From Embryos to Autopsies
Date: June 7, 2013
In 1935, decades before high definition cameras, magnetic resonance imaging, or digital photography, a young Baltimore photographer, Chester Reather, sat down at a small photographic microscopy bench that he had helped build and began photographing human embryos. There, in the Carnegie Institution’s Department of Embryology on the Johns Hopkins University campus, began the career of one of the world’s future leading biomedical photographers.
Reather had been hired to photograph embryos collected by department director George Streeter and his predecessor Franklin Mall, an anatomy professor who had brought the earliest collection to Baltimore in a fireproof vault in 1914. At Carnegie, Reather began his life’s work: collecting, photographing, and gradually classifying human embryos into stages, known as “developmental horizons.”
His photographs were published in the late 1940s in Life magazine to an astounded world audience—and eventually in Encyclopedia Britannica and Streeter’s classic textbook, Contributions to Embryology of the Carnegie Institution of Washington.
Photomicroscopy (photography through a microscope) was a developing art around that time. The Baltimore Sun, in a 1938 article, noted the field’s limitations: “Natural color photography of medical subjects can be made for publication or lantern slides but they are not yet so satisfactory as the average color drawing.” But the same article marveled at the new access to the body that the camera could provide, with details about “a diminutive camera, equipped with a flashlight, which takes candid shots of the interior of the stomach or bladder.”
World War II interrupted the progression of biomedical photography at Johns Hopkins, as photographers were called away for wartime service, but related technology—in lens, film, and shutter speeds—advanced. Returning from his own wartime service as a reconnaissance photographer, Reather freelanced for Johns Hopkins physicians, helping them visualize their research for publication.
Recognizing medical photography’s increasing sophistication and contributions to the advancement of medical knowledge, the Johns Hopkins School of Medicine brought Reather into the Department of Art as Applied to Medicine in 1950, as director of photographic services. Reather continued to specialize in photomicrography and to collect embryos to fill any gaps in the development continuum. Before long, photography became its own distinct specialty within the School of Medicine.
Within Reather’s purview were several smaller photography labs, including those in pathology, radiology, and the Wilmer Eye Institute. Among his early additions to this federation of photographic specialties was a “moving picture” subunit, to document surgeries and clinical developments.
Reather’s first decade as photography chief coincided with a golden era of medical slide creation for research and clinical presentation. By decade’s end, the large glass lantern slides of the ’30s and ’40s and ’50s were giving way to a new 35-millimeter format. The new technology, coupled with Reather’s leadership, coalesced at Hopkins to produce one of the nation’s first, and soon foremost, training programs in biomedical photography.
Reather’s first trainee in the two-year certificate program was Raymond “Pete” Lund, a former Navy corpsman and photography hobbyist, who joined Reather’s group in 1959. Five years later, Reather asked him to head the Department of Pathology’s photo lab, which specialized in autopsy and gross photography, housed one antiquated microscope, and offered only black-and-white prints.
Lund soon set his satellite group apart from Reather’s in a critical way: He offered same-day services, and determined that his group’s services would be consistently highly organized, user-friendly, and accessible. “Chester was a methodical, modest, gentle man, content to work in a small lab, but less so as director of a large program,” says Lund today. “I, on the other hand, was a very demanding boss.”
Under Lund’s push for performance, Pathology Photo grew and grew, eventually becoming independent from Reather’s Department of Photographic Services—and subsuming it. “I converted radiology photography into a color processing lab, and later absorbed the central photo lab, after Chester retired, and another in the outpatient building,” says Lund. “Our staff grew to 25 or more people.”
The funds that Lund’s fee-for-service department made during his tenure were invested back into technology and equipment. “I had a medical artist early on, but he moved to Art as Applied to Medicine,” says Lund. “I just couldn’t charge what his time was worth. It takes a lot longer to create a drawing.”
Pathology was “a very heavy user of our services,” he says, and slide creation was still a bread-and-butter business. Lund and his team churned out photos and slides of everything, from autopsies to surgeries to genetic studies—photographing up to 20 patients in a day. They photographed many of the individuals in pioneering geneticist Victor McKusick’s chromosomal studies, including those with Down syndrome and inheritable disorders of connective tissue, such as Marfan syndrome. Such photos appeared in McKusick’s landmark 1966 Mendelian Inheritance in Man, the first published catalog of known genetic disorders and genes.
By the early 1970s, a number of physicians and researchers had their own darkrooms and processed their own photos. As young physicians transitioned toward the digital age in the 1980s, Lund purchased one of the hospital’s first digital work stations. Then he invested in a new computerized system that allowed doctors to download their own photos. Lund’s group would then create slides, producing up to 500 projection slides a day.
“I had a lot of fights over money,” says Lund, who retired in 2000, and now lives in Baltimore County. “It was a good thing that I was generating it. Our faculty and staff needed these technologies and services.”
Today, under the leadership of Norman Barker, a former trainee of Lund’s, the Pathology Photography, Digital Imaging and Graphic Arts Laboratory at Johns Hopkins is “daily dedicated to the faculty, staff, and students we serve, wherever they are and whatever they need,” says Barker. He has been director since Lund’s retirement 13 years ago.
Barker and fellow pathology photographers Jon Christofersen and Fred Dubs (both Lund trainees), crisscross the hospital daily, moving between the ORs, patient units, offices, and, of course, the pathology labs and autopsy suite—where the dissection slab used by Hopkins’ first pathologist-in-chief, William Welch, still hangs on the wall.
“Name any specimen you want and I’ve photographed it,” says Christofersen, who may be called away at a moment’s notice to the OR by a pathologist or surgeon eager to document “something interesting.”
“A fixed specimen looks different from a fresh one, the pathology’s better when it’s photographed quickly,” says Christofersen. “The colors otherwise become monochromatic. So when you’re called in for a photo, you better get there in a hurry.”
“Photography presents the only opportunity we have to see a specimen in its natural state and colors,” says pathologist Elizabeth Burton, deputy director of the Department of Pathology’s autopsy division. “The impact of something is greater when you can see it with your own eyes. With pathology photographers, I know I’ll have a professional photo; the lighting and contrast and image will be good and perfect for publication.”
Such images might capture the damage in a smoker’s lungs or a once simmering infection in the liver. “If someone is struggling with a diagnosis, we can get a photograph, whether gross or microscopic, to help clinch the diagnosis. Or we can share it with colleagues to help us understand the process of disease and perhaps improve future therapies,” Burton adds.
“Photographs can help communicate the idea that I, as a pathologist and researcher, am trying to convey. That’s their power,” says Ralph Hruban, professor of pathology and oncology, who recently worked with the Pathology photographers on the creation of a teaching iPad app, The Johns Hopkins Atlas of Pancreatic Pathology, which includes 1,400 images.
“The Pathology Photography group has educated many generations of us now in the complexities of photomicroscopy and biomedical photography, and now in digital photography and computer graphics,” Hruban says. “They make us look better and become better educators. They are real gems.”