�edicine on the Midway J/ /Bulletin of the Medical Alumni Association The University of ChicagoDivision of the Biological Sciences and The Pritzker School of MedicineCover: In this issue of Medicine on the Midway we take a look at medicalstudents and housestaff at The University of Chicago----{heir involvement incommunity health care, their participation in a training program in generalinternal medicine, their fundraising efforts, and a profile of the freshmanmedical students. Pictured on the cover is Dr. Peter Gearen, intern.Medicine on the MidwayVolume 30, No.3 Winter 1976Bulletin of the Medical Alumni Association ofTh.e University of Chicago Division of the BiologicalSCiences and The Pritzker School of Medicine.Copyright 1976 by the Medical Alumni AssociationThe University of ChicagoEditor: Jay Flood KistContributing Editor: James S. SweetPhotographers: Mike Shields, Marc PoKempner,Ottawa KarshChairman 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) ContentsTosteson Appointed V-P for University MedicalCenter 4Profile-The 1975 Entering Class 4Joseph CeithamlBrendan Behan: A Remembrance 7Dr. Rory W. ChildersStudent Phonathon 9Implementing Quality Community Health Care viathe University Medical Center 10Dr. Chase Patterson Kimball and Linda KilianGunrburgerGeneral Internal Medicine at The Universityof Chicago 13Dr. Alvin R. TarlovWine & Cheese Party 16Studying Coronary Arterial Disease: SpecializedCenter for Research in Ischemic Heart Disease 18Dr. Leon ResnekovDecision Analysis and Human Factors in HealthCare 21Dr. Lee B. LustedA Rational Approach to Radiation Exposure ofPatients in the Hospital 23Lawrence H. Lanzi and Frances L. MoserPSROs, the Medical Profession, and the PublicInterest 25Odin W. AndersonAcademic RadiologyDr. Richard L. Landau 27News Briefs 31In Memoriam 3839Departmental NewsAlumni News 433Tosteson Appointed V-P forUniversity Medical CenterDr. Daniel C. Tosteson's appointment as Vice-Presidentfor the Medical Center at The University of Chicago wasannounced by President John T. Wilson on February 16.The Medical Center consists of the University's medicalfacilities and medical school located at 950 E. 59th St.Dr. Tosteson will continue in his present position asDean of the Division of the Biological Sciences and ThePritzker School of Medicine. In his capacity as Dean,he will report to President Wilson on academic affairsthrough D. Gale Johnson, Provost and Dean of Faculties.He will also provide staff support to the Board of Trust­ees Committee on Hospitals and Clinics.Dr. Tosteson will continue to act as Chairman of thedivisional department chairmen's committee, the execu­tive committee of the medical staff, and the divisionalfaculty, and to perform the other functions of the Deanof the Division.Profile-The 1975 Entering ClassJoseph CeithamlOnce again, for the medical class entering in 1975, a rec­ord number of applications was received. Whereas lastyear's class was selected from over 5,100 applicants, thelargest number up to that time ever to apply for an enter­ing medical class at The University of Chicago, therewere 5,428 applicants for the 1975 class. The enteringclass of 104 students consists of 18 women (two married)and 86 men (seven married). Of the nine married stu­dents, only one of the men had a child at the time theclass began its medical studies. Eight of the entering classwere selected for the Medical Scientist Training Program(MSTP) which leads to both M.D. and Ph.D. degrees insix calendar years. The MSTP trainees began theirstudies on campus in the Summer Quarter of 1975. Theother 96 students initiated their four-year program lead­ing to the M.D. degree in the Autumn Quarter of 1975.Of the entering students, 100 possessed at least a bac­calaureate degree. Four also had achieved Masters de­grees and two had Ph.D. degrees (one in chemistry, theother in biochemistry). Included in the class are fiveblack and five American Oriental students, as well asthree foreign students (one each from Canada, HongKong and Indonesia). See T a hie I.The age range in the class is relatively narrow, despitethe fact that four students entered after only three yearsof college preparation, and two students had Ph.D. de­grees. The youngest member of the class is one of theMSTP trainees who wasn't quite 19 when he began hisdual degree program of studies on our campus. The old-4 est person in the class is a Ph.D. who was 28 years of agewhen he began his medical studies. The average age ofthe entering class is 22, with 93 of the students being 22years of age or younger at the time they began their med­ical studies.Dean Ceithaml with freshman Sheila Fallon, a member of the MedicalSchool Council.As seen in Table II, 51 different colleges and univer­sities are represented in this year's entering class. TheUniversity of Chicago, as expected, provided the largestnumber of students, 24, followed by the University ofIllinois, Urbana, with nine. Next came Johns HopkinsUniversity, Northwestern University and PrincetonUniversity with four each; followed by Carleton College,Carroll College of Montana and the University of NotreDame with three each. The remaining 43 schools had oneor two representatives each.Table III indicates the geographical distribution of the104 students by state residence. As usual, Illinoisclaimed the largest number, 39; California followed witheight; New York had six. Delaware, Florida, New Jerseyand Pennsylvania each had four. The remaining studentsdeclared residence in 19 other states and one foreigncountry.The entering class possesses the following academiccredentials. The average cumulative grade point average(GPA) in all college studies was 3.65 on a scale where 4.0equals A and 3.0 equals B. The entering class did equallywell in both the non-science and the science areas, and,like its predecessors, did very well on the Medical Col­lege Admission Test (MCAT). The average total MCATscore was 635, which falls within the top 20 percent of allU.S. applicants to medical schools last year. The class asa whole did particularly well in the MCA T subtests inmathematical skills and in premedical sciences, wheretheir average scores in each case exceeded 670. It is alsointeresting to examine the academic majors which theentering students chose to pursue in college. As in previ­ous years, most of the students majored in the sciences,Table I: Entering Medical Class, 1975EnteringClass ApplicantsSingle men 79Married men 7Married men with children (1)Total men 86 4,259Single women 16Married women 2Married women with chil-dren (0)Total women 18 1,169Ph.D.'s 2Oriental students 5Black students 5Foreign students 3CanadianHong KongIndonesianTotal students 104 5,428 particularly in biology (40 percent) and chemistry (22percent). Eleven percent, however, were non-sciencemajors. As seen in Table IV, 71 percent of the womenwere either biology or chemistry majors and 15 percentwere non-science majors in college.Table II: Undergraduate College DistributionUniversity of Arizona (1)Barnard College (1)Boston University (1)Bowdoin College, Maine (1)Brigham Young University, Utah (1)Brown Un iversity, Rhode Island (1)University of California, Santa Barbara (1)Cal ifornia State University, San Jose (1)Carleton College, Minnesota (3)Carroll College, Montana (3)Carroll College, Wisconsin (1)University of Chicago (24)Columbia University (1)Cornell College, Iowa (1)Cornell University (1)University of Delaware (1)University of Florida (1)Franklin-Marshall College, Pennsylvania (2)Georgetown University (1)Grinnell College, Iowa (1)Harvard University (2)Haverford College, Pennsylvania (1)University of Illinois, Chicago (2)University of Illinois, Urbana (9)Johns Hopkins University (4)Lawrence University, Wisconsin (1)Long Island University, New York (1)Loyola University, Chicago (2)University of Massachusetts, Amherst (1)Massachusetts Institute of Technology (1)Michigan State University (1)University of Michigan (2)University of Missouri, Columbia (2)Montana State University (1)University of Nebraska (2)Northern Illinois University (1)Northwestern University (4)Notre Dame University (3)University of Oklahoma (1)Penn State University (1)University of Pennsylvania (1)Princeton University (4)Radcliffe College (1)College of St. Thomas, Minnesota (1)University of Southern California (1)Texas Christian University (1)Wabash College, Indiana (1)Washington University (1)University of Washington (1)Wesleyan University, Connecticut (1)Yale University (1)Number of schools: 515Since it has been, and continues to be, the policy of theCommittee on Admissions to evaluate applicants on theirown merits, it is not surprising that the family back­grounds of the entering students are quite varied. Eightmembers of the entering class come from families whereone or both parents had less than a high school educa­tion. On the other hand, 67 of the students come fromfamilies where one or both parents are college graduates.Incidentally, twelve students come from University ofChicago alumni families (11 fathers and six mothers); infive instances, both parents are alumni. Five of thealumni fathers are graduates of our medical school (fourfrom the South Side campus and one from Rush MedicalCollege). Three of the alumni fathers and one alumnamother received Ph.D. degrees from our University; theothers attended our undergraduate College.The occupations of the parents of our entering studentssimilarly cover a wide spectrum of the professions, in­dustry and labor. Included among the fathers are IIphysicians, eight engineers, five chemists, five mer­chants, three school teachers, three insurance agents,three sales managers, three plant managers, two businessexecutives, two editors and two ministers. Also rep­resented among the fathers are an auto mechanic, artist,banker, baker, butcher, dentist, lawyer, and stockbroker, as well as various merchants and tradesmen. Ofthe remaining fathers, nine were retired and six de­ceased.Approximately one-half (54) of the mothers arehomemakers; the remainder have additional careers. Inthis latter group are 14 school teachers, six secretaries,four registered nurses, four college professors, threesales clerks, two sales managers, two real estate brokersand two administrative assistants. Also included amongthe mothers are an accountant, librarian, organist, X-raytechnician, cook, seamstress, interviewer, manufactur­ers' representative, food supervisor, and telephoneoperator. The mothers of three of the entering studentswere deceased.The 1975 entering medical class, like its predecessors,has been highly selected and has every potential to be­come outstanding. Through the combined efforts of thisexcellent student body and of our fine faculty, the poten­tial of this entering class should be realized. For all mem­bers of this entering class we wish every success in theirmedical studies, followed by long and productive profes­sional careers.Joseph Ceithaml is Dean of Students in the Division of theBiological Sciences and The Pritzker School of Medicineand Professor in the Department of Biochemistry.6 Table III: Geographic Distributionof Entering ClassArizona 1 MissouriCalifornia 8 MontanaColorado NebraskaDelaware 4 New JerseyFlorida 4 New YorkIdaho 1 North DakotaIllinois 39 OhioIndiana 1 OklahomaIowa 2 OregonKansas 1 PennsylvaniaMaryland 3 WashingtonMassachusetts 3 WisconsinMichigan 1 Hong KongMississippiNumber of states: 26Number of foreign countries: 1Table IV: Academic Major DistributionMajor Men Women TotalBiochemistry 6 1 7Biology 33 12 45Biophysics 3 0 3Chemistry 22 3 25Engi neeri ng 2 0 2General Studies 0 1Genetics 1 0German Literature 0 1 1History 1 0 1Mathematics 2 1 3Microbiology 5 0 5Natural Sciences 0 1 1Physical Sciences 1 0 1Physics 3 0 3PreprofessionalStudies 2 0 2Psychology 7 1 8Religion 1 0 1Social Studies 1 0 1Zoology 3 0 3Totals 93* 21* 114**Seven men and three women carried double academicmajors. 433464132Brendan Behan:A RemembranceDr. Rory W. ChildersDr. Childers first mN Brendan Behan, Irish poet and play­wright, in a Dublin pub, while he was medical student atTrinity College. He became Behan's close friend, and laterhis physician, until the poet's death in 7964. Dr. Childers isAssociate Professor in the Cardiology Section of the De­partment of Medicine, and Director of the Electrocardio­graphic Services Laboratory.In 1955 Brendan called me at Baggot St. Hospital and welunched in Mooney's overlooking the bridge. He wasworried. He had never dreamed of slaking his thirst withanything else but beer or stout, but lately had started,particularly at night, to drink water in prodigious quan­tities. The diagnosis was entirely clear as he spoke-hisbreath was loaded with acetone. I admitted him to afour-bed ward in Baggot St. Hospital in the care of Pro­fessor Victor Millington Synge, and he was started onmodest doses of insulin. Lying in one corner was a surgi­cal patient in his fifties who, after every complicationimaginable (gastric perforation, peritonitis, subphrenicabscess, intestinal obstruction, wound dehiscence, pul­monary embolism) had settled down in his bed in a terri­ble, but decisive, calm. A patient under these circum­stances can heavily influence the outcome by painfullycoughing up, or not coughing up, the accumulated secre­tions in his lungs. Brendan, from the time he entered theward, took on the salvaging task. The patient's rapidshallow respirations, which were defeating the normalcough reflex, were soon replaced by the deep and jaggedBrendan Behan. (Reprinled, by permission, (rom Dominic Behan, MyBrother Brendan, © 1965 by Simon and Schuster.) sighs which are inevitable if one is forced into laughter.And he was.The first hospitalization of Brendan was a series ofanti-clerical uproars: he raced into the doctors' diningroom shouting, "Help! Rory, the Druids are after me!"He insisted on meat instead of fish on Friday, voicing thewell known credo: "The only time one refuses flesh iswhen you're too ph ... ing sick to eat it or too ph ... ingbroke to buy it."One day I entered the ward and found Brendan on hisknees at the foot of a patient's bed. loudly intoning,"Aamin i-daarnin i-aamin i-daamin i-aarni n i.' I t soundedvery like the noise of Soviet radio jamming. An18-year-old candidate for the priesthood was about to betaken to the operating room to have his tonsils removed,and Brendan had decided to "hear" his last confession.He would leap off his knees and bend his head down,pretending to hear what the lad had to say. The patient,who was thoroughly premedicated with morphine andhyoscine, was so groggy he was only able to smile. Bren­dan would pretend to repeat some of the details of theconfession. The concocted sequence. which made refer­ence to all manner of farmyard animals, would havemade Kinsey blush.When V. M. Synge told Brendan, on the day he wasreleased from hospital. that he must always carry a lumpof sugar wherever he went, he asked, "In case I meet ahorse?"Brendan's diabetes was ever to enhance the precariouscharacter of his life as an alcoholic. Drinking threw hisdiabetes out of control; he would start to thirst exces­sively and continue drinking. However, in the manytimes he and Beatrice, his wife, visited our flat between1960 and 1963, my wife and 1 never saw him touch adrop. He would telephone, "Have you soda siphonsthere?" He consumed two or three sodas per evening, apicture of total effervescence.The energy of Brendan's social monologue was pro­digious; it frequently became a play within a play withinplay ... The sidetrackery was not confined to narrativealone; he was given to staying with names, the sonorityof which, for whatever reason, occupied his fancy:Donagh MacDonagh-McDonagh-McDonagh. He oncegot so hung up on the dozen or so ways in which Stam­boul or Istanbul were spelt or pronounced that Ithreatened to leave if he persisted.The' narrative performance required stage space; en­tries and exits were simulated-the character switchwas preceded by a step backwards and a change in gait orcarriage. You could soon identify his clergy charactersby stance alone: he would purse his lips, speakingthrough a pupil-size mouth, extend his neck, tuck hischin into his chest, and slant his head slowly from side toside-an orthopedically outrageous sequence. Mean­while, he would exaggerate his paunch and allow it to besupported or cupped by his arms, the finger pads of histwo stubby hands just overlapping each other in front.The cleric's position in the hierarchy was probablysignified by the degree of depression of the chin. It con­ceivably blanched the skin of his breastbone when hebecame a bishop. His imitation of toothless rural old age7pensioners was a fantastic sequence. It would haveserved equally well for a babushka in Kiev. There wasplenty of movement: strutting, walking on his knees,praying, dancing three or four steps of a jig.Sooner or later he would burst into song. The reper­toire, English and Gaelic, was voluminous, and includedvirtually every patriotic song of the last two hundredyears. It included, of course, "The Zoological Gardens"and "L'rn Lady Chatterley's Lover." The amplitude wasinvariably fortissimo, and his slightly abducted armsseemed to reinforce the extraordinary intensity of thevoice-it was marvellous.His desire to entertain was not derived, as some haveassumed, from insecurity. He was above all the itinerantplayer, minstrel, raconteur, clown, troubadour, sean­chus. He was in many ways Chaucerian in character. Hisstories would have been entirely in place on the Road toCanterbury. He would also have been less frequently introuble in those medieval times, when the distance be­tween taverns was greater.He took pride in the fact that the whores of Paris calledhim Monsieur Rabelais. They were not far off the mark:not because of Brendan's obedience to the oracle of LaDive Bouteille (Pantagruel was told simply, "Buvez "i.e ., "drink!"), but because most of his life was an extraor­dinarily restless progress, a series of living arpeggios;he never said no to even the possibility of a fresh experi­ence. His attitude toward every kind of humanenterprise-intellectual, gastronomic, sexual. orexcretory-was one of extraordinary curiosity, gusto,and keen observation. I recall him questioning GershonWeiler carefully and with great amusement about themanagement of latrines in the Israeli Army. Because ofthe speed with which the duty-detail shoveled earth intothe ditch, one was never able to look around and seewhat one had achieved.Of Brendan's excessive use of four-letter words onecan say only this: few people could be at the same timeDr. Rory W Childers8 so outrageous and yet so inoffensive. Very soon after wemet, I took an attractive freshman Baptist girl (bent on amissionary life) to Davy's for lunch. She had just told mehow this, her first entry into a pub, would conceivablycause her father to self-destruct. Then Brendan ap­peared. He was covered in paint. His eyes were blood­shot. He was in the alcoholic horrors. His fly buttonswere open, disclosing (at the very least) his underwear. Iwas, of course, on all fours, my head under the tiny table,looking for invisibility. As he sat down with us, he said"Jaysus, she's so beautiful, I'd like to lick her all over."Her reaction (as if her heels had been uncorked and thesluices drained) was followed immediately and clearly byher appreciation of the flattery. I suspect this was thereason she never spoke to me again.There were only two occasions on which Brendancould be a bore: when he discussed politics, and when hewas drunk (he was probably the most boring drunk of histime). On other occasions one found oneself, more oftenthan not, going through a sequence of initial embarrass­ment, invariably on behalf of other people who werepresent, followed by a feeling of total relaxation and en­joyment. One realized that the entire situation was out ofcontrol and pleasurably riotous. In theatrical terms, onecould not use the expression "situation comedy" -"tidalwave" would have been more appropriate. I recall afrightfully earnest English tourist who had just arrived offthe plane on his first visit to Ireland. He entered theBailey, and had started to ask where he would find the"real" Ireland. Brendan entered with the group, whichincluded one of those Silent Men who were always intro­duced as havingjust finished a protracted prison sentencein England for trying to blow up something or other with"jelly" (his friends' devices never seemed to explodesuccessfully). They had just come from the funeral of thefather of another member of the group, an artisan of somekind. The Englishman took an uncomfortably long timeto express condolences. We were silent for a while. Thenfollowed this sequence: "How do you know he was re­ally dead?" "They stop twitching after a while." "In theold days, didn't they put a stake through their heartsrather than risk burying them alive?" "Don't worry lad,I'm sure he had no more life in him than a hunk of meat."The Englishman looked as though he had simultaneouslydeveloped enteritis and found himself chained to thebench. He couldn't know that the entire group was stiffwith it-the traditional anesthesia of the wake.Brendan's Gaelic translations were invariably mis­chievous. A sixteenth century Irish priest's poem ex­plains that the Episcopal Church in England originatedwith Henry VIII's desire for a divorce. Brendan's trans­lation:Don't speak of the alien ministerNor of his church without meaning nor faithFor the foundation stones of his templeAre the balls of King Henry the Eighth.Dying, Brendan could still be more or less outrageous.Beatrice describes how he turned to the nun who wasnursing him and said, "Bless you, sister, may all yoursons be bishops."Dean RiderDeborah EdelmanDeborah Weiss StudentPhonathon"I'm grateful to be here at ThePritzker School of Medicine, and Iwanted to do something about it,"says Douglas Given, one of tensecond- year medical students whospent the evening of November 11calling Chicago area alumni to en­courage their year-end support ofthe Medical Alumni Fund.The students discussed the RobertO. and Barbara Anderson Challengefund with the alumni, stressing theimportance of making a first gift, orincreasing the amount of a previousgift. The response? Contributionsfrom those contacted totaled $6,720;of that amount, $2,965 was eligiblefor matching funds from the Ander­son Gift. The grand total: $9,685.The largest single gift was $1,100,which included a $500 increase overa past gift.William B. von Stein, AssociateDirector of Development for theDivision of the Biological Sciencesand The Pritzker School ofMedicine, and Douglas Given or­ganized the phonathon, which washeld in the Development office inthe Administration Building from7:30 to 10:00. The students met fordinner at the Quadrangle Club be­forehand, as guests of the MedicalAlumni Association.Asked the students' response toparticipating in the pho nathon ,Given replied: "Everyone was veryglad to help, and would be happy todo something like this again."Not pictured: Daniel Duffey, Douglas Civen,Warren Post, Ruth Whitham. Peggy BarronDavid OxfordJeanine Car/son9Implementing QualityCommunity Health Care via theUniversity Medical CenterDr. Chase Patterson Kimball andLinda Kilian GunzburgerAt a time when the attention of the nation and ofmedicine in general is turning toward the more effectivedistribution of health resources for the prevention, detec­tion and remedy of illness and disease, academic centersgeared to the technology of the biomedical revolution ofthe past quarter century suddenly find themselves help­lessly deficient in resources to face what are doubtlessthe major challenges of the next quarter century.As The University of Chicago, similar to other majoruniversities, emerges into this new era of health educa­tion, research and service, it finds its resources in almostevery respect woefully inadequate to accommodate itselfto the changing social, political and financial patterns ofthis medical evolution.Academic medical centers will become increasinglyinvolved in all levels of education and training. This willrequire simultaneous solutions to problems regarding thekinds of students suited to medical-scientific careers, thesetting in which they should be taught, the content oftheir education and training and the allocation of publicand private resources to this enterprise. The criticalcomponent in this process, however, will be the teachers.They must select future students, create model teachingenvironments, define a curriculum relevant to the needsof both their students and their patients, provide oppor­tunities for continuing education and training which focuson improving the outcome of patient care, and assure thatsufficient resources are available to carry out these tasks.While many physicians will make essential contributionsas part-time teachers, there is an immediate need forphysicians prepared to assume full-time academic re­sponsibility for the education and training of generalpediatricians and internists. This preparation must in­clude skills in the disciplines of education, evaluationresearch and social policy relevant to medical care andteaching.The teacher functions as the intermediary between thepublic and the health care system, and it is essential thatstudents understand the issues and conflicts which arisebetween the two. They must understand the behavioralaspects of patients seeking health care, the dynamics ofthe physician/patient relationship, the impact of illnesson personal and family behavior, and the special prob­lems of the poor and the aged. On a broader level, theymust understand the social, economic and political as­pects of health care, and their impact on the life of thecommunity and the nation. They must understand theessential contribution of non-physicians, both within andoutside the health care system, in determining the settingin which personal health services operate. The distinctroles of consumers, legislators, professional