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Veterinary Pathology in the United Kingdom: Past, Present, and Future

	ABSTRACT

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 
This article presents a historical perspective on veterinary anatomic pathology in the United Kingdom from the late nineteenth century to the present. Prior to World War II, the specialty was a rather general one that also included bacteriology and parasitology and was only slightly affected by strong Germanic developments in cell and tissue pathology. The few notable figures of this era include John McFadyean, Sidney Gaiger, and J.R.M Innes. The specialty developed strongly in the second half of the twentieth century, led by a small number of individuals, and was greatly aided by the development of specialist colleges and residency training. Key individuals of this era include W.F. Blakemore, Ernest Cotchin, R.J.M. Franklin, W.F.H. Jarrett, A.R. Jennings, and A.C. Palmer. A remarkable feature of this period has been the increased employment of veterinary pathologists in biomedical industry and in private diagnostic laboratories. While standards of pathology practice have benefited from the college initiatives, there are major financial constraints on the availability of funded training posts in the United Kingdom, and there remain considerable shortages in the supply of pathologists trained to contemporary standards. The acknowledged professional and scientific importance of veterinary pathology needs to be translated into effective financial support for the training that underpins competence in this specialty. Further developments seem likely to be dominated by advances in the technology of tissue handling, applications of molecular biology to pathology, and greater use of telepathology in teaching, in quality assurance, and in continuing professional development.

Key Words: historical development • veterinary schools and pathology colleges • systematic training • biomedical industry • underfunding of training

	INTRODUCTION

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 
This review presents a historical perspective on anatomic veterinary pathology (morbid anatomy and histopathology) in the United Kingdom. Summaries of past events and individuals prior to the World War II (hereafter referred to as "the past") are based on the scholarly historical works of others.^1–3 Comments on the second half of the twentieth century ("the present") are based on the author's experiences as a general veterinary pathologist working in teaching, research, and diagnostic practice in veterinary schools and in diagnostic and biomedical laboratories in England and the United States. Several of the author's views have been expressed in earlier publications.^{4, 5}

The Past
The major concerns of veterinary medicine in the latter half of the nineteenth century and the early part of the twentieth were with infectious and parasitic diseases of economically important livestock in a period that encompassed great advances in bacteriology and immunology. An outstanding figure of this time was John McFadyean (1853–1941) (Figure 1), who qualified in both veterinary and human medicine and who in 1892 was the first holder of a Chair in Pathology and Bacteriology at the Royal Veterinary College (RVC) in London. His earlier career in Edinburgh was influenced by links with medical pathologists there, as well as by his familiarity with the veterinary literature of continental Europe. McFadyean was both a microbiologist and pathologist, yet was clearly influenced by movements in Germany that were developing in anatomic pathology, based on the seminal influence of giants such as Rudolph Virchow (1821–1902), who laid the conceptual framework of cellular pathology. McFadyean had a great reputation in England as a pathologist, but he was considered to be "the prototype of the veterinary investigation officer, for he contended also with bacteriology, parasitology, protozoology, and immunology: possible then, impossible now."⁶ His work included influential studies on bovine tuberculosis, glanders, and animal tumors. He founded the Journal of Comparative Pathology and Therapeutics and was its editor for half a century. In a wider veterinary context, his name is probably now best remembered in connection with the methylene blue staining of Bacillus anthracis in the blood of cattle with anthrax.

View larger version (126K): [in this window] [in a new window]   Figure 1: John McFadyean. From Cotchin's History of the Royal Veterinary College.3 Reproduced by permission of Professor Quintin McKellar, Principal of the Royal Veterinary College.

In the period in which McFadyean and Gaiger worked, British pathology—in both veterinary and human medicine—was dominated by bacteriology, in contrast with the situation in Germany, where pathologists led the way in the application of systematic gross and microscopic pathology to diagnosis and to the understanding of pathogenesis of disease. An outstanding later example of an individual whose work as a veterinary pathologist was steeped in the Germanic traditions of anatomic pathology is J.R.M. Innes (1903–1974). Innes's career in England and the United States involved work at the Institute of Animal Pathology at Cambridge, at Imperial Chemical Industries in Macclesfield, and at the Brookhaven National Laboratory in the United States. Innes made numerous contributions to the understanding of the pathology of domesticated species and was a notable early participant in the field of laboratory-animal pathology. His departure to the United States was a loss to the development of veterinary pathology in the United Kingdom. His Comparative Neuropathology¹⁰ is an enduring testimony to his work and influence.

