Medicine on the Midway Vol. 30 No.2Bulletin of the Medical Alumni Association The University of ChicagoDivision of the Biological Sciences and The Pritzker School of MedicineI, Hippocrates, do vow,od Appollo ,­id also to all �!!JIr"F: ise and protest to the great. 'ht --. - ... -, and Panacie,,nts of this oath, "� serve the con-is oath is carved,_ n possible, and so far.0 -ha able to direct me,y__ an ebtor to the Mastere and showed me thisor rather more thane, and that I shall livellow him in all necessi-ience and doctrine,• my Father who hatld communicate with /cs, which I shall knowrall permit, and my gove and cherish his childrenly as mine own. Further,�onstrate the said scienc I. " ave so far as my powerextend. Also that I shallmy brothers, and his prog­at I shall teach, show, and( oratis) without rewa rrl orCover: The Oath of Hippocrates and the caduceus both represent thechallenge of medicine to physicians. There is a new challenge facing physi­cians, however-the growing threat of malpractice suits. In this issue ofMedicine on the Midway we take a look at the problem and some possiblesolutions.Medicine on the MidwayVolume 30, No.2 Summer/Fall 1975Bulletin of the Medical Alumni Association ofThe University of Chicago Division of the BiologicalSciences and The Pritzker School of Medicine.Copyright 1975 by the Medical Alumni AssociationThe University of ChicagoEditor: Jay Flood KistContributing Editors: Nancy Selk, James S. SweetPhotographers: Mike Shields, John Vail, Ed Koizumi,Don Sitterlee, Bill Rogers, Fabian BachrachChairman Editorial Committee: Robert W. Wissler ('48)Medical Alumni AssociationPresident: Henry P. Russe ('57)President-Elect: Asher J. Finkel (' 48)Vice President: Myron M. HipskindSecretary: Francis H. Straus II (' 57)Director: Katherine Wolcott WalkerCouncil MembersHoward L. Bresler ('57)Sumner C. Kraft (' 55)Lauren M. Pachman ('61)Donald A. Rowley ('50)Randolph W. Seed ('60)Joseph H. Skom (' 52)Otto Trippel (' 46) ContentsMalpractice Forum 4The Physician's ViewDr. Clifford Gurney 4The Attorney's ViewLouis G. Davidson 4Society's View 6James M. GustafsonConsent and Informed Consent 8Dr. William BarclayPoor Quality Medical Practice 10Dr. Clifford GurneyMalpractice: What Does It Mean to the MedicalStudent? 13Dr. Phillip G. SpiegelThe Illinois Malpractice Law-A Solution to theProblem? 14Mark D. OlsonTeaching Medical Ethics 16James Gustafson, Dr. Chase P. Kimball, Dr. PattiTigheNew Face for Plastic Surgery 21Dr. Martin RobsonSex Therapy 23Dr. R. Taylor SegravesReproductive Biology and ContraceptiveDevelopment: 25The World Health OrganizationDr. Gebhard F. B. SchumacherKovler Viral Oncology Laboratories 27Tribute to Dr. Jacobson 31New Student Reception 32News Briefs 34In Memoriam 38Departmental News 40Alumni News 433MALPRACTICE FORUMWhat is malpractice? And what are the solutions? Physi­cians, an attorney and a theologian explored the multifac­eted problem in a three-hour Frontiers of Medicine pro­gram May 74, 7975. They present some of the problemsand propose some remedies designed to minimize the risksof malpractice suits. Participants include: Dr. Clifford Gur­ney ('57), Deputy Dean of the Division of Biological Sci­ences and the Pritzker School of Medicine; Louis G. David­son, Davidson and Associates; James M. Gustafson, Uni­versity Professor in the Divinity School of The University ofChicago; and Dr. William Barclay, Senior Vice President ofthe American Medical Association.The Physician's ViewG lime)': Physicians express growing concern over theincreasing number of malpractice suits and the escalationin the magnitude of settlements. In some areas of thecountry, malpractice insurance premiums may soon cost$25,000 per year for the practitioner of high risk special­ties. Such high premiums are ultimately passed on topatients, most of whom never contemplate suing theirphysicians, but all of whom are concerned with the highand rising cost of medical care. Costs of medical care arealso rising unnecessarily as physicians practice defensivemedicine-ordering large numbers of tests which in theirclinical judgment are superfluous.Physicians believe they and most of their colleaguesare doing the best they can for their patients. They donot, in general, object to judgments against colleaguesguilty of negligence or gross incompetence but they re­spond with fear and anxiety to reports of physicians whoafter having done what, in their judgment, was appro­priate are later the victims of law suits and inflated set­tlements. Most physicians believe law suits threaten orharm their professional reputations regardless of the ul­timate outcome.It is increasingly coming to be accepted by physiciansthat a jury may on occasion behave in a punitive fashion.Conscious or unconscious hostility toward the medicalprofession, rich doctors, or a single physician previouslyunresponsive to the needs of the jury member, may becontributory to some of the decisions and the giganticjudgments against individual physicians. The very largelegal fees, often in the form of contingency fees, that area part of malpractice settlements are viewed by manyphysicians as constituting an unwarranted and excessivestimulus to lawyers.Finally, there is a genuine concern developing withinthe medical profession that escalation of the problembeyond reason will lead to large cancellation of malprac­tice insurance. Very few physicians can contemplate thecontinued practice of medicine in an increasingly litigiousfuture if. as already is occurring in a few areas forselected high risk specialties, insurance carriers are sue-4 Since the forum on malpractice suits was held,Governor Dan Walker has signed an amendment tothe Illinois Civil Practice Act which relates to med­ical malpractice suits. The new law, which wentinto effect on November 11, sets a $500,000 limit ondamages awarded for medical malpractice. It alsoprovides for a pre-trial review of malpractice suitsby a panel consisting of ajudge, a physician, and anattorney. For an analysis of the provisions of thislaw, see Mark D. Olson's article on "The IllinoisMalpractice Law-A Solution to the Problem?"(Page 14)cessful in terminating the offerings of malpractice insur­ance.Before exploring some of the major considerations re­lating to what the medical practitioners should knowabout malpractice, it was our opinion that someoneshould speak- on behalf of the legal profession. Althoughphysicians are able to enjoy lucrative incomes in thepractice of medicine, and lawyers have an opportunity toprofit by attacks or defenses of selected practitioners, themedical profession really exists not for physicians orlawyers but because patients exist. For that reason, wefelt it appropriate to have someone enter the controversyas a collective advocate of patients or an advocate ofcollecti ve patients.The Attorney's ViewDavidson: The concern on the part of the physicians,expressed most fairly by Dean Gurney, places in focussome of the critical problems facing the profession in theform of medical malpractice claims and litigation againstphysicians. The once small cloud on the horizon hasgrown with frightening speed to a thunderhead. It hasreached dimensions, as all of us are all too painfullyaware, where it not only threatens the peace of mind ofphysicians, but has tended to threaten their financial se­curity. Perhaps through no fault of their own, doctorshave often been unable to obtain medical malpracticeinsurance because the insurance carriers have decidednot to write such coverage in a given state.More onerous still is the possibility that, without effec­tive regulation and control, the proliferation of medicalmalpractice claims and litigation may have a most un­wholesome, detrimental effect upon the overall quality ofmedical practice and research. It may discourage innova­tion in the development of better medical and surgicalprocedures that have been previously untested. It iscommon knowledge that doctors will not attempt anynew and relatively untested techniques and procedureswhen there may be substantial risk of harm in the eventLouis C. Davidsonthe procedure proves unsound. A doctor engaging inpractice which may travel uncharted fields would layhimself open to possible legal liability if the result wasseriously disabling and adverse to the patient, and hecould almost be certain that he would be inviting cancel­lation of his malpractice insurance. If that thinking andpsychology had prevailed 50 years ago, there would havebeen far less of the great progress in medicine andsurgery of which our entire society has been thebeneficiary.It would be worse than hiding our heads in the sand topretend that the problems and concerns articulated byDean Gurney and those to which I have referred do notexist. The medical profession has developed a quality ofmedical and health care in the United States far beyondthat known to most civilized nations of the world, andtremendously improved over what it had been here sev­eral decades ago. It is ironic that the profession is nowbeing subjected to a fierce onslaught of liability claimsthat make it difficult for many of its members to carryontheir practice. Some doctors are now shunning high risksurgical cases, and even, I regret to say, avoiding calls tothe emergency rooms of hospitals to assist in saving thelives of patients in a critical condition.There are two questions to be addressed. One, how toidentify the problem. Two, how to find a tolerable solu­tion conducive to the sound practice of medicine andsurgery, without unnecessarily exposing doctors to ex­cessively punitive sanctions for any failure to use proper care and skill in treating a patient. At the same time, thesolution must insure fairness to the patients who havebeen harmed by negligent and incompetent care.There is no doubt that in the past many patients suf­fered severe harm, and at times death, due to incompe­tence, negligent care, or lack of proper care. In the past,generally, such occurrences rarely resulted in medicallegal claims or litigation against doctors and hospitals.There were, relatively speaking, only a handful of suchcases filed a couple of decades ago, and those in only afew jurisdictions. But large verdicts were widely publi­cized; the public became aware of its possible rights andmore litigation minded; more and more doctors becamewilling to appear and testify on behalf of patients where itappeared that there had been negligent or incompetentmedical care that demanded some response by fair­minded and responsible people; and as a result more andmore cases were filed and tried, and there was an increas­ing number of judgments against medical practitioners.Approximately 60 percent of the verdicts of trial courtjuries, or findings by the court in a bench trial, are infavor of the defendants in this class of litigation. A studyof the decisions of the courts, furthermore, tends to showthat the courts have never hesitated to protect fully themembers of the profession when the evidence did notjustify permitting juries to pass on cases, or when a ver­dict unjustly rendered against a doctor by the trier of thefacts should be set aside. The law books are filled withcases in which trial and appellate judges held, as a matterof law, that doctors or hospitals were not liable. Cases inwhich recoveries were upheld, concomitantly, disclose aquality of medical practice or hospital care often so pat­ently bad that informed laymen, assisted usually by thetestimony of qualified experts, have had little difficulty indeciding that physicians or hospitals or both were liable.Arguably, however, much of the destructive impact ofthis class of litigation occurs even when the doctor orhospital ultimately prevails. A trial is often preceded bymany depositions taken by counsel for both parties andthen followed usually by a trial that may last from a weekto five weeks. In most cases juries will not be permittedto pass upon the questions of liability and damages unlessplaintiffs introduce the testimony of expert witnesses tosupport their contentions.The medical profession is ill-advised to attack malprac­tice litigation on the grounds that lawyers will handlethese cases whatever the facts or that they do so on acontingent fee basis. The contingent fee has quite prop­erly long been known as the poor man's key to the court­house door. I am not defending the contingent fee, but itdoes enable people to obtain the services of able lawyerswho can adequately represent them and whose servicesthey otherwise could not afford on a time basis. The veryuncertainty of a successful conclusion of medical mal­practice litigation and the substantial costs of prosecutingit are themselves, for knowledgeable counsel, adequatedeterrents against accepting cases of questionable liabil­ity or minimal harm. Lawyers experienced in medicalmalpractice litigation reject at least 9 out of 10 or 19 outof20 cases they are asked to undertake. The resolution ofthe troublesome situation that now exists will not be5found by advocating measures which will have the effectof denying the public representation by competent coun­sel.The attention that has focused on the problem of medi­cal malpractice litigation has grown a hundredfold sinceDean Gurney first planned this program. Agencies ingovernment, bar and medical associations at every level,and legislatures in many states, are examining the prob­lems involved. Few in the medical field will look withapproval upon the notion that medical care and hospitalprocedures are very probably in some significant mea­sure improved by the availability of the courts as a forumfor this class of litigation. There exist a variety of com­mittees, functioning in hospitals and operated by medicalstaffs, that seek to improve procedures and minimize un­necessary risks to patients. But self-regulation by anyprofession is at best a most difficult and frequently aninadequate enterprise. Malpractice litigation, unlikeself-regulation, turns a pitiless spotlight on hospital careand on medical practices and practitioners, even on thosepractitioners who, as a result of their eminent position orreputation, may be effectively exempt from questioningby their peers or by other than friendly interrogators solong as the inquiry remains solely in-house. It must beacknowledged therefore that malpractice litigation doesresult in some improvements in medical care, though themen and women who bear the financial and emotionalcost certainly feel it to be too high.Part of the reason for the mushrooming of claims maylie in the fact that busy specialists have never been ableto develop the rapport with their patients that oftenflowed from the old-time general practitioner's warmpersonal relationship as both physician and family ad­visor. The crush of the work load in modern medicalpractice, often beyond the capacity of even the mostcompetent doctor to handle, will not permit time enoughfor casual chatter and friendly visiting between physicianand patient. Perhaps the physician must more sharplylimit the number of his patients in order that he can takethe time to develop a friendlier relationship with his pa­tients. I am mindful that that is more easily said here thandone in actual practice, and also that highly trained doc­tors are understandably reluctant to spend what mayseem to be useless and unproductive time with a patientbeyond the requirements of good care.I am convinced that a solution will be found for pre­serving the basic rights of the severely disabled patient tojust compensation for the harm inflicted upon him, with­out fault on his part, as a result of negligent or incompe­tent care. Some patients have suffered harm so in­capacitating that lifelong care will be required. At thesame time, it is essential that in protecting the patients'fundamental rights, we avoid the oppressive effects anddisruptive consequences which result from this class oflitigation, at least in part because of the prevalent methodof resolving the problems involved. Some states are turn­ing to workmen's compensation types of remedies.Others are considering a no-fault approach, but thesehave their inherent and perhaps insoluble administrativedifficulties and present grave questions as to their legalvalidity. Screening panels have long been tried in several6 locales, but these have had very limited success. Consid­eration will necessarily have to be given to the use ofdifferent forums in which to resolve these problems, butit may be that none other will be as adequate and satisfac­tory in the long run as the jury trial system we now have.Serious consideration undoubtedly will be given toprograms managed by the courts for compulsory screen­ing out of the so-called small cases for different handlingand disposition, without the use of jurors. Arbitrationpanels may be tried to see if there are methods ofeliminating the exacerbating experience of the publicforum that a public court trial re presents. National healthplans, so long under discussion and perhaps still someyears distant, may provide some form of hospital andmedical care which would tend to eliminate the need toclaim damages for expenses allegedly incurred as the re­sult of medical malpractice. Rather than wait for nationalhealth insurance, several states are already studyinglegislation for comprehensive health insurance programsin the expectation that such legislation will probably beintroduced in every state. Bills providing for some formof comprehensive health insurance are now pending inalmost half the states. In the meanwhile, federal or stateplans for medical malpractice insurance must be devisedto make such coverage promptly available to doctors dur­ing this critical transition period.There is no way to wave a magic wand and eliminatemistakes and harm to patients who were seriouslyharmed by negligent medical care. We are still onlyhuman beings and as long as there is life and there aremultiple demands upon each of us, mistakes will be in­evitable. These frailties in our system of medical care areinherent in the fact that much of the practice of medicineand surgery is, despite great progress, less than an exactscience. Thus there is often a wide difference of opinionamong members of the medical profession itself as towhat is sound medical practice and management. Fur­thermore, we often tend to place our great doctors on apedestal, as a part of the human tendency to attributegod-like qualities to other human beings, and, as a result,to expect too much of all doctors.Society's ViewGusrafson: No one individual can represent society'sviews on medical malpractice. I present what I have tosay about a much discussed subject as my personal ob­servations informed by reading and by my ownreflections.First, like all professions, the medical profession todayis in the public eye in a different way than it was in thepast. Science reporting, investigative reporting, televi­sion, Sunday supplements and other media disclose to apartially literate public (thinking in terms of medical andscientific knowledge) a great deal more information thanthey formerly had about medicine and medical care.Also, the upgrading of education about medicine, healthand biology has increased awareness and interest in bothpreventive and therapeutic medicine.Second, the very achievements of modern medicinehave increased the expectations of the public with refer­ence to the performance of the health professions. Notonly is the public informed about remarkable feats oftherapy but also its support is enlisted to increase theseachievements. Part of the psychology of gaining publicsupport is to intensify the aspirations and hopes of peoplethat they might be the beneficiaries of research andtherapy that they are being asked to support eitherthrough voluntary contributions or through taxes sup­porting research.If the churches have gained various forms of publicsupport by appealing to the self-interest of persons forsome eternal security, so the public relations people in­volved in medicine have gained public support by appeal­ing to the self-interest that persons have in the preserva­tion of their own health. They have not hinted explicitlyof immortality but have tended to promise deferred mor­tality which might come to all of us if the principal fataldiseases can be "conquered." Dramatic and decisivewords like "conquering" are bound to elicit higher aspi­rations and higher expectations on the part of the public.Third, health seems to be replacing salvation as thechief end of man. Healthy physical life is the conditionsine qua non for most of the ends and purposes thatpersons have in life. One cannot achieve in one's profes­sion without health; one cannot enjoy the pleasures thatleisure affords without health; and one cannot envisionanything of self-fulfillment without the necessary condi­tions of health. If health is moving to replace salvation asJames M. Gustafson the chief end of man, ill health is moving to replace thefear of damnation as a profound source of anxiety. IIIhealth threatens economic welfare. It disables a personand puts under risk all the aspirations that one has forhuman fulfillment. III health and finally death are per­ceived in certain age groups to be the real enemy.Fourth, there is a loosening, if not breakdown, ofconfidence that the public has had in the medical profes­sion. I am certain that there are many explanations forthis alteration in confidence, some of which might bejustified and others not. The traditional relationship be­tween patient and physician has been one of a personalcovenant, a covenant which is grounded more in condi­tions of mutual trust than in an articulated legal contract.Some contemporary conditions of health care make thattrust difficult to engender and to sustain. The partial andvery limited relationships to patients in clinics and in­stitutions that provide special health care facilities for theseriously ill and for expensive and complicated therapies,and the proverbial interest of the physician in diseaserather than in the patient-both contribute to conditionsin which there is a breakdown of this kind of relationshipof confidence.Even where trust and confidence is sustained, the in­terposition of insurance systems precipitates a separationof personal relationships between doctor and patientsfrom the impersonal relationships of paying for care. Oneeven sues one's friends these days if one knows that theyhave liability insurance.Fifth, loss of trust has not been and cannot be replacedby a legally binding contract which assures the patient ofthe success of the therapy. I sign a purchase contract foran automobile; I get the model I ordered; I get the war­ranty guaranteeing the performance or replacement ofparts that are defective. Medical care cannot have thesame certitude that automobile manufacturers canguarantee. Thus, in a sense, the medical profession hasan open-ended contract with patients in which the aspira­tions of patients may be inordinate with reference to whatthe profession can promise to achieve. Surely legal andother documents, in the form of consent statements, forexample, attempt to limit misunderstanding. But they donot always succeed.Sixth, actual instances of incompetence become publicknowledge and thus enhance the distrust. That there areinstances of incompetence no one will deny, and thereought to be proper compensation for negligence. The de­lineation of what is judged to be culpable negligence inthe eyes of the law is a matter for the courts. The linedrawn between excusing conditions for mistakes and forculpability is no doubt a very fine one. In the non-legalrealm, I think this poses a very delicate problem to themedical profession. On the one hand, professional com­petence is the ground for the confidence that patientshave in their physicians. Without assurance of compe­tence, there would be no confidence. On the other hand,there are conditions which limit the possibility of deliver­ing what the patients desire. One of these is surely thecomplexity of the human organism, the multiple variablesthat are present in any serious condition and in the possi­ble responses of patients to therapeutic intervention.7I, a professor in the classroom, cannot predict the con­sequences of my teaching as it reverberates through thestudents' minds and actions: I am not held responsiblefor them because they cannot be predicted. You, asphysicians, presumably can make more adequate predic­tions of consequences than I can in my work. Since yourinterventions are more precise than mine, it is easier tolocate accountability for a particular act or a particularintervention. Yet, as we all know, there are limits to youraccountability for the consequences of your intervention.The bind in which this places you is that the admission ofyour own finitude (that you are likely to make mistakesand that you cannot control all the consequences of yourinterventions) and of your own limitations might verywell undercut the confidence in you that is a condition ofyour work. In my lectures, my errors do not have a deci­sive significance for my students as your errors of judg­ment might have for some of your patients. My range ofappeal to excusing conditions is broader than the publicpermits yours to be.While it is possible for individual physicians to makeclear to individual patients the limitations of their claimsfor competence, and thus of their accountability for con­sequences, it is more difficult to sustain in a broad publicimage of the medical profession both the sense of limita­tion and a sense of the tremendous competency and