Foundation of Cls

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FOUNDATIONS OF


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CLINICAL LABORATORYCLINICAL LABORATORY

SCIENCESCIENCEALSO KNOWN AS MEDICALALSO KNOWN AS MEDICAL

TECHNOLOGYTECHNOLOGY

HEALTHCARE PROFESSIONHEALTHCARE PROFESSION

PERFORM LABORATORY PROCEDURESPERFORM LABORATORY PROCEDURESTO HELP DIAGNOSE, MONITOR, ANDTO HELP DIAGNOSE, MONITOR, AND

TREAT DISEASES, AND TO PROMOTETREAT DISEASES, AND TO PROMOTEHEALTHHEALTH

WORK IN EITHER HOSPITAL ORWORK IN EITHER HOSPITAL OR

CLINICAL LABORATORIESCLINICAL LABORATORIES


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SCIENCESCIENCE MEDICAL TECHNOLOGY IS DEFINED BYMEDICAL TECHNOLOGY IS DEFINED BYHEINEMANNHEINEMANN

AS THE APPLICATION OF THE PRINCIPLES OFAS THE APPLICATION OF THE PRINCIPLES OF

NATURAL, PHYSICAL, AND BIOLOGICAL SCIENCES TONATURAL, PHYSICAL, AND BIOLOGICAL SCIENCES TOTHE PERFORMANCE OF LABORATORY PROCEDURESTHE PERFORMANCE OF LABORATORY PROCEDURESWHICH AID IN THE DIAGNOSIS AND TREATMENT OFWHICH AID IN THE DIAGNOSIS AND TREATMENT OFDISEASESDISEASES

FAGELSON CONSIDERS MEDICAL TECHNOLOGY TO BEFAGELSON CONSIDERS MEDICAL TECHNOLOGY TO BE

THAT BRANCH OF MEDICINE CONCERNED WITH THETHAT BRANCH OF MEDICINE CONCERNED WITH THEPERFORMANCE OF THE LABORATORYPERFORMANCE OF THE LABORATORYDETERMINATIONS AND ANALYSES USED IN THEDETERMINATIONS AND ANALYSES USED IN THEDIAGNOSIS AND TREATMENT OF DISEASE AND IN THEDIAGNOSIS AND TREATMENT OF DISEASE AND IN THE

MAINTENANCE OF HEALTH.MAINTENANCE OF HEALTH.


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SCIENCESCIENCE PERFORM SUCH THINGS ASPERFORM SUCH THINGS AS

MICROSCOPIC EXAMINATIONS, OBTAINMICROSCOPIC EXAMINATIONS, OBTAINBLOOD SAMPLES, MANIPULATE VARIOUSBLOOD SAMPLES, MANIPULATE VARIOUSLABWARES, OPERATE AUTOMATED ANDLABWARES, OPERATE AUTOMATED ANDSEMIAUTOMATED INSTRUMENTS, ANDSEMIAUTOMATED INSTRUMENTS, AND

MAKE CRITICAL DECISIONS.MAKE CRITICAL DECISIONS.


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AREAS OF THE CLINICALAREAS OF THE CLINICAL

LABORATORY SCIENCELABORATORY SCIENCE MICROBIOLOGYMICROBIOLOGY

IMMUNOHEMATOLOGYIMMUNOHEMATOLOGY CLINICAL CHEMISTRYCLINICAL CHEMISTRY

HEMATOLOGY AND HEMOSTASISHEMATOLOGY AND HEMOSTASIS

URINALYSIS AND BODY FLUIDSURINALYSIS AND BODY FLUIDSANALYSISANALYSIS

IMMUNOLOGY AND SEROLOGYIMMUNOLOGY AND SEROLOGY

HISTOPATHOLOGY AND CYTOLOGYHISTOPATHOLOGY AND CYTOLOGY


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AREAS OF THE CLINICALAREAS OF THE CLINICAL

LABORATORY SCIENCELABORATORY SCIENCE OPPORTUNITIES:OPPORTUNITIES:

BIOMEDICAL RESEARCHBIOMEDICAL RESEARCH

GENETICSGENETICS

TISSUE TYPINGTISSUE TYPING

EDUCATIONEDUCATION

CONSULTINGCONSULTING

LABORATORY MANAGEMENTLABORATORY MANAGEMENT

PHARMACEUTICAL AND COSMETICSPHARMACEUTICAL AND COSMETICS

FORENSIC LABORATORIESFORENSIC LABORATORIES


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HISTORY OF CLINICALHISTORY OF CLINICAL

LABORATORY SCIENCELABORATORY SCIENCE


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Ancient and Medieval TimesAncient and Medieval Times The Greek physician, Hippocrates (460 B.C.The Greek physician, Hippocrates (460 B.C.--

377 B.C.) was called the father of medicine377 B.C.) was called the father of medicineand is known for the famous Hippocraticand is known for the famous Hippocratic

Oath, the code of ethics for practicingOath, the code of ethics for practicingphysicians.physicians.

