In This IssueA look at the past, a vision of the future,and a clear look at today: A distinguishedhistorian, William McNeill, traces patternsin the development of infectious diseases in"Towards a Natural History of Disease,"and the Alumni Association honors mem­bers of the Rush Class of 1921 for fiftyyears of dedication to medicine at the An­nual Banquet. Dr. Joseph Kirsner takes overas Chief of Staff of the Hospitals and Clinicsand describes "The State of the Hospitalsand Clinics" at his first staff meeting. At alater meeting, Dr. Robert Daniels and Dr.Lloyd Ferguson talk about the role the Uni­versity will play in the new Mid-SouthHealth Planning Organization ("The Hos­pitals and the Community."). Meanwhile,a recent alumna, Dr. Joel Murray, is alreadycontributing her services to the community,and details her experiences in "MedicineNot on the Midway."THE COVER"Aileronde" by Antoine Poncet is a giftfrom the Nathan Cummings family to theUniversity. When the Cummings Life Sci­ences Building under construction is com­pleted, "Aileronde" will be moved in frontof it; the marble statue now decorates thegrassy area at 58th and Ellis where theBookstore once stood.ContentsThe State of the Hospitals and ClinicsDr. Joseph Kirsner 5The Hospital and the CommunityDr. Robert Daniels and Dr. Lloyd Ferguson, '60 9Medicine Not on the MidwayDr. Joel Murray '66 13Towards a Natural History of DiseaseWilliam McNeill 17Senior Scientific Session - 25th AnniversaryThe Annual Banquet 2235News 2 Departmental News 31In Memoriam 27 Alumni News 38Letters to the Editor 30 From the Alumni President 41Bulletin of the Medical Alumni Association of The University of ChicagoDivision of the Biological Sciences and The Pritzker School of Medicine950 East 59th StreetChicago, Illinois 60637Volume 26 Fall 1971 No.2Editor: Anne GrantMedical Alumni Association: William R. Barclay, President; Richard Landau, Presi­dent-Elect; Marcel Frenkel, '58, Vice-President; Henry P. Russe, '57, Secretary;Katherine T. Wolcott, Executive Secretary. Council Members are: Lampis Anagno­stopoulos, '61; William Moses Jones, '32; C. Frederick Kittle, '45; Charles Kligerman,'41; Robert L. Schmitz, '38; and Francis H. Straus, II, '57.NewsNew Members ofthe National Academyof SciencesDR. FRIED DR. SWIFTTwo members of the Division of theBiological Sciences and The PritzkerSchool of Medicine were among the 50new members elected to the NationalAcademy of Sciences this year. Theyare Joseph Fried, Professor in the BenMay Laboratory for Cancer Researchand in the Departments of Chemistryand Biochemistry, and Hewson H. Swift,Distinguished Service Professor in theDepartment of Biology in the College,and in the Committee on Genetics. Dr. Fried is a pioneer in the system­atic chemical alteration of steroid hor­mones for pharmaceutical uses.Dr. Swift, a cell biologist, has studiedthe nature of gene action in chromo­somes and mitochondria at the molecularlevel.Dr. Palmer ReceivesCancer Society AwardThe Annual Award for DistinguishedService in Cancer Control of the Ameri­can Cancer Society was given this yearto Dr. Walter L. Palmer, the Richard T.Crane Professor of Medicine Emeritus.The award was presented at the AnnualMeeting of the Illinois Division. A Na­tional-Divisional award, it is given yearlyto the person who has made the mostdistinguished contributions to the cancereffort on the lay or medical front.Dr. Palmer was described by theAmerican Cancer Society. as having given"valuable leadership to the Illinois Divi­sion for nearly 25 years, having servedon various committees and as Presidentin 1967 and 1968 .... To his volunteerDr. Walter L. Palmer, '21 (right), receives theAnnual Award for Distinguished Service In CancerControl from Dr. T. Howard Clarke (Res. '38-'41),President of the American Cancer Society IllinoisDivision, as Charles W. Ebersold, Chairman of theBoard of the Illinois Division, adds his congratulations. service . . . Dr. Palmer has brought theskills of a great teacher and the statureof a great figure in American medicine."Dr. Coggeshall HonoredDuring the March meeting of the Ameri­can College of Physicians in Denver,alumni and guests gathered to honor Dr.Lowell T. Coggeshall, who received theCollege's James D. Bruce MemorialA ward. The award was given "In recog­nition of Doctor Coggeshall's contribu­tions to malaria control, but even morefor his activities in the broad field ofpreventive medicine on the national andinternational stage and to his sound in­fluence upon medical education."A reception for Dr. and Mrs. Cogge­shall at the Denver Hilton was co­chaired by Dr. and Mrs. Herbert J.Rothenberg, '51, and Dr. and Mrs. Mel­vin M. Newman, '44.Dr. Coggeshall is a Life Trustee ofThe University of Chicago, Vice Presi­dent Emeritus, the Frederick H. RawsonProfessor Emeritus of Medicine, formerChairman of the Department of Medi­cine, and former Dean of the Divisionand the Medical School.Dr. Lowell T. Coggeshall (center) talks with Dr. Melvin M.Newman, '44 (left), and Dr. Herbert J. Rothenberg, '51(right), who were co-chairmen of a reception held in hishonor after he received the James D. Bruce Memorial Awardfor distinguished contrIbutions In preventive medicinefrom the American College of Physicians In Denver.2Faculty Committeeto StudyMedical EducationDr. Albert Dorfman, '44, has been ap­pointed chairman of a faculty committeeto examine the changes in the role ofmedical schools in the organization ofmedical care.Dr. Dorfman is the Richard T. CraneDistinguished Service Professor andChairman of the Department of Pedi­atrics, Director of the Joseph P. Ken­nedy, Jr., Mental Retardation ResearchCenter, Professor and Acting Directorof the LaRabida-University of ChicagoInstitute, Professor in the Departmentof Biochemistry, and on the Committeeon Genetics..The committee will also prepare along-term plan for the Division of theBiological Sciences and The PritzkerSchool of Medicine.Other members of the committee are:Dr. Lloyd A.' Ferguson, Associate Pro­fessor of Medicine and Assistant Deanof Students for the Division; Dr. JosephB. Kirsner, Deputy Dean of MedicalAffairs and Chief of Staff of the Divi­sion; Dr. Luis A. Cibils, the Mary Cam­pau Ryerson Professor and Secretary ofthe Department of Obstetrics and Gyne­cology; Dr. Jarl E. Dyrud, Professorand Director of Clinical Services in theDepartment of Psychiatry; Dr. WolfgangEpstein, Assistant Professor in the De­partment of Biochemistry and in theCollege; Dr. Donald J. Ferguson, Pro­fessor in the Department of Surgery; Dr.Godfrey S. Getz, Associate Professor inthe Departments of Pathology and Bio­chemistry and in the College and Direc­tor of the Research Chemistry Labora­tory; Dr. Javad Hekmatpanah, AssociateProfessor in the Department of Surgery;John L. Hubby, Associate Professor inthe Department of Biology, the College,the Committee on Genetics and theCommittee on Evolutionary Biology; Dr.Lee B. Lusted, Professor and Secretaryin the Department of Radiology; Dr.John D. Madden, Associate Professor inthe Department of Pediatrics and Medi­cal Director of the Woodlawn ChildHealth Center; Dr. Leon Resnekov, As- DR. DORFMANsociate Professor in the Department ofMedicine and Director of the MyocardialInfarction Research Unit; Dr. Irwin H.Rosenberg, Associate Professor and Chiefof the Gastroenterology Section in theDepartment of Medicine, and Janice B.Spofford, Associate Professor in theDepartment of Biology, the College, andthe Committee on Evolutionary Biology.Hospital ServiceAwards for TwoDr. Douglas N. Buchanan and Dr. HenryT. Ricketts were recently honored byThe University of Chicago Hospitals andClinics for forty years of service to theUniversity. Dr. Buchanan is ProfessorEmeritus in the Department of Pedi­atrics. Dr. Ricketts is Professor Emer­itus in the Department of Medicine andDirector of Hospitals and Clinics' Per­iodic Examination Program.Two Recipients of1971 Ricketts AwardDr. Solomon A. Berson and Dr. RosalynS. Yalow have been named co-recipientsof the Howard Taylor Ricketts Awardfor 1971. The award for significantmedical research was presented on May 10 in the Frank Billings Auditorium ofBillings Hospital.Dr. Berson is the Murray M. Rosen­berg Professor and Chairman of theDepartment of Medicine at Mt. Sinai(New York) School of Medicine, Direc­tor of the Department of Medicine ofMt. Sinai Hospital, and Senior MedicalInvestigator of Veteran's AdministrationHospital.Dr. Yalow is Chief of the Veterans Ad­ministration Radioimmunoassay Refer­ence Library, Chief of the NuclearMedicine of the Veterans AdministrationHospital (Bronx, New York), and Re­search Professor of Medicine in the Mt.Sinai School of Medicine.The award, established in 1913 inmemory of The University of Chicagoscientist who demonstrated that RockyMountain spotted fever is transferredamong men by ticks, was presented byDr. Leon O. Jacobson, Dean of theDivision.Quantrell AwardOne of the four 1971 Llewellyn Johnand Harriet Manchester QuantrellAwards for excellence in undergraduateteaching was presented to Philip C.Hoffman, (Ph.D. '62), Assistant Profes­sor in the Department of Pharmacologyand in the College. An active scientist,Hoffmann has used drugs to analyze thechemical regulation of metabolism andof mental behavior.As a member of the UndergraduateResearch Committee Hoffmann helpsstudents in their research and tutorialstudy. He also serves as resident adviserof Tufts House in Pierce Tower.Hoffmann served on the 1971 commit­tee for the Senior Scientific Session andhas participated in several BiomedicalCa reers Conferences, both sponsored bythe Medical Alumni Association.The Quantrell Awards were establishedin 1938 by the late Ernest EugeneQuantrcll of Bronxville, New York, aformer University trustee, in honor ofhis parents. The awards, given annually,include a $1,000 prize for the winners.Nominations are made by II special com­mittee appointed by the Dean of theCollege.A careful touch to soothe a worried child:Dr. John Madden, Associate Professor of Pediatrics,examines a Wyler patient. "Deliberate speed" Isrequired for effectivehealth care.The State of the Hospitals and ClinicsA Summary of a Speech by Dr. Joseph B. KirsnerDr. Joseph B. Kirsner, the Louis Block Professor in the Depart­ment of Medicine, was recently appointed Deputy Dean ofMedical Affairs and Chief of Staff of the Division. Kirsner(Ph.D. '42), who has been on the faculty since 1935, is authoror co-author of more than 400 publications dealing primarilywith clinical and experimental problems in gastroenterology.His major clinical interests and research activities have dealtwith peptic ulcer and gastric secretion, regional enteritis andulcerative colitis, and cancer of the gastrointestinal tract.Speaking before the clinical staff meeting on June 16, Dr.Joseph B. Kirsner, newly appointed Chief of Staff of TheUniversity of Chicago Medical Center and Deputy Dean forMedical Affairs, outlined his goals for the Hospitals andClinics while acknowledging the problems facing all hospitals.Outlining a rich history, Dr. Kirsner said:"The University of Chicago was a great medical centerthe day it first opened its doors, in the fall of 1927. Thehospitals were new; they had been planned after carefulthought. The professional staff was young, but enthusiasticand hard-working, and it was supported by a group of out­standing clinicians who then represented our first full-timefaculty. The full-time system, while regarded with suspicionby the private practice medical profession, nevertheless at­tracted national attention. We provided good, even superiorcare of patients. Our hospital beds became filled and weeven established bed quotas for individual services. Withtime, we added buildings; patient referrals increased and wegrew steadily."We taught our medical students well, I think. At leastthe students seemed happy; they participated in research andyet maintained excellent grades; and many developed sig­nificant careers, not only in academic medicine but also inother phases of the health profession. Some of you may besurprised to learn how many good 'people doctors' we pro­duced in our research-oriented medical center. These gradu- ates referred patients; and they even sent their sons anddaughters to us for medical education."We also performed well in the research arena, even withlimited funds. Research laboratories gradually increased andscientists came from everywhere to study here. We developeda Charles Huggins, an A. J. Carlson, a Dallas Phemister, aJoseph B. DeLee and a superb clinician as typified by WalterL. Palmer. We felt no conflict between patient care, clinicalteaching and basic research; all three flourished. Indeed, theunion of basic sciences and of clinical sciences within theDivision of Biological Sciences was a source of unique andgreat strength. We were relatively content even with pitifullysmall salaries; and we were proud of our association withThe University of Chicago. We were part of a new leader­ship in academic medicine and in patient care. We felt adeep loyalty to The University of Chicago Hospitals; andwe were quick to defend them from unjust criticism. In short,we were a first-class medical center."Commenting upon some of the problems of the Hospitalsand Clinics today, Dr. Kirsner cited changed attitudes, somediscontent, even some disinterest along with problems asso­ciated with rapid growth; inadequacies of a hospital andoutpatient system; the avalanche of costly new tests andprocedures, of new specialties within specialties.Stating that all must work together to solve these problems,Dr. Kirsner called for a return to the sense of pride andunity that once characterized the medical center.Turning to specific areas, Dr. Kirsner began with theclinical faculty. He said:"The strength of this clinical faculty rests in its quality,balance, and cooperative activity. From the beginning, wesought the combination of physicians interested chiefly inclinical medicine and teaching, but engaging also in research(clinical or laboratory), and of faculty more interested inthe laboratory but participating also in patient care. Twentyyears of intensified support of research without parallel sup­port of clinical training programs, and academic tenurepolicies favoring the investigator, reduced the numbers ofclinical faculty and discouraged interest in patient care here,as at other medical centers."Clinical excellence is a high-sounding but, nevertheless,an overused and poorly understood phrase. Yes, it requiresan efficient administration; a superb medical record depart­ment; quality laboratory services; and a super-duper reportdelivery system. But, clinical excellence begins first with thephysician. It cannot be automated nor can it be delegated,let us say, to a dictating machine. Clinical excellence meansa sincere commitment of the doctor to patient care; a will­ingness to see patients regularly; a humaneness in not reject­ing a sick person who happens to arrive in the clinic on thewrong day."It means seeing patients during rounds at the bedside5and not as a unit number in a conference room; it involvesinstructive and responsible supervision of the interns andresidents, so as not to condone incomplete workups or sloppymedical care; it requires efficient scheduling of necessarytests, and prompt, experienced consultations to reduce theexcessive hospital stays; and it includes the readiness of asurgeon to postpone a laboratory experiment for an acutesurgical emergency. Clinical excellence means an unwilling­ness to settle for the average; a continual assessment of one'sown contribution and performance. We need skilled clini­cians, stimulating teachers, and resourceful clinical investi­gators. We will provide them with as high an academicrecognition as the laboratory investigator."Dr. Kirsner cited specific methods to ensure the continuingquality of the clinical staff: documentation in writing by eachdepartment chairman, of the significant contributions (clini­cal, teaching, research) of each clinical faculty member inreviewing budget requests; establishment of an interdepart­mental medical audit and utilization committee, a peer re­view mechanism to improve the quality of clinical care,lower morbidity and mortality rates, and diminish costs;reinstatement of interdepartmental morbidity and mortalityconferences as an additional educational activity; and in­creased faculty involvement in the administrative aspects ofthe clinic operation.Declaring his personal hope that a mechanism be de­veloped to retain the traditional full-time system, Dr. Kirs­ner said, "The full-time system has been one of our uniquequalities. To retain this system and at the same time togenerate the monies to allow us to develop an incentive pro­gram that would appropriately reward departments andsections is the problem. Increasingly today we hear of theneed to change our system to meet the competitive salarylevels of other institutions, to facilitate recruitment and tobuild new clinical areas. Serious thought by the administra­tion and by the faculty on this very important issue will benecessary, and we should examine all aspects and all pos­sibilities."Before leaving the subject of the clinical faculty, Dr.Kirsner emphasized its general quality. "The clinical facultyis the key to all our efforts. Your dedication to clinical medi­cine, not only to care for the patient but also to educate theyoung physician," he said, "renews the ideal of the truephysician, a model I shall always believe in."Dr. Kirsner expressed his complete confidence in F. RegisKenna, Director of the Hospitals and Clinics, and in "hissincere interest and capacity to develop first-class patientcare at The University of Chicago." Citing some of theproblems the administration faces, Dr. Kirsner said:"The difficulties relate, in part, to an employee pool lesseducated and less trained than is desirable for our purposes.The in-hospital educational programs initiated recently al- ready have had a beneficial influence. Yet, all too often,patients are treated with discourtesy and even hostility; theyare subjected to delays at various points of admission tooutpatient and hospital facilities and at the time of exami­nations, and to countless other irritations. The staff must bemade aware of the absolute need to treat patients, sick peo­ple, with kindness, consideration, and respect. To accom­plish this goal, the hospital administration is recording allincidents involving the handling of patients, to obtain thenecessary documentation of employee negligence or incom­petence, preparatory to suspension and dismissal of the em­ployees if necessary."Uneven utilization and occasional misuse of the clinicalareas in the outpatient department were criticized."Some clinics function well, some are not as active asprofessional manpower might allow; some seem relativelydormant," he said.A comprehensive study of the outpatient area has beeninitiated. "Outpatient space is in demand," Dr. Kirsner said."I am requesting departmental chairmen and section headsto review their outpatient clinical activities. Some of thespace problems could be relieved in a readjustment of clinicschedules. Unused or little-used space will be reassigned tomore clinically active groups and active clinics functioningin limited areas will be given more adequate facilities," hesaid.A review of hospital bed assignments is planned for laterin the year."More complete utilization of our patient beds is necessaryfor financial stability and, of course, to meet our teachingobligations to our medical students. You must appreciatethat our capacity to initiate clinical improvements requiresmoney. The only source of such funds is patient income. Themore completely we maintain our hospital beds and the morecompletely utilized in space and time are our outpatientservices, the more likely are we to generate the funds foryour needs."Stating that he is pleased with intensified review of finan­cial activities by the hospital administration Dr. Kirsnersaid, "The fiscal policies and activities of our hospitals andoutpatient department long have been shrouded in mysticism;possibly related to the fact that we are not an independenthospital but rather the property of The University of Chicagoand with responsibility also to three additional hospitalboards. While it may be academically appropriate to regardthe hospitals and the outpatient department as the 'labora­tories' of the academic physician, and while the purpose ofThe University of Chicago Hospitals is not the accumulationof wealth, its purpose also cannot be financial insolvency."Clinical care activities should at least generate sufficientfunds to meet the costs involved in the clinical operation; tofinance essential improvements requested by the clinicalfaculty; and also perhaps to help support research within theclinical departments. I personally would not consider it sin­ful if the clinical operation also generated funds for thesalaries of clinical faculty, correspondingly