Context.—

Aldred Scott Warthin, MD, PhD, was professor of pathology and director of the pathological laboratory at the University of Michigan during the first third of the 20th century.

Objective.—

To explore the life and accomplishments of Dr. Warthin and his impact on academic anatomic and clinical pathology.

Design.—

Available primary and secondary historic sources were reviewed.

Results.—

After studying music, biology, and botany, Warthin attended medical school at the University of Michigan, graduating in 1891; he remained in Ann Arbor for 40 years, almost single-handedly transforming a rundown department into a top academic department. He was a dedicated teacher who produced 2 important pathology textbooks. His research interests were diverse. In 1913, he published one of the first papers unambiguously documenting heritability of cancers; subsequent research on one of his cancer families resulted in the description of Lynch Syndrome. He published extensively in the fields of surgical pathology and experimental pathology. He was a recognized expert on syphilis and pathology of aging.

Conclusions.—

Warthin's name is eponymously associated with Warthin-Finkeldey giant cells in measles, Warthin's tumor of the parotid, and Warthin-Starry stain for the diagnosis of syphilis as well as Warthin's sign in the clinical diagnosis of pericarditis.

Aldred Scott Warthin, MD, PhD (Figure 1), was born in Greenburg, Indiana on October 21, 1866. His parents were Edward Mason Warthin, whose English ancestors settled in Maryland before the Revolutionary War, and Eliza Margaret Weist, whose German ancestors were from Pennsylvania. In 1887, Aldred, already an accomplished pianist and organist, earned a Teacher's Diploma from the Cincinnati Observatory of Music. He also simultaneously attended Indiana University (IU) at Bloomington15  where he was influenced by famed ichthyologist David Starr Jordan, MD (1851–1931), who was IU professor of zoology (1875–1891) and IU president (1885–1891) and later became the inaugural president and chancellor of Stanford University (1891–1916).6  Warthin's lifelong interests in biology and evolution can be linked to Jordan and Jordan's protégé Charles H. Eigenmann, PhD (1863–1927), a zoologist only a few years older than Warthin. Warthin studied botany and graduated with a Bachelor's of Art in 1888. After briefly teaching botany in Bloomington, Warthin moved to the University of Michigan (U of M) in Ann Arbor, Michigan to continue his studies in 1889. IU was a stimulating intellectual environment that molded Warthin. Almost 40 years after leaving Bloomington, he received an honorary Legum Doctor degree from IU in 1928.15 

Warthin received a Master's degree (AM) in 1890, a Doctor of Medicine degree in 1891, and a Doctor of Philosophy degree in 1893 from the U of M. While in medical school, he supported himself by teaching music and working as a church organist. Warthin next pursued residency training in internal medicine at U of M, and, as noted by U of M physiologist and medical historian Horace W. Davenport, PhD (1912–2005), at a time when George Dock, MD (1860–1951), had just been appointed as professor of medicine.7  Warthin worked as Dock's assistant in 1891 to 1892. In 1892, he was appointed demonstrator in medicine and he published “Scheme for the Systematic Study of Medical Cases.”8  Soon, he described the importance of an accentuated pulmonary second sound in the diagnosis of pericarditis,9  which later was named “Warthin's sign.” Because of a shortage of teaching patients, Dock and Warthin “reached out to the local population, recruiting teaching patients with the aid of local clergy and other community leaders and relying upon the good reputation … of the University Hospital to provide a decent number of training cases.”10(p63)

George Dock, although an internist, was well-trained in pathology having studied under William Osler, MD (1849–1919), and having functioned as a pathologist in Philadelphia and Galveston before moving to Ann Arbor. Dock, an early adopter of laboratory medicine, was concerned about the inadequacy of the U of M University Hospital (UH) laboratory facilities as he believed they lacked both the space and the necessary equipment to provide essential diagnostic and teaching services. In fact, laboratories used for teaching were not even based in the hospital but rather on the university campus.7,10 

In this stimulating environment, Warthin quickly realized that the natural approach to internal medicine was through pathology. Therefore, he spent his summers in Freiburg, Germany studying under Ernst Ziegler, MD (1849–1905), and Vienna, Austria studying under Alexander Kolisko, MD (1857–1918), and Richard Paltauf, MD (1858–1924), improving his knowledge of histopathology and autopsy pathology. In 1895, he was appointed as instructor in pathology at U of M. He was promoted to assistant professor in 1899, junior professor in 1902, and professor in 1903, at which time he was also appointed director of the Pathological Laboratory.2,3 

Warthin's rapid promotion was aided by some unusual local circumstances. His immediate predecessor as professor of pathology was George Dock who, as professor of internal medicine, did not really want this additional position but, recognizing its importance, agreed to accept it. Dock had replaced Heneage Gibbes, MD (1837–1912), an Englishman who had out-of-date ideas about bacteriology and had most recently been working as a gunboat captain. During his appointment, he did not interact well with physiological chemist Victor C. Vaughan, MD (1851–1929), the U of M dean of Medicine (1891–1921). The arrival of Dock, an internist with strong pathology credentials, created an opportunity to get rid of Gibbes. Therefore, the Board of Regents voted in 1895 to combine the chairs of Pathology and Medicine, with George Dock as the occupant.7,11 

A few months before Warthin died, he provided his recollection of these events and his thoughts about Dock:

In 1891, with George Dock, the foundation was laid at Ann Arbor for a scientific department of Internal Medicine. Dock's interest was fundamentally pathologic, and very naturally our approach to internal medicine was through pathology. With the small amount of clinical material then available, we had time and opportunity to do practical work in pathology in our embryonic laboratory of internal medicine. At that time no diagnostic pathology was being carried out at Michigan; the only pathology given to students was a crude course … The then Professor of Pathology was a Britisher, lately retired from the command of a gunboat, chasing pirates in the China Sea, and had been picked up in London and brought to Ann Arbor by one of the members of the medical faculty. He was thoroughly a picturesque character … but he knew nothing of pathology … Dr. Dock's training in diagnostic pathology had been both scientific and practical; so rather sub rosa we carried on diagnostic pathology as the foundation stone of internal medicine. We examined the surgical material taken from our patients, did our own autopsies and ran them through; and gradually an increasing amount of material was sent in for diagnosis. I spent the summers of 1893-4-5 in intensive pathologic study in Vienna; and in the fall of 1895, it fell to me to succeed the Chinese pirate-chaser as the practical head of the Department of Pathology in the Medical School. Dr. Dock, nominally the head, gave me absolute freedom to organize and carry on the department according to my own ideas and desires. He never interfered, practically never suggested, and always backed me up. For this wonderful opportunity I have always been grateful, and I take the opportunity of acknowledging my indebtedness to him here.1(pp743–744)

Warthin quickly transformed the pathology laboratory at U of M into a first-rate operation. Other than the autonomy to act decisively, this required the following 1 fundamental change:

The first foundation stone of my department consisted in getting the Board of Regents to pass a rule requiring that all surgical material removed in the University Hospitals became property of the Pathological Laboratory, and must be sent there, accompanied by a history of the case for diagnosis. This included all tissue, including tonsils, placentas, herniotomy tissue, and everything else removed at operation. The Departments of Surgery, Gynecology and Obstetrics, and Otolaryngology have in all these years with few exceptions lived up to this rule and have quite fully cooperated … The results show the great wisdom of such a procedure. Not only has much material regarded as wholly negative by the clinician been shown to have decided pathology value of great importance to both patient and clinician, but through the years there has grown up a collection of pathologic material that probably has no equal in any other diagnostic laboratory in the world. Slides and records of over 150,000 cases are immediately available for comparative study.1(p744)

In this, Warthin was more than 2 decades ahead of his time, as it did not become standard policy in most North American hospitals to have all surgical specimens examined by a pathologist until the late 1920s when it became a required element as a component of the American College of Surgeon's hospital standardization program.1214  Warthin also attributed his academic productivity and the future academic productivity of others to the rich material flowing through his laboratory, by seeing high volumes, he had learned that some histopathologic entities, which were believed normally to pursue a benign course occasionally do not.1 

Because of Warthin's foresight, his pathology laboratory grew. According to Warthin in 1931, “In my first year [1895] as clinical pathologist, I had only 158 [surgical] cases and 12 autopsies, a striking contrast to the 18,194 diagnostic cases and 401 autopsies of the last year.”1p744

Likely also promoting the acceptance of his surgical pathology service was his focus on turnaround time and meeting the needs of his clinicians:

At first Warthin fixed, embedded, sectioned and stained all tissues, but he soon got a technical assistant. Only one such helped Warthin and [Carl Vernon] Weller [see below] until 1917, but there were twelve 14 years later… before Warthin's time pathological diagnoses were not returned for weeks, but Warthin was able to get a diagnosis ready for the clinic following that in which the patient had been operated upon. After 1900 he substituted paraffin for celloidin, and diagnoses were ready in two and a half days. Eventually a technician working at night had slides ready for review the next morning, and Warthin could send reports to the clinicians by 11 or 12 o'clock.11(p193)

While in Ann Arbor, George Dock's influence was profound. However, Dock relocated to Tulane University in 1908. He had been an instrumental mentor for Warthin and helped launch his career. Dock spent only 2 years at Tulane and then was chair of Medicine and dean of Medicine at Washington University in St Louis, Missouri.7 

Warthin married Katharine Angell, MD of Chicago in 1900 and they had 4 children. The family gardened and enjoyed geologic and botanic field trips. On one of these, he demonstrated his expertise in paleobiology by discovering a fossil of a previously unknown snail in a quarry (Afton Stone Co, Michigan); it is now named Welleria aftonensis Warthin.15  According to Charles F. Martin, MD (1868–1953), dean of Medicine at McGill, in his Canadian Medical Association Journal obituary for Warthin:

He drained his life's blood to the dregs … No man's life was ever more completely rounded than his; no one enjoyed more an avocation in the fine arts of painting, music and literature; few could appreciate as did he the essential and permanent values of these auxiliary studies and pleasures. Apart from his scientific achievement he was pre-eminently an authority on these subjects, having written with singular sympathy and insight on the Wagnerian tetralogy and on the Great Masters of the Venetian School, notably Titian.16(p83)

To this list of avocations within the humanities, Martin could easily have added debating philosophy and religion. This highly productive clinician-scientist was an advocate of work–life balance.

Warthin was active in organized medicine and served as president of the American Association of Pathologists and Bacteriologists (1908), the International Association of Medical Museums (1910–1913), the American Society for Experimental Pathology (1924), the American Association for Cancer Research (1928), the American Association of Physicians (1928), and the American Association for the History of Medicine (1930–1931). Warthin never lost his interest in or connections with internal medicine. From 1923, he was a member of the Board of Regents and from 1925 first vice president of the American College of Physicians. During the last 6 years of his life, he was editor of the College's official organ, the Annals of Internal Medicine.

Warthin fell ill while attending the 15th Annual Clinical Session of the American College of Physicians in Baltimore, MD (March 23–27, 1931). He was hospitalized and received surgical treatment at Johns Hopkins. According to local newspaper coverage, “after a considerable time [apparently more than 6 weeks], he rallied and came home the middle of this week.” Warthin died on May 23, 1931 at the age of 64 only a few days after returning home. He had spent the previous day gardening.17  According to the newspaper, his immediate cause of death was asthma, but other sources suggest that he died of coronary thrombosis.18 

Warthin's interest in internal medicine greatly influenced his teaching style for pathology. It also drove him to implement a regular clinical–pathologic conference rounds.2 

During the final few months of his life, Warthin provided his thoughts on teaching:

Pathology is not to my mind a separate subject to be taught academically, but one underlying and intimately connected with all the clinical subjects of the curriculum. The teaching pathologist should also be a clinical pathologist. This meant broad and not narrow teaching … The correlation of pathology with the living clinical picture represents to my mind the highest function of medical teaching.1(p745)

According to Walter M. Simpson, MD, a pathologist in Dayton, Ohio who had been an assistant working under Warthin for 5 years: “During the first years of his work in pathology, Doctor Warthin alone gave all of the lecture and laboratory courses, performed all of the autopsies, and blocked, cut, stained and interpreted all of the tissue sections. During his first year as pathologist he prepared some 30 000 teaching sections and spent the hours from one to five each afternoon during the entire year demonstrating these sections to students.”2 

Warthin noted: “Most of the pathologic material used in this course I had obtained from Vienna; but from the very first a special effort was made toward utilizing the local material for purposes of practical illustration.”1(p745) William Osler visited Warthin's museum it its early days and was impressed, even though it was small, saying, “A little field well-tilled! How much more may come from it than from a large one with its surface only scratched.”2(p503) Warthin's museum continued to grow and he was one of the founders of the International Association of Medical Museums in 1906.19 

Warthin was responsible for 2 pathology textbooks used by North American medical students. Having been raised by a German-speaking mother and having studied with Ernst Ziegler, he translated and updated Ziegler's General Pathology.20  He also wrote and published 2 editions of his own textbook in 1897 and 1911.21  In the first edition, he was dogmatic about the best way to teach pathology to medical students:

It is from the study of material itself, and not from the textbook alone, that the student can obtain a proper knowledge of pathologic changes. The most comprehensive textbook can give no adequate idea of the infinite variety of these changes; there is no absolute type, but an endless variety of appearances more or less closely related. … The student who seeks in a preparation only the appearances described in a textbook is not studying in a scientific way. He will constantly accept the author, instead of using his own impressions … With an unbiased mind the student should take each specimen… [and] build his conclusions. He should seek in the textbook the things he finds in the material; not seek in the latter the things he reads in the former.21(pX)

In the second edition, his beliefs were further entrenched by 14 more years of teaching:

The writer's views concerning the value of teaching by unknowns, that is, giving the student preparations or case material for his own analysis and independent working-out to a diagnosis – are stronger now… It accomplishes two things – it not only teaches a knowledge of pathology, but it develops objectivity and the faculties of diagnosis, and accomplishes these with more marked success than any other method of teaching.21(pviii)

On the book's title page appeared “Mortui Vivos Docent” (the dead teach the living) (Figure 2). Warthin admitted that his teaching methods, while better, were more difficult:

A greater difficulty lies with the teacher… he must be tactful and patient in leading the student to work for himself. It is easy to give a demonstration and then tell the student to work; it is very much more difficult and nerve-consuming to make a student see and demonstrate for himself… Moreover, the teacher must be fully awake to individual differences and needs, and carefully shape his teaching influence upon each student accordingly.21(pxi)

Figure 2

The cover page from Warthin's pathology textbook.