and indus-70 trial organizations, and health care institutions in shapinghealth policy must be understood, and the contributionthe general internist or pediatrician can make to suchpolicy questions appreciated.Plausible SolutionsTo address this problem, the University has established aCommittee on Community Health Affairs and Hospitalswhose charge has been to: (a) Develop guidelines for theUniversity's involvement in community health affairs asit relates to educational, consultational and referral ac­tivities; (b) implement experimental programs to test thevalidity of one or more models by which the Universitycan effectively evaluate these guidelines; and (c) reviewthe present education, research and service activities ofthe University in terms of their relationship to extramuralarrangements.In the two years that this committee has been in opera­tion, it has developed a faculty committee convened bythe Dean of the Division of Biological Sciences under theadministrative office of Dr. Clifford Gurney (,51), DeputyDean for Clinical Affairs. Dr. Gurney believes the futureof the medical center depends upon the activity of thiscommittee to establish guidelines and actively establishcontacts with community hospitals in the south Chicagoarea and northern Indiana. These contacts will includeprovision of educational services and the establishmentof referral patterns for obtaining patients who require theservices of a tertiary hospital. He sees the need to createa model liaison with a community hospital which, withmodification, could be replicated with six to eight otherhospitals over the next three or four years. These rela­tionships are mutually vital to the survival and quality ofboth The University of Chicago and the community hos­pitals in terms of patient care, education and research.The financial aspects are all-important. In terms of costs,we cannot compete for patients requiring secondary care.On the other hand, community hospitals do not have,cannot afford, and could not service the diagnostic andtherapeutic facilities necessary for patients requiringhighly expensive tertiary evaluation and treatment.The Committee includes the chairmen of the depart-Meeting of the Committee on Community Health Affairs and Hospitals.ments of medicine, pediatrics, and surgery; the divisionchiefs of radiotherapy, community mental health, andliaison psychiatry; University of Chicago coordinators ofteaching programs at community hospitals; the directorof the Center for Health Administration Studies; the di­rector of The University of Chicago Hospitals andClinics; and representatives of other divisions and unitsof the University. This committee meets weekly as aforum to discuss plans developed and/or implemented byits five subcommittees:The Committee on Community Hospitals, comprisedof the coordinators of these programs, develops and im­plements medical/educational programs in southsidehospitals.The Committee on Prepaid Health Programsaddresses itself to the relationship of the Universityclinics and hospitals to proposed prepaid health programsin the University community (Hyde Park/Kenwood,Woodlawn).The Committee on Inter-Hospital Services considershow an effective referral process can be implemented andaccommodated by the University clinics and hospitals.The Committee on Health Services studies the feasibil­ity of establishing an inter-divisional academic committeeof individuals working on health-related matters whocould develop common educational, teaching and re­search objectives.The Committee on Continuing Education reviews theUniversity's present Frontiers of Medicine program andother postgraduate medical education programs, and isevaluating their relationship to new programs in thecommunity hospitals.AchievementsDuring its tenure, the Committee has:1. Commissioned a study of the health resources ofthe metropolitan area, with particular reference toChicago's south side, and their implications for the roleof the University hospitals and clinics. This report, pre­pared by Stephen Davidson of the Social Services Ad­ministration and Odin Anderson of the Center for HealthAdministration Studies, has already proved a valuablereference for committee members in their deliberations.2. Entered into contractual arrangements with com­munity hospitals for educational-consultational programswhich have been developed with six southside commu­nity hospitals (Gary Methodist, South Chicago Commu­nity, South Suburban, Little Company of Mary, IllinoisCentral Community, and Holy Cross Hospitals). Dis­cussions continue with several other hospitals (JacksonPark, Woodlawn, St. Elizabeth's, St. Bernard's, Provi­dent, and People's Hospital in Peru, Illinois) as well aswith two local health maintenance organizations (W ood­lawn, Hyde Park/Kenwood). People's Hospital providesa contrasting rural population base for student educationand medical research.3. Established liaison activities with Mark Lepper, theCommissioner of Health for Illinois; Leon Finney, Di­rector of The Woodlawn Organization; The Mid-South­side Planning Commission; the Illinois Council for Con­tinuing Medical Education; and administrators of com- munity health activities for other universities in Chicago.4. Frontiers of Medicine-This program of providingeducational programs at the University for practicingphysicians is being reshaped to include community hospi­tal locations as well as University medical facilities inorder to meet the physicians' medical education needs.5. Established the Office of Postgraduate MedicalEducation. This office develops, implements and coordi­nates the teaching, consultation and other health agen­cies with The University of Chicago Hospitals andClinics. As of October 1, 1974, Mrs. Linda Gunzburgerassumed the administrative and coordinating functions ofthis office. The primary objectives of the Office of Post­graduate Education are to:a) Develop a central office for the coordination andadministration of University activities at Chicago'ssouthside community hospitals.b) Establish at least three clinical fellowships for resi­dents of medicine and pediatric programs who de­sire experience in the development and administra­tion of educational programs in community hospi­tals. These fellowships would be held while the res­idents pursue courses in the postgraduate schools ofThe University of Chicago (such as social servicesadministration, or the school of business adminis­tration).c) Assist in developing an organized system of healthcare between the University and the communityhospitals and health agencies.6. Inaugurated and/or participated in the followinggrant applications to private and public agencies, with aview toward developing resources to augment its role inplanning and development:a) Cancer Control Program. Application was made tosupport a teaching program on the detection andmanagement of cancer at the University and com­munity hospitals. Funding has been received and aplanning office set up under Drs. John Ultmann andChase Kimball.b) National Fund for Medical Education. This is agrant application to develop an office of medicaleducation to coordinate the University's activitiesin community hospitals and to establish a trainingprogram for directors of medical education. Thegrant was funded for the year 1974--75.c) A response to the Governor's request for programsto increase the number of physicians in the state.This is a suggestion of financial support for Univer­sity involvement in postgraduate education pro­grams for residents and staff in community hospi­tals. The proposal is pending, but it is unlikely thatthe State has the resources to support it.d) Clinical Scholars Program of the Johnson Founda­tion. This proposes a two-year training program forphysicians qualified in medical specialties tobroaden their knowledge of public affairs by pursu­ing a graduate program in one or several of the so­cial sciences while pursuing clinical activity in acommunity hospital or prepaid health program. Thegrant application was not funded, but should proba­bly be resubmitted.1 1e) Proposal to the Kaiser Foundation for additionalmonies to support the administrative expenses ofe s tabli sh i ng ed uca tion ai-co ns u I tat ion ai-referralprograms with community hospitals and healthagencies and a Fellowship training program forgeneral internists and pediatricians who would as­sume both clinical practice and director of medicaleducation duties in a community hospital. Dr. AlvinTarlov (,57) has been successful in obtaining fundsfor this program.f) Proposal for support to further investigate thefeasibility of developing a system of health care for.. River City," a community to be built on the eastbank of the Chicago River. The University Boardof Trustees recommended waiting to determine thefinancial stability of the project.g) Advanced Training Program in General InternalMedicine. This has been sent to the Health Re­sources Services Administration for funding. Theprogram will prepare general internists to assumeleadership positions as medical education directorsin community hospitals or as academic teachers ofgeneral internal medicine in medical schools.Physicians who have completed three years oftraining in internal medicine will be appointed Fel­lows for the two-year program. Emphasis will beplaced on developing broadly based skills in generalinternal medicine, particularly the ability to care forpatients with both common and complex medicalproblems in both ambulatory and inpatient settings.Special attention will be given to the Fellow's abilityto utilize consultants, provide consultation to otherphysicians and wisely apply fundamental principlesof clinical therapeutics.Upon completion of the program, the Fellow willbe recognized as a committed clinician and teacherof general internal medicine, and as such will beprepared to make unique contributions to medicalcare and education and to the organization andevaluation of personal health services. As a mul­tidisciplinary endeavor, the Advanced TrainingProgram in General Internal Medicine and Pediat­rics will have a significant impact upon patient care,medical education and health services researchwithin the Departments of Medicine and Pediatricsand the Division of Biological Sciences. It will giveadded strength to present and future programswhich relate the University to a larger communityof physicians and health care institutions.h) The Committee has prepared a Pr e c ept orshipProposal for first-year medical students. The coreof the proposal is the assignment of students fromThe University of Chicago Pritzker School ofMedicine to locations served by the NationalHealth Service Corps, in an arrangment similar to aprogram described by Dr. Kimball in Yale's Pro­gram ill Medicine and Psychiatry. These are areasof acute medical manpower shortage and conse­quently demand careful marshalling of availablemanpower. This program has been funded by theDepartment of Health, Education and Welfare.72 Dr. Alvin Tarlov examines a patient who is a resident of the LaSalle-Peruarea of Illinois.Future PotentialThe Committee holds a biweekly colloquium that bringstogether representatives of the various divisions in­terested in developing a forum for teaching and for re­search. For some time the Committee has considered thewisdom of proposing an academic Committee on HealthServices Research and Education in the Division ofBiological Sciences. This would give authenticity to andsupport for many of the activities presently undertakenby the Committee, by fostering faculty development ininterdisciplinary research and educational activities relat­ing to the areas of community health problems. To someextent, it might serve as a counterpart to the Center forHealth Administration Studies, but would be basedprimarily in the Division of Biological Sciences. Its re­search emphasis would be on the greater area from whichthe University draws patients. Its educational emphasiswould be on the development and integration of pro­grams in conjunction with other University departmentsalong the continuum of medical education, includingpre-medical, undergraduate, graduate and postgraduateprograms as these relate to community health. In thisway, social and behavioral scientists, includingepidemiologists, would be brought into the milieu of thedivision, collaborating with biological and medical scien­tists on research and educational activities.To a considerable extent, the foundation for this con­cept has already evolved. For example, several membersof the Committee are involved at the college level inplanning courses related to social and health issues.Others have been intimately involved in the first-yearmedical school course in Social and Ethical Issues inMedicine. Four individuals have developed electiveprograms in which medical students spend time workingin urban and rural health programs. Ten or more medicalstudents per year take electives in the Center for HealthAdministration Studies. A training program for directorsof medical education has been initiated and funded. Thisprogram is presently under revision with a proposal thatthe trainee receive a master's degree in education. Anoffice for post-graduate education has been established tobring some rigor to our educational programs developedin conjunction with community hospitals and healthagencies, along the lines of assessment of needs, de­velopment of objectives, identification of methods, anddevelopment of criteria for evaluation. This office, withliaison from the department of education, is engaged inplanning residency programs in primary internalmedicine and family medicine for community hospitals, and helping the latter develop an audit system. The sub­committee on Health Services continues to consider theneed for University-related prepaid health plans andprimary care programs in terms of research and educa­tional activities. In addition, there is the need to considermore extensively the development of imaginative newinvolvements of the University, such as the "RiverCity" proposal, application for a student externshipprogram in the National Health Corps, and developmentof an M.D'/Ph.D. program in the Behavioral and SocialSciences.Or. Chase P. Kimball, Chairman of the Committee on Com­munity Health Affairs and Hospitals, is Associate Professorin the Departments of Psychiatry, Medicine, and BehavioralSciences, and in the College. Linda Kilian Cunzburger is Ad­ministrator of the Office of Postgraduate Medical Education.General Internal Medicine atThe University of ChicagoDr. Alvin R. T arlov(AUTHOR'S NOTE: An affiliation between The University ofChicago and Michael Reese Hospital, which has becomeespecially close in internal medicine, was begun in 1969.Since the housestaff training programs have not been in­tegrated up to this time, the Michael Reese program willnot be described here.)HistoryFormal subspecialization of internal medicine had its be­ginning at The University of Chicago in 1927, when thenew medical school opened. The founders believed thatconcentration on a single organ system would allow eachfaculty member to master a field in great depth, foster amore learned and scientific teaching environment, bringextraordinary expertise to patients in disciplines wherethey would benefit most from it, and encourage clinicaland laboratory investigation.During the ensuing 40 years the subspecialty conceptwas further enriched and refined. Although some at­tempts at general medicine were made at the University,these were not durable. By the 1960s each of the ninesubspecialty groups had its own outpatient unit and itsown separate inpatient service. General internalmedicine as an attractive specialty had for all practicalpurposes disappeared. By 1968, 97 percent of the 39,000outpatient visits were in subspecialty clinics, and 90 per- cent of the 206 medical beds were assigned to categoricalservices.A faculty committee was convened in 1969 to considerways to improve our medical student and housestaffprograms. The committee concluded that a vigorous ef­fort in general internal medicine was needed to comple­ment the subspecialty organization. That year the firstgeneral internist, the late Dr. Lloyd Ferguson ('60), wasrecruited into the program. The past five years have seenthe following accomplishments:1. 66 of our 206 medical beds were allotted to generalinternal medicine.2. Dr. Richard Byyny was recruited to head the gen­eral medicine program.3. A four-bed intensive care unit was established as anintegral part of general internal medicine.4. Dr. David Fedson was recruited to develop thegeneral internal medicine outpatient unit. There areabout 15,000 patient visits per year there.5. General medicine was granted Section status, or­ganizationally equivalent to each of the subspe­cialty sections.6. A general internal medicine consultation servicewas established, under the direction of Drs. DavidLichtenstein and Mark Siegler (,67), to providesame-day or immediate consultation to patients onthe inpatient surgical services.737. We established relationships with six communityhospitals to the south of the University, wherebywe provide an educational program for their doc­tors in their hospitals. The faculty in the generalmedicine section spearheaded this program. Inturn, these hospitals have provided an enormouslyrich source of referred patients to the University.8. There are now five faculty members in the generalmedicine section. Four of them have been chiefresident. In addition, there are three adjunct mem­bers: one whose primary appointment is with thehospital's emergency medicine group, and two inthe student-employee health service.9. The general medicine effort is truly a departmentalprogram which has gained broad faculty supportand is the source of considerable departmentalpride. Of the attending physicians assigned to theinpatient service, approximately half are from thesection of general internal medicine, and half arefaculty from the subspecialty sections who have adesire for and a strong capability in general internalmedicine. Every subspecialty section participatesin the general medicine program.The Training ProgramThe developments described above have allowed manybeneficial modifications in our educational programs.Every medical student is assigned to the generalmedicine inpatient service for one month during the prin­cipal third-year clerkship. Approximately one-fourth ofthe class take their third-year clerkship at Michael ReeseHospital where the inpatient orientation is almost en­tirely in general medicine. Senior electives are also avail­able.Each house-officer is assigned to the general medicineinpatient service for approximately three months duringeach year of the three-year training program. Most seniorresidents gain substantial experience in providing generalinternal medicine consultations to surgical patients.Each house-officer, beginning during internship, at­tends a single three-hour session each week in the generalinternal medicine outpatient unit. There they see patientsby appointment; a few are new patients but most arepatients they have cared for during hospitalization. Asizable and rich practice is built by each housestaffmember, and the commitment to the patients is for long­term, comprehensive, and personal health care.A two-year fellowship training program to preparephysicians for careers as academic general internists oras Directors of Medical Education in community hospi­tals has just begun. Entrance into the program requirescompletion of three years of internal medicine training.Cu rrent DevelopmentsOutpatient Program. The emphasis here will be on com­prehensive long-term health services for patients, and alongitudinal outpatient experience for trainees. The pres­ent large practice will be subdivided into several smallerones, each with one faculty member from generalmedicine, one fellow, several interns and residents, onenurse practitioner, a social worker, and a secretary-74 coordinator. Each smaller practice will function as agroup and will provide 24-hour telephone access for itspatients. More effective record systems will be studied,and more efficient laboratory, X-ray, and pharmacy ser­vices sought. We will make physical modifications toprovide each practice with a waiting room, secretarialspace, nurse's office, examining rooms, and dictationsystem. Modifications in administrative support systemswill also be proposed. This program, under the directionof Dr. Fedson , receives financial support from the KaiserFoundation, and utilizes the systems and design capabil­ity of Medserco , Incorporated, a private health manage­ment and consulting firm.Preparing future faculty for careers in general internalmedicine. The fellowship training program mentionedabove will be refined. Two new trainees will be admittedeach year. Although the emphasis will be on general in­ternal medicine, other experiences will be introduced tomore effectively prepare the trainees for careers asteachers and researchers. Substantial course work, tutor­ials, and research experience will be provided by facultyin the departments or schools of Clinical Pharmacology,Education, Library Science, Sociology, Social ServiceAdministration, and the Center for Health Administra­tion Studies.Urban and Suburban Community Hospitals. Some ofthe hospitals with which we have become related duringthe past four years have developed programs that mightsoon be suitable for assignment of our medical residentsand medical students. Some have hired a Director ofMedical Education; others have hired full-time or part­time physicians in their departments of medicine to directtheir educational programs, or their intensive and coro­nary care units. Some have developed or improved theirhousestaff programs, others intend to develop a "teach­ing service" and hope to attract our housestaff to it. Atwo-month experience at the resident level in a commu­nity hospital would seem appropriate in our three-yeartraining program in internal medicine.Rural Community Hospital. One hundred miles westof Chicago, in a primarily agricultural area, are clusteredthe three communities of LaSalle, Peru, and Oglesby.Their combined resources include a population of 30,000,two hundred hospital beds, twenty physicians (17 aregeneral practitioners), and no internists. A new doctorhas not come to this area to practice in the past 16 years.There is a strong community desire to improve medicalcare. Again, through the support and help of the KaiserFoundation and Medserco, Incorporated, together withadditional financial help from the Community Hospital,we have undertaken a study bf medical resources, physi­cians' practices, medical needs, and educational needs oftheir physicians and of our students and housestaff. Inaddition to a continuing education program of the sort wehave at other community hospitals, we hope that a newdoctors' practice building will be constructed adjacent tothe hospital. We dream of creating a new three-personprivate practice of internal medicine in that building,which we call a teaching practice. The three internistsmight be graduates of our own program, and they mighthave academic titles in our department. Their office suitewould be built to accommodate two of our medical resi­dents, two of our medical students, and a small internalmedicine library. Communication might be improved bya television system connecting our institutions. Trans­portation of physicians and patients would be facilitatedby helicopter service. Gradual improvement of facilitiesfor patient diagnosis and care might evolve, and theseven other small rural hospitals in the area, which serve200,000 people, could look to the LaSalle-Peru-Oglesbyfacility as a regional resource. Housestaff and studenttraining programs in the rural setting could thus becomemore attractive.Research and scholarship beyond clinical care andteaching. The University has been very patient with us inthis regard, for putting together a program of this sortrequires great effort. New faculty, trained in research,who wish to make a career of general internal medicine,are not readily available. Research areas appropriate tothis new academic field are just now being defined. Forexample, Dr. Siegler has developed a keen interest inmedical ethics. He obtained some formal educational ex­perience in ethics, and has forged close relationships withother ethicists outside the medical school and throughoutthe country. Dr. John Schneider ('63) has a Ph.D. inbiochemistry as well as an M.D. and he is applying stableisotope technology to clinical diagnosis. Research andpublications have begun to emerge, and the harvest willbe enriched each year as the program ripens, the facultybecomes seasoned, and the field becomes more attrac­tive.What is an Internist?A broad national curiosity exists regarding the definitionof roles in health care. What is primary care? What is aprimary care physician? What is an internist? What doesa general internist do? How does a family physician fitin? A sense of urgency surrounds the debate, and theheat from this debate has put some internists on the de­fensive and has raised in some a doubt as to our purpose.But overall, the discussion has generated a stronger re­solve on the part of those involved in internal medicine toexamine its relationship to the whole of health care, andto modify and strengthen the field in the context of mod­em social, economic, and environmental imperatives.However, more data is needed on existing trainingprograms and on the actual practice characteristics of theinternist, and realistic and pragmatic estimates must bemade of the need for both general and subspecialty inter­nists. Such data will permit the development of rationalguidelines for training general internists and internists ingeneral.Three national research studies are relevant. First, theNational Ambulatory Medical Care Survey, conductedby the National Center for Health Statistics of the De­partment of