The New York Times Magazine looks at the history of autopsy, and the social and fiscal constraints that prevent our society from fully using this important medical tool. Some history, taken from the article:
The autopsy’s intellectual founder was Giovanni Morgagni, a physician and professor at the University of Padua who wrote one of the most gruesome, humane and riveting early texts of modern medicine, ”The Seats and Causes of Disease Investigated by Anatomy.” Published in 1761, when Morgagni was 79, the book describes nearly 700 autopsies he performed. His lucid, compassionate accounts demonstrated irrefutably that illness works in traceable, physical ways; medicine, therefore, should be an empirical endeavor aimed at particular physical processes rather than ”humors,” spirits or other intangibles.
Morgagni’s perspective was carried into the present era by William Osler, a Canadian who practiced and taught medicine in the United States in the late 1800’s. Osler exerted more influence on 20th-century medicine than any other doctor, primarily by creating at Johns Hopkins Medical School the model for medical education still used today, with students seeing patients beginning their third year and training in internships and residencies after graduating. Osler placed the autopsy at the center of this education, performing more than a thousand post-mortems himself and insisting that staff members and students do them regularly. Tracking the necrotic footprints of their own missteps, he believed, would teach them lessons far more memorable than any text could.
Osler’s argument was strengthened in the early 1910’s by the work of Richard Clarke Cabot, who reviewed the records and autopsies of thousands of patients at Massachusetts General Hospital and found that the autopsies showed clinical diagnoses to be wrong about 40 percent of the time — the finding replicated many times since. His reports helped solidify the autopsy’s central role in medical education and practice. Autopsy rates began to rise. By World War II, they were nearing 50 percent, and autopsies had become standard in medical schools and many hospitals, where weekly mortality and morbidity conferences often focused on what autopsies had revealed about the diagnosis and treatment of patients’ illnesses.
That midcentury peak helped drive remarkable medical progress. In 1945, for instance, the chance of survival for a patient with an aortic aneurysm was little better than it was a century earlier. But in the 50’s and 60’s, surgeons like Michael DeBakey, a pioneering cardiovascular surgeon, learned through trial and error — the errors offering their lessons only through autopsy — how to repair and replace first lower sections of the aorta in the abdomen and then, working up toward the heart, the biggest, most pressurized and most vital sections. By 1960, aortic repairs were routine. By 1970, the lessons learned helped make open-heart surgery common as well.
Read the whole article.
If you would like to learn more about the (forensic) autopsy process step by step, you can participate in Dr. Baden’s HBO interactive feature.
On this positive vibe we would like to thank you for stopping by. “The good old days” feature means that the working week is over, and a great spring weekend is ahead. Have a nice one!
(hat tip: Rebel Doctor)