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1985 Outlook Magazine, Fall 1985
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Recommended Citation Outlook Magazine, Fall 1985. Central Administration, Medical Public Affairs. Bernard Becker Medical Library Archives. Washington University School of Medicine, Saint Louis, Missouri. http://digitalcommons.wustl.edu/outlook/75
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Color-enhanced brain images generated by computer in the Laboratory ofNeuro- Imaging can be rotated to display any angle andplane. All images are derived from computer cOllverted autoradiograms ofbrain slices. See story beginning page 12. (Photos courtesy Arthur Toga) v,;:QN3
~ Volum e XX 1[ , Nlllllber 3 l'all 1985 In the Beginning ... 2 Director, Medical Public Relations A physic ian-historian, Kenneth Ludmerer has Glenda King Wiman conducted nearly a decade of research to reveal the genesis of modern medical education. In the process, he has exposed the mythical underpinnings of some Executive Editor widely believed traditional dogmas. Don Clayton
Editor Medical Mal'kejshal'e 6 Su zanne Ha gan Medical center hospitals, eager to retain and expand their marketshare, seek new ways to provide Design improved medical care. Academic hospitals can John Howze compete in every arena with their non-academic counterparts and , in many cases, have led the way in Photography developing new programs and marketing strategies. ~ Cheryl Ungar Window jo j/1e Brain 12 or Circulation Researchers from inside and outside the School of Barbara Hebrank Medicine can view the brain from a unique vantage point: the Laboratory of Neuro-Imaging. Using software written by LON! director ArthurToga, scientists can achieve high-resolution images in order • On The COWl": to understand how neurological diseases originate. A three-dimensional im age of the brain, enhanced by false color, ca n be rotated Profiles and Predict ions 18 to show any perspecti ve, and electron Using specifi c information about a woman - her age '/ icall y "sectioned" to di splay an y plane, and data from her medical history, for example that a re searcher in the Laboratory of researchers can more closely predict her vulnerability j~ Neuro-lmaging desires to examine. to breast cancer. How? By using computer programs -~- Fall 1985 developed from a collaboration between a medical Volul11e XXII , Number 3 scientist and mathematicians. .. Outlook Magazine (ISSNOI95-0487) is published quarterly by the Ernie Simllls: Against the Odds 22 Washington University School of Medicine at 660 S. Eu clid , A black man without a college degree earned a S1. Louis MO 63110. Second-cl ass tenured facult y position at the School of Medic ine. postage paid at S1. Loui s, MO . But Ernie Simms, a member of Arthur Kornberg's Nobel Prize-winning team, earned more than kudos POSTMASTER: Send address changes for his scientific re search, as his former students and to Circulation, Outlook Magaz ine, colleagues attest. Box 8065, 660 S. Euclid , S1. Loui s, M063110. Sludenlslag-e: Hot Docs 10 © Washington University School of Medicine Newsbriefs 28
Permission is granted to reproduce The Alumni Hcport :15 materials contained herein , provided OUllook, the Magazine ofWashinglOn Class Noles :38 University School of Medicine, is credited.
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BY SUZANNE HAGAN odern medical education isn't mate educational institutions with which students graduated without ever having really modern. Although it's been universities desired to affiliate. And until had the chance to follow, and care for, ; 1'" ;, called many things, it's actually well-prepared students desired admittance patients who were hospitalized. "Section a century-old product of an historic union to medical schools , the calibre of medical teaching - the forerunner of clinical among three entities: medical schools, education was by definition low. Only clerkship - was widely implemented, as universities and teaching hospitals. As with the strengthening of all levels was dispensary teaching - the outpatient with all mergers, the partners underwent of education - primary, secondary and clinics of the day. These innovations were changes that were molded and influenced beyond - did modern medical education in themselves a great advance compared by external factors - they had to reach become a possibility. to 1870 and 1880, when clinical instruc maturity before they were ready for Another necessary ingredient was tion was by lecture alone. But it was not each other. money. American philanthropy made pos as significant a change as was the labora Most people regard the Flexner Report, sible the maturation of university-based tory in scientific teaching, and that was written by Carnegie Foundation research medical schools and of teaching hospi what was needed. er Abraham Flexner and published in tals. With an endowment, medical schools "But the nineteenth century hospital 1910, as the beginning of a new era in and hospitals could perform research, a was much different from the hospital we medical education. But the truth of the vital component of good education. Once know today," continues Ludmerer. "At matter, says Kenneth M. Ludmerer, M.D., all the components were ready - the that time, very little medical care was is that modern medical education had its restructuring of the entire school system delivered in hospitals - it was still done beginnings earlier: "In 1910, when the (including medical schools), the infusion at home. Middle- or upper-class women 1 Flexner Report was issued, the overall of philanthropy that strengthened floun would del iver children at home, physi ~
,,~ - condition of medical teaching in this dering educational institutions and hospi cians would do operations at home. A hos country was very good. In fact, it was at tals, and the rise of academic medicine pital was more a domicile for the deserv the highest point it had ever been. Indeed, - could modern medical education take ing poor. Most hospital admissions were medical educators were glowing with place in America. But before this could for chronic conditions, and duration of satisfaction as to how much things had happen, a change in the role of the hospi hospital stay was long. " oj progressed in the preceding 20 or 25 tal had to take place. Thus, medical care delivery was not years. Modern medical education in the By 1910, when the Flexner Report was a function of hospitals, but moral uplift U.S. had already arrived." first issued, many of the worst medical was. Says Ludmerer: "Perhaps the best The inflated importance of the Flexner schools of the era - the proprietary description characterizing nineteenth Report is only one of the myths exposed schools, run for profit by private prac century hospitals is paternalistic. In one in Ludmerer's new book, Learning to titioners - were already dying out. In sense that's good, because the patient is 1. Heal: The Development o/America/"l Medical deed, at the time, they comprised only considered to be more than just a liver dis J' Education. * Ludmerer, who carries a joint about a fourth of the schools in existence. ease or a heart disease. But there arc nega r.- ...., appointment in two departments - medi "In the five years preceding the Flexner tive implications - who wants someone II cine and history - has spent nine years Report," points out Ludmerer, "30 pro to tell you how to run your life, or what poring over archival records, traveling prietary schools had died. By 1910, they you should believe, especially at a time across the U.S. and recording his represented the bottom tier, with univer when you're most vulnerable'?" findings, in order to discover the roots of sity-based schools at the top. But the fact However, with advances in scientific "modern" American medical education. that Flexner focused on proprietary knowledge as the basis for medical prac He has traced medical education's true schools, and was so startling in his prose tice, this role of the hospital began to lineage and found that it was derived from and his description, caused people to change. 