A History of the Development of Pathology in Pakistan
When we think of the development of laboratory medicine, we must briefly narrate the initiation of medical education in the sub-continent with a special reference to how and when the subject of Pathology was introduced in Pakistan. During the Raj by East India Company, the British rulers created a medical school in Calcutta in 1835-Calcutta Medical College. The college was a success; it was only about 25 years later when the British government decided to create another medical institution that was in Lahore which even in those days was a very central place for various activities of learning. The formation of Lahore Medical School came into existence in 1860. It was started at the present site of Government College University and the hospital for Lahore Medical School was just a mile away in the foreign stables near a well known ‘tibby police station’ close to one of the gates of the walled city of Lahore i.e. Texali Gate. The first principle of this medical school was J.B Scriven (1862-1870) — a civil surgeon previously located in Calcutta Medical School. Dr. Scriven and his followers worked hard to develop the Lahore Medical School that progressed to Lahore Medical College (1886) and ultimately to King Edward Medical College (1911) and in the year 2006 it became King Edward Medical College University.
The well known Mayo hospital which is the oldest teaching hospital in Pakistan, its building was completed in 1871 and inaugurated by the Earl of Mayo – then the Viceroy of India. Later on the King Edward Medical School was shifted to the present site of King Edward Medical College which was actually a railway hostel., next to Mayo Hospital. The subject of Pathology initiated in 1892 with the creation of a combined chair of Pathology and Materia medica. In 1895, the first Pathology laboratory (consisting of only 2 rooms) along with an adjoining autopsy room was created. The first independent chair of Professor of Pathology was created during the tenure of Lt. Col. J.F. Perry, who created it in 1908-09 by splitting the combined chair of Pathology and Materia Medica, (created in 1892). In 1911 the Lahore Medical College was renamed after the King Edward VII. This happened during the tenure of Lt. Col. D.W. Sutherland who later on created a post of Pathology lecturer as well, in addition to the post of Professor. The King Edward Medical College housed the famous Patiala Block (administrative and lecture complex block) and Bahawalpur Block (Pathology, Physiology and Biochemistry Block). The gross Pathology was practiced in medico-legal postmortem area which also housed a cold storage to preserve the dead bodies. Among them autopsies (pathological autopsies) were also performed on those who died due to natural causes.
The last principle of K.E Medical College of British raj before creation of Pakistan was Lt. Col. B.S Nat whereas the first principal after the creation of Pakistan was Lt. Col. Elahi Bukhsh (1947-54; 1955 – 59).
It was only two years before the creation of Pakistan i.e. 1945, Dow Medical College established in Karachi. The civil hospital was affiliated to this new College that has now been upgraded to Dow Medical College University. This was followed by the creation of numerous medical colleges at Government level and subsequently many medical colleges in private sector came up till date. They housed departments of Pathology both for teaching and the practice of the specialties of Pathology.
Early Development of Pathology as a Subject
Going back once again to the earlier time when the subject of Pathology was being practiced and it was also being taught to the undergraduates. Surgeon Captain Merry (1892-1902) occupied the first chair of pathology followed by Maj. H.G Me/vile (1902-1908). This was followed by the appointment of Captain W.M. Foster, who joined the department of Pathology of King Edward Medical College, Lahore in 1908 till 1918.
During this tenure soon after he became the in-charge of the department of Pathology, Captain Foster became the first full time professor of Pathology when Lt. Col. F.F. Perry was the principal. He also got 2 rooms (next to the autopsy room) to make a laboratory where they could examine the patients’ material as well as the material removed from autopsies. In other words, it became a mini laboratory that was the nucleus of future department of Pathology. This laboratory served the Mayo hospital indoor and outdoor patients and who ever would need pathological examinations. Later on the Pathology services were extended to the nearby Lady Atchison Hospital that was attached to King Edward Medical College.
