F.K. (Kash) Mostofi
Dr F.K. (Kash) Mostofi died of congestive heart failure
at the Walter Reed Army Medical Centre on April 6th, 2003 at the age of
91 years. Kash was an active, and passionate member of the Armed Forces
Institute of Pathology from 1948 until his death. His last publication
was an Editorial in Human Pathology in which he stated his concept of
how the AFIP should be functioning. The IAP was another life long passion.
The International Association of Medical Museums was founded in May
1906, but there had been very little activity during the years of the
Second World War. After that war, Surgical Pathology and Histochemistry
were the leading disciplines in Anatomical Pathology. Post mortem pathology
was no longer as important as it had been for the previous hundred years.
In 1951 the 40th Annual Meeting of the US/Canadian section of the I.A.M.M.
had only thirty registrants. Kash was appointed Secretary/Treasurer at
the next meeting in 1952.
At the Annual Meeting in 1953 he introduced a new approach to this type
of educational meeting. A whole day was devoted to an in-depth study of
one organ - in this case, the kidney. The embryology, anatomy, physiology
and pathology were presented by a number of speakers. This format was
an immediate success, and became the model for the “Long Course”
which has been so popular at I.A.P. and U.S.C.A.P. meetings ever since.
Kash engineered the constitutional establishment of the United States
and Canadian Academy of Pathology, and then the International Academy
He saw the I.A.P. in its present form come into being at the International
Congress in Washington in 1976, at the end of his second year as President
of the International Academy.
Born in Tehran, Iran, he immigrated to the United States in 1931. He graduated
from the University of Nebraska, and Harvard Medical School, and undertook
pathology training at Peter Bent Brigham and Children’s Hospitals
in Boston. During the war years 1944 - 47 he was an Army Pathologist,
rising to the rank of Colonel. He joined the Armed Forces Institute of
Pathology in 1948 and became Head of Urologic Pathology.
Kash was a prolific author and teacher. In the post war spirit of the
AFIP, he welcomed numerous students from all over the world to his department
in Washington. He also travelled to many countries giving lectures and
distributing educational material. Adonis Carvalho of Recife, Brazil,
is one of the Pathologists who remembers very well his support when Brazil
was undergoing a period of political turmoil. Adonis was particularly
grateful for his personal assistance, and also for his assistance to his
countrymen and women during and after their time of political upheaval.
As befits his contribution to pathology, Kash is remembered by the F.K.
Mostofi Distinguished Pathologist Award, an annual award from the U.S.C.A.P.
and by many other named awards, including the recently established F.K.
Mostofi Fellowship in Urologic Pathology at the AFIP.
Kash’s wife, Dorothy, died in 1994. He is survived by his son Keith,
grandson David and dear friend and companion, Dr Isabell Sesterhenn. It
is fitting that he was buried in the Arlington National Cemetery in Washington.
(with assistance from Bill Gardner, Adonis de Carvalho and Isabell Sesterhenn.)
to Contents List
The Royal Flying Doctor Service of Australia
The early European settlers of Australia gradually moved out from small
coastal riverside settlements, and spread over a vast continent. However,
a relatively meagre and highly variable rainfall soon curtailed the growing
of crops, and large scale pastoral activities involving sheep and/or cattle
became the norm. In this situation settlement could only be sparse, and
distance and isolation became a formidable foe.
Above: Uluru, a massive outcrop of sandstone rock
in Central Australia.
The Australian Flying Doctor Service began in 1928 with a base in Cloncurry
in western Queensland. It was established to bring sick and injured people
to hospital by air in a matter of hours, instead of days or weeks as was
often the case previously, and to enable a doctor to fly to remote areas
to give medical attention. It was first known as the Aerial Medical Service
of the Australian Inland Mission (the AIM) which had been founded in 1912
by Rev John Flynn of the Presbyterian Church of Australia.
