Bulletin of the Medical Alumni AssociationThe University of ChicagoDivision of the Biological SciencesThe Pritzker School of MedicineonWinter 1979Dt.L � 1 1�79At right, Robert B. Uretz, DeanNice-President ofthe Medical Center, and Joseph J. Ceithaml, Deanof Students, study the architect's model for theHospital Modernization Project. Dean's PageI am sure that many of you have heard of the $70 million, five-year Hos­pital Modernization Project that our Medical Center has undertaken.Much of the talk regarding this project focuses on the benefits it will havefor the Hospital, but the project will have many direct benefits for ourMedical School as well. I want to take this opportunity to inform you ofsome of those benefits.A new hospital itself will have benefits for the Medical School sincemedical education has such a large clinical component, even at theundergraduate level. Our medical students begin their clinical training inthe spring of their sophomore year and spend much of their time fromthat point on within the Hospital. It is essential to the continued successof our Medical School that we have a modern, efficient facility in whichto train our students. Likewise, modernization of our clinical facilities isnecessary if we are to be able to recruit and retain clinical faculty of thehighest caliber. The Hospital Modernization Project will help us achievethese goals.Construction of a new hospital will also have many spin-off effects thatwill benefit the Medical School. Moving the Hospital operations to a newfacility will free many thousands of gross square feet in our currentfacilities for application to academic teaching and research purposes. Inaddition, this freed-up space will be used to provide better space for ourmedical students and alumni. The Hospital Modernization Project willallow us to provide more adequate sleeping quarters for medical students,an expanded medical library, a new medical student lounge, and a medi­cal alumni lounge.The Hospital Modernization Project is one of the most exciting oppor­tunities we have had open to us in many years. We are planning it care­fully to insure that we get the maximum benefit from it for the Hospital,the Medical School, and the Division.BuUetin of the Medical Alumni AssociationThe University of ChicagoDivision of the Biological SciencesThe Pritzker School of Medicine Medicineon the MidwayVol. 34, No.2, Winter 1979 4 25Editor: Janice Schmidt Women in Medicine. Focus on ReproductiveContributing Editors: James S. Forty Years Later EndocrinologySweet, John Pontarelli Dr. Ruth Moulton ('39)Photographers: Mike Shields, ChuckBloom, John Wells, BarbraArmaroli, Peter Kiar, Peter Miller 9 29(line art)Chairman, Editorial Committee: Quite a Doctor News BriefsRobert W. Wissler (,48)Medical Alumni AssociationPresident: Frank W. Fitch (' 53) 1 1President-Elect: Louis Cohen ('53) 32Vice-President: Peter Wolkonsky(,52) The Midway to Three-MileSecretary: Randolph W. Seed (,60) Island In MemoriamDirector: Katherine Wolcott Walker Dr. Leonard A. Sagan ('55)Council Members:Fredric Coe ('61)Herbert G. Greenlee ('55)Abbie R. Lukens (' 50) 16Robin O. Powell (,57) 33Julian J. Rimpila ('66)Francis H. Straus (,57)Summer Support for Departmental NewsUndergraduatesCover: Women in Medicine. A mosaicpattern encompasses some aspects ofthe practice of medicine experiencedby women today. 20Copyright 1979 by the Medical 34Alumni Association Microevolutionary Populations:The University of Chicago Bushmen and Hottentots Alumni News3WOMEN INMEDICINE ...The external challenges that confront women in medicinehave changed dramatically during the past fifteen years. Thenumber of women admitted to medical schools has risen fromthe traditional 4 percent to as high as 33 percent and moreoptions are open in a wider choice of specialties - jobs withmore responsibility, equal pay, and a more general accep­tance of the value of women's contributions to the field.Women physicians are no longer apt to feel quite so "dif­ferent" and usually assume that they can lead fairly normal,although somewhat taxing lives. This change has coincidedwith an increased cultural acceptance of equality between thesexes, a realization of sex-role stereotypes, and a steady in­crease in the number of women working outside the home toa point where now more than half of all American women aredoing so. There is new legal support for women such as lawsagainst sex discrimination, mechanisms for affirmative action,and avenues for expression of grievances or other opinions;an increase in serious professional women's groups giving en­couragement and advice about how to be effective in promot­ing change. This is important because in general women are... FORTY YEARSLATERDr. Ruth Moulton ('39)often afraid to use the new options available, are uninformedabout legal or political ways to facilitate progress, and oftentend to wait for opportunities to open, perhaps still thinking it"unladylike" to apply appropriate pressure.Unconsciously, some women physicians still are handi­capped by outmoded standards of what is acceptable as"feminine." They fear assertion will be seen as hostile ag­gression and they will be criticized and disliked. Those withchildren are under special stress because of having to leaddouble lives as mothers and as professionals, being vulnerableto guilt and self-doubt, caught between divergent culturalpressures. Although part of this is due to cultural lag andcovert prejudice, part is also due to unconscious psychologi­cal attitudes that have lagged behind the new concepts offreedom. Overt obstacles as well as internal inhibitions re­main.My recent articles on the changing roles, hence the chang­ing psychology, of women have been an attempt to under­stand the intricacies of this process and to make observationsavailable to other women so that they might better be pre- pared to face the problems still confronting them in handlinga career in medicine as well as raising families. In preparingthese articles, I realized how things had changed since "mytime," the many difficulties I had lived through, and how realsome of the conflicts still remain.Influences in the PastTo go back forty years and retrace my steps I began at theUniversity's Laboratory Schools in the fourth grade and con­tinued for fourteen years until I graduated from the Univer­sity's Medical School in 1939. Although music and arttouched me first, I lacked talent. Nature study and biologyalways fascinated me and I had been encouraged by en­thusiastic teachers in University High as well as good gradesto continue.I was a Freshman in the College during the second year ofMax Mason's "New Plan" with its survey courses, class at­tendance not required, courses passed or even skipped by ex­amination only. This was an exciting time at Chicago.People's motivations interested me and I took psychologycourses only to find them dull, academic, and more interestedin color wheels, rats, and statistics than in human beings.Thus, I headed toward psychiatry becoming especially in­volved in psychosomatic medicine because of the fine teach­ing of Dr. Henry Brosin and the innovative research beingdone by Dr. Jules Masserman.I took my psychiatric residency at New York StatePsychiatric Hospital because of its reputation in treatingpsychosomatic disorders.The external challenges that confront women in medicine havechanged dramatically during the past fifteen years. The numberof women admitted to medical schools has risen from thetraditional 4 percent to as high as 33 percent, and more optionsare open in a wider choice of specialties.Dr. Clara Thompson's liberal way of teaching Freud at theNew York Psychoanalytic Institute appealed to me more thanthe "orthodox" approach. When I arranged to start analysiswith her in January 1941, she warned me that a "split" mightoccur in the Institute where I had been accepted as a studentfor the fall of 1941. The split did occur the following spring,but I expected to be able to take courses in both groups tomake my own comparisons. The director of training told me Iwas too young to make such a decision and had to make achoice. I recall replying that ten years earlier at the Univer­sity of Chicago I was considered old enough to form my ownopinions. When this was ignored as irrelevant, I decided tostay with the new group forming around Dr. Thompson thatincluded Harry Stack Sullivan, Frieda Fromm-Reichman, andErich Fromm. At the time I thought anything labeled "pro­gressive" had to be better than orthodoxy.This seemingly simple choice and unawareness of politicalintricacies led me in time to become the director of training at5Dr. Ruth Moulton ('39)the William Alanson White Institute for Psychoanalysisfounded by Clara Thompson. It was a small autonomousgroup, called "nee-Freudian" by some, eclectic by others,but a place where one had contacts with many points of viewand could follow one's own convictions. It tried to avoid let­ting the teaching hierarchy dominate the students while main­taining high standards.Courses at Chicago under Radcliff Brown (a student ofMalinowski) and Margaret Mead developed my interest insociology, anthropology, and comparati ve cultural systems.This may explain my devotion to the White Institute whichhas been called one of the "cultural" schools of analysis,using a biological model less than the Columbia Institutewhere I also teach. My research has always been clinical,based on patient observations. I started working with patientswith such problems as anorexia nervosa, pseudocyesis, andemotional changes correlated with the ovarian cycle. I wasstimulated by the work of Dr. Therese Benedek at theChicago Psychoanalytic Institute.I mention these connections with people from the Univer­sity of Chicago and the open-minded attitude toward learningthat they represented because, in retrospect, I can see thesignificant influence that the unique intellectual atmosphereand persons there had on my own way of observing people intheir cultural milieu.6 More RecentlyDuring the past fifteen years, I focused on the changingpsychology of women. I began with a study of frigidity and areevaluation of the effects of Freud's misconception about thenature of women.While studying modern women, especially women withconflicts between professional and personal lives, I becameaware of what a price I had paid for the freedom to follow myBecause of the removal of legal barriers, more career options areavailable to women, even in the "hard [physical] sciences" andother formerly male bastions.career goals without significant interruption even though mar­ried, raismg three children, and maintaining twohouseholds - a large New York City apartment with officesfor both my husband and me and a "tree farm" two hoursaway. At an early age, I was convinced that if women did notspend time on things such as bridge, meticulous houseclean­ing, and other "trivia," they could have careers, healthy sexlives, and interesting, well-informed children. My mother wasconvinced otherwise, but my father, with some trepidation,encouraged me to try.I kept moving ahead without much retrospection orphilosophical evaluation until my children were out of highschool. On the fiftieth anniversary of the Women's SuffrageAct, August 1970, I was sitting on a remote Greek islandreading a news report with a photograph of a young womancarrying a placard saying "Down with those who have madeit." It struck me that the young woman might see me assmug, self-satisfied, disinterested in the battle because it wasno longer mine. I realized how typical I was of my own gen­eration. When women decided to get professional training,they accepted the fact that they had to work harder and getbetter grades than men, not be conspicuous, ask for nofavors, and act in such a fashion with which no fault can befound and then be admitted to the inner sanctums of "male"professions. Because of the quota system (four out of ahundred medical students) women thought it necessary to seta good example, not to complain about unequal opportunities,and to accept being teased as "hen medics" with goodhumor.Many specialties were closed to us. We were expected togo into obstetrics, pediatrics, and psychiatry in which pa­tience and intuition were appreciated. No allowances weremade for pregnancies. Women often worked longer hours anddid more menial tasks. As a result, few women married whilein medical school and almost none had children. Insecurityabout being "unprofessional" or "unfeminine" made us leadrather hardworking irreproachable lives. We had little groupsupport. Women joining together was