'The 1880s was the decade of an ever-widening circle of sociological think that his comments characterized all transition ," says Ludmerer. "The germ changes that began after the Civil War. of medical education in America." theory of disease was formulated, and sur Until medical schools created full-time In real ity, says Ludmerer, medical gery became safer. " Hospitals became faculty positions in pre-clinical and clini schools had already come a long way by less a social service agency, and began to cal departments , they were not the legiti- 1910. The scientific, or pre-clinical, com adopt their present-day role as factories to ponent of medical education had already deliver medical care. As this happened, Abraham Flexner was a Carnegie Foun progressed to the point where students hospital trustees also changed roles. dation researcher whose 1910 report on "learned by doing": laboratory learning "A modern hospital's trustees meet the state ofmedical education in the U.S. occurred side-by-side with lectures. And periodically to approve policy, and created quite a stir. (Frontispiece of many proprietary schools had succeeded they're involved in fund-raising. But in Flexller's autobiography, I Remember, in becoming part of the university system. the nineteenth century, trustees would Simoll & Schuster, New York: 1940) But it was the clinical part of a student's visit the hospital daily," discloses Lud training that was anemic. Many medical merer. 'They would be involved in the "Basic Books, New York: 1985 ". Kenneth M. Ludmerer, M.D. minutiae of taking care of patients in the others were quick to follow. Ludmerer or an endowment - enrollment cl imbed. day-to-day routine. points to three events he calls "seminal University-bascd medical schools "There was a discipline in hospitals unions" - affiliations betwee n medical sought hospitals with fervor. They courted then," recounts Ludmerer. "You couldn't schools and hospitals - that marked the and wooed. sometimes successfully and make any noise for, if you did, the head crest of a wave that was to sweep out to sometimes not. "There were profound nurse would chastize you, regardless of sea all the remaining proprietary schools, economic advantages for medical schools whether you were a subordinate employ and change hospitals' missions, once and and hospitals joining forces. Both gained ee, patient or visitor. A very rigid , disci for all. These seminal unions were be financially from mergers , and that was a plined, small-family-like atmosphere tween Columbia College of Physicians very powerful incentive. Howeve r, the existed. To add medical students would and Surgeons and Presbyterian Hospital marriages had lots of strains and , al be very disruptive to an orderly in New Y 4 ? • here's a question of paternity that Billings was able to translate his ideas practice medicine. And he didn't stay at Ken Ludmerer would like to see into action when he established Hopkins' Johns Hopkins. Never affiliated with any T settled. His new book, Learning medical school and teaching hospital. medical school, he spent much of his time I;t- fa Heal: The Development ofAmerican Ludmerer says that statistician and pub- based in the Surgeon General's office. Medical Education answers the question Thus, he never achieved the status of of whose influence was most seminal a Walter Cannon or William Osler, in the development of modern medical renowned figures in medicine. education. Ludmerer stresses that the Furthermore, many of his endeavors birth of modern medical education was were outside the realm of medicine. In ad not due to the influence of only one dition to establishing Index Medicus and person. There were many forces that the National Library of Medicine, he was shaped it: the rise of the modern the creator and first director of the New university and an academic elite; York Public Library. "He's the most the affiliation between university multi-talented physician ever to have and medical school, and between lived , I think," says Ludmerer. The medical school and teaching ultimate irony is that Johns Hopkins hospitals; and the leavening has only belatedly acknowledged the provided all these entities by debt it owes Billings. The most re American phjlanthropy. But cent addition to its edifices which is there one individual who, stand in testimony to the great clini more than another, sired cians of Hopkins' early years - modern medical education? Osler, Halsted, Welch - is a new • It wasn't anyone in the administration building named after AMA, says Ludmerer. and John Shaw Billings. it wasn't Abraham Flexner, Thus, the man who founded Johns whose report of 1910 is popu Hopkins Medical School and Hospital, larly believed to have been a and later acted as consultant to New .turning point in medical educa York 's Presbyterian Hospital, urging it tion . Rather, the premier figure to affiliate with Columbia College of . ~ is a rather obscure physician who Physicians and Surgeons, remains rela brokered the marriage between tively unknown . Abraham Flexner wrote Johns Hopkins Hospital and Medical an attention-getting report but did not play School in 1893. a creative role in developing modern medi John Shaw Billings, says Ludmerer, cal education (although he did influence "was a much more seminal figure in Robert Brookings to modernize Washing medical education than Abraham Flexner. .~ ton University'S medical school and bring The irony is that everyone knows about about its affi liation with Barnes Hospital) . Flexner. but only a few know about Yet it is Flexner, rather than Billings, who Billings." Billings' importance derives John Shaw Billings (Photograph ap is like'ly to retain the title, Father of from two facts: He was among the first peared in a supplement to "Miinchener Modern Medical Education . Americans to have modem ideas about medizinische wochellschrift," W.u (Learning to Heal: The Development of what should constitute medical education American Medical Education is a publica Ii School ofMedicine Archives). I (teaching, research and patient care), tion ofBasic Books: New York. /985.) I ideas which he put forth in the early lie health expert Billings is a little-known 1870s, far before Flexner wrote his fa figure for several reasons. Except for a mous report; and, even more importantly, few years after the Civil War, he did not 'io .1 1 5 Medical 11"\ C\N/)\('I (J (' n 1\ -...... -...-TS very Monday, the 7400 floor at are only needed for that research and for Barnes Hospital used to be crowd revenues," says Peter G. Tuteur, M.D., E ed with eye patients, occupying associate professor of medicine. In fact, rooms on both sides of the halJ. By though, this medical center bears little Wednesday, those patients - most of resemblance to other academic centers in them admitted for cataract surgery the country which hold themselves aloof were spilling over to rooms on other from their communities. "This medical floors. But three years ago, then-chief res center derives great strength from the ident Lawrence Gans, M.D., performed community and returns it in the form of a the first outpatient cataract surgery. With significant contribution: a quality of medi the rapid development of new technical cal care not surpassed anywhere in the advances came a steep decline in the num country," says Lawrence I. Kahn, M.D., ber of hospitalized eye patients. "Now we co-founder and former medical director of typically have patients in rooms on one the Medical Care Group. side of the floor, and we sometimes don't Anyway, having some "ivy tower" char even fill those because all of the proce acteristics is actually an asset, says David dures once done in great numbers by the A. Gee, president of Jewish Hospital. PHI ~~l {J ~ eye service are now avaiJable on an outpa While some medical schools have slight During a speech given this spring at tient basis," says Gans, assistant profes ed scientific and research activities in a Rush University symposium, Virginia sor of ophthalmology. favor of money-making, clinical ones, he Weldon, M.D" deputy vice chancellor for Clinical developments like this one says, "the Washington University School medical affairs at W. U., cited the follow have been quietly making possible far of Medicine has maintained its strength as ing statistics compiled by the American reaching changes in the way that the medi a scientific institution by having given em Hospital Association. In 1984, U.S, hos cal center does its business. And the clini phasis to the research functions that are its pitals experienced their largest decline in cal changes have been matched by still important attributes." Yet in emphasizing the number of beds and occupancy rates greater economic and competitive pres its major educational and research mis in two decades. Just from 1983 to 1984, sures which have placed the center in an sions, he adds, the school must also ap occupancy fell from 72 percent to 66 per unfamiliar - and sometimes uncomforta preciate the economic pressures that are cent, the lowest rate since the AHA began ble - position: forcing it into an intense facing its affiliated hospitals. surveying hospitals in 1963, drive for efficiency, a scramble for busi The institutions comprising the medical Behind these figures are several I • ness to retain its market share, and