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 of Pathology.

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.

Robin Cooke
(with assistance from Bill Gardner, Adonis de Carvalho and Isabell Sesterhenn.)

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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 they could.

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.

Diana Mayne,
Melbourne.

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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 book.

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 of Pathology.

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 year.

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.

Robin Cooke
Editor
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

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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 interests.

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.

Robin Cooke