In December 1920 there is a confident new handwriting in the PM book, and the cases are initialled GBB. George Bertram Bartlett was the second appointed professor of pathology at the University of Cape Town, the first to actually take up the job. It appears he hit the ground running, performing 7 autopsies before the year was out.

A summary of the primary findings for the 12 medical autopsies of 1920:

Infections:  Disseminated tuberculosis (two cases), bacterial endocarditis, septicaemia with multiple lung abscesses, dysentery, bacterial meningitis (secondary to an ear infection?).
Neoplasms: A kidney tumour, a pancreatic tumour, carcinoma of stomach (a gastrostomy had been performed by Professor Saint, first professor of surgery at UCT).
Other: Nephritis with pulmonary oedema, perforated gastric ulcer, pulmonary embolus (following a fractured tibia and fibula, which was plated – see original notes above).

It is not a profound observation, but just sad to think that deaths could have been avoided had there been effective antibiotics available.

Today, we still hold two preserved specimens from these twelve cases, the earliest specimens in our pathology teaching collection – a  Hydrocoele of the tunica vaginalis (an incidental finding) and a Carcinoma of the stomach .

The following year (1921) autopsies rose to 58, from which 13 specimens are preserved. During the 1930s autopsy numbers ramped up to around 250 per year, remained at this level through the war years, but by 1950 exceeded 500 annually.

Along with our collection of teaching specimens, we have kept the historic post mortem books of the UCT Pathology Department – it’s amazing what medical and social history is reflected in those old reports. The first PM book opens in November 1919 and just five autopsies were recorded for that year. The youngest subject was a 10 month old boy who died of bronchopneumonia, the oldest an 81 year old man who died of infection complicating gall stones. The three other victims succumbed to bacillary dysentery, amoebic dysentery and cirrhosis of the liver.

When reading through the notes, I wondered why laboratory investigation for these cases was limited to identifying micro-organisms (such as “dystenteric organisms of the shiga type”), with no microscopic examination of the tissues i.e. histopathology. The autopsies are signed off by AS Strachan, and it turns out Dr Strachan was a bacteriologist. He must have been put in the position of conducting autopsies because the first appointed Professor of Pathology at the new medical school had sadly died, just after arriving in Cape Town in October 1918¹. Dr WB Martin was lost to the 1918 ‘flu, along with 400 other souls per day in Cape Town while the epidemic raged in October/ November of 1918².

The Pathology department had opened in 1918, along with the departments of Bacteriology and Pharmacology, to provide the third year courses for the degree in medicine (modelled on British medical schools)¹. After Dr Martin’s death there was a long delay in finding another professor for Pathology, apparently due to a scarcity of pathologists³.  Dr Strachan soldiered on as acting prosector, writing up five more medical autopsies in 1920. He also briefly noted some cases of unnatural death that passed though the morgue – two drownings on the same day, and one case of Lysol poisoning. Lysol is a disinfectant solution; according to Wikipedia it was advertised as an effective countermeasure to the influenza virus during the 1918 ‘flu pandemic. Unfortunately it was also a well known means of suicide (The Melbourne Argus 10 Jan 1912).

To be continued…

References

1. Louw JH. In the shadow of Table Mountain. A history of the University of Cape Town Medical School. Struik: Cape Town, 1969.
2. Phillips H. Plague pox and pandemics. Johannesburg: Jacana, 2012.
3. Passing Events. South African Medical Record, 14 August 1920 p.296