making moreDivisional funds available for research purposes."Noting that there is much yet to be accomplished toachieve financial stability, Dr. Kirsner said:"Deficiencies have been identified and are being adjusted.Services and procedures which had not been billed previouslynow are being incorporated into the billing system. Theaccounting procedures have been revised and improved. Thearea of professional fees, a complex and vital fiscal problem,gradually is being unravelled by Dr. Vermeulen and hiscommittees."Five years ago, our patient free care expenses approxi­mated $100,000 per annum. In 1970, these costs exceededone million dollars for adults and $800,000 for Pediatrics.As physicians we also must provide adequate documentationof our professional services to qualify for third-party pay­ments. Failure adequately to document medical recordsmeans not only loss of income but also reflects physiciandisinterest and second-rate medical care."Mentioning the hospital rate review board for the State ofIllinois, which will begin to operate by January 1, 1972,Dr. Kirsner said that the review board authority to fix hos­pital rates and procedure charges suggests that personnelreductions may be forced upon the Hospitals and Clinics.Asking for faculty suggestions and cooperation, Dr. Kirs­ner reemphasized the responsibility of the clinical facultyand the house staff to complete medical records promptlyand return them to the record room; sought suggestions onimproving the efficiency of the Outpatient Department, in­cluding expanding its usage; and highlighted recent improve­ments in laboratory services.Citing the rise in emergency room visits over the past tenyears, from 12,348 in 1961 to over 80,000 in 1971, withevery indication that this trend will continue, Dr. Kirsnersaid, "We cannot be insensitive to the needs of sick people.Without some input, we also may find, to our regret, thatinstead of participating in a regulated manner in health careprograms, we will be forced into unwanted programs. Never­theless, our resources in manpower and money are limited.We cannot overcommit ourselves to community health needs;and even our total involvement would prove inadequate forthe enormous requirements. I therefore favor some regulationof emergency room activities. If possible, our major roleideally should be as a special resource center; contributingconsultants, research components and continuing educationprograms to community health plans; activities that currentlyare represented by the Woodlawn Prepaid Health Programand by the Mid-South Health Plan-both of which, I aminformed, have excellent prospects of funding. "I also favor better organization and staffing of the emer­gency room as a humane and medically necessary approachto the proper triage of the large numbers of patients. A majorproblem is the inability to provide adequate care for thegenuine emergencies because of delay in triage. Approxi­mately 80 percent of patients arriving at the Emergencyroom are not true emergency room problems, according tomy latest information. We must develop more timesavingapproaches to the rapid evaluation of the less sick; and wemust find ways to meet the steadily mounting financial debtsincurred by this activity. I therefore favor placing all Emer­gency Room activities under the guidance of a medicaldirector, who will initiate improvements in patient care andin the many administrative activities of this area. Such modi­fications hopefully will facilitate the development of bettereducational and training programs for students and housestaff; reduce the staggering financial deficit, and perhapsallow us to consider pilot clinical studies of possible useful­ness to community health needs."I hope for the cooperative participation of other hospitalsin the community in emergency care, to better define thepopulation groups served by each emergency room andthereby to regulate, at least partially, the number of emer­gency room visits. I am pleased, therefore, to report theappointment of a former intern of ours, Dr. Peter Rosen, asthe Medical Director of the Emergency Room as of Sep­tember 1, 1971."Concluding his remarks with the reminder that the Hos­pitals and Clinics basic objectives must remain those of aUniversity-oriented hospital, Dr. Kirsner said, "Universitiesand medical schools, in their pride and in their desire to help,not infrequently have assumed too many commitments forpractical realization and for their own purposes. The businessof this University is scholarship and the search for truth. Thebusiness of this university-based medical center is qualitycare of the sick, research towards the understanding and cureof disease; and the teaching of doctors for the health needsof the people. This objective can be reached only if we onceagain become a first-class clinical center; dedicated to thebest in patient care, teaching and clinical study. I have everyconfidence we can attain this objective."I now would like to close with these remarks by Vladimir,in "Waiting for Godot" by Samuel Beckett, brought to myattention by Dr. Frank Newell:" 'Let us not waste time in idle discourse! Let us do some­thing, while we have the chance! It is not every day that weare needed. Not indeed that we personally are needed. Otherswould meet the case equally well, if not better. To all man­kind they were addressed, those cries for help, still ringing inour ears! But at this place, at this moment of time, all man­kind is us, whether we like it or not. Let us make the mostof it, before it is too late!' "The many faces of the hospitals: (top: left to right) ahelpful Student Health nurse, a weary patient, the serenesymbol of Lying-In, and (below) a clinical teacher, Dr. SidneySchulman, Introducing medical students to the complexitiesof the brain.The Hospitals and the CommunityA Discussion withDr. Robert Daniels,Associate Dean for Social and Community MedicineandDr. Lloyd Ferguson, '60Associate Professor of Medicine andAssistant Dean of StudentsAt a clinical staff meeting on July 14, Dr. Robert Daniels,Associate Dean for Social and Community Medicine in theDivision of the Biological Science and Pritzker School ofMedicine, Professor in the Department of Psychiatry and theCollege, and Director of the Center for Health Administra­tion Studies, and Dr. Lloyd Ferguson, Associate Professorin the Department of Medicine and Assistant Dean of Stu­dents in the Division of the Biological Sciences and ThePritzker School of Medicine, made an appraisal of where theHospitals and Clinics are in the general area of communitymedicine.Dr. Daniels opened the discussion:"Three and a half years ago a new administrative positionwas created in the Dean's Office, the Associate Dean forSocial and Community Medicine. I was the first appointee.At that time the charge to me and to others was unclear. Thebroad situation which confronted the institution was troub­ling and the hope was for a more aggressive involvement incommunity medicine planning to assist in preserving thequality of education and research in this institution, while atthe same time, hopefully, improving medical care on theSouth Side of Chicago. The problems were:"1. Too few physicians and dentists were in practice. Inthe 1930s there were more than 120 physicians in practicein Woodlawn; in 1968 there were slightly more than 25. InKenwood-Oakland, with a population of 40,000 people,there were three physicians, two of whom were over 75. In aten-community area of 350,000 people there were 170 phy­sicians, more than one-third over 65."2. Primary or general medical care was episodic andfragmented. It occurred in physicians' offices, in hospitalemergency rooms, and at Cook County Hospital some twelvemiles away. Our emergency room load was increasingrapidly."3. Specialized outpatient services and hospital serviceswere also obtained mainly at Cook County Hospital."4. A number of community hospitals were consideringmoving to suburban areas."5. Care for chronic illness and rehabilitation was difficultto find."6. The financing of health care was inadequate, illogical,and disorganized. Financial eligibility criteria had beenestablished at income levels that were too low ($3,600 fora family of four). There was no organized or public effortto register eligible individuals. There was very little cover­age for families earning more than the ceiling. Processes ofregistration and administration were demeaning and depre­ciating. Payments to deliverers of medical care services oftenrequired six to twelve months, and occasionally as long astwenty-four months."7. Education and research in community and socialmedicine were limited and needed upgrading. It was hoped that a cadre of interested people could be established infour departments (Obstetrics, Medicine, Pediatrics, andPsychiatry). Most of us hoped that collaboration with otherprofessional schools and with the Division of the SocialSciences might improve this deficiency."The strategy for approaching these problems had to takeinto account what would be acceptable to our faculty andthe institution; what would be acceptable to other profes­sionals and institutions; and what would be acceptable toconsumers, the residents of nearby neighborhoods, Local,state, and federal legislation and programs which made cer­tain developments possible while they precluded other de­velopments were also important."Professionals and other institutions were suspicious ofthe University'S motives. The residents of local communitieswere pursuing the governance of their own human servicesthrough their own community organizations. They mis­trusted our basic motives in any community health serviceplanning. Regional medical programs locally and nationallywere having little impact on the medical care delivery sys­tem. The Office of Economic Opportunity (OEO) was ob­taining no new monies. The only promising new programswith any hope of available money were ComprehensiveHealth Planning and Model Cities."Therefore, the approach we decided upon was: (1) toassist local neighborhoods as consultants in planning healthcare which they found acceptable; and (2) to create a sub­regional health planning group which would offer the par­ticipants, professional societies, institutions, and communityorganizations an equal voice in its health planning activities.As a result, our work during the past three years has beenpredominantly in Woodlawn and in the Mid-Southside HealthPlanning Organization (MSHPO)."In the spring of 1968, The Woodlawn Organization(TWO) asked faculty and students of The University ofChicago for assistance in preparing an "ideal" Model Citiesproposal. This initiative was taken by TWO because of itsdissatisfaction with the role offered it by the city of Chicagoin the preparation of a Model Cities plan for the community."During a seven-month period a large group of commu­nity residents organized into substantive committees, underthe allspices of TWO with University faculty and studentsas technical consultants, to write a model program, whichincluded community development, housing, economic de­velopment, manpower training, social services, legal services,education, and health. The Health Committee was composedof ten community residents. The consultants included stu­dents and faculty from the University, representatives fromthe local community hospital, Woodlawn Hospital, and phy­sicians and dental practitioners in the community."The system recommended was an independent not-for­profit community-based corporation, which was to receiveand administer funds, to construct and own a health centerfor the delivery of primary medical care, and to employphysicians, dentists, and other personnel. The system wasplanned so that ultimately it might serve forty to fifty thou­sand individuals. It would be financed on a capitation basisthrough a combination of public and private payments, aplan which would eliminate a two-class medical care system.It would provide comprehensive health care, including ambu­latory physician and dental services, emergency services,specialty services, hospitalization, rehabilitation, pharmacy,appliances, and other services. The major site of primaryhealth care delivery would be a fifty to sixty thousand squarefoot health center, while other specialty and hospital serviceswould be delivered under contract arrangements at nearbyhospitals. What we defined in 1968 has now made its re­appearance in national policy discussions in 1971 as thehealth maintenance organization.GrandBoulevard38Hyde Park41 pottH Target AreaWashingtonPark40Woodlawn42The Ten Mid-South community Areas10 "Progress has been made with this health care system inthat the corporation has been formed, land has been secured,letters of intent to cooperate have been obtained from localhospitals, and planning and operational monies are in sight.A $50,000 federal planning grant is in hand, and the Stateof Illinois has promised $150,000 for planning. The recentlyannounced $2,573,329 OEO grant to MSHPO appropriatesapproximately $600,000 for Woodlawn ($200,000 for start­up, $200,000 for remodeling and/or construction, $200,000for health care). Current activity with insurance companieswill define a package of benefits and their costs. A grantapplication has been made for the construction of the healthcenter."A group of individuals interested in health care in asub-region on the South Side of Chicago met in May, 1968to discuss a sub-regional health planning organization. Themeeting, attended by almost two hundred people, appointedNear Southt-t--t:::�7--*-+--tf;F.f:\ /Target AreaChicago Model Cities Target Areasa steering committee of four to organize the effort. Thegeographic area selected was a ten-community area of350,000 people extending from 12th Street on the north to67th Street on the south and from the Dan Ryan Express­way on the west to Lake Michigan on the east. Roughlywedge-shaped, the area is one mile wide on its northernborder and three miles wide on its southern border, andabout seven miles long. The population is predominantlyblack (85 percent) and poor. Woodlawn is one of these tencommunities."During 1968 and early 1969 the informal group wasexpanded to include representatives from seven local generalhospitals, from three medical and dental professional socie­ties, and from all community organizations with any interestin health. The group (the MSHPO) constructed its goalsand objectives, wrote bylaws, and sought and received itsnot-for-profit corporate status. It then made requests forfinancial support to foundations, to local hospitals, to Com­prehensive Health Planning, and to the Illinois RegionalMedical Program. It was funded from these several sources(about $100,000 per year) in November 1969, and subse­quently a staff was secured."As in the Woodlawn proposal, the predominant methodof payment would be prepayment on a capitation basisthrough combining public and private monies for compre­hensive health care services. The typical organization ofmedical practice would be in a multi-specialty and generalistgroup. The range of services would be comprehensive, andthere would be ownership, contract, and agreement relation­ships between primary care sites, hospitals, and after-carefacilities. The OEO grant for a two-year period to begin toimplement sections of this master plan includes start-upcosts for three health maintenance organizations."This organization has served as the model for the de­velopment of three other sub-regional groups in Chicago(West Side, Far South Side, and South Cook County). Eachof these groups has a board characterized by a consumermajority with similar objectives of improving health services."In recent months a task force of the MSHPO group,under the chairmanship of Dr. Lloyd Ferguson, devised along-range plan for health services in this area. This plandefines met and unmet health needs; inventories currentlyavailable resources; outlines modifications of the quantity,quality, and use of services; develops potential interrelation­ships between existing resources to establish a unified sys­tem; and strengthens the management capacities of localhealth projects and of the MSHPO. A series of seven oreight health care corporations, similar to that already de­scribed for Woodlawn, would be developed. They wouldprovide primary care, outreach and preventive services, hos­pital services, and after-care and rehabilitation. For morespecialized care each of these corporations would develop contract agreements with hospitals and other facilities."Dr. Ferguson took up the discussion at this point todescribe the MSHPO plans for use of the OEO funds andto analyze what these developments might mean to ourinstitution."The principal thrust of this 'new federal money' will beto establish and/or assist in the development of four HealthMaintenance Organizations (HMO) in the mid-south com­munity. In order that we have some point of departure forour discussion this afternoon, let us agree that an HMO isan organizational arrangement for delivering comprehensivehealth care to a defined population group on a prepaid capi­tation basis in which there is emphasis on ambulatory andpreventive services but with provision for the entire spectrumof acute care, chronic care, and rehabilitative services asthese are needed. The facility can be owned by hospitals,physicians, unions, industries or community groups."The MSHPO perceived that inadequate primary careservice was the most pressing problem in our community. Iwon't attempt to document this but if anyone doubts it, Imight suggest that he see Dr. Joseph Baron and sign up fora four or eight-hour tour of duty in our emergency room.Since this was perceived as the most pressing need, it fol­lowed that the development of HMOs was the highest pri­ority item on the agenda. The MSHPO envisions ultimatelythe development of at least eight. The recent award by OEOwill help in the development of four of these. Two will beowned by community groups, the Greater Woodlawn Assist­ance Corporation and the Kenwood-Oakland CommunityOrganization, one by a hospital, Michael Reese Hospital, andone by a foundation of predominantly black physiciansclosely allied to, but distinct from, the board of directors ofProvident Hospital."Because of the difficulties experienced by many Mid­South residents in getting to and from the health care facilityappropriate to their needs, an improved transportationarrangement was seen as an important part of this commu­nity network. A shuttle bus system and improved ambulanceservices were proposed and OEO granted $68,000 towardsthe development and beginning operation of the shuttle bussystem. OEO declined the opportunity to participate in thefunding of improved ambulance services on the groundsthat other agencies of government would be more appro­priate sources of such funds. The shuttle buses will providehealth-related jobs for relatively unskilled community resi­dents, which is an important byproduct of the health systemand an ancillary goal to be kept in mind in communityhealth planning. In this connection. it is anticipated that therewill be jobs around the primary care facilities for communityresidents of varying levels of skills, with opportunities forlateral and upward socioeconomic mobility."The OEO is anxious that community persons have a11meaningful voice in the planning of their health care systemand towards this end has awarded $71,500 for 'communityparticipation.' In Mid-South the money will be used to traincommunity residents to be effective members of boards ofdirectors of these HMOs and other community health facili­ties. Mr. Phil Nowlen of the Center for Continuing Educationhas been instrumental in the development of the trainingprogram and will administer it once it is operational."The advantages of these developments to the medicalschool are many. With regard to our service function, itallows us to take our place in an orderly system of healthcare delivery. This should, for example, decrease the numberof inappropriate visits to our emergency room and to ourspecialty clinics. Far from our resources being overburdenedwith checkups and minor ailments, one anticipates that withadequate primary care facilities in the community we becomemore of a referral center, with the HMOs and communityhospitals constituting the first and second lines of defense assources of referral patients."This serves our educational mission. If indeed the healthnetwork planned for Mid-South is representative of the typeof organizational arrangements within the framework ofwhich medicine is likely to be practiced in this country inthe future, the educational objective is apparent; if ourgraduates are likely to be working in such a system, it iswell to train them in that context."Administratively, there are likely to be complexities. Wemay wish to enter into constructual arrangements with anumber of primary care facilities and community hospitalsto provide specific highly