Hippocrates described four "humors" or bodyHippocrates described four "humors" or bodyfluids in man.fluids in man.

BloodBlood

PhlegmPhlegm

Yellow bileYellow bile

Black bileBlack bile


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Ancient and Medieval TimesAncient and Medieval Times In ancient times,In ancient times, urineurine was regarded as awas regarded as a

composite of these humors.composite of these humors. VisualVisualexamination of urine at the bedside couldexamination of urine at the bedside coulddiagnose illnessdiagnose illness

Astrology, superstition and folkAstrology, superstition and folk--lore oftenlore ofteninfluenced ancient physicians in makinginfluenced ancient physicians in makingdiagnoses, but they made crediblediagnoses, but they made credible

observations about urineobservations about urine Urinalysis, or the study of urine has beenUrinalysis, or the study of urine has been

passed down from ancient times and ispassed down from ancient times and isregarded as the oldest of laboratoryregarded as the oldest of laboratory

procedures todayprocedures today


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Ancient and Medieval TimesAncient and Medieval Times

The polyuria of diabetes was noted inThe polyuria of diabetes was noted inancient times.ancient times. As early as 600 B.C., aAs early as 600 B.C., aHindu physician recorded the sweetHindu physician recorded the sweet

taste of diabetic urinetaste of diabetic urineAnother physician noted in 1674, thatAnother physician noted in 1674, that

the urine in diabetes had a taste similarthe urine in diabetes had a taste similar

to honey.to honey. These descriptions are stillThese descriptions are stillvalid todayvalid today


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Ancient and Medieval TimesAncient and Medieval Times The Earliest Attempts to ConquerThe Earliest Attempts to Conquer

DiabetesDiabetes

Folklore has is that Greek physicians hadFolklore has is that Greek physicians had

a primitive but effective way ofa primitive but effective way ofdiagnosing diabetes. They would pour adiagnosing diabetes. They would pour apatient's urine on the ground close to anpatient's urine on the ground close to an

anthill. Ants swarming to the spot meantanthill. Ants swarming to the spot meantsweetness was present and that thesweetness was present and that thepatient had the "honeypatient had the "honey--siphoning"siphoning"

disease, diabetes mellitus.disease, diabetes mellitus.


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Ancient and Medieval TimesAncient and Medieval Times Throughout the middle ages, "blood letting"Throughout the middle ages, "blood letting"

was a means of curing most afflictions.was a means of curing most afflictions. AApatient was bled with leeches or by cutting apatient was bled with leeches or by cutting a

blood vessel. In a more enlightened age, thisblood vessel. In a more enlightened age, thispractice ended and the study of blood and it'spractice ended and the study of blood and it'scellular elements begancellular elements began

Today, we have a better understanding ofToday, we have a better understanding ofhow leeches prevent blood from coagulatinghow leeches prevent blood from coagulatingand thereby help restore circulation.and thereby help restore circulation. OnceOnceagain, leeches are used in treatments that aidagain, leeches are used in treatments that aid

the success of reattaching severed limbs.the success of reattaching severed limbs.


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Progress 1600Progress 1600--19001900


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The development of the microscope wasThe development of the microscope wasfirst described in 1625 with a functionalfirst described in 1625 with a functionalinstrument becoming available in 1673.instrument becoming available in 1673.

Following the introduction of theFollowing the introduction of themicroscope, great advances were mademicroscope, great advances were madein the medical fields of physiology,in the medical fields of physiology,bacteriology, chemistry and pathologybacteriology, chemistry and pathology

A pioneering course in medicalA pioneering course in medicalmicroscopy was first taught in Paris inmicroscopy was first taught in Paris in18371837


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The Seminal PeriodThe Seminal PeriodJumping ahead to the 1600s, overJumping ahead to the 1600s, over"incidental" events like the rise and"incidental" events like the rise andfall of Rome, Hun invasions and thefall of Rome, Hun invasions and theMagna Carta, William HarveyMagna Carta, William Harvey

explained the circulatory system,explained the circulatory system,and experts determined that theand experts determined that thehuman body was a chemical systemhuman body was a chemical system

that could be cured with chemicals.that could be cured with chemicals.


