Medicine on the Midway Vol. 31 No.2Bulletin of the Medical Alumni Association The University of ChicagoDivision of the Biological Sciences and The Pritzker School of MedicineREMEMBER THE 1976 MEDICAL ALUMNI FUNDThe Medical Alumni Fund is the main source ofunrestricted gifts to The Pritzker School ofMedicine and The Division of the Biological Sci­ences. Each gift by an alumnus confirms the con­viction that The University of Chicago will con­tinue to rank as one of the top medical schools inthe United States.As reported in Medicine on the Midway, Vol. 31,No.1, our medical school was named one of thetop ten medical schools in the United States byMedical Economics, a nonclinical medical jour­nal. In an earlier survey of deans of graduateschools in medicine, our medical school rankedsixth among the top ten medical schools. It is oneof only five medical schools to make both "topten" lists.In spite of the excellent rating, now and in thepast, only 34 percent of our alumni support theiralma mater, whereas the other "top ten" schoolsreport well over 50 percent support from theiralumni.Alumni, we need your gift to the 1976 MedicalAlumni Fund. (Deadline for gifts is December31). Please consider joining one of the followinggroups:Donors contributing $1,000 or more arerecognized as Medical Alumni Patrons andDean's Associates.Donors contributing $500 are recognizedas Medical Alumni Sponsors.Donors contributing $100 are recognizedas Century Club Members.You may wish to earmark your 1976 gift to one ofthe following named funds established by medi­cal alumni and friends. Student AidWilliam E. Adams Loan FundWilliam Bloom Loan FundPaul R. Cannon Loan FundYing Tak Chan Loan FundColorado Alumni Loan FundGeorge F. Dick Loan FundCharles L. Dunham Loan FundJ. Nick Esau Loan FundJoel Murray Ferguson Loan FundLloyd A. Ferguson Scholarship FundAbraham Freiler Scholarship FundRoger N. Harmon Scholarship FundBasi I Harvey Loan FundVictor Horsley Loan FundEleanor Humphreys Loan FundHilger P. Jenkins Loan FundDeane Lazar Loan FundFrancis L. Lederer M.D./Ph.D. ProgramFranklin Mclean Scholarship FundMedical Alumni Loan FundGeorge W. Merck Loan FundNorthern California Alumni Loan FundJohn F. Perkins Loan FundFrederick E. Roberg Loan FundCassius Clay Rogers Scholarship FundA. Lewis Rosi Scholarship FundBernard and Rhoda Sarnat Loan FundMary Roberts Scott Scholarship FundNels M. Strandjord Loan FundFrank W. Woods Loan FundSam Zapler Loan FundEugene and Esther Ziskind Loan FundOther Restricted FundsEmmet Bay Lectureship FundBatten's Disease Research FundJosephine Victoria Black Research FundClass of 1949 Gift FundDavis-Freedman Psychiatry Research FundCatherine L. Dobson Fund in Ob/GvnLloyd A. Ferguson Library FundFisher Endocrinology Research FundBetty Frankel Housestaff FundGoldiamond Psychiatry Research FundJohn W. Green Sr. FundJ. P. Greenhill Foundation Fund in Ob/GvnHoward Hatcher Research FundHans Hecht Lectureship FundVictor Horsley Research FundCharles B. Huggins Professorship FundLeon O. Jacobson FundAlex B. Krill FundWalter Palmer Visiting Professorship FundJohn Van Prohaska Library FundKlaus Ranniger FundMedicine on the MidwayVolume 31, No.2 Fall 1976Bulletin of the Medical Alumni Association of The Uni­versity of Chicago Division of the Biological Sciences andThe Pritzker School of Medicine.Copyright 1976 by the Medical Alumni AssociationThe University of ChicagoEditor: Jay Flood KistContributing Editor: James S. SweetPhotographers: Mike Shields, Fabian Bachrach, LloydSaundersChairman Editorial Committee: Robert W. Wissler (,48)Medical Alumni AssociationPresident: Asher J. Finkel (' 48)President-Elect: Charles P. McCartney ('43)Vice President: Joseph H. Skom (,52)Secretary: Francis H. Straus II (,57)Director: Katherine Wolcott WalkerCouncil MembersHoward L. Bresler (,57)Richard H. Evans ('59)Sumner C. Kraft ('55)Donald A. Rowley ('50)Randolph W. Seed ('60)Benjamin H. Spargo (' 52)Otto Trippel (' 46)Attention Ph.D. graduates in the Division ofBiological Sciences: This issue marks the first timethat you will receive Medicine on the Midway. Wewould like to call your attention to the article byJ. W. Bennett, a fellow Ph.D. graduate. We wel­come you as readers of Medicine on the Midway,and encourage you to send us information on youractivities so that we can report them in future issues.The Medical Alumni Association ContentsLetter from the DeanDr. Daniel C. Tosteson 4New Directions in Obstetrics and Gynecology 6Dr. Richard L. LandauDiane Weysham Ward v. Director of the Bureau of 9Vital Statistics, Louisiana State Health Dept.l. W. Bennett, Ph.D.National Health Insurance-Whither the U.S.? 13Theodore R. MarmorClinical Pharmacology-The First Two YearsDr. Leon I. Goldberg 17New Approach to Nutrition TrainingDr. Frank K. Thorp 20A Golden Celebration: 50 Years of Medical Careand Research on the Midway 23Innovative Curriculum Explores Science and Artof Medicinelames S. Sweet 24News Briefs 29In Memoriam 33Departmental News 35Alumni News 40Cover: This is the goal of all current efforts in maternal-fetal medicine-ahealthy mother and child. An overview of the field of obstetrics andgynecology in general, and The University of Chicago's Department ofObstetrics and Gynecology in particular, begins on page 6.3Letter from the DeanDr. Daniel C. TostesonMy report in the last issue of Medicine on the Midwayreviewed with you some of the developments at TheUniversity of Chicago Division of the Biological Sci­ences and Pritzker School of Medicine during the pastyear. This letter is the first of a series in which I proposeto discuss important aspects of the activities of the Divi­sion and the medical school. [t is fitting to begin witheducation.The primary goal of the Division is to promote higherlearning in medicine and the biological sciences. Suchlearning is carried out by scholars of various ages anddegrees of experience. Clearly, much higher learning in­volves independent investigation and presents itself asresearch. One important form of higher learning is thediscovery of new insights by learners present at the Uni­versity now. Perhaps more important in the long run isthe role of the University in preparing scholars to makediscoveries in the future, here and in other places. Theseyoung scholars, our students, bear the messages of ourcivilization to our descendants. They are our culturalgenes. Through them, the medicine and biological sci­ences of the future will take shape, just as you, ourgraduates, have shaped the medicine and biological sci­ences of today.The Division is now involved in education at manylevels. Members of the faculties of the several depart­ments of the Division participate in the education pro­grams of the College. They also carry out the education ofmedical students and candidates for the Ph. D. degree inthe various departments. We operate a vigorous programin graduate medical education for residents in the clinicaldisciplines. Finally, we are now and will increasingly beinvolved in continuing education, particularly of physi­cians.Our program in undergraduate medical education re­mains vigorous. Four-hundred and thirty-eight studentsare registered in the Pritzker School of Medicine at thistime. One-hundred and four new students, selected froman applicant pool of 4,939, matriculated this year. Theycame from 48 different colleges and universities, from 23states, the District of Columbia, and four foreign coun­tries. The class includes 15 women and six Americancitizens from minority groups. All these students havecompiled outstanding academic records. Three have al- ready been awarded Ph.D. degrees, and four, master'sdegrees. Many of these students will enroll in the medicalsciences training program and study for a Ph.D. as wellas the M.D. degree. In the Spring of 1980, these studentswill find residencies in the outstanding teaching hospitalsof the country, just as was the case with students in theclass of 1976 last Spring. They will go on to becomeleaders in many branches of medicine.To maintain and strengthen this outstanding programof medical education is one of the great opportunities and4responsibilities of our faculty. I am happy to announce achange in administration which I think will help the fac­ulty to meet this responsibility. Dr. Frank Fitch, thefirst Albert D. Lasker Professor of Medical Sciences,has agreed to assume the position of Associate Dean forMedical and Graduate Education.Frank brings to this task a broad experience in medicaleducation. He has served as chairman of the CurriculumCommittee in the Division of the Biological Sciences andhas also served in a special advisory capacity for theNational Board of Medical Examiners. Frank will be re­sponsible for coordinating education programs for stu­dents who are candidates for the M.D. and Ph.D. de­grees. He is an important member of the team whichDeputy Dean Robert Uretz is gathering to address theacademic activities of the Division.Another important member of that team is Joe Ceit­haml, Dean of Students. Joe continues to be the coun­selor, advisor, and friend of our students. When I travelthrough the country and talk with you, our alumni, I amimpressed by the significant role which Joe has had inyour experiences at the University of Chicago. We arefortunate indeed to have his continuing services.As you know, faculty in the departments of the Divi­sion ofthe Biological Sciences are responsible for educa­tional programs in Biology in the College. The fact thatthe same faculty is involved in working with students inthe College, in the departments, and in the PritzkerSchool of Medicine creates conditions which make it par­ticularly feasible to examine the interface between pre­baccalaureate and graduate education. Such an examina­tion is now beginning at the University in the form of anew educational program in the Arts and Sciences Basicto Human Biology and Medicine. This program seeks tointegrate medicine more fully into the life of the entireUniversity and addresses some of the changing condi­tions in which education for medicine and the otherhealth professions occurs.First, it explores the changing relationship between thebiological sciences, the physical sciences, and medicine.It includes a reassessment of the educational prerequi­sites in science for clinical medicine. Second, it speaks tochanging concepts of the relation between medicine andhealth. It recognizes the increasing role of the social sci­ences in medicine, and also the diffusion of concernsabout health throughout the entire faculty of the Univer­sity.The program will begin in the Fall of 1977, when about20 students who have completed the first two years ofcollege will be accepted for a four-year period of study. We expect that around half of these students will be pre­paring for entry into medical school, while the remaininghalf will be preparing for graduate education in otherfields relevant to health. I am very enthusiastic about thepotentialities of this new program. My enthusiasmreflects the attitudes of Professor Arnold Ravin, thecoordinator of the Program, Robert Uretz, the DeputyDean of Academic Affairs, Charles Oxnard, Dean of theCollege, Godfrey Getz, Master in Biology for the Col­lege, and other members of the faculty involved in thedevelopment of the plan. This program is, in many ways,a very direct outgrowth of the basic ideas which animatedthe founding of this University and its medical school.(For further details, see the article on page 24.)We are also taking a fresh and careful look at our pro­grams in graduate medical education, specifically our resi­dency programs. As you know, there has been muchrecent discussion about the maldistribution of physiciansby specialty. It is the conventional wisdom that we needmore doctors who deliver primary care and fewerspecialists.Some provisions of the recently enacted Health Pro­fessions Education Bill of 1976 encourage a shift in em­phasis in graduate medical education from specialty train­ing toward primary care. These and other changing cir­cumstances make it timely to look carefully at this crucialand complex period in the education of the physicianwhen his or her role is changing rapidly from student tophysician and teacher. We are exploring ways in whichthe organization of our graduate medical education pro­grams can reflect more faithfully this transition. Dr.Henry Russe, Associate Vice President for Medical Ser­vices, is working with the chairmen of several clinicaldepartments and with directors of residency trainingprograms in this exploration.These days it is easy for physicians and medicaleducators to become depressed over the increasinglydense thicket of regulations and entanglements whichcomplicate our professional lives. In such moments, I amrefreshed to work with the young scholars here at theUniversity-the students in the College, medical stu­dents, graduate students, house officers and post­doctoral fellows. It is a special privilege to have the op­portunity to encourage these young persons who willcreate the biology and medicine of tomorrow. Workingwith them, I feel acutely their energy and increasingcompetence. I also realize that we give them a legacy notonly of problems and complexities but also of increas­ingly effective tools to influence the health of human be­mgs.5New Directions in Obstetrics and GynecologyAn Interview with Dr. Arthur HerbstThe following is an interview with Dr. Arthur L. Herbst,the Joseph Bolivar DeLee Professor and Chairman ofthe Department of Obstetrics and Gynecology, by Dr.Richard L. Landau, Professor in the Department ofMedicine and the College, and Chairman of the ClinicalInvestigation Committee. Dr. Herbst was appointed lastJanuary.LAN DA U: Let me start by making a general statement.It seems to me that the field of obstetrics and gynecologyreally pioneered in bringing preventive measures tomedicine, in the areas of preventive prenatal care, an­tisepsis, and perhaps in the preservation of thepelvis-performing episiotomy and using forceps in earlydeliveries. This was all work that was done in the lastcentury and during the first half of this century, and itseems that to some extent the field of obstetrics has beenresting on its laurels for the last ten or fifteen years. Youmay not agree with this, but could you point out whereyou think the field is going next?HERBST: I think there have been significant advancesin the field as far as problems related to obstetrics andtheir prevention are concerned. In the management ofthe patient, prevention and therapy are interwoven. Forexample, there has been great progress in care of thepatient with a high risk pregnancy. We can identify prob­lems as they develop or before they occur. There aremethods to determine, from analysis of the intrauterineenvironment and the amniotic fluid, problems that mayexist or may be developing with the fetus, and to judgethe maturation of the fetus and its ability to survive inextrauterine existence.By studying amniotic fluid withdrawn early in gestation(amniocentesis) one can predict and treat genetic dis­eases and metabolic errors that adversely affect the fetus.Similarly, the growth and development of the fetus canThe newborn intensive care unit.6 be studied through analyses performed later in preg­nancy. The use of ultrasonography also enhances ourability in intrauterine diagnosis and treatment. Many ofthese techniques have been pioneered at the ChicagoLying-in Hospital.Great advances have been made in the management oflabor. The fetal monitor, a tool that is in use in all modemcenters including ours, helps us a great deal in the intel­ligent management of labor. In essence, a fetal EKG is away to visualize fetal heart rate and the changes in ratethat occur. Using fetal electronic and chemical monitor­ing, including such parameters as the pH of the fetalblood, usually obtained through a scalp sample, one canjudge the status of the fetus and its ability to withstanddifficulties of labor. For example, one can judge if it issafe to continue in labor or if the child should be deliv­ered by Cesarean section, so that it does not suffer dam­age as a consequence of tumultuous labor. This involvesboth preventive medicine and therapy and is clearly veryimportant.Further refinements and research into the managementof the fetus during gestation as well as labor and deliverywill be the subject of much. future research. Close in­teraction between the pediatrician and obstetrician in themanagement of "high risk" newborns will improve ourefforts in this area, and our Perinatal Center serves as afocus for these activities.LAN DA U: Is all of this advance and this technologyavailable in community hospitals or is it restricted tomedical centers with groups of practicing obstetricians?HERBST: I think it is probably more prevalent in uni­versity centers, but it certainly is available in manycommunity hospitals. The degree to which it is utilizedand the expertise of the people involved throughout theUnited States are quite variable. Insofar as these areadvances that have come in the past decade, they areobviously being introduced more and more into routinepractice, but I don't think they are uniformly available.LAN DA U: I ask this question because it seems to methat along with the natural delivery phenomenon and theshortening of post-delivery hospitalization, there may bea movement away from having specialists deliver babies.What do you think of this?HERBST: Well, there is an aspect of this that is occur­ring. Many medical centers in this country are lookinginto the use of paramedical personnel to assist in normaldeliveries, and certain centers have midwives. It is a wayto assist those with normal pregnancies to receive medi­cal care in a reasonable way without having to rely exclu­sively on physician care, particularly in areas wherethere is a shortage of physicians.Although most deliveries can safely occur in an envi­ronment that does not require the specialized instrumen-tation of fetal monitors and all the other things we arediscussing, there are occasional deliveries where a catas­trophy occurs unpredictably. As a result, to talk abouthome delivery is very worrisome to me. However, Ithink the management of normal labor and delivery utiliz­ing personnel other than physicians is a reasonable moveand one that we should implement. Our goal is to makenormal deliveries in the hospital as comfortable for thepatient as a home delivery could be. Family centereddeliveries offer one step in this direction.LANDA U: Then the physicians would have a hand in itand would be in a position to make the diagnosis of atroubled pregnancy and be available to do somethingabout it? And these people would only be participating inthe active program when it was ascertained that it was anormal birth?HERBST: Yes. There would be immediate supervisionand backup available, and the delivery would take placein a hospital.LANDAU: Is there a movement in the direction of hav­ing family physicians provide more obstetrical care?HERBST: I am not aware of any local programs wherethis is being carried out. As far as having family physi­cians do obstetrics, I think that the programs that arebeing developed are primarily for physicians withspecialized training in obstetrics and gynecology, whomay utilize paramedical personnel in order to achieve awider distribution of medical care. My impression is thatthe number of family practitioners who are serving asobstetricians probably is decreasing.LANDAU: I have the impression that you're primarily agynecologist. What future direction is gynecology tak­ing?HERBST: Well, there are a number of future directionsthat the entire field is taking which are easiest to discussin terms of the subspecialty areas of obstetrics andgynecology, one of which I have already mentioned-maternal-fetal medicine. This involves advanced train­ing that we give Fellows who are trained in obstetrics andgynecology. There are two other areas of subspecializa­tion. One is gynecologic oncology, which deals with thebroad problem of cancer, and the other is gynecologicendocrinology, which includes problems of reproductionand fertility. I think advances in research and treatmentare being made in both areas.Gynecologic cancer, of course, can include all prob­lems that relate to cancer. Individuals entering this fieldare qualified to render improved care to the patient withgynecologic cancer as a consequence of their training inpelvic surgery as well as their familiarity with the tech­niques of chemotherapy and radiation therapy. This al­lows unique collaboration with others who specializeonly in the discipline of radiotherapy or chemotherapyand leads to more comprehensive and effective planningfor the control of these diseases. Specialized research toimprove diagnosis and treatment of the patient afflictedwith cancer through the techniques of immunology andbiochemistry is but one example of promising paths for further investigation. Physicians who specialize ingynecologic oncology will, as a rule, function most effec­tively in specialized centers.Gynecologic endocrinology includes the study of themany problems of hormone interaction and regulation inwomen, especially those that affect ovarian function. Forexample, the various factors that result in ovulation aswell as the short-and long-term effects of those agentswhich inhibit ovulation are two areas currently underwidespread investigation. Many other areas require addi­tional efforts, such as the physiology of the menopause,the different hormonal interrelationships of themenopausal female, and what role, if any, the varioustypes of estrogens may play in the risk of the develop­ment of endometrial cancer.LANDA U: Cancer is another area in which obstetricsand gynecology have really been leaders in preventivemedicine. For example, there is the popularization of thePap smear as an early means to detect cancer. Whatdisturbs me about this is that non-gynecologists have thetendency to believe a Pap smear is all that is necessary.I'd like your opinion on two points. One, is the Papsmear going to pick up everything without a pelvic ex­amination by a physician, and two, do you think that theaverage physician should be able to perform a reason­ably competent pelvic examination?Research on fertility biochemistry is conducted in this laboratory, includingstudies of sperm enzymes and the effect of maternal DES on male offspring.The large glass structure on the left is a water still, which produces ultrapurewater used in making solutions of accurately known composition.7Using a diagnostic tool called a colposcope, Dr. Freidoon Azizi, aGynecologist-Oncology Fellow, examines the cervix of a woman whosePap smear had indicated some abnormality. Similar to a telescope, thecolposcope magnifies the surface epithelium of the cervix, vaginal lining, orvulva. A biopsy of the abnormal area is usually taken, and, based on biopsyand examination by colposcopy, the abnormal area is diagnosed as aprecancerous lesion, a malignancy, an infection, or some other condition.HERBST: In answer to your first question, a Pap smearwill not detect all gynecologic malignancies. In fact, de­pending upon the laboratory and technique used, the Papsmear can even miss a cervical carcinoma, the cancer it ismost effective in diagnosing. The Pap smear is a usefultool, but it can lull one into a false sense of security. Forexample, the Pap smear will usually fail to detect overhalf the cases of endometrial carcinoma. If a patient hasovarian cancer, the possibility of having it detected bythis test is really very slight. Therefore, a complete pelvicexamination, including an appropriate history, is neces­sary to provide an adequate screening examination. I donot feel that this screening examination has to be done byan obstetrician/gynecologist, and a well-trained physicianshould be able to do it.LAN DA U: I would like to be more specific nmv withrespect to the U niversity' s Department of Gynecology. Ithink that your predecessor, Dr. Frederick P. Zuspan,inherited a department that, for reasons beyond his con­trol and that of others, had been allowed to almost dis­appear, and I think he did a very substantial job of build­ing the department to respectability. As you see the de­partment now, what are the major areas that requirestrengthening?HERBST: Our department, like any department thatgoes through an interim period, has a number of areas8 where we would like to see things changed andstrengthened. I n this interim period a number of facultymembers left for posts in other academic institutions.One of the things with which I need to concern myselfimmediately is the recruitment of additional competentfaculty to help build a strong academic department whichcan carryon a high level of training and investigation.We are fortunate to have a good housestaff, and, basedon both the results of last year's matching plan and appli­cations that we have received so far this year, it wouldappear that we are going to be able to continue to attractwell-trained, highly qualified individuals from excellentmedical schools, including The University of Chicago.We do need, of course, to expand in a number of sub­specialty activities. We are a referral center and thereforewe must have an environment that is comfortable andconvenient for patients. In addition, we are a designatedPerinatal Center for the state of lllinois, but we needadditional facilities to establish this Center properly incollaboration with our Department of Pediatrics. At