a still center are interdependent, friendly, yet factors, says Gee: reduced admission, closer look at community service and pa sometimes adversarial partners. In the reduced numbers of ancillary services tient care. face of new pressures and changes, it is per admission, shorter length of stay, the Some members of the community, and more necessary than ever for them to nearly total disappearance of the short even practicing physicians, might be sur work together. Says Robert Frank, presi stay patient, and the shift in focus to am prised by the scope of recent changes. dent of Barnes Hospital: "All of the en bulatory care. At Jewish Hospital alone, 'The center is sometimes perceived as an tities in the medical center recognize how "we have closed 100 beds in the past 18 •• 'ivy tower' kind of place, where everyone important it is to cooperate, rather than months and reduced our in-patient work simply wants to do research and patients compete." force proportionately," says Gee. While ( 6 The new Barnes Hospital emergency room has a central nurses' station which provides staff with an immediate view of18 treat ment rooms:.five each medical and surgical, three for major trauma, as well as specialized rooms for orthopedics, otolaryngology, ophthalmology, obstetrics/gynecology, and psychiatry, they have succeeded in making substan do anything."The new system establishes "We have reaped the early benefits of the tial budget cuts, even achieving their best the rate of reimbursement in advance of system and we think they will erode fairly year ever financially, cost cutting has be the period over which the rate will apply. quickly." come the norm. "Those programs which Payment is based on Diagnosis-Related With the new emphasis on efficiency would at one time have been eagerly Groups (DRGs), a system which assigns a has come introduction of cost-accounting embraced are now carefully scrutinized patient to a particular classification de methods. "There used to be a cost and the ones which have academic sig pending upon diagnosi s, surgical proce shifting concept that said, 'We cannot nificance, but don't hold their own finan dure, complications and age. charge so many hundreds of dollars more cialJy, simply don't ever get off the The effect of prospective pricing on than appropriate for this advanced proce launchpad, " he says. Jewish Hospital finances has so far been dure, but we can charge more for a chest This new scrutiny of hospital finances favorable. "It has been one of those rare X-ray and pay for the advanced procc was stimu lated by law, as part of the Med cases where you actually have a ' win dures that way,'" say s Tuteur. "Now, the icare patients' prospective payment plan win' situation on both sides of the equa hospitals are criticially evaluating costs adopted by Congress in the Social Secu tion ," says Gee. The payors have bene and charges on a unit-by-unit basis ." .,..' rity Amendment of 1983. "Until then , fited "and it has enhanced bottom line per Patients will also make health-care deci efficiency had nothing to do with the bot formance simply because our expenses sions on the basis of cost. "If a CT scan .; tom line ," says Tuteur. "It was basically a have dropped faster than our revenue." costs $400, and th e person who needs it r cost-charge reimbursement system: There Over the four-year, phase-in period of the will have to pay 20 percent, he is likely was no sense instituting a cost-accounting program , changes in the payment ratio are to ask his doctor: 'That's going to cost ~t system - it just cost money and it didn't likely to cancel the advantage, however. me $80, is thi s really worth it') ' And the 7 I' doc tor might repl y: ' Well, maybe we can delay a week and see whether yo u really need it. ' " Consumers have al so begun looking at various competitive institutions for the ir hea lth care. PPOs and HMOs are gaining in strength; in 12 states, the investor owned hos pitals have a market share ex ceeding 20 percenl. " In 15 years, " says Weldon, "some predi ct th at fewer th an 20 corporati ons will provide most hea lth care, including health ins ura nc e, to six Americans in 10 ... . And our medical J. sc hools and teac hin g hospitals will be operating in a price-co mpetiti ve environ me nt that will not tolerate the addition of th e costs of medi cal education to th e delivery of health services ." I In SI. Lo ui s, the competition is already int ense. With a daily patient census av erag ing 875 to 925 , Barnes still enjoys the hi ghest market share in the area , says Wil liam Doty, Barnes direc tor of marketing. Barnes, Jewi sh and SI. John 's Mercy Medical Center continue to be the domi nant prov iders in the community, says Gee, though oth er hospit als - es pecially Deaconess , Mi ssouri Bapti st and SI. Anthony's - have moved in aggressively to increase their mark et share. Long-t erm , the hospitals' finan cial situ ation will hin ge on several factors, says David Gee, president oj'jewish Hospital Gee. "By 1986, a lot will depend on what happens with th e recently ann ounced ing (an adjace nt nin e-level structu re now to take patients direc tl y to the opcratin g freeze on Medi care prices, the inclusion being built) will be completed. And in rooms. of capital expense in the prospective price January, Barnes opened it s new, second This up-to-date department represe nt s a rate , and the medical education for mula . Aoor outpatient area. "It is state-of-the new commitment for th e hos pita l. admi h I f th ose are changed moderately, th en I art," says Peg Tichace k, Barnes director William Monafo, M.D. , emergenc y think we will come ou t on a reason abl y of pl an ning. " It creates a des ignated area de partment direc tor. Just 25 years ago, safe basi s: If they are cut in some Draco for patient s to enter th e outpatient area, "Pati cnt s with ac ute trauma were di scour ni an fas hi on, th en 1 think th at we will undergo a surgical procedure, and return aged from coming here - mo st we nt to have financial diffi culties," he says, home on th e same da y. The care is the city and county hos pitals. There was a addin g: "We say our prayers every day." efficient ancl very accommodating for small facility here for ac ut ely ill patien ts, outpati ents. " but it was a ve ry low-key operation. " '1'111 (Ill (,0'II' New faciliti es have also been pl anned Through th e years, thou gh, the patient The hospital s of th e medi cal cen te r with pati ent carc in mind .The brand new, mi x has changed anclthe demand for • • have been revamping facilities to accom $9.9 million Barnes emergency depart traum a care has increased, in part due to mod ate technica l advances th at make pos ment more than triples the size of the old th e clos ing of Homer G . Phillips Hos pital sibl e outpatient procedures such as in fa cility. It includes such feat ures as so and the decline of City Hospital. An d the traoc ul ar len s impl ant s. Jewish Hospital phi sti ca ted major trauma rooms where emergency facilities , once treated as the has opened an outpati ent surgery unit , se ri ously ill pati ent s can ha ve X-rays " poor stepch ild" of th e hos pital. are at quadrupling the hospita l's outpatient ca taken without mov ing from the stretcher, tracti ng fr esh att ent ion. " Now we ha ve pacit y, whi ch will operate fo r about two an aut omated sys tem to transfer spec i moved into a nice , elegant fac ility equal years. Then the Ambu latory Care Build men s to the lab , and non-public elevators to taking care of th ese serious 8 ·;. ., problems," he ~ays. ca me into being, the center was one of c lud ing the 10 most acti ve physician The Heal th, Education and Screening o nl y five academic medical ce nters in the admitters. Jewish also has set up some Center was installed last year in a highly country willing to be Involved in this new satellite operations in SI. Louis County, visible location near the Barne~ Hospi tal approach to hea lth care. "Amid the social especiall y th e Home Care Program and entrance. Two breast cancer screening unres t of the late 1960s, interest surged a physical th erapy satellite. The hospital programs filled so quickly th at a third se s in the hum anitarian aspects of medicine is ex ploring th e possibility of outpatient ,ion had to be added; a te ~ ti cu l ar screen among U.S. medical centers. The ques services in the County to more closely in g program is planned. tions being asked we re: What is thi s cen reach some of its clientele. Both Barnes and Jewish are beginning ter doing for the community'l Is it just Long-term strategies at Barnes include to call on area employers about new well fea th ering it s own nest? And many of th e " Ae shin g out our