Pathology Pioneers

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John Thomson (1831-1842)

John Thomson (1765-1846) was a remarkable character. The son of a silk weaver in Paisley, he started to earn his living at the age of eight, and had worked for ten years for his father before serving a three year apprenticeship with a Paisley general practitioner. He studied in Glasgow, Edinburgh and with John Hunter in London, became Professor of Surgery at the Royal College of Surgeons in Edinburgh in 1804, Professor of Military Surgery in the University of Edinburgh in 1806, Professor of General Pathology in 1831 and President of the Royal College of Physicians in 1834. It was no wonder that he was referred to as the "old chair maker" by Robert Knox, the anatomist, because of his ability to have chairs created for himself to occupy. Thomson. published works on chemistry, inflammation (on which he was a world expert), lithotomy, small pox vaccination, hospital administration, medical education and the Life and Work of William Cullen as well as researching on necrosis and callus formation, hernia, arrest of haemorrhage from divided arteries, and the use of mercury in the treatment of syphilis (he preferred to treat it with sarsaparilla). He gave the first lectures on diseases of the eye in Edinburgh, the first lectures on systematic surgery and military surgery; as well as being the first to organise his lectures on the practice of physic on an anatomico-physiological basis. He was instrumental in founding the Museum of the Royal College of Surgeons and the Edinburgh New Town Dispensary and the first to use drawings and paintings of disease processes to illustrate his lectures. "He never knew apathy, and medicine being his first field he was for forty years the most exciting of all our practitioners and of all our teachers" (Lord Cockburn).

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William Henderson (1842-1869) 

The second professor, William Henderson (1810-1872), was an authority on the cardiovascular system and is credited with being the first to differentiate typhus from relapsing fever. He was also one of the first to apply the microscope to pathological diagnosis (the first had been J. Hughes Bennett, Pathologist to the Royal Infirmary of Edinburgh and an unsuccessful applicant for the Chair of Pathology and later Professor of Physiology in Edinburgh). In 1845, Henderson was converted to the practice of homeopathy and was obliged to resign his post as physician to the Royal Infirmary, which was held concurrently with the Chair of Pathology. A campaign led by Professors Simpson and Syme (about the only time these two ever agreed with each other) was mounted against him. They tried, unsuccessfully, to have him removed from his University post. Their next move, which also failed, was an attempt to make pathology non-compulsory, arguing that if this were the case students would not bother to attend his lectures. Finally he was expelled from the Medicoi Chirugical Society in 1861 and asked to resign from the Royal College of Physicians. However, he continued as Professor until 1869 when he resigned because of ill health caused by an aortic aneurysm (ironically, a condition on the study of which he had made his reputation). He died three years later.

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William Rutherford Sanders (1869-1881)

Henderson's successor, William Rutherford Sanders (1828-1881) was a well-known physician and an expert on the spleen. He was a man of "remarkable good sense" unlikely to be led astray by the ignis fatuus of Hahnemannism. "His students were trained to observe for themselves the naked eye and microscopic characters of morbid conditions of which they could acquire only a superficial knowledge in the lecture room". However, Sanders consulting practice proved too much for him and for the last seven years of his tenure of the Chair his classes were conducted by his assistant Dr David Hamilton, later the foundation Regius Professor of Pathology in the University of Aberdeen (1882), and "the Bull" in Halliday Sutherland's "The Arches of the Years".

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William Smith Greenfield (1881-1912) 

The next professor, William Smith Greenfield (1846-1919) a graduate of University College, London and the first incumbent not trained in Edinburgh, inherited a department in cramped quarters, teaching a subject regarded as the soft option in the second professional examination, which also included anatomy, physiology and materia medica. Greenfield soon changed all that. He supervised the move of the Department to the new medical buildings in Teviot Place and established a new course of practical pathology taught by his assistant German Sims Woodhead (who was instrumental in founding both the Edinburgh Pathological Club and the Journal of Pathology and ultimately became the Professor of Pathology in Cambridge). Greenfield was an established experimentalist who had elucidated the bacteriology of pulmonary anthrax and was a world authority on the kidney. He was also the first to describe in 1878 the cell of Hodgkin's disease now known as the Reed Sternberg cell. He encouraged the development of investigative pathology and bacteriology and in 1894 Robert Muir (then Greenfield's assistant and later Professor of Pathology at the Universities of St Andrews and Glasgow) was appointed to the first Lectureship in Pathological Bacteriology.