Figure 2

The cover page from Warthin's pathology textbook.

Close modal

Warthin typically gave his students 175 unknown histologic specimens to workup, draw, and describe in writing; each student was also expected to process approximately 50 fresh specimens and prepare his own slides.

During the 1920s, Warthin and a few other teachers were from time to time reprimanded by the dean for failing to show up to give an examination.11  Notwithstanding these occasional lapses, others observed that his teaching methods promoted academic success. Maude Abbott, MD (1869–1940), later observed that he was:

A really great teacher, whose fundamental methods and enthusiasm for exact knowledge gave the sure fundamentals of a sound training in pathology to many of the leaders in American medicine today. No better evidence of this latter point could be adduced than the splendid Anniversary Volume presented to him on his sixtieth birthday, containing scientific contributions from some sixty of his former pupils, practically all of whom have attained high professorial status.18 

As noted by Simpson, “this anniversary volume occupies a unique place in medical literature in that the papers which comprised the Festschrift were contributed by one or more students in each of the thirty-five classes which he had taught.”2(p504)Contributions to Medical Science Dedicated to Aldred Scott Warthin was published in 1927.22 

After 1900, Warthin had occasional teaching assistants or instructors. One of them, Peyton Rous, MD (1879–1970), after graduating from Johns Hopkins Medical School, worked with him for 2 years (c1905–1907) while training to become a pathologist. Rous won a Nobel Prize in 1966. Medical students usually worked for Warthin without pay, but 1 of them, Carl Vernon Weller (see below), was employed as an instructor from 1911 to 1913, at which time he received his Doctor of Medicine.11 

Warthin's mentor, George Dock, had served as the chair of the medical school library committee beginning in 1892. Under his leadership, periodical subscriptions grew substantially. While the collection of journals to support medical research became a strength, 2 weaknesses were identified, textbooks and historic sources. Upon Dock's departure, Warthin replaced Dock as chair. To rectify the former issue, each medical student was charged an annual US $2 library fee, which was used to purchase “new text-books as they are published, giving the student the opportunity to examine these before purchasing for himself or to use them as he desires.”23(p50) Warthin noted that the library's “one-sided development as a reference library makes it preeminently a library for the medical researcher rather than a library for the cultivated scholar in medicine. It has failed in just as important function, – its lack of cultural influence upon the students who make use of it.”23(p51) Warthin was able to obtain historical works through monetary gifts or direct book gifts.24 

Warthin became increasingly interested in medical history; his first historic work, An American Medical Student: James Jackson, Junior, 1810-1833 was published in 1903.25  In the 1910s and 1920s, Warthin hosted a monthly History of Medicine Journal Club that was open to his best students from his sophomore class and he asked these students to present history of medicine articles; this activity eventually continued as the Victor Vaughan Society.10,11 

Shortly after the Flexner Report in 1910 that revolutionized medical education in North America,26  Flexner aggressively promoted the adoption of having full-time clinical faculty. According to Davenport:

All members of the faculty received salaries from the university, but all were permitted to earn additional unlimited income from private practice. Among the preclinical faculty only Aldred Scott Warthin of pathology earned a substantial amount by examining slides submitted by outside physicians. [While] private practice among the clinical faculty varied greatly … the clinical faculty was adamantly opposed to the full time concept.27(pp26–27)

However, the idea did not go away entirely during Warthin's career. Boster and Howell10  describe how some hybrid models were resurrected. They note that “Warthin warned that this change in compensation could become problematic, asking ‘Will the old commercialism … be replaced by another form, even more dangerous to medical teaching and research than the divided interests of the old situation.”10(p103)

While Warthin enjoyed private practice income throughout his career, his successor, Weller, did not. When Warthin died in 1931:

The pathology service in the University Hospital was put on a full-time basis, and there was a debate on what to do with outside referrals. At first it was suggested that Weller continue the service, keeping half the fees and giving the rest to the university. Eventually, the Pathology Diagnosis Fund was created … Money in the fund would reimburse the university for services of its staff, an early version of overhead, and $4,000 would be added to Weller's salary. The substantial residue would be used for the benefit of the medical school, but it was made clear that there would be special attention to the needs of the Department of Pathology.11(p194)

One of the best-known stories about Warthin relates to his wife's seamstress telling him in 1895 that many of her family members had died of cancer and that she feared dying of cancer. For many years after this, he followed the morbidity and mortality in the seamstress's family, which he named “Family G.” While searching for other “cancer families,” he reviewed the charts of all cancer patients having had surgery at UH for the years 1907 to 1909 and noted the absence of reliable data pertaining to family history of cancer. According to hospital records, less than 1% of these patients had a family history of cancer, but when he followed up with letters and personal visits to these patients or their family members, the percentage rose to over 50%.28,29  In 1913, he published one of the first papers unambiguously documenting heritability of cancers.30  The paper included data from the UH Pathological Laboratory from 1895 to 1913. The power of his pathological study compared with previous studies using clinical histories or death certificates without pathologic confirmation was the certainty of diagnoses. The majority of these patients were local and, unlike patients from large cities, did not have multiple hospitals from which to pick. Warthin's catchment area strengthened the validity of his data. Although he found 29 cancer kindreds in Michigan,11  he published pedigrees of 4 cancer families, including Family G in his classic 1913 paper. In the seamstress's family, he noted 17 of 48 descendants of “the cancerous grandfather” died of or had been operated on for either carcinoma of the uterus or stomach.30  This Family G pedigree was later updated 3 times3133 ; by 1970, the pedigree included more than 650 blood relatives, 95 of which developed malignant neoplasms, including 13 with multiple primaries. Further research by Henry T. Lynch, MD (1928–2019), is credited with discovering hereditary nonpolyposis colorectal cancer, now known as Lynch Syndrome.34  Lynch published a brief biographical sketch on Warthin which stated that Warthin “can properly be called ‘the father of cancer genetics'.”35(p346) However, many other sources consider Lynch to hold this distinction.34,36 

While Warthin believed that some families have a hereditary susceptibility to cancer, he believed other families had a hereditary immunity. “For hereditary immunity he cited his own family. An eighth great-grandfather had 9,000 blood descendants in whom cancer was one of the rarest occurrences.”11(p197) Warthin continued to publish on heritability of cancer, publishing his final paper in his Annals of Internal Medicine only 4 months before his death.29 

