The accuracy of the cause and manner of death based on a medical examiner external examination of the body and review of other evidence was investigated. The authors retrospectively identified 185 such forensic cases in which an autopsy was performed subsequently at a major teaching hospital. Autopsy disclosed a change in the manner of death in only one instance. Of the 89 natural deaths, the cause of death based on external examination was erroneous in 26 (29 per cent). The majority of the errors was the result of an overdiagnosis of arteriosclerotic cardiovascular disease, hypertensive cardiovascular disease, and cancer.