Canadian Medical Association Journal 1995; 153: 671
Pathology in Canada began with that godfather of Canadian medicine, William Osler. After gaining his medical degree from McGill in 1872, he spent a couple of years touring London, Berlin and Vienna, where he came under the influence of the father of pathology, Rudolph Virchow.
He returned to McGill at age 25 as professor of the institutes of medicine, which included what we now recognize as physiology, pathology and microbiology. During his 7 years at McGill, Osler did an average of 100 autopsies a year, many on his own patients. From his work, it is possible to trace an unbroken lineage to the pathology practised in Canada today.
From McGill, Osler went to the University of Pennsylvania, the oldest medical school in the US, where he continued as he had at McGill, practising as an internist and performing his own autopsies. After only 4 years he was lured to the new medical school at Johns Hopkins, where he became part of that golden quadrumvirate of Osler, Howard Kelly, William Welch and W.S. Halstead.
Welch, the dean and professor of pathology, got on well with Osler. One of the trainees in his department was W. G. McCallum, who later became chair of the department. In turn, one of McCallum's trainees was Arnold Rich, who succeeded McCallum as professor. A number of distinguished Canadians trained under Rich, and one of these was Joe McManus, a Queen's graduate who became a founding father of the discipline of histochemistry (his PAS stain is still in use).
The other Canadians to train under Rich were John Hamilton and Lyman Duff. Duff, after a brief stint at the University of Toronto, was recruited to the chair of pathology at McGill, where he established Canada's first department of scientific, experimental pathology. Duff's trainees included John Hamilton, Bob More, Gardner McMillan, Alec Ritchie, Sergio Bencosme and me -- among many others. Ritchie succeeded John Hamilton as chair at Toronto and McMillan followed Duff in McGill's chair.
Thus you can see a virtually unbroken line of what might be called the philosophy of scientific pathology at McGill, Queen's and Toronto -- a line that stretches all the way back to Osler and Virchow.
Although pathology continues to be the linkage between the basic sciences and clinical medicine, its position in the health care hierarchy has changed. When I was an undergraduate at McGill in the late `30s and early `40s, pathology was the discipline that attracted graduates who wanted to study disease using laboratory models.
All that changed, and changed forever, following World War II. The medical requirements of war resulted in a massive increase in the new breed of physicians we now call clinical scientists. This occurred because of the need to meet the wartime requirement for scientifically based medical care that would keep the fighting forces fit, with minimal losses due to illness or trauma. Research programs were developed to study all aspects of trauma, shock, exposure to the elements, psychologic stress and all of the hazards to which troops are exposed.
After the war, the new clinical scientists sought university appointments that would permit them to continue to study disease using ever more sophisticated technologies. And in the postwar boom years, money to support such efforts was readily available. Although pathology as a discipline was a beneficiary of this new development, it soon became apparent that its near-monopoly over the laboratory study of disease had been lost for good.
It now had to compete with the other clinical disciplines for research funds and traineeships, and had to assume responsibility for the operation of more and more of the increasingly sophisticated clinical laboratories.
Pathologists were slow to recognize the changed world in which they now lived, and lost valuable time in adapting to it. That recognition has now taken place and pathology is well on the way to facing new challenges and establishing itself as a true clinical discipline rather than an aloof sideline spectator.
This is not to say that morbid anatomy has ceased to be the keystone in the arch linking the basic and clinical sciences. It is simply recognition that it is now holding hands with a great many partners in its dance of life.