pos­sibilities for therapy. The competence of the profession isnot infinite: the judgments of its members are not infalli­ble. This must be recognized culturally and socially aswell as legally, and part of that recognition is up to theprofession itself.Seventh, there are perceptions of the economics ofmedicine that enter into society's views about malprac­tice as it pertains to the medical profession. Ours is asociety in which the market system, for ill or good, isdeeply embedded. When we pay more for things, we ex­pect more. Those who are well paid are expected to per­form and produce that for which they are well paid. Morepersons are watching the pitching records of CatfishHUnter this year because of the remarkable salary andbenefits he was able to induce his club owners to pay himthan was the case when a relatively obscure Vida Bluedid so astonishingly well at a relatively low salary in hisfirst dramatic year. While Catfish Hunter cannot guaran­tee to win 30 games this year, the public expects him towin well over 20 if he is to be worthy of his remuneration.If he does not win as many as the public expects, hecannot be sued for incompetence or negligence but therewill surely be many persons who will think that he de­serves to suffer economically. Many persons expectphysicians to lose few "games" since doctors are wellpaid to win.Eighth, while some of the American public are becom­ing dramatically aware of the fact that the economic costsof malpractice suits are finally borne by the patients (eitherin fees for service or in increases in insurance costs), thisrecognition is not sufficient to impose voluntary re­straints on suits. Members of the medical profession are,of course, aware of what insurance against malpracticecosts them even if no suit has been filed against thempersonally. It is in the economic interest of both physi-8 cians and patients to establish some kinds of control onthis phenomenon.Finally, we are in the midst of a right-consciousnessperiod in our history. Patients are participating alongwith other consumers, women, and minority groups in astrong claim for their individual rights. One does notknow how long this consciousness will last nor how far itcan go without infringement on the rights of others.Nonetheless, it is surely the case that the increase inmalpractice suits in recent years has been fed in part by alarger social movement of individuals claiming theirrights.Consent and I nformed ConsentBarclay: Apart from Dr. Gurney's relatively brief intro­duction, this is the first time this afternoon that a physi­cian has addressed the problem of malpractice. Unfortu­nately, when many malpractice suits have been brought,it's the physician who created the climate. He created theclimate perhaps through being negligent or by exceedinghis level of competence when he started doing the job.But in a large percentage of the malpractice suits, the suitis brought on the basis of not getting the patient's con­sent, now called informed consent. There's quite a dif­ference between consent and informed consent. Consentis really the patient's full and voluntary permission forthe physician to embark on a course of action. Generally,for legal purposes, consent is given by the patient or thenext of kin (if the patient is a minor or mentally or physi­cally unable to give consent)-on the basis of a signature.It is often felt that the signature on a standard hospitalpre-operative form constitutes adequate consent. Thismay not be true. The consent must not be given undercircumstances of fear or ignorance. A patient brought tothe emergency room may sign a consent form when he'sfrightened or because he's ignorant of the conditions ofthe form. He may not even be able to read. His languagemay not be English. If such circumstances can subse­quently be shown, this will nullify the signature of con­sent.What is the difference between consent and informedconsent? Informed consent implies that the patient hasan understanding of the benefits to be gained from what­ever the physician's going to do; the risks attendant onthat procedure; the disabilities which may necessarilyoccur from the procedure, such as an amputation or theremoval of a breast; and the alternatives to the proce­dure. A physician may be guilty of not giving the patientan opportunity for informed consent if the physiciandoesn't explain the other opportunities for treatment thatexist. This is particularly true if, for example, one istreating a malignancy and the options before the patientare: extensive surgery, radiation, chemotherapy, or, ifthe tumor has gone far enough, doing nothing and notincurring any of the expense or the trauma of the otherprocedures. These must be made quite clear to the pa­tient. Philosophically, the physician's role is to advise,and the patient's role is to decide. If you can't show thatyou gave the patient sufficient advice on which he couldDr, William R, Barclaymake an informed judgment about his own future, youmay be guilty of not giving the patient an opportunity forinformed consent.With the malpractice climate today, it may not be ade­quate for you and the patient to engage in a dialogue inwhich you do all the things I said you should do- outlinethe benefits, risk, disabilities and alternatives. You mayneed to document that you have done these things byhaving a witness, perhaps a member of the family, whocan in the future vouch that you actually went throughthis whole procedure.If you get consent to do a procedure, you must be verycareful that you don't grossly exceed the extent for whichyou have permission. The patient may give informedconsent to go to a certain point or even, if necessary, togo somewhat further. But, if you find you have to goexceedingly further than what you had consent for, thenyou had better rethink the situation. You may even wantto get a member of the family in, if you don't want tobring the patient out of an anesthetic to get consent to gothat much further. Full disclosure to the patient, how­ever, is not only impractical but it might actually be det­rimental to the patient's best interests. If you were to listall of the possible complications of a procedure or medi­cations (as do FDA pamphlets that accompany a drug), you could frighten the patient away from a procedure thatwas necessary to preserve life. Limited disclosure, pro­viding it is limited to the major risks and hazards, mightbe quite adequate to protect you in a malpractice situa­tion.Finally, be sure that the patient understands, in certainprocedures, that what is being done is irreversible. Donot imply to the patient, if you are going to do a tuballigation or a vasectomy, that the physiological conse­quences might be reversible by some experimental pro­cedure that you've read about or that they've read aboutin the Reader's Digest. And never-after you've giventhe options, hazards and benefits-never resist thepatient's request for another opinion. If the patient sug­gests or even vaguely hints that he's unsatisfied with theinformation he's been given, or he's unsure of what heshould do and would perhaps like another opinion on thesituation, by all means encourage him. In fact, becomethe advocate for another medical opinion.There are certain circumstances where a doctor may,within certain limited areas, withhold information. Iknow you do so with great caution and restraint. Thereare times when the damage or shock to the patient maybe such that you're justified, (and you may be), in with­holding some of the full possible ramifications. One of thedangers of informed consent is that the courts have heldthat this is the one class of claim where the claimant doesnot need an expert witness. The real problem here issometimes a doctor may want to go easy on the patientout of kindness; he may not want to make the patientsuffer unnecessarily and may not tell him as much as heshould be told. Worse than that is the difficulty of com­municating with a person who comes from a somewhatdifferent background than the doctor and often doesn'tunderstand or fully listen to what he's being told. Thedoctor may have told him all that he needed to hear, buthe didn't understand the words. Doctors should be care­ful about the language they use, and find, where possible,commonplace non-technical language . You often hearonly those things you want to hear and then put the otherthings out of your mind. But it helps a little to haveanother person there to listen to what's being said.Right or wrong, the patient has the right to decide whatshould be done with his own body. But the only way hecan make an informed agreement is by being told whatthe possibilities and probabilities are. We try to practicelaw the same way with our clients, who often try to say,"you decide." We invariably go back to them and say,"Thank you. We appreciate your confidence in us. Butit's your decision. We can only tell you what the chancesare each way and we'll give you our best judgment."There are many physicians who practice with some­thing less than competence and often do things for whichthey should be sued, but they are never sued in theirlifetimes because their patients have such admiration forthem. Then there are other physicians who are extremelycompetent and who probably never should be sued butwho have a multitude of suits entered against them intheir lives. They have a bad patient-doctor relationship.The best thing you can do to avoid malpractice suits isconduct yourself in the interest of good doctor-patient9relationships. In all walks of life, a good interpersonalrelationship and mutual respect are generated by goodcommunication. Communication is a two-way process.It's not only important for you to communicate with thepatient, but for the patient to communicate with you. AsI talk to patients, they say, "The thing that bothers meabout the doctor you sent me to is that he doesn't listento me. I know he's a good doctor, he's on a universityfaculty and you recommended him-but he doesn't listento me."The first thing you have to do is impress on the patientthat you're really interested in his problem and that youunderstand his problem from his standpoint. It's notenough that you understand a medical problem from itsbiochemical, physiological, anatomical and pathologicalaspects-that's only one part of understanding the prob­lem. Understanding a medical problem fully is under­standing what the problem is doing to that patient andhow he perceives the problem. He may not perceive agastric ulcer the way you perceive it from the x-ray andfrom finding blood in the stool. You must understandwhat it's doing to his life. You have to correct the prob­lem from the point of view of his perception of it, as wellas correcting the appearance on the x-ray and getting ridof the blood in the stool.You also must communicate with the patient in a waythat he understands. You cannot use medical jargon, youcannot confabulate, you cannot confuse. You have to besure that when you tell the patient someth ing, he under­stands it. There is the problem that the patient hears, andlistens, but doesn't understand. But if you can set upgood communications with the patient, then the patientviews you as a friend and not as a technician.Now we come to what is legitimate communicationversus the concept of full disclosure. The FDA, by regu­lation, has to publish a full disclosure in the physician'spackage insert and is currently trying to developpatient-package inserts. Legal counsel for the FDA saysthere must be full disclosure in these. Physicians in theFDA insist that this is not in the best interests of thepatient. An experiment was tried four years ago whenDr. John Jennings, the head of the drug section of theFDA, and I jointly wrote W h at YOLI S hould Know A boutThe Pill. This is the patient brochure that every physi­cian is supposed to give to a patient when he prescribesthe pill. It tells in lay language (and not in full disclosure)what the hazards are of taking birth control pills. Wewent through a pretty strenuous time with the FDA legalcounsel who was very unhappy about the pamphlet.The basis of the pamphlet was that Dr. Edwards, thenthe commissioner of the FDA, said the FDA insists thatevery patient who takes this medicine must receive withit an informative leaflet on how to take this pill and whatits dangers are. The AMA said, "If you do that, we'lltake you to court. We don't think that you have the au­thority to do that. Health information for the patientshould come from the physician. The patient's physician.The patient's physician should be the prime resource ofhow the disease should be treated. That includes thehazards of taking the medicine." Unfortunately, themedical profession has abdicated that responsibility. All10 too frequently, due to the constraints of time, doctorswrite a prescription, hand it to the patient and say, "takethis three times a day for the next week." We com­promised with the FDA on patient package inserts forbirth control pills by saying that if they would let us writethe pamphlet with their assistance, and if they wouldmake it non-compulsory, we would try this as an exper­iment. Each month, I get many letters from patients whohave either suffered a serious thromboembolic episode orwho've had a wife or daughter die from one. They usevituperative language against the AMA and against doc­tors and say they're going to sue the doctor who wrotethat prescription. Invariably, they point out in the letterthat the wife or daughter was not given the official pam­phlet on what you should know about the pill.I would say that adequate information includes givingan official pamphlet to the patient where such a pamphletexists. If your practice is so busy that you don't feel thatyou can concern yourself with this depth of communica­tion, you might be well advised to use allied health per­sonnel.Do not turn off patient questions which come from thepatient's reading of lay literature. The Sunday supple­ments and women's and family magazines are full ofhealth information-much of it very poor. But if the pa­tient asks you a question based on some article, don'tsay, "Don't pay any attention to that." If he has somemisinformation, be sure to correct it. Good communica­tions between the patient and the physician require time.What most of you don't have is time. But the seriousnessof the malpractice situation today is such that you'regoing to have to find the time, even if it costs money outof your pocket. You are simply going to have to absorbthose extra costs if you're going to remain insurable.Poor Quality Medical PracticeGurney: I wish to make one major point, namely, that thelarge percentage of malpractice problems relate to un­sound medical practice. George J. Annas, the directorfor the Center for Law and Health Sciences in BostonUniversity School of Law, recently wrote: "It is simplynot true that most malpractice actions are nuisance suitsand utterly without merit. Almost all surveys show thatthe majority of them have merit and even malpracticeinsurers estimate that more than 45 percent of them arefully justified."While I have no firm feeling on how sound a figure 45percent is, I suspect a generalization may well be truethat a large minority, if not the majority, of all malprac­tice suits that are carried through to a successful conclu­sion from the point of view of the plaintiff do involvesome error on the part of the physician.As we look at the quality of medical care, allowing forthe fact that most physicians do the right thing most ofthe time, we are unfortunately left with a very largenumber of patient-physician contacts that might in ret­rospect be considered inadequate or inappropriate byneutral, but knowledgeable, witnesses.As we pass from accepted high quality practice by anyDr. Clifford W. Gurneyreasonable standard to gross malpractice, we unfortu­nately must pass through a gray zone where judgmentbecomes important and where all too frequently ultimateauthority for judgment will rest not in the hands of medi­cal people, but in the hands of juries. For example, howlong maya physician be aware of a mild anemia in hispatient, without checking the stools for blood, before heis held accountable for malpractice through his failure toinstitute the procedures that ultimately lead to the diag­nosis of an occult carcinoma of the colon? If one physi­cian had such knowledge and did not undertake furtherdiagnostic tests within a period of one year, he would inmy opinion be guilty of malpractice. How about onemonth? A questionable period. One week? Probably not.How much time difference should one allow for anemia ifit is found in a menstruating woman? A woman two yearspostmenopausal? A woman ten years postmenopausaland suffering from rheumatoid arthritis which might be,but is not necessarily, the cause of the anemia?How thorough should the initial examination be forevery patient presented to the emergency room with headtrauma? Should it, in every case, involve a completeneurological examination? How about skull films? Fun­duscopic examinations? How should one make the dis­tinction between hospital admission for observation asopposed to observation at home?Here is a pertinent case. An l l-year-old boy engagedin a fist fight during the course of a baseball game. Hewas struck on the head and rode home on his bicycle, crying. A short time later, his father picked him up to takehim off on the weekend. The boy was irritable and suf­fered distress. His father took him to the emergencyroom of a nearby hospital. An intern concluded the boyshould be admitted for observation and the residentphysician on duty agreed. Emergency room personnelknew that he had been hit on the head-a large bump wasreadily apparent on the right temple, X-rays showedswollen tissues, he complained of a headache and ap­peared irritable and lethargic, he vomited twice forcibly,and he showed a decrease in pulse rate during the time hewas in the emergency room. Someone in the admittingoffice incorrectly told the intern the boy could not beadmitted because he was not being treated by a privatephysician enjoying staff privileges in that hospital. Thedirector of the pediatric out-patient clinic was in theemergency room attending another patient. The residentsought his help in getting the boy admitted to the hospi­tal. After questioning the intern and the resident, thedirector talked with the father to determine whether heseemed capable of observing the boy if hospital admis­sion should be refused. The director also talked to theboy, but he did not examine him or look at the chart. Thedirector concluded that the patient's father was a reason­able person and told him the boy could go home. Thedoctor advised the father to watch for dilation of thepupils in the patient's eyes and to be sure he could bearoused from sleep.An important factor in this case was the violation ofthe hospital's usual practice of giving the parent a sheetlisting symptoms that would call for the return of thechild to the hospital. The head injury sheet used in theemergency room listed seven symptoms, five of whichwere present when the patient was released from thehospital.Later that evening, the father noted further decrease inpulse and dilation of one pupil. The boy was returned tothe hospital. A neurosurgeon was called, but he did notarrive until 9:30 that evening. A blood clot was removedand bleeding was stopped. The boy remained in coma for46 days before he gradually regained consciousness. Heis now totally disabled except for slight movement of theright hand and foot. He is paralyzed from the neck down.He is mute, although he communicates with eye move­ment, he hears and sees well although his body isparalyzed, and his mental capacities appear to be unaf­fected. The court concluded that the brain damage heexperienced is now irreversible.This case is of some importance from a number ofpoints of view. First, consider the casual contact of thephysician with the patient and his father. In retrospectthis was a grievous error. What was the doctor doing inthe emergency room? He was there to treat his own pa­tient, not the boy who had been struck on the head. Youdon't know, I don't know and the jury didn't know whatpressures were on that doctor-how many hours he hadworked that day, how tired he was, how late he was fordinner, how many dinner guests were awaiting him athome. All these pressures might have been personal fac­tors with which one can sympathize, but they are notrelevant. Once the doctor became involved in advising11the staff and the father, it became his responsibility togather the necessary data to arrive at a sound judgment.In the second place, this case constituted the largestrecorded malpractice verdict ever rendered in the UnitedStates-$4,025,000. There have been 22 malpracticejudgments in excess of $1 million. The alarming fact isthat 17 of them have been awarded in the last two andone-half years. The specific mechanisms by which thecourt arrived at the amount in this case are of particularinterest. It took into account lost earnings in the future,past medical expenses, future medical expenses, the costof medical supplies and equipment, medical emergencyfunds, tutor, instruction and attendant care to a projectedage of 69.6 years. All these came to a value of more than$4 million by prudent assumption of a six percent in­crease per year in the cost of living. Of the first$2,150,000, the court approved payment of $508,000 inattorney's fees. Because the patient was a minor, pay­ment of the attorney's fees had to be approved by thetrial court. This was appealed on the basis of the size ofthe contribution to the attorneys, but the appeal was de­nied.Let us consider briefly the often discussed malpracticecase of Dr. John Nork, which was described by the pre­siding judge as a five-month horror. The suit had beenbrought against Dr. Nork by a former patient who un­derwent what was claimed to be unnecessary and negli­gently performed laminectomy. Dr. Nork admitted totreating the plaintiff improperly, and his admission alsoto treating other patients improperly was corroborated byan appalling list of patients for whom surgery wasconsidered by the court to be unnecessary or bungled-there were 50 operations for 38 patients. An unusualfactor in the case was Dr. Nork's attempt to claim drugdependence on his part as a defense for his acts. Thejudge concluded that any use of drugs would not haveaffected the admitted conduct, and that drug usage wasclaimed simply as a contrivance to avoid punitive dam­ages for fraud in prescribing unnecessary surgery.An interesting but not unusual feature was the liabilityshared by the hospital in which Dr. Nork practiced. Inrecent years several court cases have established thecorporate liability of activities within hospitals. Hospitalscan no longer be regarded as hotels, within which indi­vidual entrepreneurs conduct their activities. In anumber of instances, hospitals as corporate entities havebeen recognized as responsible for the quality of theirmedical care. This new twist leads to the prediction thateven more stringent controls and monitoring of thephysician's hospital practice may be anticipated in thefuture. There will be no viable alternative to demands bythe hospital trustees and administrators and stringent as­sessments of the quality of physician performance.It is interesting that in this case a rather persistentdiscrepancy between the nurses' notes at the time of apatient's discharge (which indicated he was sufferinggreat pain) and the notes by the physician (to the effectthat the patient was progressing nicely) assumed majorimportance in the final judgment of the co-responsibilityof the hospital. One responsibility of the hospital-thedocumentation of the medical record by nurses'notes-was sufficiently clear that it demonstrated the12 hospital's negligence in allowing the physician to con­tinue to practice there.A recent article in the New England Journal ofMedicine noted especially the obligation of$1.7 million incompensatory damages that were shared between Dr.Nork and the hospital where his patients' operations hadbeen performed. One point made in the article was thatthe regulations of the Professional Standards Review Or­ganization, so abhorrent to many physicians, do notreflect the ultimate extent of controls over the hospitalpractice of staff physicians. Rather, an emerging legaldoctrine of hospital corporate responsibility promises farmore stringent standards for quality control in peer re­view. The author concludes that strengthening of hospi­tal peer review quality control, where necessary, IS Im­mediately advisable.There may be great merit in the adage, "To err ishuman, to forgive divine." In medical matters, however,our society appears to be accepting the concept thatphysicians are not expected to err. At any rate, errorswill not be accepted lightly if they lead to undue sufferingor misery or if they present unrewarding expenditure ofdollars on the part of patients. Mr. Annas tells us, "Onlyone claim is asserted for every 226,000 doctor-patientcontacts." The average physician, then, will get suedonly once every 69 years, and most doctors never have amalpractice action brought against them during their en­tire careers. The major problem with the present system,as he sees it, is not that it is unfair to doctors but thatmany injured patients never get compensated and thatthose who do must pay high legal fees and wait for yearsto receive their money.I suspect at this point we are closer to defining theproblem intelligently than we are to solving it. Mygreatest concern is that there is something radicallyaskew in society. I submit to you that if you have 226,000contacts with patients in your lifetime, it is not possibleto be perfect or do the right thing every time . You willmake mistakes, many mistakes. Some of them will notlead to a suit if you have good relationships with yourpatients, but you will make far more mistakes with226,000 contacts than can be ignored. If you are usingpotent medicine or performing complex operations, theconsequences of those mistakes will often be great. Thecosts to you, to insurance companies, and ultimately topatients will also be very, very great.Continued professional education, peer reviewmonitoring, periodic recertification, and lightened workloads to minimize fatigue-can these measures reducethe percentage of errors to a level where malpractice tri­als will represent the best way to compensate for theirreducible minimum number of mistakes in judgmentand technique that will produce unwarranted sufferingand death? Or will the residual "malpractice" be sogreat, because modem medicine is so complex, as toforce society to develop alternate methods of compensat­ing the victims of error, so that the benefits of a complextechnology are to be retained? That is the question!Editor's note: The following three articles are related to thesubject of medical malpractice, but were not part of theFrontiers of Medicine forum.Malpractice: What Does It Meanto the Med ical Student?Dr. Phillip G. SpiegelI t is very difficult for some physicians not to look upon anell' patient as a potential litigant,-Dr. Malcolm Todd, President, A meric an MedicalAssociation, 1975Who has become the most important person in the prac­tice of medicine aside from the doctor and his patient? Notthe patient's relatives, not the nurse, not the technician. Itis the lawyer.