RADICI STORICHE DELLA PATOLOGIA GENERALE FIORENTINA

Prof. Massimo Olivotto

Al momento della fondazione della Regia Università nell’anno 1924, la Patologia Generale fiorentina aveva già visto svolgersi un lungo e prestigioso periodo della sua storia. Questa disciplina era stata infatti un cardine dell’insegnamento medico offerto da quello che allora si chiamava Istituto di Studi Superiori di Firenze, ove insegnarono ed operarono scienziati di fama internazionale, tra i quali, tra il 1886 e il 1889, Guido Banti, poco prima della sua chiamata alla cattedra di Anatomia patologica che sarà da lui resa giustamente famosa. Con il Banti si afferma nell’Ateneo fiorentino l’indirizzo anatomo-clinico ideato dal Morgagni, che diventerà una pietra miliare della formazione medica in questo ateneo. Al Banti succedette un personaggio destinato a dominare la vita scientifica ed accademica per oltre un quarantennio, Alessandro Lustig. Triestino di nascita e laureato a Vienna nel 1882, Lustig fu dapprima allievo di Bizzozzero a Torino, dove si fece apprezzare come direttore del laboratorio del Mauriziano; dopo pochi anni fu nominato alla cattedra di Patologia Generale di Cagliari e trasferito nel 1890 a Firenze, dove insegnò fino al 1932, a capo di una scuola da cui sono usciti gran parte dei più insigni patologi italiani del secolo scorso (1, 2). Ebbe grande risonanza come batteriologo ed immunologo e fu autore di fondamentali lavori sul colera e sulla peste bubbonica, da lui studiata in India in collaborazione con i suoi allievi Galeotti e Polverini. Tali studi lo portarono a sperimentare la sieroterapia e la vaccinazione profilattica con nucleotidi del bacillo pestoso, ottenendo risultati che gli procurarono grande reputazione internazionale. Tra il 1901 e il 1902 pubblicò il suo magistrale trattato di Patologia Generale (3), che ebbe successivamente ben nove edizioni e sostituì per lungo tempo in modo incontrastato le analoghe pubblicazioni straniere; ancora oggi, questo trattato rappresenta un ausilio prezioso per gli studiosi che desiderino approfondire i concetti basilari e i confini della Patologia Generale intesa come indispensabile cerniera tra le discipline propedeutiche dell’insegnamento medico e la clinica. Nel 1911 fu nominato Senatore e durante la Grande Guerra del 1915-18 acquisì una ineguagliata esperienza nella patologia da gas da combattimento. Notevole fu anche l’impegno sociale del Lustig, esplicato in diverse circostanze, come quando fu assessore per l’Igiene nel Comune di Firenze sotto il mandato del suo grande amico Giulio Chiarugi, o come quando gli venne affidata l’alta Consulenza presso il Comando Supremo per i servizi militari dell’Esercito italiano.
Particolarmente fruttuosa fu l’opera del Lustig come maestro e caposcuola. Per decenni, le migliori cattedre furono occupate da suoi allievi, tra cui Galeotti, Trambusti, Tiberti, Guerrini, Rondoni, Amato, Vernoni, Favilli, per nominare solo i titolari di Patologia Generale. A lui si deve la creazione del primo Istituto universitario costruito a Careggi, la zona un tempo periferica di Firenze in cui doveva poi sorgere l’intera Facoltà medica fiorentina. L’Istituto, sorse allora in aperta campagna in prossimità della Villa Medicea che fu di Cosimo e dove morì Lorenzo il Magnifico. La costruzione di quest’opera, veramente innovativa per quei tempi fu iniziata nel 1914 e completata nel 1923, dopo una lunga interruzione dei lavori dovuta allo scoppio della Prima Guerra Mondiale del 1915-18. L’intera opera fu finanziata con una legge votata in Parlamento nel 1913 e ispirata ai più aggiornati criteri sanitari ed edilizi di una Facoltà medica e la sua rinomanza divenne ben presto tale da meritare una sua dettagliata illustrazione, come un esempio di istituto modello, in una pubblicazione edita nel 1928 dalla Rockefeller Foundation (4) (vedi articolo).