Meanwhile the department of Pathology at King Edward Medical College was housed in its present premises, i.e. Bahawalpur Block. In this department the laboratories were designed to accommodate Clinical Pathology, Chemical Pathology (then called clinical chemistry), Histopathology and Microbiology (Hematology was separated as a specialty during the subsequent years i.e. in 1969). Professor A. N Goyal was the last professor of Pathology at the time of creation of Pakistan and being a Hindu he left for India, in 1947. Soon after partition Khan Bahadur Yaqub Khan whom was assistant professor working under professor Goyal became head of department and was promoted to the rank of professor whereas Dr. Abdul Majeed Khan was promoted as assistant professor. Later on the promotion of A.M Khan to the rank of professor and his transfer to the College of community medicine was followed by the promotion of Abdul Hameed Shiekh as 2nd professor of pathology at King Edward Medical College.
By now teaching and service of pathology became a very important part of medical teaching and the diagnostic medicine.
This department of pathology was supplementing the already existing clinical laboratory and some side room laboratories at Mayo hospital. This was followed by the creation of small laboratories at Lady Aitcheson hospital and Lady Willington hospital except the special investigation and the reporting of surgical specimens that were centralized in the laboratory at King Edward Medical College. After variables, many medical colleges were established in various provinces of Pakistan. They all came into a healthy competition and developed their departments according to the
Khyber Medical College, Peshawar. (Now a University) 1954
- Jinnah Postgraduate Medical Center, Karachi 1958
- College of Physicians & Surgeons Pakistan. 1962
- Quaid-e-Azam Medical College, Bahawalpur. 1970
- Bolan Medical College, Quetta 1972
- Chandka Medical College, Larkana. 1973
- Punjab Medical College, Faislabad. 1974
- Gomal University, D.I. Khan. 1974
- Rawalpindi Medical College, Rawalpindi. 1974
- Peoples Medical College, Nawabshah. 1974
- Allama Iqbal Medical College, Lahore. 1975
- Ayub Medical College, Abbottabad. 1978
- University of Health Sciences, Lahore. 2002
During the late sixties and early seventies, as new avenues opened, well trained pathologists started coming from UK and from USA; but they mainly settled in Karachi and Lahore. Later on more Pathologists came to join Pathology departments in other cities such as Hyderabad, Multan, Bahawalpur, Rawalpindi, Peshawar, Abbottabad and in various other cities. This resulted into relatively newer and better facilities in laboratory medicine that raised the standard of pathology services in those cities.
The wisest step taken by government when the Federal Government created an Institution of Basic Medical Sciences located at Jinnah hospital, Karachi in 1958. At this center under an agreement with the U.S. Government many professors and teachers of Basic Medical Sciences including Pathology, came from University of Indiana along with a lot of equipment for Basic Medical Sciences. The course of M.Phil was started soon after they commissioned this center. Many junior teachers were sent on deputation from provincial governments for training in Pathology and other Basic Medical Sciences.
The demand for the faculty exceeded the number of qualified teachers and pathologists available in various institutions and hospital laboratories. The basic sciences departments of Jinnah Postgraduate Medical Center (JPMC) could not produce enough specialists and need were felt at this time to create provincial postgraduate institutions such as one in Lahore (1974). Later on in mid eighties other provinces started their own PGMI’S. The Postgraduate Medical Institution (PGMI) Lahore helped the government sector hospital laboratories, medical colleges all over the country from Karachi to Peshawar in fulfilling their needs to have sufficient teachers in pathology, as well as to work as hospital pathologists. Countries like Kingdom of Saudi Arabia, Emirates and Yemen also sent their doctors to be trained as pathologists. It was in 1962, when the College of Physicians and Surgeons Pakistan was established at Karachi. This was an examining body for all specialists of medical sciences including Pathology but not basic sciences. Later on College of Physicians & Surgeons Pakistan expanded by opening its centers in Lahore, Rawalpindi and Peshawar.
