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Biographical entry Toker, Cyril (1930 - 2015)

MB BCh Witwatersrand 1952; FRCS Edinburgh 1957; FRCS 1957; MS 1962; JD Florida 1999.

Born
29 March 1930
Ermelo, South Africa
Died
8 August 2015
Ponte Vedra Beach, Florida, USA
Occupation
General surgeon and Surgical pathologist

Details

Cyril Toker was chief of surgical pathology at the University of Maryland School of Medicine, Baltimore. He was born in Ermelo, South Africa on 29 March 1930, the first of two sons of Philip and Fay Toker. Philip and Fay Toker immigrated as young children with their families to South Africa from Lithuania. Philip Toker was first a general practitioner in Ermelo, having graduated from the University of Witwatersrand. He later practised as an anaesthesiologist in Johannesburg and later in Baltimore and New York. Fay Toker was a mother, housewife and an excellent cook. Eugene Toker, Cyril's younger brother, also studied medicine at the University of Witwatersrand and became a psychiatrist in the USA and in Brisbane, Australia.

Cyril attended Ermelo Grammar School and the King Edward VII School in Johannesburg, where he graduated early, receiving distinctions in Latin, history and Afrikaans. He then went on to study medicine at the University of Witwatersrand in Johannesburg, starting in 1946, and completed his final examinations at the end of 1951, receiving both the bronze medal of the Southern Transvaal branch of the South African Medical Association (given to the most distinguished student of the year) and the David Lurie memorial medal for surgery. He was unable to receive his degree with the rest of his class in December of 1951 because he had not yet reached the age of 22, the minimum age for the practise of medicine in South Africa at that time; he received his degree in June 1952.

After graduating, he became a surgical houseman at the Johannesburg Hospital under Alexander Lee McGregor, who was an especially important mentor to him. He also pursued a higher surgical degree and thereafter went to London to study for the FRCS. He obtained his fellowships of the Royal Colleges of Surgeons of Edinburgh and of England in 1957, having received the Hallett prize in February 1956.

He then went back to South Africa, completing his surgical registrarship in 1961 in Johannesburg. He was allowed to combine surgery and pathology, his two loves. It was there that he began his work on Paget's disease of the breast, which culminated in his first significant academic work, published in Cancer ('Some observations on Paget's disease of the nipple' Cancer. 1961 Jul-Aug;14:653-72), which led to his discovery that Paget's disease of the nipple was actually a de novo breast cancer, not a metastasis or extension of a deeper breast cancer.

He became increasingly interested in surgical pathology, and sought to advance his training in the United States. He therefore immigrated to the USA in 1962 and completed a pathology residency at Mount Sinai Hospital, and a fellowship at the Memorial Sloan Kettering Cancer Center, both in New York City. Soon thereafter, he became co-director of surgical pathology at the Mount Sinai Hospital. In 1968, he married Karen L Harkavy, a pediatrician, and in 1969 and 1972 their two children, David and Rachel, were born.

While at Mount Sinai, he made two further seminal scientific discoveries. In 1970, he described the precursor cells to Paget's disease of the breast ('Clear cells of the nipple epidermis' Cancer. 1970 Mar;25[3]:601-10). These normal cells are now known eponymously in the medical literature as 'Toker cells'. In 1972, he first described Toker's trabecular carcinoma of the skin, also known as Merkel cell carcinoma ('Trabecular carcinoma of the skin' Arch Dermatol. 1972 Jan;105[1]:107-10). This manuscript, describing a previously undiscovered form of skin cancer, has been cited over 1,000 times.

In 1976, he left Mount Sinai to become full professor and chief of surgical pathology at the University of Maryland School of Medicine in Baltimore, Maryland. While there, he wrote a surgical pathology textbook Tumors: an atlas of differential diagnosis (Baltimore, University Park Press, 1983). This was a unique, diagnostically-oriented textbook that characterised tumours by their histologic patterns, rather than first categorising them by organ system. During his career, he published more than 100 medical journal articles, mostly as sole or senior author, that have been collectively cited over 4,000 times.