-Robert Fischl, Nell' England Journal of Medicine,October 17, 1974If there is a fa II It in medicine, it is that doctors devote alot of time to investments, stock market reports, business,and real estate. If wealth and affluence are the primarygoals of medicine, lI'e need a fresh Slip ply of men dedicatedto the art of healing.-Jim Bishop, syndicated columnistConsider the following:-One-third of all physicians will be sued during theircareers.-Since 1965, the number of malpractice claims hasrisen from 6,000 to 20,000 a year.-Total premiums for medical liability insurance forpractitioners and hospitals were $500 million in 1973.The threat of malpractice suits is a real problem, and agrowing one for those who provide health care and forthose who use it. It affects not only the costs of medicalcare but the quality as well. Solutions to this problem arebeing considered at the legislative level but other arenasshould not be neglected. Those in the medical professionmust reevaluate the problem and provide their own solu­tions throughout their careers, perhaps beginning in med­ical school.A number of arguments could, of course, be mountedagainst delving into the intricacies of malpractice at soearly a stage. The first is that the medical student is act­ing under the direction and supervision of a licensedphysician. According to the Doctrine of RespondeatSuperior, an ancient common law maxim, a "Master"(attending staff) must respond for the actions of his"Servants" (students, interns, and residents). The stu­dent is not held totally accountable for his decisions. Wefeel, however, that such narrowed parochial interestsmay, in the end, be self-defeating. Today's student istomorrow's practitioner who must deal with themultifaceted issue of malpractice. Such legal realities ofthe outside world will someday invade and disrupt eventhose nestled in the quiet of the intellectual womb. Thestudent could be an activist and help shape the changesthat will affect him directly in the future. At The Univer­sity of Chicago, we are teaching young men and womenthe healing arts; these include not only the skills they willneed as physicians but the wherewithal to make soundjudgments. It was decided, therefore, to design a course in law andmedicine that would focus on the issue of malpractice. Anumber of questions had to be answered before this couldbe done. At what point should the student be offeredexposure to law and medicine? What format should thecourse follow? Should it simply 'take a mechanistic ap­proach and teach one how to avoid malpractice suits? Isit worthwhile to emphasize the practical side; to let themknow that professional liability insurance for all hospitalsin this area, including our own, has risen 70 percent andthat if they can avoid one suit, they can save the hospital$500,000? Or should a more humanistic approach betaken which stresses the breakdown of the doctor-patientrelationship as one cause of malpractice suits? Should welisten to Dr. John Knowles when he says: "Theatomized, fragmented machine approach to the patient... dehumanizes what should be an intensely personaland humane encounter"? Should we be content to teachthe students the "art of medicine," how to listen and talkto patients and how to give of their time and of them­selves in dealing with those who seek their aid and com­fort? Or should the scope of the course be broader still?Is it incumbent upon us to stretch the students' horizonseven further, to help them see, for example, how chang­ing social attitudes have been translated into legislationthat will directly or indirectly affect them? Our feelingwas that the course must deal with all of these but focuson expanding the student's awareness of his role as aphysician vis a vis society.Dr, Phillip C. Spiegel13Last year a medical-legal seminar, sponsored by theDepartment of Surgery and Mark Olson, the Director ofMedical Legal Affairs at The University of ChicagoHospitals and Clinics, was introduced into the medicalschool curriculum. It was open to all interested partiesand seniors were given .25 unit credit. The weekly formatconsisted of one-hour lectures that were followed by aquestion and answer session. Topics covered during theten-week period included: introduction to law,physician-patient relationships, the physician and law en­forcement, medical staff privileges, professionalliabil ity-plaintiff 's view, defense of a medical malprac­tice suit, Joint Commission on the Accreditation of Hos­pitals, utilization review, medical audit, ProfessionalStandards Review Organization, emergency medical sys­tems, the changing delivery system, patients' rights,abortion and sterilization, transplants, organ donation,autops y, research, nursing and the law, and business as­pects of medical practice. Except for Olson and Dr.Marshall Segal, who are on the faculty at The Universityof Chicago, all speakers were outside experts in theirfields. A small honorarium covered their expenses. Ex­planatory materials were distributed by some. No coursebook was used and there was no examination. Atten­dance ranged from 15 to 60 persons (highest at the mal­practice sessions) and comments were, for the most part,favorable.An effort was then made to expand the seminar andmake it less of a trade school concept. A course wasoutlined for Winter Quarter 1976 to consist of two after­noon sessions a week for 10 weeks. It was to be offeredon a pass-fail basis. The range of topics was to be ex­panded to cover such issues as medical ethics, fetal andhuman research, battered children, health maintenanceorganizations, health insurance programs, alternatives tothe present malpractice system, behavior modification,rights of the dying patient, nursing and the law, and ge­netic engineering. Speakers were to include scholars fromthe Divinity, Psychology, Psychiatry, and PhilosophyDepartments here. Less than 10 percent of the seniorstudents signed up for th is proposed course, however,and regrettably it was cancelled.At this juncture, we must now reevaluate what hasbeen done and what the future outlook will be for the roleof legal medicine in the medical school curriculum. Ac­cording to George Annas, director of the Center forLaw and Health Sciences, Boston University School ofLaw, .. Almost everything that the doctor does in thepractice of medicine is in some manner regulated by thelegal system ... when the doctor does not understandthe law and the obligations and limitations it puts on hispractice, he is at an extreme disadvantage ... and whilecorporate, tax, securities, real estate and bankinglawyers can probably get through their entire careerswithout knowing anything about medicine, no doctor canget through a day of active practice without facing, inknowledge or ignorance, significant legal issues."Therefore, it is safe to say that in the future, a manda­tory law and medicine course will be a fixture of thesenior year which is now totally elective. This wouldrequire that at least part of the fourth year be devoted to14 subjects which could not be squeezed into the precedingyears. How soon this will happen is a matter of conjec­ture. It is clear, however, that the fields of medicine andlaw are rapidly interlocking. Most medical students arenot yet aware of this expanding interface. They may haveto learn this through personal experience.Have you not leam'd great lessons from those who reject youand brace themselves against you? Or treat you with con­tempt or dispute the passage with you?Walt Whitman, Stronger LessonsDr. Phillip Spiegel is Associate Professor in the Departmentof Surgery (Orthopedics).The Illinois Malpractice Law-ASol ution to the Problem?Mark D. OlsonOn September II, 1974, Governor Dan Walker signed anamendment to the Illinois Civil Practice Act relating tomedical malpractice suits. This legislation was developedwith the strong backing of the Illinois Hospital Associa­tion and the Illinois State Medical Society in response tothe current malpractice "crisis."The most visible manifestation of the crisis has beensharply increased liability insurance premiums or, insome cases, total withdrawal of liability carriers from themarketplace. In response, physicians in some areas (no­tably California and Alaska) have withheld services. Thishas caused a serious disruption in the delivery of healthcare to the public.Obviously our present system of handling malpracticeclaims is near collapse and some changes are essential.Mark D. OlsonMost analysts have agreed that reforms must come at thestate level because the dimensions of the problem in eachstate vary considerably. Also, without reform, malprac­tice insurance as we know it today will cease to exist, iffor no other reason than no one will be able to pay theprerruums.Organized medicine in lIIinois sponsored a series ofbills designed to address various facets of the problem.The new law, P.A. 79-960, represents compromises byall interested parties (such as hospitals, insurers, attor­neys, and physicians) and provides for:1. A medical malpractice review panel.2. Penalties for proceeding to trial after a unanimouspanel decision against bringing suit.3. A stronger statute of limitations.4. A ceiling of $500,000 on recovery in any suit.5. Regulation of malpractice insurance rates.Malpractice Review PanelThe panel cannot be activated until a suit is brought.After the suit is filed, the chief judge of the Circuit Courtis required to order the convening of a review panel toevaluate the suit. The order may issue no sooner than 120days or later than one year" ... after the parties are atissue on the pleadings." Parties are" at issue" after thedefendants have filed their answer to the complaint,which usually occurs within 30 days after suit is filed.The panel will consist of one judge, one physician andone attorney. Panel members will be selected from ros­ters maintained by the chief judge of each circuit. The topthree names from each roster will be sent to the attorneysrepresenting each party. The parties must each strike onename from each list. The remaining names will constitutethe panel. If the opposing parties cannot agree on thecomposition of the panel, the question will be decided bythe circuit court. A panel member may disqualify himselfwith court approval, and any potential conflicting interestor association must be disclosed.The judge will be the pres iding officer, and he may ruleon all procedural issues including questions of evidence.The panel may subpoena witnesses, examine the medicalrecords and review discovery depositions (pre-trial tes­timony). After evaluating all the materials, the panelmust make a determination on the issue of liability. Ifliability is found, the panel may set damages. The deci­sion will be in writing and any member dissenting fromthe majority decision may file a written dissent. Eachparty and their attorney will receive a copy of the deci­sion.The parties may agree before or at any time during thepanel proceedings that the decision will be binding. Aftera decision either party may, within 28 days, accept orreject the determination. If the determination is rejectedby one party the case will then proceed to trial. Theopinion of the panel is not admissable at trial.The panel was created in response to the belief in themedical community that a large number of suits filed haveno merit. One of the expected benefits of a screeningpanel is that cases that should not have been filed will beweeded out before trial. Another is to eliminate some ofthe delay between the filing of a case and its disposition. It is also expected that panel awards may more closelyapproximate actual damages than some recent juryawards.PenaltiesThe inadmissability of panel proceedings at a subsequenttrial may significantly diminish the value of the panel. Ifits decisions carry no weight, is the proceeding of valueor a needless duplication of effort and expense?These questions were anticipated. The new law pro­vides for penalties if a party rejects a unanimous paneldetermination. Any party that elects to proceed to trialafter a unanimous panel decision and loses at trial may berequired to pay the costs and attorney's fees of the suc­cessful party. These costs would be assessed at a post­trial hearing. This provision can be a significant deterrentif trial judges are willing to enforce it, although in thepast, judges have been reluctant to penalize parties whoproceed with litigation that obviously has little merit.An adverse panel decision should be a practical deter­rent to the losing party. Lawyers will be extremely reluc­tant to proceed after one loss on the merits of the case.Many cases will probably be withdrawn or settled at thispoint.Inadmissability of the decision may also protect panelmembers. If the decision were admissable, panel mem­bers would have to be available to testify at the trial. Thepossibility of being required to testify during a long trialas a result of serving on a review panel would probablydeter many qualified persons from serving.Statute of LimitationsThe new law provides that suit must be brought withintwo years of the date of the discovery of the injury, butnot more than five years after the date the injury occurred.The purpose of strengthening statutes of limitation is tocreate some certainty concerning exposure to suit. It isdifficult to insure a risk if there is no definite limit onexposure to litigation. However, although this amend­ment offers additional protection, studies have shownthat 95-98 percent of all cases are brought within fiveyears of the date the injury occurred.The rights of minors are unchanged. A minor may stillbring suit until two years past the age of majority, whichis 18 in Illinois.$500,000 LimitationThe law limits recovery in any malpractice suit to$500,000. This recognizes the phenomenon of escalatingverdicts in malpractice actions. The medical communitybelieves that many recent awards bear no relationship tothe injuries incurred and that limits are necessary to con­trol costs. The Illinois Trial Lawyers Association haspublicly stated that the constitutionality of this sectionwill be tested as promptly as possible. The allegation willbe that the limitation unconstitutionally deprives indi­viduals injured through medical negligence of equal pro­tection of the laws.Regulation of Insurance RatesThe law provides that no insurance company writing15malpractice coverage" ... shall refuse to renew any ex­isting policy providing such coverage at the rates existingon June 10, 1975 ... " without providing the state Direc­tor of Insurance with "sufficient evidence" to justify anyrequested increase. The statute also provides for publichearings after submission of the rate increase request,and no increase can be implemented until public hearingshave been held.Insurance carriers violently opposed this provision,and at least one carrier has threatened to pullout of Il-1inois. Their position is that they are losing significantsums of money underwriting malpractice coverage, andthat present rate-setting mechanisms are adequate toregulate the industry.The health care industry generally believes that car­riers have made good profits underwriting professionalliability insurance. Many legislators agree and blame in­surance companies for the existing "crisis." This sectionof the law is a direct by-product of these beliefs. Theindustry has given credibility and substance to thesecharges by consistently refusing to release financial dataconcerning their large "losses."It is now clear that industry allegations of large lossesare all too true and that without exception, carriers willlose substantial sums of money underwriting malpracticecoverage through 1974. The large premium increases aremore than justified-and the carriers' loss experienceshows that without significant legislative reform, the costof insurance will become prohibitive or private carrierswill simply stop writing coverage.SummaryThe law took effect on November 11. We are at the pointwhere the threat of malpractice suits and possible un­availability of liability coverage can cripple our existinghealth care delivery system. As is apparent, the law isnot the ultimate solution but simply a beginning to theeventual resolution of the "crisis" in Illinois. Additionallegislation may concern such areas as:(I) Attorneys' contingency fees. Studies have shownthat almost one-half of every malpractice premium dollargoes to pay legal costs. Any system which permits suchmisdistribution of dollars (at the expense of injured pa­tients) desperately needs modification. A fair solutionseems to be the "New Jersey" rule. In 1971, the NewJersey Supreme Court adopted a sliding scale to be usedif attorneys take cases on a contingency basis. The ruleprovides maximum fees of 40 percent of the first $5,000;331;3 percent of the next $45,000; 20 percent of the next$50,000: and 10 percent of anything over $100,000.(2) Disclosure of collateral source payments. Thiswould help limit compensation to actual damages in­curred, such as loss of income, continuing medical ex­pense, disability compensation, and cost of rehabilitation.Collateral sources of income (such as health insurance,Medicare, Medicaid, salary continuation, and insurance)would be taken into account in determining the finalaward. Providing for such disclosure would eliminate theneed for any ceiling on awards because compensationwould be based on actual need and loss.(3) Use of annuity settlements. Settlement payments16 would be spread over the period of need, which might bethe rest of the injured party's life in cases of seriouspermanent injury. This would assure that the awardswould always be just. A jury would not have to award ahuge lump sum to provide for all contingencies. Thiswould prevent the patient's family from receiving a sub­stantial windfall should the plaintiff patient expire shortlyafter receiving a large award.(4) State-operated reinsurance programs for cata­strophic losses. Several states have considered establish­ing insurance funds to pay catastrophic losses over andabove insurance limits. In Indiana, for example, the Pa­tient Compensation Fund covers all losses over $100,000per insurer in a suit, to the maximum limitation of$500,000 per claim. The state-established fund would bea method of spreading the risk of catastrophe claimsamong the health care providers of the state.This list of possible modifications is not complete butdoes illustrate areas where attention is needed. Obvi­ously our existing system is not working. The reformscontained in P.A. 79-960 are only a beginning, the initialstep in resolving the malpractice "crisis" in Illinois.Mark Olson is Director of Medical-Legal Affairs for theUniversity Hospitals and Clinics.Teaching Medical EthicsJames M. Gustafson, Dr. Chase P. Kimball, andDr. Patti TigheThe interest in ethical issues in patient therapy, medicalexperimentation, and the social policies of health carehas increased markedly since the dramatic introductionof heart transplants less than a decade ago. That eventand its extensive coverage in the media raised the publicconsciousness of research and therapy, of risk-benefitratios, of individual human rights and of other relatedmatters in such a way that the interest has extended andexpanded.Prior to that time the literature on ethical issues inmedicine was relatively small; outside of standard textsin medical ethics written by Roman Catholic moraltheologians, Rabbi Immanuel J akobovitz' s J ewish M edi­cal Ethics, and Joseph Fletcher's Morals and Medicine,there was no significant amount of book-length literature.Renee Fox's Experiment Perilous, a social and scientificstudy, had received little public notice. There were occa­sional articles in medical journals and religious andtheological journals, fewer in philosophical journals, andperiodically one in major journals of opinion. But thevolume of literature has now taken virtually a quantumleap: There are institutes devoted to research and educa­tion about medical ethics; there are journals devoted tothe topic, and books covering several clinical topics;books devoted to single topics such as abortion and"death and dying" continue to find markets; and thepopular media find ready audiences for oversimplifiedand dramatic presentations. Courses in medical ethicsare now taught in undergraduate colleges, medicalschools, continuing education programs for profession­als, and theological seminaries.The quality of the literature and instruction varies agreat deal. Sunday supplement articles are frequentlywritten in a skillfully oversimplified way to create eitheranxieties or hopes in the readers that exceed what isreasonable. Television programs use all of the evocativepower of that medium to affect both the intellects and theemotions of viewers in ways that often are not veryrealistic. Some of the difficulties in communication be­tween physicians and investigators on the one hand andspecialists in ethics (and law and social sciences as well)on the other hand are eroding as a result of multi­disciplinary research and contacts, but many problemsremain. Physicians and investigators find philosophersand theologians to be limited in their medical andscientific information and to be lacking in the backgroundof clinical experience and judgments required.Philosophers and theologians find their medical counter­parts to be unsophisticated about ethical principles andmodes of practical moral reasoning, and less than prop­erly self-critical about the reasons for their judgments.These difficulties are grounded in part upon accurateperceptions of each other, but also often upon suspicionsand even hostilities that have long histories and deeproots. Yet it is precisely through the more strenuous ex­pansions of areas of competence and through rigorouslydisciplined common participation in research and discus­sion that literature and instruction of higher quality arebeginning to emerge.Students coming to The Pritzker School of Medicinehave interests in medical ethics. All of them have beenexposed to the issues through the press and other media,some of them have had undergraduate courses in thearea, and a few have participated in special programs ofintensive study. Serious interest is also being shown by asignificant number of faculty members. The Committeeon Clinical Investigation which reviews all researchproposals that require human subjects, for example, is ineffect a periodic seminar that requires clarification ofwhat ethical principles and what moral values are re­quired to preserve the moral and legal rights of humansubjects, as well as to preserve the moral integrity of themedical profession.In addition to these more general determinants of in­terest in ethical issues, the first quarter course, "I ntro­duction to the Patient," offered to first-year students, hasprovided specific impetus for the initial development ofthe second quarter course, "Social and Ethical Issues inMedicine." Students had the opportunity during the firstquarter to interview medical patients in small groups witha faculty preceptor. In that setting they began to expressconcerns about how some medical decisions relating tothe patients interviewed ran counter to their personal be­liefs, emotional reactions and intuitively derived deci­sions. They seemed to be suspended in their thinkingabout ethical issues between the attitudes of both lay person and professional, the latter frequently being seenas indifferent and insensitive or even callous. Recognizedas underlying many of these concerns were the students'anxiety over their own role with patients, their lack ofhaving learned a medically established response to aproblem, and the ambiguity often attending such deci­sions.Many