Al Lustig succedette Francesco Pentimalli, che nel pur breve periodo (1933-1936) vissuto a Firenze prima del suo trasferimento a Napoli lasciò una impronta duratura del suo notevole intuito scientifico; a lui si devono infatti i primi studi sulla trasmissione del sarcoma dei polli ad opera del virus di Rous (5), studi che anticiparono un settore destinato ad un tumultuoso sviluppo negli anni sessanta del secolo scorso con la definizione molecolare dei meccanismi dell’oncogenesi virale. A Firenze Pentimalli ebbe come allievi Enrico Ciaranfi e Pietro Caselli, che lo seguirono a Napoli, dove percorsero la loro carriera accademica fino al raggiungimento della cattedra di Patologia Generale in sedi importanti.
Dal 1936 al 1958 la cattedra di Patologia Generale di Firenze fu tenuta da Bruno Borghi, allievo di Rondoni, il grande patologo toscano che per primo in Italia intuì l’importanza della giovane disciplina biochimica negli studi medici. Da lui Borghi derivò lo spunto per i suoi interessanti studi sul metabolismo del tessuto cutaneo (6). Borghi fu assessore per l’igiene del Comune di Firenze nella giunta Pieraccini e Rettore dell’Ateneo fiorentino dal 1947 al 1953. Ebbe allievi destinati a ruoli importanti nella comunità medico-scientifica fiorentina, come Filippo Pasquinelli, e Angelo La Manna, divenuti in seguito Primari rispettivamente di Analisi Mediche e di Microbiologia nell’Arcispedale di S.Maria Nova, Giorgio Marsilii diventato in seguito Professore ordinario di patologia Generale e Antonino D’Alessandro, diventato in seguito Professore ordinario di Geriatria e Gerontologia nella Facoltà Medica Fiorentina.
Nel 1962 alla cattedra di Patologia Generale, con direzione dell’istituto omonimo, fu chiamato Alberto Fonnesu, che rimarrà in tale posizione fino al collocamento a riposo e alla trasformazione dell’istituto in Dipartimento di Patologia e Oncologia Sperimentali. Laureatosi in Medicina a Perugia, Fonnesu fu, ancora giovanissimo, allievo di Ciaranfi e con lui si trasferì a Milano, ereditando dal suo maestro il rigore scientifico e l’apertura mentale verso i settori della ricerca biomedica che si erano andate affermando in quegli anni. E’ stato infatti uno dei pochissimi docenti di Patologia Generale che ha conseguito la Libera Docenza in Chimica Biologica oltre a quella in Patologia Generale. Importante per la sua formazione fu il suo soggiorno scientifico (1955) nel Dept. of Biochemistry della Oxford University, allora diretto da Sir Hans Krebs, famoso biochimico Premio Nobel per la Medicina. Sul piano sperimentale Fonnesu ha studiato inizialmente il metabolismo dell’acetato in vivo, soprattutto in rapporto con lo stato diabetico (chetosi) e successivamente si è dedicato allo studio delle prime fasi della risposta cellulare allo stimolo lesivo e alle alterazioni delle trasformazioni di energia in cellule variamente lese e in cellule neoplastiche (7-9). Coautore del più diffuso trattato di Patologia Generale dell’epoca (10), ha in seguito diretto, con integrazioni, l’edizione italiana di un analogo testo inglese (11).
Come allievo di Ciaranfi, Fonnesu riconnette la sua ascendenza accademica al Pentimalli e al Lustig, di cui emulerà, in un iter accademico ultraqurantennale, le doti organizzative e l’azione valorizzatrice della Scuola fiorentina. Socio Naz. dell’Accademia Naz. dei Lincei, è stato Prorettore sotto i mandati di G. Devoto e C.A. Funaioli, Presidente della Commissione di Ateneo fino al termine di questo organo accademico; ha fatto parte a lungo del Comitato Nazionale per la Biomedicina del CNR, contribuendo in maniera determinante alla istituzione e alla programmazione dei tre Progetti Finalizzati CNR sui tumori, ai quali si deve il primo censimento e il reclutamento organico degli oncologi sperimentali e clinici operanti sull’intero territorio nazionale. Alla Facoltà Medica di Firenze lascia, come frutto delle sue doti di realizzatore, le nuove ali dell’edificio che oggi ospita il Dipartimento di Patologia e Oncologia Sperimentali e il Dipartimento di Scienze Biochimiche, da lui volute e costruite sotto il suo mandato di Prorettore, secondo un modello ispirato ai più moderni edifici scientifico-sperimentali anglosassoni e in armonia con la sua aspirazione ad una stretta collaborazione tra i due settori disciplinari.