themoment, our intensive care nursery is in one place, itscoordinator in another, and the perinatal laboratory isdeveloping in a separate area. Both for this activity aswell as for the development of academic programs inother areas of the department, additional facilities areneeded. For example, our operating rooms and deliveryrooms date back to the 1930's and are inadequate. As youknow, plans for the development of new C Ll facilitiesare moving forward and soon it will be possible to havesufficiently specific details that will allow for the begin­ning of the implementation of construction of this vitalproject.LA N DA U: I have one more general question. The train­ing program for obstetrics and gynecology has changedin the last few years in that a prior mixed, rotating orstraight internship in medicine or surgery is no longerrequired. Do you feel that the young people who beginspecialized training immediately are missing something?Are you attempting to make any provisions to have thembroaden their base of practical medical knowledge be­fore they become specialists?HERBST: Yes, this does concern me and we are tryingto make such provisions. It is true that most centersbegin postgraduate training in the first year with obstet­rics and gynecology. We have already in existence, how­ever, a number of rotations for our first-year housestaffoutside of the department. We will continue to developthis, not only in the first year of training, but for subse­quent years as well. For example, an individual who en­ters the field of maternal-fetal medicine will get additionaltraining in various subspecialties of internal medicine.Someone who plans to become an oncologist should haveadditional surgical training to gain wider experience inoperative problems other than those that are usually en­countered in obstetrics and gynecology. I think this isextremely important and it is an area that I hope we willhave a chance to broaden in the next few years. It willobviously involve collaboration with other departmentsand I think the opportunity is there. In fact, I think theinterest is there, which is even better.Diane Weysham Ward v. Director of the Bureau of VitalStatistics, Louisiana State Health DepartmentJ. W. BennettThe editorial announcing the Perspectives WritingAward states "... most of our authors have arrivedsomeplace and in their essays are taking time to lookaround. This is probably as it should be. However, wethink we are missing the perspective of younger writers."The expression "taking time to look around" set up asympathetic vibration with me. I'm a younger writer,hoping someday to arrive someplace. I'm currently in­volved in my first consulting case. My preparations forappearing in court to present "expert testimony" havegone far beyond the legal issue, per se, and I've foundmyself "taking time to look around." Writing this essayis an attempt to organize some of the "looking."First a bit of autobiographical data. I grew up in NewYork, went to college in New Jersey, and to graduate.school in Illinois. I was fairly active in the Civil RightsMovement in the early 1960s. My geographical and emo­tional bias toward the north made me have some secondthoughts when my best job offer after graduation camefrom the deep south. Nonetheless, I am now a resident ofNew Orleans, Louisiana, where I teach genetics atTulane University.Since moving to New Orleans I've acquired two smallchildren and one very large mortgage. I've been trying todevelop an expertise in human genetics, in hopes of sup­plementing my income by doing some genetic counseling.Diane Weysham Ward v. Director of the Bureau ofVital Statistics, Louisiana State Health Department ismy first consulting case. I find it ironic that what began asa simple desire to earn some extra income has turned intoa major preoccupation. It has taught me something oflocal history, caused me to burrow into the law library,forced me to read widely in anthropology and to reex­amine my position on civil rights and the division be­tween north and south. I've learned something aboutmyself as a person, in reference to myself as a profes­sional scientist.The case involves racial designation on a birthcertificate. At first it seemed straightforward and simple.The CaseLisa Marie Anthony was born on December 3, 1969, inJefferson Parish, Louisiana. Her parents were DianeWeysham Anthony and Joseph Poleat Anthony. Whenthey filled out the birth certificate they indicated thattheir daughter was "white."In 1972 Lisa Marie's parents were divorced. Later hermother remarried and became Diane Weysham Ward.Reprinted with permission from Perspectives in Biology andMedicine, Volume 19, Number 4, The University of ChicagoPress. @ 1976 by The University of Chicago. All rights re­served. This article received honorable mention in the firstPerspectives Writing Award for authors under 3S years of age. The new husband wanted to adopt Lisa Marie. WhenDiane Weysham Ward attempted to obtain a certifiedcopy of Lisa Marie's birth certificate she was refused itby the state registrar of vital statistics. The refusal wasbased on legislation passed in 1970, after Lisa Marie'sbirth. As written in LSA-R.S. 42:267 (Act 46 of 1970),the law states: "In signifying race, a person having onethirty-second or less of Negro blood shall not be deemed,described or designated by any public official in the Stateof Louisiana, as 'colored,' 'mulatto,' 'black,' 'negro'[sic], 'griffe,' an 'Afro American,' 'quadroon,' a 'mes­tizo,' a 'colored person,' or a 'person of color.' "On January 30, 1971, the Louisiana State Board ofHealth, Bureau of Vital Statistics, issued a 10-point listof regulations for the enforcement of Act 46 of 1970. Iquote the two most pertinent points below.2. On the face of each and every certificate of any registranthaving a traceable amount of Negro blood, according to avail­able evidence, the State Registrar shall stamp, with a rubberstamp, in red ink, beneath or adjacent to the confidential sectionof said certificate in bold letters the words: "Do Not Issue AnyCopy Until Cleared U'nder Act 46 of 1970 by State Registrar."3. When a copy of said certificate is applied for it shall bechecked against the evidence in the possession of the StateRegistrar, or which has been submitted to him, to determine ifsaid evidence is applicable to the registrant or his ancestors.The state registrar of vital statistics contends that LisaMarie Anthony has precisely "3.375/32nds Negroblood," an amount which exceeds the statutory onethirty-second allowed by law. Therefore as a stateofficial, his duty being to enforce the law, he will notrelease a certified copy of the birth certificate with theoriginal racial designation.Diane Weysham Ward would like her daughter's birthcertificate to say "white." Accordingly she retained Mr.John D' Angelo as her lawyer and became the plaintiff inthe case, on behalf of her minor daughter Lisa MarieAnthony. The defendant is the state registrar of vitalstatistics, a Mr. Anthony Ciaccio. The second defendantis the State of Louisiana represented by Mr. William J.Guste, J r., the attorney general.D'Angelo called me in October of 1974 and asked mewhether I'd be willing to present expert testimony onbehalf of the plaintiff. When he first outlined the case tome I felt my northern, "liberal" sensibilities rise up inoutrage. How could this be happening in the 1970s? Itwas obviously an example of backward, racist Louisianatrying to discriminate against Negroes. It's unconstitu­tional! It's biologically absurd! There is no such thing as"3.375/32nd Negro blood"! In fact, there is no such thingas "Negro blood"!The lawyer was pleased with my reaction. My emo­tional response reflected the lines of his reasoned de­fense. His major defense would be to show that9LSA-R.S. 42:267 (Act 46 of 1970) was unconstitutional.In the unlikely event that the court were to decide thatAct 46 of 1970 was constitutional, then he would set outto prove that the act was unenforceable because it had noreasoned genetic basis. That would be my job-to dem­onstrate that Act 46 of 1970 was, indeed, biologicallyabsurd.The constitutional argument has several facets. Verybriefly they can be summarized by three major points. (1)The act, LSA-R.S. 42:267, violates the due processclause of the Fourteenth Amendment because it is arbi­trary, vague, and unenforceable. The act does not pro­vide the registrar with any guide to his mode of computa­tion. Therefore the registrar has undertaken to produce amathematical equation consisting of many unknowns,namely the terms used on old documents in his posses­sion, classifying ancestors of the child as "colored,""mulatto," "quadroon," and others. (2) The act,LSA-R.S. 42:267, is unconstitutional because it violatesthe equal protection clause of the U.S. Constitution inthat it only applies to persons of the Negro race. Nocomparable statutes exist for the Caucasian and Mon­golian races. (3) This act is unconstitutional because itdiscriminates among races. Persons having more than"I132nd Negro blood" are considered "Negro," but aperson having more than" J/32nd Caucasian blood" isnot "Caucasian," and a person having more than" 1132Mongolian blood" is not considered "Mongolian."On March 7, 1975, the Plaintiff's Trial Memorandumon the constitutional aspects of the case was submitted tothe U.S. District Court, Eastern District of Louisiana.On April 9, 1975, we received the reply argument fromthe State Attorney General's office. Also on that date theCourt ordered that the matter be handled in two succes­sive stages. Initially, consideration would be given to theconstitutionality of LSA-R.S. 42:267.The second stage, which involves the factual question ofwhether or not the State can sustain the burden of proof that theplaintiff's daughter does possess the amount of negro [sic]blood which is required by the statute and regulations in order forthe Bureau of Vital Statistics to change the racial designation ofthe plaintiff's daughter's birth certificate from "White" to"Negro," will only be reached by the Court if the statute andregulations are found to be constitutional. Plaintiff reserves theright to submit to the Court the testimony of its expert geneti­cist if the second stage is reached by the Court.The April 9, 1975, Court Order invoked a sense ofrighteousness. The case was moving along as expected.It was comfortably ego boosting to be referred to as theplaintiff's "expert geneticist," especially with all thoseconstitutional arguments buffeting me from a court ap­pearance where I'd have to perform in the role of said"expert geneticist."Then late in the summer of 1975 I received the follow­ing: "The Court having reconsidered its order of April 9,1975, it is the opinion of the majority of the Court that theformer order should be vacated and that, prior to consid­eration of the Constitutional questions, the Court prop­erly should first decide, after a hearing, whether the Stateof Louisiana can sustain the burden of proof ... "My comfortable position as armchair expert is over.10 IIIIVVIVII 6 15/J1--,- .... (-; \l__j 1�, _/2VIII J.J15/J1'-.__/ IFIG. l--Cenealogy of Lisa Marie Anthony (VIII·/) purporting to show"Negro blood" prepared by the Louisiana attorney general's office.Sometime this fall I will appear in court and attempt todemonstrate that the state's" 3. 375/32nds Negro blood"is an arbitrary computation, without a basis in scientificfact.The data I have to work with is presented in a geneal­ogy prepared by the State Attorney General's office, andsixteen accompanying exhibits. The genealogy is a curi­ous document, measuring 7 x 2 feet, recording those an­cestors of Lisa Marie who the state believes to have"Negro blood." Each ancestor is given by name; next tothe names of individuals with supposed Negro heritageare exhibit numbers. The exhibits constitute the evi­dence. I have compressed the genealogy and put it intoconventional pedigree form in figure I. The numberswithin the pedigree notations reflect the fraction of"Negro blood" purported by the state. Presumably allancestors not having "Negro blood" have been omitted.Lisa Marie Anthony is individual V /11-1. Her parents,Joseph Poleat Anthony (V 11-1) and Diane WeyshamWard (V1I-2), are both designated "white" on their birthcertificates and on their marriage certificate. With oneexception, all the exhibits which demonstrate "Negroblood" are in generations I, II, and 111. The one excep­tion is Ansel Baham, born 1857 (no record), died 1937,represented as IV-5 on the pedigree. Exhibit 11, AnselBaham's death certificate, lists his race as "C." Appar­ently in Louisiana "C" means "colored" not"Caucasian," because the state chooses to award AnselBaham with a "I" for" 100% Negro blood."In examining the evidence it cannot escape one's at­tention that all other exhibits purporting to show "Negroblood" predate the Civil War. They make fascinatingreading. For example, consider the transcript of exhibit4, concerning 111-2, Lisa Marie's great-, great-, great-,great-grandfather Abraham Honore Baham. It is fromthe Baptismal Record of Negroes and Mulattoes, St.Louis Cathedral, and has been translated from theFrench: "On this seventeenth day of March of this yearof eighteen hundred and nineteen: I, Fr. Antonio de De­della, Religious Capuchin, Cure of this Church Parish ofSt. Louis of New Orleans, baptized with the pure andholy oils, a free male terceron who was born on the four­teenth of January of this present year, natural child ofLUIS BAHAN, a native of Mobile, and of MARIARO U SE VE, free quarteron, a native of this city, andresidents of the same, and having exercised the holy Sac-raments, have given him the name of HONORE." Onthe basis of this certificate Abraham Honore Bahan(11/-2) is awarded a "1/8" by the state, and his mother,Marie Rouseve (1/4) gets a "1/4."The document I found the most interesting was exhibit14, which establishes Rosalie Maxent (/4) as having" 100% Negro blood." Exhibit 14 consists of a Xeroxcopy of page 18, the Donations Book, St. TammanyParish, December 8, 1830. The penmanship is difficult,the copy is blurred, but the following is an accuratetranscription of the legible portion.... in the year of our Lord one thousand eight hundred andthirty in the year of the independence of the United States ofAmerica the fifty-fifth, before me Jake R. Jones, Judge of saidParish duly authorized by law to exercise the power of NotaryPublic therein personally came and appeared Rosalie Maxent ofthis Parish and State, a free woman of color, who did discloseand say that for and in consideration of the good will and affec­tion which she bears for her natural children, hereinafter named,she gives and grants to each of them as a donation interest of theslaves hereinafter named, Celestes Baham, a Negro femaleslave named Amy aged eleven years of the value of fourhundred dollars. To Voltaire Baham, a Negro boy slave, namedCharles aged seven years of the value of three hundred dollars.To Pierre Baham a boy slave named Narcisse aged eight years,of the value of three hundred dollars. To Celestin Baham aslave boy named Nicolas, age six years, of the value of twohundred and fifty dollars. To Hortense Baham the slave Fran­coise a female aged nine years of the value of three hundreddollars. To Salvadore Baham the slave Julian, a boy aged sev­enteen years of the value of six hundred dollars, and to CasimusPopulos, a female slave named Monette, aged four years of thevalue of two hundred dollars, for them and their heirs to haveand enjoy, in full property forever.Rosalie Maxent may have been a free woman of color,but she certainly wasn't a free woman of color with scru­ples about the freedom of other people of color.The TrialNo court date has yet been set, so I hesitate to predictthe outcome. However, I can make some projectionsbased on similar cases that have been tried in Louisianasince 1970. In four preceding cases the court has ruledthat the child in question can retain "white" on the birthcertificate because the state cannot prove the excess of"1/32nd Negro blood" beyond a reasonable doubt. Letme quote from the decision concerning Elizabeth Plaiawho the state claimed was "5.75/32nds Negro," but whofinally retained her designation as "white" on the birthcertificate; "... it is quite clear 'mulatto' can, and muchmore frequently than not does, mean a percentage ofNegro blood greater or lesser than the one-half white orone-half Negro which is 'mulatto' by strict definition; andobviously no particular percentage of Negro blood is in­dicated by the word 'colored' or 'mixed.' In this case thatunreliability makes it impossible to determine whether ornot the amount of Negro blood is more than one thirty­second. "Thus, Lisa Marie Anthony's attorney will argue simi­larly in her case, and will also attempt to submit picturesof Lisa Marie as evidence. The court may refuse to ac­cept these pictures, but the maneuver will make everyone involved aware of her phenotype. Lisa MarieAnthony is fair skinned with straight blond hair and blueeyes.I will present my expert testimony and explain that onedoes not inherit "blood," but rather one inherits genesfrom one's parents. "Blood" may be an infinitely misci­ble substance, but genes are discreet units which do notblend. I will present statistics showing that the probabil­ity of a person inheriting exactly 1/4 of his genes fromeach grandparent, and exactly 1/8 from each great­grandparent, and exactly 1/16 from each great-, great­grandparent, etc., is so small as to make the state'sarithmetic computations ridiculous.My presentation will be a mere formality. The courtdoubtlessly will rule that Lisa Marie Anthony can retainthe designation "white" on her birth certificate, andprobably for the same reasons as were cited in the Plaiacase. It turns out, and I, myself, learned this only re­cently, that LSA R.S. 42:267 when passed was an at­tempt to protect people like Lisa Marie Anthony, who isostensibly white, from the fate of being considered aNegro in Louisiana. Under the old Louisiana law anyonewith any traceable amount of "Negro blood" could beclassified as Negro. Obviously the enforcement of LSAR.S. 42:267, the use of red stamps on birth certificates,and cases such as this have had the opposite effect of theoriginal intent.Post-Trial ContemplationsAssuming my predictions about the outcome of the trialare correct, a number of conclusions can be drawn. Allthe constitutional issues will remain unsettled. All thegenetic inaccuracy will remain on the books. Let us ex­amine some of the unanswered questions. For example,the simple point that one does not inherit blood, butrather genes. This means that one cannot inherit "Negroblood." But can one inherit "Negro genes"? What is a"Negro gene"? What is a "Negro"? What is a"Caucasian"? For that matter, what is a "race"?There are many cogent and scientifically accuratedefinitions of "race." Races are subdivisions of species.Races are breeding populations. Race is a populationconcept which describes groups of organisms, not indi­vidual organisms. Although most biologists and an­thropologists agree that races exist in Homo sapiens,there is no consensus on how many, or what kind, or howto define these races. Nonetheless, despite the difficultyof formulating a precise definition, most people identifysomething they choose to call "Negroness" or"Caucasianness. "Applying the formal definition of race to "Negroness"or "Caucasianness" one can say that certain genes areoccurring with higher frequency in one population than inthe other. Some groups of people have a higher fre­quency of genes for, say, dark melanin pigmentation thando other groups. This definition does not describe thegenotype of any individual, only the frequency of certaingenes in a population of individuals. Just as there is nosuch thing as "Negro blood," there is no such thing as a"N egro gene." Yet many people who should know bet­ter, even fellow biologists and physicians, believe there is11a special hereditary substance, different in kind fromother hereditary substances, that has to do with "Negro­ness." Heuristically it is no help to point out that what isknown about dark pigmentation and hair curling indicatesthat the genes which control these traits are dominant tothe genes which lead to light pigmentation and straighthair. The very word "dominant" invokes an I-told-you-soreaction. It is as if the sequences of ON A which give riseto enzymes which eventually lead to dark pigmentationwere in some way tainted.Let us leave the genetic issue aside for the moment andassume that we can agree on something called "Negro."In Louisiana and some other southern states, this some­thing is presumably defined by law. In most northernstates, when such designations appear on official docu­ments, individuals classify themselves and their offspringas they see fit. Is there anything discriminatory per se inbeing called a Negro? Is it unconstitutional to label aperson a Negro?The Louisiana state attorney general in his April 9,1975 response to our case states, "Classification is aneutral act serving valid government purposes, and hasequal application to all persons." I n other words, mereclassification in and of itself does not deprive a group ofequal protection. In fact, racial classification is necessaryfor many valid governmental purposes. How else canracial balance be determined in schools and voting dis­tricts? How else can the government maintain propercensus statistics, administer aid to minority groups, dem­onstrate patterns of discrimination in housing or hiring?Under the law of the United States of America thereshould be nothing innately discriminatory in labelingsomeone a "Negro," and there appear to be some verysound justifications for the government to maintain suchracial classifications.Then why is Diane Weysham Ward going to so muchexpense and trouble to see to it that her daughter's birthcertificate does not say "Negro"? Diane Weysharn Wardis going to all the trouble because she knows that eventhough the designation "Negro" may be legally neutral itis not socially neutral. Some words are not value free.Almost everyone would agree that the word "nigger"carries strong pejorative connotations. On the otherhand, "Negro" is a proper anthropological term thatshould be free of this negative overtone. Unless, ofcourse, you are someone who believes Negroes are"niggers." But you, dear reader, are not such a person.You do not discriminate against Negroes. Or do you? DoI?Let's dissect another word, the word "discriminate."The dictionary gives two definitions: (I) to make a dis­tinction, and (2) to make a difference in treatment orfavor on a class or categorical basis in disregard of indi­vidual merit. I would suggest that the two definitions arenot so neatly separable. I would suggest that every timewe do the former we may also be doing the latter. Thesame human facility that allows us to classify, organize,pigeonhole data and categorize types may lead us tomake projections about individuals which may bestereotypes, based more on our abstract concept of thegroup than they are based on our observations of the12 individual. Are sharks dangerous? How do you distin­guish a homosexual? What's feminine? Can you trustanyone over 30? What does it mean to "look Jewish"?An anecdote from personal experience may help toillustrate my point. I'm a jogger. I have several acquain­tances whom I know solely from our daily contact huffingand puffing those two or three miles around the track. Imet one of these fellow joggers for the first time awayfrom the track in a faculty procession at a Tulane Uni­versity commencement ceremony. My academic regaliais from the University of Chicago and is quite distinctive,consisting of a maroon robe and a non-mortarboard velvetcap. That particular commencement was the first time Ihad worn the regalia since having been awarded myPh. D. so I was feeling admittedly self-conscious, albeitsplendid. When I saw my acquaintance from the trackstaring at me I thought he was admiring my cap andgown. Then he came over. I'm sure he spoke withoutthinking because he said, "Why Joan! I didn't know youwere a real person. I thought you were a faculty wife."Well, I am a faculty wife. I'm also a faculty person. Isee no reason why the anatomy that allows me to be theformer should in any way affect my capacity to be thelatter. Yet I'm sorely aware that many people think itdoes. My jogging acquaintance had made an easily dis­cernible observation about me-that I'm female. He thenprojected a number of other parameters based on hisstereotype of women. Apparently his stereotype in­cluded a category called "wife" but excluded anothercategory called "real person."I think it is difficult for adult, Caucasian males to un­derstand the continual burden of being judged bygeneralities, not by specifics. Here's another example.Recently I was appointed to an important universitycommittee. I am one of only five faculty members ofTulane on the committee; I am the only representative ofmy college; I am the only biologist, the only scientist; Iam the only person under 40. But every time someonementions my appointment I'm described as the "onlywoman." I frankly don't understand it. Do people expectme to birth a baby at one of the meetings? Why is my sexconsidered my most important credential?