Warthin's work in this field was largely forgotten until resurrected by Lynch. In fact, it had been actively suppressed. Warthin's first paper was published in 1913, shortly after the American Society for Cancer Control, which eventually evolved into the American Cancer Society, was formed. The American Society for Cancer Control was formed to promote the concept that cancer is curable when detected early (ie, this was called their DO NOT DELAY campaign). As noted by medical historian Toine Pieters, PhD:

The cancer idiom of heredity that was associated with shame, fatalism and stigmatization became regarded as counterproductive to the ‘Do Not Delay' message. The ‘cancer prevention propagandists', as Warthin rather cynically called them, strongly believed that one of the major reasons for laymen to delay seeking medical attention was the creation of cancer-phobic states of mind by unfounded notions of hereditary and a predestination to certain doom. Not surprisingly, in the propaganda literature of the American Society for Cancer Control, little, if any, attention was paid to a hereditary factor in the aetiology of cancer … [as] in the interests of the American public, this hereditary doctrine ought to be combated … Even in his position as editor of the Annals of Internal Medicine and president of the American Association for Cancer Research, Warthin was unable to distinguish himself from a voice crying in the wilderness.37(p98)

Many decades later, this problem persisted as David J. Cantor, PhD, former director in the Office of History at the National Institutes of Health, noted that Henry Lynch experienced similar “difficulty winning over the American Cancer Society and other powerful groups, which feared that labeling cancer an heritable disease could discourage people from undergoing screening tests.”34 

Beginning in 1901, Warthin published a series of 9 papers on lymph node (hemolymph glands) histology and pathology,22,38  becoming recognized as an expert. He also did experimental studies related to lymph nodes.22,39  Later, he described the interrelationship of leukemias, lymphomas, and Hodgkin disease.4,22  In 1931, he described what are now known as Warthin-Finkeldey giant cells in measles (NB, W. Finkeldey described them in the German literature 1 year later).40  He published multiple observations on splenic hypertrophy with anemia (Banti disease).22  Warthin once reported findings in 50 000 tonsils. Previously thought to be rare, he diagnosed more than a dozen cases of tuberculosis of the placenta.41  He contributed to understanding the pathology of hyperthyroidism.4,22  A list of many of his publications is available elsewhere.22 

Warthin is particularly remembered for describing a relatively common, parotid tumor, papillary cystadenoma lymphomatosum (now called Warthin tumor), although he was not the first to describe it.42,43  Warthin reported 2 cases in 1929,44  and the paper was barely noticed at the time. Warthin described the tumor as papillary epithelial tumor with a lymphoid stroma, with epithelium composed of 2 layers, a tall ciliated columnar layer and a basal layer of polyhedral cells. Likely because of the cilia, he believed these tumors arose “as developmental disturbances of accessory Eustachian tube anlage.” More than 50 years later, the slides from Warthin's first patient were reexamined and the presence of ciliated epithelium could not be confirmed.43 

Warthin pushed his laboratory to be able to turn out permanent sections quickly, often within 24 hours. Therefore, as noted by Davenport: “He thought the number of cases requiring diagnosis while the patient was on the operating table to be very small, and he was contemptuous of the routine use of what he called slap-dash frozen sections.”11(p193) In fact, Warthin and James Ewing, MD (1866–1943), were 2 of the strongest frozen section opponents at a time in which organized surgery, organized pathology, the Mayo Clinic, and Joseph Colt Bloodgood of Johns Hopkins were strongly advocating for the widespread use of the technique.12,45  Warthin was not entirely opposed; he simply believed the technique was greatly over-used.1(p747–748)

Throughout the 1920s, histologic grading of cancers became a popular way for pathologists to help surgeons predict patient prognosis.46  Warthin rejected this popular concept and believed that “many … attempted gradings of neoplasms are based upon false principles, and are dangerous.” His major concern was “that all degrees of anaplasia may be found in a single specimen,” and therefore, the process was prone to sampling errors. He also had noted that some anaplastic tumors did not metastasize while some bland malignancies did. Having himself documented the existence of familial cancers, he believed that “family history is an important factor in determining prognosis.” He noted that cancers in patients with a family history developed early and were more aggressive.1(pp749–750)

Burr's Medical History of Michigan is perhaps the best place to read about Warthin's contributions to public health.3  Warthin wrote extensively about tuberculosis and led a public health campaign against it in Michigan.3,22,47 

In 1912, after predicting it 15 years earlier, Warthin reported the widespread presence of the fish tapeworm (Dibothryocephalus latus) in Michigan; he reminded the public that its larvae existed in the muscle of whitefish in the Great Lakes area and that it could cause severe anemia, resembling pernicious anemia, in people consuming raw or undercooked fish.3,22 

During World War I, the introduction of chemical warfare resulted in massive casualties and the need to understand their mechanism of action and the pathology they induced.48  Warthin and his associate Weller performed animal studies to understand the nature of the cutaneous and pulmonary lesions produced by mustard gas and these were published at the end of the war.49,50  He also described pathologic features of radiation damage.4,22 

Warthin developed an intense interest in syphilis after reading a report from Bellevue Hospital (New York, New York) that surprised him. A pathologist there reported finding only 314 cases of syphilis in 4800 autopsies. Warthin, on the other hand, had found 300 positive cases in 750 UH autopsies. He believed that the incidence in indigent patients at Bellevue should be higher than in the Midwest. He believed the explanation was that the Bellevue pathologist had relied on gross diagnoses while Warthin was staining for spirochetes.51 

Initially, Warthin had used the silver reduction method of Constantin Levarditi, MD (1874–1953), which required 7 to 10 days to give results. Warthin was convinced that this method resulted in many false negatives; therefore, he and his research assistant, Allen Chronister Starry, MD (1890–1973), improved the process, allowing results in 10 hours or less.52  However, results with the improved method were not uniform, meaning that negative results could not always be trusted and so Warthin often restained negative sections from cases he believed highly suspicious. To further reduce variability, he had a single technician do his spirochete staining. He later published 3 further improvements to the Warthin-Starry method.5355  Because of the quality of his laboratory's staining, Warthin's could often find spirochetes in specimens that might easily be missed elsewhere. However, Warthin's clinicians did not always appreciate the high frequency of this diagnosis in his autopsy reports on their patients.11 

Warthin advanced the concept of latent syphilis. He had studied under Alexander Kolisko at the Viennese autopsy table in 1893, well before the discovery of Spirochaeta pallida in 1905. Kolisko taught him that focal fibrotic thickening of the meninges was a sign of syphilis even when gummas could not be seen grossly. Warthin became an expert on histologic diagnosis in the absence of gross findings (latent syphilis). He published extensively, including providing advice on which organ systems one could successfully stain for spirochetes as well as highlighting organ systems in which staining would usually be negative (primarily meninges, central nervous system, ovary, fallopian tube, and lungs). Throughout his life, he continued to accept thickened fibrotic foci in the meninges, if accompanied by pervascular lymphocytes and plasma cells, as diagnostic. Therefore, he examined meninges grossly with oblique light or by floating them on water to better visualize these focal lesions.11,56,57  Warthin was also interested in the cardiovascular consequences of syphilis and published original observations.58 

