Babes Papa Nicola Ou

From the Department of Pathology, University of Michigan, Ann Arbor, Michigan, U.S.A.; Department of Pathology, P. Sarbu Clinic,

Bucharest, Romania; Department of Cytopathology, First IKA Hospital, Athens, Greece; and Volker Schneider Laboratory, Freiburg, Ger-

many.

Dr. Naylor is Professor Emeritus, Department of Pathology, University of Michigan.

Dr. Tasca is Senior Pathologist, Department of Pathology, P. Sarbu Clinic.

Dr. Bartziota is Departmental Director, Department of Cytopathology, First IKA Hospital.

Dr. Schneider is Laboratory Director, Volker Schneider Laboratory.

This address was presented by Dr. Naylor as recipient of the Kazumasa Masubuchi Life-Time Achievement in Clinical Cytology Award

at the 14th International Congress of Cytology, Amsterdam, the Netherlands, May 27–30, 2001.

Financial Disclosure: The authors have no connection to any companies or products mentioned in this article.

Received for publication October 16, 2001.

Accepted for publication November 7, 2001.

1

The Journal of Clinical Cytology and Cytopathology

ACTACYTOLOGICA

In Romania It’s the Méthode Babes-Papanicolaou

Bernard Naylor, M.B., Ch.B., F.I.A.C., F.R.C.Path., Luminita Tasca, M.D., M.I.A.C.,Evangelia Bartziota, M.D., M.I.A.C., and Volker Schneider, M.D., F.I.A.C.

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First I wish to thank the International Academy ofCytology (IAC) for honoring me with the Masu-buchi Life-Time Achieve-ment in Clinical CytologyAward. This award im-plies that my activities inclinical cytology havetaken place over manyyears, and, indeed, theyhave: 45 to be exact. Myreceiving this award alsoimplies that these activi-ties have been of sufficientmerit to be consideredworthy of the award, and,of course, this gives me great pleasure and great sat-isfaction. And not only am I most grateful to receive

the award because of the honor it brings, but I con-sider myself extremely fortunate because it gives

me the opportunity to ad-dress the academy on asubject of my own choos-ing.

To begin with, I shallshow you photographs oftwo men. Each of thesemen made published con-tributions to cytopatholo-gy. In the first photographalmost all of you will rec-ognize Dr. George Papani-colaou, the founder of

modern cytopathology (Figure 1). The next is a por-trait of the late Dr. Aurel A. Babes (Figure 2), the Ro-

0001-5547/02/4601-0001/$19.00/0 © The International Academy of CytologyActa Cytologica

Dr. Babes’ contribution tocytopathology has not been

overlooked in Romania, his home-land, where the Pap test is known

as the MéthodeBabes-Papanicolaou.

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manian pathologist who published a major contri-bution to cytopathology in 1928 but who, today, hasonly a tenuous position in its history. I expect thatthose of you who recognized Dr. Papanicolaou farexceeded the number who recognized Dr. Babes,even though Dr. Babes observations on the poten-tial to diagnose uterine cancer from cervical smearswere published almost one year before Dr. Papani-colaou first published his findings on the subject.

Contributions of Dr. Babes to Cervical Cytology

What, exactly, were the circumstances of these earlyannouncements of the finding of cancer cells in cer-vical scrapings and vaginal aspirates? Dr. Babesand his senior colleague, Professor ConstantinDaniel (Figure 3), presented their findings at twosessions of the Bucharest Society of Gynecology,one in January (Figure 4) and the other in April1927. Abstracts of their presentations were subse-quently published in the proceedings of theBucharest Society of Gynecology.1,2