(If you're thinking that the reason everyone mentionsmy sex first is that in this area of affirmative action it isthe cause for my appointment, then you are more or lessproving my point.)I can't offer any pat answers. Experience has taught usthat it is impossible to legislate away prejudice. Similarlyreason tells us that the ability to find order out of diver­sity is a significant component of our very humanness. Itis efficient, useful, and necessary to make generaliza­tions. Rene Dubos, in his essay OJ Human Diversity,says it more eloquently than I could. "I do not questionof course that it is wise and profitable to learn as much aspossible about human life through the abstractions thatscientists derive from the experimental models theycreate. But I am of the opinion that it is also essential tocontinue accepting the evidence we derive from oursenses and from our direct experiences."My message is simple. The next time you hear yourselfsaying someone is young or old, Jewish or Christian,foreign or American, black or white, stop; think; useyour powers of observation. Is the classification you areusing clarifying or clouding your judgment? If we scien­tists do not draw conclusions based on the data then whowill?PostscriptAn evidentiary hearing was held on December 9, 1975, inthe U.S. District Court (Eastern District of Louisiana)before a three-judge panel. On December 22, 1975, ajudgment was rendered. To quote:However, a careful review of the evidence, as discussed above,makes it clear that the defendants have failed to prove that"there is no doubt" but that Lisa Marie Anthony is a memberof the Negro race. Indeed, the defendants have failed to proveby a preponderance of the evidence that such is the case.Furthermore, the Court finds the preponderance of the evi- dence proves Lisa Marie Anthony to be a member of theCaucasian race.Therefore, having found as a matter of fact that the defendantshave wrongfully denied the plaintiff's minor daughter a birthcertificate with a Caucasian race classification, it is unnecessaryfor the Court to reach any constitutional issues. Ashwander v.TVA, 297 U.S. 288, 56 S.Ct. 466, 80 L.Ed. 688 (1936), reh.denied 297 U.S. 728, 56 S. Ct. 588, 80 L. Ed. lOll.Accordingly, IT IS HEREBY ORDERED that the LouisianaState Board of Health, Bureau of Vital Statistics, issue to theplaintiff's minor daughter, Lisa Marie Anthony, a birthcertificate with a racial classification of Caucasian.J. w. Bennett received her M.S. degree ('64) and a PhD.in Botany (,67) from The University of Chicago, and ispresently an assistant professor of biology at TulaneUniversity.National Health Insurance-Whither the u.s.?Theodore R. MarmorAmericans are understandably alarmed about medicalcare because they have been frightened about it. Inspeeches, articles, programs, all the propagandisticmeans available, American leaders and journalists haveproclaimed that crises exist in rising costs, maldistributedservices, inefficient organization and poor quality care.This doom-crying has come from such diverse sources asRichard Nixon, Edward Kennedy, George Meany, andFortune magazine. Just six months after he became Pres­ident, Nixon warned that a "massive crisis" could leadin two or three years to a "breakdown in our medicalcare system ... affecting millions." Senator Kennedy'sbook on American health care was pointedly entitled InCritical Condition. The editors of Fortune in 1971 setAmerican medicine "on the brink of chaos." TheAFL-CIO's George Meany was free to do what camenaturally. He said the "crisis" was "generally ac­cepted. "Opinion surveys suggest that Americans agree there isa medical crisis, but that it is somebody else's. The largemajority of us are satisfied with our doctors and the carewe receive, despite misgivings about the "medical caresystem." Fewer than ten percent have unsatisfactorypersonal health care, though nearly 40 percent are wor­ried about high costs and inaccessibility. These misgiv­ings about the system may merely echo the words of thevocal elites who insist on a crisis. Opinions about one'sown medical care arise from personal experience-hencethe discrepancy in these views.The specific complaints of Americans are probablyclass-related: the rich dislike waiting and pay to avoid it;the poor dislike high costs and content themselves in13waitmg; the middle class dislike both waiting and highcosts. Few Americans, however, would risk wholesalechange in order to satisfy their specific complaints.Why have our politicians used this crisis technique?Have post-New Deal reformers assumed that only therhetoric of disaster can produce public action? Is it simplya matter of the man beating his mule to get its attention?There is more involved than merely spending more andfeeling worse. Whatever the origins, the rhetoric of disas­ter hinders any realistic appraisal of the competing na­tional health insurance proposals before us.Before going further, I should acknowledge that con­cern about the cost, distribution and quality of Americanmedical care is surely warranted. But the citation of theseproblems as clear signals for a particular national insur­ance plan is misleading. Consider the topic of rising med­ical care costs, for instance. That total expenditures formedical care have increased explosively in the past·twodecades is undeniable. Americans spent more than $118billion on medical care this last fiscal year. That meansaverage expenses per person of $558, compared with$485 in 1974. The proportion of the gross national prod­uct devoted to medicine increased by more than 70 per­cent in the past twenty years, from 4.6 percent in 1965 to8.3 percent in 1975.But costs understood as total national expenditures isthe language of statisticians, not citizens. What Ameri­cans worry about are the prices of particular items (theoffice visit, an appendectomy, their insurance premium)or the costs of severe illness (cancer, a broken hip, cere­bral palsy). They fear the consequences of medicalinflation (14 percent in 1975) in these personal terms,linking rising prices with out-of-pocket costs to their ownfamily. And they worry about insurance plans expiringjust when they are essential-in the rare, financiallycatastrophic cases (fewer than one percent of us spendmore than $5,000 a year on medical care).Governments likewise worry about their costs morethan total health expenditures. Medical inflationthreatens to turn our public programs into governmentbudget catastrophes. Medicare and Medicaid now spend$25 billion on services to the elderly, the disabled, andthe welfare poor. Ten years ago-in the first full year ofoperation-Medicare and Medicaid together spent ap­proximately $6 billion. So the cost problem is not one,but three: costs to the society, to individual pocketbooks,and to government programs. And even though thegovernment's costs have skyrocketed, the needs of theirclientele have increased as economic conditions wors­ened in the 1970s. In fact, the real per capita value ofMedicaid benefits-taking inflation into account-has re­cently declined despite the annual dollar increases inprogram expenditures.American medical care is also attacked as disor­ganized, badly distributed and fragmented, losing pa­tients in the cracks" between the units." It is not clear tome, however, that quality suffers from decentralizationor that flow charts and organizational reform would im­prove it. On the other hand, there is a serious shortage ofdoctors in the rural areas and in the inner cities, and onewonders what has become of the old-fashioned family14 doctor (only some 70,000 of the 295,000 practicing physi­cians in the country are pediatricians or general prac­titioners).The quality of treatment usually comes to public atten­tion through suits for malpractice and accounts of thehigh cost of malpractice insurance. But errors of omis­sion and commission may be rarer and wreak less socialharm than questionable and inefficient medical services.Drugs are not always prescribed wisely or in moderation;surgery is not always necessary. Experts rightly point outthat we should be concerned that "so many (Americans)lose their appendices, their wombs, or their tonsils ...without good cause." All these malpractices and mis­practices divert time and money away from moreprofitable uses, such as immunizations for children andprenatal checkups for mothers.These problems are real, but even taken together it isquestionable whether they constitute a general crisis. Itis important to keep this in mind in looking at the glut ofnational health insurance (N H I) proposals, since all ofthem have been justified as responses to the ostensible"crisis." The fact is that none of the proposed N HIplans would solve all or even most of the problems of ourmedical care system. Moreover, if we look carefully attheir provisions it becomes apparent that they addressdifferent aspects of America's health problems. Whatthese N H I plans reveal is not agreement-on crisis,problem or solution-but disagreement.Competing Proposals for National Health InsuranceAll the advocates of N HI, however, agree on at least onething: the need for a larger governmental role in thefinancing of medical care as a way of easing the effects ofinflation on the consumer. Some groups-most notablythe American Medical Association (AM A)-havestopped there. The AMA Medicredit proposal was de­signed as a federal subsidy of health insurance premiumsin hopes of stimulating broader insurance coverage in thepopulation. It would have replaced the present tax de­duction for medical care expenditures with a tax credit tooffset, in whole or part, the premiums of (qualified) in­surance policies. The amount of the credit would havevaried by income tax brackets: the higher the taxableincome, the lower the tax credit.The major proposals presently before the Congress allcall for more intervention in the health insurance industrythan Medicredit offers. The most ambitious is theKennedy-Corman bill, which proposes a governmentmonopoly of the health insurance business. To insurethat "money would no longer be a consideration for apatient seeking any health service," the Kennedy­Corman plan would establish a national health insuranceprogram with universal eligibility and unusually broadcoverage of service, financed jointly by payroll taxes andgeneral revenues. There would be no cost-sharing by pa­tients so that care under the plan would be "free" at thepoint of service, with the federal government paying theprovider directly. Further provisions of the bill addressproblems of cost escalation (by limiting the total budgetfor medical care), distribution (by creating incentives forcomprehensive health service organizations and forhealth personnel in underserved areas), and quality (bypolicing the standard of care).Politically fashionable at the moment are plans thatwould provide insurance protection against financiallycatastrophic expenses and let other governmental pro­grams and private insurance cope with the rest of themedical care industry's problems. There are several ver­sions before the Congress. President Ford in his State ofthe Union Address proposed a catastrophic plan for theaged in which the government would pick up the tab formedical expenses over $750 a year (at the same time theelderly would have to pay higher deductibles and coin­surance for expenses under the $750 limit that they pres­ently pay under Medicare).Another catastrophic proposal, the Long-Ribicoff bill,defines medical catastrophe as spending more than sixtydays in the hospital or more than $2,000 in doctors' bills.By contrast, a bill introduced by Senator William BrockIII (R. Tenn.) defines medically catastrophic expenses inrelation to family income, specifying 15 percent or moreof taxable income as a catastrophic burden and providingfinancing beyond that through Internal Revenue Servicetax credits. The appeal of the catastrophic approach isthat it is effective and cheap, since its benefits are limitedto that small proportion of the population that actuallyincurs catastrophic expenses (less than one percentspend $5,000 per year or more on medical care). It leavesthe present subcatastrophic system of medical care,whatever its shortcomings, virtually intact.Finally, there are mixed strategies that call for in­creased government regulation and partial federal sub­sidy of the present medical care system. The leading hy­brid now is the Comprehensive Health Insurance Plan(CHIP), first introduced by the Nixon Administration in1974. It is a potpourri of efforts to expand insurance bymandating exployment-related insurance, to rationalizeMedicaid by requiring larger patient financial contribu­tions as the incomes of welfare families rise, and to con­trol costs by state regulation and the encouragement ofprepaid group practice.One of the main attractions of this and other mandatedemployer plans is that they are ways to insure vast num­bers of families for health expenses while incurring amodest impact on the federal budget. Employers underCHIP, for example, would be required to offer policieswith broad benefits and to pay three-quarters of the pre­mium; the employee would pay one-quarter of the pre­mium and be responsible for substantial sharing of costsat the time of use (although more modest payment scaleswould be established for families in lower incomecategories). CHIP has been touted as costing tens ofbillions of dollars less than Kennedy-Corman, but whenwe look at the total costs of the plan as shared amongpatients and employers as well as the government, itdoesn't seem likely there would be much difference intotal health expenditures between the two plans.The influence of ideology on the shape of the variousbills makes comparison of proposals difficult, if only be­cause our political rhetoric tends to not-so-subtle exag­geration and distortion. The proponents of the various plans are apt to hope and claim more for their bills than ispossibly justified. It behooves us to remember that onebill cannot solve all the shortcomings of the health indus­try. The problems are not only complicated, but solu­tions to one conflict with the solutions to another.One may not agree with the AMA solutions, but theorganization has recognized that improving "any systemof medical care depends basically on balancing threestrong and competing dynamics: the desire to make med­ical care available to all, the desire to control cost, andthe desire for high quality care." The competition amongthese goals would be fierce. The AMA points out thatany two of them work against the third: "When you linkthe quest for easy and universal access with a desire tomaintain quality of care that combination of factorsworks against cost controls If you link quality withvigorous efforts to control costs, then there has to bepressure on access .... "An important question, then, is what would be the ef­fect of the various plans on the cost, quality, organizationand distribution of medical care? Comparative experi­ence with health plans in other countries warrants skepti­cism about what might actually be expected. One has tojudge current proposals by their probable results, not bytheir legal form.Will any of these proposals do anything about the factthat the nation's health care expenditures are increasingat the rate of more than $10 billion a year? Probably not.The experiences of Canada and Sweden suggest thatlarge-scale government financing does not in itself re­verse the upward spiral in prices and expenditures. Cer­tainly this has been the case when the government usesan insurance mechanism in which financing is diffuselyshared among patients and different units of government.There is evidence that when financing is concentratedand providers are directly budgeted, expenditures andthe rate of medical inflation are lower.This is true in Great Britain, with its National HealthService, where over the past fifteen years the rate ofmedical care inflation has been roughly one-third that ofCanada, Sweden and the United States. While no oneexpects the United States to legislate a national healthservice, the experience of Great Britain suggests afinancing concentration desirable in a future nationalhealth insurance program. Ironically, the "conserva­tive" emphasis on controlling inflation may best be ac­complished by a greater degree of governmental centrali­zation than even many "liberals" favor.Of the prominent United States plans, the Kennedy­Corman bill-with its concentration of financing in asingle federal agency-affords the best theoretical pros­pects for curbing inflation.The likelihood of Congress legislating such planfinancing is not, of course, very overwhelming. Thefinancing issue reaches to the most ideologically sensitivequestions about the scope of public authority. Neitherare we likely to see the Congress force consumers to paya larger share of their regular health bills to restraininflation. More likely is CHIP or some other mixed planwhich would offer more business and further subsidies tohealth care insurers and providers without strict central15budgetary control. Such fiscal dispersal would, like Med­icare, be inflationary yet would still leave major gaps incoverage-the worst of both worlds.National health insurance is likely to be more success­ful in improving access than in containing costs. Butfinancial barriers to care are only part of the problem.Also serious is the unavailability of care in major areasand specialties. No proposed remedy has workedwell-neither educational loan forgiveness for service inund�r-doctor�d areas, nor substitution of rural or ghettomedical service for physicians' military obligations norsubsidies for medical centers in underserved locales.O�her. Western .democracies have learned that poor dis­tribution remains even after the medical purchasingpower of poor city neighborhoods and remote rural areasare i'!1p�oved. Only Draconian assignment to regions andspecialties would work; otherwise young doctors havegood professional and social reasons for continuing toprefer specialty practices in affluent suburban neighbor­hoods.National health insurance probably will do little to im­prove the quality of care. It may provide incentives forpreventive care, though there is little evidence to supportsome of the current enthusiasm for preventive care suchas mass screening and annual checkups. But national in­sura�ce cannot check malpractice or doubtful practice,�nd It .may actually stimulate the demand for costly andinefficient procedures. The quality of medical care de­pends much more on professional self-regulation andconsumer awareness than on any conceivable health in­surance plan. Adequate financing cannot insure that thecare we get is good.These reservations about national health insurance'scapacity to reform our medical care arrangements is noexcuse for inaction. The major task of insurance is tocalm. fears of financial disaster. The issues of quality, pre­vention, and reorganization are peripheral to that con­cern. The argument that more traditional medical carewill not markedly improve our health is beside the pointwhen one asks whether the current burden of medicalcare expenses are fairly distributed. Some have arguedthat national.health insurance without incentives for pre­ventron and Improvement of health is not worth having.But would anyone seriously argue that automobile insur­ance, for .example, is �ot worth having if it doesn't pre­vent accidents and Improve the quality of our au­tomobiles?Recognizing the conflicting objections in nationalheal.th insurance proposals is the beginning of prudentchoice. We have to ask, in plain English, whether weshould spend a larger share of the nation's resources onmedical care services, through the federal government orotherwise. Should efforts be made to make health caren:ore access.ible (and perhaps less fancy), of substantiallyhigher quality (and therefore more expensive), morehumanely delivered (and therefore objectionable to somecurrently satisfied providers), and should the use of med­i�al care be independent of ability to pay (and thereforelikely to be more costly in the aggregate)?These will not be the questions presented if theideological themes of the post-New Deal continue to16 dominate our conceptions of doctors, patients, and na­ti<!nal health insurance. When Republicans lock hornsWIth Democrats on the role of the private and publicsector and the virtues and vices of market versusbureaucratic solutions, the public is not well served. Forthe crisis in American medicine lies in our thinking asmuch as in our medical care arrangements.What Can One Do?The sense of crisis, as we have seen, reflects politicalstrategy as much as medical care reality. But ignoring itentirely would be a mistake for two reasons. First, mosto� the problems cited are real if not truly critical, espe­cially the relative inflation in medical care prices and ex­penditures. Second, once voters have been "sold" on theexistence of a crisis, the path of least political resistancein the United States is a mixed plan. By a mixed plan Imean a compromise, on both financing and administra­tive centralization, which would disperse regulatory andfinancial responsibility among citizens and patients, gov­ernment and private insurance companies, states andfederal gov�':1ment. The CHIP bill is a good example ofsuch a politically appealing mix, and the DemocraticKennedy-Mills proposal of 1974 was very similar infinancial, if not administrative, dispersion.Mixed compromises in medical care financing involveth� worst of t�e private and public worlds. Ironically, amixed plan WIll continue the inflation problem and soinstitutionalize that aspect of the crisis, as Swedish andCanadian experience suggests. In fact, wheneverinsurance-public or private-is offered as a cure formedical inflation, it becomes, to borrow a medicalphrase, iatrogenic, causing the very disease which it pur­ports to cure.National health insurance will increase inflationarypressures under the best of circumstances. Plans whichmix p.rivate, state, and federal financing-and�egul�tIOn---:-offer us the least hope for resisting thisinflation while expanding access.We need instead a plan which provides ample protec­tion against disastrous medical costs, encourages worth­v:hile preventive care, offers incentives to efficient prac­tree, and, for the sake of political feasibility, does notsuddenly run $118 billion through the federal budget.A compr�hensive health insurance program for all pre­school chi ldren=-with catastrophic protection foreveryone-is within our fiscal, administrative and politi­cal g�asp. �t a time when the country is beset by the fearof failure In government and discouraged by incompe­tence, a plan which the government can effectively im­plement would do much for the health of the politicalorder. But these matters are the subject of what would bea still longer essay. \Theodore R. Marmor is Associate Professor in the School ofSocial Service Administration and the College, and Re­search Associate in the Center for Health AdministrationStudies. This article is adapted from testimony on nationalhealth insurance submitted by Mr. Marmor to the HouseCommittee on Ways and Means on February 26, 7976.Clinical Pharmacology-The First Two YearsDr. leon I. GoldbergAdvances in chemistry and pharmacology during the past30 years resulted in the development of large numbers ofnew drugs for specific treatment of disease. These inno­vations have greatly extended the power of the physicianto do good. Unfortunately, they also increase his capac­ity to do harm. Public awareness of the potential dangerof therapeutic agents has greatly increased in recentyears, but there has not been an equal emphasis on thegood that drugs can do. Adverse drug reactions, malprac­tice suits, consumer group protests, FDA warnings,and Congressional investigations are frequently in thenews. Somehow, the message has not gotten to the pub­lic or to political figures that there is no such thing as acompletely safe drug and that an increase in efficacyusually carries increased risk.Clearly, there are many educational gaps which mustbe filled if the situation is to be improved. Physiciansmust now, as never before, possess the ability to estimaterelative benefits and risks every time they prescribe adrug. They must increase their knowledge of pharmacol­ogy to be able to utilize drugs rationally. More informa­tion about therapeutic drugs must be transmitted to pa­tients and to the public at large. Universities are beingasked to assume an increased role in these educationalresponsibilities, and these additional efforts must be car­ried out without diminishing critical research functions.Traditionally, pharmacology departments were re­sponsible for imparting basic knowledge of drugs to med­ical students; training in the rational use of therapeuticagents was relegated to the clinical department. The in­creased complexity of new drugs seemed to cry for adiscipline to bridge the gap between pharmacology andclinical areas which primarily involve the general field oftherapeutics rather than a single subspecialty area. Therelatively new discipline of clinical pharmacology wasfounded largely as a response to these modern needs.The therapeutic drug problem is not confined to theUnited States. In 1970, the World Health Organizationconvened a study group to demarcate the scope of thenew discipline, to remedy the shortage of clinical phar­macologists, and to provide a basis for internationalcoordination of research activities. The study group com­piled a list of the functions of clinical pharmacologists: 1)improve patient care