An idea of Greenfield's problems may be obtained from his submission to the Medical Faculty when, in 1901, the Carnegie Trust was set up and the University was asked to submit suggestions as to suitable expenditure to be supported by the Trust. It is fascinating to read the request submitted by Greenfield. "The needs of the Pathology Department are so numerous in order to render it adequate to the work demanded of it, and still more to place it on a level with those of other medical schools, and to make it worthy of the University, that only a brief summary of the most urgent can be given. The two most urgent needs are those of accommodation for research and for advanced teaching and of a sufficient annual grant to meet the ordinary needs of class teaching and laboratory expenditure". The Department was so crowded by the ordinary undergraduate classes it was both impossible to do research without interfering with the routine work of the laboratory and to give training in the methods of pathological research on which Greenfield placed a high priority. He also requested a Lecturer in Experimental Pathology at £250 p.a. (a Lectureship in Surgical Pathology was worth only £50 and one in Economic History £400) and a larger class grant to pay the laboratory "boys" (who worked from 8 a.m. to 6 p.m. with an hour for dinner, for 16/6d per ~ week and with the prospect of much unpaid overtime). "It was very difficult to get boys at all, and the work is so difficult and complex, the risks to health so great and the prospects so poor, that it is even more difficult to keep them". He also made a case for the funding of 30 microscopes at £6.0.0 each and 20 at £12 to £15, as well as £150 worth of "electric lantern and centrifuges" but Greenfield did not know if this last estimate included the cost of "the introduction of the electric light, which is not in the department". The problems of the Professor of Pathology do not seem to have changed much in the past eighty years but we do have the electric light.

Greenfield was an excellent clinical teacher, if inclined to be sarcastic and ironic. On his retiral in 1912 it was considered by the Senatus that the combined duties of Professor of Pathology and a Clinical Professor with responsibility for beds in the Royal Infirmary of Edinburgh were incompatible as each tended to detract from the other. The beds associated with the Chair of Pathology were therefore transferred to provide a basis for the Moncrieff Arnott Chair of Medicine. At the same time the opportunity was taken to create the Robert Irvine Chair of Bacteriology and thus three separate chairs stemmed from what had been Greenfield's responsibilities. Greenfield's contribution to Pathology has been underrated. He was an internationally known experimental pathologist and bacteriologist (he had worked with Pasteur), and a histopathologist of distinction. He had a considerable reputation as a teacher, both clinical and pathological, and his textbook 'Practical Pathology' was used very widely Many of his pupils and assistants later occupied chairs of both clinical medicine and pathology. If "Bobby" Muir is the father of British Pathology, Greenfield is the grandfather.

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James Lorrain Smith (1912-1931)

James Lorrain Smith (1862-1931) was an Edinburgh graduate who had worked with Burdon Sanderson and J.S. Haldane in Oxford on the physiology of respiraticn and is immortalised in the "Lorrain Smith effect". Before his appointment to the Chair of Pathology in Edinburgh he had filled chairs at Queen's College, Belfast and the Victoria University of Manchester. Whilst at Manchester he published papers on the histochemistry of lipids. During the First World War he was instrumental in the development of and in establishing the clinical efficacy of "Eusol" and collaborated in a report on the pathology of trench foot. He introduced an integrated approach to the teaching of pathology and clinical medicine and later as Dean of the Faculty of Medicine he "In collaboration with his professional colleagues, and with the authority of the Faculty got the subjects of the third year namely, pathology, pharmacology and therapeutics, junior medicine and junior surgery intimately linked, so that, in place of an imperfect patchwork stitched together by the tyro himself, the varying occurrences in the course and progress of disease were unfolded to him in natural sequence".  A far cry from the attitude of the Faculty in 1831 and a timely reminder in 1981 that the current principles of curriculum planning were advocated 60 years ago by the Professor of Pathology James Lorrain Smith.