Surgical Pathology in the Era of the Civil War: The Remarkable Life and Accomplishments of Joseph Janvier Woodward, MD

Archives of Pathology & Laboratory Medicine, Oct 2005 by Rapkiewicz, Amy V, Hawk, Alan, Noe, Adrienne, Berman, David M

WOODWARD AND AMERICAN PATHOLOGY

Woodward's interest in pathology began during his tenure at the University of Pennsylvania, where he was known as a superb teacher of microscopic technique.13 He was a well-respected gross anatomist; he attended the postmortem autopsy of President Abraham Lincoln and was one of the physicians for President James Garfield after he had been shot. In 1882, he was the first active-duty US Army physician elected president of the American Medical Association. Woodward can arguably be considered as one of the first American academic surgical pathologists who invented novel techniques and lectured widely on the controversial theories of the day. Woodward is also considered to be one of the first pathologists in the United States, particularly in the military setting, to use the microscope as a tool for diagnosis of disease.

Woodward's lecture entitled "On the Structure of Cancerous Tumours and the Mode in Which Adjacent Parts Are Invaded," given at the first of the renowned Toner's lecture series at the Smithsonian Institution,5,14 probably represents one of the first surgical pathology slide presentations. He projected lantern slides of his photomicrographs to illustrate the current theories on the origins of cancerous cells.9

Woodward consistently displayed a conservative approach to novel theories of disease pathogenesis. In 1870, Woodward observed a photomicrograph from the stomach of a mare with gastroenteritis demonstrating a white blood cell undergoing diapedesis from a small vein. Julius Cohnheim, an assistant to Virchow, had previously proposed that leukocyte diapedesis was essential for the development of inflammation.15 In his summary of this photomicrograph, Woodward asked, "Do these little moveable masses of protoplasm furnish the germs for the elements of new formations?"15 He further counseled caution in accepting the view that the "amoeboid movement" from the interior of the vein constituted the "essence of the inflammatory process." The past century of research has validated that leukocyte diapedesis is one of the initial steps in the process of inflammation.

A "talmud" of 19th-century medicine, the MSHWR incorporated many of the theories of the day, including, notably, the contagion theory:

Is dysentery contagious? Does the dysenteric subject generate in his intestinal mucous membrane, or elsewhere, a virus capable of causing the disease in others? ... It would be easy to multiply the authorities in favor of the contagion of dysentery. . . . Others, more conservative, held with Zimmermann that dysentery is contagious or non-contagious according to the circumstances.

One of his original slides from a patient with dysentery is remarkable in its preservation for more than 140 years (Figure 4, D). Amazingly, the differential diagnosis today remains contagious (infectious) versus noncontagious (inflammatory).

Based on the data available to him, Woodward appears to have supported theories that cancer arose from migrating leukocytes. He rejected Rudolf Virchow's Omnis cellula e cellula theory that all cells arose from preexisting cells.9,13 Woodward's incorrect views were more a result of primitive experimental data rather than a reflection of his intellect. Both views were later discredited.