Frederick T. Kraus, MD: An Interview With Thomas M. Ulbright · r 2016 International Society of...

International Journal of Gynecological Pathology35:482–496, Lippincott Williams & Wilkins, Baltimorer 2016 International Society of Gynecological Pathologists

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Frederick T. Kraus, MD: An Interview WithThomas M. Ulbright

Frederick T. Kraus, M.D. and Thomas M. Ulbright, M.D.

Key Words: FT Kraus—LV Ackerman—Surgical pathology—History.

Frederick T. Kraus, Fred to his many friends, is astill-active pathologist at the age of 86 yr with aspecial interest in gynecologic and placental pathol-ogy. He has practiced his entire career in the environsof St. Louis, Missouri, both at Washington Univer-sity and at 2 large private hospitals. For those of mygeneration, his book, Gynecologic Pathology, pub-lished in 1967, clarified what at that time was anespecially confusing area of pathology that hadhitherto been mostly in the province of gynecologistswith limited experience in pathology. It remains a fineexample of lucidity and clinicopathologic correlation.Early in his career Fred worked as a faculty memberat Washington University in the illustrious Divisionof Surgical Pathology headed by Dr Lauren VAckerman. He later moved to the private sector butcarried on his academic interests, with publicationsand participation in teaching courses for severalnational pathology societies. His career illustratesthat the ‘‘divide’’ between private practice andacademic pathology is one that can be bridged tothe benefit of both. He initiated one of the earliestfellowships devoted to the training of pathologistswishing for in-depth exposure to gynecologic andobstetric pathology. Many of his former fellows wenton to successful academic careers at a variety of

institutions. He developed an extensive consultationpractice in the St. Louis area, not only for lesionsrelated to gynecologic pathology but also coveringnumerous areas of surgical pathology. His diagnosticacumen and understated, modest demeanor madehim a sought-after advisor for members of thatpathology community but his influence has been feltmuch further afield. I first became acquainted withFred when he willingly gave teaching conferences toresidents in pathology at Washington University,probably about 1976. These were challenging affairs,requiring not only knowledge of the morphology ofvarious lesions but their clinical significance anddifferential diagnosis. I remember thinking that this isa person I can really learn something from, and Ihappily was able to do just that during mysubsequent fellowship with him. Today, 16 yr afterhis formal retirement, Dr Kraus continues to studyplacental pathology, returning once more to Wash-ington University. He is an author of the AFIPnontumor atlas devoted to placental pathology. I amsure readers of the journal will enjoy the reminis-cences of this superb pathologist and fine gentlemanwhose career spans many years from the days whensurgical pathology was largely dependent uponhematoxylin and eosin–stained slides and a few otherhistochemical stains to the modern era in whicha number of other sophisticated modalities areavailable. – T.M.U.

T.M.U.: As I recall you are originally fromOklahoma. Could you tell us a little about yourfamily background and early life and particularlywhat influences may have caused you to attend

From the Department of Obstetrics and Gynecology, Wash-ington University School of Medicine, St. Louis, MO (F.T.K.); andDepartment of Pathology & Laboratory Medicine, IndianaUniversity School of Medicine, Indianapolis, IN (T.M.U.).The authors declare no conflict of interest.Address correspondence and reprint requests to Thomas M.

Ulbright, MD, IU Health Pathology Laboratory, Room 4014, 350W. 11th Street, Indianapolis, IN 46202. E-mail: [email protected].

482DOI: 10.1097/PGP.0000000000000299

Copyright r 2016 International Society of Gynecological Pathologists.

mailto:[email protected]

medical school and later choose to train inpathology?

F.T.K.: My paternal grandfather had learned thetrade of making jewelry in Germany, and emigratedaround 1880 to avoid military conscription. Hearrived in Pittsburgh Pennsylvania to find a flourish-ing community of German immigrants, where hefounded a jewelry manufacturing company, andmarried a young lady with a similar background.Soon after, my father was born in Pittsburgh andwent on to study geology and petroleum engineeringat the University of Pittsburgh and at CarnegieSchool of Technology. My mother’s family, who hadScots-Irish origins, had settled in western Pennsylva-nia in the late 18th century. My mother was also bornin Pittsburgh and graduated from the PennsylvaniaCollege for Women, now called Chatham College.The 2 families became neighbors. After their mar-riage, my parents moved first to California and thento Oklahoma, where the discovery of vast oilfieldswas changing the country.I was born in interesting times in Oklahoma City

on the first of May, 1930, where my father was apetroleum engineer working in the oil industry.About the time I was born the famous ‘‘Mary Sudik’’oil gusher blew, spewing tons of oil more than aquarter mile into the air for many days, makingnational news and entertaining my mother, whocould watch the towering smoky spectacle from herwindow in the hospital even though it was a few milesaway. (She claimed that this dramatic event mighthave portended potential accomplishment for herlittle baby.) My mother did social work assistingmigrant workers headed for California, as Steinbeckdescribed in The Grapes of Wrath. Oklahoma was acolorful place in those days, full of exciting things forchildren to see. My parents took us to visit cattleranches and Indian reservations for rodeos andIndian dances. My younger brother and older sisterand I grew up mainly in the town of Bartlesville,Oklahoma, headquarters of the Phillips PetroleumCompany. My brother and I spent many hours ridingour bikes all around the countryside, playing cowboy.I also enjoyed making rubber band–powered modelairplanes, which I flew around the neighborhood andalso at our small local airport.About the time I was 13, my parents prompted me

to take my idle hands to work at a Saturday jobwashing the crockery in the pathology laboratory atthe local hospital. The hospital actually had apathologist, unusual for such a small town in those

days. Her name was Dr Elizabeth Chamberlain,recently retired from the faculty at the Women’sMedical College in Philadelphia, and also a goodfriend of my mother. I was very curious to know whatshe did and why, which she took time to explain verywell. She also regaled me with stories about herpathology studies at Johns Hopkins under thefamous William H. (Popsie) Welch and lent me hercopy of ‘‘Miss Susie Slagle’s,’’ a popular novel aboutthe education and boarding house lives of medicalstudents at Johns Hopkins around the time of WorldWar I. I was thoroughly entranced and inspired tofollow the track to become a pathologist. Otherbooks that further stimulated my interest in medicineduring my high school days included The MicrobeHunters, by Paul De Kruif, The Life of Osler, byHarvey Cushing, and Arrowsmith, by Sinclair Lewis.I enjoyed school, including several years of Latin, andplayed the oboe in the high school orchestra.I attended the College of William and Mary in