The AIM began in South Australia and rapidly spread its services across
most of the sparsely settled parts of the inland. Flynn aimed to provide
“a mantle of safety and care” to the outback in the form of
basic medical services and spiritual care for the isolated people. From
1914, the AIM set up bush nursing hostels staffed by two trained sisters,
with hospitals in larger settlements. They started “patrols”
using camels, horses, and later the automobile, which visited isolated
people on sheep and cattle stations, in miners and drovers camps, camps
of railway and telegraph workers - anywhere where there were people. By
1928 there were eight bush nursing hostels or hospitals established in
remote parts of the country.
Base station of the Royal Flying Doctor Service
of Australia in Charleville in Western Queensland.
With the development of radio, and the pioneering work of Alfred Traegar,
an engineer from Adelaide, who adapted the new technology to the conditions
in outback Australia, the establishment of the Aerial Medical Service
became possible in 1928. By this time, Traegar had nearly completed the
development of the “pedal-radio” - a radio that could send
messages up to 300 miles in Morse code, and receive messages back by voice.
The power for this was generated by the feet, pedalling as on a bicycle,
leaving the hands free to tap out messages.
In May 1928, a single engine De Havilland bi-plane (with a pilot supplied)
and equipped with a stretcher, was leased from the fledgling airline Q.A.N.T.A.S.
(Queensland and Northern Territory Aerial Service) A doctor was hired
from 21 applicants, and the service began, responding to the urgent calls
that came in by foot, horseback and automobile.
In the following year, the first radio base was set up in a room of the
Presbyterian Church in Cloncurry, and six pedal-radios were installed
by Traeger and an assistant on sheep and cattle stations within 300 miles
of Cloncurry. People were instructed in Morse code, and in the use and
maintenance of the radio. (It was usually the women who did the radio
work). These outstations with pedal-radios could now communicate with
the Cloncurry base, and send telegrams - a huge improvement in communications!
In the next few years, dozens more radios were installed on pastoral stations,
at mining settlements, missions and other remote communities.
Above: The two grey gum trees and the MacDonnell Ranges,
made famous in the painting “Twin Ghost Gums” by the Australian
artist Albert Namatjira.
From this small beginning, came the establishment in the next 26 years
of 11 more Flying Doctor Bases in all states except the two geographically
small ones, Victoria and Tasmania. The service was funded largely by donations
and Community fund raising, with the Federal Government paying half the
cost of maintaining the aircraft. In 1934 the Presbyterian Church handed
the service over to a new organisation, the Australian Aerial Medical
Service. The name changed to “Flying Doctor Service” in 1942.
Government subsidies increased thereafter, but there has always been a
heavy reliance on public appeals, donations and money from trusts.
As well as flying to remote patients and bringing them to hospital by
air if necessary, the doctors at the bases provided a daily medical consultation
service by radio. From 1942, standard medical chests were installed in
most outback homesteads comprising first aid materials, ointments and
medicines, a St John’s First Aid Handbook, and a diagram of the
human body divided into numbered sections so that areas of pain could
be identified. All items in the chest were numbered so that the doctor
could specify how much of which item to give to the patient. (This gave
rise to jokes such as this. A station manager was told to give his wife
a No. 9 tablet. Later he told the doctor, “We’d run out of
No. 9s, but I gave her one 5 and one 4 and she came good right away!”)
All this was a big improvement on the early days when the station medicine
cupboard was likely to contain little more than a few bandages, some cough
mixture, and Condy’s Crystals for snake bite.
Traegar continually made improvements to his radios over the next decade.
Batteries replaced the generator with pedals. A Morse typewriter that
translated words into Morse code made transmission of messages easier.
The Morse Code system was replaced by transceivers that could send as
well as receive the voice. Radio reception over longer distances improved,
so that virtually all the settled parts of Australia came to be in radio
contact with emergency medical services, and able to summon the Flying
Doctor when necessary. Landing strips had to be constructed to receive
the aircraft (the first plane had a specially strengthened undercarriage
for rough landings, and needed only a short runway). Anyone in medical
need could make use of the service, and there was no charge to the patient,
though grateful patients and their families made monetary donations if
Over the years, the Flying Doctor Service has undoubtedly saved hundreds
of lives and greatly reduced the suffering for thousands of accident victims.
