James Ewing: ‘The Chief’ of cancer pathology

The discovery of Ewing’s sarcoma is only a small part of his contributions to medicine.

Issue: October 25, 2008

James Ewing was a pioneer in cancer research and tumor pathology. During his lifetime, his achievements would lay the groundwork for future progress and discoveries in the field.

Among his accomplishments were the discovery and classification of Ewing’s sarcoma, the recognition of radiation as a cancer treatment and the establishment of the American Association for Cancer Research and the American Society for the Control of Cancer — now the American Cancer Society.

Even more importantly, Ewing is credited as having pushed the limits of cancer treatment in the beginning of the 20th century. He was not satisfied that surgery was the only treatment for cancer and pressed for the discovery of alternatives. Ewing believed that better cancer research could be done in humans instead of lab animals and wanted to establish cancer as its own medical specialty. He opposed the idea that cancer was one disease with one still-unknown cure. Instead, he believed it to be various unique diseases with different tumor biologies and causes.

His contributions to the field of oncology were many and proliferative, and even earned him the cover of Time magazine when he retired from medicine in 1931.

Early life

James Ewing (center) and other members of the first National Advisory Council at the groundbreaking ceremonies at the NCI’s building in June 1938.

Source: NCI

Born Dec. 25, 1866, Ewing was a Christmas present for parents Judge Thomas Ewing and Julia Rupert Ewing. He was the third of five children born and raised in Pittsburgh, Pa.

Ewing attended public schools until his childhood was interrupted at the age of 14 when he was diagnosed with osteomyelitis of the femur. For the next two years, he was confined to bed. During this time, he was tutored by Henry Gibbons, who gave the future pathologist his first microscope.

Ewing excelled in his studies at Amherst College in Massachusetts, where he received a BA in classics and philosophy. He was accepted into the College of Physicians and Surgeons of New York in the fall of 1888. Following graduation three years later, he worked briefly on the surgical service at Western Pennsylvania Hospital. He was then given an internship at Roosevelt Hospital and Sloane Maternity in New York, an honor only the best graduates receive. During his internship, he produced his first medical manuscript, a description of the role of white blood cells in pneumonia.

In 1893, he became a histology instructor at Columbia University. Then in 1897, he was promoted to assistant in clinical pathology under T. Mitchell Prudden, whom he had befriended at Sloane Maternity.

In 1899, Ewing was appointed the first professor of pathology at Cornell University. He held the position for 33 years. In 1900, Ewing wed Catherine Crane Halsted, and two years later, they had their first son, James. Sadly, his wife and unborn second child died from eclampsia during pregnancy in 1903. This loss caused Ewing to devote more time to his work and research and may have made him more empathetic to the loss and suffering of the patients he was trying to help.

Triumphs

In 1907, Ewing co-founded the AACR. He served as the president for the first two years of its existence. Around this time, he became acquainted with James Douglas, a mining engineer with a medical background and an interest in the therapeutic potential of radium. Douglas, who had lost his daughter to breast cancer, helped Ewing in his investigations of the use of radium as a therapeutic agent in cancer. In addition, Douglas provided financial backing in Ewing’s effort to establish a clinical cancer research unit at Memorial Hospital in New York. Douglas gave more than $100,000 by 1912 to finance a 20-bed unit, the purchase of X-ray equipment and clinical labs.

In 1919, after a decade of painstaking work, Ewing published Neoplastic Diseases, a reference on the pathology of tumors. This mammoth text with more than 450 illustrations and 49 chapters became a standard reference for cancer physicians and was subsequently published in multiple languages. In it, Ewing gave detailed classifications and descriptions of a multitude of tumor types. In his preface, he wrote:

“Up to a very recent time it has been the prevailing impression that tumors fall into a limited number of grand classes in which the forms occurring in the several organs are so nearly related as to be virtually identical. Hence the practical physician or surgeon has been content without regard to the organ involved, and on this theory to treat the members of each class alike … I believe that this point of view has greatly retarded the progress of the knowledge of tumors, and it has been the writer’s effort to combat such a conception, so far as present knowledge permits.”

Ewing’s sarcoma

At a New York Pathological Society meeting in 1920, Ewing presented his research on a malignant bone tumor. The tumor had clinical symptoms of osteomyelitis and most frequently manifested in certain bones of adolescents. However, Ewing characterized the neoplasm by its radiosensitivity. Ewing called his discovery endothelial myeloma, but it is still known today as Ewing’s sarcoma.

In 1932, Ewing retired from the chair of pathology at Cornell and was made director of Memorial Hospital until his retirement in 1939. At Memorial, Ewing laid the groundwork for the treatment of patients with cancer and probably helped garner much of the respect that is given to what is today Memorial Sloan-Kettering Cancer Center.

Ewing was featured in Time magazine around the time of his retirement from Cornell. The article discussed the decision by Annals of Surgery to devote one entire 54-article issue to cancer. In tribute to a great teacher, 54 of the cancer field’s foremost physicians wrote articles compiling everything about cancer, its causes, treatment and prevention known to date. The issue was later republished as a reference book for family doctors.

At age 76, Ewing fractured an area of his right femur that, when examined, revealed metastatic bladder carcinoma. On May 16, 1943, Ewing died from cancer of the urinary bladder. During his life, Ewing did not let any of his physical or emotional misfortunes interfere with his contributions to the field of oncology. James Ewing’s involvement and contributions developed his repute as one of the world’s leading cancer pathologists. – by Ashley DeNyse and Leah Lawrence

For more information:

Ewing J. An analysis of radiation therapy in cancer (The Müller Lecture). Trans Stud Coll Physicians Phila. 1922;44:190-235.

Ewing J. Neoplastic Diseases. A Textbook on Tumors. Philadelphia: W.B. Saunders Company; 1919.

Murphy JB. James Ewing: 1866-1943. Washington, D.C: National Academy of Sciences; 1951.

Zantinga AR, Coppes MJ. James Ewing (1866-1943): “The Chief.” Med Pediatr Oncol. 1993;21:505-510.