Fig 1 Entrance to Guy’s Hospital

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Fig 2 Statue of Thomas Guy in the entrance courtyard

The Gordon Museum contains displays of the first cases of Addison’s Disease (Fig 4), Hodgkin’s Disease (Fig 6&7) and Bright’s Disease (Figs 12-15). In the displays in the Museum which commemorate each of these three distinguished physicians, there are fixed specimens from some of their original cases.
In 1932 the specimens were re-mounted and microscopic preparations were made. Many of Addison’s specimens were adrenal glands replaced by Tuberculosis. Some of Richard Bright’s kidneys were indeed what we now know as acute glomerulonephritis. One of them was amyloidosis. Hodgkin recognised a disseminated disease of lymph nodes that could be distinguished from Tuberculosis and secondary carcinoma. Some of these cases do, indeed, contain Sternberg-Reed giant cells and have the appearance of what is now recognised as Hodgkin’s Disease.

Fig 3 A view inside the modern Gordon Museum at Guy’s Hospital; portraits (left to right) of Addison, Hodgkin and Bright on the wall of one of the rooms in the museum. The historical wax anatomical models of Joseph Towne are in display cases on the floor of the room and the two upper galleries in this room contain the specimens of the modern teaching pathology museum. The Governors of the museum have re-designed it so that it is the centre of audiovisual teaching for students. The door in the middle leads to another room which contains moveable seating for lectures and seminars. There are two other rooms set up in similar fashion. The museum was renovated and repainted two years before this photograph was taken. It is a pleasant environment which embodies the old and the new. By making it the centre of student study, the Governors have ensured that it will continue to be relevant into the 21st century.

Directly across the road (St Thomas’s Street) from the entrance to Guy’s Hospital there is a small church – St Thomas’s Church. It was built to a design of the architect, Christopher Wren and opened in 1703. In the attic of this church there is the oldest operating theatre in Britain. It was commissioned in 1821 as the female operating theatre for St Thomas’s Hospital, and closed in 1862 when the hospital was moved to its present site on the South bank of the river Thames, opposite the Houses of Parliament.
When it was constructed, it connected with the female ward on the top floor of the hospital by a doorway created by making a hole in the southern wall of the ward and the northern wall of the attic of the church. Natural lighting was obtained through a glass skylight in the roof. Supplementary lighting and some heating was provided by gas fired lamps.

Fig. 4 - Display panel of Addison’s Disease with a specimen of diseased adrenal glands.

Fig. 5 - Wax model (made by Joseph Towne) of one of Addison’s patients showing the deep skin pigmentation.

Fig. 6 - Display of Hodgkin’s cases

Fig. 7 - Microscopic section of one of the original cases of Hodgkin’s Disease.

Fig. 8 - The famous specimen of ligation of the abdominal aorta by the surgeon, Astley Cooper. In the first quarter of the 19th century, surgeons all over Europe were presented with injuries to major blood vessels as a result of the Napoleonic wars. Experimental ligations such as this one, led to the discovery of the collateral circulations. The operation is described in the book, "The diseases and Injuries of Arteries" (1830.) To "place" this ligature, Cooper cut the posterior layer of the peritoneum with the finger nail of his right index finger, then threaded the ligature behind the peritoneum; tied it; and bound the edges of the wound together with a bandage. No anaesthetic. No asepsis. No sutures. Minimal analgesia. No blood transfusion. "The patient survived 40 hours and died exhausted."

As can be seen in Figure 9, the whole room is built of wood. The operating table has a “pull-out” shelf for lower limb amputations. The chair allowed the surgeons to be seated while performing lithotomies and haemorrhoidectomies. A box full of sawdust was kept under the table so that it could be placed strategically to collect blood from the operations. The instruments were stored in cupboards and on tables. Students crowded into the circular galleries and jostled each other for a view of the proceedings from these “standing room only” observation galleries.

Figure 9 - The Old Operating Theatre of St Thomas’s Hospital.

Figure 10 - “Anaesthetic” for leg amputations

Before 1846 at the earliest, there was no anaesthesia, and the reproduction of the painting on the wall demonstrates the “anaesthesia” used for leg amputations. Patients were usually blindfolded before entering the theatre. Lister’s antiseptic techniques were not in use until some years after the theatre was closed. Street clothes were worn by surgeons and their assistants. Hands, instruments, table and floors were washed only occasionally. It is frightening to think that this operating theatre was the most modern in the country in 1862.
When the hospital moved to make way for a railway line in 1862, the entrance from the former female ward was bricked up and the small hole in the floor which gave access to the attic from the church could be reached only by using a long ladder. As a result, the operating theatre was forgotten until 1956. Recently it was restored and opened to the public.

Fig. 11 - The Editor, Robin Cooke, with (from left to right) Joe Dawes, now retired as Curator, and Bill Edwards, the present Curator, in the office and preparation room of the museum.