seen as separatism andmost professional women were "loners." Husbands andwives, both M.D.'s could not share hospital rooms whileinterning because it would "set a bad example." These sep-arations of a year or more helped cause divorce or encour­aged the women to make their careers secondary by workingpart-time in clinics or laboratories or using their skills to helptheir husbands in their practices. Small wonder that with suchnonassertive stances the traditional 5 percent of women inmedical schools did not change between 1900 and 1965. Now,as many as a third of first-year medical students are womenand residency programs have been remodeled to give time forwomen to run homes and raise children.Current ViewsThe vast changes in cultural attitudes toward sexual mores,sex discrimination, and sex-role stereotypes during the pastfifteen years have given both men and women much morechoice of life-styles. They are freer to live together withoutmarriage, which may give them a better chance to make wisedecisions about marriage. The divorce rate, which had beensteadily rising now seems to be more stable. Large familiesare "out of style," and there is a growing awareness ofzero-population growth and less need for women to have tojustify themselves by having large families. They are evenfree to be childless by choice and contribute to the culture inother ways.A new phenomenon has developed. Women who can sup­port themselves can now take the initiative to divorce menwhom they cannot respect, who have "held them back" be­cause of characterological rigidities, alcoholism, hostility, fearof female competence, and other sources of marital incom­patibility. Many women feel free, released from a kind ofslavery, able to have more satisfying relationships with menthan ever before.Because of the removal of legal barriers, more career op­tions are available to women, even in the "hard [physical] sciences" and other formerly male bastions. Talented,energetic women have been able to prove their competence innew areas.Small wonder that with such nonassertive stances in the past thetraditional 5 percent of women in medical schools did not changebetween 1900 and 1965 ....It is important to keep in mind that the "two paycheck"marriage has many financial advantages but some hazards aswell. There is sometimes overt competition. There is fre­quently a need to choose whose career is primary in terms ofMother and child sculptureat Chicago Lying-In Hospital.better jobs in different cities to the disadvantage of one part­ner. Some husbands enjoy participation in raising childrenand running households but others think that this is a threatto their masculinity and resent not being the center of thewoman's attention. Concepts of marriage are undergoing... Now as many as a third of first-year medical students arewomen and residency programs have been remodeled to give timefor women to run homes and to raise children.great change. Formerly, men felt trapped and now manywomen also experience marriage as a trap.A Shift in SymptomsRecently there has been a shift in symptoms that bring pa­tients to psychotherapy. Some of my observations are appli­cable to how the professional woman thinks and feels, andthese I would like to share. I have been particularly con­cerned with those symptoms affecting women although Iknow that men are increasingly involved as the culturalchanges occurring continue to evolve. Twenty-five years agowomen were apt to come to therapy for sexual frigidity, fearsabout marriage and childbirth, about being "good" mothers,and about being "feminine."Today, however, women are more apt to complain of guiltabout not staying home with children enough and about notbeing more domestic. They are caught between divergent re­quirements of interesting jobs and expectations of husbandsor families who may fault them for being less available. Bothsexes suffer from role proliferation but men find it easier todelegate jobs to subordinates, to isolate themselves, to feelfree to put the job first.Infants need "mothering" but not all of it must come frommother. Other concerned, involved, loving adults can8 alternate - fathers, relatives, paid mother substitutes whounderstand children. Later, day care centers can take over ona part-time basis. Children need to feel valued, cared for, andenjoyed and there are advantages to more than one personproviding this security for the child. Some concern has beenexpressed as to whether children would be confused abouttheir sex roles if parents shifted roles. There is no evidencethat this happens if parents are secure in their sexual identity.The latter is largely independent of the jobs done.Fear of success is another symptom connected with hiddendependency needs, fear of rejection by men and even byother women who may be jealous and defend their more tra­ditional life-styles. This can be as upsetting to the profes­sional woman as it would be to a man to be called unmas­culine, effeminate, or impotent. Both sexes have a pressingneed to feel attractive and be effectual, but with changing cul­tural attitudes they can no longer safely use old criteria.In therapy situations with women who are held back bytheir internal reservations or fears more than by external real­ity, the therapist has to explore their backgrounds. What kindof role models did they have in parents, peers, and teachers?Where did they get their concepts of expected sexual be­havior as well as sexual roles? How dependent are they be­neath the facades of pseudoindependence and what do theyfear will happen if they dare to be different? One may find agreat deal of separation anxiety from familiar figures as wellas self-doubt about sexual attractiveness or ability to cope.For a woman to formulate goals for herself, it is importantthat she assess her capacity and motivation for change. Soci­ety needs many kinds of women to fulfill a wide variety offunctions in our multifaceted world. The important thing isfor women to make appropriate, workable choices to fit theirown unique needs.SummaryWomen in science are role-breakers who threaten the estab­lished order and will continue to have difficulty in gettingsupport from conservatives. They need unusual indepen­dence, tenacity, and a strong belief in themselves both as sci­entists and as women. They need ego strength to stay firm inthe face of prejudice and opposition, which will melt awayslowly, alternating between progress and backlash. This is tobe expected as characteristic of human development; changebrings anxiety. Innovators from Socrates to Galileo to Freudhave been critiqued to the point of censure. But such an his­torical perspective makes daily battles and losses easier tobear.[]Dr. Moulton is an assistant clinical professor of psychiatry atColumbia University and a training and supervising analystat the William Alanson White Institute and the ColumbiaPsychoanalytic Clinic, New York City.Quite a Doctor•Just a few years ago, issues such as accreditation andcertification were generally thought to be the concern of onlyprofessional individuals and organizations that were affectedby them. The public policy aspects of these issues were notoften perceived by decision makers who werelong-accustomed to "guild" traditions that characterizedattitudes in the field of health care. Today these matters arenot immune from public review and criticism - and theresponsibility of both public and private leadership is to fusehealth care manpower "credentializing" with the publicinterest.Medical alumna Catherine Dobson's actions represent oneapproach to recertification and a physician's attempt to fulfillthe public's and her own expectations. She probably has more spunk thanmost physicians half her age and ac­cording to the American Board ofObstetrics and Gynecology she is ascurrent in her field as the recent medi­cal school graduate.That's because on December 6, 1978,Dr. Catherine Lindsay Dobson (Rush'32) proved her mettle in obstetrics andgynecology when she took the recer­tification examination offered by thatspecialty board.Dr. Dobson took her certification ex­amination in 1945 and then, thirty-fouryears later, decided to accept the chal­lenge of recertification.Recertification is the process bywhich a nongovernmental agency or as­sociation grants recognition to an indi­vidual who has met predetermined qual­ifications specified by that agency orassociation. It is continued assurance ofthe competence of the certified physi­cian.The recertification test Dr. Dobsontook will be given for the third time inDecember of this year and then everytwo years after that. The AmericanBoard of Obstetrics and Gynecol­ogy - one of twenty medical specialityboards that offers certification andrecertification - urges certified physi­cians to consider recertification everysix to seven years."Until the recertification exam, therereally was no way of determining if aphysician was up-to-date and paying at­tention during his CME [ContinuingMedical Education] courses," says Dr.Dobson. "Now the American Board ofObstetrics and Gynecology can assessthe doctor's knowledge currently," shecontinued, "in the past it could onlytake his record and see what he haddone previously."Why did Dr. Dobson decide to lether competence as a certified physician9be reevaluated by electing to take thismultiple-choice exam?"I did it because of the challenge,"she states. "I wanted to know if Icould do it, if I was current enough inmy field. At the same time, I had noexperience with a multiple-choice for­mat. I was somewhat anxious."Dr. Dobson thinks that there may besome federal pressure to insist on re­certification in the future. Now, how­ever, the practice profile of a physicianis kept by the board as a quality controlmeasure of what is happening in thespecialty.She also thinks recertification willhelp the physician keep track of what'sgoing on in his specialty. This canperhaps help the physician avoid amalpractice suit; and recertification it­self would be to one's advantage if asuit did arise.Dr. Dobson began the rigors of prep­aration six months before taking the test."One of the first things you do afterregistering is take a pretest," she says."But before that you can purchase andread a book put out by the the Ameri­can Board of Obstetrics and Gynecol­ogy called Precis, which is an abstractof all the literature in the field for thepast five years.""The pretest is broken down accord­ing to subjects such as obstetricsgynecology, endocrinology, infertility,and ambulatory care," she recalls."The board sends you results of howyou did and what the national averageis. It's supposed to tell you where yourknowledge is weak ... I did very well."Another method of preparation thatDr. Dobson used was listening to re­corded refreshers on medical topicscalled Update Tapes. "These tapes canbe purchased from the American Col­lege of Obstetrics and Gynecology,"says Dr. Dobson. "They come withquestions you answer before and after10 you listen to the tape ... and you cansend the tests to the board and receiveCME credit for taking them.""I listened to the tapes when I got upin the morning, in my car on the way tomy office, and when doing tasks athome."I started thinking more aboutobstetrics and gynecology and did a lotof additional reading. I had a specialplace to study where I could keep mybooks and materials, and I set asidecertain times for review."Some things you must know for theexam you don't need to know to prac­tice medicine," she said.On December 6, Dr. Dobson didn'tknow if she passed. "I made somedumb mistakes," she says. "For exam­ple, one answer I knew was wrong Icorrected, but I didn't change the nextanswer which was based on my previ­ous response.""March 1, it was there in my mail­box, an envelope that looked thick,"she recalls. "The board only sendsyour grades if you fail, otherwise youare notified of passing. I was sure mygrades were in there, that I hadflunked," she continued. "Anyway, Ipeeked inside and the word 'congratula­tions' caught my eye; then I opened itup the rest of the way."Dr. Dobson studied hard and her ef­forts paid off. "The point is," she said,"doctors who are taking the test are al­ready the ones who are most likely tostudy. The board needs to reach theother group - those who don't."Increased federal funding for the de­velopment of health care personnelprovided during the past few years re­flects a national consensus concerningthe importance of medical education,maintenance, and full utilization of ournation's health care resources. Physi­cians such as Dr. Dobson are reinforc­ing this importance.