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Progress 1600Progress 1600--19001900 The Seminal PeriodThe Seminal Period

Robert Boyle, described by many as theRobert Boyle, described by many as thefirst modern clinical chemist, whofirst modern clinical chemist, who

authored the gas law, was quick toauthored the gas law, was quick toembrace this philosophy. He was theembrace this philosophy. He was thefirst to define chemical elements andfirst to define chemical elements and

urged the development of analyticalurged the development of analyticalchemistry techniques, as described in hischemistry techniques, as described in hisMemoirs for the Natural History ofMemoirs for the Natural History of

Humane Blood.Humane Blood.


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Institutionofclinicalchemistry1800s


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The science of clinical chemistry evolved byThe science of clinical chemistry evolved bycopying the tools and techniques of analysiscopying the tools and techniques of analysisfrom mercantile manufacturers. Robert Boylefrom mercantile manufacturers. Robert Boyle

invented litmus paper to test acidity andinvented litmus paper to test acidity andalkalinity of reagents and body fluids byalkalinity of reagents and body fluids byborrowing from the textile industry. Likewise,borrowing from the textile industry. Likewise,qualitative flame tests to analyze and identifyqualitative flame tests to analyze and identify

substances, titimetry analyses, and smallsubstances, titimetry analyses, and smallfurnaces which allows for uniform andfurnaces which allows for uniform andtherefore reproducible test reactions weretherefore reproducible test reactions were

borrowed from metallurgists.borrowed from metallurgists.


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InstitutionofclinicalchemistryInstitutionofclinicalchemistry1800s1800sBy the early 1800's linkagesBy the early 1800's linkages

between chemistry and physiologybetween chemistry and physiologyhad tightened. Joseph Louis Gayhad tightened. Joseph Louis Gay--

Lussac revolutionized organicLussac revolutionized organicanalysis by employing oxidizinganalysis by employing oxidizingagents to trigger chemical reactions.agents to trigger chemical reactions.

William Prout isolated hydrochloricWilliam Prout isolated hydrochloricacid from gastric juices and dividedacid from gastric juices and dividedfoodstuffs into carbohydrates,foodstuffs into carbohydrates,

proteins and fats.proteins and fats.


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InstitutionofclinicalchemistryInstitutionofclinicalchemistry1800s1800s . Prism spectrometers with attached. Prism spectrometers with attached

telescopes were invented to view reactiontelescopes were invented to view reaction--dependent color changes.dependent color changes.

Sir Humphrey Davy demonstrated thatSir Humphrey Davy demonstrated thatelectricity could stimulate color separation,electricity could stimulate color separation,showing that base solutions move towardshowing that base solutions move towardnegativelynegatively--charged poles: acids towardcharged poles: acids towardpositivelypositively--charged poles. Using some of thesecharged poles. Using some of thesebreakthroughs, Baron Justus von Liebig'sbreakthroughs, Baron Justus von Liebig'sclinical lab was performing six testclinical lab was performing six testdeterminations per daydeterminations per day -- more than 400 yearmore than 400 year

per year.per year.


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InstitutionofclinicalchemistryInstitutionofclinicalchemistry1800s1800s

Clinical chemistry became anClinical chemistry became anacademic subject integrated into theacademic subject integrated into themedical school curriculum andmedical school curriculum and

students began to gain practicalstudents began to gain practicalknowledge at the bedside as well asknowledge at the bedside as well astheoretical knowledge in thetheoretical knowledge in the

classroom.classroom. In Munich, Hugo von ZiemssenIn Munich, Hugo von Ziemssen

established the first laboratoryestablished the first laboratory

attached to a hospital.attached to a hospital.


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By 1848, Fehling had a quantitative test forBy 1848, Fehling had a quantitative test forurine sugar.urine sugar.

Analine dyes used throughout the laboratoryAnaline dyes used throughout the laboratory

then and today were developed in 1850.then and today were developed in 1850. Early laboratories were established in the lastEarly laboratories were established in the last

half of the nineteenth century in the Unitedhalf of the nineteenth century in the UnitedStates.States. Dr. William H. Welsh, considered theDr. William H. Welsh, considered thefather of American pathology, set up the firstfather of American pathology, set up the firstpathology laboratory in America at Bellevuepathology laboratory in America at BellevueHospital in 1878Hospital in 1878


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The first recognized clinicalThe first recognized clinicallaboratory in the states was locatedlaboratory in the states was locatedatJohns Hopkins Hospital inatJohns Hopkins Hospital in

1896.1896. Before the turn of theBefore the turn of thecentury, clinical laboratories were incentury, clinical laboratories were in

operation in hospitals at Boston,operation in hospitals at Boston,New York and Philadelphia.New York and Philadelphia.