Creation Of Pakistan Association Of Pathologists (PAP)
In 1976 some Pathologists gathered in the PMA House Garden Road, Karachi to form a forum for pathologists and they named it Pakistan Association of Pathologists (PAP). A total of 18 pathologists were present and Prof N A Jaffery from Jinnah Postgraduate, Medical Center was elected as founder president and Dr. Mansoor Dar was elected as founder secretary/treasurer. The office of PAP, since then, rotates in the city from where the president and secretary/treasurer are elected.
During subsequent years this association became stringer and bigger and presently the total number of memberships including junior members and associate members has exceeded. A very successful policy for improving the awareness of the subject of Pathology in institutions and hospitals was to hold annual conferences of PAP in different cities in the medical colleges and local hospitals or ideal hotels; so that the doctors in these hospitals realize that the subject of Pathology is not confined to a small clinical laboratory, but it is the largest subject of the medical sciences with numerous subspecialties such as histopathology, microbiology, molecular pathology, hematology, chemical pathology, immunology, cytology, forensic pathology and applied cytogenetic. In addition when PAP became a member of the South Asian Society of pathologists, these academic, conferences were held every two years in different regional countries including Pakistan. This gave an international exposure to our pathologists, who in competition tried to present better research papers. In addition every four years an international conference of PAP is held on rotation giving a chance to different cities to organize a very large moot of pathologists. Senior pathologists played a vital role in improving the Pathology services and strengthening the association of Pathologists.
Modern era and Training of Pathologists
Over a period of time the clinicians who totally depended upon the Pathology services and now departments of Pathology in most of the teaching hospitals and otherwise have acquired a very central position in the development of Pathology services for the patients and the training of junior pathologists. Pathology for the last 50 years is a part and parcel of the teaching of all medical degrees, diplomas and fellowships in clinical sciences. The role of Armed Forces Institute of Pathology should not be undermined. It was created in 1949 at Rawalpindi. It provided the best services in Pathology since a long time ago along with the training of army personnel on regular basis. For the last few years they have started training the civilian candidates as well. AFIP was able to train pathologists required by the army by using their grading system and later on through college of Physicians and Surgeons and university degrees such as M.Phils and PhDs. In addition, Agha Khan University carries a star position in the development of a state of the art pathology department and a very wide pathology network in the country. They are also training many pathologists for FCPS; and carry out a good quality clinical and clinic pathological research.
An overview of Pathology services in Pakistan will tell us that there are excellent institutions with all the facilities to train people and carry out research in Pathology. The subject of Pathology like in many other developed countries is undergoing specialization in most of the places. There are four basic branches of Pathology i.e. Histopathology, Microbiology, Hematology and Chemical Pathology present in most institutions. However, in other institutions specialties such as Immuno Pathology, Molecular Biology and Clinical Genetics are also available with specialist staff to provide service and to train pathologists. The introductions of treatment/investigational modalities are being introduced fairly soon after they are marketed in the western world. The most recent pillar added to the development of Pathology was in year 2007 when with untiring efforts of Lt. Gen. Manzoor Ahmad and his helpers (i.e. PAP). The College of Pathologists Pakistan came into existence. The creation of college was an intention to increase the academic by inviting speakers from abroad and holding joint conferences, symposia and seminars.
The present status of laboratory medicine shows that its standards vary with institutions. Agha Khan University, AFIP and Shaukat Khanum Memorial Hospital and Research Center (private sector) have state of the art laboratories and provide pathology services to a significant portion of the population. These institutions have well qualified pathologists in various specialties along with a strong infrastructure. On the other hand in government sector, the pathology services are remarkably variable but are a great stress of work because they are serving the non-affording masses. In Punjab, the laboratories in various medical colleges are better developed than in other provinces, except Dow Medical College and Civil Hospital, Karachi. In addition some private medical colleges and laboratories have good to excellent facilities to provide teaching and service of pathology respectively. The private sector has recently come up in a remarkable way, particularly in the major cities of Pakistan.