[]The Midway to Three-Mile IslandWith Stops in Nagasaki and Elsewhere• • • • • •Dr. Leonard A. Sagan ('55)I welcome the opportunity to write this article because it pro­vides a chance for me to reflect on my career of the pastthirty years, particularly as it bears on an issue that is, Ithink, of importance and concern to a substantial segment ofthe readership of Medicine on the Midway. It also gives me achance to catch up with classmates and other friends from theUniversity and to express some of the gratitude that I feeland will always feel for the alma mater.The issue of which I write is nuclear power - a technologyto which I have dedicated a major portion of my time andthought during these decades since leaving the Midway.Let me sketch for you the significant aspects of my cur­riculum vitae that relate to this unexpected interest­unexpected as much to me as it may appear to others.In 1961, after a routine residency in internal medicine at theUniversity of California, San Francisco, my wife Ginetta andI decided on a "last fling" before settling down to the rigorsof a clinical practice. I took a job with what was then called the Atomic Bomb Casualty Commission, later renamed theRadiation Effects Research Foundation (RERF). The namestogether are self-explanatory. We spent three lovely years inNagasaki living with our three sons in a wonderful houseoverlooking the historic jewel of a bay that had contained theonly foreign settlement in Japan before Admiral Perry's visitmore than a hundred years ago.What had begun as a lark - this detour to Japan­became a serious interest, an interest in the health effects ofradiation exposure. Not only were there important questionsabout health to be answered related to the peacetime nuclearindustry, but I also saw an opportunity to study the largerand more-encompassing question about what the impact ofthe environment was on human health. During my medicaltraining I had come to view medical therapy as playing a rela­tively minor role in determining either the length of life or thequality of life. There is no question of the occasional dramaticlifesaving surgical intervention, but generally it had becomeIIDr. Leonard Sagan ('55)my view that the importance of physicians in prolonging life,at least in the aggregate, was relatively weak compared withthe powerful effect of some environmental factors. A betterunderstanding of radiation effects might provide some usefulinsights into the mechanisms of other environmental agents.The best-known late or delayed effect of radiation amongexposed populations is, of course, cancer. There are, in fact,no other detectable effects among exposed persons.Leukemia is the type of cancer that will most probably occurafter radiation exposure, but the incidence of other solidtumors is also increased although to a lesser extent. Not allorgans are radiosensitive. In fact, no increase in the incidenceof tumors in brain, bone, and gastrointestinal tissue has beendemonstrated among those who survived atomic bombings al­though there have been instances of bone cancer in personswho paint watch dials with radium in whom radium has beendeposited almost exclusively in skeletal tissues.The question of risk, or a quantification of the probabilityof cancer induction per unit of exposure, is now receiving agreat deal of attention. We unequivocally have a better fix ondose-response relationships of radiation exposure and cancerthan we do for any other agent. The mathematical expressionis 104 per rad (radiation absorbed dose), but the studies ofJapanese survivors probably provide a more easily under­standable example for those, like myself, who do not intui­tively grasp scientific notation. Among the 100,000 personswho are being studied by RERF, the total exposure was12 about 2,000,000 person-rads, or on the average, about 20 radsper person, the equivalent of about 400 chest X-rays. Thetotal number of instances of cancer that can, so far, be attrib­uted to this exposure, is slightly more than 200. This meansthat thirty-five years after exposure, there are about 200 morecases of cancer than would have been expected in an unex­posed population of equal size. I think it is said that ninetypercent, or some such percentage of occurrences, is causedby environmental agents. But if a massive dose of radiationequal to about 400 chest X-rays produces cancer in only oneout of 500 people exposed, then we must be ignorant not tohave spotted the other carcinogenic agents that are supposedto be producing the 400,000 instances of cancer occurringeach year in the United States.Other than cancer, there are two significant effects of radia­tion among survivors of atomic bombings that deserve atten­tion: effects to the exposed unborn fetus and genetic effects.Children who were exposed in utero to heavy doses werefound to have an increased frequency of microcephaly andmental retardation. That is the reason why pregnant womenwho require therapeutic doses of radiation to the abdomenshould be offered abortion.The question of genetic effects of radiation is complex. In anutshell, no genetic effects of radiation have been identifiedamong the offspring of Japanese survivors or anyone else forthat matter. And the absence of effects is not the result of nothaving searched for such effects. Intensive efforts in the1950s would have demonstrated effects with a high degree ofprobability if radiation does produce effects such asstillbirths, congenital malformations, or diseases resulting inchildhood mortality. What these results must mean is eitherthat the mutagenic effects of radiation are weaker than thecarcinogenic effects or that we are unable to recognize thesubtle effects induced.In 1965 after returning from Japan and after another inter­lude at Harvard where I received a masters degree in publichealth, I spent three years at what was then the AtomicMany animal and plant tissues are sufficiently radioactive in their natu­ral states to expose photographic film. The radioautogram shows aspecies of fern growing in a region of Brazil where soil contains a highlevel of thorium. (Reprinted with permission of Dr. Sagan and the Elec­tric Power Research Institute, Palo Alto, Calif.)Energy Commission. The chief at that time was ChuckDunham, whom older alums may remember as a former Pro­fessor of Medicine. It was at the AEC (later ERDA and nowDOE) that I learned a good deal about radiation researchother than the Japanese experience, and also about some ofthe beneficial uses of radiation in nuclear medicine in produc­ing electric power. More about that further on.In 1968, being thirteen years out of medical school, Ithought I had dawdled and procrastinated long enough. It wastime to return to California and start what I had set out to doalmost 20 years earlier - become a practicing Bay Areaphysician, and that I did joining the Palo Alto Medical Clinic.Just as a reformed alcoholic does, I was determined to with­draw from my radiation interest "cold turkey." After Ithought that I was cured; maybe one little radiation confer­ence or journal article wouldn't hurt.The Nuclear DebateThere were plenty of incentives to return to myoid ways.In 1968, the nuclear power controversy was heating up. Con­cern was growing first about radiation released from routinereactor operations and then about complex questions such asthose posed by radioactive waste disposal, accidents, andweapons proliferation. What were the risks, I asked myself, and how could I apply my experience in Japan and Washing­ton to make quantitative estimates of these risks that mightprovide some realistic guidance to policymakers and otherswho were wondering whether the benefits of nuclear powerwould overcome the risks?To make those risks of nuclear power meaningful, whetherexpressed in terms of deaths or instances of cancer, it seemedto me, as it has to others, necessary to make some compari­sons. After all, all human activities are associated with somerisk. If we are to make some judgment as to whether nuclearrisks are acceptable or not there must be some standard ofacceptable risk. Since there is no explicit level of acceptablerisk, there must be some level of acceptable risk implicit inother technologies with which society has learned to coexist.Since various industries have different levels of inherent risk,the question was, With which industry should I make com­parisons? The industry on which I settled is the existent elec­tricity generating industry particularly as it uses coal as a fuel.Nuclear Risks vs. Risks of CoalExamining the risks inherent in the two competing fuel cy­cles and combining both occupational and public health risksfrom the two, I came to the conclusion, as have others, thatANNUAL RADIATION EXPOSURE TO U.S. POPULATIONDose Statistical ProjectionAverage Total Cancer Genetic(mrem) (person-rem) DefectSourceNatural background 100 21,700,000 3,050 193Technologically enhanced" 5 1,000,000 150 10Medical diagnostics 85 18,500,000 2,600 164Nuclear power (general public)?" 0.03 6,000 1 0.05Nuclear power (workers) 600 33,000 5 0.3Nuclear weapons (developmentand fallout) 6 1 ,400,000 200 13Consumer products 0.03 6,500 1 0.06EffectsTotal from all radiation sources 6,007 381Total from all causes, known andunknown 400,000 356,000Percent from all radiation sources 1.5% 0.1%Note: Calculations by Ralph Lapp, based on estimates of the BEIR committee."Mainly from naturally occurring radionuclides redistributed by human activities, such as miningand milling of phosphate and burning coal.''''Assuming normal operation, normal exposure. The radiation from the TMI accident (50-mileradius) was 1.5 mrem, 3,300 person-rem, expected to produce 1 cancer, 0.05 genetic defect.13With bandaged head resulting from burns suffered in the atomic bombexplosion at Nagasaki, Japan, a three-year-old girl plays in the ruins ofher home. (U.S. Army photograph, Sept. 29, 7945)nuclear energy seems to be safer than energy generated bycoal combustion. The reasons for the conclusion are fairlyclear. The sheer volume of fuel needed for the generatingplant that uses coal, approximately 10,000 tons per day, to­gether with all of the risks inherent in the mining and trans­portation of that volume, was associated with greater riskthan obtaining the considerably smaller volume of uraniumore and its milled yellowcake necessary to fuel a reactor. Theother factor in favor of nuclear energy is the considerably les­ser risk associated with the emissions released from nuclearplants than those released in the form of flue gases from coalcombustion. These comparisons satisfied me that nuclearpower was probably acceptable; that is, the risks were lessthan those of competing technologies that had been aroundfor a long time and were presumably a standard of acceptablerisk. Although these arguments satisfied me, they satisfied14 few others and fell on deaf ears of those who were of theantinuclear persuasion.Sagan Perceptions vs. Public PerceptionsWhat were the differences between my perceptions andthose of the unconvinced public? I think that the issue thatmost arouses concern is the question not of normal operationbut rather of accidents. I had not ignored the possibility ofsuch accidents in arriving at my conclusion, but had "aver­aged" the predicted effects of all degrees of accidents duringall years of reactor operation. My assumption had been thatwe treat "X" number of deaths alike, whether they occursingly as in auto accidents, or in clusters as in commercial airtravel. After all, in spite of the sensation associated with anairliner crash, most people are willing to concede that airtravel is safer than automobile travel. So why the difference?I think that there are two reasons for the differences in thepublic fear of reactor accidents as compared with othercauses of accidental injury. First, the public concept of reac­tor accidents, fueled by movies such as "The China Syn­drome," is grossly exaggerated. Studies show that the conse­quences of the worst reactor accident, such as would resultfrom melting of the core, are assumed by the majority of thepublic to produce widespread devastation and death. In fact,however, government studies show that the most probableoutcome of a melt-down is no radioactive release at all andno deaths. When one averages the most likely outcome withthe worst possible outcome, then the average number ofdeaths, both immediate and delayed, is 400, a number not fardifferent from the number of deaths that resulted from the re­cent DC-lO crash in Chicago and a much smaller number thanthat following the recent dam failure in India. Furthermore, interms