Health, Education, and Welfare, is in thefourth year of a ten-year study of precisely what servicesare being provided by physicians in their outpatient prac­tices in all specialties. Second, the University of South­ern California Division of Research in Medical Educa­tion has initiated a broad survey of physicians in 24specialties to determine in detail the characteristics of their practices-outpatient, inpatient and by telephone.The USC group, in cooperation with the FederatedCouncil for Internal Medicine, has expanded its study toinclude all ten subspecialties of internal medicine. Third,the Association of Professors of Medicine, endorsed andsupported by the American Board of Internal Medicine,the American College of Physicians, and the AmericanSociety of Internal Medicine, has initiated a comprehen­sive study of all training programs in internal medicineand each of its subspecialties in the United States andPuerto Rico.From these studies will emerge a composite of the roleplayed by the general internist today. Preliminary datashows that general internists devote two-thirds of theirpractice time to treating chronic disease, spend approxi­mately 20 to 25 percent of their time on consultationsrequested by other physicians, and provide continuingand comprehensive care for the large majority of theirpatients.In reviewing some of these data I find the term primarycare unsatisfactory. It is insufficiently descriptive, andtends to divide all medical care into either primary careor non-primary care. The current climate attaches aninflexible positive good to primary care, and somethingless valuable, less good, to non-primary care. Therefore,I suggest that all patient-physician contacts be classifiedinto the following scheme: first encounter, episodiccare, principal care, consultation, and limited or continu­ous specialized care. All of these contacts can take placein an in-hospital or outpatient context.I use the term principal care to refer to the care forwhich the internist has been trained, and the care whichthe general internist, in fact, is providing. It is continuingcare, by appointment, in an agreement with the patientwhereby the physician provides all or the majority of thehealth care for the patient. Principal care by the generalinternist is comprehensive and all-inclusive, and uncov­ers and integrates all considerations which affect the totalhealth of the patient. The general internist also provides asignificant service to patients and other physicians as aconsultant.These services-principal care and consultation-arewhat the general internist does best, both in the outpa­tient setting and within the hospital. Specialized care oflimited scope is what the dermatologist or obstetrician!gynecologist presently provides. First encounter medi­cine and episodic care are provided and planned forby clinic physicians and industrial physicians, and arepartly the province of the family physician. This is notwhat the general internist should be trained to do.The practice of general internal medicine is an intellec­tual endeavor which requires detailed factual data regard­ing the patient's pathophysiological status. It demands ahigh order of sophisticated integrative thought, athorough knowledge of the patient, and extendedpatient-physician contact.Or. Alvin Tarlov (,57) is Chairman of and Professor in theDepartment of Medicine. This article is based on his presen­tation at the Conference on the Role and Training of theGeneral Internist in Miami Beach last December.15Outside, Chicago shivered in "a hard, dull bitterness of cold,"but inside the Bergman Art Gallery in Cobb Hall all was warmthand congeniality as the freshman medical students enjoyed aninformal afternoon get-together with alumni, faculty and deans.The occasion was the Medical Alumni Association's sixth annualwine and cheese party on January 16.Besides enjoying conversation and refreshments, those attend­ing had the pleasure of viewing the Chicago Quilt, an 89- by100-inch quilt made up of 30 panels which depict the history andscenery of Chicago.wine.cheesepartlJ127632. The Chicago Quilt 41. Dr. Daniel C. Tosteson, Dean of the Division of Biological Sciences and The Pritzker School ofMedicine, Robert Tomchik, and A. N. Pritzker, Chairman of the Council for the Division of BiologicalSciences and The Pritzker School of Medicine.3. Dr. James E. Bowman, Dr. Melvin L. Criem, Kim Williams, and Robert Caynes, a member of theMedical School Council.4. John T. Wilson, President of the University, and A. N. Pritzker.5. Jonathan Makielski, Donald Schnurpfeil, and Dr. John D. Burrington.5 6. Dr. Irwin H. Rosenberg, Christopher Lahr, DeCarr Covington, and Peter Kollros.677Studying Coronary Arterial Disease: Specialized Centerof Research in Ischemic Heart DiseaseDr. Leon ResnekovIt is somewhat chastening to reflect that despite the ad­vanced state of technological development in this coun­try, we lag behind many other western nations in healthcare of our population. We rank 24th in regard to lifeexpectancy for men. The major cause for this is the con­tinued and unacceptably high mortality from diseases af­fecting the heart and blood vessels. The most common ofthese disorders are coronary arterial disease and sys­temic hypertension. alone or in combination.Consider these facts: It has been estimated that in theUnited States, more than five million people between theages of 40 and 50 suffer obstructive coronary arterial dis­ease. Each year, more than 600,000 persons die as a re­sult of this ailment and close to one million are disabled.Perhaps some 20 to 25 million Americans have systemichypertension. The prevalence rate rises steadily with ad­vancing age, and in every age group the prevalence ishigher for blacks than for whites. There are probably150,000-200,000 new cases of angina pectoris diagnosedevery year. The enormous proportion of the problempresented by all these figures can hardly be overesti­mated.Further review of the facts reveals that 50 percent ormore of deaths due to acute myocardial infarction occurwithin the first hour of the onset of symptoms, yet 70percent of those who die do so before being brought tothe hospital. It is obvious, therefore, that the mortality ofcoronary heart disease could be dramatically reduced bythe early identification and treatment of people at risk ofdeveloping myocardial infarction. Recently, we haveseen the introduction of myocardial revascularizationsurgery by direct coronary arterial bypass procedures foranastomoses between the ascending aorta and the coro­nary artery or arteries beyond the obstruction. Suchsurgery offers the possibility of preventing myocardialinfarction, provided the population at risk can beidentified and the operation performed without complica­tions and at a low mortality rate. Equally important is theneed for understanding the basic and fundamental causesof the disease processes we wish to treat. Only by sodoing can we ever hope to make important inroads intotheir prevalence and occurrence by a program of preven­tion. Despite an enormous amount of important workand uncovering of new knowledge, a great deal remainsto be discovered and to pass from the laboratory bench toclinical practice.To meet some of these challenges. the National Heartand Lung Institute began an integrated program of re­search. Its purpose was to combine, in a multi­disciplinary approach. an investigation at the clinical andbasic levels to understand more clearly the causes andeffects on the heart of acute myocardial infarction. This18 program, for which The University of Chicago competedsuccessfully in 1967, became known as the MyocardialInfarction Research Unit (MIRU). It brought together alarge number of our clinical and basic faculty within theDivision of the Biological Sciences to investigate theproblem.After some seven years, this program was phased outand a new program developed which, while still multi­disciplinary and broad in its approach and goals, is aimedat in-depth consideration of problems in coronary arterialdisease other than those relating to the acute complica­tion of myocardial infarction. The goal of the new pro­gram is to understand more clearly the basic and funda­mental problems in association with the development ofcoronary disease in its pre-clinical and clinical forms, andto consider what therapeutic approaches might be mostadvantageous over a prolonged period of time, includingacute revascularization surgery.Once more, The University of Chicago successfullyapplied for the new program, which is known as theSpecialized Center of Research in Ischemic Heart Dis­ease. The new program will implement and support unitswhich encompass multi-disciplinary clinical and funda­mental research directed at the reduction of death anddisability from ischemic heart disease. I will present anoverview of the different areas of research being investi­gated here.There has always been a great need for a quantitativemeasure of the amount of heart muscle which has actu­ally been damaged by the ischemic processes in the coro­nary arteries. Recent developments in radiopharmaceu­ticals, isotope detection techniques and computer tech­nology, when combined, permit such studies to be under­taken in a meaningful way. Dr. Paul V. Harper, Jr., Pro­fessor of Surgery and Radiology, and in the FranklinMcLean Memorial Research Institute, and his group,working in collaboration with members of the CardiologySection, have been active in this field since about 1972.U sing the medical cyclotron of the McLean Institute,they have been able to manufacture radioisotopes whichprovide good images of the myocardium when injectedintravenously and assessed using a gamma camera. Notonly are these techniques applicable to the acutely illpatient since the imaging equipment is mobile, but, usingmanufactured very short half-life compounds, repeatedstudies can be done to the patient without subjecting himto an unnecessary risk of radioactivity. Studies of thesetypes permit an assessment to be made of the site andlocation of the underperfused areas of heart muscle re­sulting from obstructions in the coronary arteries. Fur­thermore, by repeating such studies, it is hoped that itwill be possible to gauge the effectiveness of any particu-lar line of treatment and of obtaining advanced warningof any impending deterioration in the patients' overallcardiac status.Using isotopes such as these, which monitor myocar­dial perfusion, provides important information about theareas and extent of circulatory involvement. They donot, however, provide information about the actual ex­tent of cellular damage. To study this question, differentisotope techniques are needed. Isotopes are now avail­able which, when suitably tagged, will attach selectivelyto areas of cellular damage in the myocardium. The im­portance of this work is to determine as quickly as possi­ble whether an area of damaged heart muscle is alreadydead and, therefore, not salvageable, or whether it is onlysuffering an acute insult, but still potentially viable. Thusintensive therapeutic measures could be adopted in anattempt to maintain the viability of the myocardium andlessen the risk of extension.Although we know a good deal about the anatomicallesions which make up obstructive coronary arterial dis­ease, the adaptation of the ventricles of the heart to thepresence of such lesions is not yet fully understood. Dr.Harold L. Brooks, Assistant Professor of Medicine,who, with Dr. Raul E. Falicov, directs the new HansHecht Cardiac Catheterization Laboratory and the Ex­perimental Animal Hemodynamics Laboratory, willstudy the adaptation of the heart to the presence of coro­nary arterial disease using mobile and sophisticatedmeasuring techniques, including the use of a speciallyprogrammed on-line computer and the newerradioisotope techniques being developed by Dr.Harper.Surgical approaches to the management of variousforms of ischemic heart disease steadily gain in impor­tance. The new program addresses itself with vigor tounderstanding more clearly the role of such approaches.A great deal of clinical and experimental studies of thesurgical treatment for acute myocardial infarction andchronic ischemic heart disease will be undertaken by Dr.David B. Skinner, the Dallas B. Phemister Professor andChairman of the Department of Surgery; Dr. Robert L.Replogle, Professor of Cardiovascular Surgery; Dr.Constantine Anagnostopoulos, Senior Cardiac Surgeonand Associate Professor of Surgery; and Dr. John J.Lamberti, Assistant Professor of Surgery.The failing heart in association with ischemic heartdisease continues to be a therapeutic challenge. It is be­coming clear that mechanical support of the failing heartis now not only feasible, but, when patients are chosencarefully and correctly for this form of therapy, highlybeneficial in an area that formerly carried a mortality rateexceeding 90 percent. Thus, studies will be conductedinto the effects of and methods for providing the heartwith such support, on either a temporary or long-termbasis.There are circumstances which prevent successfulcoronary arterial bypass surgery from being undertakenand yet such patients are frequently suffering greatly be­cause of their disease, and medical regimens may oftenbe unavailing. A novel surgical approach to this problemwill be studied by Dr. Anagnostopoulos, involving ret- Dr. Raul Falicov, assisted by Cardiology Fellow Dr. Eugene Chukudebelu,performs a myocardial biopsy. X-rays of the inside of the heart, projectedupon a screen, allow Dr. Falicov to position the instrument used to obtainthe heart tissue.rograde coronary venous perfusion by arterial blood toimprove the oxygenation of the myocardium sufferingfrom advanced ischemia.Coronary arterial bypass surgery generally is success­ful in relieving symptoms, but the vessel used for thebypass procedure is itself sometimes subject to obstruc­tive lesions developing either rapidly or more slowly. Dr.Seymour Glagov, Professor in the Department ofPathology and the College, in collaboration with the sur­gical group, will study this very important problem in anattempt to understand why the obstruction begins andwhat can be done to prevent it.The new SCOR program will include many investiga­tions at the basic level. Drs. Harry A. Fozzard, JointDirector of the Cardiology Section, Director of theBiomedical Computation Facility, and Professor ofMedicine and Pharmacological and Physiological Sci­ences, and Morton Arnsdorf, Assistant Professor ofMedicine, will study the effects of anti-dysrhythmicdrugs on the membrane properties, cable properties andexcitability of heart muscle fibers. Acute rhythm distur­bances continue to be the major cause of death in isch­emic heart disease, yet the acute and long-term effects ofdrugs used therapeutically, in an attempt to prevent thecomplication from occurring, are as yet little known.Similarly, conduction disturbances with sudden onsetof complete heart block or other serious and life­threatening situations continue to occur. Dr. Howard C.Cohen of the Cardiovascular Institute of Michael ReeseHospital and Assistant Professor of Medicine, will bestudying the importance of these conduction distur­bances in association with ischemic heart disease, andhow they are affected by exercise, drug intervention andpacemaking. He will attempt to determine a rationaltherapeutic approach to their management in order toprevent sudden death.Dr. Rory W. Childers, Associate Professor of Medi­cine and Director of our Electrocardiographic ServicesLaboratory, will be studying the techniques by which19previous myocardial damage, not obvious by standardelectrocardiographic or vectorcardiographic approaches,can be determined. These studies will aim at uncoveringareas of damage in the myocardium so that appropriatetherapeutic interventions can be undertaken.No study of the effects of ischemic heart disease wouldbe complete without devoting a great deal of attention tomorphology. The new SCOR program is fortunate inhaving a Core Pathology Laboratory under the directionof Dr. Robert W. Wissler ('48), Professor in and formerChairman of the Department of Pathology, and Profes­sor in the College. All pathological material, both clinicaland experimental animal, will be handled by this corelaboratory, which will provide a unique opportunity tocollate morphological and ultrastructural changes withclinical, hemodynamic and electrophysiological informa­tion.Dr. Wissler will also undertake an important study, inthe normal and the atherosclerotic primate, of the effectsof acute myocardial infarction on behavior of the ventri­cles. This experimental animal study has its counterpartin the clinical hemodynamic study to be undertaken byDr. Brooks. A primate colony of atherosclerotic animalshas been developed by Dr. Wissler, and it is possible tocreate myocardial infarction in these monkeys. A con­trolled group of non-atherosclerotic monkeys will behandled in the same way; thus the study will provideinformation about the behavior of the heart in the coro­nary atherosclerotic but non-infarcted primate, in com­parison with the atherosclerotic infarcted monkey. It willalso provide useful information about the differences ofthe effects of acute myocardial infarction in the presenceof a background of severe coronary atherosclerosis, orwhen the coronary vessels are normal.The importance of the chemical mediators ofinflammation has been recognized for many years. Thesame situation occurs in association with acute myocar­dial infarction, yet this important aspect of the effects ofinfarction has not as yet been fully studied. Dr. LouisCohen ('53), Professor of Medicine, will undertake astudy to uncover the importance of these chemical media­tors and their effects following an acute myocardialinfarct.Dr. Murray Rabinowitz, the Louis Block Professor inthe Departments of Medicine and Biochemistry; Rado­van Zak, Associate Professor of Medicine and ResearchAssociate in the Department of Biochemistry; and Dr.Donald A. Fischman, Associate Professor of Biology,Anatomy and the College, and in the Committee on De­velopmental Biology; will be collaborating with Dr. God­frey S. Getz, Master of the Division of the BiologicalSciences, Associate Dean of the College, the Division ofthe Biological Sciences, and The Pritzker School ofMedicine, and Professor of Pathology, to investigatemore closely the biochemical aspects of the process ofcoronary ischemia. Thus the mechanisms of destructionand repair of cardiac muscle cell constituents will be ex­tensively studied, as well as the control of muscle cellproliferation using novel techniques including myocardialcell culture.Phospholipid metabolism following cardiac injury and20 repair will also be extensively investigated by Dr. Getz,as will the electro physiological aspects of sympatheticinnervation in tissue culture, by Dr. Fozzard.Ultrastructural studies of the effects of ischemia andanoxia will be investigated by Dr. Ernest Page, Professorof Medicine and of the Pharmacological and Physiologi­cal Sciences, in collaboration with Dr. Philip I. Polimeni,Research Associate in the Departments of Medicine andPharmacological and Physiological Sciences. Many ofthese techniques are sophisticated and novel, and somehave already been developed by Dr. Page and his col­laborators as part of the myocardial infarction ResearchU nit. A continuation of this work will provide an in­depth understanding of the morphometric and mi­crochemical effects of acute and chronic ischemia of theheart muscle, thus providing insight into appropriatetherapeutic interventions.As can well be appreciated, the SCOR-Ischemic HeartDisease Program is truly multi-disciplinary and ex­tremely broad in its scope. In an attempt to maintainoverall cohesion, a great deal of thought and planningwas put into a centralized data management section,which is under the direction of Dr. Fozzard and includesPaul Meier, Professor of Statistics, Pharmacological andPhysiological Sciences, and the College. The central datamanagement and statistical approaches provide a CoreReaction of the heart to stress is monitored by Dr. J. Mark Sheppard,Cardiology Fellow in the Department of Medicine, as the patient exerciseson a treadmill.facility for the SCOR program as a whole, but specificresearch questions are being asked in relation to the useof the computer for biological investigation. This in­cludes the development of an electrocardiographicanalysis system under the direction of Plato D. Kinias,Research Associate in the Department of Medicine and aprogrammer in the Biomedical Computation Facility.This system will be designed to provide rapid analysis oflong-play (24-hour) electrocardiographic information col­lected on magnetic tape while the patient is up and abouthis normal activities, or sleeping at night. Preliminaryinvestigations have already indicated the great impor­tance of this approach since we now know that whilepatients are walking around or sleeping at night, seriousrhythm or conduction disturbances are occurring unbe­known. The therapeutic implications of this approachcan hardly be overestimated.In addition, Mr. A. L. Pai, Research Associate in theCardiology Section of the Department of Medicine, willdevelop new computer programs for analyzing myocar­dial perfusion and ventricular wall dynamics to provideon-line hemodynamic data. As the questions which haveto be answered in relation to the effects of ischemic pro­cesses on the heart become more complex and sophisti­cated, newer techniques for analyzing such informationbecome vital. The computer programs being developedwill provide the investigator with immediate information,permitting him to undertake his study in a more con­trolled fashion and to obtain sophisticated informationwhich previously has not been available in clinical prac­tice.The new SCOR grant provides initial funding of just over 1 million dollars for the first year of operation. Totalsupport for the five-year period exceeds 5 million dollars.The program centralizes and integrates research ac­tivities in the Departments of Medicine, Surgery,Radiology, Statistics, Pathology, Biology, Physiologyand Pharmacology at The Univ.ersity of Chicago, withthe Department of Medicine and the Cardiovascular In­stitute at the Michael Reese Hospital and MedicalCenter.We are indeed fortunate in this country to be able toafford multi-disciplinary research of this type, which in­tegrates clinical, experimental and fundamental researchaimed at uncovering new knowledge in the preventionand treatment of a major cause of human suffering anddeath. While we accept the implied challenge of a pro­gram such as this, we should not lose sight of the factthat, in other countries perhaps less fortunate from afiscal point of view than our own, the death rate for menunder the age of 55 is less than half that for the same agegroup in the United States. As documented in publishedstatistical data from Denmark, Norway and Sweden, thisdifference indicates that high death rates due to coronaryarterial disease in the United States are neither necessarynor inevitable. It is up to those who are studying thevarious aspects of the problem to provide the medicalcommunity at large and the population at risk with mean­ingful advice for the prevention and treatment of theproblem.Or. Leon Resnekov is Director of the SCOR in IschemicHeart Disease, Joint Director of the Cardiology Section, andProfessor in the Department of Medicine.Decision Analysis and HumanFactors in Health CareDr. lee B. lustedHuman Factors is a discipline encompassing appliedpsychology, applied physiology, and anthropometry.Through man-machine systems analysis, surveys and re­search, the field aims to improve the quality andefficiency of work, and the safety and comfort of work­ers. In the area of health care, research is aimed at im­proving medical systems in which the human operator-physician, nurse, pharmacist, technician, clerk,etc---plays a significant role by evaluating, studying orenhancing human performance.Decision analysis is an important part of the humanfactors field. Decision analysis and human factors re­search in health care are goal-oriented. The methodologyemphasizes benefit-cost analysis based on probabilitiesand value systems. Such an approach forces individualsto be explicit about goals, preferences and value scales,matters which are usually implicit. As a result, consistentchoice-an important component of logical decision­making-is more likely to occur, and individuals in- volved in the decision process are able to trace sources ofdisagreement about decisions and actions.The benefit-cost approach to health care uses indicesof efficacy, efficiency, and quality control. Efficacymeasures the effect of a particular medical action in im­proving the natural history of a particular disease. It alsomeasures the effect of diagnostic or therapeutic informa­tion on a diagnostic or therapeutic decision. For exam­ple, the American College of Radiology has a study inprogress to determine the efficacy of diagnostic radiologyand nuclear medicine procedures.Efficacy is measured in terms of the diagnostic infor­mation content which the radiologic procedure providesfor the physician who requests the examination. Thestudy proceeds as follows: at the time the radiologicprocedure is requested, the physician is asked to give themost important and most likely diagnoses he is consider­ing, and his estimate of the probability or odds in favor ofeach diagnosis. The radiologic procedure is then ob-21tained. After the physician has the results he is asked tore-estimate the probability of his most important andmost likely diagnoses or, if a new diagnosis were discov­ered, to record it.Probabilities or odds indicate an individual's degree ofuncertainty. Thus, if the radiologic procedure informa­tion caused the physician's degree of uncertainty to de­crease, the procedure was efficacious. If the procedureresults did not affect the