"Methods and Problems of Medical Education (Tenth Series)"
Division of Medical Education, The Rockfeller Foundation , New York , 1928

Click here for the original article

Istituto di Patologia Generale, Firenze

Institute of General Experimental Pathology
Royal University of Florence
by Professor Alessandro Lustig

The Institute of General Experimental Pathology and Bacteriology of the Royal University of Florence was inaugurated in the year 1923, but the construction was begun before the outbreak of the war (1914) which interrupted all building activities. A law issued by Parliament in 1913 provided for the erection in accordance with the latest conceptions of modern sanitary engineering of a medical faculty in the University, including all the biological institutes and some clinics, to be built on an area of some eight hectares in one of the most picturesque and healthy districts in Florence where some small buildings had already been erected for the Hospital of Santa Maria Nuova of Florence. The constructions for the Biological Institute, including the Institute of Hygiene, General Anatomy, and Forensic Medicine, have already been begun, whereas, the Institute of General Pathology is completed. The plans of the other biological institutes have been prepared but have not yet been approved. The building for general pathology covers an area of approximately 1,750 square meters Facing the new hospital square it has an eastern exposure, 45° to the south-ward and a planimetrical formation in the form of a U, with open courtyard to give natural light to the various laboratories. The wings of the building are on one floor, 1,60 meters above the ground and have covered terraces and sunny pavements.

The center building is of two stories with basement, ground floor, and entresol used as lodgings for the assisting staff. In the center building, entrance to which is gained by a wide staircase, are vestibule, the students' cloack-room, the porters' quarters, the lecture-room seating 120 pupils, an instrument room for the demonstrations of microscopic preparations.

In the right wing are the library, the director's study and laboratory, the dark room, the assistants'laboratory, the chemistry room, and a students' laboratory provided with cement and tiled benches.

In the left wing is a room for sterilization, a storeroom for glassware, a room for experimental animals with special tubular constructions in cement to support and isolate the cages of the infected animals, the vivisection room, and a laboratory for the medical students enrolled for the courses.

Riferimenti bibliografici

Vernoni G. (1936) Commemorazione di Alessandro Lustig. Boll.Ist. Sieroterapico Milanese.
Dianzani M.U. La medicina torinese dal vitalismo al positivismo. La vittoria del positivismo (In stampa).
Lustig A. (1901) Patologia Generale, Società Editrice Libraria, Milano
Lustig A (1928) Institute of General Experimental Pathology Royal University of Florence, in Methods and Problems of Medical Education (Tenth Series), Division of Medical Education, The Rockefeller Foundation, 61 Broadway, New York, U.S.A. 1928 pp 81-88.
Pentimalli F. (1936). Tumori 10, 14.
Borghi B. (1940) Giorn.ital.di dermatol.e sifil .81, 415.
Fonnesu A, Severi C. (1956). Oxidative phosphorylation in mitochondria from livers showing cloudy swelling. J. biophys. biochem.Cytol. 2, 293-299.
Fonnesu A., Severi C. (1956) The prevention of swelling of liver mitochondria in vitro. Biochem. J. 64, 769-777.
Fonnesu A. (1960). Changes in energy transformation as an early response to cell injury. In :The biochemical response to injury. Response to injurie (H.B. Stoner & C.J. Thelfall, eds.)Blacwell Sci.Publ., Oxford.
Favilli G. e coll. Patologia Generale (Varie Edizioni). Casa Editrice ambrosiana C.E.A., Milano.
Walter J.B.& Israel M.S. Patologia Generale, Edizione Italina coordinata da A.Fonnesu Editoriale Grasso ed., Bologna.

SOME NOTES ON TEACHING GENERAL PATHOLOGY IN ITALY
Prof. Salvatore Ruggieri

Lecture tenuta il 18 Settembre 2007 presso il Karolinska Institutet di Stoccolma
sulla storia e sul ruolo attuale dell'insegnamento in Italia della Patologia Generale

I want to express my gratitude to Dr. A. Wernersson for hosting me in her Department in the Framework of the Erasmus Project for Teaching Staff Mobility. I am also grateful to Dr. Wernersson for having asked me to speak to you about the teaching of General Pathology in Italy, it gives me an opportunity to discuss General Pathology, a discipline to which I have dedicated my professional life.

Before discussing teaching methodologies and the success that General Pathology has had with students, I think it would be useful to take a historical look at how General Pathology established itself in Italy.

First of all we must remember, that Pathology, as it is currently viewed as the study of illness, took root in Florence with the work of Antonio Benivieni who was the first to establish a correlation between the anatomic alterations observable in the organs of a cadaver and the symptoms present during the illness.