These were followed in 1928 by a major article byDr. Babes in Presse Médicale, the French generalmedical journal (Figure 5), titled “Diagnostic du Can-cer du Col Utérin par les Frottis”3 (“Diagnosis of Can-cer of the Uterine Cervix by Means of Smears”). Itcontained an accurate description of cells of squa-mous cell carcinoma in cervical smears. The cellswere obtained by using a platinum loop to transfermaterial from the cervix to the slides, which werethen air dried and stained with Giemsa stain. Thisarticle was Dr. Babes only major contribution to cy-topathology. He published an article in 1931 on su-perficial squamous cell carcinoma of the cervix, butit made only passing reference to the smear methodof diagnosis.4 Babes’ contribution to cytopathologyseemed not to have taken root, and his contributionwas practically forgotten. Before he died, in 1961, hewas given credit in Europe,5-7 South America8 andthe United States, where J. E. Ayre referred to him

2 Acta CytologicaNaylor et al

Figure 1 Dr. George N. Papanicolaou (1883–1962).

Figure 2 Dr. Aurel A. Babes (1886–1961).

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in his 1951 atlas, Cancer Cytology of the Uterus.9

However, Babes’ work seems to have been un-known to Dr. Papanicolaou.

Contributions of Dr. Papanicolaou toCervicovaginal Cytology

Dr. Papanicolaou presented his finding of cancercells in vaginal aspirates in January 1928 at theThird Race Betterment Conference in Battle Creek,Michigan, a city about 180 km east of Chicago. Theconference met in the Battle Creek Sanitarium (Fig-ure 6), now the Battle Creek Federal Center. (Whythe Battle Creek Sanitarium? Dr. John Harvey Kel-logg, developer of Kelloggs’ cornflakes and co-founder of the world-famous cereal company, wasthe physician-in-chief at the Sanitarium, where peo-ple came from far and wide to experience his phi-

losophy of preventive medicine, or “biologic liv-ing.”) The subsequently published article on Dr.Papanicolaou’s findings, which was of modestlength, remained in obscurity because it was pub-lished in the proceedings of the conference10 rather

Volume 46, Number 1/January–February 2002 3Méthode Babes-Papanicolaou

Figure 3 Dr. Constantin Daniel, professor of gynecology and director of gynecologic services at Coltea Hospital, Bucharest.

Figure 4 Abstract of the presentation of January 23, 1927, byDaniel and Babes to the Bucharest Society of Gynecology (“Possibility of Diagnosing Uterine Cancer by Means of Smears.”)The second paragraph may be translated: “For this purpose an attempt has been made to establish a diagnosis in 10 cases, somewith and some without cancer, by means of smears from the lesions. This new procedure, from the results that have been obtained up to the present, truly promises to become a proce-dure of practical usefulness.”

Figure 5 Title of the 1928 article by Dr. Babes in Presse Médicale (“Diagnosis of Cancer of the Uterine Cervix by Meansof Smears”).

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than in a suitable medical journal.Dr. Papanicolaou then abandoned for quite a

while the subject of the cytologic diagnosis of uter-ine cancer. After about almost 10 years, however, atthe suggestion of the chairman of the Departmentof Anatomy at Cornell University in New YorkCity, the department to which Dr. Papanicolaou be-longed, he took it up again, and in 1941 he pub-lished, with Dr. Herbert Traut, professor of gyne-cology, an article in the American Journal of Obstetricsand Gynecology titled, “The Diagnostic Value ofVaginal Smears in Carcinoma of the Uterus”11 (Fig-ure 7). This article was followed two years later bytheir epic monograph Diagnosis of Uterine Cancer bythe Vaginal Smear12 (Figure 8), with its magnificentdrawings of cells and tissues (Figure 9). These twopublications of Papanicolaou and Traut marked thebeginning of the modern era of cytopathology.

Drs. Babes and Papanicolaou: Their InternationalRecognition

Although Dr. Babes article of 1928 in Presse Médicalewas referred to in the Italian medical literature13,14

before the year was over, it seems to have remainedin obscurity until the early 1950s, when, with the in-ternational surge of interest in cytopathology, itwas “discovered.” By then, however, it had beeneclipsed by the numerous publications on the sub-ject by Dr. Papanicolaou and his colleagues. Itshould be noted that neither Dr. Babes nor the Ital-ian authors had any thought of screening symptom-less women; indeed such an idea seemed revolu-tionary even when it was introduced 20 years later.

