PATHOLOGY AND CANCER

Sun (Auckland), Volume IV, Issue 1082, 20 September 1930, Page 13

PATHOLOGY AND CANCER

ADVANCE OF A GREAT SCIENCE WORK OF THE MEDICAL TEAM The pathologist is not a conspicuous figure: but his work is of the utmost value. He is one of the foundation members of the medical team, and from among his group may come forth the discoverer of the real nature of cancer, and the means of treating it Such an one will surely rank high among those who hove deserved well of the human race. Pathology is the study of disease and its effect on the system, and is one of the sciences upon which the practice of medicine and surgery is founded. It made slow progress for many centuries. The work of John Hunter, a Scotsman who lived and worked in London nearly 200 years ago. constituted a great step forward, and tiio advance of pathology lias been phenomenal in the last 50 years. Disease processes have been studied by many new methods, and are much more completely understood. Practice has ocen altered, and is constantly being altered in accordance with its discoveries. This is most desirable, for medical practice which has no firm basis upon scientific fact is unsound and liable to error. Many parts of our practice today are still without a scientific basis, though they represent the best we. can do in existing circumstances. But such practice is not of a high order, and differs in no essential respect from the practice of magic, as seen in savage tribes. Magic is all very well when real knowledge is absent: it is on the whole a salutary tiling. But the human mind can never long b© satisfied with an inferior method, and is restless in its endeavour to search out the truth. Admiration of the achievements of the past encourages further labour, and all thoughtful men look to the future with hope, when more secrets shall be made known, and further dark places illuminated. AN IMPORTANT MEMBER The pathologist therefore is one of the most important members of a medical team. He does not practice the art of medicine or surgery, and comes very little into contact with the patient. But his presence, his studies, and his reports throw a flood of light on matters connected with the disease, and his co-operation with the practitioner raises the standard of practice in no uncertain way. This then is the justification for the laboratory of a large hospital, and - its ever growing staff and complicated equipment. Although a good deal of its work is of a routine character, fresh ground is constantly being broken, and new conceptions of great service to the staff who deal with patients are being brought to light. The laboratory may be described as the conscience of the hospital’s practice, whereby errors aie avoided, misconceptions and inaccuracies recognised, and a constant tendency' toward truth maintained. The work of each member of the laboratory staff requires considerable mental discipline. And is conducted in a corresponding atmosphere. Nothing matters but care, accuracy and faitlifui attention to facts observed. This involves the individual worker sometimes in tedious investigations and prolonged searches. But when these ar* concluded, and the report signed, it can be taken to be true as far as human powers can find the truth m our present state of knowledge. All those of scientific outlook welcome th« aid of the laboratory, and the coming of the services of pathologist and bacteriologist have never yet failed to raise conspicuously the standard of practice in the district concerned. In relation to cancer the pathologist is all important. Cancer research is largely the province of pathologists of special training and many of the facts at present known about cancer are the fruit of their work, or of physicians lor surgeons who have also been pathologists. CAREFUL INVESTIGATION The routine work or the pathologist dealing with cancer concerns th© diagnosis, the progress and the end results of the disease In diagnosis he is often the first individual to know that a tumour or ulcer from which a patient is suffering is actually cancer. Sometimes the clinician—the surgeon—can be certain of the nature of the trouble without a pathologist’s opinion, but in all highi grade practice his clinical judgment is 1 constantly checked and standardised by the pathologist’s findings. Sometimes the whole tumour is removed and submitted for examination—sometimes j only a small portion is taken from its edge. The specimen is examined in j the laboratory by naked eye study. : and later by the microscope. The ■ latter is made by treating the tissue in i various reagents over a period of three-four days, cutting thin sections of it with a razor, staining these seci tions in a manner suitable to the indii vidual tissue, mounting the stained | sections on a glass slide, and by study •of this preparation under the mierp- ; scope. By these means, many uncertainties i ar© cleared up. The pathologist recog- ! nises th© abnormal structure of the tissue, and appearances of individual’ I cells, and can almost always report with confidence as to whether the tissue is malignant or not. Further he can sometimes give an idea as to the degree of malignancy, and as to the outlook for the patient. The report sometimes clashes with the opinion based on clinical findings. Consultation between the surgeon and pathologist in the diagnosis of various troubles has revealed many pitfalls and sources of error. It is b-' no means always clear, even when me full examination has been done, as to what the exact nature of the trouble is, ajid further developments must be waited. Conditions previously thought to be malignant have been proved to be simple, perhaps of an inflammatory nature, and vice versa. It is for this reason that any discussion of a cancer cure must include pathological examination of the tumour. The trouble must first have been proved by these methods to have been really cancer, before credit for a cure can be given. So in the progress of the disease, the pathologist is of the greatest help to the surgeon in reporting absence or cessation of spread of the trouble, and th© reactions of the growth to treatment i~re studied. In this way he can frequently advise whether the firal outcome is likely to be favourable or not. The lessons to be learnt from tL a individual case do not cease even the treatment has failed and the patient dies. A post-mortem examination when allowed by the relatives rarely fails to throw light on the disease and to suggest methods of improving the treatment for the next patient. Hidden extensions of the trouble may be found, or an unusually complete healing in another region may afford encouragement. Th© pathologist makes this examination, and confirms his observations by further microscopical studies. The results ar© discussed by the surgeon with him, and the experience gained applied to the next case. For there is not. and never can be, anything cut and dried about surgical practice. It is subject to constant modification and improvement, and post-mortem studies are made with these objects in view. When therefore a patient’s relations are asked to allow such examination, they are in a position to co-operate intelligently with the surgeon and pathologist in the united effort that is being made to master the disease of cancer. Such in brief is th© role of th©