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Automated cell counters: These were initially used in haematology in the 1960s and subsequently applied more generally in flow cytometry. The principle of the Coulter counter, with blood cells counted as they pass in single file across a light or other energy source, has been applied in many aspects of clinical and research pathology.

Automated clinical chemistry: Initially, in the early 1970s, multichannel analysers were used, then sequential analysis and dry chemistry techniques were introduced and, more recently, "near-patient" testing.

Introduction of Medicare: Medicare's introduction in 1975 profoundly affected many aspects of clinical care, and has been partly responsible for a great increase in private pathology practices.

Improved standards of forensic pathology and science: The debacle of the forensic investigation for the prosecution of the Azaria Chamberlain case in the 1980s showed up the appalling state of forensic pathology and forensic science in Australia, and was an impetus for the development of excellent forensic institutes and facilities in many Australian centres, with much-improved training programs and standards of practice.

Frozen-section techniques and biopsies: Frozen-section techniques, percutaneous biopsies of kidney, liver and heart and, more recently, fine-needle aspiration and endoscopic biopsies have greatly improved knowledge of many disease processes, as well as provided accurate pathological diagnoses from very small samples.

Medical laboratory accreditation: Nationwide medical laboratory accreditation in the early 1980s, together with quality control and quality assurance programs under the aegis of unique cooperative arrangements between the National Association of Testing Authorities and the Royal College of Pathologists of Australasia (NATA/RCPA) began in the late 1970s and continue to operate to a large extent as peer-review systems.

Decline in hospital autopsies: The progressive decline in numbers of hospital autopsies during the latter part of the 20th century has resulted in the inevitable loss of clinicopathological correlations and valuable learning resources. Surveys of hospital deaths have shown large discrepancies between the clinical opinion of cause of death and comorbidities, and findings at autopsy.

Advances in microscopy and staining: In both research and diagnostic pathology, the application of transmission and scanning electron microscopy and fluorescent and immunohistochemical techniques has contributed significantly to understanding the pathogenesis of many diseases, and to their accurate diagnosis.

Advances in cytological techniques: Exfoliative cytology was initially used largely in gynaecology and pulmonary medicine, but subsequently in many other circumstances. More recently, cytology has been vastly expanded with the widespread use of fine-needle aspiration, and automated techniques for screening are coming into use, increasing overall diagnostic accuracy.

Molecular pathology: Application of techniques of molecular biology and genetic analysis to diagnosis in pathology has had profound effects in all disciplines of pathology.

Role of Helicobacter pylori: After the initial observations by pathologist Robin Warren and gastroenterologist Barry Marshall, in Perth in the early 1980s, the aetiological role of this organism in gastric and duodenal ulceration and cancer is now accepted by gastroenterologists and pathologists worldwide.

Elucidation of aspects of viral infections: Elucidation of many aspects of viral infections, including the hepatitis viruses and HIV, is having profound effects on blood donations and blood transfusion technology, and patterns of behaviour in the community.

Importance of apoptosis: The role of apoptosis (certain cells are programmed to die at a particular time) in embryological development has been known for 100 years or so. Its importance in normal adult physiology and in a large number of disease processes only became apparent after pioneering work undertaken by Brisbane pathologist John Kerr in the late 1960s.

Corporatisation of private pathology practices: The increasing corporatisation of private pathology practices in Australia, with ownership going from practising pathologists to other individuals or companies, and public laboratories becoming business units, is cause for concern. More and more individual practices are controlled by fewer and fewer people.

Peter B Herdson
Forensic Pathologist, Canberra, ACT

Richard A Scolyer
Anatomical Pathologist
Royal Prince Alfred Hospital, Sydney, NSW

Alistair R McGregor
Director, Microbiology and Infectious Diseases
Royal Hobart Hospital, Hobart, TAS

Above photograph courtesy Alfred Hospital Heritage Committee, Melbourne.

©MJA 2001
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