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From von Rokitansky to von Recklinghausen to Cullen

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Abstract

At the top of the hierarchy of the Vienna Medical School in the 1860s, Rokitansky was aware of the growing academic sentiment that macroscopic morbid pathological anatomy was no longer at the cutting edge of medical research.1 By mid-nineteenth century, the precision, control, and reproducibility of experimental science “had greatly increased scientists’ understanding of the laws governing chemical, physiological, and physical processes…For this reason physicians viewed experimental physiology, more than pathological anatomy or the clinical sciences, as the cornerstone of scientific medicine.”2 Publication of Virchow’s Cellularpathologie in 1858 had opened the era of physiologic pathology and sounded the death knell of macroscopic pathologic anatomy.3 Though he did not embrace experimentation or routine microscopic examinations of tissues in his own research, in his ministerial position at the University, Rokitansky had prepared himself, his department, and the University for this important transition.4

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Notes

  1. 1.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 274, 397: According to Erna Lesky, historian of the Second Vienna Medical School, “Around 1860…the idea gained ground … that the potentialities of the anatomical-diagnostic trend of the Rokitansky and Skoda school had been exhausted.”

  2. 2.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 10.

  3. 3.

    Erna Lesky, 112.

  4. 4.

    Erna Lesky, 264. “The fact than an associate professorship for experimental pathology was created in 1868, and that it was raised to the rank of a chair in 1873, is related to the close contact of this subject and its representative, Salomon Stricker, with the pathological anatomist and ministerial consultant Rokitansky.” Lesky, 349. “The first edition of Moriz Rosenthal’s Klinik der Nervenkrankheiten (Clinical Aspects of Nervous Diseases) appeared in 1870, and a completely new edition was published in 1875. The book was dedicated to Carl von Rokitansky, and in its solid pathological basis as well as in the careful and surprisingly complete review of the results of contemporary research in neurophysiology and neuropathology, it demonstrates the work of an indefatigable scientist who could rightly be called a student of Rokitansky and of Türck.” The same may be said of several other books by Rosenthal.

  5. 5.

    Erna Lesky, 145.

  6. 6.

    Erna Lesky, 112–113.

  7. 7.

    Erna Lesky, 112–113.

  8. 8.

    “Kundrat’s interest was a direct continuation of the developmental trend of research of Rokitansky’s late period; it was concerned with malformations due to arrested development, and had found its expression in the last work Die Defecte der Scheidewande des Herzens (Defects of the Inter-Ventricular Septa) (Vienna, 1875).” Kundrat included etiology in his theories of congenital malformations. Erna Lesky, The Vienna Medical School of the 19 th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 516. Edward Albert, a friend and colleague of Kundrat from his student days, “characterized the main field of interest of Kundrat…‘Kundrat was without doubt a great and important morphologist. His formative concepts of observation were most extraordinary. He visualized the very complicated processes of developmental history so exactly and explained the disturbances of these processes so easily, that this in itself made him the most outstanding expert in the field of congenital malformations.’”

  9. 9.

    Erna Lesky, 515.

  10. 10.

    Erna Lesky, 516. “Kundrat’s interest was a direct continuation of the developmental trend of research of Rokitansky’s late period.”

  11. 11.

    Harvey Cushing, The Life of Sir William Osler [Oxford, UK: Clarendon Press, 1926], 113–114. In a letter dated “March 1st, 1874. Allgemeines Krankenhaus,” Osler wrote “Altogether, midwifery and skin diseases are specialties in Vienna, while in general medicine and pathology it is infinitely below Berlin…After having seen Virchow it is absolutely painful to attend postmortems here, they are performed in so slovenly a manner, and so little use is made of the material.”

  12. 12.

    Harvey Cushing, 113–114.

  13. 13.

    Harvey Cushing, 114. Osler explained. “Carl Rokitansky, at his best merely a descriptive pathologist, was at this time near the end of his career, and indeed the group of other Bohemians, the great masters who had made the ‘new Vienna School’ and turned the eyes of the medical world towards Austria, had most of them, with the exception of Billroth, been born in the first decade of the century. The Berlin School, with Virchow as its chief figure, represented a group fifteen years younger.” Michael Bliss. William Osler: A Life in Medicine [Oxford, UK: Oxford University Press, 1999], 78.

  14. 14.

    Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore, MD: Johns Hopkins University Press, 1993], 78.

  15. 15.

    Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore, MD: Johns Hopkins University Press, 1993], 78.

  16. 16.

    Simon Flexner and James Thomas Flexner, 78.

  17. 17.

    Robert Joseph Miciotto, “Carl Rokitansky: Nineteenth-Century Pathologist and Leader of the New Vienna School” [PhD dissertation.] The Johns Hopkins University, 1979], 273–274.

  18. 18.

    Schaller, Anton. Reflexionen des Frauenarztes der Gegenwart auf das pathologisch-anatomische Lebenswerk Carl Freiherr v. Rokitanskys. Wien Med Wochenschr 2004;154:477–481. (Reflections of a present –day gynaecologist on the work of Carl Freiherr v. Rokitansky in the fields of pathology and anatomy).

  19. 19.

    R.J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227:216. Rather and Rohl quoted from Rokitansky’s farewell address: Carl von Rokitansky, Abschiedsrede des Professors Carl Freiherr von Rokitansky [Vienna, 1875].

  20. 20.

    R.J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227:216.

  21. 21.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346. See also: Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 498–499. “In professional circles in Germany, the old master of pathological anatomy, Carl von Rokitansky, caused quite a stir when he established a separate Chair for General and Experimental Pathology in Vienna in 1873.” He himself had stated, as early as 1846, in the introduction to Volume 1 of his manual: “pathological anatomy should be the basis not only of medical knowledge but also of medical practice, and it should include all the knowledge and fundamentals of the science and practice in medicine. Subsequently, however, Rokitansky…was [un]able to incorporate in pathological anatomy the microscopic and experimental methods which had developed so vigorously from the forties. In Vienna these methods were employed and developed outside the realm of pathological anatomy: microscopy in the laboratories of Brücke and Wedl, and animal experiments in Carl Ludwig’s laboratory.”

  22. 22.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 107–108. Referring to Virchow, Lesky wrote: “No one was able to evaluate this achievement better than the man who continued to work on the basis thereof. Rudolph Virchow (1821–1902) referred to Rokitansky as the Linne of pathological anatomy.” Lesky cited: Rudolph Virchow, WMW 5, 417 (1855). Owsei Temkin, The Double Face of Janus and Other Essays in the History of Medicine [Baltimore and London: Johns Hopkins University Press, 1977], 273. Temkin noted that 1855 marked the year that Virchow published his article entitled “Cellular Pathology,” in which he enunciated his “famous formula, omnis cellula a cellula.” See Rudolph Virchow, Zellular-Pathologie. Virchows Archiv 1855;8:23.

  23. 23.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], ix. Editor’s Preface. “The fact of the Work having been selected for translating by the Council of the Sydenham Society, is in itself a proof that it is deserving of the high estimation in which it has been held by all pathologists acquainted with continental literature; but it may not be superfluous to state that the value of the Professor’s remarks is enhanced by his being entirely unfettered by preconceived notions or prejudiced views, as to the disease of the individual brought to the dead-house for examination.” Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855]. American Publisher’s Notice, Philadelphia, August 1855. “The world-wide reputation of the author and of his work render eulogy superfluous, while the appearance of the translation under the auspices of the Sydenham Society is a guarantee of its fidelity.”

  24. 24.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. vii–ix. Editor’s Preface. “Owing to the acknowledged difficulty of the author’s style, it has however been thought advisable to divide the translation into four volumes, each of which is entrusted to a different editor.” “Of the difficulties connected with the translation, I will only say that they are much increased by the figurative style of the author. He constantly uses terms in a sense peculiar to himself, and his total disregard for the ordinary rules of composition is an additional and frequent source or obscurity.”

  25. 25.

    Robert J. Miciotto, “Carl Rokitansky: A Reassessment of the Hematohumoral Theory of Disease,” Bulletin of the History of Medicine 53, no. 2 [Summer 1978]: 183. Rokitansky’s reputation gradually declined, undeservedly tarnished by his hematohumoral theory of disease, which compared unfavorably to Virchow’s theory of cellular pathology, especially when the latter evolved into molecular biology.

  26. 26.

    Karl Sudhoff, “What is history of medicine?” in Essays in the History of Medicine trans. by various hands and ed. Fielding H. Garrison [New York: Medical Life Press, 1926], 71, 72.

