critics during his lifetime. It was not until just before World War I that his reputation began to soar. According to Dr. Ober, he ranks with Sir Thomas Browne and John Dryden as one of the three great British writers of the 17th century.

Biographies of physicians more famous for their nonmedical activities

Figure 13 Moritz Kaposi (courtesy of the New York Academy of Medicine Library).

In his essay “Jean Paul Marat, MD (1743-1793),”128 Dr. Ober reviews the career of an ambitious, intelligent young man of Swiss origin who sought fame practicing medicine, but unfortunately had not graduated from an accredited school, and failed in his attempt. After abandoning medicine, he was also unsuccessful as a teacher and writer of science and philosophy. He finally achieved immortality by becoming a radical, arguably paranoid reporter and editor of a French newspaper The Friend of the People (later called The Journal of the French Republic) during the years preceding the French Revolution. The newspaper supported the more popular Jacobin party, whose bloodthirsty leader, Maximillien Robespierre, strongly favored execution of King Louis XVI, Marie Antoinette, and their followers. Marat was assassinated at the age of 50 by Charlotte Corday, a member of

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the more conservative Federalist Girondin party. He instantly became a martyr celebrated in art, most spectacularly by the leading painter of the neoclassical period, Jacques Louis David, a great admirer of Marat and follower of Robespierre. David (1748-1825) was an artist of great ability, whose life and works would be worthy of Dr. Ober’s pen. The painter’s mouth had been slashed in a duel as a youth, leaving him with a severe stammer, which made him a subject of ridicule by his upper-class friends.244 He grew to despise them, allied himself with the masses, and was almost executed for his extreme views. His portrait of Marat depicts him lying dead in his Sitz bath (where he spent much of his time because of a painful skin rash of unknown type), with a stab wound in his right chest and his arm dangling over the side holding a writing quill (Figure 14). It is notable that another David reproduction, “The Death of Socrates,” appears in the Ober essay “Did Socrates die of hemlock poisoning?”158 This painting, which Sir Joshua Reynolds considered the greatest painting since the ceiling of the Sistine chapel, was famous not only because it portrays Socrates receiving the flask of hemlock that poisoned him, but also because it was used later to inspire the masses before the execution of King Louis XVI and many of the French intelligentsia during the Reign of Terror. The

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Figure 15 Portrait of Napoleon Bonaparte by Jacques Louis David (in Versailles Museum).

“Bourgeois Republic” that eventuated after the overthrow of the King denounced Robespierre and executed him for his excesses. David, who was equally guilty, was jailed but escaped execution. After the coup d’état of 1799 by Napoleon I, David was pardoned and appointed imperial painter after telling the Emperor, “I didn’t do anything. I’m only a painter.” The artist created a number of neoclassical-type portraits of Napoleon both on and off his horse (Figure 15). After the overthrow of Napoleon, David fled to Brussels, where he was able to control his revolutionary passions and became a successful portrait painter of the upper classes. On his death, France, still aware of his excesses, denied his relatives’ request that his body be returned there for burial.244 Dr. Ober also wrote an essay on Ignace Guillotin, MD (1738-1814),126 a respected physician, medical school lecturer, and supporter of the French Revolution. An idealist, he sought to democratize executions by advocating sudden severance of the head from the body for rich and poor alike, on the assumption that it was the most humane method of killing. Although guillotine-like machines had been in usage for centuries, they were most widely employed during the Revolution (Figure 16) and became unjustly associated eponymously with Dr. Guillotin. Dr. Ober concludes the essay by questioning the latter’s assumption that a body that has been severed from the head suffers no pain. Figure 14 Portrait of murdered Jean Paul Marat in his Sitz bath holding his quill, by Jacques Louis David (Musée Royale de Beaux Arts, Brussels).

In “Alexander Borodin, MD (1833-1887): physician, chemist, and composer,”87 Dr. Ober, after reminding us that Aesculapius was the son of Apollo, the god of both medicine and music, reviews the subject of physicians and their

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Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 written epic poetry. He had become a physician mainly to help finance the pursuit of his major interest: early Finnish literature. Eventually, he was appointed Professor of Finnish Language and Literature at the University of Helsinki. In addition to composers, the Kalevala inspired artists as well as literary figures in Finland and other countries, and as Dr. Ober suggests, probably influenced Henry Wadsworth Longfellow in the creation of his American epic poem, “The Song of Hiawatha.” The Kalevala was accurately translated into English in the mid-20th century. The multitalented Dr. Lönnrot also completed a FinnishSwedish dictionary and investigated agriculture and food substitutes for the government during episodes of crop failure. When he finally retired from his academic career, he moved to a farm with his family. During most of his career, he also practiced medicine and wrote two books: The Finnish Peasant’s Home Doctor and another on infant mortality and how to reduce it. The response of the musical world to Sibelius’ Kalevala music and contemporaneous symphonic music varied during his later years, when Stravinsky and Schoenberg were being admired for their musical innovations in continental Europe, and Sibelius’ music was regarded as old-fashioned.245 By contrast, most British and American critics continued to admire his music, and today it is very popular in concert halls. Unfortunately, Sibelius was bipolar and became an alcoholic in his later years, when he set afire some of his unpublished music, probably including his long-awaited unfinished eighth symphony.

Figure 16 Engraving of guillotining of King Louis XVI in Place de la Revolution in 1793.

connections to music. The most prominent of these was Dr. Alexander Borodin, who not only investigated and taught students about the chemistry of the body and its relation to disease, and cofounded the first Russian medical school for women, but also, in his limited spare time, composed inter alia the unfinished opera, Prince Igor, two and a half symphonies, and a tone poem, all or parts of which remain in the repertoire of modern symphony or “pops” orchestras. Another essay discusses physician Elias Lönnrot, MD (1802-1884),108 who had a unique and central role in the development of Finnish music by translating most of the Kalevala, a multi-authored collection of ancient mythological poems that became an important part of Finland’s folklore. The translated Kalevala inspired Sibelius and other Finnish musicians to compose some of their country’s greatest music. After a long history of occupation by Sweden, Finland, whose official language was Swedish, began to have stirrings of nationalism and liberty during the initially more relaxed occupation by Russia, which had conquered Sweden in the early 19th century. It took many years to convert the difficult mixed Western Siberian-Hungarian-Finnish dialect of the rural population into a simplified and comprehensible national language. Dr. Lönnrot was mainly responsible for transforming the stories of the Kalevala into gracefully

In “Their last chords,”145 Dr. Ober discusses the causes of death of composers, who are generally expected to outlive the general population because of relaxation induced by music, financial security provided by patronage or salary, pleasurable travel, and vigorous exercise conducting. But a number of them die of the same diseases as the general population, including mental depression. Among those in the last group was Peter Ilyich Tschaikovsky (1840-1893), who took his life by drinking cholera-infected water during a severe depression. In “Operatic doctors,”149 Dr. Ober discusses the relatively minor role of “doctors” in various operas. The most engaging of these is “Dr. Dulcamara,” who accomplishes wonders with his charming manner and love potion (a bottle of Bordeaux wine) in uniting in marriage Nemorino, a poor country lad, and the wealthy town beauty, Adina, in Donizetti’s “Elixir of Love.” In “Georges Clemenceau, MD, the smile on the face of a tiger”127 (1841-1929; Figure 17), Dr. Ober reviews the career of this remarkable man, who was twice Premier of France; a cosigner of the controversial Treaty of Versailles, along with Woodrow Wilson and Lloyd George, all three of whom disliked each other; a humanitarian; a follower of Charles Darwin; a political reporter; a “ladies’ man”; and a ferociously anticlerical politician and speaker, who was considered the equal of Winston Churchill in delivering brilliant and inspiring orations.

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217 Dr. Ober’s essay on the aforementioned Dr. John Arbuthnot71 (1667-1735) portrays a satirist and member of the fictional Martinus Scriblerus Club along with fellow-satirists Jonathan Swift, Alexander Pope, and others. A distinguished physician to Queen Anne and a serious medical writer, Dr. Arbuthnot is most famous for his “The History of John Bull.” “Bull” later came to personify the typical Englishman as an honest plain-dealing fellow, choleric, bold, and of a very inconstant temper; he is very apt to quarrel with his best friends, especially if they pretend to govern him; if you flatter him, you may lead him like a child. Samuel Johnson considered Arbuthnot the most eminent writer of his era as well as “an excellent physician, a man of deep learning and much humor.”246 In “Sir Henry Thompson, MD, (1820-1924): Victorian virtues,”99 Dr. Ober discusses an eccentric, prominent physician and social reformer (Figure 18) who had wide interests in many other fields of endeavor: painting, music, writing novels, astronomy, raising poultry, and dietetics (best known for “Dindon a la Sir Henry Thompson,” in which a turkey is stuffed with a rice pilaf to which truffles and pistachio nuts are added). As a physician, Sir Henry had a good practice and won many prizes for his medical writings. One of them was a well-written monograph on the diagnosis and treatment of tumors of the urinary bladder247 that contained some colored microscopical illustrations. As a social reformer, he was the founder of the Cremation

Figure 17 George Clemenceau (courtesy of the New York Academy of Medicine Library).