of radiation exposure, the majority of the 400 deathswould occur years later with only a small number of im­mediate deaths resulting from the acute radiatio� syndrome.The estimates of the consequences of reactor melt-downsquoted in the foregoing paragraph are not, fortunately, basedon actual observations, but rather upon analysis of prob­abilities through a technique known as "fault-tree" analysis.Although there is an attempt to carry out such analyses in avaluefree mode, there are inevitable uncertainties in theanalysis that require resolution and judgments, and these maybe optimistic or pessimistic. Whether the judgments in thisanalysis (the Rasmussen report) were the former or the latteris a matter of some controversy and contention. The point isthat the numbers may be high or low; that is, actual riskshigher or lower than stated. The only fact that we know forsure is that no deaths at all have occurred to date as a resultof accidents involving commercial nuclear reactors.Secondly, comparisons of various accident scenarios andtheir public acceptance miss an essential difference betweencatastrophes such as air crashes and the consequences of anaccidental radioactivity release; namely that in the latter caseconsequences may be delayed. People can cope with suddendeath or injury, but not with the uncertainty associated withradiation exposure that may produce effects years or evendecades later. In even the worst accident scenarios, thedeaths from cancer years after exposure would not produce astatistically significant increase in the rate of cancer occur-renee, but the hovering threat nevertheless seems to be ter­rifying to many.Cost-Benefit AnalysisMore recently, a different approach to the evaluation ofnuclear power plant risks has been developing. The quantita­tive estimates alluded to in the paragraphs before have led totheir application to cost-benefit analyses, and it seems wortha brief pause here to comment on that use. The cost-benefitconcept relates to the view that human enterprise - whetherit be a family trip to the seashore or the development of asupersonic jet airplane, should provide benefits - as well asthey can be measured, that outweigh the costs, including thesocial costs, of the activity. The case can easily be made thatall of us in our daily lives are implicitly making suchanalyses. For example, shall I choose the 1948 Mouton­Rothschild or a nice little California zinfandel? Will the pleas­ure of a fine old vintage outweigh the considerably greatercost? Dignifying the process as an analysis, however, implies something more: it implies systematic comparisons in quan­titative terms, using a logical sequence of steps that can beverified (or challenged) by others.Proponents of this technique identify several advantages ofapproaching complex problems of technology in this manner.It forces all parties to identify and quantitate their concernsrather than react solely from an emotionally biased position.It permits the examination of expert testimony on the valueof various costs or benefits to be expected. The problemsgenerally arise on the cost side, the benefits usually beingmore apparent. Among the costs may be such "disbenefits"as risks to health, loss of aesthetic values, and annoyance dueto noise. Critics of cost-benefit analyses often charge that be­cause of these uncertainties, analysts can impose their ownvalue-laden conclusions on the analysis, weighing the uncer­tainties consciously or unconsciously.In any case, cost-benefit analyses do permit an approach tosuch questions as, How much radioactivity should a reactorbe designed to release? Or, put another way, How muchradiation exposure do we want? The question has within itModel of bronze sculpture entitled "NuclearEnergy" by Henry Moore. The sculpture locatedon Ellis Avenue between 56th and 57th Streetsmarks the spot where Enrico Fermi and 41other scientists achieved man's first controlled,self-sustaining nuclear chain reaction on De­cember 2, 1942.15the implicit assumption that at great enough cost reactorscould be designed to release decreasing amounts of emissionsas the "technological fix" is increased for the containment ofthe generated radioactivity within the reactor core. The catchis that the relationship between the expense of containmentand the reduction of emissions is not linear; that is, the in­cremental cost begins to rise rapidly after the initial bargainsare implemented. The problem is something like peeling apotato. As the determination of the cook increases toward·100% removal, more and more of the potato is lost for lessand less return in terms of the remaining skin. The sameprinciple applies in safety engineering. If zero release is un­tenable in economic terms, what level is acceptable? Cost­benefit analysis permits a rational approach to this question,but has only recently been introduced into regulatory decisionmaking. In fact, the amount of radiation exposure to personsliving near nuclear plants adds only a few percent to background exposure from natural sources.Three-Mile IslandWhat about Three-Mile Island? Doesn't that incident shakemy confidence? How can an irrepressible "pro-nuke" lookhimself in the face after that? Well, I never said that nuclearpower was absolutely safe and would never hurt anybody.What I said was that on the average, accidents included, nu­clear power was as safe as the alternatives and, in somecases, safer. That is still true. In spite of an enormousamount of equipment and plant damage, releases from theTMI accident were trivial, hurt no one, and there is only anextremely remote possibility that anyone will suffer any ef­fects later.Of course, some say that we do not need either nuclearpower or coal power, that we can depend on solar power al­though solar advocates are a bit fuzzy about exactly whatthey mean by solar power or about how quickly or at whatcost solar technologies can be introduced. Those are difficultquestions that are not addressed by bumper stickers.My own feeling is that, at least in the short run, we needall of the energy sources we can get - nuclear, fossil, andsolar fuels. Our society, heavily dependent on energy, hasmade remarkable progress in addressing problems of equityand justice. As I see it, that society and its institutions arefragile. The economic consequences that will surely follow anabrupt decline in energy sources could well threaten the sys­tem of social justice that we have achieved just as Hitlerarose from the economic chaos in Germany after World War1. This is the melt-down that I fear most.The significant issue here is pace. As new homes and fac­tories are built, energy-conservative measures reflecting thehigher price of energy will be instituted. To replace our capi­tal stock, however, requires more decades to reach equilib­rium with the new higher cost of energy. It is this interval ofadjustment that worries me. If the management of that transi­tion is inept or manipulated by those who inject a moral qual­ity into our economic system, our productive capacity couldbe seriously threatened. Our productivity is already in de­cline: the United States is now sixth in the world in terms ofannual rise in productivity trailing just behind Italy and barely16 a percentage point above last year's producti vi ty. In otherwords, we have almost reached the no-growth condition thatmany are prescribing for us. During this transitional period,as the aspirations of many are blunted, will there be tranquil­ity or will there be increased friction as more and more wantan increased share of a shrinking pie?Concluding CommentsDoes a discussion of nuclear power and energy supply be­long in a medical publication? I believe it does, and for tworeasons. First, as I hinted earlier, health, at least as measuredby death rates, is highly sensitive to industrialization and forreasons that have not yet been made clear. Not too long ago,I spent a sabbatical year in Austria studying the relationshipbetween economic development and health working with abiostatistician, Professor Afifi of UCLA. What we found wasa powerful relationship between energy consumption andhealth, but the relationship was not linear beyond middlestages of development. What that means to me is that healthis not likely to be affected by economic perturbations in theindustrialized countries, but that further improvements inhealth in the underdeveloped countries will strongly dependon continued access to energy supplies. After world petro­leum supplies run dry, then what? For countries that have nocoal, the only presently available energy source is uranium.With the United States dropping out as a nuclear supplier,who is going to provide leadership in that "international" nu­clear movement?The second reason that I find it appropriate for the prob­lems of energy, particularly nuclear energy, to be examined inthis publication is that the issues most widely discussed rela­tive to the acceptability of nuclear flower are health issues.Nuclear power plants release essentially no nonradioactivechemicals. Therefore, whether the issue is accidents or wastedisposal, the ultimate question is, What is the possible impactof nuclear energy on human health given radioactive emis­sion?Physicians should be knowledgeable about these issues andable to provide guidance to the public and to decision makers.There you have it, a sometimes rambling account of a fas­cinating and complex technopolitical issue, nuclear power,blending scientific observation with some personal views.Whether these views will prevail, only the future will tell.[]Dr. Sagan is manager of theBiomedical Studies Program inthe Environmental AssessmentDepartment of the EnergyAnalysis and Environment Divi­sion of the Electric Power Re­search Institute, Palo Alto,California.Above, Susan Tenabe and Edward D. Garber. Below, Tokumasa Nakamoto and Steven Singer. Seven undergraduate students in theUniversity's Collegiate Division of theBiological Sciences participated in orig­inal research during the Summer Quar­ter as the Edmondson Summer Re­search Fellows.The fellowship - a stipend of$750 - supported research proposedand generated by undergraduate stu­dents who met certain requirements.Funding for a significant portion of theprogram was made possible by Dr.Hugh A. Edmondson ('3 I) and Mrs.Dorothy M. Edmondson for whom thefellowship is named. Dr. Edmondson isa general pathologist and educatorwhose research showed there is a linkbetween benign tumors and oral con­traceptives and consequently opened upnew avenues of investigation of hor­mone effects on liver cell histology. Heis also a recipient of the UniversityAlumni Association's ProfessionalAchievement A ward for recognition ofattainments in his field.To be considered for the stipend astudent was required to have completedat least a one-quarter course study dur­ing 1978-1979 in Biological Sciences199 - a course in individually guidedresearch for students with no previouslaboratory experience; to submit a briefstatement about the intended research;and to have a faculty sponsor submit arecommendation supporting the applica­tion. Recipients of the fellowship wereSummer SupportforUndergraduates17required to prepare an abstract of theirsummer accomplishments at the end ofthe Summer Quarter.Chairman of the Undergraduate Re­search and Special Honors Committee,Gerson M. Rosenthal, was largely re­sponsible for selection of the fellows.He is also an Associate Professor ofBiology in the College.The 1979 Edmondson Summer Re­search Fellows are:• Kwi Y. Byun whose research cov­ered a problem in developmental biol­ogy. She studied the relationship of twodifferent processes of cell developmentin the chick retina: functional andstructural. Kwi's faculty sponsor wasMaika Moscona, Research Associate(Associate Professor) in the Departmentof Biology and Associate Professor andLecturer in the College and Committeeon Developmental Biology.• Elizabeth Ciezki who did researchon the neurochemical mechanisms thatare involved with the development oftolerance to different psychoactivedrugs, in particular amphetamine. Re­cent evidence linked tolerance to thedrug with an increase in the release of aneurotransmitter in the brain calleddopamine. She measured and comparedthe release of dopamine using an invitro technique in various rats treatedwith amphetamine and in control rats.Her faculty advisor was Lewis S.Seiden, Professor in the Departments ofPharmacological and Physiological Sci­ences and Psychiatry and the College.