Williamsburg, Virginia, where my science interestsinvolved especially a major in chemistry, but includedseveral courses in biology, physics, and mathematics.As long as I was there I took languages, includingFrench and German, but also ancient Greek and asmany courses in English, economics, and art historyas I could get into. This took the usual 4 yr, but Ispent every summer there as well. You could say thatI really did like school!While I really enjoyed to the fullest all the

educational steps along my way through college andmedical school, my pathology-oriented goal neverchanged. This focus may have been a compellingfactor in the success of my medical school applica-tion, which included my enthusiastic determinationjust as I tell it now. My admission to WashingtonUniversity in St Louis was accompanied with aJackson Johnson Scholarship, for which I will beforever grateful.Washington University and its pathology depart-

ment turned out to be a wonderland for me. Ourprofessor and chairman during my student years wasRobert A. Moore, whose lectures told an interesting,well-organized, and authoritative story about lesionafter lesion while he puffed on one cigarette afteranother. His Textbook of Pathology provided athorough grounding in general pathology. By thetime my residency began, we had a new chairman, W.Stanley Hartroft, known especially for his studies ofnutritional injury to the liver. The major highlight oflearning during my pathology residency was MargaretG. Smith, an outstanding, almost magical, gross

483INTERVIEW WITH FREDERICK T. KRAUS, MD

Int J Gynecol Pathol Vol. 35, No. 5, September 2016


pathologist and teacher. Dr Smith managed to makeher extremely detailed gross reviews of my autopsiesso richly educational for me that I spent an extra year,doing autopsies as well as supervising junior residents,in a newly created office of chief resident. A talentedvirologist, Dr Smith also cultured the virus for StLouis encephalitis and identified its curious multi-generational chicken mite reservoir, a tour de force ofvirologic investigation (1). She was also the first topropagate the cytomegalic inclusion disease virus intissue culture explants. We residents, including me,who collected the submaxillary glands from newborn/infant autopsies for culture, called it ‘‘salivary glandvirus’’ in those days. At Dr Smith’s suggestion, I madea point of reading the original descriptions of themajor diseases displayed in my autopsies, which themarvelous open library stacks of the WashingtonUniversity library made so easily accessible, even in19th century French and German journals as well asthose in English. Dr Smith was often around the officearea evenings after supper. Sometimes she sat down inmy office area and read a paper she was preparing todeliver. I felt hugely flattered by this attention, until Iultimately became aware that my presence merelyallowed her to avoid the appearance that she wastalking to herself had she stayed alone in her ownoffice.Other important teachers included Dr Sara A.

Luse, a neuropathologist, who also stimulated us tolearn details and techniques of the emerging field ofelectron microscopy, and Dr Paul E. Lacy, who wasdeeply involved with the ultrastructure and func-tional biology of the pancreatic islets. Dr Lacyfollowed Dr Hartroft as the next Department ofPathology Chairman, and was a friend and veryinstrumental in keeping me involved in the Wash-ington University pathology department.Some fundamental writings I remember included

especially The Pathogenesis of Tuberculosis by ArnoldRich of Johns Hopkins, Pathology of the Fetus andInfant by Edith Potter, and The Borderland betweenEmbryology and Pathology by Rupert A. Willis. Intime my favorite pathology text became Pathology, anew, more encyclopedic successor to Dr Moore’stextbook, edited by W.A.D. Anderson. Several yearslater, I found myself honored to follow Arthur T.Hertig as author of the chapter on Female Genitaliaafter Dr John M. Kissane took over the editorship oflater editions of Anderson’s Pathology.

T.M.U.: You trained under Dr Lauren Ackerman inthe middle of the ‘‘Ackerman era’’ at BarnesHospital. It seems like anyone who trained with

Dr Ackerman has some favorite anecdotes concern-ing him. What are your most vivid memories of DrAckerman during this period, or even later in yourcareer?

F.T.K.: Dr Ackerman was a strongly charismaticteacher and leader. The learning day began at 7 AM.There would be case presentations with all of the staffand residents present, each of us waiting in a state ofhigh alert to answer his questions, delivered like alightning strike from the end of his roving pointedfinger. The scope included recognition of lesions onprojected slides, all significant details of patient,pathology, prognosis, pathogenesis, knowledge ofrecent relevant publications, and their authors. It wasstrenuous and exhilarating. After this, the long hoursof relative quiet dissecting tissues, reading slides, andmaking reports were almost relaxing. Our prepara-tion for these Socratic excursions involved extensivereading; we regularly followed, with expectation ofeventually quoting, especially articles in Cancer, TheAmerican Journal of Surgery, and all the majorAmerican and English pathology journals, carefulnot to miss publications by Cushman D. Haagenson,Arthur Purdy Stout, Fred W. Stewart, among manyothers. We also gave special attention to the tumorfascicles published by the Armed Forces Institute ofPathology as a gold mine of useful information forsurgical pathologists.Dr Ackerman generously did not confine his

pedagogic approach to surgical pathology. Each yearhe took the current crop of fellows to his club forlunch where he began our introduction to theappreciation of fine French wines. His office wallswere decorated with signed lithographs by well-known painters, mainly French impressionists, andhe firmly implanted into us the idea that oureducation included visits to art museums to widenour knowledge of modern art and artists. I stared somuch at a Raoul Dufy lithograph mounted above hismicroscope that he ultimately gave it to me as thanksfor my assistance with revisions of his books. Itremains visible today on my wall at breakfast, atreasured remembrance of our friendship.

T.M.U.: I have to take note of a wonderfulphotograph that is published in the book edited byDr Juan Rosai, Guiding the Surgeon’s Hand. It isFig 7-14 in the chapter authored by Drs LouisDehner and John Kissane concerning surgicalpathology at Washington University and BarnesHospital and it shows you in a group of fellows andstaff for 1958–1959, specifically mentioning you as

484 KRAUS AND ULBRIGHT



one of the ‘‘wunderkinder.’’ Would you like toelaborate a little on that photo and comment?