It is not widely known, however, that Clemenceau, who was descended from a long line of physicians, had been persuaded to become a doctor, and practiced medicine for a short period of time in Greenwich Village, New York. He visited there as a political reporter who felt passionately about the Civil War. He left New York after 4 years, greatly disappointed by the failure of the postbellum reconstruction period. In his later years, Clemenceau became a fervent supporter and dear friend of the avant-garde painters, Claude Monet and Edouard Manet. At last, he had found artists with whom he could agree during discussions of art instead of attacking their opinions. He became a tiger again, however, when on joining the procession of mourners at Monet’s funeral, he ripped the black sheet off the casket and replaced it with a brightly hued cloth to celebrate the pioneer of light and color. Unlike Clemenceau, Johan Frederick Count Struensee, MD (1737-1772),120 an excellent physician and prominent social reformer, who was appointed court physician in Denmark, was unsuccessful in his attempt to assume governmental reins. He tried to achieve his goal by illicitly wooing Denmark’s unattractive, intellectually retarded Queen Carolina. The story of Struensee and Carolina is presented by Dr. Ober as a humorous drama that ends with a most barbarous execution of the Count and an accomplice, an event that Dr. Ober considered the blackest in Denmark’s otherwise gentle history.

Figure 18 Sir Henry Thompson (courtesy of the New York Academy of Medicine Library).

218 Society in England; a bust at the Golders Green crematorium in London memorializes him. Although Sir Henry was not one of Lytton Strachey’s “Eminent Victorians,”243 Dr. Ober argues that he was more qualified than some of those who had been included in that category. He was very self-confident and was intolerant of anyone who questioned his judgment on nonmedical matters; he was stingy, except when he was spending for his own comforts or for social climbing among fellow Victorians. He thought little of women; he married the leading pianist in England, who gave up her career and contributed to the family income by giving piano lessons. He considered the marriage of his daughter to a perceived lower-class suitor “a terrible blow,” which precipitated severe neuralgic pains for several months, while he was being comforted by a sympathetic Victorian lady. One of Dr. Ober’s most interesting essays is entitled “Peter Mark Roget, MD, FRS (Fellow of the Royal Society) (17791869), utilitarian and lexicographer”64 (Figure 19). Although many writers consult current or recent editions of Roget’s Thesaurus, a mammoth compendium of synonyms and antonyms, from time to time, some authors may not realize that the first edition was written by an exceptionally talented physician and scientist. A graduate of Edinburgh Medical School, Dr. Roget had a general practice but became better known as an indefatigable lecturer and writer on the nature of knowledge and the scientific method in med-

Figure 19 Portrait of Peter Mark Roget (photograph by Ernest Edwards, 1867; courtesy of Wellcome Library, London).

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 icine and other scientific fields. He received numerous prestigious honors and prizes.248-250 In 1814, he invented a slide rule for calculating the roots and powers of numbers. He also conducted research on contraction and dilation of the iris and retention of an object’s image on the retina after it has passed out of view. A century later, one Hollywood authority credited Roget for stimulating later scientific experiments that led to the advent of motion pictures. In 1815, Roget became a Fellow of the Royal Society of London, and 12 years later, its Secretary. Over the next 15 years, criteria for membership in the Society and even appointment as one of its officers became increasingly relaxed, leading to the founding of many rival societies, organizations, and institutions dedicated to a more vigorous pursuit of sciences of various types. Some of the new societies acquired a royal charter. Dr. Roget became a fellow or an officer of most of the new organizations, including the most prestigious, the British Association for the Advancement of Science in 1831. By that time, the Royal Society had been regarded by leading scientists as a social club made up of nonscientists and “scientific dinosaurs” rather than a truly scientific organization. Roget, whose most recent writings had become metaphysical, finally resigned as its Secretary in 1848. A new breed of physicians and scientists who were attuned to the emerging evidence of evolution (championed by Herbert Spencer and Charles Darwin) began the Royal Society’s reform. Over a period of about 13 years, Roget wrote many articles for the Encyclopedia Britannica. He was also cofounder of both Manchester and London Medical Schools and a professor at both institutions. He had always been obsessed with the meaning and correct usage of words, as well as organizing them into generic and specific categories, a hobby that led him to his most memorable achievement— writing his Thesaurus (Gr. Treasury). He began it at the age of 26 and continued working on it throughout his career. After his retirement at the age of 69, he completed the book within 4 years. He continued to prepare new editions every few years thereafter, and later his son, and then his grandson, assumed his editorial duties. The Thesaurus has been published in languages other than English; most editors have expanded it and improved its approach. After finishing work on his last edition of the Thesaurus, Dr. Roget continued his scientific investigations, reading and writing until close to his death at the age of 90. A new biography by Kendall250 stresses the effects of familial insanity on Roget’s life and work. Especially important were the madness of his mother and her brother, Sir Samuel Romilly. The latter was the most admired member of Parliament at the time, a national hero, and a surrogate father to Roget. Romilly’s final depression ended with slitting his throat and dying in Roget’s arms. This episode led to one of several severe depressions during which Roget was unable to function. Working on his Thesaurus appeared to have a role for him in his eventual recoveries.250 Roget had an obsessive-compulsive disorder. In the The-

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saurus, he made certain that the categories listed ended in even numbers, which he achieved by also using letters (eg, 199, 199a, 200). Also, he compiled a list of relatives with their estimated weights (but not their heights). The Thesaurus was welcomed by some writers and by crossword-puzzle enthusiasts, but was criticized by others because it listed related words and phrases without attention to their precise meanings (which can be found in good dictionaries) those using the Thesaurus were expected to already know the meanings of the words listed. It is difficult to penetrate the character of Roget. He has been portrayed as a man devoid of interpersonal relationships.250 One critic of Kendall’s book suggests that Roget might have had a high-achievement form of the Asperger syndrome.251 His apparent love of, or affection for, some of his family members and friends, however, raises the question whether he fulfilled all the criteria for that diagnosis within the spectrum of the autism-Asperger syndrome. In “Sir Charles Bell, F.R.C.SE (1774-1842): anatomy of expression,”112 Dr. Ober informs us that this great physician (Figure 20) is not only famous for his neuroanatomical, neurophysiological, and neurological findings (eg, Bell’s palsy) but also was an expert artist who drew human faces exhibiting emotions of various types, such as terror, anguish, suspicion, and remorse (Figure 20). These drawings

Figure 20 awe.

219 antedated by over a century Harvard Professor of Physiology Walter B. Cannon’s acclaimed book Bodily Changes in Pain, Hunger, Fear and Rage, published in 1915. In “John XXI: ophthalmologist, professor of physic, pope,”66 Dr. Ober discusses Pope John XXI, who was born in Portugal, the son of a physician, in 1215. The precise details of his canonical, medical, and philosophical training are unknown, and accounts by historians vary.252,253 He was educated at the University of Paris and studied there under St. Albertus Magnus (1193-1280), the famous philosopher, theologian, and scientist. At the age of 35, he was appointed Chairman of Physic at the University of Siena, where he practiced medicine for 14 years. He later became physician to the court of Pope Gregory X. He was elected Pope John XXI in 1276 during a period of political turmoil; he was the fourth pope to serve within the year of his election (two of his three predecessors had died of the extreme heat in Italy at that time). John XXI unexpectedly died in the ninth month of his papacy, shortly after a hastily constructed ceiling in the Papal Palace collapsed on him. Before his election as Pope, John XXI had written a compendium on logic; several theological treatises; a book on the anatomy of the eye, its diseases, and their treatment; and a home medical guide for the poor, called “The Poor Man’s Treasury.” As Pope, he was unable to accomplish much be-

(A) Caricature of Sir Charles Bell. (B) Bell’s drawings of emotional states: terror, despair, astonishment, and supernatural

