-Medicine on the Midw� �Bulletin of the Medical Alumni Association The , v rIoDivision of the Biological Sciences and The Pritzker Sc-hool.of,Medi6fe\ 1.'Cll /.,; 1jl'-', :;:trI ' � l ;t:...,\DEC 16 1974Calendar of EventsApril 7-Alumni Reception duringThe American College of Physi­cians Meeting, San Francisco.June 12-Medical Alumni Day,Chicago.Cover: The nursing motto at UCHC ... " The patient is our primary concern." For the full story onThe Nurse as Practitioner, see page 2.Medicine on the MidwayVolume 29, No.2 Summer- Fall 1974Bulletin of the Medical Alumni Association ofThe University of Chicago Division of the BiologicalSciences and The Pritzker School of Medicine.Copyright 1974 by the Medical Alumni AssociationThe University of ChicagoEditor: Nancy SelkContributing Editor: James S. SweetPhotographers: Mike Shields, Bill Rogers, Lloyd Saun­dersChairman Editorial Committee: Robert W. Wissler (48)Medical Alumni AssociationPresident: Otto H. Trippel (46)President-Elect: Henry P. Russe (57)Vice-President: Asher J. Finkel (48)Secretary: Francis H. Straus II (57)Executive Secretary: Katherine T. WolcottCouncil MembersJoseph Baron (62)Sumner Kraft (55)Lauren Pachman (61)Edward Paloyan (56)Donald Rowley (50)Joseph Skom (52) ContentsThe Nurse as Practitioner 2Perinatal Committee 5Center for Clinical PharmacologyDr. Richard Landau 7Cataract-The Falling CurtainDr. Albert Potts 11Fellow Advocates Use of Physicians' Assistants 14Concern for the Dying Patient 16On the Health Services Front 18Measuring Access to Health Care 19News Briefs 21In Memoriam 25Departmental News 26Alumni News 311The Nurse As PractitionerNurses at the University are taking on increased respon­sibility and authority as they apply the full scope of theireducation to patient care."The concept of a nurse as messenger, limited to suchroutine tasks as dispensing medications, taking tempera­tures and blood pressures and giving treatments is a thingof the past," says Gabrielle Martel, Associate Directorof University Hospitals and Clinics and Director ofNursing Services. "Their domain now extends to plan­ning, implementing and evaluating patient regimens,teaching people to cope with their illnesses, helping themSKILL INVENTORYName:School of Nsg.:Yr. Grad.:Experience:Area of experience:Please indicate in the appropriate column what your experiences with thefollowing procedures are:Can Function Have Never NeedIndependently Done Review1. Alternating pressure mattress2. Application of ace bandages3. Baron pump for tube feedings4. Bedscale5. Cardiac Monitors6. Cardio-pulmonary Resuscitation7. Catheterization:a. Insertion of Foleyb. Removal of Foley8. Central Venous pressure9. Clean catch urine specimen10. Circo-electric bed11 Colostomy care12. Dermatology dressings13. Fractionals14. Gastric feed ings2 to change habits which may be detrimental to their well­being, providing supportive, therapeutic and rehabilita­tive care and assisting the patient to return to and main­tain optimum health. The head nurse of the cardiologyconvalescent unit, for example, has developed a self­medication teaching program in which the patient learnsenough about the nature and use of his medication toadminister it himself. Diabetics are routinely taught totest their own urine and take their own insulin. The nurseis a practitioner, counselor, teacher, organizer, plannerand co-worker in a medical team. "She has been trainedto make independent decisions and to take responsibilityfor the minute-by-minute care of those in her charge. Theold production-line mentality serves only to producefrustrated workers. We have set up patient transporta­tion, laboratory and pharmacy messenger services to freethe nurse for patient care and for making rounds with thedoctors. "One physician adds, "Nurses can, and do, stop us inthe hall and say 'Hey, how about this? Let's do some­thing about it.' Since those of us here are on staff full­time, we are usually accessible and can confer with theother members of our patient care team." Nurses areencouraged to question those aspects of the patient's re­gimen about which they have doubts. The policy of theHospitals states that the nursing staff functions withinthe framework of legal, hospital and departmentalpolicies. Though certain tasks require prior approval, thenurse's judgment is to be respected.The field of nursing is rapidly opening new oppor­tunities to its practitioners. Research is now providing aplace for the nurse. At this University, nurses are in­volved in studies in oncology, endocrinology and car­diology; they work directly with the doctors and the pa­tients. Increasingly, nursing practitioners train forspecialties, gaining clinical expertise in such fields asneurosurgery, gastroenterology, nephrology and neurol­ogy.Traditional programs are also undergoing changes tomake the field of nursing more professional.A new method of nursing care assignment is being im­plemented. Primary nursing is a method of organizing thedelivery of optimum care and services to patients andtheir families under the guidance of one professionalnurse. It focuses nursing care on the individual patientneeds. Just as there essentially is one doctor who is incharge of the medical care of a patient, this program at­tempts to have one nurse who has ongoing responsibilityfor the nursing care of a patient throughout his hospitali­zation."When there are three or four practitioners taking careof one person, treatment tends to be compartmentalized.This new system provides for continuity of care." Theprimary nurse is an R. N. who is accountable to the headnurse for the twenty-four hour planning and coordinatingof care for her patients using the nursing process. Feed­back is provided to the head nurse by the primary nurseabout the needs of the individual patient. Informationabout the patient is obtained by the primary nurse bymeans of a patient interview, history and assessment ofneeds at time of admission. Then a twenty-four hourPracticing the correct procedures for resuscitation.nursing care plan for the patient is designed, continuingto reflect any changes in the care plan based on com­munications with the patient, physician, associate nursesand other members of the health team. When the primarynurse is off duty, an associate nurse follows the care planoutlined by the primary nurse. To date, this service hasbeen initiated in some areas of pediatrics, surgery, andgeneral medicine.The usual practice in hospitals has been for the nurseto move further and further from patient care as shemoves up the career ladder, leaving the less experiencedpractitioners to deal with the patients. This trend is beingreversed at the University. A system of clinical progres­sion is being developed for implementation in the nearfuture. This would provide a means of promotion for the professional nurse who would not have to withdraw fromactive patient care involvement. "No matter what posi­tion a nurse would hold here, there would be direct in­volvement in patient care. Practitioners will move upthrough the system of clinical progression based on theirknowledge and expertise. While still maintaining contactwith the patient, the nurses will also advance in status,responsibility and salary level.A number of experiential training programs are availa­ble to help the nurses move from one stage to the next.For the beginning practitioner with six month's trainingor less, there is an internship program to bridge the gapbetween student status and independent practitioner.The program is not perceived as an extension of formaleducation. Participants are expected to have a solid3Enterostomal therapist instructs patient in proper use of appliance.background in nursing in order to enter. As in internshipprograms for doctors, the system provides guidance forpractitioners who are performing a variety of tasks forthe first time. Nurse-coordinators teach the 13-week in­ternship sessions which cover both general and specifictopics-from how to make patient assignments to pro­cedural questions concerning peritoneal dialysis or der­matology treatments. The program helps the beginningpractitioner to deal with her feelings about her new roleand responsibilities. The coordinators provide supportand counseling and assist the new nurse to developconfidence in her knowledge and skills.When planning for this program began in 1968, therewas a high staff turnover at the 11 hospitals on the Uni­versity complex. Nurses complained that they receivedinsufficient orientation to their units and pointed out somany areas of need that the "head nurses could not pos­sibly find the time to fulfill them." The 33 beginning prac­titioners who were questioned responded that they couldonly perform 40 to 50 percent of the tasks that they weresupposed to handle independently. Many had never dealtwith a dying patient or faced other traumatic experiencesthat are common in a hospital setting. Others had neverused monitoring respiratory equipment. Still others hadcoped with most of the expected situations but needed tolearn how to apply better understanding and judgment.Today, the department is operating on a more efficientlevel. There is little turnover (28 percent for all R. N.positions). Nurses feel more comfortable in their jobsand most of the 1,000 nursing positions at the Hospitalsare filled.All registered and licensed practical nurses who jointhe nursing staff are given a 26 point skill inventory tocomplete during their orientation. This helps each ofthem to assess and evaluate their own strengths andweaknesses. More important, the Staff DevelopmentCoordinators and the head nurses can plan an indi­vidualized training program to meet the needs of eachnewly employed person, Ms. Martel says.Nurses participate in patient care conferences, meet­ings, workshops and training seminars for advanced pro­cedures. They also engage in informal discussions with4 members of the health care team. Working closely withthe physician, they have knowledge of ongoingreasearch. Nurses can see firsthand what is being doneand can follow the studies to their conclusions, observinghow the findings are applied to patient care.Members of the nursing staff serve on a variety ofmedical, nursing, and hospital committees, thereby as­sisting in the decision-making and policy development.This offers yet another means of professional growth.Nurses here also talk with colleagues from other medicalcenters across the nation, discussing successful and un­successful programs and seeking solutions to mutualproblems."Working with nursing schools adds another dimen­sion because it involves members of the staff in discus­sions about nursing and nursing education with otherfaculties." Seven schools in the metropolitan Chicagoarea send their students to this medical complex for theirclinical training. Among these are Augustana HospitalSchool of Nursing, DePaul University, St. Xavier Col­lege, Kennedy King Junior College and Olive-HarveyJunior College. Many of these students come back to thismedical complex to work after they receive their degrees.Nursing practitioners plan, implement and evaluate patient regimens..�F�,., () ')(��,�}r}�����Jt\;<I"J C'H':., It 1 h1> .. ,< ..Patient educationPerinatal CommitteeRepresentatives of the Departments of Pediatrics, Ob­stetrics, Anesthesiology, Pathology and several support­ing disciplines including Radiology, Endrocrinology andCardiology, have formed a Perinatal Committee at theUniversity Hospitals and Clinics. The program is de­signed to identify high risk pregnancies and to provideinterdisciplinary approaches to the care of the mother,fetus and newborn. The Committee has been operatingsince the first of the year. Through its efforts, the Uni­versity has made application to the state to be designateda regional perinatal center.About 30 percent of the 2,700 pregnancies handledyearly at the Chicago Lying-in Hospital are high riskcases. This figure is well above the national average.These patients are teenage mothers, diabetics andwomen with sickle cell anemia, hypertension, renal dis­ease and potential congenital defects. A senior obstetri­cian and a consulting internist work together at the highrisk obstetrics clinic where the majority of these patientsare treated. A physician, nurse and social worker providecare for teenage mothers in a clinic which has beenoperating for the past three years. It is the only teenage pregnancy clinic in Chicago. New out-patient depart­ment facilities opened at Chicago Lying-in Hospital Sep­tember 16. Additional facilities will be completed in Feb­ruary, 1975.Specialists have been involved in neonatal care andresearch since the current Chicago Lying-in began tofunction in 1932. Doctors here were among the first intheir field to study in depth the drug-addicted mother andthe effects of the drugs on the child. This major investiga­tive effort involved both basic and clinical science includ­ing pediatrics, psychiatry, medicine, cytogenetics,pathology and drug abuse counseling, as well as obstet­rics. Physicians here were also among the first to studyand explain the causes of death in newborn infants. Dr.Edith Potter's work in this area is world renowned.The major emphasis of the work done here has been onthe treatment of mothers with hypertension, kidney prob­lems, and other disorders; prediction of the safest deliv­ery period; prevention of infections and delivery of theinfant. The scope of concern has evolved to include thestudy of the physiology of the developing fetus and thecare of the newborn who suffers from complications.University of Chicago physicians are learning to diag­nose and correct some disorders in utero. Doctors arestudying the amniotic fluid to discover whether a varietyof problems from mongolism to congenital heart diseasecan be prevented. Specialists in neurology, surgery, car­diology, pathology, radiology, anesthesiology, and en­docrinology are also involved in studies of the fetus andnewborn. Back-up facilities at the University include alipid laboratory, an endocrinology laboratory and a vari­ety of other such units with ultra-sound systems andother modem equipment. The newest devices and tech­niques are used to monitor the development of the fetusand to signal potential danger.All high risk patients in labor, and those who needlabor stimulation, have continuous monitoring of uterinecontractions and the fetal heart rate. The labor-deliveryarea is equipped with four portable monitors and onelarge monitor. Any deviations from the normal evolutionof labor are immediately diagnosed and steps are taken tocorrect them. As a consequence of this procedure, in­fants are born in better condition than they would havebeen if the equipment and trained personnel were notavailable. The monitoring system allows members of thehouse staff, under faculty supervision, to observe closelyhigh risk patients in labor.The Department of Pediatrics is concerned with boththe immediate and the long-range care of high risisk in­fants. It has established an intensive care unit with one­to-one care for very small and premature babies whosuffer from a respiratory distress syndrome or other seri­ous illnesses. Infants with less severe problems, such asthose who are small for their gestational age or have amild case of jaundice or low blood sugar, are placed in anintermediate care unit.The department is now equipped to handle twentybabies and an expansion is planned. The average stay isthree weeks, though some babies are sent home after afew days and others are hospitalized for several months.Formerly, the policy had been to keep parents out of5Listening to the fetal heart beat.special care units for the newborn. "Now we believe thatit is unhealthy for the child to be separated from theparents for so long a period right after birth. A parentwho does not handle the child in its first days oflife mightlater be fearful and reluctant to do so," says Dr. JohnMadden, Associate Professor and Director of ClinicalServices of the Department of Pediatrics. "We encour­age both parents to come to the hospital as soon as possi­ble and take part in caring for their infants. They areinvited to talk to the doctors and the nurses, to find outwhat the disorder is and what is being done to correct it."Aggressive treatment of severe diseases is a relativelynew phenomenon. According to Dr. Madden, "Infantswere formerely handled very cautiously. The doctorsmade use of incubators and other equipment to reducethe discomfort, but the infants were not given chestX-rays or run through lab tests. Today, we know muchmore about diseases in very 'small infants and have de­veloped special equipment and methods for treatingthem. Doctors can anticipate and prevent complica­tions." Previous misconceptions are being corrected asnew information is discovered. The belief that all babieswho weigh less than five and a half pounds are prematurehas been found to be erroneous. Prematurity refers to theperiod of gestation, not to weight. More than thrity per­cent of the infants who have been labeled "premature"were low birth weight children who needed a differenttype of care, according to Dr. Madden.While the special care units handle a variety of prob­lems, they are particularly well suited to the treatment ofrespiratory diseases, cardiac diseases, surgery for new­borns, infections and metabolic problems. Originally, allthe babies in the pediatric units had been delivered at6 Lying-in Hospital. But as the program has developed, itsdesigners have made provisions for dealing with referralsfrom other hospitals. A transport system has been de­veloped which will provide ambulances equipped withincubators and resuscitators. A neonatology fellow fromthe department will ride in the transport vehicle tomonitor the patient.Many women who come to the University Hospitalsand Clinics for obstetric care have never had preventivemedical care, and their cases are often complicated. "Atthis University," says Dr. Madden, "we are particularlyfortunate because we have the resources of highly trainedspecialists in a multitude of disciplines who can worktogether both in patient care and in research."Infant in intensive care nursery receives gavage feeding.Center for Clinical PharmacologyDr. Richard LandauDr. Leon I. Goldberg has joined the faculty of ThePritzker School of Medicine as Professor in the Depart­ment of Pharmacological and Physiological Sciences andthe Department of Medicine. The University plans todevelop a program of international scope in clinicalpharmacology. Dr. Goldberg will also serve as chairmanof a newly established Committee on Clinical Phar­macology, an interdisciplinary group which will coordi­nate educational and research activities in this importantarea.Dr. Goldberg, 48, has been Professor of Pharmacol­ogy and Medicine and Director of the Clinical Phar­macology Program at Emory University. He specializesin investigations of drugs in animals