F.T.K.: The staff photo to which you refer (Fig. 1)includes the 4 of us Surgical Pathology fellows in1958–1959. To my knowledge the term ‘‘wunderkind’’was never applied to any of us until it appeared in‘‘Guiding the Surgeon’s Hand.’’ However, our headyself-confidence may have attracted some attention,because Dr Ackerman never missed a chance to takeus down a peg. When he caught us unprepared on anysubject – and of course this did happen – we bouncedback, eager for more. Visiting professors wereroutinely requested to ply us residents and fellowswith detailed questions about their topic because as heoften told them, in our hearing, ‘‘They think theyknow everything, but they don’t.’’ The constantchallenge was exciting and it stimulated us to keepup with current literature. I always tried to read up asmuch as I could about any visiting professor’spublications before they arrived to speak, if possible.One of the Fellows, Jules Kernen, who was summa

cum laude in his Harvard undergraduate class, wasthe brightest of us all. He is the Surgical PathologyFellow to the right of me in Figure 1. Jules and I keptup a constant barrage of questions aimed at eachother on obscure subjects, in constant hope ofeliciting an anguished cry of defeat. Expressions ofannoyance from our colleagues never improved ourmanners. Gene Foster, to the right of Jules Kernenin Figure 1, entertained us all with his astoundingarray of variations on the ‘‘Trout’’ motif from theSchubert Piano Quintet, which he loved to whistle forus at odd moments. Tom Hunt, the remaining Fellowin our group (second from the left in the first row)graced us with his unfailing optimism and goodhumor.That group picture (Fig. 1) also includes at least 3

surgery residents, including Dr Lynn Krause (far left,front row), who remains a friend to this day. Thesurgery residents all had a required rotation insurgical pathology as an integral part of their trainingin those days and for many years thereafter. Aprofound appreciation and respect for each other’srole in the care of the patients came out of this long,close contact between these specialties as we workedtogether in our later years of practice.

T.M.U.: Who were other important figures in yourpathology training and could you elaborate a bitconcerning their personalities?

F.T.K.: The most senior member of Dr Acker-man’s surgical pathology department when I started

was Harlan J. Spjut, a calm, steady and very effectiveteacher, much less scary than Dr Ackerman could be.Two more junior faculty, Walter C. Bauer andMalcom H. McGavran (Fig. 1), had graduated fromWashington University and finished the residency theyear before Jules Kernen, Dave Edwards, and I, butthey were frighteningly competent and already wellsettled into teaching and always ready to help.Malcolm was focused on skin and Walter onprostates and ENT. Walter, of course, followed DrAckerman as Chief of Surgical Pathology. Walterwas a notable polymath who took singing lessonsfrom a professional and gave truly excellent recitals,singing such memorable operatic works as the‘‘Wintersturme’’ aria from ‘‘Die Walkure’’. Walteralso had a large metal working studio where heproduced interesting molded, curved, and weldedworks of art. He did not advertise his productionswidely, but I often managed to find out about them.

T.M.U.: Do you have any other memories oranecdotes concerning your fellow trainees at Barnes?

F.T.K.: During the first couple of years on theautopsy service the one first up on the rotation wouldoften comment to the others about feeling sick – tozero sympathy and to no avail. We performed theautopsies immediately after the permission wassigned, at whatever hour, day or night. Each of usgot a pair of rubber gloves on the first of July; theyhad to last a year. Of course they did not, and weresoon full of holes. The notion of becoming infectedby contact with infected tissues was not ignored; itwas assumed we would avoid it by washing our handsafter completing the dissection. Sidney Saltzstein, myroommate, actually constructed a tiny sailboat in ourroom and launched it in one of the ponds in nearbyForest Park. In the evenings, the unmarried group,Sidney Saltzstein, Carlos Perez-Mesa, and I, wouldhang around finishing up autopsy reports until about9:30 and head to a nearby bar, the Martinique, for abeer.Our surgical pathology group adopted the habit of

taking a 10:00 AM coffee break, usually attended by 4or 5 of us, including Barbara Rosenberg, Bob Ahlvin,Sidney Saltzstein, Jim Pitcock, and Gene Foster. Weall expressed, vehemently, our conflicting views oncurrent politics, the baseball Cardinals, and the stateof the world for about 15min, defiantly resisting anyhope of consensus.

T.M.U.: I know that for a period of time thegynecologic pathology at Barnes Hospital wasperformed by members of the Department of




Obstetrics and Gynecology. How was it arrangedthat you were exposed to this material and becameinterested in gynecologic pathology? Was theresomeone in particular who was key to your interestin gynecologic pathology?

F.T.K.: In the first half of the 20th century, even inmost university hospitals, the biopsies and organsresected by the individual surgical specialties (Gen-eral Surgery, Obstetrics and Gynecology, Neuro-surgery, etc.) were examined by members of thesurgical specialties themselves. The academic pathol-ogy departments confined their scope to the autopsiesand to basic research. Surgical specimens fromOB/GYN were delivered to a pathology laboratoryin Maternity Hospital where 1 of us 4 surgicalpathology residents did gross dissections, microscopicdescriptions, and signed out the cases. We were

supervised by and consulted with John E. Hobbs,MD and Seth Wissner, MD, both gynecologists withconsiderable training and experience in GYN pathol-ogy. Gynecologists in those days were very proud oftheir knowledge of pathology, a required subject fortheir residencies, and many of them spent 1, or often2 yr studying GYN pathology, either at JohnsHopkins, or in Boston with Arthur Hertig at theFree Hospital for Women.

T.M.U.: I know that you spent a period of time atthe AFIP. You wrote some excellent papers with DrRobert Neubecker, who was chief of gynecologicand breast pathology there in early years. He issomeone who is not much known by youngerpathologists. Can you share a few words about him?

F.T.K.: Just after I completed the year of surgicalpathology with Dr Ackerman, the firm hand of the

FIG. 1. Surgical pathology staff and fellows, 1958–1959. Front row, left to right: Dr Lynn Krause (surgical resident), surgical pathologyfellow Tom Hunt, Dr Malcom H. McGavran, Dr Ackerman, Dr Walter C. Bauer, surgery resident. Second row, surgery resident, SurgicalPathology fellows Frederick T. Kraus, Jules H. Kernen, Eugene Foster, and Carlos Perez-Mesa.