students requested additional curricular time tofurther investigate these issues. It seemed appropriate toincorporate this attempt into the Social Medicine coursepreviously existing in the first year program. The overrid­ing objective of the course became, then, to assist the stu­dents in bringing further into awareness their own affec­tive and largely unconscious bases for the attitudes andopinions they impose in their developing clinical judg­ment. Thus it is not the intention of the course to definewhat constitutes the morally right action in any clinical orexperimental situation in which moral values or moralprinciples are in apparent conflict. To reiterate, the prin­cipal objective is to raise to consciousness and to criticalscrutiny the moral positions, attitudes, beliefs, princi­ples, and values that students already have.This principle objective has two foci, or takes the formof two other objectives. One is to enable students torecognize their own feelings about moral issues. Moralityis not only a matter of disinterested ethical reflection; it isa matter of very deep human affections and uncon­sciously determined feeling states. It involves not onlyvalues and principles believed in, but also affectivecommitments and inchoate sensitivities which give direc­tion to professional conduct. Evidence for this becomesclear in the responses of different students to differentclinical problems that are discussed in the course. Somestudents have very passionate feelings and convictionsabout the patterns of health care services; others havemore obvious feelings about abortion or withdrawal oftherapy from dying patients.The other focus is to enable students to come to great­er rational clarity about the moral values or moral princi­ples that inform their judgments, and about procedures ofpractical moral reasoning that are operative as they makethem. It is clear, for example, that some students moveconsistently from a strong affirmation of certain rights ofindividuals-their rights to full information, their rightsto determine what they can have done to their bodies,their rights to refuse recommended or prescribed treat­ment. Other students think more consistently from anethics of consequences in which their first thought isabout the potential benefits and potential harms that willbe done to a patient, to the patient's family and even tothe society as a result of a particular therapeutic or inves­tigative procedure. Some students think more intuitivelyabout what would constitute the morally appropriatemedical procedure in a given case; in a sense they "re­invent the wheel" with each case. Others have ratherfirm principles that they seek to apply to all similar cases.To fulfill this double objective in one course or in eachsession of the course is very difficult. Indeed, frequentlyit cannot be done because of the varieties of material, thedifferences in presentations, and the differences amongthe students themselves. One possible way of teaching17ethics to medical students has been rejected as unsatis­factory, that of studying various schools or systems ofethics as these have been formulated by moralphilosophers or by religious thinkers. We have not at­tempted, for example, to expound the tradition of thenatural law as this was developed in the philosophicaland theological traditions of the West and has been ap­plied to medical ethics by various writers. We have notread classic texts in utilitarian or Kantian ethics in orderto indicate how particular issues in medical care and re­search would be thought through from these alternativeapproaches. We do not present material from the Jewishlegal tradition to demonstrate how both the texts and themethods used in it address contemporary medical issues.Our judgment has been that it is important to begin withthe medical students' personal experience, or with ex­periences with which they can have empathy as a resultof early professional contact.The point where the affective and the rational dimen­sions are evoked is in the particular responses of physi­cians to particular clinical or experimental circum­stances. Thus our attempt has been to design a format inwhich the students are participants in dissecting out anddiscussing their reactions to the perplexing problemsaround the presentation of an actual case. Hence wethought it best, in general, to begin each session of theclass with one or several case vignettes presented by aclinician or investigator who is a specialist in the medicaldimensions of the case involved. Audiovisual materialsuch as videotapes or films sometimes enhances thesepresentations. Students then raise questions of bothscientific and ethical sorts with the physician who hasmade the presentation. Some of these questions areasked for clarification; others press the physician for thereasons he or she would offer to justify on ethicalgrounds the procedure that is used.Not all sessions, however, have followed this format.A film on decisions about death, for example, was ob­tained from the American Broadcasting Company, andpoignantly depicted the feelings as well as the thoughts ofpatients and physicians about such matters. Or, to insurethat the differences of moral opinion on abortion werepresented. an articulate physician representing the posi­tion of the "right to life" movement was enlisted to par­ticipate as well as a physician whose views on the moral­ity of abortion were more liberal. In each session, how­ever, the intention has been to open with a presentationthat would raise difficult issues of moral reasoning as wellas issues in which students would feel some of the affec­tive weight of being responsible for making judgmentswhich determine in a crucial way the well-being of otherpersons.Since there is as yet no validated way of fulfilling theobjectives. there has been some experimentation inteaching procedures. In each of the two years that thecourse has been offered, the principal presentation wasmade to the entire class during a one-hour session. Some­times. in response to the physician's presentation, therehas been a rather formal moral argument by a theologianor philosopher who developed alternative positions for oragainst the judgment made or proposed. These presenta-18 tions stressed the more rational ethical objective. Whilethe formal presentation had the advantage of offeringmore systematically critical ethical analysis, it had thedisadvantage of preempting the students' own initiativesand capacities to raise questions based on their ownreflections. Another approach has been a panel discus­sion by health professionals, theologians, and lawyersmediated by the course leaders after the initial studentquestions had been addressed. On other occasions thepresentation has taken the full hour, without further dis­cussion.The class was divided for a second hour into smallgroups to continue, expand, or revise the agenda deter­mined by the initial presentation. During the first year,physicians from various departments and areas of themedical school acted as preceptors. In the second year,each groups was co-preceptored by the psychiatrist withwhom the students had worked during their course on"Introduction to the Patient" in the first quarter, and bya graduate student in ethics from either the Departmentof Philosophy or the Divinity School. The preceptorialgroups were intended to facilitate the achievement of thedouble objectives of the course.Several difficulties in this approach have emerged.First, the students are relatively unsophisticated in thetechnical aspects of many of the health and medical prob­lems introduced. Second is the problem of informationoverload, which frequently results in students limitingthe number of approaches that they are willing to con­sider at one time in assessing an issue. This coursenecessarily requires examining some very complexissues-ethical principles as they have been codified inlegal systems, accepted as rules of social groups and re­ligious organizations, and established as medical ethicsper se (do not harm, heal thyself ), as well as the applica­tion of ethical principles from the various schools ofphilosophy and theology. Third, the format of the courseprovides a disparity of approach relative to the rest of thecurriculum. The individual is encouraged to face am­biguous issues and become aware of his or her own prej­udices and ambivalence by contrast to the more dogmaticand didactic approaches of basic science course work.This is an entirely different conceptual modality whichmany students have sought to escape by enteringmedicine, expecting very specific approaches to veryspecific problems. Fourth, the course is of low priority inthe curriculum when matched with anatomy, biochemis­try and physiology. Fifth, the language systems concern­ing these issues are largely foreign to the student; thisreduces the likelihood that assigned ethical literature ref­erences will be utilized. Sixth, the course is required butto date has utilized no examination or other device toexert pressure for accountability.On the other hand, because of the intrinsic interest ofthe subject, students do stay involved and sensitized.The relevance and value of the course for harriedfirst-year students is increased by selecting topics fromconcerns expressed by the students themselves in "In­troduction to the Patient," by incorporating clinical ma­terial from the vignettes and films, and by encouragingstudents to relate their opinions and feelings to personalDr. Chase P. Kimball (second from left) and students in the "ClinicalApproach to the Patient" course discuss the issue of informed consentexperiences and belief systems. Although evaluationthus far has been only by attendance, anecdote and ques­tionnaire, the response has been encouraging.Conceptual and Rational ConsiderationsMedical research and care is an arena of human activityin which some of the classic issues of moral practice andof ethical theory have a concrete locus. Many of theconcepts developed in Western ethical theory and manyof the ambiguities in the application of these conceptspertain directly to decisions made about research andtherapy. Specific issues tend to emerge whether the casevignette is drawn from a pediatric intensive care unit,when decisions to begin or withhold treatment from radi­cally defective neonates must be made, or from the prac­tice of a psychiatrist in which commitment of a patient tohospital is the question, or from any other set of clinicalcircumstances. Four designations can be used to indicatein ethical terms the range of these issues:1. There are issues of individual rights, the moralequivalent to civil liberties.2. There are issues of judgment of consequences, ofbenefits and harms not only in strict medical terms butalso in more amorphous terms of other human values.3. There are issues of professional accountability; ofthe authority and the responsibility of the physician orthe hospital.4. And there are issues of distributive justice, of fair­ness in access to health care as a whole or to scarcemedical resources. with a hospital patient (left) who has volunteered to talk with the studentsabout his experience.Little thought is required to see that these four consid­erations are interrelated in many particular circum­stances.Individual rights come to sharp focus in the classicmatter of" informed consent." In a society and a medicalsystem that is grounded in the liberty of persons voluntar­ily to consent to or reject intrusions into their bodies orcustomary patterns of life, the legal and moral require­ments of informed consent to therapy or to experimenta­tion are of great importance. The gaining of informedconsent is simplified by the development of consentforms, and the signing of such a form is of great legal andmoral importance. But the process is frequently morecomplex, as every physician knows. It rests uponspecific classic assumptions about human beings,namely, that they have the intellectual and emotionalcapacities to comprehend what has been proposed, andthat they have the "free-will" to accept or reject whatthey comprehend. Both of these assumptions are hon­ored, but it is difficult to insure that the conditions whichmake each viable are fulfilled in every case.The standard questions come quickly to mind. Howmuch does a patient or subject have to know in order tobe properly informed? What information is most impor­tant for the patient to have? How does one test whetherthe patient comprehends the information? How free isthe patient to reject a proposed intervention? Are theresubtle coercive factors in the social conditions or in thephysician-patient relationship which limit the freedom toreject? Do inducements such as special benefits to ex-19perimental subjects constitute an honoring or a violationof the principle of informed consent? Is it always in thebest medical interest of the patient to be informed?Informed consent is clearly not the only focus of theissues of individual rights, but it does provide a clearillustration of them. It is clear that there are profoundvalue commitments underlying individual rights, com­mitments nourished by the libertarian tradition of modemWestern societies. It is also clear that these commitmentssometimes work against possible benefits to the patientor to other persons. This can be illustrated by the provi­sions of the "Uniform Anatomical Gifts Act," whichdelineates rigorous legal procedures for the donation ofcadaver organs, based upon the profound value commit­ment. These procedures obviously make it more complexto get the right to extract usable organs such as kidneys.A weaker commitment to individual rights of self­determination or familial determination would obviouslymake it possible to "harvest" organs and thus to obtainmore benefits for more living patients.The judgment of the consequences of procedures be­comes complex as soon as the physical survival of pa­tients is not taken to be of absolute value. As soon asother consequences are added to the considerations, theparties involved in a decision are on a "slippery slope."When the "quality of life" of the patient is considered,one has introduced a concept that is not subject to thesame precision as is survivability in purely biologicalterms. When the economic factors involved for thepatient's family, for the state and for other parties aretaken into consideration, the slope gets even more slip­pery, for in some sense monetary values are being com­pared with non-monetary human values. In recentmonths this general range of issues has attracted atten­tion with regard to the decisions made about radicallydefective newborns. Medical science and technologyhave made it possible to save the lives of many infantswho would have died only a few years ago. Yet it ishighly predictable that many of these infants will livewith serious deficiencies when compared with the pros­pects for a more normal child, and also that many of themwill require costly treatment and care facilities through­out their lives. For example, ought a Down's syndromeinfant with other physical defects be subjected to surgeryfor those other defects when it is known that the childwill have sub-normal intelligence and be subjected to thesorts of relationships that our society normally has withthe retarded? Answers to this question, and to similarquestions about other classes of cases, reveal what par­ents, physicians, and society truly value about humanlife. It is predictable that a Down's syndrome child willhave deficient intelligence and require extra care, but thisconsideration does not in and of itself determine whethersuch a child is without "value" to himself or others orhas no "right" to rather ordinary surgical intervention.The predictable medical and social consequences are as­sessed either intuitively or with critical self­consciousness in the light of moral principles and humanvalues that have some independence from the facts of thegiven case. The moral or value judgment of potentialconsequences for radically defective neonates, as for20 other patients, is a very complex matter, and needs to bebrought to critical self-awareness in all who are involvedin decisions.Ambiguities about the authority and the accountabilityof physicians come to attention with disconcerting fre­quency for many professional persons. The legal aspectof accountability has recently taken a dramatic turn in therising costs of malpractice insurance. The more frequentcircumstances in which one senses this ambiguity occurwhenever it is reasonable to ask, "Who has the authorityto make this decision? Who will be held accountable forthis decision?" From these questions one can move toothers-" Authorized by whom? Authorized to do what?Accountable to whom? Accountable for what?"There is no question but what the authority of thephysician is grounded in his or her competence and in thecertification of that competence by the profession. Anambiguity arises about the scope of that competence. In adecision pertaining to withholding or withdrawingtherapy from a critically ill patient, for example, it is clearthat the physician is in the best position to judge thebiological consequences for the patient-the physician'sjudgment is based upon technical medical competence.But other consequences are also frequently taken intoconsideration, such as the quality of the life of the patientshould therapy be instituted or continued, or thepsychological and economic consequences for thepatient's family. It is less obvious that the physician hasthe same competence to judge these matters, and it isunclear whether or not certification of competence ex­tends to them. That various procedures have been estab­lished to come to grips with this sort of problem is wellknown: consultations with families, impromptu hallwayconsultations with colleagues, committees, etc.These procedures do not resolve the question of au­thority in principle; they relocate it in a different socialcontext. That the physician is accountable to his or herpeers is well established, and that the physician is ac­countable for his or her practice is also clear. Account­ability, like authority, is associated with definitions ofroles. Where the physician's role becomes unclear, linesof accountability become equally unclear. Thus one ofthe issues proper for consideration in medical ethics isthe authority and the accountability of the medical pro­fession in matters that extend beyond purely medicaljudgments into areas of other forms of value judgments.The fourth designation noted is the issue of distributivejustice. Without introducing any historical delineation ofthe concept, the medical profession, like other groups,exercises judgments about justice. In Western ethicsthere have been two formal definitions of justice that canbe noted here. One is "to each his due;" the other is"equals shall be treated equally." The practical ques­tions are, "How do we determine what is due to an indi­vidual?" "Who are the equals to be treated equally?"Many areas of medical care and research involve im­plicitly if not explicitly answers to these questions. Oneof the classic cases in modem medical ethics has been theselection of patients for scarce medical resources; thiswas particularly critical in the earlier years of the use ofdialysis machines. There were hospitals which sought todetermine the "social worthiness" of candidates fordialysis. In effect they answered the "due" question bysaying that persons more socially worthy deserve priorityfor medical care.The puzzle is obvious: How does one determine socialworthiness? In effect they answered the "equals" ques­tion by saying that the equals who shall be treated equallyare those who are equally socially worthy. Against thevagueness of these procedures others have suggestedthat casting lots is the least biased, and its moral propri­ety is based on a sense of the radical equality of personsqua human persons. In effect, when it comes to the pres­ervation of life, "One man's blood is not redder thananother's" (to use a saying from Jewish legal and ethicalliterature) .The issue of justice also arises with reference tobroader social policies pertaining to access to health ser­vices. In the first year of the ethics course the studentswere confronted with an interesting instance of this bythe presentation of four cases in which the symptoms of gastric ulcers were present. Each of the four patients wasinvolved in different arrangements of paying for diagnos­tic and therapeutic procedures. The type of care thateach received was relative to the capacities of the patientor his or her third party payer to meet the expenses in­volved. In a sense, the "due" question was answered,"A person is due the medical care that he or his insurersor others can pay for." The "equals" question was an­swered, "Persons with equal capacities to have medicalcare paid for will be treated equally." To raise into con­sciousness the implicit determinations of fairness or jus­tice, and to make self-critical evaluations of the ways inwhich a principle of justice is applied, is part of learningabout the ethics of medical care and research.james Gustafson is University Professor in the DivinitySchool. Or. Chase Kimball is Associate Professor in theDepartments of Psychiatry and Medicine. Or. Patti Tighe isAssistant Professor in the Department of Psychiatry.New Face for Plastic SurgeryDr. Martin RobsonThe word "plastic" means malleable or capable of beingmolded. The Plastic and Reconstructive Surgery Sectionat The University of Chicago is being remolded throughthe efforts of a new and expanded staff. Our goal is todeliver quality care to patients with congenital or ac­quired defects which need aesthetic and reconstructiveprocedures of the head and neck, trunk, genitourinarytract and extremities.The plastic and reconstructive surgeon must be skilledin wound management and healing in several spheres ofsurgical practice. He deals with such diverse disorders ascongenital malformations, cleft lip and palate, maxillofa­cial trauma, cancer of the head and neck, hand injuriesand deformities, and somatic defects resulting from burnsor other trauma. He also attempts to alleviate problemsof body image through aesthetic or cosmetic surgery, re­construction of the breast, or sexual conversion proce­dures. The importance of body image was emphasized byGaspare Tagliacozzi in 1597 when he wrote: "We re­store, re pair and make whole those parts of the facewhich Nature has given but which Fortune has takenaway, not so much that they may delight the eye but thatthey may buoy up the spirit and help the mind of theafflicted.' ,Plastic and reconstructive surgery possesses an inher­ently individual character because of the broad spectrumof diseases that it must accommodate. Recognizing thisas early as 1844, Joseph Pancoast said, "The deformitiesrequiring operations of this class are necessarily so dis­similar in different cases, (that) each one becomes a sepa- rate study to the surgeon and opens a fresh field for theexercise of his mind in restoring the lost or deformedparts. "A patient may require the skills of other specialists inaddition to those offered by the plastic surgeon. If a per­son has a deformed or wounded hand, for example, thebones of the hand as well as the soft tissue may be af­fected. We have, therefore, instituted a combined PlasticSurgery-Orthopedic Surgery Hand Service at the hospi­tals here. A Combined Hand Clinic is held weekly and isfollowed by a joint Hand Teaching Conference. This ef-The treatment area of the burn center includes this Hubbard tank, a largewhirlpool unit which allows the patient to exercise underwater. A plasticliner prevents cross-contamination between patients.21Physical therapist Sharon Martin assists a young burn patient in the tank.She does not need to use plastic gloves because the boy's burn woundshave closed.fort is part of a broader multidisciplinary team approachthat we are developing. Those with advanced cancer ofthe head and neck, for example, require treatments byseveral modalities. We are working with members of theDepartments of Otolaryngology, Radiotherapy,Chemotherapy and Pathology to evaluate new therapeu­tic regimens for people in this category. A child with acleft lip or palate may be seen by pediatricians, otolaryn­gologists, orthodontists, pedodontists, speech therapists,pediatric psychologists and social workers, in addition toplastic surgeons.Plans for establishing a major bum center at the Uni­versity are well underway. The treatment area was com­pleted in the summer of 1975. It has hydrotherapy anddebridement equipment as well as other modern equip­ment for bum treatment. The remainder of the facilitywill be completed by July, 1976, and will provide cen­tralized beds for bum patients. Such beds are presentlydispersed throughout the hospital.22 I n addition to alleviating the present shortage of bumbeds in Illinois, the Center will serve as a focal point forbasic and clinical research and will provide a program fortraining paramedical personnel to work with burn pa­tients. The Center is being developed under a grant bythe W. K. Kellogg Foundation.In addition to surgical duties, staff members also haveteaching duties here. We have three part-time and twofull-time faculty members including Drs. Stuart Landa,William Hagstrom, Jack Berger ('46), Lee Edstrom andmyself. Dr. Berger, a psychiatrist, helps the patient dealwith emotional difficulties that attend his physical prob­lems. Dr. Berger was formerly a practicing surgeon andcan view the cases from the