1443-1502
Antonio Benivieni
“De Abditis Nonnullis ac Mirandis Morborum et Sanationum Causis”

Benivieni's work was continued by Giovan Battista Morgagni with his monumental opus, "De sedibus et causis morborum per anatomen indagatis". In reality, the actual causes of illness remain unknown in Morgagni's work, as well as the mechanisms of disease. This would attract the attention of the medical society only after the advent of Experimental Pathology a century later.

1682-1771
Giovan Battista Morgagni
“De Sedibus et Causis Morborum per Anatomen Indagatis”

Two great scientific personalities of the 19th century contributed to the foundation of General Pathology; Rudolph Virchow and Claude Bernard.

Virchow's contribution is related to his theory of cellular pathology, according to which, diseases, with their symptoms, and their pathological lesions are confined to cells. These cellular alterations were grouped into a few fundamental pathological processes, the so-called elementary lesions. In spite of its European resonance, the scientific hypothesis proposed by Virchow showed evident limits such as: not having considered the contribution of the neuro-humoral interactions in diseases, not having considered the cause of diseases and, not having proposed the study of elementary pathological processes on an experimental basis. However, the importance of Virchow's scientific hypothesis relies on having introduced for the first time in the history of medical thought the concept that various diseases can be ascribed to a few fundamental pathological processes.
Thus, Virchow's theory on cellular pathology opened the field of General Pathology as the study of the fundamental pathological processes.

1821-1902
Rudolf Virchow
“Die Cellularpathologie”

The contribution of Claude Bernard to the foundation of General Pathology is based on having introduced the experimental method for the study of physiological mechanisms and on having extended it to the study of pathological processes, going beyond Virchow's view that pathological mechanisms could be studied only morphologically. This opened the possibility of studying the physio-pathological complexity of diseases. Claude Bernard is the author of the classical work, Introduction a l'étude de la Medicine Experimentale in which he established the general criteria of experimentation in medicine. Moreover, Claude Bernard introduced the concept that normalcy relies on the maintenance of the internal equilibrium of the organism and that the disease is the loss of this equilibrium. The result of this concept is that pathological processes are quantitatively altered forms of physiological processes. This concept will become the basis of the modern definition of disease.

1813-1878
Claude Bernard
“Introdution a l’étude de la Médicine Expérimentale”

The heritage left by these two great scientific personalities was received in Italy in the second half of the 19th century by Giulio Bizzozero, professor of General Pathology at the University of Turin, where he founded the Laboratory of Experimental Pathology, the first laboratory in this field in Italy, and a widely circulated journal, L'Archivio per le scienze mediche, where he published his observations. At the end of the 19th century the positivistic movement, very favorable to experimentation, was flourishing in the city of Turin, thereby offering to Bizzozero's work the most appropriate environment. Bizzozero is remembered in the history of medicine for being the first to establish the role of platelets in haemostasis and thrombosis, and for having discovered the hematopoietic function of bone marrow and for having introduced a classification of mature cells on the basis of their capacity for replication. It is interesting to note that the program for the General Pathology examination proposed by Bizzozero covered the same subjects still proposed today.

1846-1901
Giulio Bizzozero
Senatore del Regno d'Italia

The work of Bizzozero was continued by Camillo Golgi, professor of General Pathology at the University of Pavia since 1880. Golgi gave an extraordinary contribution to the knowledge of neurohistology for which he received the Nobel Prize. Golgi also stands out for its discovery of the so-called apparato reticolare interno (internal reticular apparatus) di Golgi in neurons as well as in other types of cells. Moreover, he distinguished himself for his research on malaria, one of the major sanitary problem in Italy after the Italian Unification.

1843-1926
Bartolomeo Camillo Emilio Golgi
Nobel 1906

In the first half of the 20th century, the study of General Pathology received a great stimulus by the enormous progress of life sciences such as: Biochemistry, Cellular Biology, Molecular Biology and Microbiology, Genetics and Immunology, which offered new bases for the study of the mechanisms of diseases at a molecular level. This event represented a great stimulus for the growth of General Pathology in Italy. Indeed, immediately after WWII many Italian researchers, who sensed their inadequacy in the scientific field due to the well-known Italian political events, went abroad to be trained in these new disciplines bringing back into Italy an immense cultural awareness. Thanks to the advancement of the scientific level of Italian researchers involved in the study of the mechanism of diseases, the prestige of General Pathology greatly increased in the curriculum of medical studies in Italy. In particular, today, General Pathology is considered the most important pre-clinical discipline that trains students in methodological reasoning and in the elaboration of all the information derived from basic sciences which today are essential in medical practice and in preventive medicine. In addition, General Pathology continues to represent a sort of archive of medical progress.

