The Texas Society of Pathologists: A Historical Perspective of the First 90 Years

The year was 1921. Picasso and Einstein, among others, were stretching the boundaries of art and physical science in directions that could not be envisioned only a short time before. In medicine, new insights into the processes of infectious disease, serology, and blood grouping were similarly transforming long-held concepts of medical practice. These advances encouraged the growth of medical specialties—increasingly, physicians honed their skills in chosen aspects of practice. With time, these specialized physicians drew together, forming state and national associations to compare experiences and otherwise cultivate their areas of interest.Clinical applications of the remarkable advancements, particularly in microbiology and serology, called for expertise, technical skills, space, equipment, and reagents beyond the reach of many physicians. Thus, to meet these new challenges, some physicians began to devote all or part of their practice to “laboratory medicine,” and the medical laboratory soon became commonplace in hospitals.1It was in this setting that the 16 founding members of the State Pathological Society of Texas, later to be known as the Texas Society of Pathologists (TSP), gathered for their organizational meeting on May 9, 1921, at the Oriental Hotel in downtown Dallas. They formed what is now the oldest state pathology society in continuous existence, even older than the College of American Pathologists (CAP), the American Society for Clinical Pathology (ASCP), and the American Board of Pathology (ABP).2–5 The founding members, who thought of themselves as an assemblage of “pathologists and bacteriologists,” are remembered in Table 1. The initial bylaws stated that the purpose of the society was to “federate and bring into one compact organization, the pathologists and bacteriologists of the State of Texas and to affiliate with similar associations of other states; to advance and to extend a knowledge of pathology and bacteriology; to promote friendly intercourse among pathologists and bacteriologists; and to guard and foster the material interests of its members and protect them against imposition.”The original bylaws stipulated 3 categories of membership. Active members were qualified physicians who taught pathology, bacteriology, or allied subjects or who limited their practice to clinical pathology or bacteriology. Active members also were required to be physicians in good standing with the Texas State Medical Association (now the Texas Medical Association [TMA]). Associate members were physicians who, while not limiting their practice to pathology, combined pathology with some other branch of medicine. Honorary members were not physicians but were individuals who had attained prominence in pathology or allied disciplines (Figures 1 and 2). Membership dues were $5 annually.After the constitution and bylaws of the society were adopted, the first officers were installed. Questions of concern to the founding members included the following:In varying forms and degrees, these concerns of the founding members of the State Pathological Society of Texas have remained active and difficult issues. Nonetheless, at the organizational meeting of the ASCP, Dr Thomson, then the secretary-treasurer of the TSP, sounded a confident note: “…I want to say that we have a very thriving society…[o]rganized a little more than a year ago…. You would be surprised to see how readily the clinicians, of that part of the country at least, accepted the idea that clinical pathology is a specialty in the practice of medicine. We are, therefore, somewhat surprised to encounter these disagreements in the organization of the national body, as we had not encountered such in the organization of our state society.” In the first years, the TSP met twice a year. One meeting was held at the time and place of the TMA annual meeting, an early display of the belief of Texas pathologists in the importance of maintaining tangible ties with their state medical association. In time, the TSP pared back the number of full meetings to once a year, typically held in January or February. Until recently, the TSP also maintained an educational “Section of Pathology” at the TMA annual meetings. In 1926, the American College of Surgeons revised its minimum standards for hospitals to require that “…clinical laboratories be under the direction of MD physicians with special training in clinical pathology” and that “… all tissue removed at operations … be examined in the laboratory and reports rendered thereon.” A decade later, in 1936, the ABP was organized. In 1943, the House of Delegates of the American Medical Association (AMA) recognized pathology as the practice of medicine, rescinding a contrary AMA policy established in 1921.6As clinical and anatomic pathology came to be accepted as legitimate specialties of medicine, the TSP bylaws were revised, requiring active members to hold a medical license, to be certified by the ABP, and to be members of both the TMA and the ASCP. Initially, the TSP gatherings provided a forum for discussions about mechanisms of pathology practice. Later, the TSP sponsored scientific programs that featured local experts and nationally recognized pathologists who conducted microscopic slide seminars and presented scholarly lectures. To encourage and highlight these educational activities, the TSP awarded certificates of merit for “contributions to scientific medicine.”In 1943, Baylor University College of Medicine relocated from Dallas to Houston, becoming a major institution in Houston's new Texas Medical Center. Out of this momentous change in medical education and medical practice in Texas, a new medical school, the Southwestern Medical College of the Southwestern Medical Foundation (later the University of Texas Southwestern Medical School), was established in Dallas. Through the turbulence and opportunities created by these events, TSP continued to prosper as a unified society supported by pathologists from the academic and private practice communities. The bond of “town and gown” among Texas pathologists survived the distractions of this reorganization of Texas medical education—mutual respect and cooperation between Texas pathologists in differing practice environments is an ingrained characteristic that has served the TSP well to this day.Following World War II, TSP membership increased significantly, as physicians returned to Texas to establish or resume their civilian practices. The first postwar meeting of the TSP was held in January 1946 on the campus of the Southwestern Medical College. At this meeting, the TSP unanimously adopted standardized procedures for serologic evaluations conducted in Texas medical laboratories. The training and qualification standards of medical technologists remained a concern, as the demographic shifts after the war pressured the supply of quality personnel. During this time, the TSP and the Texas Society of Medical Technologists exchanged