Pathology in Literature

Do you still have your first science book? Maybe your bookshelf holds a cherished childhood story or an heirloom consisting of your grandparent’s favorite novella. Patrick Hansma’s book collection, however, exceeds a typical collector’s bookshelf. From medicine to theology, this forensic pathologist knows a thing or two about buying and selling rare and collective books. And, of course, his collection is inundated with historical pathology books!

We connected with Hansma to learn more about his collection and how his experience as a pathologist has influenced this side project.

Where did your journey with forensic pathology begin?
 

I discovered forensic pathology during my senior year of high school. Once I heard about pathology and autopsy, I was immediately intrigued. Shortly thereafter I learned that most pathologists don’t do autopsies, so if that was my goal, forensic pathology was the way to achieve it. During my first semester of college, I worked in the anatomic pathology department at a local hospital. And once I’d completed my first autopsy at 18 years old, my career choice was solidified.

I was then trained as a pathologists’ assistant on the job (which was still an option back then) but I never sat the exam because I was soon accepted into medical school. The rotations in my AP/CP residency kept me intellectually gripped, but nothing evoked passion in me like forensics. I just really enjoy doing autopsies!

What drew you to the world of rare and collectible books?
 

I’m not completely sure how I got here, but in college I quickly acquired a collection of antiquarian anatomy books, and pathology books naturally followed. A few years into buying whatever I could get my hands on, I realized I needed to refocus my collection and sold a large portion of my books to other pathologists. With the success of these re-sales, my wife and I launched our rare book business: Patrick’s Rare Books, with a focus on medicine, surgery, and theology books. Most of our clients are surgeons and pathologists collecting 16th through 19th century books. Of course, I still maintain my own collection, but I get to handle much more than I could keep through operating a rare book business. It has been extremely educational.

Are there any books that hold particular significance for you in your collection? What makes them stand out?
 

Absolutely – some of the finest medical chromolithographs appeared in pathology books by Cruveilhier, Orfila, and Hofmann, known for their stunning realism. Recently, I added works by Rokitansky, Morgagni, and Virchow to pathologists' personal collections, which are key highlights in medical history. I use my antiquarian pathology book collection to publish articles on medical history, including works on the evolution of the autopsy in Academic Forensic Pathology and a recent analysis of one of Virchow's autopsies in the American Journal of Forensic Medicine and Pathology. I am also preparing several monographs.

What are the parallels between the skills you use in your work as a forensic pathologist and in rare book collecting?
 

In rare books, condition is everything. So the ability to scrutinize and describe a book’s condition is essential. My rare book descriptions often sound like a pathologist wrote them, using terms like "mild, patchy, ill-defined toning of endpapers"—phrases other bibliophiles don't use. Being a pathologist gives me an advantage in understanding antiquarian medical books through hands-on experience. Non-physician bibliophiles lack that perspective. It works both ways, though. Collecting rare books helps combat physician burnout. I encourage all physicians to learn the history of medicine, especially in their specialty. It can reignite your passion when you're feeling burned out. Reading about the history of pathology can boost your motivation.

Do you find that certain eras or medical figures are more sought after in rare book collecting, particularly in the field of pathology?
 

Absolutely. Jean Fernel, in the 16th century, was likely the first true pathologist, coining the term "pathology" as we know it today. The 18th century brought influential figures like Albrecht von Haller, Herman Boerhaave, Morgagni, and Baillie. Pathology saw rapid development in the 19th century with the advent of the microscope, which refined Rokitansky's work and defined Virchow's contributions. By the century's end, many authors – some memorable, like Hektoen – were writing pathology books.

Historically, pathology was as much a surgeon's domain as a physician's. Surgeons like Ambroise Pare and Theodore Billroth were just as important as physicians like Sydenham and Andral. As surgical survival rates improved in the 19th century, pathology shifted. The autopsy, once the cornerstone of medical knowledge, remained vital, but surgical pathology, bacteriology, immunology, and transfusion medicine gained prominence as more patients survived.

Forensic pathology followed a similar path, growing rapidly in the late 19th and early 20th centuries due to population growth and urbanization. While older forensic books exist, key works for a forensic library aren't as rare or hard to find as one might expect.

Can you share a memorable story from your book-collecting adventures?
 

Lately, it’s been werewolves! I acquired an 18th century book on the history of medicine which contained a discourse on lycanthropy. At first, it seemed odd, but after checking my other books, I was surprised to see how many serious physicians wrote about werewolves. They viewed lycanthropy as a form of melancholy, often discussed in chapters on mania or mental illness. In my own collection, I traced references to it as far back as 1532, though it certainly dates back much further than this. It’s been an unexpected and interesting journey in medical history.

To what extent was your own book, The Grave Below, inspired by your work (either in forensic pathology or book collecting)?
 

One of the main characters in The Grave Below is a 21st century diener who moonlights as a grave robber. Of course, grave robbing is a huge part of the history of medicine – Astley Cooper being one of the most notorious culprits. I used my knowledge of those topics, as well as the history of dissection and autopsy, to give my novel flourishes that I think other authors could not.

The diener’s day job is given in realistic detail, true to form for the modern practice of surgical and autopsy pathology. But his life of crime at night is more akin to 18th and 19th century body trafficking and lurking around graveyards. Another main character of the book is a 16th century vampire, living as an anachronism in the 21st century. My forensic knowledge was also crucial here, allowing for more detail on the murders she commits, as well as the ensuing criminal investigations. The book is an exploration of evil in humanity – and frankly, a lot of my career in forensic pathology has inadvertently been that as well.

Do you think the rise of digital archives and e-books has impacted the value or appreciation of rare medical texts? What’s your perspective on this shift?
 

The digital age has definitely made an impact. Many books are available online for free, but most haven’t been digitized yet. While scanned copies make surface-level research quick and easy, truly understanding a book as an artifact across centuries requires handling the physical copy. Once you do, you realize there’s no substitute for the real thing. Working with a 16th century book is a completely different experience from looking at a scanned copy on an iPad. It’s like comparing examining a glass slide to viewing a photomicrograph in a textbook – there’s no comparison.

What do you see as the future of medical book collecting, both for yourself and the wider world?
 

Digital learning in medical education has distanced students and physicians from their heritage. Today’s students don’t view books as valuable objects or recognize their authors as authorities, so they don't see books as something to be respected. I use social media to show medical students that the eponyms they study can also be part of their personal libraries. For example, learning about Pancoast’s tumor becomes more meaningful when you own a copy of Pancoast’s Operative Surgery. Many great bibliophiles were physicians with impressive collections. I hope current trainees will invest in the history of medicine or other subjects like theology, literature, or astronomy. You never know what you’ll discover or build until you start exploring.

^{Images supplied by Patrick Hansma}