Austin L. Vickery, Jr., M.D., Professor of Pathology, emeritus, at Harvard Medical School and a leader in Surgical Pathology at the Massachusetts General Hospital for over 50 years, died March 2, 2005, at his home in Westwood, Massachusetts. Dr. Vickery’s contributions to medical science place him in the top tier of pathologists of his day. He was an expert on the pathology of the endocrine system, particularly the thyroid gland. He authored many important papers on the thyroid, including pioneering descriptions of needle biopsy diagnosis, radiation effects, thyroiditis and thyroid tumors. Having trained before the era of subspecialization, Dr. Vickery was knowledgeable in many areas of surgical pathology, and also published important studies in prostatic and gastrointestinal pathology.
“Vic”, as he was known to most of his friends and colleagues, was born in Omaha, Nebraska on August 18, 1919. He received his M.D. from the University of Nebraska in 1943. He was trained in both surgery and pathology. After a one-year rotating internship at the University of Nebraska Hospital, he moved to Boston to be an intern and resident in Pathology at the Peter Bent Brigham Hospital (1944-46). The next year was spent at the Brigham as a resident in Surgery for one year, during which time he was the Harvey Cushing Fellow. He finished his training (1947-48) at the Cleveland Clinic with separate fellowships in surgery and in surgical pathology under George Crile, Jr., and J. Beech Hazard respectively. It is probable that Dr. Vickery chose to become a pathologist during that year because of a wrist abnormality due to an old fracture that was incompatible with the skillful performance of surgery.
Dr. Vickery was recruited to join the staff of the Pathology Department at MGH in 1949 by Tracy B. Mallory, then Chief of Pathology. This marked the beginning of a remarkable span of service to the MGH and Harvard, interrupted only by a leave of absence in 1952-54 to serve as a Captain in the Army Medical Corps in Japan at the 406th Medical General Laboratory with his long time friend and colleague Robert E. Scully. Dr. Vickery was appointed Professor of Pathology at Harvard in 1972 and was co-director of surgical pathology at the MGH from 1974 to 1985. Dr. Vickery retired from active service in 1998, at age 79, and continued to hold an MGH appointment as Honorary Pathologist until his death.
The long tradition of endocrine pathology at the MGH and the very active thyroid clinic made study of that gland a fertile field for Dr. Vickery, of which he took full advantage. Early studies included work on radiation effects on the thyroid gland, including those observed in inhabitants of the Marshall Islands, and in patients and experimental animals treated with radioactive iodine. Experience gained at the Cleveland Clinic, where the needle biopsy technique for the thyroid gland was pioneered, made Dr. Vickery one of the first pathologists confident with evaluation of these specimens. His experience with this technique was partly responsible for it being utilized at the MGH earlier than at most other institutions.
The most original contributions of Dr. Vickery to the field of thyroid pathology have been the authorship of the standard work on the fibrous variant of Hashimoto’s thyroiditis and the original description of the diffuse sclerosing variant of papillary carcinoma. He was a long-standing champion of the core needle biopsy procedure for the diagnosis of thyroid diseases, particularly thyroiditis in children, and a strong advocate of a conservative approach to the therapy of papillary thyroid carcinoma. His painstaking review of the MGH experience in this area with the leading thyroid surgeon, C.A. Wang, published in 1987, was a classic clinicopathologic study with long-term follow-up data. His position received wide support many years later through the analysis of the nation-wide data obtained by ad-hoc committee of the American College of Surgeons.
One of the greatest qualities emerging from all of Dr. Vickery’s publications is the wisdom of his conclusion and recommendations, the combined result of his great personal experience and his common sense approach to the interpretation of microscopic sections. Nowhere is this more evident than in the essay he wrote in 1983 on the pathological and philosophical controversies concerning papillary thyroid carcinoma, a publication which should be required reading for thyroid pathologists. The following of the many precepts and recommendations that he includes in that masterful article would avoid many diagnostic pitfalls and therapeutic excesses.