220 cause of his short tenure. According to some historians, he was the most distinguished intellectual of his time; also, Dante admitted him to heaven in his Divine Comedy. The subject of the long essay “Oliver St. John Gogarty, MD (1878-1957): Buck Mulligan of the Irish Renaissance,”102 was a remarkable Irish surgeon, writer, humanist, patriot, and athlete, whose achievements in all these roles fell short of greatness according to most of his contemporaries. His many accomplishments were overshadowed for posterity by a brief youthful drinking and whoring association with James Joyce, who described him unsympathetically as “Buck Mulligan” in his revolutionary novel Ulysses (1922). Gogarty was the son of a well-to-do Catholic family with three generations of doctors in its background. He was given a Jesuit education, which he abhorred, and was then sent to the Catholic Royal College by his widowed mother to study medicine. After he failed his examinations, she transferred him to the Protestant Trinity College to resume his medical training. Its faculty, however, was strongly oriented toward atticism (the pursuit of intellectual life similar to that of Greece’s golden age). Gogarty’s nimble mind and retentive memory enabled him to master classical Greek, and later classical Latin. He was greatly admired by faculty members for his verses, which brought him several prizes, his agile wit, and his skill in conversation. He was also a leading athlete, excelling in football (soccer), croquet, and bicycleriding, for the last of which he won both the college prize and the prize of Ireland. His relative disinterest in medicine again led to his failing a number of examinations and postponement of his medical licensure for several years. While completing his medical studies, Gogarty met Joyce, who was 4 years his junior. Gogarty was an aristocratic, educated dandy, and Joyce, a down-at-the-heels heavy drinker. They shared a passion for ribald, often abusive conversation; for 7 days, they shared an unpretentious dwelling in an old Martello tower (one of the fortifications built in the British Empire during the Napoleonic wars) in Sandycove outside Dublin (now a museum dedicated to Joyce). At the end of their hedonistic week, Joyce left in anger after having been insulted. The close association of these two rowdy savants was apparent to Dubliners and generally known elsewhere in Ireland as well. After completing his general medical education, Gogarty went to Vienna to receive specialty training in otolaryngology. He returned to Dublin to set up a practice. Although he contributed very little to advancement in medical knowledge, he was appreciated as a skillful and kindly surgeon and became a leader in Dublin society. He joined the Sinn Fein, but he was strongly averse to violence and included among his friends several IRA members, such as Michael Collins, who shared his passion for a peaceful approach to Irish home rule. He detested the militant Eamon DeValera, whom he characterized as “a Spanish onion in an Irish stew.” Just as Gogarty was being appointed a member of the Irish Senate, Joyce’s Ulysses was published, causing Gogarty great embarrassment. Except for his portrayal as “stately and plump”

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 instead of lean and athletic, however, Joyce’s description was accurate. Although deeply wounded by the “Buck Mulligan” portrayal, Gogarty survived his humiliation. In 1939, Gogarty volunteered for the Royal Air Force’s medical division but was rejected because of his age. Having accepted a United States literary speaking tour previously, he traveled to New York, where he was warmly received by American intelligentsia, and wrote articles for popular magazines as well as two books. In the ensuing years, he returned to Dublin several times but was disillusioned by the state of Irish affairs, and the absence of many of his old friends, who had passed away. He became an American citizen. He died alone, apparently of myocardial infarction, in New York City in 1957. According to his earlier request, he was flown to Connemara for his funeral and burial, which was attended by his daughter, one of his two surviving sons, and their spouses. Throughout his career, Gogarty turned, whenever possible, to his favorite and most memorable pastime—writing. He authored novels and plays that were undistinguished, but some of his reminiscential books and essays, particularly “As I was Going Down Sackville St.,” were considered minor masterpieces. The greatest of Gogarty’s literary output, however, consisted of his verses and limericks, which were often antireligious and rabelaisian. He had many close friends among the contemporary literary and artistic elite of Ireland, such as William Butler Yeats, George Russell (AE), and George Moore. Yeats called Gogarty “one of the great lyric poets of our age.” Dr. Ober also thought highly of Gogarty’s prose and poetry, which is not surprising in view of his own preference for reading witty and salacious writing.

Miscellaneous historical essays In a historical essay, “Obstetrical events that shaped Western European history,”207 Dr. Ober presents a detailed discussion of the subject, which includes: a learned analysis of the therapeutic blunders of the physicians who treated their royal patients; and also of the latters’ reproductive-tract disorders and genetic defects—problems that greatly influenced European history in the 18th and 19th centuries. Dr. Ober displays a remarkable knowledge of the practice of obstetrics throughout the essay. In “Speaking out: we should legalize abortion,” Dr. Ober reviews the philosophical and religious history of abortions.

Books BOSWELL’S CLAP AND OTHER ESSAYS: MEDICAL ANALYSES OF LITERARY MEN’S AFFLICTIONS169 (Figure 21) comprises 10 essays, most of them psychobiographies of literary figures, many of whom were physicians. “Boswell’s Clap” is the longest essay, documenting the 17 attacks of gonorrhea that occurred during the licentious life-

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221 acters, to be an “unbiased witness” instead of a “judge of their character, and portray them in their own language.”250 A most serious event in Chekhov’s life was the onset of tuberculosis at the age of 24, when his first episode of hemoptysis occurred. The disease progressed over the next 4 years, but Chekhov was so absorbed in his study of mankind that he ignored his illness and traveled across frigid Siberia to interview prisoners on the island of Sakhalin; he died in the German health resort, Badenweiler, at the age of 44, having lived 14 years after his foolhardy trip. Chekhov’s four theatrical masterpieces, The Three Sisters, The Cherry Orchard, Uncle Vanya, and The Sea Gull, continue to entertain modern theater-goers. He also wrote about 600 short stories. In “Did Socrates die of hemlock poisoning?”158 Dr. Ober uses Jacques Louis David’s neoclassical painting of Socrates accepting a cup of hemlock in a spacious room full of his disciples (Figure 23) to illustrate Plato’s description of the event in his Phaedo dialogue.255 The latter was written many years after Socrates’ execution, which Plato did not attend because he was “ill.” “The Phaedo” is a lengthy (33 pages of small print) work

Figure 21

Boswell’s Clap—paperback edition of book.

time of James Boswell (1740-1795). Boswell was the author of the “Life of Samuel Johnson, LLD,” generally considered to be the greatest biography ever written. Dr. Ober attributes Boswell’s abnormal behavior to a sickly childhood, a mother who doted on him, and an unforgiving father, Lord Auchinleck. The latter was a staunch Presbyterian and a stern jurist who wore his judicial robes in his home as well as in court. Another essay of considerable current interest is “Chekhov among the doctors.”136 Dr. Anton Pavlovich Chekhov (1860-1904; Figure 22), leader of the realist school of Russian literature, was torn between the practice of medicine (his “lawful wife”) and writing stories and plays about the people he observed (“his mistress”). When he “tired of one” he would “pass the night with the other.” He was an astute observer of his subjects; some of his stories were humorous, others dreary. Although Chekhov was a gregarious man who sympathized with his patients long before the advent of psychosomatic medicine, the characters he portrayed in his writings were unable to cope with their problems and solve them—“nothing ever happens in that regard,” according to Dr. Ober. In Chekhov’s words, he strove to “distinguish between important and unimportant statements” of his char-

Figure 22

Anton Chekhov in his garden at Yalta, circa 1900.

222 in which a number of Socrates’ disciples question him about the nature of life and death, wisdom, justice, and other lofty themes, and he solemnly answers their queries up to the moment of his demise. Dr. Ober proceeds to recount the events leading up to the execution of Socrates for “sedition,” which was performed by a “police-state” type of government, called “The Tyranny of the Thirty.” It had seized power after the Athenians were defeated by the Spartans in the Peloponnesian war, and the democratic sage, Socrates, was an obvious target of the conquerors. The effects of ingesting hemlock (a poisonous drink made from Conicum Maculatum, an umbelliferous herb) are discussed next. Hemlock contains a neurotoxin that causes nausea and vomiting, followed by aphasia, convulsions, and progressive muscular dystonia, with terminal dyspnea and cyanosis. Dr. Ober concludes that Plato’s description and David’s portrait of Socrates’ prolonged and peaceful exitus while he was teaching his disciples were incompatible with his execution by a tyrannical government. Yet both the description and the portrait befit the noble Socrates more than the unpleasant, but realistic account of a scholar like Dr. Ober working on a cold evening in the British Library. The answer to the question posed in the title of the essay is: yes, Socrates died of hemlock poisoning, but we are not indebted to Plato or David for reaching that conclusion. In “Swinburne’s masochism: neuropathology and psychopathology”148 Dr. Ober makes an heroic attempt to explain the great poet’s complex character traits, but his conclusions are incompatible with current knowledge. BOTTOMS UP comprises 14 essays including: a remarkable pictorial history of leprosy181; an original account of a 14th century epidemic of plague and of the scholar who was imprisoned for heresy for proclaiming that the disease was contagious178; and the story of Robert Musil (18801942),132 an Austrian novelist, referred to as “the German Proust.” A psychobiographical analysis of the precocious French

Figure 23 “The Death of Socrates” by Jacques Louis David (Metropolitan Museum of Art, New York).