delegates to foster communication and cooperation among laboratorians confronting workforce issues.Later in 1946, the CAP was born. The CAP was founded to address the widely held belief that pathologists needed a national association to supplement the ASCP, focusing, among other goals, on “… [improving] the economic aspects of the practice of Pathology …” and “[maintaining] the dignity, precision and efficiency of the specialty of Pathology….”At the TSP annual meeting in January 1948, members discussed the emergence of cytology. Dr George N. Papanicolaou had sent a telegram to the TSP leadership expressing hope that Texas pathologists “would fully evaluate the procedure [the Papanicolaou test] before passing an opinion as to its merit and also expressing belief in its usefulness as a diagnostic tool.” The TSP formed a delegation to meet with representatives of the Texas Division of the American Cancer Society to assist in the development of Texas guidelines for the new procedure. During this era, the TSP also initiated a dialogue with Blue Cross and Blue Shield of Texas about the role of pathologists in the clinical laboratory, resulting in an exemplary relationship with one of the largest commercial health insurers in the state. The Texas legislature, with the help of the TMA, established a framework for a codified medical examiner system in the 3 largest urban areas of Texas.During the 1960s, sparked by the introduction of Medicare, pathologists, hospital administrators, and health insurers had renewed interest about methods of payment for all physicians, including pathologists. In a few regions of the country, including Texas, some pathologists began to bill patients separately from the hospital for their services, equivalent to the method of payment for most other physicians of the time. The justification of separate billing hinged on acceptance of pathology as the practice of medicine. In Texas, Opinion WW-1511 of the Attorney General of Texas, issued December 21, 1962, provided such confirmation (Figure 3). Separate billing was endorsed by the TSP and the TMA; both adopted resolutions that supported separate billing as a valid method of payment for pathologists and other hospital-based physicians. Payment for pathologists under Medicare transformed to the current framework after the Tax Equity and Fiscal Responsibility Act of 1984 was passed by the United States Congress. In the same decade, non-Medicare health insurance evolved in the direction of “managed care.” The TSP responded to the needs of its members for Texas-specific information by hosting periodic “New Issues Forums” to share knowledge and provide guidance.In the mid 1980s, the TSP established a House of Delegates (HOD), organized by geographic districts, to better represent its members. The HOD was expected to serve as a forum for discussions among a broadly representative body of pathologists about the complex issues confronting the TSP, thereby supplying the Board of Directors with reliable guidance from the broader membership. The TSP bylaws were revised, stating that the HOD, “when in session, [was] responsible for ‘the government of this society,’” thus opening a path for the HOD to supplant the Board of Directors. In practice, the HOD has maintained a synergistic and constructive relationship with the board and the board has remained the principal shepherd of the TSP.Conforming to present-day technology, the 2009 and 2010 HOD sessions of the TSP were conducted electronically, shortly before the annual meeting. The proceedings of these sessions were discussed at the membership business session at the annual meeting, creating another avenue of opportunity for members to participate in the deliberations of their society. In this manner, the HOD has continued to meet the purpose for which it was created.For decades, the TSP home office has been located in Austin in the headquarters of the TMA. The TSP administrative staff has been drawn from the Association Management Services of the TMA. This relationship has been economically efficient for the TSP and is consistent with its commitment to maintain a mutually beneficial relationship with the TMA.The TSP has nurtured the colorful heritage of the society by publicly and formally honoring its leaders, by recognizing the contributions of others, and instilling the spirit of the TSP in younger colleagues. The George T. Caldwell Distinguished Service Award has been bestowed on deserving Texas pathologists each year since 1955; it is presented during the TSP annual meeting at the Caldwell banquet (Table 2). Among his many accomplishments, Dr Caldwell was the first chair of the Department of Pathology at Southwestern Medical School.The John J. Andujar Citation of Merit has been presented to deserving individuals since 1993 at the TSP annual meeting (Table 3). The recipient of this citation may be a person other than a Texas pathologist who has made contributions to the field of pathology. Dr Andujar, with his spouse, Texas State Senator Betty Andujar, contributed greatly to the development of the TSP and the Texas pathology community during his long career. He served as president of the ASCP from 1960–1961.The Vernie A. Stembridge Memorial Lecture is traditionally scheduled during the Saturday morning scientific session of the TSP annual meetings. Dr Stembridge was the long-time chair of the Department of Pathology at Southwestern Medical School and was president of the ASCP from 1977–1978.In 1997, the TSP established the Young Pathologists' Section (YPS) for pathologists in training or in the early phase of their careers. The YPS convenes at the TSP annual meeting and sponsors a midsummer program that features topics of special interest to young pathologists. The YPS chair has a slotted seat on the TSP board.Currently, the TSP annual meeting includes poster and platform presentations by residents and fellows in Texas training programs. The presentations are judged, with awards given to 3 platform and poster presentations. In addition, the training programs of the first-place recipients receive a commendation.Ninety years ago the founding members of the State Pathological Society of Texas could not have foreseen that their society would grow to 705 members by 2010. Eighty-two physicians have served as president of the TSP since the society's inception, with Dr Truman C. Terrell as the only 5-term president (Table 4). As the TSP approaches its centennial year, the initial ideas of the founding members, “… to advance and to extend a knowledge of pathology, … to promote friendly intercourse among pathologists, …[and] to guard and foster the material interests of its members, …” remain an eloquent statement of purpose.The scientific articles following this historical introduction represent contributions from pathologists throughout Texas, commemorating the Texas Society of Pathologists' ninetieth anniversary.The authors thank Shari Noonan, CMP, CAE, and Lorie Garcia, AA Fine Arts, for their assistance with the manuscript and illustrations.