  27. 27.

    Robert J. Miciotto, “Carl Rokitansky: A Reassessment of the Hematohumoral Theory of Disease,” Bulletin of the History of Medicine 53, no. 2 [Summer 1978]: 183–199: 185–186.

  28. 28.

    Paul Klemperer, Notes on Carl von Rokitansky’s Autobiography and Inaugural Address. Bulletin History of Medicine 1961;35:364–380:376–377. Klemperer quoted Wunderlich: “Wunderlich, an enthusiastic visitor in 1840, wrote: ‘The Vienna Institute no more counts the number of autopsies in the hundreds, and Rokitansky can consult thousands of protocols in reference to more than one disease.’ I do not believe that any other institute can match this proportion.”

  29. 29.

    Paul Klemperer, Notes on Carl von Rokitansky’s Autobiography and Inaugural Address. Bulletin History of Medicine 1961;35:364–380:379.

  30. 30.

    Paul Klemperer, 1961;35:364–380:379.

  31. 31.

    Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 17.

  32. 32.

    Paul Klemperer, 1961;35:364–380:379. Klemperer cited Rudolph Virchow, Hundred Jahre allgemeiner Pathologie [Berlin: August Hirschwald, 1895].

  33. 33.

    R.J. Rather, Eva R. Rohl. An English Translation of the Hitherto Untranslated Part of Rokitansky’s Einleitung to volume 1 of the Handbuch der allgemeinen Pathologie (1846), with a Bibliography of Rokitansky’s Published Works. Clio medica 1972;7:215–227: 216. Rather and Rohl quoted from : Rudolph Virchow, “Ein alter Berichte ueber die Gestaltung der pathologischen Anatomie in Deutschland, wie sie is und wie sie widen muss,” Virchows Archiv 1900;159:24–39.

  34. 34.

    Park, Roswell. An Epitome of the History of Medicine. 2nd Ed. Philadelphia: FA Davis Company, 1908: 250.

  35. 35.

    Paul Klemperer, Notes on Carl von Rokitansky’s Autobiography and Inaugural Address. Bulletin History of Medicine 1961;35:364–380:379. Klemperer quoted Sigerist from: Henry E. Sigerist, Grosse Aerzte [Muenchen: J.F. Lehmann, 1933].

  36. 36.

    Paul Klemperer, 1961;35:364–380:376, 379. Referring to Rokitansky’s Handbook of Pathological Anatomy, Klemperer, a pathologist, stated in 1961: “Today its contents are inadequate for the second year medical student.”

  37. 37.

    Roy Porter, “Medical Science,” in The Cambridge Illustrated History of Medicine, ed. Roy Porter [Cambridge: Cambridge University Press, 1996], 154–201:177.

  38. 38.

    Brosens IA, Brosens JJ. Endometriosis. Eur J Obstet Gynecol Reprod Biol 2000;414:105–112. Ronald E. Batt, Smith RA, Buck Louis GM, Martin DC, Chapron C, Koninckx PR, Yeh J. Müllerianosis. Histol Histopathol 2007;22:1161–1166. Bloom MS, Buck Louis GM, Schisterman EF, Liu A, Kostyniak PJ. Maternal serum polychlorinated biphenyl concentrations across critical windows of human development. Environ Health Perspect 2007; 115:1320–1324. Buck Louis GM, Hediger ML, Pena JB. Intrauterine exposures and risk of endometriosis. Hum Reprod 2007;22:3232–3236. Buck Louis GM, Gray LE Jr, Marcus M, Ojeda SR, Pescovitz OH, Witchel SF, Sippell W, Abbott DH, Soto A, Tyl RW, Bourguignon JP, Skakkeback NE, Swan SH, Golub MS, Wabitsch M, Toppari J, Euling SY. Environmental factors and puberty timing: expert panel research needs. Pediatrics 2008;121 Suppl 3:S192-207.

  39. 39.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346. “Rokitansky was profoundly influenced…by the concepts of comparative anatomy and embryology” of Johan Friedrich Meckel. Meckel published Handbuch der pathologischen Anatomie (1812–1816) and System der vergleichenden [comparative] Anatomie (1821–1831).

  40. 40.

    See specimen one [Magdalena Fischer], first seen by Rokitansky in 1828 and described in 1838 in: Von Prof. Dr. Rokitansky, Uber die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbucher des kaiserl. konigl osterreichischen Staates 1838;26:S39-S77:40.

  41. 41.

    Johannes Müller, Bildungsgeschichte der Genitalien aus anatomischen Untersuchungen an Embryonen des Menschen and der Thiere, nebst einem Anhang über die chirurgische Behandlung der Hypospadia. [Düsseldorf, 1830]. Goethe, the poet-scientist, inspired Johannes Müller to a lifetime of meticulous basic science research and teaching that in turn motivated investigators in the German speaking world. In that scientific atmosphere, Rokitansky investigated müllerian anomalies.

  42. 42.

    Von Prof. Dr. Rokitansky, Uber die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbucher des kaiserl. konigl osterreichischen Staates 1838;26:S39-S77.

  43. 43.

    Ann La Berge and Caroline Hannaway, “Paris Medicine: Perspectives Past and Present,” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 1–69:5.

  44. 44.

    The author is referring to the 1828 case of partial müllerian agenesis that was retrieved in a specimen jar on 30 July 1838. See: Von Prof. Dr. Rokitansky, Uber die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbucher des kaiserl. konigl osterreichischen Staates 1838;26:S39–S77. For the importance of case reports in medicine, see Owsei Temkin, “The Scientific Approach to Disease: Specific Entity and Individual Sickness,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 441–455:452–453. Temkin notes: “It is not immediately clear why the anatomical interpretation of disease had to follow the road from case histories to disease entities….The role of the case history in a particular phase of medical development elucidates further the notion of the abnormal in medicine…The case history is the form in which the physician links the science, which does not deal with the unique directly, and the patient, who requires attention as an individual.”

  45. 45.

    Ghirardini G, Popp LW. The Mayer-von Rokitansky-Küster-Hauser syndrome (uterus bipartitus solidus rudimentarius cum vagina solida): the development of gynecology through the history of a name. Clin Exp Obstet Gynecol 1995;22:86–91.

  46. 46.

    Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life. With a Memoir of Dr. Meyer by Emil Novak, MD. [New York: Henry Schuman, 1949], 16–17.

  47. 47.

    Roland Sedivy, “200 Jahre Rokitansky – sein Vermachtnis fur die heutige Pathologie,” Wiener Klinische Wochenschrift 2004;116/23: 779–787. This article contains a bust and a photograph of Rokitansky executed in 1874 on the occasion of his retirement at age 70. In February 2004, Roland Sedivy conducted a PubMed search of “Rokitansky”; 238 citations (47%) were in reference to the Mayer-Rokitansky-Küster-Hauser syndrome, the next nearest citation, 138 (27%), was in reference to history. Table 1 gives a list of seventeen of Rokitansky’s discoveries by surname or scientific name. Item 7 in the list is: “Endometriose.” See also: Ottokar Rokitansky, “Carl Freiherr von Rokitansky – zum 200, Geburtstag: Eine Jubilaumsgedenkschrift, Wiener Klinische Wochenschrift 2004;116/23: 773–788.

  48. 48.

    Ghirardini G, Popp LW. The Mayer-von Rokitansky-Küster-Hauser syndrome (uterus bipartitus solidus rudimentarius cum vagina solida): the development of gynecology through the history of a name. Clin Exp Obstet Gynecol 1995;22:86–91.

  49. 49.

    Venita Jay, “The legacy of Karl Rokitansky,” Arch Pathol Lab Med 2000;124:345–346. Rokitansky published On some of the Most important Diseases of the Arteries (1852) and The Defects in the Septum of the Heart (1875). See also: Davies MK, Hollman A. Karl Freiherr von Rokitansky (1804–1878). Heart 1997;78(5):425.

  50. 50.

    Park, Roswell. An Epitome of the History of Medicine. 2nd Ed. Philadelphia: FA Davis Company, 1908:250–251. Roswell Park wrote: “for fourteen years he studied the defects of the septum of the heart and the comparative anatomy of the uterus and genito-urinary organs.”

  51. 51.

