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 2730, 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 J ournal of
Clinic al Cytology
and Cytopathology
ACTA
CYTOLOGICA
In Romania Its the Mthode
Babe s-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.
C
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First I wish to thank the International Academy of
Cytology (IAC) for honoring me with the Masu-
buchi Life-Time Achieve-
ment in Clinical Cytology
Award. This award im-
plies that my activities in
clinical cytology have
taken place over many
years, and, indeed, they
have: 45 to be exact. My
receiving this award also
implies that these activi-
ties have been of sufficient
merit to be considered
worthy 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 a
subject of my own choos-
ing.
To begin with, I shall
show you photographs of
two men. Each of these
men made published con-
tributions to cytopatholo-
gy. In the first photograph
almost 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. Babe s (Figure 2), the Ro-
0001-5547/02/4601-0001/$19.00/0 The International Academy of Cytology
Acta Cytologica
Dr. Babe s contribution to
cytopathology has not been
overlooked in Romania, his home-
land, where the Pap test is known
as the Mthode
Babe s-Papanicolaou.
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manian pathologist who published a major contri-
bution to cytopathology in 1928 but who, today, has
only a tenuous position in its history. I expect that
those of you who recognized Dr. Papanicolaou far
exceeded the number who recognized Dr. Babe s,
even though Dr. Babe s observations on the poten-
tial to diagnose uterine cancer from cervical smears
were published almost one year before Dr. Papani-
colaou first published his findings on the subject.
Contributions of Dr. Babe s to Cervical Cytology
What, exactly, were the circumstances of these early
announcements of the finding of cancer cells in cer-
vical scrapings and vaginal aspirates? Dr. Babe s
and his senior colleague, Professor Constantin
Daniel (Figure 3), presented their findings at two
sessions of the Bucharest Society of Gynecology,
one in January (Figure 4) and the other in April
1927. Abstracts of their presentations were subse-
quently published in the proceedings of the
Bucharest Society of Gynecology.
1,2
These were followed in 1928 by a major article by
Dr. Babe s in Presse Mdicale, the French general
medical journal (Figure 5), titled Diagnostic du Can-
cer du Col Utrin par les Frottis
3
(Diagnosis of Can-
cer of the Uterine Cervix by Means of Smears). It
contained an accurate description of cells of squa-
mous cell carcinoma in cervical smears. The cells
were obtained by using a platinum loop to transfer
material from the cervix to the slides, which were
then air dried and stained with Giemsa stain. This
article was Dr. Babe s only major contribution to cy-
topathology. He published an article in 1931 on su-
perficial squamous cell carcinoma of the cervix, but
it made only passing reference to the smear method
of diagnosis.
4
Babe s contribution to cytopathology
seemed not to have taken root, and his contribution
was practically forgotten. Before he died, in 1961, he
was given credit in Europe,
5-7
South America
8
and
the United States, where J. E. Ayre referred to him
2 Acta Cytologica Naylor et al
Figure 1 Dr. George N. Papanicolaou (18831962).
Figure 2 Dr. Aurel A. Babe s (18861961).
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in his 1951 atlas, Cancer Cytology of the Uterus.
9
However, Babe s work seems to have been un-
known to Dr. Papanicolaou.
Contributions of Dr. Papanicolaou to
Cervicovaginal Cytology
Dr. Papanicolaou presented his finding of cancer
cells in vaginal aspirates in January 1928 at the
Third Race Betterment Conference in Battle Creek,
Michigan, a city about 180 km east of Chicago. The
conference met in the Battle Creek Sanitarium (Fig-
ure 6), now the Battle Creek Federal Center. (Why
the Battle Creek Sanitarium? Dr. John Harvey Kel-
logg, developer of Kelloggs cornflakes and co-
founder of the world-famous cereal company, was
the 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.
Papanicolaous findings, which was of modest
length, remained in obscurity because it was pub-
lished in the proceedings of the conference
10
rather
Volume 46, Number 1/JanuaryFebruary 2002 3 Mthode Babe s-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, by
Daniel and Babe s 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, some
with 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. Babe s in Presse
Mdicale (Diagnosis of Cancer of the Uterine Cervix by Means
of 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, at
the suggestion of the chairman of the Department
of Anatomy at Cornell University in New York
City, 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 Obstetrics
and Gynecology titled, The Diagnostic Value of
Vaginal Smears in Carcinoma of the Uterus
11
(Fig-
ure 7). This article was followed two years later by
their epic monograph Diagnosis of Uterine Cancer by
the Vaginal Smear
12
(Figure 8), with its magnificent
drawings of cells and tissues (Figure 9). These two
publications of Papanicolaou and Traut marked the
beginning of the modern era of cytopathology.