Warthin believed in thymic hyperplasia, status (thymico) lymphaticus, thymic stridor, thymic asthma, and thymic death (“mors thymica”), and he wrote dogmatically about these interrelated clinical and pathologic entities.5961  The underlying concept was that an enlarged thymus can compress the trachea and other underlying structures, and can be fatal, especially in children. He believed an enlarged thymus could usually be seen at autopsy, but when caused by congestion could be missed. Warthin and some other contemporary physicians believed that children with an enlarged thymus had a “thymolymphatic constitution,” which predisposed them to sudden death, and that children with clinically diagnosed thymic enlargement should receive prophylactic irradiation. In some instances, this treatment eventually resulted in secondary malignancies.11  None of the above-mentioned thymic entities are currently believed to exist and have been discussed in detail elsewhere.62 

Why was Warthin so interested in thymic hyperplasia? During his summers studying in Germany in the 1890s, Warthin learned about “constitutional pathology,” as this concept was in vogue among German pathologists from the 1880s through the 1920s. German medical historian Cay-Rüdiger Prüll, PhD, provides excellent insight into this important theoretic concept.63  By the late 19th century, German anatomic pathologists were having a turf war with German hygienists (bacteriologists). Before the discovery of bacteria, anatomic pathologists reigned supreme in the Germanic medical hierarchy. However, it bothered Rudolf Virchow (1821–1902) and other German pathologists that autopsies sometimes did not provide a cause of death. Hygienists, who had essentially locked German pathologists out of the field of bacteriology, were legitimately claiming to have found the causes of various diseases, rather than simply describing them. German anatomic pathologists countered by focusing on the importance of the human “constitution” as an “inner cause of disease.” It was commonly believed that some individuals were simply weaker than others. Status thymicolymphaticus became the “poster disease” for constitutional pathology and more than 800 papers were published on this topic between its “discovery” in 1888 by Paul Albert Grawitz (1850–1932), a German pathologist trained by Virchow, and 192362 ; several of these papers were written by Warthin. Related to this, Ziegler's textbook, which Warthin translated in 1908, describes thymic conditions called “constitution lymphatica”20(p89) and “general feebleness of constitution, as shown by its inability to withstand external influences.”20(p49) Such ideas likely resonated with Warthin because they were consistent with his beliefs in the evolutionary concept of survival of the fittest. Warthin's incorrect beliefs on constitutional pathology and thymic death were products of the time period in which he practiced and his German training.

Warthin was asked to give the New York Academy of Medicine's first Wesley M. Carpenter Lecture on October 1, 1928. It was the keynote lecture for their program entitled “The Problem of Aging and Old Age.” Here he described life very matter-of-factly as a 3-act play, saying:

The title of this tragicomedy is “The Life of Man”: its three acts are entitled: I, Evolution; II, Maturity; III, Involution. It is the story of a living, multicellular organism – a chemicophysical machine transforming, storing and releasing energy – capable of building and restoring its own substance, and repairing its wear-and-tear damage within certain bounds, but only for a limited period of time. As is the case with all energy-producing machines, the life of the individual human machine is not immortal, but has, perforce, from the very nature of its substance and construction, the complexity and intricate relationships of its manifold parts, and peculiar nature of the work it has to do, a limited period of useful existence. The individual machine wears out: but before wearing out it has the power of producing out of its own substance and energy-store the materials for the evolution of other machines of its own kind. Although mortal as an individual organism, it secures a potential immortality for its kind. It does this, however, at the price of its own self-destruction, for under normal conditions its duration of existence is determined by factors inherent within the machine itself… Unfavorable factors in the environment may check the career of the individual at any time in its course—pathologic extrinsic death—the most common fate of animal life; or there may be present inherent abnormalities in the germ plasm of any given line fore-ordaining its early or premature termination—pathologic intrinsic death (inherited). Very few, if any, human beings achieve a biologic span of life and a normal intrinsic death; the great majority succumb to a pathological extrinsic death, a smaller number to a pathologic intrinsic death.64(pp1006–1008)

The academy sponsored the event, which also featured other prominent speakers, including Nobel Prize-winning surgeon Alexis Carrel (1873–1944), to address recent claims of charlatans who, recognizing that modern medicine had been successful at prolonging life, were now attempting to monetize false claims that it was possible to reverse aging and prolong life indefinitely.64  According to Warthin:

The deferring of old age, the rejuvenating of the senescent individual is but idle and foolish talk, and we have had much of this in the last decade. What modern medicine has accomplished along the lines of hygiene and the prevention of disease has only been to increase the number of human individuals, both fit and unfit—unfortunately too many of the latter kind—who come to maturity and to the period of senescence. There may be individuals who wish to live to the very limit of their biologic allotment, to pass the last decade or two of their descent to the grave in uselessness, non-productive existence, dependency, in personal discomfort, and a burdon to others – I personally am not of that sort.64(pp1045–1046)

Almost 70 years later, historian of geriatrics W. Andrew Achenbaum, PhD, considered this conference to have been simultaneously an important event and a missed opportunity that should have kick-started geriatrics and gerontology research in America.65 

Warthin used this lecture as the “nucleus” for his 198-page long monograph, “Old Age: The Major Involution: The Physiology & Pathology of the Aging Process,” which he published in 1930. Warthin dedicated this book to Peyton Rous, One-time Assistant of Mine, and Ever Since a Dearly Beloved Friend. The monograph reproduces, with the permission of the academy, his Carpenter Lecture, adding additional text, images, and analysis.66 

Of note, Sir William Osler, whom Warthin greatly admired,67  had made a glib statement in a public lecture in 1905, essentially quipping that the elderly cease to be useful and should be chloroformed at age 60. Although he was approaching 60 himself and was not serious, Osler quickly regretted it when the world press latched on to the statement,68  which still reverberates today.69,70  Warthin, who would have been aware of Osler's faux pas, was never repentant related to his controversial views on aging.

The concept of eugenics was popular among many academics at the time of Warthin.71,72  Warthin, who had become an atheist, was swept into this movement by people he admired. His original biology mentor, Jordan, was a staunch proponent,73  as was Victor Vaughan, his first Dean at U of M. Vaughan was outspoken on the topic and lectured widely in the 1910s. Vaughan spoke at and was an organizer of a state-wide conference in Battle Creek, Michigan sponsored by the Race Betterment Foundation and cereal magnate John Harvey Kellogg, MD (1852–1943).27,7476  Warthin, who was a friend of Kellogg, embraced Kellogg's “religion of biologic living,”75  and he presented a paper on this topic at Kellogg's conference in 1928,77  which became the basis of Warthin's book, The Creed of the Biologist, 2 years later.78  Warthin believed in a sort of Lamarckian form of evolution, in which positive or negative acquired traits in humans can be passed on to their offspring. Warthin, and his successor Weller, both believed blastophthoria (the degeneration of germ plasm due to poisoning by lead, alcohol, syphilis, or other disease) partially accounted for transmission of negative acquired characteristics. In fact, Weller developed a small animal model to study the phenomenon.79  Warthin's belief in “constitutional pathology” would also have figured into his eugenics beliefs.