Original Cases of Bright’s Disease

Fig. 12 - Gross

Fig. 13 - Acute diffuse glomerulonephritis

Fig. 14 - Amyloidosis

Fig. 15 - Acute crescentic glomerulonephritis


Text and photographs by Robin Cooke with the permission and assistance of the Curators, Professor Sebastian Lucas and Messrs Joe Dawes and Bill Edwards and the Curator of St Thomas’s Old Operating Theatre Museum, Ms Karen Howell.

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There are 54 Divisions of the I.A.P. Reports were presented during the year by 12 of these. All Divisions reported active educational programmes within their own territories. Many of them also engaged in activities with other Divisions in their region. Some activities that have not been highlighted in recent News Bulletins are as follows:
United States and Canadian Academy of Pathology
With 8 000 members, this is the biggest Division. It hosts an Annual Meeting with attendances of 3000 (including delegates from many countries outside North America ). The Academy has an active website which provides a plethora of free, on-line educational material (www.uscap.org). If a pathologist outside North America wants to subscribe to one of the Academy’s journals, they should join their own IAP Division, and they can then obtain USCAP member rates for a subscription to a USCAP journal and its associated electronic access via High Wire.

French Division

They regularly support Arab Division meetings and meetings of the French Speaking African Division. The Bulletin is published twice a year with colour pictures of illustrative areas of cases presented at their slide seminars. They now circulate one CD Rom slide seminar each year.

British Division

Actively supports the Arab Division meetings and is funding an Arab/British School of Pathology, supplying 2 - 3 lecturers each year. The first such “school” was held in Beirut, December 9 - 13, 2002. They support the pathologists in Southern Africa and they provide a number of travel scholarships to the United Kingdom for young pathologists. Applications for these scholarships can be made to the British Division Secretariat. Email: bdiap@blueyonder.co.uk

Hong Kong Division

In 2001, the Hong Kong Division of the I.A.P. officially merged with the Hong Kong Society of Pathology ( a much older organisation). The latter then ceased to exist. Professor David Hardwick was elected an Honorary member of the Hong Kong Division for his enormous contribution to pathology education in Hong Kong and mainland China. Dr Phil Allen is the other Honorary member. The Fourth Annual Meeting of the Association of Directors of Pathology of China was held in Changchun, August 10 - 12, 2002. Changchun has been called the capital of Northeast China (formerly Manchuria). For the first time, the official, government sponsored Chinese Society of Pathology attended the meeting. The next meeting will be held in Changchun July 19 - 20, 2003. These meetings are co-sponsored by the Hong Kong Division of the I.A.P., the University of British Columbia Visiting Scholar Program, and a private foundation. At the USCAP meeting in Washington March 20 - 26, 2003 there will be the first International Symposium of Chinese Pathologists. This aims to promote collegiality and co-operation amongst Chinese pathology groups and IAP Divisions in China, Hong Kong, Macau, North America, Taiwan and the Asia-Pacific regions.

Mexican Division

The Mexican Division recently amalgamated with the Mexican Association of pathology and the Federation of Anatomic Pathology of the Republic of Mexico. This gives the Division 180 affiliated members. The Mexican Board of Pathology lists 845 certified pathologists, and it is calculated that there are about 1,400 pathologists in Mexico. 400 pathologists attended National Meetings in the past three years, and 30 attended International Meetings. The main reason for these low attendances is the bad state of the economy.

Hellenic Division

The Division is running an Intra European Conference in Athens May 8 - 10, 2003. It was successful in its bid to host the International Congress of the I.A.P. in 2008.

Argentine Division

The Division currently has 301 members. They have started a Program of Board Certification and Recertification in Pathology. This is tied in with a program of continuing education.

South African Division

They have been actively working with the British Division to have lecturers visiting Southern Africa. They continue to work with pathologists in all the countries of Southern Africa. Pathologists in Zimbabwe cannot afford to buy journals or books because they have no access to foreign exchange. Anyone who can help may contact Dr Martin Hale in Johannesburg. Email: martinh@mail.saimr.wits.ac

Bolivian Division

The XVI Annual Meeting of the Division was held in association with the Chilean Society of Pathology in the Chilean city of Arica. The Division has an active program of Continuing Education planned for 2003 with slide seminars arranged for each month.

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Practical Pulmonary Pathology
London UK, 22-25 July, 2003
This course is designed to provide histopathology and cytopathology trainees and consultants with an opportunity to study diagnostic lung pathology in a comprehensive manner. It comprises lectures and practical microscopy sessions, the latter making up roughly half the time and consisting of individual study of a unique collection of cases.
Further details and application forms are available from Professor Bryan Corrin, Brompton Hospital, London SW3 6NP UK.
Email: b.corrin@ic.ac.uk
Fax: + 44 20 7 351 8293.

Current Concepts in Surgical Pathology
Four Seasons Hotel, Boston, Massachusetts
November 10-14, 2003
Contact: Department of Continuing Education, Harvard Medical School.
Email: hms-cme@warren
Website: www.med.harvard.edu
Fax: +1 617 432 1562

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