US Army clamped on my shoulder; I had beendeferred temporarily on the Berry plan to completemy pathology residency, but now my 2 yr of activeduty in the army began. I was actually stationed a fewmiles away from the AFIP, in the Second Army AreaPathology laboratory, in Fort Meade, Maryland. Iwent to the AFIP just to see the place in my sparetime one day. As a US Army pathologist, the AFIPalso served routinely as my consultant. I waswelcomed courteously, shown around, and intro-duced to some of the available staff pathologists.They were well aware of my teacher, Dr Ackerman,by then an author who contributed to the AFIPtumor fascicle series, which may have given me someadded degree of credibility. I announced my hope tohave a chance to work on some project there. Lo, ithappened! My commanding officer, Colonel RobertL. Cavenaugh, MC became aware of my academicinterests and allowed me one afternoon a week to gothere to work on projects. The AFIP was a wonder-land with outstanding photographic and clinicalfollow-up facilities. Because of my inchoate interestin breast and gynecologic pathology, I gravitatedtoward Dr Neubecker (‘‘Newby’’), and asked himwhat I could do with him. This led first (his choice) toan article demonstrating that the luteinization of theovarian theca in infants and children was a normalprocess, in contrast to prior concepts (2). Next, mychoice, was to use the combination of the AFIP’slarge collection of breast lesions and superb follow-up services to develop some logic to distinguishbenign from malignant papillary lesions of the breast,which turned out to be the first significant surgicalpathology paper with my name on it (3).

T.M.U.: Was it at the AFIP that you first becameacquainted with Dr Herbert Taylor, who has beenthe subject of one of the historical essays in thisjournal? Could you tell us a little concerning yourexperiences with Dr Taylor and other notablefigures at the AFIP while you were there?

F.T.K.: Yes, Herb Taylor was in the Skin and GIbranch, headed by Elson Helwig at that time. Herbhad a magnetic personality with an encyclopedicknowledge of pathology in general and was alwayswilling to talk, answer questions, and, like DrNeubecker, generally made me feel welcome. Soonafter we completed our collaborations my armyservice ended and Dr Neubecker moved to theMarshfield Clinic in Wisconsin. Herb Taylor thentook over as chief of the Breast-OB/GYN branch. Istayed in contact with him and a year or so later

asked him to review some chapters of my developingGynecologic Pathology book (Fig. 2) for the publish-er, C. V. Mosby Co. Thanks to his approval thepublisher took me seriously and the book was underway. I was very glad to welcome Herb to St Louiswhen he came as professor of surgical pathology at StLouis University. Herb was witty, wise, and a verygood friend. We began to collaborate on a secondedition to my Gynecologic Pathology book. Sadly, hisdecline in health and premature death did not allowthe project to proceed very far. I was very muchaffected by Herb’s illness, became seriously de-pressed, and lost interest in the revision of the book;indeed I avoided it.

T.M.U.: When I was a resident in pathology atWashington University, I ‘‘discovered’’ your text-book, Gynecologic Pathology (4), in the departmen-tal library. In the mid to late 70s it was one of thefew available texts in gynecologic pathology and, inmy opinion, it was the most accessible, so I read itfrom cover to cover. It first stimulated my owninterest in this area, so I am curious what inducedyou to undertake its writing.

F.T.K.: The idea that I could even do a book beganwith the happy invitation to work with Dr and Mrs.Ackerman on revised editions of his books. When Ireturned from my US Army duties in 1961 asAssistant Professor of Surgical Pathology, I em-barked on the task of helping revise the GYNpathology chapters in Dr Ackerman’s Cancer andSurgical Pathology books. This was a delightfulexperience. Approximately 1 night a week at 8:00 PM

sharp I arrived at the Ackerman residence with mysuggestions and proposed photographs for therelevant chapters and we worked steadily for 2 hrwith Mrs Ackerman (Elizabeth) at the typewriterpreparing the typed inserts, the final wording by DrAckerman. This was great fun, interspersed with hiswitty comments. If an illustration I had prepared didnot meet his standard, he immediately tore it in half,to ensure that he would ‘‘never see it again.’’ Westopped immediately when the clock struck 10:00.The coffee pot was rescued from the declining embersin the fireplace and I was supplied with a small glassof wine. In this pleasant way I began to learn how togo about doing a pathology book. We returned tothis process through some later revised editions of hisSurgical Pathology book after I moved from BarnesHospital to work at St Luke’s Hospital in July, 1963.It was also the basis for our collaboration on a seriesof articles on tumor pathology that were published in




1962–63 in CA: a Cancer Journal for Clinicians(Fig. 3) (5–9).My concern about the state of gynecologic

pathology itself began during the surgical pathologyresidency period allotted to gynecologic/obstetricpathology, which at that time, as noted earlier, wasperformed in the OB/GYN Department at Barnes. Ibecame aware that clinical-pathologic correlationswere not as well developed in the existing books as Ithought they should be, so I determined to tackle thesubject myself, beginning after my army service. Ialso felt the need to straighten out certain ill-definedconcepts like pregnancy-associated changes in theendometrium, misapplications of the term ‘‘meso-nephroma,’’ lack of awareness of the contributions ofsuch European pathologists as Magnus Haines,Harold Fox, and Fred Langley in England, LarsSantesson in Sweden, and Gunnar Teilum in Den-mark, in the early 1960s. The illustrations of mybook, Gynecologic Pathology (4), were mostly fromspecimens I had dissected, with gross and microscopicphotographs taken by a professional photographer,Mr K. Cramer Lewis, at Washington University.

T.M.U.: I know that you have always been devotedto excellence in teaching. When and how did

teaching become a component of your professionallife?

F.T.K.: Teaching at Washington University beganfor me during my third year of residency there, evenbefore I started surgical pathology. My first lecture wason bone pathology given to the second year pathologyclass. I prepared like crazy and enjoyed it all. Evenafter I moved to St Luke’s Hospital in 1963, I was kepton as a lecturer and laboratory demonstrator to thesecond year students for the next 27 yr. In this sort ofteaching appointment I became ultimately titled as a‘‘Clinical Professor.’’ I regarded myself as a member ofthe team of teachers for the second year pathologystudents and enjoyed the connection thoroughly. Ispecialized in gynecologic pathology during theseyears. I also had teaching responsibilities to preparefor the OB/GYN residency programs, both at Wash-ington University and St Luke’s Hospital. So back inthose days I continued to maintain regular and verycordial connections with Washington University. Thisrelationship continued after I moved from St Luke’s tothe position of Pathology Chief at St John’s MercyMedical Center in 1974.Most enjoyable and professionally rewarding of all

was the opportunity for pathology teaching, asProgram Director of the Pathology Residency atSt John’s. I tried very hard to imitate and follow theregular academic surgical pathology teaching confer-ences that I had experienced under Dr Ackerman. Thisprogram expanded to include my fellowship ingynecologic pathology, and later fellowships in derma-topathology under the direction of Dr Daniel J. SantaCruz and renal immunopathology under Dr FredericG. Germuth. We had a lot of bright and interestingpeople around, a truly rewarding experience.