by promoting safer and more effec­tive use of drugs, 2) increase knowledge through re- search, 3) impart knowledge through teaching, and 4)provide services, such as drug information and advice onthe design of experiments. Clearly, all these functionscannot be carried out by a single individual. They requirean interdisciplinary approach, with participation by manydifferent individuals with varied expertise.The University of Chicago is an ideal institution for theestablishment of a strong program in clinical pharmacol­ogy, for it has always excelled in collaborative endeavorswhich cut across departmental lines. After years of plan­ning, the Committee on Clinical Pharmacology wasfounded on September 1, 1974, with 14 faculty membersfrom the Departments of Pharmacology, Medicine,Psychiatry and Statistics. The Committee was given theresponsibility of developing a central facility, recruiting aDr. David Kornhauser (/eft) and Dr. Alvin Kotake, using gas chromatog­raphy, measure drug levels in blood plasma and determine how wellcertain drugs are metabolized,17core faculty and staff, stimulating collaborative efforts inresearch, service and education, and seeking funds tosupport this increased activity. Two years after thefounding of the Committee, a progress report is in order.RecruitmentThree research associates joined the program in 1975-76.Dr. Jai Kohli, Research Associate (Associate Professor)in Pharmacological and Physiological Sciences, was as­sistant director of the Central Laboratories for Drug Re­search in Lucknow, India. Dr. Kohli obtained an M.S.degree in Pharmacology at the University of Chicago in1951. His expertise is in autonomic pharmacology. Dr.Alvin Kotake, Research Associate (Assistant Professor)in Pharmacology, has a Ph. D. in medicinal chemistryand spent three years as a postdoctoral fellow studyingdrug metabolism at the University of Minnesota. Dr.Yen- You Hsieh, Research Associate in Pharmacologicaland Physiological Sciences, was director of the coronarycare unit at the National University of Taiwan and isinterested in the clinical pharmacology of cardiovasculardrugs.Dr. David Kornhauser was appointed Assistant Pro­fessor of Pharmacology and Medicine last July. Dr.Kornhauser is a Board Certified internist who obtainedtraining in drug metabolism and clinical pharmacology atthe National Institutes of Health and Vanderbilt U ni ver­sity. Two additional faculty members will be recruited.FacilitiesCore facilities currently occupy most of the fourth floorof Abbott Hall. Abbott Hall is an old building and exten­sive renovation will be required before the entire area canbe utilized. A pace-setting gift from Mr. and Mrs.Nathan Bederman provided facilities for one laboratoryand subsequent gifts from foundations and industrialfirms provided support to begin additional laboratoriesand to hire technicians. Two drug metabolismlaboratories and two animal pharmacology laboratoriesare presently in operation. Office space is available forfaculty, postdoctoral fellows, and staff. The availabilityof these facilities enabled the University to successfullycompete for an institutional training grant from the N a­tional Institute of General Medical Sciences (N IGMS).Three postdoctoral trainees in Clinical Pharmacologybegan their training period in July of 1975, and two addi­tional fellows joined the program last July.Consulting ServiceThe first coordinated effort to provide clinical serviceand an educational base in the hospital was the develop­ment of the Clinical Pharmacology consulting service, acooperative project of the Clinical Pharmacology Com­mittee, the Department of Medicine's General MedicalService, and the hospital pharmacy. Medical students,house officers and faculty can request information con­cerning drugs or advice in handling drug-related prob­lems, such as evaluation of potential adverse drug reac­tions. This is how the service works: When advice isneeded, the General Medical resident or a ClinicalPharmacology postdoctoral fellow discusses the problem18 with medical students and house officers, reviews thehospital chart, and examines the patient. A ClinicalPharmacology faculty member assists in solving theproblem. Information is supplied from data banks in thepharmacy, with the assistance of a clinical pharmacist.Interesting problems raised in these consultations arediscussed in detail by a faculty member at regularlyscheduled rounds. Initial response to the service hasbeen good, and we plan to coordinate consultation ac­tivities with intensive drug utilization surveillance whichwill be carried out by clinical pharmacists. These effortsare designed to improve the rational use of drugs and toreduce the number of adverse drug reactions. Clinicalconsults have also stimulated research to improve drugtherapy and to define previously undescribed adversedrug reactions.Course in Clinical PharmacologyThe Clinical Pharmacology Committee offers a 40-hourcourse for second-year medical students given in theSpring quarter. The course was previously a lectureseries in therapeutics given primarily by clinicalspecialists. The addition of Clinical Pharmacology fac­ulty members and postdoctoral fellows enabled us to ex­pand the scope of the course and provided increased op­portunities for other learning experiences, such as infor­mal seminars and discussions of test questions.Case reports involving therapeutic problems, adversedrug reactions, and drug-drug interactions are currentlybeing prepared for next year's course. These case re­ports, which students will work out with the assistance ofthe postdoctoral fellows and members of the ClinicalPharmacology Committee, increase students' personalcontacts with faculty, an element lacking in the previouslecture course.ResearchArmed with financial support from private sources, weinstituted collaborative research acti vities shortly afterthe clinical pharmacology program was established. Ourdemonstration of successful collaboration made feasi­ble an application to NIGMS for support of aPharmacology-Toxicology Center. In order to receivesuch a grant, a university must demonstrate the ability tocarry out interdisciplinary research activities which "en­compass most, if not all, of the flow of basic informationto its ultimate application in man." Only a few clinicalpharmacology centers have been established in theUnited States.The University was awarded a five-year grant for es­tablishment of a Clinical Pharmacology Center on JuneI, 1976, with a first-year award of $329,848 and afive-year total of $1.3 million. We were encouraged topursue research in the broad area of Pharmacology andToxicology, and received approval for six specific proj­ects.Project I is an investigation of the cardiovascular andrenal actions of new dopamine-like agents. Investigatorsin this project are Dr. Kohli, Dr. Paul Volkman (post­doctoral fellow), and myself. This project is a continuationof our long-term objective to discover dopamine analogsDr. Jai Kohli is studying the effect of various drugs on smooth muscletissue. His laboratory is equipped with isolated organ baths (left) and aOynograph Recorder to analyze test results.to expand the clinical uses of dopamine. Our previousstudies demonstrated that dopamine, a naturally­occurring catecholamine, increases blood flow to thekidney by acting on a specific dopamine receptor. On thebasis of this research, dopamine is now used in the treat­ment of shock and other conditions with reduced renalblood flow. More extensive use of dopamine is limitedbecause it is not effective when administered orally andbecause it produces other effects in addition to acting ondopamine receptors. If a dopamine analog which is orallyabsorbed can be found, it may pave the way to newmethods of therapy for congestive heart failure andhypertension.Project 2 is concerned with determining whether thereis a physiological role for dopamine in the kidney.Dopamine levels in the kidney and plasma will be mea­sured and dopamine will be localized in the morphologi­cal elements of the kidney. If dopamine can be localizedin specific cells, and methods of measuring dopamirieplasma level can be developed, it may be possible todetermine whether dopamine has a physiological role.These studies in the kidney are related to earlier studiesof the central nervous system which led to the demon­stration that Parkinson's disease is related to deficiencyof dopamine in the caudate nucleus of the brain. Inves­tigators in this project are: Philip C. Hoffmann, As­sociate Professor of Pharmacological and PhysiologicalSciences and in the College; Dr. Lloyd J. Roth, Profes­sor of Pharmacological and Physiological Sciences and inthe College; Dr. Robert Dinerstein, Research Associatein Pharmacological and Physiological Sciences; andIhsan M. Diab, Research Associate (Associate Profes­sor) in Pharmacological and Physiological Sciences andPsychiatry.Project 3 is an investigation of new prostaglandins andprostaglandin antagonists. Prostaglandins are fatty acidswhich are found in most human tissues and, in minute doses, produce a wide range of physiological and phar­macological actions. Josef Fried, the Louis Block Pro­fessor in the Departments of Chemistry, Biochemistry,and the Ben May Laboratory for Cancer Research, isprincipal investigator of this project, and Dr. Kohli,Philip Hoffmann and myself are co-investigators. Friedis an internationally renowned expert in prostaglandin re­search and has synthesized a large number of prostaglan­din derivatives of unusual chemical structure. Some ofthese compounds have undergone pharmacological tests,but cardiovascular studies have not yet been performed.The goal of this investigation is to determine whetherthese compounds act on the cardiovascular system andwhether some of them might have clinical use.Dr. Kotake is the principal investigator of Project 4. Inthe first phase of this work, he will determine the feasibil­ity of using isolated liver cells in the study of drugmetabolism. In the second phase, he will investigate howthyroid hormone affects the drug metabolism ability ofliver cells. The effects of thyroid hormone on drugmetabolism are poorly understood and new techniques tostudy its action have potential benefit for patients withthyroid dysfunction.Project 5 is a study of the effects of certain drugs on theability of the liver to break down other drugs and naturalproducts. The investigators in this project are: Dr. JohnSchneider, Assistant Professor of Medicine; Dr. JamesL. Boyer, Associate Professor of Medicine and Directorof the Liver Study Unit; and Dr. Peter D. Klein, Profes­sor of Medicine and Senior Scientist at the Biology andMedical Research Division of Argonne NationalLaboratory. Their goal is to develop further a techniquein which nonradioactive carbon-I3 is used for measuringdrug metabolism. It is not necessary to draw blood forthis technique because results are determined by measur­ing carbon-I3-labeled carbon dioxide in the expired air.This method has particular application to the study ofdrugs in children, who should not receive radioactiveisotopes.The final project is concerned with the development ofnew statistical methods to be used in clinical trials. In­vestigators in this project include Paul Meier, the Ralphand Mary Otis Isham Professor of Pharmacological andPhysiological Sciences, Statistics, and in the College;Shelby J. Haberman, Associate Professor in Statisticsand the College; and Theodore Karrison, Research As­sociate in Statistics.In addition to studies supported by the Center Grant, anumber of cooperative investigations have been carriedout, or are being carried out, in collaboration with clinicalspecialists. One goal of the Clinical PharmacologyCommittee is to increase the number of clinical trialsbeing conducted at the University by informing facultymembers of the availability of new drugs to study and byassisting in the design and performance of investigations.A major reason for the lag in time from the synthesis ofa new drug to its ultimate use by a physician is the lack ofacademic centers willing and able to participate in thesestudies. In the first two years, several collaborativestudies have been conducted with faculty members in theDepartments of Medicine and Psychiatry. These proj-19Dr. James R. Rick, an Upjohn Fellow in Clinical Pharmacology, testsanalgesic drugs in mice. ects investigated antihypertensive agents, antiarrhythmicdrugs, drugs used for the treatment of shock, antidepres­sants, and drugs used for the treatment of Parkinson'sdisease. Among studies currently under considerationare investigations of new diuretic agents, antiasthmaticdrugs, and analgesic agents.Societal problems in drug development and utilizationextend beyond the boundaries of the Division of Biologi­cal Sciences. A host of ethical, legal and economic prob­lems require innovative solutions and this need will be­come more critical when National Health Insurance be­comes a reality. Faculty members in several schools anddivisions of the University are now working in relatedareas and initial probes suggest that collaborative educa­tional and research efforts should be fruitful, if appro­priate funds can be found.The activities of the Clinical Pharmacology Center arebecoming international. Visiting scientists and physi­cians from several countries are participating in researchand training programs and the Committee plans to spon­sor an important international meeting within the nextthree years.In summary, the first two years have been good. Op­portunities for the future appear almost unlimited.Dr. Leon I. Goldberg is Professor of Pharmacological andPhysiological Sciences and Medicine, Chairman of theCommittee on Clinical Pharmacology, and principal inves­tigator of the five-year grant for the Clinical PharmacologyCenter.A New Approach to Nutrition TrainingDr. Frank K. ThorpIn response to the nationally-recognized critical need fornutrition training programs for medical students, newinterdisciplinary guidelines for curricula have been de­veloped at the University's Pritzker School of Medicine.This approach is considered necessary because society'sneeds involve more than just teaching nutritional data.RationalePrevious approaches to nutriuon education, e.g. fortreatment of diabetes, have failed because many patientsseem unable to change their food habits. To be effective,nutrition education programs require appreciation of cer­tain socio-economic, educational, and psychological fac­tors on the part of the personnel involved. These includean awareness of ethnic food customs, workable methodsof changing behavior, and individual variations in percep­tual abilities and forms of learning. Physicians who wishto improve their patients' nutrition must rely on helpfrom allied health workers. Physicians must know whento ask for the assistance of such persons, but must also beaware of their limitations.20 In the long-ignored area of disease prevention andhealth maintenance, physicians must now plan for nutri­tional needs of well people. In this era of world foodcrisis, physicians will also need to understand global fac­tors that affect food availability. They may be asked tohelp change U.S. eating patterns to allow better distribu­tion of food, fertilizer and pesticides in other parts of theworld. All of these demands require a different emphasispreviously not available in medical school programs.Physicians in training must understand complex nutritionneeds and work as directors or members of an interdisci­plinary team.Roles in Interdisciplinary Health CareThe physician's role in such teams is relatively new.Within many medical schools, students, house officersand faculty are becoming accustomed to working on suchteams, but this does not appear to be the case for manyphysicians in independent practice; indeed, there is evi­dence that some physicians have difficulty accepting asharing role as a member of a team which includes dieti-cians and clinical nutritionists. In addition to varyingconceptions by team members as to their respectiveroles, there are problems of restrictive hospital policiesand shortages of trained dietician-educators. Physiciansare unlikely to delegate nutritional care of a patient to adietician if they feel that the dietician is poorly qualifiedto identify the behavioral, social, cultural, economic andeducational factors involved in changing nutritionalhabits.In such relatively new professions as nurse clinician orassociate, some of the problems of relating to physicianshave been resolved, unlike the case of clinical nu­tritionists or dieticians. There is concern that nutritionspecialists, acting in an expanded role as team members,may lose their primary identity. In some instances physi­cians and nurses have adopted game-playing roles, wherethe physician must appear to be in charge at all times andcan only accept indirect suggestions. It is assumed thathe really knew all about the matter. This kind of relation­ship would be as unattractive to nutrition specialists as itis to many nurses. However, the real problem may lie inthe degree of independence physicians allow such pro­fessionals. For example, should a dietician prescribediets or contribute discussion to medical rounds? Thediscomfort of both physicians and health personnel withtheir new roles is evident in job titles. Does nutritionassociate connote a person who associates with physi­cians, or a physician's "handmaiden?" Doesparaprofessional mean working parallel to a physician ordoes it imply subservience? Much of the current preoc­cupation with titles reflects conceptual growing pains ofthese new functions. Perhaps it is ultimately not of majorimportance, since the nature of one's job depends onwhat one actually does, and not on what one is called.An Approach to Interdisciplinary Nutrition Training andEducationIf the nutrition training of physicians is to be improved,medical students, too, must be trained. If students seephysicians working effectively with a team and partici­pate themselves, they will have less difficulty aftergraduation.In addition, nutrition training programs for health pro­fessionals and the public can benefit from certain recog­nized educational concepts. These include: 1) learningearly in life, in the preschool years, 2) individualizedprograms that recognize human variability, 3) educationas a continuing life process, 4) use of out-of-school orstreet experiences, 5) teaching techniques that incorpo­rate awareness of personal relationships and the learner'spersonality, and 6) imaginative use of the communica­tions media. To meet some of these challenges, our nutri­tion clinics have initiated several projects involving themedical school, university and community.Graduate Nutrition Program and Medical Student Train­ingAfter several years of planning, a new program ofgraduate study leading to a master's degree in clinicalnutrition from the Department of Medicine was insti­tuted in 1973. The program originated in the nutrition clinics, from collaboration of nutritionists and physicians,with the assistance of interdisciplinary consultants. Theprogram trains qualified independent nutritionists capa­ble of working in any area of medicine. Graduates shouldbe able to do everything now accomplished by nu­tritionists and dieticians in existing programs. In addi­tion, they can more knowledgeably advise physiciansabout the dietary requirements of particular patients, andwill be able to instruct these patients. Graduates shouldbe able to manage patients' dietary and related socialconcerns with the same independence currently investedin psychiatric social workers. They can assist in educat­ing physicians and the public in the prevention of certaindiet-dependent diseases.This program identifies nutrition as an independentdiscipline with a unique curriculum in the Pritzker Schoolof Medicine and combines a number of nutrition-relatedhospital and university activities. Although it was de­signed to train allied health personnel, a number of medi­cal students have elected to take portions of the cur­riculum.Course material for degree candidates includes ele­ments of biochemistry, cell biology, organ physiology,cell pathology and virology. Sharing classes with medicalstudents prepares one for collaboration with physicians.Candidates in the two-year program take courses on thephysiology and pathophysiology of nutrition, clinicalmedicine (with material from all major disciplines), andsocial and psychological aspects of appetite and satiety.The latter course includes practical behaviormodification techniques to control obesity. Othercourses are offered in the educational and psychosocial­cultural aspects of patient counseling. In the final precep­torship, students learn how to instruct patients and howto get along with physicians.The pivotal course of the degree program is "Physiol­ogy and Pathophysiology of Nutrition," a newly­structured interdisciplinary course designed for bothmedical students and degree candidates. It includes anDr. Thorp and colleagues discuss nutrient requirements in the child andat what age diet fat modification might best be started to prevent develop­ment of arteriosclerosis in the adult. Left to right: nutritionists CatherineSchneider and Paula Peirce, Dr. Thorp, and medical student RalphSmathers.21initial review of biochemistry and physiology relevant tonutrition and the metabolism of foodstuffs; a review ofbasic principles of human nutrition (body composition,growth, and development, periods of physiologicalstress); and an examination of hormonal-neural factorsaffecting nutrition. The course also covers clinical con­sequences and management of various nutritional dis­eases, with emphasis on therapeutic and preventativediet manipulation. Material on world nutrition problemsand fad diets is also included. Students prepare studies ofselected cases to demonstrate an understanding of thenutritional needs of the patient and ability to meet theseneeds.This training program should help narrow the existinggap between the physician's lack of nutritional knowl­edge and the nutritionist's lack of medical competence.The hospital-based nutritionist should be able to acceptmore responsibility for initial decisions regarding diet,implement these decisions, and establish a program forfollow-up care. He should be able to help educate andconsult with allied health workers. In a medical schoolsetting, this new specialist will be able to collaborateclosely in the nutrition training of medical students,housestaff and attending physicians through involvementin patient care. Degree candidates will be encouraged tocollaborate in graduate research in therapeutic nutrition.Ultimately, it is hoped that some graduates will help es­tablish similar programs in other health centers.One thing the program has accomplished is thebroadening of the scope of medical education and train­ing. In Pediatrics, third-year students work with agraduate nutritionist, learning how to obtain diet historiesand nutritional profiles of patients. They participate inpatient care in a metabolism-nutrition clinic, workingwith a team including physicians, a social worker and anutritionist. If they choose a preceptorship, they are as­signed patients needing nutrition intervention and are re­sponsible for effecting a supervised patient educationprogram. They may join the medical team at a children'sdiebetes summer camp program, working with a nu­tritionist in planning for the children's changing nutri­tional needs and in teaching. Finally, they may partici­pate in the planning and development of a public healthand nutrition education project sponsored by a localhealth maintenance program.Educational Diagnosis in Nutrition CounselingThe concept of educational diagnosis in nutrition coun­seling evolved from application of certain aspects oflearning theory developed at the University. For exam­ple, in Pediatrics we are developing a juvenile diabetesmedical nutrition education project aimed at indi­vidualized learning. This project grew out of frustrationwith available teaching methods and tools and frustrationin dealing with recurrent episodes of ketoacidosis (ac­cumulation of acids) in some patients. We felt many ofthese recurring crises could be prevented through a com­prehensive education program.It is obvious that, to be successful, a therapeuticmedical-nutrition education program must be indi­vidualized. Children are in various phases of cognitive22 development when diabetes becomes manifest. Adultshave different ways of learning new material. In thisproject, principles of learning theory are applied to a dia­betes medical-nutrition program. The goal is to developteaching methods and tools that meet individual modes oflearning and thus enable each patient to better care forhimself, to understand the rationale of treatment, and tolearn to live with the chronic disease of diabetes.Current theory suggests that in childhood, cognitiondevelops through the following modes: enactive, ikonicand symbolic. The adult learns through interaction ofthese modes, but may give preference to one of them.The enactive mode is the most overt and primitive and ischaracteristic of the young child of 12-18 months.Habitual, manipulative actions are used in coping withthe world and schemes are developed for organizationbased on elements of movement, contour, discrepancyand sensory feedback. The ikonic mode involves rep­resentation through imagery or visual aids and is charac­teristic of