The Politics Underlying the Provision of and Changes in Pathology and Laboratory Services in the United States During the Roaring Twenties

James R. Wright

25 citations0/0 files storedArchives of Pathology & Laboratory Medicine

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History of Science and Medicine Medical History and Innovations History of Medical Practice

Abstract

CONTEXT: -Prior to 1900, laboratory tests were simple enough to be performed by clinicians on the wards and most pathologists were academicians with little involvement in patient care issues. In the next 2 decades, laboratory test menus expanded rapidly and the increasing complexity of the tests created a potential niche for clinical pathologists (ie, pathologists providing patient-oriented anatomic and clinical pathology services). In the late 1910s and early 1920s, most of these services were provided by mail-order commercial laboratories or state public health laboratories rather than by hospital-based pathologists. OBJECTIVE: -To describe the political events in the 1920s that would drastically alter the practice of pathology and laboratory medicine and that would have been important to the discipline at the time the Archives of Pathology and Laboratory Medicine was being conceived and first published. DESIGN: -Available primary and secondary historical sources were reviewed. RESULTS: -In the 1920s, clinical pathologists organized, forming the American Society of Clinical Pathologists, and took on the powerful American Medical Association for permitting advertisements by private laboratories in the pages of the Journal of the American Medical Association that listed test prices as if these were commodities. They found a strong partner in the American College of Surgeons, which was attempting to elevate surgical practice by creating minimum standards for hospitals. Through this symbiotic relationship, hospital-based practice was firmly established and the commercial laboratory model faltered. CONCLUSIONS: -The Roaring Twenties was the time when the practice of pathology and laboratory medicine evolved into what we recognize today.

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References

1982The Discovery of Insulin 1985The development of the frozen section technique, the evolution of surgical biopsy, and the origins of surgical pathology.1999A brief history of medical diagnosis and the birth of the clinical laboratory. Part 1--Ancient times through the 19th century.2012Albert C. Broders' Paradigm Shifts Involving the Prognostication and Definition of Cancer 2001In Search of the Origins of Modern Surgical Pathology

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