Pathological Anatomy (Pathological anatomy is the science that)

PATHOLOGICAL ANATOMY Pathological anatomy is the science that studies the changes in organs and tissues in diseases. The development of pathological anatomy is closely connected with the development of general pathology. In the ancient world, pathological anatomy was based on the theory of humors, which attributed diseases to an imbalance of four fluids in the body. This theory was challenged by the work of Morgagni (1761), who established that diseases are associated with changes in individual organs. The further development of pathological anatomy was associated with the work of Bichat (1801), who distinguished between pathological processes occurring in tissues and those occurring in organs. Virchow (1856) proposed the cellular theory of disease, which states that all diseases are caused by changes in cells. This theory quickly replaced the humoral theories and gained universal acceptance. Virchow's theory was supported by his detailed studies of pathological changes in cells and his brilliant explanation of the essence of a number of pathological processes (e.g., leukemia, chlorosis, embolism, thrombosis, inflammation, tuberculosis, syphilis, tumors, and many others). The significance of Virchow in the development of pathological anatomy is enormous. He not only developed a number of its sections but also gave a method that has a leading importance to the present day. Thanks to this, the subsequent years were a time of flourishing development of pathological anatomy, and cellular pathology remained unshakable for more than 50 years. This period includes the brilliant development of the pathological anatomy of inflammation (the classic studies of Cohnheim and the school of Marchand); tuberculosis (the works of Rindfleisch, Baumgarten, Orth, Birch-Hirschfeld); tumors (Borret, Ribbert, Hansemann) and others. However, since the beginning of the 20th century, a process of synthesis of humoral and cellular directions has begun, which gives a picture of modern pathology, which can be characterized as 'cellular-humoral'. The ideas about the essence of pathological processes had to move somewhat from Virchow's purely cellular understanding on the basis of a large number of facts that established that a number of both normal life manifestations and pathological disorders of them primarily occur not in cells, but in intercellular substances and in the body's fluids; these extracellular processes can underlie a number of changes. This understanding of the essence of pathological processes was greatly facilitated by the development of the doctrine of immunity, the development of physical and colloid chemistry, the great strides made by endocrinology, and finally the evolution of the doctrine of mesenchyme and interstitial substances, which replaced the previous assumptions about the dead, passive state of intercellular substances with the view that all intercellular substances are living, active formations that participate significantly in metabolism; similarly, the opposition of cell and extracellular proved untenable and was replaced by the concept of the biological unity of cells and intercellular formations. Finally, at the present time, it is quite clear that the view of the organism as an aggregate of cellular elements and Virchow's view of disease as a consequence of changes in certain groups of these elements represent mechanistic, and therefore incorrect, concepts. All of the above determines the direction of pathological anatomy at the present time. Modern pathological anatomy naturally should not retain as its basis the cellular direction given to it by Virchow; remaining a morphological discipline in describing and registering changes underlying pathological processes, pathological anatomy must in judgments about the essence of these changes constantly go beyond cellular concepts, also taking into account the environment in which the cells are located; in other words, modern pathological anatomy in its interpretations of pathological processes sees the anatomical substrate of the latter not in changes in groups of cells, but in changes in the entire tissue and the entire given system as a whole; in addition, pathological anatomy constantly strives, when evaluating the significance of anatomical changes, to take into account the state of the entire organism as a unity, the laws of which are subject to processes occurring both in the whole organism and in individual tissues and cells. It can also be noted that modern pathological anatomy has ceased to be a purely descriptive discipline; the accumulation of factual material relating to the most diverse stages of pathological processes, as well as the application of the experimental method in pathological anatomy, have made it so that modern pathological anatomy includes not so much the study of pictures of pathological-anatomical changes as such, but the elucidation of the entire dynamics of pathological processes in the sense of their very beginning ('histogenesis'), further development, course, outcome, influence on other organs and tissues, as well as on the entire organism. Finally, the pathological anatomy of our time also has to a large extent a clinical-anatomical character; pathoanatomists, working hand in hand with clinical physicians, as Virchov also called for, strive to evaluate the changes they discover from the point of view of their clinical, antemortem manifestations, when possible, providing an anatomical basis for the various expressions of the disease and explaining the symptoms of the disease from the point of view of pathological-anatomical findings. To the above, it must be added that at the present time pathological anatomy sets itself another new task: to elucidate the peculiarities of the course and manifestations of diseases in persons belonging to one or another profession, as well as persons living in certain social and living conditions. This task, which is based on the development of pathological anatomy of social collectives, brings pathological anatomy even closer to the clinic and closely connects it with preventive disciplines. Such orientations of post-Virchow pathological anatomy, with the transfer of the center of gravity in the evaluation of morphological changes from the cell to the tissue as a whole and to the organism, and from the disease to the patient with account of external environmental conditions, had enormous significance for the further progress not only of pathological anatomy itself, but also of some related disciplines. It can be noted that the further development of the pathological anatomy of