    Rokitansky C. Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. See also: Simpson JL. Genetics of the female reproductive ducts. Am J Med Genet 1999;89:224–239. Simpson reports two cases of a rare condition of excessive müllerian tissue: true duplication of the müllerian ducts: “affected women must have two separate uteri, each of which can have two fallopian tubes.” Simpson believes it may result from division of one or both müllerian ducts early in embryogenesis. Recall the spectacular case of true duplication with two vaginas, two uteri each with two fallopian tubes, in which the woman conceived and carried a normal male child until a therapeutic abortion had to be performed to preserve the life of the mother due to deficient pelvic capacity to carry the child further.

  52. 52.

    Von Prof. Dr. Rokitansky, Uber die sogenannten Verdoppelungen des Uterus. Medicinische Jahrbucher des kaiserl. konigl osterreichischen Staates 1838;26:S39–S77. Partial müllerian agenesis, the Mayer-Rokitansky-Küster-Hauser syndrome.

  53. 53.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563.

  54. 54.

    Carl Breus, Uber Wahre Epithel Führende Cystenbildung in Uterusmyomen [Leipzig und Wien: Franz Deuticke, 1894], 6. “Oskar Schroeder, O. Heer und C. Grosskopf haben die Mühe nicht gescheut, in ihren Dissertationsschriften alle in der Literatur mitgetheilten Falle von solchen Cystomyomen zu sammeln und haben so bis 1884 über 100 derselben zusammengestellt.” See also Breus, page 10, where he cites the 1860 article of Rokitansky. See: Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 424. Carl Breus (1852–1914) and the pathologist Alexander Kolisko, a student of Kundrat – second successor to Rokitansky’s chair of pathological anatomy in Vienna, wrote the classical book Pathological Shapes of the Pelvis (3 Vols. Vienna, 1900–1912). Leopold G. Koss and Philip H. Lieberman, “Surgical Pathology at Memorial Sloan-Kettering Cancer Center,” in Guiding the Surgeon’s Hand: The History of American Surgical Pathology, ed. Juan Rosai [Washington, DC: Armed Forces Institute of Pathology, 1997], 66. Alexander Kolisko, Carl Breus’s coauthor, was the third successor to Rokitansky’s chair of pathological anatomy in Vienna. See also: Thomas Stephen Cullen, Adenomyoma of the Uterus [Philadelphia: WB Saunders, 1908], 1. Thomas Cullen, who was conversant with the Austrian and German literature, also recorded that Breus had credited Schroeder, Herr, and Grosskopf with having collected 100 cases of myomata containing glandular elements up to the year 1884.

  55. 55.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 265. Lockyer did not refer to the original report of Breus of 1884. Instead, he cited Cullen and gave the incorrect year. Lockyer wrote: “Cullen mentions that about one hundred had been recorded under various titles up to 1896.”

  56. 56.

    Bailey KV. The etiology, classification, and life history of tumors of the ovary and other female pelvic organs containing aberrant müllerian elements, with suggested nomenclature. J Obstet Gynaecol Brit Emp 1924;xxxi:539–573:540. Bailey made only passing reference to the first two authorities, Cullen and Lockyer.

  57. 57.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1554. Emge may have stated the date incorrectly when he wrote: “stromatosis was first described by Virchow in 1864.” Additionally, Emge did not cite the reference to Virchow; he was probably recalling a reference he had read years before. However, von Recklinghausen did reference Virchow in 1863, not 1864. See: Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.], 96. Referring to Virchow’s description of endometrial stromatosis, von Recklinghausen stated: “So by the first look under the microscope at the simple construction of the histology of this organoid tumor of Virchow we arrive at the conviction that we must separate this special tumor from the usual spherical myoma.” See: Reference 60: R. Virchow, Die krankhaften Geschwulste. 1863. I. 263–286, III. 150. (The pathological tumors)

  58. 58.

    Emge LA. 1962;83:1541–1563:1542. It is possible that the dissertation to which Breus referred was located in a university library or archive in Austria. That might explain Emge’s failure to find it.

  59. 59.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 424. Breus was a reliable authority who was promoted to associate professor in 1894.

  60. 60.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 265. “1894” Instead of 1884 in all probability represents a typographic or type-setting error. Lockyer states that “Cullen mentions that about one hundred [myomas containing cysts lined by epithelium] had been recorded under various titles up to 1896, but only a few of the most important need here be given [in Lockyer’s monograph of 1918].”

  61. 61.

    Cuthbert Lockyer, 265. Babes G. Uber epitheliale Geschwulste in Uterusmyomen Allgem. Wiener med Ztschr 1882;27:36–48. Lockyer never mentioned the contributions of Rokitansky. 1882 was the year that Koch announced his discovery of the tuberculosis bacillus which stimulated investigators to search for the cause of disease. For chronic diseases, the search began for pathogenesis, for an explanation of the pathway taken by the disease process.

  62. 62.

    Cuthbert Lockyer, 274–275.

  63. 63.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.] Von Recklinghausen most certainly was aware of the entire German and Austrian literature on the subject of adenomyomas as well as contributions from England and the other countries on the Continent of Europe.

  64. 64.

    Von Recklinghausen, Cullen, and Lockyer all picked Babes (1882) as the first reliable reference to “myomas containing cysts lined by epithelium.”

  65. 65.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.] Bailey KV. The etiology, classification and life history of tumours of the ovary and other female pelvic organs containing aberrant müllerian elements, with suggested nomenclature. J Obstet Gynaecol Brit Emp 1924;xxxi:539–573:540. Writing two decades after von Recklinghausen, Bailey considered articles on the pathology of adenomyomas by Breus, Chiari, Martin, Orthmann, Werth, and Schauta worthy of mention.

  66. 66.

    Illustrated Stedman’s Medical Dictionary. 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 1224. Embryonic rest: “[From the Latin restare, to remain]. A group of cells or a portion of fetal tissue that has become displaced and lies embedded in tissue of another character.”

  67. 67.

    LJ Rather, The Genesis of Cancer: A Study in the History of Ideas [Baltimore, MD: Johns Hopkins University Press, 1978], 122.

  68. 68.

    Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 257.

  69. 69.

    LJ Rather, The Genesis of Cancer, 170–171. See also: David Cantor, “Cancer.” In Companion Encyclopedia of the History of Medicine. Vol. 1. ed. W. F. Bynum and Roy Porter [London: Routledge, 1997], 537–561:540–544. David Cantor, “Cancer.” In Companion Encyclopedia of the History of Medicine. Vol. 1. ed. W. F. Bynum and Roy Porter [London: Routledge, 1997], 537–561:540–542. The search for the cause of malignant as well as benign tumors constitutes an interesting chapter in the history of science and medicine. Until Bichat argued at the turn of the nineteenth century that for the seat of cancer in body tissues, “the history of cancer was part of a broader history of inflammation.” Subsequently Laennec distinguished between gangrene and cancer. David Cantor, 542. In the late 1830s, Johannes Müller integrated Schwann’s cell theory into the genesis of cancer. Müller believed that “both normal and pathological cells were structured aggregates of transformed cells, developed for the most part de novo from an amorphous blastema ultimately derived from circulating blood.” Later, “Virchow believed that tumour cells developed from ‘embryonic’ cells, scattered throughout the omnipresent connective tissue.” Cantor, 543. In 1867, Wilhelm Waldeyer argued that “normal epithelium was the sole source of epithelial cells contained in a given carcinoma. The sole mechanism of local spread was the active or passive movement of cancer cells into adjacent tissue, while the sole mechanism of metastatic spread was through the transport of cancer cells to the metastatic sites via the blood, lymph, or other body fluids.” Cantor, 544. In the twentieth-century, the cause of cancer has shifted between two polarities “explanations favouring the action of exogenous factors such as viruses, parasites, environmental chemicals, or physical agents such as radiation; and those favouring endogenous factors such as genetic mutation.” Alexander Berglas, Cancer: Nature, Cause, and Cure [Paris: Institute Pasteur, 1957] 6–7. Berglas from the Pasteur Institute compared cancer to a “runaway healing attempt.” Once the cancer cells dedifferentiates to a functionally more primitive cell, “control mechanisms of the body no longer have any influence on the constantly dividing ‘malignant’ cells; they no longer submit to the regulatory processes of the organism.”

  70. 70.

    K. Codell Carter, The Rise of Causal Concepts of Disease: Case Histories [Burlington, VT: Ashgate, 2003], 134. Carter quotes Paul Ehrlich’s recollection of that meeting: “all who were present were deeply moved and that evening has remained my greatest experience in science.”

  71. 71.

    Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. [Cambridge, UK: Cambridge University Press, 2000], 4.