Quality control and quality assurance should be properly practiced in all laboratories at all levels whether in government sector or private sector. However in some institutions and laboratories quality control is a part of regular laboratory practice. We should be honest and practice professional ethics to the extent to produce best possible results in clinical and pathological investigations. The internal and external audits need to be encouraged and practiced.
Research Development In Pathology
In good old days i.e. prior to 1970, the research was practiced in clinical sciences as a part of MD and M.S examinations. However, it was never projected in any periodical. Research in laboratory medicine is now an important component in its development. There was no concept of institutional research until early seventies. It was with the introduction of JPMC where research started as a part of M.Phil course. The role of Pakistan Medical Research Council (PMRC) needs to be mentioned as they opened PMRC centers in many hospitals and colleges in various provinces with full time staff engaged for their approved projects. PMRC also sponsored projects submitted for funds by any institution but their helping amount was usually meager and arrives late.
Later on Pakistan National Science Foundation came into existence. They are playing a significant role in sponsoring research in all science & medical subjects including pathology. Higher Education Commission is now dishing out more realistic funds against projects submitted through university departments. This step by HEC has resulted in the influx of highly sophisticated equipment in various medical universities and pathology gets its due share. HEC also brings visiting professors to work in our universities where they train our pathologists. Here I would like to mention that in Punjab the first medical university named as University of Health Sciences, Lahore was created in the year 2002. Although it is an examining body for 90% of medical college professional examinations and all postgraduate examinations, it also has its own departments of basic medical sciences & preclinical subjects such as histopathology, microbiology, immunology, chemical pathology, hematology and Allied Health Sciences.
All these departments are equipped with state of the art equipment and fun time staff. The M.Phil and PhD students carry out research in various branches of Pathology. This was followed by the creation of medical universities in other colleges such as Dow Medical College University, Baqai University, King Edward Medical College University, Liaquat and Khyber Medical College Universities. They all are playing their important role in advancing research with a special reference to laboratory sciences. In addition to carrying out clinicopathological and basic pathology research, these researches are projected in various national and international journals and periodicals. Though there are now many national journals and periodicals such as JPMA, Biomedica, JCPSP, Ayub Medical Journal etc. the Pakistan Association of Pathologists published “The Pakistan Journal of Pathology” so that there can be a good projection of research in pathology. It is heartening to see that researches carried out by Pakistani pathologists in Pakistan and abroad are being projected in many journals published in Pakistan and abroad.
To wind up this discussion on the history of pathology and how pathological services developed in Pakistan; I would like to mention that pathology has become the most rapidly advancing subject of all medical sciences in Pakistan. I also hope and pray that Pakistan Association of Pathologists and now the College of Pathologists Pakistan will put further efforts in bringing pathology at par with the developed countries. A deficiency that I wish to point out is the lack of a well-organized Tumor Registry at national level with its provincial centers to be created. This is definitely a very uphill task to be undertaken by the College of Pathologists Pakistan, rather than individual institution/hospital.
I end this rather small attempt (that might have missed some facts & names) to gather the information on the history of pathology with an advice from Henry Baker (1743) to pathologists.
Cautions in viewing Objects-Henry Baker 1743
Beware of determining and declaring your opinion suddenly on any object; for imagination often gets the start of judgment and makes people believe they see things, which better observations will convince them could not possibly be seen; therefore assert nothing till after repeated experiments and examinations in all lights and in all positions.
When you employ the microscope, shake off all prejudice, nor harbor any favorite opinions; for, if you do, ‘tis not unlikely fancy will betray you into error and make you see what you wish to see.
Remember that truth alone is the matter that you are in search after; and if you have been mistaken, let not vanity seduce you to persist in your mistake.
Prof. A.H. Nagi
Department of Pathology
University of Health Sciences,
Lahore.