inflammation in terms of the dependence of the picture of the inflammatory process on the state of the organism (the research of Rössle, Gerlach and others), the detailed elucidation of the pathological anatomy of most infectious diseases, the deciphering of the pathological anatomy of tuberculosis, syphilis, kidney diseases and many others are connected with this direction of pathological anatomy. Not only that: the data of pathological anatomy have provided enormous help in the development of some sections of embryology, histology and physiology. For example, observations concerning some congenital malformations of the heart, bladder, spine helped to establish the course of normal embryonic development of these organs; studies of focal lesions of the central nervous system contributed to the elucidation of the normal function of the affected parts, etc. The works of pathoanatomists have developed the histology of the atrioventricular system of the heart, the doctrine of the reticulo-endothelial system, the physiology of the spleen; finally, pathological-anatomical studies of the endocrine glands had enormous significance in elucidating the histology and physiology of these glands. Structure of the subject of pathological anatomy. It has already been indicated above that pathological anatomy includes the study of both macroscopic changes accessible to the naked eye and histological changes determined with the help of a microscope. What relates to microscopic changes was formerly accepted to single out as 'pathological histology'; it should however be noted that the latter by no means constitutes a separate discipline, as for example is the case with normal histology, which as in the sense of its presentation in textbooks and manuals, and in teaching, goes to a large extent as a separate discipline, separately from anatomy. In modern pathological anatomy, its histological part is not separated at all from macroscopic pathological anatomy; the study and description of microscopic changes are always in the closest connection with macroscopy; in other words, pathological anatomy as a science includes the study of macro- and microscopic pathological changes inseparably from each other. On this basis, the use of the name 'pathological histology' in the sense of a special part or section of pathological anatomy or the appearance of special textbooks on 'pathological histology' from the point of view of the structure of modern pathological anatomy should be considered an anachronism. Since ancient times, pathological anatomy has been divided into two parts: I - general and II - special pathological anatomy. General pathological anatomy concerns general pathological processes, such as: disorders of blood circulation, disturbances of nutrition and metabolism in tissues (atrophy, necrosis, degenerations, deposits), manifestations of pathological growth (hypertrophy, regeneration, tumors), inflammations, malformations. Special pathological anatomy deals with the consideration of pathological processes by organs and systems - namely, as they are expressed, for example, in the blood and blood-forming organs, in the organs of circulation, respiration, digestion, etc. This division is also preserved by modern pathological anatomy. However, in recent times, doubt has arisen about the advisability of presenting special pathological anatomy by organs, which is too abstract and far from the expressions that are characteristic of pathological processes in real life, i.e., when observing them in patients. In fact, diseases rarely represent diseases of individual organs, more often they are a violation of the normal state of the entire organism, and hence the need for the study and presentation of pathological anatomy not of organs, but of the entire organism in diseases.

The structure of pathological anatomy. Pathological anatomy is divided into general and special. General pathological anatomy studies the common pathological processes that occur in various diseases. Special pathological anatomy studies the pathological processes that occur in specific organs and tissues. The development of pathological anatomy has been marked by a number of important advances. The cellular theory of disease, proposed by Virchow in 1856, was a major advance in the understanding of disease. This theory states that all diseases are caused by changes in cells. Virchow's theory was based on his detailed studies of pathological changes in cells. He showed that cells are the basic units of life and that diseases are caused by changes in the structure and function of cells. Virchow's theory quickly replaced the humoral theories of disease and gained universal acceptance. The cellular theory of disease remained the dominant theory in pathological anatomy for more than 50 years. However, in the early 20th century, a new understanding of disease began to emerge. This new understanding was based on the synthesis of the cellular and humoral theories of disease. The new understanding of disease is known as the cellular-humoral theory. The cellular-humoral theory states that diseases are caused by both changes in cells and changes in the body's fluids. The cellular-humoral theory is based on a number of important advances in medicine. These advances include the development of the theory of immunity, the development of physical and colloid chemistry, and the development of endocrinology. The cellular-humoral theory has led to a more complete understanding of disease. It has shown that diseases are caused by a complex interaction of cellular and humoral factors. The cellular-humoral theory has also led to the development of new treatments for diseases. The development of pathological anatomy has also been marked by the development of new techniques. These techniques include the microscope, the use of stains to visualize cells and tissues, and the use of experimental methods to study disease. These techniques have allowed pathologists to study disease in greater detail than ever before. The development of pathological anatomy has also been marked by the development of new concepts. These concepts include the concept of the mesenchyme, the concept of the reticulo-endothelial system, and the concept of the endocrine system. These concepts have helped to explain the complex processes that occur in disease. The development of pathological anatomy has been a major factor in the advancement of medicine. Pathological anatomy has provided a better understanding of disease, which has led to the development of new treatments and preventive measures. Pathological anatomy continues to be an important part of medicine today.