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 poet, Arthur Rimbaud (1854-1891)193 describes the effects of his sexuality, smoking hashish, and drinking absinthe on his salacious poetry, which was full of “guilt and redemption . . . hope and despair, pride and shame.” Dr. Ober discusses the pharmacology of absinthe, which contains oil of wormwood as well as alcohol and was a favorite drink of Parisian bohemians in Rimbaud’s time. Because of its potency as a hallucinogenic drug, its usage was banned in France and Switzerland, and its importation by the United States was prohibited in 1912. Recently (2008), drinking absinthe has become legal in the United States, but its price is prohibitively high. Other essays in Bottoms Up concern the life of Margery Kempe (1373-1440),192 famous mystic, with a discussion of whether she was a true mystic, a victim of hysteria, or both; the life of the Italian composer Carlo Gesualdo (15601613),137 who created music for his madrigals (lyric poems) and who murdered his wife and her lover. “Weighing the heart against the feather of truth,”172 began in ancient Egypt to determine whether the deceased was worthy of entering paradise (Figure 24), evolved into portrayal of the heart in Christian literature and art, and later into measurements of cardiac components, finally complemented by weighing the heart at autopsy. In “The sticky end of Franisˇek Koczˇwara, Composer of the Battle of Prague,”185 Dr. Ober discusses the death of the creator of the famous battle music which was the most popular of its kind in Europe and America from 1790 to 1820. In “Johnson and Boswell: ‘vile melancholy’ and the hypochondriack,”190 Dr. Ober discusses 18th century concepts of “madness.” At that time, there were several terms for this disorder based on fanciful theories of its causation (Table 4). The great intellects and writers of the 18th century, Samuel Johnson (1709-1784) (Figure 25), an essayist, literary critic, poet, and author of a dictionary, and James Boswell (1740-1795), Johnson’s biographer, have written the most illuminating accounts of their depressions among contemporaneous British authors. Of Johnson’s numerous episodes of melancholy, two were remarkable for their severity. The first, which occurred at the age of 20 and lasted for over 2 years, was initiated by a series of untoward events: failure of his father’s bookselling business; his father’s resultant “vile melancholy”; poverty, requiring him to abandon his studies at Oxford; multiple illnesses, including disfiguring facial tuberculosis and scrofula; inadequacy as a teacher because of his girth, slovenly appearance and abhorrence of teaching English grammar; and death of his beloved wife. He considered himself a failure and friendless, and feared that he would succumb to madness. He became apathetic and was unable to continue his work as a writer. After recovery from this prolonged attack, Johnson had numerous less severe attacks of shorter duration. Although not mentioned by Dr. Ober,

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223

Figure 24 Papyrus painting of the “Book of the Dead” (XIX Egyptian Dynasty) showing scales, with a dead man, a scribe named Ani, standing under them on the left side. His heart (behind him) is being weighed against the feather of truth on the right side. Anabis, the jackal-headed god of the underworld, is performing the ceremony. If the heart outweighs the feather, Ani will be judged bad and be devoured by the crocodile-headed monster at the far right; if the feather outweighs the heart, Ani will live happily in the underworld. Standing in front of the monster is Thoth, the god of wisdom (analysis courtesy of Judith A. Ferry, MD), (British Museum, London).

Boswell’s biography of Johnson recounts that a major factor in his recovery was having learned companions with whom to converse. Johnson also had a number of obsessive-compulsive elements in his madness: writing his dictionary, touching every lamppost as he walked down Fleet St.,250 and making sure that one of his feet, right or left, always preceded the other on opening a door. Later, a religious conversion, brought about by reading what he considered to be “the finest piece of exhortatory religion in any language” became a strong factor in his recoveries. When Johnson was 57 years of age he had his second severe depression, which was also of 2 years’ duration. Like the first one, it was associated with feelings of failure, loneliness, and dread of madness, even though at that time he was at the peak of his success, had received many honors, and had many friends in his intellectual circle.

Table 4

Eighteenth century concepts of madness

Melancholy-black bile. Hypochondria: either underneath the breast bone (ie, the heart) or underneath the rib cage (ie, the spleen). Heart and spleen thought to be sites of emotion. “Hypochondriac” evolved to refer to a person who has imaginary disease(s).

James Boswell, lawyer, skillful essayist, and biographer, had repeated episodes of depression that appeared less severe then those of Johnson. He had a strong family history of insanity (including that of his father’s twin brother and his own younger brother). Both parents were very religious. His father, Lord Auckinleck, was a stern, inflexible Presbyterian judge, and his mother, a “delicate hypochondriac Calvinist.” Boswell was a fragile child, whose mother went to great lengths to see that he was well versed in Calvinist doctrine, which he found intimidating and depressing. As an adult, his episodes of depression were manifested by feelings of guilt, fear of his father’s disapproval often complicated by drunkenness and compulsive gambling. The episodes were never as long as the worst of Johnson’s— he was too eager to return to his writing and never missed a deadline. Lord Auckinleck died when Boswell was 42 years old, and although he did not attribute his cure to that event, possibly out of respect for his father, he had no attacks thereafter. Johnson and Boswell both wrote about melancholy in general, the former in his dictionary and essays, and the latter in a weekly column in the London Times called “The Hypochondriac.” Today, much information is available about the genetic and metabolic aspects of mental depression as a result of advances in imaging of the brain and biochemical investiga-

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Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 Table 5 Ober publications: outstanding or unique contributions in pathology and history of pathology A. 6 papers on oral contraceptives and contraceptive devices. B. 10 papers on effects of hormones on endometrium. C. Paper (227 pages) on pathology of first 100 cases of choriocarcinoma treated by chemotherapy at NCI. D. Paper: Observations on endometrium and ovary in newborn. E. Tumors of subcoelomic mesenchyme. F. Five papers on experimental toxemia of pregnancy in animals, including nonhuman primates. G. Comprehensive review of stilbestrol. H. Paper and editorial: differential diagnosis of Boerhaave’s syndrome. I. Two papers: American pathology in the 19th century.

Figure 25 Portrait of Samuel Johnson by Sir Joshua Reynolds (National Portrait Gallery, London).

tions, using rodents, nonhuman primates, and humans. The concepts of unipolar and bipolar disease were not recognized as such in the 18th century; in the light of present knowledge, it appears likely that Boswell was bipolar, and Johnson, unipolar and depressed without a manic component.

Epilogue Dr. William B. Ober was a unique Renaissance man among pathologists, living and dead. His writings in his specialty, obstetrical-gynecological pathology, surpassed those of most of his contemporaries both in quality (Table 5) and quantity (Table 6). Bill traveled to libraries and museums throughout the world to do research for his historical essays, which reflected an extensive knowledge of the arts and sciences. Most of his essays were laced with gentle humor, often of the erotic type. A medical reviewer of his first book, Boswell’s Clap, described it as “a happy blend of scholarly content and literary form, a lucid, jargon-free, often witty book . . . recommended for physician and layman alike.” Time Magazine, reviewing Bottoms Up, stated that Ober “writes better, more delightfully and with greater flexibility

than most professional critics.” The Washington Post said that Bottoms Up was a “bravura selection of essays that shows what a first-rate intelligence can do with the tools of scholarship and a sense of fun.” Dr. Ober’s writings were not free of imperfections. A few essays lacked easily obtainable, important information. He has been accused of attributing the poetry of his subjects to salacious intent more often than warranted. He was uncharacteristically harsh on a few of his subjects, such as Dr. Brenner and Dr. Kaposi. He assumed that the former joined the colonial service and later became a general practitioner because his poorly researched paper in 1907 made it impossible for him to obtain another position in academic medicine in Germany. No convincing evidence was presented, however, that the paper was criticized by his contemporaries during the early years after its publication. Dr. Kaposi was condemned for taking advantage of a variety of opportunities to advance a career that might otherwise have been impeded by anti-Jewish prejudice. Although all the steps he took could be considered overkill in Dr. Ober’s time, they might have been necessary for a Hungarian living in Austria in the latter half of the 20th century. Table 6 Ober publications: other pathological and historical contributions A. Pathological 1. 15 papers in obstetrical-gynecological field. 2. 23 papers in other pathological fields. 3. Co-edition of over 60 clinicopathological conferences on many types of disease. B. Historical 1. 52 essays on physicians also famous for other activities. 2. 10 essays on artists (literary and musical) whose works were influenced by medical or psychological problems. 3. 30 miscellaneous historical essays.

