yale medicine autumn 2002 Everyone loves the Yale System. So why can’t they all agree? autumn yale medicine 2002CONTENTS 2 Letters 4 Chronicle 12 Rounds 16 Findings 18 Books 19 On Campus 20 Capsule on the cover 22 “A steam engine in pants” When a group of medical students In 1920, Milton Winternitz became dean and ushered in wrote to alumni about exam require- ments earlier this year, they received a new era in medicine at Yale, creating the Yale System in the more than 500 responses, includ- process. For much of his 15 years at the top, what Winternitz ing the testimonials that appear on wanted, Winternitz got. pages 38 to 42. In their letters, By Gerard N. Burrow, m.d. ’58, hs ’66 the majority of those writing recall a Yale System that allowed them the freedom to pursue knowledge 30 Everyone loves the Yale System. independently and instilled a life- So why can’t they all agree? long love of learning. The debate over exams this spring centered on two key questions: how should medicine be taught in the 21st century and how should a student’s progress be measured? By John Curtis 38 The Yale System lives! Long live the Yale System. When nine Yale medical students wrote to 5,000 alumni last winter about changes in the curriculum, they triggered a flood of reminiscences about the experience of becoming a doctor at Yale. 43 Faculty 47 Students 48 Alumni 62 In Memoriam 64 Archives On the Web info.med.yale.edu/ymm On our website, readers can submit class notes or a change of address, check the alumni events calendar, arrange for a lifelong Yale e-mail alias through the virtual Yale Station and search our electronic archive. 2 letters Eyes opened, hearts Body (Bouvier, Philadelphia, 1813). claim that Ogden C. Bruton ‘dis- extended In the United States at about covered’ X-linked agammaglobu- this time Benjamin Rush in linemia, as my father had col- Kudos on Monique Tello’s Letter Philadelphia was defining alco- lected 13 cases and was about to from Guatemala [“Eyes Wide holism as a disease. publish his findings when Col. Open,”Summer 2002]. It was well Charles A. Janeway is pre- Bruton published first. Instead written and moving and prob- sented on page 35 as the person of publishing his original work ably similar to the experience of who “discovered gamma globu- on agammaglobulinemia, my many medical students rotat- lin deficiency.” This is not true, father worked on the intramus- ing outside of the industrialized as the present Dr. Janeway [his cular and intravenous adminis- world, where the “brutal social son] would be the first to con- tration of the crude gamma dichotomy” does indeed exist. firm. Ogden Bruton described globulin fraction of blood, which As for the challenge for the the syndrome in “Agammaglobu- he had isolated as part of Dr. rest of us to “fight complacency, linemia,”Pediatrics, 9, 722-728, Edwin Cohn’s plasma fractiona- to open the closed and con- 1952. The condition is now tion project during the Second tented mind,” many learned and known as X-linked agamma- World War.” well-meaning social crusaders globulinemia (Bruton) and the have tried and failed miserably, enzyme affected is known being accused of American More alumni news, please as the Bruton tyrosine kinase. imperialism, cultural genocide I am delighted with the “new” Our medical school has one and worse. For an example of Yale Medicine.It’s readable and of the very best history of medi- the pitfalls inherent in this kind full of good information. cine faculties in the United States. of work, read Death Without One disappointment, how- I urge you to have them review Weeping: The Violence of Every- ever. What has happened to articles which purport to state day Life in Brazil about a Califor- alumni news? The undergradu- historical facts before you pub- nia social worker who attempted ate alumni journal, the Yale lish. This would save you the nui- to improve literacy and vacci- Alumni Magazine, ignores the sance of chiding like this letter! nation among Brazilian children medical school in its alumni how to reach us m.d. at her own expense and was Robert J.T. Joy, ’54 section, and the medical journal Yale Medicine welcomes news rewarded with continued expul- Bethesda, Md. has only a skimpy bit of news. and commentary. Please sions from the country on the The writer is emeritus professor, For those of us whose gradu- send letters to the editor and grounds of subversive activity. Uniformed Services University of ation occurred almost 60 years news items to Yale Medicine, Sometimes changing the the Health Sciences, Department ago, we are very interested in P.O. Box 7612, New Haven, political landscape must precede