This discussion on the structure of Pathological Anatomy is currently resolved as follows: general Pathological Anatomy should retain its former significance; special Pathological Anatomy of organs undoubtedly plays an important role for reference purposes regarding how a particular process manifests in a particular organ or what pathological processes are characteristic of a particular organ; the abolition of special Pathological Anatomy of organs would be an error, as this would eliminate the possibility of clarifying many aspects of local pathological changes in organs that often do not fall under the concept of diseases as defined nosological units; therefore this part of Pathological Anatomy should be preserved. However, alongside this, a third part of Pathological Anatomy is necessary, namely special Pathological Anatomy of diseases; this is especially important for teaching purposes, so that after familiarizing the student with general pathological processes, he is introduced to Pathological Anatomy of the actual material with which he will deal. This is being implemented in our USSR, where in medical institutions the teaching of Pathological Anatomy has been reconstructed accordingly (see below) and where appropriate textbooks are being prepared. The same replacement in teaching special Pathological Anatomy of organs with special Pathological Anatomy of diseases has been introduced in some places in Germany (in Berlin, Leipzig). Schools. Pathological Anatomy after Virchow reached its greatest flourishing in Germany, where in the beginning of the second half of the 19th century, pathological-anatomical institutes began to be rapidly organized at medical faculties and in hospitals, many of which in the very next years began to attract a large number of workers coming for advanced training from the most different countries. These same pathological-anatomical institutions of Germany became the places from which the most outstanding research in Pathological Anatomy emerged. The most famous schools of Pathological Anatomy in Germany are (for the scientific significance and peculiarities of individual pathological-anatomical schools, see in the biographies of the listed scientists): 1) founded in Berlin by Virchow, headed after Virchow by Orth, Lubarsch, and at the present time by Rössle; 2) organized in Leipzig by Marchand and directed at the present time by Hückel; 3) founded in Freiburg (Baden) by Ziegler and successfully developed under the leadership of Aschoff; 4) organized in Munich by Bollinger and continued at the present time by Borst; 5) founded in Frankfurt am Main by Weigert, strongly developed by Albrecht and directed at the present time by Fischer-Wasels. In addition to Germany having the largest pathological-anatomical institutions, it unites pathologists of all countries through its special society (Deutsche pathologische Gesellschaft), the annual congresses of which have international significance; furthermore, only Germany publishes a whole series of specialized pathological-anatomical journals (see below). All this explains why Germany to the present day maintains a leading role in Pathological Anatomy of all countries. Of the Austrian schools, the one founded in Vienna by Rokitansky, later headed by Weichselbaum, Paltauf and now Maresch, is known. In Switzerland, Sweden, Finland and many other countries, Pathological Anatomy was always under strong German influence and often (e.g. in Switzerland) was served by German pathologists. Among the schools in these countries, the one founded in Geneva by Zahn, directed at the present time by Askanazi and organized in Helsinki by Homén can be mentioned. The development of Pathological Anatomy in Japan and China proceeds entirely from Germany, and to this day it is still practiced to invite specialists from Germany to organize pathological-anatomical affairs or to head a department in one of the cities of Japan or China. However, in the last 15-20 years, Japan already has a number of pathological-anatomical schools headed by Japanese scientists, although they received their qualification in Germany, for example the schools of Prof. Kawamura in Niigata, Tanabe in Okayama, Wiyono in Kyoto, Yamagiva and Nagayo in Tokyo. In contrast to all this, in France, England and America Pathological Anatomy did not develop as an independent discipline and to the present day remains in the position of a specialty of an auxiliary nature; in connection with this, for example, in France there are almost no specialist physicians in pathological anatomy, and some clinicians simultaneously work in the field of Pathological Anatomy (in Paris formerly Charcot, Cornil, Letulle, at the present time Roussy, Masson). In America, the pathologist ('pathologist') mainly manages laboratory (clinical) work. There are no pathological-anatomical schools in America; there are only individual pathologists known for their works, e.g. McCollum, Mallory. Many German pathologists work in America. Russian Pathological Anatomy developed to a large extent under the influence of German Pathological Anatomy and although in our country