specialized services when needed.The demands for efficiency and fiscal accountability willundoubtedly be more urgent, more specific, and more insist­ent. I must confess that I view all of these factors as chal­lenges rather than disadvantages."In addition to providing these highly specialized services,of which in this area we are uniquely capable, our institutionis likely to be asked to lend its prestige and its standards tothe entire undertaking. It will be asked to help recruit phy­sicians to the community health network and to help createan atmosphere in which such recruits can continue their pro­fessional growth. This means having our colleagues partici­pate actively in the teaching conferences. It means continu­ing education efforts such as the Frontiers of Medicine series.It means prompt and frequent communication with referringphysicians and invitations to the referring physicians to joinward rounds and to participate in the discussions regardingthe management of patients.I? "This may appeal to the missionary spirit in some of you.My personal view is that the educational process is a two­way rather than a one-way street, a dialogue rather than amonologue and that the principal beneficiaries of this dia­logue are our patients, our students, our professional col­leagues, and us."Following these remarks by Dr. Ferguson, Dr. Danielsconcluded the discussion."Medical care on the South Side of Chicago and in thesouthern part of Cook County will eventually require thatsystematic functional interrelationships exist between sub­regions. The area south of Woodlawn and extending to thecity limits is currently being organized as a health planningarea by a group comparable to the Mid-South group. Thisorganization, known as Comprehensive Research and De­velopment ("Comprand"), has goals which are similar tothe Mid-South group. This area though, is relatively betteroff in primary care service availability, and is relativelyworse off in hospital service availability. In fact, many hos­pital services for this geographic area should be acquired inhospitals located in the Mid-South area. With more thanthree thousand beds the Mid-South hospitals have more thantriple the capacity required by Mid-South residents. Theplanning and development task is, therefore, somewhat dif­ferent in this area when it is compared with Mid-South."For Cook County outside the city limits the planningand development task is also different. This area has irregu­larly available primary care and hospital care. Some sectionsare relatively well off; others are not. Referrals to distantpoints for some highly specialized services are required.Examples of these might include services such as therapeuticradiology, complex and highly specialized surgery, andmedical sub-specialty services. The teaching hospitals lo­cated in the Mid-South area would be likely referral institu­tions."Some highly specialized services require populations aslarge as ].5 to 2.0 million people or more to derive enoughneed and use to make those services feasible, efficient, andeconomic. For some of these services one might even includethe two-county metropolitan area of northern Indiana as aportion of the service area. Currently, politicaland boundaryproblems interfere with such planning. They should not,however, be permitted to constrain these logical and rationaldevelopments indefinitely. These other groups and popula­tions will require our attention and our collaboration withinthe next year."Medicine Not on the MidwayBy Dr. Joel E. Murray, '66Assistant Professor,Department of Medicine (Neurology)Dr. Joel E. Murray is Assistant Professor in Neurology at TheUniversity of Chicago. She received her B.S. degree from theUniversity in 1962, and her M.D. in 1966 and completed herinternship at the University of Washington Hospitals in Seattlein 1966-67. Dr. Murray returned to the University for herresidency from 1967-70. She joined the University's faculty in1970 as an instructor and from 1970-71 was a Special ResearchFellow for the United States Public Health Service. Dr. Murrayis a member of the American Academy of Neurology and hascontributed to neurological journals.I first learned about the Englewood Center at a somewhatawkward cocktail party held last fall (in an elegant HydePark townhouse) to recruit volunteeer MDs to work in freehealth centers in Chicago poverty areas. I was one of twopotential recruits who showed up at the meeting-the restwere either people who already worked at such clinics, orrepresentatives from community clinics which lacked pro­fessional health staff necessary to their operation. I recall(with some embarrassment) asking whether any of theclinics could use a neurologist-and being told that what theyneeded were doctors.It was probably the realization that, by spending oneevening every two weeks at the Englewood clinic, I wouldenable the organization to increase its medical services byabout one-third, that overcame the reservations I had at thetime. While this small clinic was equipped for routine OPDmedical services, with two salaried staff (a director and anLPN), as well as volunteer medical students, lab technicians,receptionists, and maintenance personnel, none of this wasuseable, of course, without a licensed physician. Of thesethey had only one, a U. of C. medical resident who put inone evening's work a week and who was soon to be drafted.It may be guessed that the Community Health Center ofEnglewood (CHCE) was not making much of a quantitativedent in providing the health services needed in the commu­nity. The figures on poverty, infant mortality, and lack ofphysicians in the area (bounded, roughly, by Garfield Boule­vard, King Drive, 75th Street, and Ashland Avenue) cor­respond to the worst in tables you have no doubt seencontrasting area health statistics for the Midwest. On thoseIinendrawing maps of Chicago depicting degrees of need invarying shades of grey, the Englewood area is one of thesolid black sections. In this sort of community, where neitherof the two neighborhood private hospitals has an outpatientfacility, a one-or-two evenings per week clinic, with or with­out a doctor, cannot profess to spare many of the localinhabitants the hour or so bus ride to the Cook CountyHospital when the need for medical attention arises.To me, however, this discouraging "drop-in-the-bucket"aspect of working at CHCE has been outweighed by severalmore positive considerations. One is that the Center im­presses me as a model, on a minute scale to be sure, demon- strating that even under the most difficult circumstances, acommunity-organized-and-run facility can provide free healthservices to the needy. Another has been my own education­through-exposure to the medicine not on the Midway-aneducation, or if you will, an eye-opener, elsewhere unavail­able to one university-trained, university-based specialist.And, finally, it should perhaps be admitted that the changein roles every now and then, from one of a multitude ofBillings Hospital physicians to one on whose services thewhole show may depend, has its gratifying moments.The Center occupies a small three-story building donatedto the Englewood Health Committee by the Salvation Armyseveral years ago. Over the past two years much of theinterior has been remodeled (work still is in progress) byvolunteers from the community and members of the HealthCenter staff. The building is on a rather bleak-looking sidestreet (more like an alley) near 62nd and La Salle Street,half a block east of the frontage road running northwardalong the Dan Ryan Expressway.The "neighborhood" in the immediate vicinity of the cen­ter seems to consist of warehouses and deserted buildings;parking is ample along the remains of curbs, in pools ofwater when it rains.The clinic waiting room, entered via the front door, israther more cheerful, decorated with posters, and usuallyfull of patients who have come early for routine lab testsbefore being seen by the physician. Two small offices adjoin­ing the waiting room house administrative essentials, includ­ing volunteer receptionist, telephone, typewriter, files, andrecords. On the first floor there are three small examiningrooms (equipped with tables, routine supplies, washbasins,and writing desks), restroom facilities, a laboratory, and alaboratory waiting room, where patients are weighed, mea­sured, and have their blood pressures taken. Most patientsare seen by appointment but some walk-in acute problemsare also handled. New or return appointments almost alwaysare kept. At present the supply of volunteer MDs is suchthat the Clinic can operate regularly twice a week, Mondayand Wednesday, from about 6 p.m. to 10 p.m.The charts are filed alphabetically, in the reception office.Originally, notes were kept in somewhat scanty fashion onloose sheets of CHCE letterhead. The suggestion for xeroxedforms covering past-history, family-history, and review-of­systems, for the patients to fill out while waiting, was ac­cepted, and these are now used for all new patients. This isa great advantage both for "proper record keeping", and forshortening the time required per patient by the physician,who is usually working alone. The patients are seen in(strict!) order of arrival, with the exception of those few whoare acutely ill. When things are running smoothly-that is,when no critical staff member (lab technician, nurse, andreceptionist) is sick that evening-the clinic can handle13about ten patients per physician per hour. By the time I seethem, the patients are settled in an examining room, withchart outside the door, in which vital signs and results of theroutine blood counts and urinalysis are recorded. (I can'tresist adding that the "chart unavailable" frustration is oneI've not encountered at the CHCE.)A large percentage of the patients are children for routinephysical examinations. Since every Chicago school child isrequired to return a form signed by an MD attesting to hisstate of health and immunizations, a marginal-income, non­welfare family with 5 or 6 children may be unable to affordsuch exams from a private MD, assuming one is available.As it turns out, some of these children have never beenexamined previously by a doctor, and most of them onlyonce or twice; a surprising number have never received rou­tine DPT and smallpox immunizations. The clinic suppliesany required immunization free of charge.As far as I can tell, almost all the patients like the clinic.Since it is free and a lot closer than the Cook County Clinic,this may not seem too surprising. However, some of thepatients, whether or not they are on welfare (in which casethey can receive free care, for instance, at the U. of C.clinics), have confided to me their distrust of county anduniversity medical facilities, or have intimated a fear ofdoctors in general. Some of the conversations which ensuewhen I identify myself as a representative of the very thingthey are complaining about are models of tact on both sides.I think it's a toss-up as to whether I'm evoking communitygood-will in this role, or simply mild confusion and surprise.The number of hematocrits in the low 30's reported by thelab, for children and adults alike, made me suspect at firstthat there was something wrong with the lab. Controls provedme wrong. With sickle-cell preps duly performed, the diag­nosis is still nutritional iron deficiency for close to 50 percentof patients seen. The results of follow-up blood counts areusually gratifying. But even though iron tablets and almostall routine medications are supplied free to the patient beforehe leaves the clinic (carefully counted into an envelope withinstructions printed on the outside), there is the familiarproblem of patients who do not take what is prescribed. The"pharmacy" has a surprisingly complete collection of basicmedications arranged about the shelves of a large walk-incloset, consisting mainly of stocks of samples donated bypharmaceutical companies.The laboratory, using equipment donated by the SalvationArmy and staffed by volunteer professional technicians aswell as several first-year medical students from NorthwesternUniversity, is open about 4 nights a week, to perform routineblood counts and urinalyses on all new patients. Cultures,serologies, lead screening tests, and pap smears are sent tothe Chicago Board of Health for free reporting. There areno X-ray facilities at the clinic, but one period-piece EKG14 machine is available. The clinic has arrangements with alocal private hospital to provide clinical chemistry tests andX-rays at cost to patients referred from CHCE. This does notinclude emergency service, but is otherwise comparable inefficiency to the routine work obtainable at the U. of C.OPD clinics. High school students from the Englewood areawork under supervision in the laboratory as part of theHealth Center's educational program.The nursing staff consists, in effect, of one person, MariaWilliams, a young LPN who became deeply involved in thecause of black civil rights after experiencing racial discrimi­nation in a Midwest convent, where she was then a nun. Arare sort of person, she can command respect without raisingher voice and combines a natural ability for organizationwith continuous hard work. She has become over the pastyear the backbone of the clinic, a sort of Chief-of-Staff forall matters other than the political and financial, which arehandled by the Director, Mr. Alexander Ben. The smallsalary Miss Williams receives as "part-time" nurse in theclinic helps finance her studies at the U. of Illinois, whereshe is enrolled for a bachelor's degree in nursing. Impressedwith her energy and capabilities, I asked her why havingdecided to go back to school, she didn't aim for an MDrather than an RN. Financial problems and the length of thecourse of study were her reasons. However, I suspect thatcultural "conditioning," combating the effects of which shesees as one of her roles, has been a factor in her decision.How many black girls envision for themselves careers asphysicians?The CHCE is somewhat unique in that it offers free carewhile subsisting entirely on private donations; there is nofinancial support of any kind from local, state, federal, oreducational-institution sources. Thus it stands in contrast tolarger and better known community health centers such asThe Woodlawn Organization Clinic, or the recently publi­cized Daniel Hale Williams Neighborhood Center, which isfinanced by Model Cities grants. If the CHCE's limitationsstem largely from lack of finances, these limitations in turnreduce the effectiveness of the organization's ability to per­suade the "powers that be" that the center is worth financing.As originally conceived in 1967, the Englewood centerwas to serve equally as an educational and a service facility.Thus the name "Center" is stressed to distinguish it from asimple clinic or dispensary. An organizational EnglewoodHealth Committee, composed of community members andrepresentatives from area civic groups, laid the basic plansfor both functions. The clinic facilities were opened to thepublic in May, 1968. Since then the center's policy-makingbody is a Board of Directors, comprised of both staff andrepresentatives of the communities for whom the servicesare intended.The educational goals have had some practical success;At the Community Health Center of Englewood,Dr. Joel Murray Interviews a patient (top left), giveshim an eye test (top right), and later consults withstaff members.1 c;the most tangible aspect is a classroom on the third floor,remodeled from its prior warehouse status and equipped ina modest way with donated books, as well as laboratoryapparatus including microscope and balances. Area highschool students are invited to come after school for tutoringin the theoretical and practical aspects of "health-related"subjects (everything from basic biochemistry to how to runa hematocrit or take a blood pressure). George Spencer, aU. of C. biochemistry graduate student who plans to go intomedicine, teaches the classes. The sessions meeting almostevery weekday afternoon have been successful: The aim isnot to turn out biochemists, but to encourage the youngpeople from the neighborhood (which is one, as might beguessed, where finishing high school is considered an educa­tional achievement) to consider themselves just as eligiblefor jobs and careers in all echelons of health services as thekids from middle class backgrounds. They also obtain directexperience by working as nurses aides and laboratory aidesin the clinic.The CHCE was first financed by a grant from the Wheat­stone Foundation, a Lutheran organization, with facilitiesand equipment provided by the Salvation Army; the moneywas to be sufficient to support the center for two or threeyears. That period is now about up and discouragement overfuture financing is growing. (I would say they need the serv­ices of an aggressive, high powered administrator, whateverthat is, to talk one or another government agency into pro­viding funds.)The CHCE has received neither support nor significantharassment from the city authorities. Perhaps it is simply toosmall to bother with. Furthermore, although it is a free clinicand in the "renegade" category, having lIO official sanction,the name "Community Health Center of Englewood" (asopposed for example to "The Panther Clinic") carries nopolitical connotations.The standard of medical care at the CHCE clinic is identi­cal to that at the U. of C. clinics; all of the physicians, withone exception, are U. of C. faculty and residents. From alow point last fall, when there were only two of us, the sup­ply of volunteer MDs reached a peak this past spring with14, most working once a month or every two weeks.The U. of C. has no official connection with the CHCE(aside from an arrangement extending malpractice insuranceto those of us who work there). The manner in which the16 center has gradually come to depend on Billings Hospital forits supply of physicians is an interesting example of what istermed, in today's marvelous jargon, "the sociology of uni­versity-poverty community interaction." An organizationsuch as the CHCE, which can use the help of anyone willingto come, even for just one evening, gets little or no responseto public appeals for volunteers. A number of universitydoctors, while sympathetic on principle, have reservationsabout the quality of medical care practiced, political impli­cations, safety of the neighborhood, etc. Those who comealong one evening with a friend who works there "just to seewhat it's like" usually sign on for a regular commitment.This same phenomenon may account for almost all thelaboratory help coming from Northwestern University, andthe Loyola Dental School being in charge of the once-a-weekdental clinic on the second floor of the building. The onlyformal liason between the CHCE and a Chicago area medicaleducational institution was one discussed with the ChicagoCollege of Osteopathy but so far not yet realized.How does the CHCE evaluate itself? While 1 have notattended a meeting of the Board of Directors, I have heardthat even with the (somewhat fortuitous) progress made inobtaining volunteer medical staff, discouragement persistsin other areas. They have not been able to include the servicesof social workers, nutritionists, or legal advisors, called forin the original plans. One full time licensed physician andtwo RNs still remain an out-of-sight goal. The lack ofvolunteer help from medical students, with a few notableexceptions, still surprises me, considering that much of theimpetus for viewing good medical care as a civil right hadits roots in the student "activist" movements of the mid-1960s.Publicity for the center has been good-too good, as theysee it: both CBS-TV and the Chicago Sun-Times ran fea­tures the past winter in which the Center received prominentattention, resulting in an influx of patients, rather than moneyor professional staff.The needs of the CHCE, when stated simply, sound simi­lar to those, say, of the U. of C. Medical School: financialsupport and quality staff. The difference in scale, of course,is such that this tiny organization views the resources of aninstitution such as The University of Chicago with an attitudethat has some unmistakable analogies with the way we as auniversity view those of the federal government.Towards a Natural History of DiseaseBy William H. McNeillThe Robert A. Milliken DistinguishedService Professor of HistoryWilliam H. McNeill, A.B. '38, M.A. '39, Ph.D. Cornell '47, theRobert A. Milliken Distinguished Service Professor of History,has been with the University since 1947 and was formerlyChairman of the Department of History. McNeill is the authorof The Rise of the West, which won the National Book Awardfor history and biography in 1964 and has recently been pub­lished in paperback. He is also the author of numerous articlesand several other books including Europe's Steppe Frontier1500-1800 (1964), A World