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History of Pathology

Pathology, the parent discipline, started with physicians doing autopsies
[on their patients] during the Renaissance in Italy... to try to understand
the reasons for the symptoms and the signs that they had been monitoring

Juan Rosai (Argentina, USA and Italy)

  More quotes on History of Pathology
The historian among these pathologists is Juan Rosai, who wrote Guiding the Surgeons’ Hand.  “The history of surgical pathology was very rich; nothing comprehensive had been written about it, and the founders of surgical pathology were fading out, so I thought that maybe somebody should record their experiences before it was too late to do so.”

He talks about the various changes in emphasis between the academic and the “practical, clinically orientated” aspects of pathology, as he traces its origins from Renaissance Italy.

Rosai, like Nicholas Wright, highlights the pivotal role of Rudolph Virchow, “who really established the basis of pathology and disease.  But since then we've come an awful long way.” (Nicholas Wright)

Francisco González-Crussí tells the story of how, as a medical student in Mexico in the 1950s, he observed the ‘passing of the baton’ from the German school of pathology to the modern American one.  “All of a sudden I saw that there were two worlds: one, the old world of the erudite, complex classifications, difficult terminology, all of which sounded very elegant, very impressive; and another which saw through this tangle of things into what was more essential, more rational.”

Miguel Reyes-Múgica talks specifically about the very recent development of paediatric pathology as a specialism in its own right, and the obstacles encountered.  The resistance lay in the belief that children and adults are essentially the same: But paediatrics is really different from adult medicine, and paediatric pathology is completely different“but paediatrics is really different from adult medicine, and paediatric pathology is completely different....  In paediatrics the key is development. ...Things are in continuous growth.”  Richard Hewlett similarly traces the development of neuropathology as a specialist branch.

Key interviewees:
Juan Rosai, Nicholas Wright, Miguel Reyes-Múgica, Francisco González-Crussí, Richard Hewlett

See also:
Autopsy, Children, Research versus Clinical Work

 

QUOTES

Juan RosaiPathology, the parent discipline, started with physicians doing autopsies [on their patients] during the Renaissance in Italy... to try to understand the reasons for the symptoms and the signs that they had been monitoring.  Most physicians did not record their experiences, or the records were lost, but it just happened that one, Antonio Benivieni, from Florence, was very good at documenting his cases from both a clinical and a pathological standpoint. Some years after his death his brother found his record book and had it published. It is now recognised as the first book in anatomic pathology and clinico-pathologic correlations.  This must have been around 1300.
 - Juan Rosai (Argentina, USA and Italy)

Nicholas WrightI think that before the Second World War, most hospitals [in the UK] had what was called a general pathologist...who would perform postmortems, would do clinical biochemistry, haematology, and would also look at micro-organisms – bacteria -- and isolate and diagnose infectious diseases. So they were very much generalists.
After the Second World War it became quite clear that nobody could actually do everything, so we had specialisations. We got the evolution of what are now called histopathologists – they're the people who perform autopsies, analyse tissue sections, look at breast biopsies, look at things like cervical cytology. And other people spun off into being specialist haematologists, microbiologists, clinical biochemists, virologists. So now we have a cadre of people who specialise in each of these disciplines and give a very highly competent service.
 - Nicholas Wright (UK)

Bill BassSo I got a masters and went to the University of Pennsylvania to work with Dr Wilton Krogman, who was internationally known as a forensic anthropologist. It wasn't called that at the time – they were called 'bone detectives'. It was on the biological side, physical anthropology, but it had not yet been named 'forensic anthropology'. That came in the early 70s, after I had gotten my degree. There were a number of us who were working with police and it was in the forensic area – 'forensic' means where science and law overlap -- and we said, ‘Well, hey, you've got forensic engineering, and forensic pathology, why don't we have forensic anthropology?’ I think it was one of those ideas that matured in everybody's minds at the same time.
 - Bill Bass (USA)

Juan RosaiIn Germany in the 1800s, [pathology] took a very significant turn under the influence of Rudolph Virchow. Virchow was a scientist... He was also an anthropologist and an active politician. Almost single-handedly, he transformed pathology into a science – into the scientific basis of medicine. And when pathology was imported into the United States in the late 1800s it came through the German schools, and therefore it followed the German philosophy.
 - Juan Rosai (Argentina, USA and Italy)

Francisco Gonzáles-CrussíWhen I first came, [paediatric pathlogy] was really a developing field… There were not more than 100 people in the whole of the United States practicing that specialty.  [It was slow to develop] because people thought that children were pretty much like adults.  They were just adults in miniature… The attitude was ‘you can't do anything about them anyway, so you're not helping the medical profession, you're not helping the patient, you're not helping anyone by diagnosing those abstruse syndromes of congenital anomalies.’  So there was a general lack of interest, I think for that reason.
 - Francisco González-Crussí (Mexico and USA)

In the 40s and 50s in the United States, there was a pioneer, Edith Potter, and she was really like the founding mother of paediatric pathology, who was working in Chicago, in the Cook County Hospital…She was skillful enough to obtain permission from the authorities of the city that any stillborn child there could be autopsied by her…She did fantastic work. She really made what became later like the bible of paediatric pathology: an inventory and a categorisation of the different forms of anomalies that can be present.
 - Francisco González-Crussí (Mexico and USA)

Paola DomizioPathology, at the beginning of the twentieth century and up to about the 1960s, was really strong in curricula. It was felt really important for doctors to know the pathological basis of disease. It was felt they needed to know the structure of tissues and organs, how they worked and what happened when they went wrong. So pathology was a really, really big subject. 

Then medical education started to change in the early 1970s. It was a slow but definite sea change. It was felt that doctors needed to know more about how to communicate with people, more about ethics and psychology – that they were overloaded with facts. Pathology was considered to be a factual, science-based subject, much like anatomy, physiology and biochemistry, so that was the target for fact-cutting in many curricula... [But] there's the beginning of a groundswell to say that, well, we actually need to put back some of the basic sciences into the curricula.
 - Paola Domizio (UK)





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