15283-B-Blokker

12 Chapter 1 Microscopy Van Leeuwenhoek discovered the microscope and used it to closely examine ( ӬӣӨөӼӲ / ӬӣӨөӺ , skopeo/ skopo ) the small ( ӥӢӣӪӹӫ , mikros ) things, like microorganisms. Virchow was the first to apply state of the artmicroscopy for the examination of cells and tissues. He and other academic researchers comprehensively investigated disease processes, such as cancer, thromboembolism and inflammation, and made many contributions to the basic understanding of diseases. Over the years, the limitations of gross pathology were recognized and the added value of microscopy was generally acknowledged. Thus, with the further standardization of autopsy techniques, the protocols included macroscopy and microscopy. CURRENT PRACTICE In the twentieth century, medical progress and the understanding of disease, mainly depended on clinicians’ observations and proving their diagnoses to be wrong or right through autopsy. Until the present day, the conventional autopsy (CA) has proven to be a valuable tool in clinical medicine. On an individual level, by revealing the cause of death and other possibly relevant or missed diagnoses, the autopsy outcome may aid next-of-kin in their grieving process 5,6 and provide doctors with information for risk counselling and with feedback on clinical diagnoses and therapies. The importance of this feedback is borne out by the frequency of discrepancies between clinical diagnoses and post mortem findings that are still found, in spite of the advanced diagnostic techniques used in modern medicine. 7-14 These include major errors or class-I-discrepancies in up to one fourth of the cases, depending on the case mix. In the bigger picture, CA is relevant for healthcare quality control and policy making; for medical science and education; for accurate death certificates and epidemiologic databases; and for obtaining human tissue samples for laboratory research 15-27 Attitudes toward autopsy in history The Egyptians believed that major disfigurement of the deceased’s body would prevent the deceased from entering the afterlife. Other (earlier) civilizations also had objections against autopsy, either based on religious grounds (the body must be treated with respect and buried promptly), on humanitarian and aesthetic grounds, or out of fear