History (1967), and The Con­temporary World (1968)."Towards a Natural History of Disease" was given as part ofthe Fishbein Lecture Series.Researchers in medical history know how impossible it isto give modern classifications to diseases recorded by menwho used different terminologies. And researchers in epi­demiology know how very complex and changeable are therelationships between mankind and the innumerable organ­isms that disease human bodies.The cautionary preposition 'towards' in my title is toimply recognition of the difficulties of achieving real under­standing of the changing interactions of human hosts anddisease organisms. However, the importance of the subjectis self-evident. Historians have overlooked possible detect­able changes in the patterns of man's symbiosis with diseasesin the past, thereby disregarding one of the most importantparameters of the entire human adventure. Also, epidemi­ologists and other experts in public health, primarily inter­ested in controlling the future, have found little occasion toreflect upon the past, even though some of the concepts andprinciples they have generated to analyze the propagation ofdiseases in this century may allow speculative retrojection ofprobable disease patterns upon the past.These remarks will be confined to infectious diseases,partly because until recently they were the more importantstatistically among men and partly because nothing aboutmen's changing ways of living seems to correlate in aprobable way with changing frequencies of non-infectiousdiseases.Focusing on infectious diseases, then, it is obvious thatclimate, frequency of contact among prospective hosts, sizeof potential host population and frequency of immunitieswithin it, mode of transmission, length of incubation period,length of infectivity period, longevity of the disease organ­isms outside a human or non-human host, etc., are all factorsaffecting the propagation of diseases. Extremes are likely tobe inimical, either to the human hosts, when dense popula­tions with little or no immunity stand ripe for some lethalinfection, or to the disease organism itself, when killing coldor crippling dehydration may make propagation from onehost to another difficult or impossible. A natural history ofdisease becomes possible by reflecting on extreme conditionsand their probable effects on the propagation of infectiousdiseases among men in times past. Consider the probable conditions of life among our earliestancestors. The wandering bands of anthropoid hunters andgatherers ancestral to man lived most probably in warmclimates where temperatures seldom went below freezing.Hairlessness would otherwise not have been tolerable. Ar­chaeological evidence currently suggests that Africa was thecradle of mankind, although the discovery of skeletal frag­ments is too accidental to make the inference absolutelysure.On the analogy of hunting and gathering bands that havesurvived to the present, it seems sure that our earliest humanancestors lived in small communities of not more than 60-100individuals. Bands may have come together for special occa­sions from time to time, but even on such occasions thelimitations of available food supply must have restricted thetotal number of individuals in bands to fewer than onethousand.These probable inferences suggest two possibilities aboutthe incidence of disease among proto-mankind and ourearliest human ancestors. First, man-to-man infections whichcivilized men most frequently experience (the common cold,the infectious "childhood" diseases) could not have hadmuch importance. Within isolated small bands of huntersand gatherers the number of prospective hosts must havebeen insufficient to keep such infectious organisms alive.I do not know what is the required minimal population infrequent contact with one another to sustain any of the com­mon infectious diseases of today. One epidemiologist casuallyremarked that it took about 1,000 persons to sustain a com­mon cold. Other infections that generate longer-lasting im­munities would require rather larger populations, andobviously the frequency of inter-personal contact, length ofinfectivity, etc. are also critical factors. A series of roughfigures for the commoner diseases of mankind today wouldgive the historian and demographer a series of thresholdsbeneath which particular disease organisms could be assumednot to be transmissible. A substantial ordering of the epi­demiological history of mankind might then become possible.Since such figures are not available, I have made thegeneralized observation that small human groups, isolatedfrom others most of the time and never congregating in num­bers exceeding 1,000, make very unfavorable terrain forman-to-man infections. However, our remotest ancestors didnot live in an Eden without disease. On the contrary, ageneral principle of ecology suggests that given enough time,elaborate balances between hunter and his prey, host andparasite, herd and disease organism assert themselves. Theevolution of mankind was probably slow enough to permitthis principle to prevail.The only kind of disease organisms suitable for survivingas parasites within the early isolated human communitieswere tropical diseases such as malaria, yellow fever. and17sleeping sickness. These organisms are not propagateddirectly from man to man but through variously elaborateintermediary hosts or developmental stages. Since mosquitoesare more abundant than men where both are found, thecomparative rarity of hunting and gathering human hostswould not necessarily interrupt the life cycle of infectiousorganisms.And when men were scarce in the balance of nature, aninfection that killed off its human host too soon had a poorchance of survival. Therefore, diseases that debilitated with­out quickly killing their human carriers had the best chanceof survival. The common tropical diseases fit the patternclosely. To be sure, malaria and other fevers quickly killedmost Europeans who ventured into Africa before modernmedicine mastered effective counter-measures, but Africans,I believe, suffered chronically from diseases that were lethalto those who lacked prior exposure.After hundreds of thousands of years had defined anappropriately elaborate ecological balance between the rovingbands of human hunters and a formidable array of tropicaldisease organisms, one or more bold bands broke out of thetropical environment where mankind had been existing. Thediscovery that a named man could don his prey's hairy skinand thus withstand climates with below freezing temperaturesfor relatively long periods of time opened up the temperatezones of the earth to mankind.1 R I think that most of man's previous diseases were thensimply left behind. Organisms that had adapted their lifecycles to parasitism upon a definite sequence of hosts couldnot easily adapt to climatic zones where a necessary partnerwas absent; and tropical mosquitoes never learned aboutclothes. The result was the now familiar ecological explosionwhenever a new organism bursts into a new environment,shedding its natural parasites or leaving its accustomedpredators behind. Man, leaving his tropical cradle, probablybehaved as rabbits did in Australia in the nineteenth century.A globe-girdling expansion brought the first human inhab­itants to the New World as one manifestation of this ex­plosion.If my reconstruction is correct, it is possible that for along time the bands that penetrated into new habitats in thetemperate zones were healthier than their predecessors, andhealthier, too, than their contemporaries still in the tropics.This is a very powerful reason for the relative backward­ness of Africa in historic times. If it is true that the diseasesof tropical Africa had a peculiar elaboration as compared todiseases indigenous to other parts of the tropical world, Ithink this is an indirect but quite powerful reason to believethat men did originate in Africa, as Dr. Leakey's bonessuggest. It requires a geological time scale to produce maxi­mally fine adjustments between host and invading organisms,and from the imperfect information I found, the diseases oftropical Africa fit the bill better than diseases of other partsof the world.Elsewhere, however, there was probably insufficient timeafter man's breakaway from his tropical cradleland forwidespread biological adaptation to occur across species ofthe kind required for the disease balance of earliest mankind.Instead, men proceeded in certain favorable areas to developagriculture and then to form cities and states, the early formsof civilization.Two points here are important. First, the places whereearly civilizations arose were separated by large distances.Regions between were thinly populated, and thus could notat first transmit diseases of the new, civilized man-to-manvariety. Second, as civilized populations grew and becamedenser, and as movement between the regions of densestsettlement became more frequent with the rise of states warand trade, civilized human populations became large enoughto sustain an unending circle of man-to-man infection with­out any alternative host.It follows that locally diverse infections established them­selves in China, the Middle East, India, and the Mediter­ranean lands of Europe as diverse civilizations grew up ineach region. Communications between civilized communitiesin early times may have allowed some interchange of diseaseorganisms. This would depend on how incubation and in­fectivity compared with travel times between the separatedcivilized areas. Where thin populations alone existed, man­to-man propagation of the new civilized diseases could notlong continue because the circle of available hosts wouldsoon run out.Presumably when an infection first appeared, it wouldhave had epidemic force, killing a considerable proportionof the human population. But resistances would arise fairlyfast among the survivors. Genetic-behavioral modificationsmay also have taken place among the disease-causing organ­isms. All 'successful' cases, then, must have concluded witha balance of infection and resistance that allowed both humanhosts and infectious organisms to survive in rough equilib­rium. Diseases of this type thus would become endemic. Thisis not incompatible with modest fluctuations in infectivity orincidence, perhaps even in a cyclic pattern as is now, I be­lieve, characteristic, say, of measles.As civilized populations acquired suitable levels of resist­ance to their own particular mix of infectious diseases, theyacquired a very potent means of disrupting traditional lifeand social organization among adjacent peoples who hadremained isolated, in small communities. Indeed, I believethat tolerance of a variety of highly infectious diseases wascivilized mankind's most potent weapon in expanding thegeographic scope of his dominion. Often some merchant,captive, or fugitive must have arrived in a small frontiercommunity carrying a disease which could lethally attack thehitherto isolated human population.Heavy die-off and psychological disorientation then re­sulting meant that no effective resistance was possible to theadvance of civilized mankind. Territorially vast and cultur­ally-ethnically integrated civilized societies could thus per­sistently spread to new ground, wherever cultivable land orother valued resources were found.Indian civilization is a partial exception. Civilized styles oflife began in northwest India in semi-arid regions of the IndusValley. Moving east and south meant penetrating wettertropical environments, where disease conditions similar tothose of Africa either existed already or developed as ship­ping allowed the importation of malaria and other tropicaldiseases. Civilized men from the north and west were here ata disadvantage analogous to that of European slave traderson the coasts of Africa in modern times. The local diseases ofisolated 'forest' peoples proved about as fatal to civilizedintruders as 'civilized' diseases were to 'forest' peoples.An epidemiological standoff presumably ensued, allowingcivilized values and attitudes to spread, perhaps more slowlythan in 'healthier' climes, but permitting the survival ofnumerous small communities which were incorporated ascastes and sub-castes into the structure of Indian civilization.The small communities preserved archaic magical practiceswhich had no logical relation to high civilization. The uniquevariability of Indian society and civilization may have been a necessary and natural adaptation to the epidemiological situa­tion south of the Himalayas where civilized lifestyles metunyielding disease barriers.Until shortly before the Christian era, the separate civilizedregions of the Old World continued to expand without link­ing up with one another in any sustained fashion. Each hadits own array of endemic diseases and possibly suffered occa­sional disease setbacks under unusual conditions. An armyon a distant frontier, for instance, better supplied with licethan food, might be suddenly destroyed like the army ofSennacharib before Jerusalem. But traditional sanitary codes,much emphasized in Indian and Jewish religious tradition,adapted to local disease conditions. Therefore, epidemio­logical stability was approached from about 3000 to 500 B.C.,except along the frontier of expanding civilized societies.The situation altered substantially when contacts amongmajor civilized communities of the Old World became fre­quent. Shortly before the Christian era, China 'discovered'western Asia and organized the Silk Road. At about thesame time, regular sea commerce began between the Red Seaand south India, and sea traffic across the Bay of Bengal andin the South China Sea supplemented movement overland.Diseases as well as goods travelled these routes. Whichdiseases arrived in China from the west, and which camethe other way cannot be determined. Descriptions of plaguesand epidemics in ancient texts are too vague for moderndiagnosis; and many epidemiologists think the symptoms ofinfectious diseases changed within historic times with themutation of the infectious organisms and/or altering levelsof resistance among human hosts.Still, it is worthwhile to scan the texts of Galen and otherclassical writers of the Mediterranean regions, as well asChinese texts, to determine what assumptions could be madeabout the appearance of new infections.Both the Roman Empire and the Han Empire of Chinasuffered substantial population losses in the early Christiancenturies; and both societies recorded a series of plagueswhich, at least among Romans, were extremely severe. Thepreviously separate disease pools associated with each majorcivilization of the Old World began to flow into one another.As a result, from time to time a dense population, withoutinherited or acquired immunity, encountered a new com­municable disease, often with drastic results. Deaths werenumerous, especially at the extremes-China and LatinEurope.By the 5th century A.D., however, the shock of this majorexchange of diseases had worn out and population decayslowed or stopped, except where prolonged political disorderintroduced a political factor into population dynamics. OldWorld civilizations all survived the onslaught of previouslyunfamiliar diseases. The surviving populations all acquireda satisfactory level of immunity to a wider range of infections;')() diseases like measles, mumps, whooping cough, smallpox,diphtheria, the common cold, and fiu had probably becomeendemic in the Eurasian world by then.Nomadic steppe dwellers, who had pioneered a distinctivestyle of life beginning about 3000 B.C. must also have beenaffected by the new ecumenicity of infectious diseases. Sincethey provided the manpower for the caravans crossing thedeserts between civilized communities, they were among themost exposed human populations. Changes in political-mili­tary organization also helped spread disease among nomadsas large confederations developed in the 3rd century B.C.Especially between 500 B.C. and 500 A.D. nomad con­querors who invaded civilized lands and settled down tocollect taxes and rents were exposed to unfamiliar diseaseswhich unfavorably affected the durability of their 'empires.'Nomad invaders of India continued to encounter disastrousdiseases through historic times, but in temperate zones afterthe period of the great V olkerwanderungen the nomads ofthe northern steppe adjusted to civilized diseases. Among theMongols, for instance, the customary annual assemblage ofall the tribes for a great hunt in the fall provided an oppor­tunity to exchange diseases as well as gossip about the year'sdoings. Under these conditions, even a widespread popula­tion probably passed the critical numerical threshold at leastonce a year to allow propagation of an impressive array of'civilized' man-to-man types of infections.After 500 A.D. nomad conquerors had no particular diffi­culty in remaining healthy in civilized environments. TheTurkish influx into Moslem lands, for instance, could nothave occurred otherwise. Similarly, the Mongol and Manchuregimes in China did not suffer devastating epidemics.Even after the mingling of civilized disease pools by about500 A.D., pestilence continued to break out occasionally. Butsuch diseases were marginal in one of two senses. Eitherthey were, like bubonic plague, a disease of another specieslike rats that affected humans primarily when an epidemicamong rats deprived the rat fleas of their accustomed hosts.Bubonic plague was endemic in India, where various wildrodents and their fleas lived in a somewhat stable fashion;from time to time it became epidemic among rats living indense agglomerations among men, but in temperate climesthe organism killed off so many rats (and men) that it diedout after a few seasons from lack of hosts. This highly un­stable situation lasted from the time of Justinian, when thefirst identifiable bubonic plague is thought to have affectedEurope, to the seventeenth century. But a change in thespecies of rats infesting human habitations in the eighteenthcentury had the effect of wiping out bubonic plague as aserious disease among civilized mankind of the temperatezones-though not in warmer climates, where the new grayrat did not drive out the older black species.The other kind of epidemic that persisted as a major forceamong civilized mankind after about 500 A.D. was typifiedby unusual and inherently unstable circumstances. Foodshortages and famine might provoke mass migrations andprovide a suitable human mass for the propagation, for in­stance, of typhus. Armies remained particularly vulnerable,and could spread a disease among a civilian populationeither in advance or retreat. A climatic gradient probablyoperated, with warmer climates and summer months moreconducive to epidemic outbreaks.This meant, among other things, that the repeated Germaninvasions of Italy in the Middle Ages and early moderntimes regularly miscarried as the troops fell ill of fevers. Con­sider how important this was for Europe's political history.The failure of the Hohenstaufen Reich, upon which Germanpatriots spent so much emotion in the nineteenth century,was due to the unhealthy climate of Italy-for Germans.Similarly, the failure of Charles V to consolidate administra­tive control over Latin Christendom when other 'gunpowder'empires were spreading elsewhere may have depended incritical degree on the way his German forces melted awayunder the Italian sun. (Significantly, it was Spaniards, notGermans, who conquered Italy; their troops came mainlyfrom the same Mediterranean disease milieu as the Italians.)The survival of Indian multiplicity under Moslem con­quest was surely related to decimation by disease of invadersfrom cooler climes. The epidemiological consequences for theMoslem world of the annual vast pilgrimage to Mecca mustalso have been substantial, allowing African and IndonesianMoslems, for example, to exchange parasites-insofar as thedry climate of Arabia allowed.The next landmark in the natural history of disease wasa byproduct of the European oceanic discoveries. All theislands of the seas previously inhabited by isolated humangroups were laid open to a formidable array of civilizeddiseases. The largest human population endangered was thatof the Americas. In central and Andean South America,dense and previously unexposed communities were helplessbefore the diseases of the Spaniards and Africans who crossedthe Atlantic. The result was catastrophic depopulation, re­ducing the Amerindians to helplessness. It has been calculatedthat the central valley of Mexico had 15 million inhabitantsor more when Cortes arrived in 15l9-by 1650 the popula­tion of all Mexico was 1.5 million, and probably relativelyfew had purely Indian blood.Similar destruction occurred in Polynesia, among Eskimos,and generally wherever previously isolated populations hadto confront infectious disease carried by civilized peoples.Among the civilized peoples of the Old