  72. 72.

    Michael Worboys, 4.

  73. 73.

    K. Codell Carter, The Rise of Causal Concepts of Disease: Case Histories [Burlington, VT: Ashgate, 2003], 143.

  74. 74.

    Mel Greaves, “Finale: Cause, Complexity, and the Evolutionary Rub,” in Cancer: The Evolutionary Legacy [Oxford: Oxford University Press, 2000], 213–220:213.

  75. 75.

    Carl Breus, Uber Wahre Epithel Führende Cystenbildung in Uterusmyomen [Leipzig und Wien, Franz Deuticke, 1894], 1–36

  76. 76.

    Diesterweg B. Ein Fall von Cystofibrom uteri verum Zeitschr f Geb 1883:9:191.

  77. 77.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 265–266.

  78. 78.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1543.

  79. 79.

    Chiari H. Zur pathologischen Anatomie des Eileiter-Catarrhs. Pager Ztschr. Heilkunde 1887;8:457–473. That same year, Martin reported cases similar to Chiari. Martin. Uber Tubenkrankung. Zeitschr für Geb und Gynak 1887;13. S. 299. Martin cited by: Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 284.

  80. 80.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 307.

  81. 81.

    Von Recklinghausen F. Ueber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Medicinische Wochenschrift 1893;xix:325–326.

  82. 82.

    Von Recklinghausen F. Ueber die Adenomyome des Uterus und der Tuba. Wiener Klinische Wochenschrift 1895;29:530.

  83. 83.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896].

  84. 84.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 266. Cuthbert Lockyer, MD, BS, FRCP, FRCS was Vice-President Obstetrical and Gynaecological Section, Royal Society of Medicine; Corresponding member of the Societe d’Obstetrique Belge; Surgeon to In-Patients, Samaritan Hospital for Women; Obstetric Physician to Out-Patients Charing Cross Hospital; Joint-Lecturer on gynaecology and Obstetrics, Charing Cross Hospital Medical School; Examiner to the Royal College of Physicians and Surgeons; Late Examiner in Midwifery and Diseases of Women to the University of London.

  85. 85.

    Cuthbert Lockyer, 307–308. The theories of pathogenesis and etiology of cancer and endometriosis have been discussed earlier in this chapter.

  86. 86.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. “Of the existing connective tissue tumors of the uterus, the round fibroids are to be differentiated from the so called fibrous polyps of the uterus in which glandular tubules are found. These are connective tissue tumors rooted in the basal stroma of the uterus and cannot be shelled out (Paget’s continuous growth) in contrast to the well circumscribed fibrous tumors. They commonly develop within or from the submucosal stratum and grow into the uterine cavity as so called polyps of various shapes (cylindric, pear-club shaped) and are covered by an adherent uterine mucosa. The various changes in its texture may appear identical to the changes seen as a result of chronic inflammation. [Italics added]. In contrast to the easily removable fibrous tumors, we commonly consider these connective tissue tumors as sarcoma [benign], here specifically as uterus sarcoma. These tumors growing into a mucosal cavity generally retain their old name of polyp and uterus polyp and, according to the discussion above, would be distinguished from the round fibroids prolapsed into the uterine cavity. As round fibroids may develop within the inner tissue layers of the uterus, so can sarcomas on rare occasion develop from a mucosal-free outer layer. In view of the above discussion, it is important to recognize the changes occurring in the mucosa and the submucosal stratum of the uterus as consequences of chronic inflammation.” [Italics added]. When Rokitansky stated: “As round fibroids may develop within the inner tissue layers of the uterus, so can sarcomas on rare occasion develop from a mucosal-free outer layer,” did he anticipate Iwanoff’s serosal theory of metaplasia of 1898?

  87. 87.

    LJ Rather, The Genesis of Cancer: A Study in the History of Ideas [Baltimore, MD: Johns Hopkins University Press, 1978], 122. As early as 1854, Robert Remak, a student of Johannes Müller, suggested that tumors might originate “at an early developmental stage of the human embryo.” Remak anticipated the hypothesis of Julius Cohenheim that tumors originated from embryonic rests.

  88. 88.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1543. Diesterweg theorized the pathogenesis of uterine adenomyomas resulted from invasive idiopathic stromal hyperplasia, a theory supported by “Carl Ruge (1889), Carl Schroeder (1892), and Hauser (1893).”

  89. 89.

    Rabinovitz M. The pathogenesis of adenomyosalpingitis (salpingitis nodosa): report of ten cases. American Journal of Obstetrics and Diseases of Women and Children 1913; lxviii;711–752.

  90. 90.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 115, 558.

  91. 91.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1543. Diesterweg theorized the pathogenesis of uterine adenomyomas resulted from invasive idiopathic stromal hyperplasia, a theory supported by “Carl Ruge (1889), Carl Schroeder (1892), and Hauser (1893).”

  92. 92.

    A. Pilliet. Fibromyome de la trompe uterine. Bull de la Soc Anat de Paris 1894:554. Cited by Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 284. Sampson, JA. Ovarian hematomas of endometrial type (perforating hemorrhagic cysts of the ovary) and implantation adenomas of endometrial type. Boston Medical and Surgical Journal 1922;186:445–456. Sampson wrote, without direct citation, “In 1894, Pilliet took the view that the cysts and glands of adenomyoma were of mucosal origin.” Undoubtedly, Sampson’s information came from Lockyer whom he acknowledged in the opening sentence of this paper.

  93. 93.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.] Ref. No. 19.

  94. 94.

    A. Pilliet, Les debris du corps de Wolff et leur role dans la pathogenie des tumours. Tribune medicale. 1889. See: Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.]: Ref. No 20.

  95. 95.

    Erwin H. Ackerknecht, A Short History of Medicine [New York: Ronald Press, 1968], 166. Bichat and Virchow were fortunate, their theories endured. But Ackerknecht’s assessment of Rokitansky would apply to von Recklinghausen: “But unfortunately his factual foundation was insufficient.”

  96. 96.

    Harold Speert, Obstetric & Gynecologic Milestones: Illustrated [New York: Parthenon Publishing Group, 1996], 89. “The female genital tact, from the ovary to the hymen, contains a mine of embryonic remnants, vestiges of the primitive urogenital system, which provides a yield of never-ending interest to the clinical gynecologist as well as the student of embryology.” The mesonephros – the primitive vertebrate kidney – comprises two elongated masses in the early vertebrate embryo. The mesonephros was named the Wolffian body to honor Caspar Wolff who discovered these primitive kidneys in 1759. A Wolffian rest represents a group of cells or a portion of the mesonephros (Wolffian body) that has become displaced and lies embedded in tissue of another character that persists as an embryonic remnant in the adult.

  97. 97.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 266. Von Recklinghausen’s four varieties of adenoma are taken directly from Lockyer. See: Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896]. My copy of this monograph obtained online from the Center for Research Libraries, Identifier: m-r-000252-f3, Scan Date: September 26, 2007 contained only text, no illustrations.

  98. 98.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 267–268.

  99. 99.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896].

  100. 100.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 437.

  101. 101.

    Cuthbert Lockyer, 438–439.

  102. 102.

    Cuthbert Lockyer, 274–275. Lockyer named the supporters of the Müllerian origin of adenomyomas as: “Diesterweg, Schroeder, C. Ruge, Babes, Schottlander, Hauser, Strauss, Orloff, Ricker (for the uterus), and A. Martin, Orthmann, Chiari, Baraban, Pilliet (for the tube).” Müllerian rest: The paired müllerian tubes – primitive vertebrate fallopian tubes, uterus, cervix, and upper vagina – comprise two elongated masses in the early vertebrae embryo. A müllerian rest represents a group of cells or a portion of the müllerian anlage that has become displaced and lies embedded in tissue of another character that persists as an embryonic remnant in the adult. Wolffian rest: The mesonephros – the primitive vertebrate kidney – comprises two elongated masses in the early vertebrate embryo. A Wolffian rest represents a group of cells or a portion of the mesonephros (Wolffian body) that has become displaced and lies embedded in tissue of another character that persists as an embryonic remnant in the adult.

  103. 103.

    Cuthbert Lockyer, 281.

  104. 104.

    Von Recklinghausen F. Ueber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Medicinische Wochenschrift 1893;xix:325–326.

  105. 105.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 106. Orth was Virchow’s favorite assistant and future successor to his chair.

  106. 106.