Surrealistically, Warthin's longstanding obsession with eugenics and his belief that acquired traits can be inherited motivated his research on cancer families. Likewise, his preoccupation with syphilis's blastophthoric effect on the germ plasm likely led him to optimize Warthin-Starry staining.

Carl Vernon Weller, MD, was Warthin's assistant, long-time collaborator, and successor. He was born in St. Johns, Michigan on February 17, 1887. He received his Bachelor of Arts from Albion College in Albion, Michigan (1908) and his Doctor of Medicine (1913) and Master of Science (1916) from U of M. He began his career as an instructor in 1911 and served at U of M for another 45 years. He was promoted to assistant professor in 1916 but further “promotion came slowly … until he began to receive offers from outside, and on March 3, 1924, Warthin recommended Weller's promotion to full professorship to head off a bid from Iowa.”11(p192) He later served 25 years as department head, replacing Warthin upon his death. He also replaced Warthin as editor of the Annals of Internal Medicine (1931–1933) and was later editor-in-chief of the American Journal of Pathology (1941–1956). According to his successor A. James French, MD (1921–1985), he was “the author of approximately 100 publications that dealt chiefly with poisoning by mustard gas, neoplasms, tuberculosis, blastophthoria as a result of poisoning by lead and alcohol, and the history of medicine.”80(p332) In 1916, he was awarded a bronze medal from the American Medical Association for his blastophthoria research.79,81  Initially, he accepted Warthin's beliefs about cancer susceptibility, and he extended Warthin's cancer family to another generation.32  However, after noting a rapid increase in the incidence of lung cancer, he began to accept the importance of extrinsic factors in cancer susceptibility. He was one of the early proponents suggesting lung cancer was caused by smoking. He died suddenly of a coronary artery thrombosis on December 10, 1956. The Michigan Pathological Society, which he founded, established a lectureship in his name.80 

Weller appears to have greatly respected his mentor as he organized Warthin's 60th birthday celebration and, importantly, compiled Warthin's publications before this date.22 

While it is easy to access the overall importance of Warthin's publication opus, he was so prolific that his total number of publications is unknown and cannot be accurately estimated. Weller provides a list of Warthin's 158 journal articles, 104 articles in volumes 1 through 8 of Reference Handbook of Medical Sciences edited by Albert H. Buck, MD (1842–1922) (IndexCat lists this as a journal but these would essentially be short review articles rather than generation of new knowledge), 7 books, and 18 book chapters22  published before October 21, 1926. Unfortunately, there is no ongoing list covering the last 4.5 years of his life, but it is known that he published at least 3 more books.66,78,82  One of these has not been previously mentioned.

As noted above,16  Warthin had extremely diverse interests including studying the arts in his spare time; his final book, published just before his death, is entitled The Physician of the Dance of Death. It is a limited-edition book with only 1000 numbered copies printed. It includes Warthin's lifetime collection of artistic depictions of death covering 6 centuries and his scholarly analysis of each image. The book begins with black and white prints of several versions of the “Danse Macabre,” including copies of the original from the cloisters of the churchyard of the Innocents in Paris, a wall painting from 1424.

Davenport in his biography of George Dock describes the origin of this book as follows:

Warthin took over the lectures in pathology from Dock in 1898 and in 1903, on one of his trips to Germany, Warthin saw [Albrecht] Dürer's Ritter, Tod und Teufel in a shop window; he bought it as the first of a collection that grew to 685 etchings, drawings and prints depicting Death. In 1931 he published a handsome volume, The Physician of the Dance of Death, based upon his collection. He intended to present the first copy to Dock, inscribing it in a shaky hand: “George Dock, from Aldred Scott Warthin, In Memory of the good times we had in the 1890's” but Death danced off with him [Warthin].7(p12)

It is unknown how many papers he published after his 60th birthday. According to Simpson, Warthin continued to publish at a high level of productivity for the remainder of his life and still had many papers “in the works” when he died.2 

Warthin made many important contributions, including the development of academic pathology in Ann Arbor. His name is eponymously associated with Warthin-Finkeldey giant cells in measles, Warthin tumor of the parotid, and Warthin-Starry stain for the diagnosis of syphilis. He published extensively on the histology and pathology of lymphoid tissue and he described the interrelationship of leukemias, lymphomas, and Hodgkin disease. He made seminal early contributions related to cancer genetics. Later in his career, he published a monograph on the pathology of aging and became outspoken on this topic. In his Carpenter Lecture on aging, Warthin concluded:

Happy then is the senescent who can approach his inevitable end with normal cerebral rate of involution, still capable of intellectual pleasures, and the mature contemplation thereof, and meet a speedy release before the unhappy days of second childhood are upon him.64(p1046)

The always erudite, outspoken, and controversial Aldred Scott Warthin exited the world as he wished; he was productive for his entire mature life and then “danced away” after spending a day gardening.

The author thanks Kristin Rodgers, MLIS, collections curator, The Ohio State University Health Sciences Library Medical Heritage Center; Thomas Kryton, BFA; Charlotte Monroe; and the University of Calgary Interlibrary Loan Service.