marketing mix, invo lv ness programs, currentl y offered on ly to fa culty here began to ask those questions ing promotion, pricing and distribution hospital employees. And Jewish has th emselves." st rategy," Doty says. One step was th e already been holding successfu l Nicotine Soon Gerald Perkoff. M.D., joined by purchase of Sutter Clinic (now Barnes/ Withdrawal Clinics for Smoki ng Cessa Kahn , tri ed a two-pronged ex periment: To Sutter Hea lth carel last year, to provide in tion, open to th e public. test whether new methods of health care du stri al, medical and pri mary emergenc y The Apnea Program at Chi Idren 's Hos delivery popular on the West Coast services fo r downtown employees. rital has been helping famil ies of children worked here; and whether it was possible Another was the recent formation , with at risk for Sudden Infan t Death Syndrome to determine ways to contain health care nine other Mi ssouri ho sp it als, of a corpo for three years. "Our program is th e direc t costs within such a system of prepaid ration that gives them a competitive edge res ult of serving the needs of th e commu group practice. The experiment proved over for-profit hospital chains. The corpo ... ~ nity and practicing physicians,"' says successful. Now, under the sponsorship or rati on, called YHA Mid-America, plans Georgia Schellt, patient care and research Met ropolitan Life Company, MCG will to red uc:;e costs through such joint e fforts coordinator for th e program. The program be used as a model for the nationwide as gro~p purchasing. provides information and training to par marketing and development of prepaid Along with the changes, doctors em ents who need to use equipment to moni group practice. phasize, th e medical center continues to tor th ei r baby's breathing. Like other hos "We were the pioneers in th e commu ex hibit its trad itional st rength s - which . ~,-. pital programs, this one represents a shift nity, " says Kahn . ''It was not th e business also benefit the co mmunity. The academic ... in emphasis toward economy and more ef community or even patient demand th at clinician, for example, is "a li aison be fective patient care. created MCG - we had a hard time tween the researcher and the primary phy Similarly, the Barnes Home Health convincing th em. Those who examined sici an, taking the material which comes Department aims at sav ing money and a prepaid group practice, genera ted it , fro m th e lab and applying it to clinical helping patients who might otherwise fo stered it, and made it work were people practice," says Alan P. Ly ss, M.D. , ass is ~ lac k the rollow-up care th ey need . The at th e Washington University Med ica l tant professor of medicine and director program, begu n las t September, ope ra tes Center. That's been, and continues to be, of clinical oncology at Jewish Hospital. "1 in associati on with the Irene Walter an enormous contribution to the SI. Louis And the center continues to ac t as a J Johnson Institute of Rehabilitation in community. " re ferra l center, tak in g care of specialized offering a range' of nursin g and supple Prodded by competition and econom cases. "You' ve always seen some public -1 mentary se rvi ces to oncology patients, ics, the medica l ce nter is branching out in perception that the universit y is an ivy diabetics and burn patients, among oth new directions. At Barnes , advertising is covered tower and activities here are ers. Doctors who use Home Health may one. " Five years ago, you didn't find hos removed from the mainstrea m of med ica l also participate in the hospital's new pitals, physicians or dentists doing any practice. Yet, when people have unusual program whi ch encourages patients under kind of promotion other than normal pub diseases or are at a crossroads in their going tests or treatment, but need ing little lic relations an nouncements." says Barnes med ica l care. th ey have turned to the in th e way of nursin g care, to stay in marketing director Doty. uni versi ty for innovation," says Lyss. ~, I QueenyTower rather than occupy a hospi Children's Hosp ital ha s just hired But th e medical cent er is also chang tal bed. Home health care has been pur a marketing director, as has Jewish Hospi ing. "And not only are we changin g, sued by Jewish Hospita l for 3S years, tal. At Jewish , th ough, "we're concentrat we are also lead ing," concludes Tu te ur. ,1 _ points out Gee: "We've been in the Ihome ing primaril y on our voluntary medical "We haven't bee n a leader in letting th e carel bus in ess a long time," he says with staff, since 90 percent of all admissions community kn ow about our inn ovations, satisfaction. are derived from part-time fac ulty," says but we have been a leader in developing ,. As the very existence of th e Med ica l Gee. The hospital , for exa mpl e, recently innovative programs. " • Care Group d e m ons tr ate~ , the medical purchased two office buildings on Ba ll as Can(kice O'Connor is a 51. Louis-area center ha s long been wi II i 19 to respond to Road whi ch have 60 percent occupancy freelance wriler and ji'equenr conrrihwor chan ge , says Kahn. Tn 1969, when MCG by Jewish Hospital sta ff members , in 10 Outlook. 9 STUDENT STAGE top campus. And anywhere they play, about the Hot Docs, he's pleased but BY GAIL DIBERNARDO audiences love them. quickly puts it in perspective: "We try to 'They're fabulous," says Chris Owens, put on a great show. But you have to come he Hot Docs have been playing director of medical alumni programs. wanting to see a group of medical students Glenn Miller and Tommy Dorsey 'They're crisp, talented, enthusiastic, and not expect Woody Hermann's band." Ttunes at medical school class shows lively and professional." Charles Norland, Joe Awad, M. D. '85, director for the and alumni reunions for the past six years. M.D. '59, former president of the medical past two years, says he tries todraw on the • • In that time, they've become a medical alumni association and a musician him band's strengths and limit it to what it does school tradition. You can see them in their self, is very enthusiastic about the Hot well. They play the traditional big band white lab coats and shirts, black pants, Docs: "They are really good, I kid you sounds the best - the songs you know and red cummerbunds and bow ties, play not. Most have played professionally in even if you're too young to remember the ing their hearts out at noontime concerts in college. They have a good sound." '30s and '405 - "In the Mood," "String of Barnes Hospital cafeteria, the graduation If you tell Ellis Neufeld, M.D. '85, Pearls," "Sing, Sing, Sing." Says Awad: party thrown by the Department of Phar director and conductor of the band for its "We stay away from rock music, more macology, or at the Gargoyle on the Hill first four years, what people are saying modern big band jazz or progressi ve jazz. ( 10 Over the years, musically inclined students have played their way into the Hot Docs. Neufeld remembers their first class Some of these new students eventually show performance: 'The class th at en end up in the band, even th ough their time tered in '79 started a band for our class is limited for rehearsals. The Hot Docs show. Our first rehearsal was terrible. Our make no money - any concert performed drummer played jazz without being able in the medical ce nter is done gratis. They to re ad mu sic. Several of the musicians performed at a charity concert for a loca l hadn't played si nce high sc hoo l. It was children's cause thi s year, so mething that very depressing. But there was a lot of Awad says he would like to see them do enthusiasm. People practiced and got it on a re gular basis, "to show that medical to gether for that first show." students are interested in what's going Money was very short at the beginning, on outside the medical center." and expenses were hi gh. "When J was a "We do all thi s, " muses Neufeld , second-year student," says Neufeld , " it "because it keeps us from going crazy. cost $20 to buy sheet mu sic for one jazz And it 's nice to do something you don't band tune . If you play 20 to 30 tunes a get graded for. It's ni ce to hear the com dance , that 's $600 worth of mu sic." Early pliments." Awad says th at he's been able on, the Medical Alumni Association pro to carry out the time-consuming duties of vided them with sheet music, band stands , the director without sacrificing hi s grades: and their trademark cummerbunds and 'That's because thi s music is a part of my bow ties. Neufeld came up with their life. All the Hot Docs are used to giving name, and the band was on its way. up their time for rehearsals becau se we The Hot Docs grew and developed see it as something import ant. " largely