• Sookyung Chang who analyzed theDNA replication pattern in an abnormalchromosome. The abnormal chromo­some was actually a translocatedchromosome that has parts of two nor­mal chromosomes; one of them nor­mally replicates its DNA near the endof the cell cycle, the other replicatesearly. She wanted to determine if jux­taposition of these two pieces of DNAwould have an effect on the time ofreplication of ei ther one or whethertime of replication was autonomous foreach chromosome and that translocat-Clockwise from top left: Dr. Wade Hamiltonand Jeremy Paul; Elizabeth Ciezki and LewisS. Seiden; Edwin M. Taylor and Young KyuSon; Sookyung Chang and Rosann Farber;and at center, left, Kwi Y. 8yun and MaIkaMoscona.18ing them had no effect. Her faculty ad­visor was Rosann Farber, AssistantProfessor in the Department of Mi­crobiology and the Committee onGenetics.• Jeremy Paul who learned to pre­pare nerve growth factor, a protein thathas many important functions in thenervous system, especially the sym­pathetic nervous system, which has animportant effect on the heart. He pre­pared the factor from submaxillaryglands of male rats. The preparationwas then injected daily into newbornrats for a specified number of days,thereafter weekly and the effects of theprotein on the cardiovascular systemnoted. Jeremy's faculty sponsor wasDr. Wade T. Hamilton, Assistant Pro­fessor in the Department of Pediatrics.• Steven Singer who was interestedin protein synthesis. He studied thekinetic rates at which ribosomes bind toa certain site on RNA, which containsthe information for the protein struc­ture. He wanted to find exactly how theribosome recognized the starting orbinding point. His faculty sponsor wasTokumasa Nakamoto, Associate Pro­fessor in the Department of Biochemis­try, the Franklin McLean Institute, andthe College.• Young Kyu Son who did his workon muscle contraction. Young workedon smooth muscle, which is regulatedin a different way than striated muscle.He prepared heavy meromyosin, a sol­uable fragment of myosin and studiedthe effect of phosphorylation of thisprotein on its activation by actin.Young's faculty advisor was Edwin M.Taylor, Professor and Chairman of theDepartment of Biology and formerMaster of the Biological Sciences Col­legiate Division and Associate Dean ofthe College and the Division of theBiological Sciences and The PritzkerSchool of Medicine.• Susan Tenabe who did research onspontaneous and induced mitotic re­combination in diploid strains of Us­tilago vio/acea. Susan's faculty advisorwas Edward D. Garber, Professor inthe Department of Biology, the College,and Committees on Genetics and Evo­lutionary Biology, and the co-editor ofBotanical Gazette. []19IN.ALlAGOMicroevolutionary Populations:Bushmen and HottentotsThe Bushmen and the Hottentots are anatomically differentfrom all other populations.The Bushmen, also known as the San, and the Hottentots,the Khoikhoi, make up the African peoples call Khoisan.They share, to a large extent, a complex of physical charac­teristics that for centuries caused laymen to confuse onegroup with the other and encouraged much speculation abouttheir origins and kinship.Today, Dr. Ronald Singer, University of Chicago anatomistand anthropologist, continues to uncover new facts about thecharacteristics and interrelationships of these surviving primi­tive populations following significant investigations he con­ducted since the late 1950s in his former native homeland ofSouth Africa and in Namibia in South West Africa."My interest in the biology of the Hottentots and theBushmen," says Singer, "is derived from my general attemptto understand the origins of the indigenous populations of Af­rica, that is, the Hottentots, Bushmen, and Negroes ... tounderstand human adaptation at different times.""The San and the Khoikhoi peoples are, genetically atleast, part of the African Negro mosaic," he explains. "Wethink that on the basis of our genetic studies the Hottentots,Bushmen, and the Bantu-speaking Negroes of southern AfricaThought to be one of the first illustrations depicting the Hottentots pub­lished by Hans Burgkmair the Elder, an artist of Augsburg, in 1508. are microevolutionary populations derived from some com­mon ancestral group or groups about 50,000 years ago."To test this hypothesis Singer found a fossil-bearing site ofthe period. He and colleagues spent two years excavating theseries of caves and rock shelters at the Klasies River mouth,which is the largest Middle Stone Age site in Africa. Thecomplex of cave structures contains an enormous, uninter­rupted pile of bones, stones, and soil from civilizations thateventually attained a height of about 70 feet. One discoverywas that remains dating back 100,000 years not only seem tobelong to Homo sapiens but also show the characteristics ofpopulations that could have given rise to the. modern indige­nous populations such as the Khoisan and the Negroes.Singer also stresses understanding the biological structureof the Khoisan because they constitute living primitive humanpopulations. The Bushmen and the Hottentots - hunter­gatherers and nomadic pastoralists, respectively-"constitute the basic patterns of early man."Although the Bushmen are shorter and smaller in size thanthe Hottentots and display some serological differences, bothgroups are relatively light skinned (pale yellow to darkbrown), have sparse distribution of body hair, and are some­what flat-faced. The most outstanding physical characteris­tics, however, are manifested in the Khoisan women, namelyelongated labia minora (the "Hottentot apron") andsteatopygia.21Dr. Ronald Singer22 The Hottentot apron is an enlargement of the labia minora,the inner lip-shaped folds of a woman's external genitalia. Atpuberty, a significant number of Khoisan girls show an en­largement of the labia minora that starts to extend beyond theouter labia majora. They may grow to a length of about fourinches. They swell considerably during childbirth, then de­crease in size after about ten days but remain slightly longerthan they were before pregnancy.Singer thinks that this is a "genetic phenomenon acted onby unknown - probably endocrine - factors at puberty andexacerbated by childbirth."SteatopygiaSteatopygia is an accumulation of fat or fibro-fatty tissuethat is located high over the buttocks and projects shelflikefrom the lower back. It is a particularly noticeable featurewhen a woman is not generally obese."We know," Singer says, "that the condition has existedfor a long time because rock paintings found in South Africadepict the condition in ancient populations. The survival of apossible mutant for such a long period of time suggests that itwas advantageous to the bearer; if it were a disadvantage, itwould have disappeared." One of the paintings is on the wallof a cave at Tylden in Cape Province, and is many centuriesand perhaps thousands of years old.Steatopygia was recorded as early as the 16th century bytravelers in Africa and it has been noted and theorized aboutsince the latter part of the 18th century.Why do the Khoisan women have this characteristic?Singer admits we simply don't know. But his findings and ex­planations of why the condition exists are constantly beingcorrelated with data obtained from the study of these popula­tions. He has considered many explanations for the charac­teristic, such as sexual selection, food availability, age, andresults from X-ray and fat chemistry studies.FindingsIn the past, investigators suggested that' 'the large buttocksmay be part of the Bushman woman's glamorous attraction,and that sexual selection maintained the phenomenon in thepopulation. "Singer thinks it is doubtful that sexual selection playedsuch a dominant role. "Our careful investigations failed to lo­cate a preference by Bushmen and Hottentot males forsteatopygous females," says Singer."The important biological consideration is its mode of ori­gin and physiological significance, rather than its mode ofmaintenance," he says.Singer contends that its persistence during hundreds andprobably thousands of years indicates an advantage of naturalselection to the possessor. But he admits the mode of inheri­tance is not yet clear. "Steatopygia, such a marked physicalcharacteristic, disappears in a few generations after admixturebetween whites and Hottentots, as observed in the resultantCape-Colored populations," notes Singer.Typically, most of a person's body surface has an underly­ing layer of fat to serve as protection from injury, as insula­tion to cold and heat, and as a caloric reserve. X-ray studiesdone by Singer of steatopygous Khoisan women confirm histheory that, in addition to this layer, their fat is lumped moreabove the base of the spine at the sacrum than below the but­tocks. In other populations, fat deposits are located above thehip bones at the sides of the waist, and in the fold below thebuttocks where it meets the thigh, but not above the sacrumand the upper part of the buttocks.Steatopygia is rarely seen in Khoisan girls before puberty.After that, it gradually becomes more and more prominent. Itis more obvious in older women, and it is interesting to note"that there is a higher incidence of steatopygia in post­menopausal Khoikhoi women than in women in their 30s and40s." This suggests that women with steatopygia live longerthan those without it.Singer suggests that in simple societies uncomplicated byurban stress and high technology, fat plays a role in survivalrather than being a contributing factor to early death as in ourcomplex highly competitive Westernized societies.Among the Hottentot women, a large bottom is thought tobe a sign of good health.It has been suggested that the degree of fat accumulationover the buttocks of Khoisan women is directly related to theavailability of food: the buttocks develop largely during peri­ods of plenty and diminish rapidly during lean ones. Singersays that controlled experiments are necessary to corroboratethis theory. "Nevertheless," he explains, "we observed thatwhen women lose weight rapidly, as in tuberculosis, thesteatopygous deposit is the last to go."Singer says that a theory was outlined at the turn of thecentury about steatopygia that survived in many generationsof textbooks. It suggested that statuettes such as the Venusof Willendorf found in diggings of Stone Age cultures in partsof Europe resembled steatopygous Bushmen women. The ap­parent similarities of some European fossil remains toBushmen skeletons led to the hypothesis of a EuropeanCro-Magnon origin of the African Bushmen. "Irrespective ofthe arguments against the validity of this theory," saysSinger, "the figurines are not steatopygous, but just generallyhyperobese women."In the past, investigators thought that an abnormal forwardcurvature of the lumbar spine, called lordosis, was associatedwith the pronounced projection of the buttocks in steatopy­gous women. However, X-ray studies of these women show alack of such a pronounced curvature. In fact, in a controlstudy of 200 patients done at Billings Hospital, the lumbarcurvature of the Hottentot spine was less than that of thecontrol group.Singer observed two positions of rest that are adopted fromearly childhood by the Bushmen, Hottentots, and many tribalNegroes. One is squatting on the haunches with tightly flexedthighs and knees with the bottom just off the ground; a posi­tion that can be maintained for long periods seemingly with­out effort. The other Singer refers to as "the Africanphysiological stance ... in which the knees and hips are al­most hyperextended so that the belly appears protuberant."Compensatory positioning of the trunk produces the effect ofaccentuated lumbar curvature, which, when associated withsteatopygia, was easily mistaken for lordosis.Singer's studies on the chemical composition of thesteatopygous deposit show that in premenopausal and post­menopausal women there was no difference in any majorfatty acids, suggesting that estrogens do not influence the de- Rock painting showing steatopygous women on cave wall at Tylden atCape Province, South Africa.23Bushman woman showing extent of steatopygia. Notice the peppercorndistribution of her hair and her small, flat face.posit. But between Khoisan men and women, there are statis­tically significant differences in fatty acid composition of thebuttock region. However, these differences are also similar inpopulations without steatopygia.Singer contends that this seems to disprove the view thatsteatopygia results from a greater metabolic turnover in thewomen. If such a turnover exists, then it would be expectedthat male-female differences in a population such as theKhoisan would be greater than in peoples lacking the charac­teristic. But if steatopygia does not represent a greatermetabolic turnover, then the deposit may not be entirelyfat but may consist of a good amount of fibrous connectivetissue.Another theory to be substantiated that is held by some in­vestigators about steatopygia is that it is correlated with cli­mate and hibernation or dormancy during the summer or dryseason. It has also been suggested that the single large fat de­posit allows women to control heat loss more effectivelyunder physiological stress such as in pregnancy.24 Khoisan person squatting on haunches with tightly flexed knees andthighs.State of the ArtToday there are about 50,000 Bushmen. As a population,they have remained isolated and have a strong "clan" cul­ture. They seldom marry outsiders, whereas Hottentots areexogamous. There are only about 10,000 to 15,000 trueHottentots - those who speak the Hottentot language andwhose parents and grandparents speak the language.Bushmen and Hottentots speak "click" languages, a uniquecultural phenomenon. "The Negroes speak Bantu," reportsSinger, "and that is the major language of the whole ofsouthern Africa."Singer would like to do endocrine studies and variousbioassays that require only a small amount of blood or tissue.However, political problems in Namibia prevent his conduct­ing further adequate studies in the near future.Singer believes that the biology of these modern popula­tions is tied intimately to the data obtained from careful, con­trolled excavations of those sites occupied during the last100,000 years. The extrapolation of such data will enable himto eventually piece together the evolutionary patterns andorigins of the Khoisan and Negro populations.