medical vantage point as wellas that of the individual.To be able to understand and treat the variety of prob­lems that he will have to handle, the student of plasticand reconstructive surgery must take courses inanatomy, biochemistry, physiology and pathology.Following therapy, the boy's arms are rebandaged.,._--_/'jLDr. Karin Plym Forshell rewards the brave young patient.Courses in plastic surgery are also offered to medicalstudents and graduate students in other specialties andpost-graduate practicing physicians. A lecture series is arequired course for juniors. Subjects covered includewound healing, bums, hand surgery, aesthetic surgery,the biology of surgical infection, maxillofacial trauma,reconstruction of head and neck cancer, and skin neo­plasms. Third year students may elect to take surgicalclerks hips in plastic surgery and fourth year students canelect subinternships.A residency program for plastic and reconstructivesurgery was reactivated here in July. It is a two-yearprogram designed to allow residents to fulfill the requi­sites of the American Board of Plastic and Reconstruc­tive Surgery. The resident may enter the program after aminimum of three years of postgraduate surgical educa­tion and training. The first resident, Dr. Karin Plyrn For­shell, came to the University following training at theKarolinska Institute in Stockholm, Sweden. In the shorttime since her arrival, she has distinguished herself bywinning first prize in the Resident's Research Competi­tion of the Chicago Plastic Surgery Society and by deliv- ering a paper at the annual meeting of the MidwesternPlastic Surgery Society.The section also offers a program for house officers inother specialities. A basic surgical resident is assigned tothe service during his first year of postgraduate training.Major research interests within the section focus onsurgical bacteriology, microcirculation involved in ther­mal injuries and pedicle flaps, replantation of amputatedparts, and vectors of neoplastic agents. The pendingcombined head and neck cancer grant and the BumCenter's Kellogg grant will open new vistas of research.The Section of Plastic and Reconstructive Surgery isconcerned with form-whether it be in the area of clinicalcare, education or research. In all areas, we plan to moldour work to the benefit of the University and the peoplewe serve.Or. Martin Robson is Associate Professor and Chairman ofthe Department of Surgery Section of Plastic and Recon­structive Surgery. He came to the University as Chairmanof the Section of Plastic and Reconstructive Surgery in Sep­tember, 7974.Sex TherapyDr. R. Taylor SegravesClinical psychiatry is in a state of rapid change due inlarge part to the demand for strict empirical validation ofclinical procedures and assumptions. It also results froma shift in interest from long-term, insight-orientedpsychotherapies with vaguely formulated goals towardbriefer, more directive psychiatric interventions withmore clearly specified objectives. This important shifthas led to the introduction of many new and effectiveclinical procedures. One very important representativeof these new treatment techniques is "sex therapy."As recently as 10 to 15 years ago, most psy­chotherapists viewed sexual problems as products of in­dividual psychopathology rather than symptoms ofdifficulties in marital interaction. The preferred treatmentapproach was usually some form of prolonged insight­oriented psychotherapy. There was little factual knowl­edge about "normal" sexual behavior or physiology andsystematic studies of treatment results were rare.This situation has changed considerably. We nowknow that many sexual difficulties such as prematureejaculation, erectile failure, vaginismus and orgasmicdysfunction are amenable to brief, directive modes ofpsychotherapy. We also know that sexual difficulties arenot necessarily related to deeper psychopathology, andthat many psychologically normal people can, and do,suffer from sexual problems. Doctors William Mauriceand Samuel B. Guze at Washington University, for ex- ample, recently conducted independent psychiatric as­sessments of couples who sought treatment of sexualproblems at the Reproductive Biology Research Founda­tion (the Masters and Johnson clinic) in St. Louis. Theyfound evidence of psychiatric disorder in only a minorityof these patients.Psychiatrists who believed that sexual dysfunction isreflective of deeper psychopathology have been con­cerned that direct symptom reversal treatments mighthave adverse effects such as symptom substitution. Sur­prisingly, careful follow-up studies of patients treated bydirective therapies have not revealed much evidence ofadverse reactions. To my knowledge, Dr. H. S. Kaplanof the Cornell Sex Clinic has reported the only adversereaction to sex therapy. In this case, the successfultreatment of a husband's premature ejaculation appar­ently elicited an acute psychotic episode in the patient'swife. This report supports the newer concept that thesymptom is often a product of the social context or sys­tem in which it occurs, rather than a problem of indi­vidual psychopathology.The newer treatment strategies regard most sexualdisorders as learned behavior maintained by performanceanxiety, lack of information, and marital interaction pat­terns. While oversimplifying the etiology of many sexualdifficulties, this view leads to a unified way of looking atboth the etiology and treatment of sexual problems.23Members of the therapy teams meet weekly to discuss their cases. Attend­ing this meeting are (from left): Lee Creenwald, Susanna Tagliacozzo,Karen Janzen, Dr. R. Taylor Segraves, Ruth Schwartz, and ArthurSchwartz.Most adolescent females, for example, are taught to besexually attractive to males, to indulge in sexual ac­tivities only up to a certain point and to always remain incontrol of their sexual feelings. Upon entering a pro­longed sexual relationship, many of these women mayfind it hard to give up controlling their sexual feelings,have difficulty with intercourse, become tense and with­draw from sexual activities. An angry, demanding spouseor boyfriend will unwittingly help sustain the difficulty.The treatment strategy in such a case is relativelystraightforward. The first objective is to ease the per­formance pressure the woman is receiving from her sex­ual partner. This can be accomplished by engendering asense of cooperation between the partners in jointpsychotherapy sessions, and by asking the couple to re­frain from intercourse until therapy has progressedfurther. The second objective is to teach the woman howto let go of the control she exercises over her sexualfeelings. This can be accomplished in several ways. Theusual technique is for the therapist to assign graduatedsexual exercises to be done in the privacy of the bed­room. In the absence of performance pressure (prohibi­tion of intercourse) and with the support of their part­ners, approximately 80 per cent of these women will be­come progressively sexually aroused and then orgasmicwithin 12 to 15 one-hour sessions of outpatientpsychotherapy. An alternate approach is for a femaletherapist to teach the patient how to masturbate and toincorporate manual clitoral stimulation in foreplay withher partner. The University of Oregon Sex Clinic hasreported 100 percent success using this technique inselected women who have never experienced an orgasm.The third, and most difficult, aspect of treatment is tohelp the woman to become aware of what elicits her sex­ual arousal and to persuade her to communicate this toher husband.The role of performance anxiety in impotence is obvi­ous. Most men have had episodes of temporary "impo­tence." Examples would include attempts at sexual in­tercourse after having too much to drink, while angry, or24 when a girlfriend casually says, "By the way, I'm not onthe pill." This becomes a problem only when the manbegins to worry the next day. Then a vicious cycle ofperformance anxiety contributing to future erectile fail­ure is possible. The man may be so anxious about erectilefailure at his next intercourse opportunity that he cannotbecome sexually aroused. The treatment approach issimilar to that discussed for treating orgasmic dysfunc­tion. The primary objectives are to break the viciouscycle of failures and to ease performance anxiety. Ap­proximately 80 percent of men treated in this direct man­ner for impotence will become sexually aroused againand be able to have erections.The contribution of marital discord to sexualdifficulties is far more complex and, unfortunately, farmore common. Problems often arise when one spousewithdraws emotionally from the marital relationship andthe other, who may miss the emotional intimacy, in­creases the demand for physical intimacy, causing thepartner to withdraw even further. To an outside ob­server, such a couple may present what looks like a bittermarital power struggle centering around sex. This escala­tion could have been avoided if the first spouse had saidwhat was bothering him (or her) and the partner had saidthat it was the emotional (as well as the physical) with­drawal which was upsetting. Unfortunately, neither onemay have been aware of the factors involved. Therapy insuch a case is complex. Ideally, each member of thecouple needs to be taught to recognize crucial internalemotional states, to express these feelings, and to hearthe feelings expressed by the other. These complex in­terpersonal skills are learned to varying degrees ofproficiency by each of us. Unfortunately, the technologyfor effectively teaching these skills is only partially de­veloped.In certain cases, correction of sexual misinformationmay be helpful. One example would be the myth of thevaginal orgasm. Although there is still controversy con­cerning the physiology of the female orgasm, presentevidence suggests that most or all human female orgasmsare primarily clitoral in origin. It appears that the coitalorgasm is due to the thrusting of the penis which causestraction against the labia minora; this sensation is thentransmitted to the clitoris. If this is correct, the vaginalorgasm is simply a clitoral orgasm caused by indirectstimulation.Another example of misinformation would be thestatement in many sex manuals that the man should findthe clitoris during foreplay and "stay with it." There areseveral problems with this piece of misinformation. Thefirst is that there is frequently a fine line between pain andpleasure in direct clitoral stimulation. Most women mas­turbate by stimulating the mons pubis area rather thanemploying direct clitoral stimulation. Secondly, theclitoris withdraws into the clitoral hood during stages ofhigh sexual arousal and is very difficult "to stay with."Dr. William Masters speaks of an engineer who read thisadvice in a sex manual and religiously tried to follow it.He would stimulate his wife clitorally until she washighly aroused. Then he would be unable to find theclitoris. He would put on his glasses and turn on thelights to try to find the elusive organ. Needless to say, hiswife was somewhat displeased with her husband's sexualtechnique.The treatment approaches I have outlined reflect thetechniques used in the Sex and Marital Therapy Clinic atBillings Hospital. In July of 1974, Arthur Schwartz and Iset up a.sexual dysfunction clinic within the outpatientdepartment of psychiatry. With the support of Drs.Eberhard Uhlenhuth and Jarl Dyrud, we expanded andnow have four co-therapy teams and a waiting list ofpatients. Our primary purpose for initiating this clinicwas to provide a needed service and learning oppor­tunities for social work students and psychiatry resi­dents. We believe that sexual problems uncomplicatedby marital discord are rather simple to treat and a highrecovery rate after brief therapy can be expected. Unfor­tunately, in many couples, sexual problems co-exist with more complex relationship problems. We are trying todevelop greater proficiency in teaching the interpersonalskills necessary to avoid prolonged marital discord. It ismy hope that this may be the area where psychiatry cancontribute to the pioneering work done by the obstetri­cian, William Masters.Or. R. Taylor Segraves is Assistant Professor in the Depart­ment of Psychiatry "and Co-director of the Sex and MaritalTherapy Clinic. Arthur Schwartz is Associate Professor inthe School of Social Service Administration and the De­partment of Psychiatry and Co-director of the Sex and Mari­tal Therapy Clinic. Or. Eberhard Uhlenhuth is Professor inthe Department of Psychiatry. Or. Jarl Dyrud is Professorand Director of Clinical Services in the Department ofPsychiatry.Reproductive Biology and Contraceptive Development:Interests and Contributions of the World Health OrganizationDr. Gebhard F. B. SchumacherThe World Health Organization, as an agency of theUnited Nations, initiated in 1971-1972 the "ExpandedProgramme of Research, Development and ResearchTraining in Human Reproduction." This program hasbeen vigorously promoted by the Human ReproductionUnit of the WHO during the last three years.It was recognized that the world population problemsare of increasing concern for each country and that thecurrent technology in family planning practice is still un­satisfactory in many respects. Although considerable ad­vances have been made during the last two decades incontraceptive technology and delivery of family planningcare, the need exists to develop new and to improve ex­isting methods of fertility regulation. Effectiveness,safety, lack of side effects, acceptability and accessibilityin the different settings of the world population are themain requirements for the highest possible standards incontrace ptive technology.The organization has developed a system of interna­tional collaboration that utilizes the existing expertise atinstitutions that are already involved in research in re­productive biology and medicine. The program providesfor extensive contact with other agencies involved inpopulation research activities in order to avoid duplica­tion of efforts.The research strategy of the WHO Expanded Pro­gramme is based on the development of:• Task forces for Collaborative Research and De­velopment • Clinical Research Centers• Research and Training Centers• Programme Planning and AssessmentThese were placed under the guidance of an advisorygroup, a review group, consultants, task force membersand members of the clinical research and training center,and the scientific and medical staff of the WHO HumanReproduction Unit.The donors to the programme are Canada, Denmark,Norway, Sweden, Finland, the Ford Foundation, andrecently, The International Development ResearchCouncil (Ottawa), and the United Nations Fund forPopulation Activities. Other governments may contrib­ute to the programme in the future.The development of the task forces begins usually withthe identification of areas of interest (priority field). Thepresent state of knowledge is being reviewed by a groupof experts from different countries, and strategic plansare being developed defining short-term, intermediate,and long-term objectives if the development toward cer­tain goals appears to be feasible and desirable. In someinstances additional consultation meetings with expertsare necessary to assess the situation, or symposia arearranged with their proceedings distributed to interestedscientists all over the world. Part of the exploration andthe strategic planning is the initial estimate of time andcosts to achieve a designated goal ("Macro-NetworkPlans"). Systems analysis techniques are being appliedby experts to prepare these estimates. The calculations25from the network-plan provide information on time, costsand, to a certain degree, on the probability of success.This helps the planning scientists to locate individual re­search projects within a master plan and to review prog­ress at later stages, which may require decisions either toterminate certain approaches or to continue and to assesswhat remains to be done.After the plans to attack certain promising areas ofdevelopment have been approved by the WHO, scien­tists who can make contributions at various stages of theplan are invited to participate.At present the following task forces for collaborativeresearch and development are operating:I. Task Force on Methods for the Regulation ofOvum Transport2. Task Force on Methods for the Regulation ofMale Fertility3. Task Force on Methods for the Regulation ofSperm Migration and Survival in the HumanFemale4. Task Force on Methods for the Regulation of Im­plantation5. Task Force on Prostaglandins for the Regulationof Fertility6. Task Force on Immunological Methods for theRegulation of FertilityDr. Cebhard F. B. Schumacher26 7. Task Force on Injectable Contraceptives8. Task Force on Assessment of the Sequelae of In­duced Abortion9. Task Force on Acceptability of Fertility Regulat­ing Methods10. Task Force on Methods for the Prediction and De-tection of OvulationSeveral other task forces are developing. More than 250scientists from 45 countries are involved in the task forceresearch activities at the moment. Four research andtraining centers are operating, at the All-India Instituteof Medical Sciences in New Delhi; at the All-UnionScientific Research Institute of Obstetrics and Gynecol­ogy in Moscow; at the Karolinska Institute in Stock­holm; and in the "Three Nations" program: BuenosAires, Santiago, Montevideo.More than 80 fellows have received research trainingin these institutions during 1973-1974.At present, 20 clinical research centers exist inEurope, India, Southeast Asia, Africa, South America,Mexico and the USA. The clinical research center in theUnited States is in the Department of Obstetrics andGynecology at the University of Southern California,under the direction of Dr. Daniel Mishell. The trainingcenters are also participating in these activities, whichconstitute a network for clinical research and develop­ment in 23 countries. The clinical research centers aremainly concerned with clinical studies and clinical trialsin collaboration with task forces. All projects involvinghuman subjects are given a rigorous assessment by thereview group to obtain informed consent and to protectthe safety of the persons involved in clinical trials. Thecentral computer facilities of the WHO provide assis­tance in data processing for the statistical analysis of theclinical trials.At The University of Chicago, we have underway twoWHO research projects, related to methods of regulatingsperm migration and survival, and to immunologicalmethods for the regulation of fertility.One can expect that the WHO Expanded Programmeof Research, Development and Research Training inHuman Reproduction will contribute substantially to thedevelopment in contraceptive technology and familyplanning practice by a multidisciplinary and multi­national approach, although its financial background israther moderate and needs more support.The better understanding of reproductive mechanismssusceptible to interference that emerge from intensifiedresearch efforts in this area will also contribute to thedevelopment of better diagnostic and therapeutic proce­dures for the benefit of numerous patients suffering fromchildlessness.Or. Gebhard F. B. Schumacher is Professor and Chief of theSection of Reproductive Biology, Department of Obstetricsand Gynecology and in the Committee on Immunology inthe Chicago Lying-In Hospital and The Pritzker School ofMedicine. He is the principal investigator for theUniversity's WHO projects and was actively involved in 17consultations, planning meetings and symposia of four dif­ferent task forces since 1972.Kovler Vi ral Oncology LaboratoriesA special ceremony and program marked the laying ofthe cornerstone of the Marjorie B. Kovler Viral Oncol­ogy Laboratories on October 24. The model viral re­search center, scheduled for completion in 1977, will en­able scientists from a variety of disciplines to collaboratein studying the relationships between viruses and cancer.The two-story, 30,000 square foot facility, located atthe northeast comer of 58th Street and Drexel Avenue,will be separated into a biohazardous area with fourmajor research laboratory suites and common supportfacilities, and a non-biohazardous area of offices, recep­tion and conference areas. The biohazardous research area will have a ventilatingsystem consisting of several completely separate airzones which will provide maximum safety in the event ofmechanical failure in any particular zone. Two cen­tralized electron microscopy units, computation areas,and common animal quarters will also be housed here.Each laboratory suite will contain separate tissue cul­ture facilities, laminar flow rooms, biochemicallaboratories, environmental control rooms, equipment,and instrument centers. These modern facilities will pro­vide an optimum environment for the important researchbeing conducted by University scientists.Architectural rendering of the proposed building.27Bernard Roizman, Professor of Microbiology,Biophysics and Theoretical Biology, and in the Commit­tee on Genetics, and Chairman of the Committee on Vi­rology, and other virologists have reported finding afragment of a herpes simplex virus linked to human cellchromosomes in a cervical cancer. These findings pro­vide a strong link in the evidence suggesting that thisvirus may actually cause cervical cancer. Roizman,whose work is supported in part by The University ofChicago Cancer Research Foundation (UCCRF), andhis colleagues continue to study the fundamental proper­ties of herpesviruses that could, under appropriate condi­tions, make them cancer-causing, and also the conditionsunder which these properties are expressed.While Roizman concentrates on the nucleic acidmetabolism of the virus, the structure of the viral ON A,the transcription of the ON A and RN A, and the transla­tion of the RN A into proteins, Patricia Spear, AssistantProfessor of Microbiology, studies the herpesvirus pro­teins that become incorporated in cell membranes. Spearand her research associates use antibodies to study theeffect of herpesvirus proteins in and around the mem­brane of infected cells on the signals that are transmittedfrom the cell surface to the nucleus, particularly thosewhich relate to the control of cell division.Dr. Elliott Kieff, Associate Professor of Medicine andin the Committee on Virology, whose work is supportedby the UCCRF, is studying the Epstein-Barr virus,which has been linked to Burkitt's lymphoma, a lymphcancer that strikes children and young adults in centralAfrica. Dr. Keiff has concluded that the virus is identicalto the virus linked to infectious mononucleosis in thisThe late Marjorie B. Kovler28 country. He is attempting to discover why the same viruscauses a malignant disease in one region and a benignself-limiting disease in another.Dr. Werner H. Kirsten, Professor and Chairman of theDepartment of Pathology and Professor of Pediatrics andin the Committee on Genetics, is interested in the rela­tionship between viruses and leukemia. Dr. Kirsten, aninternationally recognized authority in this area, and hisresearch associates, Sandra Panem and Stephen A.Schwartz, are studying the structure of viruses known tocause leukemia and other forms of cancer in laboratoryanimals, the way these viruses infect cells grown in tissueculture, and the biochemical changes that occur duringinfection. Their recent research indicates that everyhuman cell harbors latent genes (DNA) to program theproduction of its own type C RNA viruses (viruses of atype that has been known for many years to cause cancerin animals). Dr. Kirsten's work is supported in part bythe Renee Shaffer Gettleman Memorial FoundationAuxiliary.The National Cancer Institute is lending support tothese areas of research through provision of a matchingfunds grant for construction of the building. Leonard S.Florsheim, Jr., President of the UCCRF, is heading adrive to raise the matching funds required by the grant.The building is named for the late Marjorie B. Kovler,founder and director of Chicago's Kovler Gallery andwife of Everett Kovler, a member of the Council for theBiological Sciences.Other names that will be identified with the buildingare the Brunswick Corporation of Skokie, Illinois, andthe Seabury Foundation, which is underwriting alaboratory named for the late Martha Seabury Fisk.The building was designed by Metz, Train, Olson andYoungren, Inc., an architectural firm experienced in thedesign of highly complex and unique scientific buildings.The firm worked with representatives of the Universityand the National Cancer Institute in planning the facility,which is being built by the Pora Construction Company.Presiding over the hour-long program which precededthe cornerstone laying ceremony was Dr. Daniel C.Tosteson, Dean of the Division of the Biological Sci­ences and The Pritzker School of Medicine, and theLowell T. Coggeshall Professor of Medical Sciences inthe Department of Pharmacological and PhysiologicalSciences. Dr. John E. Ultmann, Director of the CancerResearch Center and Professor in the Department ofMedicine, was the main speaker. He pointed out that theKovler Laboratories will fulfill many different goals-those of the patient, the researcher, the university, andthe government.The importance of the Laboratories to cancer researchwas noted by Thomas King, director of Cancer Re­search Resources and Centers, of the National CancerInstitute; Leonard S. Florsheim, Jr.; and Dr. StefanoVivona, vice president for research of the AmericanCancer Society.Laying of the cornerstone at the building site wascommemorated by Bernard Roizman, Everett Kovler,and Philip D. Block, Jr., a member of the University'sBoard of Trustees.A reception followed at the Bergman Gallery.The times changeAnd we change with them.