T.M.U.: After some years at Barnes you moved intothe private practice setting, first at St. Luke’sHospital in St. Louis and later to St. John’s MercyMedical Center. What prompted these moves andwhat are your reflections on the differences forpathologists in the private practice and academicsettings?

F.T.K.: Research involving experimental animalswas always promoted at Washington University.Even before graduation I participated in a studyinvolving the beneficial effect of shielding the spleensof radiated mice before exposing them to an infectionchallenge with Escherichia coli. Another involved theautopsy component of experimental aortic coarcta-tion in dogs. Most embarrassing was a failed study ofrats with experimentally induced liver cancer in

FIG. 2. End view and front cover of the textbook, GynecologicPathology, by Frederick T. Kraus.




FIG. 3. Frontpiece at the beginning of a series of articles on tumor pathology coauthored by Drs Lauren Ackerman (left) and Frederick T.Kraus (right) for CA: A Cancer Journal for Clinicians.




whose serum I planned to seek evidence of asubstance that might promote regeneration. Iweighed them with bare hands, because the heavygloves upset them, and actually seemed to develop afriendly relationship. This made the time I ultimatelyhad to kill them especially traumatic – not just to therats, but to me! I had concluded that I could never doresearch happily with experimental animals. What Idid want to do was patient-oriented surgical pathol-ogy. Both St Luke’s Hospital and, subsequently, StJohn’s Hospital, were teaching hospitals with oppor-tunities for teaching pathology residents, writing abook (at St Luke’s), and conducting clinicopatho-logic studies bolstered by electron microscopy andimmunohistochemistry (at St John’s). These oppor-tunities seemed to provide the type of life I wanted.At the time of my move to St Luke’s I had finished

2 yr of Army service and was back as an assistantprofessor in the surgical pathology department atWashington University. Dr Ackerman had an out-standing associate, Harlan J. Spjut. As competition atthe next level were 2 superb surgical pathologist-teachers, Walter C. Bauer and Malcolm H. McGavran(Fig. 1), both securely ensconced in dermatopathologyand ENT Pathology, respectively, and with theclinicians in those services. Senior to me also at thistime were Sidney Saltzstein and Barbara Rosenberg.They were all valued friends, only 1 yr ahead of me intraining, and I could see no realistic expectation for along-term place in surgical pathology at WashingtonUniversity for me. Furthermore, my lack of interest ina basic research career, especially involving animalexperimentation, made my academic future lesspromising at Washington University. Nearby at StLuke’s Hospital, Robert W. Ogilvie, an earlier Acker-man trainee whom I already knew well, had becomehead of the pathology department and offered me aposition as associate pathologist, with a major timecommitment to surgical pathology. Many of thesurgeons and internists there were either current orformer staff I had met at Barnes Hospital. Dr PaulLacy, then Chairman at Washington University,appointed me to continue duty as a teacher (femalegenital tract) of the second year pathology course atWashington University, and there was no dilution ofpathology standards; so it did not seem to be such atotal departure. Bob Ogilvie and the St Luke’s staffwere quite pleased to find that I was starting to writemy gynecologic pathology book. By 1967 the book waspublished. I continued to maintain my appointment onthe ‘‘Visiting Staff’’ in the pathology department atWashington University. This move made sense to me.

I should emphasize that I have always felt myselfsomehow to remain connected, however informally,with Washington University School of Medicine. Overthe years I have maintained my acquaintances andcontinue to feel welcome whenever or wherever I haveturned up. It has been like family: no red tape, ever.Almost all the gross and photomicrographic

Illustrations published in my articles as well as inthe Gynecologic Pathology book were taken with theassistance of Mr K. Cramer Lewis in the Photog-raphy Department. I made appointments and walkedin with my slides. When I wanted to include someultrastructural observations on radiated uteri for thestudy I reported in the USCAP Long Course in1971 (10) I took my tissues from specimens Idissected at St Luke’s over to friends in the anatomydepartment. With some refreshed direction fromcolleagues there, mainly Dr Allen Enders, I tookmy EM pictures. I had frequent invitations to presentpathology lectures to the residents and fellows in theOB/GYN department. However, my teaching atWashington University pathology course came toan end in 1990 as my wife became terminally ill, and Ineeded to reduce my activities as much as possible.After this time, I ceased being a part of thedepartment, the existence of a ‘‘Visiting Staff’’ hadbecome anachronistic, and the new Chairman of theDepartment of Pathology and Immunology, Dr EmilUnanue, eliminated it. When I retired from practiceat St John’s in 2000 I was approached by Dr MichaelNelson, the head of Maternal-Fetal Medicine atWashington University, to assist in departmentalresearch projects involving placentas. So now, I aman Adjunct Professor of Obstetrics and Gynecologyat Washington University. Happily, I am still there,in the ‘‘Nelson Lab,’’ every day.

T.M.U.: I consider myself one of the greatbeneficiaries of your fellowship program in gyneco-logic pathology that you ran while at St. John’s. Ihave to believe this was one of the very earliest ofsuch fellowships. Would you care to tell us how itbegan and also mention those who were your fellows.