physician's uncertainty, then thestudy was non-efficacious as defined in this project.This definition of efficacy, based on the informationcontent of an examination, does not take into accountthat a radiologic procedure or a laboratory test, or any bitof patient data, may have a value to the physician and thepatient beyond the information content. The "what's atstake" aspect of efficacy has yet to be tackled, but itsrelationship to benefit-cost analysis should be clear. Is azero-or-low-efficacy procedure worth the cost in dollars,patient inconvenience, or patient risk?Health care based on efficacious diagnosis and treat­ment may be practiced in a variety of settings, some moreefficient than others. Efficient strategies for managementof health care systems make optimum use of personneland materials to achieve the desired results. These man­agement strategies cover problems of treatment, screen­ing, diagnosis, place of treatment and length of stay, and,if necessary, rehabilitation.As an index, efficiency may not be very satisfactoryfor a wide range of services and management systems,but it serves as a good starting point. There are also somedifficulties in discussing efficiency of health care deliveryOr. Lee B. Lusted22 systems because, at present, there is no general agree­ment on what specific services should be available towhat people. Some believe that quality of life, not thehealth delivery system, should be the focus of concern.Some suggest that even a radically altered health deliverysystem, which does improve on problems of cost andpatient access, could not be expected to produce adramatic impact on the overall health of the population.A. L. Cochrane, in an interesting analysis of the NationalHealth Service in England, says that the present ineffec­tiveness and inefficiency of the N HS has largely beenproduced or condoned by the clinical establishmentwithin that organization, and that changes in attitude willrequire some form of remuneration comparable to aclinician's merit award.Should we be pessimistic about efficiency studies inhealth care? Probably not. National resources are lim­ited; questions of medical costs and access to care areimportant, and we must decide how to use available re­sources.A few topics illustrate a wide range of interests for thehuman factors and decision analysis field:I. Human factors in a comprehensive communitymedical emergency service program.2. Measuring the difficulty of nursing assignments.3. Evaluation of man-machine systems in the mobilityof the visually handicapped.4. Human factors in the construction and use of or­thopedic prosthetic castings and sockets.5. Design and placement of a dental instrument trayfor efficient use by dentist and dental assistant.6. Human factors in the design and use of the fiberoptic endoscope, anesthesia machine, cardiacdefibrillator, and other equipment. (Note: En­gineers design equipment and they often need thehelp of a human factors specialist on questions suchas placement and use of control knobs, levers, me­ters, etc.)Neither decision analysis nor human factors researchreceives much attention in medical education. As W. B.Schwartz pointed out recently:A number of house-officers and students argue that good de­cisions can almost always be made in an informal fashion andthat even if the technics of decision analysis are at timesuseful they are too time-consuming and demanding, and otheraspects of patient care command a higher priority. They alsoargue that factual information and knowledge of patho­physiology are more important to the student, that the rewardand evaluation system in medical schools is based largely onone's store of information rather than on one's decision­making capability. This argument is difficult to counter, sinceit does reflect much of the current approach to teaching andevaluation. It also brings into focus, however, the question ofgoals. Presumably our intent is to educate physicians to begood decision makers. What remains to be determined iswhat mix of teaching efforts directed toward factual knowl­edge on the one hand and the strategy of decision-making onthe other is likely to produce the most effective clinicians.Or. Lee B. Lusted is Professor and Faculty Secretary in theDepartment of Radiology.A Rational Approach toRadiation Exposure ofPatients in the HospitalLawrence H. Lanzi and Frances L. MoserThe chief causes of radiation exposure to man are diag­nostic and therapeutic X-ray procedures. This statementshould not come as a surprise to anyone because theseprocedures represent situations in which radiation is pur­posely and deliberately directed toward a patient. In re­cent years, however, a number of measures have beentaken to reduce the amount of absorbed dose to patientsfrom medical X-ray procedures. In diagnostic radiology,for example, one important step has been to limit thecross-section of the beam to the size of the radiationdetector, which may be a radiographic film or some otherimaging device.There are two types of measurements which have abearing on patient exposure to radiation in the hospital.The first, which applies to radiotherapy, evaluates thelocal tumor control probability as a function of dose. Thesecond measures exposure, under standardized condi­tions, for a variety of techniques presently used in diag­nostic radiology.It has only been in the last ten years that definitivestudies were reported in the literature on the measure­ment of tumor control probability as a function of totaldose delivered to a tumor. In radiation therapy, the aim isa high probability of tumor control with as Iowa level ofharmful side effects as possible. In the case of squamouscell carcinoma of the supraglottis, studies show that anincrease of only ten percent in the dose delivered in­creases the tumor control probability from 20 percent to75 percent. Thus, the treatment dose needs to be selectedwith great care and treatment needs to be carried out witha high degree of precision and accuracy. For Hodgkin'sdisease, also, some definitive measurements of tumorcontrol probability have been made. Very few othertypes of tumors have been analyzed in detail in terms oftumor control probability versus dose. However, for le­sions in the supraglottis and also for Hodgkin's disease,at least, the radiotherapist can now choose a treatmentdose with a radiation exposure to patients which max­imizes the benefit-risk ratio on a scientific basis.The level of absorbed dose in a therapeutic procedure isabout one thousand times greater than that in a diagnosticprocedure. Nevertheless, the total radiation to the popu­lation is far greater in diagnosis because of the largenumber of individuals who undergo diagnostic proce­dures compared with those who receive radiationtherapy.M. E. N euweg and P. N. Brunner of the Illinois Divi­sion of Radiological Health, Department of PublicHealth, carried out a study to determine the range ofradiation exposure levels used in several common diag­nostic examinations. Radiographic technique factorssuch as kilovoltage, milliamperage, time, and LATERAL LUMBAR SPINE140130120110100({) 90w0: 80::0(f) 700a. 60xur 50'lI: 40302010200 400 600 800 1000 1200 1400\160018002000 2200 2400 2600OOSE (MI LLiROENTGENS) MANDATORY LIM ITFigure 1target-to-film, distance were obtained for an "average­sized" adult undergoing these examinations. Subse­quently, using the same factors, Neuweg and Brunnermeasured the exposure directly above the radiographicfilm with a direct-reading low-energy dosimeter, whilethe patient was removed from the beam.Figure 1 is a plot of the number of exposures measuredas a function of exposure in milliroentgens (mR) for 866lateral lumbar spine exposures. It should be noted thatthe exposures varied from 200 to 2,600 mR per radio­graph. This wide range should be understood in terms ofthe variety of techniques employed by diagnosticradiologists in a large number of medical facilities. Inspite of this range, each examining radiologist apparentlyis satisfied with the quality of the radiographic filmswhich are obtained by use of his or her particularmethods. The data show that 75 percent of lateral lumbarspine exposures were below 1,400 mR each. Of the 866exposures, 216 were above 1,400 mR.It was reasoned that, if 75 percent of the existingfacilities could obtain a clinically acceptable radiographby exposing the patient to a maximum dose of 1,400 mRper radiograph, all other facilities should be able to altertheir techniques to reduce unnecessarily high radiationexposures. On this basis, the State Health Departmentstaff developed a new rule which was subsequently ap­proved by the governor-appointed Illinois Radiation Pro­tection Advisory Council. This rule states:"After January 1, 1975, the exposure, measured at thetabletop, with the technique used for an average adultpatient for routine medical radiography will be the fol­lowing: 'Lumbar spine (lateral) incident exposure shallnot exceed 1400 milliroentgens per radiograph andshould not exceed 1000 milliroentgens perradiograph.' "This new approach to the reduction of patient exposuredoes not interfere with medical practice, except for re­quiring changes by those practitioners whose proceduresresult in higher patient exposures than those used by asubstantial majority.We have estimated the impact, in terms of reducedexposure, to Illinois patients due to the implementation23of this rule together with companion rules for examina­tions of the abdomen, cervical spine, and skull. The es­timates were made on the basis of U.S. census data for1970 for the total Illinois population, and of the numberof radiographs per year per person for a sample region ofIllinois for these four examinations. The data on thenumber of radiographs were taken from a report issuedby the State of Illinois. Using the exposure distributionof Figure 1 for lumbar spine and Figures 2,3, and 4 forabdominal, cervical spine, and skull exposures, we esti­mate that the total exposure received by Illinois residentsis as follows:Lumbar spineAbdomenCervical spineSkull 465,000 man-roentgens/year22,800 man-roentgens/year38,600 man-roentgens/year20,800 man-roentgens/yearIf all techniques were modified to reduce the exposure tothe Medical Radiographic Incident Exposure limits, thefollowing figures show the amount by which the exposureto the lIIinois patient population would have been re­duced starting January I, 1975:Lumbar spineAbdomenCervical spineSkull 60,000:::,::: 20,000 man-roentgens/year3,600:::,::: 1,800 man-roentgens/year1,500:::'::: 450 man-roentgens/year2,500:::'::: 1,500 man-roentgens/yearThe uncertainty in these figures is due to the statisticalvariation of the number of radiographs in the studies per­formed.If the incident exposure had been reduced to less thanthe mandatory limit, a still greater overall reductionwould have been achieved. We have also calculated re­ductions for changes in technique so that those exposuresabove the incident exposure limits were reduced to theformer average values, which are below the 75 percentmandatory limit. These reductions are as follows:Lumbar spine 100,000 man-roentgens/yearAbdomen 5,300 man-roentgens/yearCervical spine 1,700 man-roentgens/yearSkull 5,600 man-roentgens/yearFurther reduction in patient exposure may certainly bepossible for other diagnostic procedures as well. It is wellknown that the hazards of radiation include genetic dam­age, which can affect future generations, and the induc­tion of various types of cancer. Thus it is imperative thatwe continue to reduce unnecessary radiation exposuresto man without diminishing their very substantial diag­nostic and therapeutic benefits.Lawrence H. Lanzi is Professor of Medical Physics in theDepartment of Radiology and in the Franklin McLeanMemorial Research Institute (FMI). He is currently servingas Chairman of the Radiation Protection Advisory Councilof the Illinois Department of Public Health. Frances Moseris a fellow in FMI and Research Associate (Instructor) in theDepartment of Radiology. They presented these findings atthe American Public Health Association annual meetinglast November.24 500r----------------------------------------,460420380(f) 340w§i 300is 260Qx 220w'II: 1801401006020 ABDOMEN100 200 300 400 5°Ol600 700 800 900 1000 150020002500DOSE (MILLIROENTGENS) MANDATORY LIMITFigure 2A. P CERVICAL SPINE55504540(f)35wa:::::l 30(f)0Q 25xw 20it:1510Figure 3 25 50 75 100 125 150 l'75 200 225 250 275 300 400DOSE (MILLIROENTGENS) MANDATORY LIMITA.P SKULL908580757065(f) 60wa: 55::::l 50(f)0 45Q 40xw 35'* 3025201510550 100 150 200 250 300 350 400 \ 450 500 550 600 650 700DOSE (MILLIROENTGENS) MANDATORY LIMITFigure 4PSROs, the Medical Profession,and the Public InterestOdin W. AndersonIntroductionIn the management of its health services delivery system,the United States is unique among countries in that weare moving directly into monitoring the decision-makingof doctors. I believe this is so because we lack the healthservices organizational structures and relatively closed­ended financing true of European health insurance orhealth services systems, particularly those of Great Brit­ain or Scandinavia.We are experiencing rapidly escalating costs, in con­junction with serious consideration of some form of na­tional health insurance and a painful experience withMedicare expenditures. This is occurring in a context ofvery vague organizational and fiscal boundaries. We donot like visible boundaries and structures with visiblelimits on budgets, although we are-as are othercountries-moving inevitably in that direction. The pacein each country is a matter of degree.Odin W. Anderson It seems we hope that the proper level of expenditureswill be established for us by a properly functioning Pro­fessional Standards Review Organization (PSRO), ratherthan by an arbitrary year-to-year determination throughthe processes of governmental budgeting in competitionwith the national priorities.It is ironic, then, that in this country the medical pro­fession faces more direct monitoring of its decision­making prerogatives than do its colleagues in governmentsystems elsewhere. This is due in part-if you can be­lieve this-to greater deference to doctors in Europeansystems. Nevertheless, health administrators and politi­cians in Europe look enviously at the PSRO develop­ments in the U.S. and naturally exaggerate their impacthere. Their attitudes are somewhat analogous to our pen­chant for over-idealizing the government systemsabroad.What universal government systems abroad and inCanada have accomplished is to free their citizens fromhigh-cost episodes of serious illnesses, an accomplish­ment which appears to be forgotten as other unexpectedproblems emerge. Cost containment is now the politicalbattle cry elsewhere, as it is here. To contain cost, westart with the PSRO, a descendant of utilization review,which was mandated by the Medicare Act as a device toshorten length of stay and eventually to limit hospitaladmissions. The trend may continue, to include monitor­ing of office visits as well-not to mention admonishingpatients to see the doctor only when it is necessary (apresumably precise judgment) and to strike a balance be­tween hedonism and asceticism in their lifestyles.The PSRO development is, indeed, remarkable. Atfirst the profession fought it and now it will probablyco-opt it-I see no other alternative unless doctors arehanded a manual of instructions to follow. This hardlyseems likely or tenable. If, in their judgment, doctors arepressed too hard, they will sabotage the monitoring sys­tem by many subtle or not so subtle means at their dis­posal, or threaten to strike on the seemingly unassailablereason that good patient care is being jeopardized. Wit­ness house-officers in hospitals across the country-preceded by nurses-who brilliantly intrude into theirbargaining process the issue of proper professional stan­dards for proper patient care.In attacking the cost imperative through the PSROmechanism, I agree with Clark Havighurst and JamesBlumstein that Congress has not sufficiently faced thequality imperative, a powerful weapon in the professionalarsenal. "Because the quality imperative dictates that noone should very obviously enjoy better health care thananyone else on the basis of income, the ideal to be strivenfor is likely to be higher," they say. "A great deal of thediscussion surrounding the PSRO concept in the periodsince its enactment has been rendered almost unintelligi­ble by operation of the quality imperative in a highlycharged political and professional environment."The SituationAfter this introduction, where are we? In more rationalmoments I deplore broadside legislating for a perfor-25mance monitoring mechanism such as the PSRO beforethere is even the semblance of a systematic methodologyto monitor performance according to validated criteria.At the same time, in more pragmatic moments, I agreethat we need to work toward some form of performancemonitoring. The issue is then not the princi pie, but thepace and form the performance monitoring will take. Iwill also observe that, given the desirability of some formof performance monitoring, it is unlikely the professionand the medical schools would voluntarily initiate actionand research on performance criteria, other than the onesthey share informally among themselves in day-to-daypractice. At least the PSRO is forcing systematic atten­tion to medical performance criteria which may not havecome about otherwise. May the medical schools and or­ganizational research agencies respond to the call for re­search on performance indicators!A sizable portion of medical practice is considered anart rather than a science. It is a reasonable assumptionthat the medical profession-indeed, any profession-isinclined to exaggerate the extent to which performance isbeyond systematic monitoring, given the quality andequality imperative. And it is a reasonable observationthat we do not presently know the extent to which medi­cal practice is capable of being monitored according tovalidated criteria-short of cookbook medicine, whichnobody wants. Perhaps the best that can be done is tostrengthen formal and informal peer review, as is pre­sumed to be done in well-organized group practices.Very little research has been done on the methodologyof monitoring physicians' services. A great deal ofroutine data on physicians' decision-making profilesneeds to be collected and evaluated. The Canadian prov­ince of Ontario, for example, compiles a tremendous databank of physician decision-making profiles, but has donelittle with it so far in terms of analyzing decision-making inmedical practices. The chief emphasis is to expose thevery high income physicians. The monitoring system ex­poses the gross deviations from the norm and calls thedoctors so exposed into account. Medical care founda­tions in California use similar monitoring systems. I getthe impression, however, that the deviations uncoveredare so gross that these doctors would be known to theircolleagues without the aid of an elaborate record system.Medical decision-making is, of course, a very difficultproblem to analyze, not to mention the difficulty of de­veloping a methodology for application. Medical practiceis essentially a one-to-one relationship between doctorand patient, and doctors face understandable dilemmas inmaking decisions regarding individual patients on thebasis of group statistics. The tendency, I assume, wouldbe to en' on the side of safety.There appear to be only two attempts to set upmonitoring standards for hospital admissions on a large­scale basis. Both studies took place in the 1960s. An­ticipating the interest in physician decision-making as itapplies to hospital admissions and discharges, I con­ducted a survey with Paul B. Sheatsley, now a SeniorSurvey Director with The University of Chicago Na­tional Opinion Research Center (NORC). We studied arepresentative sample of 2,000 surgical. medical, and26 diagnostic discharges in the state of Massachusetts for atwelve-month period, querying patients and their refer­ring and attending doctors about the chain of events anddecisions that led to hospital admission and discharge.(Obstetrical cases were excluded.)One table in that survey which stands out relates to thedoctor's after-the-fact judgment of the degree of urgencyin admitting his patients to the hospital. We establishedfour categories of urgency-non urgency as determined bythe attending doctors: (I) Hospitalization absolutelynecessary; the procedure could not have been carried outexcept in the hospital. (2) Quite urgent; it would havebeen difficult, though possible, to carry out the procedureoutside of the hospital. (3) It would have been possible tocarry out the procedure outside of the hospital, but hos­pitalization was desired to reduce the margin of error. (4)Hospitalization made no difference.Surgical CasesAbsolutely necessary 74%)Quite necessary 15%) 89% necessarySafety marginNo difference 7%)4%) 11% could be eliminatedMedical CasesAbsolutely necessary 46%)Quite necessary 37%) 83% necessarySafety marginNo difference 14%)3%) 17% could be eliminatedDiagnostic AdmissionsAbsolutely necessary 45%)Quite necessary 32%) 77% necessarySafety marginNo difference 15%)8%) 23% could be eliminatedThe other survey studied a representative sample of5,000 discharges in Michigan. It selected eighteen diag­noses (including maternity cases) which were relativelyclear-cut disease cases. Committees of physicians foreach diagnosis found it quite easy to arrive at a consensusregarding the need for hospital admission and discharge.These eighteen diagnoses comprised 46 percent of allgeneral hospital admissions. To summarize the results ofthe study, "overuse" represented 2.3 percent of the ad­missions and 6.8 percent of the days. The Michigan studycriteria were eitherlor as opposed to the range formulatedin our Massachusetts study. It is seen that in relying onprofessional criteria, there was very little purely wastefuluse of hospital services.[ refer to these old-but still new-surveys becausethey are the only ones that give some idea of the" soft­ness" of decision-making among doctors for hospitaladmissions. They indicate what proportion of admissionsmight be eliminated, given a control mechanism, beforeboth doctors and patients would begin to protest in visi­ble numbers. I predict that costs will continue to rise,making stabilized PSRO criteria impossible. Rising ex­pectations and the quality imperative will continue to af­fect expenditures. Criteria need to be revised and tight-ened periodically unless the body politic is willing to ac­cept what the medical profession as a whole, and thepublic who seek their services, regard as appropriatemedical care.Observations and ConclusionsLegislation and discussion regarding PSROs appear toemphasize exclusively the role of the doctor in decisionsregarding his patients. The tendency is toward purelytechnical medical decision criteria, while extenuating fac­tors regarding the social and family environment of pa­tients, and their psychological states, are not taken intoaccount. PSROs will therefore make medical practiceeven more technocratic and patients will have even lessto say about decision-making in the enlarging bureau­cracy than they do now. Can patient viewpoints be in­cluded in the PSRO type of decision monitoring? I amnot optimistic. One thing is certain-we are entering aperiod of tensions and possible standoffs between pa­tients, doctors, hospital managers, and government fund­ing agencies. Due process suits from doctors are alreadyappearing.While the United States tries to contain costs bymonitoring physician decision-making, we are also laying the groundwork for a structure to contain supply. This isevident in the newly-implemented National Health Plan­ning and Resources Development Act of 1974 (PublicLaw 93-641) which follows the failed comprehensivehealth planning and regional medical legislation of thelatter 1960s.In other countries the idea of monitoring physicians isfollowing the creation of organizational structures, be­cause costs are not contained by that means either. Thus,all countries are converging, with various degrees of in­tensity, in establishing planned limits to expansion,examining possibilities of monitoring physiciandecision-making, and capping this off with arbitrarybudget ceilings. The actors can then sort themselves outin these contexts and arrive at some politically tolerableequilibrium. This seems to be the fate of health servicesdelivery systems.Odin W. Anderson is Director of The University of ChicagoCenter for Health Administration Studies, and Professor inthe Graduate School of Business and the Department ofSociology. This article is based on observations he pre­sented at the American Public Health Association's annualmeeting last November.Academic RadiologyAn Interview with Dr. John FennessyDr. Fennessy, Chairman of the Department of Radiologysince 1974, has a wide experience in academic radiology.A native of Clonmel, Ireland, he received the M.B., B.Ch.,and B.A.O. degrees from University College in Dublin. Heserved his internship at Dublin's Mater Misericordiae Hos­pital and at Mercy Hospital in Chicago. Following a three­year residency in the Department of Radiology at The Uni­versity of Chicago, he joined the faculty here as an Instruc­tor in 1963. In 1965 he became Assistant Professor, As­sociate Professor in 1968, and Professor in 7974.Dr. Fennessy received the J. A. McClintock Award forOutstanding Teaching in 1969. The following year heserved as Consultant Radiologist at Mater MisericordiaeHospital. Upon his return here, he became Chief of Chestand Gastrointestinal Radiology in 1977 and Acting Chief ofDiagnostic Radiology in 1973.Author of many research reports on bronchial brushing,Dr. Fennessy has been a leader in introducing this tech­nique to the United States as an aid in diagnosing lungcancer. In addition, he has published research on ulcera­tive