-From Owen's EpigrammataName Graduation YearHome Address TelephoneCity, State, ZipBusiness Address TelephoneCity, State, ZipTitleNew address?IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII! New position?New medical practice?military assignment?civic or professional honor?book?Have you made your gift to the 1975 Medical AlumniFund? There's still time. Just attach your check to this page;fold; staple or tape closed; and drop in the mail box.Thanks!--- - -- ---- - ------ - - -- -- -- -- -- - --- - -- ---- - - - -- -- -- - ---- -- --- --- -- - - -- - ---_ ... _-Medical Alumni Association1025 East 57th StreetChicago, Illinois 60637Fold this flap in first PlaceStampHereTribute to Dr. JacobsonA scientific program and dinner honoring Dr. Leon O.Jacobson was sponsored by the Council for the Biologi­cal Sciences on Saturday, November 8.Dr. Jacobson retired after two terms as Dean of theUniversity's Division of Biological Sciences and ThePritzker School of Medicine on June 30, to resume teach­ing and research. He is the Joseph Regenstein Professorof Biological and Medical Sciences and Director of theFranklin McLean Memorial Research Institute.Scientific papers were presented from 2:00 to 5:00 inthe Frank Billings Auditorium on the following topics:"Erythropoietin and Red Cell Formation." EugeneGoldwasser, Ph.D. (,50), Professor of Biochemistry,University of Chicago Pritzker School of Medicine."The Regulation of Heme Oxygenase by Metals." Dr.Attallah Kappas (,50), Professor and Physician-in-Chief,Rockefeller University Hospital (New York City)."Glucose-6- Phos phate Dehydrogenase Abnormalities."Dr. Ernest Beutler (,50), Chairman, Division ofMedicine, City of Hope Medical Center; and ClinicalProfessor of Medicine, University of Southern Califor­nia."Expression of Friend Polycythemia Virus-InducedErythroid Differentiation in Vitro." Dr. Sanford Krantz(,59), Director, Division of Hematology, and Professorof Medicine, Vanderbilt University School of Medicine."Unusual Susceptibility of Red Cells to ComplementLysis: PNH and Hempas." Dr. Wendell Rosse (,58),Professor of Medicine, Duke University School ofMedicine; and Chief of Medical Services, Veterans Ad­ministration Hospital. "Unraveling the Histocompatibility Barriers to HumanTransplantation." Dr. John Thompson ('53), Professorof Medicine and Vice Chairman of Internal Medicine,University Hospital (Iowa City); and Chief of Medicine,Veterans Administration Hospital."Chronic Lymphatic Leukemia-Two Diseases." Dr.Matthew Block, Ph.D. (,41), M.D. (,43), Professor ofMedicine and Chief of Division of Hematology, Univer­sity of Colorado School of Medicine.A dinner tribute to Dr. Jacobson followed at the HyattRegency Chicago Hotel. Main speaker was Dr. LowellT. Coggeshall, Life Trustee and Vice President Emeritusof the University, and Frederick H. Rawson, ProfessorEmeritus in the Department of Medicine. Dr. Coggeshallis a former Chairman of Medicine, and was Dean of theDivision of the Biological Sciences from 1947 to 1960.John T. Wilson, Provost and Acting President of theUniversity, delivered the University's tribute to Dr.Jacobson; Dr. Charles B. Huggins, William B. OgdenDistinguished Service Professor, the faculty's tribute;Gaylord Donnelley, Chairman of the Board of Trustees,the trustees' tribute; and Dr. Henry P. Russe (,57),President of the Medical Alumni Association, thealumni's tribute. .Dr. Daniel C. Tosteson offered a toast on behalf of allpresent.A. N. Pritzker, Chairman of the Council for theBiological Sciences, was chairman of the dinner tribute.An exhibit focusing on Dr. Jacobson's research ac­complishments was on display in the lobby of the Ad­ministration Building during the summer. It included abiographical sketch, and copies of writing by and aboutDr. Jacobson on cancer treatment, the kidney hormoneerythropoietin, the role of the spleen in erythropoiesis(blood formation), and tissue transplantation.31New Student ReceptionHighlighting three days of orientation to The PritzkerSchool of Medicine was a reception and social hour forentering medical students on September 24. Students hadan opportunity to meet with their preceptors and facultyduring the reception.The orientation program also included informative re­marks on such topics as medical education at The Uni­versity of Chicago; present and planned hospitalfacilities; special aspects of the first year medical cur­riculum and the Medical Curriculum Committee; theStudent Health Service, the medical student, and thespecial responsibilities of the physician; and student useof the biomedical libraries.Students and faculty enjoying the reception:1. Ann Mittelstaedt2. Mark Snider3. Dr. Alfred L. Baker, Assistant Professor in the Department ofMedicine, and Helen Ho.4. Judith Banks5. Dr. James O. flam, Professor in the Departments of Anes­thesiology and Obstetrics and Gynecology, and WilliamKetcherside.5 433News BriefsCancer Research GrantsOne-year grants totaling $138,000 havebeen awarded to The University ofChicago by the American Cancer Soci­ety for research on herpesviruses, whichare suspected of causing some humancancers. An Institutional ResearchGrant of $30,000 was also awarded asinitial support for short-term or ex­ploratory cancer research projects.Bernard Roizman is principal inves­tigator under an ACS grant of $84,929 tostudy the "Biochemistry of Herpes­viruses." Roizman, Chairman of theCommittee on Virology, is Professor inthe Departments of Microbiology and ofBiophysics and Theoretical Biology.Patricia Spear is principal investigatorunder a grant totaling $53,500 for a pro­gram entitled "Biochemical and Im­munological Studies of Membrane Pro­teins Specified by Herpesviruses.'·Spear is Assistant Professor in the De­partment of Microbiology.Dr. Michael Newton is Chairman ofthe Institutional Research Grant Com­mittee that administers the $30,000grant, which is to be furnished juniormembers of the faculty in amounts up to$3,000 for innovative studies of problemsrelated to cancer. Dr. Newton is Profes­sor in the Department of Obstetrics andGynecology.Dr. Thomas F. Deuel has receiveda four-year Faculty Research Awardfrom ACS. His research involvesstudies of the biochemistry of enzymesof normal and cancerous cells and tis­sues. Dr. Deuel is Associate Professorin the Department of Medicine's Sectionof Hematology-Oncology.Other recent one-year ACS grants in­clude:-Elwood V. Jensen, $73,250, "Roleof Estrogen Receptors in HormonalControl of Growth." Jensen is Professorin the Department of Biophysics andTheoretical Biology and Director of theBen May Laboratory for Cancer Re­search and the Biomedical Center forPopulation Research.-Dr. Charles B. Huggins. $66,000."Cell Transformation and Cancer." Dr.Huggins is the William B. Ogden Distin­guished Service Professor in the BenMay Laboratory for Cancer Research.-Alvin Markovitz, $52,056, "Regula­tion of the Gal Operon UV and X-RaySensitivity," concerning the effect ofradiation on certain genes involved in thebiochemistry of cells. Markovitz is Pro­fessor in the Department of M icrobiol­ogy and the College.34 -Nancy Caroline Hinckley-a post­doctoral fellowship for study and train­ing under Dr. Murray Rabinowitz. Herproject involves a study of specializedaspects of the genetics of rapidly grow­ing cells. Dr. Rabinowitz is the LouisBlock Professor in the Departments ofMedicine and Biochemistry.The ACS-supported research, plusindependently funded research programssupported by the privately endowedUniversity of Chicago Cancer ResearchFoundation, and programs of the Na­tional Cancer Institute-supported Uni­versity of Chicago Cancer ResearchCenter, make up the University'sbroad-scale cancer program.National Cancer Institute FundsThe University of Chicago was the toprecipient of National Cancer Institutefunds in Illinois in fiscal 1974, accordingto the Institute's 1975 Fact Book.The total sums received by those Il­linois institutions receiving over $1 mil­lion in fiscal 1974 (in thousands of dol­lars) were:University of ChicagoIllinois I nstitute ofTechnologyRush- Presbyterian-St.Luke's Medical CenterNorthwestern UniversityUniversity of Illinois $9,9641,9301,5891,5291,428The University of Chic ago was eighth onthe list of 106 institutions. The totals areforthe period July I. 1 973-June 30,1974.Frontiers of MedicineThe Frontiers of Medicine series beganits eleventh year of monthly programsfor the practicing physician on Sep­tember 10. Conferences are held in theFrank Billings Auditorium, P-117, thesecond Wednesday of each month fromSeptember through June. An additionalprogram was presented on October 29.The conferences are designed to providephysicians with a comprehensive reviewof recent developments in medicine,with particular emphasis upon clinicalapplication. There are five all-day pro­grams in this series.The 1975-1976 lectures (and times)are:September 10-New Developments inBronchial Asthma (2:00)October 8-Surgical Control of Pain,Brain Aneurysms and Tumors(9:30-all day)October 29-Sleep Disorders (9:00-allday)November 12-Frontiers of EmergencyMedicine (I :30) December 10-Advances in the Diag­nosis and Management of Hyperten­sion (2:00)February II-Lung Cancer (2:00)March 10-Advances in Perinatology(9:30-all day)April 14-Gastroesophageal Reflux: ACritical Review of Pathogenesis,Diagnosis and Treatment (9:30-allday)May 12-Community Programs in Clini­cal Genetics (2 :00)June 9-Coronary Heart Disease (9:00-all day)For additional information, write toLouis Cohen, M.D., Frontiers ofMedicine, The University of Chicago,Box 451, 950 East 59th Street, Chicago,Illinois 60637, or call 947-5777.Dr. Rubenstein Honored for Diabetes Re­searchDr. Arthur Rubenstein, Professor andVice Chairman, Medicine, and As­sociate Director of the Diabetes­Endrocrinology Research Center, wasawarded the first Established Inves­tigator A ward at the annual meeting ofthe American Diabetes Association. Hewas cited for his work in proinsulin andthe measurement of C-peptide.The award, which carries with it afive-year financial grant, is designed tofoster maximal research productivity forhighly qualified individuals. It will begiven each year to individuals of unusualresearch ability and originality who havemade major contributions to the field ofdiabetes research.Dr. Rubenstein received theassociation's Lilly Award in 1973 for hiswork in developing and verifying theusefulness of diagnostic tests used by theUniversity's research team. The LillyA ward is given yearly to the most out­standing diabetes researcher under 40years of age.Dr. Arthur Rubenstein (right) is congratulated byDr. Ceorge Cahill, president of the AmericanDiabetes Association, and Dr. Ann Lawrence(residentlfacu/ty, 1960-74), second vice presi­dent of the association's Northern Illinoisaffiliate.Tostesons and Dr. Steiner VisitU.S.S.R.Dean Daniel C. Tosteson and his wifeMagdalena were the guests of theU.S.S.R. during October at the 250thanniversary celebration of the Academyof Sciences of the U.S.S.R. TheAcademy of Sciences invited the Toste­sons to visit research establishments andhistoric sites as well as attend the an­niversary celebrations in the KremlinPalace of Congresses in Moscow and inLeningrad during their ten-dayexpenses-paid visit.Mrs. Tosteson, who was associatedwith Dr. Tosteson in research onartificial lipid membranes at Duke Uni­versity before his appointment here asDean in April, is Research Associate(Assistant Professor) in the Departmentof Pharmacological and PhysiologicalSciences.Another visitor to the U.S.S.R. wasDr. Donald F. Steiner, who participatedin a symposium on the evolution of thepancreatic islets at the Academy of Sci­ences, Leningrad on September 17. Hespoke on "Evolutionary Aspects of theStructure and Biosynthesis of Insulin."Dr. Steiner also attended the meeting ofthe European Association for the Studyof Diabetes in Munich, September 4 to6. He spoke on insulin synthesis at theAcademy of Sciences of the GermanDemocratic Republic, East Berlin, onSeptember 10, and at the GerhardKatsch Institute, Karlsburg, East Ger­many, on September 11. Dr. Steiner isthe A. N. Pritzker Professor and Chair­man of Biochemistry.Ingelfinger is Palmer Visiting ProfessorDr. Franz J. Ingelfinger, the fourth WaI­ter L. Palmer Visiting Professor, deliv­ered a lecture here on October 20, par­ticipated in seminars, and met with stu­dents.Dr. Ingelfinger, clinical professor ofmedicine at Boston University School ofMedicine, is a noted clinician, inves­tigator, teacher, and editor (New En­gland Journal of Medicine). His contri­butions to gastroenterology include stud­ies of normal esophageal motility and dis­turbances of motility in diseases of theesophagus. He was elected president ofthe American Gastroenterological As­sociation in 1962, and president of theInter-American Association of Gas­troenterology from 1964 to 1967. He wasawarded the Friedenwald Medal in Gas­troenterology in 1969. The AmericanCollege of Physicians appointed him aMaster in 1973, and in 1975 honored himwith the Distinguished Teacher Award.He was made a Fellow of the Royal Col­lege of Physicians this year. Empress Nagako of Japan (center) toured the Silvain and Arma Wyler Children's Hospital on October7, where she viewed this play therapy session for young presurgical patients. With the empress andthe young "doctors" are (from left) Andrea Friede, Acting Director of Children's Activities andrecreational therapist; John T. Wilson, Provost and Acting President of the University; and WilliamGoodall, recreational therapist.The visiting professorship honors Dr.Walter L. Palmer, Richard T. CraneProfessor of Medicine Emeritus in ThePritzker School of Medicine, one of theworld's foremost gastroenterologists,and a member of the medical school'soriginal faculty. A Walter L. Palmer Vis­iting Professor is appointed every twoyears.Brain Damage Research GrantA new $448,588 U.S. Public Health Ser­vice grant has been awarded to The Uni­versity of Chicago to finance the firstyear of a study of the relationship ofbrain damage early in life to subsequentbehavioral deficits occurring in adult­hood.The five-year project is funded by theNational Institute of Neurological andCommunicative Disorders and Stroke ofthe U. S. Public Health Service, and rep­resents a total of $1.6 million in directcosts.Dr. Alfred Heller is principal inves­tigator under the grant, which is forstudies of the development of brain func­tion under normal and pathological cir- cumstances. Dr. Heller is Professor andChairman in the Department of Phar­macological and Physiological Sciencesin the Division of the Biological Sciencesand The Pritzker School of Medicine.The research involves studies of ani­mal models of brain damage. Minimalbrain damage has been implicated inepilepsy and mental retardation and insome learning disabilities and behavioralproblems in children. The study also hasapplications to adult disorders such asParkinsonism.A portion of the research will be sub­contracted to the University of Califor­nia, Los Angeles, under the direction ofNathaniel Buchwald, UCLA professorof anatomy and psychiatry.University of Chicago and UCLA sci­entists will study nerve cell function innewborn and maturing animals. Minoralterations will be made by surgery orpharmacological methods in the animals'central nervous systems to study the ef­fects of "insults" to specific areas of thebrain on learning and other behavior.The investigators will make intensivestudies of the physiological and biochem­ical reactions of the uninjured parts of35the brains of the animals. In addition,they will test the animals' ability to per­form certain tasks when given be­havior-modifying drugs.The purpose is to learn more about themechanisms involved in the response ofhuman beings to brain damage, and howto prevent or correct the harmful conse­quences.Major projects under the grant andtheir principal investigators include:"Effect of Neonatal Disruption ofSpecific Neural Systems on Develop­ment of Transmitter Neurochemistry inthe Brain." Dr. Heller."In vestigations of the Neonatal De­velopmental and Mature Behavior Pat­terns in Rats with Modified Cate­cholaminergic Functions." Lewis S.Seiden, Associate Professor in the De­partments of Pharmacological andPhysiological Sciences and of Psychiatryand in the College."Behavioral and Neurochemical De­velopment in Kittens with Nigro-StriatalLesions." Nathaniel Buchwald(UCLA)."Doparninergic Input of MammalianNeostriatum: An Anatomical Study."Eileen S. Kane, Assistant Professor inAnatomy."Correlative Cytopharmacology."Dr. Lloyd J. Roth, Professor in Phar­macological and Physiological Sciences."Neuronal Identification by Com­bined Histofluorescence Autoradiog­raphy." Dr. Angelos E. Halaris, Assis­tant Professor in Psychiatry."The Relationship between the Mat­uration of Neurotransmitter Systemsand Post-Synaptic Neurochemical De­velopment." Philip C. Hoffmann, As­sociate Professor in Pharmacologicaland Physiological Sciences and in theCollege."Characterization of Dopamine Re­ceptors." Dr. Leon I. Goldberg, Profes­sor in the Departments of Pharmacolog­ical and Physiological Sciences and ofMedicine, and Chairman of the Commit­tee on Clinical Pharmacology.Child Expert Joins Department ofPsychiatryDr. Joseph Marcus, an internationallyknown child psychiatrist, has been ap­pointed Professor in the Department ofPsychiatry.Dr. Marcus, 47, was formerly direc­tor of the department of childpsychiatry and development in theJerusalem Mental Health Center, andtaught child psychiatry in the HebrewUn iversity-Hadassah Medical School,Jerusalem, Israel. He was the founderand is chief editor of the journal Early36 o� .. �'\Dr. Ernest B. Howard (right) is back in medical school after 27 years as a leader in the AmericanMedical Association. At the age of 65, Dr. Howard is in the first year of a three-year residency indermatology here. He retired last year as the executive vice president of the A.M.A., a post which heheld from 1969 to 1974. Dr. Howard is pictured here with fellow dermatology residents Dr. CarmenCasas, Dr. Tony Sio- Ta Fu, Dr. David Cornbleet, and Dr. Vladimir Tkalcevic.Child Development and Care, publishedin London.His appointment was made by John T.Wilson, Provost and Acting President,on the recommendation of the Dean ofthe Division of the Biological Sciencesand The Pritzker School of Medicine.Dr. Daniel X. Freedman, the LouisBlock Professor and Chairman ofPsychiatry, said that "the Departmentof Psychiatry has been making an effortto bring research and treatment of chil­dren into the collaborative center of ourteaching and research activities. Dr.Marcus is an important addition to thisdevelopment.' ,Dr. Marcus has done extensive re­search on individual differences amongchildren raised in the collective setting ofthe Israeli kibbutz, and on kibbutz andnon-kibbutz children with schizophrenicparents. He will continue his research inJerusalem on suspected genetic and en­vironmental influences in infants born topsychotic parents and will develop ageneral research program in infant de­velopment and child psychiatry at TheUniversity of Chicago.Included in this will be collaborativework with other faculty researchers inpsychiatry, pediatrics and human de­velopment, dealing with behavioral,neurophysiological and biochemical as­pects of child development. In particu­lar, they expect to investigate childrenwho are considered" at-risk" because of suspected brain damage or being born topsychotic or drug-addicted parents.A native of Cleveland, Dr. Marcus at­tended Western Reserve University. In1948 he emigrated to Israel, where helived on a kibbutz before continuing hisstudies. He obtained his M.D. degreefrom the Hadassah Medical School,Jerusalem, in 1958, and his B.Sc. (in ab­sentia) from Western Reserve in 1963.Dr. Joseph MarcusDr. Marcus interned at the TelHashomer Government Hospital andserved his residency in psychiatry andchild psychiatry in the Israeli Ministry ofHealth. He also studied developmentalneurology and psychobiology at theUniversities of Groningen and London.He has held staff and teaching posi­tions at the Ness Ziona RehabilitationCenter Hadassah University Hospital,Tel H�shomer Hospital, the OranimChild Guidance Clinic of the Kibbutzim,the Israel Institute of Applied Social Re­search in Jerusalem, the Infant and ChildDevelopment Center of Hadassah Uni­versity Hospital, the Department ofMental Health of the Israel Ministry ofHealth, and the Hebrew University­Hadassah Medical School.Vietnamese Tuberculosis Specialist HereDr. Vo Van Le, formerly of the StateTuberculosis Hospital, Saigon, has re­ceived a postdoctoral fellowship fromthe Chicago Lung Association, and hasjoined the staff of the Section of Re­spiratory Medicine. He is prepanng totake an examination in December toqualify him to practice medicine in theUnited States.Dr. T. William Lester of The Un iver­sity of Chicago, who knew Dr. Le a� aph ysician at the Hinsdale, IIh no is ,Tuberculosis Sanitarium from 1961 to1963, said Dr. Le is "among the world'smost experienced specialists in tuber­culosis. "Dr. Le returned to Vietnam, and Dr.Lester heard nothing from him in recentyears until his arrival in Camp Pendle­ton, California in May. Dr. Lester cred­ited the Chicago Lung Association withproviding assistance to "help bring backinto medicine a man who can be veryproductive.' ,Dr. Lester is Professor in the Re­spiratory Section of the Department ofMedicine.Dr. Le and his family left Vietnam bymilitary plane on April 25 and arrived atCamp Pendleton, California, via thePhillippines and Guam. His son, 12, whowas born in the United States and IS aU.S. citizen, arrived two weeks ahead ofthe rest of the family.The family established residence inDeKalb, Illinois on May 30. His wife,who received her degree in elementaryeducation from Northern Illinois Uni­versity, DeKalb, in 1965, is working in aDeKalb jewelry store. His daughter, 14,and son are attending school in DeKalb.Dr. Les mother is also living in DeKalb.His father, an engineer, died of a heartattack in the Philippines while the fam­ily was en route to the United States. Dr. Alvin R. Tarlov with Mrs. Corinne Ferguson, Dr. Lloyd Ferguson's daughters Debra and Diana, andMrs. Rose Ferguson.Dr. Le was born in Saigon and at­tended the Lycee St. Charles in Mar­seille, France. He received his M.D. de­gree from the Faculty of Medicine, Mar­seille. He married in Saigon in 1960 andcame to the United States in 1961 toserve a two-year residency under Dr.Lester in Hinsdale. He received severalmonths' additional training at the Mis­souri State Sanitarium in Mt. Vernon,Missouri.While at Hinsdale, he was co-authorwith Dr. Lester of several published re­search studies on tuberculosis.From 1964 to 1967 Dr. Le was medicalstaff physician at the State TuberculosisHospital, Saigon. He then served fiveyears at a military tuberculosis hospitalnear Saigon, and in 1972 returned to theState Tuberculosis Hospital.As Saigon appeared about to fall,friends of Dr. Le in the U.S. Embassy inSaigon helped him and his family leaveVietnam.Dr. Vo Van Lee Dr. lloyd A. Ferguson Medical libraryThe University of Chicago has renamedthe library of its Department ofMedicine in honor of the late Dr. LloydA. Ferguson ('60).Dr. Ferguson was Associate Profes­sor of Medicine and Assistant Dean ofStudents in The University of ChicagoDivision of the Biological Sciences andThe Pritzker School of Medicine. Healso was Medical Director of the Great­er Woodlawn Assistance Corporation,Chicago, and was active in hel�ing �oplan community health care services Inthe Mid-South area of Chicago.Speakers at dedicatory services in­cluded Joseph Ceithaml, Dean of Stu­dents in the Division and PritzkerSchool; Dr. Alvin Tarlov ('56), Profes­sor and Chairman in the Department ofMedicine; Dr. David Fedson, AssistantProfessor of Medicine; and James W.Wagner of the Mid-South Health Plan­ning Organization, Chicago.Among those present were Mrs.Corinne Ferguson, Dr. Ferguson'smother; Mrs. Rose Ferguson, his formerwife; and his daughters Diana and DebraFerguson.Fifty friends and former colleagues ofDr. Ferguson also attended.Council for the Biological SciencesIn the Spring, 1975 issue of Medicine onthe Midway we announced the appoint­ment of 10 new members to the Council.One member, Thomas F. Jones, Jr., waslisted incorrectly as Thomas F. Hones,Jr. Our apologies to Mr. Jones.37Dr. Priscilla Kincaid-Smith and Dr. james S.Robson.Hypertension inPregnancy MeetingDrs. James S. Robson of Scotland andPriscilla Kincaid-Smith of Australiawere among the participants in an Inter­national Symposium on Hypertension inPregnancy, presented at theUniversity's Center for ContinuingEducation on September 25-27. Thesymposium was sponsored by theChicago Heart Association and the Na­tional Heart and Lung I nstitute. in coop­eration with the American Heart As­sociation, the Illinois Regional MedicalProgram. and the University's Depart­ment of Obstetrics and Gynecology.Dr. Robson is physician-in-charge ofthe medical renal unit of the departmentof medicine at the University of Edin­burgh. Dr. Kincaid-Smith is a professorand physician-in-charge of the depart­ment of nephrology at the University ofMelbourne. On September 24, she gavea special lecture on "Renal Disease inPregnancy." sponsored by the Board ofDirectors of The University ofChicago's Lying-in Hospital.Dr. Marshall