Hektoen International

A Journal of Medical Humanities

Canadian contributions to the study of pathology

Guillermo Quinonez
Laurette Geldenhuys
Nova Scotia, Canada

John George Adami, Head of the Department of Pathology, McGill University
John George Adami, Head of the Department of Pathology, McGill University, Quebec, Canada, author of The Principles of Pathology. Via English Wikipedia.

Canadian and American medicine in general, and pathology in particular, have developed in parallel and in synchrony since the nineteenth century. Despite Canada’s limited population, scientific cultural similarities and geographical conditions would explain such development. Canadians, some of whom practiced both in the U.S. and Canada, have made important contributions to the American pathology literature.

In the nineteenth century, Canadian physicians practicing in America are well represented by William Osler, one of the “Great Four” at Johns Hopkins, who made autopsy practice the cornerstone of his medicine.1,2 His successor as physician-in-chief at Johns Hopkins, the Ontarian Lewellys Franklin Barker, also added to the literature.3 In the mid-twentieth century, W. A. D. Anderson at the University of Miami School of Medicine in Florida4 was the author of a popular pathology manual and the editor of one of the first well-known multiauthor textbooks in pathology.5,6

In Canada, Canadian pathologists also contributed to the American literature in the twentieth century. They wrote textbooks that were widely used by trainees and practicing pathologists in America and Canada, notwithstanding the fact that their texts had to compete with similar publications by American authors. Three such texts are Adami’s (Figure 1) The Principles of Pathology,7 Oertel’s (Figure 2) Outlines of Pathology,8 and Boyd’s (Figure 3) A Text-book of Pathology.9 Although these are only three examples compared to the many textbooks published by Americans in the twentieth century, they illustrate not only the influence of Canadian pathologists on American pathology but also the synchronous nature of scientific developments in both countries, including common use of nomenclature, definitions, concepts, and sources of information such as journals.

Adami’s The Principles of Pathology

J. George Adami’s Principles was published between 1908 and 1914. Volume I on basic sciences appeared in 1908 and was followed by Volume II on systemic pathology in 1909, the latter written with the assistance of Albert G. Nicholls, an assistant professor at McGill University. The second edition, with a different title, was published in 1914 in collaboration with John McCrae, a lecturer in pathology at McGill University and the author of “In Flanders Field,” a poem that aptly and poignantly symbolizes Canadian sacrifices in the First World War.10 In Adami’s opinion, there was no authoritative book on anatomic pathology in the English literature, ignoring or underestimating contemporary textbooks written by Americans like Delafield & Prudden,11 Councilman,12 and Mallory.13

Principles offers a summary of the pathology knowledge accumulated by the Germans in the nineteenth century at a time that this school of medicine was dominant in English-speaking North America. It is a well-written text that includes comparisons between the normal and the pathological, an emphasis on facts and experimentation to support or rule out hypotheses, extensive application of biochemistry to animal experiments, and references to comparative anatomy. Anatomic pathology is already viewed as an unquestionably cellular discipline. Current controversial topics are discussed extensively, updating knowledge at the dawn of the twentieth century. Immunobiology and neoplasia are two examples. Immunobiology is considered a branch of bacteriology, not pathology. This is understandable because of the importance of bacteriology in those years, and the fact that bacteriology was part of pathology. Departments were labeled “of Pathology and Bacteriology.” The text discusses the approach of general chemists, physiological chemists, and pathologists and bacteriologists to immunobiology. General chemists considered toxin-antitoxin reactions as enzymatic, while pathologists and bacteriologists considered these reactions biological. Physiological chemists were somewhere in between. Malignancy is considered to be a problem of cell growth. As a consequence, tumor cells are regarded to be transformed normal cells; external factors play only a secondary role in such transformation; cell mutations are a possibility, with the resulting cellular modifications becoming permanent and transmissible to future generations; and cell nutrition is altered and used mainly for growth and multiplication. It is felt that the basis of tumor classification must be embryological and based on histogenesis because tumor morphology could be traced to an embryological layer giving rise to the cell of origin of the tumor.