[]Dr. Ronald Singer is the Robert R. Bensley Professor in Biol­ogy and Medical Sciences in the Departments of Anatomyand Anthropology, the Committees on Evolutionary Biology,Genetics, and African Studies, and in the College. His re­search was supported by grants from the United States Pub­lic Health Service; the National Science Foundation; theWenner-Gren Foundation for Anthropological Research; theBoise Fund of Oxford University; and the Abbott and BlockFunds at the University of Chicago.Focus on Reproductive EndocrinologyDr. George B. Maroulis is Associate Professor andChief of the Section of Reproductive Endocrinologyand Infertility of the Department of Obstetrics andGynecology. He became Chief of the Section in July1979 and was interviewed thereafter by the editor ofMedicine on the Midway (MOM).An Interviewwith Dr. George B. MaroulisMOM: Dr. Maroulis, the Department of Obstetrics andGynecology became active in May 1931. When did the Sec­tion of Reproductive Endocrinology and Infertility become apart of it?MAROULIS: Under the chairmanship of Dr. Frederick Zus­pan, the Section of Reproductive Endocrinology and Infertil­ity became active in the Department in 1965.MOM: How many faculty make up the Section?MAROULIS: In addition to myself, there are two other full­time faculty members in the Section: Dr. Richard Hatch andDr. John S. Holt - both of whom were full-time facultywhen I joined the Section.As a team we work closely with faculty in the Section ofReproductive Biology of which Dr. Gebhard F. B.Schumacher is the Chief.25MOM: I understand that you are interested in the concept ofreproductive medicine. Could you explain what that conceptinvolves?MAROULlS: In terms of the concept, we are primarily in­terested in those functions that have either a direct or indirecteffect on reproduction. The concept encompasses expertise inunderstanding the mechanism of the reproductive organs,such as the ovaries, the Fallopian tubes, and the uterus, andhow they interrelate to other parts of the body especially thepituitary gland, hypothalamus, adrenal gland, thyroid, andcentral nervous system.In our section we see many patients who are infertile. Wehave the means to evaluate and treat most aspects of infertil­ity for both women and men with the exception of in vitrofertilization, that is, test-tube fertilization.We are also interested in taking care of patients who haveother gynecologic problems as well as irregular menstrual cy­cles, hirsutism, and precocious puberty.We have extensive laboratory back-up for the evaluationand treatment of these problems.MOM: What are the research interests of you and your col­leagues?MAROULlS: My main interest is in the relationship of andro­gens, such as testosterone or androsterone (male hormones),to infertility and reproduction. In addition I am interested inthe role of the endometrium in infertility.Dr. Hatch is working on identification of a hormone thatmay be related to the function of the pituitary gland, whichmay originate in the ovaries. He is attempting to identify itsexact nature and mechanism.Dr. Holt, who is the Director of the Department's Endo­crinology Laboratory, is interested in the function of the cor­pus luteum, which is the part of the ovary that develops afterovulation, as well as the role of various estrogen and proges­terone receptors reported to be present in gynecologic cancer.MOM: Do you plan any changes in procedure for handlingpatients with infertility or reproductive problems who cometo the clinics?MAROULlS: My main concern is for the patient to feel com­fortable when she or he comes to the hospitals and clinics fortreatment. We are attempting to create the environment ofindividualized care that a patient would receive in the officeof any physician in private practice. I think it is important to26 have an environment that is soothing because treating infertil­ity can be a long process and patience is important. I don'twant the patient to become frustrated with the more hecticaspects of clinical practice. The patient will get private care,yet the care will encompass the benefits of consultations andknowledge of other physicians in the Medical Center as thepatient's condition requires them.To accomplish this we are converting a part of theMother's Aid Research Pavilion to private offices.MOM: Do you think that the University is a leader in imple­menting change in the field of reproductive endocrinology?MAROULlS: Yes. We probably have more to offer here thananybody or any institution in the city. We have people in­volved in every aspect of endocrinology who are nationallyand internationally known. To develop the concept of repro­ductive medicine more fully so it would incorporate variousdisciplines into the practice of obstetrics and gynecologywould be something very worthwhile. This is the highest ofmy priorities, my goal.MOM: Have you done extensive planning to get the privatepatient service and research programs under way since July?MAROULlS: Yes. I have been involved in asimilar practicesituation in another hospital and I can see many possibilitiesfor growth and expansion of services, I bring that experiencewith me. Some of these services are already developing.MOM: Do you get many referrals?MAROULlS: All the persons who come here for the treat­ment of infertility do so as referral patients. Every patientwho comes to the medical center for infertility and reproduc­tive medicine will be my private patient. I will attend to thempersonally and keep the referring doctor constantly apprisedof the patient's condition and progress.MOM: How have you found being Chief of the Section thusfar?MAROULIS: We have had excellent support from the medicalcenter. I remain enthusiastic about the Section developinginto a more encompassing unit as it is the core of the de­velopment of the reproductive medicine concept within theUniversity. I look forward to taking advantage of the pos­sibilities for growth during the next few years.[]We know what we arebut not what we may. be.-ShakespeareName Graduation YearHome address TelephoneCity, State, ZipBusiness address TelephoneCity, State, ZipTitleN ew address?New position?N ew medical practice?military assignment?civic or professional honor?book?Please tear out; fold, staple or tape; and drop in the mail box.Thanks!1-----'11 Place 11 Stamp 11 11 Here 11 1Medical Alumni Association1025 East 57th StreetChicago, IL 60637Fold this flap in firstNews BriefsMore Brain Synapses inInfancy May ExplainRecoveryUsing a special electron microscopymethod, a University of Chicagopediatric neurologist has found that theyoung child has a more complex set ofcortical brain cell synapses than menand women possess at any time in laterlife.Research by Dr. Peter Huttenlocherreveals that infants aged one to twohave about 50 percent more synapsesper cubic millimeter of cortical braintissue than adults. This apparentsuperfluity of synapses may helpexplain why immature brains some­times recover more completely from in­jury, says Dr. Huttenlocher."For example," comments Hutten­locher, "if a child has a severe injuryto the speech areas of the brain, thechild will recover his speech within afew days. An adult with an identical in­jury will remain permanently aphasic orspeechless. "Previously, it had been thought thatbrain synapses increased with age. ButHuttenlocher's study on human braincells has revealed that we all start out"brainier" than adults."This initial overproduction of thesynapses may be an anatomic basis forwhat we call plasticity," he says. "Ifthe brain has an excess of interconnec­tions at the time of injury, brain signalscan be rerouted."Other evidence of plasticity in thedeveloping child is the fact that chil­dren can readily learn to speak secondlanguages without an accent, but adultscannot, says Huttenlocher.As we grow beyond infancy, the tinyprojections (dendrites and axons) fromnerve cells (neurons) form functioningdendrite-axon interconnections (synap­ses). Those synapses that are notneeded may ultimately atrophy and dis­appear.Huttenlocher, in performing a post­mortem analysis of frontal cortex cellsfrom 21 human brains, discovered:- synaptic density in newborn in- fants was high, "in the range seen inadults," Huttenlocher reported in a re­cent issue of Brain Research (Amster­dam);- synaptic density increased duringinfancy, reaching a maximum about 50percent above the adult mean at ageone to two years;- synaptic density declined betweenages 2 and 16;- synaptic density was constantthroughout adult life, from age 16 to72 years. There was a slight decline inthe brains of those aged 74 to 90 years.The purpose of the research was to es­tablish normal ranges from brain cellsynapses at various ages to comparethem with synaptic density counts inabnormal brain conditions.Direct study of synapses has beenhampered by lack of methods thatallow rapid accumulation of results andby lack of data on normal counts. Al­though extensive studies of synapsedevelopment in animals have been per­formed, this is the first extensive studyof normal human synapses at all ages.Recent postmortem studies of thefine structural organization of the cere­bral cortex in the retarded have showna variety of abnormalities. "In some ofthem, there is less branching of thedendrites, or there may be a persis­tence of superfluous synapses thatnormally disappear during develop­ment," says Huttenlocher. "There maybe abnormally shaped dendrites."Huttenlocher applied an electron mi­croscope method for examining spe­cially stained tissue from the middlefrontal gyrus area of the brain. Thestain that he employed selectivelyhighlights only synaptic profiles. Pre­pared sections were randomly exam­ined and photographed under the mi­croscope. Twenty to thirty photomic­rographs were made of each sample. Amean synapse count per cubic millime­ter was calculated for each sample.Although the infants had moresynapses, the immature synaptic pro­files were clearly distinguishable fromthe adults. "Separation of the densepresynaptic projections into well­defined polygonal shapes was not yet evident," says Huttenlocher. "Synap­ses gradually took on adult morphologiccharacteristics between ages 6 and 24months."