It was during Cyril's time in New York and Baltimore that he taught, published with, and influenced many future pathologists during their residencies and fellowships. He was very devoted to his students, and they to him. One of his former residents sent a card inscribed with the message: 'To Dr Toker, who teaches wisdom which I cannot find in books.'

In 1986, he left the University of Maryland for a position as head of surgical pathology at the Community General Osteopathic Hospital in Harrisburg, Pennsylvania, where he remained for five years. In 1991, he and Karen moved to Ponte Vedra Beach, Florida, but he continued doing part-time pathology work in Pennsylvania, and later (from 1996) served on the editorial board of the Annals of Diagnostic Pathology.

In 1996, at the age of 66, Cyril began his second career as a lawyer, enrolling in law school in Jacksonville, Florida. He graduated from the Florida Coastal School of Law in 1999, the same year his daughter, Rachel, graduated from Harvard Law School. He passed the Florida Bar and was admitted to practise before the Florida Supreme Court as well as other state courts. He practised medical malpractice law for several years, until illness prevented him from public appearances in court, at which time he retired from the law.

Cyril was a Renaissance man. He loved poetic verse, memorising Gray's Elegy, the Rubaiyat of Omar Khayyam and the Rime of the ancient mariner as a young man, and reciting Shakespeare quotations in his courtship of Karen. He became a pilot as a teenager, learning to fly a Tiger Moth biplane in South Africa. His passion for flying persisted throughout his life, and he flew for both pleasure and work, travelling to perform on-site consultations for community hospitals throughout Maryland and later commuting to part-time positions in Pennsylvania while living in Florida. He was also an avid photographer, particularly of wildlife, and his photographs were published in books and magazines, including two (one of the Olduvai Gorge and one of Bushmen in the Kalahari Desert) in the Encyclopedia Britannica. He loved 'all creatures great and small', but African animals, particularly primates, held a special place in his heart. He was a strong advocate for environmental causes and stewardship of the planet.

Throughout Cyril's career, he remained concerned about the way the medical profession policed itself and addressed medical errors. As a member of oversight ('tissue') committees in surgical pathology at Mount Sinai Hospital and the University of Maryland Hospital, he insisted on improving practices and procedures to prevent medical errors. He wrote The sibylline books (Cumaean Press, 1989), a fictionalised medical drama based on real events, illustrating many of the most poignant medical errors he witnessed during his career. The book was published at a time when the medical profession was hesitant to bring such issues into public discourse, but foreshadowed the evolution of patient safety in medicine. Shortly before his death, he completed his memoirs: The final diagnosis: a surgical pathologist remembers (Cumaean Press, forthcoming).

He was a man of courage, persistence, intelligence, kindness and humour, dedicated to justice, fairness and environmental conservation. He was passionate about aeroplanes, and his grandchildren called him 'Captain Cyril', a pilot's moniker he chose for himself as a term of endearment. Cyril Toker died on 8 August 2015, aged 85, and was survived by his wife of 47 years, Karen Harkavy Toker; his son, David Newman-Toker, professor of neurology, otolaryngology, ophthalmology and director of the Armstrong Institute Center for Diagnostic Excellence at the Johns Hopkins University School of Medicine; his daughter, Rachel Toker, president and chief executive officer of Urban Ecosystem Restorations, an environmental nonprofit organisation; and his four grandchildren - Maya, Adina, Alexander and Adam.

Karen Toker

Sources used to compile this entry: [Toker, C. The final diagnosis: a surgical pathologist remembers Cumaean Press, forthcoming; information from Eugene Toker, David Newman-Toker, Rachel Toker and Saul Suster; The Washington Post 11 August 2015 www.legacy.com/obituaries/washingtonpost/obituary.aspx?pid=175475898 - accessed 24 April 2017; The Florida Times-Union 11 August 2015 www.legacy.com/obituaries/timesunion/obituary.aspx?pid=175478432 - accessed 24 April 2017].

The Royal College of Surgeons of England