of Medical History. what is happening to our old CT 06519-0612, or via elec- humanitarian efforts. For this colleagues in our class and those tronic mail to [email protected], we must look to our political sci- Dr. Joy is correct that Drs. Rush around us. More importantly, and include a daytime tele- ence colleagues for guidance— and Trotter regarded alcoholism in the most recent issue, there phone number. Submissions and hope. as a disease almost 200 years was nothing before the 50s. may be edited for length, m.d. hs ago. Jellinek, however, is consid- Are those of us from the 40s style and content. Susan M. Richman, , ’83 Guilford, Conn. ered by many to be the most written off? Many of us are still The writer is an assistant profes- influential proponent of alco- alive and vigorously kicking. sor of obstetrics and gynecology holism as a disease in the 1950s. Make the class secretaries and director of the Women’s Cen- He presented a disease model for get to work and satisfy the ter at Yale-New Haven Hospital. alcoholism, described four classes old-timers as well as the more of drinkers and invented what is recent graduates. known as the “Jellinek curve,” Raymond A. Gagliardi, m.d. ’45 Just the facts which describes the progression Boca Raton, Fla. I have become used to accept- of the disease. His work is consid- ing regular misstatements of ered a major factor in the medical historical fact in Yale Medicine, establishment’s acceptance of but the Spring 2002 issue has alcoholism as a disease. Although tried my patience with two the World Health Organization certain errors. had recognized it as a medical On page 7:“Yale scientist problem in 1951, and the Ameri- E.M. Jellinek pioneered the can Medical Association (ama) 2002 notion that alcoholism is a dis- declared it a treatable illness in ease. …” Not so. Thomas Trotter, 1956, it was only in 1965 that the a British Royal Navy physician, American Psychiatric Association autumn clearly defined alcoholism as a called alcoholism a disease. disease or medical condition in The ama followed suit in 1966. edicine An Essay, Medical, Philosophical, As for the senior Dr. Janeway’s m and Chemical, on Drunkenness contributions, his son replies: ale y and Its Effects on the Human “I have always resented the from the editor 3 yale medicine Alumni Bulletin of the Yale University School of Medicine Autumn 2002, Volume 37, No. 1 Editor-in-Chief Michael Kashgarian, m.d. ’58 Professor of Pathology and Biology Publisher Jane E. Reynolds Associate Dean The state of The System Editor In the Spring issue of we promised to report on the state of the Yale System, Michael Fitzsousa Yale Medicine Director of Publications the school’s eight-decade-old educational model and the subject of some debate earlier this Associate Editor year. As this issue of the magazine evolved over the summer, it became obvious that the John Curtis topic was to play a starring role and figure prominently in the issue’s three feature articles Contributing Editors as well as in our coverage of the June reunions that begins on page 48. Wherever we Sharon McManus turned, someone was talking about the Yale System. Karen Peart Cathy Shufro “Everyone Loves The Yale System. So Why Can’t They All Agree?” (page 30) details Jacqueline Weaver recent initiatives by Dean David A. Kessler, m.d., and others to increase support for teach- ph.d. Marc Wortman, ing at the medical school and explains the controversy that erupted in March after a Contributors mailing from a group of students to medical school alumni regarding exam requirements. Susan Froetschel Anne Thompson Among the voices heard were those of more than 500 alumni who wrote passionately Copy Editing about the issue of testing and in doing so wonderfully articulated what it means to become Anne Sommer a doctor at Yale. Excerpts from those testimonials appear on pages 38 to 42 (“The Yale Office Manager / Editorial Assistant System Lives! Long Live the Yale System.”). Claire M. Bessinger Finally, we take a look at the man who set the Yale System in motion more than Senior Administrative Assistant 75 years ago. Adapted from a chapter in a new history of the school by former Dean Gerard Cheryl R. Violante N. Burrow, m.d. ’58, hs ’66, “A Steam Engine in Pants” (page 22) chronicles how Milton Design m.d Daphne Geismar C. Winternitz, ., brought Yale back into the ranks of elite medical schools after a period Production Consultant of decline and gave birth to the Yale System in the process. It’s a fascinating story that Joe Maynard sheds light on the origins of the current debate. Yale RIS Printing Michael Fitzsousa W.E. Andrews of Connecticut Inc.