[JInsulin, Glucagon ReduceHepatitis MortalityUniversity of Chicago scientists havereduced mortality in patients with acutealcoholic hepatitis by carefully con­trolled infusions of insulin and gluca­gon. Whereas 25 to 30 percent of suchpatients usually die, according to Dr.Alfred L. Baker, only 12 percent werefatalities in the treated group at theUniversity of Chicago.This is the first known double-blindtest of the treatment in humans any­where in the world.Three of 25 patients receiving theinsulin-glucagon treatment died, com­pared with 6 of 25 who received noinsulin-glucagon treatment, according toBaker, Assistant Professor of Medicineand Director of the Liver Study Unit atthe University.In the most severely ill patients, thedifference in mortality was evengreater: I of 9 in the insulin-glucagontreatment group died, compared with 5of 12 in the control group.Baker said it would be necessary totreat many more patients before reach­ing final conclusions, but "there is atrend toward reduced mortality andmore rapid improvement in patientstreated with insulin and glucagon."If this proves to be a worthwhiletreatment, it may allow liver healingand regeneration. The effects probablywon't be prolonged over months andyears, unless the patient ceases al­coholic consumption."The usual treatment for alcoholichepatitis is hospitalization with controlof infection and internal bleeding. Thepatient is sustained to recover on his orher own.29News BriefsScientists have long known that ananimal whose liver has been deprivedof its normal blood drainage via theportal vein will suffer liver damage,says Baker. Portal vein blood firstdrains from the pancreas, which syn­thesizes insulin and glucagon.While everyone agrees that alcoholabuse triggers the problem, Bakerthinks it may also follow severe neglectof adequate nutrition by the heavydrinker. "We also have carried out astudy of patients who have had ilealbypasses for extreme obesity," hecomments. "These patients developeda kind of liver injury that is identical toalcoholic hepatitis and cirrhosis duringthe period of rapid weight loss. So theanalogy is hard to escape."Baker notes that in animal studies,alcohol induces malabsorption of manyvitamins, proteins, and fat. "It mightbe a failure to absorb some specificnutrient that leads to the disease," hecomments.Patients in the study received bloodbilirubin tests plus so-called trans­aminase blood tests and a new, experi­mental aminopyrine breath test thatthe University's Liver Study Group isstudying. The latter measures theliver's ability to metabolize drugs bymonitoring the carbon dioxide contentof the breath. The insulin-glucagongroup registered improved liver func­tion on these tests.The patients spent 30 days each inthe Medical Center's General ClinicalResearch Center. The insulin-glucagoninfusions were given in a dextrose solu­tion every 12 hours. "Control" (non­treated) patients received dextrose solu­tion only.Dr. Baker's associates in the studywere Drs. Glenn Hatfield and NormanHaines of the Liver Study Unit, Drs.John Jaspan and Arthur Rubenstein ofthe Section of Endocrinology and Dr.John Schneider of the Section of Gen­eral Internal Medicine, all in the De­partment of Medicine.The study was funded, in part, by theMargaret E. Fairbairn Trust Fund and,in part, by a Clinical Research CenterGrant.[]30 Surgery Technique DoublesColon-Rectal CancerSurvivalA new University of Chicago surgicalprocedure has doubled the number ofpatients with operable colon and rectalcancer who are alive after five years.Eighty percent of all such patientsare alive at the University of Chicagovs. a national average of 40 percent.The current national survival rate for"stage C" cases, in which the cancerhas completely penetrated the bowelwall and begun to invade nearby lymphnodes and organs is about 35 percent,while the survival rate at the Universityis almost 70 percent, say Drs. GeorgeBlock and Warren Enker.The procedure, introduced in the mid1960s by Block, Professor of Surgery,involves removing not only the affectedand nearby areas of the rectum orcolon but all the lymph nodes that drainfrom them.Block and Enker consider the usualoperation for colon cancer to be toolimited. "If someone really has locallymph node disease, it wouldn't be en­compassed," says Dr. Enker. "The pa­tient wouldn't have a very good futureoutlook. "Typically, Drs. Block and Enker re­move about a third of the colon plus allthe lymph nodes that drain from theremoved colon section."It's a big operation," commentsBlock. "It isn't just removing the rec­tum. It isn't as simple as removal of atube of bowel. It is removal of all theanatomy that pertains to that area. It'sa major undertaking. It's a lot of work,a lot of travail, and you can't be theoccasional surgeon who does this,either. "Block's extended procedure requiresonly one more unit of blood than thestandard operation. The operativemortality is I to 2 percent, same as forthe standard operation says Enker, As­sociate Professor of Surgery.About eight of ten rectal and coloncancers are operable. The extended op­eration may be inadvisable for persons with severe heart disease or strokesymptoms. "If a male patient has rectalcancer with a radical pelvic dissection,he will be impotent," says Block.Colon cancer affects all ages, but pa­tients aged 50 to 70 are the dominantpatient group. Blacks and whites havean equally good prognosis. Womenhave a slightly higher survival rate."Patients with ulcerative colitis andpolyps have a somewhat greater ten­dency to colon cancer," says Enker.About 100,000 new cases of colon orrectal cancer occur in the United Stateseach year.[]"Vitreous Nibbler"Saves EyesightWhen Anna was admitted to BillingsHospital she was nearly blind in oneeye. Her vision was so clouded by aninfected vitreous that she could recog­nize only hand motions. Unskilled orcareless surgery in such cases can oftenimpair or destroy sight in the affectedeye.Yet, a University of Chicago eyesurgeon, without removing the lens orinjuring her eyesight, used a newly de­veloped operating device, aptly called a"vi treous nibbler," to remove aclouded, diseased vitreous humor, thejellylike substance inside the eyeball.Today, Anna's vision is close to20/20.Dr. Ramesh Tripathi inserted a nee­dlelike vitreous cutter and suction de­vice through the pars plana, a sectionsurrounding the vitreous in which rela­tively few blood vessels are present.He inserted another hollow, light-tippedinstrument into the eye from anotherlocation on the pars plana.Using a microscope, Tripathi, Profes­sor of Ophthalmology, watched theprogress of the surgery through the pa­tient's cornea and lens. He used thevitreous cutter to cut out tiny cylindri­cal portions of the vitreous and suckthem from the eye. While maintaining asteady fluid pressure inside the eyeball,he irrigated the eye with an antibioticsolution.The technique was a delicate proce­dure with grave risk and little room forerror. "The surgeon is operating withina depth of about one centimeter,"commented Tripathi. "If he goes invery deep, he can cut the retina. If hehits the lens, he can cause a cataract."Anna was a drug user. She had in­jected heroin into her left carotid ar­tery, one of two arteries on each sideof the neck which supply fresh blood tothe brain and eyes. The needle sheused was infected and germs lodged inher left eyeball. The vitreous becameclouded with pus.Laboratory examination of the puswhile Anna was in the operating roomhad revealed white blood cells andclumps of "staph" -like germs, and Dr.Tripathi had immediately proceeded tooperate to remove the infected vitre­ous.The germs infecting her eye werelater identified by culture asStaphylococcus epidermidis andH erellea. These germs normally arerelatively harmless, but can cause in­flammation and pus in sterile regions ofthe body, such as inside the eye.Under further treatment, Anna's vi­sion eventually cleared, and she wasdischarged from the Medical Center, with almost normal vision in the in­fected eye.Infections from drug injection intoblood vessels are extensively describedin medical literature. Bacterial infectionof an eye from such injections, how­ever, is rare. Infection has usually beenlimited to fungal invasion.Actually, you don't have to be a drugabuser to get an infected vitreoushumor, says Tripathi. A strep throatthat spreads to your heart will do, hesays. If germs from a strep-infectedheart break loose, they can travel any­where in your body. "A prompt recog­nition of the infecting organism andspecific institution of medical and sur­gical treatment is the key to saving theeye and the sight," comments Dr.Tripathi.[)Eye Researchlabs DedicatedA major new facility for research ondiseases of the eye was dedicated at theUniversity of Chicago Medical CenterSeptember 14.The Eye Research Laboratories lo­cated at 939 East 57th Street are ex­pected to become the central facility forresearch by faculty members of the Department of Ophthalmology at theUniversity.The facility includes special laborato­ries for measuring color vision, darkadaptation, electrical currents in theeye, and other physiologic functions ofthe eye. Two electron microscopes areinstalled in specially built quarters onthe building's second floor. The thirdfloor houses a computer that is used inthe diagnosis of eye disorders. Admin­istrative offices, a photographic dark­room, a machine shop, and an electricalshop are also located in the new facil­ity.The Eye Research Laboratoriesbuilding was constructed in 1947 andformerly served as the University'SExperimental Biology Building. Thebuilding was completely renovated andremodeled to provide needed facilitiesfor the Department of Ophthalmology.Ophthalmology was a Section of theDepartment of Surgery when the Uni­versity'S medical school was .estab­lished in 1927. Dr. Frank Newell wasnamed head of the section in 1953, andin 1970 Ophthalmology became a sepa­rate department. Dr. Newell, Chairmanof the Department, is the James andAnna Raymond Professor of Ophthal­mology.Funding for the Eye Research Labo­ratories was made available by analumnus of the University.[]In MemoriamAlumni Deaths, 17. James E. Lebensohn, Chicago,Illinois, died July 31, 1979, age 86.'20. Lindon Seed, Oak Park, Illinois,died March 3, 1979, age 82.'21. Rollin H. Moser, Belleair Beach,Florida, died June 26, 1979, age 84.'21. Paul Stappenbeck, Lake Juna­luska, North Carolina, died March 23,1973, age unknown. '23. Raymond Green, Chicago, Illi­nois, died March 10, 1979, age un­known.'26. Reno W. Backus, Cloquet, Min­nesota, July 25, 1979, age 78.'26. James R. Daly, Gainesville,Florida, died February 25, 1979, age 82.'32. Beulah C. Bosselman , Evanston,Illinois, died June 6, 1979, age 82.'32. Irene C. Sherman, Oak Park, Il­linois, died August 23, 1979, age 84.'34. Carl A. Gustafson, Youngstown,Ohio, died April 11, 1977, age 84.'37. Maurice C. Rudens, Montebello,California, died February 24, 1979, age65. '38. Alvin J. Carlson, Seattle, Wash­ington, died January 13, 1979, age 67.'42. Gerald A. Fostvedt, Claremont,California, died November 24, 1978,age 66.'43. Arthur M. Gray, San Antonio,Texas, died August 16, 1979, age 58.'74. Amy Hamburg Brown, Seattle,Washington, died September 21, 1977,age 30.Division Alumni Deaths'33 Ph.D. Paul E. Steiner, (Pathol­ogy, Faculty '34-'58), died October 24,1978, age 76, Lima, Ohio.31DepartmentalNewsAnatomyDr. Ronald Singer, the Robert R.Bensley Professor in the Departmentsof Anatomy and Anthropology, pres­ented a paper' 'Growth of Body Heightand Skeletal Maturation in HottentotChildren" at the Fourth InternationalSymposium on the Morphological Sci­ences in Toledo, Aug. 1 to 4. He alsochaired the session on Developmentand Growth during the symposium.Recently, Dr. Singer was appointedChairman of the Subcommittee on An­thropology and Primatology of the In­ternational Anatomical NomenclatureCommittee.AnesthesiologyAppointments:Dr. Shobhana Patodia - InstructorDr. Krishnaswami Rangachari­Instructor/TraineeBiochemistryAppointment:Robert O. Poyton, Ph.D. - Asso­ciate ProfessorEmergency MedicineAppointment:Dr. Kenneth G. Kreye - InstructorMedicineAppointments:Dr. Andrew Blei - InstructorDr. Gary L. Robertson - ProfessorObstetrics and GynecologyAppointments:Dr. Zvi Binor - Assistant ProfessorDr. Richard Blake - InstructorDr. George A. Johnston - InstructorOphthalmologyThe Department of Ophthalmology ded­icated new Eye Research Laboratorieson September 14 and 15. The laborato­ries will provide 17,000 square feet of32 research space for the department. Thetwo-day dedication included a scientificprogram, reception, and a dinner.PathologyDr. Robert W. Wissler ('48), the DonaldN. Pritzker Distinguished Service Pro­fessor of Pathology and the Director ofthe Specialized Center of Research(SCOR) in Atherosclerosis, was re­cently selected as the recipient of the1979 American Medical Association'sJoseph B. Goldberger Award in HumanNutrition.The award is given to physicians whohave contributed to the knowledge ofclinical nutrition in public and personalhealth.Also as director of SCOR-A, Dr.Wissler recently presented a paper"The Interaction of Arterial SmoothMuscle Cells with Lipoproteins" at theErwin-Rirsch Symposium on thePathophysiology of the VascularSmooth Muscle at the Tiibingen Insti­tute of Physiology, Eberhard-KarlsUniversity, Federal Republic of Ger­many.