Dr. Vickery’s interests extended beyond the thyroid gland to the parathyroid and adrenal glands. In his later years he co-authored a major study on the features of adrenal carcinoma that had prognostic significance, combining cases encountered over many years at both the Peter Bent Brigham Hospital and the Massachusetts General Hospital. Dr. Vickery’s emphasis on clinical pathologic correlation and the role of the pathologist in providing clinically relevant information was highlighted in that study.
His major other published works were in urologic pathology, particularly carcinoma of the prostate gland. With Dr. Walter S. Kerr, Jr., he painstakingly reviewed the outcome of all patients treated by radical prostatectomy for prostate carcinoma at the Massachusetts General Hospital over a period of a quarter of a century.
Although Dr. Vickery was known throughout the world for his original contributions to pathology, it is less well known that he was a frequent contributor to a unique educational series at MGH – the Clinicopathologic Conferences, or CPC’s. These have been published for over 80 years in the New England Journal of Medicine as Case Records of the MGH, and are one of the most widely read medical publications in the world. Between 1949 and 1996, Dr. Vickery presented the pathology findings in 169 cases – during the 50’s and 60’s, as many as 10 cases per year, spanning virtually the entire gamut of surgical pathology diagnoses.
Dr. Vickery was a tall man with an imposing presence. Although to those much younger he could occasionally come across as somewhat “gruff” on first encounter, one very quickly became aware that underneath was a warm, caring person who delighted in getting to know the residents and seeing their careers progress. Dr. Vickery loved to teach both at the resident and postgraduate level and directed our residency program for many years. In the mid-1970’s Dr. Vickery inaugurated an annual postgraduate course in general surgical pathology, Current Concepts in Surgical Pathology, which is still ongoing and thriving, thanks in significant part to the firm foundation that Dr. Vickery provided by his careful organizational skills during the early years. Dr. Vickery was active in many national and international pathology societies, directed workshops on thyroid pathology from 1975 to 1990, and served on the World Health Organization panels of expert pathologists in 1980 and 1986 that developed standardized nomenclature for tumors of the thyroid gland and other non-gonadal endocrine organs. In 1992 he received the Distinguished Service Award of the American Society of Clinical Pathologists.
Dr. Vickery was married to Amelia Frances Wheelwright in 1955 after a long courtship. She was a warm, unpretentious lady, a lover of nature and an ardent conservationist.
One of the most singular events in our memory of Dr. Vickery occurred on February 9, 2000, after he had retired. Dr. Vickery asked for an appointment to see Dr. Colvin. He came into his office and said – “Sit down, Bob, I think you are going to like what I have to say.” Well, he was right, and it was lucky he was sitting down. – Vic and Fran were endowing a professorship in Pathology at Harvard Medical School, to be based at MGH. Endowed professorships are rare and most precious – it was only the second in our department.
But Dr. Vickery was not finished with his overwhelming generosity to the MGH. In his will, Dr. Vickery left a further donation of several million dollars to support the Pathology Department. As further evidence of his generosity, Dr. Vickery, in his estate, also donated funds to the University of Nebraska Medical Center to endow a Chair and a Professorship in Pathology.
In 2000, a gait difficulty developed and progressed, leading to a wheel-chair existence. Fran accepted the challenge of being his caretaker in his remaining years, but tragically, she passed away in 2002. During his last three years, Dr. Vickery became resigned to his fate, and with the help of friends and nurses’ aides at the retirement home, continued to organize small parties for his friends until his death due to cardiac failure and sepsis. Dr. Scully recalls that “in conversations with Vic during his last few years, he often joked about his own illness, but expressed concern about my much milder disorder.” Dr. Vickery is survived by his sister-in-law, Elizabeth B. Wheelwright and many nephews and nieces.
Dr. Vickery was a man of strong character who devoted both his personal and his professional life to the greater good of others. It is heartwarming that his presence will always be felt, not only for his exceptional generosity, but also for the skills he transmitted to the minds of the hundreds of pathologists he trained, and the many memories of a uniquely charming, witty and wise human being shared by us all.
Robert B. Colvin, Chairperson
Nancy Lee Harris
Robert E. Scully
Robert H. Young