This evolution of General

Pathology has been less prominent in Anglo-American Schools of Medicine, where General Pathology continues to be considered as an introduction to Systemic Pathology, rather than a an independent discipline. Of course, there are several important exceptions, if we consider the unforgettable Lectures of General Pathology edited by Florey, which included various classical topics of General Pathology presented by specialists which worked at Oxford University.

We should also

remember that the General Pathology covered in Cotran and Robbin's textbook, which reflects the teaching of General Pathology at Harvard University, has continued to expand in its various editions in these last decades.

In Italy, the evolution of General Pathology has produced a continuous differentiation between General-pathologists and Anatomo-pathologists on a teaching as well as an institutional level, which brought about in 1978 a clamorous division within the Italian Society of Pathology, to which the two groups had belonged since 1901. How is General Pathology taught within the Schools of Medicine in Italy? General Pathology is generally taught in two semesters in the third year of the first three year curriculum of Medical Studies, while Systemic Pathology (Morbid Anatomy) is taught in the second three years together with the clinical disciplines.

Students who take the courses in General Pathology have already acquired notions of Histology, Cellular Biology, Anatomy, Physiology, Genetics, Biochemistry, Immunology, and Microbiology. The close relationship between General Pathology and basic sciences is well illustrated by the graphic representation created by Dr. Diamantopulos, which presents General Pathology as a trunk that has its roots in the basic sciences.

The Tree of Medicine:
the trunk is General Pathology, which draws from all the basic sciences, and divides into the many branches of Special Pathology; each one of these supports a specialized field of Medicine.
(Courtesy of Dr. George Th. Diamandopoulos, Harvard Medical School, Boston MA.)

General Pathology is taught with formal lectures, seminars organized by the professors or the students themselves, and practical exercises in histopathology directed by instructors. We consider it very useful for the students to learn how to recognize the morphological features of some typical pathological processes, such as necrosis, inflammation, tumors, etc., since, in our opinion, the morphological representation of pathological processes contains a great deal of information that stimulates the imagination of students. Moreover, in our opinion, skill in histopathology gives the students a precious tool for future involvement in research and diagnosis. One will note that the list of the principal chapters presented in our course in General Pathology also includes Immunobiology and Immunopathology. The various Medical Schools in Italy have the freedom to present Immunobiology and Immunopathology as independent disciplines or as a part of General Pathology. Our preference for teaching Immunobiology and Immunopathology together with the other topics of General Pathology is due to the consideration that immunological mechanisms underlie several pathological processes.

Principal chapters presented to medical students in the Course of General Pathology
Academic Year 2006-2007

1st semester

Definition of disease Definition of etiology
Definition of pathogenesis
The major causes of disease
Inflammatory process
Repair and regeneration
Immunobiology and immunopathology
Host-parasite relation
General pathology of the circulation: ischemia, shock
General pathology of hemostasis

2nd semester

General pathology of tumors
Cellular pathology
Pathology of extracellular matrix
Genetic disorders
General pathology of bleeding and of red blood cell disorders
General pathology of chemical equilibrium
General pathology of metabolism and nutrition

The course develops around a definition of disease that derives from the concept expressed by C. Bernard; that is: disease is an alteration of specific functions carried out by cells, tissues or complex apparatuses, which affects the homeostasis of the whole organis. In agreement with this definition, an equal attention is dedicated by professors to the alterations of cellular functions (e.g. necrosis, hyperplasia, etc.), and of complex integrated physiological systems (e.g. shock, etc.).

“Disease is an alteration of specific functions carried out by cells, tissues or complex apparatuses, which affects the homeostasis of the whole organism”

At the beginning of the course, we spend some time in introducing the students to the language of General Pathology by familiarizing them with the concept of Etiology and Pathogenesis.The students will acquire the notion that etiology goes beyond the mere study of the causes of disease, but also includes the modalities of their interactions with the host and the receptiveness of the host, which favour the incidence of disease. This concept make the students aware that etiology is the basis of preventive medicine.