Drs. Babe s and Papanicolaou: Their International
Recognition
Although Dr. Babe s article of 1928 in Presse Mdicale
was referred to in the Italian medical literature
13,14
before the year was over, it seems to have remained
in obscurity until the early 1950s, when, with the in-
ternational surge of interest in cytopathology, it
was discovered. By then, however, it had been
eclipsed by the numerous publications on the sub-
ject by Dr. Papanicolaou and his colleagues. It
should be noted that neither Dr. Babe s 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. Babe s publication of 1928 attract so
little attention? Having been published in a general
4 Acta Cytologica Naylor et al
Figure 6 Battle Creek Sanitarium, Battle Creek, Michigan,
where Dr. Papanicolaou gave his presentation in 1928 on the
nding of cancer cells in vaginal aspirates.
Figure 7 Cover with the title of the article by Drs. Papanicolaou
and Traut published in the American Journal of Obstetrics and
Gynecology 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 Babe s, grandfather of Dr. Aurel A.
Babe s.
medical journal in the French language, it would
not have reached the much wider audience in the
vast English-speaking world. In contrast, Drs. Pap-
anicolaou and Traut published in the American Jour-
nal of Obstetrics and Gynecology in the United States
in English at a time when this was about to become
the lingua franca of the international medical and
scientific communities. Furthermore, the popula-
tion of the United States was rapidly becoming
more cancer conscious, and gynecologists there
were quick to recognize the potential of Dr. Papani-
colaous observations. The American Cancer Soci-
ety was also quick to recognize the tremendous
value of Dr. Papanicolaous observations
15
and
gave him the financial support to pursue his re-
search in cytopathology right up to the time of his
death, in 1962. He was thus able to publish his re-
search in books and numerous articles.
The Babe s Family
Much is known about the life and work of Dr. Pap-
anicolaou.
16
In contrast, relatively little has been
published about the life of Dr. Aurel Babe s, yet one
cannot but remark on certain shared aspects of their
lives. They were born in the same part of the world:
Dr. Babe s in Romania, Dr. Papanicolaou in Greece.
They were from upper-middle-class families: Dr.
Papanicolaou was the son of a physician, Dr. Babe s
the son of a professor of chemistry. However, we do
know the genealogic background of Dr. Babe s, well
illustrated by his family tree, which was given to
me in Bucharest by his nephew, Dr. Vincent Babe s.
At the top of the tree was Vichentie Babe s, a man of
apparently high position, judging from his rather
elaborate clothes (Figure 10). He was a judge and
had 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.
Volume 46, Number 1/JanuaryFebruary 2002 5 Mthode Babe s-Papanicolaou
Figure 9 Drawing of cells and a biopsy specimen of cervical
squamous cell carcinoma in the 1943 monograph by
Papanicolaou and Traut.
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Babe s (Figure 11); he became a professor of chem-
istry, Professor Aurel V. Babe s.
One cannot discuss the Babe s family without
mentioning that one of Judge Babe s nine children
was Dr. Victor Babes (Figure 12), professor of
pathology at the universities of Bucharest and Bu-
dapest and uncle of our Dr. Babe s; he became an in-
ternationally renowned medical scientist, especial-
ly in the fields of microbiology and infectious
diseases. If you consult a medical dictionary and
look up the name Babe s you will find about 14 en-
tries that incorporate his name, probably the most
familiar being the disease babesiosis. It was Dr. Vic-
tor Babe s who discovered the etiologic agent of this
disease.
Dr. Babe s: His Scholarly Achievements
I have digressed briefly from Dr. Aurel A. Babe s to
illustrate that he was blessed with the genetic back-
ground that would equip him to carry out scholar-
ly medical work. Did Dr. Aurel Babe s fulfill his ge-
netic promise? He certainly did. Time prevents me
from mentioning more than a few of his scholarly
accomplishments; instead, I shall mention only a
sample of them to give you an idea of his ability, his
diversity of interests and his achievements.
In 1915 Dr. Babe s graduated magna cum laude
from medical school at the University of Bucharest.
His graduation thesis on cerebrospinal fluid won
awards from both the Faculty of Medicine and the
Romanian Academy. In 1921 he became senior as-
sistant to Professor Constantin Daniel, head of the
gynecology clinic of Coltea Hospital, in the center of
Bucharest (Figure 13). There he began the collabo-
6 Acta Cytologica Naylor et al
Figure 11 Dr. Aurel V. Babe s, father of Dr. Aurel A. Babe s and
professor of chemistry, University of Bucharest.