Why did Dr. Babes publication of 1928 attract solittle attention? Having been published in a general


Figure 6 Battle Creek Sanitarium, Battle Creek, Michigan,where Dr. Papanicolaou gave his presentation in 1928 on thefinding of cancer cells in vaginal aspirates.

Figure 7 Cover with the title of the article by Drs. Papanicolaouand Traut published in the American Journal of Obstetrics andGynecology in 1941.

Figure 8 Title page of the monograph published by Papanicolaou and Traut in 1943 on the diagnosis of uterine cancer by the vaginal smear.

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Figure 10 Judge Vichentie Babes, grandfather of Dr. Aurel A.Babes.

medical journal in the French language, it wouldnot have reached the much wider audience in thevast English-speaking world. In contrast, Drs. Pap-anicolaou and Traut published in the American Jour-nal of Obstetrics and Gynecology in the United Statesin English at a time when this was about to becomethe lingua franca of the international medical andscientific communities. Furthermore, the popula-tion of the United States was rapidly becomingmore cancer conscious, and gynecologists therewere quick to recognize the potential of Dr. Papani-colaou’s observations. The American Cancer Soci-ety was also quick to recognize the tremendousvalue of Dr. Papanicolaou’s observations15 andgave him the financial support to pursue his re-search in cytopathology right up to the time of hisdeath, in 1962. He was thus able to publish his re-search in books and numerous articles.

The Babes Family

Much is known about the life and work of Dr. Pap-anicolaou.16 In contrast, relatively little has beenpublished about the life of Dr. Aurel Babes, yet onecannot but remark on certain shared aspects of theirlives. They were born in the same part of the world:Dr. Babes in Romania, Dr. Papanicolaou in Greece.They were from upper-middle-class families: Dr.Papanicolaou was the son of a physician, Dr. Babesthe son of a professor of chemistry. However, we doknow the genealogic background of Dr. Babes, wellillustrated by his family tree, which was given tome in Bucharest by his nephew, Dr. Vincent Babes.At the top of the tree was Vichentie Babes, a man ofapparently high position, judging from his ratherelaborate clothes (Figure 10). He was a judge andhad nine children, with four of his five sons becom-ing scientists, lawyers or physicians. One of them,whose name was also Aurel, was the father of Dr.


Figure 9 Drawing of cells and a biopsy specimen of cervicalsquamous cell carcinoma in the 1943 monograph by Papanicolaou and Traut.

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Babes (Figure 11); he became a professor of chem-istry, Professor Aurel V. Babes.

One cannot discuss the Babes family withoutmentioning that one of Judge Babes’ nine childrenwas Dr. Victor Babes (Figure 12), professor ofpathology at the universities of Bucharest and Bu-dapest and uncle of our Dr. Babes; he became an in-ternationally renowned medical scientist, especial-ly in the fields of microbiology and infectiousdiseases. If you consult a medical dictionary andlook up the name Babes you will find about 14 en-tries that incorporate his name, probably the mostfamiliar being the disease babesiosis. It was Dr. Vic-tor Babes who discovered the etiologic agent of thisdisease.

Dr. Babes: His Scholarly Achievements

I have digressed briefly from Dr. Aurel A. Babes toillustrate that he was blessed with the genetic back-

ground that would equip him to carry out scholar-ly medical work. Did Dr. Aurel Babes fulfill his ge-netic promise? He certainly did. Time prevents mefrom mentioning more than a few of his scholarlyaccomplishments; instead, I shall mention only asample of them to give you an idea of his ability, hisdiversity of interests and his achievements.

