Correspondence THE AUTOPSY T o TIlE EDITOR;

T h e comedy o f tile debate about autopsies proceeds witli an air o f Gilbert a n d Sullivan intplausibility. In a letter to the Editor, a pafllologist castigates other pathologists for actively discouraging autopsies; I in a separate letter anotller patllologist, anxious for referrals, finds tllat tile fault is with primary physicians wllose fear o f ntalpractice claints inhibits referrals, and he looses a broadside at die J C A H for not regulating the medical practice of pathologists;"- a self-styled "eklerly" patltologist criticizes a young pathologist in residency for writing about tile autopsy without reading the r e p o r t o f a s y m p o s i u n t S - a synlposiuna tlmt slle in fact a t t e n d e d and stmmmrized in her article! 4 At tile sante tinte, to insure tlmt everyone is covered, d e p a r t m e n t clmirnten are faintly d a m n e d , and the Editor is taken to task for publislling the work o f a young person! All three letters, and ntucl~ o f tile widespread debate, betray an eagerness to distribute some sort o f blame a r o u n d on everyone else, and it's not really clear wllat everyone else is being blamed for. Dialogue, suggestions, plans, and stlaring o f ideas are surely important, but it seenls to me tllat tllis a b u n d a n c e o f sackcloth, ashes, and recriminations, coupled with dazed rellections on wllat ntight have been, is unlikely to lead anywllere. Surely a course more likely to akl the resurgence of tile autopsy would be for eacll of us to search carefiflly (and honestly, like Dr. Robinson's physicians 2) for wlmt is best in o u r own situation, develop o u r objectives, our plan, and go to it in a way that is helpfid, usefnl, attd appreciated. I f a surgeon Dotes tlmt lie is being r e f e r r e d progressively fewer patients for surgery, he is unlikely to reverse the trcnd by blante-fixing o r calling for governmental regulation: Tile surgeon had best look to Iris own practices! In my na'/vet6, I really can't see why we should expect priumry physicians to go repeatedly to tile considerable trouble o f sendI n g n s patients for autopsies for o u r "interest." First it has to be useful, helpful, interesting, or profitable for the referring ph)'sician. It is desirable tllat it also be profitable and interest-

ing to us, but if it does not appeal to them, we will not get the referrals. I look forward happily to the day, not too far off, when a professional fee will be allowed tl~roughout the country for the autopsy pathologist. I have moments o f real hand-rubbing glee, however, when I retlect that, like professional fees for surgery or any other medical practice, tile fee will be allowed only if rite pathologist personally p e r f o r m s rite autopsy o r is personally present and supervisiilg d u r ing its entire performance. Such scurrying a r o u n d tllere will be! Pathologists vying witlt each other for posts! Referral patterns assiduously cuhivated! Even a few filrtive kickbacks to referring physicians! Oh, dear! Dr. Kaplan doesn't know how lucky she Ires been, doing those autopsies with responsibility a n d autonomy. 4 Tontorrow's resident, elbowed aside in the scdnctiox] o f tile dollar, while holding the suction o r o p e n i n g the gut, will bi~ wondering what h a p p e n e d to all the autopsies fornler residents used to have responsibility for! A fitting bit o f slapstick in ~'{his long low conlcdy, on which rite c u r t a i n ~ l ! o u l d be descending rigllt now. I say hooray for rite patl~ologists, tile referring pllysicians, tile J C A H , the clmirmen (I blusll), tile Editor, a n d the letter writers. A n d I say a special hooray for Dr. Kaplan's good i m m o r e d look at tile present, and lter hot)eful, creative look at the fllture. T h e decline of the autopsy is over if such as she are rising in our ranks; it is time for pathologists to catch up with its resurgence. ROLLA B. HILL, M.D. S U N Y - t ' p s t a t e ,Medical Center Syracuse, New York

1. 2. 3. 4.

Lener. ttum. Path., 9:609, 1978. l.etter, ttum. l'ath., 9:610, 1978. l.ener, lhmL l'ath., 9:611, 1978. Kaplan, R. A.: "File autopsy--to be or not to be. thtm. l'ath., 9:127-129, 1978.

T o TIlE EDITOR:

Haruspical is a naughty word. "Haruspical" relates to tile formulation o f predications based on inspection o f the entrails o f sacrificial atdmals. It was a practice o f ancient

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