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The Relationship of Clinical and Laboratory Haematology

During 1953 I was fortunate to spend almost a year working in Professor J. V. Dacie’s department at the then Postgraduate Medical School of London, yet even before this I had begun to question the relationship between laboratory and clinical haematology. What I saw then helped me to form my present views, which have been only reinforced and extended, not altered, by further experience and subsequent visits to major haematological centres in the United Kingdom and North America. Haematology has developed in several different ways. In many English centres it grew from a small part of the general clinical pathology laboratory to become a laboratory or pathology specialty in its own right. Professor Dacie (1960) has adequately traced the development of British haematology and discussed the current situation in England at that time. He described how, in 1936, he carried out unaided all the blood counts made on patients at a London teaching hospital, together with other haematological and blood transfusion procedures. In Scotland at about the same time, in 1938, Professor L. S. P. Davidson was appointed to the Chair of Medicine in Edinburgh. Here he continued his strong interest in haematology which had begun while he was in Aberdeen. Much of the Scottish haematology was carried out in clinical side-room laboratories by senior and junior physicians with direct responsibility for patient care. In this way Davidson influenced a series of eminent physicians in his belief that haeinatologists should also be clinicians. One such physician was Professor H. N. Robson, who subsequently influenced me when he was appointed to the Chair of Medicine at the University of Adelaide and who has kindly supplied me with information concerning the Scottish school. Unfortunately, the Scottish side-room haematology did not develop into major haematological laboratories under the control of clinically trained physicians and much of what Professor Davidson commenced in Scotland has lapsed. Without the development of specialist laboratories the clinical side-rooms became totally inadequate to keep abreast of the rapid developments which occurred in haematology after World War II and which have continued ever since. Elsewhere, in some European countries and particularly in the United States of America, haematology did continue under the supervision of clinicians, and this has given rise to the true ‘Clinical Haematologist’, a physician well trained in both clinical medicine and in laboratory procedures. Such a person must surely be in an ideal situation to obtain the maximum interest from his subject, having full access and control over the management of his patients with time and facilities not only for supervision of laboratory investigations but for research. However, I make the point that a great deal of laboratory experience is essential if the clinical haematologist is to understand thoroughly all aspects of his subject. Under these conditions the patient suffering from a haematological disease should also be in the most favourable situation.