because of the work of its direc Owens notes a "real ca maraderie" that tors. The director/conductor gets gigs, ar transcends individual band members. At ranges rehearsals, and lobbies for money this spring's alumni dance, Norland sat in and equipment. Neufeld persuaded th e and played drums, and other graduates Med ical Alumni Association to fund the were asked to sit in. It is this camaraderie band's sheet music, which th e assoc iation and good will- a feeling of community now supports to the tune of $300 per year. - that has made the Hot Docs a tradition, Their repertoire now includes some mod perh aps the only student tradition at the ern big band sounds from Count Basie medical sc hool. and Woody Hermann , and pop tunes Rumor has it that the tradition goes "Where Is the Lov e," " You Light Up My back weJ.l beyond the six-year tenure of Life." Awad secured th e band's sound the Hot Docs. Awad says he found old system an d an electric pi ano. music tucked away from 25 years ago th at Today, the Hot Docs are a Glenn Miller suggests there may have been a band back sized band . They have fi ve each of players th en. Over the years, medical students skilled at trumpet, trombone and sax informally played at alumni dances, but ophone, and a drummer, piano, base and there was no formal band until the Hot These are technically difficult and require acoust ic guitar player. "Our big probl em Docs' first performance six years ago. that everyone in the band be a really good now is that the medical school hasn 't "Cornell and Stan ford and Boston player. Also, it means that we need a lOI taken in a trombone pl ayer," laments Children's -they all have bands. I hope of practice time , which we don 't have . Neufeld . Trombonist-conductor Awad is we're a tradition here," says Neufeld. "I So we stick to th e traditional music ." leaving th e band to start residenc y. think we' ve convinced th e ad ministration The Hot Docs may not be in Woody "We've been pretty lucky getting players that we're firmly established - we're Hermann's league, but what they 've ac from within th e med ical sc hool commu in the medical sc hool catalog thi s complished in the past six years has been nity," recounts Neufeld. " But the problem year - and we Ivill keep going ." • remarkable. Owens remembers a rehearsal we have every year is th at first-year .-' for their first show: "I heard th em practic students don't admit it if th ey're mu si ing a week before the dinner dance. I was cians. Th ey're nervous about being able f skeptical .. Let'sjust say, they sounded to get their work done if they commit a little rough - actually, very rough. And themselves to a band. Then, at class ..-\ their repertoire was very limited. You had show time , they show up with their Gail DiBernardo is a 51. Louis-area to hear ' rn the Mood' three or four times." instruments. " Feelance wrila II " ., .... . 12 1 BY LINDA SAGE ••• .,.. . f TO THE he brain . In humans, three pounds at the School of Medicine interact in the of pink-gray, convoluted jell y. Laboratory of Neuro- Imaging (LON!), Over one- hundred billion nerve located in McMillan 3 15 . LONI is the cell s, trilJi ons of interconnecti ons. Capa brainchild of Robert C. Collins, M. D . bl e of balancing a checkbook , fallin g in professor of neurology, and director love, memorizing a concerto. Capable of ArthurW. Toga , Ph.D .. research as sistant cont empl atin g itself and it s abilities to professor of neurology. After many years think, feel emotion , and remember. of manually analyz ing brain images , Scientists ex pl ore the working brain "whi ch was time-consum ing and in accu with electrodes, which map nerve cells' rate," says Toga, "we thou ght th at if we elec tri ca l activity as an animal moves could apply NASA technology to neuro a paw or has a se izu re. But though such imag in g , it would be the greatest thing maps are valuable, th ey are limited be since sli ced bread. Thi s revo luti oni zes th e cause a fe w electrodes cannot spy on bil study of functi onal brain ac tiv it y. " lions of brain cells. NASA uses computers to di giti ze and Some neuroscientists are makin g maps th en enhance sate ll ite pictures of th e of the whole working brain , rath er than of ea rth 's surface, mak in g the im ages clearer preselected reg ions. They use radi oactive and amenable to quantitative analysis. tracers, wh ich enter every cell and li ght Toga want ed to do the same for brain up th ose that are espec ially active during images and to act as a reso urce to other a given ac ti vity. Thi s approach is provid researchers studying brain fun cti on. With ing in sights into diseases such as epil epsy, a $2 13 ,000 shared instrument at ion grant stroke and de mentia. To analyze the re from the Divi sion of Research Reso urces sulting im ages, neurosc ient is ts enli st at N!H and additional money from th e th e help of computers and computer School of Medi cine, th e Department of sc ientists. Neurology and Neurologica l Surgery, and Neurologist s and co mputer scienti sts the McDonnell Center for th e Study of Hi gher Brain Function, th e laboratory Autoratliograms, serial brain sections opened on Janu ary 25, 1984. Less than or from an animal given a radioactive two years later, LONf has 50 use rs. metabolite, point out "hot 5pots" regions ofintense metabolic activity f to researchers interested in documenting Collins uses LONI to stud y epilepsy, brain regions respon sible for certain a di sease th at affects over four million actions or behaviors. Ameri cans. During an epil ept ic seizure , 13 .. ) . f • .. Ruthmary K. DeueL uses the faciLities ofthe Laboratory ofNeuro-lmaging for her investigations ofa particuLar brain region during certain movements. brain cells become overexcited, gener seizures that have plagued her since she I am or what to do. 1 can't complete a , . ating an electrical storm that may over was six years old: "I get a tingly feeling thought, I can't write legibly, 1 can't do power large regions of the brain and pro with pressure in my chest or vagina," she a simple thing like make a bed." duce the convulsions of a grand mal sei says. "It lasts from 30 seconds to over a "Epilepsy is an experiment of nature," zure. But when just a few regions of the minute. Sometimes that feeling goes Collins says. "It lights up the brain in a brain malfunction, a partial seizure re away, but sometimes it brings on an at very dramatic way and allows us to think sults. In adults, this is commonly in the tack, when I hear myself making sounds. about which parts are responsible for the limbic region, a part of the brain that gov They're laughing, giggling sorts of symptoms." .A • erns emotions and other "primitive" func noises, but they're low pitched, as when a Collins studies limbic system seizures tions. Limbic system seizures begin in boy's voice changes at puberty. It sounds in animals with quantitative autoradiog part of the forebrain. They alter con like I'm hearing somebody else, not me. raphy (QAR), a technique developed by sciousness, presenting the sufferer with And 1 can't control it - it controls me. Louis Sokoloff, M.D., at NIMH. The ra strange sensations or with visions of "Sometimes 1just black out and fall dioactive tracer is a glucose-like molecule childhood scenes. like a ton of bricks. I' m told that my legs that remains partly metabolized in brain <. • One Barnes Hospital patient, a woman make pedaling motions and my eyes are cells, revealing rates of metabolic - and in her 40s, describes the limbic system glazed. Afterwards, I don't know where therefore electrical- activity. QAR's ad 14 ~C r vantage over the analogous technique of positron emission tomography (PET) is its IOO,OOO-fold greater resolution. But because QAR requires the brain to be sliced before imaging, it cannot be used without sacrificing the experimental animal. The brain slices Collins studies come from monkeys that have undergone limbic system seizures while taking up radioac ti ve sugar. Collins stains each section with histochemicals and makes both an anatomically perfect, photographic image and an autoradiogram. The latter, a pic ture of sugar metabolism, develops when a section is placed in contact with film for a couple of weeks. Radiation from the ..; , sugar's carbon atoms darkens areas of film on which they impinge, producing an image in shades of gray. By comparing the anatomical and func tional images of each section and convert ing optical density measurements from the autoradiograms into rates of sugar metabolism, Collins determines exactly which areas of the brain are hyperactive during a limbic system seizure. He has de tected increased activity not only in the area where the seizure