'Living in the clouds of a vain illusion': The decline and fall of clinical autopsies

ABSTRACT

Autos is Greek for oneself and opsis refers to the act of viewing; combined into autopsy, the word refers to the act of seeing for oneself.1,2 Historically, autopsies have been crucial to our understanding of the natural history of disease and the efficacy of our attempts to treat them. They have also humbled us by showing our shortcomings and errors. Campos and Rocha have reviewed autopsies over the past 4000 years and have highlighted their pedagogical value.3 In the era preceding Roentgen, autopsies were an unparalleled means for learning pathology. Works of great masters such as Giovanni Battista Morgagni (1682–1771) and Rudolph Virchow (1821–1902) were based on meticulous autopsies; Virchow added the use of the microscope. Carl Rokitansky (1804–78), working at the Allgemeine Krankenhaus in Vienna, performed 30 000 autopsies personally and supervised many more, making his institute one of the most respected training centres in pathology in Europe.1,2 The names of two early clinicians, who used autopsies to understand disease, come to mind. Pierre Charles Alexandre Louis (1787–1872) studied enteric fevers and distinguished typhoid from other causes of fevers. He correlated the intestinal lesions termed Peyer’s patches (after Johann Conrad Peyer [1653–1712] who had described them in the 1670s) with typhoid and used medical statistics to lay the foundation of what we now term evidence-based medicine.4 The surviving volumes of autopsy notes by William Osler at McGill University, the Montreal General Hospital and Philadelphia General Hospital, stand witness to his enthusiasm and competence in extracting the last bit of information from his subjects. His genius lay in correlating autopsy findings with clinical features to build unforgettable descriptions of several diseases. The lessons learnt in the autopsy room were disseminated to his students at dissections, through papers, books and at meetings.