Oertel’s Outlines of Pathology

Horst Oertel, Head of the Department of Pathology, McGill University
Horst Oertel, Head of the Department of Pathology, McGill University, Quebec, Canada, author of Outlines of Pathology. Via Wikimedia.

Outlines was published in 1927 by Horst Oertel, the successor of Adami as head of pathology at McGill University. This text is a very unique publication in the pathology literature. It is dedicated to students with the goal to teach them the origin, methods, problems, and interaction of pathology with other sciences and the theory of knowledge. It focuses on the basis of this science rather than the volume of facts found in the contemporary literature. In other words, its aim is to make the student a critical thinker. The content is a philosophical and historical analysis of pathology as the study of disease, including its etiology, pathogenesis, and morphology. The supplementary publication on systemic pathology was published in 1938.14

The content of Outlines is unique because, from a philosophical historical perspective and in simple language, it includes information about the nature of “pathology” in general and “general pathology” in particular. It discusses history, disease, cell theory, morphology, experimentation, and recommendations on definitions and classifications. Pathology is considered “the science of disease.” General pathology, as opposed to systemic pathology, consists of “common characters and common relations of morbid lesions and morbid processes.” There is also a passionate argument on the difference between basic science pathology and clinical medicine. The history of pathology is elaborated from the time of Vesalius, proposing that the practice of autopsy was necessary to develop an understanding of anatomical and functional aspects of pathology. The history of immunology is considered from the point of view of immunity as a defense mechanism and as a cause of disease. The evolution of the concept of disease is described as following the three stages of intellectual explanation of phenomena by mankind described by Auguste Comte. These are the theological, by gods; metaphysical, by substances and forces; and positivistic, by laws obtained by the scientific method. Disease is regulated by the physical laws of cause and effect; and pathology aims to explain disease by these laws. Virchow’s main contribution is considered to be the principle that physiology and pathology can be understood by studying environmental influences on the cell. By doing so, he introduced a new stage in the history of disease, namely, “cellular pathology.” Pathological morphology receives special attention because “it furnished the concrete, visual, material conceptions of pathological lesions.” The history of experimentation begins with the works of Aristotle as the initiator of deductive reasoning and the contribution of Francis Bacon who introduced empirical, critical, inductive, and methodological investigation. There is advice on the construction of definitions; they must be “simple, unprejudiced, objective descriptive statements of occurrences.” Classification also had to be constructed according to scientific laws. Each section of the text contains abundant information on normal physiology and biochemistry, displaying a strong German influence that reflects the training of the author.

Boyd’s Text-Book

William Boyd, Head of the Department of Pathology, University of British Columbia
William Boyd, Head of the Department of Pathology, University of British Columbia, Vancouver, Canada, author of A Text-book of Pathology. Via Peter Easthope and Jbarta on Wikimedia. CC BY-SA 3.0.

Text-Book lacks the sophistication of Adami and Oertel’s texts, but has the unsurmountable advantage of simplicity that makes it a unique educational tool. It is written for students. William Boyd was professor and chairman of the departments of pathology of the Universities of Manitoba, Toronto, and British Columbia.15,16 The relevance and popularity of the text are evident in its nine editions, from 1932 to 1990, being last edited by A.C. Ritchie.17 It was translated into a number of languages and each edition had several reprints.18 The text has a strong physiological basis, and provides extensive descriptions of post-mortem changes, histochemical stains, and clinical-pathological correlation.

Each edition is divided into general and special pathology and contains a synthesis of current knowledge. The first section, “general pathology,” is understood as follows: “The structural changes observed at autopsy are not due to death . . . They are the result of the processes of degeneration, reaction, repair, and growth disturbances which have preceded death. . . . a study of these general processes comprises the subject of General Pathology.” Pathology is defined as “. . . the study of the processes which go to make up what is called disease.” Lastly, disease is interpreted as “. . . merely a summation of chemical reactions that have gone wrong.” The second section is on the pathology of systems, including a chapter on dental pathology.