The achievements of McFadyean, Gaiger, and Innes need to be remembered against an unfavorable background for the development of anatomic veterinary pathology in the United Kingdom. During this period, the discipline is said "to have been practiced and taught by one or at most two veterinarians to whom the appellation pathologist could seriously be applied. Others, including those who professed to teach the subject, did so in a pedestrian way that contributed little by way of advances to it."² The same author² refers to a flourishing of veterinary pathology in the United Kingdom in the mid-twentieth century, a period coinciding with the incorporation of three colleges (Edinburgh, Glasgow, London) in the university system and the foundation of two new veterinary schools at the Universities of Bristol and Cambridge. A half-century later, in 2006, an additional UK veterinary school opened at the University of Nottingham.

	THE PRESENT

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 
Following World War II, anatomic veterinary pathology began to develop strongly in the United Kingdom; this development was led mainly by a few individuals at veterinary schools and at the Central Veterinary Laboratory of the State Veterinary Service (SVS). One of the leaders in this period was Ernest Cotchin (1917–1988) (Figure 2), described as "the first competent pathologist to teach the subject at the RVC after the retirement of John McFadyean in 1927."² Cotchin's whole professional life was spent at the RVC, where he published extensively on the pathology of animal tumors. He instituted an MSc course in veterinary pathology and convened one of the first international symposia on the pathology of laboratory rodents. The MSc course was recognized as providing, for the first time in the United Kingdom, a source of well-trained specialists for diagnostic, research, and teaching posts. Cotchin was greatly admired for his teaching, his examining, and his willingness to share materials and experience with colleagues; his influence was felt throughout the veterinary community of that time.

View larger version (171K): [in this window] [in a new window]   Figure 2: Ernest Cotchin. From Cotchin's History of the Royal Veterinary College.3 Reproduced by permission of Professor Quintin McKellar.

View larger version (98K): [in this window] [in a new window]   Figure 3: W.F.H. Jarrett. Image courtesy of Professor Ruth Jarrett.

Outside the university system in the United Kingdom, other centers of competence are in equine pathology at the Animal Health Trust in Newmarket; in spongiform encephalopathy at the Neuropathogenesis Research Laboratory of the Institute of Animal Health in Edinburgh; and in sheep diseases at the Mordeun Research Institute in Edinburgh. During this period the contributions to veterinary pathology by the SVS (and its organizational successor, the Animal Health Service or AHS) have been ambivalent. The Central Veterinary Laboratory at Weybridge and the Stormont Laboratory in Belfast had, for a long post-war period, great strengths across a range of diagnostic and research areas, led by J.T. Done, S.H. Done, J.D.J. Harding, L.M. Markson, and S. Terlecki. In the later era of bovine spongiform encephalopathy and the problem of widespread sea-mammal deaths from paramyxovirus infection, this reputation in anatomic veterinary pathology was enhanced by R. Bradley, G.A.H. Wells, and S. Kennedy. At the level of regional laboratories (formerly veterinary investigation centers), the diagnostic tradition was of the generalist, and, until recently, histopathology provision depended on referral to specialist laboratories. This practice contrasts with the situation in North America, where state and provincial laboratories recruit diagnosticians from a pool of trained veterinary pathologists. In contrast, the Veterinary Laboratories Agency (VLA) continues to recruit veterinarians without post-graduate pathology training and relies on in-house and part-time extramural training of its neophyte pathology employees. The absence of a strategic plan by the VLA for the maintenance of its national skill base in laboratory medicine seems to this author a regrettable feature of UK veterinary pathology. The SVS/AHS has long been a notable absentee from the small band of financial contributors to residency training in veterinary pathology.

Training
A feature of major importance in the past three decades has been the development of systematic (residency) training in veterinary pathology. In North America it has long been recognized that structured training in anatomic and clinical pathology is essential if veterinarians are to become broadly competent in these specialties within a reasonable period. The initiative was influenced by the American College of Veterinary Pathologists (ACVP) at its inception in 1948, but there was a long delay in the United Kingdom before the Royal College of Pathologists (RCPath), influenced by Ernest Cotchin, began its examination system in the 1970s, followed by development of advice about the training practices that are necessary preparation for the college membership examination (MRC Path). The college's advice, as well as its examination system, continues to evolve and allows some degree of specialization to reflect the realities of employment and training opportunities within the United Kingdom. In 1995, at the instigation of the European Society of Veterinary Pathology (ESVP), the European College of Veterinary Pathologists (ECVP) was inaugurated in Edinburgh at its annual meeting. ECVP has functions similar to those of the ACVP and RC Path, providing guidance on training and conducting a rigorous examination in the theory and practice of anatomic veterinary pathology. Both colleges have played major roles in helping to raise standards of competence in the United Kingdom, and it remains to be seen whether both will continue to operate separately within Europe.