and man, with em­phasis on cardiovascular problems. In the 1960s, Dr.Goldberg and his associates discovered that the heartstimulant dopamine, unlike other heart drugs, has theunusual action of increasing blood flow to the kidneys. In1974, the Food and Drug Administration approveddopamine, as a result of this research, for treating victimsof congestive heart failure and severe shock in whomblood pressure and urine flow are abnormally low.Dr. Goldberg has served on a number of editorialboards of national and international pharmacologicaljournals and is the author of over 100 publications inpharmacology and therapeutics. He serves the UnitedStates Pharmacopeaia as a member of the SCOPESCommittee and the Subcommittee on Bioavailability andis chairman of its Cardiovascular Panel. He has heldconsulting and advisory positions with the AmericanHeart Association, the Food and Drug Administration,The Veterans Administration, the National Institutes ofHealth, the American Medical Association, the Nationalacademy of Sciences and the World Health Organiza­tion.The following article is an interview conducted by Dr.Richard Landau, Professor in the Department ofMedicine and the College. LANDA U: Leon, the University has appointed you Di­rector of a new clinical pharmacology committee here.What will your functions be?GOLDBERG: I have a great deal of difficulty definingmy role and usually invite the questioner to follow mearound to see what I do. A clinical pharmacologist in anacademic institution has a wide variety of roles. Educa­tion is the most important. There are serious problemsMonitoring electrocardiogram of patient in the intensive care unit.7with many aspects of drug utilization in this country.Some of us feel that this may be due in part to adeficiency in pharmacological education in medicalschools.LANDAU: You mean that there is an overuse of drugsor an incautious use of drugs?GOLDBERG: The answer is probably both. More re­search is needed in this area. Perhaps we will be able tostudy some aspects of the problem in this institution. Ifeel that one cause of poor prescribing habits is the waypharmacology is taught in most medical schools. Phar­macological instructions are usually discontinued afterthe second year. When the student moves into the moreclinical years, drug education is not emphasized exceptby a few enlightened specialists. Students are extensivelyinstructed in diagnosis but the treatment of disease is notstressed. The task of the clinical pharmacologist is toemphasize educational deficiencies to students and fac­ulty and encourage everyone to be more concerned withboth the use and abuse of drugs.LAN DA U: It seems to me that drugs are becoming more potent and have a greater potentiaL than ever for causingharm as weLL as good. What can be done about this?GOLDBERG: That is certainly true. If one reviews thecharts in almost any hospital ward, many patients arefound who are receiving as many as 15 to 20 drugs. Oftenthere is no good rationale for such extensive therapy. It isalmost a general rule in pharmacology that the moredrugs prescribed, the more chance for an interaction.This is particularly true today with many of the drugs weuse. One of the main teaching jobs is to try to encouragethe physician to think about why he is prescribing a drugand to eliminate those which are not necessary. Thispoint is emphasized so frequently by the clinical phar­macologist that his presence often causes students andhouse officers to think twice before prescribing a drug.LANDAU: What will your other roLes be?GOLDBERG: First, I would like to discuss the educa­tional role a bit more. We will be giving a formal course inclinical pharmacology, will sponsor informal seminarsand invite noted lecturers. We plan to institute wardrounds with specific emphasis on drugs. Eventually, IDr. Goldberg (left) works with doctors, nurses and patients. He is often consulted by physicians about problems involving drug therapy.8hope that at least one faculty member in each of thespecialty areas will have a primary interest in drugs andwill carry the message to students and faculty in hisdiscipline.The second role is research. We plan to develop aCenter with the capability to study a drug all the wayfrom its synthesis to its utilization for man. Both gov­ernment and private foundations have recognized theneed for such broadly based academic centers wherephysicians and scientists with diverse research back­grounds can work together. The path from the synthesisof a new drug to its utilization by practicing physicians islong and difficult. The time span may exceed ten years.We will develop a Clinical Pharmacology Committeewhich will make it easier for basic and clinical scientiststo work toward the common goal of providing safer andmore effective drug therapy.The third role is training. There is an acute shortage ofclinical pharmacologists in academic institutions, indus­try and the federal government. Yet young physicians arenot entering the field in sufficient numbers. We will insti­tute a training program in which physicians and otherscientists from the United States and abroad may obtainexperience in the wide spectrum of basic and clinicalresearch we will be conducting here.Finally, there are many service functions in which clin­ical pharmacologists participate in an academic institu­tion. These include identifying adverse reaction to drugs,investigating potential mechanisms of drug interactionand assisting and encouraging physicians to study newdrugs. There are so many regulations these days thatphysicians who are not familiar with the procedures areoften discouraged from embarking on drug investiga­tions. The clinical pharmacologist is usually more famil­iar with the procedures and should be able to help con­siderably in this area.LANDAU: You don't intend to displace the pharmaceu­tical industry in the development of new drugs, but youare interested in a working relationship with theindustry-are you not? What roles will you and membersof the Committee play?GOLDBERG: This is a very good question. Actuallythe clinical pharmacologist is in a unique position be­cause he can maintain a neutral position in the numerousconflicts which arise between the Food and Drug Ad­ministration and the pharmaceutical industry. Theacademic clinical pharmacologist should be able to be anally or adversary of both government and industry atdifferent times, depending upon the specific issue. Heshould, on one hand, point out to medical students mis­leading drug advertising and on the other, complain to thefederal government when regulations are proposed whichmay slow the development of new drugs. I have servedas a consultant to both government and industry. I do notfeel that we should eliminate all regulations of drugs.Yet, we must have a strong pharmaceutical industry inorder to develop new drugs. It is impractical and almost impossible for an academic clinical pharmacology groupto undertake all the research necessary before a new drugcan be placed on the market. It has to be studied inthousands of patients. Industry has the capability ofcoordinating multi-clinic trials.· The pharmaceutical in­dustry also has an immense capability for synthesizingand screening potentially useful chemical compounds.LANDA U: And they also have, don't they, the facilitiesto test experimental animals for toxicity?GOLDBERG: Yes, and the extensive screening of newchemical compounds now carried out by industry wouldnot be feasible in an academic institution. On the otherhand, because most drug companies are so large, theymay not be able to conduct some of the imaginative in­vestigations carried out by academic clinical phar­macologists. Certainly a large industrial firm is not ableto study many drugs which do not have a high profitpotential. Furthermore, the discovery of new drugs isoften serendipitous. By increasing the number of indi­viduals conducting drug research, we hope to increasethe possibility of taking advantage of unusual findings. Ifone reviews the history of new drug development, it isnoteworthy that almost as many new drugs were discov­ered by accidental findings as from systematic research.LANDA U: Is it your experience that the pharmaceuticalindustry would listen to a clinical pharmacologist with anidea for a new product?GOLDBERG: Yes-l have had the experience of study­ing a drug in which the first evidence of clinical efficacywas obtained in an academic institution. However, thefurther development had to be carried out by industry.Sometimes it is difficult to obtain cooperation if there isinsufficient profit motive, but this is not surprising. Afterall, the pharmaceutical industry is a business and has tosatisfy stockholders.LANDA U : You differ from the basic pharmacologist inthat you are studying the effects of drugs in humans, isthat right?GOLDBERG: Yes, I would also like to emphasize adifference between the research of clinical phar­macologists and that of specialists such as cardiologists.A clinical pharmacologist concentrates on the drug itself.The specialist focuses on the effects of a drug on a singleorgan system. The clinical pharmacologist should beprepared to investigate a drug in any disease state inwhich he thinks it might be effective. For example, Ihave investigated one drug in patients with hypertension,Parkinson's Disease, shock and cirrhosis. Now this doesnot mean that I am an expert in all these areas. As muchas I would like to be, I am not a renaissance man. Thus,one of the main duties of the clinical pharmacologist is tocollaborate with specialists when he becomes aware of aninteresting new drug or an unusual finding in an olderdrug.9LANDA U: So, this is why you are structuring a commit­tee rather than a department for your activities?GOLDBERG: Yes and this question brings me back toan earlier question you asked-why I came to the Uni­versity of Chicago. One of the main reasons is the com­mittee structure at the University. It is difficult to build anew educational and research program which must cutacross traditional departmental speciality lines. Mostmedical schools are administratively oriented only in aperpendicular manner: there are departments of surgery,medicine, pediatrics, pharmacology and so forth. Eachdepartment is concerned with its own area. The commit­tee structure is by definition interdisciplinary.LANDAU: What is the breadth of the committee thatyou visualize?GOLDBERG: I hope that it will be broad enough toinclude the wide range of scientists ranging from thosewho have the capability to synthesize new drugs to thosewho are interested in the ethical problems of drug utiliza­tion.LANDAU: And non-scientists?GOLDBERG: Of course- I did not intend to excludenon-scientists in my last answer. We are living in a verycomplex world and the major problem that we face in thestudy of new drugs is not excessive government restric­tion, but difficulties in dealing with ethical problems.There are many problems which should be discussedwith non-scientists interested in these areas. These in­clude, for example, administration of new drugs to chil­dren, studies in pregnant women, use of healthy volun­teers and many others. I hope that the Committee willhave representatives from law, theology, economics andother non-scientific areas who will assist us in studyingthese important issues.LANDA U: I know that you have testified before theSenate Subcommittee on Health chaired by Senator Ed­ward Kennedy. Congress is indeed interested in improv­ing pharmacologic development and research. What isyour view of the most effective way in which the federalgovernment can assist medical schools like The Univer­sity of Chicago, or the country as a whole, in the de­velopment of more effective, clinical pharmacology?GOLDBERG: The simple answer to that is to providemore money-however I am not sure that providingfunds is the only answer. We must have an institutionwhich facilitates interdisciplinary cooperation if such aprogram is to succeed.Let me get back to my testimony before this SenateCommittee. Senator Kennedy was a sponsor of a billwhich proposed that a National Center for ClinicalPharmacology be developed. The intent of the bill wasthat there should be a governmental center for investigat­ing the efficacy and safety of drugs in man. I was againstthis proposal for a number of reasons. First, I feel that10 the pharmaceutical industry is doing the job reasonablywell under the present regulations. In fact, it would beeconomically disadvantageous for those in the drug in­dustry to conduct inadequate studies. If an investigatorworking for industry makes an error in judgement in theearly phases of clinical studies, the error will be eventu­ally recognized in subsequent studies and the companymay lose several million dollars. Indeed, the first goal ofsuch investigations is to determine whether the drugshould be studied further.Furthermore, I do not think that there are sufficientclinical pharmacologists to staff such a center and thoseavailable would probably not want to have a position ingovernment in which their sole function would be tocarry out clinical trials. I feel that some of the functionsproposed for the national center could be carried out byacademic institutions if funds are made available.LANDAU: The University has plans to develop a pro­gram of international scope in clinical pharmacology.What will this mean?Dr. LandauGOLDBERG: The problems addressed by clinicalpharmacology extend beyond national boundaries.Clearly the detection of adverse reactions, evaluation ofsafety and efficacy of drugs and regulation of ethical is­sues benefit from the cooperative efforts of scientists inmany countries. Not enough is known of possible genet­ic, environmental and cultural differences which mayprevent universal utilization of data obtained from differ­ent countries. The University of Chicago has a traditionof being involved in international affairs.· Thus, it wasonly natural for clinical pharmacology to follow this pathhere. We expect to become involved in cooperative re­search with pharmacologists from other nations and totrain scientists from both developing and developedcountries.Cataract-The Falling CurtainDr. Albert M. PottsThe logotype of the University Department of Ophthal­mology shows the lens of the eye in its proper relativeinternal position and suggests by the diagrammed lightrays that the lens is an essential part of the image-formingsystem of the eye. A measure ofthe tardiness of accurateknowledge of the eye is the fact that the true anatomicalposition of the lens was not known until 1600 when Fab­ricius of Aquapendente placed it properly. Cataract hasbeen a cause of blindness from the beginning of thehuman race, but it was not until the communication ofBrisseau to the French Academy of Sciences in 1705 thatthere was public knowledge that cataract is a clouding ofthe lens. The classic opinion, at least as old as the Alex­andrian Greek physicians of the third century B.C., wasthat cataract was a collection of evil humors in the emptyspace in front of the lens. The uproar among the medi­cally orthodox caused by Brisseau's communication losthim membership in the Academy. General acceptance ofhis radical notion took another half century.Even our word "cataract" has a curious and cloudybackground. Despite its Greek roots, it is a Latin wordand a Johnny-corne-lately at that. It was coined by amedieval monk, Constantine the African, who studied atthe famous school of Salerno and who spent his lateryears at the monastery of Monte Cassino translatingArabic medical writers into medieval Latin. Thuscataracta dates only from the end of the eleventh cen­tury. Its Greek roots mean: something that comes downprecipitously, like a cliff or, figuratively, like a portcullis.It signifies the curtain that comes down over vision aslens turbidity progresses. The classical Greek was en­tirely different-glaucoma was used in the Hippocraticwritings and hypochysis was used by the AlexandrianGreeks which translated into the Latin of classic times assuffusio, The last two mean "pouring down" signifyingthe pouring down of evil humors concept mentioned pre­viously. The humors later condense and cause clouding.CouchingThere is no more clarity in the recommended treatmentfor cataract in ancient times. The only effective treat­ment even today is surgical but in the West in antiquitynothing valid was said about the treatment of cataractuntil the time ofCelsus (25 B.C.