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The above comments notwithstanding, the volume and quality of Dr. Ober’s writings as a humanist, historian, and scientist greatly outweigh his occasional minor faults. Throughout most of his life, Bill maintained frequent contacts with his many friends, including RES, at medical meetings and at dinners and by correspondence and telephoning. He was loved by his wife and daughter, with whom he shared knowledge of his activities and his friends. All of us marveled at his brilliance, wit, and periodic eccentric but amusing behavior. We “shall not look on his like again” [Shakespeare’s Hamlet Act 1 Scene 2 (Hamlet speaking to Horatio about his (Hamlet’s) late father)].

Acknowledgments Dr. Edi Brogi of Memorial Sloan-Kettering Cancer Center kindly obtained many articles not available in the Countway Library of HMS. Ms. Martha Stone, Librarian, Treadwell Library, Massachusetts General Hospital, was characteristically helpful in tracking some of Dr. Ober’s publications. Ms. Christine Carr provided excellent and patient secretarial assistance. Ms. Arlene Shaner, Assistant Curator and Reference Librarian of the New York Academy of Medicine, was most helpful in obtaining portraits from the Academy Collection. Dr. Rosemary Tambouret helped with our searches for other portraits. Dr. David N. Louis, Chief of Pathology Services at the Massachusetts General Hospital and Benjamin Castleman Professor of Pathology, HMS, kindly provided advice on neuropsychiatric aspects of some of Dr. Ober’s psychobiographies. Mrs. Michelle Forrestall Lee worked heroically to keep all of the photographs in order in this digital era. Drs. Robert J. Kurman and Henry J. Norris provided a number of letters and reprints from Dr. Ober as well as recollections of his life. Dr. Mary Lawrence, Professor of Ophthalmology at the University of Minnesota, kindly clarified the nature of Dr. Ober’s ocular diseases. Finally, the late Mrs. Rhoda Ober and her daughter, Mrs. Peter Skagestad (Elaine Ober), graciously shared details of Dr. Ober’s life and activities.

References Bibliography of William B. Ober, MD 1. Boas NF, Ober WB: Hereditary exophthalmic goiter: report of eleven cases in one family. J Clin Endocrinol 6:575-588, 1946 2. Ayres WW, Ober WB, Hamilton PK: Posttraumatic subcutaneous granulomas associated with a crystalline material. Am J Pathol 27: 303-315, 1951 3. Morrison H, Mixter CG, Schlesinger MJ, et al: Tuberculosis localized in the vermiform appendix. N Engl J Med 246:329-331, 1952 4. Blumberg J, Ober WB: Carcinoma in situ of the cervix: recurrence in the vaginal vault. Am J Obstet Gynecol 66:421-425, 1953 5. Ober WB, Jason RS: Sarcoma of endometrial stroma. Arch Pathol 56:301-311, 1953

225 6. Ober WB, Palmer RE, Glassy FJ: Rhabdomyosarcoma of the vulva and vagina. Arch Pathol 56:364-373, 1953 7. Ober WB, Edgcomb JH: Sarcoma botryoides in the female genital tract. Cancer 7:75-91, 1954 8. Ober WB, Reinder L: Cancer of the cervix in Jewish women. N Engl J Med 251:555-559, 1954 9. Ober WB, Black MB: Neoplasms of the subcoelomic mesenchyme. Arch Pathol 59:698-705, 1955 10. Ober WB, Moore TE Jr: Congenital cardiac malformations in the neonatal period. N Engl J Med 253:271-275, 1955 11. Ober WB, Velardo JT, Greene RC, et al: Desmoid tumor of the popliteal fossa occurring during pregnancy: report of a case with bioassays. J Natl Cancer Inst 16:569-577, 1955 12. Ober WB, Bernstein J: Observations on the endometrium and ovary of the newborn. Pediatrics 16:445-460, 1955 13. Ober WB, LeCompte PM: Acute fatty metamorphosis of the liver associated with pregnancy. Am J Med 19:743-758, 1955 14. Jewett JF, Ober WB: Primary pulmonary hypertension as a cause of maternal death. Am J Obstet Gynecol 71:1335-1341, 1956 15. Roby CC, Ober WB, Drorbaugh JE: Pregnanediol in the urine of newborn male infants. Pediatrics 17:877-881, 1956 16. Ober WB, Wharton RN: On the “Phrygian Cap.” N Engl J Med 255:517-572, 1956 17. Ober WB, Reid DE, Romney SL, et al: Renal lesions and acute renal failure in pregnancy. Am J Med 21:781-810, 1956 18. Ober WB, Grady HG, Schoenbucher AK: Ectopic ovarian decidua without pregnancy. Am J Pathol 33:199-217, 1957 19. Brown DE, Ober WB: Sickle cell-thalassemia (microdrepanocytic disease) in pregnancy. Am J Obstet Gynecol 73:773-784, 1958 20. Ober WB, Kaiser GA: Hamartoma of the parathyroid. Cancer 11: 601-606, 1958 21. Ober WB, Smith JA, Rouillard FC: Congenital sarcoma botryoides of the vagina. Cancer 11:620-625, 1958 22. Ober WB: Uterine sarcomas. Histogenesis and taxonomy. Ann NY Acad Sci 75:568-585, 1959 23. Ober WB, Tovell HMM: Mesenchymal sarcomas of the uterus. Am J Obstet Gynecol 77:246-268, 1959 24. Ober WB: The endocrine pathology of the female reproductive tract, in Velardo JT (ed): Essentials of Human Reproduction (Chapter 10). New York, NY, Oxford University Press, 1959 25. Ober WB, Bruno MS, Simon RM, et al: Hemoglobin S-C disease with fat embolism. Am J Med 27:647-658, 1959 26. Ober WB: Historical perspectives on trophoblast and its tumors. Ann NY Acad Sci 80:3-20, 1959 27. Ober WB, Tovell HMM: Malignant lymphoma of the uterus. Bull Sloane Hosp Women 5:65-75, 1959 28. Ober WB: Solid ovarian teratoma with struma ovarii, theca lutein reaction and endometrial hyperplasia. J Obstet Gynaecol Br Emp 67:451-454, 1960 29. Ober WB, Berg P, Tuchman M, et al: Acute trichinosis. Festschr Rudolph Virchow Soc 320-362, 1960 30. Ober WB, Bruno MS, Jones FM, et al: Fatal intravascular sickling in a patient with sickle-cell trait. N Engl J Med 263:947-950, 1960 31. Bailey OT, Ober WB, Bruno MS: Central pontine myelinolysis. Am J Med 29:902-906, 1960 32. Ober WB, Fass RO: The early history of choriocarcinoma. J Hist Med Allied Sci 16:49-73, 1961 33. Ober WB, Kaiser GA: Pregnanediol: methods, limitations, and applications. Am J Clin Pathol 35:297-318, 1961 34. Narasimhan P, Ober WB: Sarcoidosis: report of a fatal case with myocardial involvement. Indian Pract 14:205-213, 1961 35. Ober WB, Grady HG: Subinvolution of the placental site. Bull NY Acad Med 37:313-330, 1961 36. Ober WB: Sarcoidosis. Gynecol Pract 24:88-89, 1961 37. Janovski NA, Schuldenfrei R, Ober WB: Adenocarcinoma of the endometrium: report of a case developing after pelvic irradiation, associated with ovarian hilus cell hyperplasia. Am J Obstet Gynecol 82:1186-1191, 1961

