1. 100 years of Pathology at Preston

2. Pathology at Preston 1914: Dr Tindall Dr Tindall [a bacteriologist] appointed honorary Pathologist and has charge of the department “For the purposes of scientific research and to support medical and surgical colleagues” Pathology Laboratory at Preston 1925

3. Pathology at Preston: First Quality Inspection 1914 “The pathology department is good and constitutes another proof of the thorough way in which the medical and surgical work is carried on at this institution” “One of the most interesting county hospitals in Great Britain” Sir Henry C Burdett KCB KCVO

4. Pathology at Preston 1914: Dr Tindall 1922: Dr KM Duncan - a gynaecologist takes control Br Med J. June 21, 1913

5. Pathology at Preston 1925: Pathology develops “The pathological Laboratory.. is an extremely important instrument for tracking down and isolating mankind’s greatest enemy - disease. It is one of the specialists most valuable allies and can be called the scouting department of the modern hospital.” Preston Royal Infirmary Annual Report 1925 Visit of HRH the Princess Mary, Viscountess Lascelles 1925

6. Pathology at Preston: Workload Year192219231924 Histological examinations81219245 Sputum/urine cultures and 250375103 other examinations Blood346846 Urine microscopy288736 Gonococci and spirochaetes0184 2014 Histology 31,000 Microbiology 508,000 Haematology1,100,000 Clinical Biochemistry5,200,000 Immunology 196,500

7. Pathology at Preston: 1914: Dr Tindall 1922: Dr KM Duncan - a gynaecology surgeon takes leadership 1930: Dr FB Smith “The Board of Management has placed its laboratory under my direction as a whole-time pathologist.” “This is an attempt to fill what has been felt to be a gap in the prevention, diagnosis and treatment of disease, and to supplement the health service of the area of which Preston is the centre.”

8. Pathology at Preston: Finance 1823 the price of leeches had risen to 3d each The treasurer proclaimed: –“As a great proportion of the expenditure was absorbed by the purchase of leeches, greater care is needed to be used in their usage. The usage of leeches was to be kept at a minimum and not longer than 4 weeks”

9. Pathology at Preston : Finance Preston Laboratory Handbook 1930

10. 1930 equiv. 20142014 av. UK Calcium £1 £40 £0.69 Full blood count £1 10s £60 £3.44 Swab full culture £1 £40 £7.98 Histological report £1 £40 £49.80 Pathology at Preston : Finance Preston Laboratory Handbook 1930

11. Histology report 1979 Histology report 2014 Histology reports more complex due to improvements in laboratory techniques and increased requirements for diagnosis and patient treatment plan

12. Pathology at Preston 1935-1946: period of growth Preston Laboratory 1935

13. Pathology at Preston: 1914: Dr Tindall 1922: Dr KM Duncan - a gynaecology surgeon takes leadership 1930: Dr FB Smith 1946: Public Health Laboratory Service (PHLS) –A nationally organised framework of laboratories to support the control of infectious disease –A very strong link between public health and Preston

14. Pathology at Preston: 1946-2014 1990: Moved to Royal Preston Hospital 2014: Highly automated modern Pathology Department

15. 1914-2014: Preston Pathology Cellular Pathology Neuropathology Forensic Pathology Molecular Biology Microbiology Virology Haematology Transfusion Clinical Biochemistry Immunology Clinical Haematology Haemato-oncology Primary Immunodeficiency Allergy Clinical Microbiology OPAT Nutrition Lipidology Anti-coagulation Phlebotomy

16. What has Pathology done for us? “ It is estimated that 70-80% of all health care decisions affecting diagnosis or treatment involve pathology investigation” Lord Carter of Coles But pathology does so much more…..

17. Pathology: Innovation supporting medicine Lewis, R. C., and Benedict, S. R., A Method for the estimation of sugar in small quantities of blood, J. Biol. Chem., 1915, xx, 61. The single most important development in diabetes research was the rapid improvement between about 1910 and 1920 in techniques for measuring blood sugar. In 1910 a blood sugar test still required 20mL of blood, by 1920 it could be done with 0.2mL

18. Pathology: Translational science supporting medicine Alexandra Flemming and Penicillin and Pathology Bacterial identification and vaccination programmes Antibiotic disc

19. Pathology: Process engineering supporting medicine Automation –Reduced cost –Improved turnaround time Point of care testing Informatics Telemedicine

20. Pathology: personalised medicine supporting medicine HER2 testing is performed in breast cancer patients to assess prognosis and to determine suitability for trastazumab therapy Molecular biology

21. Pathology: Patient pathway redesign supporting medicine Pathology testing embedded in the patient pathway improves: –Improves patient journey –Improves decision making –Reduces total pathway cost

22. Preston Pathology the next 100 years Much has changed, but the job is still the same Continue to be the “scouting department of the modern hospital”. –Diagnosis and treatment –Scientific basis of disease –Translation science –Personalised medicine –Patient pathway redesign –Patient focussed delivery –Scientific and financial innovation –Public understanding of health and disease –Disease prevention

23. Preston Pathology the next 100 years Todays meeting has experts in their field to set the scene for what Pathology needs to deliver for the next 100 years