D. Lindheimer, As­sociate Professor in Obstetrics andGynecology. and in Medicine. waschairman of the symposium planningcommittee.A Dedication ...Muriel Beadle's new book. A Nice NeatOperation and the Hospital' Whf'l'e ItOccurred, is dedicated to Dr. Walter L.Palmer. Woodlawn Hospital and theRichard T. Crane Professor Emeritus inthe University of Chicago Departmentof Medicine: Samuel Eblen. WoodlawnHospital: and Ruth (Mrs. John) Ult­mann. Assistant Head Nurse. floor N-I.University of Chicago Hospitals andClinics.In Memoriamlester R. Dragstedt, 1893-1975Physiologist or Surgeon?Dr. Dragstedt died suddenly on July 1638 at the age of 8!. H is death occurred inhis home at his beloved Wabigarna , acolony on Elk Lake, Michigan, foundedin 1921 by Dr. Dragstedt and a group ofUniversity of Chicago scientists.Dr. Dragstedt was born in Anaconda,Montana, in 1893, the son of Swedishimmigrant parents. During his youth hemet the late Anton Julius Carlson whocame to Anaconda as a substitute minis­ter in the Swedish Lutheran Church.This contact later played a crucial role inthe development of Dr. Dragste dtscareer. Dr. Carlson abandoned theministry, became a physiologist and in1904 came to The University of Chicago.When Dr. Dragstedt was ready for col­lege a decade later, this old friendshipwith Dr. Carlson lured him to The Uni­versity of Chicago, where he completedhis entire college and professional educa­tion. He received his B.S. degree in1915, a Master's degree in physiology in1916, a Ph.D. in physiology in 1920 andthe M. D. degree (Rush Medical College)in 192!.During this period Dr. Dragstedt con­sidered himself a physiologist. His firstacademic position was in physiology atthe State University of Iowa. and it wasthere that he met and married GladysShoesmith, who was his constant com­panion and strongest supporter through­out h is long and distinguished career.Later Dr. Dragstedt became Professorand Chairman of the Department ofPharmacology and Physiology atNorthwestern University. He main­tained, meanwhile, his close associationwith Dr. Carlson and the ChicagoSchool of Physiology, which includedhis brother, Dr. Carl A. Dragstedt (,21),Dr. Arno B. Luckhardt ('12), and Dr. A.C. Ivy (,21).Dr. Dragstedts second career beganin 1925. When The University ofChicago decided to build a Universityhospital on campus, the late Dr. DallasB. Phemister was appointed Professorand Chairman of the Department ofSurgery. At the conclusion of this as­signment. Dr. Phemister appointed Dr.Dragstedt Associate Professor ofSurgery and is said to have stated, "Ican teach surgery to a physiologist: I aminterested in teaching physiology tosurgeons." Following a sojourn in Euro­pean surgical clinics, Dr. Dragstedt tookup residence in Dr. Phernisters depart­ment, where he became an internation­ally famous surgeon. In 1947 he suc­ceeded Dr. Phemister as DepartmentalChairman. a position he held until his re­tirement from the University in 1959.Throughout his career as surgeon Dr.Dragstedt continued without interrup­tion his distinguished and productivecareer as a physiologist. His most significant and lasting contributions tobasic science were made durin� thisperiod. It is not surprising that when hewent to the University of Florida follow­ing his Chicago retirement, he revertedto full-time physiologist with a joint ap­pointment as research professor in thedepartments of surgery and physiology.He continued, as he had done inChicago, to direct and guide the researchactivities and scientific education ofmedical students, graduate students inphysiology. surgical residents, andforeign fellows. He worked eightmonths a year in Gainesville, spendingthe four summer months at Wabigarna.Although age gradually took a physi­cal toll. Dr. Dragstedts sharp and origi­nal mental activities showed no deterio­ration. There was a new group of youngmen beginning in the research laboratoryon July 1 this year. so Dr. Dragstedtpostponed his departure for Wabigamauntil their arrival, Only two weeks be­fore his death he spent hours with theseyoung people outlining in his own hand­writing the details of experiments theywere to conduct during his absence forthe summer.Was Dr. Dragstedt a physiologist or asurgeon? He was both. As a physiologisthe made significant contributions in thephysiology of the pancreas and theparathyroids. However, his lifelongpreoccupation, stemming from his longassociation with Dr. Carlson, was thephysiology of the stomach-particularlythe pathophysiology related to pepticulcer disease. His competence as a basicscientist is well illustrated by his electionto the National Academy of Sciences, anhonor which he considered the mostsignificant of the many he received.As a surgeon he was more than a skilledclinician. An operative procedure in hishands was literally a work of art becauseof his unusual dexterity. His fame as asurgeon. however, stems directly fromh is ability to apply research findings topatient care. This is best exemplified byDr. Lester R. Dragstedt and Dr. Edward R.Woodward on the 25th anniversary of the firstvagotomy operation, performed at The Univer­sity of Chicago.his approach to peptic ulcer. His first re­search paper on this topic was publishedin 1917. It was not until 1943, however,that he felt certain enough of his labora­tory data to apply these findings to ahuman subject with duodenal ulcer.On January 18, 1943, Dr. Dragstedtperformed a transthoracic vagotomy ona patient with duodenal ulcer who hadrefused the accepted surgical treatmentof the day, subtotal gastrectomy. Al­though not the first attempt at vagotomy,it was the first application of this proce­dure based on long-continued and pro­gressive experimental evidence. I n thethree decades since that fateful day inthe operating rooms at the Albert MerrittBillings Hospital, Dr. Dragstedt's workhas led directly to a complete revolutionin the surgical approach to the treatmentof peptic ulcer. This feat, above. all, hasgiven Dr. Dragstedt a permanent posi­tion among classic contributors to medi­cal science.Dr. Dragstedt, a skillful an,d prolificwriter, published 363 scientific articlesduring his long career. He was also anunusually talented public speaker, andhad that rare capacity to give an appro­priate address for a lay audience and anequally skillful presentation to a sophis­ticated scientific society. He wasselected commencement speaker by theClass of 1975 at the University ofFlorida College of Medicine. Only sixweeks before his death he presented adelightfully worded overview of medicalscience today-without a note, without alantern slide.Although an outstanding lecturer, Dr.Dragstedt's major impact as a teacherwas in the laboratory. Many will re­member the traditional four o'clock teaheld daily in Dr. Dragstedt's laboratoryon the fifth floor of Billings Hospital.Here the experimental data of the daywere discussed in an informal settingwhich included students, residents, re­search fellows, and, frequently, distin­guished visitors. It was my privilege toknow him originally through this con­text. Beginning with my junior surgicalexternship in 1940, I continued as hisstudent, colleague and close friend, withonly a few brief interruptions, until hisfinal departure from Gainesville a fewdays before his death. Many others willremember him as warm friend, staunchsupporter and brilliant scientific thinker.E. R. Woodward (,42)University of FloridaGainesville, FloridaA memorial service was held for Dr.Dragstedt on Wednesday, October 8, inthe Bond chapel on campus. Drs.Dwight Ingle, Walter Palmer ('21), andEdward Woodward commented on as- pects of Dr. Dragstedt's life and career.Dr. Dragstedt is survived by his wife,Gladys; two sons, Dr. Lester R. Drag­stedt II of Des Moines, Iowa, and JohnAlbert Dragstedt of Moraga, California;two daughters, Charlotte Jeffrey ofBowie, Maryland, and Carol Stauffer ofDecatur, Georgia; thirteen grandchil­dren; two sisters, Alice Wolf of Ronan,Montana, and Myrtle Weaver of Tuc­son, Arizona; and his brother Carl, ofPark Ridge, Illinois.• • •Dr. Dragst edt delivered the followingspeech (excerpted here) at The Univer­sity ofChic ago Alumni Award Luncheonlast June, when he Ivas presented with the1975 Alumni Medal.THE LEGACY OF KNOWLEDGEbyDr. Lester R. DragstedtHow is medical knowledge secured? Theolder physicians were mostly limited toobservation and experience in the treat­ment of the sick, and these are still im­portant methods today. Then came care­ful examination of the bodies of thosepatients that died. In our day, the con­trolled experiment on animals in themedical laboratory has proved to be themost successful method. Practically allof the important advances in medicineduring this generation have come fromthis route.It has sometimes been said that medi­cal discoveries come about as a result ofa happy accident. Professor WalterCannon, a great physiologist at HarvardUniversity, modestly referred to severalof his important discoveries as due toserendipity. Dr. Cannon worked in somany fields of physiology that it is quitepossible that some unexpected reactionin an animal studied gave him a clue tothe solution of another problem, and sohe made this discovery by accident. ButI like Pasteur's statement better-"Inthe field of observation, chance favorsthe mind that is prepared."Let me explain. In 1750, Reamur dis­covered that the digestion of food in thestomach is accomplished by the chemi­cal action of gastric juice. He made thisdiscovery by making a pet buzzard swal­Iowa perforated metal sphere into whichhe had placed a sponge. After an hour orso he pulled the sphere out of thestomach by an attached string, squeezedout the juice, and showed that this fluidwould dissolve meat, bread, and cheesewithout the usual odor of putrefaction.This discovery aroused great interest.Some physicians dismissed the experi­ment as having no significance for man.Buzzards eat anything! Other physicians queried if man has such a fluid in hisstomach which can dissolve meat. Whydoes it not dissolve the wall of thestomach, which is composed of essen­tially the same material? Why does notthe stomach digest itself?Captain William Beaumont, anAmerican Army surgeon stationed at Ft.Mackinac in 1830, was interested in thiscontroversy. One day Alexis St. Martin,a French Canadian voyageur, was acci­dentally shot in the left upper abdomen,receiving a fearful wound. Parts of thestomach and left lung were shot away.By some miracle St. Martin survived,and when the wounds healed he was leftwith a permanent opening into thestomach-a gastric fistula. Beaumont atonce saw his opportunity. He lookedinto St. Martin's stomach, saw foodbeing digested, described the stomachmovements, collected the gastric juicefor experiments and chemical analysisand described all these findings in a smallbook which has become a medical clas­SIC.Physiologists claim Beaumont as ourfirst scientific physiologist and wesurgeons claim Beaumont as our firstscientific surgeon. It is true that Beau­mont was lucky to have encounteredsuch a patient, but he also had a pre­pared mind to make the best of his op­portunity. It is important for the physi­cian to keep abreast of developing knowl­edge in as many fields of medicine as hepossibly can. Thus, he has a preparedmind and can take advantage of experi­ences in caring for patients and perform­ing surgical operations.I t has been said that Isaac Newtonwas sleeping in his orchard when anapple fell on his head, leading him toformulate his views on gravitation. I takeno stock in this fairy tale. I have been hiton the head many times and nothingcame of it other than a headache. I thinkthat Newton's apple fell on a preparedmind.Harold Lincoln Thompson, 1897-1975Dr. Harold Lincoln Thompson died inGlendale, California, August 28, 1975after a long lingering illness. Born inBayard, Iowa, May 23, 1897, Dr.Thompson came to The University ofChicago to study medicine. He receiveda Master of Science degree in Anatomyin 1922. After attending Rush MedicalCollege, he received his Doctorate inMedicine from the University in 1924.His residency in surgery at MinneapolisGeneral Hospital was followed by a fel­lowship at the Mayo Clinic, with work inthe Mayo Foundation under the late Dr.Frank Mann on the subject of gastricsurgery.39Dr. Thompson was awarded the de­gree of Doctor of Philosophy by theUniversity of Minnesota in 1930. Hethen settled in the Los Angeles area,where he was on the staff of St. VincentHospital and Glendale Memorial Hospi­tal. He became a senior attendingsurgeon at the Los Angeles CountyHospital, now the University of South­ern California Medical Center. At LomaLinda University, he held the rank ofassociate clinical professor of surgery.Dr. Thompson maintained a busy prac­tice in general surgery, with special ref­erence to the gastrointestinal tract.While many men engage in photog­raphy as a hobby, Dr. Thompson rosewell above the status of amateur. Hemade his own exposures, developed thefilms, and made his own prints. His stillphotographs were exhibited in salonsover the world and won many prizes.The surgical lectures he delivered athome and abroad were famous for hisphotographic illustrations. Dr. Thomp­son became interested in motion picturesand at one time was chairman of theCinema Section of the PhotographicSociety of America. Friends privilegedto view his films in the theater built intohis home in Los Feliz Hills were inspiredby their beauty and perfection.The funeral service for Dr. Thompsonwas held in the Little Church of theFlowers in Glendale's Forest LawnMemorial Park. Dr. Thompson is sur­vived by his wife, Sarah, of LosAngeles; his brother, Dr. William PaulThompson, also of Los Angeles; and hissister, Mrs. Ruth Melligan of Boulder,Colorado.Dr. Daniel L. Harris, 1915-1975Dr. Daniel L. Harris, a faculty memberin the Department of Physiology at TheUniversity of Chicago from 1947 to 1964,died on August 2 in Dallas, Texas fol­lowing a brief illness. Dr. Harris servedon the Faculty Council from 1955 to1958, and on the Committee of theCouncil from 1956 to 1958. He left theUniversity to join the Southwest Centerfor Advanced Studies in Dallas, whichsubsequently became the University ofTexas at Dallas.Joseph J. Ceithaml, Dean of Studentsin the Division of the Biological Sciencesand the Pritzker School of Medicine. andProfessor of Biochemistry, spoke at amemorial service held August 18 at theUniversity of Texas. A Dr. Daniel L.Harris Memorial Fund has been estab­lished at the University of Texas at Dal­las.Dr. Harris is survived by his wife,Catherine, and a son, Jonathan.40 ALUMNI DEATHS'97. Mavnard A. Austin , Evansville,Indiana, November 25, 1973, age 97.'01. Samuel C. Schmitt, Fallbrook,California, May 26, 1975, age 103.'12. James T. Rooks, Bellevue,Washington, April 25, 1975, age 97.'15. George Mc Creiglit , Carmel Val­ley, California, June 13, 1975, age 87.'15. Francis J. SClllly, Hot Springs,Arkansas, March 10, 1975, age 84., 16. Frank Porter Miller, Riverside,California, March 12, 1975, age 84.'17. Bertha M. Shafer, La GrangePark, Illinois, March 7, 1975, age 85.'21. Lester R. Drag st edt , Gainesville,Florida, July 16, 1975, age 82.'21. Ralph E. Hawes, HuntingtonBeach, California, January 9, 1975, age79.'21. G. L. Rosene, Chicago, Illinois,July 30, 1975, age 82.'23. Harold L. Thompson, Glendale,California, August 28, 1975, age 78.'23. Bertrand O. Woods, AgateBeach, Oregon, March I, 1975, age 75.'27. John S. Duncan, Gary, Indiana,March 6, 1975, age 78.'30. Lewis J. Ferrell, Everett,Washington, January 4, 1975, age 73.'30. Wayne Gordon, Lexington, Ken­tucky, July 12, 1975, age 71.'31. Marion Corrigan, Chicago, Il­linois, February 21, 1975, age 74.'3l.James L. O'Leary. St. Louis, Mis­souri, May 25, 1975, age 72.'32. Chester B. Davis. Lincoln, Il­linois, June 9, 1975, age 79.'33. Earle E. Wilson, Westchester, il­linois, February 19, 1975, age 69.'34. Nelson Zi vit r , Miami Beach,Florida, December 23, 1974, age 67.'39. Elmer W. Haertig , Honolulu,Hawaii, May 25, 1975, age 65.'41. Arnold Lazarow, St. Paul, Min­nesota, June 25, 1975, age 59.'42. Eugene Y. Hall, Salt Lake City,Utah, 1974, age 65.'43. Walter D. Davis, Wilmington,Delaware, July 7, 1975, age 57.'50. Martin Kohn , Burlingame, Cali­fornia, September 19, 1975, age 56.FORMER STAFF AND FACULTYRoderick R. Belknap (Obstetrics andGynecology, Resident, '31-'32), On­tario, Oregon, March 23, 1975, age 74.George Bogardus (Surgery, Intern,'39; Resident, '45-'48), Seattle,Washington, November 27,1974, age 60.Daniel L. Harris (Physiology, Fac­ulty, '47-'64), Dallas, Texas, August 2,1975, age 60.Anna Sokoloff (Obstetrics andGynecology, Intern, '31), Chicago, Il­linois, June 7, 1974, age 80. Departmental NewsAnatomyStuart A. Altmann, Professor of Biologyand of Anatomy, was elected SecondPresident-elect of the Animal BehaviorSociety.Eileen S. Kane, Assistant Professor,was appointed to the review boards ofJ ournal of N eurocytology and AmericanJournal of A n atomy .R. Eric Lombard, Assistant Professor,participated in the American Associa­tion of Ichthyologists and Herpetologistsconference on June 12 in Williamsburg,Virginia. He presented a paper on"Comparative Functional Morphologyof the Otic Semicircular Ducts inSalamanders. "Dr. Charles E. Oxnard, Professor inthe Departments of Anatomy, An­thropology, and the Committee onEvolutionary Biology, and Professor andDean of the College, received the D.Sc.degree of the University of Birmingham,England on July 11.Dr. Ruth Rhines, Associate Professor,retired on July I. She served on the fac­ulty since 1956.Dr. Ronald Singer was chairman of thesession on human genetics at the 10thI nternational Congress of Anatomistsheld in Tokyo, Japan on August 25-30.Dr. Singer is the Robert R. Bensley Pro­fessor of Biology and the Medical Sci­ences, Chairman of the Department ofAnatomy, and Professor in the Depart­ment of Anthropology, Committee onGenetics, Committee on EvolutionaryBiology and Committee on AfricanStudies.AnesthesiologyAppointment s:Dr. Daniel S. Crowley-Instructor.Dr. Jung S. Han-Instructor.Dr. Gilbert H. V. Ribeiro-AssistantProfessor.Promotion s:Dr. Patrick H. Hughes-AssociateProfessor.Ben May LaboratoryGrant:A. Haridara Reddi, Assistant Professor,was awarded a $19,058 grant from theMarch of Dimes to study the factorswhich affect bone cells as they developfrom primitive to more specific types.His research will cover the cell's rela­tions with surroundingcells and with thehormonal balance of the whole body, aswell as its genetic inheritance.Dr. Charles B. Huggins, the William B.Ogden Distinguished Service Professorin the Ben May Laboratory and the De-Dr. Ruth Rhines, Emeritus Professor HeinrichKlUver, and Dr. Ronald Singer at a retirementparty honoring Dr. Rhines.partment of Surgery, spoke at theAmerican Academy of Arts and Sci­ences meeting in Boston on November12. His subject was "The DiscoveryCult." At this meeting Howard G.Williams-Ashman, the Maurice Gold­blatt Professor in the Ben May Labora­tory and the Departments of Biochemis­try and Pharmacological and Physiologi­cal Sciences, received the Amory Prize,awarded for achievement in medicine andreproductive physiology. The prize in­cludes a citation and an honorarium of$2,000. Two others received an AmoryPrize in 1975.Biophysics and Theoretical BiologyAppointments:Thomas Nagylaki-Assistant Profes­sor.Emergency MedicineAppointments:Dr. Harvey W. Meislin-AssistantProfessor.Dr. George L. Sternbach-AssistantProfessor.La RabidaAppointments:Dr. Andrew 1. Aronson ('69)­Assistant Professor.Dr. Phisit Saphyakhajon-AssistantProfessor/Trainee.Dr. Elsa J. Roe-Instructor.MedicineAppointments:Dr. Charles O. Elson-Instructor.Dr. Harvey M. Golomb-AssistantProfessor.Dr. Freddy J. Hendler-In-structor/Trainee.Dr. Melvin E. Medof-Assistant Pro­fessor.Dr. Bernard A. Nemchausky-In­structor.Dr. James B. Wagonfeld-Instructor. Promotions:Dr. Richard L. ByynY-AssociateProfessor.Dr. Michael Blackstone, Assistant Pro­fessor (Gastroenterology), participatedin a course at the Cook CountyGraduate School of Medicine. The titleof his lecture was "The Current Statusof Endoscopic Retrograde Cholangio­Pancreatography (E.R.C.P.)."Dr. James L. Boyer, Associate Profes­sor, was an invited discussant at theSecond NATO Advanced Study Insti­tute on the Biliary System held in Aal­borg, Denmark, August 25-30. He alsoparticipated in the Second InternationalGstaad Symposium on "The Liver:Quantitative Aspects of Structure andFunction," held September 2-4 inGstaad, Switzerland. His paper was en­titled, "Scanning Electron Microscopyof the Liver." At the meeting of theAmerican Society of ClinicalPathologists, held in Chicago on Sep­tember 24, he discussed "Diagnosis andClinical Patterns of Viral Hepatitis."Dr. G. Jeelani Dhar, Fellow in Gas­troenterology, was elected a member ofSigma Xi.Dr. David L. Horwitz ('67), AssistantProfessor (Endocrinology), has receiveda $4,000 research grant from the Ameri­can Diabetes Association, GreaterChicago and Northern Illinois Affiliate.Dr. Horwitz is one of five young localinvestigators to receive the grant. Hewill study the diabetic patient's ability tomake insulin.Dr. Janet Rowley ('48), Associate Pro­fessor in the Department of Medicine,the Franklin McLean Memorial Re­search Institute, and the Committee onGenetics, spoke on random and non­random chromosome abnormalities inleukemia at a program at the Given Insti­tute in Aspen, Colorado on July 23. Dr.Rowley was awarded a two-year $50,000March of Dimes basic research grant.She will study blood cells from patientswith genetic abnormalities to gather datafor a "genetic map" pinpointing the lo­cation of specific genes on the chromo­somes. Her project involves patientswith chromosomal deletions in thebone-marrow cells that produce bloodcells.Dr. Alvin Tarlov (' 56), Professor andChairman of Medicine, has been electedSecretary-Treasurer and Councilmember of the Association of Professorsof Medicine, an organization of chair­men of departments of medicine.in U.S.medical schools.MicrobiologyThe Clinical Microbiology Section pre­sented a conference on "Topics in Vogue" at the University's Center forContinuing Education on August 18-20.The conference was designed forlaboratory supervisors and pathologistswho have responsibility for directingclinical microbiology laboratories, tohelp them keep abreast of and evaluatenew procedures. Participants included:Dr. James Bowman, Professor, Depart­ments of Pathology and Medicine andDirector of Laboratories; Josephine A.Morello, Associate Professor of Pathol­ogy and Medicine and Director of theClinical Microbiology Laboratories; andFrank E. Kocka, Assistant Professor ofPathology and Associate Director ofClinical Microbiology Laboratories.NeurologyAppointments:Dr. Lawrence P. Bernstein ('70)­Instructor.Dr. Douglas N. Buchanan, ProfessorEmeritus in Pediatrics and Medicine,has returned to the medical school to beActing Chairman of Neurology.Obstetrics and GynecologyAppointments:Dr. Aikaterini Kyriazis-Instructor.Promotions:Dr. John R. Esterly-Professor.The Department of Obstetrics andGynecology held a four-day post­graduate course, sponsored by Lying-inHospital, on October 23-25 at theUniversity's Center for ContinuingEducation. The course was of special in­terest to residents preparing for theirBoard Examination. Dr. Frederick P.Zuspan, professor, chairman andobstetrician-gynecologist- in -ch ief, theOhio State University Hospitals andClinics, was the dinner speaker.Dr. Kurt Benirschke, Mothers' AidResearch Professor and professor of re­productive medicine, University ofCalifornia at San Diego, and director ofresearch, San Diego Zoo, participated inseminars and grand rounds on October14-15. His lectures were entitled:"Mammalian Chimerism, Mosaicismand Hybrids," "Biology of Twinningand its Pathology," and "NewerPathologic Aspects of Placenta."Dr. Marshall D. Lindheimer,Associate Professor of Medicine andObstetrics and Gynecology, was a guestspeaker at the Fifteenth Annual Sym­posium on Kidney Disease of the Kid­ney Foundation of Southern California.held in Los Angeles on September 17.H is topics were: "Renal Function andDisease in Pregnancy" and" Hyperten­sive Complications of Pregnancy."41OphthalmologyAppoint ment s:Dr. Karl Johnston Fritz ('71)- Assis­tant Professor.Dr. Peter H. Morse (,63)-AssociateProfessor.The Department of Ophthalmologyreceived an annual grant of $5,000 fromResearch to Prevent Blindness, Inc.