Today there are 20 Flying Doctor Bases, including some in major cities.
Some early ones have been closed or relocated. Modern aircraft are now
used which have more space for doctors, nurses and patients, and are fitted
out with all the necessary medical equipment. The telephone has largely
replaced the radio as the main means of communication. In 1980 the staff
was expanded by the appointment of flying specialists. The first of these
was a flying surgeon; then a flying obstetrician, and a flying paediatrician.
An aircraft can be airborne within 45 minutes of an emergency call being
received, and thanks to the Flying Doctor Service network of bases across
Australia, no-one is more than two hours away from medical help, 24 hours
a day, 365 days a year.
Back to Contents
International Histological Classification of Tumors
The W.H.O. BLUE BOOKS
In 1952 a subcommittee of
the W.H.O. Expert Committee on Health Statistics decided that
if statistics about the occurrence of various types of cancer in different
countries was to be reliable, a universally accepted nomenclature was
needed. The main components of such a nomenclature were: anatomical site;
histological type; degree of malignancy.
A few years before this, at the fourth
International Cancer Congress held in St. Louis, U.S.A. in 1946, a group
of pathologists decided to produce an “Atlas of Tumor Pathology.”
They managed to get support and funding from a number of organizations,
government and non government, and it was printed by the Armed Forces
Institute of Pathology. The exact details about which of the “Fascicles,”
as they were finally called, was the first, second and third, etc, and
the year in which they were actually published, is not at all clear. Perhaps
the most reliable information on this score comes from Arthur Purdy Stout’s
account in the publication “Guiding the Surgeon’s Hand –
the History of American Surgical Pathology “ Edited by Juan Rosai.
Stout says that in 1947 he was 1 of 6 members of a sub-committee formed
to supervise the work. He was commissioned to produce 4 volumes.
Histological typing of breast tumours Series 2 in English,
French, Spanish and Russian.
Series 3 of “Breast Pathology” will be on
sale by the end of 2003.
He started at once on “the
Peripheral Nervous System.” It was quickly completed, because he
had already prepared the text and the illustrations for other publications.
It was then “three long years” before it was published, because
it was used as a prototype that was endlessly dissected and altered by
editors, printers and administrators. By the time his Fascicle was finally
published, others had been completed and published - the first of them
in 1949. The A.F.I.P. Tumor Fascicles were based on anatomical site. They
featured large, high quality, black and white prints of low magnification,
as well as high magnification micro-photographs.
Clockwise above: Four of the people involved in this
series and previous series - Leslie Sobin, Paul Kleihues, Humberto Torloni
and Nikolai Napalkov.
In 1956 the World Health Organization
passed a resolution requesting the Director General of W.H.O. to “explore
the possibility that W.H.O. might organise centres in several places in
the world and arrange for the collection of human tumors and for their
histological classification. The main purpose of such centres would be
to develop histological definitions of cancer types, and to facilitate
the wide adoption of a uniform nomenclature”. This task was entrusted
to the Division of Non Communicable Diseases of W.H.O.
Lid of the polystyrene box. All copies of the first
series were mailed like this in English, French, Spanish and Russian.
The box contained the transparencies along with the
In 1958 W.H.O. entered the field of
nomenclature and tumour classification with an approach that was on an
international scale in keeping with its charter. This was a different
method from that used by previous organisations. W.H.O. designated eleven
international reference centres covering tumors of lung, breast, soft
tissues, oropharynx, bone, ovaries, salivary glands, thyroid, skin, urinary
bladder and leukaemia/lymphoma. These centres involved 115 pathologists
from 37 countries. In the few years after this they designated another
11 centres for tumours of jaw (odontogenic), uterus, kidney, prostate,
testis, stomach and intestines, oesophagus, liver, eye, central nervous
system and endocrine glands.