there was no case of a German scientist being invited to organize a department or institute, still very many of the first Russian pathologists received their qualification in Berlin from Virchow, in Freiburg from Ziegler, in Leipzig from Marchand etc. However, already from the 1860s of the 19th century, independent pathological-anatomical schools were organized in Russia in St. Petersburg and Moscow, from which came a number of pathologists who headed departments and prosectories in different cities of the USSR and laid the foundation for new schools. The St. Petersburg school was founded by M. M. Rudnev (1837-1878) and had as its continuators N. P. Ivanovsky (1843-1912), K. N. Vinogradov (1847-1906), A. I. Moiseev and those heading the main Leningrad departments of pathological anatomy at the present time - G. V. Shor, F. Ya. Chistovich, N. N. Anichkov. The founder of the Moscow school should be considered A. I. Polunin (1820-1888), after whom it was directed by I. F. Klein (1837-1922), M. N. Nikiforov, G. V. Vlasov, V. I. Kedrovsky, and at the present time A. I. Abrikosov (1st MMI) and I. V. Davydovsky (2nd MMI). From the St. Petersburg school came V. P. Krylov, who organized the Kharkov school of pathologists, the development of which was continued by N. F. Melnikov-Razvedenkov, who came from the Moscow school. The latter also gave D. P. Kishensky and M. M. Tizengauzen, who founded the Odessa school of Pathological Anatomy, and from the Kharkov school came I. F. Pozharsky, who first held the department of Pathological Anatomy in Warsaw, and from 1915 in Rostov-on-Don, where he organized the largest pathological-anatomical institute in the USSR, now headed by Sh. I. Krinitsky. The Kharkov school also gave the well-known V. K. Vysokovich (1854-1912), who after G. N. Minikh held the department of Pathological Anatomy in Kiev and founded a prominent pathological-anatomical school here; his continuators were Konstantinovich, I. T. Titov (now head of the department of Pathological Anatomy in Minsk), and at the present time P. A. Kucherenko. In Kazan, the development of Pathological Anatomy proceeded independently; pathological-anatomical affairs were organized here by A. V. Petrov and especially by N. M. Lyubimov, continued by F. Ya. Chistovich, and now by I. P. Vasiliev. The Kazan school gave P. I. Zabolotnov, who organized the department of Pathological Anatomy in Saratov. All the listed schools, so to speak of the second line, also gave and continue to give many young workers in pathological anatomy, who occupy positions in medical institutes of the USSR or are prosectors in various hospital institutions. A characteristic feature of most of the modern Leningrad schools is the development of problems of atherosclerosis with the setting up of broad experiments. A characteristic feature of the Moscow schools is the infectious trend and the clinical-anatomical approach to the corresponding problems both in their scientific development and in teaching. The methods of Pathological Anatomy are closely connected with three sources from which Pathological Anatomy draws its data: 1) autopsies, 2) examination of material obtained from living patients (biopsy, surgical operations), 3) experiments on animals. --1. Autopsies of persons who died from various diseases represent the main scientific material of Pathological Anatomy. One can definitely say that the entire modern state of Pathological Anatomy is indebted to this source; its continuous progress is based on enriching it with ever new data from the same source. During an autopsy, by means of various methods (see below), the changes underlying a given pathological condition are studied and conclusions are drawn about their nature, origin and development. The accumulation of corresponding observations forms the basis for the development of Pathological Anatomy as a science. Autopsies also have very great significance in the teaching of Pathological Anatomy as the best illustration of the changes that underlie diseases. 2. Examination of material taken from living patients concerns cases of biopsy for diagnostic purposes and surgical operations with the removal of one or another tissue; therefore this source has a limited range of application. However, the material obtained by this method has the value that it is just separated from a living organism and can be examined in a state close to living. 3. Experiments on animals are used for the artificial reproduction of various pathological processes, with the animal being killed at different stages of the disease and subjected to pathological-anatomical examination. The positive side of this method is that by means of it one can vary the conditions for reproducing pathological changes and study the changes at any stage of their development, clarify the influence of various secondary factors on the main process, etc. The disadvantage of the experimental method is the circumstance that far from all diseases characteristic of humans can be induced in animals and far from all conclusions drawn from experiments on animals can be transferred to humans without reservations.

