The changing practice of pathology.

The beginnings of pathology Pathology is the study of deviation from normal health. It has been studied from the time when man first began to reason on the disorders which affected him. Its separation from medicine in general began with enquiry into the causes of disease and the early history of pathology has been described by Long.' During the 5000 years of Egyptian dynasties around three quarters of a billion human bodies were embalmed but no anomalies were recorded. Later, during the fourth and fifth centuries, BC, the Greek school of Hippo-crates developed a philosophy of humoral pathology, which suggested a mechanistic concept of disease in place of mythology. Various Roman doctrines of pathology followed in the first century, BC-the pneumatists, the methodists , and the eclectics. These early ideas of disease were formed at a time when dissection of the body was regarded as a desecration and not permitted. A total change of outlook came with the Renaissance when necropsies were permitted and printing vastly widened the dissemination of knowledge. In the 18th century pathology was a branch of anatomy-morbid anatomy, most gross anatomical lesions being simply described. The microscope was invented in the 16th century but was not sufficiently refined for tissue to be studied until the early 19th century. This was associated with new techniques of fixation, embedding, microtome cutting, and staining. Cellular pathology was thus established. Bacteriology developed in parallel, allowing the pathogenic process to be recognised and chemistry, previously a fundamental science, also came to be applied to medicine alongside physiological concepts of disease during the 19th century. Early pathology practice Great advances in the science of pathology were made in the latter half of the 19th century, but there was little demand for the services of pathologists outside university centres where necropsies were regularly performed as part of the teaching curriculum.2 In most hospitals at this time, simple chemical tests on urine and microscopic examination of blood and urine were performed in ward side-rooms by clinicians. Clinical pathology laboratories were being developed at the turn of the century. The range of tests was limited to blood cell counting, chemical analysis and cell counting of urine, bacterial staining and culture of urine, sputum, cerebrospinal fluid, swabs, stools and blood, and the serological Wassermann reaction for syphilis. Clinical pathologists performing this work earned their living as clinicians in medicine by private practice from consulting rooms, which …