My 60 years as a Clinical Anatomist
I was born on October 5, 1925 in Brantford, Ontario, Canada. To teach a little Canadian History, I told my children that Alexander Graham Bell, a Canadian scientist who invented the first practical telephone, was also born in Brantford, as was Wayne Gretzky.
My father, the Rev. James H. Moore, was born in London, Ontario, Canada. He was a Presbyterian minister who graduated from Mc Master University (B.A). in Toronto, Ontario (now located in Hamilton, Ontario). He taught me how to read and write by the time I was 6 years old. My mother, Gertrude M. Moore, was an Associate of the Toronto Conservatory of Music (ATCM). She was an excellent pianist, organist and vocalist. They both agreed that I should go to university. Dad wanted me to be a minister and Mom wanted me to do what ever I wanted, but she was adamant that I get a university education.
I was the fourth of their five boys. The family lived in Bethel Ontario, just southwest of London Ontario. Shortly thereafter my father accepted a pastorate in Wallacetown, near St. Thomas, Ontario. I started school there with my younger brother Grant. Subsequently our family moved to London Ontario and then to Shakespeare Ontario near Stratford. Ministers usually only stay for a few years in one place. I attended the Stratford Collegiate Vocational Institute in Stratford, Ontario, Canada (1938-1944). I had to hitchhike to school for two years before buying an old car.
Corvette HMCS Humberstone
I joined the Royal Canadian Navy in 1944. I was a Sick Birth Attendant (Paramedic) on a Castle Class Corvette (HMCS Humberstone) during WW II (1944-1946). The length of the ship was 250 feet and had a crew of 93 seamen, 5 officers and 8 others (such as the cook and paramedic). The medical room was about 8 feet wide and 15 feet long. There were two beds and a desk. I was the only person on board with medical knowledge.
In September 1946, I enrolled in University College at the University of Western Ontario in London, Ontario. Initially I took a general course that was a mixture of Arts and Science. However I soon realised that I wanted a more scientific education so I took more science courses (botany, biology, genetics, zoology and comparative anatomy). I graduated with a Bachelor of Arts (B.A.), General Course in 1949. Ithen earned a Master of Science (M.Sc.) in Anatomy in1951 and a Doctor of Philosophy (Ph.D.) in Microscopic Anatomy in 1954.
Naval Officers. Keith is in the top right corner.
The supervisor for my M.Sc. and Ph.D. degrees was Dr. Murray L. Barr, a world-renowned neurohistologist and cytogeneticist. I studied sex chromatin patterns in the nuclei of various cells of humans and animals. The sex chromatin is a characteristic mass of chromatin in the nuclei of somatic cells of normal females of many animals, including humans.
An editorial in the Canadian Medical Association Journal described Dr. Barr and his team’s research on the sex chromatin (E.G. Bertram, L. Bertram, K.L. Moore and M.A. Graham) as “the most important Canadian contribution to fundamental medical science since Banting discovered insulin in 1921.
It was Mike Bertram (Dr. Barr’s M.Sc. student) who first observed the nucleolar satellite in the nuclei of female cats. The term “satellite” was changed to the sex chromatin (see arrow) when it became apparent that it was an inappropriate term. The sex chromatin is a condensed X chromosome.
The sex chromatin is
indicated by the arrow.
Progress in the understanding of human sex anomalies was accelerated by the development of clinical sex chromatin tests. The first test I developed was the skin biopsy sex chromatin test. Small pieces of skin were removed by a plastic surgeon from the upper part of the forearm of males and females. In less than a year, 27 skin biopsies from intersex patients came to my laboratory from all over the world. This test is rarely used today because it has been replaced by the buccal smear sex chromatin test that I developed in 1952.
This procedure is easier to perform and avoids the minor surgical operation of obtaining a skin biopsy. The buccal smear technique is simple. The inside of the cheek is scraped with a surgeon’s nickel spatula to obtain mucosal scrapings, which are spread out as a thin film on a clean microscope slide, fixed, stained and studied with the oil immersion objective of a binocular microscope. Buccal smears are used for the detection of the gender of persons who have ambiguous external genitalia and /or sex chromosome abnormalities. The buccal smear test is used world wide, for example by doctors examining athletes at the Olympics.
The buccal smear test for detecting gender is the single main laboratory test in the management of human intersexuality (hermaphroditism) and sex chromosome aberrations. However, examination of the chromosomes is usually performed if a buccal smear test indicates an abnormal sex chromosome constitution, such as XXY or XXYY in males and XXX or XXXX in females.
After receiving my doctorate, I was awarded a two year Postdoctoral Fellowship from the National Cancer Institute of Canada to continue research on the morphology of cell nuclei, with special reference to sex chromatin in human malignant tumors. Later I cultured human chromosomes, with special reference to sex chromosomal abnormalities (e.g., in persons with the Down syndrome, Klinefelter syndrome, Turner syndrome and mental deficiencies). I was the first one to observe that most males with the Klinefelter syndrome have abnormal sex chromosome complements that is XXY instead of the normal XY. Subsequently, I observed 5 males with sex chromatin in their nuclei in the 1911 infants from whom I obtained buccal smears (0.26 %).