begins, but also in parts of the limbic system remote from the seizure focus. "There's a whole series of structures in A three-dimensional image ofthe brain begins with an autoradiogram which has its volved," says Collins, "and they are all outer dimensions electronically copied by computer. Next, the computer assembles the ,.. connected to the area of discharge . What brain slices, generating from these serial sections a three-dimensional picture ofthe .. . the metabolic studies have allowed us to whole brain. Specific areas ofthe brain can be visualized, and the computer can do is see the full extent of those pathways. color-enhance that section. Now we have to try to develop the idea that all these structures are linked to Collins is continuing his study of ~E\\, JlII!'E FOB STHOI\E \ 'ICTIMS? gether. It's not appropriate to think that epilepsy by looking at generalized sei the abnormal behavior caused by seizures zures "where no one has any idea which Another project nourished by LONI is is the expression of one part of the limbic pathways are involved." In addition , he is a study of cerebral metabolism following .... system or another, but more of a complex mapping cerebral metabolism in animals the creation of brain lesions. Ruthmary functional system that has been taken over with symptoms of Parkinson's disease. K. Deuel, M. D., associate professor of pe by an epileptic di scharge. I think that idea Besides pinpointing brain mitochondria diatrics and neurology, is interested in the is one that LONI is going to be able to - a cell's " batteries" - Collins measures control of thinking by the cerebral cortex. support ... that brain function is the ex metabolic rates with a fatty acid that en For a model, she analyzes events in the pression of activity throughout intercon ters the brain much more rapidly than dorso-Iateral parietal lobe - the part of nected systems rather than of one area sugar, revealing changes in metabolism the brain that lies above and behind each that's dominant over another. But if we during transient activities. ear - when sequential voluntary move are going to understand brain function in With the aid of LONI, Collins hopes ments are performed. Adults with strokes ~ terms of interacting systems, we have to eventually to study very subtle changes in often exhibit apraxia - an inability to have a way of seeing all those systems. the brain. "One day, " he says, "there will perform certain movements despite the .... Our method allows us to sample the entire be a functional neuroanatomy of fear or absence of paralysis - or display diffi brain for functional activity." pleasure or anticipation." culty with sequential movements. For ex 15 terrible problem," she says. "Despite ex cellent bodily health and normal strength, some stroke victims cannot function nor mally. If they have an altention deficit, they cannot do acti vities we associate with a normal life - dri ving a car, speak ing intelligibly, or taking a walk around the neighborhood . But if we could deter mine the factors that create recovery of the brain's metabolic function, we might have a chance of promoting the recovery of higher brain function in people with strokes. " The list of projects grows. Joseph L. Price, Ph. D., professor of anatomy and neurobiology, surveys brain slices in search of the enzyme that makes acetyl choline, a neurotransmitter whose loss may be related to Alzheimer's disease . Pharmacologist Emily M. Santori, Ph.D., research instructor in neurology, assays receptors for neurotransmitters in the brains of epileptic r(lts. She hopes to dis Robert C. Collins, M.D., one ofthe founders ofthe Laboratory ofNeuro-Imaging, cover if changes in a neurotransmitter's uses itsfacilities to study brain events during epileptic seizures. Collins has discovered affinity for its receptor can explain why functional systems activated during an episode ofabnormal eLectrical activity in the one epileptic seizure promotes another. brain. Thisfinding means that compLex events in the brain cannot be defined simply From his quarters on two floors of the by studying individual regions in that organ. McMillan Building, RobertA. Moses, M.D., professor of ophthalmology, sends ample, they may not be able to tie a shoe the recovered monkeys' brains used sugar pictures of the retina to investigate blood because they cannot put together the at normal rates. flow in this organ. Other users, bearing sequence of movements required. "What we found ," she says, "is that an images, trek in from Iowa, New York and Monkeys with new parietal lobe lesions animal with neglect and apraxia is one Houston, eager to develop new techniques exhibit apraxia and neglect the side of the that has decreases in glucose utilization or find new applications for tried and true body opposite the le sion. But by the time deep within the br(lin. These appear to be ones. two months have elapsed, the abnormal related to a lack of electrical activity in Commenting on the quantitative auto behaviors have resolved , even though the the pathways that used to come from the radiography performed by LONI users, lesion is still present. What changes in parietal lobe. This seems to outline a sys NIH's Sokoloff (the technique's develop cerebral activity, Deuel wondered, occur tem of structures within the brain that is er) says: "It's beautiful work. Many peo during the recovery period? active in selective attention and motor ple at other institutions are using the After infusing monkeys with radioac praxis. This reinforces Dr. Collins' methods blindly, without understanding tive sugar, Deue! prepared brain slices of finding of functional systems within them or applying them properly. So it's monkeys with new lesions and monkeys the brain. a relief to see somebody doing things th(lt had recovered normal behavior. 'The experiment also told us something right." • Using LONI, she scanned the brain slices about recovery. Recovery of some of the for abnormal rates of sugar metabolism. structures within the functional system What she found was unexpected and pre allows recovery of function of the entire Linda Sage, Ph.D., is afreelance writer and viously undemonstrated. system: What you need in order to get frequenl conlribulor 10 Outlook. The monkeys with new lesions had some functions back is for di stant struc very low rates of sugar metabolism not tures to regain their normal rates of glu only in one parietal lobe , where nerve cose utilization." Note: Arthur Toga was among the 39 Ameri .. cells were missing, but al so in two quite Deuel anticipates that her finding may cans held hostage in Beinll in June. This distant sites where there was no structural one day help stroke victims who, like her SIOlY was written from inlerviews held before damage. But nerve cells in those sites of monkeys, have brain lesions. "Stroke is a his trip. ( 16 Models OF THE l MIND "M any research activities generate visual data, presenting the researcher with the problem of quantifying it," says ArthurToga, Ph.D. , director of the Laboratory of Neuro-I maging (LONI). "So we take pictures and transform them into computer lan guage. Then we have a set of numbers from which we can make statistical or mathematical conclusions." The transformation of an image such as an autoradiogram begins in a digi tizer, an array of photodiodes that moves up and down across the image. The machine measures the amount of light coming through the film at over four million spots. This converts the continuously varying shades of gray to numerical values for optical densi ty Arthur W. Toga , Ph.D., is co-founder and director ofthe Laboratory ofNeuro falling between 0 (black) and 255 Imaging (LON/). In addition to his work in neuroscience, he writes computer (white). The numbers can be translated programs (software) that enabLe LONI users to create three-dimensionaL brain into metabolic rates. They can also be images Like the olle on tlte screen in the background and on the cover ofthis issue. manipulated into computer-generated images with much greater contrast than computer by matching these reference visual data, and as that vi sual data is the original. points. Toga now wants to align images digitized. Then we try to put all those One option for enhancement is to of slices from different brains so that sl ices back together again." expand an image's grayscale, giving it users can compare the brains of control To make a three-dimensional func a wider range of contrasting tones. and experimental animals and contrast tional model of an epileptic rat brain, Another technique is to assign false different brain functions such as Toga in structed his system for image color to the image. This makes details glucose metabolism