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Guido Majno, MD: 1922–2010

2010; American Medical Association; Volume: 134; Issue: 12 Linguagem: Inglês

10.5858/2010-0435-imr.1

1543-2165

Armando E. Fraire, Bruce A. Woda,

Guido Majno, MD, humanist, educator, and man of science, died on May 27, 2010, at age 88, from complications resulting from Parkinson disease.Dr Majno (or simply Guido to his many friends and colleagues) was born on February 9, 1922, in the northern Italian region of Lombardy. He earned a doctorate in medicine and surgery from the University of Milan in 1947 and shortly after graduation moved to the Institute of Pathology at the University of Geneva, Switzerland, where he became an assistant in pathology, a post that he held until 1951. A promotion to Chef des Travaux (chief resident) followed, and in 1952 he received his Diplôme de Médecin Spécialiste en Pathologie et Anatomie Pathologique (board certification). At this point, he was already committed to investigate basic mechanisms of disease and sought to broaden his perspectives for a future career in experimental pathology by moving across the Atlantic, to begin working as a research associate at Tufts Medical School in Boston, Massachusetts. While Dr Majno was in Boston, Arthur Hertig invited him to the Department of Pathology at Harvard Medical School, and this was the start of his 15-year association with Harvard. This association began in 1953 with an appointment as instructor in pathology and matured with successive appointments as associate in pathology (1955–1958), assistant professor (1958–1961), and associate professor (1961–1968). A brief but prolific interruption of his Harvard affiliation occurred in 1958–1959 when he took a sabbatical to become a guest investigator at the Rockefeller Institute, where he closely collaborated with his friend and associate, Nobel Laureate George Palade. In 1968, Dr Majno was persuaded to return to Switzerland to become professor and chairman of the Department of Pathology at the University of Geneva, a post that he retained for 5 years. Seminal cardiovascular work conducted at Geneva in collaboration with Bouchardy led to the discovery of the wavy fibers as one of the earliest if not the earliest morphologic manifestation of acute myocardial infarction. Today, wavy fibers are cited worldwide in countless publications. While chairman at Geneva, Dr Majno also made what may be regarded as one of his major discoveries, along with his elucidation of the vascular leak: that of the myofibroblast, when he convincingly demonstrated the contractile nature of the cells. But he missed the pace of life and dynamics of American medicine, and in 1973, he made the momentous decision to return to America, to become chairman of the Department of Pathology of the newly created University of Massachusetts (UMass) Medical School at Worcester, Massachusetts. His friends and close associates recount that upon accepting the UMass position, Dr Majno was not even sure where Worcester was, but successful persuasion from the dean of the medical school, Lamar Soutter, led to his acceptance. This marked the start of a fruitful 35-year association with UMass, first as professor and chairman (1973–1995), later as professor (1995–2002) and ultimately as professor emeritus (2002–2010). During his long tenure at UMass, Dr Majno was instrumental in the transformation of the UMass Medical School Department of Pathology from a small fledgling unit to a large dynamic department focused on experimental pathology and providing quality diagnostic pathology services to the patients of central Massachusetts.Dr Majno distinguished himself with major contributions in research and teaching. These activities can be roughly divided into the Geneva, Boston, and Worcester stages. The early Geneva-based stage saw Dr Majno engaged in issues as diverse as the benefits of preoperative irradiation for carcinoma of breast and the surgical management of Felty syndrome. While at Harvard Medical School, he published important studies on lipid biosynthesis in the peripheral and central nervous systems, issues related to scar contraction and cellular death, and necrosis in rat liver. Concurrent with his research work at Harvard, Dr Majno began a new curriculum in which a few selected medical students would spend a year with him learning pathology. This was the genesis of his famous and unique general pathology course at Harvard, which at a later time he brought to Worcester when he became chair at the brand new medical school of UMass. As noted, a major development in his career occurred when George Palade of the Rockefeller University was invited to give a talk at Harvard in which he first demonstrated vesicular transport at the ultrastructural level. At this point, Dr Majno approached Palade to see if he could work with him at the Rockefeller, where they had one of the first electron microscopes in the nation for biologic research. This ability to observe submicroscopic organelles marked the birth of ultrastructural cellular pathology. In collaboration with Palade and Schoefl, seminal studies on inflammation and vascular permeability took place, resulting in important clarifications on how serotonin and histamine contribute to vasodilation. Amazingly, he demonstrated that nothing happened in the capillaries but that there was separation of the endothelial cells in postcapillary venules, which was the pathogenesis of the vascular