World, however,the speedier and more continuous linkages through trans­oceanic shipping meant that the mixture of diseases was moreconsistent than ever before. Opportunity for local epidemicswas correspondingly narrowed. No substantial civilized pop- ulation was not in constant epidemiological contact withmore of the rest of mankind. For a century and a half(roughly the same period required for Amerindians to adjustto civilized diseases) great ports like Lisbon and Londonwere notorious for their unhealthfulness. But after about1650, even these maximally exposed locations ceased tosuffer much from epidemic disease. At about this time, andnot by coincidence, the modern population growth rate ofsomething like 1 percent per annum began in all parts of thecivilized world; the altered demographic impact of diseaseplayed an important part.The final stage in the natural history of disease is the veryrecent scientific unravelling of patterns of infection and de­velopment of effective prophylaxis. The first of these achieve­ments of modern medicine was Dr. Jenner's advocacy ofinoculation for smallpox towards the end of the 18th cen­tury. The work of Pasteur, Koch, and other famous 'microbehunters' is not a century old, and the mobilization of publichealth organizations to check infectious diseases is still morerecent. The medical revolution is now upon us, and the con­sequence for population growth throughout the world areformidable. Because disbalances created by changes in diseasepatterns are now so critical, attention to the natural historyof disease along the lines suggested here might have atheoretical as well as a historical interest.Senior Scientific Session25th Anniversary"Some years ago, as a young facultymember of this medical school, Leon A.Jacobson ('39) conceived the idea thatmedical students should have some wayof presenting the results of their re­search accomplished during the tenureof their medical school careers. Thisconcept was brought to fruition in thefirst Senior Scientific Session, held inthe spring of 1946. For many years Dr.Jacobson infused the annual event withhis intelligence and energy, so that nowit has developed into the tradition weare celebrating today." With these words,Francis H. Straus, II (,57), AssistantProfessor in Pathology and chairman ofthis year's program, opened the 25th an­niversary session. Assisting him on thefaculty committee were Harry Fozzard,Philip Hoffmann, Robert Replogle, andJoseph Swartwout.The program is sponsored each yearby the Medical Alumni Association, anda prize is awarded to the student givingthe best oral presentation of his research.This year Lambert N. King won, forhis presentation of "Phospholipids andOxygen Consumption in SynchronizedYeast." Dr. King, who also received aPh.D. degree this June in Pathology, istaking his internship at Cook CountyHospital, Chicago.A DEMOGRAPHIC STUDY IN ANALEUT AND AN ESKIMO VILLAGEIN ALASKABy Harlan D. AlpernSponsor: Joseph R. Swartwout, M.D.During the summer of 1970, the Stateof Alaska was considering the expan­sion of its family planning services. Inorder to determine the acceptance andimpact of the present program as well asthe demand for increased services, I, afourth-year medical student, was given agrant by the State to visit an Aleut andan Eskimo village. In these villages I col­lected birth statistics and conducted anoriginal knowledge, attitude, and prac­tice survey dealing with contraception ofwomen in the reproductive years. Atti­tudes toward abortion, which becamelegal in July, 1970, were also explored.An effort was made to define what prob­lems women were encountering in ob-22 taining birth control information or ma­terials and to explain contraceptivemethods to women who were not fa­miliar with them.The Aleut village, located in the Aleu­tian Islands, is a relatively prosperousfishing community of 400 people. Thewomen here were familiar with birthcontrol, used modern methods of con­traception, and expressed family plan­ning-related attitudes comparable to thoseof middle class culture elsewhere inAmerica. The widespread use of con­traception and the acceptance of abor­tion among these women is probably dueto the village's prosperity and outsidecontacts.The Eskimo village is a community ofabout 2000 people located on the Arc­tic Ocean. The women here expressed amoderate knowledge and use of contra­ception. Many women desired to avoidpregnancies but had never heard of con­traception or were unaware that it wasavailable to them. Other findings werethat the Eskimos tend to have largefamilies and that illegitimacy is sociallyacceptable. A relative lack of knowledgeof abortion and less liberal attitudes to­ward it were discovered.The study demonstrates that duringthe decade 1961-1970, there was amarked decline in the birth rates inthese native villages and a simultaneousincrease in the use of contraceptives.These two phenomena appear to be re­lated.This investigation confirms that peo­ple as geographically and culturally iso­lated as Alaskan natives desire and prac­tice birth control.A COMPARISON OF THEINSIDE-OF-THE-BODY TEST:MEDICAL VS. LAW STUDENTSBy Bruce AndichSponsor: Richard V. Kaufman, M.D.The object of this study was to discovervalid verbal categories and descriptionsof non-verbal mental imagery. This isan attempt to analyze a type of "think­ing in pictures" elicited with the "inside­of-the-body" test and assess the mean­ingfulness of various aspects of graphiccomposition. This involved classing pre- sentational elements of the drawings intological and discursive thought and test­ing the applicability of these descrip­tions.Two groups which were presumed tohave different attitudes, anxieties, andknowledge of the body were chosen andwere roughly matched in other areas.Two groups of sixteen senior studentsfrom the medical and law schools wereasked to "draw the inside of the bodywith all the internal organs." The med­ical students were told not to considerthis a test of anatomy. Many participantswere able to regress cognitively fromwhat they knew to be visually accurateto drawing fantasies which they couldrecognize as being unrealistic.Three judges rated each drawing rel­ative to seven categories. Statisticallysignificant differences (p less than 0.05)were found in five categories; continuityof outer envelope, amount and spatialarrangement of internal contents, globalintactness, and sophistication. There wasno significant difference in two categor­ies: line quality and number of naturalbody openings. Interjudge reliability wason the order of 75 per cent.We have demonstrated that certain ofthe terms used to describe the "insideof the body" drawings are meaningful,and that where two small populationswere expected to be different, five ofseven concepts showed a statistical dif­ference to be present. It is not withinthe scope of this project to explore thereasons for these differences, which couldreflect anything from differences insensory motor coordination, anatomicaltraining, or concepts about the body. Weare primarily interested in the study ofmental imagery and the discovery ofways of understanding pre-verbal andnon-verbal forms of mental content.DR. ALPERN DR. ANDICHSURGICAL MANAGEMENT OF SICKLECELL ANEMIA: THE USE OFPARTIAL EXCHANGE TRANSFUSIONSBy: Mark L. BatshawSponsor: Robert L. Replogle, M.D.Sickle cell anemia is a Mendelian reces­sive hemoglobinopathy, manifest clin­ically by crisis and pathophysiologic allyby an abnormal hemoglobin (HemoglobinS) which in the deoxygenated state formsneedle-like tactoids destroying the shapeof the erythrocyte. The incidence is esti­mated at 1 per cent of the black popu­lation. Until recently the life expectancyof patients with sickle cell anemia wasabout fifteen years. With more effectivemanagement of sickle crisis and its se­quelae, the life expectancy has risenconsiderably. Operations performed onsicklers have risen concomitantly for bothelective procedures and operations ne­cessitated by long term sickle ceil anemia.These patients are notably poor op­erative risks. The functional capacity oftheir vital organs is severely reduced byinfarcts and fibrosis. Furthermore, asmall fall in oxygen saturation, especiallyin the presence of acidosis, hypothermia,or hypovolemia is sufficient to causegeneralized sickling with disastrous ef­fects.Six children, ranging in age from 18months to 12 years, have receivedpartial exchange transfusions prior toelective surgery at Wyler Childrens Hos­pital in the past five years. The advan­tage of this method over simple transfu­sion is that the oxygen-carrying capacityof the blood is increased without over­loading the circulation. It further pro­vides a means of increasing the hemo­globin level while immediately reducingthe percentage of Hemoglobin S to lessDR. BATS HAW DR. BROWNSTEIN than 50 per cent. As a result, the prob­lem of increased viscosity and sensitivityto hypoxia is avoided.Clinically the result has been a ver­itable absence of operative morbidity be­yond normal limits. Healing is rapid andlength of post-operative hospitalizationreduced.NEURAL CONTROL OFPINEAL ENZYMATIC ACTIVITYBy Michael J. Brownstein, Ph.D.Sponsor: Alfred Heller, M.D.There is considerable evidence to sup­port the concept that the level of pin­eal hydroxyindole - 0 - methyl transferase(HIOMT), as well as the levels of otherpineal constituents, is under neural con­trol. In animals exposed to continuouslight for 7 to 30 days, the levels ofHIOMT in the pineal are low; while inthose rats which have been kept in dark­ness or blinded, there is an elevated levelof the enzyme. This light-dark differencecan be abolished by lesions producingbilateral degeneration of the inferior ac­cessory optic tract or by superior cerv­ical ganglionectomy. The postganglionicsympathetic fibers arising from the su­perior cervical ganglion are thought tosupply the pineal gland in the rat itssole source of inervation. Therefore, neu­ral control of HIOMT is undoubtedlymediated via these fibers.In the rat, stimulation of the pregang­lionic nerve trunk to the superior cerv­ical ganglion causes a reduction in pin­eal hydroxyindole - 0 - methyl-transferaselevels which is time-dependent. This fallin enzyme level can be blocked by ad­ministration of a-methyl-p-tyrosine, aninhibitor of norepinephrine's synthesis,prior to and during the time of stimu­lation. These results provide direct evi­dence for a role of afferent input in thecontrol of pineal enzymatic activity.A PROJECT IN COMMUNITYMEDICAL EDUCATIONBy Dorothy DaviesSponsor: Joseph R. Swartwout, M.D.In the summer of 1968 a pilot programin sex education of community tee nag- ers was initiated in Woodlawn with theassistance of Georgia Houston, a blackhigh school student, Dr. Joseph Swart­wout, the Student Health Organization,and the Ford Foundation. This projectwas undertaken to explore some possi­bilities for carrying out preventive com­munity medical education which couldbe responsive to the specific needs of thecommunity members, contact those atrisk who are not yet sick, and commun­icate in pertinent and comprehensiblelanguage.The topic of reproductive health waschosen and discussion with members ofcommunity agencies led us to focus onsex education of teenagers. A survey ofintra and extra-community resources wasundertaken. Lists of potentially contribu­tory community agencies and of avail­able films, pamphlets, and books werecompiled. A course outline was preparedutilizing selected media from those sur­veyed. This was used in three ten-sessionclasses during the summer.Methods of contacting potential stu­dents included contacts with pre-existinggroups, informal introduction to com­munity individuals by community agen­cies, incorporation of interested bystand­ers, and contacting people on agencylists. The first method was most efficient,the last method entirely unsuccessful.Continuation of the program hastaken two forms. An inter-agency meet­ing was held and lists of available re­sources were distributed to encouragethe agencies to establish their own pro­grams. A mother living in the com­munity was trained to carryon similarclasses on a year-round basis, and wassubsequently hired by Dr. Swartwout ona Rockefeller Foundation family plan­ning grant. In this position she has givensimilar sessions to various communitygroups outside the hospital. Three addi­tional community teachers have beentrained and hired, and a file of filmsand pamphlets (some produced by thefamily planning group at The Univer­sity of Chicago) has been acquired foruse in this and similar programs.To be preventive, community medicaleducation must reach beyond the wallsof a place to which people come whensick. To be effective at all, it must be23given in language which is meaningfulto the listeners. We have found cooper­ation with existing service agencies andgroups to be invaluable in initiating con­tacts within the community. Mrs. Cald­well has provided a convincing demon­stration to all of us working with herthat a person who culturally, linguis­tically, and emotionally is of the com­munity is the most effective speaker tothat community.COMPUTER MODELING OFEYE OPACITIESBy Karl J. Fritz, Ph.D.Sponsor: Albert M. Potts, M.D.A diseased cornea may become cloudyand thereby be a scattering region forincoming photons. A Monte Carlo modelof such a cornea has been developed andthe image degradation caused by variousamounts of clouding has been estimated.Photons from a point source on the op­tical axis are started at random pointson the anterior surface of the cornea.After a photon is refracted, according toSnell's law it travels a distance deter­mined by the optical density of thecornea and a random number. If thephoton remains in the cornea after tra­versing this distance it is scatteredthrough an angle which is determined byanother random number and the relativeprobabilities for scattering through var­ious angles in the cloudy cornea. Thepropagation and scattering in the corneacontinues until the photon escapes backout the anterior surface, out the edge,or intersects the focal plane for paraxialrays. In the third case the distance fromthe focal point for paraxial rays is re­corded.When this process is repeated for alarge number of photons and the re­sulting distribution of photons is com­pared to the corresponding distributionproduced by a clear cornea, an estimateof image degradation can be made. Inthe limit of vanishingly small clouding,the modeled image coincides with thatfor corneal spherical aberration. Sig­nificant image degradation begins withclouding sufficient to scatter an averageof one-half the photons. As the opticaldensity of the cornea increases beyond24 this level, there is a precipitous drop inthe central image intensity, the rate ofchange of intensity with the distancefrom the optical axis, and the integral oftotal photons in the central region ofthe image. Expansion of the model tothe entire set of optical elements of theeye is underway.PHOSPHOLIPIDS AND OXYGENCONSUMPTION INSYNCHRONIZED YEASTBy Lambert N. KingSponsor: Godfrey Getz, M.D.Synchronized cultures of Saccharomycescerevisiae (National Collection of YeastCultures No. 239) were utilized to studythe timing of phospholipid synthesis inrelation to the cell cycle and to suchmajor parameters as nuclear DNA syn­thesis and whole cell oxygen consump­tion. Increases in phosphorus mass oftotal cell phospholipids were shown tooccur incrementally during a limitedportion of the cell cycle. Continuouslabeling experiments employing tri­tiated galactose or tritiated glyceroldemonstrated that the maximal rateof incorporation of label into themajor phospholipids lecithin and phos­phatidyl ethanolamine occurred at thetime of budding and early daughter-cellenlargement. Pulse labeling experimentswith tritiated glycerol and p3Z confirmedthis pattern of synthesis of the majorphospholipids. Assay of CDP-chlorinetransferase activity in synchronized cul­tures showed that enzyme activity wasoscillatory with one peak period of ac­tivity per cell cycle occurring at thetime of budding and nuclear DNA syn-DR. DAVIES DR. FRITZ thesis. Both continuous labeling andpulse labeling experiments demonstratedthat the timing of synthesis of the mito­chondrial phospholipid cardiolipin wassimilar to that of lecithin and phos­phatidyl ethanolamine. This discontin­uous pattern of synthesis of cardiolipinis in contrast to the synthesis of mito­chondrial DNA, which has been shownby other investigators to be continuousin the strain of S. cerevisiae we used.THE MATERNAL EEGDURING LABORBy Ronald M. KlarSponsors: Frederick P. Zuspan, M.D.,and James O. Elam, M.D.Although considerable attention has beenfocused on the mechanisms of parturi­tion, no patterns of human cortical ac­tivity have been described. This investi­gation was undertaken to determinewhether a maternal electroencephalogram(EEG) could be obtained during laborand what waveforms and patterns mightbe characterized.Spontaneous labor was followed fortwenty-two selected patients at The Uni­versity of Chicago, Lying-in Hospital.Cortical recordings using scalp electrodesalong with simultaneous monitoring ofuterine contraction and patient percep­tion of pain were performed during allstages of labor. Tracings were obtainedwhen the patient was unmedicated, bothwhile experiencing pain and while not,and when unmedicated, while anesthe­sia or analgesia was achieved.The records revealed that a recogniz­able EEG can be obtained during labor.DR. KING DR. KLARThe EEG of the parturient patient wasdistinct from that of the non-parturientpatient. It was characterized by twodifferent patterns of waveforms andrhythms. The organization of these pat­terns and the amplitude of one of thewaveforms varied with the progressionof labor. This was independent of thetiming of uterine contractions and ofpatient perception of pain, was not ap­parently altered during effective anes­thesia by spinal conduction block, butwas altered characteristically during ni­trous oxide analgesia. Consideration isgiven to the origin of the waveforms andrhythms, the basis for the patterns andtheir organization, and their relevancyto several hypotheses for the mecha­nism of labor.EXPLORATION INTO THEEFFECT OF COLOR ONCONTRACEPTIVE EDUCATIONBy Corbin RoudebushSponsor: Joseph R. Swartwout, M.D.In order better to assess one of the po­tentially most important aspects of com­munication in contraceptive education, astudy of the effect of two colors wasundertaken. Two hundred postpartum pa­tients of the Chicago Lying-in Hospitalwere tested. One hundred saw a shortslide presentation with red as the back­ground color; the remainder viewed theidentical presentation with a blue back­ground on the slides. Their response wasevaluated by a questionnaire designedto measure emotional response, certainof their attitudes, and retention of fac­tual material.Of those surveyed 90 per cent feltthat the female partner or the coupleDR. ROUDEBUSH DR. SILVERT should choose the method of contracep­tion used. Only 3.5 per cent felt themale should decide. Almost 95 per centfelt economics should not play the ma­jor role in a decision to use contracep­tion. Finally, 90 per cent of these re­cently delivered women felt that painin childbirth was not a significant deter­rent to further children. No differencebetween red and blue background couldbe detected in these attitudinal or in theinformational questions.However, a significant difference wasobtained on one emotional question.Nearly twice as many women viewingthe blue series felt children were hap­pier in a small family as opposed to alarge family. With the red series, pref­erence was for large families. The dif­ference with color was significant at the.02 level.It is hypothesized that a very funda­mental aspect of education communica­tion has been discovered. The impli­cations of this finding are many.Obviously the emotional effect of color incontraceptive education needs to be ex­tensively studied. However, it seemsU of C - Medicine - Galley 31 ..equally evident that other unrecognizedbarriers to communication should besought and investigated.EVALUATION OF RENAL CALCULITHERAPY UTILIZING ARADIOASSA Y FOR URINARYCALCIUM OXALATE SATURATIONBy Mark SilvertSponsor: William B. Gill, M.D.Calcium oxalate accounts for over two­thirds of all renal calculi. If a stone isto form and grow, the urine mustDR. WU DR. ZIEGLER be supersaturated with calcium oxalate.Measuring the total amount of calciumand oxalate excreted does not tell uswhether that urine is supersaturated ornot. To determine supersaturation orundersaturation, one needs to knowwhether the concentration of calciumoxalate increases or decreases after theurine has been exposed to solid calciumoxalate. Because of the difficulty and un­reliability of determining urinary oxalate,studies on calcium oxalate saturationstates have previously not been feasible.In order to deal with trace amountsof calcium oxalate in the urine andother interfering calcium compounds, wehave