Developments in training have resulted from the initiative and commitment of individual pathologists, mostly within university veterinary schools, supported mainly from a variety of ad hoc, non-university, non-recurrent financial sources. The available funds have been insufficient to support the numbers of able veterinarians who have applied for residency training posts and are quite inadequate to train the number of pathologists needed for employers in both public and private sectors. This shortfall has resulted in a number of thwarted veterinarians leaving the United Kingdom for residency training in the United States; some return, but many do not. There has never been any shortage of very able veterinarians applying for training in pathology, and this interest seems likely to increase further following the expansion of opportunities for undergraduate veterinary students to take intercalated science degrees in pathology at both the RVC and Edinburgh.

Toxicological Pathology
The past half-century has been marked by enormously increased demand for anatomic pathologists in biomedical research and development (R&D). At the outset, much of this need was met in the United Kingdom and the United States by medically trained pathologists and, in the United Kingdom, by non-medical, non-veterinary biological scientists. In the United States, this area of biomedical pathology is largely a veterinary preserve, so the demand for veterinary pathologists has had a distorting effect on employment patterns. The same effect is present in the United Kingdom, in which biomedical industry is now the largest single employer of veterinary pathologists (see Table 1).⁵ This industry is now beginning to respond to its employment interests by funding residency training posts in university veterinary schools. It seems likely that this employment trend in biomedicine will continue, for a variety of reasons including the attractions of high-quality facilities and science in biomedical industry and the relative poverty of support within the university system. In this area the British Society of Toxicological Pathologists (BSTP) has played a major role in delivering modular educational programs.

From these considerations it follows that there is a mismatch between supply and demand for veterinary pathologists across a range of employment areas in the university, state, and private sectors. It seems unlikely that balance will be achieved until there is improvement in the funding of veterinary training posts in the United Kingdom. Similar problems are recognized in the United States.^{13, 14} To some extent the problem of recruitment is ameliorated in the United Kingdom by the employment of veterinary pathologists from other parts of Europe, for reasons that are peculiarly European and have to do with widespread and major overproduction of veterinarians, the availability of unpaid training posts in veterinary pathology, and the less attractive veterinary employment opportunities outside the United Kingdom.

	THE FUTURE

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 
Strengths
The strengths of veterinary pathology in the United Kingdom involve several considerations, summarized below:

• The UK's broad, clinically based undergraduate training, in which integral extramural clinical experience is followed by post-graduate clinical work contrasts with the more limited clinical experience of many European veterinarians. The clinical background of UK pathologists allows them to play key roles in diagnostic practice, veterinary research, and biomedical R&D.
  
• A small number of individual veterinary pathologists share a commitment to the high standards of training necessary to meet the requirements of examining boards. The emphasis is on individual commitment because there has not been the same degree of support from individual universities, nor from the Royal College of Veterinary Surgeons (RCVS). Residency intramural training is complemented by participation in a range of extramural opportunities, including BSTP modules; meetings of the ESVP and ACVP; ECVP summer schools; and other individual institutional initiatives, such as histopathology seminars organized through the Animal Health Trust.
  
• Close institutional and personal relationships between pathologists in veterinary and medical schools provide both with a broader spectrum of understanding about tissue reactions and disease processes in more than one species.
  
• In recent decades, traditional skills in morbid anatomy and histopathology have been complemented by a range of technical developments that offer greater refinement in the recognition of specific infections (e.g., PCR, in situ hybridization); differentiation pathways (e.g., intermediate filament immunostaining, CD markers in lymphoproliferative lesions); specific organelles and virus infections (e.g., electron microscopy for orf). Computerized databases of disease and lesion prevalence are among the hallmarks of competent pathology practice that should facilitate greater use of smaller, geographically dispersed pathology collections. Many of these technical advances are not just research tools but, increasingly, part of best diagnostic pathology practice.
  

Weaknesses
Weaknesses are easy to identify, but are less easy to overcome. They include the following:

• There is an imbalance in the workload of veterinary school pathologists. All UK veterinary schools have increased student and clinical staff numbers over the past two decades, yet the numbers of veterinary pathologists have not increased proportionately: in most schools, numbers of academic pathologists are similar to or even smaller than in earlier decades. The RVC in London seems to be a current exception to this trend, one of the funding consequences of a vast increase in student numbers. As the number of clinical staff increases, so does the volume and sophistication of clinical work, thus increasing the requirement for anatomic pathology contributions in both surgical and necropsy pathology. It is a failure of academic resource allocation, and of the RCVS overview of veterinary education, that this imbalance has become so severe.
  
