Letters to the Editor The Autopsy Supplement
Received April 10, 1978; accepted for publication April 10, 1978. Address reprint requests to Dr. Robinson. Key words: Autopsy.
To the Editor:—The Epistle Dedicatory that Sir Thomas Browne wrote prefatory to his Hydriotaphia, while not commonly recognized as part of the literature of pathology, does contain the following paragraph: Received March 6,1978; accepted for publication March 6, 1978. Address reprint requests to Dr. Allen. Key words: Autopsy
Table 1. Autopsies Performed Autopsies
1969 1970 1971 1972 1973 1974 1975 1976 1977
Deaths
No.
%
1,109 1,240 1,154 1,171 1,162 1,154 1,086 1,137 1,075
458 479 439 371 334 259 216 214 172
41.29 38.62 38.0 33.2 28.7 22.4 20.6 18.8
16.
1971 there has been no effective stimulus from hospital accrediting agencies is the tangible reason for the precipitous decline in numbers and percentages of autopsies performed. Action by the JCAH or specialty certification boards could reverse this decline. As a first step in insuring the future of the autopsy, these groups should set specific and enforcible standards for what constitutes an adequate minimum number of postmortem examination for teaching and quality control. The existing "mother-
Beside, to preserve the living, and make the dead to live, to keep men out of their Urnes, and discourse of humane fragments in them, is not impertinent unto our profession; whose study is life and death, who daily behold examples of mortality, and of all men least need artificial mementos, or coffins by our bed side, to minde us of our graves. My own philosophy of the autopsy has always been summarized by " t o preserve the living, and make the dead
hood" types of statements made by these groups have proven to be ineffective. Concurrent with implementation of specific standards to provide an adequate number of autopsies should be action to insure that autopsies are performed in a fashion meaningful to the contemporary physician, as cited in the many suggestions in the Supplement. Without fixed minimum standards, the suggestions are meaningless, since natural trends are removing the autopsy from the "spectrum of medical care." Among organized medical groups, the idea of real standards by certifying agencies apparently is unpopular. For those of us concerned with the future of the autopsy in a hospital setting, such standards seem the only way to achieve immediate reversal of the current trend. MORTON J. ROBINSON, M.D.
Pathology Department Mount Sinai Medical Center Miami Beach, Florida 33140 Reference 1. The autopsy: A beginning, not an end. Am J Clin Pathol 69:215-265, 1978
to live," and I offer it as a belated "supplement" to your own very excellent supplement. 1 PLINY A. A L L E N , M.D.
89 Baxter Road Williamson, Massachusetts
01267
Reference 1. The autopsy: A beginning, not an end. Am J Clin Pathol 69:Suppl 215-265, 1978
Blood Gas Measurements. To the Editor—I think it appropriate to reopen the dialog dealing with the
correction of blood-gas measurements performed on patients with abnormal
Received March 6, 1978; received revised manuscript May 2, 1978; accepted for publication May 2, 1978.
Address reprint requests to Dr. Blume. Key words: Blood gas variables; Hypothermia; Hyperthermia.
440
body temperatures. In practice, this usually refers to patients made hypothermic during the course of cardiac surgery (since the consequences of fever generally seem to be ignored). The theoretical analysis of the effect
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 7, 2016
To the Editor:—The excellent supplement "The Autopsy: A Beginning, Not an End" 1 indicates the current decline of the autopsy but does not sufficiently emphasize the critical situation that exists in most teaching hospitals in both quality and quantity of patients who come to postmortem examination. One hospital's experience is summarized in Table 1. The relatively few cases that come to autopsy today reflect more physician patterns of requesting autopsy permission than careful selection of patients who die with particularly unusual, "interesting," or "doctor's dilemma" types of illnesses. In no way do the unselected core cases meet the needs of a dynamic autopsy service in a teaching institution. While many factors, from pathologist disinterest to clinician malpractice fears, have received national attention as the cause for the decrease in hospitalperformed autopsies, the fact that since
Received April 10, 1978; accepted for publication April 10, 1978. Address reprint requests to Dr. Robinson. Key words: Autopsy.
