Horst Oertel and the Russell Sage Institute of Pathology: Impacts on vital statistics and the origins of the short-lived heyday of autopsies in America

Horst Oertel was an early 20th century pathologist who began his career as an instructor of clinical pathology at the New York University and Bellevue Hospital Medical College in 1899. In 1903, he was appointed pathologist for City Hospital, an institution for indigent patients on New York City's Blackwell's Island. In 1907, Oertel became the first director of the Russell Sage Institute of Pathology, a unique new blended public-private entity based at City Hospital, that was named after a wealthy benefactor. The Institute was established to utilize the Island's indigent population to perform anatomical pathology research on diseases of aging. Oertel and the Institute thrived until 1911, when a newly-appointed New York City bureaucrat seeking patronage and graft began meddling in the Institute's governance. After press coverage of a vitriolic one-week-long exchange of charges and counter-charges between the Institute's Board of Directors and the bureaucrat, the Institute imploded. While these events meant that the Institute's tenure on Blackwell's Island would soon be coming to an end, Oertel continued to work and submit articles from the Institute throughout 1912. In May 1913, he published "The Inaccuracy of American Mortality Statistics" in American Underwriter, a bombshell article documenting low autopsy rates and high clinical diagnostic error rates at Bellevue Hospital during 1912. This, along with similar studies by Richard Cabot at Massachusetts General Hospital in Boston, highlighted fundamental problems in hospital care and medical education across America. Simultaneously, Oertel led the Public Health, Hospital and Budget Committee of the New York Academy of Medicine which reported that, in a selected series of large American hospitals, the autopsy percentage when compared to the number of deaths was one-eighth the rates in Canada, Great Britain, Austria, and Germany. This paper addresses how American autopsy rates skyrocketed and then plummeted again during the mid-20th century.