• The emphasis of the University Research Assessment Exercises (RAE) has had, inter alia, an adverse effect on academic veterinary pathology, as it has on academic human pathology in medical schools.¹⁵ In the RAE judgmental framework that drives financial survival, involvement with surgical and necropsy pathology is a time-consuming activity that brings poor rewards by comparison with other academic functions.
  
• Demands on academic pathologists have increased enormously—from students, from universities, and from professional bodies such as the RCVS. In spite of the emphasis on student-centered and problem-based learning, the demand is for more "spoon feeding" through the provision of even more teaching aids, involving both text and illustrations. Examinations have become major exercises for staff, involving the provision of model answers and marking criteria. The staff/student imbalance has meant that the multiple-choice format of examinations has progressively come to dominate the educational experience, with its inevitable emphasis on the ability to memorize and regurgitate facts.
  
• The ability to conduct basic post-mortem examinations (PME) is now included in the RCVS Day One competences expected of all new UK graduates, so that teaching staff and residents must now spend much more time on teaching this experience-based skill to very large numbers of students. In this author's view, this is a wasteful use of pathologists’ time and a profligate use of the time of students, a large proportion of whom are unlikely to develop any real competence in necropsy in companion-animal practice. The needs of future practitioners whose work is likely to call for PME (e.g., sheep and pig practice) can be more sensibly incorporated in student electives or included in the post-graduate professional developmental phase in the appropriate areas of veterinary practice. A view of present reasonable and attainable objectives in practical pathology is outlined in Table 2 and discussed in more detail elsewhere.^{5, 17} It is notable that a recent survey of UK veterinary student experiences includes no reference to a perceived need for necropsy experience.¹⁶ Furthermore, this author has yet to be told that a veterinarian's competence in clinical practice has been adversely affected by a relative lack of familiarity with the details of PME. Against a background of competition for curriculum time, commitment to core teaching, and student electives, it is hoped that this particular professional requirement can be reassessed by the RCVS in relation to contemporary veterinary educational issues and professional employment opportunities.
  
• In UK veterinary schools, pathology departments may be led by non-pathologists or non-veterinarians, largely as a result of RAE imperatives, and this is unhelpful for the image of a specialty that may often be regarded as having little more than a service function. This practice contrasts with the situation in clinical departments, in which clinical competence is regarded as a necessary criterion for credible academic leadership.
  

• Exciting developments in cell and molecular biology and their application to the study of disease have encouraging implications for veterinary pathologists who look for intellectual stimulation beyond the familiar hematoxylin and eosin slide, and these developments will increasingly be incorporated into mainstream diagnostic practice. A problem in teaching, at both undergraduate and post-graduate levels, is to strike a balance between the plethora of biological and microscopic detail and the core understanding that is appropriate for the immediate educational needs of students and residents.
  
• Employment opportunities will remain buoyant, in the United Kingdom and elsewhere, in diagnosis, research, and teaching and will provide worthwhile, exciting careers for veterinarians whose choices are not circumscribed by clinical practice.
  
• Veterinary pathologists, however employed, should seek to enhance the importance and excitement of pathology for veterinary graduates—through student electives, through funded scholarships that provide experience in diagnostic and research laboratories, and by acting as role models in the everyday practice of problem solving that is inherent in clinico-pathological diagnosis.
  
• Veterinary pathologists should seek to improve the status of the specialty within our profession. A recently formed liaison committee between the RCVS and RC Path seeks to promote this goal, against a background in which most pathologists are employed outside mainstream veterinary medicine (see Table 1). A nascent British Society of Veterinary Pathology may have a similar role. In particular, within veterinary schools, pathologists need to be more effective in promoting their profession as the cornerstone for understanding the practice of veterinary medicine and surgery.
  
• Pathologists in academia, as elsewhere, will become more involved in the use of information technology in teaching, in using electronic databases of digitized photographic images, in speeding diagnostic reporting through use of speech-recognition software and institutional networks. External quality assurance will become more important in anatomic pathology and will be facilitated by the use of telepathology, using digitized photomicroscopy systems. This will be good for the maintenance of diagnostic standards, and for continuing professional development, but will inevitably add to the workload of pathologists.
  

	CONCLUSION

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 
Anatomic veterinary pathology will remain at the educational heart of clinical veterinary medicine and surgery, forming the basis of diagnosis and pathogenesis. Workers in this specialty will have exciting careers, strengthened by technical advances in tissue processing and cell biology and aided by electronic communications and enlarged databases. Systematic training is now recognized as critical to the development of core competence, but our profession and our employers must recognize their vested interest in ensuring that such training is adequately supported and funded. In the past the response in the United Kingdom has been rather poor, but there are recent signs of improvement in funding opportunities. Finally, we should retain a historical perspective, recognizing that current UK problems are not entirely new but were articulated half a century ago:¹⁸

There was a time in the history of veterinary science when much stress was laid on morbid anatomy and histology.