226 38. Cutler A, Ober WB, Epstein JA, et al: The effect of 1- (p-2-diethylaminoethoxyphenyl)-1-phenyl-2-p-anisyl ethanol upon rat pituitary and uterine response to estrogen. Endocrinology 69:473-482, 1961 39. Ober WB: Guest editorial: information for the pathologist. Gynecol Pract 25:80-81, 1962 40. Ober WB: Embryonal carcinoma of the testicular type arising in the gonad of a true hermaphrodite. Bull Jewish Memorial Hosp 6:94-102, 1962 41. Berg P, Ober WB: Endocardial fibroelastosis associated with hypoplasia of the right coronary artery in an adult. N Engl J Med 266:863-866, 1962 42. Salomon MI, Narasimhan P, Bruno MS, et al: Renal lesions in essential hypertension: problem of correlation between renal biopsy and clinical parameters. Angiology 13:216-225, 1962 43. Buckingham JC, Hertz H, Ober WB: Carcinosarcoma of the endometrium. Am J Obstet Gynecol 83:1534-1539, 1962 44. Berg P, Tuchman M, Redner WJ, et al: Acute trichinosis. Gynecol Pract 26:82-90, 1962 45. Bruno MS, Ober WB, Kupperman HS: Coexistence of Addison’s disease and thyrotoxicosis. Arch Intern Med 110:155-161, 1962 46. Ober WB: The gynecologic biopsy in office practice. Gynecol Pract 26:112-120, 1962 47. Ober WB, Pollak A, Gertsmann KE, et al: Krukenberg tumor with androgenic and progestational effects. Am J Obstet Gynecol 84:739744, 1962 48. Salomon MI, Bruno MS, Ober WB: Precutaneous renal biopsy: its importance in research and clinical medicine. NY State J Med 62: 3248-3254, 1962 49. Baron HC, Ober WB: Parotid gland atrophy. Arch Surg 85:10421044, 1962 50. Ober WB: The endometrial biopsy in office practice. Gynecol Pract 27:108-112, 1963 51. Janovski NA, Weiner L, Ober WB: Soap intoxication following criminal abortion. NY State J Med 63:1463-1487, 1963 52. Daino JA, Tchertkoff V, Akhavan TH, et al: Leydig cell tumor of testis in a male pseudohermaphrodite with testicular feminization. NY State J Med 63:2258-2262, 1963 53. Ober WB: Endocrine pathology, in Kupperman HS (ed): Human Endocrinology (Volume III, Chapter 33). Philadelphia, PA, FA Davis Co, 1963, pp 1150-1160 54. Roland M, Ober WB: The endometropic effect of Provest in ovulatory and anovulatory patients. Int J Fertil 8:619-634, 1963 55. Bruno MS, Grier WRN, Ober WB: Spontaneous laceration and rupture of the esophagus and stomach. Arch Int Med 112:574-583, 1963 56. Ober WB: Unsigned Editorial: The Boerhaave syndrome. J Am Med Assoc 187:57, 1963 57. Roland M, Clyman MJ, Decker A, et al: Classification of the endometrial response to synthetic estrogen-progestagen compounds. Fertil Steril 15:143-163, 1964 58. Roland M, Ober WB: Los progestagenos sinteticos en la infertilidad endocrina y en los trastornos menstruales. Proceedings of the 4th International Congress on Fertility, Mexico, 1964, pp 359-363 59. Ober WB, Clyman MJ, Decker A, et al: Endometrial effects of synthetic progestagens. Int J Fertil 9:597-608, 1964 60. Rankow RH, Bruno MS, Ober WB: Congenital pharyngeal pouch malformation with hyperparathyroidism. NY State J Med 64:25682572, 1964 61. Ober WB: Overuse of laboratory tests. Issues 2:2-7, 1965 62. Ober WB: Clinical and pathological aspects of abnormal trophoblast, in Park WW (ed): The Early Conceptus, Normal and Abnormal. Dundee, University of St. Andrews, 1965, pp 141-144 63. Ober WB: James Grainger MD (?1721-1766): poetry and tropical medicine. NY State Med J 65:1257-1260, 1965 64. Ober WB: Peter Mark Roget, MD, FRS (1779-1869): utilitarian and lexicographer. NY State J Med 65:1804-1807, 1965 65. Ober WB: Thomas Bowdler MD (1754-1825): pre-Victorian reformer and editor. NY State J Med 65:2026-2030, 1965

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 66. Ober WB, Conway AJ: John XXI: ophthalmologist, professor of physic, pope. N Engl J Med 273:39-40, 1965 67. Ober WB: Nicholas Barbon, MD (?1640-1698): fire underwriter, speculative builder, economist. NY State J Med 65:2388-2391, 1965 68. Ober WB: John Armstrong, MD (1709-1779): a Scot in London. NY State J Med 65:2711-2717, 1965 69. Ober WB: Sir Richard Blackmore, MD (1653-1729) and the Raphael cartoons. NY State J Med 65:2951-2953, 1965 70. Roland M, Applezweig N, Clyman MJ, et al: Progestagen Therapy. Springfield, IL, CC Thomas, 1965 71. Ober WB: John Arbuthnot, MD, FRS, FRCP (1667-1735): satirist and member of the Martinus Scriblerus club. NY State J Med 66: 276-281, 1966 72. Roland M, Clyman MJ, Decker A, et al: Control of conception with a new progestational steroid. Obstet Gynecol 27:222-231, 1966 73. Davis JE, Clyman MJ, Decker A, et al: Varicocele as a contributing factor in male infertility. Fertil Steril 17:359-372, 1966 74. Ober WB: Charles Morison: Surgeon of Greenock and pioneer telegrapher. NY State J Med 66:649-651, 1966 75. Kwittken J, Ober WB, Mannheim HL: Bilateral salivary gland tumors. NY State J Med 66:649-651, 1966 76. Ober WB: Synthetic progestagen-oestrogen preparations and endometrial morphology. J Clin Pathol 19:139-247, 1966 77. Ober WB: Sir Richard Blackmore, MD (1653-1729) and the Psalms of David. NY State J Med 66:1125-1128, 1966 78. Roland M, Clyman MJ, Decker A, et al: Sequential endometrial alterations during one cycle of treatment with synthetic progestatenestrogen compounds. Fertil Steril 17:338-350, 1966 79. Tchertkoff V, Ober WB: Primary chancre of the cervix uteri. NY State J Med 66:1921-1924, 1966 80. Ober WB, David Kinloch, MD (1559-1617): early Scottish physician-poet. NY State J Med 66:1931-1934, 1966 81. Roland M, Clyman MJ, Decker A, et al: Clinical study of quinestrol in infertile women. Fertil Steril 17:531-540, 1966 82. Ober WB, Decker A, Clyman MJ, et al: Endometrial morphology after sequential medication with mestranol and chlormadinone. Obstet Gynecol 28:247-253, 1966 83. Ober WB: George Clark Cathcart, MD (1860-1951) and concert pitch. NY State J Med 66:2302-2305, 1966 84. Ober WB: We should legalize abortions. Saturday Evening Post, October 8, 1966, pp 14-18 85. Ober WB: Mariano Azuela MD, (1873-1952): physician and novelist of the Mexican Revolution. NY State J Med 66:2828-2831, 1966 86. Ober WB: Sir William Knighton, MD (1776-1836): physician and keeper of the privy purse. NY State J Med 67:293-301, 1967 87. Ober WB: Alexander Borodin, MD (1833-1877): Physician, chemist, and composer NY State J Med 67: 836-844, 1967 (see also Alexander Borodin, the “Sunday” Composer Hi-Fi/Stereo Review 18:54-58, 1967) 88. Ober WB, Bronstein SB: Endometrial morphology following oral administration of quinestrol. Int J Fertil 12:210-228, 1967 89. Ober WB: Conan Doyle’s dying detective: a problem in differential diagnosis. NY State J Med 67:2141-2145, 1967 90. Ober WB: The Purple Island of Phineas Fletcher (1528-1650): classical anatomy’s last stand. NY State J Med 67:2630-2635, 1967 91. Ober WB: FP Wierzbicki, MD (1815-1860): California’s first press agent. Acad Bookman 20:3-6, 1967 92. Ober WB: A modest proposal for preventing choriocarcinoma among innocent mothers. Obstet Gynecol 31:866-869, 1968 93. Ober WB, Bronstein SB: Effects of quinestrol on endometrial morphology. Proceedings of the 5th World Congress on Fertility and Sterility. In Excerpta Medica International Congress Series No. 113: 1073-1075, 1968 94. Ober WB: Sir Hans Sloane, MD, FRCP, FRS (1660-1753) and the British Museum. NY State J Med 68:1422-1430, 1968 95. Ober WB: Thomas Lovell Beddoes, MD (1803-1849): “Death keeps his pale court.” NY State J Med 68:1745-1755, 1968