In 1956 I was appointed Assistant Professor of Anatomy in the Faculties of Medicine and Dentistry at the University of Manitoba in Winnipeg, Manitoba, Canada. I taught gross anatomy and embryology. Although these subjects were taught separately, they were integrated during small group sessions in the gross anatomy laboratory (e.g. subhepatic cecum and rotation of the gut).
I continued my study of the sex chromatin in humans and developed the vaginal smear sex chromatin test, which is used routinely by gynaecologists in cases of primary amenorrhoea and other sex disorders in females. Because of my studies using this test, I was elected Fellow of the International Academy of Cytology and a Member of the Board of Consultants in the International Academy of Gynaecological Cytology. Dr. G. Papanicolaou who developed the Pap cervical smear for screening for malignant cells signed the certificate.
In 1959 I was promoted to Associate Professor of Anatomy. In 1965, I was appointed Professor and Head of the Department. In 1966 W. B. Saunders published a reference book entitled, The Sex Chromatin, which I edited. There were 22 contributors; I wrote 6 of the 26 chapters. The widespread applications of knowledge of the sex chromatin, clinically and in research, are described in this reference book.
In 1976, after 20 years at the University of Manitoba (11 years as the Head of Anatomy), I was offered and accepted the Chair of Anatomy in the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. I was honored and delighted to be invited to this prestigious Chair that was occupied for 26 years by Professor J. C. Boileau Grant, a world- renowned anatomist. Through his textbooks, Dr. Grant made an indelible impression on the teaching of anatomy throughout the world. Interestingly, he was Professor and Head of Anatomy in the Faculty of Medicine, University of Manitoba for 11 years (1919-1930), the same number of years that I was the Head (1965-1976).
I have been a member of AAA for 53 years and I think my main contribution has been to promote anatomy education at the AAA meetings and around the world. I have published 60 scientific papers (including abstracts) based on my research and teaching methods. I am the senior author of 14 textbooks in gross anatomy, embryology, cytology and neuroanatomy. Five of these books are still in print. The 8th edition of my main embryology book, The Developing Human, Clinically Oriented Embryology, is translated into 14 other languages. The 7th edition of his smaller embryology book, Before We Are Born, Essentials of Embryology and Birth Defects, has been translated in 8 other languages.
The 6th edition of the gross anatomy book, Clinically Oriented Anatomy, has been translated into 9 other languages. The 4th edition of his smaller book, Essential Clinical Anatomy, has been published in several languages. The 2nd edition of my Color Atlas of Clinical Embryology was published in 2000. My best friend and wife, Marion, worked closely with me during the preparation of all these books.
Marion and Keith
As a classically trained anatomist and dedicated teacher, I have taught anatomy and embryology for 60 years and have traveled around the world ( Australia, Brazil, China, Costa Rica, Ecuador, Egypt, Great Britain, Japan, Mexico, Russia, Saudi Arabia, South Africa and Turkey) to give anatomy and embryology lectures on the clinical correlates of anatomy and embryology. Wherever I go, I always emphasize that:
To learn anatomy without a sound knowledge of gross anatomy and embryology is like sailing a ship without a navigator's map. In either case, there is likely to be serious consequences.
"You will remember some of what you hear; much of what you read; more of what you see, and almost all of what you experience and understand fully."
For twelve years I was an embryology consultant for three medical dictionaries: Stedman's Medical Dictionary; Stedman's Medical Dictionary for the Health Professions and Nursing, and Dorland's Medical Dictionary. I was also a reviewer for part of the embryology section of the 40 h edition of Gray’s Anatomy. Although I retired in 1991, I have not relaxed very much. I am always working on new editions of my books, attending anatomy meetings worldwide and giving guest lectures. I enjoy meeting students and autographing their books. I have taught in the gross anatomy laboratories for several days for about 10 years at the Albert Einstein College of Medicine in the Bronx, New York, and have held numerous other visiting professorships around the world.
I have received many honors and awards, but I was really surprised when I was told that I would be the first recipient of the Henry Gray/Elsevier Distinguished Educator Award, AAA’s highest award for human anatomy education. The nominator said “Keith is an individual of nearly legendary status among anatomists around the world. He has had a monumental impact on anatomical education, not only at a national but also at an international level.” The Chair of the Award Committee who presented the award said “His books were like a breath of fresh air for faculty and students alike. Structures and developmental processes were no longer viewed in isolation from practical application, things to be memorized to exceedingly fine detail, but were presented within a clinical context--- that became the famous blue boxes---and taught to a level of detail useful for clinical practice---His contribution to anatomy education around the world has been profound and continuous, and will be a an enduring legacy.”
Other notable associations, honors and awards are listed below:
Recipient of the Degree of Doctor of Science (DSc) honoris causa from the Ohio State University, 2012 in recognition of outstanding contributions in clinical anatomy, epitomized by his books in anatomy and embryology.
R. Benton Adkin JR Service Award from the American Association of Clinical Anatomy in recognition of scholarly accomplishments in the field of Clinical Anatomical Services, 2012
The British Medical Association awarded a Highly Recommendation for the 9th edition of “The Developing Human", 2013
I enjoy meeting students from around the world who line up to have copies of their books signed, and to have pictures taken with me. These meetings often last three or five hours.
Medical students in Belem, Brazil