1.
Warthin
AS
.
Forty years as a clinical pathologist
.
J Lab Clin Med
.
1931
;
16
:
743
750
.
2.
Simpson,
WM
.
Aldred Scott Warthin, 1866-1931
.
Am J Surg
.
1931
;
14
:
502
504
.
3.
Burr
CB
,
Michigan State Medical Society.
Medical History of Michigan
.
Vol.
1
.
Minneapolis, MN
:
Bruce Publishing Co.
;
1930
:
625
813
.
4.
Wick
MR
.
Warthin, Alfred Scott (1866–1931)
.
In:
van den Tweel
JG
,
eds.
Pioneers in Pathology (Encyclopedia of Pathology)
.
Berlin, Germany
:
Springer Science+Business Media; 1997:544–546
.
5.
Nair
VG
,
Krishnaprasad
HV
.
Aldred Scott Warthin: pathologist and teacher par excellence
.
Arch Med Health Sci
.
2017
;
5
(1)
:
123
125
.
6.
Jordan
DS
.
The Days of Man: Being Memories of a Naturalist, Teacher and Minor Prophet of Democracy
.
Vol. 1 1851-1899 and Vol. 2. 1900-1921
.
Yonkers-on-Hudson, NY
:
World book Co.
;
1922
.
7.
Davenport
HW
.
Doctor Dock. Teaching and Learning Medicine at the Turn of the Century
.
London, UK
:
Rutgers University Press;
1987
.
8.
Warthin
AS
.
Scheme for the Systematic Study of Medical Cases
.
Ann Arbor, MI
:
The Register Publishing Co.;
1892
.
9.
Warthin
AS
.
Accentuation of the pulmonary second sound: an important sign in the diagnosis of pericarditis
.
Med News
.
1895
;
66
:
395
399
.
10.
Boster
DH
,
Howell,
JD
.
Medicine at Michigan. A History of the University of Michigan Medical School at the Bicentennial
.
Ann Arbor, Michigan
:
University of Michigan Press;
2017
.
11.
Davenport
HW
.
Fifty Years of Medicine at the University of Michigan 1891-1941
.
Ann Arbor, Michigan
:
The University of Michigan Medical School;
1986
.
12.
Wright
JR
Jr
.
The development of the frozen section technique, the evolution of surgical biopsy, and the origins of surgical pathology (William Osler Medal Essay)
.
Bull Hist Med
.
1985
;
59
(3)
:
295
326
.
13.
Wright
JR
Jr
.
The politics underlying the provision of and changes in pathology and laboratory services in the United States during the Roaring Twenties
.
Arch Pathol Lab Med
.
2016
;
140
(9)
:
983
991
.
14.
Wright
JR
Jr
.
The American College of Surgeons, minimum standards for hospitals, and the provision of high quality laboratory services
.
Arch Pathol Lab Med
.
2017
;
141
(5)
:
704
717
.
15.
Welleria aftonensis Warthin.
Smithsonian Institute Web site
.
October
19,
2020
.
16.
Martin
CF
.
Aldred Scott Warthin, M.A., Ph.D., M.D., LL.D. (Hon.)
.
CMAJ
.
1931
;
25
(1)
:
83
.
17.
Dr.
A. S. Warthin Passes Away Here. Death follows return to home after prolonged illness in Baltimore hospital. Private funeral service planned Monday
.
Ann Arbor News
.
May 23, 1931. Accessed November 21, 2020.
18.
Abbott
ME
.
Aldred Scott Warthin, M.A., Ph.D., M.D., LL.D. (Hon.)
.
CMAJ
.
1931
;
25
(1)
:
82
83
.
19.
Cooke
RA
.
Scientific Medicine in the Twentieth Century: A Commemoration of 100 Years of the International Association of Medical Museums and the International Academy of Pathology
.
Charlotte, NC
:
Information Age Publishing;
2006
20.
Ziegler
E.
General Pathology tr. from the 11th rev
.
German ed. (Gustav Fischer, Jena, 1905) edited and brought up to date by Aldred Scott Warthin ... with 604 illustrations in black and color.
New York, NY
:
W. Wood Co.
;
1908
21.
Warthin
AS
.
Practical Pathology. A Manual of Autopsy and Laboratory Technique for Students and Physicians. 2nd ed
.
Scotts Valley, CA
:
CreateSpace Publishing;
1911
.
22.
Stone
WJ
,
Weller
CV
.
Contributions to Medical Science Dedicated to Aldred Scott Warthin
.
Ann Arbor, MI
:
George Wahr;
1927
.
23.
Warthin
AS
.
The Medical Library of the University of Michigan
.
Bull Med Libr Assoc
.
1917
;
6
(3)
:
46
53
.
24.
Warthin
AS
.
The Peter White Gift to the Medical Library
.
Ann Arbor, MI
:
Ann Arbor Press;
1916
.
25.
Warthin
AS
.
An American Medical Student: James Jackson, Junior, 1810-1833
.
Whitefish, MT
:
Kessinger Publishing;
1903
:
1
14
.
26.
Ludmerer
KM
.
Learning to Heal: The Development of American Medical Education
.
New York, NY
:
Basic Books;
1985
.
27.
Davenport
HW
.
Victor Vaughan: Statesman and Scientist
.
Ann Arbor, Michigan
:
Historical Center for the Health Sciences University of Michigan;
1996
.
28.
Tobin
J.
The rounded life of Aldred Warthin. Medicine at Michigan Web site
.
2020
.
29.
Warthin
AS
.
Heredity of carcinoma in man
.
Ann Intern Med
.
1931
;
4
:
681
696
.
30.
Warthin
AS
.
Heredity with reference to carcinoma as shown by the study of the cases examined in the pathological laboratory of the University of Michigan, 1895-1913
.
Arch Int Med
.
1913
;
12
:
546
555
[Reprinted in: CA Cancer J Clin. 1985;35(6):348–359].
31.
Warthin
AS
.
The further study of a cancer family
.
J Cancer Res
.
1925
;
9
:
279
286
.
32.
Hauser
IJ
and
Weller
CV
.
A further report on the cancer family of Warthin
.
Am J Cancer
1936
;
27
:
434
449
.
33.
Lynch
HT
,
Krush
AJ
.
Cancer Family “G” revisited: 1895-1970
.
Cancer
.
1971
;
27
(6)
:
1505
1511
.
34.
Marcus
A.
Henry
T.
Lynch obituary
.
The Lancet
.
2019
;
394
(10192)
:
22
.
35.
Lynch
HT
.
Classics in oncology. Aldred Scott Warthin, M.D., Ph.D. (1866-1931)
.
CA Cancer J Clin
.
1985
;
35
(6)
:
345
347
.
36.
Lynch
Henry T.
.
Wikipedia Web site
.
2020
.
37.
Pieters
T.
Aldred Scott Warthin's Family ‘G': The American plot against cancer and heredity (1895–1940)
.
In:
Petermann
H
,
Harper
P
,
Doetz
S
,
eds.
History of Human Genetics
.
Switzerland AG
:
Springer;
2017
.
38.
Warthin
AS
.
A contribution to the normal histology and pathology of the hemolymph glands: preliminary report
.
J Boston Soc Med Sci
.
1901
;
5
:
415
436
.
39.
Warthin
AS
.
The changes produced in the hemolymph glands of the sheep and goat by splenectomy, hemolytic poisons, and hemorrhage
.
J Med Res
.
1902
;
7
(4)
:
435
463
.
40.
Warthin
AS
.
Occurrence of numerous giant cells in the tonsils and pharyngeal mucosa in the prodromal stage of measles: report of four cases