F.T.K.: When I assumed the Pathology Director-ship at St John’s in 1974, I was encouraged andsupported from the start to develop the pathologyresidency to include appointees in every year of astandard 4-yr program. Before that year ended, I wasapproached by a young woman who was justcompleting her pathology residency at WashingtonUniversity; she requested that I admit her to afellowship in gynecologic pathology, under my




direction. I responded that there was no such fellow-ship, to which she replied, ‘‘So start one.’’ I went tothe Hospital President, Sister Mary Roch, who saidon the spot, ‘‘Do it.’’ At which point I told my firstapplicant, Fattaneh (Tanya) Tavassoli, ‘‘We start onJuly 1.’’ Together Dr Tavassoli and I published astudy of 48 consecutive patients we identified withatypical hyperplasia of the endometrium treated byhysterectomy, with a critical evaluation of the lack ofsignificance of focal carcinoma in 12 of the subsequenthysterectomies (11).Tanya was followed by a remarkable series of

talented young people, most of whom, like Tanya,who is now at Yale, and of course, you, Tom, arenow professors at various institutions. All of thefellows authored one or more publications in peer-reviewed pathology journals; actually, so did nearlyall of our pathology residents. Beverly Kraemer alsowrote a book; Helen Michael, Michael Mazur, GregSpiegel, and Scott Martin became professors, andScott returned to follow me as Chief of the PathologyDepartment at St John’s. I can be proud of all ofthem. Figure 4 is a representative photograph ofsome of the St John’s pathology staff in 1980,including Dr Thomas Ulbright during his year asGynecopathology Fellow (back row, center) with afew other residents and pathology staff.

T.M.U.: I know that over the years you haveparticipated in a number of educational programsfor organizations such as the ASCP and IAP (latertermed ‘‘USCAP’’) and others. I believe you hadmajor responsibilities for at least 2 of the ‘‘LongCourses’’ of the latter society. Who did you enjoyworking with on these activities?

F.T.K.: My introduction into the IAP educationalprograms was promoted by Dr Ackerman. He soughtto convince me that I would flounder hopelessly afterfinishing my gynecologic pathology book if I did notimmediately embark on some new projects. Thus, heinduced me to submit a Short Course on ‘‘Vulva,Vagina and Cervix,’’ which I presented for severalyears at the annual IAP meetings. This course lastedfar too long, such that I became sick of the subject.Jason Norris, by this time head of the AFIP Breastand GYN branch, took charge of organizing theannual Long Course dealing with the uterus in 1970,as well as editing the resultant monograph based onthe course. He asked me to contribute a couple oftalks to be presented at the 1970 meeting. Theseeventually took the form of chapters, one on thebiology of carcinoma in situ and microinvasive

carcinoma of the cervix (12), and another an ultra-structural study of irradiation changes in the ute-rus (10). Almost 20 yr later I found myself editing,with Dr Ivan Damjanov, the USCAP Long Coursewhich was titled The Pathology of ReproductiveFailure (13). As a highlight of this course presenta-tion, we made a special point of honoring Dr Hertig,still quite hale and hearty and in attendance at themeeting, as we showed some of his remarkable earlyova. His cheery response brought loud applause.In addition, other friends and mentors included me

in the conduct of CME courses in gynecologicpathology. The first was Frank Vellios, a surgicalpathology trainee of Arthur Purdy Stout, who had bythis time become editor of the American Journal ofClinical Pathology and professor at Indiana Univer-sity. Frank organized a CME gynecologic pathologycourse for the ASCP, and asked me to join his facultygroup, comprised of Robert Scully (Harvard),William Christopherson (Louisville), and James W.Reagan (Case Western). Needless to say I wasimmensely flattered to be included with this set ofeminent surgical pathologists and threw myself intoit. The ASCP experimented with my pictures ofvulva, vagina, and cervix to do a prototype atlasillustrating the pathology of these organs based onmy part in that course. This course lasted 4 or 5 yr,during which I learned a lot from all of them andthoroughly enjoyed our developing friendships.About this time the Arthur Purdy Stout Societydecided to enlarge its membership from Stoutassociates and trainees to include well recognizedsurgical pathologists as a group. Each existingmember selected one new member; I was thrilled tofind that Frank Vellios selected me. We had our firstmeeting in New York at which I, as well as someothers, was required to present an interesting case.For a few years I was Chair of the AdmissionsCommittee. Since that time the Arthur Purdy StoutSociety of Surgical Pathologists has expanded tre-mendously.The ASCP course was followed by an invitation by

Steve Silverberg to participate as a teacher in asimilar course sponsored annually for several years inJuly by the University of Colorado at the GivenInstitute in Aspen, Colorado. The summer trips toAspen were a major treat, allowing me to indulge infly-fishing on the Roaring Fork River and explore themany hiking trails there. Later, I took part in a seriesof courses on placental pathology organized byDouglas Shanklin, first at the University of Chicago,and later at Woods Hole. In addition to the usual




slide presentations, Doug managed to have freshplacentas around, which he presented bare-handed,assuring us that it was very good for improving one’sskin complexion.In more recent years I enjoyed some itinerant trips

as visiting professor to give lectures on gynecologicpathology topics as the guest of Dr Vincenzo Eusebiat the University of Bologna (1997) and at theUniversity of Rome (Tor Vergata) in 1995 as theguest of Dr Giuseppe Santeusanio and ProfessorLuigi Spagnoli in the company of Robert R. Pascal, awell-known member of the Arthur Purdy Stouttrainees at Columbia University.

T.M.U.: As noted earlier, in your ‘‘retirement’’ youhave moved back to Washington University and nowoccupy a position in the Department of Obstetricsand Gynecology where you study placental pathol-ogy. Even when I was a fellow I saw that you werequite interested in the placenta, so I would like toknow what stimulated this interest to the extent thatyou have devoted the latter portion of your careerto it.

F.T.K.: Ah, placentas! Placentas were rarely sent topathology during my residency days at St LouisMaternity Hospital. My interest became known, andI started presenting pathology to the local/regionalmaternal mortality conferences. If placentas werevery remarkable in some way, they would be broughtto the lab to be looked at by a cluster of interestedobstetricians. But I was always interested and after Imoved to St Luke’s Hospital in 1963 my OB friendswould sometimes send an unusual one, as a personalpresent, something I could photograph for the book.No one expected a report and certainly there was nobill from the pathology department. Several yearspassed and then the lawsuits on obstetricians beganto pile up. Not too long after I moved to St John’sMercy in 1974, the OB Department there set stand-ards for submission of clinically indicated placentasto be sent for pathologic study. Placenta submissionsincreased, especially if there was any indication oftrouble, and the value of these examinations soonbecame apparent, especially in the event of a lawsuit.These provided the pathologic basis for our articles

FIG. 4. A portion of the pathology staff and residents at St John’s Mercy in 1980. In the front row are Drs Tomas I. Aquino, Andres J.Valdes, Nissi Varki, John Chumas, and Donna Weise. In the back row are Drs Phillip Burch, Thomas M. Ulbright, and Frederick T. Kraus.




