Father of pathology

Rudolf Ludwig Karl Virchow

1821 - 1902

Rudolf Ludwig Karl Virchow was among the greatest minds in medicine in the 19th century.  As a result of his hard work and determination, great strides were made in the fields of pathological and physiological medicine.  Virchow was born in Schivelbein, Pomeranian, Prussia on October 13, 1821.   He attended Friederich Wilheim Institute where he studied to become a physician with a passion for pathological histology. 

Throughout his studies, Rudolf Virchow also performed a plethora of research disproving that phlebitis was the cause of most diseases.  Once he graduated from Friederich Wilheim Institute, Virchow went on to study at the University of Berlin where he became a medical doctor in 1843 . 

He was employed as an intern at Charite Hospital in Berlin but was suspended on March 31, 1849 due to his liberal view of the German government.  He was championed as the founder of cellular pathology because of his extensive research that disease is created and reproduced at the cellular level of the body.  However, he did not accept Pasteur's germ theory, and in later life devoted himself to archaeology and anthropology, forming a close friendship with Schliemann and collaborating in the excavation of Troy.

Rudolf Virchow was not only a brilliant physician and researcher but he was a father and husband as well.  In 1850 he married Rose Mayer and throughout their marriage they became parents of 6 children, three sons and three daughters . 

Rudolf Virchow was always busy attempting to better the lives of the German people.  Even at the time of his death on September 5, 1902 in Berlin, Rudolf Virchow was still serving on committees and counsels and working diligently as editor of journals in medical education . He was constantly working to provide quality health care to his patients and fighting for the their rights with the German Government

Rudolf Ludwig Karl Virchow

born on December 27, 1822 in Dole, in the region of Jura, France. His discovery that most infectious diseases are caused by germs, known as the "germ theory of disease", is one of the most important in medical history.

His work became the foundation for the science of microbiology, and a cornerstone of modern medicine.

Pasteur's phenomenal contributions to microbiology and medicine can be summarized as follows. First, he championed changes in hospital practices to minimize the spread of disease by microbes. Second, he discovered that weakened forms of a microbe could be used as an immunization against more virulent forms of the microbe. Third, Pasteur found that rabies was transmitted by agents so small they could not be seen under a microscope, thus revealing the world of viruses. As a result he developed techniques to vaccinate dogs against rabies, and to treat humans bitten by rabid dogs. And fourth, Pasteur developed "pasteurization", a process by which harmful microbes in perishable food products are destroyed using heat, without destroying the food.

Louis Pasteur discovered the method for the attenuation of virulent microorganisms that is the basis of vaccination. He developed vaccines against chicken cholera, anthrax and swine erysipelas. After mastering his method of vaccination, he applied this concept to rabies. On July 6, 1885, Pasteur tested his pioneering rabies treatment on man for the first time : the young Joseph Meister was saved.

Carl Rokitansky

Carl Rokitansky (1804 – 1878)

Investigation of the pathology of the CNS lesions continued throughout the 19th century, with developments in microscope technology allowing the analysis to become increasingly detailed.

This slide shows a portrait of Carl Rokitansky, one of the most outstanding morphological pathologists of the 19th century. Working at the Institute of Pathology in Vienna,

he was one of the first to examine MS lesions microscopically .

Rokitansky made a particularly important observation

in 1857 when he noticed 'fatty corpuscles' in the MS lesions. Charcot later described these as:

"the wreck and detritus resulting from the disintegration of the nerve-tubes

Penicillin researchers (c1940)

During the 1950s, James Gowans revealed the life cycle of the lymphocyte, whose role was at that time completely obscure. Gowans showed that the small lymphocyte continuously recirculated from the blood to the lymph and back again to the blood. He later demonstrated that this cell was at the centre of the immunological response.

James Gowans

 

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History of the Microscope

The Development of the Microscope

(Janssen / circa 1590’s)

Although the original microscope was a rather simple device, its ability to magnify the range of human vision paved the way for a revolutionary discovery of microbial life. Credit for the initial device has historically been given to a Dutch craftsman, Zacharias Janssen, working in the Netherlands late in the 16th century as a spectacle maker. These tradesmen, considered to be the world’s finest, had been using concave lenses for more than a century to correct far-sightedness. Janssen subsequently extrapolated this approach to visual amplification by creatively attaching two such lenses at opposite ends of hand-held tube. Janssen’s device was unquestionably primitive, but the microscope (from Greek words meaning "to see small"), would shortly reveal a hitherto unimagined realm of life.

http://www.az-microscope.on.ca/

history.htm

 

From ancient times, man has wanted to see things far smaller than could be perceived with the naked eye.

