Correspondence official cause of death of each cadaver. I realized that the medical students were helping me with the most tllorough autopsies of my pathology training. I took sections of obvious tumors and of grossly undiagnosable lesions for histologic examinntion. These were e m b e d d e d in o u r pathology laboratory and nlost t u r n e d out to be ahnost indistinguishable fiom sections of fi'esh surgical specimens (Fig. 1). At tile e n d of tile ternl, I wrote an autopsy s u m m a r y of tile gross and microscopic findings for each cadaver a n d discussed the material witll tile stndents. Solne pathologic abnormality was f o u n d in every cadaver. In about two-thir~ls of tile 46 cases the cause of death was identifiable. (Tile brains had been removed.) T h e surprising finding was that in a great many cases the cause o f death was clinically not identified correctly, and there.were a n u m b e r of cases in which a major disease process was not even suspected. By integrating some general principles of pathology into freshman anatomy, an atmosphere was created that heightened tile stndents' curiosity about all diseases and how

T o TilE EDITOR: As a senior resident in pathology at the University of Iowa, I had tile opportunity to participate in a cancer education project that was flmded by tile National Cancer Institute. T h e project was to have a pathologist present in tile freshmala medical student gross anatomy laboratory to examine traces o f disease found in the cadavers. It was based on some ideas of MetcalP in 1970 and e x p a n d e d by T e r n l a n et a17 in 1975. Whereas tile original purpose of this project was to imbue in tile young medical students a cancer-seeking attitude that would persist in their attitudes toward their patients, I realized that this project migllt llave a n o t h e r impact relevant to the field of pathology. This was an explicit demonstration of the importance of the autopsy. T h e r e were 46 cadavers. I visited every table on a regular basis and studied any abnormalities that had been f o u n d d u r i n g the meticulous dissection. I discussed the various pathologic findings in the light of a scanty ante mortem clinical history or the stated

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t h e y have tlleir final e x p r e s s i o n in the patient. T h e y l e a r n e d the i m p o r t a n c e o f a n a t o m y to t h e pathologist a n d o f p a t h o l o g y to the clinician. In effect, this exercise b e c a m e the students' first antopsies, a n d t h e y l e a r n e d h o w r e w a r d i n g it can be. T h e students w e r e b e w i l d e r e d by the disc r e p a n c y b e t w e e n w h a t we f o u n d and what h a d b e e n k n o w n clinically o r stated on the d e a t h certificate. S o m e w e r e a n g e r e d . Was t h e i r newly chosen c a r e e r indifferent to accuracy and t r u t h ? I f e v e r t h e r e was a p o i n t to attack the medical world's i n d i f f e r e n c e to the atttopsy, tiffs is the place. T h e curiosity o f medical s t u d e n t s is at its h e i g h t d u r i n g the first year. I f a desire can be instilled in t h e m at this p o i n t to always want to k n o w the cause o f d e a t h o f t h e i r patients, p e r h a p s we will see a r e s u r g e n c e o f the concept tlmt t h e autopsy is a final and necessary step in the s t u d y o f each patient. Let us, as pathologists, find o u r way into t h e gross dissection r o o m s o f o u r country's medical schools with t h e c h a l l e n g e to the first )'ear s t u d e n t tllat lie is p e r f o r m i n g his first autopsy. Not only will a n a t o m y be less boring, but lie will be m o r e r e c e p t i v e to the discipline o f atttopsy pathology.

114

In a d d i t i o n , this project p r o v i d e d m e with 46 e x t r a autopsies in my own r e s i d e n c y training. T h i s is a benefit for the individual pathologist in an e r a w h e n the n u m b e r o f autopsies is diminislfing. Because o f a scanty ante m o r t e m history, if t h e r e w e r e o n e at all, s o m e o f t h e e x c i t e m e n t and s u r p r i s e o f a forensic autopsy s u r r o u n d s each case. T h e s e cadavers r e p r e s e n t a p o p n l a t i o n o f cases that is somewllere in tim m i d d l e o f the s p e c t r u m r a n g i n g f r o m those atttopsies that are definite medicolegal cases to those that are tile higllly selective atttopsies o f a large medical center. N o t only m i g l i t : v a l u a b l e e p i d c m i o l o g i c data be obtained, but the pathologist h i m s e l f can see disease in its p r o p e r perspective in o n r society. EDWARD

F.

~[cCARTHY,

M.D.

Sinai ttospital of Bahimore Bahimore, Maryland

Metcalf, N. F.: Pathology in gross lab: motivation or correlation? Anat. Rec., 172:440, 1972. Terman, S. A., Metcalf, W. K., Metcalf, N. F., and Miller, D.: Cancer case-finding in gross anatomy to stimulate sntdent interest. J. Iowa Med. Soc., August 1975.