The tendency seems to have been to devote less and less time and study to this aspect of disease and to concentrate more upon cause than effect.

There is today a marked scarcity of veterinary personnel well trained in pathological techniques.

Although the tendency has been to neglect the subject to some extent, we have never been entirely without our veterinary pathologists in this country. They have shown us very clearly the need for this type of work and study.

	ACKNOWLEDGMENTS

 
I owe special thanks to those who have been mentors and friends through a lifetime of pleasurable pathology: Austin Gresham, Arthur Jennings, Jack McGrath, Tony Palmer, and Leon Saunders.

	Footnotes

 
AUTHOR INFORMATION

Donald F. Kelly, MA, PhD, BVSc, MRCVS, FRCPath, Dipl. ECVP, is a graduate of Bristol and Cambridge and worked in pathology teaching, research and diagnostic practice at the Universities of Cambridge, Pennsylvania, and Bristol between 1962 and 1979. From 1979 to 2000 he was Professor and Head of the Department of Veterinary Pathology, University of Liverpool. He chaired the Royal College of Pathologists’ Specialty Advisory Committee on Veterinary Pathology and was the Foundation President of the European College of Veterinary Pathologists. He is now retired, is an Honorary Senior Fellow at the University of Liverpool, and works in private diagnostic histopathology practice. He is author or co-author of 200 contributions to journals and books. E-mail: Donpatkel{at}aol.com.

	REFERENCES

TOP ABSTRACT INTRODUCTION THE PRESENT THE FUTURE CONCLUSION REFERENCES

 

1. Pattison I. John McFadyean: The Founder of Modern Veterinary Research.London: J.A. Allen, 1981.
2. Saunders LZ. A Biographical History of Veterinary Pathology.Lawrence, KS: Allen Press, 1996 p221, p229.
3. Cotchin E. The Royal Veterinary College London: A Bicentenary History. In. Carter V, ed. Buckingham, UK: Barracuda Books, 1990.
4. Kelly DF. Veterinary pathology: the benefits and the cost. J Small Anim Pract 35:65–67, 1994.
5. Kelly DF. Veterinary pathology: retrospect and prospect. Proc Sheep Vet Soc 25:69–74, 2002.
6. Innes JRM. Veterinary pathology: retrospect and prospect. Vet Rec 85:730–741, 1969 p731.[Medline]
7. Gaiger SH. Grass disease in horses. Essex Co Farmers Union Yb 1926:290–301, 1926.
8. McCarthy HE, French NP, Edwards GB, Poxton IR, Kelly DF, Payne-Johnson CE, Miller K, Proudman CJ. Equine grass sickness is associated with low antibody levels to Clostridium botulinum: a matched case control study. Equine Vet J 36:123–129, 2004.[Medline]
9. Gaiger SH, Davies GO. Veterinary Pathology and Bacteriology.London: Bailliere, Tindall and Cox, 1932.
10. Innes JRM, Saunders LZ. Comparative Neuropathology.New York: Academic Press, 1962.
11. Jennings AR. Animal Pathology.London: Bailliere, Tindall and Cox, 1970.
12. Gresham GA, Jennings AR. An Introduction to Comparative Pathology: A Consideration of Some Reactions of Human and Animal Tissues to Injurious Agents.London: Academic Press, 1962.
13. Cockerell GL, Patterson DR. Closing the supply versus demand gap for veterinary pathologists: a multifaceted problem in need of a multifaceted solution. Toxicol Pathol 33:621–622, 2005.[Free Full Text]
14. Cockerell GL, Patterson DR. Closing the supply versus demand gap for veterinary pathologists: a multifaceted problem in need of a multifaceted solution. Vet Pathol 42:403–404, 2005.[Free Full Text]
15. Wright NA. The waxing and waning of academic pathology: a personal view. In Hall PA, Wright NA, eds. Understanding Disease: A Centenary of the Pathological Society.Chichester, UK: John Wiley, 2006 p109–120.
16. British Veterinary Association and the Association of Veterinary Students Survey Results, 2005. London: British Veterinary Association, 2005.
17. Kelly DF. The place of the post-mortem room in the training of the small animal veterinarian. J Small Anim Pract 25:339–345, 1984.
18. Dalling T. Editorial: veterinary pathology. Brit Vet J 107:129–130, 1951 p129–130.

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