colitis, carcinoma of the coion, gallstones, Hodgkin'sdisease, pulmonary aspergillosis, hiatus hernia, and car­cinoembryonic antigen diagnosis of cancer. A Special Consultant to the Committee on Bron­choesophagology of the American College of Chest Physi­cians, Dr. Fennessy is also a member of several profes­sional societies in radiology and gastroenterology.Dr. Richard L. Landau, Professor in the Department ofMedicine and in the College, conducted the following in­terview.Landau: Dr. Fennessy, what do you think are themajor problems facing academic departments of radiol­ogy in America today?Fennessy: Probably the major problem is impressingupon our medical colleagues the fact that there is such athing as academic radiology. In most teaching hospitals,radiology is looked upon as being purely service-orientedand people don't consider that the radiologist also hasacademic responsibilities.Landau: This means not just teaching medical studentson our staff but also developing the science of radiology.Fennessy: Correct, developing the science of radiol­ogy and investigating some of the things that are some­times considered peripheral to radiology-such as radia­tion biology.27Landau: You don't consider the development of newmachinery as is usually done in business and in researchinstitutes an academic function?Fennessy: The machinery is usually developed bybusinesses, but academic departments need to have aninput, as was well demonstrated by Dr. Paul C. Hodgeswhen he was in charge of this department. Dr. Hodgespioneered many of the safety features which have subse­quently been adopted by manufacturers.Landau: Is the fact that there is a shortage ofradiologists in America a major problem for academicdepartments of radiology, and if so, what problem doesthis create for you?Fennessy: There are conflicting arguments about theshortage of radiologists in some areas. It is argued thatthe market is flooded with radiologists, which is true insome of the major cities such as San Francisco and herein Chicago. The main problem in radiology is maldis­tribution in the community as it is with many physicians.There is a shortage of radiologists in academic radiologyand that is something with which this department mustconcern itself. It is a general phenomenon in academicdepartments.Landau: Is that because the rest of the medical com­munity tends to regard the radiologist more or less as ahandmaiden?Fennessy: It has something to do with that, but thechange in American medicine over the past twenty yearsalso has something to do with it. Academic departmentsof twenty years ago, and perhaps more recently, were inthe forefront of the development of radiologic technologyand instrumentation. This is no longer the case. VeryDr. John J. Fennessy28 often community hospitals are better equipped than someof the traditional leaders in teaching hospitals. This hasbeen a problem in our own area. Another reason peoplehave had difficulty in recruiting radiologists for academicdepartments is that in private practice radiologists arepaid very generously. And while any of us in academicradiology realize that the salary is not what the thing isabout, it's very difficult to convince young men andwomen that the salary differential between private prac­tice and academic radiology is not all that important.Landau: If you could construct an ideal job descriptionfor a diagnostic radiologist, how much time would onehave to spend in doing clinical work or diagnostic radiol­ogy and how much time would one be free to carryonresearch and scholarly activities?Fennessy: If a man or woman is a clinician or is underthe flag of a clinician of any specialty, then he or she mustbe prepared to devote the major portion of effort to that.I would be very hesitant to say that a specific period oftime spent on certain non-clinical activities is what makesan academic radiologist. For some it might be as little asa tenth, for others it might be a third, but I feel verystrongly that one can be an amateur investigator and notendanger society, but one cannot be an amateur clinician.However, I would like to see a system where even ourclinical radiologists would have a period of up to two orpossibly three months free in every academic year toengage in research activities. This could be in a block oftime, or some individuals might have to break it up.Landau: How many faculty members are in the De­partment of Radiology at present?Fennessy: We hope to have 15 faculty in diagnosticradiology in the coming academic year and three in radia­tion therapy. We do not anticipate having more than twoin nuclear medicine, which is 50 percent of what wewould like to have.Landau: If you had the extra two in nuclear medicine,would this satisfy the requirements for the moment?Fennessy: Yes, it would. I must point out that nuclearmedicine is one of the branches of the specialty which isgrowing at a tremendous rate. We will probably increaseour nuclear medicine clinical examinations by 20 to 25percent per annum.Landau: How do you account for the very rapidgrowth in nuclear medicine?Fennessy: The reason that nuclear medicine is attrac­tive and growing is that it has gone from a static energymode, very similar to diagnostic radiology, into onewhich is increasingly physiologic. We are on thethreshold of providing more and more physiologic and/orpathophysiologic data about patients; this can be muchmore meaningful, I think, than the static image of modes.I'm thinking now about such uses as the evaluation ofblood flow to the extremities, not just an evaluation asone does in arteriography, so that we are now able tomeasure how many red blood cells are traveling to anarea and therefore have an idea of how much oxygen thearea needs. This is the kind of project that makes nuclearmedicine attractive and increases the number of de­mands. We now have a residency program in nuclearmedicine.Nought endures but change.-Ludwig BoerneName Graduation YearHome Address TelephoneCity, State, ZipBusiness Address TelephoneCity, State, ZipTitleNew address?New position?New medical practice?military assignment?civic or professional honor?book?Please tear out; fold, staple, or tape; and drop in the mailbox. Thanks!Medical Alumni Association1025 East 57th StreetChicago, Illinois 60637 '--------lI II II Place II II Stamp II II Here II I� J----------- -------------------------------------------_.Fold this flap in firstNews BriefsLasker Professorship EstablishedAn Albert D. Lasker Professorship inMedical Science has been established tomemorialize Albert D. Lasker, a bene­factor and former Trustee of the Uni­versity who died in 1952. Announcementof the new chair was made February IIat a dinner at the David and AlfredSmart Gallery, 5540 Greenwood A v­enue, on campus. Albert Lasker'swidow, Mary, and other members of theLasker family attended.Dr. Frank W. Fitch, Professor ofPathology and Chairman of theUniversity's Committee on Immunol­ogy, has been named the first Albert D.Lasker Professor. The appointment wasmade by John T. Wilson, President andTrustee of the University, on the rec­ommendation of Dr. Daniel C. Toste­son, Dean of the Division of the Biologi­cal Sciences and The Pritzker School ofMedicine, and D. Gale Johnson, Pro­vost.Lasker, a Trustee of The Universityof Chicago from 1937 to 1942, and hisfirst wife, Flora, gave the University$1,250,000 in 1928 and 1929 for study ofthe diseases of the aging. He also gavethe University his estate at Lake Forest,Illinois, and other gifts. Lasker was theowner of the Lord and Thomas advertis­ing agency and was also active in publicaffairs. From 1921 to 1923 he headed theU.S. Shipping Board.In the early 1940s Lasker authorizedthe University to place his portion of theDr. Frank W. Fitch gifts in the University's unrestrictedfunds. Flora Lasker's portion, approxi­mately $300,000, was placed in the FloraLasker Fund as part of the medical en­dowment of the University. She died in1936.In 1942, Lasker turned over Lord andThomas to three of his employees,Emerson Foote, Fairfax Cone, and DonBelding, and the firm was renamedFoote, Cone & Belding.That same year, he and his wife Maryestablished the Albert and Mary LaskerFoundation to administer the Laskers 'gifts to medical research. The LaskerFoundation gives annual Albert Laskerawards for outstanding medical researchin major causes of death and disability.Twenty-five of the winners, includingthe University's Dr. Charles B. Hug­gins, have later won the Nobel Prize.In 1944 the Laskers, Emerson Foote,and other Lasker associates launched acampaign to build up private donationsto the American Cancer Society and topromote greater governmental appropri­ations for cancer research. The culmina­tion of this effort, in which Mrs. Laskerhas been continuously active, was theNational Cancer Act of 1971, whichmade the conquest of cancer a top na­tional goal. The Laskers were also activein the movement to obtain larger privateand public funds for mental health andbirth control.Since the death of Albert Lasker, Mrs.Lasker has been a national leader in thepromotion of increased governmentalhealth insurance and medical research inmajor causes of death and disability,such as heart attack, stroke, arthritis,eye disease and neurological disorders.Dr. Fitch, a native of Bushnell, Il­linois, attended Monmouth College andBradley University. He received theM.D. degree with honors from The Uni­versity of Chicago School of Medicine in1953, and the S.M. and Ph.D. degrees inpathology from the University in 1957and 1960.He interned at University Hospital,Ann Arbor, Michigan, and was a U.S.Public Health Service Postdoctoral Re­search Fellow in 1954-55 and 1957-58.In 1955-57 he served as a Captain in theU.S. Air Force Medical Corps.Dr. Fitch joined The University ofChicago faculty in 1957 as an Instructorin the Department of Pathology. He be­came Assistant Professor in 1960, As­sociate Professor in 1963, and Professorin 1967. Dr. Fitch held a Lederle Medi­cal Faculty Award in 1958-61. He was aJohn and Mary Markle Scholar inAcademic Medicine in 1961-66. He wasVisiting Scientist at the University ofLausanne, as a Commonwealth Fund Fellow, in 1965-66, and Visiting Profes­sor in the Swiss Institute for Experimen­tal Cancer Research, Lausanne, as aGuggenheim Fellow in 1974-75.In 1974. Dr. Fitch was named Chair­man of the University's interdisciplinaryCommittee on' Immunology. The Com­mittee sponsors research and grantsgraduate degrees in immunology, whichis concerned with the body's defensesagainst cancer and other diseases andwith the immune response to trans­planted kidneys and other organs.Sprague Professorship EstablishedAn Otho S. A. Sprague Professorship ofMedical Science has been established inthe Division of the Biological Sciencesand The Pritzker School of Medicine.Dr. Harry A. Fozzard has been ap­pointed to the chair by John T. Wilson,President of the University. on the rec­ommendation of Dr. Daniel C. Toste­son. Dean of the Division of BiologicalSciences and The Pritzker School ofMedicine. The appointment was effec­tive November 20. Dr. Fozzard, a car­diologist, specializes in the study ofheart rhythms. particularly irregularrhythms, known as dysrhythrnias, thatare the principal cause of heart failure.The chair honors Otho S. A. Sprague,a prominent Chicago businessman whodied in 1909. The Otho S. A. SpragueMemorial Institute has made contribu­tions for research to The University ofChicago Division of the Biological Sci­ences since the 1930s. The total receivedis now well over $1 million. Similar sumshave also been given to NorthwesternUniversity and Rush-Presbyterian-St.Luke's Medical Center. The SpragueI nstitute Board has approved the estab-Dr. Harry A. Fozzard31lishment of Sprague Professorships at allthree institutions.Dr. Fozzard has been Professor in theDepartments of Medicine and Phar­macological and Physiological Sciences,Joint Director of the Cardiology Sectionof the Department of Medicine. and Di­rector of the Biomedical ComputationFacility at The University of Chicago.He joined the University faculty in 1966as Associate Professor of Medicine andPhysiology, and was appointed Profes­sor in 1971.Dr. Fozzard is the author and co­author of numerous published researchpapers on myocardial injury in burnshock. the biochemistry and electricalproperties of heart muscle action, car­diac Purkinje fibers, computerization ofcoronary care unit data, electrocardio­graph mon ito ring. and "sudden death"from irregularities in the" pacemaking"electrical signals of the heart.He is a member of the editorial boardof the American Journal oj Phvsiologyand a former associate editor and editor­ial board member of Circulation Re­search. He served the National Insti­tutes of Health as Chairman and memberof its Physiology Study Section and is amember of the Veterans AdministrationCardiology Merit Review Board.Herbst Appointed Chairman of Ob/GynDr. Arthur Lee Herbst has been ap­pointed Chairman of the Department ofObstetrics and Gynecology. He will alsoserve as the Joseph Bolivar DeLee Pro­fessor of Obstetrics and Ch ief of Staff ofthe University's Chicago Lying-inHospital.The appointment. effective January I.was made by .President John T. Wilsonon the recommendation of Dr. Daniel C.Tosteson , Dean of the Division of theBiological Sciences and the PritzkerSchool of Medicine. Dr. Herbst wasformerly Associate Professor of Obstet­rics and Gynecology at the HarvardMedical School. held positions on the at­tending staffs of the Massachusetts Gen­eral Hospital. Boston Hospital for Wom­en and the Pondville State Cancer Hos­pital. and was an affiliated Scientist at theNew England Regional Primate Re­search Center.He is widely known as the head of theresearch team that demonstrated in 1971that an unusual type of vaginal cancer in8 young women was linked to diethyl­stilbestrol (DES). which had been takenby their mothers during pregnancy. Sub­sequently the DES-findings of Dr.Herbst and his associates wereconfirmed. and a nationwide search32 Dr. Arthur Lee Herbstbegan for the children of mothers givenDES in pregnancy.In 1971. with Dr. Robert E. Scully.pathologist at the Massachusetts Gen­eral Hospital, Dr. Herbst founded theRegistry of Clear-cell Adenocarcinomaof the Genital Tract in Young Females.Dr. Herbst has served as its directorsince then and will maintain the Registryin Chicago. while continuing his collab­oration with Dr. Scully. To date the Reg­istry has accessioned approximately 250cases of these rare cancers and has es­tablished a definite history of maternalingestion of 0 ES in most of the investi­gated cases. The Registry is also study­ing the clinical and pathologic aspects ofthese carcinomas. their natural history,and optimal methods of treatment. Inother studies Dr. Herbst and his co­workers have also found numerousnon-malignant changes in the genitaltracts of most young DES females.These alterations are currently beingstudied by many investigators through­out the United States.Dr. Herbst is a 1953 magna cum laudegraduate of Harvard College. After serv­ing during the Korean War as a lineofficer in the U.S. Navy, he enteredHarvard Medical School. where he re­ceived his M. D. degree cum laude in1959.He served his internship and resi­dency at Massachusetts General Hospi­tal and subsequently performed endo­crinology research at Harvard and Edin­burgh. Scotland. He became instructorin Obstetrics and Gynecology at Har­vard in 1965. assistant clinical professorin 1970. and associate professor in 1973.He is the author of published researchstudies of liver steroid metabolism,hyperthyroidism. nitrogen mustard metabolism, and DES-associatedchanges.Dr. Herbst is a Fellow of the Ameri­can College of Obstetricians andGynecologists and American College ofSurgeons and is a member of numerousother medical, scientific, cancer. endo­crinological and gynecological organiza­tions. He is particularly interested inproblems related to the treatment of pa­tients with gynecological cancer and hasbeen certified for special competence inthis area by the American Board of Ob­stetrics and Gynecology.While at Harvard, he won the BordonUndergraduate Research A ward (1959)and the U pjohn A ward of the EndocrineSociety (1962). He received the FrancesStone Burns Award of the AmericanCancer Society. Massachusetts Division(1972), and the Foundation Prize of theAmerican Association of Obstetrics andGynecology (1973)."Pay Back" Training GrantsThe University of Chicago has received$1,058,443 under a new federal NationalResearch Service Awards "pay back"training grant program for pre- andpost-M.D .. Ph.D. or other doctoraltrainees and fellows in medicine, biolog­ical sciences, and mental health. Thisamount will cover one year of the pro­gram.Recipients are presented various "payback" options. which include teachingand research, medical or related servicein an "under-doctored" area, or repay­ment of the grant money.The grants to the University project atotal of $8,13 I ,169 in direct costs in thenext five years, says Robert Uretz,Deputy Dean for the Basic Sciences inthe Division of the Biological Sciencesand The Pritzker School of Medicine.According to Uret z , approval hasbeen received for institutional grants inthirteen basic science and clinical areas,many of them interdepartmental and in­terdisciplinary. This includes an awardto allow the Division of the BiologicalSciences and The Pritzker School ofMedicine to continue to support its Med­ical Scientist Training Program.The University will designate the re­cipients of support under the grants,which emphasize interdisciplinary re­search.Four other program proposals arepending, says U retz. Some of these havebeen approved, but no funding is yetavailable.The new "pay back" program wasmandated by Congress in The NationalResearch Act (Public Law 93-348, July12. 1974) after the administration hadproposed phasing out all biomedicaltraining grants. The National ResearchService A wards will replace two otherprograms which are now being phasedout: the "old" pre-1973 program, whichwas terminated except for grants alreadycommitted for periods up to five years;and the "Weinberger" research man­power training grants of November,1973, which were available to postdoc­toral trainees only.As University of Chicago grants underthese older programs are phased out,says U retz, total amount of supportunder the new program will rise. How­ever, the net effect is that the Universitywill receive less training grant support,and that it will be available to fewergrantees.PL 93-348 covers training grants madeby the National Institutes of Health(NIH) and by the Alcoholism, DrugAbuse, and Mental Health Administra­tion (ADAMHA).Essentially the "pay back" plan is asfollows: If suitable health research andteaching positions are available the re­cipient is expected to engage in biomedi­calor behavioral research or teaching fora period equal to the period of support. Ifno such positions are available and if therecipient becomes a physician, he or shemay agree to serve as a member of theU.S. government's National HealthService Corps for a like period. Alterna­tively, physician-recipients may serve inprivate practice or in an approved healthmaintenance organization (HMO) in an"under-doctored" area for twentymonths for each twelve months of sup­port. Recipients may also pay back thegrant directly in dollars, with interest,under a formula that also takes into ac­count any partial service performedunder the plans.Cooperative Surgical ServiceThe University of Chicago Hospitalsand Clinics (UCHC) and the IllinoisCentral Community Hospital (lCCH)are cooperating in a new program to pro­vide expanded surgical services.The program is in response to an in­creased patient census requiring servicesfor plastic and reconstructive surgery,neurosurgery, thoracic, and generalsurgery. A twenty-eight bed unit atICCH has been remodeled and is now inservice as an extension of the UCHCDepartment of Surgery.Admission to the new unit at IllinoisCentral Community Hospital will bemade by UCHC attending surgeons whoalso hold medical staff appointments atthe Illinois Central Community Hospi­tal. In making the announcement of thenew agreement, hospital officials at bothinstitutions said that shared medical andhospital services is a highly desirablegoal in health delivery. Utilization of ex­isting facilities is an efficient approach tokeeping down costs of health care.Cooperative efforts between UCHCand Illinois Central Community Hospi­tal include participation by ICCH in­terns and residents in UCHC teachingrounds, and medical education confer­ences and seminars in The PritzkerSchool of Medicine. The University'smedical staff is currently providingpsychiatric consultation for the ICCHAlcoholics Services Unit.Coordinating the new cooperativesurgical service are Dr. David B. Skin­ner, Chairman of the University's De­partment of Surgery and the Dallas B.Phemister Professor of Surgery; and Dr.Philip L. Campagna, Chairman of theBoard of Directors and Director of Med­ical Education, Illinois Central Com­munity Hospital.Cancer Research Annual ReportThe Second Annual Report of CancerResearch at The University of Chicago,1974-1975, has been issued.The report summarizes current re­search and other projects of The Univer­sity of Chicago Cancer Research Centerand Cancer Control Center; the BenMay Laboratory for Cancer Research;the Franklin McLean Memorial Re­search Institute; the U.S. Public HealthService Clinical Cancer Training Pro- gram in The University of Chicago Divi­sion of the Biological Sciences and ThePritzker School of Medicine, and othercancer research projects and contracts atthe University.Dr. John E. Ultmann is Director ofThe University of Chicago Cancer Re­search Center, which prepared the re­port. It presents "a sampling" of currentanti-cancer effort at the University,based on reports by involved facultymembers and staff.The 25 I-page paper-bound book re­ports on 158 major research projectsunder seven subject headings: Virology;Cell Biology; Tumor Immunology; Car­cinogenesis; Clinical Research;Radiotherapy, Radiation Physics andNuclear Medicine; and Core Facilities.A 53-page bibliography lists 1974-75publications by 79 individual cancer re­searchers at the University, 153 specialcancer-related lecture programs, and six­teen special conferences and symposiapresented at the University. Sources offunding, provided by grants and con­tracts from 55 public and privatesources, are noted for each project.According to the National Cancer In­stitute Fact Book, 1975, the Universityranked eighth in the nation in the amountofNCI grant, contract, and constructionfunding received in fiscal 1974, with atotal of $9,964,000.The University currently receives$1,023,907 in grant support of one yearor more from the American Cancer So­ciety, the largest sum in Illinois, accord­ing to an August 1 tabulation by theSociety's Illinois Division. The Univer-//'./ / /� /This nursing station is the center for the clinical and evaluative work of the 28-bed unit at IllinoisCentral Community Hospital.33sity received $813.210 in the year endingJune 30 from The University of ChicagoCancer Research Foundation. thelargest contribution in the Foundation'shistory, according to the Foundation's1975 annual report. The Foundation wasestablished in 1947 by Chicagobu s inessma n-ph ila n th ropi st MauriceGoldblatt, Founder and HonoraryChairman. Chairman of UCCRF is Dr.Leon O. Jacobson. and its president isLeonard S. Florsheim. Jr.Total Body ScannerThe University of Chicago will soonpurchase a total body scanner that willgive it the most advanced availablemeans of making X-rays of the abdomenand other parts of the human body.The equipment has been described asthe most important advance in diagnosticradiology since the introduction of theX-ray. It operates on the same principleas the EM I brain scanner already in useat the University.Computational and tomographic scan­ners make a number of exposuresthrough tissue along different planes.Through the use of a computer. theyprovide much greater information aboutthe existence, location, and shape oftumors. I n effect, they produce imagesof "slices" or cross sections of thehuman body, which, taken together,provide a three-dimensional view of theinterior of the body.The equipment will be used for diag­nosis and "staging" of tumors, to pro­vide more detailed information as a guidefor treatment. in the Department ofRadiology.University trustees authorized pur­chase of the equipment. at an estimated$630.000, for delivery in about a year.The device will be purchased throughreserve funds and gifts. Cost of theequipment will eventually be recoveredby charges made to patients for its use,according to Dr. John J. Fennessy,Chairman of the Department of Radiol­ogy.Warfarin Linked to Birth DefectWarfarin and other orally administeredblood-thinning (anti-coagulant) drugscan cause a potentially fatal birth defectin fetuses of pregnant women who aregiven the drug to prevent blood clots,says pediatric radiologist Dr. K. JefferyKranzler. He believes there is sufficientevidence to warn against warfarintherapy during pregnancy.The child born of a mother who hastaken certain anti-coagulant drugs mayhave a nose that is so deformed that the34 Dr. K. Jeffery Kranzlerinfant may smother. Dr. Kranzler toldthe Society for Pediatric Radiologymeeting in Atlanta. Co-authors of thepaper were Dr. Ronald Port and Dr.John Madden.Dr. Kranzler is Director of the Sec­tion of Pediatric Radiology in The Uni­versity of Ch icago s Wyler Ch ildren "sHospital. which is operated by theHome for Destitute Crippled Children.Chicago. He is Assistant Professor inthe Department of Radiology. Dr. P0I1is Assistant Professor in the Departmentof Radiology and in the Wyler Hospital.Dr. Madden is Professor and Director ofClinical Services in the Department ofPediatrics, and Pediatrician in Charge ofNurseries in the University's ChicagoLying-in Hospital.Anti-coagulants are prescribed for pa­tients, such