Figure 12 Bust of Dr. Victor Babe s, uncle of Dr. Aurel A. Babe s,
on the grounds of the medical school of the University of
Bucharest.
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ration with Professor Daniel that resulted in the two
above-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 Means
of the Weil-Flix Reaction with Proteus X19, for
which he received another award from the Roman-
ian Academy. He collaborated subsequently with
his uncle, Dr. Victor Babe s and his father, Professor
Aurel V. Babe s, and together they wrote a treatise
on the disease pellagra (Figure 14). He also wrote a
text on general anatomic pathology (Figure 15), and
toward the end of his career he authored, with Drs.
Parhon and Petrea, a book on endocrinology of the
salivary glands (Figure 16). He also published
works 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 his
scholarly accomplishments. It also shows the diver-
sity of his interests, which should help us under-
stand why he did not have any more publications
on cytopathology. In all, Dr. Babe s published 283
scientific articles and books in Romania and
abroad.
17
Many of his studies were translated into
foreign languages and were well known and often
quoted in the medical literature of his time. Because
of his important original contributions, Dr. Babe s
was elected member of numerous foreign medical
associations and worked with such famous pathol-
ogists as Wegelin, Lubarsch and Meyer in Ger-
many. For his scientific contributions, Dr. Aurel A.
Babe s will remain one of the most distinguished
representatives 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-
Volume 46, Number 1/JanuaryFebruary 2002 7 Mthode Babe s-Papanicolaou
Figure 13 Coltea Hospital, in the center of Bucharest, where Dr.
Babe s began his collaboration with Professor Daniel, head of the
gynecology clinic.
Figure 14 Title page of a treatise on pellagra authored by Drs.
Victor Babe s, Aurel V. Babe s and Aurel A. Babe s.
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ber 2000 a team of four met in Bucharest, the capital
of Romania, to see where Dr. Babe s had lived and
worked and to speak to any of his former col-
leagues. All the members of the team are here
today: Dr. Evangelia Bartziota, a cytopathologist
from Greece who knows Romania well and who
speaks Romanian fluently; Dr. Volker Schneider,
secretary-general of the IAC, who is from Germany;
Dr. Luminita Tasca, a senior pathologist in
Bucharest; and myself (Figure 17).
8 Acta Cytologica Naylor et al
Figure 15 Title page of a book on general anatomic pathology
authored by Dr. Aurel A. Babe s.
Figure 17 The team of four: clockwise, Drs. Bartziota,
Schneider, Naylor and Tasca.
Figure 18 Medical school of the University of Bucharest. The
statue in front of the building is of Dr. Carol Davila, founder of
the medical school in the 19th century and a leader in medical
education.
Figure 16 Title page of a book on endocrinology of the salivary
glands authored by Drs. C. I. Parhon, Aurel A. Babe s and Ion
Petrea.
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Volume 46, Number 1/JanuaryFebruary 2002 9 Mthode Babe s-Papanicolaou
After visiting the medical school (Figure 18), we
visited the famous Dr. Victor Babe s Institute, which
opened in 1899 (Figure 19). This institute was
named after Dr. Babe s uncle, Dr. Victor Babe s, who
became a medical hero in Romania, as depicted in
Figure 20. The institute was built expressly to en-
able him to carry out his research and routine in-
vestigations. Our Dr. Babe s also worked in the in-
stitute.
After visiting the institute, we went to the diplo-
matic quarter of Bucharest, where Dr. Babe s had
built 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 country
became communist they were forced to live in only
one room of the house because of restrictions on the
amount 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 Babe s Institute where Dr.
Aurel A. Babe s worked.
Figure 20 A portrait of Dr. Victor Babe s when he was director
of the institute.
Figure 21 Former home of Dr. Babe s and his wife at No. 2
Ankara 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. Babe s spent the last nine years of
his professional life. Despite its rather rundown ap-
pearance (Figure 22), it still remains an important
hospital and research center for endocrinologic dis-
eases.
Finally, we visited Serban Voda Cemetery (Fig-
ure 23), a huge and crowded cemetery situated near
the center of Bucharest. On one side of the entrance
were flower sellers (Figure 24); on the other side
was something much more practical: coffins for sale
(Figure 25). We visited the grave of Dr. Babe s, who
died in 1961; there his bones and those of his wife
are interred (Figure 26). (Other persons whose
names on the gravestone are not Babe s are not rela-
tives of the Babe s family. Because of space limita-
tions at the cemetery, a grave that is not completely
filled and that will accommodate more bodies is
made available for unrelated people, who may even
wish to make a reservation for themselves.)