    Andreas W. Daum, “Wissenschaft and knowledge,” in The Short Oxford History of Germany: Germany 1800–1870 [Oxford: Oxford University Press, 2004], 137–161:137. Daum equated the German term Wissenschaft with scholarship and research, which included “the sciences, social sciences, and humanities.” See Martzloff KH. Thomas Stephen Cullen. Am J Obstet Gynecol 1960;80:833–843:835: Cullen spent 6 months in the laboratory of Johannes Orth. The tradition of Wissenschaft was strong in the laboratory of Johannes Orth; it was based on an intellectual genealogy directly traceable to Goethe himself. Goethe profoundly influenced Johannes Müller who, in turn, became the great German medical educator of the nineteenth century. Müller trained Virchow, who trained Orth who directly influenced Cullen in his early and formative 6 months spent in Orth’s pathology laboratory.

  107. 107.

    Judith Robinson, Tom Cullen of Baltimore, 108–109.

  108. 108.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 404–411.

  109. 109.

    Judith Robinson, 216. Soon after he returned to Johns Hopkins Hospital, Cullen began a lifelong friendship with Max Broedel, Howard Kelly’s master medical illustrator. The two made a pact; Broedel would write and converse with Cullen in English and Cullen would reciprocate in German. To his biographer, Cullen recalled: “All his life I don’t think I spoke two hours of English to him, or wrote fifty words that were not German.” See also Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 168. This practice facilitated Cullen’s lectures in Germany and his communication with von Recklinghausen.

  110. 110.

    Judith Robinson, 113.

  111. 111.

    Judith Robinson, 113, 117.

  112. 112.

    Judith Robinson, 118. Simon Flexner & James Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore: Johns Hopkins University Press, 1993], 163. See also: Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education [New York: Basic Books, 1985], 41. William H. Welch maintained in 1886 that medicine had become a model of experimental research and that if a university wished to achieve creditability as a research university, it had to accommodate scientific medicine.

  113. 113.

    Simon Flexner & James Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore: Johns Hopkins University Press, 1993], 163.

  114. 114.

    Simon Flexner & James Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore: Johns Hopkins University Press, 1993], 245. “You are to be congratulated upon the excellent way in which you have written up and discussed these interesting cases. The drawings are works of art and make everything clear. You are taking the right way to build up a scientific reputation.” See also: Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 119.

  115. 115.

    Judith Robinson, 113. Howard A. Kelly was so impressed with Cullen’s foundation in gynecological pathology that, after his residency in gynecologic surgery, he took Cullen as his assistant with the rank of Instructor in Gynecology in the Johns Hopkins University and Assistant Resident Gynecologist in the Johns Hopkins Hospital. Kelly had recognized that Cullen’s talents in gynecological pathology complemented his own extraordinary talents as a gynecological surgeon; they made a good team for research and teaching. Furthermore, subsequent to Cullen’s experience, Kelly made a year of gynecologic pathology requisite before beginning the residency in gynecologic surgery. Judith Robinson, 136. Howard Kelly later remarked to Cullen that “he would give fifty thousand dollars to have had [Cullen’s] experience in pathology.” Judith Robinson, 113.

  116. 116.

    Frederick Jackson Turner, “The Significance of the Frontier in American History,” in The Early Writings of Frederick Jackson Turner, ed. Frederick Jackson Turner [Madison WI, [1893] 1938], 185–229. The essence of Turner’s Frontier Thesis is contained in the last sentence of the first paragraph of his famous 1893 essay: “The existence of an area of free land, its continuous recession, and the advance of American settlement westward explain American development.” Turner was one of the first American professional historians; he trained at Johns Hopkins University.

  117. 117.

    There was no territory within the United States that had fewer than two inhabitants per square mile.

  118. 118.

    Thomas Stephen Cullen, Adenomyoma of the Uterus [Philadelphia: WB Saunders, 1908], v. Cullen recounted the story of his first encounter with an adenomyoma in the opening paragraph of the preface. Ironically, the first case that Cullen encountered was the less common variety, an adenomyoma of the anterior wall of the uterus; the more common site being the posterior wall.

  119. 119.

    Cullen discovered his first case of diffuse uterine adenomyomas in October 1894 while engaged in a study of uterine myomata with his surgical mentor, Howard A. Kelly. He had just returned from Europe where he spent 6 months in the pathology laboratory of Carl Orth in Berlin. See: Howard A. Kelly and Thomas S. Cullen, Myomata of the Uterus [Philadelphia: WB Saunders, 1909], v. “In 1894 we commenced a careful study of uterine myomata and contemplated publishing the results of our findings. A year later, however, the work was temporarily laid aside, as it was deemed wiser to take up the subject of carcinoma of the uterus. After the publication of that work in 1900 we again turned our attention to uterine myomata, and since that time we have been continually gathering data on that subject.”

  120. 120.

    Thomas Stephen Cullen, Adenomyoma of the Uterus [Philadelphia: WB Saunders, 1908], v. Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 195.

  121. 121.

    Thomas Stephen Cullen, Adenomyoma of the Uterus [Philadelphia: WB Saunders, 1908], v.

  122. 122.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896].

  123. 123.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus.

  124. 124.

    In 1862, 2 years after Rokitansky’s description of endometriosis, von Recklinghausen described lymph channels, known as canals of Recklinghausen.

  125. 125.

    Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 254. In 1877 in Strassburg, Welch studied gross pathology with von Recklinghausen, normal histology with Waldeyer, and physiological chemistry with Hoppe-Seyler. Page 258. It was von Recklinghausen who pointed out to Welch the significance of bacteria.

  126. 126.

    Cullen, Thomas Stephen. Adeno-myoma of the round ligament. Johns Hopkins Hospital Bulletin. 1896;7:112–114. In a carefully crafted understatement, Cullen recorded his reaction. “Recently our interest in these cases has been awakened by the excellent work of v. Recklinghausen.” In the references, see: Cullen: Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports, Vol. VI (in press). That Volume 7 of the Johns Hopkins Hospital Bulletin was published before Volume 6 was not the first time the Hospital reports were published out of sequence. See: Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore, MD: Johns Hopkins University Press, 1993], 243. Volume II written by William Osler was published 7 years before Volume I written by William Welch.

  127. 127.

    Laura Otis, Müller’s Lab [Oxford: Oxford University Press, 2007], 63. Otis quotes Schwann’s dramatic awakening, which illustrates the role of analogy in the formulation of his biological cell theory: “One day when I was having dinner with Schleiden [in October 1837] that illustrious botanist indicated to me the important role that the nucleus plays in the development of plant cells. Suddenly, I remembered having seen a similar structure [un organe pareil] in cells of the chorda dorsalis, and at that very instant I grasped the extreme importance the discovery would have if I succeeded in showing that, in the cells of the chorda dorsalis, the nucleus plays the same role that it plays in the development of plant cells…This fact, if solidly established through observation, would imply the negation of a vital force common to animals and would make it necessary to admit the individual life of the elementary parts of other tissues and a common means of formation through cells. This recognition of a principle, later verified by observation, constitutes the discovery I had the good fortune to make…I invited Schleiden to accompany me to the Anatomical Theater, where I showed him the nuclei in the chorda dorsalis cells. He saw [reconnut] a perfect resemblance to the nuclei of plants.”

  128. 128.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 125.

  129. 129.

    Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore, MD: Johns Hopkins University Press, 1993], 170.

  130. 130.

    Donald Fleming, William H. Welch and the Rise of Modern Medicine [Boston, MA: Little Brown and Company, 1954], 33–34. From December 1877 to February 1878, Welch had performed a “piece of scientific investigation under von Recklinghausen” in Strassburg. Hence, Welch was familiar with von Recklinghausen’s microscopic techniques from that period. Welch also knew that von Recklinghausen was a skilled microscopist as would be expected of an assistant trained by Rudolf Virchow, who was an assistant of Johannes Müller. See also: Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine [Baltimore, MD: Johns Hopkins University Press, 1993], 108. Welch might also have remembered the experiment that von Recklinghausen had had him perform nearly 20 years before regarding the origin of pus cells. When it came to interpretation of the experiment, “Welch recognized [von Recklinghausen’s] reasoning as fallacious and reserved judgment, assuming there must be some other explanation.”

  131. 131.

    Cullen cut his tissue sections with a microtome, an instrument that von Recklinghausen did not have.

  132. 132.