on such subjects as chorioamnionitis (14), fetalthrombotic vasculopathy (15,16), hemangiomas (17),and other vascular lesions. I am especially pleased byan autopsy series that demonstrated cerebral andother visceral thrombi and infarcts in newborns withfetal thrombotic vasculopathy in the placenta (15).I was pleased and flattered by the fact that some of

the obstetricians would often attach a note indicating‘‘Attention Dr Kraus’’ to the placentas from theirpatients. Pathologists generally did not seem to sharemy infatuation with placentas. I have heard it saidthat on a busy day some of my pathology colleaguesmight have been tempted to add themselves a note of‘‘Attention Dr Kraus’’ to placenta specimens in-tended for their day’s work. If so, I never noticed.I have been extremely fortunate to be able to

assemble a remarkable pathology staff at St John’sMercy Medical Center. We were good friends,competent pathologists, and all motivated to achieveexcellence in teaching, and the practice of pathologyin a tertiary care environment. Pathology subspecial-ties represented included neuropathology, renalimmunopathology, clinical chemistry, microbiologyand virology, hematopathology, dermatopathology,gynecologic and perinatal pathology, and bloodbanking.When, in 1991, I stepped down as chief of the

pathology department at St John’s Mercy, and I askedto be allowed to take over the examination of all of theplacentas and all of the perinatal autopsies, the requestwas definitely greeted with smiles from everyone. WhenI ultimately retired in July, 2000, it was because theeffort to examine as many as 20 – or more – placentas aday had become too much for my back, not from anyebbing of interest. At this point I must add that myplacental work was made lighter by the devotedassistance of Doctor Ackerman’s younger daughter,Jennifer Ackerman Arndt, who for years weighed,measured, and organized my examination ofthe placentas. She also organized the photographysetup for many gross photographs selected by me andfor all of the pathologists and residents in the grossroom.

T.M.U.: During your long distinguished career youhave seen many changes in the field with the adventduring the time of electron microscopy, immunohis-tochemistry and molecular pathology. Much as thenew techniques may contribute I think it faircomment that some senior pathologists have con-cerns that it can lead to a trend to de-emphasize allthe ‘‘old’’ important aspects such as clinicopatho-logic correlation and gross features of specimens.

Do you have any reflections on what I am raisingand indeed on the overall course of pathology as yousee it today?

F.T.K.: Surgical pathology has undergone remark-able changes in the past 65 yr. I believe that theimpact of all these new techniques has beenconsistently positive. The main contribution ofimmunohistochemistry, electron microscopy, andmolecular pathology has been to confirm, refine,and sometimes correct the diagnostic informationthat microscopic study of cells, tissues, and tumorsconveyed to us by the simple hematoxylin and eosin–stained slides when I graduated in 1955. As of today,pathologists continue to do much, or even most ofthe definitive significant diagnostic surgical pathologyinterpretations with the same hematoxylin and eosinslides and microscopes as used when I started. Thepathologist now has a better-informed brain and theability to confirm opinions that were less certain inyears past, by applying these new techniques.

T.M.U.: I know your daughter, Madeleine, has goneinto pathology and, like many, you have had a verysupportive spouse. Would you care to share with thereader any reflections on the strong happy familyenvironment (Fig. 5), which I am sure contributed toa positive outlook at work?

F.T.K.: Yes, Madeleine got her pathology start atBrigham and Womens, where she branched intoHematopathology under Geraldine Pinkus. Shefollowed my steps in medical school at WashingtonUniversity School of Medicine and even, for a shortperiod, at St Luke’s Hospital. She is now head ofhematopathology at the Nemours Children’s Hospi-tal in Orlando, Florida.Her younger sister, Caroline, has developed a

career as a writer and documentary film maker, witha focus on human-animal relationships. Her currentdocumentary in preparation is titled Moments ofTruth Project. Her first book was a memoir entitledBorderlines, published by Random House.My son, Grant is an attorney employed as senior

counsel by the National Labor Relations Board. Inthis way he fulfills his personal goal to improve labor-management relations and ensure balanced imple-mentation of the National Labor Relations Act. Hehas served as a member of the vestry of St John’sEpiscopal Church on Lafayette Square in Washing-ton DC and on the Board of Directors of RebuildingTogether of Washington DC, a nonprofit that repairsthe homes of low income residents. He is an activerower and a member of the Capital Rowing Club.




My late wife, also Madeleine (Monny), wassupportive of my career from the beginning, andeven involved in my academic pursuits. She encour-aged my extracurricular activities at the AFIP duringmy army service by defending my schedule and bytyping the long hand drafts of my early papers. WhenI started work on my gynecologic pathology book,handwritten on lined pads, Monny typed the wholemanuscript. She was totally attentive to our child-ren’s education, but saw to it that I participated also,from reading aloud before bedtime, to changingdiapers and attending teacher conferences. I wasconvinced that each of our children should have his/her own microscope, with which I showed them theteeming life forms present in pond water andinfusions from a tuft of grass from the yard outsidethe house. I actually envisaged the microscopes ashaving constant enthusiastic use. They took all this in

good humor, but only Madeleine still uses a micro-scope.Our family has remained close. For over 20 yr my

second wife, Gayle (Fig. 6), and I have rented a housein Islesboro, Maine, in August, where we havevacationed together with at least 1, but usually moreof my 3 grown children. We have fun together as afamily, sailing, playing tennis, paddling sea kayaks,and on foggy days playing bridge. We also shareChristmas holidays together, each year in St Louis.Whenever at least 4 of us gather we set up the bridgetable.Gayle has pursued a very absorbing international

business career in the energy industry and wasalready widely travelled when we met. In recent yearsGayle has given encouragement and major assistancein organizing my travels to give placental talks inGranada, Bologna, and Rome. We have also traveled

FIG. 5. The Kraus family circa 1986, from left to right, Caroline, Grant, Madeleine, Monny, and Fred.




as tourists and to visit friends in London, Paris,Berlin, Vienna, Athens, the Greek Islands, Venice,the Dalmatian Coast, and, most recently, Istanbuland Milan. As an avid and competitive tennis player,Gayle gets me on the court, in a shared lesson with apro each week, more in the summer. She is very activeprofessionally as trustee on corporate and nonprofitboards, which stimulates me to continue my dailyappearance at the WUMS laboratory.