-50 A.D.). Circumstan­tial evidence, however poorly documented, suggests thatthe earliest surgical treatment of cataract arose in India.This treatment known as couching or reclination waspracticed in virtually the same manner from whenever itwas introduced until the mid-eighteenth century. Indeed it is still practiced in that manner in rural India by illegalitinerants.The technique is described with admirable clarity inthe Sanskrit writings of Susruta. A sharp instrument isused to penetrate the white leathery outer coat of the eye(the sclera in modem terminology) and a second bluntinstrument is then inserted through the incision and thecataractous lens is pressed backwards and out of theoptic axis until it is dislocated into the vitreous space.There is no problem with the accuracy of this descrip­tion, the problem is in dating it. Our knowledge of thechronology of writing in India is so poor that dates havebeen given to the writings of Susruta that range from 1000B.C. to 1000 A.D. Susruta is mentioned in the Indianepic Mahabharata which other evidence dates in the vi­cinity of 400 B.C. In the absence of any manuscript fromIndia datable before 400 A.D. establishment of a firmchronology is difficult. It is tempting and logical to as­sume, however, that Susruta antedates the invasion ofIndia by Alexander of Macedon (327 B.C.). Then infor­mation about couching could have come back to the Westeither with the victorious Greeks or along the route es­tablished by them.This cannot be established with certainty, for not asingle work of the physicians of Hellenistic Alexandriasurvives. However much of the work of Celsus (Periodof Tiberius and Nero) and of Galen (131-201, Period ofMarcus Aurelius) is based on the work of the Alexan­drian school. Couching is dealt with in detail by Celsusand Galen and they give credit to the Alexandrian schoolas having practiced it.Couching with much of the rest of classical medicinewas kept alive in Arabic texts of the middle ages and thisknowledge re-entered Europe via such writers as Con­stantinus Africanus. It was fully described by Bartischwhose Das is! A ugendienst (1583) was the first Europeantextbook of ophthalmology.The lack of antisepsis with resulting eye infection; themechanical irritation of the eye by the mobile dislocatedlens; and the chemical irritation of the eye by lens con­tents as resorption of the lens took place, all made fornumerous failures in treatment by couching. These wereobservable beginning two to five days after the proce­dure, and were capable of occurrence at any later time.Thus, traditionally, couching was done by itinerants whomade a tremendous impression by demonstrating im­proved vision during the first hours after the operationand who collected their fee and left town before latecomplications set in.111753, A landmark YearThis was the situation from the hazy beginning ofcouching in antiquity until 1753, a landmark year for thetreatment of cataract. In that year Jacques Daviel, thesurgeon-oculist to Louis XV, presented to the RoyalAcademy of Surgery in Paris an account of how he hadextracted the cataractous lens from the eye in 115 caseswith permanent success in 100 of these.Daviel made aknife incision in the eye where the transparent corneajoins the white sclera. He ruptured the anterior capsuleof the lens and expressed the opaque lens contents fromthe eye leaving the posterior lens capsule in place andproviding a clear optical axis. Since a major image­forming component is lost from the eye when the lens islost, compensating spectacles are required to obtain aclear view after a cataract operation. Lens grinding andspectacle making was sufficiently advanced in Daviel'sday so that this presented no real difficulty.ImprovementsThe story of the treatment of cataract since 1753 is thestory of many small but significant improvements onDaviel's technique, to the point where cataract surgery isamong the most successful of all surgical procedures.Asepsis and the availability of antibiotics has reducedinfection to negligible levels. We have learned to extractthe lens intact within its capsule (the intracapsular ex­traction). This is aided in younger patients by the use ofan enzyme which dissolves the fibers which normallyhold the lens in place (enzymatic zonulolysis). The use ofa very cold metal rod which adheres to the lens and formsa ball of ice within it (cryoprobe) allows extraction of theintact lens with ease. The use of multiple sutures to closethe wound-either of very fine absorbable material ormicroscopic non-absorbable material, neither requiringremoval-allows very early ambulation. It is customaryto use local anesthesia obtained by topical drops and in­jection of small volumes of successors to novocaine be­hind the eye and into the eyelids. These two factors­-early ambulation and local anesthesia-mean thatthere is no upper age limit for cataract surgery. All of theabove techniques can be learned by a medical graduatewith reasonable manual dexterity, and the physician whocompletes a residency in ophthalmology at a major teach­ing hospital such as ours is a skilled cataract surgeon atthe conclusion of his training. The expected rate of suc­cess in modern cataract surgery is 95 to 98 percent.Innovative TrendsThe innovative trends in the study of cataract and itstreatment take two major directions. The first direction isthe attempt to improve surgical technique farther. Withthe success rate quoted above this becomes an increas­ingly difficult task. Each proposed change must be ex­amined critically to make sure that the claimed improve­ment is a real one. The most recent innovation, intro­duced with much publicity in the national media and verylittle presentation of statistics in the medical literature,deals with the technique of "phacolemulsification." Anapparatus has been devised using a double bore needle12 which is vibrated at ultrasound frequencies. The needlepenetrates the lens and the lens is fragmented by thevibration of the needle. The lens fragments are thenwashed out through one bore of the needle by a stream ofdilute salt solution entering through the other bore. Theadvantage of the procedure is that it uses a tiny incisionwhich requires only one suture for closure. The propo­nents of the method emphasize the minimum hospitalstay which this entails and the ability of some patients toreturn to work the next day. The disadvantages are firstthat the procedure returns to the extracapsular procedureof Davie!. The lens capsule is left within the eye and itmay give rise to an opaque "secondary membrane."Second, the vibrating needle may damage the delicateinner lining of the transparent cornea and extreme preci­sion is required to prevent this from happening. Third,just as in the old extracapsular extraction some lensfragments may be left within the eye. In adults the pres­ence of these fragments may give rise to inflammation.Fourth, the apparatus is expensive, and it is complexenough to require steady maintenance. It is evident thatone would want to examine the statistics for a largenumber of patients collected by an impartial observerbefore adopting the proposed technique. Such statisticsare not yet available.Ultrasound is used to evaluate the contents of the eye behind an opaquelens.PreventionA second direction, which cataract research is justnow taking, concerns a very precise set of studies on thenature and cause of cataract with the hope that at longlast medical prevention rather than surgical treatmentmay be possible. Let it be emphasized that medicaltreatment is still only a hope. There is no known effectivemedicine at present. It is only with the availability ofvastly improved techniques of biochemistry andbiophysics of the last twenty-five years that such a hopecould be justified. Thanks to the Federal financial sup­port of medical research, which up until the last seven orso years could be termed generous, we know a great dealmore about the properties of the lens of the eye than weever knew in the past.One set of facts tells us that the transparent lens is anenormously complex biochemical factory with a numberof features unique to lens and not shared by other tissues.It is theoretically possible that the factory could sustaindamage at many different stages along the process whosepurpose is to create ever new lens tissue. The end resultof concern to us, however, is that the ultimate expressionof this damage wherever it occurs is loss oftransparency-cataract. Thus, as clinicians have sus­pected for a long time there are many causes of cataract,and it is foolish to expect to find a single curative medica­tion.Research in Progress At the UniversityAt the Eye Research Laboratory of The University ofChicago a study is in progress on the basic physical na­ture of the clouding which develops in the cataractouslens. Dr. Ronald Schachar in collaboration with Profes­sor S. A. Solin of the Fermi Institute has employed aseries of optical examinations of the isolated lens. Theseexaminations include measurement of the Raman spec­trum excited by high intensity laser generated light ofnarrow wave lengths and examination of the interferencefigures generated by axial polarized light. Their prelimi­nary conclusions suggest that the transparency of thelens is dependent on the precise orientation of the proteinmolecules which make up the greatest part of the lensweight. Any disturbance of this orientation by increase inwater content, by decrease in amino acid (the buildingblocks of protein) intake, or by disturbance of energymetabolism can lead to cataract formation.At the National Eye Institute Dr. Kinoshita hasworked out the mechanism of water increase that leads todiabetic cataract and he has several synthetic drugs thatcounter this effect in the test tube.Thus this once dreaded disease of the falling curtain iscurable by surgery. That surgery which began with aglimmer of an idea in ancient India is now a beautifullyeffective tool in the hands of modem ophthalmologists.Another hope, the medical prevention of cataract, is justbeginning to take shape and is a worthy subject for futureresearch in our laboratories.Dr. Albert Potts is Professor and Director of Eye ResearchLaboratories, Department of Ophthalmology. Biomicroscopy of the eye provides valuable information about anteriorand posterior segment diseases.13Fellow Advocates Use of Physicians' AssistantsDr. Harvey M. Golomb, a Fellow in the Department ofMedicine of The Pritzker School of Medicine, advocatesthe use of physicians' assistants who would work withthe doctors to help deliver emergency medical care. Suchstaff members could take medical histories, give physicalexaminations, prescribe medications for routine prob­lems and treat situations such as acute lacerations andcommon diseases such as upper respiratory infections,gastroenteritis and skin disorders, he says. Doctorscould continue to see all of the patients but deliver lessthan 50 percent of the care. They could evaluate diagnos­tic tests, admit patients to the hospital, handle triage andtreat those who require roentgenography or need im­mediate care for upper respiratory distress, shock,trauma, dulled reflexes or other emergencies. The nurseon this team might treat abrasions and animal bites re­quiring no sutures, uncomplicated puncture wounds andfirst-degree burns.A three year study which Dr. Golomb conducted at aMaryland hospital emergency room indicated that onlyabout one third of the 2,505 cases seen were of an urgentnature. He maintains that half could have received careby a physician's assistant."In many areas of the country, the number of privatephysicians is declining. Those who are available are moreoften specialists than generalists and all are making fewerhouse calls than they once did. The public is turning tothe emergency room for round-the-clock service. As thedemand continues to increase, it may be necessary toreassess the situation, deciding how much of the workrequires a physician and what part can be done by aphysician's assistant."Dr. Golomb proposed that the combination of physi­cian and physician's assistant be used in rural hospitalslike the one in Maryland. He also contends that is appli­cable to urban hospitals. "Numerous studies have shownthat emergency rooms across the nation are dealing withlarge numbers of non-emergency cases. A physician'sassistant could contribute to this ever growing work load,assisting in routine physical examinations or suturing, forexample.Dr. Peter Rosen, Professor and Director of the Divi­sion of Emergency Medicine at the University ofChicago Hospitals and Clinics says, "Due to the largedeficit in primary care physicians, the emergency de­partment cannot keep pace with increasing service de-14 mands. There will never be enough doctors to meethealth needs. Every hospital has to find ways of augment­ing the physician's care. By law, we must treat all ofthose who come through our doors. We must care for thepatient who is concerned about his sore throat as well asthe one who suffers a threat to life or limb. The care ofmany of the cases, therefore, would be expedited by per­sonnel working with the doctor in charge."There is still much disagreement among health profes­sionals, however, as to the exact role these staff mem­bers should play. In some states, this is stipulated by law;in others, it varies from hospital to hospital. About twoyears ago, the University established a program, employ­ing six former military corpsmen as emergency roommedical technicians (EMT). Their responsibilities rangefar beyond simple technical tasks. Their main duty at theUniversity Emergency Room is to handle triage, that isto take a "presenting complaint" history, acquire vitalsigns and divide the emergency population intoemergent, urgent and ambulatory clinical categories."Effectively sorting out the more than 200 cases thatcome to us daily is key to the effective operation of ouremergency room," Dr. Rosen says. "Those who are indanger, are seen within minutes of their arrival. Othersare directed to doctors in accordance with the gravity oftheir problem. We have found that the EMT corpsmencan make these kinds of decisions accurately, freeing thedoctors and nurses for other duties. We find approxi­mately 4 percent retriage, mostly due to physician pref­erence." The corpsmen also take ECGs, start IVs andassist in the treatment of trauma victims. "We feel thatthey can help provide most technical skills needed by apatient in the emergency room," Dr. Rosen says. "Ofcourse, they do not make diagnoses or treat patients."The corpsmen, who received their training while inmilitary service, are brought up-to-date in the latest pro­cedures through weekly seminars conducted byemergency department residents.The University of Chicago experience is just one ofmany taking place across the nation. The concept of aphysician's assistant came into being in the 1960s. Sincethat time, training programs and schools have been crop­ping up nationwide and hospitals are deciding how theycan use the new manpower. By 1973, the graduates ofvarious training programs number 585, 461 of whom arenow practicing as physicians' assistants.Emergency medical technicians work with the doctors in the EmergencyDepartment here. Their main function is triage. They can also do suturingand assist doctors in a variety of ways. Technicians are also used inHemodialysis where they work with patients who use the kidney machine.Concernfor theDying PatientPatients with life-threatening diseases are seen by a chaplain or trainee at each return visit.For centuries, those in the medical profession have ap­plied their knowledge to improving and prolonging man'slife. Faculty members at The University of ChicagoPritzker School of Medicine are also concerned withfinding ways to serve the patient who is dying.The Department of Chaplaincy Services counsels ter­minal patients, their relatives and staff members. A chap­lain or trainee is assigned to every in-patient unit in theHospitals and to the Emergency Department andHemodialysis, which are out-patient services. Eachcounselor must be responsive to the needs of the patientand act as a member of the medical team, sharing infor­mation that will be useful in treatment. He can provide avariety of services, from giving practical advice to engag­ing in philosophical discussions. His approach differsfrom case to case. He may help one patient to put hisfinancial affairs in order and another to improve relation­ships that have not been satisfactory. This advisor worksthroughout the patient's hospitalization, offering emo­tional support as a sense of loss increases. After a death,he helps the family adjust to the situation.Those who are dying face four common emotionalstates according to the Rev. James Gibbons, Director ofChaplaincy Services. The first of these is grief and an­guish. Those who are aware of death feel a sense of loss,he says. For some, this focuses around oneself; forothers, around leaving friends and relatives. The secondis anger-at one's impotence, at fate or God or at thosewho will go on living. The third is anxiety. "My experi-16 ence is that overall, people are much more afraid of dyingthan of death. They need to talk about their feelings withothers and to explore the fears that are haunting them,"the Rev. Mr. Gibbons says. The last of the traits is de­nial. The patient or one of his relatives might try to talkhimself into believing that the person will continue tolive."There are no special qualifications for talking to thedying other than the usual human skills of communica­tion and the willingness to face the possibility of yourown death" the Rev. Mr. Gibbons says.Dr. Chase Kimball, Associate Professor in the De­partments of Psychiatry and Medicine, approaches theproblem in terms of the patient's age.As a person grows older, his attitudes towards deathalter, Dr. Kimball says. He categorizes these changesfrom youth to old age, specifying which is common ateach age."For the child up to the age of six, reality is often inthe power of words. Verbal denial of the fact is tan­tamount to the proof that the fact does not exist. Later,the child may verbalize death as the 'going away' of theloved one. The absence is considered temporary and the'bad mommy or daddy' will return as they always havebefore." Children at this stage are, therefore, likely tosuffer little anguish at pending death, Dr. Kimball says.Between the ages of six and ten, a child may becomepreoccupied with death and killing, but only in fantasyterms. "The life and death game, embodied in Cowboysand Indians,-the falling down with the hand over themortal wound-puts the concept of death into one moreconsistent with adult concepts. But children cannot longremain either immobile or endure being buried. Theyprovide their own antidote to death by resurrection-reversing roles or changing games."The first real understanding of the meaning of deathoccurs in adolescence, he says. If the death does notinvolve a close fried or relative, the experience will stillbe somewhat unreal at this time. The adolescent shouldlearn how to grieve when his parents or peers die, hesays. "If he does not allow himself to grieve, he maydisplace his feelings in ways which can jeopardize hislater development. " Defenses against death are strong atthis age he contends. It is the adolescent who is primarilyconcerned about his appearance and imperfections. Atthe same time, people of this age have little sense offuture or mortality and are disposed to participate indeath-defying acts. "The high incidence of psychotic dis­turbances occuring in adolescents and young adults maynot only be due to the anxiety engendered from an inabil­ity to adjust to and resolve conflicts of life but also theconflicts of death. ' ,When a person reaches his late twenties, he'll ac­knowledge death on a more sophisticated level, accord­ing to Dr. Kimball. Though this person is occupied withliving in the present, he shows some concern about thefuture. As people marry and have children, they start toplan for their lives, to think about their mortality and togive up dangerous activities.As a person reaches 30, Dr. Kimball says, he givessome thought to approaching death, to all that he hasn'tdone and all that he wants to do. This often leads theperson to increased activity or, conversely, to depres­sion. With the forties, illness and death are often a part ofthe peer scene. "The provision for and care of one'schildren constitute the primary concern of adults fromages 35 to 50."Dr. Kimball says, "The pace of the acceptance ofdeath is stepped up with the onset of the fifties and sixtiesand given emphasis by retirement, which for many isidentified with death." How people adjust to retirementwill determine to a large extent whether or not death willoccur at this time, he adds. After 70, there is a kind ofstatus associated with living. "One lives not so much infear of death as in defiance of it. "Clinicians should be aware that most terminal patients,despite their age, will have certain concerns which mustbe understood, Dr. Kimball points out. The first of theseis that the patient will experience anxiety about his vul­nerability and mortality. The patient and his family mayalso need permission to express their grief and be assuredthat mourning is both normal and necessary. "In assist­ing the