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96. Ober WB: Thomas Whythorne, Elizabethan madrigalist. Am Record Guide 34:748-756, 1968 97. Ober WB: Drowsed with the fume of poppies: opium and John Keats. Bull NY Acad Med 44:862-881, 1968 98. Ober WB: Robert Mayer, MD (1814-1878) and the mechanical equivalent of heat. NY State J Med 68:2447-2454, 1968 99. Ober WB, Sir Henry Thompson, MD (1820-1904): Victorian virtues. NY State J Med 68:2571-2577, 1968 100. Ober WB, Mark Akenside, MD (1721-1770): Physician and philosophic poet. NY State J Med 68:3166-3180, 1968 101. Ober WB, Sobrero AJ, Kurman R, Gold S: Endometrial morphology and polyethylene intrauterine devices. Obstet Gynecol 32:782-793, 1968 102. Ober WB, Oliver St. John Gogarty, MD (1878-1957): Buck Mulligan of the Irish Renaissance. New York State J Med 69:469-480, 1969 103. Ober WB, John Wolcott, MD (1738-1819): Peter Pindar the satirist. JAMA 208:103-108, 1969 104. Ober WB, William Carlos Williams, MD (1873-1963): The physician as poet. NY State J Med 69: 1084-1098, 1969 105. Ober WB: George Stubbs (1724-1806): anatomic artist. Acad Bookman 22:2-9, 1969 (see also George Stubbs: the mirror up to nature. NY State J Med 70:986-992, 1970) 106. Ober WB: Lady Chatterley’s what? Bull Acad Med New Jersey 15:41-65, 1969 107. Ober WB: Boswell’s gonorrhea. Bull NY Acad Med 45:587-636, 1969 108. Ober WB: Elias Lönnrot and the Kalevala. NY State J Med 69:21592167, 1969 109. Ober WB: Bach, Handel, and “Chevalier” John Taylor, Ophthalmiater? NY State J Med 69:1797-1807, 1969 110. Ober WB, Hurwitz RM: Robert Recorde, MD (?1510-1558): tudor physician, mathematician, and pedagogue. NY State J Med 69:21592167, 1969 111. Ober WB: A few kind words about W. Somerset Maugham (18741965). NY State J Med 69:2692-2701, 1969 112. Ober WB: Sir Charles Bell, FRCSE (1774-1842): anatomy of expression. Acad Bookman 22:2-10, 1969 113. Ober WB: Sir Theodore Turquet de Mayerne, MD, FRCP (15731655): Stuart physician and observer. NY State J Med 70:449-458, 1970 114. Ober WB: Madness and poetry: a note on Collins, Cowper, and Smart. Bull NY Acad Med 46:203-266, 1970 115. Ober WB, Sobrero AJ, De Chabon AB, et al: Polyethylene intrauterine contraceptive device: endometrial changes following long-term use. J Am Med Assoc 212:765-769, 1970 116. Ober WB: Balthasar (Isaak) Orobio de Castro, MD (1620-1687): Marrano physician and theologic disputant. NY State J Med 70:13211328, 1970 117. Ober WB: The case of the Kaiser’s cancer, in Sommers SC (ed): Pathology Annual. New York, NY, Appleton-Century-Crofts, 1970, pp 207-216 118. Ober WB, Sobrero AJ, de Chabon AB: Endometrial findings after insertion of a stainless steel spring IUD. Obstet Gynecol 36:62-68, 1970 119. Ober WB: Gestational choriocarcinoma: immunologic aspects, diagnosis and treatment. In Proc Lenox Hill Hosp. Symp. Gynecol Oncol. Excerpta Medica Internat. Congress Series No. 302, 1970, pp 304316 120. Ober WB: Johan Frederick, Count Struensee, MD (1737-1772): King, Queen, Jack. NY State J Med 70:2139-2143, 1970 121. Ober WB: Austin Freeman and Dr. Thorndyke: forensic detection. NY State J Med 70:2242-2249, 1970 122. Ober WB: Beethoven, a medical view. Practitioner 205:819-824, 1970 123. Ober WB: Sir Francis Seymour Haden, P.R.E. (1818-1909): etcher and surgeon. Artist’s Proof 10:39-47, 1970 124. Ober WB: Thomas Shadwell: his exitus revis’d? Ann Int Med 74: 126-130, 1971

227 125. Ober WB, Edgcomb JH, Price EB Jr: The pathology of choriocarcinoma. Ann NY Acad Sci 172:299-426, 1971 126. Ober WB: Ignace Guillotin, MD (1738-1814): off with their heads! NY State J Med 71:787-790, 1971 127. Ober WB: Georges Clemenceau, MD (1841-1929): the smile on the face of the “tiger.” NY State J Med 71:987-996, 1971 128. Ober WB: Jean Paul Marat, MD (1743-1793): physician turned radical. NY State J Med 71:1125-1135, 1971 129. Ober WB: Medical polemic of 1651: physician contra surgeons and apothecaries. NY State J Med 71:1880-1886, 1971 130. Ober WB: Claude Perrault, MD (1613-1688): anatomist, physicist, architect. NY State J Med 71:2977-2981, 1971 131. Ober WB: Sarcoma botryoides of the cervix uteri: case report in a 75-year-old woman. Mount Sinai J Med 38:363-374, 1971 132. Ober WB: Robert Musil (1880-1942): what price homosexual sadism? NY State J Med 72:1071-1076, 1972 133. Ober WB: Henri Mondor, MD (1885-1962): surgery and French letters. NY State J Med 72:2222-2227, 1972 134. Ober WB: Sir William Petty: medical education, hospitals, and health care. Bull NY Acad Med 48:998-2002, 1972 135. Ober WB, Labay GR: The histopathology of the endometrium: selected topics, in Wynn RM (ed): Obstetrics and Gynecology Annual. New York, NY, Appleton-Century-Crofts, 1972, pp 373-420 136. Ober WB: Chekhov among the doctors: the doctor’s dilemma. Bull NY Acad Med 49:62-76, 1973 137. Ober WB: Carlo Gesualdo, Prince of Venosa: murder, madrigals, and masochism. Bull NY Acad Med 49:634-645, 1973 138. Ober WB: Adenocarcinoma of the endometrium: a pathologist’s view, in Brush MG, Taylor RW, Williams DC (eds). Symposium on Endometrial Cancer. London, Heinemann, 1973, pp 73-81 139. Ober WB: Noble quacksalver: The Earl of Rochester’s merry prank. Hist Med 5:24-26, 1973 140. Ober WB: The Sydenham Society (1843-1857): rise and fall. Mount Sinai J Med 41:295-306, 1974 141. Ober WB: Kidney disease a hundred years ago: a gloss on Broadbent. Med Counterpoint 5:15-21, 1974 142. Lane ME, Dacalos E, Sobrero AJ, et al: Squamous metaplasia of the endometrium in women with an intrauterine contraceptive device: follow up study. Am J Obstet Gynecol 199:693-697, 1974 143. Ober WB (ed): Great Men of Guy’s. New York Academy of Medicine-History of Medicine Series, No. 42. Metuchen, NJ, Scarecrow Press, 1974 144. Ober WB: The autopsy of George II. Int Pathol 3:14-20, 1974 145. Ober WB: Their last chords. Practitioner 214:567-572, 1975 146. Romney SL, Ober WB, Moyer DL: The uterus, in Romney, Gray, Little, et al (eds): Gynecology and Obstetrics: The Health Care of Women (Chapter 74). New York, NY, McGraw-Hill, 1975 147. Ober WB, Cohen MW: Multiple primary carcinomas of the female genital tract: conceptual considerations, in Severi L (ed): Multiple Primary Malignant Tumors, Proc. Vth Perugia Quad Conf on Cancer, 1975, pp 493-502 148. Ober WB: Swinburne’s masochism: neuropathology and psychopathology. Bull Menninger Clin 39:500-555, 1975 149. Ober WB: Operatic “doctors.” Practitioner 216:100-116, 1976 150. Ober WB: American pathology in the 19th century: notes for the definition of a specialty. Bull NY Acad Med 52:326-347, 1976 151. Ober WB, Kabakow B, Hecht H: Malignant interstitial cell tumor of the testis: a problem in endocrine oncology. Bull NY Acad Med 52:561-583, 1976 152. Ober WB, Edgcomb JH: Two centuries of medical progress, 17761976. NY State J Med 76:1006-1118, 1976 153. Abitbol MM, Gallo GR, Pirani CL, et al: Production of experimental toxemia in the pregnant rabbit. Am J Obstet Gynecol 124:460-470, 1976 154. Abitbol MM, Driscoll SG, Ober WB: Placental lesions in experimental toxemia in the rabbit. Am J Obstet Gynecol 125:942-948, 1976