developed a simple and reliabletechnique utilizing 14C-oxalate and solidcalcium 14C-oxalate. The degree of un­dersaturation can be estimated by theamount of 14C-oxalate that will go intosolution from solid calcium l4_C-oxalate.An estimate of the degree of supersatu­ration can be made by first adding traceamounts of radioactive oxalate ions tothe urine, and then measuring the re­duction of radioactivity in the superna­tant urine after non-radioactive calciumoxalate seed crystals have been added.To estimate and eliminate the effects ofthe nonspecific ion exchange between theradioactive and non-radioactive oxalateions, all tests are run in duplicate againstsamples of the urine previously saturatedwith non-radioactive calcium oxalate. Wehave shown that the total procedure canbe performed in 4-5 hours with goodaccuracy and precision.In a series of presumably normal pa­tients, we have found not only under­saturated and saturated morning urines,but also supersaturated urines. Stoneformers have also been found to havevarious degrees of calcium oxalate satu­ration including higher degrees of super­saturation than we found in the non­stone formers. Some stone formers withhighly supersaturated urines have beensuccessfully converted to undersatura­tion by diuretic therapy. These resultsare consistent with the crystallizationtheory of stone formation.This new radioassay for urinary cal­cium oxalate saturation will readily en­able various proposed stone therapies tobe evaluated in vitro as well as in vivo.We have also investigated the effects of25certain proposed crystal poisons andcomplexers on in vitro crystal growth.Thus, this radio assay has proved to bea most reliable method for determiningthe efficacy of stone therapies and moni­toring the long-term maintenance of anundersaturated urine scientifically.ULTRASTRUCTURE OF UTERINEARTERY ADAPTATION TOGESTATION: ORIGIN AND ROLEOF INTIMAL THICKENINGBy George WuSponsor: Seymour Glagov, M.D.In arteries of adult mammals, the numberof medial fibrocellular layers is re­lated to vessel diameter and to tangen­tial tension. During growth and matu­ration, the arterial media grows byaddition of new layers and/ or widening oflayers already present at birth. To in­vestigate some of the factors which reg­ulate the extent and mode of arterialmedial growth, differentiation, and re-o modelling, we studied the uterine arteryof the rabbit; during a 30-day gestationperiod, the length of this vessel increasesby a factor of about 8 and its diametertriples. A standard sample of the mainuterine artery, proximal to the first ma­jor bifurcation, was taken at various in­tervals from conception and examinedby light and electron microscopy.In virgin animals, the media con­tained 5 or 6 circumferentially orientedsmooth muscle layers and an intact in­ternal elastin lamella (IEL); the intimararely contained myointimal cells. Bythe 15th day of pregnancy, the numberof medial smooth muscle layers doubled;the cell membranes were markedly con-26 voluted, forming numerous cytoplasmicprojections or pseudopods, and myofi­brillar dense bodies were increased innumber. There were numerous sub­endothelial thickenings consisting mainlyof layers of smooth muscle cells. TheIEL was usually intact with fenestra­tions resembling those in the uterine ar­tery of the virginal animal. Focally, how­ever, gaps in the IEL were very wideand contained radially or longitudinallyoriented smooth muscle cells. These ele­ments formed an uninterrupted transi­tional cellular bridge between the cir­cumferentially oriented medial cells andthe longitudinal myointimal cells. Colla­gen and elastin fibers developed be­tween adjacent myointimal cells and adistinct newly formed IEL eventuallyseparated the intimal fibrocellular layersfrom the endothelium. Endothelial con­tinuity persisted throughout gestation, butmany endothelial cells were unusual inthat they contained fascicles of fibrilswith associated dense bodies morpho­logically indistinguishable from thoseseen in myointimal or medial cells.The findings indicate that enlargementof the uterine artery wall during preg­nancy is achieved by the proliferationof medial cells and penetration of theseelements into the subendothelial com­partment through gaps in the IEL. Themyointimal elements and associated ex­tracellular fibers are organized into lay­ers and a new subendothelial IEL isformed. There was no evidence that themyofibrillar endothelial cells were mod­ified medial cells inserted into the endo­thelial lining; the appearance of endo­thelial myofibrils may be a response tothe same humoral and/ or mechanicalstimuli which induce the medial hyper­plasia. EFFECTS OF D-LYSERGIC ACIDDIETHYLAMIDE ON THE UPTAKEAND RETENTION OF5-HYDROXYTRYPTAMINEIN VIVO AND IN VITROBy Michael G. ZieglerSponsors: Daniel X. Freedman, M.D.,and Richard A. Lovell, Ph.D.Tritiated 5-hydroxytryptamine (3H-5HT)was administered to male Sprague-Daw­ley rats by means of a permanent can­nula implanted into the lateral ventricleof the brain. D-Iysergic acid diethyla­mide (LSD), injected i.p. simultaneouslywith the intraventricular administrationof 3H-5HT enhanced the retention of3H-5HT in addition to elevating endog­enous brain levels of 5-HT. Ouabain,administered intraventricularly togetherwith 3H-5HT, reversed the enhancing ef­fect of LSD on the retention of 3H-5HTand abolished the LSD-induced increasein endogenous 5-HT. Pargyline pretreat­ment also abolished the LSD-inducedincrease in brain 5-HT.In vitro uptake of 3H-5HT into brainslices in the initial 5-minute period wasdecreased by LSD but retention of 3H_5HT by the slices at later times was en­hanced. Pargyline at 104M did notfurther enhance retention of 3H-5HT inthe presence of 106M LSD in themedium. These results suggest that thedecreased turnover of 5-HT observed af­ter LSD is due to inhibition of neuronalfiring, since this can be overcome by theneuronal depolarization caused by oua­bain. They also are consistent with theidea that LSD by some mechanism pro­tects 5-HT from deamination by mono­amine oxidase.In MemoriamTHE NATURE OF MODESTY:Richard B. Richter, 1901-1971(The following eulogy was deliveredby Dr. Sidney Schulman at the Me­morial Service for Dr. Richter in BondChapel on May 20, 1971. Dr. Rich­ter served as President of the MedicalAlumni Association in 1956.)Dr. Richter was the University's neu­rologist for thirty years, until his retire­ment in 1966. He was also a son of theUniversity, and of the Midwest. He wasborn in La Porte, Indiana. His motherdied very soon after his birth. He wasraised by his father, a businessman inLa Porte, a person of great intellectualattainment, who was regarded by hisson as the most cultivated man he hadever known.When Richard Richter came to Chi­cago, he lived in Hitchcock Hall. Hestudied under Carlson, Luckhardt, andJudson Herrick. He graduated from RushMedical College in 1925. His postgrad­uate training in neurology extended overa period of six years with two of thegreat figures of Chicago neurology, Drs.Thor Rothstein and Peter Bassoe. It wasin 1936 that he was invited to comeback to the University by Dr. GeorgeDick, a seclusive but commanding fig­ure, a master clinician, who was Chair­man of the Department of Medicine.Dr. Richter was a clinical neurologistand a neuropathologist. He spanned theinterval in both fields from near the endof their classical descriptive phase towell into their modern biochemical and molecular period. He was completely pro­fessional in both. There were never anyinnuendos of rejection from either group,such as one hears from chemists, forinstance, about anatomists dabbling inchemistry, and vice versa. In fact, itwas the pathologists who insisted thatDick Richter was no clinician, but apathologist, and likewise the clinicianscould not believe he was a pathologist,and claimed him exclusively for theirside. This unusual dispute was finallysettled by Dr. Richter's election to thepresidency of the major national soci­ety of each-he was President of theAmerican Association of Neuropathol­ogists in 1961, and of the AmericanNeurological Association in 1964.So far as I was ever able to judge, hisgreat skill as a neuropathologist was self­taught. In the beginning, this was witha microscope, histological sections, anda highly-prized second-hand copy of abeautiful book by Walther Spiel meyer,one of the classical founders of neuro­pathology. This would not be an appro­priate time to analyze Dr. Richter'spublications. They are, of course, special­ized and technical. But there are somethings about them that are so unusual,and so revealing of his personality, thatI would like to speak about them a lit­tle, in a general way.Although he did one piece of impor­tant laboratory work with experimentalanimals, most of his major publicationswere pathological case reports. None ofthem could be dismissed as merely that,however. Nobody ever wrote patholog­ical case reports like Dick Richter's.Reading them makes you think of Mi­chelangelo working for the General Out­door Advertising Company. It is trueenough that he had elegant literary stylein the best sense of that word, so true,in fact, that it would be easy to accountfor the excellence of his papers on thatbasis alone. But this would be superficialpraise.In each of his papers, his introduc­tory remarks placed the case to be de­scribed in the perspective of knowledgein a masterly way. His organization ofthe background of the history of ideasabout a group of diseases, and his con­ception of the relations between them,were always laid out with beautiful clar- ity and assurance. His grasp of his ma­terial was so uniquely comprehensivethat these introductory expositions gaveyou not just a useful framework, but awhole new slant on a broad area ofknowledge.In the brief clinical descriptions whichcame with these reports, his account ofthe symptoms was so skillful, and freeof the usual medical cliches and catch­all technical phrases with their pseudo­precision, that one got an intimate senseof the course of the disease at once.The same kind of thing happens whenyou read the pathological findings. Theseare given in great detail, but readingthem is a radically different experiencefrom the feeling of drudgery you getfrom plodding through just the ordinaryfirst-class literature of neuropathology.The descriptions are organized aroundthe nature and distribution of the dis­ease in the nervous system, and not inany standard, regional scheme. The im­portant changes and the severe alter­ations are brought to the fore strikingly,without the use of vulgar superlatives.The questions that are raised in yourmind by one sentence are answered inthe next, so that you come to be car­ried along in a rhythm of thought andlanguage that engages your concentra­tion irresistibly.The content of the body of everyoneof his case reports saturates you in suchDickensian fashion, that you get an urgeto take up pencil and write the commentand conclusions yourself, but, of course,you don't. You read what Richter wroteand discover you could never have re­produced his finesse in stating the mean­ing of his observations with just theright amount of confidence, or reserva­tion. He made an artform out of thewriting of pathological case reports.This aspect of his publications, thetechnique, gives one view of his makeup.The subject matter gives another. Thereis no single trend in the work. There isnothing that can be called a progress­ively deeper and wider pursuit of asingle great theme, no opus with unityand structure. He had no romantic ideaof himself as a man with a destiny tofulfill for neurology. He studied whatcame to him in the course of his life asa neurologist. This was his modest, un-27spoken dedication. He wrought his rawmaterial into his thought, and into thescholarship of neurology.The content of his work, therefore,was diverse. To mention only a few ofhis contributions: He extracted an en­tity from a confusing, heterogeneousgroup of diseases of the cerebellum, anddemonstrated that it was hereditary, andin doing so, wrote the definitive accountof the histology of that particular dis­ease. In a series of papers which wereirregularly and widely spaced in time, hedescribed several forms of inflammatorydisease of the brain in man and in themonkey, which provide, in composite, amore useful account than any other Iknow of the morphological spectrum ofnon-suppurative inflammation in the ner­vous system. He foreshadowed therecent era of research on regional meta­bolic differentiation in the brain by dem­onstrating the exquisitely focal charac­ter of the necrotizing lesions producedin monkeys by carbon disulfide and byaminoquinoline compounds, and in do­ing so, he was the first to induce a Park-. insonian syndrome in experimental ani­mals. He gave the most comprehensivedescription available of a disease callednecrotizing encephalopathy of infancy,based on four cases in two publications.His analysis and interpretation of thechanges in the brains of these childrenled him to predict what has recentlybeen proven, that this disease is a con­sequence of a genetically determinedmetabolic disorder.These and his other studies, publishedand unpublished, made him completelyat home with the pathology of the ner­vous system, and a superb teacher of thesubject. His consummate skill as a path­ologist makes it sound strange, perhapsimpossible, to say that his forte wasclinical neurology. Yet it was true thathe was a master clinician. I knew no onewho was his equal in the precision anddecisiveness of his clinical work. Hisopinions were given "full-throated," asone of his colleagues once characterizedthem. They rang with authority.Whenever you happened to see DickRichter, you looked at a face that washandsome, finely-worked, the kind thatimproves with time. But it was whenhe was at his work that his face took28 on what was for me a beauty and ex­pressiveness so stunning that I could noteasily take my gaze away from it. Thehonesty and fullness of his interest cameinto his eyes when he inquired of a pa­tient about his symptoms. He would be­come so steeped in a patient's historythat when he recounted the symptomsfor others on rounds, in a conference, orduring a clinical lecture, his facial ex­pression made you think he was exper­iencing the symptoms himself.Whether he was examining a patient,the medical record of a patient, a brainspecimen, or some microscopic sections,however rich the disorder of the mate­rial at hand, it never produced anyhint of strain or bafflement in his face.What you saw in it was unselfconscious,unharried, encompassing curiosity, intel­ligence and assurance. Sometimes, whenthe problem was truly difficult, some­thing else would come into his face-afaint trace of excitement, a just barelyperceptible twitching of the end of hisnose and upper lip. This meant thepieces were beginning to fall into place,and you were about to hear his thoughtsand his diagnosis, which, because youwere still befuddled yourself, were sur­prising, unexpected, yet compelling andinevitable.Dick Richter could carry great bur­dens of work, responsibility and anxiety,with no interruption of his urbane witand gaiety, no show of fatigue, no sub­tle exhibition of himself as a man ofgreat importance. This was the natureof his modesty-the pure, unembroi­dered kind which never needed to in­terfere with his firm step, or his decisivehand and mind.For me his death was the close of apriceless apprenticeship of more than 20years. I have the illusion about him thathe was made of some substance otherthan the rest of the human race.A MODEL OF GENERAL PRACTICE:L. David Comstock, 1923-1971L. David Comstock, Jr. (M.D. '51)died June 8 at the age of 48 of an acutemyocardial infarction. For 19 years, af­ter graduation from medical school andinternship at Blodgett Memorial Hospi- tal in Grand Rapids, Michigan, he prac­ticed in Dowagiac, Michigan, where, asa youth, he had spent many summerswith his family. In addition to his prac­tice, he planned and implemented a Cor­onary Care Unit at the Lee MemorialHospital, making it one of the first ruralhospitals in Michigan to have such aunit; and he served as its Chief of Stafffrom 1968 to 1970.Dr. Comstock also was a civic leader.He served long as a member and atone time president of the School Board.He was elected the first president ofthe Dowagiac City Charter Commis­sion and was responsible for the de­velopment of the Human Rights Com­mission in his city. For years, he providedleadership in establishing, funding, di­recting and maintaining a volunteerclinic for the large number of migrantfarm workers who came annually tothis area of Michigan.He was intensely interested in schol­arship, his own and that of others, onall levels. On graduation from the Uni­versity High School he was awarded thecoveted Manilow Medal for scholarshipand athletic and social leadership. Fol­lowing service in the Army during WorldWar II, he attended The University ofChicago and was elected to the Skulland Crescent Honor Society. In medicalschool his scholarship was acknowledgedby his election to AOA. After intern­ship he continued his own educationby attending many post-graduate educa­tional programs, and for many yearsparticipated in those offered by the med­ical schools of the University of Mich­igan and The University of Chicago.The Michigan State Medical Societyasked him to assume responsibility forseveral medical educational programs of­fered throughout the State of Michigan.For two years before his death heprovided a superb elective for our seniormedical students who wished training inGeneral Practice. His students returnedwith remarkable enthusiasm for this ex­perience and grateful for the opportun­ity to have worked with this gifted man.The graduating class at the DowagiacUnion High School recently acknowl­edged his many contributions to theireducation by establishing the Dr. L. D.Comstock, Jr. Scholarship, to be giveneach year to a deserving student.He loved the woods and lakes. He hada special attachment to trees and plantedthem in countless numbers in the areaof Indian Lake. He often urged, "Planta tree, anywhere." "Protect a seedlingfrom the lawn mower." "Keep one treefrom being cut down."He was an avid reader, especiallyfond of the study of American historyand Ernest Hemingway. One of his fa­vorite passages, from The Old Man andthe Sea, may sum up the tragedy of hispremature death.It is easy when you are beaten,he thought. I never knew how easyit was."And what beat you," he thought,"Nothing," he said aloud."I went out too far."Dr. Comstock is survived by his widow,Mary Louise (nee Watkins), their fourchildren, Emily, Martha, Stephen, andWayne, of Dowagiac, Michigan; his par­ents, Mr. and Mrs. L. David Comstock,Sr. of Florida; and a sister, Mrs. Kath­leen Pfister of Madison, Wisconsin.He leaves each member of his fam­ily, and those who had the good for­tune to know him, a great legacy.Louis Cohen, '53ALUMNI DEATHS'01. Arthur G. Schroeder, Chicago, Illi­nois, June 14, 1968, age 91.'02. James B. Maple, Sullivan, Indiana,AprilS, 1971, age 92.'08. Alfred A. Strauss, Chicago, Illinois,AprilS, 1971, age 88.'11. C. R. Stanley, Minneapolis, Minne­sota, AprilS, 1971, age 87.'12. Arthur J. McCarey, Green Bay,Wisconsin, January 9, 1971, age 83.'13. Frank Richard Nuzum, Santa Bar­bara, California, March 19, 1971, age83.'14. Robert H. Lowry, San Antonio,Texas, December 7, 1970, age 79.'16. Leland H. Anderson, Woodland Hills,California, October 6, 1970, age 81.'17. John B. Doyle, Los Angeles, Cali­fornia, March 24, 1971, age 77. '18. Clark J. Laus, Syracuse, New York,December 1, 1970, age 77.'18. Albert G. Peters, Chicago, Illinois,May, 1971, age 78.'19. Edward D. Allen, Walnut Creek,California, July 19, 1971, age 79.'21. Joseph F. Shimpa, Madison, Wis­consin, October 15, 1970, age 73.'22. Lawrence Jacques, Chicago, Illinois,March 23, 1971, age 72.'22. Harry B. van Dyke, Cape MayCourthouse, New Jersey, February 14,1971, age 76.'24. Michael L. Leventhal, Chicago, Illi­nois, July 8, 1971, age 69.'24. Richard B. Richter, Chicago, Illi­nois, April 6, 1971, age 70.'25. Donald K. Hibbs, Battle Creek,Michigan, May 5, 1971, age 71.'26. S. U. Newfield, Birmingham, Ala­bama, 1968, age 1970.'29. Samuel A. Freitag, New Glarus,Wisconsin, October 24, 1968, age 68.'29. Warren B. Matthews, Marietta, Geor­gia, May 8, 1971, age 69.'29. Holland Williamson, Danville, Illi­nois, October 25, 1970, age 70.'30. Harry H. Boyle, Munster, Indiana,February 23, 1971, age 75.'30. Carl L. Gast, Chicago, Illinois, May11, 1971, age 66.'31. James J. Lutz, Kenosha, Wisconsin,January 9, 1971, age 66.'34. John K. Helferty, Boise, Idaho,March 24, 1971, age 65.'34. David M. Jenkins, Bloomington, Il­linois, September 13, 1970, age 67.'34. Jandon Shaw, Asbury Park, NewJersey, 1970, age 63.'35. William F. Beswick, Buffalo, NewYork, May 12, 1971, age 67.'36. Garnet B. Bradley, Hundred, WestVirginia, April 10, 1971, age 59.'37. Melvin O. Goodman, Rockville,Maryland, June, 