children aged 5 to 7 years. The symbolic mode,developed in early adolescence, employs abstract reason­ing and the use of language.Piaget has indicated that the overt action mode be­comes increasingly internalized until covert action, ver­bal and symbolic, dominates cognition. This principle ofinternalization is also felt to be applicable to the masteryof specific cognition. In other words, an adult learnermay pass through these modes of cognition in order tomaster a new concept.Personality theory of learning identifies the stereopath,a person who requires a great deal of structure in educa­tional efforts, and the rational, a person who requireslittle structure and learns best when left to his own de­vices. Further, there are non-learners who must becoaxed or forced to learn something new.With the Department of Education, we have been at­tempting an educational diagnosis of each new juvenilediabetic patient. We are developing education toolswhich will correspond to the juvenile diabetic's preferredmode of learning.ConclusionInterdisciplinary approaches to nutntion trairung andeducation involve two levels. On one level is the integra­tion of concepts derived from many disciplines, espe­cially social and behavioral sciences, into the study ofhuman nutrition. A second level is the integration of in­terdisciplinary nutrition efforts of allied health personnelwithin the discipline of medicine. Such integration is animportant first step in the practical application of nutri­tion principles to improve the nutritional status of bothdiseased and well persons, and to help reduce world-widemalnutrition.Or. Frank K. Thorp is Associate Professor and Joseph P.Kennedy, Jr. Scholar in the Department of Pediatrics. Thisarticle is adapted from a paper presented at the First AnnualInterim Meeting of the American College of Nutrition heldin November, 1974. The original paper will be publishedshortly in a book entitled Nutrition in Quality Health Care,Hemisphere Publishing Company.A Golden Celebration-50 Years of Medical Care andResearch on the MidwayThe University of Chicago Hospitals and Clinics willhave their 50th birthday next year.A celebration centered about the anniversary of thededication of this distinguished teaching and care facilityin November, 1927, will be held during the week ofNovember 13. The theme of the observance will be qual­ity medical care and quality medical research in relationto patients.Planning and coordinating the events of the celebrationis a Planning Committee that includes representativesfrom the faculty, the Medical Alumni Council, and theMedical Alumni Association administrative staff.Chairman of the committee is Dr. Robert W. Wissler, theDonald N. Pritzker Professor of Pathology and in theCollege.Several professional, scientific and social events areplanned.Convocation-honorary degree candidates will be pro­posed, some of whom may be distinguished alumni(former faculty, students, and housestaff) who deserve tobe honored for their scholarly work related to medicalcare and diagnosis.Symposium-a special program will include the re­search of those receiving honorary degrees.Walter Palmer Lecture-this biennial lecture, given bythe Walter Palmer Visiting Professor in gastroenterol­ogy, will be scheduled during the three-day period.Dedication of Surgery-Brain Research InstitutePavilion-there will be a formal dedicatory ceremony,open house and reception to mark the opening of the newfacility which will house the University's Brain ResearchInstitute and Clarence C. Reed Surgery Center.Banquet-a banquet honoring individuals who havemade important contributions to the history and progressof the medical school will be sponsored by the Councilfor the Division of Biological Sciences and The PritzkerSchool of Medicine. A University medal will be pre­sented to those honored. Medical alumni, students, fac­ulty, housestaff, and hospital employees will be invited.Members of the Planning Committee include: JosephJ. Ceithaml, Dean of Students in the Division of Biologi­cal Sciences and The Pritzker School of Medicine andProfessor of Biochemistry; Elwood V. Jensen, Professorof Biophysics and Theoretical Biology and Director ofthe Ben May Laboratory for Cancer Research and theBiomedical Center for Population Research; Dr. JosephB. Kirsner, the Louis Block Distinguished Service Pro­fessor of Medicine; Dr. Janet Rowley (,48), AssociateProfessor in Medicine, the Franklin McLean MemorialResearch Institute, and the Committee on Genetics; Dr.Arthur Rubenstein, Professor and Associate Chairman of the Department of Medicine; Dr. Henry P. Russe (,57),Professor of Medicine, Associate Vice President for theMedical Center (Medical Services), and Chief of Staff ofthe University Hospitals and Clinics; Dr. Joseph H.Skom (,52), Vice President of the Medical Alumni As­sociation; John Piva, Associate Vice President for theMedical Center (Development), Director of Develop­ment for the Division of Biological Sciences and the med­ical school, and Executive Director of the University ofChicago Cancer Research Foundation; and KatherineWolcott Walker, Assistant Director of Development andDirector of the Medical Alumni Association.As further plans for the 50th anniversary celebrationdevelop, we will report them in Medicine on the Midway.Meanwhile, mark this week on your 1977 calendar andsa ve the date!23Innovative Curriculum Explores Science and Art of MedicineJames S. SweetA new four-year curriculum in human biology andmedicine that spans the last two years of college and thefirst two years of medical school was announced by theUniversity last summer. Starting in the junior year of theundergraduate College, the new program will intermingleupper levels of collegiate education with pre-clinicallevels of medical education.It is aimed not only at students who intend to go on tothe final two clinical years of medical school, culminatingin the M.D. degree and medical practice, but also forthose who will pursue a wide variety of graduate disci­plines in the science of human health.The new curriculum, in the liberal arts and sciencesbasic to human biology and medicine, will start in the fallof 1977. Thirty students will be accepted in the programthe first year, 45 in the following year and 60 in the thirdand succeeding years. It is anticipated that about half ofthose in the special program will become medical stu­dents and half will do advanced work in related healthfields, such as socioeconomics of health care, humanecology and public health, administration or public policydecision making in relation to health, and basic biomedi­cal research.A two-year, $1. 8 million initial grant from the. Com­monwealth Fund of New York will help finance the pro­gram effective July 1, 1976. John T. Wilson, President ofthe University, and Dr. Carleton B. Chapman, Presidentof the Commonwealth Fund, announced the award fromthe Fund. A further third-year grant of $1 million as partof the initial support is foreseen.Speaking for the Commonwealth Fund, Dr. Chapmancommented, "The general strength of The University ofChicago, its unusual organizational structure, and itstraditional role in recognizing and rationalizing importantmyths that hamper intellectual and academic advance­ment in American higher education, are its characteristicand unique features."The program for which the Commonwealth Fund hasmade the award, is the creation of important segments offaculties in the biosciences, the behavioral sciences, andthe humanities. It will, when successful, be an importantstep toward returning American institutions of higherlearning to a legitimate university ideal and promises tobe an achievement in the best tradition of that ancientideal, as well as an enormous service to the nation."D. Gale Johnson, Provost of the University, says:"The new program offers numerous challenging op­portunities for both students and faculty who are in­terested in health and medical care. The program ex­plicitly recognizes that improved health of individualsdepends upon much more than the availability of medicalcare. Due to the program's flexibility, students will havethe opportunity to choose, on the basis of adequateknowledge, how they can best contribute to improved24 health care. Many will choose to do so through clinicaltraining and the M.D. degree, but those who wish toprepare themselves for other careers related to healthwill do so from the background of a considerable under­standing of the science and art of medicine. The four­year program will provide those who do receive theM.D. degree a much broader perspective on numerousaspects of health care than is ordinarily available. Wevery much appreciate the willingness of the Common­wealth Fund to participate with us in this innovative ef­fort. "The Commonwealth Fund is a philanthropic founda­tion established in 1918 by the late Mrs. Stephen V.Harkness with the broad mandate "to do something forthe welfare of mankind." For most of its history its fundshave been used for the improvement of health care andmedical education. In 1975 the Commonwealth Fundgave approximately $5 million for medical education andcommunity health programs.Development of the new curriculum was coordinatedby Robert B. Uretz, Deputy Dean for Academic Affairsand Associate Vice President for the Medical Center,through a Steering Committee chaired by Professor Ar­nold Ravin. A number of working committees from thesciences, medical and humanities faculties proposedspecific portions of the curriculum.Ravin is Professor in the Departments of Biology andMicrobiology, the College, the Committee on Genetics,and the Morris Fishbein Center for the Study of the His­tory of Science and Medicine, and Chairman of theCommittee on the Conceptual Foundations of Science.Wilson announced that Ravin has been appointed thefirst Addie Clark Harding Professor of Biology and itsConceptual Foundations in the undergraduate College(see News Briefs).Ravin will serve as Program Coordinator and Chair­man of the Program Committee in the new program. Dr.Godfrey S. Getz will serve as Vice Chairman of theProgram Committee, whose members will be namedlater. Dr. Getz is Master of the Biological Sciences Col­lege Division, Associate Dean of the College, and Pro­fessor of Pathology and Biochemistry and in the College."The new curriculum will build upon the base of lib­eral education in the biological sciences, physical sci­ences, social sciences, and humanities that is alreadydemanded in the first two years of the College at TheUniversity of Chicago," says Dr. Charles Oxnard, Deanof the College at the University. "These students willthen move into the new curriculum that will seek, first, tointegrate biological sciences in the College with biomedi­cal sciences in the medical school in a university setting.Second, it provides a series of new courses to explore thebehavioral, social, environmental, economic, ethical,and legal aspects of biology and medicine. Third, it in-eludes all the elective and liberal education opportunitiesnormally provided for every College student at Chicago.Finally, it emphasizes undergraduate research as amechanism for obtaining a first-hand grip upon problemfinding and solving." Dr. Oxnard is also Professor ofAnatomy and Anthropology, in the Committee onEvolutionary Biology, and in the College.When the curriculum is in full operation (1981-82), thePritzker School of Medicine expects to admit at leasttwenty students from the program to study for M.D. de­grees, says Dr. Daniel C. Tosteson, Vice President forthe Medical Center and Dean of the Division of Biologi­cal Sciences and The Pritzker School of Medicine. "Stu­dents interested in health-related careers would apply foradmission to this program during their second year ofcollege," he says. "It is anticipated that the majority ofthe applications will come from students already in theundergraduate college at Chicago; however, transfersfrom other institutions at this point will be possible. Oncein the program, students who decide that they want to goon to clinical training and an M.D. degree would applyfor a place in the Pritzker School of Medicine no laterthan the time at which they would normally apply tomedical school, namely, during their second year in thisprogram (their fourth year of college). Students couldalso apply for admission to other medical schools at thistime and, because of the rearrangement and restructuringof course offerings over the four-year period of this pro­gram, would enter such medical schools with substantialadvanced standing in many of the traditional pre-clinicalcourse areas."Those students electing other health-related careertracks would also continue in the program, shaping theirelectives so that they could best move on to Ph.D. train­ing in the basic medical sciences or to other graduate orprofessional school training relevant to their particularcareer aspirations. Entry to and from the program and/orthe University at various points in time for students withdifferent or changing career goals is an important featureof the program."The new program seeks to integrate medicine morefully into the life of the entire University. Several histori­cal changes contribute to our desire to initiate this ef­fort. First, the relation between medicine and science haschanged substantially since the days when AbrahamFlexner's report re-defined the structure of medical edu­cation in the United States. Second, the relation betweenmedicine and health of the people and the attitudes ofsociety toward health issues is evolving. Our Programaddresses these changing conditions.(Abraham Flexner, 1866-1959, in 1910 wrote anepochal report on the 155 medical schools then operatingin the United States and Canada, published by the Car­negie Foundation for the Advancement of Teaching. Hisreport, issued as a Carnegie Foundation bulletin, led tothe closing of many U. S. medical schools and the reor­ganization of others. From 1913 to 1928 he was secretaryand later director of studies and medical education of theGeneral Education Board. In this position he played aleading role in the reorganization of U. S. medical schoolsand the establishment of higher standards in medical education. In 1930 he organized the Institute for Ad­vanced Study in Princeton, N.J., and served as its direc­tor until 1939.)"During the sixty years since Flexner's report, thebiomedical sciences have experienced fantastic growthand differentiation. We have moved from a time when therelevance of science to medicine was deeply questionedby many physicians to a time when such relevance isaccepted, in principle, though not well expressed in prac­tice. We have moved from a time when many personsinvolved in medical education believed that each studentcould learn all of the science necessary for prudent prac­tice to a time when the mere mass of potentially relevantinformation precludes that naive delusion. The cleardefinition of that body of scientific information which allphysicians must know becomes increasingly unclear.Limitations in financial resources cause university ad­ministrators to look carefully at the extra costs incurredthrough such traditional separations. Our program ad­dresses these and other concerns about the relation be­tween medicine and science in several ways. It involvesthe entire science faculty of the University in the designand implementation of learning experiences for studentsinterested in medicine and other health fields. It permitsthe introduction of a medical orientation into the scienceeducation of such students at an earlier time in their intel­lectual development. It encourages effective articulationbetween the science experiences which heretofore oc­curred either pre- or post-matriculation in the medicalschool. It emphasizes learning as discovery and discov­ery as learning in science rather than the idea that scienceinformation relevant to medicine is a finite entity to becaptured in one or two years of intensive study. Itteaches that scientific knowledge is not to be acquired,stored and consumed, but rather to be continually shapedand reinforced by use."Not long ago it was widely believed that the cure ofdisease was the main path toward improved health. Itwas further assumed that most disease is the result ofspecific remediable extrinsic factors such as infectiousagents. Increasingly, we come to realize that these prop­ositions are incomplete. Poverty, pollution and publicignorance are seen as etiologies of ill health which are atleast as important as viruses and bacteria. The attitudesof society toward health and medicine have also changed.Maldistribution of physicians by specialty and by geog­raphy have caused considerable public complaint. Theacceptance of vast numbers of foreign medical graduatesin the U.S. medical marketplace is a sobering commen­tary on the inadequacy of the efforts of organizedmedicine in the United States to provide health servicesin a way which is satisfying to our citizens. Most impor­tant, the phenomenal inflation in the costs of medical carehas become an increasing concern to private citizens andlegislators alike."Clearly, these issues are not the special problems ofmedicine. On the other hand, they cannot be isolatedfrom medicine. Our program speaks to this changing rela­tionship between medicine and health in many ways. Byincluding in the student body both persons interested incareers in medicine, as well as persons with other25health-related interests, it expresses the extent to whichthe physicians of the future must work together withother professional colleagues to solve health problems. Itseeks to illuminate the biological consequences of humanintervention in the environment, not only as they relatedirectly to man, but also as they relate to ecological bal­ance. It recognizes the importance of behavioral, social,economic and ethical considerations in the developmentof public policy toward health."Past efforts at U.S. universities to increase the liberalarts content of pre-medical and medical education haveusually failed because many of the liberal arts coursesoffered were electives, says Dr. Oxnard, himself amember of the faculty of the medical school. Given thechoice, most medically-oriented students have preferredto take additional specialized courses promising to givethem added technical proficiency.After completion of the new curriculum, whose lasttwo years will complete the remaining requirements forthe pre-clinical years of medical school, medical studentsin the program will take the traditional final two clinicalyears of medical training and receive the M.D. degree.Others will go on in Ph.D. or other higher degree pro­grams in biomedical or health subjects already deter­mined by them. "That a program such as this can be carried out atChicago is a tribute to the flexible structure of the institu­tion that permits, indeed encourages, intermingling ofsubjects across disciplinary boundaries and conjointteaching by faculties from different areas," says Dr. Ox­nard.He points out that "faculty from the professionalschools frequently teach in the College and demands ofcollegiate programs can have liberating effects on profes­sional education."The money from the Commonwealth Fund will beused to remodel classrooms and laboratories, to recruitnew faculty and course assistants, to cover administra­tive costs, and to provide support for special student proj­ects.Renovation will involve selected classrooms andlaboratories in the Erman Biology Center, the ZoologyBuilding and Culver Hall, located at 1025-1103 East 57thStreet. A portion of the undergraduate laboratories of theResearch Institutes, 940 East 57th Street, will also beremodeled. The "bulge" of new faculty recruited for theperiod of program development and supported by theCommonwealth Fund will anticipate the retirement ofother present faculty.26The ever-whirling wheele of Change,the which all mortall things doth sway.-Edmund SpenserName 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 '---------1I II II Place II II Stamp II II Here II I!. J-------- ------------------------------------------------Fold this flap in firstNews BriefsHarding Professorship EstablishedArnold W. Ravin has been appointed thefirst Addie Clark Harding Professor ofBiology and Its Conceptual Foundationsin the College. The appointment, effec­tive July I, was made by John T. Wilson,President of The University of Chicago,on the recommendation of Dr. CharlesE. Oxnard, Dean of the undergraduateCollege, and D. Gale Johnson, Provost.Ravin is professor in the Departmentsof Biology and Microbiology, the Com­mittee on Genetics, and the Committeeon Evolutionary Biology and in the Col­lege, and Chairman of the Committee onConceptual Foundations of Science.The professorship honors the lateAddie Clark Harding, an author wholived in the Hyde Park area of Chicagonear the University and who willed$300,000 to the University. An addi­tional $300,000 will be added to thechair's endowment from an unrestricted$1,250,000 grant received by the Univer­sity in 1971 from the Andrew W. MellonFoundation.Ravin served as chairman of the steer­ing committee that planned the Uni­versity's new four-year undergraduate­graduate curriculum in arts and sciencesbasic to human biology and medicine.He will serve as Program Coordinatorand Chairman of the Program Com­mittee in the new program.A biologist with special interests inbacterial genetics, microbial evolution,and DNA-mediated transformation,Ravin joined the University as Professorof Biology in 1968. From 1968 to 1972,he was Master of the Collegiate Divisionof Biology, Associate Dean of the Col­lege, and Associate Dean of the Divisionof Biological Sciences and the PritzkerSchool of Medicine.In recent years he has become in­terested in the history and philosophy ofscience. He has written on the subject,and has recently taught courses onevolving concepts of heredity and de­velopment and, with James Gustafson,University Professor in the DivinitySchool, on "The Biological and EthicalAspects of the Control of Reproduc­tion. "A native of New York City, he re­ceived the B.S. degree from the Collegeof the City of New York, 1942, and theM.A. and Ph.D. degrees from ColumbiaUniversity in 1948 and 1951.He held faculty and research appoint­ments at C.C.N.Y., Columbia, the Uni­versity of Paris, and the University ofRochester, and a visiting professorship Arnold W. Ravinat the University of California, Berke­ley, before coming to The University ofChicago.Ravin received the Edward P. Curtisaward for Excellence in UndergraduateTeaching in 1966, and a National Sci­ence Foundation Faculty Fellowship in1975. He has served as a Sigma XiBicentennial Lecturer in Science andSociety, 19.74-77. Among his other hon­ors and professional activities, he hasedited Genetic Organization, publishedby Academic Press; is a Trustee of theBergey's Manual Trust; and is a memberof the Educational Committee, GeneticsSociety of America, and of the Numeri­cal Taxonomy Sub-Committee of theAmerican Society for Microbiology.He has written a book on the evolutionof genetics (1965) and is author andcoauthor of numerous published re­search reports on bacterial adaptability,transformations in Pneumonococcus andStreptococcus bacteria, infection by vi­ruses and genes, the origin of bacterialspecies, bacterial resistance to strep­tomycin and erythromycin, and thegenetic mapping of DNA molecules.Dr. Jacobson Enters N.D. Hall of FameDr. Leon O. Jacobson, the Joseph Re­genstein Professor of Biological andMedical Sciences and the College, Pro­fessor of Medicine, and Director of theFranklin McLean Institute, entered theNorth Dakota Hall of Fame on October1 when he received the TheodoreRoosevelt Rough Rider Award from hisnative state.The North Dakota Century Codestates that "Such award shall be thehighest recognition by the state of pres­ent and former North Dakotans whohave been influenced by this state in achieving national recogmuon in theirfields of endeavor, thereby reflectingcredit and honor upon this state and itscitizens." The award is presented by thegovernor upon the concurrence of thesecretary of state and the superintendentof the State historical society, and is thestate's highest honor for service.Dr. Jacobson received the award fromGovernor Arthur A. Link during the an­nual meeting of the North Dakota Divi­sion of the American Cancer Society. Itconsists of a wall plaque featuring a bustof Theodore Roosevelt, a leather scrolldepicting Dr. Jacobson's accomplish­ments, and a portrait of Dr. Jacobsonthat will be displayed in the Hall of Fameon the ground floor of the state capitol.Mobile Emergency Program Saves livesA 49-year-old Blue Island man has aheart attack; an auto accident in Ken­wood critically injures a 9-year-old girl; aSouth Chicago teenage diabetic sud­denly loses consciousness.In each case the period immediatelyfollowing the crisis is crucial to life. Andin each case, the newly initiated ChicagoFire Department (CFD) mobile inten­sive care and The University of Chicagocommunications base may save a life.The Region III (South Side) mobile in­tensive care/paramedic program, in fulloperation since July 15, provides com­prehensive care for an accident or acuteillness victim from the moment the CFDambulance arrives staffed with trainedparamedics, Emergency treatment con­tinues until arrival at the closest receiv­ing hospital.Under the radioed instruction of Uni­versity of Chicago emergency medicinephysicians, certified paramedics ad­minister care enroute. This consists ofadvanced first aid and advanced lifesupport-giving medications and in­travenous solutions, implementing car­diopulmonary resuscitation procedures,and monitoring electrocardiograms.In addition to the standard ambulancelife-support system, the mobile intensivecare unit (M ICU) is equipped with atechnologically sophisticated telemetrysystem. The paramedics monitor thepatient's blood pressure, respiration,and pulse rate, and transmit this informa­tion and other physical findings by radioto the communication center. An elec­trocardiogram can also be taken im­mediately and transmitted to theUniversity's communications base.After the treatment is started the physi­cians notify the receiving hospital of thepatient's problem, medical data, and thetreatment underway."The combination of well-equippedand staffed mobile intensive care vehi-29cles and direct communication with TheUniversity of Chicago Hospitals'emergency department will significantlylower the mortality rate of people en­route to a hospital for emergency care,"says Dr. Frank J. Baker, Assistant Pro­fessor and Associate Director ofEmergency Medicine.Area receiving hospitals participatingin the program are Holy Cross, Mercy,Englewood, Jackson Park, SouthChicago Community, Roseland Com­munity, Provident, and Michael Reese.A total of 15 specially equipped CFDmobile intensive care units are plannedfor the south and southwest areas byJanuary, 1977, with five presently in op­eration.Cancer Research Center Receives GrantsThe University of Chicago Cancer Re­search Center has received additionalfederal funding to bring its operatingbudget for the year ending June 29, 1977to a total of $1. 