as victims of heart diseaseand phlebitis, in whom blood clots arefeared. Such clots may migrate throughthe circulation to the lungs or other or­gans and kill the patient.Dr. Kranzler reported on a child whowas referred to Wyler Children's Hospi­tal from a suburban Chicago hospitalwith a deformed nose and abnormalskeletal calcifications. He and Dr. Mad­den recognized the condition as a mal­formation known as chondrodysplasiapunctata. This was confirmed on anX-ray examination by Dr. Kranzler.Chondrodysplasia punctata is thought tobe genetic in origin. However. in thiscase Dr. Kranzler suggested, after astudy of the literature. that warfarintaken by the mother for phlebitis andpulmonary blood clots during pregnancyhad caused the deformity. He terms thecondition teratogenic chondrodysplasiapunctata. The term teratogenic refers tobirth deformities. Chondrodysplasia re­fers to abnormally calcified cartilages inthe growing ends of bones and at junc­tion points between bones.Warfarin is rarely prescribed duringpregnancy, says Dr. Kranzler, becausethe compan ies that market it warn that it may cause hemorrhaging in pregnantwomen. leading to miscarriage. In addi­tion, several pharmaceutical houseswarn of isolated "hypoplastic nasalstructures" in infants born of motherswith coronary disease who had beengiven warfarin during pregnancy afterreceiving artificial heart valves.The pharmaceutical companies' warn­ings applied to the later months ofpregnancy, but warfarin should not begiven at all during pregnancy. suggestsDr. Kranzler. who found seven morewarfarin-related cases described in themedical literature, plus three more notreported. One of the eleven infants diedof suffocation. Infants born with the de­formed noses must be resuscitated andgiven an artificial airway.Warfarin readily passes through theplacenta into the fetus, said Dr. Kranz­ler. An alternative drug might be hepa­rin, which does not so severely affect thefetus. he said. The patient suffering fromthrombophlebitis might also havesurgery to prevent migration of the clotsto the lung and heart.Mouth breathing is a learned reflexthat is usually acquired when the infantis weaned, Dr. Kranzler said. and anewborn infant who cannot breathe na­sally cannot breathe at all.Warfarin is a naturally occurring sub­stance that first came to the attention ofveterinarians and agricultural chemistsbecause it killed cattle when they ate aplant in which it is found. It is also apotent poison for rats and mice, and infact is used as a rodent killer. Subse­quently, in small doses it was shown tobe an effective means of preventingblood clots in human beings. Later, itschemical structure was determined andsynthetic means of producing it were de­veloped. Chemically it is related tocoumarin, another commonly used drug.Early Diagnosis Vital in Aortic Dissec­tionsSurvival should be the rule rather thanthe exception when the aortic artery wallweakens and threatens to burst, Dr.Constantine E. Anagnostopoulos, Uni­versity of Ch icago heart surgeon, be­lieves. Rupture of the aorta is the mostcommon cause of death in such cases, hesays. But early and correct diagnosis andtreatment can prevent death.The term aortic dissections, by whichphysicians refer to this condition, appliesto separation of the layers of the aorta,the body's principal artery, which leadsdirectly from the heart. It is of multipleorigin, hence the plural: "dissections."This condition, the most frequentcatastrophe involving the human aorta,is sometimes wrongly termed ananeurysm, says Dr. Anagnostopoulos."In the early phases of acute dissection,there is no visible enlargement, and astudent or young house-officer about tomake a diagnosis may be steered awayby the absence of an aneurysm onX-ray.""The best term should be the easiestand most descriptive, i.e., separation ofthe aortic wall, since even 'dissection' isa misnomer inherited from theanatomists and pathologists of the past,"he continues."Even though aortic dissection mayappear to affect few over-all, there is lit­tle doubt that its obvious manifestationsare dramatic and rapidly lethal if un­treated. As in other serious conditions,prophylaxis, early detection, and treat­ment of primary causes of dissectionswill yield superior results. Treatment,if not ideal as yet, has been developed inthe past 18 years, and the improvementin results is encouraging," says Dr.Anagnostopoulos.Dr. Anagnostopoulos has written abook, Acute Aortic Dissections, whichreviews the literature on the subject andthe records of 36 patients with the condi­tion who were followed by Dr. Anagno­stopoulos during the past seven years.In a review of the experience ofsurgeons with 549 cases, surgical mortal­ity after one month ranging from 10 to 70percent was seen, with an average of 40percent, Dr. Anagnostopoulos reported.Mortality was about 50 percent after twoyears. Of 969 patients who received nomedical or surgical treatment for thecondition, 90 percent died within a year.Early diagnosis is vital, says Dr.Anagnostopoulos. It is essential to beaware that a dissection may be responsi­ble for the patient's unusual pain, and toimmediately administer antihypertensivedrugs to lessen heart muscle action onsuspicion.The aorta divides into the ascendingand descending aorta, and diagnosis ofthe correct location of artery wall weak­ness is vital. In some cases, medicationis found to be preferable to surgery.At The University of Chicago, the pa­tient remains in the University's newlyestablished Combined Cardiac Service(Cardiac Surgery and Cardiology) undercombined medical-surgical care.Dr. Anagnostopoulos is AssociateProfessor and Senior Cardiac Surgeon inthe Section of Thoracic and Cardiovas­cular Surgery in the Department ofSurgery, Division of the Biological Sci­ences and The Pritzker School ofMedicine at The University of Chicago.He is an established investigator of theAmerican Heart Association. Dr. Leon O. Jacobson takes the podium following a dinner, and earlier scientific session, held in hishonor on November 8.Child and Maternal Health InsurancePlan Proposed"Kiddie care" -comprehensive medicalinsurance for pre-school children andpregnant women-should be the firststage in a National Health InsurancePlan. suggests Theodore R. Marmor, aUniversity of Chicago health care policyspecialist. It should be supplemented bya reform in the current tax treatment ofhealth care expenses to provide, throughtax credits, 100 percent insuranceagainst medical catastrophes for allAmericans. This would be above a sub­stantial annual proportion of income thatthe patient must first bear himself.The proposal was based on a study byMarmor funded by a grant from theRobert Wood Johnson Foundation toThe University of Chicago Center forHealth Administration Studies (CHAS).'This dual program might be an ac­ceptable compromise between the lead­ing current and hotly contested nationalhealth insurance proposals," says Mar­mor. In putting forth this plan to helpsolve the nation's health problems, heargues that:• It adopts the comprehensive ap­proach to health care of Senator EdwardKennedy (D. Mass.) and Rep. JamesCorman (D. Calif.) (S 3, HR 23, 1975)but restricts it to mothers and children.It has the advantage of low cost-children have better health and rela­tively few chronic health problems.Their ailments cost considerably less totreat. Child and maternal health insur- ance would emphasize preventive care,with more ultimate health benefits perdollar. It would make health care moreavailable to many children from thehomes of the unemployed, the disabled,and working poor. It is more politicallyacceptable than super-costly com­prehensive health care for all.• Major-expense insurance through taxcredits would still place the primary bur­den on the individual-IO percent ormore of annual income. The patientwould pay 50 percent of further care upto 20 percent of his adjusted gross in­come, and the government would paythe rest. This would be done eitherthrough cash rebates or credits againsttax. This proposal would combine the"medical catastrophe" approach ofSenators Russell Long and AbrahamRibicoff (S2470) with that of MartinFeldstein (1971), who is Professor ofEconomics at Harvard University.From the proposal of Professor Feld­stein, whose approach is embodied in abill by Senator William Brock (R.Tenn.), it would adopt a high first cost tobe paid by the patient and retain the tra­ditional responsibility of non-indigentpatients for manageable medical costs.But this would not involve a new insur­ance bureaucracy. Rather, IRS would atthe end of each tax year incorporate thisplan in individual income tax returns.This would be a substitute for the pres­ent medical deductions, the benefits ofwhich go mostly to the upper incomegroups.35About all that Americans agree on isthat the federal government will have toassume a greater financial responsibilityfor U.S. health care, says Marmor, whois Associate Professor of Social ServiceAdministration and Research Associatein CHAS.He sees some hope today of making amore rational choice than in the "in­temperate debate which characterizedthe legislative and public discussion ofMedicare in the decade before its enact­ment in 1965." In the Medicare debate,he says, Americans became ideologi­cally polarized and were unable to learnanything from the criticisms of their op­ponents. There is at least more agree­ment that the federal government musttake a more positive role in assuringadequate health care.But there is "mythology" in publicdialogue about health: while mostAmericans agree there is a "health carecrisis," surveys show that a large major­ity don't regard it as theirs. Most familyheads are happy with the overall qualityof their health care. However, about athird are concerned about the high costand accessibility of health care. "Pollsdo indicate a widespread concern aboutthe possibly catastrophic financial con­sequences of illness," says Marmor.Marmor made his proposal in a recentpaper entitled "National Health Insur­ance and Children" delivered in Sep­tember at the Sun Valley Forum on Na­tional Health, which he also submitted tothe House Ways and Means Com­mittee's fall hearings on National HealthInsurance.Cholesterol and Heart DiseaseChicken, yes. Eggs, no.Eggs are better for hatching into babychickens than for eating, according toDr. Robert Wissler(,48), DirectorofTheUniversity of Chicago SpecializedCenter of Research in Atherosclerosis."When baby chickens grow up a littleand are properly prepared," he said,"they offer one of the best and least ex­pensive sources of animal protein that isalso low in cholesterol and saturatedfat." Dr. Wissler noted that egg yolksare very high in cholesterol, the samechemical that makes up most of the sub­stance of the plaques that fill up the ar­teries and cause most heart attacks.Dr. Wissler was responding to recentnewspaper advertisements by the N a­tional Commission on Egg Nutrition,Park Ridge, Illinois, that said thatAmerican scientists have no proof that"for 95 percent of all Americans, thosein normal good health, eating eggs, meat36 or dairy products causes heart attacks."Another advertisement said that it isonly an hypothesis that eating foods ofanimal origin-milk, meat and eggs, allof which contain cholesterol-causescoronary heart disease.Dr. Wissler said that in his opinion theadvertisements were "filled with quota­tions lifted out of context as well as mis­leading and false statements." He notedthat they were apparently designed toundermine the confidence of the publicin the advice of those thousands ofphysicians who are trying to preventheart attacks."It is perfectly true that we don'tknow everything we'd like to knowabout heart attacks and their causes," hesaid, "but weight of the evidence at thispoint indicates that the principal underly­ing cause of heart attacks, i.e., athero­sclerosis (cholesterol-filled arteries), ispreventable." The evidence also indi­cates, he said, that atherosclerosis is"likely to be substantially reversible inboth man and experimental animals if theblood cholesterol can be maintained at alow enough level over a period ofmonths."Cholesterol in the diet, he said,"works with saturated fats in the foodwe eat to stimulate the liver to make toomuch of cholesterol-containing fat­protein complexes (lipoproteins) that getinto the artery wall, get trapped thereand deposit their cholesterol there... Most populations around the worldthat eat excessive quantities of choles­terol and a high-fat diet have high bloodcholesterol levels and a high incidence ofatherosclerosis and heart attacks. Mostpopulations around the world that eat alow-cholesterol and low-fat diet have av­erage blood cholesterol levels of aboutISO mg per 100 milliliters (ISO mg %) andhave a low incidence of cholesterol-filledarteries and few heart attacks."Dr. Wissler cited evidence that thecholesterol in thickened arteries comesfrom the blood stream, and that when theblood cholesterol is high, more gets de­posited in the arteries. He also indicatedthat the level of blood cholesterol inmost Americans is too high-higher thanis normal for our species. It averagesabout 220-230 mg% and many individu­als have levels above 250 mg%. He ex­plained that in human beings, as con­trasted to some other animal species, ahigh level of cholesterol intake in thediet-such as is furnished by eggs-getsadded to the cholesterol being made bythe liver to raise the blood cholesterollevel.Dr. Wissler said that the correlationbetween the level of cholesterol in theblood and the incidence of heart attacks is increased if the other major risk fac­tors of high blood pressure and heavycigarette smoking are present. "Theserisk factors work together," he said. "Ifthey are all high, a person has about tentimes the risk of having a heart attack ascompared to those people with all ofthem low."He urged that concerned individualsfollow their blood cholesterol level andknow how it compares to a normal leveljust as they do for heart rate, body tem­perature, blood pressure, etc.Normal is about I SO mg%, em­phasized Dr. Wissler: "Many peopletake at face value a statement by theirdoctor that blood cholesterol 'is normal'when he really means that it's near theaverage for our nation-i.e., 220-250mg%-when in fact their cholesterol ismuch too high," he said.Vitamin A PoisoningYou can" poison" yourself with exces­sive vitamin A.It might take some time to diagnose,because the symptoms for vitamin Apoisoning-fatigue, fluid accumulation inthe abdomen, and jaundice-are similarto those for cirrhosis, says a Universityof Chicago liver specialist, Dr. James L.Boyer.Dr. Boyer, Associate Professor ofMedicine, recently had two patients whotook massive daily amounts of vitamin Afor five to eight years, thinking it wouldprevent constipation or colds."Despite the infrequency of reports,vitamin A toxicity may be more commonthan is realized," said Dr. Robert M.Russell, Dr. Boyer, and associates in areport in the Nell' England Journal ofMedicine. "Large doses of vitamin A areoften taken liberally for colds and skinrashes, and are recommended enthusias-Dr. lames L. Boyertic ally by popular books on nutritronwithout sufficient reference to toxicity.Although the FDA has recently re­stricted the use of nonsupplementaldoses of vitamin A to prescription byphysicians, vitamin A toxicity may wellbecome more frequent in contemporaryhealth-conscious society." Excessivevitamin A is stored in the liver, whichhas no rapid means of getting rid of it.Associated in the two cases with Dr.Boyer, head of the University's LiverStudy Section, were Dr. Russell and Dr.Saeed A. Bagheri, former fellows in gas­troenterology; Dr. Zdenek Hruban ('56),Professor in the Department of Pathol­ogy and the College; and Dr. SeymourG lagov, Professor in the Department ofPathology and the College.A second report of their research ap­peared in the American .l ourn al ofPathology.Here is what happened to the two pa­tients on whom the scientists reported.Their livers became enlarged from mas­sive amounts of vitamin A stored there.Fibrous scar tissue developed near thelarge number of vitamin-A engorgedlipid storage (Ito) cells, impairing liverfunction. Veins in the liver becameplugged up with fibrous tissue. The en­larged liver pressed on the hepatic veins,which normally carry blood away fromthe liver, raising the blood pressure in thevein. The increased blood pressureforced blood fluids to ooze out of smallnearby capillaries into the upper abdo­men. The abdomen became painfullydistended from the excessive fluid thathad invaded the abdominal cavity.Other symptoms were: The palms be­came red and flushed. Spidery red linesappeared under the skin where small ar­teries and the connecting capillaries be­came engorged. The lips and gums be­came cracked. The nails became brittle.The eyebrows disappeared, as well as allof the hair on the temples. The patientsbecame easily fatigued and had no appe­tite.It was only learned through carefulquestioning that the two patients had in­gested excessive amounts of vitamin A.One of them had several bottles of vita­min A containing 25,000 U per tablet atthe hospital bedside.It took six months, once the vitamin Aover-consumption ceased, for the pa­tients to lose their skin dryness and toget back their eyebrows and lost hair.The abdomen slowly became lessbloated. However, the liver remainedenlarged. Liver function improvedslightly in one patient, but it did not inthe other.Even if one stops abusing vitamin A,says Dr. Boyer, it may take years for the liver to rid itself of the stored up vitaminA by-products. Meantime, the liver maygo on responding to the overload of vi­tamin A by forming more and more fibercells.Aflatoxin-Nature's Powerful CarcinogenOf the several thousand known car­cinogens, or cancer-causing agents,aflatoxin is one of the most potent. Itmay contaminate beer, peanut butter, orthe corn or other meal fed the fowl andcattle whose flesh we eat."One hundred percent of the rats thatreceive small quantities of aflatoxin for 9to 24 months will develop cancers of theliver," says a University of Chicago ex­pert on fungus diseases, Dr. John W. Rip­pon, Associate Professor in the Depart­ment of Medicine. If the rats ingest largequantities, they will get cirrhosis, hesays.Human liver cancer appears to bemost heavily concentrated in areas of theworld in which food storage methods andclimate favor the growth of a mold, As­pergillis fiavus, on such crops as corn,peanuts, rice, or wheat, says Rippon,who is Director of the Mycology ServiceLaboratory and author of MedicalMycology: The Pathogenic Fungi andthe Pathogenic Actinomycete s.Aflatoxin is a poison, given off by As­p ergillis fiavus. that produces liver dam­age as well as liver cancer in some ani­mal species. Rats, turkeys, ducklingsand rainbow trout are particularly sus­ceptible.In quantities of 3110 part per million,administered to ducklings, aflatoxin reg­ularly produces liver damage and livercancers in 100 percent of the ducklings,Rippon reports.The evidence of its implication inhuman cancer is circumstantial, saysRippon, but sufficient to cause concern.Since it is known to cause liver cancer inexperimental animals, it seems logical tostudy the extent of human liver cancer ingeographic areas where As p ergillisfiavus flourishes, principally the tropicsand subtropics. A damp climate favor­able to growth of the mold, plus malnu­trition among young males, plus poorstorage methods of foods susceptible toAspergillis contamination, seem to coin­cide with high incidence of liver cancer.Aflatoxin has often been found in thepeanuts (ground nuts) used as a majorfood staple by some African tribes andhas been associated with the high rate ofliver and kidney disease, includingcancer, of these people. For instance,the liver cancer rate of Bantu males inMozambique is 500 times that of U.S. male blacks and whites, says Rippon. Astudy undertaken in Swaziland, anotherSouth African area, in 1970 seems to up­hold this theory. Liver cancer in thePhilippines is highest in humid areas inwhich com and peanut butter are verycommon in the diet.After a simple procedure for itsidentification was devised, aflatoxin wasfound to contaminate many humanfoods. In one example it was found ingrain used in making beer in a Chicagobrewery. Since the entire supply of itsgrain was affected, the company wentbankrupt.Contamination can be avoided by cor­rect storage methods, says Rippon, andby disposing of contaminated portions ofthe affected foods. Reliable methodsexist to prevent mold damage to foodsand to detect even small quantities ofaflatoxin. Such measures are effectivewhere the food processing and distribu­tion is done at a technologically sophisti­cated level. The risk of aflatoxin expo­sure is greatest in areas where conditionsare most favorable to mold damage andwhere control measures are not avail­able.A sp ergillis fiavus readily grows on soybeans, but no aflatoxin is produced. Evi­dently soy beans do not contain the sub­stance which Aspergillis fiavus requiresto produce aflatoxin.Recent interest in Aspergillis fiavuscontamination of foods began in 1960with investigation of the so-called "tur­key X" disease in England, which killedducklings, calves, and pigs as well asturkeys. Liver disease and cancer werefound in affected animals, particularly inducklings. The common factor wasfound to be Brazilian ground nut (peanutmeal) in the feed. Further investigationrevealed that the peanuts contained atoxic substance which was attributed togrowth of As p erg illi s, Subsequently,aflatoxin was isolated from grains in­fected by Asp ergillis fiavus and by ex­perimentation was defined as the causeof the strange manifestations of turkey Xdisease.Later investigation indicated thatthere are a series of compounds withsimilar activity, designated as aflatoxinB I, B2, B2.alpha, G 1, G2 and G2.alpha.Aflatoxin B 1 has been found to cause thehighest cancer susceptibility, at minimaldosages, in experimental animals.Asp ergillis fiavus is quite common inthe United States in the early fall, ac­cording to Rippon. Along with severalother common molds, its spores, fromwhich the mold reproduces, proliferateparticularly in August and September,causing allergic reactions similar to hayfever in some susceptible people.37In MemoriamCharles l. Dunham, 1907-1975Dr. Charles L. Dunham, a former Uni­versity of Chicago faculty member whobecame Director of the Atomic EnergyCommission's Division of Biology andMedicine. died in the George Washing­ton University Hospital, Washington.D.C.. December 7 after a brief illness.He was 68.Author of Radioactive Fallout, a re­port prepared for the CongressionalJoint Committee on Atomic Energy(1959). Dr. Dunham was known for ini­tiating many AEC-supported studies onthe effects of radiation on human beings.He promoted AEC-supported ecologicalstudies, both radiological and non­radiological, at a time when environmen­talism was not yet a major national con­cern.With Dr. Leon O. Jacobson, hehelped plan the Argonne Cancer Re­search Hospital, Chicago, now known asthe Franklin McLean Memorial Re­search Institute. This six-story facility isoperated by the University under a con­tract with the Energy Research and De­velopment Administration (ERDA), asuccessor agency of A EC. For manyyears. Dr. Dunham was in charge ofAEC relations with the AEC-supportedArgonne Hospital.After Dr. Dunham's retirement fromthe AEC in 1967, he served as Chairmanof the Division of Medical Sciences ofthe National Academy of Sciences­National Research Council until the endof 1972,A native of Evanston, Illinois, Dr.Dunham graduated from Yale in 1929and received his M. D. degree at TheUniversity of Chicago Rush MedicalSchool in 1934. He served his internshipand part of his residency at The Univer­sity of Chicago. After another year ofresidency at Yale University, he re­turned to The University of ChicagoSchool of Medicine, now The PritzkerSchool of Medicine, in 1936, becomingan I nstructor in 1942.DUling World War II he served in theU. S. Army Medical Corps in SouthernCalifornia and Hawaii. An allergist andinternist, he returned to the Universityas Assistant Professor of Medicine andChief of the Arthritis Clinic in 1946.Upon the organization of the AtomicEnergy Commission, he became Assis­tant Chief and Chief of its medicalbranch in 1949 and 1950 and Deputy Di­rector and Director of the Division ofBiology and Medicine in 1954 and 1955.In 1967, Dr. Dunham became Chairmanof the Division of Medical Sciences of38 the National Academy of Sciences­National Research Council, Washing­ton, D.C., a position he held until theend of 1972.He was closely associated at N AS­NRC with the Atomic Bomb CasualtyCommission and Academy activitysearching for late adverse effects of theatomic bomb on the survivors inHiroshima and Nagasaki. He was alsoespecially interested in the Division'sCommittee on the Biological Effects ofIonizing Radiation and a similar commit­tee concerned with environmental pol­lutants. He played a key role in the cre­ation of the Institute of Medicine or­ganized by the Academy to study policyissues related to health and medicine andthe problem of assuring the delivery ofhealth services to all sectors of society.After his retirement from NAS-NRC, hecontinued to serve as a consultant to theNational Institutes of Health and theWorld Health Organization.Dr. Dunham and his wife, who is alsoa medical graduate of The University ofChicago, in 1974 received ProfessionalAchievement Awards from the AlumniAssociation. Mrs. Dunham, a formercancer research assistant to Dr. Paul E.Steiner of The University of Ch icago , isa cancer pathologist and epidemiologist.She served from 195 I to 1974 as a medi­cal officer at the National Cancer I nsti­tute , Bethesda. Maryland.Dr. Dunham received the AEC Dis­tinguished Service A ward in 1957 in rec­ognition of research programs he estab­lished to determine the biological effectsof radiation. He was active in many med­ical and scientific organizations andserved in 1969-70 as President of one ofthem, the Radiation Research Society.I n the 1950s he established ecologicalresearch programs at A EC installationsat Hanford, Washington, and OakRidge, Tennessee, and subsequently atother AEC laboratories and universities.He established a national registry of allpersons having significant amounts ofplutonium in their bodies, for medicalfollow-up on the possible radiation ef­fects.Dr. Dunham was a Director andmember of the Executive Council of theNational Council on Radiation Protec­tion and Measurement. He was active inN AS committees on survivors of theHiroshima and Nagasaki bombings andon U.S. radiological safety standards.He was also a member of the ExpertPanel on Radiation of the World HealthOrganization and an Advisor to theUnited Nations Scientific Committee onthe Effects of Atomic Radiation.Dr. Dunham is survived by his wife,Dr. Lucia Jordan Dunham, of Washing- ton, D.C.; a son, George StuartDunham of Washington, D.C.; twodaughters, Carol Trotter of Denver andSarah Kraskin of Washington, D.C.;three grandchildren; a brother, ProfessorWilliam H. Dunham, Jr. of New Haven,Connecticut; and a sister, Mrs. RobertC. Stockton of Kenilworth, Illinois.A memorial service was held onJanuary 10 at the Westmoreland Con­gregational Church in Washington, D.C.Contributions in his memory may bemade to The University of Chicago forthe Dr. Charles L. Dunham MedicalStudent Loan Fund. They should be ad­dressed to Dr. Leon O. Jacobson, Di­rector, The Franklin McLean MemorialResearch Institute, The University ofChicago. Chicago, Illinois 60637.J. P. Greenhill, 1895-1975Dr. J. P. Greenhill, internationallyknown obstetrician and gynecologist andthe first resident at Chicago Lying-inHospital. died on December 22 inChicago.Dr. Greenhill received his M.D. de­gree from Johns Hopkins MedicalSchool in 1919. His involvement withChicago Lying-in Hospital dates back to1921. when he began his residency underDr. Joseph B. DeLee. There followed adistinguished career: chairman of thedepartment of gynecology at CookCounty Hospital, co-chairman of the de­partment of obstetrics and gynecology atLoyola University, senior attending ob­stetrician and gynecologist at theMichael Reese Hospital, consultinggynecologist at Cook County Hospital.professor of gynecology at Cook CountyGraduate School of Medicine, andmember of the Emeritus Clinical As­sociate Staff of Ch icago Lying-in Hospi­tal.In 1973 Dr. Greenhill, through theJ. P. Greenhill Foundation, made a giftof $84.037 to the University. The J.P.Greenhill Fund in Obstetrics andGynecology established a traveling fel­lowship and a lectureship, and lendsDr. J. P. Creenhillsupport to the departmental library inChicago Lying-in Hospital.Dr. Greenhill was a member of 26medical societies in the United States,an honorary fellow of 28 foreign obstet­ric and gynecologic societies, honoraryprofessor of the National University ofPeru, and a Chevalier of the French Le­gion of Honor. He authored numerouspapers published in American andforeign journals, several books, and waseditor of the Year Book of Obstetricsand Gynecology.Dr. Greenhill is survived by two sons,Carl B. and John D. Hess; four grand­children; and a great-grandchild. Amemorial service was held on January 25at Chicago Sinai Congregation Au­ditorium. Contributions in his memorymay be made to the J. P. GreenhillFoundation Fund in Obstetrics andGynecology.ALUMNI DEATHS'12. Charles E. Palmer. Ontario,Oregon, April 30, 1975. age 87.'16. Fred L. Glascock, Carmel.California, July 2, 1975, age 86.'16. Edmund C. Roos, Boulder, Col­orado, August 17. 