    Anhang. Klinische Notizen zu den voluminosen Adenomyomen des Uterus. Von W. A. Freund. [The complete clinical picture of adenomyomas of the uterus.] Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.] Robert Meyer, Autobiography of Dr. Robert Meyer: (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 33. Robert Meyer confirmed that W. A. Freund first identified the classical clinical symptoms of uterine adenomyoma/adenomyosis.

  133. 133.

    Owsei Temkin, “Basic Science, Medicine, and the Romantic Era,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 427.

  134. 134.

    Freund, Wilhelm Alexander. Eine neue Methode der Extirpation des ganzen Uterus. Sammlung Klinischer Vortage no. 133, Gynkologie, vol. 41, pp. 911–924, 1878. Longo LD. Classic pages in obstetrics and gynecology. Am J Obstet Gynecol 1977;128:117.

  135. 135.

    Owsei Temkin, “Health and Disease,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 426. “The ontological view of disease, i.e., thinking of them as real, distinct entities, was nothing new. Even the comparison of a disease with an animal was old-Plato (Timaeus 89B) had used it, and Varro (116-27B.C.) had actually spoken of animals, too small to be seen by the eye, ‘which by mouth and nose through the air enter the body and cause severe diseases.’ (Rerum rusticarium 1, 2).”

  136. 136.

    Robert P. Hudson, Disease and Its Control: The Shaping of Modern Thought [Westport, CT: Greenwood Press, 1983], 231.

  137. 137.

    Robert P. Hudson, 229.

  138. 138.

    Owsei Temkin, “Health and Disease,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 435.

  139. 139.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 82.

  140. 140.

    Owsei Temkin, “Health and Disease,” 434–435.

  141. 141.

    Roy Porter, Blood and Guts: A Short History of Medicine [New York: W. W. Norton & Company, 2002], 82.

  142. 142.

    Georges Canguilhem, The Normal and the Pathological. Trans. Carolyn R. Fawcett in collaboration with Robert S. Cohen [New York: Zone Books, 1991], 29. In the Preface to the Second Edition (1950), Canguilhem wrote: “This second edition of my doctoral thesis in medicine exactly reproduces the text of the first, published in 1943.” The text quoted above was originally published in 1966 as Le normal et le pathologique and copyrighted by Presses Universitaires de France. It was originally published in English and copyrighted in 1978 by D. Reidel Publishing Company, Dordrecht, Holland.

  143. 143.

    Georges Canguilhem, The Normal and the Pathological. Trans. Carolyn R. Fawcett in collaboration with Robert S. Cohen [New York: Zone Books, 1991], 41.

  144. 144.

    Robert P. Hudson, Disease and Its Control: The Shaping of Modern Thought [Westport, CT: Greenwood Press, 1983], 231.

  145. 145.

    Owsei Temkin, “The Scientific Approach to Disease: Specific Entity and Individual Sickness,” in The Double Face of Janus and Other Essays in the History of Medicine [Baltimore, MD: Johns Hopkins University Press, 1977], 450.

  146. 146.

    Knud Faber, Nosography in Modern Internal Medicine [New York: Paul B. Hoeber, Inc., 1923], 98.

  147. 147.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 196. Years later, Cullen recalled: “Microscopic examination of large sections of the first two specimens had clearly shown the glandular element in adenomyomata… originated in a flowing outward of the normal uterine mucosa.”

  148. 148.

    Cullen TS. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports 1896;6:133–157. Cullen was unaware of two brief notes on the subject that von Recklinghausen had published, the first on May 19, 1893, the second on June 14, 1895. Von Recklinghausen F. Ueber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Medicinische Wochenschrift 1893;xix:325–326. Von Recklinghausen F. Ueber die Adenomyome des Uterus und der Tuba. Wiener Klinische Wochenschrift 1895;29:530.

  149. 149.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 120.

  150. 150.

    Judith Robinson, 120.

  151. 151.

    Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life. With a Memoir of Dr. Meyer by Emil Novak, MD. [New York: Henry Schuman, 1949], 29.

  152. 152.

    Cullen TS. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports 1896;6:133–157:136. Fielding H. Garrison, An Introduction to the History of Medicine. 4th edition, reprinted [Philadelphia: W. B. Saunders, 1914], 859. Weigert introduced hematoxylin staining in 1885. Fielding H. Garrison, An Introduction to the History of Medicine. 4th edition, reprinted [Philadelphia: W. B. Saunders, 1914], 522. “Virchow did practically all his work with carmine [tissue stain].”

  153. 153.

    RM Allen, The Microscope [New York: D. Van Nostrand Company, 1940], 10–12.

  154. 154.

    Fielding H. Garrison, An Introduction to the History of Medicine. 4th edition, reprinted [Philadelphia: W. B. Saunders, 1914], 522. Purkinje (1787–1869 had a microtome. “The microtome was definitely introduced by Wilhelm His in 1866, but was not perfected until about 1875, after which it became an important labor-saving device.” Another source gives a later date. Alexander Hellemans and Bryan Bunch, The Timetables of Science: A Chronology of the Most Important People and Events in the History of Science, Touchtone Edition [New York: Simon & Schuster], 362–364. However, some advances such as the microtome to slice thin tissue sections were not invented until 1885. The microtome was invented by Charles Darwin, son of Charles Darwin, author of The Origin of Species.

  155. 155.

    Rokitansky. Ueber Uterusdrüsen-Neubildung in Uterus u. s. w. Zeitsch. der k. k. Gesellsch. der Aerzte zu Wien, 1860, S. 577. Also: Rokitansky. (klob.) Gusserow in Billroth u. Luecke, 1886, Bd. II, S. 15.

  156. 156.

    Schatz. Ein Fall von Fibro-adenome cysticum diffusum et polyposum corporis et colli uteri. Archiv f. Gyn., 1884, XXII, S. 456.

  157. 157.

    Schroder. Handbuch der Krankheiten der weiblichen Geschlechtsorgane. 7. Auflage, Leipzig, 1886, S. 228.

  158. 158.

    Diesterweg. Ein Fall von Cystofibroma uteri verum. Zeitschr. F. Geb. u. Gyn., Bd. IX, 1883, S. 191.

  159. 159.

    von Recklinghausen. Ueber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Med. Woch., XIX. 1893, S. 825. Also: Von Recklinghausen. Die Adenomyome und Cystadenome der Uterus und Tubenwandung. Berlin, 1896.

  160. 160.

    Nachtrag means supplement to the main text.

  161. 161.

    Cullen TS. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports 1896;6:133–157:133.

  162. 162.

    To more fully appreciate the fruit of Welch’s philosophy to allow assistants in his laboratory to learn and discover by plunging into the work of the laboratory, consider the early achievement of Cullen with his demonstration of the pathogenesis of uterine adenomyomas. Cullen’s short career in pathology at the time of his discovery is summarized: Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 78. Cullen started at Johns Hopkins Hospital in late September, 1891. Ibid: 81. Cullen spent the next months in the “Pathological,” the pathology laboratory of William Henry Welch. Ibid: 103. Following a year long internship, Cullen spent several months studying pathology in the laboratory of Johannes Orth at Göttingen, Rudolf Virchows “chosen disciple.” Ibid: 113–114. Cullen returned to Johns Hopkins Hospital expecting to start his residency in Gynecology only to find that the more senior William Russell had decided to take the gynecologic residency. Unexpectedly, Cullen would spend October 1893 until October 1896 in Welch’s Pathological. He would become a well-trained gynecological pathologist before he started his residency in gynecology.

  163. 163.

    Cullen TS. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports 1896;6:133–157: 149–150.

  164. 164.

    Cullen TS. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports 1896;6:133–157:150.

  165. 165.

    Cullen, TS. Adeno-myoma uteri diffusum benignum. Bulletin Johns Hopkins Hospital 1896;6:133–157.

  166. 166.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 125.

  167. 167.

    Judith Robinson, 125.

  168. 168.

    Cullen TS. 1896;6:133–157:133. On the first page of his article, Cullen states “v. Recklinghausen in the ‘Nachtrag’ accompanying his recent work, ‘Die Adenomyome und Cystadenome der Uterus-und Tubenwandung,’ carefully depicts a case belong to this group [diffuse adenomyomata].”

  169. 169.

    Judith Robinson, 125. What Cullen long remembered as v. Recklinghausen’s expression of “scientific equivalency” may have been tinged with “chagrin;” the German professor’s mental distress caused by humiliation at the hands of an apprentice armed with a microtome.

  170. 170.

    Adams was Frederick Jackson Turner’s dissertation advisor at Johns Hopkins University late in the nineteenth century.