In 1915 Dr. Babes graduated magna cum laudefrom medical school at the University of Bucharest.His graduation thesis on cerebrospinal fluid wonawards from both the Faculty of Medicine and theRomanian Academy. In 1921 he became senior as-sistant to Professor Constantin Daniel, head of thegynecology clinic of Coltea Hospital, in the center ofBucharest (Figure 13). There he began the collabo-


Figure 11 Dr. Aurel V. Babes, father of Dr. Aurel A. Babes andprofessor of chemistry, University of Bucharest.

Figure 12 Bust of Dr. Victor Babes, uncle of Dr. Aurel A. Babes,on the grounds of the medical school of the University ofBucharest.

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ration with Professor Daniel that resulted in the twoabove-mentioned publications on gynecologic cy-tology of 1927. But prior to these publications on cy-tology Dr. Babes had published, for example,“Study of Fine Morphology of Negri Corpuscles”and “The Diagnosis of Epidemic Typhus by Meansof the Weil-Félix Reaction with Proteus X19,” forwhich he received another award from the Roman-ian Academy. He collaborated subsequently withhis uncle, Dr. Victor Babes and his father, ProfessorAurel V. Babes, and together they wrote a treatiseon the disease pellagra (Figure 14). He also wrote atext on general anatomic pathology (Figure 15), andtoward the end of his career he authored, with Drs.Parhon and Petrea, a book on endocrinology of thesalivary glands (Figure 16). He also publishedworks on gynecologic pathology, syphilis, tubercu-losis, epidemic typhus and the pathology of the ex-

perimental approach to cancer.This is only a small selection of his publications,

but it illustrates the breadth of his interests and hisscholarly accomplishments. It also shows the diver-sity of his interests, which should help us under-stand why he did not have any more publicationson cytopathology. In all, Dr. Babes published 283scientific articles and books in Romania andabroad.17 Many of his studies were translated intoforeign languages and were well known and oftenquoted in the medical literature of his time. Becauseof his important original contributions, Dr. Babeswas elected member of numerous foreign medicalassociations and worked with such famous pathol-ogists as Wegelin, Lubarsch and Meyer in Ger-many. For his scientific contributions, Dr. Aurel A.Babes will remain one of the most distinguishedrepresentatives of Romanian medical scholarship,well recognized beyond the boundaries of his coun-try.18-21

Our Visit to Bucharest

Fortified with some of this information, in Decem-


Figure 13 Coltea Hospital, in the center of Bucharest, where Dr.Babes began his collaboration with Professor Daniel, head of thegynecology clinic.

Figure 14 Title page of a treatise on pellagra authored by Drs.Victor Babes, Aurel V. Babes and Aurel A. Babes.

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ber 2000 a team of four met in Bucharest, the capitalof Romania, to see where Dr. Babes had lived andworked and to speak to any of his former col-

leagues. All the members of the team are heretoday: Dr. Evangelia Bartziota, a cytopathologistfrom Greece who knows Romania well and whospeaks Romanian fluently; Dr. Volker Schneider,secretary-general of the IAC, who is from Germany;Dr. Luminita Tasca, a senior pathologist inBucharest; and myself (Figure 17).


Figure 15 Title page of a book on general anatomic pathologyauthored by Dr. Aurel A. Babes.

Figure 17 The team of four: clockwise, Drs. Bartziota, Schneider, Naylor and Tasca.

Figure 18 Medical school of the University of Bucharest. Thestatue in front of the building is of Dr. Carol Davila, founder ofthe medical school in the 19th century and a leader in medicaleducation.

Figure 16 Title page of a book on endocrinology of the salivaryglands authored by Drs. C. I. Parhon, Aurel A. Babes and Ion Petrea.

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After visiting the medical school (Figure 18), wevisited the famous Dr. Victor Babes Institute, whichopened in 1899 (Figure 19). This institute wasnamed after Dr. Babes’ uncle, Dr. Victor Babes, whobecame a medical hero in Romania, as depicted inFigure 20. The institute was built expressly to en-able him to carry out his research and routine in-vestigations. Our Dr. Babes also worked in the in-stitute.