7 million. The money hascome from the National Cancer Institutefor the Center's programs In viral oncol­ogy, biology, and clinical cancer re­search and for continuing core support.Comparable sums are anticipated forthe following two years, says Dr. JohnE. Ultmann, principal investigator underthe grants. Dr. Ultmann is Director ofthe Cancer Research Center, co­Director of the University's CancerControl Center, and Professor in theDepartment of Medicine.The new grants cover direct costs ofthe Center program, which began in 1973with a single three-year $4.7 million op­erational and equipment grant and a$4.75 million construction grant. Sup­plementing these grants was a $243,000three-year grant in 1973 in support of theCancer Control Center.The grants were authorized by theU.S. Congress under the NationalCancer Act of 1971 and the current De­partment of Health, Education, and Wel­fare Appropriation Act.. . . And Issues Third Annual ReportThe Third Annual Report of Cancer Re­search at The University of Chicago,1975-1976 was issued last summer. Thereport summarizes current research andother projects of The University ofChicago Cancer Research Center andCancer Control Center; the Ben MayLaboratory for Cancer Research; theFranklin McLean Memorial ResearchInstitute; and the U.S. Public HealthService Clinical Cancer Training Pro­gram in The University of Chicago Divi­sion of the Biological Sciences and The30 Pritzker School of Medicine, and othercancer research projects and contracts atthe University.The 244-page paper-bound book re­ports on 134 major research projectsunder seven subject headings: ViralOn­cology; Cancer Biology; Tumor Im­munology; Carcinogenesis; Clinical Re­search; Radiotherapy, RadiationPhysics and Nuclear Medicine; andCore Facilities.There are separate sections on theUniversity's Cancer Control Center,Clinical Cancer Training Program, Con­struction and Renovation, Conferences,and Tumor Clinics, and there is a56-page bibliography listing 1975-76 pub­lications by 72 individual cancerresearchers at the University. Sources offunding, provided by grants and con­tracts from 59 public and private agen­cies and 75 other private sources, arelisted.The report notes these constructionand renovation projects: the Marjorie B.Kovler Viral Oncology Laboratories;expanded radiation therapy facilities;developmental biology laboratories,sixth floor, Cummings Life ScienceCenter; mass spectrometer pharmacol­ogy laboratories, Billings Hospital; CellBiology Core Facility, Ida B. and WalterErman Biology Center.It lists 14 spec ial conferences andsymposia presented at the Universityand 108 special cancer-related lectures.How We Spent Our SummerTen Pritzker School of Medicine stu­dents worked with small-town andinner-city community health centers forten weeks last summer as part of theU.S. Health Manpower Education Ini­tiative Program on Physician ShortageAreas. This University of Chicagosummer program is supported by a grantfrom the U.S. Department of Health,Education, and Welfare, and adminis­tered by the Chicago Regional Office.Dr. Chase P. Kimball, Associate Pro­fessor in the Department of Psychiatry,is in charge of the program. Dr. MichaelCary Schuster and Robert Tomchik. K. Posner, Clinical Associate (AssistantProfessor) in Pediatrics, is co-Director.The students receive per diem ex­penses during their service period in theinterim between their freshman andsophomore years at the medical school.Each student has a faculty and a localpreceptor. Before going to their summerpreceptorships, the students took anintensified course at the University inmedical diagnosis.James Fosnaugh of Lincoln, Nebras­ka, and Sheila Fallon of Pittsburghworked at the Illinois Valley CommunityHospital in La Salle, Illinois. Dr. Ber­nard Doyle, a La Salle physician, wastheir local preceptor, and Dr. Alvin R.Tarlov ('56), Professor and Chairman inthe University's Department of Medi­cine, was their faculty preceptor.Dr. Doyle reports that Fosnaugh andFallon spent mornings at the hospital,scrubbing in at operations and acting assecond or first surgical assistants, mak­ing hospital rounds with local physi­cians, and observing operation of theemergency room and intensive care unit.Afternoons, they worked with local doc­tors in their offices, seeing how the officework was handled and, with the permis­sion of patients, observing medical ex­aminations. They helped take medicalhistories and assisted in examinations.They worked a week at a time withsurgeons, gynecologists, dermatologists,and general practitioners.According to Dr. Doyle, the two med­ical students have blended in well withthe professional and social life of LaSalle, attending parties and weddings aswell as participating in the hospitalroutine.Here is a list of the Pritzker studentsand their summer assignments under theHEW grant:Harriet Skom (Odin Anderson, Uni­versity of Chicago preceptor), ProvidentHospital, Chicago.Jeff Sugimoto and Allan Nadel (Dr.Leon O. Jacobson, '39), Pawting Hospi­tal, Niles, Michigan.Robert Rosman (Dr. Michael Posner),Hyde Park-Kenwood CommunityHealth Center, Chicago .Sandra Turner and Ann Mittelstaedt(Dr. Alice Stratigos), Woodlawn ChildHealth Center, Chicago.Sheila Fallon and James Fosnaugh(Dr. Alvin R. Tarlov), Illinois ValleyCommunity Hospital, La Salle, Illinois.Robert Tomchik and, Gary Schuster(Dr. George Sternbach), University ofChicago Hospitals and Clinics.In addition, says Dr. Kimball, otherstudents worked under other funding ar­rangements at the Woodlawn MentalHealth Center, Chicago, and on theNavajo Indian Reservation.New Insulin Precursor DiscoveredUniversity of Chicago scientists havediscovered a new precursor to insulin,preproinsulin. Preproinsulin is a precur­sor molecule to proinsulin, the precursorof insulin. The discovery indicates thatthe body produces insulin in three,rather than two stages, reports Dr.Donald F. Steiner ('56).As a result of studies of messengerRNA from the rat pancreas, scientistsare now closer to decoding the geneticmechanism by which the body orders theislets of Langerhans in the pancreas tocreate insulin.It may point the way to genetic "en­gineering" to correct inborn errors in in­sulin synthesis. Some day the geneticmaterial (DNA) responsible for creatingpreproinsulin, proinsulin and insulin maybe fabricated in the laboratory and in­serted into "islet" cells of diabetics,says Steiner. They would then be able toproduce correct amounts of their own in­sulin, and would not require animal insu­lin.Shu Jin Chan is the principal author ofa report on the discovery of preproinsu­lin in the Proceedings of the NationalAcademy of Sciences, June 1976. He is agraduate student and researcher inbiochemistry. Coauthors are PamelaKeim, a research technician inbiochemistry, and Dr. Steiner, the A. N.Pritzker Professor and Chairman in theDepartment of Biochemistry and Pro­fessor in the Department of Medicineand the undergraduate College at theUniversity, and Director of The Univer­sity of Chicago Diabetes-EndocrinologyCenter.Dr. Steiner discovered proinsulin in1967. This finding opened up a newbiochemical field of hormone precursors,a number of which have since been dis­covered by other researchers. Discoveryof preproinsulin indicates that manyhormones may have two precursorsrather than one, consisting of a "pre­protein" that is reduced to a "pro­protein," which is in turn reduced to thefinal hormone.In addition to correcting genetic "mis­takes" in the islets of Langerhans ofdiabetics, genetic engineering might beable to tum other living organisms, suchas bacteria, into insulin-producing "fac­tories. "Insulin has been synthesized in main­land China, but not by a commerciallyfeasible process. Diabetics now relysolely on animal insulin. While thenumber of diabetics in the world is in­creasing, the supply of slaughtered ani­mals is not increasing proportionately.Steiner points out there soon may be anurgent need for synthetic insulin. Dr. Donald F. SteinerHe notes recent research by the Ger­man scientists Brandenburg and WolI­mer, based on his proinsulin concept, bywhich the A and B chains of insulin arecombined by a non-peptide connectingmoiety which guides the correct foldingand disulfide bond formation. He notesfurther research by Busse, Hansen, andCarpenter on abbreviated "mini­proinsulins" that might help short-cutthe synthesis process.This suggests, says Steiner, "thatother complex polypeptides could bebuilt up without necessarily synthesizingthe entire peptide sequence ... insulinitself might be made smaller when theactive topography is identified."Since techniques now exist to "read"the code sequences in mRNA, saysSteiner, scientists can also look for ge­netic defects in the code for insulin syn­thesis. The code "reading" is done in aBeckman sequencer, a recently de­veloped device.Further research at the Universityseeks to locate glucose receptors in betacells. Presumably glucose is a stimulusto insulin synthesis. Faulty receptormechanism might cause faulty insulinsynthesis. Islet cell enzymes and an­tigens are also being studied.The research was supported by grantsfrom the National Institute of Arthritis,Metabolism, and Digestive Diseases andthe Lolly Coustan Memorial Fund.Hydrocarbon Alters Genetic CodeRonald G. Harvey, Associate Professorin the University's Ben May Laboratoryfor Cancer Research, is coauthor of areport in Science magazine that demon­strates how BP, a hydrocarbon found insoot, coal and cigaret tar, smoked foods, and automobile exhaust, may alter thegenetic code, causing cancer. Sevenother authors of the paper are from Co­lumbia University and the NationalCancer Institute.The article demonstrates that a deriva­tive of BP (benzo(a)pyrene) binds chem­ically to guanine, one of the five organicmolecules that, in various combinations,make up the genetic code (DNA andRNA).DNA and RNA provide the geneticinformation for the body's assembly ofabout twenty amino acids, in a multitudeof sequences, into proteins, the basicstuff of all living organisms. If the genet­ic code is altered, theoretically, it will"code" for cancer rather than for normalcells. If scientists can demonstrate ex­actly how this happens, they can studyhow to prevent it-and cancer.BP is one of the most potent knowncancer-causing agents. Applied to theears of experimental rabbits, it will al­most invariably cause cancer. That wasdemonstrated in the early 1920s, a land­mark in cancer research. BP is one ofvarious so-called aromatic or cyclic hy­drocarbons that are known to do this.Cancer researchers want to know theprecise biochemical chain reactions thattake place when these substances act onthe growing cell that may transform itinto a cancer cell.In addition to BP research, Harveyand Frederick Beland, Research As­sociate in the Ben May Laboratory, arestudying how DMBA (dimethylbenzan­thracene), another cancer-causingaromatic hydrocarbon, attacks the genet­ic code.DMBA is being used by Dr. CharlesB. Huggins of the Ben May Laboratory,and other researchers, to induce cancersand leukemia in experimental animals.Huggins, former Director of the BenMay Laboratory, is the William B.Ogden Distinguished Service Professorin the Laboratory.Before Beland and Harvey synthe­sized the two BP-derived isomers(three-dimensional variants), the twovariants were inaccessible to cancer re­searchers for experiments. It had beenposited that one or both of the isomers,rather than BP itself, could be the directcancer-causing agent.It's been known since the 1960s thatBP, DMBA, and other so-called car­cinogenic hydrocarbons do not them­selves cause cancer. They must first be­come slightly altered chemically to an in­termediate form, known as an areneoxide, to "bind" chemically to nucleicacids and their derivatives. The problemis to find the specific chemical bindingsite whereby the hydrocarbon joins thegenetic mechanism of the living cell.31It's now known that the "binding"portion of the hydrocarbon is the so­called exocyclic amino group of the nu­cleic acid base. An amino group is anNH2 molecule, made up of one atom ofnitrogen (N) and two of hydrogen (H).Exocyclic means the group is linkedchemically to the outside of a chemicalring (a circular chain or "cycle" ofatoms or molecules).BP was the first chemical substanceproved to cause cancer. Sir PercivalPott, a British surgeon, theorized in 1775that chimney sweeps developed skincancer because of their exposure to soot.BP is emitted into the air of the UnitedStates at an estimated rate of about 1,300tons per year, according to the NationalAcademy of Sciences Committee onBiologic Effects of Atmospheric Pollu­tants (1972).The research on the BP derivatives atThe University of Chicago was sup­ported by grants from the NationalCancer Institute and the AmericanCancer Society.Frontiers of MedicineThe twelfth annual Frontiers ofMedicine program began its series ofmonthly lectures for practicing physi­cians on October 13. Most programs inthe series are held on the secondWednesday of each month from Octoberthrough June, in the Frank Billings Au­ditorium, P-117. There are two programsplanned for February.The lectures present a comprehensivereview of recent developments inmedicine, with special emphasis on clin­ical applications.The 1976-77 lectures are:October 13-New Concepts In Pulmo­nary DiseaseNovember 10-Symposium on Pancre­atic Disease (all day program)December 8-1 nterfaces Between Or­thopedics and Primary CareJanuary 12-Cancer Chemotherapy:Progress in Adjuvant Therapy and inTherapy of Advanced DiseaseFebruary 2-Care of the Bum Patient(all day program)February 23-Nutrition and DiseaseMarch 9- The Relation of Sex Hor­mones to Sexuality (all day program)April 13-Advances in the Diagnosisand Management of Renal DiseaseMay II-Lung Diseases (all day)June 8-U nderdiagnosed Causes of Car­diac Pain and Their ManagementFor further information, write toLouis Cohen, M.D., Frontiers ofMedicine, The University of Chicago,Box 451, 950 East 59th Street, Chicago,Illinois 60637; or call (312) 947-5777.32 New Drug Combination Fights lungCancerImproved survival rates in some cases ofadvanced" Stage [I I" lung cancer havebeen produced at The University ofChicago and Michael Reese Hospitalwith a new combination of anti-cancerdrugs. The drugs supplement surgeryand radiation treatment of lung cancer ofthe "non-oat cell" type.While some patients respond remark­ably well, others do not respond at all,report Dr. Tom R. De Meester and Dr.Harvey M. Golomb. "The response rateof 48 percent is encouraging for Stage IIIlung cancers as a group, and the mediansurvival rate of the responders is about13 months. This is much greater than thetwo to four months previously ex­pected," says DeMeester. "Encourag­ing preliminary results have also beenobtained in treating 'oat cell' (small cell)lung cancers, using a slightly differentdrug combination." DeMeester is Assis­tant Professor of Surgery and Chief ofthe University's Thoracic and VascularSurgery Service."Patients whose cancers are inopera­ble but restricted to the chest have thebest one-year survival rates with the newchemotherapy regime," says Golomb,Assistant Professor of Medicine(Hematology/Oncology) and Co-directorwith DeMeester in the project. "Lungcancer, a disease heavily associatedwith cigaret smoking, is one of the mostlethal of all cancers, and its incidence isincreasing. In Stage III lung cancer, theprimary cancer has spread to otherareas, such as the viscera, bone, orbrain, or has so spread throughout thechest that it is inoperable."Preliminary results with the new com­bination drug therapy are described in areport to be published in a forthcomingissue of Cancer Treatment Reports.Principal author is Dr. Jacob D. Bitran,Fellow in Hematology/Oncology, De­partment of Medicine, The University ofChicago Division of the Biological Sci­ences and The Pritzker School ofMedicine.Coauthors are Dr. De Meester, Dr.Golomb, and Dr. Melvin Griem, Pro­fessor of Radiology and Director of theSection of Therapeutic Radiology andthe Chicago Tumor Institute (RadiationTherapy). Other coauthors fromMichael Reese Hospital, Chicago, are:Dr. Richard K. Desser, Dr. MartinColman, Dr. Arthur Billings, Dr.Charles Shapiro (,54), and Dr. RichardEvans ('59).Although Dr. DeMeester and Dr.Golomb are the Co-directors of the proj­ect at The University of Chicago Hospi­tals, the approach is a multidisciplinary one which includes surgery, medicine,radiation therapy, nursing, social work­ers and pharmacy personnel.The chemotherapy program has beengiven the acronym of CAMP, for thefour drugs used:.Cyclophosphamide, or Cytoxan, anitrogen mustard variant that is lesstoxic than nitrogen mustard, one of thefirst anti-cancer drugs developed. (Dr.Leon O. Jacobson of The University ofChicago introduced nitrogen mustard asa cancer treatment in 1942.).Adriamycin, a Streptomyces derivedanti-tumor agent first produced in Italy,which possesses an action to interferewith cell division..Methotrexate, a folic acid antagonistoften used as an anti-cancer drug. Folicacid is required for cell growth, includingcancer cell growth.• Procarbazine, another anti-cancerdrug that supposedly hinders ON A,RN A, and protein synthesis, requiredfor the growth of cancer cells.Other drug combinations have beenused with advanced lung cancer in othermedical centers, but not the CAMPcombination. Cancer researchers areseeking ways to combine various drugsknown individually to act against cancer,so that the patient receives a spectrum ofdrugs.The theory is that some drugs will actagainst some cancers and not others.Combining the various known anti­cancer drugs should provide better re­sults than using only one or two of them,The four drugs are given in carefullytimed cycles and nonlethal doses, underclose medical supervision. Not only hasthe CAMP combination proved more ef­fective, but it is better tolerated by pa­tients and can be given on an outpatientbasis.Another drug combination designatedas CAML treatment is used at the Uni­versity against "oat-cell" lung cancers.CAML is an acronym for cyclophos­phamide, adriamycin, methotrexate, andleukovorin. Oat cell carcinoma of thelung is a highly malignant tumor with aone-year survival of about 15 percent.The tumor spreads widely and earlybeyond the lungs. Leukovorin is used tocounteract otherwise lethal doses ofmethotrexate given to these patients.Initial complete responses are seen inthe majority of patients, but one-year re­sults are not yet available on the" oat­cell" patients.An earlier report on a different treat­ment, in which vincristine was used in­stead of adriamycin, appeared in CancerTreatment Reports, March, 1976. Dr.Bitran was the principal author. Theoverall one-year survival rate was about40 percent.In MemoriamMorris Fishbein, 1889-1976If you would not be forgotten, eitherwrite things worth reading or do thingsworth the writing.Benjamin FranklinOn September 27, 1976, a medical giantpassed from our scene after a career thatspanned more than sixty-five years=-sixty-five years of unique contribu­tions to medicine, to people, and to theworld. Morris Fishbein was the only oneof his kind-a man with a remarkablemind, an intense intellectual drive, analmost unbelievable efficiency in the wayhe lived his life and carried on his work,and a humanitarian in the truest sense ofthe word.During his lifetime Dr. Fishbein com­bined a number of careers. He was aphysician with an excellent educationand training, which served as a founda­tion for his unusual capacity to keep upto date on innumerable aspects ofmedicine.He received his B.S. degree from TheUniversity of Chicago in 1910, and hisM.D. from the University's Rush Medi­cal College in 1912. He was Clinical As­sociate in Medicine at Rush MedicalCollege in 1924-5, and Assistant ClinicalProfessor from 1925 to 1941. He wasProfessorial Lecturer in The Universityof Chicago School of Medicine, nowThe Pritzker School of Medicine, from1942 to 1947.Dr. Fishbein had a unique talent forcommunicating with the public, andwrote many books of advice about vari­ous health matters, such as The HumanBody and Its Care, Shattering HealthSuperstitions, Your Diet and YourHealth, and New Advances in Medicine.He had recently completed two vol­umes,Ask the Doctor (1973) and ModernHome Dictionary of Medical Words(1976). His daily syndicated health col­umn appeared in numerous newspapersacross America, and he contributed in­formative, commonsense articles tomagazines such as the Saturday EveningPost, Good Housekeeping, Reader'sDigest, and McCalls. A talented writer,he used words and phrases much as askillful doctor uses medication, or an ex­perienced surgeon uses a scalpel.Perhaps best known for his long as­sociation with the American MedicalAssociation, Dr. Fishbein was assistanteditor of JAMA, the Journal of theAmerican Medical Association, from1913-24, and editor from 1924-49. Dur­ing these 36 years the Journal became astandard for excellence in medical publi- Dr. Morris Fishbeincation, and Morris Fishbein became theleading spokesman for Americanmedicine. He also edited other publica­tions, such as Hyg eia (later known asToday's Health, which was sold lastyear to Family Health) and MedicalWorld News, which he established in1960.Another area of communication inwhich Dr. Fishbein excelled is speakingbefore medical and public groups of allkinds. He was an impressive speaker;though he used no notes, he couldquickly organize his mind like a giantcomputer and give a brilliant, organizedpresentation on almost any subject in thehealth field. His talks were liberallyspiced with humor, and he had an inter­national reputation as a raconteur. Dr.Fishbein was in great demand for speak­ing engagements at luncheons and din­ners. Despite his many activities and re­sponsibilities, he found time to be helpfulto everyone. While thousands of peoplewrote to ask for his advice, hundreds ofhospitals would ask him to speak at theirfundraising drives. He would make anaverage of 100-200 speeches a year,many of them in support of hospital de­velopment programs. Few people realizethe central role that he played in the de­velopment of countless hospitalsthroughout the country.An innovative man, Morris Fishbeinalways was generating new ideas; he re­ceived a great deal of satisfaction fromlistening to someone else's observationsand coming up with a bright new idea.He had many of these flashes of intuitivetruth, referred to by John Steinbeck as"glory moments."No detail was too small for his intel­lectual interest. One time I was intrigued with the story of the blind men and theelephant (" It was six men of Indostan tolearning much inclined, Who went to seethe elephant, Though all of them wereblind, That each by observation mightsatisfy his mind"), and I was curiousabout the full text of the poem and itsorigin. Dr. Fishbein couldn't think of itat the moment, but within 24 hours I re­ceived a letter in the mail thatdocumented the poem in its entirety, itssource, and the author.Dr. Fishbein was a prodigious reader,with a capacity for both rapid readingand complete retention. In addition to awide variety of medical journals andother scientific publications, he wouldread several books each day, in variouscategories-detective stories, mysteries,fiction, nonfiction-and later could giveincisive reviews of each of these publica­tions.Throughout his life, Morris Fishbeinwas committed to good causes and tocivic involvement. His affiliations in­cluded: chairman of the scientific advi­sory committee of Chicago's MunicipalTuberculosis Sanitarium, member of theappeal board of Chicago's Departmentof Environmental Control, former presi­dent and chairman of the board of theGastro-lntestinal Research Foundation,association with the Polio Foundation(later the International Congress onPoliomyelitis and on Congenital Mal­formations), past president