patient to grieve for himself, one must keep inmind the specifically personal nature of his grief. Thegrieving is for his pain, his losses, his past being and whathis future 'might have been."Staff members should keep in mind that most patientsexperience a great fear of being alone, he says. When thepatient feels most hopeless, others tend to distance them­selves unconsciously." Doctors and nurses must con- tinue to visit these patients, even when they can nolonger provide medical assistance. Since those in themedical field are geared toward saving lives, they oftenface a special set of obstacles when dealing with thedying." The hospital affords a number of options to helpstaff members to work through these problems. Thereare group meetings to discuss these difficulties, informaltalks with peers and colleagues and talks with clergymembers.This brings us full circle. The University of Chicagointerdisciplinary approach assures the dying patient thathis last days will be as comfortable as possible. From thetrainee to the sub-specialist, every member of a medicalteam is concerned with the patient's feelings.The most important thing that a clinician can do is toremember that each patient is a unique individual andneeds a unique kind of care, Dr. Kimball says. There isno magic formula. What will work for one person will beuseless for another. "Some of those here are so sick thatthey just want company and medicine to relieve theirpain. They could not actively engage with others. Yet,there are those whose minds are alert. They need to befully engaged. It is a fantasy to say that we, or anyone forthat matter, can make dying a pleasant experience but wecan serve to make a difficult situation less traumatic. Thismeans helping the patient in whatever way he feels aneed."Trainees discuss the best methods of handling a case,17On the Health Services FrontThe Center for Health Administration Studies is an in­terdisciplinary research unit of The University ofChicago concerned with the broad areas of financing,organization and delivery of health services. Its interestsrange from consumer use, expenditures, and attitudes tooverall health delivery systems.It is one of the few research centers in the countrywhose activities are directed exclusively to the generalproblems of the financing and organization of health ser­vices. It is well known for its extensive national house­hold research in health service systems in the UnitedStates and other countries, as well as for research in theoperational problems of the health services and their rela­tionships to emerging public policy issues.The range of problems under study at the Center in­cludes differences in staffing patterns between Swedish,British, and American general hospitals, effectiveness ofhealth planning agencies, evaluation and comparison ofvarious economic models of the hospital and the struc­ture and organization of medical practice. An analysis ofthe history and development of the Blue Cross move­ment has been completed; its emphasis is on the problemof government using intermediaries to purchase servicesmandated by legislation. A topic of continuing interest iscomparison of the development and operation of theSwedish, British, and Canadian health service systems,as discussed in Odin Anderson's Health Care: CanThere Be Equity? The United States, Sweden, and Eng­land (Wiley, 1972.) The Center also is involved in com­parative studies of the staffing patterns of general hospi­tals in the United States, Sweden and Great Britain. Mr.Anderson is Professor of Sociology in the University'sGraduate School of Business and the Department ofSociology.The Center has been closely associated with the ongo­ing debates and proposals regarding national health in­surance. A statement of administrative implications forhospitals was prepared for the Commission on NationalHealth Insurance established by the American College ofHospital Administrators. It was published by ACHA asNational Health Insurance: Implications for the Man­agement of Hospitals. Another study underway, fundedby the Robert Wood Johnson Foundation, is an examina­tion of issues of implementation of national health insur­ance.The Center, administratively within the Graduate Schoolof Business, houses the graduate program in HospitalAdministration, which prepares M.B.A. students forcareers in hospital and health service management.Mr. Anderson, is director of the Center. Assistant Di­rector is J. Joel May, who is also Director of the Hospital18 Administration Program. The Center has a staff of about30, half of whom are on an academic and research level.Formation And DevelopmentThe Center was created by the Board of Trustees of theUniversity of Chicago in 1964 as a continuation of theHealth Information Foundation. The Foundation hadbeen established in 1950 by the pharmaceutical, chemicaland drug industry as a nonprofit research and educationalagency concerned with the financing and organization ofhealth services. From 1950 to 1962 the Foundation car­ried out an extensive research program in its designatedMBA student specializing in hospital and health administration learnsfrom both hospital staff and faculty.area, including, nationwide household surveys of healthservice use and expenditures and the impact of voluntaryhealth insurance. Much of this research was done incooperation with the University of Chicago's NationalOpinion Research Center as the survey agency.In 1962 the Foundation and its staff were invited by theUniversity to move from its New York City headquar­ters and become an integral part of the Graduate Schoolof Business at Chicago. After a dozen years in New Yorkas a national research agency unaffiliated with a univer­sity, the Health Information Foundation respondedfavorably to the Chicago invitation. The Board of Direc­tors and senior staff of the Foundation agreed to movethe staff, program, and financial resources to the Univer­sity under the direction of the then President of theFoundation, George Bugbee, and its Research Director,Odin W. Anderson.Mr. Bugbee became the Director of the Foundation,(later the Center for Health Administration Studies),Professor of Hospital Administration and Director of theProgram in Hospital Administration. Mr. Anderson wasappointed Associate Director. Two full-time appoint­ments were created in connection with the Program inHospital Administration-one for the program and theother for research-late in 1961. This was done after RayE. Brown had resigned as Superintendent of BillingsHospital and Clinics and as Director of the HospitalAdministration Program to become V ice President ofAdministrative Affairs for the University.Affiliation of the original Health Information Founda­tion with The University of Chicago has proven to be awise and fruitful move. It has enabled the Center forHealth Administration Studies to integrate teaching and research in hospital and health administration, Mr. An­derson says.Graduate ProgramFurther graduate work in health services is possiblethrough the Ph.D. programs of the Graduate School ofBusiness, the Department of Sociology and the Depart­ment of Economics, among others. The Center providesan academic research base for graduate students andfaculty from all parts of the University who are interestedin research concerning some aspect of health services.Since 1962, about 175 MBA's specializing in hospitaland health administration have been graduated, and fivePh.D's. There have also been Ph.D's from sociology,economics, the Committee for Human Development andpolitical science who have done their dissertations in thehealth field under the auspices of the Center.FundingSince the move from New York City, the funding ofthe Center's research activities has become diversifiedbetween private and public sources. Backbone of thefunding for research since 1964, has been two substantialprogrammatic grants from the National Center forHealth Services Research and Development, the first forseven years and the second for five years. The program­matic grant concept supports development of a researchprogram which generates specific projects for specialfunding from a variety of sources. It facilitates the hiringand stabilizing of research staff which can move from oneresearch project to another. In fact, the programmaticgrants have generated grants from other sources of fund­ing.Measuring Access to Health CareOne of the recent projects undertaken by the Center forHealth Administration Studies was an investigation ofaccess to health services. A summary of the findings ispresented below.How much time elapses between the point at which yourecognize the need for medical care and the actual visit tothe doctor? How many visits did you make to the doctorlast year? How many visits should you have made to thedoctor last year?These are the kinds of questions that were asked in asurvey analyzed in 1973 by The University of Chicago'sCenter for Health Administration Services as a part of a three-year project under a grant from the Robert WoodJohnson Foundation. The purpose of the project is toconduct research designed to improve the delivery ofhealth care services to the people in the United States.The first year of the study-under the direction of LuAnn Aday, Study Director, and co-principal inves­tigators Odin W. Anderson, the Center's Director, andRonald M. Andersen, Research Associate and AssociateProfessor-was devoted to the development of a numberof "access indices." The goal was to determine what isactually meant by access and how it can be measured.Factors in health care considered changeable by publichealth policies were given the greatest attention. The re-19search team developed two types of indices as a result oflast year's work: process indices and outcome indices.The process index does not directly measure aspects ofhealth care utilization, but rather factors thought to affectthe kind and amount of services used, such as travel timetoa source of care and waiting time in a doctor's office.Outcome measures are directly concerned with utiliza­tion and its effects. They include: conventional usemeasures such as number of doctor visits; need-baseduse measures, which attempt to examine the use of ser­vices of various population groups, relative to the disabil­ity or morbidity experienced by those groups; continuitymeasures, which attempt to gauge services received ac­cording to their probable level of integration and con­tinuous nature over the course of an illness episode; andmeasures of consumer satisfaction with the services av­ailable to and received by them.It was found that: .-In general children have more of an advantage thanadults with respect to having a usual source of care that isconvenient to them. Those 55 and over must often travelmore than an hour to reach care. The 55 to 64 year-oldsare also more likely to have unscheduled visits to aphysician. Once in the doctor's office, they have thelongest waits.-Residents of the inner-city and rural farm dwellersare the most disadvantaged with respect to having a regu­lar source of care convenient to them.-Those who identify "clinics" as their usual caresource generally have less convenient care than thosewho list a medical doctor as their usual care source. Peo­ple who go to general practitioners, such as clinic users,are more apt to "walk in" to obtain care than those whouse specialists. People who make appointments to seespecialists generally have longer waits before beingscheduled than those who go to general practitioners.-Children 6-17 were least apt to see the doctor. Whenactual need for care was considered, however, it wasfound that the middle-aged and older adults had the leastaccess, i.e., the most unmet medical need. Elderly whosaw a doctor were more apt than other age groups to haveserious kinds of complaints. People under 65, however,were more likely to go to a hospital emergency room ifthey needed primary medical attention. Those under 65were also least satisfied with the process of getting healthcare. Dissatisfaction extended to cost-convenience andthe characteristics and performance of providers.-Nonwhites consistently had fewer physician con­tacts and visits, less use relative to their actual need forcare, more fragmented and ill-coordinated patterns ofcare and greater levels of dissatisfaction with the cost andconvenience of services overall than whites.-Rural farm and inner-city residents had the least"access" in terms of the outcome indicators of the con­cept. People who lived on farms in rural areas had thelowest rates of physician use and the lowest levels of userelative to their real need for care. People in inner citieswere apt to have the most fragmented and ill-coordinatedpatterns of care. Inner city and rural farm dwellers weremost dissatisfied with the cost and' convenience of ser­vices in general.20 -People whose income was below the poverty levelwere less apt to contact a doctor than the nonpoor; usedfewer services relative to their need; had more frag­mented and less continuous care then the non poor; andwere much more dissatisfied overall with the out-of­pocket costs and inconvenience of medical services.-People who had no particular place they went formedical advice and treatment were apt to have the fewestvisits to a doctor and, according to the need-based accessindices, have the highest levels of unmet medical need.People who routinely went to clinics were apt to have themost serious complaints when they did see a doctor.Clinic users and people with no regular physician wereapt to have the most discontinuous care. Clinic userswho had no particular physician that they saw or peoplewho had no regular place they usually went for care weremost dissatisfied with all aspects of care-both its costand convenience and the characteristics and performanceof the providers themselves.The second year of the project, which began last April,says Aday, will be devoted to the development of a ques­tionnaire to be used in a nationwide survey of health careaccess.During the next two years, the Center will also bestudying a number of ambulatory care programs in com­munities throughout the United States. They will beprimary health care sources based at hospitals. The na­tional questionnaire, it is hoped, will serve as a model forsurveys before and after the establishment of programs inthe small towns. It will measure whether there has beenan improvement in access as a result of program efforts.The third year of the program will be spent administer­ing these local level surveys.i!::?�/WV�'Odin AndersonNews BriefsMichael Reese-PritzkerThe following full-time members ofMichael Reese Hospital and MedicalCenter have been named to the staff ofThe Pritzker School of Medicine:Department of MedicineAppointments:Dr. Antonio Chan to Instructor fortwo years, effective July 1.Dr. Juan Chediak to Instructor for oneyear, effective July 1.Dr. Fred L. Fishman to Clinical In­structor for two years, effective July 1.Dr. Fishman served as Resident (71-73).Dr. Barry Levin to Assistant Profes­sor for three years, effective July 1.Dr. Monty J. Levinson to Clinical As­sistant Professor for two years, effectiveJuly 1.Dr. David Lowenthal to AssistantProfessor for three years, effective July1.Dr. Cyril Mendelson to Clinical As­sistant Professor for two years, effectiveJuly 1.Dr. Stephen H. Norris to Clinical In­structor for two years, effective July 1.Dr. Edward Walton (B.S. 58) to Clini­cal Instructor for two years, effectiveJuly 1.Promotions:Dr. Richard Desser to Clinical Assis­tant Professor from Instructor, for twoyears, effective July 1.Dr. Michael Ellman to Assistant Pro­fessor from Instructor for three years,effective July 1.Dr. Murray Favus to Assistant Pro- fessor from Instructor, for three years,effective July 1.Dr. Gerald Glick to Professor fromAssociate Professor for three years, ef­fective September 1.Dr. Arthur Schneider (67) to AssistantProfessor from Instructor, for threeyears, effective July 1.Reappointments:Dr. Imitiaz Hamid, Instructor, for oneyear, effective July 1.Dr. Sherwin Kabins, Associate Pro­fessor, for three years, effective July 1.Dr. Charles M. King, Assistant Pro­fessor, for three years, effective July I.Dr. Mabel Koshy, Instructor, for oneyear, effective July I.Dr. Alfred Pick, Professor, for oneyear, effective July I.Dr. Kenneth Robbins, Professor, forthree years, effective July I.Dr. Ung Yun Ryo, Assistant Profes­sor, for three years, effective July I.Dr. Leslie J. Sandlow, Assistant Pro­fessor, for three years, effective July I.Dr. Aaron Shaffer to Clinical As­sociate Professor from Associate Pro­fessor for two years, effective July I.Dr. Louis Sherwood, Professor, forthree years, effective July I.Dr. Margaret Telfer, Assistant Pro­fessor, for three years, effective July I.Department of Obstetrics and Gynecol­ogyAppointments:Dr. Laurence I. Burd to AssistantProfessor for two years, effective July I.Dr. Melvin P. Cohen to Clinical Pro­fessor for two years, effective July I.Dr. Archimedes Diamante to ClinicalInstructor for two years, effective Sep­tember 1.Dr. Henry Hankin to Clinical As­sociate Professor for two years, effectiveSeptember I.Dr. Aaron Lifchez to Clinical Instruc­tor for two years, effective September I. Dr. Martin Motew to Clinical Instruc­tor for two years, effective September I.Dr. Ramaa Rao to Instructor for twoyears, effective July I.Dr. Jorge Valle to Clinical Instructorfor two years, effective September I.Promotions:Dr. Paul Dmowski to Associate Pro­fessor from Assistant Professor, for twoyears, effective September I.Dr. David Zbaraz to Clinical Assis­tant Professor from Instructor, for twoyears, effective July 1.Reappointments:Dr. William M. Alpern, Clinical As­sociate Professor, for two years, effec­tive July I.Dr. Allan Charles, Clinical Professor,for two years, effective July I.Dr. Donald L. Chatman, Clinical As­sistant Professor, for two years, effec­tive July 1.Dr. Richard Frank, Clinical AssociateProfessor, for two years, effective JulyI.Dr. Ronald Meltzer, Clinical Assis­tant Professor, for two years, effectiveJuly 1.Dr. Bertrand R. Nedoss, Clinical As­sistant Professor, for two years, effec­tive July I.Dr. Alfred Platt (32), Clinical As­sociate Professor, for two years, effec­tive July 1.Department of PediatricsAppointments:Dr. Robert Kretschmer to AssistantProfessor for two years, effective July I.Dr. Eugene N. Pergament (70) to As­sociate Professor for two years, effectiveJuly I.Dr. Arthur H. Rosenblum (35) to Clin­ical Professor for two years, effectiveJanuary I, 1974.Dr. Irving H. Rozenfeld (47) to Clini­cal Professor for two years, effectiveJanuary I, 1974.Dr. Ernest Weis to Assistant Profes­sor for two years, effective July I.21Department of PsychiatryAppointments:Dr. Helmut Baum to Clinical As­sociate Professor for two years, effectiveJuly 1.Dr. Stuart S. Burstein to Clinical As­sistant Professor for two years, effectiveJuly 1.Dr. Robert