1971, age 60.'38. Ernest L. Smith, Richland, Wash­ington, January 15, 1971, age 59.'38. Preston J. Van Kolken, Grand Ha­ven, Michigan, April 2, 1971, age 59.'41. Robert P. Walton, Charleston, SouthCarolina, March 27, 1971, age 60. '43. Maxwell A. Johnson, Tulsa, Okla­homa, February, 1971, age 57.'51. Leon D. Comstock, Jr., Dowagiac,Michigan, June 8, 1971, age 48.'60. Harvey S. Marvel', Dallas, Texas,July 11, 1971, age 36.DEATHS OF CURRENT FACULTYAND FORMER FACUL TVClarence Cohn (Michael Reese Hospital,Department of Medicine), Chicago, Illi­nois, May 1, 1971, age 61.Benjamin F. Miller (Asst. Professor,Medicine and Director, BiochemistryLab., W. G. Zoller Mem. Clinic, '37-'43), Philadelphia, Pennsylvania, June28, 1971, age 63.Melba Robson (Argonne Cancer Re­search Hospital, Assistant '52, AssociateScientist '64-'65), Chicago, Illinois,March 5, 1971, age 59.HANS H. HECHT, 1913-1971A memorial service for Dr. Hans H.Hecht, the Blum-Riese Professor of Med­icine and Physiology and Head of theCardiology Section, was held Thursday,September 9, in Bond Chapel. Speakerswere George W. Beadle, President Emer­itus of the University and the WilliamE. Wrather Distinguished Service Pro­fessor of Biology, Dr. Alvin Tarlov, Pro­fessor and Chairman of the Departmentof Medicine, and Dr. Max Schmidt, Pro­fessor and Chairman of the Universityof Illinois Department of Medicine.Dr. Hecht died suddenly in Chicago onAugust 12, 1971, at the age of 58. Hecame to the University as a professorof medicine and served as chairmanfrom 1966 to 1969. He had previouslybeen at the University of Utah. As Dr.Leon Jacobson said, "By his contribu­tions to the understanding of hemody­namics, cardiac electro-physiology, andheart failure in lung disease, and hisconcern for the application of cardiacresearch, Dr. Hecht distinguished him­self hoth nationally and internationallyin all areas of coronary medicine."The Hans Hecht Memorial Fund hasbeen established to receive donationsto support annual lectures in memory ofDr. Hecht.29Letters to the EditorDear Sir:In the obituary appearing in your Spring,1971 issue, many of Dr. E. M. K. Geil­ing's accomplishments are duly recorded.However, we wish to call attention totwo important omissions-one of factand one of feeling.First of all, much of Dr. Geiling's lifein Washington after 1958 was spent invery active academic contribution asProfessor of Pharmacology at HowardUniversity. This was his last academicappointment, and he carried out his re­sponsibilities to graduate students, medi­cal students and colleagues in variousdisciplines with his customary infectiouswit and wide-ranging intelligence.Dr. Geiling played a very significantrole in our teaching of medical students.In the small groups, particularly, wearranged for him to meet students oncea week to discuss the developments incatecholamines, insulin and the pituitaryhormones, in which fields he had workedextensively. The students looked uponhim as a direct branch from Abel toHoward, and thus he gave them real.strength in the thought that Howard hadsuch a historical tie with Johns Hopkins.What the students did not know was thatGeiling while at Hopkins had excited Dr.A. H. Maloney's interest in Pharma­cology. Maloney was interning at Provi­dence Hospital in Baltimore, where hewas met by Geiling and was later en­couraged to go to Wisconsin; there heearned the Ph.D. under E. L Tatum,who had once been a Professor of Phar­macology at Chicago, and whose vacancyGeiling later filled when he moved fromHopkins to Chicago.Maloney came to Howard as its firstHead of Pharmacology upon completionof his Ph.D. How small the world is!Secondly, a rather bleak feeling wascommunicated when your obituary endedwith the standard phrase, "Dr. Geilinghad no immediate survivors." Certainly,all of us who were touched by him werechanged by him. Who has ever taughtmore memorably than did Dr. Geiling ashe stressed the need for prudence andsound judgment in employing elementsof the "therapeutic armamentarium"upon one's fellow human beings? In onesense, then, much of the best in American30 medicine must be regarded as Dr. Geil­ing's "immediate survivor."In this spirit, other readers may wishto know that the Dean's Office at HowardUniversity College of Medicine is in theprocess of establishing a special studentloan fund in memory of this incredibleman.Sincerely yours,Walter M. Booker, Ph.D.(Physiology, 1942)Professor and Chairman,Department of Pharmacology,Howard UniversityCollege of MedicineFredric Solomon, M.D. (1958)Assistant Professor and Director ofthe Division of Behavioral SciencesDepartment of Neurologyand PsychiatryHoward UniversityCollege of Medicine Medical AlumniAssociation HostsFreshman PartyFollowing the successful innovation oflast year, the Medical Alumni Associa­tion again hosted a wine and cheeseparty for members of the FreshmanClass and their guests. It was an oppor­tunity for students and faculty to meetinformally outside the class room. Asone professor said at the first wine andcheese party last spring, "If we can con­tinue talking to each other, we have atleast a chance to make this a betterschool."Making a start to that goal by get­ting to know the new students were Dr.Richard Landau, President-Elect of theMedical Alumni Association and Pro­fessor in Medicine, Association VicePresident Dr. Marcel Frenkel, '58, ofCook County Hospital, Freshman Pre­ceptors Drs. Leslie J. DeGroot, RobertDruyan, '56, Edward Ehrlich, StanfordLemberg, Marshall Lindheimer, RobertRosenfield, Angelo Scanu, and ReneeMenegaz-Bock, Dean Leon Jacobson,'39, and Dean of Students JosephCeithaml, and faculty members Drs. Ed­ward P. Cohen, William L Doyle, JarlDyrud, Wolfgang Epstein, Donald Fisch­man, Harry Fozzard, Seymour Glagov,Charles Oxnard, Jack Stern, John UIt­mann, and Robert Wissler, '49.Freshmen students joinedmembers of the faculty ata wine and cheese partyhosted by the MedicalAlumni Association.Departmental NewsANATOMYAt the 84th Session of the AmericanAssociation of Anatomists in Philadel­phia last April, the following facultypresented papers: Dr. Peter P. H. De­Bruyn, Professor; Dr. Robert Y. Moore,'57, now Professor; Dr. E. J. Kollar,Assistant Professor; Dr. Luis M. H.Larramendi, Professor; and Dr. DonaldA. Fischman, Assistant Professor. Dr.Kollar chaired one session.Dr. Kollar also presented a paper atthe Cranio-Facial Symposium of theInternational Association for Dental Re­search. He has been appointed to thefaculty of the Tissue Culture Course, W.Alton Jones Cell Science Center, LakePlacid, New York.Dr. Ronald Singer, Professor in Anat­omy, Anthropology, and the Committeeson Evolutionary Biology and on Gene­tics, has been reappointed chairman ofthe Department of Anatomy. He wasselected as a National Lecturer of theSociety of the Sigma Xi, and in Mayaddressed Chapters at the University ofTexas at Arlington, Austin, and Gal­veston, Eastern New Mexico University,and Arizona State University.Dr. Lorna P. Straus, Assistant Pro­fessor of Anatomy and in the College,Senior Adviser, and Assistant Dean ofUndergraduate Students, has been ap­pointed Dean of Undergraduate Studentseffective October 1. She will continueteaching in the Department and in theCollege.ANESTHESIOLOGYDr. Merel H. Harmel, under whosechairmanship Anesthesiology became adepartment, left the University in Julyto take up new duties as Chairman ofDuke University's Department of Anes­thesiology in Durham, North Carolina.Before leaving he was honored at adinner in the Sheraton-Blackstone Hotel.Dr. Harry J. Lowe, Professor, is ActingChairman of the Department.In April the Department hosted theMidwest Anesthesia Residents Confer­ence on campus at the Center for Con­tinuing Education. Dr. Lowe coordinatedthe meeting, which was attended byfaculty and residents from many Mid­western universities. The Eighth Annual Midwest Anes­thesia Conference was held at the Con­rad Hilton Hotel in Chicago in May. Anexhibit entitled "Dose-Regulated Anes­thesia," prepared by Dr. Lowe, Dr.Pushpa J. Shah, and Mr. Karl J. Haglerof the Department, received the thirdplace award.BIOCHEMISTRYDr. Donald F. Steiner, '56, the A.N.Pritzker Professor of Biochemistry, hasreceived the Hans Christian HagedornMedal of the Steenson Hospital ofCopenhagen for his contributions in thefield of insulin biosynthesis and chemis­try.Dr. Steiner delivered the third 1971E.F.F. Copp Memorial Lecture at theUniversity of California, San DiegoSchool of Medicine in La Jolla, on"Studies in Insulin Biosynthesis."MEDICINEDr. Robert Cutler, Associate Professor,was visiting professor of neurology atCase-Western Reserve in January.Dr. Raul Falicov, Assistant Professor,has been awarded a Guggenheim Fellow­ship and will spend a year doing researchat the Postgraduate Medical School inLondon on acute myocardial infarction.Dr. John Hammerstad, '64, AssistantProfessor, and Dr. Robert Y. Moore, '57,Professor, presented research papers atthe 23rd Annual Meeting of the Ameri­can Academy of Neurology in New Yorkin April.Dr. Ronald Krone, '66, Instructor,left the University in June to becomeDirector of the Cardiac CatheterizationLaboratory at the Jewish Hospital of S1.Louis.Dr. Irwin H. Rosenberg, AssociateProfessor in the Department of Medi­cine, has been named Chief of the De­partment's Section of Gastroenterology.He succeeds Dr. Joseph B. Kirsner, theLouis Block Professor of Medicine re­cently appointed Deputy Dean of Medi­cal Affairs and Chief of Staff. "UnderDr. Kirsner, the University's Gastro­enterology Clinic attained a world-widereputation for its clinical excellence;'Dr. Rosenberg said at his appointment,"It is our aim to maintain our clinicalstrength and position as a referral center DR. SINGERDR. STRAUSDR. LOWE31and to extend even further our investi­gational and teaching activities."Dr. Ann M. Lawrence, Associate Pro­fessor, was recently granted a fellowshipin the American College of Physicians.Dr. Leon Resnekov, Associate Pro­fessor and Director of the MyocardialInfarcation Research Unit, has beenelected a Fellow of the Royal College ofPhysicians.Dr. John W. Rippon, Associate Pro­fessor (Dermatology), was appointed adiplomate of the American Academy ofMedical Microbiology.Dr. Nicholas Vick, '65, Assistant Pro­fessor, participated as a faculty memberin a post-graduate course on the histo­pathology and fine structure of braintumors at Ohio State University.Dr. John E. Ultmann, Professor ofMedicine, along with Dr. Melvin L.Griem, Professor of Radiology; Dr.Werner H. Kirsten, Professor of Path­ology; and Dr. Robert W. Wissler, '49,Chairman of the Department of Path­ology, edited Volume 36 of Recent Re­sults in Cancer Research, entitled "Cur­rent Concepts in the Management ofLymphoma and Leukemia." With Dr.Lawrence W. Allen, Instructor in Medi­cine, Dr. Ultmann has been studying theuse of diagnostic surgery with existingtechniques to treat Hodgkin's and otherlymphoma diseases. The surgical pro­cedure they are using was introduced byDr. Donald J. Ferguson, Professor ofSurgery.OBSTETRICS AND GYNECOLOGYDr. Marluce Bibbo, Assistant Professor,was made an Honorary Fellow of theSpanish Society of Cytology on June 5in Seville.Dr. Josef Bieniarz has been promotedto Professor with appointments at theMichael Reese Hospital and The Uni­versity of Chicago.Dr. Joseph R. Swartwout, AssociateProfessor, discussed "Family Planning"at the Biennial Conference of State andTerritorial Epidemiologists held recentlyin Chicago.Dr. Frederick P. Zuspan, the JosephBolivar DeLee Professor and Chairmanof the Department, was named President­Elect of the Association of Professors ofGynecology.32 PATHOLOGYDr. Frank W. Fitch, '53, Professor, hasbeen invited to be an editor of the Cellu­lar Immunology section of the Journalof Immunology.Dr. Heinz Kohler, Assistant Profes­sor in the Department and the College,received a two-year grant of $63,346from the American Cancer Society tosupport his program on "The ImmuneSpecific Receptor in Normal, Walden­strom and Myeloma Immunocytes." Healso was awarded a $5,000 Merck Grantfor Faculty Development for research.Dr. Robert W. Wissler, '49, Professorand Chairman of the Department, wasa guest lecturer at the University ofKansas Medical Center in May. Hespoke on "Studies on the Pathogenesisof Atherosclerosis" as part of the Bio­logical Sciences Lecture Series. In Junehe spoke on "The Natural History ofCoronary Heart Disease" and partici­pated in a panel discussion on "PrimaryPrevention in Coronary Heart Disease"at the Montreal, Canada Heart Institute.In July he served as Visiting Professorat the University of Texas MedicalBranch in Galveston where he deliveredtwo lectures on "Pathogenesis of Rheu­matic Fever" and "Modern Concepts ofAtherosclerosis. "Two Michael Reese Hospital staffmembers have been appointed in theDepartment: Dr. Miriam Christ, Assist­ant Professor, and Dr. Luciano Ozzello,Associate Professor.PEDIATRICSDr. Lauren Pachman, '61, Assistant Pro­fessor at La Rabida, has been namedhead of the newly formed Division ofImmunology at The Children's Memo­rial Hospital, the pediatric teaching hos­pital of Northwestern University MedicalSchool.Dr. Robert L. Rosenfield, AssistantProfessor, was given a quantity of soma­tropic hormone, one of several hormonesthat regulate human growth, by theNational Institute of Arthritis and Meta­bolic Diseases to assist his pituitaryresearch.OPHTHALMOLOGYDr. Tibor G. Farkas has been promotedto Associate Professor. PHARMACOLOGYKenneth P. DuBois, Ph.D., Professor ofPharmacology and Director of the Tox­icity Laboratory, received the MeritAward in Toxicology for 1971 from theSociety of Toxicology.PSYCHIATRYDr. Robert S. Daniels, Associate Deanfor Social and Community Medicine,Professor of Psychiatry, and Director ofthe Center for Health AdministrationStudies, is returning to the University ofCincinnati Medical School as Directorof the Department of Psychiatry. He hadbeen at the University of Chicago forten years. He received his M.D. fromthe University of Cincinnati and servedan internship and residency in psychiatrythere.Dr. Daniel X. Freedman, Professorand Chairman, was named chairman ofa U.S. Department of Health, Educationand Welfare panel to consider the use ofbehavior modification drugs on schoolchildren. In June he chaired a session,"Pathology and Treatment-Drugs andAffective Disorders," at the 25th anni­versary program of the National MentalHealth Act, sponsored by the NationalInstitute of Mental Health at the HiltonHotel in Washington, D.C. Dr. EdwardC. Senay, Associate Professor, also wasa participant.Dr. Jerome H. Jaffe, Associate Pro­fessor, has been appointed special con­sultant to the White House to direct anational narcotics treatment program.He is an authority on methadone therapyfor heroin addicts, and a major figurein research on drug abuse. Succeedinghim as Director of the Drug Abuse Pro­gram for the Illinois Department ofMental Health is Dr. Edward Senay,Associate Professor, who had been Di­rector of Clinical Research for the Pro­gram. Dr. Senay, who has been workingwith Dr. Jaffe on the use of acetyl­methadol in narcotic treatment, is alsochief of the Psychiatric ConsultationService at the University.Dr. David A. Turner, '66, has beenappointed chief resident in psychiatry.RADIOLOGYDr. Robert J. Moseley, Jr., and Mrs.Moseley were honored at a farewellparty in June by their many friends inthe Clinics. Dr. Moseley is now Pro­fessor of Radiology, Assistant Chairmanof the Department and Chief of its Diag­nostic Division at the University of NewMexico in Albuquerque. Dr. Moseleywas presented with a certificate of com­mendation from the Hospitals and Clin­ics for his twenty-two years of service,thirteen as chairman of the Department.He also received the newest model ofKodak Carousel Slide Projector.During the spring Dr. Moseley waselected to membership in the Physio­graphic Society of the University ofLund, the second American so honored.Dr. Alexander Gottschalk, Professorof Radiology and Director of the Ar­gonne Cancer Research Hospital, hasbeen named Chairman. He is a specialistin the use of radioactive isotopes asscanning agents in the diagnosis of di­seases.Dr. John J. Fennessy, who receivedthe McClintock Award here in 1969,has returned from Ireland as AssociateProfessor in the Department.Dr. Dieudonne J. Mewissen, Profes­sor, has conducted a seven-year studyshowing that tritium, a radioactive by­product of nuclear power, increases theincidence of cancers in mice. No studyhas been made of potential hazards tohumans.Dr. Stephen M. Pinsky, Chief Resi­dent in Diagnostic Radiology, reportedat the 18th annual meeting of the Societyof Nuclear Medicine in Los Angeles ona new radiological scanning techniqueinvolving radioactive gallium-67 whichhelps diagnose Hodgkin's disease deepwithin the body. The technique hasachieved about 95 per cent accuracy.Gallium-67 emits radioactivity that canbe recorded photographically. Co-authorswere Drs. Paul B. Hoffer, '63, David A.Turner, '65, Paul V. Harper, Jr., andDr. Gottschalk.SURGERYDr. Constantine Anagnostopoulos, As­sistant Professor, was granted a Fellow­ship in the American College of Cardi­ology.Dr. Rene Menguy, former Chairmanof the Department, is now Professor ofSurgery at the University of Rochester Medical School and Chief Surgeon atGenessee Hospital, Rochester, New York.Two former members of the Ortho­pedics Section have returned as AssociateProfessors: Dr. Arsen Pankovich, whowas here from 1962 to 1970, and Dr.Louis Kolb, '62, who left in 1967. Dr.Kolb will be part time.COMMITTEE ONEVOLUTIONARY BIOLOGYLeigh Van Valen, Assistant Professorand in the Department of Anatomy, haspublished on atmospheric oxygen, de­velopmental fields, and late Pleistoceneextinctions. In addition, he has co-editeda small symposium volume, "Evolutionof Communities," and been named tothe editorial board of the Journal ofMolecular Evolution.Robert Inger, Lecturer, has beennamed editor of Evolution.FORMER FACULTYAlberto Ramirez-Ramos (Res., Medi­cine '58-'59) has been elected Presidentof the Peruvian Society of Gastroenter­ology for 1971-73. He also has beenappointed Professor of Medicine at theCayetano Heredia University MedicalSchool, Lima.James J. Rams (Fac. Surgery '55-'66)last fall moved from Kentucky to Pitts­burgh where he is associated with Dr.Daniel M. Enerson, '46, in the practiceof thoracic and cardio-vascular surgery.I1za Veith (Fac. Medicine '49-'63)Professor and Vice-Chairman, Depart­ment of the History of Health Sciences;Professor, Department of Psychiatry,University of California, San Francisco,was awarded the Officer's Cross of Meritof the Federal Republic of Germany forher accomplishments in the field of thehistory of medicine. Dr. Veith also waselected Charter Member of the AmericanOsler Society. DR. GOTTSCHALKDR. DU BOISDR. ZUSPANPROMOTED TO PROFESSOR (7/1/71)Dr. J. Anthony CifonelliDept. of Pediatrics & Dept. BiochemistryDr. Jarl E. DyrudDept. of PsychiatryDr. Harry A. FozzardDept. of Medicine & Dept. of PhysiologyDr. Ferenc J. KezdyDept. of Biochemistry Dr. Robert Y. Moore, '57Dept. of Ped., Dept. of Med. and Dept.of AnatomyDr. William C. OffenkrantzDept. of PsychiatryDr. Christian C. RattenborgDepartment of Anesthesiology33Before the banquet there was time to relax and chat with oldfriends. Top left: Dr. Andrew Brlslen, '35, shares a joke with Dr.Abraham Lash, '21 (right), and (bottom left) Dr. David W.Hume, '43, winner of a Distinguished Service Award for 1971,listens attentively to Alumni Secretary Dr. Henry Russe, '57.Dr. Thomas Grayston, '48, who also received a DistinguishedService Award (1), and outgoing Alumni Association PresidentDr. Sidney Schulman, '46 (r), concentrate on what Dr. RichardLandau, this year's President-Elect, has to say (top right).One of the more moving moments at the banquet, as In otheryears, came when the graduating class rose to take theHippocratic Oath administered by Dr. Douglas Buchanan (below).34The Annual BanquetThe Annual Alumni Association Ban­quet was held this year at the Pick­Congress Hotel. The Banquet honoredboth this year's graduates of The Pritz­ker School and the 1921 class of RushMedical College.The main address, "Medicine, Medi­cine Men, and their MoraIs," waspresented by Joseph J. Schwab, the Wil­liam Rainey Harper Professor of Nat­ural Sciences in the College and Pro­fessor in the Department of Education.The annual Distinguished ServiceAwards were established 19 years agoto honor outstanding alumni. The threerecipients of the Distinguished ServiceAwards for 1971 are:-Samuel W. Banks (B.S. '30, M.D.'34). Dr. Banks is an Associate Profes­sor of Orthopedic Surgery at North­western University Medical School. Heis a member of the American Academyof Orthopedic Surgery and a Diplomateof the American Board of Orthopedics.He has been President of the AdvisoryBoard for Medical Specialists on threeoccasions and also has served as Vice­President. In addition, he has beenChairman of the Chicago Committee onTrauma of the American College ofSurgeons and of the Committee on In­juries of the American Academy of Or­thopedic Surgeons. He also has servedon the Executive Committee of the An­nual Clinical Conference of the Chi­cago Medical Society. Dr. Banks is theauthor of many publications, a contribu­tor to the Year Book series, and theauthor of two textbooks.