1975, age 83.'17. Joseph Chivers, San Diego,California, October 4, 1975, age 84.'18. C lifford J. Pearsall, Salt LakeCity, Utah, October 8, 1975, age 84.'20. James F. Curry, Chicago, Il­linois, October 28, 1975, age 81.'21. Harry J. Veatch, Hollister, Mis­souri, September 9, 1974, age 77.'22. Vinton A. Bacon, Detroit,Michigan, December 11,1975, age 81.'24. Belle F. Korman, Chicago, Il­linois, June 30, 1975, age 84.'26. William M. McMillan, Chicago,Illinois, November 11,1975, age 76.'27. Charles B. Congdon, Hinsdale,Illinois, January 3, 1976, age 79.'29. Clayton F. Hogeboom, Baker,Montana, August 25, 1975, age 73.'30. Benjamin B. Earle, Glastonbury,Connecticut, September 27, 1975, age72.'32. Cecil C. Draa, Chicago, Illinois,October 24, 1975, age 71.'32. Kilby P. Turrentine, Kinston,North Carolina, July 30, 1975, age 70.'33. Lewis H. Armentrout, Jr.,Tazewell, Virginia, May 15, 1975, age69.'33. Irving Gordon, Miami Beach,Florida, July 11, 1975, age 69.'34. Charles L. Dunham, Washington,D.C., December 7, 1975, age 68.'�4. Margaret E. Tucker, Cleveland,OhiO, October 29, 1975, age 68.'34. David J. Zub at sky , Tustin,California, February 29, 1975, age 66. '35. Sam E. Namming a, ClearwaterBeach, Florida, November 20, 1974, age66.'35. Howard V. Valentine, Manzanita,Oregon, April 18, 1975, age 67.'36. Monroe K. Ruch, Monterey Park,California, February 21, 1971. age 61.'37. Leonard R. Sillman, Westport,Connecticut, January 10, 1976, age 62.'45. Ruth L. Nicholson, Santa Fe,New Mexico, April 17, 1975, age 53.'57. Harvey L. Higger, Anaheim,California, October 3, 1975, age 45.FORMER STAFF AND FACULTYJ. P. Greenhill (Obstetrics andGynecology, Resident, '21-'23),Chicago. Illinois. December 22, 1975.age 80.George H. Loge (Obstetrics andGynecology, Intern, '41), Tigard.Oregon, December 25. 1974, age 65.Nicholas Rashevsky (MathematicalBiology, Assistant and Associate Pro­fessor. '35-'38; Chairman, '48-'64), AnnArbor, Michigan, 1972, age 73.Maureen Taylor (Medicine-Derma­tology, Fellow and Physician, Univer­sity Health Service, '74), Chicago, Il­linois, November 15, 1975, age 34.Departmental NewsAnatomyDr. Donald Fischman, Associate Profes­sor, Departments of Biology andAnatomy, presented a paper on "Im­munological Studies of the MyogenicCell Surfaces," at the Albeit EinsteinCollege of Medicine seminar, New YorkCity, November 20.Beatrice Garber, Associate Professor,Departments of Biology and Anatomy,was chairman of the Cell DevelopmentSession of the American Society for CellBiology, San Juan, Puerto Rico, onNovember 12. She spoke on "Brain His­togenesis in vitro: Reconstruction ofSubstantia Nigra Structures in MidbrainCell Aggregates" at the meeting of theSociety for Neuroscience in New York,November 4.James A. Hopson, Associate Profes­sor, Department of Anatomy, wasChairman of a session on "Reptiles andEarly Mammals" at the annual meetingof the Society of Vertebrate Paleontol­ogy held at Harvard University,November 7, where he also presented apaper on "Functional Morphology of thePostcanine Dentition in Trirachodon(Cynodontia: Tritylodontoidea)." Leonard B. Radinsky, Associate Pro­fessor, Department of Anatomy, pre­sented a paper on "Interpreting Be­havior from Fossil Brains" at the Biol­ogy Department of the University of Il­linois at Chicago Circle, November 18.Dr. Ronald Singer, the Robert R.Bensley Professor of Biology and theMedical Sciences, Chairman of the De­partment of Anatomy, and Professor inthe Department of Anthropology, pre­sented a series of six lectures and a TVinterview as the 1975 University Lec­turer in the Distinguished Lecture Seriesof the University of Saskatchewan,Saskatoon, Canada, November 23-26,on the following topics: "The MiddleStone Age of South Africa," "The Mid­dle and Upper Pleistocene of SouthernAfrica," "Investigations at Clacton andHoxne, U.K.," "Steatopygia," "Whoare the Hottentots and Bushmen," and"The Place of Human Biology in Medi­cal Education."At the Fourth Annual Christmas Lec­ture Series of the Illinois Science Lec­ture Association, held at NorthwesternUniversity. Chicago Campus, De­cember 27 and 28, Dr. Singer moderateda panel discussion and Dr. Charles Ox­nard, Professor, Department ofAnatomy and Anthropology, delivered apaper on "Evolution of Man." Dr. Ox­nard also spoke to University of ChicagoAlumni in Boston and Hartford on"New Views of Old Bones."Dr. Oxnard and Dr. Ruth Rhines,Associate Professor Emeritus in the De­partment of Anatomy, will be guest lec­turers at Indiana University, NorthwestCampus, in the Spring semester honorscourse on "The Ascent of Man."AnesthesiologyAppointments:Dr. Livingstone Muddamalle-In­structor/Trainee.Dr. Mohamed Shafieha-Instruc­tor/Trainee.Ben May LaboratoryDr. Charles B. Huggins, the WiUiam B.Ogden Distinguished Service Professorin the Ben May Laboratory and the De­partment of Surgery, received theCartwright Medal of the College ofPhysicians and Surgeons of ColumbiaUniversity. November 19, at which timehe delivered the Cartwright lecture on"Cell Surface Control of Gene Expres­sion: Solid State Biochemistry."On December 7-11. Dr. Huggins.Nobel laureate. participated in the cele­bration of the Nobel Foundation's 75thAnniversary in Stockholm.39Dr. Elwood V. Jensen, Professor in theDepartment of Biophysics and Theoreti­cal Biology, and Director of the BenMay Laboratory, served as honorarypresident of the 7th Congress of the In­ternational Study Group for SteroidHormones, held in Rome. December3-5. He delivered the presidential lec­ture, entitled" Receptor Proteins, Past,Present and Future."The Papanicolaou Cancer ResearchInstitute's 1975 Pap Award for ScientificAchievement was presented to Dr. Jen­sen at the annual Pap A ward Dinner inChicago, February 9.BiochemistryDr. Donald Steiner ('56), A. N. PritzkerProfessor and Chairman of Biochemistryand Director of the University's Dia­betes Endocrinology Research Center,delivered the 19th Woodyatt MemorialLecture at the Eighteenth Annual Sym­posium on Diabetes Mellitus held by theAmerican Diabetes Association ofGreater Chicago, November 21.BiologyGeorge W. Beadle, Nobel laureate, willbe a guest lecturer on "The Ascent ofMan" in the Spring semester honorscourse at Indiana University's North­west campus. Mr. Beadle is the WilliamE. Wrather Distinguished Service Pro­fessor Emeritus in Biology and the Col­lege and former president of The Uni­versity of Chicago.Arnold W. Ravin, Professor, Depart­ment of Biology and Microbiology, hasbeen appointed a Sigma Xi lecturer forits Bicentennial Program on Science andSociety. He will be visiting and speakingat a number of small colleges and univer­sities in 1976 and 1977. He also is amember of the National HumanitiesFaculty, which is concerned with improv­ing humanities curricula in high schoolsthroughout the country, and will visitschools to help them integrate scienceand humanities programs. ProfessorRavin spoke at the Illinois Institute ofTechnology in February on his workwith the role of ribonucleic acid syn­thesis in the cellular integration of DN Aderived from foreign species. This springhe will give a seminar on the" HumanProspect" to the faculty and advancedstudents of the Chicago Cluster ofTheological Schools.Biophysics and Theoretical BiologyThe diamond knife, the most delicatecutting tool in the world, developed byDr. Humberto Fernandez-Moran, A. N.40 Pritzker Professor of Biophysics, is ondisplay at Chicago's Museum of Scienceand Industry as part of an exhibit titled"Illinois: Land of Innovation." The ex­hibit is part of the museum's three-yearBicentennial observance of "America'sInventive Genius." The diamond knifeis used in brain and cancer research, andfor eye surgery and related work.Emergency MedicineAppointment:Dr. James S. Greene-ClinicalAssociate/ Assistant Professor.Franklin Mclean Memorial Research In­stituteDonald B. Charleston, Associate Profes­sor, Department of Radiology andF.M.I., and Supervisor, ElectronicShop, F.M.I., participated in the Inter­national Atomic Energy Agency meetingin Vienna, Austria, December 8-12, forscientists and leading manufacturers ofnuclear medicine instruments to discuss"Strategies for Improving Maintenanceof Nuclear Medicine Instruments in De­veloping Countries."Dr. Leon O. Jacobson ('39). the JosephRegenstein Professor of Biological andMedical Sciences, and Director ofF. M.I., was elected to DistinguishedService Membership in the Associationof American Medical Colleges at a meet­ing in Washington. D.C., November 10.La RabidaAppointment:Dr. Elsa J. Roe-Instructor, LRUCIand Pediatrics.MedicineDr. Sumner C. Kraft (' 55), Professor inMedicine, was a guest speaker for apostgraduate course entitled "ClinicalProblems in Gastroenterology" at theCleveland Clinic in November.Dr. Suzanne Oparil, Associate Profes­sor in Medicine (Cardiology), withcoauthors Dr. John Low (,75), presentlya resident in the San Francisco GeneralHospital, and Dr. Anthony Cutilletta,Assistant Professor in Medicine, pre­sented a paper on: "Catecholamines.Blood Pressure, Renin and MyocardialFunction in the Spontaneously Hyper­tensive Rat" at the Fourth Meeting ofthe International Society of Hyperten­sion. Sydney, Australia, February24-26.Dr. Murray Rabinowitz, the LouisBlock Professor in Medicine andBiochemistry, presented papers at the Cell Biology meeting in San Juan, PuertoRico, November 11-14. Dr. RadovanZak, Associate Professor in Medicineand Research Associate in Biochemis­try, was a coauthor.Dr. Arthur H. Rubenstein, Professorand Associate Chairman in Medicine,and Program Director for the Diabetes­Endocrinology Center, spoke on "Re­cent Advances in Diabetes Researchand Management" at the 19th WoodyattMemorial Lecture in Chicago,November 21.Dr. Rubenstein, with Dr. JeromeStarr, former resident in Medicine, et al.,wrote a paper on "Degradation of Insu­lin in Serum by Insulin-Specific Pro­tease," published in the Journal ofLaboratory and Clinical Medicine, Oc­tober 1975.Dr. Angelo Scanu, Professor inMedicine and Research Associate inBiochemistry, Ferenc J. K. Kez dy ,Professor of Biochemistry, and Dr. DaleG. Deutsch, Research Associate inMedicine, presented papers at the 48thScientific Session of the American HeartAssociation meeting in Anaheim,California, November 17-20.The following presented papers at the26th Annual Meeting of the AmericanAssociation for the Study of Liver Dis­eases. held in Chicago. November 4-5:Dr. John F. Schneider (,63), AssistantProfessor in Medicine; Dr. BernardNemchausky, Instructor in Medicine;Dr. James L. Boyer, Associate Professorin Medicine; Dr. Peter D. Klein,Professor in Medicine; Dr. Irwin H.Rosenberg, Professor in Medicine; Dr.James Wagonfeld, Instructor inMedicine, and Dr. Thomas J. Layden,former Instructor in Medicine.Dr. Alvin R. Tarlov (,56), Professorand Chairman of Medicine, was aspeaker and discussant at the 72nd An­nual Congress on Medical Education,held in Chicago, January 30-February I.The topic of his paper was: .. SocialChanges and the Educational Process."Linda Hughey (,77) was a session mod­erator and spoke on "Physician: Scien­tist, Deity or Human Being?"Dr. John UItmann, Professor inMedicine and Director of the CancerResearch Center, presented a Sym­posium on Cancer Chemotherapy, heldin Chicago, November 5.The following presented a paper on"Mid- Ventricular Obstruction in Hyper­trophic Obstructive Cardiomyopathy:New Concept" at a meeting of theChicago Cardiology Group, January 16:Dr. Paul E. Falicov, Associate Professorin Medicine (Cardiology); Dr. Leon Res­nekov, Joint Director, Cardiology Sec­tion; Dr. Noel Cahill, Assistant ProfessorIn Medicine (Cardiology); and Dr.Maurice Lev, Professorial Lecturer inMedicine.Obstetrics and GynecologyAppointments:Dr. Edgar Del Castillo-AssistantProfessor.Dr. Evans Fiakpui (70)-AssistantProfessor.Dr. Vaclav Hlavaty=-Assistant Pro­fessor.Promotion:Dr. Imre Hidvegi-Assistant Profes­sor.Dr. Luis A. Cibils, Mary CampauRyerson Professor in Obstetrics andGynecology, was the guest of honor inNovember at the Fifth GuatemalanCongress in Guatemala City. He par­ticipated in round table discussions andpresented lectures on "Fetal Monitoringin Labor" and" High Risk Pregnancy."He also attended the Society ofGynecologists and Obstetricians meet­ing in Costa Rica, November 10-14,where he discussed "Female Steriliza­tion," "High Risk Pregnancy," and"Techniques of Permanent Steriliza­tion. "Dr. Arthur Herbst, Joseph Bolivar DeLee Professor and Chairman of the De­partment of Obstetrics and Gynecology,was moderator of a session on "DES,Clear Cell Adenocarcinoma: Report ofthe Registry" at the Basic Course inColoscopy in March, sponsored by theUniversity of Utah's Department of Ob­stetrics and Gynecology.OtolaryngologyAt the American Academy of Ophthal­mology and Otolaryngology meetingheld in Dallas in September, Dr. CesarFernandez, Professor of Surgery, andDr. John R. Lindsay, Thomas D. JonesProfessor and former chief of the sec­tion, were honored at a dinner given bytheir former residents. Each was pre­sented with a plaque showing the threegenerations of doctors they trained be­tween 1940 and 1966. The list includesmany chairmen at major medical schoolsthroughout the country.At the same meeting Dr. Ralph Naun­ton, Professor of Surgery and Chief ofthe Section, and Stanley Zerlin,Research Associate in Otolaryngology,presented a paper on "Electrocochleog­raphy in the Evaluation of PeripheralAuditory Function." Stanley Zerlin waselected an Associate Fellow of theAmerican Academy of Ophthalmologyand Otolaryngology. Dr. John R. Lindsay and Dr. Cesar Fernandezreceive plaques from residents they havetrained.Dr. Anthony Geroulis, resident, pre­sented a film at the meeting on "SurgicalIntervention for Posterior Epistaxis,"and a scientific exhibit presented byDr. Fernandez,' Dr. Paul Ward(resident-faculty '58-' 62), departmentchairman at U.C.L.A., and BarbaraBohn, histologist at Washington Univer­sity, won the Gold Medal. The exhibitshowed inner ear damage to animals ex­posed to loud noises, and included a filmby Dr. Ward. The experiment took placein a Chicago nightclub where the threescientists exposed a box of chinchillas,placed three feet from the loudspeakers,to two and one-half hours of rock music.The noise level averaged 107 decibels,which compares with a noise level of 110to 114 decibels produced by a snow­mobile and 130 decibels experienced bya person standing next to a jet airplane.Examination of the animals' inner earsshowed all suffered irreversible ear dam­age ranging from mild to severe.Robert A. Butler, Professor in the De­partments of Surgery (Otolaryngology),Psychology, and Behavioral Sciences,was elected President of the Associationfor Research in Otolaryngology at itsannual meeting in September in Dallas.Dr. Ralph Naunton was appointedChairman of the Committee on Ethics atthe annual meeting of the American Au­diology Society in San Francisco inNovember. He presented a paper on"Congenital Anomalies of the Ear andOtosclerosis" at the Ninth Conferenceon Radiology in Otolaryngology of thellIinois Eye and Ear Infirmary, Chicago,November 28-29.Dr. Leonard Proctor, Associate Pro­fessor in Otolaryngology, was appointedDirector of the Section's Clinical Ves­tibular Laboratory.Stanley Zerlin was appointed Direc­tor of the Section's Clinical Audiol­ogy Laboratory in November. He pre­sented a paper on "Principles and Prac- tice of Electrocochleography" at the an­nual meeting of the American Speechand Hearing Association, Washington,D.C., November 21.PATHOLOGYAppointment:Dr. Andrew M. Churg (,73)-Instructor.Promotion:Dr. Jayrne Borensztajn-AssociateProfessor.Dr. Werner H. Kirsten, Professor andChairman of Pathology and Professor ofPediatrics, was appointed to the medicaland scientific advisory committee of theNational Board of Trustees of theLeukemia Society of America. Thecommittee sets policies for the society'sresearch programs.Dr. Robert W. Wissler ('48), DonaldN. Pritzker Professor of Pathology, par­ticipated in the Tenth Princeton Confer­ence on Cerebrovascular Diseases inPrinceton, New Jersey, January 7-9. Hegave the introduction, "Overview on theProblem of Atherosclerosis." OnJanuary 23 he lectured at the MedicalCollege of Pennsylvania on "GeneralPrinciples of the Pathogenesis ofAtherosclerosis.' ,PediatricsPromotion:Nancy B. Schwartz, Ph.D.- Assis­tant Professor.Dr. Ruthmary Deuel, Assistant Profes­sor, Departments of Pediatrics andMedicine (Neurology), was appointedchairman of the by-laws committee ofthe Child Neurology Society, the na­tional organization of pediatricneurologists.Dr. Albert Dorfman ('44), the RichardT. Crane Distinguished Service Profes­sor in Pediatrics and Professor inBiochemistry and the Committees onGenetics and Developmental Biology,spoke on "Mucopolysaccharidoses " atthe Symposium on Biochemistry of In­herited Neurological Diseases at the So­ciety for Neuroscience annual meeting inNew York, November 3-4.He also participated in a symposiumon Connective Tissue, sponsored by theAlbert Einstein College of Medicine andthe New York Rheumatism Associationin New York, November 5. He spoke on"Medical and Biological Aspects ofM ucopolysaccharides."On November 8 he spoke on "Studiesin Differentiation of Cartilage Cells" atthe Midwest Connective Tissue Work­shop, held at The University of Chicago.41Dr. Johanna Heumann (' 18) wasawarded an honorary membership on theWyler Hospital medical staff and in theDepartment of Pediatrics by Dr. Spec­tor. Dr. Heumann has practiced pediat­rics in Hyde Park since 1926 and hasbeen a "regular" at departmental meet­mgs.Dr. J. Laurence Hill, Assistant Profes­sor in Surgery (Pediatrics). presented thefollowing papers: "Capsulatomy forRenal Ischemia" at the American Col­lege of Surgeons meeting; "ClinicalTechnique and Success of theEsophageal Stent to Prevent CorrosiveStrictures" with coauthor Dr. HernanM. Reyes, Associate Professor inSurgery (Pediatrics). at the AmericanAcademy of Pediatrics meeting; and"Progress in Transplantation" at theCh icago Surgical Society.Dr. Samuel Spector, Professor andchairman of Pediatrics and Director ofLRUCL was honored by Case WesternReserve Un ivers ity ped iatric clin icalfaculty and Rainbow Babies' andChildren's Hospital at the school's fifthannual pediatric program on November12. The program was called "What'sNew in Pediatrics: Sam Spector Day."Dr. Spector had been a member of thepediatric faculty at Case Western Re­serve University for 24 years.Pharmacological and Physiological Sci­encesDr. Daniel C. Tosteson, the Lowell T.Coggeshall Professor of Medical Sci­ences and Dean of the Division of theBiological Sciences and The PritzkerSchool of Medicine. was appointed to atwo-year term as a member of the Coun­cil of the Institute of Medicine of the Na­tional Academy of Sciences.PsychiatryDr. Chase P. Kimball, Associate Profes­sor in Psychiatry and Medicine. dis­cussed the psychiatric aspects of cancertherapy at a conference for parish clergyand seminarians sponsored by theAmerican Cancer Society in November.He was elected to the executive councilof the College of The University ofChicago.Dr. Paul J. Schwab, Associate Profes­sor in the Department of Psychiatry andChiefofthe Inpatient Service. presentedtwo papers at the annual IllinoisPsychiatric Society meeting in the fall.The titles of the papers were: "PrivateHealth Insurance and the AdolescentPsychiatric Inpatient," and" A Suppor­tive Clinic: Who Comes. How Often.For What')" with coauthor Barbara H.Smith. M.S.W .. Social Worker in thePs ychiatric Outpatient Department.42 RadiologyPromotions:Dr. Herber M. MacMahon- Assis­tant Professor.Dr. Charles E. Metz-Associate Pro­fessor.Dr. Paul V. Harper, Jr., Professor. De­partment of Surgery (General) andRadiology. and Katherine Lathrop,Associate Professor in Radiology. pre­sented a paper on "Response of theMouse Fetus to Radiation from Na"'""TeO;' at the I AE Symposium onBiological Effects of Low Level Radia­tion Pertinent to the Protection of Manand His Environment. in Chicago.November 3-7.An exhibit prepared by Arthur G.Haus, Research Associate in Radiologyand F. M. I.; Kunio Doi, Associate Pro­fessor of Radiology and F.M.I.; Dr. JoelBernstein ('69). Instructor in Radiology;Dr. John T. Chiles ('69). former instruc­tor in Radiology; and Kurt Rossman,Director, Section of Radiological Sci­ences. and Professor, Department ofRadiology and F. M. I.; won an award atthe Radiological Society of NorthAmerica meeting in Chicago. December1-5. The exhibit title was "The Effect ofthe Recording System and GeometricU nsharpness on I mage Quality and Pa­tient Exposure in Mammography."Lawrence H. LanzI, Professor of Med­ical Physics in the Department ofRadiology and F. M. I., was reappointedto the Biomedical Subcommittee of theLos Alamos Meson Physics FacilityProgram Advisory Committee, LosAlamos Scientific Laboratory. last fall.Also last fall, he was appointed to theInstitutional Review Board of Fermi-labby the Universities Research Associa­tion. Inc.Lanzi was an invited speaker on.. State and Federal Regulatory Mea­surement Responsibilities Around Med­ical Facilities" at the National Bureau ofStandards 75th Anniversary Symposiumon Measurements for the Safe Use ofRadiation, March 1-4, Gaithersburg,Maryland. He is program chairman of aHealth Physics Conference on En­vironmental Nuclear Impact which willbe presented in Itasca, Illinois, April8-9. by the Midwest Chapter of theHealth Physics Society.Dr. Dieudonne J. Mewissen, Professor.attended a Congress on Micro­Distribution of Radioactive Isotopespresented by the Atomic Energy Estab­lishment in Julich, West Germany lastfall. He was a U.S. delegate to the Inter­national Meeting on Water Resourcesheld in New Delhi, India. December12-18, by the International Associationon Water Resources. SurgeryDr. Jack C. de la Torre, Assistant Pro­fessor in the Department of Surgery(Neurosurgery), presented a paper on"Evidence for Noradrenergic Innerva­tion of Intracerebral Blood Vessels" atthe Society for Neuroscience, NewYork City. November 4.Dr. Lee E. Edstrom, Assistant Profes­sor of Surgery (Plastic and Reconstruc­tive Surgery), was elected to the Ameri­can Bum Association and the AmericanAssociation for Automotive Medicine.Dr. Donald J. Ferguson, Professor inthe Department of Surgery. spoke atSurgery Grand Rounds, NationalCancer Institute, Bethesda, Maryland,in November on "The Role of StagingLaparotomy in Hodgkin's and Non­Hodgkin's