The Autopsy, Medical Practice and Public Policy

322 Pages·1989·53.731 MB·English

by  Rolla B Hill

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bel Copyright Elsevier 2020
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b This book belongs to Sophie Lecomte
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The Autopsy-
Medical Practice and
Public Policy
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The Autopsy-
Medical Practice and
Public Policy
Rolla Β. Hill, M.D.
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m Research Professor of Pathology, State University of New York, Health Science
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ec Center-Syracuse, Syracuse, New York
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hi Robert Ε· Anderson, M.D.
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o Frederick H. Harvey Professor and Chairman of Pathology, University of New
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g Mexico, School of Medicine, Albuquerque, New Mexico
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k Foreword by Frederick C. Robbins, M.D., University Professor, Department
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bo of Epidemiology and Biostatistics, Case-Western Reserve University, Cleve­
his land, Ohio; Former President, Institute of Medicine, National Academy of
0 T Science, Washington, DC
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r Illustrated by Michael F. Norviel
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Butterworths
Boston London Singapore Toronto Wellington
Copyright © 1988 by Butterworth PubHshers, a division of Reed Publishing (USA)
Inc.
All rights reserved.
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o No part of this publication may be reproduced, stored in a retrieval system, or
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e transmitted, in any form or by any means, electronic, mechanical, photocopying,
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e recording, or otherwise, without the prior written permission of the publisher.
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s t Library of Congress Cataloging-in-Publication Data
g Hill, Rolla Bennett, 1929-
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o The Autopsy—Medical Practice and Public Policy
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b by Rolla Β. Hill and Robert Ε. Anderson; with illustrations by Michael F.
ok Norviel.
bo p. cm.
s Bibliography: p.
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T Includes index.
0 ISBN 0-409-90137-7
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0 1. Autopsy—Social aspects. I. Anderson, R. E. (Robert Edwin),
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r 1931- . II. Title.
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vi RB57.H55 1988
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s 616.07'59—dcl9 87-31963
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op British Library Cataloguing in Publication Data
C Hill, Rolla Β.
The Autopsy—Medical Practice and Public Policy
1. Autopsy
I. Title II. Anderson, Robert E.
616.07'59 RB57
ISBN 0-409-90137-7
Butterworth Publishers
80 Montvale Avenue
Stoneham, MA 02180
10 9 8 7 6 5 4 3 21
Printed in the United States of America
To our students and teachers,
with gratitude
for all that they taught us,
and
to the patients we have autopsied,
with gratitude
for all that they taught us.
They made their final contribution.
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Contents
Contributing Authors xi
Foreword Frederick C. Robbins, M.D. xiii
te Preface xvii
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c Acknowledgments xix
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e Perspecdve. Autopsies in Everyday Life: Learning
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p from Experience xxiii
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s t Part I EVOLUTION OF THE AUTOPSY:
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n CHANGING GOALS AND PURPOSES
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b 1 Autopsy Practice Today 3
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o The Procedure. Hazards. Costs.
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s 2 The Recent History of the Autopsy 17
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0 T Evoludon of the Modern Autopsy. Autopsy as
2 the Source of Scientific Medicine. Present
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r and Future, Decline and Evolution.
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evi 3 Contributions of the Autopsy to Modem
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El Medical Science and Practice 43
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g Myocardial Infarct, a Paradigm of Discovery
yri through Autopsy. Advances in Medical
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o Science Provided by Autopsy. Medical
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Education. Quality Assessment.
4 Missed Diagnoses: Toward an Under­
standing of Diagnostic Discrepancies 67
Definitions. How Serious Are Diagnostic
Discrepancies.? How Frequent Are Discrepant
Diagnoses.? Impact of New Technology on Diag­
nostic Accuracy. Physician-related Factors.
Other Factors. Sensitivity and Specificity of
Clinical Diagnostics. Autopsy as Reference
Value. Final Comments.
Contents
Contributions of Autopsy to Modem
Neurologic Science {with Michael N. Hart,
M.D.) 91
Historical Role of the Autopsy in the
Development of Neurology. The Autopsy in
Neuropathology Today. The Future of
Autopsy in Neuropathology.
Contributions of Autopsy to Modem
Forensic Medicine {with John Smiaiek, M.D.) 107
Overview: Definitions and Procedures.
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mt History of Forensic Pathology. The Forensic
co Pathologist. Cause of Death. Identification of
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L the Remains. Education. Other Purposes.
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hi Forensic Pathology and the Decline of the
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o Autopsy.
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t Contributions of Autopsy to Society {with
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ng Mane Valdes-Dapena, M.D.) 123
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el Benefits to the Family. Benefits to the Public
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k Welfare.
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T Part Π DECLINE OF THE AUTOPSY
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0 8 The Rise and Fall of the Autopsy 149
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e 9 Decline of the Autopsy: Reasons in Society 157
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se Public Policy and Medicine. Fees. Autopsy
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t Rate Requirements. Death Certification and
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g Health Statistics. Families. Religion. Consent.
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p 10 Decline of the Autopsy: Reasons in
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Pathology 175
Autopsy Reporting. Autopsy Technique.
Quality Control of Autopsy. The Art of
Autopsy. Autopsy Demeaned. Autopsists.
One-upmanship and Physician Egos.
Ignorance of New Uses of Autopsy.
11 Decline of the Autopsy: Reasons in
Clinical Medicine 191
Medical Practice and Theory. The
Physicians. Medical Education. Medical
Administration. The Bottom Line.