The methods of studying material obtained from autopsies, biopsies and operations, as well as from experiments on animals, are diverse. Autopsies of human and animal bodies are performed according to a special technique of path.-anat. autopsies (see Autopsy). The organs and tissues of the corpse, as well as material from biopsies and operations, are studied macroscopically in terms of data concerning size, weight, shape, color, consistency, and other properties accessible to the naked eye, and then microscopically—in accordance with the rules of histological technique using various methods of material processing, staining, microphysical methods, and microchemical reactions. In the examination of path.-anat. material, bacteriological research is often of importance, and in some cases, chemical research of objects as well. The preservation of material is of extremely great importance in path.-anat. technique; it is important both for preserving objects of scientific interest and for teaching purposes, specifically in order to always have the possibility of illustrating to students the pictures of various pathological processes. The preservation of microscopic preparations presents no difficulties; they are numbered and kept in special cabinets, being recorded in the appropriate catalog. In cases where it is necessary to capture and preserve a specific place of a microscopic preparation, resort is made to drawing and microphotography; slides with microphotographs can be used for projecting microscopic pictures. Objects in the form of pieces of organs, tumors, etc., valuable only for microscopic purposes, are kept in a formalin solution or in alcohol. More complex is the preservation of macroscopic preparations in the form of organs and their parts in such a state that they can illustrate changes as they appear directly at autopsy (see Preparations). It is extremely important in path.-anat. institutions that all materials preserved there be systematized and easily accessible for finding individual objects and for various calculations and statistical computations. This is achieved through a card system; card indexes of autopsy protocols, microscopic collections, and museum specimens must be available in each path.-anat. institution. The teaching of P. a. has always played an important role in the system of medical education due to the significance which P. a. has in mastering concrete ideas about the morphological essence of pathological processes. However, the plan and methods of teaching P. a. differ in different countries. In Germany and many other countries that follow Germany in the organization of medical education, P. a. is considered a basic subject of medical faculties and a significant number of hours are allotted to the teaching of P. a. The teaching of P. a. in German medical faculties was organized by Virchow and to the present day consists of: 1) lectures with demonstrations on the systematic course of P. a.—approx. 200 hours, 2) practical exercises in pathological histology—approx. 150 hours, and 3) practical sectional course with exercises in autopsies—approx. 120 hours. In some universities (e.g., in Berlin) there is also a special demonstration course for senior students—approx. 120 hours. A feature of the teaching of P. a. in Germany and some other countries is that lectures on the first, general part of P. a. also cover data of general pathology; separate departments of general pathology or pathological physiology do not exist in most German universities. In France, England, and America, P. a. is taught as a separate subject, but to this day it has a secondary importance and consists of lectures and a small number of practical exercises. In Russia, the teaching of P. a. was introduced from the very beginning of the opening of Medical Faculties at universities, and the teaching of P. a., on the one hand, and general pathology (pathological physiology)—on the other, was always carried out in two separate departments. The teaching of P. a. in Russian universities particularly developed in the second half of the 19th century under the strong influence of the organization of this teaching as it was carried out in Germany. In connection with this, in our country as well, the teaching of P. a., as in Germany, consisted of three parts: 1) reading lectures on the systematic course of P. a. with demonstration of macro- and microscopic preparations on the 3rd year of medical faculties—approx. 150 hours, 2) practical exercises in pathological histology, which were first held on the 5th year, and later on the 4th year—approx. 50 hours per student, and 3) practical exercises on cadaveric material, carried out on the 5th year—approx. 