Apart from being able to visit with Dr. Vincent
Babe s, the nephew of our Dr. Babe s, we could not
find any other person in Bucharest who had known
or worked with hima big disappointment. His
nephew, 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 man
about 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 of
Dr. Babe s former professional colleagues, Dr. Ion
Petrea (Figure 27), who had worked with him at the
Institute of Endocrinology in Bucharest for the last
nine years of Dr. Babe s life. (In 1970, Dr. and Mrs.
10 Acta Cytologica Naylor et al
Figure 23 Entrance to Serban Voda Cemetery near the center of
Bucharest.
Figure 24 On one side of the entrance to the cemetery: owers
for sale.
Figure 22 C. I. Parhon Institute of Endocrinology in Bucharest,
where Dr. Babe s spent the last nine years of his professional life.
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Petrea left Romania for the United States to take a
position at Yale University medical school. Now in
retirement, they live close to Yale in a suburb of
New Haven, Connecticut.)
Epilogue
Almost 40 years ago, in a commemorative article,
18
Dr. Petrea described Dr. Babe s as a tireless physi-
cian, research worker and professor, a warm and
honorable man who pursued all of his professional
activities to his last day with passion, probity, and
devotion, contributing with modesty, which was
his characteristic feature, to the development of Ru-
manian Science. Dr. Petrea also assured me that
Dr. Babe s knew of the great international reputa-
tion in cytopathology that Dr. Papanicolaou had
gained in contrast to his own. However, Dr. Babe s
Volume 46, Number 1/JanuaryFebruary 2002 11 Mthode Babe s-Papanicolaou
Figure 25 The other side, featuring more practical wares: cofns
for sale.
Figure 26 The grave of Dr. Babe s, where his bones and those of
his 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 without
rancor; after all, he had a wealth of other scientific
accomplishments. Furthermore, Dr. Babe s contri-
bution to cytopathology has not been overlooked in
Romania, his homeland, where, in a spirit of fair-
ness and generosity, the Pap test is known as the
Mthode Babe s-Papanicolaou.
This brings us to the end of our story. Again, I ex-
press my gratitude to the IAC for giving me this
award. 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 having
honored us with your presence.
Acknowledgments
We gratefully acknowledge the following for their
contributions to the development of this article:
Drs. Vincent Babe s, Larry E. Douglass, Paz Bue-
naventura Naylor, Ion Petrea and Daniel G.
Remick.
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1. Daniel C, Babe s A: Posibilitatea diagnosticului cancerului cu
ajutorul frotiului. In Proc of Bucharest Gynecology Society,
Bucharest, January 23, 1927, p 55
2. Daniel C, Babe s A: Diagnosticul cancerului colului uterin
prin frotiu. In Proc of Bucharest Gynecology Society,
Bucharest, April 5, 1927, p 23
3. Babe s A: Diagnostic du cancer du col utrin par les frottis.
Presse Med 1928;36:451454
4. Babe s A: Sur le cancer superficiel du col utrin. Gynecol Ob-
stet 1931;23:418433
5. Bourg R, Gompel C, Pundel J-C: Diagnostic Cytologique du
Cancer Gnital chez la Femme. Paris, Masson, 1954
6. Zinser H-K: Die Zytodiagnostik in der Gynkologie. Second
edition. Jena, Gustav Fischer, 1957
7. Boddington MM, Cowdell RH, Spriggs AI: Development of
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8. Ferreira CA: Colpocitologia e Citodiagnsticos em Ginecolo-
gia. Rio de Janeiro, Iguass, 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 528534
11. Papanicolaou GN, Traut HF: The diagnostic value of vaginal
smears in carcinoma of the uterus. Am J Obstet Gynecol
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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;30:781793
14. Scalambrino R: La biopsia degli organi interni. Arch Sci Med
1928;52:273275
15. Vayena E: Cancer detectors: An international history of the
Pap test and cervical cancer screening, 19281970. 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;
30:10911102
18. Petrea I: Aurel Babe s. Neoplasma 1962;9:445446
19. Wied GL: Pap-Test or Babes method? Acta Cytol 1964;9:
445446
20. Douglass LE: A further comment on the contributions of
Aurel Babes to cytology and pathology. Acta Cytol 1967;11:
217224
21. Petrea I: Soixantime anniversaire de la codification par A
Babs, due cytodiagnostique du cancer du col utrin. Rev
Franc Endocrinol Clin 1988;29:505510
Keywords: cytology, babesiosis, Papanicolaou
smear, cervix neoplasms, cervical smears, Papani-
colaou, Babes, Romania. (Acta Cytol 2002;46:1
12)
12 Acta Cytologica Naylor et al
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