This led to the construction, in the 16th century, of a magnifier composed of a single convex lens, and this, in turn, led to the eventual development of the microscope

Perhaps the most famous early pioneers in the history of the microscope are Digges of England and Hans and Zcharias Janssen of Holland

But it was Antony van Leeuwenhoek who became the first man to make and use a real microscope.

Leeuwenhoek ground and polished a small glass ball into a lens with a magnification of 270X, and used this lens to make the world's first practical microscope

Because it had only one lens, Leeuwenhoek's microscope is now referred to as a single-lens microscope. Its convex glass lens was attached to a metal holder and was focused using screws.

After his historic invention, Leeuwenhoek continued to devote himself to studies base on the microscope. His discoveries included bacteria, bellanimalcules and spermatoza. Leeuwenhoek actually constructed a total of 400 microscopes during his prolific lifetime

The magnification ratio of a single-lens microscope like the one invented by Leeuwenhoek is calculated in the same way as calculations are made for a simple magnifying glass.

250mm--accepted to be the distance of most distinct vision--is divided by the length of the lens.

To increase the power of a single-lens microscope, the focal length has to be reduced. However, a reduction in focal length necessitates a reduction of the lens diameter, and after a point, the lens becomes difficult to see through

To solve this problem, the compound microscope system was invented in the seventeenth century. This type of microscope incorporates more than one lens so that the image magnified by one lens can be further magnified by another

day, the term "microscope" is generally used to refer to this type of compound microscop

in the compound microscope, the lens closer to the object to be viewed is refers to as the "objective", while the lens closer to the eye is called the "eyepiece"

Since its invention, the compound microscope has made tremendous contributions to the progress of science. Using a compound microscope that he had built himself, the 17th-century Englishman Robert Hooke discovered the fact that living things are composed of cells

n the medical world, Louis Pasteur of France used a compound microscope to discover yeast fungus, while Karl J. Ebert, a German bacteriologist, employed a compound microscope in his discovery of Eberthella Thyphosa

It was also a compound microscope that Robert Koch discover tubercle and cholera bacilli

The 19th century saw dramatic progress in the development of the microscope, thanks to the contributions of such great minds as Carl Zeiss, who devoted significant effort to the manufacture of microscopes, Ernst Abbe, who carried out a theoretical study of optical principles, and Otto Schott, who conducted research on optical glass

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ALCHEMISTS

Avicenna [985-1037]

Avicenna, b. 980, Bukhara, Iran d. 1037, Hamadan Arabic IBN SINA, in full ABU 'ALI AL-HUSAYN IBN 'ABD ALLAH IBN SINA, Iranian physician, the most famous and influential of the philosopher-scientists of Islam. He was particularly noted for his contributions in the fields of Aristotelian philosophy and medicine.

He composed the Kitab ash-shifa' ("Book of Healing"), a vast philosophical and scientific encyclopaedia, and the Canon of Medicine, which is among the most famous books in the history of medicine.

Albertus Magnus [1193-1280]

Roger Bacon [1220- 1292] Thomas Aquinas [1225-1274]

Arnold de Villanova [1240 -1310?]

Nicolas Flamel [1330-1418] Geber [14th century]

Basil Valentine [supposed 15th cent.] The 12 Keys Georg Agricola [1494-1555] Paracelsus [1493-1541] Jacob Bohmen [1575 - 16?] Valentin Weigel >[1533-1588]

John Dee [1527-1608] Edward Kelley [1555-1595] Jacob Boehme [1575-1624] Heinrich Khunrath [1560-1605]

Jan Baptista van Helmont [1577-1644]

Robert Boyle [1626-1691] Isaac Newton [1642 -1727] Count Cagliostro [1743-1795]

Count de Saint Germain [18th Century]

Demosthenes - The Alchemist God Alexandre Saint Yves d'Alveydre - Archeometre [19th Century]

Welcome to my new updated Pathology web site hoping this time it will not go down as the previous server

Hoping  YOU WILL LEARN SOMETHING AND HAVE FUN

This web site is for General Audience and Medical students

animated gif

note thay some of y notes and lectures and more developped in my other main sites as surgery, obgyn, pediatric and some lectures on my USMLE pages