Lymphoma."Dr. Edwin Kaplan, Professor in theDepartment of Surgery, Dr. JohnTaylor, resident in Surgery, and HowardS. Tager. Ph.D., Assistant Professor inthe Department of Biochemistry, pre­sented a paper on "A HypercalcemicFactor in Commercially Prepared Insu­lin" at the Association of AcademicSurgery meeting, November 12-14, inMinneapolis.Dr. A. R. Moossa, Assistant Professorin the Department of Surgery. was a vis­iting professor at the Universities ofLiverpool, Leeds, Bristol, and Cardiff inEngland and Wales during the first threeweeks of November. He delivered lec­tures and conducted seminars on pan­creatic cancer, the injured bile duct, andthe surgical treatment of inflammatorybowel disease.Dr. Martin Robson, Associate Profes­sor and Chief of the Section of Plasticand Reconstructive Surgery, last fallpresented the following papers: "Resec­tion and Immediate Reconstruction forPatients with 'Inoperable' RecurrentHead and Neck Cancer." at the Fred­erick Coller Society meeting in SanDiego; "The Mucoperiosteal Flap forRepair of Oral Cavity Defects," at themeeting of the American Society forPlastic and Reconstructive Surgeons(submitted to the Journal of Plastic andReconstructive Surgery) with coauthors,Drs. Edstrom, Hagstrom, and Landa, inthe Department of Surgery; and"Forearm Compression Syndrome" atthe American Association for HandSurgery (submitted to Orthopedic Re­I'iell' with Dr. Edstrom as coauthor).Dr. Robson was elected to the Fred­erick Coller Society and to the AmericanSociety of Maxillofacial Surgeons. Hehas been appointed to the SpecialtyConsultants Board of ChicagoMedicine.Dr. David Skinner, the Dallas B.Phemister Professor and Chairman ofSurgery, was Visiting Professor at theUniversity of Wisconsin Hospitals inNovember. He spoke on "Evaluationand Treatment of Hiatal Hernia andGastro-esophageal Reflux."ZollerDr. Albert A. Dahlberg, Professor in theCommittee on Evolutionary Biology andResearch Associate in the Zoller DentalClinic and Anthropology, lectured inNovember at the Institute of Ethnog­raphy in Moscow and consulted withRussian colleagues on dentition of peo­ples of the Arctic regions.Michael Reese-PritzkerThe following full-time members ofMichael Reese Hospital and MedicalCenter have been named to the staff ofThe Pritzker School of Medicine:Department of MedicineAppointments:Dr. Ivan D'Cruz to Assistant Profes­sor, for one year, effective January I,1976.Dr. Dennis Sloan to Clinical Instruc­tor, for one year, effective January I,1976.Reappointment:Dr. Alan Kanter, Clinical AssociateProfessor, for one year, effectiveJanuary 1, 1976.Obstetrics and GynecologyPromotion:Dr. Ramaa Rao to Assistant Profes­sor, for two years, effective October 1,1975.Reappointments:Dr. Frederick Auletta, Assistant Pro­fessor, for two years, effective June 1,1975.Dr. Joseph Bieniarz, Professor, forone year, effective January 1, 1976.Department of PediatricsAppointments:Dr. Bangaru Jayalakshamma to In­structor, for one year, effective July 1,1975.Dr. Sharon Libit to Assistant Profes­sor, for one year, effective July I, 1975.Dr. Sherwood Libit to Assistant Pro­fessor, for one year, effective July 1,1975.Dr. Milford Schwartz (,65), to Assis­tant Professor, for one year, effectiveJuly 1, 1975. Dr. Andree Walczak to Assistant Pro­fessor, for one year, effective July 1,1975.Reappointments:Dr. Pipit Chiemmongkoitip, AssistantProfessor, for one year, effective July 1,1975.Dr. Nancy B. Esterly, Associate Pro­fessor, for one year, effective July I,1975.Dr. David E. Fisher, Assistant Pro­fessor, for one year, effective July I,1975.Dr. Samuel L. Gotoff, Professor,effective April 16, 1975 through June 30,1976.Dr. Lynne L. Levitsky, AssistantProfessor, for one year, effective July 1,1975.Alumni News1920Joseph J. Jelinek retired from generalpractice on January I. Dr. Jelinek livesin Glendale, California.1928Louis and Virginia P1zak are both en­gaged in the practice of medicine andpharmacy respectively at the Memphis,Tennessee V. A. Hospital.1929Arthur N. Ferguson is retired and livingin Walnut Creek, California.Grace Hiller wrote to us that she is stilla resident of the Augsburg LutheranHome in Baltimore, Maryland. Otherthan difficulty in walking, she is doingfine.1931Marcus T. Block, age 72, is activelyteaching dermatology at the New JerseyCollege of Medicine and Dentistry inNewark.1932Samuel S. Bernstein was promoted toclinical professor of pediatrics at WayneState Medical School in Detroit.Robert M. Oslund received the PearlHarbor Naval Shipyard Superior Ac­complishment Award as industrialsurgeon. He is retired and living inAlameda, California.1934William B. Tucker, professor ofmedicine at the University of Florida,was made an Honorary Member of the International Union Against Tuber­culosis at its biennial conference in Mex­ico City in September. For over twentyyears Dr. Tucker has served this inter­national organization. He is a past presi­dent of the American Thoracic Societyand the American Lung Association.1935Ralph L. Fitts has moved to Rio Rancho,New Mexico and is working part-time inthe Northwest Clinic, which is a part ofthe Lovelace Medical Center of Albu­querque.Nathan F. Fradkin has been appointedprofessor emeritus of medicine at Al­bany, New York Medical College.Maurice R. Friend is actively engagedin the practice and teaching of child andadult psychoanalysis as clinical profes­sor of psychiatry at State University ofNew York, Downstate Medical Center.One son is completing a second-yearresidency in psychiatry and one daughteris a psychiatric social worker.Kate H. Kohn was named chairman ofthe department of rehabilitationmedicine at Michael Reese Hospital andMedical Center. Acting chairman since1970, Dr. Koh n is the first full-timewoman chairman of a medical depart­ment at the hospital. She also serves asclinical associate professor of physicalmedicine and rehabilitation at the Uni­versity of Illinois.Eva T. McGilvray writes that her hus­band retires in Mayas director of theChristian Medical Commission of theWorld Council of Churches in Geneva,Switzerland. He will take a temporaryjob at Tubingen, Germany, working withchurch, medical school and universitygroups there and in England to providebetter health care.1938Charlotte Babcock was honored by thePittsburgh Psychoanalytic Society andInstitute on October 24-25 at the FirstAnnual Symposium in honor Of Char­lotte Babcock. Over two hundredguests, moderators and panel membersattended the celebration symposium on"Parent and Sibling Loss: Effects on theClinical Course of Psychoanalysis andPsychoanalytic Psychotherapy." JoanFleming (,36), professor emeritus,University of Colorado, was a panelist.Her topic was "The Mutual Influence ofDevelopmental and Structural Conceptson the Diagnosis and Treatment ofParent- Loss Patients."1940Harriet E. Gillette of Evanston, lllinoisreceived the Gold Key Award of theAmerican Congress of Rehabilitation43Medicine for outstanding service in thefield of rehabilitation of disabled chil­dren. Dr. Gillette is on the faculty ofNorthwestern University School ofMedicine.1941Harold A. Bjork of Kenosha, Wisconsinwrites that his oldest son, John.graduated in 1971 from the Medical Col­lege of Wisconsin and is finishing a fel­lowship in gastroenterology at MCW.1946Herbert E. Warden is professor and chiefof the section of thoracic and cardiovas­cular surgery at West Virginia Univer­sity Medical Center, past president ofthe West Virginia Heart Association,and President of the Monongalia CountyMedical Association.1947John V. Denko has a clinical faculty ap­pointment as associate professor ofpathology at Texas Tech UniversitySchool of Medicine, Amarillo branch.1948Winslow G. Fox and Mrs. Fox (ElizabethFerwerda, Ph.B. '48) celebrated thirtyyears of marriage with a rededication ofvows and a service of thanksgiving onNew Years Eve. Our best wishes foranother thirty.George B. What more of Seattle,Washington is the author (with Daniel R.Kohli. M.D.) of The Phvsiop ath ologvand Tre at m e nt of Functional Disorders.published by Grune & Stratton in 1974.Basic principles of neurophysiology areapplied to the clinical problems of func­tional disorders resulting from 23 yearsof study and treatment.1951Richard C. Koenig is president of theChicago Society for AdolescentPsychiatry.Robert S. Mendelsohn, pediatricianand hospital executive. has been ap­pointed director of development forMichael Reese Hospital and MedicalCenter, Chicago.Clyde G. Miller has specialized full­time in community psychiatry for elevenyears. Currently he is deputy directorand chief of the Walk-in Clinic of theSouthern Arizona Mental Health Centerin Tucson.William H. Sippel lives in Tempe.Arizona and works for the ArizonaHealth Plan. a prepaid medical plan.W. McFate Smith was appointed as­sociate dean for program coordinationand chief. research branch. P.H.S., divi­sion of hospitals, at the University ofCalifornia at San Francisco.44 1952Eugene Y. Gootnick is assistant professorof obstetrics and gynecology at the U ni­versity of Southern California School ofMedicine and chief of staff at the Medi­cal Center of Tarzana, California.Willis E. Gouwens, Jr. writes that hisoldest son, David, is a freshman at theUniversity of Florida School ofMedicine. He attended Wake ForestUniversity at Winston-Salem, NorthCarolina. for three years, after which hewas accepted by three medical schools.He was elected to Phi Beta Kappa in hisjunior year. N ineteen-year-old Paul is ajunior at the University of SouthFlorida. having completed one year ofcollege before graduating from highschool in June, 1974. Jim and Kathy arein high school and middle school respec­tively.1953Jack W. Japenga, a radiologist in Glen­dora. California, has been appointed tothe Public Health Commission of theCounty of Los Angeles.1954Erwin N. Whitman was appointed direc­tor of the department of clinical phar­macology of Hoffmann-La Roche Inc ..Nutley. New Jersey, on November I.His department has responsibility for ac­tivities in clinical pharmacology at theDeer Lodge Research Center, NewarkBeth Israel Special Treatment Unit,Hershey Medical Center and the CornellUniversity Medical School.1955L. F. Barrington (Ph.D., Biochemistry)was named executive secretary of theAdvisory Council of the Office of Tech­nology Assessment (OT A). The OT A isa congressional agency which developsindependent and timely informationabout the potential effects and side ef­fects, both beneficial and harmful, of pol­icy options that affect the uses of tech­nology. Barrington was formerly execu­tive director of the Committee on PublicEngineering Policy at the National Re­search Council of the National Academyof Sciences and National Academy ofEngineering.Leonard A. Sagan of Atherton,California, is interested in Amnesty In­ternational and had a letter to the editorreprinted in the January 6 San FranciscoChronicle. He wrote on the subject oftorture in Chile and the ethical dilemmafacing the physician who is asked to treata fugitive.1956Donald D. Brown, staff member of thedepartment of embryology at Carnegie Dr. Donald D. Brownlnstitute of Washington, Baltimore,Maryland, was awarded the 1975 V. D.Mattia Lectureship of the Roche Insti­tute of Molecular Biology. At a cere­mony held at the Roche Institute in Nut­ley. New Jersey, Dr. Brown presented alecture on "The Structure and Evolutionof Animal Genes." He received acertificate for his outstanding researchachievements, and a $5,000 award. Aleader in the field of molecular biology,Dr. Brown is noted for his studies on theisolation and characterization of animalgenes. He is currently president of theSociety for Developmental Biology.Paul R. Kuhn and his wife ( JacquelynLarks, A. B. '52) live in Newport Beach,California, where Dr. Kuhn has a pri­vate practice in internal medicine.1957John B. Aycrigg was appointed chief ofdiagnostic, medical and mental healthservices. division of correctional servicefor the State of Colorado. He is workingto upgrade the quality, quantity and rel­evance of this department to and in allthe State correctional facilities.Herbert Z. Geller writes that he hasbeen director of the department ofradiology at Nyack Hospital, NewYork, for the past nine years. He has aseven-man group performing the fullrange of diagnostic radiology and nuclearmedicine. The hospital has 350 beds andis about to start an addition. He lives inNew City, New York, with his wifeUdell and five children-four boys and agirl.1958Fredric Solomon received the 1975Gary Morris Research Prize for hispaper on "Visual [mages DuringPsychoanalytic Hours." The prize isawarded annually by the WashingtonPsychoanalytic Society for the year'soutstanding pre-publication psycho­analytic research paper. Dr. Solomoncompleted requirements in adult andchild psychoanalysis last year and wasrecently elected to membership in theWashington Psychoanalytic Society. Heis associate professor of psychiatry atHoward University College ofMedicine.1959Hugh Graham, Jr. was team manager forthe U.S. figure skating team which com­peted in the Winter Olympics in Inns­bruck, Austria in February. Dr. Grahamis a physician in Tulsa, Oklahoma.1960Allen M. Dekelboum is an otolaryn­gologist in San Francisco, where he ischief of the section at Mt. Zion Hospitaland Medical Center. He is associate clin­ical professor of otolaryngology at theUniversity of California, San FranciscoMedical Center.Philip Kaplan is an ophthalmologistpracticing in Bay Shore, New York,where he is secretary-treasurer of theSuffolk Ophthalmological Society.Edward Wolpert of Wilmette, Illinoispresented a summary of his research onmanic depressive illness to the GeorgeKlein Psychoanalytic Research Forumat the December meeting of the Ameri­can Psychoanalytic Association in NewYork.1962Don Megill has moved from the U.S.Embassy in Bangkok, Thailand to theFamily Health Center in Shiprock, NewMexico.1963Michael J. Kinney has bee n boardcertified in nuclear medicine as well asinternal medicine. Dr. Kinney is with theU.S. Public Health Service, Renal Divi­sion, Staten Island, New York.Charles E. Platz joined the departmentof pathology at the Un iversity of Iowa inIowa City. He had been associate pro­fessor at The University of Chicago andassociate director of the Surgical Pathol­ogy Laboratory.Harvey Wolinsky is a visiting associateprofessor at Rockefeller University dur­ing 1975-76. He is associate professor ofmedicine and pathology at Albert Ein­stein College of Medicine. For manyyears Dr. Wolinsky has helped raisefunds for the Medical School in the NewYork City area. 1964Robert J. Costarella became a fellow ofthe American College of Surgeons at theOctober meeting in San Francisco. Dr.Costarella lives in Arcadia, California.Joseph M. Garfield was promoted toassistant professor of anesthesia, Har­vard Medical School, at the Peter BentBrigham Hospital as of July I, 1975.1965Wayne E. Janda has opened an office fororthopedic surgery in Sonoma, Califor­nia. Dr. Janda is a diplomate of theAmerican Board of Orthopedic Surgery.Frederick Hornick has a solo practiceof obstetrics-gynecology in Hillsboro,Oregon and is looking for a partner. Heis a newly-elected fellow of the Ameri­can College of Obstetricians andGynecologists and was electedsecretary-treasurer of the WashingtonCounty Medical Society.1966Glenn Howard Miller specializes in childand adult psychiatry in Bethesda, Mary­land.1967Sidney P. Kadish was appointed directorof the department of radiation oncologyat St. Vincent Hospital, Worcester,Massachusetts.William R. Sloan completed a resi­dency in urology last June at the JohnsHopkins Hospital and was appointed as­sistant professor of surgery, section ofurology, at the Medical College of Ohioat Toledo. Dr. Sloan is on the urologyand renal transplant service and lecturesin the medical school. He is a member ofthe tumor registry cancer committee.1968Alan O. Feingold has a private practice ofgeneral internal medicine in Decatur,Georgia and continues in a part-timeposition as assistant professor ofmedicine at Emory University MedicalSchool. In the fall he spoke on "ClinicalSigns of Streptococcal Pharyngitis" atthe Georgia regional American Collegeof Physicians meeting, and in the June,1975 Southern Medical Journal he had apaper on "TB Without Fever."Albert Tsai completed a residency inobstetrics-gynecology at ChicagoLying-in Hospital and is on the faculty ofthe University of Illinois MedicalSchool.1969Gerald L. Becker was appointed assis­tant professor in the department ofbiochemistry at the University ofAlabama Medical Center, Birmingham in September. For the last five years hehas been a postdoctoral fellow and in­structor of physiological chemistry atJohns Hopkins School of Medicine.1970Anthony Philipps IS a clinical fellow inneonatology at the University of Col­orado Medical Center. Last year he waschief resident in pediatrics at the medicalcenter following two years as a pediatri­cian at the U.S. Naval Hospital inTaipei.Arthur G. Robins is a research fellowin pulmonary medicine and on thethoracic service at Boston UniversityMedical Center.Walter H. Stern accepted an appoint­ment at the V. A. Hospital in San Fran­cisco. Dr. Stern had been assistant pro­fessor in ophthalmology at The Univer­sity of Chicago.1971Ronald M. Klar has a new appointmentin the Department of Health, Educationand Welfare. He is director of a new di­vision of health financing, Office of Pol­icy Development, Office of AssistantSecretary for Health; and executive sec­retary of the Health I nsurance BenefitsAdvisory Council (HIBAC) for Medi­care and Medicaid.David Martin is completing a six­month appointment as chief medicalresident at The Cleveland Clinic and inJuly begins a fellowship in infectious dis­eases at Upstate Medical Center inSyracuse, New York.1972Murray Engel is a fellow in child neurol­ogy at Columbia-Presbyterian MedicalCenter.Stephen H. Lebowitz is a cardiologyfellow at UCLA-Center for Health Sci­ences.Lawrence David Schuster is a fellow inendocrinology in the department ofmedicine at the University of MinnesotaHospitals.1973Daniel Knowles is a resident in the de­partment of pathology at Columbia Uni­versity. During 1975-76 he is a postdoc­toral fellow at Rockefeller University, inthe laboratory of Dr. Henry Kunkel.Last year he was a coauthor of papers inSurvey of Ophthalmology and in Gas­troenterology.Former StaffRichard Albin (intern, '68; Surgery resi­dent, '70-'71; Ph.D. '71) is completinghis military duty as chief of surgical ser­vices at Loring AFB Hospital. Maine.45In July he will begin a plastic surgeryresidency at the University of Virginia inCharlottesville. This past year he haspresented papers at meetings of the So­ciety of Military Orthopedic Surgeonsand the American Society for Surgery ofthe Hand.William G. Birch (Obstetrics. intern­resident, '33-'37) is a retired Colonel inthe United States Army, now living inLargo, Florida. He received the highesthonor of the Michigan State MedicalSociety, a "certificate of commenda­tion" for the physician assistant con­cept, as well as the Kalamazoo,Michigan Red Rose Citation for com­munity service. His book, Doctor Dis­cusse s Pregnancv, is in the 5th edition.Gerald E. Byrne, Jr. (Pathology,resident-faculty, '66-'75) accepted anappointment at the University of MiamiSchool of Medicine.John S. Coon (Pathology, intern­resident-instructor, '70--' 75) is with theU.S. Naval Regional Medical Center inSan Diego.Robert A. Fink (N eurosurgery. resi­dent, '62-'66) was elected a Fellow ofthe American College of Surgeons. Dr.Fink is in the practice of neurologicalsurgery in Berkeley and is a member ofthe faculty of the University of Califor­nia School of Medicine in San Fran­cisco.Paul M. Fleming (Otolaryngology, res­ident, '72-'75) has joined the SheboyganClinic and has been appointed a memberof the faculty of the Medical College ofWisconsin as a clinical instructor insurgery (otolaryngology).Gary G. Ghahremani (Radiology,resident-faculty, '68-'72) was appointededitor of Gristroint c stin al Radioing.", anew international journal. Dr. Ghahre­mani is associate professor and chief ofthe gastrointestinal radiology section atthe Medical College of Virginia. His re­cent monograph, Radioing." of l nt crn alAb d o niin a! Hernias, constitutes onevolume of the Current Prob l e m s illRudiolog» Series published by YearBook Medical Publishers of Chicago.Donald 1'1, Greer, Jr. (Plastic Surgery,resident-instructor, '62-'70) has beenappointed associate professor, depart­ment of plastic surgery, University ofTexas Health Science Center, San An­tonio.Richard A. Lovell (Psychiatry,instructor-assistant professor, '66-'75)was appointed director of biochemicalpharmacology at Ciba-Geigy Corpora­tion, Summit, New Jersey.Robert A. Orlando (Pathology.intern-resident-instructor, '65-'71;Ph.D. '71) was appointed professor andchairman of the department of pathology46 CalendarTuesday, April 6Reception for alumni and spousesduring American College ofPhysicians Meeting in Philadel­phia, Barclay Hotel. Wales Room,5:30--7:00.Wednesday, May 1930th Senior Scientific Session, Bil­lings Hospital, P-117, 9:30--5 :00.Thursday, June 10Medical Alumni Day: breakfasthonoring Century Club members,scientific program, awards lun­cheon, evening banquet honoringthe graduates, reunion classes,Gold Key recipients, and McClin­tock winner.Reminder to alumni of 1926, 1946,1951 and 1956: Reunions areplanned for June 10. Write to theMedical Alumni Office if you havenot received information. Classchairmen are:1946: Earl Hathaway and OttoTrippel1951: Arnold Tanis1956: Donald Steinerat the Southern California College ofOptometry and director of laboratoriesat Canyon General Hospital. His re­search is directed towards immunologi­cal aspects of malignancy and steroidbinding protein receptor functions.Daniel J. Pachman (Pediatrics, faculty,'34-'40) was re-elected chairman of theIllinois Pediatric Coordinating Councilfor 1976-77. Dr. Pachman is professor ofpediatrics at Rush Medical College andclinical professor of pediatrics at theUniversity of Illinois Medical School.Mitchell Rhodes (Medicine, intern­resident-fellow-instructor, '65-'70) re­cently was appointed associate professorof medicine at the University of IowaCollege of Medicine. He received firstprize in the Cecile Lehman Mayer re­search competition for pulmonary andcardiology investigators at the 40th meet­ing of the American College of ChestPhysicians.Gerhart S. Schwarz (Radiology,resident-faculty, '42-'46) received a dis­tinguished member award of the PirquetSociety of Clinical Medicine. Dr.Schwarz is director of radiology at theNew York Eye and Ear Infirmary, andclinical professor of radiology at New York Medical College. Before the pre­sentation he delivered a talk on "ABiologist's Excursion into History."Sharon Thomsen (Pathology, intern­resident-faculty, '66-'75) accepted anappointment at Jackson Memorial Hos­pital in Miami.IIza Veith (Medicine, faculty, '49-'64)was awarded the Doctor of Medical Sci­ences degree by the Juntendo Universityof Tokyo for "important contributions inthe studies of Oriental Medicine." Thisis the highest medical degree given inJapan, equal to the M.D. degree. Dr.Veith earned it after an examination indefense of her thesis on .. Foundations ofOriental Psychiatry." Dr. Veith is pro­fessor and vice-chairman of the depart­ment of history of health sciences at theUniversity of California, San Francisco.Robert M. Walter, Jr. (Medicine,intern-resident. '65-'68) is beginning histhird year as assistant professor ofmedicine in the section of endocrinologyat the University of California at Davis.Record Year for AlumniFundThe 1975 Medical Alumni Fund com­pleted its most successful fund-raisingyear with an 83 percent increase over1974. Gifts to unrestricted, restrictedand student aid funds topped all previousyears. A record $397,957 was receivedfrom 1,606 contributors. Gifts matchedthrough the Anderson Challenge Fundtotaled another $130,197. Decembergifts made through the American Medi­cal Association Education and ResearchFund were not received in time to be in­cluded in this report for Medicine on theMidway. A detailed report will be mailedin the spring to each alum with the honorroll of contributors.A total of $121 ,535 was raised for gen­eral support of the school as compared to$83,372 last year. Gifts to student aid in­creased from $70,166 to $82,689. Threenew loan funds were added during theyear: the Charles L. Dunham LoanFund established in memory of Dr.Dunham who died on December 7; theNorthern California Medical AlumniLoan Fund, directed by Dr. J. AlfredRider (,44); and the Colorado Medical 'Alumni Loan Fund, headed by Dr.Everett H. Given, Jr. ('59). Gifts to re­stricted funds reached $190,137, withgifts to the Leon O. Jacobson Fund total­ing $66,662.We thank all our donors and volun­teers across the country who helped withphonathons and letters to achieve this1975 total.NEW! A Fall WeekendSeminar for MedicalAlumniFriday-Sunday, November5-7In response to the changing in­terests and needs of our alumni,the Medical Alumni Association isplanning a new and exciting fallweekend seminar. The In­residence program, to be held atthe University's Center for Con­tinuirig Education, will includestimulating and challenging collo­quium sessions with Universityfaculty and alumni as well as timefor social and campus activities.All alumni and spouses are invitedto join us for this program.For further information completethis form and return to:Medical Alumni Association1025 East 57th StreetChicago, Illinois 60637D Yes. Please send me informa­tion on the Fall WeekendSeminar.Name __AddressCity State.; __ Zip--Comments or suggestions: __Me'�lieine on the MidwayTh� University of Chicago. Thl Medical Alumni AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, Illinois 60637•Address corrections requestedreturned postage guaranteedThe Joseph Regensteln LibrarySeria 1 Records Department, Room-2221100 East 57th StreetChicago, Illinois 60637 NON·PROFIT ORG.u.s. POST AGEPAIDPERMIT NO. 9666CHICAGO. ILL.