Dr Bill Hunt rev iews A Handbook of Anatomical Pathology Technology, which was edited Edited by Dr RA Burnett (pictured below), RIPH, London, 2004

There were two medical Heggie brothers, often known, behind their backs of course, as Good Heggie and Bad Heggie. I only knew Good Heggie, to whom the latest edition of the red book is dedicated. He would have been proud of it.

The outstanding feature of the book is the amount of valuable information that it manages to pack into such a small volume. Running a mortuary is no longer the straightforward task it used to be. Written protocols, guidelines, standard operating procedures for almost every activity, simple or complex, have made mortuary management a potential nightmare. Through these and through COSHH’s, MEL’sand OES’s, the new Handbook is a much needed guiding light.

The increased realisation that dealing with relatives is a vital and often difficult part of the profession is well recognised in the Handbook, which gives very sensible advice and guidance. The whole perception of the dead seems to have changed over the last half century. A theological friend of mine believes that the present emphasis on the substance of the body rather than on the soul is a phenomenon of post-Christian Britain. Whatever the reason, it seems to have come to stay.

As a pathologist, I found the chapter on autopsy technique very interesting. Several bits of it raised the eyebrows. A quick straw poll of pathologists in the south of England, for example, showed a marked preference for the en bloc technique of evisceration, rather than the Rokitanski ‘all-in-one’ method (rather pedantically referred to in this book as the ‘Letulle Technique’). Not a single pathologist had ever heard of the recommendation (page 64) that the intercostal muscles should be divided before the sternum is removed; very few dissected out the clavicles, but just disarticulated the sterno-clavicular joint. The technique (page 73) of only sawing the outer table of the skull and cracking the inner table with a mallet and key is not nearly so often used as it once was and should never be employed in a forensic case where there may be a skull fracture. All these things go to show that the well-rounded APT needs a knowledge of a number of different techniques if he has more than one pathologist working in his autopsy room.

Perhaps slightly dangerous is the recommendation of ‘sweeping cuts’ with a PM40. It reminds one of the famous 19th century French surgeon whose sweeping cuts, when he broke the world speed record for upper thigh amputation in the days before anaesthesia, included the patient’s left testis and two fingers of his assistant’s right hand.

There is one glaring omission in the contents of the Handbook: there is no chapter on how to deal with a difficult pathologist. Perhaps the editor should seek an APT to write one for the next edition: there should be no shortage of experienced volunteers.

Dr. Bill Hunt, (retired Home Office Pathologist and former president, British Association in Forensic Medicine)