60 hours per student. The details of the organization of these three parts of teaching differed somewhat in different universities depending on the nature of the equipment and other local conditions. In this form, the teaching of P. a. remained until the time of the reorganization of all medical education, which began shortly after the October Revolution. In relation to the teaching of P. a., the reorganization at first manifested itself in that all teaching was given a more practical character. From 1924, in many universities, on the initiative of the P. a. department of Moscow State University, lectures were combined with practical exercises; in other words, on the 3rd year, each chapter of P. a. was first presented in a lecture for the entire course, after which followed group practical exercises on the same topic. Subsequently, with the reduction of the training period in medical schools to 4 years, with the expansion of teaching preventive disciplines and the development of continuous production practice, the volume of teaching P. a. was reduced. At present (1931-32), according to the curricula of medical institutes of the RSFSR, on therapeutic and prophylactic faculties, 120 hours are allotted to P. a. and additionally approx. 24-30 hours for the sectional course (exercises on cadavers) as part of production practice. The technique of teaching P. a. was also reorganized. According to the general principles of the active laboratory method, the main work of students is done in groups. As groups approach a particular topic, they listen to an introductory lecture by the instructor, after which the groups independently study the path.-anat. material (macro- and microscopic preparations) related to this topic, using auxiliary guidance from the teacher; this is followed by a conference at which there is a discussion between students and the teacher (or instructor) on the same topic. The sectional course is conducted in the form of attaching a group of students for 1-1^1/2 decades to a path.-anat. institution, where they practice in autopsies, in path.-anat. diagnostics, drawing up autopsy protocols, preserving preparations for the museum, etc. A great step forward in the teaching of P. a. in the USSR was the replacement in teaching of the usual private P. a., which described path.-anat. processes by organs, with special pathology of diseases (see above). Thus, at present in medical institutes of the USSR, in the 4th semester, general P. a. is taught by the above-mentioned method, in the 5th semester—special P. a. of diseases (infectious diseases, diseases of the blood, diseases of the heart, etc.), and in the 7-8th semesters—the sectional course. Path.-anatomical institutions: are of two types: 1) some serve for the purpose of teaching P. a., 2) others, located at medical institutions, belong to the so-called prosectorial part of hospital affairs. It should be noted that at present, in the vast majority of medical schools in the USSR and abroad, those institutions in which P. a. is taught are simultaneously institutions performing prosectorial functions of the hospital or clinic with which the medical school is associated; in other words, P. a. departments in their pedagogical work are closely connected with the hospital cadaveric material. An exception to this rule are medical schools in France and England and individual medical schools in our country, in the USSR, where the P. a. department carries out its work in the form of reading lectures and practical exercises on preparations in the 'path.-anat. laboratory,' while the contact of teaching with autopsies is carried out outside the department and has a secondary importance in the teaching system, which of course is extremely abnormal. Larger path.-anat. institutions, having the character of separate, specially equipped buildings, are called 'path.-anat. institutes'; smaller institutions mainly belong to hospital 'prosectoriums' or 'anatomical theaters' of hospitals. They are sometimes also designated as path.-anat. departments of hospitals, maternity homes, etc. Pathological-anatomical institutes are particularly widespread in Germany, where, since they conduct work in pathology in general, they are more often called path. institutes ('Pathologisches Institut'); not only in those hospitals associated with medical schools, but also generally in large hospitals in Germany, there are path. institutes in the form of 3-4-story buildings, which include, in addition to the morphological, experimental, bacteriological, chemical, photographic, and X-ray departments, lecture halls, special rooms for practical exercises and for scientific work, a museum, a maceration room, a cremation room, etc.; the dissecting hall usually has at least 10-12 tables for autopsies; storage rooms (basement) for cadavers and organs are equipped with artificial cooling.