ETIOLOGY: study of the causes
(grec: aitia = cause, logos = study)

Determinant factors

Causes of diseases (chemical and physical agents, immunological reactions, infectious agents, hypoxia,nutritional deficit, etc)
Modalities of interactions of pathogens with the hostintensity of the stimulus
Length of exposure to the stimuli (temporary or permanent)
Pathways of penetration

Promoting factors

Receptivity of the host due to:
Age
Sex
Nutrition
Hormonal status
Environmental factors
Metabolic characteristics of the organs
Individual genetic background
Pre-existent alterations of the organs

Particular attention is devoted to the introduction of the concept of pathogenesis which should be distinguished from the natural history of diseases often reported as a synonym of pathogenesis in Anglo-American textbooks of Internal Medicine. The general characteristics of the pathogenetic mechanisms herewith illustrated turn out to be useful to establish an adequate therapy that can restore normal functional levels.

PATHOGENESIS

Definition:
mechanism through which a stimulus interacting with a receptive host produces a stable alteration of a specific function, that is, a disease

General characteristics of pathogenetic mechanisms:
pathogens, by altering specific physiological mechanisms (metabolic, neuro-endocrine, etc.), trigger specific reactions and causes specific patterns of injury
since physiological mechanisms are interconnected according to pre-established programs, their alteration propagates through an ordered sequence of events

The knowledge of pathogenetic mechanisms allows:
the understanding of the syntomps of diseases
the establishment of an adequate therapy to restore normal functional levels

In our School of Medicine, the students are supported in their preparation of the exam by a detailed course syllabus. The principal chapters, e.g. Physiopathology of blood, are subdivided in subchapters (A, B, C, etc), each of which contains the topics (1 to ...) of the lectures. The objectives set out in the subchapters are considered by the students very useful in organizing their study. An example, herewith reported, may be useful to illustrate how the program is organized. At the end of the course, the students give anonymous evaluations of the instruction they have received.

A GUIDE FOR THE STUDENTS IN THEIR PREPARATION OF THE EXAMINATION OF GENERAL PATHOLOGY

Some samples of the content:

PHYSIOPATHOLOGY OF BLOOD

C) PHYSIOPATHOLOGY OF RED BLOOD CELLS
1. Erythropoietin regulation of erythropoiesis: the polycytemia
2.Nutritional factors in erythropoiesis
3.Hemoglobin synthesis
4.Morphologic and metabolic characteristics of red blood cells
5.Anemia: definition and criteria of classificatio
6.Some examples of hypoproliferative hemolytic, and hypomaturative anemias
7.The anemic condition: tissue injury and anemic hypoxia; adaptation mechanisms

Objectives: After having acquired the concept of erythron as morpho-functional unit specifically involved in O2 transport, the students will resume the fundamental steps in the generation and maturation of red blood cells. Thus, the students will acquire the essential elements for viewing anemia as a unitarian disorder of a complex system, a sort of a functional elementary lesion, caused by the interference of various causes of diseases with specific control mechanisms. This unitarian view of anemia will help the students understand that the anemic condition, regardless of the etiology, is responsible of hypoxic tissue injury and induces uniform adaptation mechanisms.

Finally, the exam! The exam for General Pathology in Italy differs depending on the University offering the exam: oral exams, written exams, multiple choice tests, papers, etc. At our University, we give oral exams, where the students are asked to discuss three different subjects, each of which is proposed by each member of the examination committee, which is comprised of three examiners. Our oral exam is preceded by a preliminary exam in histopathology and by a test of the principal biological parameters. Our preference for oral exams is due to the belief that this type of exam, although time consuming and rather stressful for the professor as well the student, offers the possibility of exploring the intellectual ability of the student in a more reliable manner. It also allows the professor to verify to what extent the student has organized and integrated the entire discipline.

Every once and a while there is a proposal to reduce the scope, and consequently the weight of General Pathology as a discipline in the curriculum of medical studies, mainly on the basis of the observation that research on the mechanisms of diseases at the present time is carried out in departments other than those of General Pathology. Although we recognize the validity of this observation, we think that General Pathology should be taught as a single doctrine in order to give a unified view of the mechanisms of diseases. It seems to us that this point of view is supported by the appreciation of our discipline demonstrated by the students who have come to consider it a vital part of their professional training. Pathologytree

There is another concern regarding General Pathology, due to the enormous wave of information derived from the explosion of the studies on molecular biology. Although some of this information has contributed to some advancement in Medicine, most do not fit, at least not yet, with a coherent picture, therefore limiting the medical perspectives. Furthermore, there is the risk that this information may remain abstract for the students in their approach toward the complex physiological phenomena which characterize medical practice. Moreover, the progressive molecularization of medical knowledge will influence the pedagogic function of General Pathology which must then preselect those notions of molecular biology that account for important events in the field of medicine. This implies that in the future General Pathologists should wisely revise the whole discipline, in order to preserve the bulk of its vital function in medicine.