  171. 171.

    Frederick Jackson Turner, “The Significance of the Frontier in American History,” in The Early Writings of Frederick Jackson Turner, ed. Frederick Jackson Turner [Madison WI, [1893] 1938], 185–229. The essence of Turner’s Frontier Thesis is contained in the last sentence of the first paragraph of his famous 1893 essay: “The existence of an area of free land, its continuous recession, and the advance of American settlement westward explain American development.” See also: Harry Ritter, Dictionary of Concepts in History [New York: Greenwood Press, 1986], 170–178.

  172. 172.

    Martzloff, KH. Thomas Stephen Cullen [Presidential Address]. Am J Obstet Gynecol 1960;80:833–843. In 1960, Karl Martzloff gave his presidential address before the American Gynecological Society; a biographical essay entitled “Thomas Stephen Cullen.” Martzloff, a former student of Cullen, confirmed that v. Recklinghausen and Cullen enjoyed a long and cordial professional relationship. “They corresponded for years” contrary to the opinion of some that it was a “long period of ill will.”

  173. 173.

    James V. Ricci. One Hundred Years of Gynaecology 1800–1900. A Comprehensive Review of the Specialty during it Greatest Century with Summaries and Case Reports of All Diseases Pertaining to Women [Philadelphia: Blakiston, 1945.] Professor James V. Ricci trained Edward J. Winkler, who was my professor of obstetrics and gynecology during medical school, internship and my first year of residency at the University of Buffalo School of Medicine, 1954–1960.

  174. 174.

    Martzloff, KH. Views and Reviews. Western J Surgery, Obstetrics, and Gynecology 1946;54 (August):338. The pagination is confusing. On the top of the page, immediately it reads: VIEWS and REVIEWS (Continued from page IX). On the bottom of the page, it reads: 338.

  175. 175.

    Martzloff ended with “Although Recklinghausen had his forthcoming book in press, he added a footnote, according to Dr. Ries, (not Reis, p. 510), recognizing Cullen’s work.” This last sentence seems counterfactual. Von Recklinghausen had published his book before Cullen published his article. Recall that both Welch and Cullen had read the monograph before Cullen walked up to Welch’s laboratory with his giant slides from the 1894 and 1895 cases. Recall also that it was von Recklinghausen’s monograph, with the appendix containing the one case of mucosal invasion (von Recklinghausen’s minor thesis), that “awakened” Cullen to the significance of his two cases.

  176. 176.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 125.

  177. 177.

    Judith Robinson, 125. See also: Martzloff, KH. Thomas Stephen Cullen [Presidential Address]. Am J Obstet Gynecol 1960;80:833–843:833–834. Martzloff offered an insight into Cullen’s personality that may tangentially shed some light on Cullen’s apparent ambiguity toward von Recklinghausen at this early period. Referring to Cullen, Martzloff said: “These comments are designed to be neither fault-finding nor critical, but only to afford an interesting side light to a distinguished, though not a particularly popular individual. It may seem strange that a man so generous, kind, and thoughtful, who always enjoyed the confidence and loyalty of his staff, should lack popular appeal. Always genuinely appreciative and punctilious in acknowledging a kindness or a favor, he nevertheless gave the impression of being constantly pressed for time and of being self-sufficient to the point of apparent brusqueness.” Martzloff, KH. 1960;80:833–843:836. I believe Martzloff’s assessment of Cullen may be taken at face value. He described his own relationship with Cullen as follows: “One whom it has been my privilege to know, one who encouraged me in my early years.”

  178. 178.

    Cullen, TS. Adeno-myoma of the round ligament. Bulletin Johns Hopkins Hospital 1896;7:112–114.

  179. 179.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 126.

  180. 180.

    Cullen, TS. 1896;7:112–114:113.

  181. 181.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 126.

  182. 182.

    Judith Robinson, 126.

  183. 183.

    Martzloff, KH. Thomas Stephen Cullen [Presidential Address]. Am J Obstet Gynecol 1960;80:833–843.

  184. 184.

    Lorraine Daston and Peter Galison, Objectivity [New York: Zone Books, 2007], 161, 49, 27–28. “Learning to see was never, is never, will never prove effortless…We always return to our central question: how does the right depiction of the working objects of science join scientific sight to the scientific self?…However dominant scientific objectivity may have become in the sciences since circa 1860, it never had, and still does not have, the epistemological field to itself. Before objectivity, there was truth-to-nature; after the advent of objectivity came trained judgment…The relationship between epistemic virtues may be one of quiet compatibility, or it may be one of rivalry and conflict. In some cases, it is possible to pursue several simultaneously; in others, scientists must choose between truth and objectivity, or between objectivity and judgment. Contradictions exist.”

  185. 185.

    Robert E. Fechner, “The Birth and Evolution of American Surgical Pathology,” in Guiding the Surgeon’s Hand: The History of American Surgical Pathology, ed. Juan Rosai [Washington, DC: Armed Forces Institute of Pathology, 1997], 1.

  186. 186.

    Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 29. Robert Meyer met Viet, Professor of Gynecology, at his uncle’s home in 1895. In response to this meeting with Viet, Meyer began his work as a pathologist in a “closet” sized laboratory in his apartment so he could be close to the hospital.

  187. 187.

    Robert Meyer, Autobiography, 29. circa 1895–1896: “I had a microscope, bought a small microtome, and learned in a short time to make sections and diagnoses with the help of Veit and books. Soon I was a virtuoso who could make sections through a whole kidney in celloidin, some of which I still have. I learned to bring the unstained sections from the knife into diluted alcohol onto the slide and to observe them with low power in comparing them with stained sections under high power. That technique I needed in order to look for anomalies in the uterus of many fetuses and adults. I stained and preserved only the positive findings. It required the patience and perseverance of a mule, which I had.” Later Meyer trained a technician for this work. Meanwhile, unbeknownst to Meyer, his old professor of pathology von Recklinghausen was still cutting tissue sections by hand using a knife as he had taught Meyer in medical school.

  188. 188.

    Lorraine Daston and Peter Galison, Objectivity [New York: Zone Books, 2007], 325. “By the end of the nineteenth century…The perfection of the microscope made it possible to go from the organ pathology of Morgagni and the tissue pathology of Xavier Bichat to the cellular concepts of Rudolf Virchow, and the later introduction of the oil immersion lens greatly aided the development of microbiology. The discovery of anesthesia made vivisection practical, thereby providing the physiologist with his most important tool. The microscope and developments in chemistry made it possible to study the morphological and molecular elements of body fluids. …a huge growth in the size of the scientific community was facilitated by a remarkable expansion and transformation of scientific pedagogy in Europe and North America during the period roughly between 1880 and 1914, especially in Germany, France, Great Britain, and the United States.”

  189. 189.

    Lorraine Daston and Peter Galison, Objectivity, 164.

  190. 190.

    Lorraine Daston and Peter Galison, Objectivity, 135.

  191. 191.

    Lorraine Daston and Peter Galison, Objectivity, 51.

  192. 192.

    Robert Meyer, Autobiography of Dr. Robert Meyer: (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 32.

  193. 193.

    Robert Meyer, Autobiography, 32.

  194. 194.

    Robert Meyer, Autobiography, 32.

  195. 195.

    Meyer R. Uber Genese der Cystadenome und Adenomyome des Uterus, mit Demonstrationen. Zeitschr Geburtsh und Gyn 1897; 37: 327–337.

  196. 196.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 281–282.

  197. 197.

    Emil Novak, A memoir of Dr. Meyer in Robert Meyer, Autobiography of Dr. Robert Meyer: (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], xii. “In my own judgment the one factor above all others which made possible Meyer’s preeminence in the field of pathology was his profound knowledge of embryology. He was really one of the great embryologists of his time, the recognized peer of such men as Fischel, Keibel, Felix, and Mall. It was this great asset which gave him a fundamental approach in the interpretation of problems of pathology which was not possessed by any other pathologist of his day.”

  198. 198.

    Robert Meyer, Autobiography, 32. Ibid: 38. Meyer wrote: “I had, on occasion, seen and heard Virchow as the President of the Berliner Medizinische Gesellschaft and was deeply impressed by his clarity. He had accepted from me a short article on osteoid tissue in the cervix of the uterus (Virchows Archiv 167 [1902]).”

  199. 199.

    Kossmann R. Die Abstammung der Drüseneinschlüsse in der Uterus und der Tuben. Archiv für Gynak 1897; Bd. liv. S:359, 381. See Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 277.