To the Editor:—The Epistle Dedicatory that Sir Thomas Browne wrote prefatory to his Hydriotaphia, while not commonly recognized as part of the literature of pathology, does contain the following paragraph: Received March 6,1978; accepted for publication March 6, 1978. Address reprint requests to Dr. Allen. Key words: Autopsy
Table 1. Autopsies Performed Autopsies
1969 1970 1971 1972 1973 1974 1975 1976 1977
Deaths
No.
%
1,109 1,240 1,154 1,171 1,162 1,154 1,086 1,137 1,075
458 479 439 371 334 259 216 214 172
41.29 38.62 38.0 33.2 28.7 22.4 20.6 18.8
16.
1971 there has been no effective stimulus from hospital accrediting agencies is the tangible reason for the precipitous decline in numbers and percentages of autopsies performed. Action by the JCAH or specialty certification boards could reverse this decline. As a first step in insuring the future of the autopsy, these groups should set specific and enforcible standards for what constitutes an adequate minimum number of postmortem examination for teaching and quality control. The existing "mother-
Beside, to preserve the living, and make the dead to live, to keep men out of their Urnes, and discourse of humane fragments in them, is not impertinent unto our profession; whose study is life and death, who daily behold examples of mortality, and of all men least need artificial mementos, or coffins by our bed side, to minde us of our graves. My own philosophy of the autopsy has always been summarized by " t o preserve the living, and make the dead
hood" types of statements made by these groups have proven to be ineffective. Concurrent with implementation of specific standards to provide an adequate number of autopsies should be action to insure that autopsies are performed in a fashion meaningful to the contemporary physician, as cited in the many suggestions in the Supplement. Without fixed minimum standards, the suggestions are meaningless, since natural trends are removing the autopsy from the "spectrum of medical care." Among organized medical groups, the idea of real standards by certifying agencies apparently is unpopular. For those of us concerned with the future of the autopsy in a hospital setting, such standards seem the only way to achieve immediate reversal of the current trend. MORTON J. ROBINSON, M.D.
Pathology Department Mount Sinai Medical Center Miami Beach, Florida 33140 Reference 1. The autopsy: A beginning, not an end. Am J Clin Pathol 69:215-265, 1978
to live," and I offer it as a belated "supplement" to your own very excellent supplement. 1 PLINY A. A L L E N , M.D.
89 Baxter Road Williamson, Massachusetts
01267
Reference 1. The autopsy: A beginning, not an end. Am J Clin Pathol 69:Suppl 215-265, 1978
Blood Gas Measurements. To the Editor—I think it appropriate to reopen the dialog dealing with the
correction of blood-gas measurements performed on patients with abnormal
Received March 6, 1978; received revised manuscript May 2, 1978; accepted for publication May 2, 1978.
Address reprint requests to Dr. Blume. Key words: Blood gas variables; Hypothermia; Hyperthermia.
440
body temperatures. In practice, this usually refers to patients made hypothermic during the course of cardiac surgery (since the consequences of fever generally seem to be ignored). The theoretical analysis of the effect
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 7, 2016
To the Editor:—The excellent supplement "The Autopsy: A Beginning, Not an End" 1 indicates the current decline of the autopsy but does not sufficiently emphasize the critical situation that exists in most teaching hospitals in both quality and quantity of patients who come to postmortem examination. One hospital's experience is summarized in Table 1. The relatively few cases that come to autopsy today reflect more physician patterns of requesting autopsy permission than careful selection of patients who die with particularly unusual, "interesting," or "doctor's dilemma" types of illnesses. In no way do the unselected core cases meet the needs of a dynamic autopsy service in a teaching institution. While many factors, from pathologist disinterest to clinician malpractice fears, have received national attention as the cause for the decrease in hospitalperformed autopsies, the fact that since