of theChicago Medical Society and of theChicago Heart Association, and manyothers. He was a member of 21 societiesand clubs, including the American As­sociation for the Advancement of Sci­ence, Royal Society of Medicine in Lon­don, American Medical Writers Associ­ation, Chicago Literary Club, Arts Club,and the University's Quadrangle Club.A well-known medical historian, Dr.Fishbein frequently presented essays ontopics of historical interest at theChicago Society of Medical History andat similar organizations around the coun­try and worldwide. In 1966 Mrs. AnnaFishbein helped to establish a professor­ship in the history of biology andmedicine at The University of Chicago,which led to the establishment in 1970 ofthe Morris Fishbein Center for the Studyof the History of Medicine and Science,of which Allen G. Debus is Professorand Director.Anna Fishbein has been a most per­fect mate for Morris Fishbein. She sup­ported him in all his activities, and in herown right made significant contributionsto health organizations such as theUniversity's Chicago Lying-in Hospitaland Mothers' Aid. In 1976 she wasnamed an Honorary Director of Lying­in at the hospital's 80th anniversary din-33ner. She graduated from Teacher's Col­lege of Butler University, and attendedThe University of Chicago in 1925 and1926.The Fishbeins have had a continuedclose association with the University formany years. They helped support theFishbein Medical Library EndowmentFund, which has been used to purchasescientific journals and books for both Bil­lings Hospital Library and the medicalhistorical library. In 1954, with the helpof friends, they established the MorrisFishbein Reading Room in the BillingsLibrary. They provided gifts to purchaseequipment for the Laboratory School,and a laboratory at La Rabida Children'sHospital, which is affiliated with theUniversity, is named in memory of theirlate son, Morris, Jr. Dr. Fishbein was amember of the advisory board ofPerspectives in Biology and Medicine,which is published by the University'sDivision of Biological Sciences and ThePritzker School of Medicine.Throughout his long and distinguishedcareer, Dr. Fishbein has received manyhonors, among them a Certificate ofMerit from President Harry Truman(1948), the Heart of Gold from theChicago Heart Association (1969), theDistinguished Achievement Award ofthe American Heart Association (1960),the Chicago Medal of Merit (1969 and1972), and the Knight Commander of theCrown, Italy (1933). The University ofChicago has awarded him with theAlumni Medal (1962), the RosenbergerMedal (1968), and the Medical AlumniDistinguished Service Award (1956). In1943 he received a citation from the Col­lege Division of the Alumni Associationfor "unselfish and effective service tocommunity, nation and humanity."Perhaps the best indication of the in­ternational esteem with which MorrisFishbein was regarded is an incident thathappened to me in Tokyo. I was intro­duced to a physician who, in seeking toidentify himself, introduced himselfproudly as "the Japanese Fishbein."I used to visit Morris at frequent in­tervals until he became ill a couple ofyears ago, when the visits came fartherapart. Each time we met the conversa­tion was sparkling with new information,new stories, and new plans. At the age of85, Morris Fishbein had more ideas andmore purpose than anybody I have evermet. How do you measure a humanbeing like this? He was a physician, sci­entist, teacher, medical editor, medicalinnovator, catalyst of research, com­municator to the world, dedicated citi­zen, humanitarian, medical historian,and wise observer of our world and oursociety. I think the following true story34 best characterizes the unique humanbeing known as Morris Fishbein:A young girl from Chicago wanted toknow how to go about studying to be adoctor. She wrote a letter addressed to"The Chief Doctor of the United Statesof America." In the lower right handcorner of the envelope an anonymouspostal clerk had scrawled the name"Morris Fishbein."We certainly will never see his kindagain on this earth.Joseph B. KirsnerLouis Block Distinguished ServiceProfessor of MedicineA metnorial service for Dr. Fishbein washeld October 13 in Rockefeller Chapel.He is survived by his widow Anna; twodaughters, Mrs. Marjorie Clavey andMrs. Barbara Friedell; and a son, Justin.Dr. Martin E. HankeMartin E. Hanke, 1898-1976Dr. Martin E. Hanke, ProfessorEmeritus of Biochemistry and facultymember of the University of Chicagofrom 1922 to 1963, died of a heart attackon September 18, 1976 near his summerhome in Traverse City, Michigan. Alife-long resident of Chicago, Dr. Hankeand his two children were alumni of theUniversity of Chicago. Dr. Hanke at­tended the University from 1915 to 1921,receiving his B.S. degree in 1918 andhis Ph. D. degree in 1921, both in Chem­istry. He was elected to Phi BetaKappa and to Sigma Xi membership.During his long tenure as a member ofthe Department of Biochemistry, he wasappointed successively Instructor, As­sistant Professor, Associate Professor,and Professor. Although he served theDepartment and the University in sev­eral different capacities, his primaryfunctions always were teaching medicalschool and graduate school courses inbiochemistry, and conducting researchin enzymology and in physical andanalytical biochemical procedures andmethods. He was the coauthor, withDr. F. C. Koch, of Practical Methods inBiochemistry, which was recognized as an excellent laboratory manual inbiochemistry and was widely used in thiscountry for several decades. Always vi­tally interested in students, Dr. Hankefor many years was the departmentalcounselor for graduate students. During1949-5 I, he served as the AssistantDean of Students in the Division of theBiological Sciences.In 1930-31, Dr. Hanke was at theRockefeller Institute For Medical Re­search in New York City, conductingresearch on methods for amino acidanalyses in the laboratory of Dr. D. D.Van Slyke. During 1955-56, while hewas on leave of absence from the Uni­versity, Dr. Hanke served as head of thedepartment of biochemistry at the U.S.Naval Medical Research Unit in Cairo,Egypt. From 1958 until his retirement in1963, Dr. Hanke held the post of Direc­tor of the University's Clinical Chemis­try Laboratory. Throughout his retire­ment, he remained active by attendingseminars and meetings on the campus ofthe University, and functioning as aguide-lecturer at Chicago's Museum ofScience and Industry.Dr. Hanke was a member of numer­ous scientific, social and civic organiza­tions, including the American ChemicalSociety, the American Society of Biolog­ical Chemists, the Society for Experi­mental Biology and Medicine, theAmerican Association of ClinicalChemists, and the Innominates. In 1948he served as president of the Associationof Vitamin Chemists. He held numerouselected offices, over a long period oftime, in the Chatham-Avalon ParkCommunity Council. In 1964 he re­ceived the Gold Key of the University'sMedical Alumni Association.Martin E. Hanke will be rememberedby his colleagues and by the thousandsof students who knew him, not only as amost capable, wise and conscientiousteacher and researcher, but also as a manof resolute character, unimpeachable in­tegrity, refreshing frankness, and whole­some sincerity.Dr. Hanke is survived by his daugh­ter, Ruth Frances (B.S. '44). His wife,Maude, died in 1974 and his son, Martin,Jr., (B.S. '49, M.D. '58) suffered an ac­cidental death in 1963.Joseph J. CeithamlProfessor of BiochemistryDean of Students, BSDUniversity of ChicagoAlfred E. Emerson, 1897-1976A memorial service was held October 9at Huletts Landing, New York forAlfred E. Emerson, Professor Emeritusin the Department of Biology at TheUniversity of Chicago, who died of aheart attack in Glens Falls, New York,October 3. He was 79.Editor of Ecology from 1932 to 1939and coauthor with several University ofChicago colleagues of Principles of Ani­mal Ecology (1949), Emerson helped es­tablish ecology as a coherent and quan­titative science. His renowned collectionof termites, which contained one millionspecimens, represented 93 percent of the1,900 known termite species. It is betterknown than any other taxonomic collec­tion of a group of organisms of compara­ble size.A member of the University ofChicago faculty from 1929 until his re­tirement in 1962, Emerson was a pioneerin biogeography, trying to determinewhy species flourished in specific loca­tions at specific times throughout theworld. He developed the concept of the"superorganism," in which the unit ofevolution is the community and not onlythe individual.He did not hesitate to apply to humanecology the principles he expoundedconcerning the termite ecological sys­tem. Cooperation, not competition, hemaintained, is the main way that termitessurvive. He believed that behavior aswell as biological structure could bestudied from an evolutionary viewpoint.Emerson was born in Ithaca, NewYork, where his father was professor ofarchaeology at Cornell University. Hereceived his B.S. degree at Cornell in1918. Following service in the U.S.Army in World War I, he visited theTropical Research Center of the NewYork Zoological Society in BritishGuiana with the naturalist and explorer,William Beebe."Dr. Beebe showed me a nest ofGuianan termites, and I was launched,"said Emerson in an interview in the NewYorker, January 18, 1964. "I went backto the Center twice, and became assis­tant director there. I had intended to gointo psychology until Beebe turned mythoughts to termites."Emerson received his A.M. andPh.D. degrees from Cornell in 1920 and1925. He was appointed instructor in thedepartment of zoology at the Universityof Pittsburgh in 1921, becoming assistantprofessor in 1922, and associate profes­sor in 1925. He was Visiting AssociateProfessor of Zoology at The Universityof Chicago in 1926 and 1929, becomingAssociate Professor in 1934. He wasalso visiting professor at various times atthe University of California, Berkeley,and Michigan State University.After his retirement from the Chicagofaculty in 1962, Emerson spent much ofhis time at the American Museum of Natural History, New York, where heserved as a research associate from 1940to his death. He donated his termite col­lection to the museum in 1964.Emerson's first wife, Winifred, died in1949. His second wife, Eleanor, died in1972. His daughter, Helena Wilkening,of Madison, Wisconsin and son, Wil­liam, of Chicago, survive. Other sur­vivors are three grandchildren and twosisters, Edith Emerson of Philadelphiaand Gertrude Boshi-Sen of AlmoraU.P., India.Through Mrs. Boshi-Sen, a formereditor of Asia magazine, Emerson wasacquainted with the late JawaharlalNehru, Prime Minister of India, and In­dira Gandhi, the present Prime Ministerof India.He was the coauthor of Termite City(1937), a popular book about termites,with his second wife, and wrote or co­authored a total of 146 scientific publica­tions.Emerson was a member of manyscientific organizations, including theNational Academy of Sciences, and waspresident of the Ecological Society ofAmerica, Illinois Academy of Sciences,Society of Systematic Zoology, and So­ciety for the Study of Evolution. He wasvice president of the American Associa­tion for the Advancement of Science,Section F, and was chairman of the NASpanel on Systematic Biology.He helped organize and participated inThe University of Chicago Darwin Cen­tennial Celebration in November, 1959.In his later retirement years, he lived atHuletts Landing, N.Y., his formersummer residence on Lake George.Alumni Deaths, 12. Morris Fishbein, Chicago, Il­linois, September 27, 1976, age 87.'16. Elmer G. Senty, St. Petersburg,Florida, November 25, 1975, age 84.'18. Thomas Francis O'Toole, RapidCity, South Dakota, December I I, 1975,age 83.'19. Clyde J. Westgate, Chicago, Il­linois, July 19, 1976, age 81.'23. Chester C. Guy, New Buffalo,Michigan, August 24, 1976, age 77.'24. C. Russell LaBier, Terre Haute,Indiana, November 23, 1975, age 86.'27. Frank L. Jenkins, Chicago, Il­linois, May 30, 1976, age 79.'32. Herbert L. Michel, Los Angeles,California, May 21, 1976, age 72.'36. Eldor C. Sailer, San Francisco,California, December 24, 1975, age 66.'41. Robert W. Reid, St. Petersburg,Florida, August 5, 1975, age 62.'73. Linda B. Landgrebe, Coal Valley,Illinois, September 10, 1976, age 29. Departmental NewsAnatomyEileen S. Kane, Assistant Professor ofAnatomy, was' elected to the editorialboard of the American Journal ofAnatomy.Lorna P. Straus, Associate Professorin the Department of Anatomy and theCollege, and Associate Dean, Dean ofStudents, and Dean of Admissions in theCollege, was elected to the executivecommittee of the Radcliffe Board ofTrustees.Richard J. Wassersug, Assistant Pro­fessor in the Department of Anatomyand the College, was appointed researchassociate in the department of vertebratezoology at the Smithsonian Institution,Washington, D.C.AnesthesiologyAppointment:Dr. Batool Hajzanpour-Instructor.Promotion:Dr. Daniel S. Crowley-AssistantProfessor.Ben May laboratoryDr. Charles B. Huggins, the William B.Ogden Distinguished Service Professorin the Ben May Laboratory for CancerResearch, was presented to QueenElizabeth I I of Great Britain during theQueen's visit to Nova Scotia on July 14.Dr. Huggins is the honorary Chancellorof Acadia University in Wolfville, N.S.,where the Queen attended a luncheonand toured the campus. Dr. Huggins is agraduate of Acadia University.Or. Charles B. Huggins35Elwood V. JensenElwood V. Jensen, Professor ofBiophysics and Theoretical Biology andDirector of the Ben May Laboratory andthe Biomedical Center for PopulationResearch, received the Gold Medal ofthe American Cancer Society on Oc­tober 15. The medal was given in recog­nition of his research on estrogen recep­tors.A scientific session and banquet at theQuadrangle Club on November 19 com­memorated the 25th anniversary of theBen May Laboratory, which was estab­lished in 1951 under Dr. Charles H ug­gms,BiochemistryEugene Goldwasser, Professor in theDepartment of Biochemistry, the Frank­lin McLean Institute, the Committee onDevelopmental Biology, and in the Col­lege, presented a lecture entitled" Eryth­ropoietin" at a Symposium on TissueGrowth Factors at the Vth InternationalCongress of Endocrinology, held lastJuly in Hamburg, Germany.Dr. Donald Steiner (,56), the A.N.Pritzker Professor and Chairman in theDepartments of Biochemistry andMedicine and in the College, and Direc­tor of the Diabetes-Endocrinology Re­search Center, published "Cell-freeSynthesis of Rat Preproinsulins: Charac­terization and Partial Amino Acid Se­quence Determination" in the June issueof Procedures of the National Academyof Science. Shu Jin Chan, graduate stu­dent in the Department of Biochemistry,and Pamela Keirn, Research Associate inthe Department of Biochemistry, arecoauthors of the paper.36 BiologyNiza Frenkel, Assistant Professor ofBiology, is the principal author of"Herpes Simplex Virus DNA inTransformed Cells: Sequence Complex­ity in Five Hamster Cell Lines and OneDerived Hamster Tumor" in a recentissue of the Journal of Virology.Dr. Aron A. Moscona, Louis BlockProfessor of Biological Sciences, waschairman of the Symposium onBiochemistry of Embryonic Differentia­tion at the Tenth International Congressof Biochemistry in Hamburg, Germany,July 26-29. He presented an invitedpaper on the Molecular Basis of Cell In­teractions.Dr. Moscona also presented an invitedpaper at the Conference on Differentia­tion in Cell Biology at the Given Insti­tute of Pathobiology in Aspen, Col­orado, August 15-20. Following the con­ference he attended the Sigrid JuseliusSymposium on Cell Interactions in Dif­ferentiation in Helsinki, Finland, August23-25, and chaired the session on CellRecognition.Dr. Moscona was an invited speaker atthe EM BO/N A TO I nternational Sum­mer School on Molecular Interactionsheld in Spetsae, Greece, August26-September 4.Dr. Moscona and Dr. R. E. Hausman,Research Associate (Assistant Profes­sor) in Biology, presented a paper on theBiochemical Basis of Embryonic CellRecognition at the annual symposium ofthe Society of General Physiologists,Woods Hole, Massachusetts, September12-16.Dr. Moscona has been elected to theeditorial boards of the Journal of Ex­perimental Zoology and Differentiation.Charles E. Olmsted, ProfessorEmeritus in Biology, and Fred J. Eggan,the Harold H. Swift Distinguished Ser­vice Professor Emeritus in the Depart­ment of Anthropology and Director ofthe Philippine Studies Program, weremembers of a committee appointed bythe National Academy of Sciences toevaluate results of the InternationalBiological Program, a seven-year biolog­ical and ecological research effort thatbegan in 1967. The committee has pub­lished an SI-page report entitled AnEvaluation of the International Biologi­cal Program, which is available from theNational Technical Information Servicein Springfield, Virginia.La RabidaDr. Donald A. Rowley, Professor in theDepartments of Pathology and Pediat­rics, and Research Director of LaRabida Children's Hospital and Re- search Center, was named to the medicaladvisory board of the Leukemia Re­search Foundation, Inc. He was alsoappointed associate editor of the Journalof Immunology.MedicineAppointments:Dr. Mamoun AI-N ouri-Instructor.Dr. H. B. Karunaratne-Instructor.Dr. David Kornhauser-AssistantProfessor.Dr. Carol Richman-Instructor.Dr. Peter Rudd-Assistant Professor.Promotions:Dr. Rory W. Childers-Professor.Dr. Charles O. Elson-Assistant Pro­fessor.Dr. Michael Goodman-AssistantProfessor.Dr. Donald Lee Sweet, Jr.-AssistantProfessor.Dr. Louis Cohen (' 5 3), Professor ofMedicine, is the principal author of"Diethylstilbestrol Effects on SerumEnzymes and Isozymes in MuscularDystrophy" in the Archives of Neurol­ogy, July 1976.Dr. Kenneth A. Fisher, Assistant Pro­fessor of Medicine, is the principal au­thor of "Prediction of Asathioprine In­tolerance in Transplant Patients" inLancet, April 17. the coauthors are: Dr.Sudesh K. Mahajan, former Fellow inNephrology; Dr. J. Laurence Hill,Assistant Professor in Surgery; Dr.Frank P. Stuart, Professor in Surgery;and Dr. Adrian I. Katz, Professor andChief of Nephrology in Medicine.Dr. Sumner C. Kraft (,55), Profes­sor of Medicine, has been elected to theeditorial board of Gastroenterology.Dr. Edgar Moran, Associate Professorof Medicine, presented a paper entitled.. Prognostic Value of Vascular Invasionin Histocytic Lymphoma" at the 16thI nternational Congress of Hematologistsin Kyoto, Japan, September 5-11. Hechaired a session on Leukemia andLymphoma.Dr. Murray Rabinowitz, the LouisBlock Professor in the Departments ofMedicine and Biochemistry, was an in­vited participant at a meeting on Genet­ics and the Biogenesis of Chloroplastand Mitochondria held in M unich, Ger­many, August 2-7. He presented threepapers: .. Restriction EndonucleaseMapping and Analysis of Grande andMutant Yeast mtDNA," "TransferRNAs of Yeast Mitochondria," and"Characterization and Translation ofYeast Mitochondrial RNA."Dr. Alvin R. Tarlov ('56), Professorand Chairman in the Department ofMedicine, is the principal investigatorfor a $130,000 Henry J. Kaiser FamilyFoundation grant for a one-year study of"Strengthening Medical Care throughInstitutional Development, InstitutionalInterrelations, and Medical Education."Dr. John E. Ultmann, Director of theCancer Research Center and Professorof Medicine, has been asked to serve aschairman of the Board of ScientificCounselors of the Division of CancerTreatment, the National Cancer Insti­tute.Dr. Ultmann discussed "Classificationand Clinical Staging of Non-Hodgkin'sLymphoma" and "Chemotherapy ofLymphoma" at a Cancer Symposium onNon-Hodgkin's Lymphoma sponsoredby the Hennepin County Unit of theAmerican Cancer Society, held Sep­tember 17 in Minneapolis. He was alsoan invited discussor on Staging theNon-Hodgkin's Lymphomas at a sym­posium on the Non-Hodgkin's Lym­phomas. Sponsored by the NationalCancer Institute and the Cancer ClinicalInvestigation Review Committee, thesymposium was held September3D-October 2 in San Francisco.Obstetrics and GynecologyAppointments:Dr. Chin-Chu Lin-Assistant Profes­sor.Dr. Frank Reale-Assistant Professor.Dr. Luis A. Cibils, the Mary CampauRyerson Professor in Obstetrics andGynecology, was elected to the editorialboard of Revist a Espanola de Obste­tricia y Ginecologia, and has received aFellowship in the American Gynecolog­ical Society.Dr. Arthur L. Herbst, the JosephBolivar DeLee Professor and Chairmanin Obstetrics and Gynecology and Chiefof Staff of Lying-in Hospital, receivedthe George B. Kunkel Memorial Awardof Harrisburg Hospital in Harrisburg,Pennsy Ivania.Dr. Herbst discussed the Clear-CellCancer Problem during a panel presenta­tion on the DES-Exposed AdolescentGirl, October 14, at the Districts I, II,and III American College of Gynecol­ogy meeting in Philadelphia. He alsodiscussed Diethylstilbestrol in Preg­nancy at a Symposium on Endocrine­Induced Neoplasia, held October 21-22at the University of Nebraska MedicalCenter.He served as moderator of a panel onVaginal Adenosis and Malignancy, Oc­tober 12, during the American College ofSurgeons meeting in Chicago.Dr. Marshall D. Lindheimer, Professorin Obstetrics and Gynecology andMedicine, participated as a session Dr. Frank W. Newellchairman and panel member at the In­ternational Symposium on HypertensiveDisorders in Pregnancy held in Munster,Germany, August 24-26.Dr. Gebhard F. B. Schumacher,Professor in the Department of Obstet­rics and Gynecology and the Committeeon Immunology, and Chief of the Sec­tion of Reproductive Biology, attendedan International Workshop on HumanFertility in Essen, West Germany lastJuly.The University'S Chicago Lying-inHospital and Department of Obstetricsand Gynecology presented a Post­graduate Course in Obstetrics andGynecology October 6-8 at the Centerfor Continuing Education. The coursecovered such areas as maternal and fetalmedicine, menopause, gynecologiccancer, infertility, endocrinology, andcontraception.On November 11 the Departmenthosted the 1976 Barren Foundation Lec­ture. Dr. Egon Diczfalusy, this year'srecipient of the Barren Medal, presentedthe lecture on Regulation of HumanFertility-the Present and the Future.Dr. Diczfalusy is head of the SwedishMedical Research Council at KarolinskaHospital's Reproductive EndocrinologyResearch Unit, and director of theWorld Health Organization Collaborat­ing Center for Research and Training inHuman Reproduction at the KarolinskaInstituter in Stockholm. The BarrenFoundation is an association for repro­ductive research.OphthalmologyDr. Terry Ernest, Associate Professorand Secretary in the Department ofOphthalmology, gave a paper entitled "Optic Disk Blood Flow" at the Cam­bridge Ophthalmological Symposium inCambridge, England, September 13. Healso spoke on the "Pathophysiology ofthe Choroidal Circulation" at RoyalVictoria Hospital in Belfast, Ireland onSeptember 16.Dr. Frank W. Newell, the James andAnna Louise Raymond Professor andChairman of the Department ofOphthalmology, was elected recently toa four-year term as first vice president ofthe Academia Internationalis Ophthal­mologicus at the organizational meetingin Ghent, Belgium. Membership is re­stricted to ophthalmologists who havepublished at least one book and 100scientific papers.Dr. Newell has been named editor ofophthalmology for Stedman's MedicalDictionary.OtolaryngologyAppointment:Dr. Mahmood Mahdavi-Instructor.PathologyPromotion:Dr. Robert Wollmann ('69)-As­sistant Professor.Dr. Seymour Glagov, Professor inPathology and the College, is coauthorof a paper entitled "Evaluation and Pub­lication of Scanning Electron Micro­graphs," published in the June issue ofScience.Dr. Werner H. Kirsten, Professor andChairman of Pathology and Professor ofPediatrics, was elected to the board ofdirectors of the Damon Runyon-WalterWinchell Cancer Fund on July I.The Fund, a private organizationwhich supports fellowships in the area ofcancer research, was founded by WalterWinchell in 1946 in honor of Damon Run­y.on, noted journalist and short storywriter.Dr. Kirsten served as co-chairman ofthe Gordon Research Conference onMolecular Pathology at BrewsterAcademy, Wolfeboro, New Hampshire,June 28-July 2, with Dr. Godfrey Getz,Professor of Pathology, Biochemistry,and in the College. Dr. Kirsten chaired asession on the Intracellular Assembly ofViruses.Dr. Benjamin Spargo ('52), Professorand Associate Chairman in the Depart­ment of Pathology, has accepted an invi­tation to serve another five-year term onthe editorial board of the AmericanJournal of Pathology, beginning January1, 1977.37Dr. Francis H. Straus, Associate Pro­fessor of Pathology and Acting Directorof the Surgical Pathology Laboratory,served as moderator of a RehabilitationVolunteers Seminar sponsored by theUniversity of Chicago Cancer ControlCenter and the American CancerSociety's Chicago Unit on October 6.Volunteers who answer calls fromcancer patients and their families in theSociety's Call-PAC program attendedthe seminar, which focused on four ap­proaches to cancer treatment. Partici­pants in the seminar included Dr. ArthurL. Herbst, Joseph Boliver DeLee Pro­fessor and Chairman in the Departmentof Obstetrics and Gynecology and Chiefof Staff of Chicago Lying-in Hospital;Dr. Jeannie J. Kinzie, Assistant Profes­sor of Radiology; Dr. Daniel Paloyan,Assistant Professor of Surgery; and Dr.Donald L. Sweet, Jr., Fellow in the De­partment of Medicine's Section onHematology/Oncology.Dr. Robert W. Wissler (,48), DonaldN. Pritzker Professor of Pathology andDirector of