Practical pathology

by Aldred Scott Warthin

The autopsy method given in the main text is a composite one, made up from the Rokitansky, Virchow, Chiari and Nauwerck methods, according to the judgment of the writer as to what was the best in these, and put together with modifications and additions arising out of his own experience. The aim has been to offer a method by which an autopsy can be performed with the greatest speed and ease, and at the same time with the greatest completeness, the various steps of the operation following in logical order in such a way that nothing can be lost or destroyed, and thereby revealing a complete picture of the pathologic conditions present. A choice of methods is offered whenever the aims of the examination may be so varied as to make variations in method advantageous. The general order of the autopsy is the same as that given in the Protocol Blank-book, the present book being designed as a guide and reference-book for that. The points to be noted in the examination of each region are given in connection with the method of examination of that region, and represent the condensed special pathology of the latter. This should be of great service to the beginner in autopsy work, as affording a concise but complete guide to the most important conditions of each region. A textbook on Special Pathology should be used as a reference book in connection with these condensed statements of special pathology.

The technical methods for microscopic examination given in Part II have been brought up to date, and all recent methods of value included. Original methods have been given in preference to modifications; the latter, when of value, are also mentioned. As a rule that method has been chosen which in the light of the writer’s laboratory experience has yielded uniformly the best results. An effort has been made to reduce the number of methods to the lowest number as representing the best and most indispensable ones. During the fourteen years of laboratory experience since the publication of the first edition there has been plenty of time for changes in points-of-view concerning laboratory methods. Then an ardent exponent of celloidin-imbedding as a routine method, the writer has now practically discarded it in favor of paraffin-imbedding and the celloidin-sheet made by the dextrin-sugar or molasses method. This combination method is so superior in every way to ordinary celloidin-imbedding that the latter becomes obsolete except for a limited number of conditions. A number of personal modifications of various methods will also be found in this part of the book; indeed, it is intended to be an expression of individual opinion concerning laboratory methods.

The writer’s views concerning the value of teaching by unknowns,—that is, giving the student preparations or case-material for his own analysis and independent working-out to a diagnosis—are stronger now than they were when the preface to the first edition was written. Experiments with other methods of teaching have always brought me back to this as yielding by far the best results. It accomplishes two things—it not only teaches a knowledge of pathology, but it develops objectivity and the faculties of diagnosis, and accomplishes these with more marked success than any other method of teaching pathology.

Aldred Scott Warthin, Ph.D., M.D.

Ann Arbor, Michigan, May, 1911.

PREFACE TO THE FIRST EDITION.

Pathologic Histology deals with departures from the normal in the various tissues of the body, which, occurring as the sequelæ of disease-processes, or standing in the closest causal relationship to the clinical symptoms and physical signs, constitute the foundation of all diagnostic conclusions, and of all rational therapeutic treatment. Without a definite knowledge of these abnormal changes, of their various forms, of the manner in which they arise and progress, no physician can deal intelligently with disease. The knowledge of the natural history of disease, based upon a knowledge of the normal body, makes the wise and successful practitioner; and to such, the autopsy, the microtome and the microscope must ever stand as constant aids in the satisfying of his intellectual curiosity.

It is, therefore, essential that the student in his undergraduate work should be so trained that, in addition to a broad conception of General Pathology, he may acquire also such a technical knowledge as to fit him to carry on his investigations after leaving the laboratory. Not only in everyday practice in certain lines is a knowledge of this technique necessary for diagnostic purposes, but the true physician should so hold himself toward every problem of diagnosis which presents itself to him, that with every opportunity, he will, through excision, curettage or autopsy, make use of his technical skill to further his knowledge of disease, and to aid his science toward a solution of its great problems.

It is for these reasons, that in my laboratory courses in pathologic histology, I wish to give each student a practical working knowledge of the technique of pathologic investigations. That the student become an expert as the result of such undergraduate courses is neither possible nor desirable; it is only hoped that he may be placed in a position to cope intelligently with the questions awaiting him in the field of practice.

For the guidance of the student toward this end, I have compiled this little book of laboratory methods, endeavoring to make it as practical as possible, but yet thorough and complete. The methods given are taken from the original papers, or from the compilations of Friedländer and von Kahlden, but are modified in many instances according to the writer’s own experience. The autopsy methods are, in the main, those used by Kolisko of Vienna; but methods of Virchow, Chiari, Nauwerck, and others, are also given.