After visiting the institute, we went to the diplo-matic quarter of Bucharest, where Dr. Babes hadbuilt the house shown in Figure 21. He and his wife,Lucia-Maria, also a pathologist, lived in this archi-tecturally interesting house, but after the countrybecame communist they were forced to live in onlyone room of the house because of restrictions on theamount of living space people were allowed to oc-cupy. The rest of the house was occupied by com-munist officials.

Figure 19 The famous Dr. Victor Babes Institute where Dr.Aurel A. Babes worked.

Figure 20 A portrait of Dr. Victor Babes when he was directorof the institute.

Figure 21 Former home of Dr. Babes and his wife at No. 2Ankara Street in the diplomatic section of Bucharest.

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This was followed by a visit to the C. I. Parhon Institute of Endocrinology, named after a former di-rector, where Dr. Babes spent the last nine years ofhis professional life. Despite its rather rundown ap-pearance (Figure 22), it still remains an importanthospital and research center for endocrinologic dis-eases.

Finally, we visited Serban Voda Cemetery (Fig-ure 23), a huge and crowded cemetery situated nearthe center of Bucharest. On one side of the entrancewere flower sellers (Figure 24); on the other sidewas something much more practical: coffins for sale(Figure 25). We visited the grave of Dr. Babes, whodied in 1961; there his bones and those of his wifeare interred (Figure 26). (Other persons whosenames on the gravestone are not Babes are not rela-tives of the Babes family. Because of space limita-tions at the cemetery, a grave that is not completelyfilled and that will accommodate more bodies ismade available for unrelated people, who may evenwish to make a reservation for themselves.)

Apart from being able to visit with Dr. VincentBabes, the nephew of our Dr. Babes, we could notfind any other person in Bucharest who had knownor worked with him—a big disappointment. Hisnephew, a retired virologist, described him as a re-served and pleasant man. That is about all he re-membered since he was then just a young manabout to begin his studies at the university. Howev-er, on returning to the United States I was extreme-ly fortunate to be able to track down and visit one ofDr. Babes’ former professional colleagues, Dr. IonPetrea (Figure 27), who had worked with him at theInstitute of Endocrinology in Bucharest for the lastnine years of Dr. Babes ‘ life. (In 1970, Dr. and Mrs.


Figure 23 Entrance to Serban Voda Cemetery near the center ofBucharest.

Figure 24 On one side of the entrance to the cemetery: flowersfor sale.

Figure 22 C. I. Parhon Institute of Endocrinology in Bucharest,where Dr. Babes spent the last nine years of his professional life.

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Petrea left Romania for the United States to take aposition at Yale University medical school. Now inretirement, they live close to Yale in a suburb ofNew Haven, Connecticut.)

Epilogue

Almost 40 years ago, in a commemorative article,18

Dr. Petrea described Dr. Babes as a “tireless physi-cian, research worker and professor,” a warm andhonorable man who pursued all of his professionalactivities “to his last day with passion, probity, anddevotion, contributing with modesty, which washis characteristic feature, to the development of Ru-manian Science.” Dr. Petrea also assured me thatDr. Babes knew of the great international reputa-tion in cytopathology that Dr. Papanicolaou hadgained in contrast to his own. However, Dr. Babes


Figure 25 The other side, featuring more practical wares: coffinsfor sale.

Figure 26 The grave of Dr. Babes, where his bones and those ofhis wife are interred.

Figure 27 Drs. Ion Petrea and Naylor outside the Medical Library of Yale University.

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accepted his lack of recognition in the field withoutrancor; after all, he had a wealth of other scientificaccomplishments. Furthermore, Dr. Babes’ contri-bution to cytopathology has not been overlooked inRomania, his homeland, where, in a spirit of fair-ness and generosity, the Pap test is known as theMéthode Babes-Papanicolaou.