Andrew Fajardo to Clini­cal Assistant Professor for two years, ef­fective July 1.Dr. James M. Fisch to Clinical Assis­tant Professor for two years, effectiveJuly 1.Dr. Benjamin Garber to Clinical As­sistant Professor for two years, effectiveJuly 1.Dr. Gerson Hirsh Kaplan to ClinicalAssistant Professor for two years, effec­tive July 1.Dr. Thomas J. Pappadis to ClinicalAssistant Professor for two years, effec­tive July 1. Dr. Pappadis served asRotating Intern in 1961.Dr. Esther Pizer to Clinical AssistantProfessor for two years, effective July 1.Dr. Robert N. Polsky to Clinical As­sistant Professor for two years, effectiveJuly 1.Dr. David A. Rothstein to ClinicalAssistant Professor for two years, effec­tive July 1.Dr. James H. Saft to Clinical As­sociate Professor for two years, effectiveJuly 1.Dr. Seymour B. Siegel to Clinical As­sociate Professor for two years, effectiveJuly 1.Dr. Morris A. Sklansky to ClinicalProfessor for two years, effective July 1.Dr. Sklansky served as ProfessorialLecturer (66-74).Dr. Richard H. Telingator (A.B. 46)to Clinical Associate Professor for twoyears, effective July 1.Dr. James E. Wilson to Clinical Assis­tant Professor for two years, effectiveJuly 1.Department of RadiologyAppointments:Dr. Nancy L. Brown to Instructor forone year, effective September 1.Dr. Alan V. Cadkin to Instructor forone year, effective September 1.Dr. Albert S. Johnston to AssistantProfessor for two years, effective Sep­tember I.Dr. Perry Rudich to Instructor for oneyear, effective September 1.Dr. Himmat T. Shah to Instructor forone year, effective September I.Dr. Siddalingappa Srikantaswamy toI nstructor for one year, effective Sep­tember 1.Promotion:Dr. Jacques Ovadia to Professor from22 Associate Professor for two years, effec­tive July 1.Frontiers of MedicineThe Frontiers of Medicine series beganits tenth year of monthly programs forthe practicing physician October 9. Con­ferences are held in the Frank BillingsAuditorium, P-I17, the second Wednes­day of each month from October throughJune with the exception of the December18th lecture. They are designed to pro­vide physicians with a comprehensivereview of recent developments, with par­ticular emphasis upon clinical applica­tion. Three all-day programs are plannedin this series, beginning at 9:00 a.m. Af­ternoon programs begin at 2:00 p.m.The 1974-75 lectures are:October 9-Advances in Disease Detec­tion by Nuclear ScanningNovember 13-Cutaneous MedicineDecember 18-Lethal Diseases of theAscending Aorta and Branches (allday)January 8-Advances in EndocrinologyFebruary 12-New Developments inDiagnosis and Management of LiverDisease (all day)March 12-Neuromuscular Disease:Current Ideas in Diagnosis and Man­agementApril 9-Aggressive Treatment ofCancer: Rewards and RisksMay 14-Medical MalpracticeJune II-Immunologic Considerationsin Medical Practice. Modern Con­cepts in the Management of Arthritis(all day)For additional information, write toLouis Cohen, M.D., Frontiers ofMedicine, The University of Chicago,Box 451,950 East 59th Street, Chicago,Illinois 60637.Committee on Immunology ApprovedAn interdepartmental Committee onImmunology has been established in theDivision of the Biological Sciences. Dr.Frank W. Fitch (53), Professor ofPathology, was appointed chairman forthree years.The purposes of the Committee are toprovide instruction in immunology forgraduate students and to facilitate ex­change of information and ideas amongfaculty members and students engaged inresearch in immunology.A newly developed program of studyleading to the Ph.D. degree is offeredunder the sponsorship of the Committee.The academic program consists of atleast nine formal courses in addition toresearch courses. Usually three courseswill be in immunology and six courses incellular and molecular biology. Dr. Freedman Elected to Institute ofMedicineDr. Danield X. Freedman, Louis BlockProfessor and Chairman of the Depart­ment of Psychiatry, has been elected tomembership in the Institute of Medicineof the National Academy of Sciences.Members are elected on the basis of pro­fessional achievement relevant to theproblems of medicine and of demon­strated interest, concern and involve­ment with problems and critical issues inhealth care, the prevention of disease,medical education, and medical re­search. There are 270 active members ofthe Institute. Other University ofChicago members are Dr. Leon O.Jacobson (39); Dr. Albert Dorfman (44),Richard T. Crane Distinguished ServiceProfessor, Department of Pediatrics andOdin W. Anderson, Professor and Di­rector, Center for Health AdministrationStudies.Comprehensive Cancer Program Under­wayIn the past issue of Medicine on theMidway, the News Brief on the IllinoisCancer Council Comprehensive CancerProgram failed to credit Dr. JohnBrewer (S. B. 25, M.D. 29, PhD. 36), ofNorthwestern University and Dr.Samuel Taylor Ill, (M.D. 32), of Rush­Presbyterian-St. Lukes Medical Center,for their leadership in the program. Bothdoctors are alumni of The University ofChicago Pritzker School of Medicine.Eye Tracking Test for SchizophreniaA simple test of how well the eyes followa moving target promises to solve someof the mysteries of schizophrenic illness.Philip S. Holzman, working in collabora­tion with Dr. Leonard Proctor, andgraduate student Deborah Levy, disco­vered that most schizophrenic patientsshowed subtle but definite impairment intheir ability to follow a moving pen­dulum. In contrast, only a few non­schizophrenic psychiatric patients, in­cluding those called manic-depressive,showed the eye tracking difficulties.Previously, this abnormality had beenassociated only with brain lesions or cer­tain toxic conditions. Holzman is Pro­fessor in the Departments of Psychiatryand Psychology. Dr. Proctor is As­sociate Professor in the Department ofSurgery Section of Otolaryngology."We were suprised to find also," saidHolzman "that a large percentage of thefirst-degree relatives of the schizo­phrenics also showed impairment in theirslow eye movements, while the relativesof non-schizophrenic patients and 95 percent of non-patients who were testedshowed unimpaired tracking."The eye tracking test, according toThe University of Chicago team, mayprove to be a genetic marker and thus beused to trace lines of transmission for thepotential in families.The research was supported by grantsfrom the Supreme Council of the Scot­tish Rite Northern Masonic Jurisdiction,Maurice Goldblatt, Howard Pack andthe National Institute of Mental Health.Holzman and Dr. Proctor hold facultyappointments in the University's Divi­sion of the Biological Sciences and ThePritzker School of Medicine.A report on The University ofChicago research appears in the Augustissue of the Archives of GeneralPsychiatry. Chief Editor Dr. Daniel S.Freedman said, "These findings haveimportant implications. The test repre­sents one of the very few techniques forunveiling a dysfunction that is specificfor schizophrenia and not for all psy­chotic states. The test itself is non­psychological; it is one in which elec­tronic recording of the muscle and eyemovements are made while the eyestrack a pendulum. Thus, it does not de­pend upon an examiner's interpretationof the meaning of the patient's com­munication." Dr. Freedman is Chair­man and the Louis Block Professor inthe Department of Psychiatry.Holzman said the results of the exper­iment suggest that for the schizophrenicpatient some abnormality may exist inthe communication network betweennerves and between nerves and musclesand that this abnormality is not limited tothe acute outbreak of psychosis. The re­searchers believe that the eye trackingdysfunction may represent a necessarybut not sufficient predisposition for de-Ramon Lim veloping the disorder. "Since so manyfirst-degree relatives of schizophrenicsshow the eye tracking disorder," saidHolzman, "the test may open up thepossibility for tracing the genetic trans­mission of schizophrenia. For manyyears it has been strongly suspected thatthe predisposition for developingschizophrenic illness was conveyedgenetically. Because of the difficulties indiagnosing schizophrenia, it has not yetbeen possible to establish this beyond adoubt, let alone establish how the poten­tial is transmitted-whether a 'threshold'of multiple genes or a single gene is in­volved." The test is now in the experi­mental stage. The team is seeking thesource of the eye tracking abnormalityand testing its usefulness as a geneticmarker for schizophrenia.Protein May Aid Cancer ResearchDrs. Ramon Lim and Katsusuke Mit­sunobu have detected a large protein ofabout 350,000 molecular weight thatcould be of potential value in cancer re­search as well as in the understanding ofbrain cell maturation.The protein is present in the adultbrain and several other normal organs.When extracted and added to a culture ofembryonic rat brain cells, it drasticallyalters the appearance of the individualcells and changes the intercellular pat­tern from a simple to a well organizedform. The most dramatic change occursin cells which originally are devoid ofany characteristic mature features.These "flat" cells are stimulated by theprotein to acquire the morphologicalproperties of mature astrocytes by an ex­tensive outgrowth of processes. Astro- cytes belong to a type of cell called"glia" which, together with the neurons,are the normal constituents of the maturebrain.Dr. Lim is Assistant Professor in theDepartments of Surgery (Neurosurgery)and Biochemistry and in the Brain Re­search Institute in the University's Divi­sion of the Biological Sciences and ThePritzker School of Medicine. Dr. Mit­sunobu is a former Fellow and ResearchAssociate in Dr. Lim's laboratory. Theirreport, entitled "Brain Cells in Culture:Morphological Transformation by a Pro­tein," appeared in the magazine Scienceon July 5.Dr. Lim said, "We are dealing with arelationship between chemistry andmorphology. In our experiment, wecreate a perturbation in the chemical en­vironment of the culture cells and inducethe morphological changes. The pertur­bation is the presence or absence of thisprotein factor. The development of acomplete organism from a single cellembryo remains to this day a mystery. Inthe past two decades, emphasis inbiological research has been placed onDNA, the genetic blueprint of a cell. Inrecent years there has been an increasingawareness among scientists that ON Aalone cannot sufficiently explain all theobserved phenomena in embryonic de­velopment, and the cell environmentplays an important role as well. We hopethe study of this protein factor mightcontribute in some way to the under­standing of problems in developmentalbiology. "Drs. Lim and Mitsunobu separatedcells from embryonic brain tissue bytreatment with trypsin, a digestive en­zyme that breaks tissues up into indi-The first set of cells has been exposed to the protein factor-the second has not.23vidual cells. The cells were then culturedto form a single layer on the surface ofplastic tissue culture flasks. By doingsome experimental manipulations, theywere able to obtain a homogeneouspopulation of immature cells. Whenthese cells were exposed to brain ex­tract, which contains the protein factor,they developed extensive multiple out­growths in about 20 hours. The cellsstimulated by Lim and Mitsunobu ap­parently have several other characteris­tics of mature brain cells; such as thepresence in abundance of microfilamentsand microtubules. An inhibitor of pro­tein synthesis, cycloheximide, preventedthe cells from undergoing the changesobserved when exposed to the brain ex­tract, indicating that cell metabolism isthe underlying mechanism for the mor­phological change.Drs. Lim and Mitsunobu first realizedthat the factor is a protein from the ob­servation that its activity was destroyedby heating, and that it could not passthrough certain cellulose membranesused in biochemical work. Later, theprotein nature of this factor wasconfirmed by the fact that it is degrad­able by enzymes capable of attackingproteins. Lim and Mitsunobu then iso­lated this protein from the brain and nar­rowed the protein's identity down to oneof about 350,000 molecular weight. Al­though the protein has not been obtainedin a completely pure form, they wereable to demonstrate its effect when usedin minute amounts. "The persistence ofthe activity at such a low concentrationplaces it in the category of homones andenzymes. "Dr. Lim said that in the living matureorgan, the protein could be part of thecells' surface membrane, and by meansof this surface protein the cells couldmutually influence one another, produc­ing a cooperative effect in keeping all thecells at a certain level of differentiation.The loss of this presumptive cellularcontact effect when the cells in an organare separated from each other or areotherwise prevented from coming inproximity, could cause them to revertback to a more primitive state. Whenasked about its implication in cancer,Dr. Lim said, "One salient featurecommon to all cancer cells is their rever­sion from a higher to a lower state ofdifferentiation. It might well be that forsome unknown reason individual can­cerous cells are 'out of touch' from oneanother so that they do not benefit fromthe cooperative influence enjoyed bynormal cells." Backed by some prelimi­nary evidence, Dr. Lim speculated thatthere might be a lack of this factor incancer tissues. "If this can indeed be24 substantiated," said Dr. Lim, "someday we might even think of its therapeu­tic applicability." "However"cautioned Dr. Lim, "the real biologicalsignificance of this protein factor is asyet unknown."Successful Kidney TransplantPatrolman Michael Nicoletti of theChicago Police force passed the sixthanniversary of his successful kidneytransplant this August. His case, consid­ered by some to be one of the most suc­cessful cadaver kidney transplants in theChicago area, is one of 33 kidney trans­plants that have been performed withoutfatality since 1973 at the University ofChicago medical complex.In 1968, after one and one-half yearson an artificial kidney, Nicoletti receiveda cadaver transplant at the University'sBillings Hospital. He had only one smallrejection episode two weeks after trans­plantation, which was reversed easilywith additional immunosuppressiondrugs, according to Dr. Frank Stuart,University of Chicago transplantsurgeon and Professor in the Depart­ment of Surgery.Nicoletti and his wife already had twoboys but a long hoped-for girl was bornto the N icolettis August 2, 1971, thethird anniversary of his transplant.Nicoletti, 44, is a patrolman with thecorporation counsel's office. He is onlight duty serving summons, warrantsand notices of building code violations.He has worked steadily during the entiresix years since transplantation. Hejoined the Police Department in 1959.Subsequently, he developed kidney dis­ease, but the disease was present forseveral years without him knowing it. Atthe age of 35, Nicoletti's disease wasreaching its peak. He was started ondialysis treatments at Hines VeteransAdministration Hospital, requiring sev­eral lengthy visits to their dialysis unit.Once he was approved for the artificialkidney machine, the government hand­led the expense of the dialysis.Study Measures PrestigeThoracic surgeons, among all of 41 med­ical health professional categories, carrythe most prestige in the opinion of othermedical doctors. Chiropractors rate theleast.In a study done by Stephen M. Shor­tell, Acting Director of The Universityof Chicago's Graduate Program in Hos­pital Administration in the GraduateSchool of Business, three groups ofrespondents-doctors, hospital patientsand graduate business school students-were asked to evaluate 41medical and allied health specialities on anine point scale of prestige. Prestige wasdefined as "how much you look up toeach occupation."Shortell believes that prestige withinthe medical profession might be relatedto the nature of the doctor-patient rela­tionship. He distinguishes three basictypes of relationships between doctorand patient: activity-passivity,guidance-cooperation and mutual par­ticipation. He proposes that specialtieswhich adhere more to the activity­passivity model (the physician actuallydoes something to the patient who actsonly as a passive recipient) will receivehigher prestige ratings than those whichadhere more to the other models.When the specialties were classifiedaccording to which of these three par­ticipants typically adopted, those usingthe activity-passivity model were as­signed the highest prestige by all threegroups of raters-doctors, patients andgraduate business school students, bear­ing out Shortell's proposition. Wheneach group was asked what criteria itwas using in its ratings, the most fre­quent one mentioned by all three groupswas the degree of skill of each speciality.The medical speciality and health­related occupational ratings were madeby 117 medical doctors drawn from threeChicago-area hospitals. The ratings fol­low:1. Thoracic Surgeon2.5. Neurosurgeon2.5. Cardiologist4. Neurologist5. Internal Medicine6. Ophthalmologist7. Plastic Surgeon8. Pathologist9. Orthopedic Surgeon10. Radiologist11. General Surgeon12. Pediatrician13. Gastroenterologist14. Ob-gynecologist15. Psychiatrist16. Urologist17. Otolaryngologist18. Anesthesiologist19. Preventive Medicine20. Dermatologist2L AllergistOthers in order were: General Prac­tice; Physiatrist; Dentist; Director ofNursing Service; Hospital Adminis­trator; Registered Nurse; Pharmacist;Hospital Controller; Medical SocialWorker; Physical Therapist; Occupa­tional Therapist; Inhalation Therapist;Medical Technician; X-ray Technician;Psychiatric Technician; Osteopath;Practical Nurse; Nurse Aide; Podiatristand Chiropractor.There were relatively few rank-orderdifferences in the ratings made by pa­tients and students and those made bythe doctors.Shortell says the finding that prestigeappears to be related to the degree ofcontrol a physician has over patient out­comes has important implications for thechanging nature of the doctor-patient re­lationship. "It, perhaps in part, explainsthe resistance of some physicians to pa­tients' demands for more informationand a larger voice in decisions affectingthe outcome of care," he says. "Thefindings also suggest that the prestige ofsuch new categories of health manpoweras physician assistants and pediatricnurse practitioners will depend not somuch on their ability to define a specificset of duties or responsibilities but,rather, how they will typically relate tothe patient in terms of their ability tocontrol outcomes of care. " Most realis­tically, their prestige, and in turn, theirability to attract patients, will probablydepend on the prestige of the specialistswho employ them. A general surgeon'sphysician assistant, for example, willprobably be accorded higher prestigethan a general practitioner's physicianassistant..