The reference centres functioned as follows - for each topic, a tentative
histopathological classification was submitted by up to ten pathologists;
the head of the reference centre arranged for circulation of clinical
histories, with glass slides and paraffin blocks to a number of designated
collaborating laboratories to evaluate the proposed classification. This
was followed by one or more technical meetings called by W.H.O. to resolve
any disagreements. The reference centre then prepared ten sets of microscope
slides for each entity, and sent them to ten independent, and previously
uninvolved pathologists, for further testing of the classification.
Above: Introductory page to Series 1, Number 2 and cover
of Series 1, Number 2. Histological Typing of Breast Tumours.
When all of this information was received,
it was collated by the head of the reference centre who prepared a text
explaining the basis of the classification. He then prepared a small series
of photomicrographs taken from appropriate fields that were thought to
represent the diagnostic criteria explained in the text. From these photomicrographs,
35mm transparencies and colour plates were made. (W.H.O. made a small
payment to each reference centre as a contribution towards the cost of
the exercise.) The series editor was then responsible for the final printing
and distribution of the books. All 25 books in the first series were published
between 1967 and 1981. They all contain a number of pages each with two
colour prints of the microscopic sections. (Colour printing was expensive
and relatively rarely used at that time). A set of 35mm transparencies
was also prepared for each book.
The books and the 35mm transparencies
were packaged in individual custom-made polystyrene boxes for sale. Approximately
5,000 copies were made for each book in Series 1. All of the 25 books
in Series 1 and the first two books in Series 2, were published in English,
French and Spanish. Books 1, 2, 3, 4, 6, 7, 9, 10, 11 and 12, were also
published in Russian. The printing was done by W.H.O. in Geneva. Approximately
500 copies of each book were sent to Moscow, where a Russian translation
was inserted, and a final printing was made for distribution of the books
within the Soviet Union. After number 2 in Series 2, all of the books
were published in English only.
There were some difficulties with
the publication of the books in the first series, because funding from
W.H.O. was rather haphazard. Hence, there were quite long delays between
the preparation of individual books, and their subsequent printing. The
editor for Series 2 approached a number of publishers to ask whether they
would be willing to publish the W.H.O. Blue Books. There was little enthusiasm
for this, because the publication of the books was not profitable, especially
if they were to be in colour. Springer-Verlag agreed to publish the whole
of Series 2, but with limited colour, unless authors could raise their
own funds for this. About 1500 copies of each book in Series 2 was published
by them. Some sets had 35mm transparencies prepared by the American Registry
As indicated in the article in News
Bulletin 2/2002, the first series editor was Dr Humberto Torloni from
Sao Paulo, Brazil. He was replaced in 1970 by Dr Leslie Sobin, who worked
at the W.H.O. office in Geneva from 1970 - 1981. Then he moved to the
A.F.I.P. in Washington, where he became Chief of the Gastrointestinal
Pathology section. He supervised 19 of the 25 books in Series 1 and all
23 books in Series 2. The last of the books in Series 2 entitled “Histological
Typing of Tumours of the Prostate” was published in 2002. Leslie
continues as Co-Series Editor for Series 3 with Paul Kleihues from the
I.A.R.C. in Lyon.
As described in News Bulletin 2/2002,
Series 3 is being produced mainly as a result of the energy and enthusiasm
of Dr Paul Kleihues, Director of I.A.R.C. He proposed that Series 3 should
have a totally new look and should be called Pathology and Genetics -
Tumours of (the various organs of the body). This would incorporate new
knowledge of tumors coming from the research laboratories of I.A.R.C.
itself, and other cancer research laboratories worldwide. I.A.R.C. operates
under a charter defined by W.H.O. One of its functions is to co-ordinate
cancer research internationally. Thus, the new Series 3 W.H.O. Classification
of Tumors fitted comfortably within his Institute.
Paul was appointed Director of I.A.R.C. in 1994. In 1995 he established
I.A.R.C. Press to publish and market the multiple reports that were generated
by I.A.R.C. It was a natural progression for the Series 3 books to be
published by I.A.R.C. Press. The printing is down by “Team Rush”,
a printer which is conveniently situated in Lyon.