and blood flow. analysis to outline slices of the brain stand out to the human eye, which can LONI's algorithms are designed for and then to stack the outlines like a pile distinguish between two colors more neurologists with no knowledge of of hoops, aligning the images as de easily than between diffcrent shades of computer science. With the aid of a scribed above. "Because these images gray. A LON I user can place a digitized menu and on-line help, scientists can are displayed on a two-dimensional image in a computer and assign 16 dif align and enhance grayscale or colored screen," says Toga, "the user has to ferent colors to the optical density images without endangering their ori g play 'tricks' to get a three-dimensional scale. For example, an autoradiogram inal data. LON! software is also avail effect - the image can be rotated could be colored to distinguish be able to scientists at other universities. around any axis. " Finally, by inserting tween areas with different metabolic As well as enhancing and analyz metabolic data from autoradiograms, rates . ing two-dimensional images, Toga (a Toga derived a model that could be Since LON! users often wish to neuroscientist and computer scientist) sliced at any angle and plane to reveal compare images, Toga has addressed has constructed three-dimensional an image of sugar metabolism in the the problem of alignment. His simple images of the brain showing the spatial exposed wedge. " It's like slicing but elegant solution is to introduce two distribution of glucose metabolism in through a hard-boiled egg and seeing columns of radioactive paste vertically relation to anatomy. "In order to gener the yolk," he says. into the embedding material so that ate visual data," he says, "we have to Before such models become routine two discs of paste appear on each sec slice up the brain. So we wanted to put ly available, Toga must speed up the tion when the brain is sliced horizon it back together and still retain the lengthy computations. "It's a very dif tally. Because the discs are both radio quantitative information. What we are ficult problem," he says, "because you acti ve and stainable, they show up on trying to do is retain the coordinate sys have an incredible volume of data. You both autoradiograms and photographs tem that is inherent in real life and may slice the brain into 100 slices, and of stained sections. Therefore a user keep track of it as th e brain is sectioned each slice may have a million bytes of can align the two types of images in a up into slices, as those slices generate information. " 17 • AND. BY LINDA SAGE" • 18 amela Buschard, a 32-year-old ad the 119,000 American women who will between ages 35 and 40, while the ministrator at McDonnell Douglas, discover that they have breast cancer this National Cancer Institute recommends Pabsentmindedly scratched her chest year. Over 38,000 will die from the dis mammography only for women at high as she watched television. By chance, ease. But the number of deaths - and the risk - over 50 or with a family history her fingers alighted on a mass in her right number of surgicaUy removed breasts of breast cancer. breast, a lump as hard and round as a could be reduced. Breast cancer detection Reaching for a floppy disk, Gohagan, pebble. need not be accidental, as in Buschard's who is also a professor of engineering, In July 1984, a surgeon removed the case, or late, as in Rothman's case. says, "This allows you to sit in front of lump and discovered breast cancer. But Tumors can be detected long before they an IBM PC and enter data characterizing because the tumor was small (1.5 cm in can be felt or even have time to spread, a woman's risk profile. For example, diameter) and cancer cells had not spread giving women a 93 percent chance of you can say that a woman is 42, has two to other parts of the body, surgeons were survival for at least 20 years. children, and was 24 when the first was able to save Buschard's breast and to But who should be checked for breast born, nursed them for a total of 12 promise her l.n excellent chance of surviv cancer? Under what conditions? And months, and has no symptoms of breast al. They removed lymph nodes from her which diagnostic procedures are best? cancer. The computer then goes through right armpit and administered radiation Using breast screening data, a team of the calculations and recommends that a therapy. Today she is apparently free researchers headed by John K. Gohagan, woman have or not have a mammogram." of cancer and still has two intact breasts. Ph.D., professor of preventive medicine, Copies of the disk should be available to Geri Rothman, 40-year-old wife of developed mathematical models that medical educators later this year through lawyer/politician Ken Rothman, was less could help physicians answer these ques the division of health care research in pre fortunate. In December 1981, she decided tions. Like other researchers, the team ventive medicine. The disks will be avail to do "one of my semi-annual breast concluded that mammography - X-ray able to medical schools, where future physi exams. As I lay there, my fingers felt my examination of the breasts - is the most cians learn to balance the pros and cons of world come to a screeching halt. Surely accurate single method for early detection breast cancer tests. this small, hard rock couldn't be a lump in of breast cancer. But unlike other re Richard D. Costlow, Ph. D., head of the my breast." searchers, they used mathematical tech National Cancer Institute's Cancer Detec The "rock" was a malignancy in her niques to decide when mammography is tion Branch, directed a national, five-year right breast. Moreover, a breast X-ray appropriate. Their models reveal that a breast cancer detection project sponsored showed small white dots scattered over woman's age and the competence of her by NCI and the American Cancer Society. the film, a sign that cancer had spread. radiologist should be the most important He says the Washington University math The breast would have to be removed. factors affecting a decision to perform ematical models, drawn from part of that Eighteen months after a modified radical a mammogram. And that benefits clearly project's data, "provide another piece of mastectomy, the cancer recurred and outweigh all costs by the time a woman information in a large void. They don't an i I; Rothman needed radiation treatment and reaches her late 40s. swer all the questions, but they do help chemotherapy. Her hair fell out, and she The models consider not only accuracy, determine how frequently we suggest a had to wear a hat anytime she left the but also financial and social costs of the screening exam, the age groups that house. Although cheerful about her tests, future costs of undetected cancers, should have it, and the sequence of the experience and thrilled with the natural and the possibility that the radiation dose examinations. " appearance of her reconstructed breast, from mammography could itself induce a The 10,000 women who generated data Rothman might have been spared chemo small number of breast cancers. used for the models were seen at the therapy and extensive surgery if her The Gohagan team's findings increase Cancer Research Center in Columbia, cancer had been detected earlier. current doubts about self-examination as Missouri, one of 27 NCI-ACS breast Buschard and Rothman are typical of a premier detection method. The results screening projects. Between 1974 and also lead Gohagan to suggest that women 1979, the Missouri center, directed by A tumor is clearly visible as the large col ask important questions about radiation Ned D. Rodes, M.D., screened women ored mass in this image ofa breast. This level, frequency ofequipment checks, annually, using mammography, clinical picture is the product ofmagnetic reso and number of mammograms their clinic palpation by a nurse-clinician, and ther performs. mography. The center also taught women, nance imaging (MRl), obtained without the use ofX-rays. MRI is under scrutiny, At present, physicians have no firm ages 35 to 74, how to examine their in comparison with mammography and guidelines because there is disagreement breasts at home. physical examination, to test each tech over the scheduling of mammography. The specialists who interpreted and nique's effectiveness in detection of The American Cancer Society recom recorded the results worked indepen breast cancer. mends that all symptom-free women re dently so that they could not influence ceive periodic mammograms beginning each other. Then they pooled informa 19 JI IJ .. ba.>nb.~ " ··:·;I!.J ..... :~': I \l.'