�InsecticidesUniversity of Chicago scientists have in­formation about insect biochemistry thatcould point the way to new and im­proved insecticides. Their research, re­ported at the annual meeting of theAmerican Chemical Society (ACS), in­volves the so-called juvenile hormonewhich is secreted by all insects and crus­taceans.The juvenile hormone, analogs ofwhich are already in commercial use asinsecticides, helps regulate the transfor­mation of insects from one "instar"(growth stage) to another, (e.g., fromlarva to pupa, or from pupa to adult.) Aninappropriate dose of juvenile hormoneor an analog can interfere with normalgrowth processes. It may cause the de­veloping insect, for instance, to grow anew larval skin, become imprisioned inits own skin, and die. However, Univer­sity of Chicago researchers have foundthat insects also secrete an enzyme thatinactivates juvenile hormone at certaingrowth stages. Using this enzyme, in­sects might have an immunity to thehormones used as an insecticide. Thisdiscovery was reported by Karl Kramer,Research Associate in the Departmentof Biochemistry. The enzyme acts on themethyl ester group in juvenile hormone.If a synthetic juvenile hormone analog can be developed that lacks this estergroup, the insect's inbuilt defenseagainst juvenile hormone imbalances canbe by-passed.The research was performed under thedirection of John H. Law and Ferenc J.Kezdy. Law is Professor in the Depart­ments of Biochemistry, Chemistry, andthe College. Kezdy is Professor in theDepartment of Biochemistry. It wassupported by grants from the NationalScience Foundation and the NationalInstitutes of Health.The University of Chicago Researchwas reported in two papers presented inthe ACS Division of Pesticide Chemis­try:-David Reibstein reported on the"Enzymatic Synthesis of Juvenile Hor­mone." Reibstein, a Ph.D candidate inbiochemistry, outlined tentatively thecomplicated process by which insectssynthesize juvenile hormone.Reibstein's researches, conducted onhomogenized corpus alia tum glands ofthe tobacco hornworm (Manduca sexta),demonstrated that a compound,S-adenosylmethionine, acts as a donor ofthe methyl group which is incorporatedinto the ester function of juvenile hor­mone. Such specific knowledge of howinsects synthesize juvenile hormone mayprovide the basis for its synthetic pro­duction, or production of an analog, inchemical laboratories. With this in­creased knowledge, biochemists mayalso be able to design methods to inter­fere with juvenile hormone synthesis byinsects. Professor Law was co-author ofReibstein's paper.-Kramer reported on the "Interac­tion of Juvenile Hormone withHemolymph from Manduca sexta;Purification of Carrier Protein andCharacterization of Hormone SpecificEsterases." He reported on his discov­ery of a "binding protein" of relativelylow molecular weight that enhanced theactivity of juvenile hormone in tissueculture, and on the discovery by LarrySanburg, a colleague, of juvenile hor­mone esterase enzymes that controljuvenile hormone levels in the insects'shemolymph (blood). Kramer reportedthat specific juvenile hormone esterasesappear in the fifth larval instar, just be­fore metamorphosis to the pupa stage,that destroy all juvenile hormone in thehemolymph. Kramer said that other re­searchers had hypothesized that thejuvenile hormone carrier had a molecularweight of about 200,000, but he had ob­served a carrier of 30,000 molecularweight. Co-authors of the paper given byKramer were Sanburg, also a ResearchAssociate in Biochemistry; Kezdy andLaw. In MemoriamAlumni Deaths'00. Charles W. Leonard, Fond DuLac, Wisconsin, February 9, 1974, age98.'04. Earle B. Stewart, Roseburg,Oregon, May 29, 1974, age 92.'09. John T. Strawn, Vinton, Iowa,July 21, 1974, age 93., 16. Karl J. T heige, Viroqua, Wiscon­sin, August 13, 1974, age 91.'22. James A. Gough, Lexington,Kentucky, May 14, 1974, age 78.'23. James D. Alway, Sun City,Arizona, February 22, 1974, age 77.'26. Harold J. Heath, Juneau, Wis­consin, June 30, 1974, age 68.'27. James O. Helm, New Florence,Missouri, September 22, 1973, age 77.'29. Alva C. Surber, Jr., LagunaBeach, California, November 28, 1973,age 72.'31. Dale F. Scott, Sterling, Illinois,February 22, 1974, age 73.'34. John T. Hauch, Toronto, On­tario, Canada, May 25, 1974, age 73.'34. Philip C. Hemming, Costa Mesa,California, September 1, 1971, age 67.'34. Alvin E. Ottum, Portland, Maine,February 21, 1974, age 69.'35. Sandor D. Papp , Joplin, Mis­souri, March 3, 1974, age 65.'38. Nathan Morris, Plainfield, NewJersey, March 9, 1974, age 63.'38. Lucille Watt, Chicago, Illinois,June 3, 1974, age 78.'40. Alfons F. Tipshus, Santa Clara,California, February 2, 1974, age 58.'54. George H. Burnett, Madison,Wisconsin, July 8, 1974, age 49.'66. James M. liles, San Jose, Califor­nia, May 20, 1974, age 33.Former StaffDorothy E. Eshbaugh (Medicine, Resi­dent, 43-44), Chicago, llIinois, June I,1974, age 56.25Departmental NewsAnatomyPromotions:Beatrice Garber-Associate Professor.Beatrice GarberGrants:William L. Doyle, Professor inAnatomy, is principal investigator for atwo-year, $25,000 grant from the Na­tional Science Foundation to study "In­tracellular Mechanisms in TranscellularFluid Transport."AnesthesiologyAppointments:Dr. Erica Ford-InstructorDr. Donald W. Benson (50) is returningto The University of Chicago January 1as Professor and Chairman of Anes­thesiology. He is leaving The JohnsHopkins University School of Medicinewhere he has been professor and chair­man of anesthesiology.Dr. Benson is no stranger to medicalalumni, having received a B.S. degree in1948, his M.D. in 1950, and a Ph.D. inpharmacology in 1957. Following his in­ternship at Millard Fillmore Hospital,Buffalo, he returned to the Universityfor a residency in anesthesiology. In1953 he was appointed instructor in anes­thesiology and later assistant professor.In 1956 he left to become associate pro­fessor and anesthesiologist in charge atThe Johns Hopkins Hospital.26 Dr. Benson played a prominent part inintroducing closed-chest cardiopulmo­nary resuscitation into clinical practiceand assisted in establishing anesthesiol­ogy as an esteemed specialty nationally.Both here and abroad, his name has beenassociated with high standards of clinicalexcellence and he has been recognizedas a leader in American anesthesiologyeducation. He has served as president ofthe Maryland Society of Anes­thesiologists, vice president of the sec­tion on anesthesiology of the AmericanMedical Association, and director of theAmerican Board of Anesthesiology.Dr. Benson is the author and co­author of 45 published research papersand edited the Clinical Anesthesia SeriesNo.3 of Surgical Specialties (1966).Promotions:Dr. Phebe L. Tan-Instructor.Dr. Tamding Tempo-Instructor.Ben May laboratoryElwood V. Jensen, Professor and Direc­tor of The University of Chicago's BenMay Laboratory for Cancer Research,Director of the Biomedical Center forPopulation Research and Professor inthe Department of Biophysics andTheoretical Biology, participated in the11th International Cancer Congress inFlorence, Italy, October 20-26. Hespoke October 22 on recent findings of atest he developed to predict the successof hormone therapy in breast cancer.Also participating in the Congress wasRonald G. Harvey, Associate Professorin the Ben May Laboratory. He discus­sed "Oxidized Metabolites of Car­cinogenic Polycyclic Hydrocarbons:Synthesis and Properties."Donald Benson Harvey also spoke recently at JohnsHopkins, Columbia, the Fox Chase In­stitute, Philadelphia and the NationalCancer Institute on his research on car­cinogenic hydrocarbons.Jensen also visited Bulgaria, Sep­tember 28-0ctober 19, as a guest of theBulgarian National Academy of Sci­ences. During his visit, he consultedwith cancer specialists there. His tourof Bulgeria was arranged by the U. S.National Academy of Sciences. Jensenis a member.Elwood JensenBiochemistryAppointments:Dr. Ake Lernmark- Visiting AssistantProfessor. Dr. Lernmark, who is fromDenmark, will work in the Diabetes­Endocrinology Center under Dr. DonaldSteiner.Howard S. Tager, (Biochemistry Re­search Associate, 72-73)-AssistantProfessor.Grants:Glyn Dawson, Associate Professor inPediatrics, Research Associate inBiochemistry and Joseph P. Kennedy Jr.Scholar, received a $30,396 grant fromthe National Science Foundation tostudy four inborn errors of metabolisminvolving deposition of different glyco­proteins in tissues, causing damage par­ticularly to the brain and liver.John Westley, Professor in Bio­chemistry, and in the College, is principalinvestigator for a a study titled"Mechanisms of Sulfur TransferCatalysis." He'll be working under a$50,000 grant from the National ScienceFoundation.Earl A. Evans, Jr., Professor inBiochemistry and in the College, hasbeen elected to the Society of Scholarsof Johns Hopkins University.Eugene Goldwasser, Professor inBiochemistry, the Franklin McLeanMemorial Research Institute, the Com­mittee on Developmental Biology and inthe College, presented two papers at theInternational Conference on Ery­thropoiesis in Tokyo, in August.H. G. Williams-Ashman presented apaper, "Mechanisms and Regulation ofS-Adenosylmethionine Decarboxylasesin Eukaryotes," at the InternationalSymposium on the Biochemistry ofAdenosylmethionine, Rome, May21-26. He presented a lecture, "SpecificBasic Proteins Involved in MamalianSpermatogenesis," at the University ofBologna, May 28 and at the Universityof Parma, May 31. Dr. Williams­Ashman is the Maurice Goldblatt Pro­fessor in the Ben May Laboratory and inBiochemistry.BiologyAppointments:Stevan J. Arnold-Assistant Professor.Niza Frenkel (Microbiology, Ph.D.72, Research Associate 72-74)- Assis­tant Professor. Mrs. Frenkel won theMark Galler prize for the best Ph.D.dissertation in the Division of the Biolog­ical Sciences. She was a Weizmann Fel­low at the Weizmann Institute in 72-73with Professor Ernest Winoeur and aLeukemia Society Fellow with ProfessorBernard Roizman 73-74.Promotions:Michael Esposito-Associate Professor.Beatrice Garber-Associate Profes­sor.Grants:The Division was awarded a trairunggrant in Behavioral Biology from the N a­tional Institute of Mental Health. StuartAltmann, Professor in Biology, is pro­gram director. Faculty contributing tothe program include Stevan Arnold, As­sistant Professor in Biology; JamesHopson, Associate Professor inAnatomy; Monte Lloyd, Associate Pro­fessor in Biology; Eric Lombard, Assis­tant Professor in Anatomy; Dr. CharlesOxnard, Professor in Anatomy; LeonardRadinsky, Associate Professor inAnatomy; Montgomery Slatkin, Assis­tant Professor in Biophysics andTheoretical Biology; and Russell Tuttle,Associate Professor in Anthropology.William K. Baker, Professor in Biol­ogy and in the College and in the Com- mittees on Developmental Biology,Evolutionary Biology and Genetics, de­livered a series of nine lectures on "Cur­rent Research in the DevelopmentalGenetics of Insects" at the University ofPuerto Rico this summer.Aron A. Moscona, Louis Block Pro­fessor in Biology and Pathology andChairman, Committee on Developmen­tal Biology, participated in a session onmolecular and developmental biology, inErice, Sicily, August 1-14. It was spon­sored by NATO Scientific Affairs Divi­sion, the Centro di Cultura Scientifica,European Molecular Biology Organiza­tion and International Society of De­velopmental Biologists.Niza FrenkelHe spoke at the Fourth InternationalCongress on Hormonal Steroids, inMexico, September 2-7; attended theNational Institute of Health Fogerty In­ternational Center Workshop on CellSurfaces and Malignancy, September11-13 at Bethesda, Md.; and presented apaper on "Outer Cell SurfaceSpecificities and Cell Interaction" at theSecond International Santa CatalinaColloquium, September 18-24.Thomas Park became an EmeritusProfessor this summer. He has been amember of The University of Chicagofaculty since 1937. Professor Park willcontinue to do research at the Universityand serve as a visiting professor of Biol­ogy at the University of Illinois CircleCampus for 1974-75. Biophysics and Theoretical BiologyAppointments:Dr. Marvin W. Makinen-AssistantProfessor.Promotions:Lucia B. Rothman-Denes-AssistantProfessor.Grants:Paul B. Sigler, Professor in Biophysicsand Theoretical Biology and in the Col­lege, is principal investigator for a Na­tional Science Foundation Project,"Crystallographic Study of the Structureof Initiator tRNA." The grant is$65,000. Professor Sigler has also beenawarded a Senior Aharon Katzir­Katchalsky Fellowship by the KatzirCenter of the Weizmann Institute, Is­rael, where he will study next year.Kwen-Sheng Chiang, Associate Pro­fessor, has taken leave of absence tostudy at the Institute of Botany,Academia Sinica, Taiwan, until nextJuly.Divisional GeneralAppointments:Dr. G. Thomas Evans-Assistant Pro­fessor (Emergency Room).Promotions:Dr. Frank J. Baker-Assistant Pro­fessor (Emergency Room).La RabidaAppointments:Dr. Samuel Spector, Professor andChairman of the Department of Pediat­rics, was appointed Director of the LaSamuel Spector27Rabida Children's Hospital and Re­search Center. He succeeds Dr. AlbertDorfman (44), Department of Pediatrics,who served as Director of La Rabida formany years.Dr. Edward P. Cohen, Associate Pro­fessor at La Rabida and in Medicine andMicrobiology, has been elected chair­man of the Chicago Association of Im­munologists for 1974-75. Dr. Cohen isauthor of the article on "Allergy Shotsfor Hayfever" in the July issue ofTodays Health.MedicineAppointments:Dr. Michael Blackstone-AssistantProfessor-Gastroenterology.Dr. William Causey-Instructor- In­fectious Diseases.Dr. Dirk V. DeYoung (63)- Physi­cian in the University Health Service.Dr. Kenneth Fisher-Assistant Pro­fessor-Nephrology.Dr. Lincoln Ford-Assistant Pro­fessor -Cardiology.Dr. Valentin Popa-Assistant Pro­fessor-Respiratory Medicine.Dr. Frederick Gary Toback­Assistant Professor-Nephrology.Dr. Pierce Gardner-Associate Pro­fessor, Section of Infectious Diseases.Dr. Gardner was associate professor ofmedicine at the Harvard Medical Schoolwhere he received his M.D. in 1961. Heis a specialist in adverse drug reactions,the treatment of various specific viraland bacterial infections and the publichealth problems of developing nations.He interned at King County Hospitaland was an assistant resident in medicineat the University of Washington. From1963 to 1965 he was chief of the Surveil­lance Unit for Central Nervous Diseasesin the Epidemiology Branch, Com­municable Diseases Center, Atlanta.Subsequently, he was a senior residentin medicine at University Hospital,Cleveland; a research fellow in medicinein the infectious disease unit, Mas­sachusetts General Hospital; and assis­tant professor of medicine at the U niver­sity of Florida and Harvard MedicalSchools. In 1971 he served as visitingprofessor at the Children's Hospital,Saigon and was a consultant on medicalprograms for Bengali refugees. He wasappointed associate professor ofmedicine at Beth Israel Hospital, Har­vard Medical School in 1972, and in 1973was named consultant to the RockefellerFoundation on the infectious diseaseprogram at Ramathibodi Hospital,Bangkok.Dr. Gardner is the author of over 30published research reports. His book28 Acute Bacteria/Infections: Ear/y Diag­nosis and Therapy is to be published byLittle-Brown in 1975.Promotions:Dr. Noel Cahill-Assistant Professor-Cardiology.Dr. Dimitros Emmanouel-AssistantProfessor-Renal Diseases.Dr. David S. Fedson-AssistantProfessor-General Internal Medicine.Dr. David Horwitz (67)-lnstructor­Endocrinology.Dr. Joseph W. Jarabak (60)- As­sociate Professor.Dr. Thomas M. Jones-Instructor­Endocrinology.Dr. Thomas Layden-Instructor­Gastroenterology.Dr. Dennis Levinson-Instructor­Arthritis and Metabolism.Dr. David Lichtenstein-AssistantProfessor-General Internal Medicine.Dr. Calixto Romero, Jr. (70)- Assis­tant Professor-Cardiology.Dr. Noel Solomons-Instructor.Dr. Theodore L. Steck-AssociateProfessor-Medicine and Biochemistry.Grants:Neal H. Scherberg, Research Associate(Assistant Professor) in Medicine, Sec­tion of Endocrinology, has received athree-year grant totaling $97,018, fromthe National Institutes of Health tostudy" Isolation and Characterization ofThyroglobulin mRN A."Radovan Zak, Associate Professor inMedicine, and Research Associate inBiochemistry and the Franklin McLeanInstitute, received a three year grant to­taling $124,250 from the National Heartand Lung Institute to study the "De­velopment and Regression of CardiacHypertrophy. "Dr. Joseph B. Kirsner is the author of"Toxic Megacolon Complicating Ul­cerative Colitis: Current TherapeuticPerspectives" in Gastroenterology,May, 1974. The commentary concernstoxic dilation of the colon, which mayrequire emergency removal of all or asection of the colon. Dr. Kirsner is theLouis Block Distinguished Service Pro­fessor, Chief of Staff of the Clinics andDeputy Dean for Medical Affairs.Dr. Chin Ok Lee, Fellow in Cardiol­ogy, has been awarded the 1974 LouisN. Katz Basic Science Research Prizeby the Council on Basic Science of theAmerican Heart Association. The prizewill be presented at the Annual ScientificSessions of the American Heart Associ­ation, in Dallas, in November. His paperwas entitled, "Activities and ActivityCoefficients of Potassium and SodiumIons in Rabbit Heart Muscle."Dr. John E. Ultmann, Professor in Medicine and Director of the CancerResearch Center, taught a course on"Cancer Treatment: Developments inDrug and Immunological Therapy,"sponsored by the American College ofPhysicians, June 3-5, at Albany MedicalCollege. June 6, he participated in Medi­cal Team Rounds at Columbia Univer­sity College of Physicians and Surgeonson the subject, "Malignant Lym­phoma."MicrobiologyGrants:James A. Shapiro, Assistant Professorin Microbiology and in the College, re­ceived a two year grant totaling $100,000from the National Science Foundation tostudy "Genetics of Glutamic Acid Bac­teria. "Obstetrics and GynecologyDr. Iracema M. Baccarini, AssociateProfessor, presented a paper entitled"Transmission on Scanning ElectronMicroscopy of the Follicle in the HumanOvary" at the meeting of the AmericanAssociation of Electron Microscopists inSt. Louis, August 12-17, and another en­titled "Transmission and Scanning Elec­tron Microscopy of the ExperimentalGranulosa Cell Tumor in Mice" at themeeting of the 8th International Con­gress of Electron Microscopists in Can­berra, Australia, August 24-September2.Dr. James L. Burks, Associate Pro­fessor, prepared a patient education filmentitled The Gynecologic Examination.The American College of Obstetriciansand Gynecologists has endorsed thisfilm.Dr. Rudolph Moragne, a member ofthe Lying-in Clinical Associate Staff,has co-authored Our Baby's Early Years(Len Champs Publishers, April 1974)with his sister, Dr. Lenora Moragne, aWashington, D.C. nutritionist. Thebook discribes the experiences of thenew born and outlines the care of thenewborn. It also gives advice on toothdevelopment and proper diet and in­cludes references on infant care.As the coordinator of