(RPB) to advance eye research. Unre­stricted funds totaling $80,000 have beengiven to the University from RPB overthe past sixteen years.PathologyAppointments:Dr. James Vardiman-Instructor.Dr. Francis H. Straus II C 57) was ap­pointed acting Director of the SurgicalPathology Laboratory.Promotion s:Dr. John R. Esterly-Professor.Dr. Alexander E. Boyo, professor andhead of the department of pathology inthe University of Lagos, Nigeria. was avisiting professor during June and July.An international authority on sicklehemoglobin, he also was a consultant tothe University's Comprehensive SickleCell Center.Dr. Sidney Schulman (,46), presentlyon leave of absence, is visiting professorat Harvard University Medical School.Dr. Robert W. Wissler ('48), DonaldN. Pritzker Professor and Director ofSCOR-Atherosclerosis. was vice chair­man of the Gordon Research Confer­ence on Atherosclerosis held at KimballUnion Academy, Meriden, New Hamp­shire on June 23-27. He also served aschairman of the session on "DietaryFactors Other Than Cholesterol inAtherosclerosis." For the third consecu­tive year he participated in the annualteaching courses at the Given Institutein Aspen, Colorado during the week ofJuly 3. Dr. Wissler presented a plenarypaper on "Current Concepts of Coro­nary Thrombosis as Related toAtherosclerosis and Myocardial I nfarc­tio n " at the International WorkshopConference on Atherosclerosis at theUniversity of Western Ontario, London,Ontario, Canada, September 1-3.PediatricsAppointments:Dr. Miraj Hussian-Instructor.Promo/ions:Dr. John D. Madden-Professor.Dr. Michael K. Posner-Clinical As­sociate (Assistant Professor).Dr. John D. Burrington, Professor ofSurgery and Chief of Pediatric Surgery,participated in the Program for HealthSystems Management, June IS-July 25,42 conducted by Harvard University'sSchool of Public Health and MedicalSchool. The purpose of the program wasto help medical directors perform theirjobs more efficiently.J. Anthony Cifonelli, Professor, waselected to the executive committee of theSociety of Complex Carbohydrates.Dr. Ruthmary K. Deuel, AssistantProfessor of Pediatrics and Medicine,was elected to the Central Associationfor Electroencephalographers.Dr. Albert Dorfman (,44), the RichardT. Crane Distinguished Service Profes­sor in Pediatrics and Professor inBiochemistry and the Committees onGenetics and Developmental Biology.was named chairman of the Mental Re­tardation Program Project and CenterGrants Committee of the National Insti­tute of Child Health and Human De­velopment. He participated in the Ben­jamin Knox Rachford Memorial Lec­tureship program at a symposium onmental retardation at the Children'sHospital Research Foundation, Cincin­nati, on June 13. His topics were: "SomeRecent Advances in the Causation ofCentral Nervous System DisordersLeading to Mental Retardation" and the"Metabolic Basis of Mental Retarda­tion." Dr. Dorfman; Nancy B. Schwartz,Research Associate; and Glyn Dawson,Associate Professor, attended the ThirdInternational Meeting on Glycoconju­gates at the University of Sussex, Brigh­ton, England, July 6-12. Dr. Dawsonwas appointed to serve a five-year termwith the Grant Review Study Section"A" of the National Institute of HealthNeurology.Dr. Burton J. Grossman ('49), Profes­sor, spoke on "Juvenile Rheumatoid Ar­thritis" as guest lecturer at GrandRounds of the Children's MedicalCenter in Dayton, Ohio, on July 30.Dr. Peter R. Huttenlocher, Professor,lectured on Re ye ls Syndrome andneonatal neurology at a postgraduatecourse in pediatrics at the State U niver­sity of New York at Buffalo, June 2-3.Dr. H uttenlocher was elected to the So­ciety for Neurosciences.Dr. Hernan Reyes, Associate Profes­sor, spoke on "A New Technique toPrevent Corrosive Esophageal Stricturein Children" at the Symposium on Ad­vances in Pediatric Surgery and Inten­sive Care in Pediatrics, on July 24, at theHospital del Nino I.M.A.N. in MexicoCity. Dr. Reyes was elected to theAmerican Pediatric Surgical Associa­tion. He successfully completed the ex­amination for certification with "specialcompetence in pediatric surgery," givenby the American Board of Surgery,Inc.. making him a member of the firstgroup of physicians certified as Pediatric Surgeons by the American Board ofSurgery.Dr. Christian H. L. Rieger, AssistantProfessor, was elected to fellowship inthe American Academy of Pediatricsand membership in the AmericanAcademy of Allergy. Dr. Rieger visitedhis native Germany in September andpresented a paper at the German Societyfor Pediatrics meeting, in Munich.Pharmacological and Physiological Sci­encesAppointments:Dr. Robert Burn Gunn-AssociateProfessor.Promo/ions:Dr. Dario B. Domizi (' 58)-ResearchAssociate (Associate Professor).Paul Meier, the Ralph and Mary OtisIsham Professor in the Departments ofStatistics and in Pharmacological andPhysiological Sciences and the College,is the author of .. Statistics and MedicalExperimentation" in Biometrics, June,1975.PsychiatryAp point ments:Dr. Maurice Dysken-Assistant Pro­fessor.Dr. Richard M. Glass-AssistantProfessor.Dr. Dennis Grygotis (,70)-AssistantProfessor.Dr. Joseph Marcus-Professor.Promo/ions:Dr. Harry Trosman-Professor.RadiologyAppointments :Dr. Joel R. Bernstein ('71)- Instruc­tor.Dr. Peter Doris-Instructor.Dr. Barry B. Edelstein (,70 Ph.D.)-Instructor.Dr. Judith A. Kelsey-Instructor.Dr. Heber M. MacMahon- Instruc­tor.Dr. Ruthann G. Ramsey-AssistantProfessor.Dr. David Rochester (,71)-lnstruc­tor.Promotions:Dr. James D. Bowie-Assistant Pro­fessor.Dr. Axel Kunzman-Assistant Pro­fessor.Dr. Chien-Tai Lu-Associate Profes­sor.Dr. Bernard Oppenheim ('63)- As-sociate Professor. 'Dr. Mahendra I. Vyas-AssistantProfessor.Dr. John H. Rust, Professor in theDepartments of Radiology and Phar-macological and Physiological Sciences,became emeritus on July I. Dr. Rustjoined the faculty in 1959.SurgeryAppointments:Dr. Lee E. Edstrom-Assistant Pro­fessor (Plastic and Reconstructive).Dr. Henry M. Kawanaga-AssistantProfessor (Neurosurgery).Dr. Michael Simon-Assistant Pro­fessor (Orthopedics).Promotions:Dr. Edwin L. Kaplan-Professor.Dr. William B. Gill, Associate Professor(Urology) was visiting professor of urol­ogy September 17-20 at the Long IslandJewish-Hillside Medical Center (StonyBrook Branch Medical School of NewYork University). His lectures were on"Kidney Stones" and "Urological As­pects of Renal Transplantation."Dr. Ramon Lim, Assistant Professorin the Departments of Surgery(Neurosurgery) and Biochemistry, pre­sented a seminar at the University ofMichigan on August 15 on the topic,"Morphological Transformation ofBrain Cells in Culture."Dr. Karin Plym Forshell, a residentin plastic surgery, was a warded thefirst annual Clarence W. Monroe Prize bythe Chicago Society of Plastic Surgeonsfor her paper on "MicrocirculatoryChanges after Distant Bum Injury."Dr. Martin Robson, Associate Profes­sor (Plastic and ReconstructiveSurgery), was elected to the Society ofHead and Neck Surgeons, the ChicagoSociety for Plastic Surgery, the Mid­western Association of Plastic Surgeons,the American Association for HandSurgery, and the International Societyfor Burn Injuries.The following presented papers at theAmerican College of Chest Physiciansmeeting, held in Anaheim, California,October 26-30: Dr. Donald W. Benson(,50), Professor and Chairman of theDepartment of Anesthesiology; Dr.Thomas R. De Meester, Assistant Pro­fessor (Vascular and Thoracic); Dr.Richard H. Evans (,59), Associate Pro­fessor (Vascular and Thoracic); Dr.Nicholas J. Gross, Assistant Professor;and Dr. David B. Skinner, Dallas B.Phemister Professor and Chairman ofSurgery.ZollerAppointments:Dr. Herbert Kanter-Assistant Pro­fessor.Dr. Li-Min Lin-Instructor/Trainee.Michael Reese-PritzkerThe following full-time members of Michael Reese Hospital and MedicalCenter have been named to the staff ofThe Pritzker School of Medicine:Department of MedicineAppointments:Dr. Anthony L. Barbato to AssistantProfessor, for two years, effective JulyI, 1975.Dr. Fred A. Corey (,72), to ClinicalInstructor, for two years, effective JulyI, 1975.Dr. David F. Fretz in to AssociateProfessor, for two years, effective July1, 1975.Dr. Raj Gopal Gupta to AssistantProfessor, for two years, effective JulyI, 1975.Dr. Dennis Levinson to AssistantProfessor, for two years, effective July1, 1975.Dr. Victoria S. Lim to Assistant Pro­fessor, for two years, effective July 1,1975.Dr. Allan B. Sutow to Clinical In­structor, for two years, effective July I,1975.Dr. Jay R. Walther to Instructor, fortwo years, effective July I, 1975.Dr. Barry Weber to Instructor, fortwo years, effective July I, 1975.Dr. William J. Weiner to AssistantProfessor, for two years, effective JulyI, 1975.Department of PediatricsAppointment:Dr. Charles N. Swisher to AssistantProfessor, for two years, effective JulyI, 1975.Department of RadiologyReappointment:Dr. Bertram Levin, Professor, for oneyear, effective July 1, 1975.Correction:Dr. Harold Klawans was listed underboth the Department of Medicine andthe Department of Psychiatry in Vol. 30,No.1 of Medicine on the Midway. Theentry should be under the Department ofMedicine and read as follows: Dr.Harold Klawans was promoted to Pro­fessor from Associate Professor, forthree years, effective January 1, 1975.Alumni News1925Leander W. Riba retired as associateprofessor of urology at Northwestern University Medical School and movedto 140 South East St. Lucie Boulevard,Stuart, Florida. Dr. Riba returned tocampus on June 12 for his fiftieth classreunion.1930H. Ivan Sippy and Mrs. Sippy movedfrom Walkerville, Michigan to 1351-0Rio Rancho Drive South East, Rio Ran­cho, New Mexico. Dr. Sippy retired in1969.1931Gene H. Kistler retired July I and hasmoved to 110 North Palisades Drive,Signal Mountain, Tennessee.1934Donald M. Britton retired from hisobstetrics-gynecology practice in Madi­son, Wisconsin and has moved to 1600North Ocean Boulevard, Apt. 413,Pompano Beach, Florida.1935Nathaniel Safran has completed thirtyyears of private practice as a radiologistin Buffalo, New York and plans to con­tinue "this stimulating and rewardingexperience.' ,1937David Bodian retired June 30 as directorof the department of anatomy at JohnsHopkins University and has been ap­pointed full-time professor of neurobiol­ogy in the department of otolaryngologyat Hopkins.Clayton G. Loosli was honored by theUniversity of Southern CaliforniaSchool of Medicine, Graduate Division,and the University of Hawaii School ofMedicine "for his many contributions tothe practice of medicine, medical educa­tion, administration and research" at theschools' Eighteenth Annual Post­Graduate Course. The course, held Au­gust 9-20, was dedicated to him. Dr.Loosli is the Hastings Professor ofmedicine and pathology and medical di­rector of the Hastings Foundation at theUniversity of Southern CaliforniaSchool of Medicine. He served as theschool's dean from 1958 to 1964.1942Our apologies to Robert P. Hall ofOlympia, Washington, whom we re­ported as deceased in Vol. 30, No. I ofMedicine on the Midway. He is alive andwell.1945Stewart F. Taylor has returned to generalpractice in Portage, Wisconsin after afour-month residency in radiotherapy atthe University of Wisconsin.431950Richard M. Bernard of Beaverton,Oregon was installed as president of theOregon Academy of Family Practice atthe organization's May meeting. Dr.Bernard was one of nine panelists whomet July 17-18 in Washington, D.C. todevelop a desirable physician manpowermix for Oregon.Marjorie S. Braude was incorrectlylisted in the Class of 1950 Newsletter asbeing in general practice. She has been inthe private practice of psychiatry fortwenty years, is an active member of theSouthern California Psychiatric Associ­ation, and works with the County of LosAngeles in areas related to the develop­ment, coordination and training oftreatment personnel in drug abuse pro­grams.1953Marvin S. Weinreb was named associateclinical professor of dermatology at theUniversity of California Medical Schoolat San Fancisco on July I. Mrs. IleneWeinreb (M.A. '53) was elected mayorof the City of Hayward in April, 1974.1954Gordon S. Siegel retired as a commis­sioned officer of the U.S. Public HealthService on September I after 27 years offederal service. Dr. Siegel joined Equi­table Environmental Health, a new con­sulting firm in environmental sciencesand control, as director of its Washing­ton, D.C. office and its chief medicalprofessional. He will also conduct a lim­ited private practice of internal medicinein Rockville, Maryland.1956Harold Boverman left the University ofOregon Medical School to become pro­fessor of psychiatry and of pediatrics atthe University of California MedicalSchool at Davis.Norman R. Gevirtz was promoted toclinical associate professor of medicine(hematology division) at the College ofMedicine and Dentistry of New Jersey.He also has a private practice ofhematology and oncology in Belleville,New Jersey.Constantine G. Panos is chairman ofgeneral practitioners at Caylor-NickelHospital, Bluffton, Indiana.1959Harvey W. Glasser writes that in the lastfifteen years he has practiced clinicalpsychiatry, established two psychiatricgroups, and three years ago phased outof active psychiatric practice into man­agement. He is now president ofCalifornia Health Services, a hospital44 operating and management company in­volved with five hospitals in northernCalifornia. Prior to this, in 1969, he waspresident and board chairman of theWright Institute in Berkeley, which hassince grown into a successful graduatelevel institute in the social sciences. Herecently resigned the presidency butcontinues as a board member. InNovember of 1974 he was elected to thefirst board of directors for the Bay AreaRapid Transit District (BART) where herepresents a district of 300,000 people.He also serves on the board of the Ex­ploratorium, a science museum em­phasizing light and sound, which serves20,000 people a month living in the BayArea.James A. Roberts is professor ofsurgery (urology) at Tulane MedicalCenter, and head of the urology depart­ment at the Delta Regional Primate Re­search Center.1962Maximo L. Cuesta, a private physician inRoanoke, Virginia, was made a fellow ofthe American College of Obstetrics andGynecology.1964WiUiam F. Brath has been named chiefof aeromedical services at Luke AirForce Base, Arizona. In June he wascertified by the American Board of Pre­ventive Medicine as a specialist inaerospace medicine.Richard Rada is in the department ofpsychiatry at the University of NewMexico in Albuquerque.1965David S. Harrer is chief of clinicalpathology at Suburban Hospital inBethesda, Maryland, and laboratory di­rector of Bionetics Medical Laboratoriesin Kensington, Maryland.1966Stewart Duban was appointed assistantprofessor of pediatrics at the King-DrewMedical Center in Los Angeles. He ex­pects to complete his doctorate in de­velopmental psychology at U.C.L.A. in1976. At the King-Drew Medical Centerhe works with community-focused pro­grams aimed at identifying, treating andcounseling families in which childrenhave developmental problems.Julian J. RimpiJa was elected to mem­bership in the American College ofPhysicians. On April 28 the ChicagoSociety of Internal Medicine presentedhim with an award for meritorious re­search on "Immune Mechanisms InInflammatory Bowel Disease." 1967Stan Shulman is associate professor inthe division of infectious disease andimmunology at the University ofFlorida, Gainesville.Ben Siegel is assistant professor ofpediatrics at Boston University, and afaculty member of the Primary CareResidency Training Program at the Bos­ton City Hospital, where he is involvedin the team approach to primary care as aservice and teaching model. Dr. Siegeland his wife, Jane, a social worker, havetwo daughters, Elizabeth, age 6, and Re­becca, age 5.Ronald J. Slaughter has completed hispathology residency at Duke UniversityMedical Center and has joined thepathology group at Sunrise Hospital inLas Vegas.1968William Ehlers completed a fellowship inchild psychiatry in July and is now ageneral and child psychiatrist with theMental Health and Family ServicesClinic in Vancouver, Washington. He isalso a consultant at the Warm SpringsIndian Reservation and has a privatepractice. He writes, "1 am at home inmy Mt. Hood cabin in Rhododendron,Oregon."Alan E. Tasoff completed a residencyin ophthalmology at the GeorgeWashington University Medical Centerand now is in private practice in AtlanticCity.1969Mark Ballow is assistant professor in thedepartment of pediatrics at the Univer­sity of Connecticut Health Center inFarmington.Karen Leininger Kaplan is a researchassociate in the department of medicineat Columbia University College ofPhysicians and Surgeons.1970Robert L. Karp has left the U.S. Armyafter being a physician and commanderof a clinic in West Germany. He and hisfamily are living in Birmingham,Alabama, where he is taking a urologyresidency at the University of Alabama.Roxane McKay is registrar at Hilling­don Hospital in Uxbridge, Middlesex,England.1971Mark Batshaw was appointed instructorin the department of pediatrics at JohnsHopkins medical institutions and theJohn F. Kennedy Institute on July I.Richard Heinrich is chief resident inthe department of psychiatry at theSepulveda Veterans' AdministrationHospital. On September 5, Dr. Heinrichdelivered a paper on "Guided Imageryin the Treatment of Selected ChronicPain Patients" at the first internationalcongress of the International Associa­tion for the Study of Pain, held in Flor­ence, Italy.Charles E. Welander is stationed at theU.S. Naval Hospital in Puerto Rico.1972Louis L. Constan has opened an office infamily medicine in Saginaw, Michigan.Lawrence D. Schuster completed hisresidency in internal medicine at theUniversity of Minnesota Hospital and isremaining as an endocrine fellow.1974Charles Eil is a resident in internalmedicine at the University of Michigan.In July, 1976, he will become a clinicalassociate in endocrinology and begin athree-year clinical and research fellow­ship at the National Institute of ChildHealth and Human Development of theNational Institutes of Health inBethesda, Maryland.Pam and John Gallagher announce thebirth of their daughter, Tara Marie, bornAugust 13. They are both second yearresidents in surgery at the New YorkHospital-Cornell Medical Center.Peter Ree, a resident in radiationtherapy at Stanford University Hospital,had an article published in the January,1975 issue of Journal of Surgical Re­search, entitled, "Rectal and Rectosig­moid Carcinoma: Physician's Predictionof Local Recurrence."Former StaffDesmond Archer (Ophthalmology, fac­ulty, '68-'72) is professor and chairmanin the department of ophthalmology atRoyal Victoria Hospital in Belfast,Northern Ireland.Jack D. Barchas (Medicine, intern,'61) writes, "Medicine 011 the Midway isa terrific journal." Dr. Barchas is in thedepartment of psychiatry at StanfordMedical School.Lauretta Bender (intern-resident,'27-'28) is clinical professor ofpsychiatry at the University of Marylandin Baltimore.Ethan Braunstein (intern, '70) is aradiology resident at Mt. Sinai Hospitalin Los Angeles.Philip G. Coleman (Surgery, resident;'71-'73) is a thoracic and cardiovascularsurgeon in Chicago.James E. Elbaor (intern, '69) com­pleted his orthopedic surgery residencyat Harvard and joined the staff at LenoxHill Hospital in New York City. Prior to Dr. Steven C. Kramerthis he had completed rheumatologytraining at Columbia-Presbyterian Hos­pital in New York, where he was an at­tending physician. He presented paperson "Talonavicular Fusion" at meetingsof the American Academy of Or­thopedic Surgeons in San Francisco andof the American Rheumatism Associa­tion in New Orleans.Uwe Freese (Obstetrics-Gynecology,faculty, '56-'75) was appointed profes­sor and chairman of the department ofobstetrics and gynecology at the Univer­sity of Health Sciences, Chicago Medi­cal School.Steve Goldman (Medicine, resident,'69-'70) is assistant professor of internalmedicine (cardiology) at the VA Hospi­tal in Tucson.David S. Helberg (Ophthalmology, res­ident, '60-'63) has practiced ophthal­mology in Waukegan for eleven years.He is president of the Lake County Med­ical Society and a member of the boardof directors of the Illinois Association ofOphthalmology.Noel S. Howard (Pathology, resident,'66-'70) became president of the HawaiiPsychiatric Society in May. Dr. Howardis chief of service of the mental healthclinic of the Naval Regional MedicalClinic in Hawaii.Ronald J. Kallen (Pediatrics, assistantprofessor, '60-'75) is head of the sectionof pediatric nephrology at the ClevelandClinic.Major Lewis L. Kramer (Derma­. tology, resident, '72-'75) is stationed atFort Gordon, Georgia, with the U.S. Army Medical Center DermatologySection.Steven G. Kramer (Ophthalmology,chief resident and instructor, '65-'71;Ph.D. '71) has been named professorand chairman of the department ofophthalmology at the University ofCalifornia, San Francisco. Dr. Krameris responsible for the coordination ofboth the teaching and research activitiesof the department. He is one of thenation's youngest major departmentchairmen.Allan L. Metzger (Medicine, intern­resident, '68-'70) has opened an officefor the practice of rheumatology-internalmedicine in Beverly Hills, California.Robert D. Moseley, Jr. (Radiology,faculty, '58-'71), professor of radiologyand chief of the diagnostic division of theUniversity of New Mexico School ofMedicine, was the first radiologist to beadmitted an honorary fellow of the RoyalCollege of Radiologists (England). Fol­lowing his admission on June 6th, hegave the inaugural address on the sub­ject, "The Future of Radiology: NewImaging Technology." As chairman ofthe American College of Radiology'sCommittee on International Affairs, hewill head the United States delegation tothe International Congress of Radiologyto be held in Rio de Janeiro in 1977.Bright Y, Onoda (Surgery, res iden t,, 56) is medical director of the depart­ments of anesthesia and respiratory careat Augustana Hospital, Chicago.Edith L. Potter (Obstetrics-Gyne­cology, faculty, '64-'67) was presentedan "award of achievement" for out­standing contributions to the discipline ofobstetrics and gynecology by the Ameri­can College of Obstetricians and Gyne­cologists at its 1975 annual meeting.Harry Prosen (Psychiatry, resident,, 58-' 59) was appointed professor andDr. Robert D. Moseley, Jr. (right) is welcomedon his admission to honorary Fellowship byProfessor J. Howard Middlemiss, president ofthe Royal College of Radiologists.45head of the department of psychiatry atthe University of Manitoba. He ischairman of the National ScientificPlanning Council of the Canadian Men­tal Health Association and of the Profes­sional Standards and Practice Council ofthe Canadian Psychiatric Association.Edward L. Sclamberg (OrthopedicSurgery, intern-resident, '65-'70) is inprivate practice at St. Francis Hospitalin Evanston, Illinois and on the attend­ing staff at Cook County Hospital,where he directs the foot, arthritis andback service.Jerry E. Sims (Pathology, resident,'71-'75) was promoted to major in theU.S. Army and is stationed at Fort Car­son Army Hospital, Colorado, in the de­partment of pathology.Marguerite Volini (Biochemistry, as­sistant professor, '68-'75; Ph.D. '65) isassociate professor in the departments ofbiochemistry and biophysics at the U ni­versity of Hawaii in Honolulu.46 Nominate a candidate fora Distinguished ServiceAward to be presented onMedical Alumni Day. Sendnames and qual ificationsto the Medical Alumni As­sociation by December 15,1975. CalendarMonday, December 1Reception for alumni and spousesduring American Medical Associ­ation Clinical Meeting, Honolulu,Sheraton-Waikiki, Hilo Room,5:30--7:00 p.m. Tickets at $10 perperson can be purchased at thealumni desk in the convention reg­istration area.Monday, April 5, 1976Reception for alumni and spousesduring the American College ofPhysicians Meeting in Philadel­phia. Details will be announcedlater.Thursday, June 10, 1976Medical Alumni Day.REMEMBER THE 1975 MEDICAL ALUMNI FUNDThere is still time to participate in the 1975 Medi­cal Alumni Fund. Remember, the deadline forgifts is December 31. In order for gifts to be cred­ited to the Medical Alumni Fund and to receiverecognition in the medical school's Honor Roll ofContributors, "Medical School" must be indi­cated on your check or envelope.We urge all medical alumni to support the1975 Fund. Our greatest need is for unrestrictedgifts to the medical school. However, all gifts,whether restricted or unrestricted, are neededand will be appreciated. Consider joining one ofthe following groups:Donors contributing $1,000 or more arerecognized as Medical Alumni Patrons andDean's Associates.Donors contributing $500 are recognizedas Medical Alumni Sponsors.Donors contributing $100 are recognizedas Century Club Members.Listed below are some of the named funds estab­lished by medical alumni and friends of theschool. You may wish to earmark your 1975 giftto one of them. Student AidWilliam E. Adams Loan FundWilliam Bloom Loan FundPaul R. Cannon Loan FundYing Tak Chan Loan FundColorado Alumni Loan FundGeorge F. Dick Loan FundJ. Nick Esau Loan FundJoel Murray Ferguson Loan FundLloyd A. Ferguson Scholarship FundAbraham Freiler Scholarship FundRoger N. Harmon Scholarship FundBasil Harvey Loan FundVictor Horsley Loan FundEleanor Humphreys Loan FundHilger P. Jenkins Loan FundDeane Lazar Loan FundFrancis L. Lederer MD.lPhD. ProgramFranklin Mclean Scholarship FundMedical Alumni Loan FundGeorge W. Merck Loan FundNorthern California Alumni Loan FundJohn F. Perkins Loan FundFrederick E. Roberg Loan FundCassius Clay Rogers Scholarship FundA. Lewis Rosi Scholarship FundBernard and Rhoda Sarnat Loan FundMary Roberts Scott Scholarship FundNels M. Strandjord Loan FundFrank W. Woods Loan FundSam Zapler Loan FundEugene and Esther Ziskind Loan FundOther Restricted FundsEmmet Bay Lectureship FundBatten's Disease Research FundJosephine Victoria Black Research FundClass of 1949 Gift FundDavis-Freedman Psychiatry Research FundCatherine L. Dobson Fund in Ob/GynLloyd A. Ferguson Library FundFisher Endocrinology Research FundBetty Frankel Housestaff FundGoldiamond Psychiatry Research FundJohn W. Green Sr. FundJ. P. Greenhill Foundation Fund in Ob/GynHoward Hatcher Research FundHans Hecht Lectureship FundVictor Horsley Research FundCharles B. Huggins Professorship FundLeon O. Jacobson FundAlex B. Krill FundJames A. McClintock Award FundWalter Palmer Visiting Professorship FundJohn Van Prohaska Library FundMedicine on the MidwayThe University of ChicagoThe Medical Alumni AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, Illinois 60637 NON·PROFIT ORG.U.S. POST AGEPAIDPERMIT NO. 9666CHICAGO, ILL.•Address corrections requestedreturned postage guaranteed