T.M.U.: Perhaps you would like to elaborate a littlebit more on your post-‘‘retirement’’ activities.

F.T.K.: Throughout my postretirement years Ihave continued as associate editor of Human Pathol-ogy. I continue to enjoy editing the case reports, mostof which present interesting ideas and keep mypathology concepts a little more current. Now that Iam less pressed for time, interacting with the reviewersand authors has also become more rewarding. This

involves some degree of activity pretty much everyday.I have already mentioned my teaching activities in

the OB/GYN department at Washington University.The relationship there resumed in July 2000 with anappointment as Adjunct Professor of Obstetrics andGynecology (!) assigned to the ‘‘Nelson Lab’’ directedby D. Michael Nelson, MD, PhD, the Virginia S.Lang Professor of Obstetrics and Gynecology.Currently, I continue to enjoy the stimulation ofcontact with residents, fellows, and the research teamin the Obstetrics and Gynecology Department at theWashington University School of Medicine.I have contributed my observations of the relevant

placental pathologic features to several of theresearch publications from this laboratory. We haveidentified placental pathologic features in growthrestriction in a series of 161 SGA fetuses, identifiedthe apoptotic nature of the nuclear changes in

FIG. 6. Gayle and Fred sailing in Maine.




meconium-associated vascular necrosis, and showncorrelations between different placental sites and geneexpression. In 2004 I completed an Atlas of PlacentalPathology (18) for the AFIP Non-Tumor Seriespublished by the American Registry of Pathology,with the aid of coauthors Raymond Redline,Deborah Gersell, Jeffrey Dicke, and Dr Nelson. Ienjoyed helping Ona Marie Faye Petersen organize aweek-long course on perinatal pathology for theSociety of Pediatric Pathologists, which took place inSalt Lake City in 2008.In April, 2010 I assembled an international group

for a course on placental pathology, which washosted and beautifully organized by ProfessorFrancisco Nogales and presented in his pathologydepartment at the University of Granada in Spain.The speakers included Eoghan Mooney (NationalMaternity Hospital, Dublin), Rebecca Baergen(Cornell University, New York), and RaymondRedline (Case Western Reserve, Cleveland), withMichael Wells (President, European Society ofPathology) and Professor Nogales presiding anddiscussants. This event was dedicated in homage tothe late Professor Harold Fox, The founding editorof Placenta, who was, sadly, too ill to attend. Inaddition to his long friendship with all of us, hismany contributions to placental pathology, Haroldwas fondly remembered by all of us for his witty andacerbic delivery. Some years previously I had hadthe pleasure joining in a gynecologic pathologyseminar and visit to Harold and his wife, Augusta, inManchester, England where I was treated to thedetails of preparing a delicious ‘‘proper Manxkipper’’ for our Sunday breakfast. All of us whoattended this course were looking forward toHarold’s customary panache, which we sorelymissed, due to his illness.This event coincided with my 80th birthday. Thus,

with Gayle, son Grant, and dear friends, I foundmyself on the evening of my birthday dining at alovely restaurant on a high point in Granada gazingover at a stunning view of the beautifully illuminatedAlhambra some 1000 yards away.

Acknowledgments: The authors thank Dr Robert H.

Young for his encouragement and helpful comments and

suggestions and Madeleine Kraus, MD, for providing some

of the photographs.

REFERENCES

1. Smith MG, Blattner RJ, Heys FM, et al. Experiments on therole of the chicken mite, Dermanyssus gallinae. and themosquito in the epidemiology of St. Louis encephalitis. J ExpMed 1948;87:119–38.

2. Kraus FT, Neubecker RD. Luteinization of the ovarian thecain infants and children. Am J Clin Pathol 1962;37:389–97.

3. Kraus FT, Neubecker RD. The differential diagnosis ofpapillary tumors of the breast. Cancer 1962;15:444–55.

4. Kraus FT. Gynecologic Pathology. Saint Louis: CV Mosby;1967.

5. Ackerman LV, Kraus FT. The pathology of tumors. I.Introduction, precancerous lesions and benign lesions thatresemble cancer. CA Cancer J Clin 1962;12:222–32.

6. Ackerman LV, Kraus FT. The pathology of tumors. II. Biopsyand exfoliative cytology. CA Cancer J Clin 1963;13:18–24.

7. Ackerman LV, Kraus FT. The pathology of tumors. CACancer J Clin 1963;13:57–64.

8. Ackerman LV, Kraus FT. The pathology of tumors. IV. CACancer J Clin 1963;13:99–108.

9. Ackerman LV, Kraus FT. The pathology of tumors.V. CACancer J Clin 1963;13:138–48.

10. Kraus FT. Irradiation changes in the uterus. In: Norris HJ,Hertig AT, Abell MR, eds. The Uterus. Baltimore: Williams &Wilkins; 1973:457–88.

11. Tavassoli F, Kraus FT. Endometrial lesions in uteri resected foratypical endometrial hyperplasia. Am J Clin Pathol 1978;70:770–9.

12. Kraus FT. The biology of carcinoma in situ andmicroinvasive carcinoma of the cervix. In: Norris HJ, HertigAT, Abell MR, eds. The Uterus. Baltimore: Williams &Wilkins; 1973:348–81.

13. Kraus FT, Damjanov I, Kaufman NE. The Pathlogy ofReproductive Failure. Baltimore: Williams & Wilkins; 1991.

14. Zhang JM, Kraus FT, Aquino TI. Chorioamnionitis: acomparative histologic, bacteriologic, and clinical study. Int JGynecol Pathol 1985;4:1–10.

15. Kraus FT, Acheen VI. Fetal thrombotic vasculopathy in theplacenta: cerebral thrombi and infarcts, coagulopathies, andcerebral palsy. Hum Pathol 1999;30:759–69.

16. Kraus FT. Fetal thrombotic vasculopathy: perinatal stroke,growth restriction, and other sequelae. Surg Pathol Clin 2013;6:87–100.

17. Mucitelli DR, Charles EZ, Kraus FT. Chorioangiomas ofintermediate size and intrauterine growth retardation. PatholRes Pract 1990;186:455–8.

18. Kraus FT, Redline RW, Gersell DJ, et al. Atlas of Non-TumorPathology: Placental Pathology. Silver Spring, MD: ARPPress; 2004.




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