SCOR-Atherosclerosis, hasbeen elected to the board of directors ofEarlham College in Richmond, Indiana,and the board of directors of the Ameri­can Heart Association. He also receiveda certificate for honorary membership inthe Japanese Atherosclerosis Society inTokyo. Dr. Wissler and the followingdoctors participated in the I Vth Interna­tional Symposium on Atherosclerosis inTokyo, August 24-28: Sandra Bates,Research Associate in Pathology,Robert Chen, Resident/Trainee inPathology, Kathy Fischer-Dzoga,Research Associate (Associate Profes­sor) in Pathology, Seymour Glagov,Angelo Scanu, Professor in Medicine,and Draga Vesselinovitch, Research As­sociate (Associate Professor) in Pathol­ogy.PediatricsAppoln t ment s:Dr. Katherine K. Christoffel-Assis­tant Professor.Dr. Allen L. Horwitz (,n)-AssistantProfessor.Dr. Susan Leehey-Assistant Profes­sor.Dr. Anne W. Lucky-Assistant Pro­fessor.Dr. Generosa G. Lumicao-Instruc­tor.Dr. Brenda J. Thompson-AssistantProfessor.Promotion:Dr. Margery Franklin-AssistantProfessor.Dr. Andrew J. Aronson, Assistant Pro­fessor of Pediatrics, was elected to38 Dr. Robert W. Wisslermembership in the American Society ofPediatric Nephrology, the AmericanSociety of Nephrology, and the Interna­tional Society of Nephrology.Dr. Albert Dorfman (' 44), the RichardT. Crane Distinguished Service Profes­sor of Pediatrics, Biochemistry, and theCommittees on Genetics and Develop­mental Biology, and Director of theJoseph P. Kennedy, Jr. Mental Retarda­tion Research Center, participated in theAUA-ANL Bicentennial Conference onAccomplishments and Challenges forAmerican Life Sciences, held October11-13 at Argonne National Laboratory.He discussed genetic disorders duringthe session on Frontiers in Health Re­search.Drs. Dorfman; Glyn Dawson,Associate Professor in Pediatrics; AUenStoolmiller, Assistant Professor inPediatrics; William B. UphoIt, ResearchAssociate (Assistant Professor) inPediatrics; and Nancy Schwartz,Assistant Professor in Pediatrics, at­tended the annual meeting of the Ameri­can Society for Biological Chemistry,held June 6-10 in San Francisco. Dr.Dawson presented two papers entitled"Substrate Specificity of Human(1'- L- Fucosidase " and .. Serum Lipopro­tein Glycosphingolipids in NormalHuman Subjects and Patients withHypo-and Hyperlipoproteinemias." Dr.Stoolmiller discussed the "Effect ofNorepinephrine on Ganglioside Synthe­sis in Cultured Mouse NeuroblastomaCells." Dr. Schwartz presented a paperentitled "Effect of ,B-xylosides onSynthesis of Chondroitin Sulfate Pro­teoglycan by Chondrocyte Cultures" ina Symposium on Complex Polysac­charides. Pharmacological and Physiological Sci­encesAppointment:Margaret Hollyday-Assistant Pro­fessor.Dr. Ramon R. Latorre-AssistantProfessor.Dr. Leon I. Goldberg, Professor in theDepartments of Pharmacological andPhysiological Sciences and Medicineand Chairman of the Committee on Clin­ical Pharmacology, was co-chairman of aSymposium on Dopamine Hydrochlo­ride presented by the Royal Society ofMedicine in London, June 30. He pre­sented a paper entitled" Pharmacologi­cal Basis of the Clinical Use ofDopamine."Dr. Goldberg testified before the Sub­committee on Health and Environmentof the Committee on Interstate andForeign Commerce, United States Con­gress, on Bill HR-14289, which concernsthe proposed changes in Food and DrugAdministration regulations regarding thesafety and efficacy of drugs.He also served as member of a Panelon Adverse Drug Effects of the Office ofTechnology Assessment of the U.S.Congress. The panel met in Boston on anumber of occasions to prepare a com­prehensive document on committees.The Office of Technology Assessmentwas created to help the Congress antici­pate and plan for the consequences ofthe uses of technology.Dr. J. D. Kohli, Research Associate(Associate Professor) in Pharmacology,and Dr. Paul Volkman, Fellow in Clini­cal Pharmacology, were co-authors oftwo papers presented at the fall meetingof the American Society for Pharmacol­ogy and Experimental Therapeutics,held August 15-19 at Tulane University,New Orleans. The papers were entitled"Conformational Requirements inDopamine Analogs for Vascular SmoothMuscle Excitatory Activity," and.. Lack of Correlation Between Inhibi­tion of Prolactin Release and Stimulationof Dopaminergic Renal Vasodilation."PsychiatryAppointment:Dr. Carol Hengeveld-Instructor andFellow.Promotion:Dr. Chase P. Kimball-Professor.Dr. John W. Crayton, Assistant Profes­sor in Psychiatry, and Dr. Herbert Melt­zer, Professor in Psychiatry, arecoauthors of "Serum Creatin Phos­phokinase Activity in PsychiatricallyHospitalized Children" in the June issueof the Archives of General Psychiatry:Dr. John Davis is the author of "Com­parative Doses and Costs of Antipsy­chotic Medication" and the coauthor of"Pharmacokinetics of Red Blood CellPhenothiazine and Clinical Effects:Acute Dystonic Reactions" in the Julyissue of the Archives of GeneralPsychiatry.Dr. Dennis C. Grygotis ('70), AssistantProfessor in Psychiatry, is now ActingDirector of the University's ChildPsychiatry Outpatient Clinic.Dr. Angelos Halaris, Assistant Profes­sor in Psychiatry and Behavioral Sci­ences, participated in the 10th Meetingof the International College of Neuro­psychopharmacology, July 4-8, Quebec,Canada. He presented a paper on"Studies on Uptake Release ofDopamine with Psychotropic Com­pounds. "Dr. William Offenkrantz, Professor inPsychiatry, discussed "The Psychologi­cal Relations Among All Dreams of theNight" on October 31 as part of theUniversity's lecture-discussion series atWoodward Court.Charles R. Schuster, Professor inPsychiatry, Pharmacological andPhysiological Sciences, and the College,participated in the Second National In­stitute of Environmental Health Sci­ences Task Force for Research Planningin Environmental Health Sciences at theUniversity of North Carolina, June20-July 10. He chaired a sub-section ofthe Task Force concerned with be­havioral consequences of environmentaltoxins.Dr. Taylor Segraves, Assistant Profes­sor in Psychiatry, and Dr. Robert Smith,Postdoctoral Fellow in the Departmentof Psychiatry, are coauthors of "Con­current Psychotherapy and BehaviorTherapy" in the June Archives of Gen­eral Psychiatry.RadiologyAppointments:Dr. Maria Bouzouki-Instructor.Dr. Mary A. Radkowski-AssistantProfessor.Dr. Thyagarajulu Reddy-Instructor.Promotions:Robert Beck-Professor.Dr. Peter E. Doris-Assistant Profes­sor.Dr. Cicely F. Elahi-Assistant Pro­fessor.Dr. David Rochester (,7 I)-AssistantProfessor.SurgeryAppointments:Dr. Mathew M. Malerich-AssistantProfessor. Dr. Craig Reckard-Assistant Profes­sor.Dr. David S. Stulberg-AssistantProfessor.Dr. Christopher Zarins-AssistantProfessor.Dr. Jack de la Torre, Assistant Professorin Surgery (Neurosurgery) and Psy­chiatry, was elected a member of the In­ternational Brain Research Organizationin September. He was also one of seveninvited speakers at the First TarboxParkinson's Disease Symposium, spon­sored by the American Association ofNeurological Surgeons, held October14-16 at Texas Tech University Schoolof Medicine, Lubbock. His presenta­tion, entitled "Neurophysiology ofMovement Disorders," will be pub­lished in book form next year by PlenumPress.Dr. Warren E. Enker, Assistant Pro­fessor in Surgery, and Dr. BernardLevin, Assistant Professor in Medicine,have been awarded a five-year contractfrom the National Cancer Institute toevaluate the relative values of im­munotherapy, chemotherapy, and radia­tion therapy as adjuvant treatment forpatients with colon or rectal cancer. TheNational Cancer Institute will select oneof these treatments for University pa­tients once they have qualified for entryinto the study.Drs. Enker and Levin will be studyingthe role of immunotherapy with a drugcaJled methanol extraction residue(MER), which has been shown to boostcellular immunity. Only patients deemedcurable by surgery are eligible for treat­ment.Dr. Edwin Kaplan, Professor ofSurgery, presented a paper entitled "ACalcium Elevating Polypeptide fromPancreas" at the Fifth InternationalCongress of Endocrinology in Hamburg,Germany, July 21.Dr. John F. Mullan, Professor in theDepartment of Surgery (Neurosurgery),was awarded an honorary doctor of sci­ence degree July 6 by his alma mater,Queen's University in Belfast, NorthernIreland.The following members of the De­partment of Surgery participated in the1976 Clinical Congress of the AmericanCollege of Surgeons, held October 10-15in Chicago: George E. Block, John D.Burrington, Thomas R. De Meester,Warren E. Enker, Edwin L. Kaplan,Gerald S. Laros, Gregory Matz, A. R.Moossa, Daniel Paloyan, Carlos A. Pel­legrini, Robert L. Replogle, Martin C.Robson, David B. Skinner, John Taylor. Michael Reese-PritzkerThe following fuJI-time members ofMichael Reese Hospital and MedicalCenter have been named to the staff ofThe Pritzker School of Medicine:Department of MedicineAppointment:Dr. Thomas A. Carlson to Clinical In­structor, for one year, effective July I,1976.Department of Obstetricsand GynecologyReappointment:Dr. Paul Dmowski, Associate Profes­sor, effective September I, 1976,through June 30, 1977.Heinrich Kluver, the Sewell L. A veryDistinguished Service ProfessorEmeritus in the Division of BiologicalSciences, was named a Life Member inthe Section on Neurology of the PanAmerican Medical Association in recog­nition of his contributions to medicine.He was also recently elected a Fifty­Year Member of the American Associa­tion for the Advancement of Science andan Honorary Member of the Society ofBiological Psychiatry.Heinrich Klever39Alumni News1930Leonidas H. Berry, special deputy forprofessional-community affairs, Healthand Hospitals GOVERNING Commis­sion of Cook County, was nominatedChicago candidate for the 1976 SpingardMedal of the N.A.A.C.P.Dr. Berry is senior author and editorof Gastrointestinal Pan-Endoscopy,published by Charles C. Thomas, and ofThe Clinical Significance of Gastroin­testinal Pan-Endoscopy, part of RocheLaboratories' Continuing EducationSeries in Gastroenterology.1932Ingvald J. Haugen of Ada, Oklahoma,retired on May 28, 1976.1934Richard E. Heller of Chicago retiredfrom his private practice of medicine onJune I, and is now teaching grossanatomy at Northwestern UniversityMedical School in Chicago.1938Merton Gill, professor of psychiatry atthe University of Illinois' Abraham Lin­coln School of Medicine, published twobooks: Freud's Project Reassessed,with coauthor Karl H. Pribram ('41),professor of psychiatry and psychologyat Stanford University Medical School;and Psychology Versus Metapsychol­ogy, with Philip S. Holzman, professorof psychiatry and behavioral sciences atThe University of Chicago.1939Thomas W. Sugars is retired and has apart-time practice in Roseburg, Oregon.1942Nicholas C. Johns is medical director ofthe Grand Canyon Clinic in Arizona,and is clinical professor at Yavapai Col­lege extension school.1944J. Alfred Rider was recently electedsecretary-treasurer of the CaliforniaBoard of Medical Quality Assurance.Dr. Rider is also the director of the Gas­trointestinal Research Laboratory at theFranklin Hospital in San Francisco,vice-president of the American Collegeof Gastroenterology, a member of thegoverning board of the American Soci­ety of Gastrointestinal Endoscopy, andpresident of the Children's Brain Dis­eases Foundation.1949Albert Sjoerdsma returned early this yearfrom the Centre de Recherche, Merrell40 International in Strasbourg, France. Heestablished the center in 1972. Dr.Sjoerdsma is now senior vice presidentand director of Merrell Research atMerrell-N ational Laboratories, Divisionof Richardson-Merrell Inc., in Cincin­nati. Dr. Jan Koch-Weser ('49 A.B.),vice president for research, Merrell In­ternational, has taken over the directionof the Strasbourg Research Center inFrance.1954Dorothy B. Windhorst was recently ap­pointed director of clinical research indermatology, at the department of med­ical research, Hoffmann-La Roche,Inc., in New Jersey.1959Hugh C. Graham, Jr., associate clinicalprofessor of pediatrics at the Universityof Oklahoma Medical School, writesthat he is a consultant to the President'sCommission on Olympic Sports.1961Anthony A. Gottlieb is practicingpsychiatry in Denver and is assistantclinical professor of psychiatry at theUniversity of Colorado School ofMedicine. Dr. Gottlieb has publishedscientific papers on group psycho­therapy, evaluation of psychiatric treat­ment, psycho-endocrinology, genderpathology, and other topics. Last yearhe was invited to present his evalua­tion research at a meeting of the Societyfor Psychotherapy Research in London,England.1962Ruth Collins Covell was appointed to asecond term on the National Profes­sional Standards Review Council of theDepartment of Health, Education, andWelfare, and to the DHEW's HealthServices Research Study Council. Dr.Covell gave birth to her third son in Au­gust, 1975.Maximo L. Cuesta was named chair­man of the department of obstetrics andgynecology and elected president of themedical staff at Burrell Memorial Hospi­tal in Roanoke, Virginia.Stephen L. Michel is assistant directorof surgery at the newly completed1,120-bed Cedars-Sinai Medical Centerin Los Angeles. He was recently electedvice-chairman of the Los AngelesCounty Commission on EmergencyMedical Care.1964David M. Dressler was promoted to as­sociate professor of psychiatry at theUniversity of Connecticut Health Center in Farmington, and last May waselected a Fellow of the AmericanPsychiatric Association.Lawrence Kass, associate professor ofinternal medicine and research associateat the Thomas Henry Simpson MemorialInstitute for Medical Research, Univer­sity of Michigan, Ann Arbor, wasawarded the Giovanni DiGuglielmoprize for 1976. This prize honors the con­tributions of the late distinguished Italianhematologist Giovanni DiGuglielmo.Dr. Kass received this award for his re­search on the DiGuglielmo syndrome(acute and chronic erythremic myelosis,erythroleukemia, and refractory sidero­blastic anemia), and for his book on thistopic entitled Refractory Anemia,published by Charles C. Thomas in 1975(coauthor Bertram Schnitzer).Dr. Kass is also the author of adefinitive monograph entitled PerniciousAnemia, published by W. B. Saunders.Robert Zelis, professor of medicineand chief of cardiology in the Pennsyl­vania State University College ofMedicine at the Milton S. Hershey Med­ical Center has been selected president­elect of the American Federation forClinical Research. Dr. Zelis is the au­thor of more than 140 scientific publica­tions and has been active in research oncardiocirculatory control mechanisms.Dr. Zelis was elected to the AmericanSociety for Clinical Investigation in1975, and serves on the editorial board ofthe Annals of Internal Medicine and theAmerican Journal of Physiology.1967David Wilbur Larson is chief of staff atSpruce Pine Community Hospital inNorth Carolina. He is also medical ex­aminer for Mitchell County, clinical di­rector of the Spruce Pine CommunityHospital Laboratory, and president ofthe Mitchell-Yancey Counties MedicalSociety.Dr. Larson is a member of the Col­laborative Oncology Group, which con­sists of about 20 physicians in westernNorth Carolina who treat patients usingthe chemotherapy protocols of AcuteLeukemia Group B. This program,which is under the supervision of theBowman Gray School of Medicine's de­partment of hematology, enables pa­tients to receive such therapy close tohome.1969Robert Rubenzik began a practice inophthalmic plastic surgery in Phoenixlast August.1970Sanford Meyers holds a Retinal Fellow­ship in the department of ophthalmologyat the University of Wisconsin Hospitalsin Madison.Michael Sherlock is instructor inpediatrics and child psychiatry at JohnsHopkins Hospital, and has a privatepractice in pediatrics in Baltimore.Ruth Ann Smith is an instructor inmedicine at the University of Utah Med­ical Center in Salt Lake City.1971Michael R. Brown began a practice inpediatrics and adolescent medicine inDoylestown, Pennsylvania.Kevin G. Geyer has begun a practice inophthalmology at Center Medical Com­plex, Huntington Beach, California.John A. Schafer completed his resi­dency in neurology at the University ofCalifornia, San Francisco, where he isnow instructor in neurology. He is alsostaff neurologist at the Naval Hospital inOakland.George Wu is chief resident in plasticand reconstructive surgery at StanfordUniversity, California.1972Gary Lynn Harkins is an associate inves­tigator in hematology at the VeteransAdministration Hospital, La Jolla,California.James Vincent Lustig is assistant pro­fessor in pediatrics at the Medical Col­lege of Ohio in Toledo.Robert L. Ramsey is a Fellow inhematology/oncology at the Universityof California, Los Angeles.Lawrence David Schuster is a secondyear Fellow in endocrinology in the de­partment of medicine at the Universityof Minnesota Hospital, Minneapolis.Jose L. Velazquez of Dunedin, Floridawas recently certified by the AmericanBoard of Anesthesiology.Katherine Wier has joined the WinsorMedical Associates as a dermatologist inRiverside, Illinois, and is on the staff atMcNeil Memorial Hospital in Berwyn.1973Joel Kleinman has joined the staff at St.Elizabeth's Hospital in Washington,D.C.Jean-Paul Pegeron has a private prac­tice in psychiatry and he is a clinical in­structor at the University of Michigan'sNeuropsychiatric Institute.Former StaffAlfred Feingold (Anesthesiology, resi­dent, '66-'70) is associate professor inthe department of anesthesiology at theUniversity of Miami School ofMedicine, and director of anesthesiologyat the new Bascom Palmer Eye Institute/Anne Bates Leach Eye Hospital. Edward Nijensohn (Medicine,resident-faculty, '70-'75) is director ofnuclear medicine and ultrasound atChrist Hospital, Oak Lawn, Illinois.Wesley E. Root (Radiology, intern,'69-'70) is assistant clinical professorand assistant director in the departmentof radiology, and chief of chest radiologyat the University of California, IrvineMedical Center, Orange, California.Class Chairmen AppointedThe School of Medicine is about tocelebrate its 50th Anniversary year, theClinics having officially opened inNovember of 1927. Representativesfrom each class have been selected toassist in making each alumnus andalumna feel a part of the University'SMedical Center and the festivities.Most of the classes have a representa­tive as their chairman (listed below). In­terested alumni from classes that do nothave a chairman may volunteer by writ­ing to me in care of the Medical AlumniAssociation.The areas in which the chairmen willhelp Dean Tosteson, the MedicalCenter, and the Medical Alumni Associ­ation are as follows:-assist in the observance of the 50thAnniversary year-nominate candidates from theirclass for Distinguished Service Awards-report news about their class mem­bers for publication in Medicine on theMidway-coordinate their class reunions-write to class members to encouragetheir support of the Medical AlumniFund, the fundraising arm of the Medi­cal Center.Each alumnus is encouraged to replyto his or her chairman's October letter.With your participation and suggestions,we will have a more active MedicalAlumni Association and can plan for agala 50th Anniversary celebration.� �. <r.".:W /1.v.Several classes will be holding reunionsin early June of 1977. Members of thefollowing classes are asked to reservethis time on their calendars: 1937, 1947,1952, 1957, 1962, and 1967.* * *These are your class Chairmen:1930no chairman. 1931no chairman.1932no chairman.1933no chairman.1934no chairman.1935Dr. Vida B. WentzApartment 13-A5820 Stony Island AvenueChicago, Illinois 606371936Dr. John P. FoxUniversity of WashingtonSchool of Public Health and CommunityMedicineDepartment of Epidemiology and Inter-national HealthSeattle, Washington 981951937Dr. Eli L. BorkonDoctors Memorial Hospital404 West Main StreetCarbondale, Illinois 629011938no chairman.1939Dr. Leon O. JacobsonThe Franklin McLean Memorial Re-search InstituteThe University of Chicago950 East 59th StreetChicago, Illinois 606371940no chairman.1941no chairman.1942no chairman.1943 (Class of March)Dr. Charles P. McCartney12412 South 74th AvenuePost Office Box 605Palos Heights, lIIinois 604631943 (Class of December)Dr. W. E. FroemmingTeletype Corporation5555 Touhy A venueSkokie, Illinois 600761944Dr. Charles W. SchlageterPsychiatric Associates, S.C.41Suite 1100-1117707 North Fairbanks CourtChicago, Illinois 606111945Dr. Stewart F. Taylor116 E. Pleasant StreetPortage, Wisconsin 539011946Dr. Edward R. Munnell8601 North GeorgiaOklahoma City, Oklahoma 731141947Dr. Henry De Leeuw4090 Highgate RoadMuskegon, Michigan 494411948Dr. Asher J. FinkelAmerican Medical AssociationScientific Affairs Continuing MedicalStudies535 North Dearborn StreetChicago, Illinois 606101949Dr. Mary D. Carroll124 N. Main StreetCrown Point, Indiana 463071950Dr. Abbie R. Lukens87th and County Line RoadHinsdale, Illinois 605211951Dr. Arnold L. Tanis925 No. Northlake DriveHollywood, Florida 330191952Dr. Benjamin H. SpargoThe University of ChicagoDepartment of Pathology950 East 59th StreetChicago, Illinois 606371953Dr. Frank W. FitchThe University of ChicagoDepartment of Pathology950 East 59th StreetChicago, Illinois 606371954Dr. Dorothy WindhorstHoffmann-La Roche Inc.Research DivisionNutley, New Jersey 071101955Dr. Sumner C. KraftThe University of ChicagoDepartment of Medicine42 950 East 59th StreetChicago, Illinois 606371956Dr. Walter B. Edibo3201 Wauwatosa DriveDes Moines, Iowa 503151957Dr. Francis H. Straus, IIThe University of ChicagoDepartment of Pathology950 East 59th StreetChicago, Illinois 606371958Dr. Gerald Paul Herman8224 Mentor AvenueMentor, Ohio 440601959Dr. E. H. Given234-A West Rockrimmon Blvd.Colorado Springs, Colorado 809191960Dr. Randolph W. SeedGrant Hospital551 West Grant PlaceChicago, Illinois 606141961Dr. Roger W. Becklund1224 Metropolitan Medical Office Bldg.825 South Eighth StreetMinneapolis, Minnesota 554041962Dr. Joseph M. BaronThe University of ChicagoDepartment of Medicine950 East 59th StreetChicago, Illinois 606371963Dr. Rostik Zajtchuk, LTC, MCThoracic Surgery ServiceFitzsimons Army Medical CenterDenver, Colorado 802401964Dr. Daniel PaloyanThe University of ChicagoDepartment of Surgery950 East 59th StreetChicago, Illinois 606371965no chairman.1966Dr. Julian J. RimpilaSuite 406, Lake Point Tower505 North Lake Shore DriveChicago, lIlinois 60611 1967Dr. Andrew J. Griffin2520 N. Lakeview A venueChicago, Illinois 606141968Dr. Burr EichelmanVeterans Administration Hospital2500 Overlook TerraceMadison, Wisconsin 537051969Dr. Andrew J. AronsonThe University of ChicagoLa Rabida-University of Chicago Insti­tuteLa Rabida Children's Hospital and Re-search CenterEast 65th Street at Lake MichiganChicago, Illinois 606491970no chairman.1971no chairman.1972Drs. Eric and Lucy LesterThe University of ChicagoDepartment of Medicine/PediatricsChicago, Illinois 606371973Dr. Richard F. GaekeThe University of ChicagoDepartment of MedicineChicago, Illinois 606371974no chairman.1975no chairman.1976no chairman.Where Are They Now?We seem to have lost track of thefollowing alumni. Can you help uslocate them and complete our rec­ords? If you are able to supply anaddress, please notify the MedicalAlumni Association, Culver Hall400, 1025 E. 57th Street, The Uni­versity of Chicago, Chicago, Il­linois,60637.Fernando Ugarte ('65 M.D.)Nehemiah O. Nwankwo (,67M.D.)David Masao Ota ('73 M.D.)Wyler Birthday PartyThe Silvain and Arma Wyler Children'sHospital celebrates its Tenth Anniver­sary this winter. To honor this specialbirthday, the Department of Pediatrics issponsoring a medical symposium on theFuture of Children's Health Care onWednesday, January 26, in BillingsHospital, P-117.All hospital medical staff and em­ployees, alumni of The Pritzker Schoolof Medicine, and Chicago area pediatri­cians, housestaff, and medical studentsare invited without charge.Guest speakers include Dr. BenjaminSpock, noted pediatrician and author ofbooks on child care and development;Dr. Mary Ellen A very, chairman of pediatrics at Harvard Medical School,Dr. John Littlefield, chairman of pediat­rics at Johns Hopkins Medical School,and Dr. Robert Chanock ('47), directorof the virology section of the NationalInstitutes of Health.In conjunction with this Tenth An­niversary celebration, The Home forDestitute Crippled Children will hold abenefit dinner-dance at the AmbassadorWest Hotel on Tuesday, January 25.Tickets are $40.00 per person, and aretax deductible.For further information on these twoevents, contact Mrs. E. Medof, WylerPublic Relations, Box 426, (312)947--6976.Medicine on the MidwayThe University of ChicagoThe Medical Alumni AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, Illinois 60637•Address corrections requestedreturned postage guaranteedCalendarTuesday, January 25Benefit .dinner-dance for WylerChildren's Hospital, AmbassadorWest Hotel, Chicago.Wednesday, January 26Medical symposium on the Futureof Children's Health Care, spon­sored by the Department ofPediatrics in honor of the TenthAnniversary of Wyler Children'sHospital. Billings, P-117.Tuesday, February 1Symposium for Women and lun­cheon at the Drake Hotel, spon­sored by the Board of Directors ofChicago Lying-in Hospital. Forfurther information, contact TaraPreisser, (312) 947-5337, or writeto Chicago Lying-in Hospital,Room 620, 5841 Maryland Av­enue, Chicago, 60637.Monday, April 18Reception for alumni and spousesduring American College ofPhysicians meeting in Dallas.Wednesday, June 8Medical Alumni Day. NON-PROFIT ORG.U.S. POST AGEPAIDPERMIT NO. 9666CHICAGO. ILL.