.
Arch Pathol
.
1931
;
11
:
864
874
.
41.
Warthin
AS
.
Tuberculosis of the placenta: a histological study with especial reference to the nature of the earliest lesions produced by the tubercle bacillus
.
J Infect Dis
.
1907
;
4
(3)
:
347
368
.
42.
Chapnik
JS
.
The controversy of Warthin's tumor
.
Laryngoscope
.
1983
;
93
:
695
716
.
43.
Baugh
RF
.
Aldred Scott Warthin. The man behind the tumor
.
Arch Otolaryngol Head Neck Surg
.
1987
;
113
(4)
:
365
367
.
44.
Warthin
AS
.
Papillary cystadenoma lymphomatosum
.
J Cancer Res
.
1929
;
13
:
116
125
.
45.
Wright
JR
Jr
.
The radicalization of breast cancer surgery: Joseph Colt Bloodgood's role in William Stewart Halsted's Legacy
.
Bull Hist Med
.
2018
;
92
(1)
:
141
171
.
46.
Wright
JR
Jr
.
Albert
C.
Broders' paradigm shifts involving the prognostication and definition of cancer
.
Arch Pathol Lab Med
.
2012
;
136
(11)
:
1437
1446
.
47.
Warthin
AS
.
The organization of a state anti-tuberculosis association
.
J Michigan Med Soc
.
1908
;
7
:
1
7
.
48.
Wright
JR
Jr
,
Baskin
LB
.
Pathology and laboratory medical support for the American Expeditionary Forces by the US Army Medical Corps during World War I
.
Arch Pathol Lab Med
.
2015
;
139
(9)
:
1161
1172
.
49.
Warthin
AS
,
Weller
CV
.
The medical aspects of mustard gas poisoning
.
St Louis, MO
:
C. V. Mosby Co
;
1919
.
50.
Warthin
AS
.
The general pathology of mustard gas (dichloroethylsulphide)
.
J Lab Clin Med
.
1919
;
4
:
265
306
.
51.
Warthin
AS
.
The new pathology of syphilis
.
Harvey Lectures
.
1919
;
13
:
67
96
.
52.
Warthin
AS
and
Starry
AS
.
A more rapid and improved method for demonstration of spirochetes in tissues
.
Am J Syphilis
.
1920
;
4
:
97
104
.
53.
Warthin
AS
and
Starry
AS
.
Second improved method for the demonstration of Spirochaeta pallida in tissues
.
JAMA
.
1921
;
76
:
234
237
.
54.
Warthin
AS
.
A Silver-starch-gelatine method for the demonstration of spirochetes in single tissue sections
.
Br J Vener Dis
.
1929
;
5
(4)
:
255
266
.
55.
Warthin
AS
and
Farrier
R.
A study of the effect of pH upon the third improved Warthin-Starry method for demonstrating spirochete in single sections
.
Am J Syphilis
.
1930
;
14
:
394
401
.
56.
Warthin
AS
.
Lesions of latent syphilis
.
Br Med J
.
1929
;
2
(3579)
:
236
242
.
57.
Warthin
AS
.
The lesions of latent syphilis
.
Southern Med J
.
1931
;
24
:
273
278
.
58.
Warthin
AS
.
The role of syphilis in the etiology of angina pectoris, coronary arteriosclerosis and thrombosis and of sudden death
.
Am Heart J
.
1930
;
6
:
163
171
.
59.
Warthin
AS
.
The clinical diagnosis of enlargement of the thymus
.
Internat Clinics
.
1907
;
1
:
49
66
.
60.
Warthin
AS
.
Diseases of the thymus
.
In:
Modern Medicine
.
Osler
W
,
ed.
Philadelphia, PA
:
Lea & Febiger;
1908
:
779 Osler W, 807.
61.
Warthin
AS
.
The pathology of thymic hyperplasia and the status lymphaticus
.
Arch Pediatr
.
1909
;
26
:
597
617
.
62.
Wright
JR
Jr
.
A fresh look at the history of SIDS
.
Acad Forensic Pathol
.
2017
;
7
(2)
:
146
162
.
63.
Prüll
CR
.
Holism and German pathology (1914-1933)
.
In:
Greater than the parts: Holism in Biomedicine, 1920-1950
.
New York, NY
:
Oxford University Press;
1998
:
46
67
.
64.
Warthin
AS
.
The pathology of the aging process
.
Bull N Y Acad Med
.
1928
;
4
(10)
:
1006
1046
.
65.
Achenbaum
WA
.
Crossing Frontiers: Gerontology Emerges as a Science
.
Cambridge, UK
:
Cambridge University Press;
1995
:
52
53
.
66.
Warthin
AS
.
Old Age: The Major Involution: The Physiology & Pathology of the Aging Process
.
New York, NY
:
PB Hoeber;
1930
.
67.
Bryan
CB
.
Warthin, Aldred Scott, Reminiscence of William Osler
.
In:
Sir William Osler: An Encyclopedia
.
CS
Bryan
,
Novato,
CA
,
eds.
Novato, CA
:
Jeremy Norman & Co.;
2020
:
819
820
.
68.
Bliss
M.
William Osler: A Life in Medicine
.
Toronto, Canada
:
University of Toronto Press;
1999
:
323
327
.
69.
Bryan
CB
.
Osler goes viral: “The Fixed Period” revisited
.
Proc (Baylor Univ Med Cent)
.
2018
;
31
(4)
:
550
553
.
70.
Ambrose
CT
.
William Osler and the “fixed period” of creativity
.
J Med Biogr
.
2019
;
27
(4)
:
189
197
.
71.
Gillette
A.
Eugenics and the Nature-Nurture Debate in the Twentieth Century
.
New York, NY
:
Palgrave Macmillan;
2007
.
72.
Bashford
A
,
Levine
P.
The Oxford Handbook of the History of Eugenics
.
New York, NY
:
Oxford University Press;
2010
.
73.
Jordan
JS
.
The Blood of the Nation: A Study in the Decay of Races by Survival of the Unfit
.
Boston, MA
:
American Unitarian Association;
1901
.
74.
Vaughan
VC
.
A Doctor's Memories
.
Indianapolis, IN
:
The Bobbs-Merrill Co.;
1926
.
75.
Wilson
BC
.
Dr. John Harvey Kellogg and the Religion of Biologic Living
.
Bloomington, IN
:
Indiana University Press;
2014
.
76.
Markel
H.
The Kelloggs: The Battling Brothers of Battle Creek
.
New York
:
Pantheon Books
,
2017
.
77.
Warthin
AS
.
A biologic philosophy or religion a necessary foundation for race betterment
.
In:
Proceedings of the Third Race Betterment Conference
.
Battle Creek, MI
:
Race Betterment Foundation;
1928
:
86
90
.
78.
Warthin
AS
.
The Creed of a Biologist: A Biologic Philosophy of Life
.
New York, NY
:
P.B. Hoeber
;
1930
.
79.
Weller
CV
.
Histological study of the testes of guinea pigs showing lead blastophthoria. Preliminary report
.
Proc Soc Exp Biol Med
.
1916
;
14
:
14
.
80.
French,
AJ
.
Weller
Carl Vernon
1887-1956
.
Am J Clin Pathol
.
1957
;
27
(3)
:
332
334
.
81.
The Michigan Alumnus
.
1916-17
;
23
:
75
75
.
82.
Warthin
AS
.
The Physician of the Dance of Death: A Historical Study of the Evolution of the Dance of Death Mythus in Art
.
New York, NY
:
Paul B Hoeber Inc;
1931
.

Author notes

The author has no relevant financial interest in the products or companies described in this article.