  1. How to read a microscopic slides and pictures.
  2. Biopsies
  3. Stain
  4. Cell Death
  5. Vascular and hemodynamic
  6. Inflammation
  7. Tumors

  1. Amyloidosis
  2. Lupus
  3. POLYARTERITIS NODOSA
  4. Wagner's disease
  5. Scleroderma
  6. FAMILIAL MEDITERANNEAN FEVER DIFFERENT FROM MEDITERANNEAN FEVER AN INFECTIOUS DISEASE CAUSE BY A DOG TIC GIVING THE ASPECT OF LEOPARD SKIN
  7. IMMUNOPATHOLOGY

  1. Thyroid pathology
  2. Heart pathology
  3. BREAST pathology
  4. OVARIES pathology
  5. GI pathology
  6. Kidney pathology
  7. Bone pathology
  8. Endocrinopathology
  9. rheumatic fever
  10. CNS PATHOLOGY
  11. SKIN PATHOLOGY
  12. brain tumors

  1. most important bug to know

for the tumor part please check my oncosurgery web site

You have medical question or concern click on ask the question

You are a medical student, nurse  or physician assistant and have questions or cases to solve  click below

Sorry fox I do not tutor any more no much time and a lot of demand

 

SOME GENERAL DEFINITION

PATHOLOGY

The branch of medical science that studies the causes and nature and effects of diseases  therefore pathology will not mean autopsy but other as biopsy of tissue to know what is going on , cytology as papsmears in one word anything that will be seen under microscope after tissue removal [surgery] is part of the pathology. Agood surgeon should be a good pathologist in understanding the disease and pathway.

    PATHOLOGY: the study of the reaction of the body to disease

    DISEASE: any departure from a state of health

    ANATOMIC PATHOLOGY: tissues and organs

    CLINICAL PATHOLOGY: blood and other body fluids

    FORENSIC PATHOLOGY: the application of the science and methods of pathology to the resolution of problems of the law and issues of public interest

    do you think a biopsy or FNA is needed

    Thyroid  wasn't even described in scientific literature until in 1656 Thomas Wharton made a distinction between it and the larynx, but for 200 more years its function (regulation of the body's metabolism) was completely unknown. Goiters are excessive enlargements of the thyroid, which may be caused by iodine deficiency, or by an excess of thyroid stimulating hormone. Because we salt everything with iodized salt, iodine deficiency is never a problem in America, but it is elsewhere in the world.

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Below from http://www.co.pierce.wa.us/pc/abtus/ourorg/me/define.htm

I think it is a good historical and good definition on the subject

The term Coroner has been in use in England since about the year 900. It derives from the term coruner (root word corona, Latin for crown, "officer of the crown", meaning worked for the King). The position of Coroner has evolved over the centuries as a public official responsible for the investigation and certification of cause and manner of cases of sudden and unnatural death.

Much of American law derives from the English system and the office of the Coroner has remained in use in the United States to date. The use of the office of the Coroner varies widely throughout the U.S. Some are elected positions, others are appointed. Many are open to lay persons, others require that the Coroner be a physician, and a few require that the Coroner be a forensic pathologist.

In the State of Washington, law directs that the investigation of sudden and unnatural deaths take place within the 39 county jurisdictions. The system varies from county to county. The counties that are smallest by population have the elected Prosecuting Attorney also serve as Coroner. In most of the medium sized counties, the Coroner is a separate elected office. In Washington there is no requirement for the Coroner to be a physician. Currently (as of 1999), six Washington counties have Medical Examiners rather than Coroners (Clark, King, Pierce, Snohomish, Spokane, and Whatcom). Five of the counties (Clark, King, Pierce, Snohomish, and Spokane) have forensic pathologists serving as the Medical examiner.

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MEDICAL EXAMINER

The concept of the Medical Examiner developed in 1877 in the State of Massachusetts. The public was dissatisfied with layman Coroners and the system changed to one of appointed physicians. One medical doctor was appointed to each district (similar to a county jurisdiction) to be the public official responsible for the investigation of sudden and unnatural death. Medical examinations were a part of the investigation and the term AMedical Examiner@ has been in use since. The Medical Examiner concept is used in many states. All are appointed, not elected positions, and all Medical Examiner=s are physicians, but not necessarily trained in forensic pathology. The modern medical examiner system developed in 1915 in New York City. A forensic pathologist was appointed to be the Medical Examiner with statutory authority to investigate death and provided with a dedicated facility, support staff, and toxicology laboratory.