  200. 200.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 278–279.

  201. 201.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 281.

  202. 202.

    Esmond B. Long, A History of American Pathology [Springfield, IL: Charles C. Thomas, 1962], 54.

  203. 203.

    Donald Fleming, William H. Welch and the Rise of Modern Medicine [Boston, MA: Little Brown and Company, 1954], 35.

  204. 204.

    This was approximately the same time when William Henry Welch worked on a project supervised by v. Recklinghausen.

  205. 205.

    Robert Meyer, Autobiography of Dr. Robert Meyer: (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 16.

  206. 206.

    Robert Meyer, Autobiography of Dr. Robert Meyer: (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 33.

  207. 207.

    Robert Meyer, Autobiography, 33. Meyer wrote: “Not that theory is almost forgotten but in retrospect one wonders how von Recklinghausen could in thirty cases have overlooked the connection of the adenomyosis with the endometrium, which is now quite clear…Only in later cases did he see it and have to admit in a supplement the possibility of the endometrial histogenesis.”

  208. 208.

    Rabinovitz M. The pathogenesis of adenomyosalpingitis (salpingitis nodosa): report of ten cases. American Journal of Obstetrics and Diseases of Women and Children 1913; lxviii;711–752.

  209. 209.

    To paraphrase the hackneyed expression: thrown out the baby with the bathwater.

  210. 210.

    Robert Meyer, Autobiography, 64. Meyer quoted the physicist Mack to that effect; “The observation is already influenced by the theory.”

  211. 211.

    Robert Meyer, Autobiography, 33.

  212. 212.

    Robert Meyer, Autobiography, 33.

  213. 213.

    Robert Meyer, Autobiography, 33.

  214. 214.

    Iwanoff NS. Drusiges cystenhaltiges Uterusfibromyom compliciert durch Sarcom und Carcinom. Monatsschr. Geburtsh u. Gynak. 1898;7:295. Cited by Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563. See also Pick L. Ueber Neubildungen am Genitale bei Zwittern nebst Beitragen zur Lehre von den Adenomen des Hodens und Eierstockes. Arch f Gynaek 1905;lxxvi:251–275. In reference 34, Pick gives the bibliographic reference for Iwanoff’s dissertation. Iwanoff, Adeno-myome de l’uterus. Inaug.-Diss. Petersburg. (Russisch.) Vergl. auch Frommel’s Jahresberichte für 1897. S. 103 u.

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    Bailey KV. The etiology, classification, and life history of tumors of the ovary and other female pelvic organs containing aberrant müllerian elements, with suggested nomenclature. J Obstet Gynaecol Brit Emp 1924;xxxi:539–57:540.

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    Robert Meyer, Autobiography, 33.

  217. 217.

    Russell, William Wood. Aberrant portions of the müllerian duct found in an ovary. Johns Hopkins Hospital Bulletin 1899; 10:8–10.

  218. 218.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 282. See: Franque OV. Salpingitis nodosa isthmica und Adenomyoma tubae. Zeitschr f. Geb 1900; Bd. xlii: S. 42. “Von Franque’s conclusions were that a pre-existing inflammation explained the origin of most of the ‘growths,’ but that von Recklinghausen’s hypothesis must be held as the elucidation of the few.”

  219. 219.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 279. Lockyer cited Franque OV. Salpingitis nodosa isthmica und Adenomyoma tubae. Zeitschr f. Geb 1900; Bd. xlii: S. 41.

  220. 220.

    Robert Meyer, Autobiography, 32.

  221. 221.

    Robert Meyer, Autobiography, 33.

  222. 222.

    Illustrated Stedman’s Medical Dictionary. 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 474. The epidiascope is a “projector by which images are reflected by a mirror through a lens, or lenses, onto a screen, using reflected light for opaque objects and transmitted light for translucent or transparent ones.” Carl Zeiss was the company for which Ernst Abbe worked.

  223. 223.

    Robert Meyer, Autobiography, 32–33.

  224. 224.

    Meyer R. Uber Drüsen, Cysten und Adenome in Myometrium bei Erwachsenen. Zietschr f. Geb und Gynak 1900–1901; xlii, xliii, xliv.

  225. 225.

    Robert Meyer, Autobiography, 70–71.

  226. 226.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 279. Lockyer cited Franque OV. Salpingitis nodosa isthmica und Adenomyoma tubae. Zeitschr f. Geb 1900; Bd. xlii: S. 41. Robert Meyer believed that inflammation might initiate basal endometrial invasion characteristic of diffuse adenomyosis, a concept harbored by Chiari for initiation of salpingitis isthmica nodosa (endosalpingiosis). Meyer abandoned the inflammatory theory in favor of the hormonal theory introduced by Lauche in 1923. See Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563. Emge cited Arnold Lauche. Virchow’s Arch Path Anat 1923;243:298.

  227. 227.

    Lester S. King, Medical Thinking: A Historical Preface [Princeton, NJ: Princeton University Press, 1982], 197–198.

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    Lester S. King, Medical Thinking: A Historical Preface [Princeton, NJ: Princeton University Press, 1982], 229–233.

  229. 229.

    Lester S. King, The Medical World of the Eighteenth Century [Huntington, NY: Robert E. Krieger Publishing Co., 1958, Reprint 1971], 284, 287.

  230. 230.

    Lester S. King, The Medical World of the Eighteenth Century, 291–292.

  231. 231.

    Russell C. Maulitz, Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century [New York: Cambridge University Press, 1987], 207.

  232. 232.

    Russell C. Maulitz, Morbid Appearances, 205.

  233. 233.

    Jacalyn Duffin, “Laennec and Broussais: The ‘Sympathetic’ Duel” in Constructing Paris Medicine, ed. Caroline Hannaway and Ann La Berge [Amsterdam, NL: Editions Rodopi B. V., 1998], 251–274: 254, 262.

  234. 234.

    Robert Meyer, Autobiography, 70–71.

  235. 235.

    Franque OV. Salpingitis nodosa isthmica und Adenomyoma tubae. Zeitschr f. Geb 1900; Bd. xlii: S. 41.

  236. 236.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 279–280. Lockyer cited: Legueu F, Marien. Ann de gyn et d’obstet 1897:134

  237. 237.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 285–286.

  238. 238.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 285–286. Meyer R. Uber Drüsen, Cysten und Adenome in Myometrium bei Erwachsenen. Zietschr f. Geb und Gynak 1900–1901; xlii, xliii, xliv.

  239. 239.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 288. Meyer R. Uber Drüsen, Cysten und Adenome in Myometrium bei Erwachsenen. Zietschr f. Geb und Gynak 1900–1901; xlii, xliii, xliv.

  240. 240.

    Robert Meyer, Autobiography, 38.

  241. 241.

    Illustrated Stedman’s Medical Dictionary, 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 474. A projector by which images are reflected by a mirror through a lens, or lenses, onto a screen, using reflected light for opaque objects and transmitted light for translucent or transparent one.

  242. 242.

    Robert Meyer, Autobiography, 35. See also: Robert Meyer, Eine unbekannte Art von Adenomyom des Uterus mit einer kritischen Besprechung der Urnierenhypothese v. Recklinghausen’s. Zeitschr. f. Geburtsh. Gyn. 1903;49:464–507.

  243. 243.

    Robert Meyer, Autobiography, 33.

  244. 244.

    Robert Meyer, Autobiography, 35.

  245. 245.

    Robert Meyer, Eine unbekannte Art von Adenomyom des Uterus mit einer kritischen Besprechung der Urnierenhypothese v. Recklinghausen’s. Zeitschr. f. Geburtsh. Gyn. 1903;49: 464–507.

  246. 246.

    Emil Novak, “A Memoir of Dr. Meyer,” in Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], xii. Novak opined: “In my judgment the one factor above all others which made possible Meyer’s preeminence in the field of pathology was his profound knowledge of embryology. He was really one of the great embryologists of his time, the recognized peer of such men as Fischel, Keibel, Felix, and Mall. It was this great asset which gave him a fundamental approach in the interpretation of problems of pathology which was not possessed by any other pathologist of his day.”

  247. 247.

    Robert Meyer, Autobiography, 32.

  248. 248.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1543.

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    Ronald E. Batt M.D., Ph.D. (Professor of Gynecology)

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Batt, R.E. (2011). From von Rokitansky to von Recklinghausen to Cullen. In: A History of Endometriosis. Springer, London. https://doi.org/10.1007/978-0-85729-585-9_4

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