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19001900--PresentPresent

Eraoftechnologicalrefinement 1900s


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EraoftechnologicalrefinementEraoftechnologicalrefinement1900s1900s Entering into the 20th century, a handful ofEntering into the 20th century, a handful ofAmerican medical centers were establishingAmerican medical centers were establishinghospitalhospital--based laboratories.based laboratories.

the William Pepper Laboratory at thethe William Pepper Laboratory at theUniversity of Pennsylvania was established inUniversity of Pennsylvania was established in1895,1895,

the Ayer Laboratory of the Pennsylvaniathe Ayer Laboratory of the PennsylvaniaHospital was established in 1898 andHospital was established in 1898 and

the Rockefeller Institute of New York wasthe Rockefeller Institute of New York wasestablished in 1903.established in 1903.


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A census at the turn of the centuryA census at the turn of the centuryindicated that 100 technicians wereindicated that 100 technicians wereemployed in the United states, allemployed in the United states, all

men, but not all medical techniciansmen, but not all medical technicians

WWI (1914WWI (1914--1918) was an important1918) was an important

factor in the growth of the clinicalfactor in the growth of the clinicallaboratory with a demand forlaboratory with a demand formedical personnel in the military asmedical personnel in the military as

well as civilian hospitalswell as civilian hospitals


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In 1915, the state of Pennsylvania passed aIn 1915, the state of Pennsylvania passed alaw that required all hospitals be equippedlaw that required all hospitals be equippedwith adequate laboratories employingwith adequate laboratories employingtechnicianstechnicians

By 1920, the census recorded 3500By 1920, the census recorded 3500technicians, 2000 of whom were women.technicians, 2000 of whom were women. InIn1922, 3000 U.S. hospitals indicated they had1922, 3000 U.S. hospitals indicated they had

established a clinical laboratory department.established a clinical laboratory department.

There was a need for appropriately trainedThere was a need for appropriately trainedmedical personnel in the field of laboratorymedical personnel in the field of laboratory

medicine.medicine.


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Practicing physicians trained their assistants,Practicing physicians trained their assistants,secretaries and nurses to perform simplesecretaries and nurses to perform simplelaboratory procedures in their officeslaboratory procedures in their offices

Trends in the early years indicated the needTrends in the early years indicated the needfor formal and standardized trainingfor formal and standardized trainingprograms.programs. The first formal laboratory courseThe first formal laboratory coursewas established at Woman's Medical Schoolwas established at Woman's Medical School

and Woman's Hospital in Philadelphia inand Woman's Hospital in Philadelphia in19211921--1922 and is recorded in the files of the1922 and is recorded in the files of theRegistry of Medical Technologists.Registry of Medical Technologists.


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James C. Todd'sJames C. Todd's Clinical Diagnosis, A Manual ofClinical Diagnosis, A Manual ofLaboratory MethodsLaboratory Methods 4th edition, published in4th edition, published in1920, provides a "time capsule" view of clinical1920, provides a "time capsule" view of clinicalpathology. This article consists of edited excerptspathology. This article consists of edited excerpts

from this book, chosen to illustrate both thefrom this book, chosen to illustrate both thethought processes and methodology of clinicalthought processes and methodology of clinicalpathology in the 1920s. Compound microscopespathology in the 1920s. Compound microscopeswere in widewere in wide--spread use, but other instrumentsspread use, but other instruments

were primitive. The newest instruments,were primitive. The newest instruments,colorimeters, were read with the human eye bycolorimeters, were read with the human eye bycomparing colors; and the speed of centrifuges wascomparing colors; and the speed of centrifuges was

judged by sound.judged by sound.


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In 1922, theIn 1922, theAmerican Society ofAmerican Society ofClinical PathologistsClinical Pathologists, ASCP, was, ASCP, wasorganized.organized.

The University of Minnesota isThe University of Minnesota iscredited with the first degreecredited with the first degree

program in Medical Technology,program in Medical Technology,established prior to 1925.established prior to 1925. It hadIt hadadmission requirements equivalentadmission requirements equivalent

to those of a B.A. or B.S. degreeto those of a B.A. or B.S. degree..


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In summary, this is a quote fromIn summary, this is a quote fromthe 19th century Canadianthe 19th century Canadianpathologist William Osler: "Thatpathologist William Osler: "Thatman can interrogate as well asman can interrogate as well as

observe nature was a lessonobserve nature was a lessonslowly learned in his evolution."slowly learned in his evolution."Fortunately forus, ourFortunately forus, our

interrogations have helpedinterrogations have helpedharness a treacherous foe. Thisharness a treacherous foe. Thisvictory in the making is veryvictory in the making is very

sweetsweet

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Foundation of Cls

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