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in the biologic sciences may curtail his hitherto full mastery of all aspects of
laboratory work so that his position will become that of a moderator whose
function it is to dovetail the clinical diagnostic problems and the technical
work in the laboratory, and to facilitate the clinical and laboratory research
and the training of younger members of the hospital staff. He will keep morphologic pathology as his own domain and will direct the work of the laboratory.
In addition to interpretation of the findings at necropsy and biopsy and of various
laboratory procedures, he will be available for consultation with other members
for clinicopathologic conferences and tumor conferences, and will participate
in ward rounds and other teaching duties. In his unique position he will be called
upon to concern himself with many different aspects of hospital work.
By virtue of his training in pathology and laboratory diagnosis and because
he is not engaged in competitive clinical practice, he should be qualified as a
consultant in clinical medicine and as a leader in medical education. 3 Since
many of his activities are of immediate diagnostic and therapeutic benefit to
the individual hospital patient, the pathologist is becoming more and more a
physician in the true sense of the word. Young men with high scientific and
clinical ideals should, therefore, find this field increasingly attractive and satisfying. In the last analysis, clinical pathology provides the working conditions
which test one's knowledge of medicine and ideals of service.
Chicago
HANS POPPER
REFERENCES
1. CURPHBY, T. J . : Widening horizons in pathology. Am. J. Clin. P a t h . , 19: 1-9, 1949.
2. KLEMI'ERKB, P . : Introduction, in Anderson, W. A. D . : Pathology. St. Louis: C. V.
Mosby Co., 1948.
3. W E L L S , H. A.: The pathologist and continuation of medical education in a private
hospital. Am. J. Clin. P a t h . , 19: 369-371, 1949.
T H E NECROPSY RECORD*
The rapid evolution of modern medicine has brought about changes in the
whole concept of necropsies, their purpose, the manner of their performance,
and their recording. Only when the examination is made for medicolegal purposes, or in case of sudden and apparently unexplained death, is the immediate
cause of death of primary interest. In all other examinations the necroscopist
attempts from the findings to reconstruct the sequence of the disease processes
and their interrelations.
As a disease process evolves, structural changes occur in the organs concerned.
These are frequently detectable on physical examination and are productive of
clinical signs and symptoms. Some are demonstrable by roentgenographic, electrocardiographic or electroencephalograph^ methods. Some may be revealed by
alterations in function or they may be amenable to exploration by clinical laboratory procedures. The assembling and interpreting of these data usually result
in a concept of the disease process that enables the clinician to attempt its in* Received for publication, October 30, 1950.
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terception, its cure, or delay of its progress. Some lesions may be overlooked,
or some may be silent, and for others no clinical methods of detection are as yet
available. It is the purpose of the necropsy to elicit and expose all lesions present,
to determine the sequence in which they developed, and the extent to which
they were interdependent. The principal lesson to be learned from each necropsy
is, therefore, clarification of the evolution or natural history of the disease
culminating in changes that caused the death of the individual. The correlation
of these changes and their sequence with the physical findings, the clinical signs
and symptoms, and the laboratory data provides the best opportunities for the
evaluation of the accuracy of clinical diagnosis and of the efficacy of treatment.
The modern necropsy record constitutes a unit of scientific information for
subsequent study and analysis. In its completeness it has no counterpart in the
past. A carefully prepared abstract of the clinical history including the pertinent
physical findings, the laboratory data, and the observed course of the disease is
an essential part of the record. The protocol contains the postmortem observations
made on external examination of the body and on examination of the individual
organs with photographic illustrations of the lesions. It also contains microscopic descriptions of the principal organs and of all those grossly involved. The
findings are summarized in the anatomic diagnosis. This is a record in an anatomic
language of the events in their sequence as revealed by the gross and microscopic
examinations and of the incidental lesions. First are recorded in sequence the
principal lesions that led to death; then are listed the incidental other lesions and
abnormalities observed. For example, a patient with hypertension, if this were
a dominant factor in the cause of death, may according to the necropsy findings
have had "nephrosclerosis, arterial and arteriolar; cardiac hypertrophy and
dilatation; chronic passive congestion of viscera with ascites, hydrothorax, bilateral, and hydropericardium; pneumonia, focal, bilateral." Another patient
with hypertension may have had "nephrosclerosis, arterial and arteriolar; cardiac
hypertrophy with scarring of myocardium; sclerosis of the coronary arteries
with occlusion of left anterior descending branch and infarction of myocardium."
Still another may have had "nephrosclerosis, arterial and arteriolar; cardiac
hypertrophy; sclerosis of cerebral vessels with occlusion and hemorrhage into
left cerebral hemisphere."
The correlation of clinical data and necropsy findings as practiced in clinicopathologic conferences broadens the knowledge of the clinician and of the pathologist. The cooperative spirit that develops at such contacts contains the most
potent seed for the further growth of scientific medicine. In such circumstances
modern anatomic pathology takes its proper place as a dynamic living subject.
BELA HALPERT
Veterans Administration Hospital
Houston 4, Texas