228 155. Ober WB: Stilbestrol: a pathologist’s view, in Somers SC (ed): Pathology Annual. New York, NY, Appleton-Century-Crofts, 1976, pp 227-254 156. Abitol MM, Pirani CL, Ober WB, et al: Production of experimental toxemia in the pregnant dog. Obstet Gynecol 48:537-548, 1976 157. Ober WB: Hodgkin’s disease: historical notes. NY State J Med 77:126-133, 1977 158. Ober WB: Did Socrates die of hemlock poisoning? NY State J Med 77:254-258, 1977 159. Abitbol MM, Ober WB, Gallo GR, et al: Experimental toxemia of pregnancy in the monkey with a preliminary report on renin and aldosterone. Am J Pathol 86:573-590, 1977 160. Ober WB: Effects of oral and intrauterine contraceptives on the uterus. Hum Pathol 8:513-527, 1977 161. Ober WB: Report of the Committee on Library Publications. Bull NY Acad Med 53:919-924, 1977 162. Ober WB: Experimental toxemia of pregnancy: review and speculation. Pathol Ann 12:383-410, 1977 163. Ober WB: Mark Akenside, MD (1721-1770): first recorded description of multiple neurofibromatosis. Am J Pathol 92:315, 1978 164. Ober WB: Recent ideas in the pathology of endometrial cancer, in Brush MG, King RJB, Taylor RW (eds): Endometrial Cancer (Chapter 12). London, Balliere Tindall, 1978, pp 111-117 165. Ober WB: Friedrich Krukenberg and his tumor. Am J Pathol 93:792, 1978 166. Ober WB: Friedrich Wilhelm Zahn, MD (1845-1904): what’s my line? Pathol Ann 13:165-174, 1978 167. Ober WB, Rausen AR: Neuroblastoma: historical background and current therapy, in Severi L (ed): Tumors of Early Life in Man and Animals, VIth Perugia Quad Conf on Cancer, 1977, pp. 399-410 168. Ober WB: The Earl of Rochester and ejaculatio praecox, in Ober WB (ed): Boswell’s Clap and Other Essays: Medical Analyses of Literary Men’s Afflictions (Chapter 8). Carbondale, IL, Southern Illinois University Press, 1979 169. Ober WB: Boswell’s Clap and Other Essays: Medical Analyses of Literary Men’s Afflictions. Carbondale, IL, Southern Illinois University Press, 1979 170. Ober WB: Carcinosarcoma of the ovary: case report, review of literature, and comment on the subcoelomic mesenchyme. Am J Diagn Obstet Gynecol 1:73-81, 1979 171. Ober WB: Notes on placentophagy. Bull NY Acad Med 55:591-599, 1979 172. Ober WB: Weighing the heart against the feather of truth. Bull NY Acad Med 55:66-651, 1979 173. Ober WB: History of the Brenner tumor of the ovary. Pathol Ann 14:107-124, 1979 174. Ober WB: Empeiria and episteme in surgical pathology: Theodor Billroth and Reginald Fitz, in Fenoglio CM, Wolff M (eds): Progress in Surgical Pathology, Vol. 1 (Chapter 2), 1980, pp 5-13 175. Rybak BJ, Ober WB, Bernacki EG Jr: Malignant Brenner tumor of the ovary: report of three cases. Diagn Gynecol Obstet 3:61-74, 1981 176. Ober WB, Sciagura C: Leydig, Sertoli and Reinke: three anatomists who were on the ball. Pathol Ann 16:1-13, 1981 177. Ober WB, Maier RC: Gestational choriocarcinoma of the fallopian tube. Diagn Gynecol Obstet 3:213-231, 1981 178. Ober WB, Alloush N: The plague at Granada, 1348-1349: Ibn alKhatib and ideas of contagion. Bull NY Acad Med 58:418-424, 1982 179. Ober WB: Toxemia of pregnancy: unresolved problems. Diagn Gynecol Obstet 4:247-250, 1982 180. Ober WB: Emil Zuckerkandl and his delightful little organ. Pathol Ann 18:103-120, 1983 181. Ober WB: Can the leper change his spots? The iconography of leprosy. Am J Dermatopathol 5:43-55, 173-186, 1983 182. Ober WB: William Carlos Williams: the influence of a medical practice. J Med Soc NJ 80:715-718, 1983 183. Ober WB: Ghon but not forgotten: Anton Ghon and his complex. Pathol Ann 18:79-85, 1983

Seminars in Diagnostic Pathology, Vol 25, No 3, August 2008 184. Ober WB: Questions to the Editorial Board. Am J Dermatopathol 5:201-202, 1983 185. Ober WB: The sticky end of Frantisek Koczwara, composer of “The Battle of Prague.” Am J Forensic Med Pathol 5:145-149, 1984 186. Ober WB: Recognizing papillary serous carcinoma of the endometrium. Contemp Obstet Gynecol 24:225-228, 1984 187. Ober WB: Androgen-secreting ovarian tumors in postmenopausal women. J Med Soc NJ 81:878-883, 1984 188. Ober WB: Reuben’s mandrakes: infertility in the Bible. Int J Gynecol Pathol 3:299-317, 1984 189. Ober WB: Bottoms Up! The fine arts and flagellation. Am J Dermatopathol 6:451-460, 541-552, 1984 190. Ober WB: Johnson and Boswell: “Vile melancholy” and “The Hypochondriack.” Bull NY Acad Med 61:657-678, 1985 191. Ober WB: Infanticide in eighteenth-century England: William Hunter’s contribution to the forensic problem. Pathol Ann 21:311-319, 1986 192. Ober WB: Margery Kempe: hysteria and mysticism reconciled. Lit Med 4:24-40, 1985 193. Ober WB: All the colors of the Rimbaud. Med Herit 2:187-207, 1986 194. Ober WB: Trophoblastic disease: a retrospective view. Hum Reprod 1:553-557, 1986 195. Ober WB: Pathology of trophoblastic diseases. Hum Reprod 2:143152, 1987 196. Ober WB: Choriocarcinoma: historical notes, in Szulman AE, Buchsbaum HJ (eds): Gestational Trophoblastic Disease, 1-7. New York, NY, Springer-Verlag, 1987 197. Ober WB: The trial of Spencer Cowper: expert witnesses to the rescue. Am J Forens Med Pathol 8:172-178, 1987 198. Ober WB: Hemorrhoidectomy, in Mandell H, Spiro HM (eds): When Doctors Get Sick. New York, NY, Plenum, pp 419-424 199. Ober WB: The iconography of Fanny Hill: how to illustrate a dirty book, in Ober WB (ed): Bottoms Up! A Pathologist’s Essays on Medicine and the Humanities. Carbondale, IL, Southern Illinois University Press, 1987 200. Ober WB: Bottoms Up! A Pathologist’s Essays on Medicine and the Humanities. Carbondale, IL, Southern Illinois University Press, 1987 201. Ober WB: Kaposi: the man and the sarcoma, in Gottlieb GJ, Ackerman AB (eds): Kaposi’s Sarcoma: A Text and Atlas. Philadelphia, PA, Lea & Febiger, 1988 202. Ober WB: Eighteenth-century spleen, in Fox C (ed): Psychology and Literature in the Eighteenth Century. New York, NY, AMS Press, 1988, pp 225-257 203. Ober WB: To cast a pox: the iconography of syphilis. Am J Dermatopathol 11:74-86, 1989 204. Ober WB: John Donne as a patient: devotions upon emergent occasions. Lit Med 9:21-37, 1990 205. Ober WB: Anorectal trauma [comment]. Am Forens Med Pathol 11:181, 1990 206. Ober WB: The man in the scarlet cloak. The mysterious death of Peter Anthony Motteux. Am J Forens Med Pathol 12:255-261, 1991 207. Ober WB: Obstetrical events that shaped Western European history. Yale J Biol Med 65:201-210, 1992 Other References 208. Tchertkoff V: Obituary: William B. Ober, M.D. J Am Med Assoc 275:1625, 1993 209. Ostor AG, Fortune DW, Riley CB: Fibroepithelial polyps with atypical stromal cells (pseudosarcoma botryoides) of vulva and vagina. A report of 13 cases. Int J Gynecol Pathol 7:351-360, 1988 210. Lauchlan SC: The secondary müllerian system. Obstet Gynecol Surv 27:133-146, 1972 211. Tavassoli FA, Norris HJ: Peritoneal leiomyomatosis (leiomyomatosis peritonealis disseminata): a clinicopathologic study of 20 cases with ultrastructural observations. Int J Gynecol Pathol 1:59-74, 1982 212. Clement PB, Young RH, Hanna W, et al: Sclerosing peritonitis associated with luteinized thecomas of the ovary. A clinicopathological analysis of five cases. Am J Surg Pathol 18:1-13, 1994

Scully and Young

William B. Ober, MD

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