Pathology in Britain
St Bartholomew’s Hospital is the oldest hospital in London. It was founded in 1123 by an Augustinian friar at Smithfield close to the present St Paul’s Cathedral. In 1546 Henry VIII took over the hospital and gave it to the City of London.
An entrance gate was erected in commemoration of Henry VIII and is still called the Henry VIIIth Gate (Figs 1&2). Some of their early famous physicians were William Harvey (1578 – 1657). He studied anatomy in Padua and, on his return to London, he demonstrated the circulation of the blood. (Fig 3).
Above: Fig 1 - Henry VIIIth Gate
Fig 2 - Inside the Victorian-architecture type museum with glass roofing panels to provide light.
Fig 3 - William Harvey and the front cover of his book “The Circulation of the Blood” .
Percival Pott (1715 – 1788) (Fig 4) became famous
for his description of the characteristic fracture of the spine which
results from Tuberculosis (Fig 5).
Fig 4 - Percival Pott
Fig 5 - Vertical section through the lumbar vertebrae in a patient with Tuberculosis of the vertebral bodies. The collapse of the anterior portions of the vertebral bodies is characteristic of what is called Pott’s Fracture of the Spine.
One of his original specimens is preserved in the Pathology Museum of the hospital. He also described the Squamous Cell Carcinoma of the scrotum (Fig 6) which occurred in chimney sweeps – men whose job it was to clean the soot and other residue from the chimneys and fireplaces in the houses in London (Fig 7).
Fig 6 - Specimen of squamous cell carcinoma of the scrotum recognised as an occupational disease of chimney sweeps by Percival Pott.
Fig 7 - Old fashioned chimneys (chimney pots) from coal-fired fireplaces in central London
In those days the fires burned coal. He also described a similar cancer on the hands of gardeners who spread the residue from the London gardens (Fig 8).
Fig 8 - Squamous cell carcinoma of the hand of a gardener who spread the sweepings from fireplaces and chimneys on the gardens in London.
He said this was an occupational disease and postulated that the cancer was caused by an ingredient in the residue from the burning coal. This hypothesis was confirmed nearly 200 years later by Katsusaburo Yamagiwa (Fig 9) in Tokyo University.
He produced Squamous Cell Carcinoma in the ears of rabbits by painting coal tar on their ears daily for 660 days. (Fig 10).
Fig 9 - Katsusabura Yamagiwa, Second Professor of Pathology, Tokyo University.
Fig 10 - Rabbit’s ear with squamous cell carcinoma induced by the continued application of coal tar to the surface. This was experimental proof of Potts’ hypothesis of 200 years previously.
John Hunter (1728 – 1793) was a surgeon at St Bartholomew’s Hospital. His Anatomy and Pathology Museum are housed at the Royal College of Surgeons, London. They were illustrated in News Bulletin 1/2002.
James Paget (1814 – 1899) (Fig 11) trained at St Bartholomew’s and later became a leading surgeon. He could not afford the fee to be apprenticed to a surgeon, so he joined the physician training program which was free. He then joined the Pathology Department at St Bartholomew’s and exhibited so much skill and dedication to work that he was allowed to sit for the examinations to become a Fellow of the College of Surgeons. He is famous for his description of Paget’s Disease of Bone and Paget’s Disease of the Nipple. In the Museum there is a display which demonstrates the features of the first case of Paget’s Disease. (Fig 12).
Fig 11 - James Paget
Fig 12 Display of the first case of Paget’s Disease of Bone from a male aged 65 at the time of his death. The hats in the centre of the display demonstrate the increase in size of his skull. The photograph shows the characteristic deformities and the bones show the characteristic thickening seen in this disease.
[Photographs published with permission from Professor Sir Colin Berry, Barts and the London Medical School, and Professor Rikuo Machinami, Tokyo University]
Robin Cooke