In summary, the Canadians Adami, Oertel, and Boyd’s textbooks have contributed to the education of pathologists and allied health professionals in the U.S. and Canada, an indication that pathology has developed in parallel and in synchrony in both countries. Principles drew on the traditions of the German School, Outlines focused on the humanistic aspects of pathology, and Text-book was a highly regarded and widely used educational text.


  1. Osler William. The Principles and Practice of Medicine. Edinburgh & London: Young J. Pintland; 1892. Google Books. Access on April 20, 2020.
  2. Rodin Alvin E. Oslerian Pathology: An Assessment An Annotated Atlas of Museum Specimens. Kansas: Coronado Press; 1981.
  3. Garrison Fieldging H. An Introduction to the History of Medicine with Medical Chronology, Suggestions for Study and Bibliographic Data. 4th ed. Philadelphia: W.B. Saunders; 1929; 632.
  4. Morales Azorides R. W.A.D. Anderson, MD.: (1910-1986). Am J Clin Pathol. 1986; 86 (5): 690–691.
  5. Anderson WAD. Synopsis of Pathology, 6th ed. Saint Louis: C.V. Mosby Co; 1964.
  6. Anderson WAD, ed. Pathology. 3rd ed. Saint Louis: CV Mosby; 1957.
  7. Adami J George. The Principles of Pathology. Philadelphia & New York: Lea & Febiger; 1908.
  8. Oertel Horst. Outlines of Pathology: In Its Historical, Philosophical, and Scientific Foundations. A Guide for Students and Practitioners of Medicine. Montreal: Renouf Publishing Co; 1927.
  9. Boyd William. A Text-Book of Pathology: An Introduction to Medicine. 3rd ed. Philadelphia: Lea & Febiger; 1938.
  10. Adami John George and McCrae John. A Text-Book of Pathology for Students of Medicine. 2nd ed. Philadelphia & New York: Lea & Febiger; 1914.
  11. Delafield F and Prudden TM. A Text-Book of Pathology with an introductory section on post-mortem examination and the methods of preserving and examining diseased tissues. 6th ed. New York: William Wood and Co; 1901.
  12. Councilman WT. Pathology: A Manual for Teachers and Students. Boston: W.M. Leonard; 1912.
  13. Mallory FB. The Principles of Pathologic Histology. Philadelphia: W.B. Saunders; 1914.
  14. Oertel H. Special Pathological Anatomy. Montreal: Renouf Pub; 1938.
  15. Carr Ian. William Boyd: Silver Tongue and Golden Pen. Markham: Fitzhenry & Whiteside; 1993.
  16. Quinonez G. From the “Science of Death” to the “Science of Life”: Boyd’s Tenure at the Department of Pathology at the Winnipeg General Hospital (1916-1937). Can J Pathol 2016; 8 (4): 26-36.
  17. Ritchie AC. Boyd’s Textbook of Pathology, 9th ed. Philadelphia: Lea & Febiger; 1990.
  18. Carr, William Boyd 122-123.

GUILLERMO QUINONEZ, M.D., MS, MA, FRCP, is a retired pathologist and former Professor of Pathology at the University of Manitoba. He trained as a general pathologist at Ohio State University Hospitals and re-trained as an anatomic pathologist at McMaster University, Ontario, Canada, where he did also a fellowship in electron microscopy. Dr. Quinonez also has an MS from Ohio State and MA in medical history from the Universities of Winnipeg and Manitoba. He is an Emeritus Member of the Canadian Association of Pathologists and currently an Independent Scholar.

LAURETTE GELDENHUYS, MBBCH, FFPATH, MMED, FRCPC, FIAC, MAEd, has served as Division Head and Service Chief of Anatomical Pathology at the QEII Health Sciences Centre since 2012. She is a Professor at Dalhousie University in Halifax, and a nephropathologist. She also has an interest in Medical Education and the Medical Humanities, including Medical History. She was trained in South Africa, and has master’s degrees in Anatomical Pathology and Medical Education.

Spring 2020



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