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FORENSIC PATHOLOGIST

Forensic pathology is a branch of medicine that applies the principles and knowledge of the medical and related sciences to problems that concern the general public and issues of the law. A forensic pathologist is a physician with specialized medical and forensic science training and knowledge. In practice, forensic pathologists concentrate closely on the understanding of types and causation of injuries and causes of sudden and unnatural death. The American Board of Pathology was established in 1936 and recognized forensic pathology as a formal sub-specialty in 1958. Forensic pathologists are commonly involved in death scene investigations, the performance of forensic autopsies (forensic autopsies have a different focus than that of hospital autopsies conducted in cases of natural death), review of medical records, interpretation of toxicology and other laboratory studies, certification of sudden and unnatural deaths, and court testimony in criminal and civil law proceedings.

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DEATH CERTIFICATION

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  • (UNDERLYING) CAUSE OF DEATH: that disease or injury which initiates the
  • sequence of events leading to, or ending in, death
  • a competent underlying. cause of death should be etiologically specific
  • IMMEDIATE CAUSE OF DEATH: complications of the underlying cause
  • CONTRIBUTORY CAUSE OF DEATH: diseases or injuries which make a physiologic contribution to the death but do not result in the underlying cause
  • MANNER OF DEATH: a description of how - under which circumstances -the cause arose
  • natural deaths: deaths caused exclusively by disease
  • violent deaths: deaths caused fully or in part by injury
  • subheadings of violent deaths:
    - HOMICIDE: death at the hands of another person or as the result of a hostile or illegal act of another person; does not require an intent to kill but only a deliberate act
    - SUICIDE: death at the hands of oneself; an intentionally self-destructive act; it is the only manner of death which requires intent
    -ACCIDENT: violent deaths occurring not as a result of a deliberate or illegal act of another person; no definitive demonstration of intent to do harm
    - UNDETERMINED: inconclusive manner of death; violence cannot be ruled out
  • independence of medicolegal death certification from the criminal justice system:
    - HIT AND RUN FATALITIES -- Medical Examiner certifies as accident; still prosecutable by law enforcement
    - VIOLENT DEATHS OCCURRING DURING PURSUIT OF A FLEEING SUSPECT OR WHILE IN POLICE CUSTODY -- Medical Examiner certifies as homicide; not necessarily punishable or prosecutable in the legal system
  • 1909 death certificate

    to read the full report click here

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    MAJOR DIFFERENCES BETWEEN THE HOSPITAL AND FORENSIC AUTOPSY

  • 1) authorization
    • hospital: next of kin or individual responsible for burial arrangements
    • forensic: Medical Examiner
    2) purpose / objective(s)
    • hospital: to confirm the cause of death or to evaluate the effects of treatment of a disease
    • forensic:
      *to assist in ascertaining the manner of death
      *to assist in reconstructing the fatal injury or event
      *to assist law enforcement agencies in the prosecution of a crime
      *to document and preserve evidence
      *to evaluate the possible contributions of natural disease and / or drug intoxication in the causation of a violent death
      *to exclude or rule out reasonable possibilities regarding the cause or manner of death
      *to assist in matters of public health importance
    3) focus
    • hospital: internal examination, histology ;
    • forensic: external, internal examinations, toxicology
  • suicide or murder

     

AUTOPSY  PATHOLOGY

1-the legal or forensic autopsy, destined to investigate the the death in cases of violence or presumed violence;

2-the verification of the cause of death, performed in cases of non violent death without medical accompaniment and

3-the hospital autopsy, performed by pathologists in hospitalized patients who died of natural causes

The autopsy goal is not only to identify the cause of death, as many may think, but it has several other functions:

  • Diagnosis and treatment quality control, through the knowledge of the autopsy findings by the team that assisted the patient, seeking to identify possible flaws and its causes, so that they won't be repeated in other patients.

  • Source of information for the Secretary of Health, allowing the making of precise statistics on the most frequent diseases, what influences in the politics of health of the State and of the Municipal district.

  • Material for the residents, students and staff learning. The clinical-pathological correlation accomplished during all autopsy stages of the is an excellent exercise, constituting the largest knowledge source in Pathology.

  • Material for scientific research.

  • Recognition of new diseases and of new lesion patterns.