This brings us to the end of our story. Again, I ex-press my gratitude to the IAC for giving me thisaward. I also express my appreciation for the gen-erosity of an esteemed physician, educator and for-mer president of the academy, the late Dr. Kazu-masa Masubuchi, who, shortly before he died,established the fund that made the award possible.And finally, on behalf of Drs. Bartziota, Schneider,Tasca and myself, I thank all of you here for havinghonored us with your presence.

Acknowledgments

We gratefully acknowledge the following for theircontributions to the development of this article:Drs. Vincent Babes, Larry E. Douglass, Paz Bue-naventura Naylor, Ion Petrea and Daniel G.Remick.

References1. Daniel C, Babes A: Posibilitatea diagnosticului cancerului cu

ajutorul frotiului. In Proc of Bucharest Gynecology Society,

Bucharest, January 23, 1927, p 55

2. Daniel C, Babes A: Diagnosticul cancerului colului uterin

prin frotiu. In Proc of Bucharest Gynecology Society,

Bucharest, April 5, 1927, p 23

3. Babes A: Diagnostic du cancer du col utérin par les frottis.

Presse Med 1928;36:451–454

4. Babes A: Sur le cancer superficiel du col utérin. Gynecol Ob-

stet 1931;23:418–433

5. Bourg R, Gompel C, Pundel J-C: Diagnostic Cytologique du

Cancer Génital chez la Femme. Paris, Masson, 1954

6. Zinser H-K: Die Zytodiagnostik in der Gynäkologie. Second

edition. Jena, Gustav Fischer, 1957

7. Boddington MM, Cowdell RH, Spriggs AI: Development of

carcinoma of the cervix uteri. Br J Cancer 1960;14:151–164

8. Ferreira CA: Colpocitologia e Citodiagnósticos em Ginecolo-

gia. Rio de Janeiro, Iguassú, 1954

9. Ayre JE: Cancer Cytology of the Uterus. London, Churchill,

1951

10. Papanicolaou GN: New cancer diagnosis. In Proc of 3rd Race

Betterment Conference, Battle Creek, Michigan, USA, 1928,

pp 528–534

11. Papanicolaou GN, Traut HF: The diagnostic value of vaginal

smears in carcinoma of the uterus. Am J Obstet Gynecol

1941;42:193–205

12. Papanicolaou GN, Traut HF: Diagnosis of Uterine Cancer by

the Vaginal Smear, New York, Commonwealth Fund, 1943

13. Viani O: La diagnosi precoce del cancro uterino mediante lo

striscio. Clin Ostet 1928;30:781–793

14. Scalambrino R: La biopsia degli organi interni. Arch Sci Med

1928;52:273–275

15. Vayena E: Cancer detectors: An international history of the

Pap test and cervical cancer screening, 1928–1970. Doctoral

dissertation, University of Minnesota, 1999

16. Carmichael DE: The Pap Smear: Life of George N. Papanico-

laou. Springfield, Illinois, Charles C Thomas, 1973

17. Spriggs AI: History of cytodiagnosis. J Clin Pathol 1977;

30:1091–1102

18. Petrea I: Aurel Babes. Neoplasma 1962;9:445–446

19. Wied GL: Pap-Test or Babes method? Acta Cytol 1964;9:

445–446

20. Douglass LE: A further comment on the contributions of

Aurel Babes to cytology and pathology. Acta Cytol 1967;11:

217–224

21. Petrea I: Soixantième anniversaire de la codification par A

Babès, due cytodiagnostique du cancer du col utérin. Rev

Franc Endocrinol Clin 1988;29:505–510

Keywords: cytology, babesiosis, Papanicolaousmear, cervix neoplasms, cervical smears, Papani-colaou, Babe s, Romania. (Acta Cytol 2002;46:1–12)


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