the section ofproteinases and proteinase inhibitors ofthe World Health Organization TaskForce on Spermatozoa and CervicalContraception, Dr. Gebhard Schu­macher, Professor, attended a meetingof this task force at Wayne State Univer­sity, September 16-18. He also attendedthe 40th annual meeting of the DeutscheGesellschaft fi.ir Frauenheilkunde undGeburtshilfe (German Society forGynecology and Obstetrics), held inWiesbaden on September 24-28, atwhich he gave a round-table conferencepresentation on "Immunological Fac­tors in Infertility." On October 12, hedelivered a postgraduate course lecture,"Developments in Fertility Control Re­search," at the Department of Obstet­rics and Gynecology at the University ofMi.inster, Germany.Dr. Douglas R. Shanklin, Professor inthe Departments of Obstetrics andGynecology and in Pathology, lecturedon hyaline membrane disease in Swedenand the British Isles during June andJuly. He presented a paper at a jointmeeting of the British Pediatric Pathol­ogy Society and Pediatric PathologyClub in July.Dr. George L. Wied, Blum-Riese Pro­fessor of Obstetrics and Gynecology andProfessor of Pathology, has been namedActing Chairman of the Department.The Department sponsored a post­graduate course in Family Planning andHuman Sexuality on June 14-15 at the50th-at-the-Lake Travel Lodge. Thecourse was designed to provide in-depthinstruction in family planning, tech­niques, and sexual counseling for physi­cians, nurses and specialists in familypractice.OphthalmologyPromotions:Dr. Ronald Schachar-Assistant Pro­fessor.Dr. Walter H. Stern (70)-AssistantProfessor.Grants:The Department received its annualgrant of $5,000 in unrestricted fundsfrom Research to Prevent Blindness,Inc. (RPB). The grant is specifically de­signed to promote new techniques andconcepts in the saving of sight. Over thepast 15 years, RPB has awarded $75,000in similar grants to the Department. Dr.Jules C. Stein (21), chairman of RPB,cited work at the University as an exam­ple of the increased intensity with whichthe problem of blindness is being at­tacked under RPB leadership.Dr. Frank Newell, the James andAnna Louise Raymond Professor andChairman of the Department, was theninth annual O'Brien lecturer at theTulane Medical Center in June. Hespoke on ocular circulation and heredi­tary disorders of the pigment of theretina.PathologyAppointment:Dr. Robert L. Wollmann (69, Intern andResident, 69-72)-Instructor. Promotions:Dr. John S. Coon-Instructor.Dr. Gary W. Miller-Instructor.Grants:Dr. Seymour Glagov has received agrant, effective January 1, 1975, to studywhy coronary artery surgery is success­ful in some patients and not in others.The project is part of a SCOR grant enti­tled "Ischemic Heart Diseases." Dr.Glagov is Professor of Pathology and inthe College.Stan D. Vesselinovitch has received acontract renewal for fiscal 1975 totaling$104,826 from the National Cancer Insti­tute to develop experimental animalmodels of pancreatic cancer. The Uni­versity is one of several research centerstrying to develop methods, under NCIauspices, to study pancreatic cancer inexperimental animals. Dr. Ve s­selinovitch is Professor in the Depart­ments of Radiology, Pathology, and theFranklin McLean Institute. He beganthis project in 1972.Stan VesselinovitchDr. Vesselinovitch has been elected acorrespondent member of the ItalianSociety of Prevention and Detection ofTumors.Dr. James E. Bowman spent onemonth as a consultant in pathology toPahlavi University, Shiraz, Iran. Pre­liminary plans were made to set up acoordinated research, education and training program between Pahlavi Uni­versity and The University of Chicago.While in Shiraz, Dr. Bowman was pre­sented a plaque by the chancellor ofPahlavi University. It honored hisachievements in the development ofeducation, training, service and researchin pathology in Shiraz, 1955-61. On hisway back to the States, he spent threedays as a consultant in population gene­tics to the Research Hematology Unit,Ain-Shams University Medical School,Cairo, Egypt.Dr. Bowman is Professor of Pathol­ogy, Medicine, Committee on Geneticsand the College; Director ofLaboratories; and Director of the Com­prehensive Sickle Cell Center at TheUniversity of Chicago.Dr. Henry Rappaport, Professor ofPathology and Director of SurgicalPathology, spoke on "Classification ofHodgkin's Disease" at the InternationalSymposium on Standardization inHematology and in Clinical Pathology inSan Giovanni Rotondo (Foggia), Italy,September 12-14. He attended the 10thInternational Congress of the Interna­tional Academy of Pathology, Sep­tember 15-20 in Hamburg, where hechaired a workship on leukemias. Dr.Rappaport was also in Beyrouth to give apaper on the "Pathology of Mediterra­nean Lymphomas" for the JorneesMedicales de Beyrouth.Dr. Benjamin Spargo (52) Professorand Vice-Chairman of the Department,has been appointed ConsultingPathologist in Nephrology to TheArmed Forces Institute of Pathology inWashington, D.C.PediatricsAppointment:Dr. Peter R. Huttenlocher-Professorof Pediatrics and Medicine (Neurology)and Chief of the Pediatric NeurologySection.Dr. Huttenlocher holds a M.D. de­gree, 1957, from Harvard MedicalSchool. He was trained in pediatrics andneurology at Children's Medical Centerand at Massachusetts General Hospitaland then spent two years as a researchassociate at the National Institutes ofHealth. From 1964-66 he was instructorin neurology at Harvard; 1966-68 assis­tant professor in pediatrics at Yale Uni­versity School of Medicine; and 1968-74associate professor of pediatrics andneurology at Yale.Dr. Huttenlocher's interests are thedeveloping brain and its disorders.Laboratory investigations include workon the fine structure of the cerebral cor­tex in certain forms of mental retardationand in animal models of retardation. His29clinical contributions have included ob­servations on the syndrome of en­cephalopathy with fatty degeneration ofthe liver in childhood (Reye's syn­drome). He is presently concerned withevaluation of therapeutic approaches tothis disease as well as with investigationsof its etiology.He is the author of 34 scientific articlesand recently has contributed a newneurology section to Nelson's Textbookof Pediatrics.Promotions:Dr. Anthony F. Cutilletta-AssistantProfessor.Dr. Christian Rieger-Assistant Pro­fessor.Dr. Albert Dorfman (44), Richard T.Crane Distinguished Service Professor,Director of the Joseph P. Kennedy, Jr.Mental Retardation Research Centerand Professor of Biochemistry, partici­pated in the Second International SantaCatalina Island Colloquium on "Ex­tracellular Matrix Influences on GeneExpression" held at the University ofSouthern California Marine BiologicalLaboratory, Santa Catalina Island, Sep­tember 18-24. The symposium wassponsored by the National Institute forDental Research, National Institutes ofHealth. Dr. Dorfman's abstract is enti­tled "The Mechanism of BUdR Inhibi­tion of Cartilage Differentiation." Dr.Dorfman and Dr. Reuben Matalon, As­sistant Professor and Joseph P. KennedyJr. Scholar, presented a paper on "TheEnzymic Defects in the Mucopolysac­charidosis " at the 14th InternationalCongress of Pediatrics, held October3-9, in Buenos Aires, Argentina, on"Advances in the Recognition andTreatment of Inborn Errors ofMetabolism.' ,Dr. Huttenlocher, discussed a paperon "Modification of Ketogenetic Diet inthe Treatment of Intractable Seizures inChildren" at a meeting of the ChildNeurology Society at the University ofWisconsin, October 10. October 29, heparticipated in a symposium on ReyesSyndrome, co-sponsored by the Colum­bus, Ohio Children's Hospital ResearchFoundation and the National Institute ofChild Health and Human Development.November 2, he discussed Reyes Syn­drome at the National Pediatrics Con­gress in Buenos Aires.The Department held its fifth annual"Progress in Pediatrics" program June21 in Wyler Children's Hospital. Thestaff presented highlights of new de­velopments in pediatrics and focused onthe areas of cardiology and immunology.Members of the Cardiology Sectionwho spoke on "Recent Advances in the30 Peter HuttenlocherManagement of Heart Disease in Chil­dren" were: Dr. Rene A. Arcilla, Pro­fessor of Pediatrics; Dr. Robert L. Re­plogle, Professor and Head, Section ofPediatric Surgery; Dr. Otto G.Thilenius, Professor of Pediatrics; Drs.Rajamma Mathew, Rabi Sulayman, andKau Shan Lin, Residents in Cardiology.Dr. Richard M. Rothberg (58), Profes­sor of Pediatrics, spoke on "Biologic Ef­fects of Antibodies Against Morphine."A tour of the Wyler Cardiac facilities,including the $250,000 CardiacCatheterization Laboratory, was con­ducted by Drs. Otto Thilenius, Profes­sor of Pediatrics and Physiology, andDomingo de la Feunte, Assistant Pro­fessor of Pediatrics.PsychiatryPromotions:Dr. Henry Evans-Instructor.Dr. Beverly J. Fauman-AssistantProfessor.Dr. Angelo Halaris-Assistant Pro­fessor.Dr. Robert T. Segraves-AssistantProfessor.Dr. John N. Chappel, Assistant Pro­fessor and Chief of the Psychiatric Staffin the Drug Abuse Program, is the au­thor of "Methadone and Chemotherapyin Drug Addiction: Genocidal orLifesaving?" in the May 6 JAMA.Dr. Beverly J. Fauman, AssistantProfessor, and Rex Lewis, AssociateDirector of the Chaplain's Office, Uni­versity Hospitals and Clinics, partici­pated in the Chicago Police Academypanel on management of rape victims,July 2.Krishan K. Kaistha, Research As­sociate, received a Governors IncentiveEconomy Award, from Illinois Gover­nor Dan Walker, for perfecting a bettermethod for detection of drugs in humanurine. Mr. Kaistha is Director of the Toxicology Laboratory in the IllinoisDrug Abuse Rehabilitation Program.Dr. Chase P. Kimball, Associate Pro­fessor, has been elected a fellow of theAmerican Psychiatric Association.Charles R. Schuster, Professor inPsychiatry, Pharmacological andPhysiological Sciences and the College,has been appointed to the editorial boardof Drug and Alcohol Dependence, a newinternational journal.RadiologyAppointments:Dr. Ronald B. Port (Radiology Residentand Instructor, 68-72}-Assistant Pro­fessor.Dr. Mahendra I. Vyas-Instructor.Promotions:Dr. T. McDowell Anderson, Jr.- In­structor and Trainee.Dr. Carlos Bekerman-Assistant Pro­fessor.Dr. James Bowie-Instructor andTrainee.Franca T. Kuchnir,-Associate Pro­fessor.Dr. Axel Kunzmann-Instructor.Lawrence H. Lanzi, Professor inRadiology and the Franklin McLeanMemorial Research Institute, has beenappointed a member of the RadiationProtection Advisory Council of Illinoisby Governor Dan Walker.Dr. Lee B. Lusted, Professor andFaculty Secretary, participated in acomputer workshop of the computercommittee, Royal College of Physicians,in London, England, May 31. Dr.Lusted is a member of the committee.He presented papers on decisionanalysis at aNA TO Symposium on"Human Factors in Health Care" inLisbon, June 4 and at the Association ofEuropean Radiologists Symposium on"Computers in Diagnostic Radiology"at The Hague, Holland, June 19.Dr. James E. Marks (Radiology Resi­dent, Instructor, and Assistant Profes­sor, 67-74) and associates of theUniversity's Center of Radiologic ImageResearch are the authors of "Localiza­tion Error in the Radiotherapy ofHodgkin's Disease and Malignant Lym­phoma with Extended Mantle Fields" inCancer, July, 1974. The paper reports onmeans developed at The University ofChicago to reduce unnecessarytherapeutic radiation of patients withHodgkin's disease and malignant lym­phoma. Co-authors are: Arthur G.Haus, Research Associate, FranklinMcLean Institute; Dr. Harold G. Sut­ton, Jr., Assistant Professor; and Dr.Melvin L. Griem, Professor.Martin RobsonSurgeryAppointments:Dr. John Z. Bilos-Assistant Pro­fessor -Orthopedics.Dr. Tom R. DeMeester-AssistantProfessor-Cardiac and Thoracic.Dr. John J. Lamberti-AssistantProfessor-Cardiac and Thoracic.Promotions:Dr. Edward Ganz (67)-AssistantProfessor-�eurosurgery.Dr. Martin C. Robson-AssociateProfessor of Surgery and Chief of theSection of Plastic and ReconstructiveSurgery.Dr. Robson has been associate pro­fessor of surgery and director of thetrauma program at the Yale UniversitySchool of Medicine. He is a specialist onbums, trauma, and emergency surgicalcare. He has a M.D. degree from TheJohns Hopkins University School ofMedicine in 1964 and held a surgical in­ternship at The University of Chicago in64-65.Dr. Robson is the author of over 50research studies on staph and strep in­fections, wound healing, cancer of thehead and neck, skin grafts, burn man­agements, military and civilian wounds,and emergency service care of auto acci­dent patients.Grants:Dr. Leonard Proctor, Associate Profes­sor (Otolaryngology), has been awardeda one-year grant totaling $23,318 fromthe National Institutes of NeurologicalDiseases and Stroke to study "Vestibu­lar Pathways in the Cerebellum."Dr. Warren E. Enker, Assistant Pro­fessor, presented a paper on "ActiveSpecific Immunotherapy of the MorrisHepatoma 5123 with Concanavalin A Modified Tumor Cells" at the Fifth I n­ternational Congress of the Transplanta­tion Society in Jerusalem, August 28.Co-authors of the paper were Miss K.Craft and Robert W. Wissler (48),Donald N. Pritzker Professor in the De­partment of Pathology.While in Jerusalem, Dr. Enker was alecturer at the Department of Surgery ofthe Ben Gurion University School ofMedicine. He spoke on carcinoma of thecolon in the aged and implications ofimmunotherapy for the treatment of car­cinoma of the colon.Dr. Javad Hekmatpanah, AssociateProfessor in Surgery (Neurosurgery),has been elected president of the CentralN eurosurgical Society.Dr. Hernan M. Reyes, Associate Pro­fessor, and president of the Society ofPhilippine Surgeons in America, pre­sided at a meeting of the executive com­mittee and the board of governors inMontreal, Canada, May 31-June 2, todiscuss problems confronting Filipinosurgeons practicing in the U.S. andCanada.Alumni NewsTolbert HillAfter 76 years of practice, Dr. TolbertHill decided not to renew his medicallicense. Dr. Hill, who graduated fromthe University of Chicago-Rush MedicalSchool in 1896, began his practice inAthens, Illinois two years later. He de­livered more than 2,250 babies betweenthat time and 1955. In the late 1960's, hebegan to phase out his practice and in1971, he closed his office. He still had hislicense, however, and patients continuedto come to him with minor ailments.When his license came up for renewalthis year, Dr. Tolbert had just turned100. He no longer wished to practice."The problem is that there is not another doctor available in Athens,"says the nurse who has worked with himfor the past 15 years. "Of course, thereare three or four physicians in Peters­burg which is about seven miles away,"she adds. Patients who need to be hos­pitalized are sent to Springfield. WhenDr. Hill came to Athens, it was a miningtown with a population of I ,900. Thepopulation decreased until it hit a low of1,200. This trend has reversed and thereare now 1,500 residents. The high schoolhas been enlarged twice and the elemen­tary school is growing. "This would be aperfect place for a physician to set up apractice," his nurse says.1924Our apologies to Dr. George J. Ruks­tinat of Chicago. Dr. Rukstinat attendedthe 50th anniversary of his class in Juneand was identified as Dr. Helge Jansonin the class picture, which appeared inVol. 29, No.1 of Medicine on the Mid­way.1930Leonidas H. Berry, Chicago gastroen­terologist, is editor and senior author ofthe recently published book: Gastroin­testinal Pan-Endoscopy with Interna­tional Contributors, published byCharles C. Thomas, Springfield, Illinois.The book covers technics and endo­scopic pathology of esophogoscopy, gas­troscopy, duodenoscopy with papillacannulation, proctoseigmoidscopy, co­lonoscopy with polypectomy andperitoneoscopy. It is the first book tocover these areas in one volume. Thebook has 650 pages with 128 colorphotographs.Helen Crawford Davis would like fel­low alumni to know her specialty andaddress. Dr. Davis practiced as aradiologist in Indianapolis and Wausau,Wisconsin. She retired in 1962. She livesat 6001 Olive Avenue, Sarasota, Florida,33581.1934William L. Curtis, a radiologist in Bur­ton, Washington, is semi-retired.Vincent Accardi ofGaJlup, New Mex­ico, since he retirement three years ago,has been helping two groups of Catholicsisters with their clinics in St. Michaeland at Lukachukai, both in Arizona onthe Navajo Indian Reservation. Formany years Dr. Accardi was chief ofstaff and chairman of the department ofsurgery at the old St. Mary's Hospitaland the recently built McKinley GeneralHospital in Gallup. He also was CivilDefense Director for the City of Gallupand for the County of McKinley.311935Molly Radford Ward is the author of BillMartin, American, the story of her hus­band and his career as a detective."When Bill went to war in 1942, Mollytook on several medical clinics and soonbecame the only anaesthetist in SantaFe, New Mexico, as well as the firstwoman doctor in the town and the firstwoman president of the local CountyMedical Society. After Bill died in 1950as a result of injuries acquired during thewar, she wrote his story." This is thesecond edition, published by VantagePress, Inc., New York. In June, 1960,she married Capt. C. O. Ward, U.S.Navy (Ret.).1936Louis R. Wasserman, director of the de­partment of hematology at Mount SinaiHospital, New York City, 1954-1973),and Distinguished Service Professor atthe Mount Sinai School of Medicine, hasbeen appointed chairman of the HEWNational Cancer Institute's CancerTreatment Advisory Committee.1938Ralph P. Christenson is director of theIdaho Division of the Mountain StatesRegional Medical Program. He lives inBoise.1943John W. Findley is a gastroenterologistin San Mateo, California. He has a part­time appointment at the University ofCalifornia in San Francisco as associateclinical professor in the department ofMedicine.William E. Froemming is medical di­rector at Teletype Corporation, Skokie,Illinois. Dr. Froemming was medical di­rector at Western Electric Co. in Balti­more.1946J. Alfred Rider, San Francisco gastroen­terologist, has been appointed by Gov­ernor Ronald Reagan to the CaliforniaState Board of Medical Examiners. Hejoins Harry Oberhelman (46) on theBoard. Dr. Oberhelman is professor ofsurgery at Stanford University School ofMedicine.Dr. Rider and his wife Graclynn es­tablished The Children's Brain DiseasesFoundation for Research to studyBatten's disease. Their 26-year old sonhas this disorder. It is known that per­sons with Batten's disease are deficientin the enzyme peroxidase. With theFoundation's support, research is beingdone on how to get the enzyme to the32 children. It is found in horseradish root,avocados and green peas. Approxi­mately 5,000 to 10,000 children in thiscountry have Batten's disease. A bloodtest can now identify those with the en­zyme deficiency. The Riders are urgingparents to have blood tests for any childwith the symptoms of the disease, whichinclude clumsiness, stumbling, failure ofvision, seizures, personality changes andpoor school performance. The Founda­tion office is 350 Parnassus Avenue, SanFrancisco.1947Richard B. Stoughton was appointed fullprofessor and chairman of the depart­ment of dermatology at the University ofCalifornia School of Medicine, SanDiego, and its affiliated V.A. hospitals.He retains his position as head, divisionof dermatology at Scripps Clinic and Re­search Foundation in La Jolla. Dr.Stoughton is current president of theSociety for Investigative Dermatologyand a 1973 appointee to the AmericanBoard of Dermatology. The July 15thissue of JAM A carried his article on"The Heartbreak of Psoriasis."1949William H. Wainwright, psychiatrist atRoosevelt Hospital, New York, writeshe is having a great time commuting be­tween Paris and New York for theCenter for Educational Research andInnovation.1953David S. Greer took a leave of absencefrom his internal medicine practice inFall River, Massachusetts to accept anappointment as associate dean and pro­fessor of community medicine at the newBrown University School of Medicine,Providence, Rhode Island.1955Robert Schlegel has been designated oneof the first six recipients of Robert WoodJohnson Health Policy Fellowships tospend a year studying and working withCongress in Washington, D.C. Dr.Schlegel is professor of pediatrics at theDrew Postgraduate Medical School andchief of clinical pediatric services at theMartin Luther King, Jr. General Hospi­tal, Los Angeles.1956Robert Druyan has affiliated with theVeterans' Administration Hospital,Hines, Illinois. Dr. Druyan was at TheUniversity of Chicago from 1965-74 asAssistant and Associate Professor ofMedicine. 