  • Recognition of the effect of the treatment in the evolution of the disease.

  • Clarify cases without clinical diagnosis or in those in which the patient death was unexpected [http://www.uff.br/mpt/eautopsy.htm]

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AUTOPSY REPORTS & THEIR INTERPRETATION

    The typical autopsy report is a two-pane sheet which looks like the following:

PATHOLOGICAL DIAGNOSIS:

Cardiovascular: Heart normal, no signs of hypertrophy, valvular, or congenital abnormalities. Coronary arteries normal and distributed. No right coronary predominance. Myocardium, no evidence of trauma, fibrosis, or inflammation. Aorta, mild arteriosclerosis.

Respiratory: Larynx, trachea, and bronchi show no signs of trauma or obstruction. Lungs, pulmonary congestion and edema present; upper lobes have atypical obstruction.

Liver: No evidence of trauma or inflammation.
Spleen: No evidence of trauma
Pancreas & Adrenal Glands: No significant alterations.
G.I. Tract: No evidence of trauma, hemorrhage, or ulceration.
Genitourinary Tract: Kidneys show no signs of trauma; Urinary bladder and other organs in good condition.
Head: Perforating gunshot wound present

Cause of Death: Perforating Wound to Head:

Peritoneum: Intact, smooth

Heart: 415 gm. No gross evidence of trauma, some slight right coronary predominance.

Lungs: Right 640 gm; Left 490 gm; all areas free of obstruction except apex of upper lobes which show evidence of scarring.

Liver: 1840 gm; Intact, some congestion
Glands: No significant alterations
G.I. Tract: Stomach empty

Brain: 1575 mg; Perforating gunshot wound, entrance in right superior to ear, oval wound 5/8" by 1/2" with rim of powder debris. Linear track extends backward and to left, passing thru parietal lobe and left cerebrum, exiting near left parietal bone. Multiple fractures on exit side.

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INTERPRETATION

The anatomic patologists performs microscopic exams including surgical pathology and frozen sections , cytopathology , electron microscopy (400/year), children's autopsy  and adults' autopsy .

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MEDICOLEGAL SCENE INVESTIGATION

  • the death scene: the medical examiner has jurisdiction and presides over the board ; but the law enforcement agency has ultimate jurisdiction over the scene
  • observation of the body: position, clothing
  • estimation of the postmortem interval:

1) rigor mortis:

Temperature of body

Stiffness of body

Time since death

Warm

 Not stiff

Not dead - more than three hours

Warm

 Stiff

Dead between 3 to 8 hours

Cold

 Stiff

Dead between 8 to 36 hours

Cold

Not stiff

Dead in more than 36 hours

Rigor mortis should never be the only basis for estimating time of death

  • Ca++ pumps run out of ATP
  • Ca++ cannot be removed
  • continuous contraction
  • eventually tissues break down
  • definition: the stiffening of the muscles after death due to chemical changes in the muscle fibers (depletion of ATP, lowered pH)
  • timetable:
    1. onset: 1/2-1 hr
    2. peak: 12 hr
    3. duration: 12 -36 hr
    4. disappearance: 24-36 hr (hot environment: 9 -12 hr)
  • variables:
    1. accelerate rigor -- exercise; seizures; electrocution; heat (hyperthermia, increased environmental temperature)
    2. retard rigor -- cold (hypothermia, decreased environmental temperature); decreased muscle mass (elderly, disabled, emaciated, and young children infants); some drugs/poisons (carbon monoxide)
  • applications:
    1. actually a relatively crude indicator of the time of death
    2. if present in an antigravity position (position does not correlate with surroundings), may indicate that the body was moved after the development of rigor

2) livor mortis:(discoloration)

  • definition: the red-purple discoloration caused by the settling of the blood in the dependent portions of the body due to gravity -timetable:
    1. onset: minutes -few (2-4) hrs
    2. fixed: 8 -12 hrs - point at which livor cannot be displaced by blanching (pressure) or by turning the body
  • applications:
    1. time of death - also a crude indicator
    2. color may provide clue relating to cause or circumstances of death --
          * cherry-red: carbon monoxide; cyanide; cold (refrigeration / hypothermia)
          * green-brown: drugs or poisons causing methemoglobin or sulfhemoglobin formation in the blood
    3. may indicate movement of the body after death (after development of livor); a dual pattern may result if a body is moved after partial development of livor