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100 years of Pathology at Preston
Pathology at Preston
• 1914: Dr Tindall
Dr Tindall [a bacteriologist] appointed honorary
Pathologist and has charge of the department
“For the purposes of
scientific research and
to support medical and
surgical colleagues”
Pathology Laboratory at
Preston 1925
Pathology at Preston: First Quality Inspection 1914
• “The pathology department is
good and constitutes another
proof of the thorough way in
which the medical and surgical
work is carried on at this
institution”
• “One of the most interesting
county hospitals in Great
Britain”
Sir Henry C Burdett KCB KCVO
Pathology at Preston
• 1914: Dr Tindall
• 1922: Dr KM Duncan - a gynaecologist takes control
Br Med J. June 21, 1913
Pathology at Preston 1925: Pathology develops
Visit of HRH the Princess Mary, Viscountess Lascelles 1925
• “The pathological Laboratory.. is an extremely
important instrument for tracking down and isolating
mankind’s greatest enemy - disease.
• It is one of the specialists most valuable allies and
can be called the scouting department of the
modern hospital.”
Preston Royal Infirmary Annual Report 1925
Pathology at Preston: Workload
Year
Histological examinations
Sputum/urine cultures and
other examinations
Blood
Urine microscopy
Gonococci and spirochaetes
Histology
Microbiology
Haematology
Clinical Biochemistry
Immunology
1922
81
250
2014
31,000
508,000
1,100,000
5,200,000
196,500
1923
219
375
1924
245
103
346
288
0
846
736
184
Pathology at Preston:
• 1914: Dr Tindall
• 1922: Dr KM Duncan - a gynaecology surgeon takes
leadership
• 1930: Dr FB Smith
“The Board of Management has placed its
laboratory under my direction as a whole-time
pathologist.”
“This is an attempt to fill what has been felt to
be a gap in the prevention, diagnosis and
treatment of disease, and to supplement the
health service of the area of which Preston is
the centre.”
Pathology at Preston: Finance
• 1823 the price of leeches had
risen to 3d each
• The treasurer proclaimed:
– “As a great proportion of the
expenditure was absorbed
by the purchase of leeches,
greater care is needed to be
used in their usage. The
usage of leeches was to be
kept at a minimum and not
longer than 4 weeks”
Pathology at Preston : Finance
Preston
Laboratory
Handbook
1930
Pathology at Preston : Finance
1930
equiv. 2014
2014 av. UK
Calcium
£1
£40
£0.69
Full blood count
£1 10s
£60
£3.44
Swab full culture
£1
£40
£7.98
Histological report £1
£40
£49.80
Preston
Laboratory
Handbook
1930
Histology report 1979
Histology reports more
complex due to
improvements in laboratory
techniques and increased
requirements for diagnosis
and patient treatment plan
Histology report 2014
Pathology at Preston 1935-1946: period of growth
Preston Laboratory 1935
Pathology at Preston:
• 1914: Dr Tindall
• 1922: Dr KM Duncan - a gynaecology surgeon takes
leadership
• 1930: Dr FB Smith
• 1946: Public Health Laboratory Service (PHLS)
– A nationally organised framework of laboratories to
support the control of infectious disease
– A very strong link between public health and Preston
Pathology at Preston: 1946-2014
1990: Moved to Royal Preston Hospital
2014: Highly automated modern Pathology Department
1914-2014: Preston Pathology
Cellular Pathology
Nutrition
Allergy
Virology
Primary Immunodeficiency
Haemato-oncology
Lipidology
Immunology
OPAT
Anti-coagulation
Phlebotomy
Neuropathology
Forensic Pathology
Clinical Haematology
Haematology
Molecular Biology Transfusion Microbiology
Clinical Microbiology
Clinical Biochemistry
What has Pathology done for us?
• “It is estimated that 70-80% of all health care
decisions affecting diagnosis or treatment involve
pathology investigation”
Lord Carter of Coles
• But pathology does so much more…..
Pathology: Innovation supporting medicine
• The single most important
development in diabetes
research was the rapid
improvement between about
1910 and 1920 in techniques for
measuring blood sugar.
• In 1910 a blood sugar test still
required 20mL of blood, by
1920 it could be done with
0.2mL
Lewis, R. C., and Benedict, S. R., A Method for the estimation of sugar in small
quantities of blood, J. Biol. Chem., 1915, xx, 61.
Pathology: Translational science supporting medicine
• Alexandra Flemming and Penicillin and Pathology
• Bacterial identification and vaccination programmes
• Antibiotic disc
Pathology: Process engineering supporting medicine
• Automation
– Reduced cost
– Improved turnaround time
• Point of care testing
• Informatics
• Telemedicine
Pathology: personalised medicine supporting
medicine
• HER2 testing is performed in breast cancer patients
to assess prognosis and to determine suitability for
trastazumab therapy
• Molecular biology
Pathology: Patient pathway redesign supporting
medicine
• Pathology testing embedded in the patient pathway
improves:
– Improves patient journey
– Improves decision making
– Reduces total pathway cost
Preston Pathology the next 100 years
• Much has changed, but the job is still the same
• Continue to be the “scouting department of the
modern hospital”.
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Diagnosis and treatment
Scientific basis of disease
Translation science
Personalised medicine
Patient pathway redesign
Patient focussed delivery
Scientific and financial innovation
Public understanding of health and disease
Disease prevention
Preston Pathology the next 100 years
• Todays meeting has experts in their field to set the scene for
what Pathology needs to deliver for the next 100 years