\Dr. Robert W. WisslerPediatricsAppointments:Dr. Alma E. Buckner-Chandler­Assistant ProfessorDr. Fred Leffert - Assistant Profes­sor (La Rabida) Pharmacological andPhysiological SciencesAppointment:Dr. Michael R. O'Shea - AssistantProfessorPsychiatryAppointment:Dr. Kenneth Rivers - Assistant Pro­fessorRadiologyAppointments:Dr. John V. Courtney - InstructorDr. Joseph P. Gouveia - InstructorDr. Ann Kieran - InstructorDr. Alan C. Williams - InstructorDr. jonathan M. RubinDr. Jonathan M. Rubin ('74, Ph.D.'77), Assistant Professor in the De­partment of Radiology, was named theBen Horwich Scholar of Medical Sci­ences for his research in radiology, byRobert B. Uretz, Vice-President for theMedical Center and Dean of the Divi­sion of Biological Sciences and ThePritzker School of Medicine. Dr. Rubinis honored for his work in three­dimensional X-ray images. Using com­puterized scanners, he developed amethod of how to combine severalX-ray images on the same screen. TheBen Horwich Fund was established in1975 by the family of Ben Horwich tosupport medical research at the Univer­sity.Alumni News1934John H. Darst has retired and movedfrom Greeley, Colorado, to Sun City,Arizona.1954Robert L. Peters, pathologist at theUniversity of Southern California andthe USC Liver Unit at Rancho LosAmigos Hospital, writes that a newlaboratory building exclusively for thestudy and treatment of liver diseases isopening at the USC liver unit - theculmination of twenty years of effortand political and county battles. This isthe final step of their liver diseasehospital at USC. With Dr. Hugh Ed­mondson, he is putting together thenext AFIP fascicle on liver tumors.1956s. Walter Kran of San Leandro,California, was named a Fellow of theAmerican College of Radiology at itsannual meeting and convocation inChicago, Sept. 19. Dr. Kran is affiliatedwith Doctors Hospital of San Leandroand Laurel Grove Hospital in CastroValley.1957David R. Duffell has been chief of thedepartment of pathology at NorthwestCommunity Hospital in ArlingtonHeights, Illinois, since 1973.1960Robert I. Kohut has been appointedprofessor and chief of the section ofotolaryngology at Bowman Gray Schoolof Medicine of Wake Forest Universityin Winston-Salem, North Carolina. Dr.Kohut was professor and chief of thedivision of otolaryngology at the Uni- versity of California - Irvine for thepast seven years. He is president-electof the Society of University Otolaryn­gologists and a member of the Board ofDirectors of the American Board ofOtolaryngology.1966Joan Zajtchuk has been promoted toColonel. She is stationed at the WalterReed Army Medical Center in its ENTsection. 1967Nicholas J. Lenn has been appointedassociate professor of neurology andpediatrics and head of the division ofpediatric neurology at the University ofVirginia at Charlottesville. He spent thepast five years at the University ofCalifornia at Davis, where he was di­rector of the Sacramento/Davis Tay­Sachs Disease Prevention Program.While at Davis, he received one ofthree outstanding teaching awards fromthe 1978 medical school graduatingclass. In his new position he will con­tinue his research on the developmentand plasticity of synapses.AN ALUMNUS TALKS ABOUT HIS ESTATE PLANDr. Benjamin H. Hager is a retiredurologist living in Southern California.He received both his undergraduate andmedical degrees from the University ofChicago.X'he latter in 1917. Prior to hisretirement, Dr. Hager was associatedwith the University of SouthernCalifornia School of Medicine. In addi­tion to membership in a number of pro­fessional societies, he also served as amedical and scientific advisor to amajor philanthropic foundation.Dr. Hager comments on his EstatePlan:It had long been my desire to have incomeavailable for my family, to honor my friendsand former professors, A. P. Mathews andA. J. Carlson, and to provide a fund foryoung faculty and promising new medicalresearch at the University. This desire hasbecome a reality through the coordinated ef­forts of University specialists, my lawyer,and myself with attention to financial, es­tate, and tax considerations.The flexible funding provided by theHager Fund is now, I am told, very impor­tant in seeking new, promising young facultyand in supporting their early projects. Wewho attended the University profited fromour education which was in a large part sup­ported by others who had established fundsor provided for endowment. To continuethis legacy and to learn yearly of thosewhose work is made possible by the Hager Dr. Benjamin H. Hager ('17)Fund is gratifying. This is particularly truewhen I also know my wife and family areprovided for. Goals such as these can beachieved through careful planning. Each ofus can choose the best methods to accom­plish them, but I earnestly hope that more ofus will.For further information, contact theOffice of Gift and Estate Planning,5801 Ellis Avenue, Chicago, lL 60637.Phone: (312) 753-4930.331972Golder Wilson is beginning his thirdyear as assistant professor in the sec­tion of pediatric genetics at the Univer­sity of Michigan.1973Maj. Robert David Toon is stationed atthe Nuremberg Army Hospital, or­thopedic section.1976Elizabeth R. Hirsh has moved to Sandy,Utah, from Salt Lake City, where sheis a unit psychiatrist at a family re­source and counseling service.Audrey Kavka is a private prac­titioner in psychiatry and a part-timestaff member in psychiatric emergencyservices at San Francisco General Hos­pital.1977Steven Fox is one of two medical peopleamong 25 advanced trainees chosen bythe National Academy of Sciences toparticipate in the first year of the Na­tional Educational Exchange betweenthe United States and China. Dr. Foxwill be affiliated with the Peking Medi­cal College for one year.Former StaffDoris M. Hunter (Medicine, intern, '51)retired in June as director of thePittsburgh Psychoanalytic Institute. Ata party honoring the occasion, Char­lotte G. Babcock (M.D. '38) gave thetoast to her colleague, student, andfriend.Herbert S. Ripley (Medicine, intern,'33 - '34) is president of the AmericanCollege of Psychoanalysts. Dr. Ripleyis professor of psychiatry, emeritus, atthe University of Washington School ofMedicine in Seattle.34 1980 Medical AlumniActivitiesPlanned for MayThe Medical Alumni Association re­cently approved a change in schedulingits annual activities. Traditionally, theseevents were held in June at the time ofMedical School graduation - beginningin 1980, they will take place in May.The Association thinks that becauseJune seems to be a busy time of theyear for alumni, more alumni will beable to participate in May.The following events are planned:• May i3 - Senior Scientific Ses­sIOn• May 14 - Frontiers of Medicine!Continuing MedicalEducation Program• May 15 - Century Club Recogni­tion Breakfast: Distin­guished Service A wardsScientific Program;Awards Luncheon• May 16 - Hospital Rounds andToursAt the Senior Scientific Session, May13, graduating medical students willpresent the results of their research ac­tivities. The presentations will be fol­lowed by a reception for participatingstudents and alumni.On May 14, the Frontiers ofMedicine program will be an all-daysession entitled "Controversies in Coronary Heart Disease." CME creditswill be available to participants. Alsothere will be an alumni luncheon duringwhich the Association's new officerswill be elected.The traditional Dean's Breakfasthonoring alumni members of the Cen­tury Club will be held on May 15. Itwill be followed by the DistinguishedService A wards Scientific Program andthe Awards Luncheon. Hanna H. Gray,President of the University, will be theAssociation's guest at the luncheon.That afternoon the Class of 1955, whichis celebrating its 25th year reunion, willpresent a Scientific Program. In theevening, there will be a private recep­tion and showing of the current exhibitat the Smart Art Gallery.The Association hopes to makeavailable tickets for the Chicago Sym­phony, theater, a lake excursion, andother timely events for the evenings ofMay 14 and 15.Arrangements will be made foralumni to attend rounds with variousclinical services in the morning of May16 and to tour places of interest on thecampus.Mark your calendars to reserve thesedays. Additional information will besent to you as plans are completed.[]---------------- Class Chairmen1935Dr Vida B. Wentz5830 Stony Island AveApt 13-AChicago, IL 606371936Dr John P. FoxUniversity of WashingtonSchool of Public Health, SC 36Seattle, WA 981951938Dr Willard B. Weary1901 W Park DrIrving, TX 750611939Dr Leon O. Jacobson5801 S DorchesterChicago, IL 606371940Dr Gerald B. Macarthy91 Merced AveSan Francisco, CA 941271941Dr John J. Bertrand450 Sutter St, Suite 1137San Francisco, CA 941081943 (Class of December)Dr William E. FroemmingTeletype Corporation5555 Touhy AveSkokie, IL 600771944Dr J. Alfred RiderParnassus Heights Medical Bldg350 Parnassus Ave, Suite 900San Francisco, CA 941171945Dr Stewart F. Taylor116 E Pleasant StPortage, WI 539011946Dr Edward R. Munnell8601 N GeorgiaOklahoma City, OK 731141947Dr Henry DeLeeuw4090 Highgate RdMuskegon, MI 494411948Dr Asher J. Finkel10314 S Oakley AveChicago, IL 606431949Dr Mary E. D. Carroll11810 ChaseCrown Point, IN 463071951Dr Arnold L. Tanis925 N North Lake DrHollywood, FL 33019 1952Dr Benjamin H. Spargo5719 S Kenwood AveChic,ago, IL 606371953Dr Frank W. FitchThe University of ChicagoDepartment of Pathology950 E 59th StChicago, IL 606371954Dr Dorothy B. Windhorst269 Sunset Key, Harmon CoveSecaucu� NJ 070941955Dr Sumner C. KraftWalter Reed Army Institute of ResearchDepartment of GastroenterologyWashington, DC 200121956Dr Walter B. Eidbo3201 Wauwatosa DrDes Moines, IA 503211957Dr Francis H. Straus II5642 S Kimbark AveChicago, IL 606371958Dr Gerald P. Herman8224 MentorMentor, OH 440601959Dr Everett H. Given, [r1562 Red Hill North DrUpland, CA 917861960Dr Randolph W. Seed999 N Lake Shore DrChicago, IL 606111961Dr Dennis K. Wentz3411 Waynoka AveMemphis, TN 381111963Col Rostik Zajtchuk, MC, USA8236 Windsor View TerPotomac, MD 208541964Dr Daniel PaloyanGlenbrook Hospital2100 Pfi ngsten RdGlenview, IL 600251965Dr Robert G. Hillman465 Saint Michaels DrSanta Fe, NM 875011966Dr Julian J. Rimpila11049 Windsor DrWestchester, IL 60153 1967Dr Andrew J. Griffin834 W Chalmers AveChicago, IL 606141968Dr Burr S. Eichelman421 Bryce Canyon CircleMadison, WI 537051969Dr Andrew J. Aronson5000 S Cornell AveApt 14-AChicago, IL 606151970Dr Calixto Romero, [r1611 W HeronDenison, TX 750201971Dr Mary Ann PolascikMcNichol's Clinic, Ltd101 W First StDixon, IL 610211972Drs Eric and Lucille Lester12335 Pueblo RdGaithersburg, MD 207601973Dr Richard F. Gaeke5612 S Blackstone AveApt 1Chicago, IL 606371974Drs John and Pamela Gallagher435 E 70th StApt 15-ANew York, NY 100211975Dr Maga E. Jackson3400 Vinton StApt 207Los Angeles, CA 900341976Dr David E. Hall2907 E Baltimore StBaltimore, MD 212241977Or Burton F. Vander Laan2951 S King OrApt 1902Chicago, IL 606161978Dr James FasulesUniversity of Colorado Medical CenterDepartment of PediatricsDenver, CO 802201979Dr DeCarr (Dow) Covington IIIStanford University HospitalDepartment of MedicineStanford, CA 94305Medicine on the MidwayThe University of ChicagoThe Medical Alumni AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, IL 60637 I NON-PROFIT ORG.U.S. POSTAGEPAIDPERMIT NO. 9666CHICAGO, ILL.Bio-�edlcal LibraryJoseph Regenstein Library1100 East 57th streetChicago, Illinois 60637•Address correction requestedReturned postage guaranteedCalendarApril 21-24, 1980Alumni Reception - American Collegeof Physicians, New OrleansMay 6,1980Alumni Reception - American Collegeof Obstetricians and Gynecologists,New OrleansMay 13-16, 1980Medical Alumni Reunions(See page 34 for more information.)June 12, 1980Graduation BanquetClass of 1980 Continuing MedicalEducationJanuary 9Frontiers of Medicine, * Alcoholism:Pathophysiology and ManagementFebruary 13Frontiers of Medicine, * Teenage Preg­nancyMarch 3-8Comprehensive Psychiatry ReviewMarch 8-9Spinal Cord Injury WorkshopMarch 12, 1980Frontiers of Medicine, * RespiratoryFailureMarch 21-22Update in Geriatric PsychiatryMarch 27-29Tutorial on Management of the Patientwith Early Cervical Neoplasia and Vag­inal AdenosisFor further information on these pro­grams or departmental conferences forwhich Continuing Medical Educationcredits are offered, please write: TheUniversity of Chicago, Continuing Med­ical Education, Mary Ann Dillon, Box139, 950 East 59th Street, Chicago, IL60637, or call (312) 947-5646, or contactFrontiers of Medicine office" (312)947-5777.[J