leak; this totally unexpected observation is widely regarded as one of the major discoveries in experimental vascular pathology. Further collaborative work with Ramzi Cotran and others1,2 resulted in important publications on inflammation and vascular injury. Throughout his professional life, Dr Majno's intellectual curiosity led him to ask questions such as why blood vessels leak, why wounds contract, and how atherosclerosis is related to inflammation. Using his inquisitive mind and the tools of scientific investigation, he greatly contributed to the clarification of these fundamental questions.The Worcester years were first dedicated to establishing and solidifying the academic status of the department of pathology through the recruitment of first-class research faculty, including Isabelle Joris, Henri Cuenoud, Raymond Welsh, and Arthur Like (to name a few), and clinical faculty, including Jag Bhawan, Frank Reale, David Purtillo, Rajwant Malhotra, Umberto DeGirolami, and Tom Smith. Later, his emphasis moved to writing and publishing. During his productive career in pathology, Dr Majno published several books and more than 170 papers in first-rate journals. While at Worcester he very quickly established himself as primus inter pares in the field of medical student teaching. He is fondly remembered by his former students. Recently and upon learning of his passing, a former medical student wrote, “In second-year medical school at UMass I will never forget how—his voice getting weaker and weaker—it was a problem. We students knew we were in the presence of a gentle genius. We did not want to miss a single pearl from his lips, so a fellow student fashioned, with a coat hanger, a special holder for the lapel microphone (it kept the mic about 3 inches from the mouth).” The student further said, “And now we could hear him. He lectured the rest of the year using the contraption.”Dr Majno's excellence in teaching was widely recognized at home and abroad. Notable honors conferred upon him included his election as President of the New England Society of Pathology, receiving the Gold Headed Cane Award from the American Association of Pathology, delivering a Maude E. Abbott Lecture for the US and Canadian Academy of Pathology, his appointment as President of the Swiss Academy of Pathology, and achieving the Alpha Omega Alpha Distinguished Teacher Award from the Association of American Medical Colleges as well as numerous (14) consecutive Outstanding Medical Educator Awards given by the Faculty and Student Body of the UMass Medical School. Dr Majno's books listed in the references below have been the subject of multiple honorable mentions and awards. Writing for the British Medical Journal on Dr Majno's book The Healing Hand,3 Charles Newman wrote: “What vitality—a great laughing, learned extroverted giant, dragging you with him on one of the most stimulating and entertaining journeys for a long while . . . this is just a great astonishing book.” Dr Majno received the Phi Beta Kappa award for The Healing Hand. Dr Majno felt that scientists, even accomplished ones, must understand the basic mechanisms of disease. His quest to transmit this knowledge resulted in the book that he and Isabelle Joris wrote, Cells, Tissues, and Disease,4,5 consistent with his premise that we first must understand disease at the cellular level. This book represents the second (after The Healing Hand) centerpiece of his academic life, clearly laying out the principles of general pathology for medical students, graduate students, physicians, and biomedical researchers, with elegance and deep insight. Drs Majno and Joris received an award from the American Medical Writers Association for this work. An Italian translation, Cellule, Tessuti e Malattia: Principi di Patologia Generale,6 followed in the year 2000.Dr Majno had a wonderful sense of humor and enjoyed crafting practical jokes. He told Keith Porter, who did pioneering work on the ultrastructure of cells and described the endoplasmic reticulum and confirmed the presence of the Golgi apparatus, that there was a statue of Camillo Golgi at the University of Pavia, Pavia, Italy. Porter thought that he should have one also. When Dr Majno and Porter traveled to Italy, Dr Majno commissioned a prominent sculptor to craft a statue of Porter and had it placed in the courtyard of the university, adjacent to Golgi's. Porter's reaction to this can only be guessed.Everyone in Dr Majno's department was important, and he treated everyone with care and respect. At lunch, Dr Majno's table included a wide range of laboratory workers and, quite often, medical students. His interests in life extended beyond medicine to the fine arts, ancient Asian and European civilizations, pre-Columbian Mesoamerican history, music (he was accomplished at the violin and the musical saw), and scuba diving. Dr Majno is survived by his wife, Dr Isabelle Joris, and children from a previous marriage, Corinna, Lorenzo, and Luca. Those who have had the treasured experience of working with Dr Majno may rest confident in the knowledge that they have studied with one of the finest physicians-scientists-educators in the field of pathology. We are honored for the privilege of writing these lines.To close this remembrance, it is fitting to recall how on the occasion of his retirement as chair, Dr Majno addressed everyone in the audience and said: “Thank you again, farewell and—as the Navajo say, may you walk in beauty.”