-David W. Hume ('43). Dr. Hume isProfessor and Chairman of the Depart­ment of Surgery at the Medical Collegeof Virginia. He has made fundamentalcontributions to methods of immuno­suppression and was the first to trans­plant kidneys in non-related people. Healso became the first to perform multi­ple kidney transplants when he trans­planted a second and then a thirdkidney as rejection of their predecessorsoccurred. In 1968, he became the firstto treat patients with liver failure byrouting their blood through the liverof a baboon. Dr. Hume was the re­cipient of the Francis Amory Prize ofthe American Academy of Arts andSciences in 1962. He is a member of many professional societies and govern­ment research committees and commis­sions including the National HeartInstitute's Program Project Committee, theNational Institutes of Health NephrologyPlanning Committee, the Atomic En­ergy Commission's Advisory Board, andthe National Kidney Foundation.-J. Thomas Grayston (B.S. '47, M.D."48, S.M. '52). Dr. Grayston is VicePresident for Health Affairs and Profes­sor of Epidemiology and InternationalHealth of the University of Washington,Seattle. He is best known for his workwith trachoma, infectious respiratory ail­ments, and rubella. He served as chiefresident in medicine and on the facultyof The University of Chicago from 1953to 1960. During that time he also spentseveral years in Taipei, Taiwan, as chiefof the Division of Microbiology andEpidemiology for a U.S. Navy medicalresearch unit. Dr. Grayston has servedon numerous national boards and com­missions concerned with the preventionand control of infectious diseases andacute respiratory diseases. Earlier thisyear, he was appointed to the WorldHealth Organization's Expert AdvisoryPanel on Trachoma.The Gold Key Award, given for pastcontributions to both the medical schooland the University, was presented toDr. Allen T. Kenyon (B.S. '22, M.D.'26 Rush). Dr. Kenyon is ProfessorEmeritus of Medicine (Endocrinology).He served on the faculty from 1929 to1969. Dr. Kenyon's research centered up­on the glandular and hormonal regula­tion of growth in both healthy individ­uals and those afflicted with glandulardisease.Joseph J. Ceithaml, Dean of Studentsand Professor of Biochemistry presentedthe honors and awards to the class of1971. Recipients were:-Dr. Dorothy R. Davies, the firstMary Roberts Scott Memorial Prize of$100 for the graduating woman medi­cal student who has achieved an excel­lent scholastic record.-Dr. William Docken, the UpjohnAchievement A ward, in recognition ofoutstanding accomplishments during fouryears in medical school, $150 and aplaque.-Dr. Lambert N. King, the Medical Alumni Prize for the best oral presen­tation of his research, delivered at theSenior Scientific Session, May 19, $100.-Dr. George Wu, the Franklin Me­Lean Award, for the most meritoriousresearch as a medical student, $200.-Dr. Gerald Schertz, The Joseph A.Capps Award, for outstanding profi­ciency in clinical medicine, $100.-Drs. Donald E. Mosier and JeffreyRoseman, the Sheard-Sanford Awardsfor outstanding research in pathology,given by the American Society for Clin­ical Pathologists, $100 and a Bauschand Lomb Medal. Drs. Mosier and Rose­man received both the M.D. and Ph.D.degrees in 1971.Drs. Robert Dreisin, Karl Fritz, Don­ald E. Mosier, and Gerald Schertz grad­uated with honors, the highest honorthat can be bestowed on a medical stu­dent. Honors are awarded each year tostudents who have demonstrated "out­standing leadership, scholarship, and re­search abilities and achievements."RUSH CLASS OF 1921Fifteen members of the Class of 1921were present to receive 50-year testi­monials from Dr. Sidney Schulman, whoadded a personal vignette from eachdoctor's life. They were:-Florence Ames, the first woman phy­sician in Monroe, Michigan, during herpractice in family medicine delivered arecord 3,000 babies. For 21 years shewas secretary-treasurer of the MonroeCounty Medical Society.-Alfred D. Biggs, a pediatrician on thesouthwest side of Chicago since 1928.still carries a full office practice. He isEmeritus Professor of Pediatrics of RushMedical School and a consultant to fourChicago hospitals.-Evelina Ehrmann of Western Springs,Illinois retired last November as anophthalmologist and is now pursuing herhobbies of travel and nature studies.-Samuel Fogelson, Professor Emeritusof Surgery at Northwestern UniversityMedical School, was honored for start­ing the tissue and organ bank at CookCounty Hospital in the early 1950s andthe Burn Unit there in 1958.35At the banquet:Top: Speaker Joseph Schwab hits a serious note (I), and old friends meet:Dr. and Mrs. Henry Ricketts chat with Dr. Allan Kenyon, winner of the 1971Alumni Gold Key Award, and Mrs. Kenyon.Center: Fifty years later, four Rush '21 graduates relax: (I to r) Drs. FrancisLederer, Samuel Fogelson, Gail Soper, and S. C. "Chick" Henn; andanother, Dr. Roy Grlnker (I) joins Dr. Joseph Klrsner In attentive audience.Bottom: Dean Celthaml listens with Dr. Kevin Foley, '71, at the cocktail hour;and later, Dr. Andrew Brlslen, '35 (I) presents a 1971 Distinguished ServiceAward to Dr. Samuel W. Banks, B.S. '30, 'M.D. '34.36-R. I. Harrington returned to his hometown of Sioux City, Iowa in 1936; he isnow the senior member of a three-mangroup of internists there.-Roy Grinker, Director of the Institutefor Psychosomatic and Psychiatric Re­search and Training of the MichaelReese Hospital and Professor of Psy­chiatry at The Pritzker School of Medi­cine, is actively engaged in teaching, re­search, care of patients, administration,and writing.-So C. (Chick) Henn was a pediatri­cian in Chicago until 1957, when hemoved to Iowa. He retired 5 years agofrom the Student Health Center at theUniversity of Northern Iowa, but sayshe actually "quit" this past May.-Raymond Householder of Chicago isthe Chief Surgeon of the Chicago, Mil­waukee, St. Paul, Pacific Railroad. Oneof his hobbies includes reading poetryaloud, and he obliged by reciting a favor­ite passage at the banquet.-E. R. Huckleberry of Salt Lake City,Utah has practiced all his life as a coun- try physician. He described his life inhis recent book, The Adventures of Dr.Huckleberry, from which Dr. Schulmanexcerpted a humorous incident.-Abraham F. Lash is Professor of Ob­stetrics and Gynecology and Director ofthat Division at Cook County Hospital,where he has been associated since 1926.He is Professor Emeritus from North­western University Medical School, al­though he still teaches undergraduatestudents there. He was on the· staff atMichael Reese until 1968.-Francis L. Lederer is Professor Emer­itus and from 1925 until retirement in1967 was head of the Department of Oto­laryngology at the University of IllinoisCollege of Medicine. From 1946 until1967 he also headed the service at theIllinois Eye and Ear Infimary. His book,Diseases of the Ear, Nose and Throat,Principles and Practice, is considered astandard reference work.-Samuel Lerner, one of the organizersof Roosevelt Memorial Hospital in Chi­cago' in 1944 and its medical directorfrom 1950-1964, still sees patients and does some surgery.-Walter L. Palmer, the Richard T.Crane Professor Emeritus of the De­partment of Medicine at The Univer­sity of Chicago and a member of theschool's original faculty, maintains anactive practice at Woodlawn Hospital.At the banquet, Dr. Palmer was honoredfor his many years of University serviceand leadership, most recently as chair­man of the three-year fund-raising cam­paign for the Medical School.-William A. Smiley specialized in ENTand broncho-esophagology until retire­ment in 1962. He served at MichaelReese Hospital and at the Illinois Eyeand Ear Infirmary.-Gail R. Soper has practiced in Ev­anston, Illinois since 1926 as an oph­thalmologist. He is on the staff of Evans­ton Hospital and until three years agowas in the Eye Department of CookCounty Hospital. Dr. Soper has twobrothers who are also Rush graduates,Fred L., '18, of Washington, D.C., andH. Vern, '28, in general practice in LosAngeles.The Banquet required a greatdeal of planning by last year'sMedical Alumni Associationofficers (left to right):Catherine Dobson, '3� Rush,Robert L. Schmitz, '38,Francis H. Straus, II, '57,Joseph Celthaml, HeinzKohut, Henry P. Russe. '57,Sidney Schulman, '46, LamplsD, Anagnostopoulos, '61, C.Frederick Kittle, '45, andEdward S, Lyon, '53,Alumni NewsDR. BARCLAY IS ALUMNI PRESIDENTDr. William R. Barclay accepted thepresident's gavel from Dr. Sidney Schul­man, outgoing president, at the Associ­ation's annual June Medical Alumni Ban­quet.Dr. Barclay, Assistant Executive Di­rector of Scientific Affairs for the Amer­ican Medical Association, left the Uni­versity last year after twenty years inthe Department of Medicine. In 1960-61he served as the Vice President of theAlumni Association.Before introducing the new officers,Dr. Schulman stated that under the newconstitution a new position of president- elect has been added and the positionof treasurer has been dropped.Other Association officers are:President-elect: Dr. Richard Landau,Professor of Medicine at The Universityof Chicago. Dr. Landau served twoterms as Vice President, in 1966 and in1967.Vice-President: Dr. Marcel Frenkel,'58, Chairman of the Department ofOphthalmology at Cook County Hospi­tal.Secretary: Dr. Henry P. Russe, '57,Chairman of the Department of Med­icine at Columbus-Cuneo Medical Cen­ter, Chicago. Dr. Russe is serving a sec­ond term as secretary.At the Annual Banquet, Dr. William R. Barclay speaks tomembers of the AlumnI AssocIatIon for the fIrst tIme aspresIdent, as outgoIng presIdent Dr. SIdney Schulman, '46,listens. Elected to the Council for three-yearterms are:Dr. Charles Kligerman, '41, Profes­sorial Lecturer in the University's De­partment of Psychiatry,Dr. William Moses Jones, '32, Oph­thalmologist, on the staffs of ProvidentHospital, Woodlawn Hospital, JacksonPark Hospital, and Sturgis MemorialHospital in Michigan, andDr. Francis H. Straus, II, '57, As­sistant Professor in the University's De­partment of Pathology.Dr. Lampis Anagnostopoulos, '61, Dr.C. Frederick Kittle, '45, and Dr. RobertL. Schmitz, '38, continue as membersof the Council.ALUMNUS IN THE NEWSDr. John R. Hogness, '46, has taken of­fice as the first full-time president ofthe Institute of Medicine of the Na­tional Academy of Sciences. The Insti­tute was organized in December 1970to advise on "the protection and ad­vancement of the health of the public."(Dr. Leon O. Jacobson, Dean of the Di­vision of the Biological Sciences and ThePritzker School of Medicine, is a char­ter member of the Institute.)The Institute will prepare studies onleading health issues, and has alreadybegun to study the comparative advan­tages of various health delivery systemsand "death with dignity," Dr. Hognesstold a press conference in Washington.Dr. Hogness had been at the Univer­sity of Washington since 1950, when hewent to Seattle as chief resident in med­icine, after internship and residency atColumbia-Presbyterian Medical Center inNew York. In November of 1970 heassumed responsibility of coordinating allhealth education activities of the uni­versity and became the first Director ofthe Health Sciences Center and Chair­man of the Board of Health Sciences.The new Center is composed of six col­leges, two hospitals, and four healthcare and research centers. For the pre-DR. HOGNESS ceding two years he had been executivevice president of the University.Succeeding him at Seattle is anotheralumnus, Dr. Thomas Grayston '48, whohas been Dean of the School of PublicHealth and Community Medicine at theUniversity of Washington. Both Dr. Gray­ston and Dr. Hogness are also grad­uates of the College of The University ofChicago. 'RUSH-UNIVERSITY OF CHICAGO'21. Lester R. Dragstedt, Research Pro­fessor of Surgery and Professor of Phys­iology at The University of FloridaCollege of Medicine, Gainesville, was de­picted in the senior class skit at Floridaas the Pope defending socialized med­icine. The seniors presented him witha large painting in recognition of thehonor.'21. Eloise Parsons has retired from thepractice of obstetrics and gynecology andmoved to her farm. Her new address isR.F.D. No.1, Neponset, Illinois 61345.'42. George H. Handy was named Wis­consin State Health Officer and Admin­istrator of the State Division of Health.In 1967 he was appointed assistant statehealth officer. Before joining the divi­sion in 1964 he was a general practi­tioner in Wisconsin Rapids.DR. SOLOFF RUSH'31. Louis A. Soloff, professor of med­icine and former chief of the division ofcardiology at Temple University HealthSciences Center, has been appointed thefirst holder of the Blanche P. Levy Dis­tinguished Service Professorship. The ap­pointment honors a member of the Tem­ple faculty who has made significantcontributions to the university and thecommunity in his chosen field. Dr. So­loff went to Temple as an intern.In addition to developing a cardiacdepartment, he established with threeother faculty the first cardiovascular re­search center at Temple. He is the au­thor of more than 200 articles.NEWS OF ALUMNI'35. Andrew J. Brislen was installed asthe 122nd president of the Chicago Med­ical Society, the third largest countymedical group in the United States. Dr.Brislen, a cardiologist and internist, isco-chairman of the Department of Med­icine at Woodlawn Hospital and headof its intensive care section; he serveson three other hospital staffs. His in­volvement in community, professional,and welfare activities is extensive. Heis on the Board of Directors of the Chi­cago Heart Association, and the Com-DR. BRISLEN3�prehensive Health Planning and IllinoisRegional Medical Program, and is aTrustee of the Mid-South Planning Com­mission.'43. James A. Schoenberger, professorof medicine at the new Rush MedicalCollege and director of the hyperten­sion study project at Rush-Presbyterian­St. Luke's Medical Center, commentedon the risk of high blood pressure lead­ing to a heart attack or stroke in a Chi­cago Tribune interview. Dr. Schoen­berger said that the findings of a 3'h­year study involving 22,000 Chicagoworkers showed that seven of eight per­sons with high blood pressure didn'tknow they had it or knew they had hy­pertension but were receiving no treat­ment or were receiving treatment thatdidn't work. As a result, the Illinois Re­gional Medical Program hopes to startscreening programs this fall through com­munity hospitals.'45. Loren T. DeWind writes that hehas changed his business address to 9818Paramount Blvd., Downey, California90241. Dr. DeWind's specialty is inter­nal medicine and endocrinology. He addshe is doing research on surgical methodsto control extreme obesity.'50. Harry G. Kroll of Topeka, Kansas,with Mrs. Kroll attended the AlumniBanquet this June. Dr. Kroll recently re­turned from the Caribbean, where heserved as orthopedic consultant withCARE-Medico in the Dominican Re­public. He is chairman of medical edu­cation come from The University ofSociety and has been serving as chair­man of the section of orthopedic surgeryat Stormont-Vail and St. Francis Hos­pitals.'55. John R. Benfield, Associate Profes­sor of Surgery and Acting Chief of theDepartment at the University of Cali­fornia, Los Angeles, School of Med­icine, has received the "Golden AppleAward" for outstanding teaching fromthe 1971 graduating class. Dr. Benfieldadded the following: "Many of the foun­dations of my concepts of medical education for the Shawnee County MedicalChicago and I therefore think that themembers of the Alumni Associationmight wish to share this honor withme."40 '56. Alan H. Schragger, a staff memberof the dermatology division at Hahne­mann Medical College and Hospital,with another Hahnemann doctor pre­pared an exhibit entitled, "Familial Hy­perlipoproteinemias" for the 1971 Amer­ican Medical Association meeting. It wasfeatured in an eight-page, four-color sec­tion in the April 5 issue of ModernMedicine.'57. G. Robert Mason has been namedProfessor of Surgery and Head of theDepartment of Surgery at the Universityof Maryland in Baltimore. Dr. Masonleaves Stanford University after elevenyears.'62. Leon R. Kass of the National Acad­emy of Sciences in a speech before ameeting of science writers at the Acad­emy predicted the "useful" life span ofsome individuals may be extended 20 to40 years if efforts to understand and alterthe aging process are pursued fully.'63. Robert C. Lentzner has entered pri­vate practice of internal medicine andcardiology in Carmichael, California, asuburb of Sacramento. Dr. Lentzner willbe director of the coronary care unit atMercy San Juan Hospital in Carmichael.'64. David E. Fixler has joined the fac­ulty of Southwestern Medical School,The University of Texas, Dallas, wherehe is assistant professor in the section ofpediatric cardiology.'64. Joseph M. Garfield completes hismilitary service this summer and inSeptember will become an instructor inAnesthesia at Harvard Medical Schooland a staff anesthetist at the Peter BentBrigham Hospital.'65. Robert G. Hillman recently finishedhis residency in psychiatry at StanfordSchool of Medicine and has entered pri­vate practice in Santa Fe, New Mexico.He also earned his M.A. this June inthe History of Health Sciences at theUniversity of California at San Fran­cisco. Dr. Hillman writes, "My wife,son and various dogs and cats that wehave acquired during our travels lookforward to seeing classmates if theirvacations take them to Santa Fe." Hisaddress is Radio Plaza Building, 208 E.Marcy Street, Suite 16A, Santa Fe.'65. Murray D. Kuhr was appointed Di- rector of St. Elizabeth Medical Center'sPediatric Educational Program, in Day­ton, Ohio. Dr. Kuhr, a native of Day­ton, recently completed a two-year teach­ing fellowship in Community Pediatricsat the University of Pittsburgh.'66. Daniel Rosenblum has been ap­pointed instructor in medicine at Wash­ington University and the Jewish Hos­pital, St. Louis, and acting chief ofhematology.'66. Julian J. Rimpila completed his resi­dency in internal medicine at Northwest­ern University and is serving as a Ma­jor in the Army Medical Corps. Hispresent position is Chief of Medicine,Bassett Army Hospital, Fort Wainwright,Alaska.'70. Jane Multi writes that she will bein Seattle another year, beginning a resi­dency in pathology.DR. CHANOCK RECEIVES MEDALDr. Robert M. Chanock, '47, MedicalDirector and Chief of the NIH Labora­tory of Infectious Diseases, was given amedal in April at the Naval Hospital inBethesda. The accompanying citationstated that he was being honored "forhis outstanding contribution to knowl­edge of the etiology and epidemiologyof human respiratory infections due toviruses and mycoplasma, and for hisscientific leadership in preventing andalleviating acute respiratory diseases, andfor his achievements in medical re­search."DR. YING TAK CHAN LOAN FUNDDr. Huberta M. Livingstone, Chairmanof the Student Loan Fund named inmemory of Dr. Ying Tak Chan, Rush'31, is pleased to report that the medicalschool has received $36,810 from Dr.Chan's estate. Dr. Chan died in Novem­ber, 1968, willing half of her estate toThe University of Chicago. Friends ofDr. Chan asked that her bequest beused to establish a loan fund for medicalstudents. Additional gifts from friendshave amounted to �t;3, 167.Two loans already have been madeto first year medical students.Memorial gifts may be sent to TheYing Tak Chan Fund, Box 451, 950East 59th Street, Chicago, Illinois, 60637.From theAlumni PresidentDear Alumni,Anyone is privileged to have had an official association with the University ofChicago, be it as a student, a house officer, or a faculty member. An even greaterprivilege is to be asked to serve as president of the Alumni Association, and Ifeel both grateful and honored that this office has been conferred on me.The Annual Meeting and Banquet given for the graduating class was an excitingoccasion and an opportunity to meet with old friends and colleagues. All of youwould have felt a keen sense of pleasure at seeing Allan Kenyon receive the GoldKey and hearing Douglas Buchanan recite the Oath of Hippocrates for thegraduating class.In my official travels for the American Medical Association I plan to meet withmany University of Chicago alumni and I hope that I can bring to each of youthe enthusiasm I feel for The University of Chicago Pritzker School of Medicineand its current educational program.MEDICINE ON THE MIDWAYTHE UNIVERSITY OF CHICAGOTHE MEDICAL ALUMNI ASSOCIATIONTHE PRITZKER SCHOOL OF MEDICINE950 EAST 59TH STREETCHICAGO, ILLINOIS 60637•ADDRESS CORRECTION REQUESTEDRETURN POSTAGE GUARANTEED NON-PROFIT ORG.U.S. POSTAGEPAIDPERMIT NO. 9666CHICAGO, ILL.