The development of chemical pathology 1 ARTHUR JORDAN

I see the development of chemical pathology in Great Britain in two phases, the first up to the end of the second world war, and the second since that time. In the earlier phase the emphasis was on the word chemical. The chemical pathologist was above all an analyst and this was the golden age for the development of new methods based on the traditional techniques of the chemist. The medical consequences of the results were not always well known or appreciated and so there was a tendency to regard a medical qualification as much less important than a scientific qualification in this branch of hospital laboratory work. This view is still held in some circles. I do not share it. Since the war, the outlook has been changing and now the emphasis is increasingly on the word 'pathology'. The chemical pathologist must be first and foremost medically qualified, that is to say, he must be a clinical pathologist, as one of his important duties is to help both in diagnosis and in treatment. A number of developments have contributed to this change of outlook. The first of these is the considerable extension of our knowledge of human biochemistry, as this is changing the face of medicine. The physician needs to know not only what is happening, but why, and this often leads to a biochemical explanation so that treatment is becoming daily less empirical. Therefore if pathologists are to have a place as doctors and not as technicians only it must be because they can bring to the problems of medicine a scientific knowledge more extensive than that which clinicians have the time to acquire. In my view the primary examination for membership of our College could well require biochemistry at a level intermediate between that of the undergraduate medical curriculum and that of an honours B.Sc. school, and this without regard to the branches of pathology that the candidate was offering. Another development has been the introduction of techniques which belong to physics rather than to chemistry. An obvious example is flame photometry. Physical methods are creeping in and these are usually quicker and more accurate. A third development I wish to mention is auto-