Life and Lectures of Lent Johnson, M. D.

By Justin Howland M.D.

The Life and Lectures of Lent Johnson, M. D. arose because of my high regard for this pathologist who was chief of pathology at the Armed Forces Institute of Pathology (AFIP) for 50 years. The AFIP is the referral center for all tissues taken from members of the military. By peering through his microscope at samples sent to him

• Language: English
• Publisher: Authors Press
• Release date: Dec 23, 2019
• ISBN: 9781643141930

Justin Howland M.D.

Retired Orthopedic Surgeon Justin Howland practiced orthopedics in Redding, California for 28 years. After graduating from Yale University, he recieved his MD degree from N.Y. Medical College. He interned at Kaiser in San Francisco, and his residency was at Fitzsimons in Denver After a tour in Europe and a stint as Chief of Orthopedics at Fort Dix, N.J., he and his family (five children) returned to California.

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Copyright © 2019 by Justin Howland, M.D.

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CONTENTS

DISCLAIMER

PREFACE

Chapter 1: Lent C. Johnson, M.D.¹

Chapter 2: Bone Development

Chapter 3: The Phospholipids

Chapter 4: Cellular Physiology

Chapter 5: Dr. Johnson’s Seven Basic Concepts.

Chapter 6: Formation of Bone

Chapter 7: Electron Microscopy

Chapter 8: Bone Cell Cycles

Chapter 9: Fracture Healing

Chapter 10: Myositis Ossificans16

Chapter 11: Myositis Ossificans continued (5 cases)

Chapter 12: Cortical Desmoid

Chapter 13: Inflammation

Chapter 14: Immunochemical Diseases

Chapter 15: Gout

Chapter 16: Osteoarthritis

Chapter 17: Osteoporosis

Chapter 18 : Osteomalacia

Chapter 19: Basic Principles in Metabolic Diseases

Chapter 20: Vitamin Diseases

Chapter 21: Hormones

Chapter 22: Calcium Carrier Mechanism

Chapter 23: LATHYRISM

Chapter 24: Fluorine

Chapter 25: Circulatory Disturbances

Chapter 26: Nerve Supply

Chapter 27: Paget’s Disease

DISCLAIMER

The concepts of Dr. Lent Johnson are not to be viewed per se for study prior to taking the Orthopedic Boards; rather, they are to be considered complementary to the literature already written on the subject and an aid to understanding the microscopic anatomy and total picture of a particular disease entity. These concepts are intended to simplify the understanding of orthopedic diseases by combining various entities according to the aspects of time, quantity, and space. For the most part, they are not found in standard texts and have not been established as standard truths. Many of these concepts will probably become accepted facts.

PREFACE

In the fall of 1962 I was sent to the Armed Forces Institute of Pathology (AFIP) from Fitzsimons in order to study orthopedic pathology for 6 weeks as part of my residency. The fact that I received 9 weeks at the AFIP and thus had more time to hear lectures by Lent Johnson came about in this way.

On October 19th a U2 spy plane over Cuba showed that the Russians had 4 operational missile sites. As part of the resulting blockade of Cuba, President Kennedy put the U.S. Military on high alert to enforce the blockade and to be ready to invade Cuba at a moment’s notice. As a commissioned Captain in the Regular Army, I was required to be ready to participate in the invasion and was recalled from the AFIP after studying there for three weeks. I was given reassurance that I would be able to return the following year. So I took a flight from Washington, DC to Denver and awaited further orders. On October 28th messages were passed between Khrushchev and Kennedy which in effect started to defuse the crisis, and the Russian missiles were dismantled and removed. I was able to return to the AFIP in 1963 for the entire 6 week course. I attribute my time there to my subsequent passing of the pathology questions on the Orthopedic Certification testing.

Any discrepancies or inadequacies in the following monograph would be the fault of the author in transcribing Dr. Johnson’s lectures. Thanks to pathologist John Greaves, M.D. for reviewing this manuscript.

J. Howland, M.D.

This book is dedicated to Leroy Travis, MD and George Omer, Jr., MD.

CHAPTER 1

Lent C. Johnson, M.D.¹

Lent Johnson, M.D. (1910 – 1998) was born in Nebraska, but his parents decided to move to Chicago where he attended a religious seminary called North Park College. Following that he matriculated at the University of Chicago and majored in Chemistry. As a young lad he had read the story of David Livingston, a medical missionary, and decided to become a doctor. He attended Rush Medical School where he came under the tutelage of Dallas Phemister. Dr. Phemister not only taught him skeletal pathology, but also instructed him to have respect for the referring MDs who did not have the fancy lab tests to diagnose the cases that they sent to the medical school. Also, he pointed out that often the disease in question had become more advanced by the time the patient had reached the ivory tower which made the diagnosis easier. He taught him to learn from his mistakes and correct them. There was plenty of pathology – in fact at Rush during his 3 rd and 4 th years there was more pathology instruction than at any other medical school. For the final exam in pathology each student was issued a series of slides from which he had to deduct the age, sex, color and the kind of person who was represented. Moreover, he had to derive the clinical course and the laboratory findings.

After med school he interned in surgery in the mid-west, then transferred to the Harvard medical service at the Boston City Hospital. His first tour with the AFIP (Armed Forces Institute of Pathology) was with their outlying facility in Indianapolis. His transfer to the Army Medical Museum (renamed the AFIP in 1947) in Washington, D.C. began in 1946. Altogether, he spent 50 years with the AFIP, ending his career in 1992. In the early years the Army Medical Museum was part of the Surgeon General’s office, so during night-time while on duty, he was the acting Surgeon General. During the early years at the AFIP he worked with Dr. Hans Smetana (until 1965 Head of the Hepatic and Pediatric Pathology branches) and Dr. Walter G. J. Putschar, a world-renowned bone pathologist.

He pointed out that during the Civil War diseases outnumbered trauma pathology by a factor of 10 to 1. With the Spanish-American war came tropical diseases. Then during World War I, the AFIP workload involved shrapnel injuries, flu, and trench foot. During World War II a different sort of trauma included blast injuries. In addition, there were arctic and tropical diseases to deal with. Compared to the battles of 80 years before, the pathology had switched to more trauma than disease. Research at the AFIP on the nature of the gunshot wounds was done by Gen. George Callender, who shot animals and analyzed the resulting wounds. He was the commandant of the Army Medical School and organized an eight week course in military and tropical medicine in August 1941 – just a few months before the Pearl Harbor introduction to World War II.

With Colonel James Ash, Dr. Johnson emphasized to referring doctors the need for gross specimens since these complemented the microscopic slides and aided in diagnosis. He felt that to understand a disease, one needs the following:

1. the gross specimen

2. microscopic sections

3. x-rays

4. the patient’s clinical course

5. surgical report

In 1967 Dr. Johnson received the Philip S. Hench Award (Issued by the Association of Military Surgeons). This award is given to a physician in the Federal Medical Service who has made outstanding contributions in the field of rheumatology and arthritis.

CHAPTER 2

Bone Development

One of the main underlying precepts that Dr. Johnson felt was important in understanding bone pathology