The largest pathological institutes in Germany are located in Berlin at the Charite Hospital, two in Munich (one of which was built in recent years and opened only in 1930), in Hamburg at the Eppendorf Hospital (opened in 1926), in Leipzig, in Frankfurt am Main, and in Wurzburg. The pathological institute in Vienna was completely rebuilt, expanded, and renovated in 1929. In France and England, there are no institutions of the pathological and pathological-anatomical institute type. In America, they are rare (for example, a large pathological institute that also includes functions of a bacteriological institute in Baltimore). In France, England, and America, pathological-anatomical work is mostly carried out in 'pathological departments' or 'offices,' 'laboratories' at medical institutions. In the USSR, pathological-anatomical institutes in the form of special large buildings even at medical institutes are rare, and their equipment is far behind German institutes; the largest pathological-anatomical institute (3-story building) is in Rostov-on-Don, where it was built during 1918-1919. A good institute exists in Odessa. At many medical universities in the USSR, pathological-anatomical institutes are combined in one building with institutes of normal anatomy or forensic medicine and operative surgery, for example in Moscow. Some medical institutes have their own departments for P. a. in hospital morgues, for example in Moscow: State Institute for the Advancement of Physicians-in Babukhin Hospital, 2 MMI-in Medsantrud Hospital, in Leningrad: 1 LMI-in Erisman Hospital, 2 LMI-in Nechaev Hospital. Morgues and anatomical theaters at hospitals in the USSR, not connected with medical universities, mainly serve as places for autopsies and examination of corpses of persons who died in hospitals. Their character and equipment are extremely varied. In many, even large cities, there are no special morgues at hospitals, autopsies are not performed at all or are sometimes done by the attending physician in the basement for storing corpses; sometimes such a morgue has a room for autopsies. Finally, in addition, a laboratory for pathological-anatomical work by a special staff may be organized in one of the hospital rooms; sometimes such a laboratory and its staff simultaneously perform the functions of an analytical hospital laboratory. The next step is a separate building of an anatomical theater of various sizes and equipment. In recent times, in view of the enormous importance attached to autopsies and all morgue work, all new hospitals already have separate buildings of anatomical theaters and small pathological-anatomical institutes: or departments; the larger ones are in Moscow in Botkin, Babukhin, Krasnosovetskaya, Medsantrud hospitals; in Leningrad-in Botkin Hospital (3-story building), Victims of the Revolution Hospital, Erisman Hospital, Nechaev Hospital. Similarly, there is a noticeable tendency in old hospitals that did not have morgues to organize them. In Moscow and Leningrad at present, all hospitals have independent morgues (in Moscow--35, in Leningrad--20). A special scientific research institute for P. a. in the USSR exists only one in Kharkov (Director Academician N. F. Melnikov-Razvedenkov); however, there are no such special scientific research institutions for P. a., not related to corpse material, abroad either. All scientific work in P. a. successfully proceeds in pathological-anatomical institutes of medical universities and hospitals, as well as in hospital anatomical theaters and morgues. Pathological-anatomical museums, i.e., collections of demonstrative or rare pathological-anatomical preparations, exist in all pathological-anatomical institutes and at many hospital morgues; the largest of them abroad is the museum founded by Virchow at the Berlin pathological institute at Charite Hospital (approx. 35,000 preparations), in the USSR-the Moscow one at the Pathological-Anatomical Institute of 1 MMI (approx. 6,000 preparations). A special position is occupied by the Dupuytren Museum in Paris, which has the character of an independent institution and, in addition to the preparations themselves, includes a large number of casts, models, and other reproductions. Societies and congresses. Of pathological-anatomical societies, the German pathological society (Deutsche pathologische Gesellschaft) plays the largest role, founded with the participation of Virchow in 1898 and at present numbering more than 400 members, belonging to scientists not only from Germany but also from other countries. This society annually organizes congresses in one of the German cities, which have long had international significance; in 1931 the 26th congress of the German pathological society took place in Munich. Annually the society publishes a volume of its works. In some other countries, for example in Italy, Japan, there are pathological societies of purely local significance. In the USSR, the first society of pathologists was organized in 1909 in Leningrad; its activities consisted of regular meetings and annual publication of its works (until 1916). In 1914 the Moscow society of pathologists was organized, which existed until 1922, when from both of the above-mentioned societies one Russian society of pathologists ('ROP'-Chairman A. I. Abrikosov) was formed with departments in Leningrad, Moscow, Nizhny Novgorod, and Krasnodar. In 1926 in Ukraine the Ukrainian society of pathologists ('UKROP'-Chairman N. F. Melnikov-Razvedenkov) arose with departments in Kharkov, Kiev, Odessa, Dnepropetrovsk. At the same time a society of pathologists was founded in Baku (Chairman I. I. Shirokogorov). Congresses of pathologists in the USSR date back to 1921, when in honor of the 100th anniversary of Virchov's birth, a congress of the Leningrad society of pathologists and the Moscow society of pathologists was held in Leningrad; then in 1923 in Leningrad and in 1925 in Moscow, Russian congresses of pathologists were convened, to which representatives of pathology and P. a. from the entire USSR came, and in 1927 in Kiev and in 1930 in Baku the 1st and 2nd All-Union congresses of pathologists were held; the next such All-Union congress is planned for the autumn of 1932 in Moscow.