Saturday, July 11, 2009

Morbid Anatomy

I used to wear a hat in those days. Actually, I owned two; one was an oversized Homberg that my father had given me and the other was a 'Robin Hood' with a feather in the hatband, which I bought from Dunns the hatmaker. In 1963 most people wore hats. As a medical student I had been heavily influenced by the Richard Gordon books, 'Doctor in the House', and 'Doctor at Large'. My ambition was to take part in Rag Week, when the students got up to all sorts of pranks. I had been early disappointed by the fact that the medical course ran on facts from the 1930s, and all the recent science that I had done at school like DNA and molecular pathways hadn't penetrated the University. I did not take my studies seriously since there was no chance of being sent own at the end of the first year. I did enough to survive and treated the first year exams as a joke.

This was the year that General DeGaulle rejected Harold Macmillan's application to join the Common Market (as it was then called). We constructed a papier mache caricature of General DeGaulle with a caterpillar's body and called it 'de gall stones bug'. The nights before the Rag Parade we camped out guarding the effigy against the Engineers who had sworn to destroy our float. The Spring of 1963 was one of the coldest on record. It snowed heavily at Easter. The swimming costumed Rag Queen shivered as snowflakes landed on her bare flesh during the Rag parade. We won second prize, first going to the veterinary students who made a giant elephant which contained half a ton of rhinoceros dung that was shoveled out over the watching crowd at discrete intervals. Student humor!

Anyway, in the middle of this I attended a lecture in pathology. We were supposed to spend two hours the first half listening to a talk with slides on a particular pathological topic and then an hour looking down the microscope trying to identify what we had been lectured about. As soon as the lights went out I fell into a deep sleep. When the time came for us to troop out into the microscopy room, the other students left me there fast asleep. Eventually, a lecturer came in to wake me and I had to go and apologize to the Professor. For my pains I was invited to Sunday tea at his house. I didn't realize it at the time, but this involved an afternoon's back-breaking gardening!

I was reminded of this because my wife used the term 'morbid anatomy'. This is a phrase that has gone out of fashion. It used to be the term used to describe that branch of Pathology that did autopsies and looked at dead tissues to find out why someone died. Nowadays they call themselves 'histopathologists' and they mainly deal with the living. The autopsy has died. As a student I was a frequent attender at the mortuary. Every lunchtime there was an autopsy demonstration when three of four bodies that had been dissected that morning were displayed to students. We learned to recognize sago spleens and nutmeg livers. In my last year in practice the pathologist only conducted 11 autopsies in the hospital mortuary. In part this was due to the reluctance of relatives to allow post mortem examinations, but mostly it is a result of CT scans and MRIs. Hardly anyone dies undiagnosed now.

Out in the community people drop dead, but usually their family doctor knows that they had high blood pressure or a dicky heart and they are written up as 'stroke' or 'coronary' and a death certificate issued. People forget that an autopsy would often reveal several other diseases that the person was suffering from.

The reluctance of relatives to consent to autopsy stems from the Dutch Professor of Pathology at Liverpool who kept a collection of children's heats in formalin-filled pots in his office. He said that he needed them as 'research' though research on what no-one knew. More likely they were trophies.

Bereaved parents were outraged that little Betty's heart wasn't buried with them. (Shades of Michael Jackson's brain). This led to Draconian legislation that effectively barred any part of an autopsied body being retained. Distressed relatives were even asking for the paraffin block containing Junior's appendix, removed years before, so that they could exhume the coffin and bury it with the whole body in a new funeral service. Bizarre!

The legislation even extended to the dregs of blood tests, which would otherwise be tipped down the drain. The research on IgVH genes for which I made my name would have been impossible under the new legislation. there was even talk that hairdressers would have to return cut hair to the individual. Such 'reductio ad absurdo' softened the legislation.

Today histopathologists mainly work on the living. Most of their specimens come from biopsies not autopsies. The take part in many 'multi discipline team' meetings where they explain what the biopsies show and why it is important. Their role is vital.

When I was appointed at a Consultant Pathologist I was asked on what day did I want to do my autopsies. This was a perk, since autopsied requested by the coroner attracted a substantial fee. I replied that I had never done an autopsy in my life and I didn't intend to start then. I was one of the first to see hematology as a clinical discipline. I intended to treat patients with blood diseases who at that time were being mistreated by general physicians. But I also intended to build a laboratory where treatment was based on science not tradition. It took me a long time to get what I wanted, but on February 1st 1974 I made a start.


bob larkin said...

How lucky for us that you embraced Hematology back then. I am amazed at your vivid recall of incident details from '63. What a mind!

Brian Koffman said...

When I went to medical school at McGill, Montreal, the home to Sir William Osler and Wilder Penfield among others, I had to attend only four autopsies in my entire four year. But I did spent a year dissecting a cadaver with 3 classmates. I will never forget the sights and smells of 40 cadavers when, just a few days into medical school, and all of 19 years old, I first entered the "gross anatomy" lab, another term that may already be antiquated. We started dissection with the accessible axilla, with no idea where the complex nerves of the branchial plexus were starting from or going to. Kind of like starting War and Peace a hundred pages into it, because that was an easy part of the book to open.

Anonymous said...

Since I was born in 1950, I should have noticed every one wearing hats. My father never did. I never did, unless I was playing baseball, and it was a baseball cap, not a hat. Later, I did purchase several hats with a broad brim to ward off skin cancer, that I especially used hiking in the mountains, at altitude (10,000 feet not uncommon).

Of course, I lived in California, a notoriously informal state. The weather is never cold enough (except in those mountains) to require a hat; it's more to keep the sun off.

The only person who regularly wore a hat was my late grandfather. He had several, most of which were stolen in the nursing home, along with his false teeth.

Manu Manickvel said...

Richard Gordon's 'Doctor' books - hilariously entertaining, insightful & (as did Wodehouse)portrayed the weaker sides of great men in a very novel, human way.

Manu Manickvel said...

i shouldn't have given the 'Doctor' books away - miss them now!