7 - A Hospital Laboratory

Summary

Biochemical testing in laboratories as an adjunct to patient care (clinical biochemistry) appeared in Britain chiefly in the 1920s. Before the Biochemistry Laboratory opened in Edinburgh in 1921 the Infirmary had two laboratory services: that of the Pathology Department and a socalled clinical laboratory which was mainly devoted to electrocardiography. The surgeons had their own laboratory facilities and did not call much on the Pathology Department.There were also ward “side rooms” for carrying out simple tests and microscopy.

During the nineteenth century, chemistry was increasingly held to be an important example of a basic science with the power to change medicine. Very early in the century, examination of the urine for chemical change was hailed as practical proof of the subject's clinical value. Richard Bright's description of his now eponymous disease that linked dropsy with the presence of albumin in the urine was soon regarded as one of the first demonstrations of the merits of chemical pathology. In the early part of the century a new chemistry based on organic compounds was created and later a chemistry of life, biochemistry,was built from this.These developments mainly originated in Germany. One of the many ways in which researchers with biochemical interests sought to establish their discipline in Europe and America was by gaining access to the pre-clinical medical curriculum (as had the physiologists before them). In universities, biochemistry largely remained within physiology departments where socalled chemical physiologists unravelled animal and human biochemical processes.4 The subject, along with experimental physiology, was proclaimed as heralding a future revolution in clinical practice.However, apart from urine testing, biochemistry had little place conceptually or practically in clinical medicine before the First World War. The close links of biochemistry to physiology are important for understanding the perceptions, approaches, and enthusiasms of those who embraced the subject and the doubts and uncertainties of those who did not.

Apart from one small case study, the history of the institutionalization in Britain of clinical biochemistry in hospitals has not been charted.5 There seems to have been no pattern.