1957Robert Y. Moore has accepted an ap­pointment in the department of neuro­sciences at the University of California,San Diego. Dr. Moore took a residencyin neurology from 1959-64 at The Uni­versity of Chicago and joined the facultyin 1964, rising to full professor.1960Donald Comiter was elected chief of thedepartment of surgery at Cypress Com­munity Hospital in Pompano Beach,Florida.Robert A. Moody has returned toChicago and is chairman of theneurosurgery division at Cook CountyHospital.1963Paul B. Hoffer left The University ofChicago to become professor of radiol­ogy and chief of the section of nuclearmedicine at the University of CaliforniaMedical Center, San Francisco. Dr.Hoffer took his residency at Billingsfrom 1966-69. He served on the Univer­sity faculty as Instructor, Assistant, andAssociate Professor from 1969-1974.Horst R. Konrad is clinical director ofthe human vestibular project atU.C.L.A. School of Medicine, He hadbeen chief of the division of head andneck surgery at Harbor General Hospi­tal.1964Nicholas J. Lenn accepted a position asassistant professor of neuology at theUniversity of California, Davis campus.Dr. Lenn was a Resident from 1965-70and Assistant Professor from 197{}-74 atThe University of Chicago.Robert Zelis has been named profes­sor of medicine and physiology and chiefof the division of cardiology in ThePennsylvania State University Collegeof Medicine at The Milton S. HersheyMedical Center. Dr. Zelis is a fellow ofthe American College of Cardiology,American College of Chest Physicians,American College of Physicians and In­ternational College of Angiology.1966David Avery Turner left The Universityof Chicago to become assistant professorin the department of psychiatry at theUniversity of Oregon Medical School,Portland. Dr. Turner was a Residentfrom 1969-72 and Assistant Professor1972-74.1967Glenn R. Hodges completed two yearsof active duty in the U.S. Navy as head,section of infectious diseases, U.S.Navy Hospital, Great Lakes, Illinois.July he was appointed assistant profes­sor of medicine at the University ofKansas Medical School, Kansas City,Kansas and chief, section of infectiousdiseases, V.A. Hospital, Kansas City,Missouri.1968Bradley T. Hales is a resident inotolaryngology at University Hospital,Salt Lake City. .Donald A. Rothbaum is assistant pro­fessor of medicine in the department ofcardiology at Indiana University Schoolof Medicine.1969Judith E. Wall completed a fellowship inhematology. July I, she became as­sociate director of the hematology­oncology unit at Highland Hospital ofRochester and assistant professor ofmedicine at the University of RochesterSchool of Medicine and Dentistry.1970Lawrence A. Okafor is with the depart­ment of hematology at Chicago MedicalSchool.David A. Simonowitz has completedhis military service and returned to TheUniversity Chicago to complete his resi­dency in general surgery.1973Diana Jean Breslich is studying internalmedicine and working at the RegionalMedical Clinic, McDowell, Kentucky,until December.Samuel H. Doppelt is taking a resi­dency in orthopedic surgery at the Uni­versity of North Carolina MemorialHospital, Chapel Hill.David Gordon is a research associateat the National Institutes of Health,Bethesda.Joel E. Kleinman received a Ph.D. inPharmacological and Physiological Sci­ences from The University of Chicago atthe August Convocation.Richard R. Lichte is beginning a resi­dency in internal medicine at Rhode Is­land Hospital, Providence. He plans anemergency room residency later.Barry Edward Wright is beginning aresidency in ophthalmology atMontefiore Hospital in the Bronx.The following are remaining at theirplaces of internship for residencies:Robert Freilich: Ohio State Univer­sity Hospitals-medicine; Richard Fur­lanetto: The University of ChicagoHospitals-pediatrics; Richard Gaeke:The University of Chicago Hospitals­-internal medicine; Michael Glick: University of Wisconsin Hospital-internal medicine; Jeffrey Gordon:Washington University Clinics, BarnesHospital-medicine; John Harlan: Uni­versity of California, H. C. MoffittHospital-internal medicine; Arlen Hol­ter: Massachusetts General Hospital-general surgery; Kenneth Krantz: TheUniversity of Chicago Hospitals-pediatric neurology; Alfred Lewy:Mount Zion Hospital Medical Center,San Francisco-psychiatry; RichardMier: University of Rochester, StrongMemorial Hospital-pediatrics; BrooksMirrer: Montefiore Hospital and Medi­cal Center, Bronx-medicine; LaurencePeterson: University of WashingtonSchool of Medicine-pathology; Theo­dore Pysher: Case Western ReserveUniversity, Cleveland MetropolitanGeneral Hospital-pathology; ElizabethReid: Massachusetts GeneralHospital-medicine; Stanley Schwartz:University of PennsylvaniaHospitals-medicine; Jeffrey Semel:Rush-Presbyterian-St. Luke's MedicalCenter-medicine; Michael Silverman:University of Iowa Hospitals-internalmedicine.1974Lawrence Paul Aggerbeck received aPh.D. in Biochemistry from The Uni­versity of Chicago at the August Convo­cation. He is a post-doctoral researchfellow at Centre de GenetiqueMoleculaire, Centre National de la Re­cherche Scientique, Gif-Sur- Yvette,France.Former StaffWilliam G. Beadenkopf (MedicineI ntern- Resident 41-43 and AssistantProfessor 46-50) is director of Em­ployees Health Service at Kings CountyHospital Center in Brooklyn, N. Y.William Burrows (Microbiology Pro­fessor Emeritus 32-73) has co-edited abook entitled, Cholera, 458 pages withillustrations, by W. B. Saunders Co.,1974.Charles K. Dashe (Medicine Internand Resident 69-71) is director of thepulmonary section, department ofmedicine, and assistant professor ofmedicine at the University of Min­nesota.Harry Genant (Radiology Resident,Instructor and Assistant Professor68-74) is at the University of CaliforniaMedical Center, San Francisco. Alexander Gottschalk accepted anappointment September 1 as chief of thesection of nuclear medicine at Yale Uni­versity School of Medicine. Dr.Gottschalk carne to The University ofChicago in 1959 for a residency inradiology and remained to rise to fullprofessor in 1969 and DepartmentChairman and Director of the FranklinMcLean Institute in 1971.W. Garth Hemenway (Otolaryngol­ogy Resident and Assistant Professor52-62) is chief of the division of head andneck surgery at Harbor General Hospi­tal, U .C.L.A., Torrance.H. Close Hesseltine (Obstetrics andGynecology 34-64) is chairman of theBoard of Trustees of the Illinois MedicalService-Blue Shield.T. G. Hiebert (Psychiatry Intern 62)has been appointed coordinator of pro­fessional development at Chicago'sSchwab Rehabilitation Hospital and clin­ical assistant professor in the departmentof physical medicine and rehabilitationof the Chicago Medical School. He is incharge of the Ergometry Laboratory andwill develop the cardio-pulmonary re­habilitation programs for Schwab andneighboring and affiliated hospitals.John F. Lee (Surgery Intern and Resi­dent 67-73) completed a fellowship inperipheral vascular surgery with Dr. D.Emerick Szilagyi at Henry Ford Hospi­tal. He has moved to St. Petersburg,Florida and has a private practice in gen­eral and vascular surgery.Huberta M. Livingstone (Surgery In­tern and Resident 28-33; AnesthesiologyFaculty 35-52) of Hopkinton, Iowa ischairman of the Friends of Our CabanaCommittee of the World Association ofGirls Guides and Girl Scouts.Jay C. Mall (Radiology Resident andAssistant Professor 71-74) has joined theV.A. Hospital in San Francisco.John A. Mantle and Mrs. Mantle an­nounce the June 25 birth of BelindaAnne. Dr. Mantle (Medicine Intern andResident 69-72) practices in Birming­ham, Alabama.Allan L. Metzger (Medicine Internand Resident 68-70) opened a privatepractice in Beverly Hills, California. Heis a specialist in internal medicine andrheumatology.Hiroshi Nishida (Pediatrics Resident70-72) is neonatologist in the departmentof pediatrics at Kitazato UniversityHospital in Kanagawaken, Japan.Stanley Slater (Psychiatry Residentand Trainee 69-72) is at the laboratory ofclinical science, section of clinicalneuropharmacology, National Institutesof Health, Bethesda, Maryland.William Q. Sturner (Pathology As­sociate Professor 67-69) was named by33the Governor of Rhode Island as thestate's chief medical examiner.James R. Williams (Radiology Resi­dent through full Professor 58-74) is withthe Hilo Radiology Association, Hilo,Hawaii.The American College of PhysiciansFellowsThe following alumni were inducted asFellows of The American College ofPhysicians at the April I, 1974 Convoca­tion in New York City:Jack J. Adler (62), Brooklyn, NewYork; Leonidas H. Berry (30), Chicago,Illinois; Clara Bloomfield (68), Min­neapolis, Minnesota; Charles Ellen­bogen (64), U.S. Air Force; John E.Kurnick (66), Denver, Colorado; Law­rence M. Lichtenstein (60), Baltimore,Maryland; Harry Lopas (60), Chicago,Illinois; Joseph Richard (57), Peekskill,New York.Former house staff included: Bruce R.Batchelor, New York, New York; Mor­ton P. Berenson, Columbus, Georgia;James H. Caldwell, Columbus, Ohio;Doris Goodman, Philadelphia, Pennsyl­vania; Martin W. Graf, Potomac, Mary­land; John Laszlo, Durham, NorthCarolina; Yelva L. Lynfield, Brooklyn,New York; Rimgaudas Nemickas,Maywood, Illinois; Edward A. Op­penheimer, Panorama City, California;and Louis M. Sherwood, Chicago, Il­linois.American College of Surgeons FellowsThe following were inducted as Fellowsof the American College of Surgeons atthe 60th Convocation held in Chicago,October 18, 1973:Pat O. Daily (62), Palo Alto, Califor­nia; Birdwell Finlayson (57), Gaines­ville, Florida; Ralph V. Ganser (52),South Bend, Indiana; Lt. Col. WilliamH. Gernon (63), Medical Corps, UnitedStates Army; Morris J. LeVine (52), St.Petersburg, Florida; Gary D. Lower(62), Bountiful, Utah; Peter H. Morse(63), Wynnewood, Pennsylvania; J.Gordon Rich (60), Springfield, Mas­sachusetts; William G. Smith (47), EIPaso, Texas; Sakae Uehara (55),Wailuku, Hawaii; and Rostik Zajtchuk(63), Denver, Colorado.Former residents and faculty in­cluded: Arnold M. Cohn, Houston,Texas; Allan H. Goodman, San Diego,California; Charles L. Janes, LosAngeles, California; Louis D. Lowry,Oklahoma City, Oklahoma; Jafar ShahMirany, Evanston, Illinois; HernandoTorres, Chicago, Illinois; and KishanChand, Associate Professor, Section of34 Orthopedic Surgery, University ofChicago.First Lloyd Ferguson ScholarshipAwardedEdward D. Hutt, a senior medical stu­dent, has been awarded the first Dr.Lloyd A. Ferguson Scholarship. Theaward covers full tuition of $4,210. Itwas established in memory of Dr. Fer­guson (60) who died January 1, 1973.Hutt met Dr. Ferguson when he beganhis medical studies here. When notifiedof the honor, Hutt wrote to Dr.Ferguson's mother: "The true educationand shaping of future physicians takesplace when excellent educators and finemen lend their talent and expertise. Dr.Ferguson was one of those men. It is myhope that as my education progresses, Imay return some of the strength and vi­sion Dr. Ferguson gave so freely soother future physicians may find medicalschool the rich experience that I have."Hutt has worked hard for his medicaleducation. An orphan, he was raised byEdward Hurta grandmother in Watseka, Illinois.After high school he went to Eastern Il­linois University in Charleston, majoringin medical technology. He worked hisway through college sometimes holdingas many as four or five part-time jobssimultaneously.After receiving a B.S. degree in medi­cal technology in 1967 he worked in hos­pitals in Danville and Champaign. Huttwas always interested in a career inmedicine but could not consider it untilhe learned of the Minority StudentsProgram at The University of Chicago.During his three years in medicalschool he has proven himself a capablestudent. Last year he received first prizein the annual Student National MedicalAssociation Medical Arts A ward for hispresentation on the "Use of Heparinaseto Eliminate Heparin Inhibition inRoutine Coagulation Assays." Hutt, 29, is married. His wife is in her final year ofnurses' training.Contributions to the Lloyd A. Fergu­son Scholarship Award may be sent tothe Medical Alumni Office and creditedto the 1974 Medical Alumni Fund.Alumni Establish Loan FundsDr. J. Nick Esau (32), a Chicago physi­cian, gave his home to the Universityand designated that the proceeds fromthe sale be used to establish the J. NickEsau Loan Fund for Medical Students.Alumni have given $38,000 to studentaid during the 1974 annual fund drive.Last year Dr. Eugene Ziskind (24) andhis wife, Dr. Esther Somerfeld (25), LosAngeles psychiatrists, pledged funds toestablish a loan fund for medical stu­dents.It is estimated that an additional$100,000 will be needed this year to meetcommitments. For the third year, 104first year students have been admitted tothe medical school. In accepting morestudents the school is continuing itscommitment to admit qualified candi­dates from varied socio-economic back­grounds. Because of this large enroll­ment and the tuition increase to $1,070per quarter, the student aid program for1974 continues to be a major concern.Last year 360 of the 438 students neededand received scholarship or loan assis­tance.Alumni may designate their 1974 Med­ical Alumni Fund gift to the student aidprogram of their choice or they may es­tablish their own loan fund with aminimum pledge of $10,000.Association ActivitiesSeptember 9, Dean Leon O. Jacobson(39) met with alumni in Portland at a din­ner at the Multnomah Athletic Club. Af­terwards Dr. Jacobson showed theaward-winning cancer research film,"The Quiet War," and briefed the groupon the new Cancer Center at the Univer­sity. Dr. and Mrs. Harold Boverman(56) served as the local representativesof the Medical Alumni Association.September 11, Dean Jacobson metwith alumni in Seattle. Dr. and Mrs.Glen Hayden helped plan the dinnermeeting at the Washington AthleticClub. Dr. Jacobson again showed thecancer research film.October 9, Chicago area medicalalumni joined Law School alumni for aluncheon program at the University'sBoard Room in the First National BankBuilding. Mr. Perry Fuller, an attorneywith Hinshaw, Culbertson, Moelmannand Hoban, spoke on "So You've BeenSued, What's New?"Nothing in the world lastsSave eternal change-Honorat De Buei INAME Graduation YearHome Address TelephoneCity, State, ZipBusiness Address TelephoneNew add ress? City, State, ZipTitleNew position?New medical practice?military assignment?civic or professional honor?book?Please tear out, fold, staple, or tape, and drop in the mail box. Thanks!Medical Alumni Association1025 East 57th StreetChicago, Illinois 60637Fold this flap in first r-------,I I: Place :: Stamp :: Here :I IL ,REMEMBER THE 1974 MEDiCAL ALUMNI FUNDDonors contributing $1,000 or more arerecognized as Medical Alumni Patrons andDean's Associates. Student AidWilliam E. Adams Loan FundWilliam Bloom Loan FundPaul R. Cannon Loan FundYing Tak Chan Loan FundGeorge F. Dick Loan FundJ. Nick Esau Loan FundJoel Murray Ferguson Loan FundLloyd A. Ferguson Scholarship FundAbraham Freiler Scholarship FundRoger N. Harmon Scholarship FundBasil Harvey Loan FundVictor Horsley Loan FundEleanor Humphreys Loan FundHilger P. Jenkins Loan FundDeane Lazar Loan FundFrancis L. Lederer MD.lPhD. ProgramFranklin Mclean Scholarship FundMedical Alumni Loan FundGeorge W. Merck Loan FundJohn F. Perkins Loan FundBernard and Rhoda Sarnat Loan FundA. Lewis Rosi Scholarship Fund '",Mary Roberts Scott Scholarship FundNels M. Strandjord Loan FundFrank W. Woods Loan FundSam Zapler Loan FundEugene and Esther Ziskind Loan FundThere is sti II time to participate in the 1974 Med i­cal Alumni Fund. Remember, the deadline forgifts is December 31. In order for gifts to be cre­dited to the Medical Alumni Fund and to receiverecognition in the medical school's Honor Roll ofContributors, "Medical School" must be indi­cated on your check or envelope.We urge all medical alumni to support the1974 Fund. Our greatest need is for unrestrictedgifts to the medical school. However, all gifts,whether restricted or unrestricted, are neededand will be appreciated. Consider joining one ofthe following groups:Donors contributing $500 are recognizedas Medical Alumni Sponsors. Other Restricted FundsEmmet Bay Lectureship FundClass of 1949 GiftDepartment of AnesthesiologyDepartment of MedicineDepartment of Obstetrics and GynecologyDepartment of OphthalmologyDepartment of PathologyDepartment of Ped iatricsDepartment of SurgeryCatherine L. Dobson Fund in Ob/GynJohn W. Green Sr. FundJ. P. Greenhill Foundation Fund in Ob/CvnHans Hecht Lectureship FundCharles B. Huggins Professorship FundAlex B. Krill FundJames A. McClintock Award FundWalter Palmer Visiting Professorship FundDonors contributing $100 are recognizedas Century Club members.Listed below are some of the named fundsestablished by medical alumni and friends of theschool. You may wish to earmark your 1974 giftto one of them." .:��:� .. � .., ," .: ,; �,� �,::Medicine ori:;:tb� J�f!�!,.�yThe U itiversihf�()t ChicagoThe Medic'al Alumni AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, Illinois 60637•Address corrections requestedreturned postage guaranteedThe Joseph Regenstein LibrarySerial Records Department, R 22oo�- v21100 East 57th StreetChicago� Illinois 60637 NON-PROFIT ORG.u.s. POSTAGEPAIDPERMIT NO. 9666CHICAGO, ILL.