I.A.R.C. (International Agency for
Research on Cancer) has an interesting history. It was established at
the suggestion of Charles de Gaulle, first President of France after the
Second World War. He suggested that it might be a good idea for the industrialised
countries of the world to contribute approximately 1% of their military
budget each year for research on cancer. This idea was accepted by W.H.O.
The Mayor of Lyon offered that the city would
build a research institution with an appropriate lecture/conference hall
on land in the centre of the hospital and university area in Lyon. The
city would lease the building and land to W.H.O. for 1 French franc per
The mailing centre for the tumour books in the IARC
headquarters in Lyon. The Chief Librarian, Sue Cotterell, is in the foreground.
Thus, the I.A.R.C. started its work
in July 1965. The original buildings are still in use. A new lecture theatre
was built in 1988 with money donated by the Japan Shipbuilding Industry
Foundation of which Mr Ryoichi Sasakawa was Chairman. Another series of
buildings was added with further money provided by the governing council
of I.A.R.C., together with money provided by donations from other outside
organisations. I.A.R.C.’s mission is stated as being cancer research
for cancer control with four main arms -
• Monitoring global cancer occurrence
• Identifying the causes of cancer
• Elucidation of mechanisms of carcinogenesis
• Developing scientific strategies for cancer control
The series editors for Series 3 have
a very ambitious program to complete the ten books in this series by the
end of 2003. While this appears to be a daunting task, they are greatly
encouraged by the runaway success of the first three books that have been
published so far.
The I.A.P. has been actively involved
in supporting and promoting the W.H.O. Blue Books ever since their inception.
At each International Congress of the I.A.P. the latest books in the series
have been launched at sessions specially put aside for that purpose. The
I.A.P. is continuing its support of Series 3 by advertising new books
in its quarterly News Bulletin, and also through sessions at each International
Congress. It is planned that the last volumes of this series will be launched
at the XXV International Congress of the I.A.P. in Brisbane, Australia,
October 10 - 15, 2004.
With information provided from numerous sources, particularly Leslie Sobin,
Paul Kleihues, Juan Rosai, Nikolai Napalkov, Humberto Torloni and the
support staff at I.A.R.C
to Contents List
Gold Medal of the IAP
Anna Kadar at the Budapest Congress, 1996.
Awarded a Gold Medal of the IAP in 2003, Anna Kadar
has had a distinguished career. She graduated in Medicine from the Medical
University, Budapest, Hungary (now the Semmelweis University) in 1959.
She was awarded a PhD in 1972 and a DMSc in 1980. The research for these
Doctoral degrees centred around the pathology of elastic fibres, and the
pathogenesis of Atherosclerosis. These topics became her life long research
In the early years of her professional life she spent significant periods
of time in London, England; and in Paris, France. In later years she was
a visiting Professor in Bologna, Italy; Boston and Rochester, USA.
She played an active role in the service and teaching functions of her
Department, and entered the administrative field in 1982 when she was
appointed Professor of Pathology. She later became Director of her Department
and served a term as Associate Dean. In 1983 she became Secretary General
of the Hungarian Society of Pathologists, and President 1998 - 2000.
From the 1980’s she was involved in the Committees of the European
Society of Pathology and the International Academy of Pathology. She was
the organiser and President of the 1996 International Academy of Pathology
International Meeting held in her home city, Budapest. From 1998 - 2000
she was President of the IAP. She continues to play an active role in
the affairs of the IAP.
The Gold Medal of IAP is one of a number of awards she has received in
the past three years in recognition of her outstanding contributions to
her chosen profession, Pathology, in the National and International arenas.
On August 20, the anniversary of the establishment of Hungary as a state
in 996, Anna was awarded the second highest civil order in Hungary by
the President of the Republic for her contributions to Pathology, Teaching
and Research. This decoration is called the Officers' Cross.