~ John K. Gohagan, Ph.D. tion to decide whether a woman should to the five-year project in Missouri. When survival rates. Mammograms revealed have a biopsy to diagnose detected they assessed the individual screening cancers as small;Js pinheads, but only abnormalities. methods commonly used on symptom-free cancers at least one centimeter (about women, mammography stood out as the 0.4 inch) in diameter could be found by \);IIIII!\"~;ljlll\ \/"... , \1"1' Iwk ~rf"l lI,d most accurate. It correctly identified 58 per clinical palpation. .. . The Washington University group cent of all the breast cancers, and mis "By the time a mass reaches a centi began to analyze the screening data in classified only I percent of noncancerous meter in diameter, it has about a billion t ".. 1979 in collaboration with the Mi ssouri breasts. Clinical palpation alone, however, cells." says cancer specialist Rodes. now screening project. The work was sanc correctly identified about one-fourth; ther at the Audrain Medical Center in Mexico, tioned by the National Cancer Institute mography demonstrated just over a third. MO. "And masses may be as big as golf and funded by the National Center for Thermography produced the most false balls before they are detected by palpation Health Services Research. U.S. Publ ic alarms because infections as well as tumors in some obese breasts. Moreover, 50 per Health Service. generate abnormal heat patterns. This made cent of all masses have metastasized by \ 01 The researchers - including Edward L. thermography unsuitable for screening, and the time they become palpable." Spitznagel , Ph. D., professor of math all 27 screening centers discontinued its use The data did not lead to any firm con ematics, William P Darby, Ph.D., asso in 1976. clusions about the value of breast self ciate professor of engineering, and others The screening methods also differed in examination because not many women - noted that 152 breast cancers had been ability to detect very small tumors, whose were willing to practice it methodically. detected during and between 50,000 visits diagnosis and treatment offer the greatest Further, the 16 cancers detected outside r 20 "l -I l BEYOND MAMMOGRAMS ,/ " urrently, mammography is the tional Institutes of Health that wiII .I. ( best technique for early detec compare the usefulness of MRI with '. tion of breast cancer, and it is mammography and physical examina l performed at two locations in the medi tion. MRI may be especially useful in ca'l center. Mallinckrodt Institute of cases in which mammography results 1 th e center represented both cancers found Radiology conducts breast X-rays are indefinite. by th e women th emselv es and their physi ofover 5,000 women each year. The MRI offers a unique view of breast cians. But even if all 16 had been found at Department of Radiology at Jewish structure, one not provided by mam ho me. th e detecti on rate would ha ve been Hospital will test about 4 ,000 women mography or other procedures. "In the low enough compared to the number of in the coming 12 months. Both con future," says Gohagan, "this may be bi opsies done to cast doubt on the effec form to standards for radiation expo helpful to clinicians in identifying the ti ve ness o f breast self-examination. " Fur sure suggested by John K. Gohagan, extent of lesions and cysts in fibrocys thermore," says Gohagan, " most o f these Ph.D., professor of preventive medi tic breasts, and in discriminating be wou ld have been found in the next screen cine, radiology, and engineering and tween some benign and malignant tu in g examin ati on." ..... applied sciences at Washington Univer mors without the need for biopsy. " He Beyond in dividual methods, the team sity. The examination, performed in points out that this investigation ofMRI analy zed the effectiveness of various ." two or three exposures per breast with is an extension of studies that began combinati ons. They di scovered that clini X-ray film, imparts about a halfrad for nearly IO years ago, comparing the ef cal palpati on, th ough not very effective three views. But Gohagan is investigat fectiveness of mammography, ther by itself in detecting small cancers, ing the potential of a followup procedure mography, and physical examinations. greatly in creased detection rates when for women whose mammograms hint at Within the next year, Gohagan plans combi ned with mammography. The two a potential problem. to conduct MRI evaluations on some meth ods used together correctly identified Magnetic resonance imaging (MRI) 200 women. Women who have routine 82 percent of all th e cancers, while mis does not involve irradiation with mammograms at Mallinckrodt Institute classifyin g onl y 2 percent. X-rays. Images like the one on page of Radiology will be invited to receive S in ce mammography was obviously 18 are obtained through the use of a an MRI free of charge. Those who are superi or to the oth er methods, Gohagan's powerful magnet and radio waves. interested in participating in the MRI group addressed the problem of wh en Gohagan is principal investigator of study and would like to schedule a sho uld a sympto m-free woman have a a two-year study funded by the Na mammogram may call 362-7110. mammogra m? He wanted to balance th e .., probable bene fit s against the probable costs. "A woman with no symptoms of breast cancer has to periodicall y decide th at th e benefit s of annual mammography out. "Tf a center's accuracy rates are sub (. whether to have a mammogram or other ou tweigh th e ri sks by the time a woman stantia ll y below ours, mammography tests," says Gohagan . "And a false nega reaches her late 40s. probabl y shouldn't be used." ti ve or fa lse positive test is always possi Unfortunately, usin g their data , th e Gohagan thinks th at women would "'" .., bl e . But the consequences associated with researchers could not directly assess the benefi t if the nati onal cancer organiza ... mi ss in g a cancer are certainly greater th an ri sks associated with two important fac ti ons could monitor and reveal detecti on th e consequences of doing a biopsy when tors in developing breast cancer - previ rates. "I'd like to see organizati ons like a woman only has fibrocystic di sease [be ous repeated X-rays and fam il y hi story of th e Nati onal Can cer Institute and the ",. ni gn, fibrous tumors]. So wh en we make th e di sease . They had to rely on th e pro America n Cancer Society devel op a decisions, we have to try to balance th e jecti ons of other researchers. But a recent screenin g po li cy to encourage accuracy possible negative consequences and po study by the federal Centers for Di sease mon ito ring and enhancement ," he says. tential benefits associated with th em. " Control found that women with an af "Such a po li cy might indicate key fe atures ~ fec ted mother or sister had a relative ri sk assoc iated with accuracy to the benefit of \ ;":1 III,] \('I''II' "') nursed babies, or the age of menopause. ratel y read mammogram still doses a Implicaliol1s, " published in 1982 by Praeger Consequently, the researchers conclu ded woman with radiation," Gohagan poi nt s Publishers. New York . ,+. .4 ~, 21 ANTIBODIES immunoglobulin I I • ERNIESI ~. AGAINST THE ODDS BY KAREN BURNS rnest St. John Simms must have been special. When he died two years ago this fall at the age of 66, he was an associate professor E with tenure - in the Washington University Department of Micro biology and Immunology. He played an integral part in historic scientific research, including the Nobel Prize-winning discovery of how DNA replicates. As an academician, Ernie contributed to the education of hundreds of medical students. World-renowned scientists credit him with some of the most valuable instruction they have ever received. And many consider him one of their closest friends. But Ernie's greatest accomplishment at the university is that he suc ceeded in one of the toughest institutions there is, even though he was black, and even though he didn't have a college degree. Ernie was 19 years old when he came to went out. J always had to be doing some Washington University to look for work. thing and, when I would get home , Erni e He had just returned to St. Louis after two would still be there waiting for me." years as an engineering student at the Uni Ernie and Ginnie left Homer G. Phil versity of Minnesota; hi s father, a college lips in 1942 to look for more lucrative professor, had died and Ernie was looking work. World War Jl was well underway for work to support his family. He was and they found jobs making bullets at the hired to work in the Department of Sur St. Louis small arms plant. It was one of .. gery as a laboratory technician . the earliest opportunities Ernie had to Four years later he left the medical cen speak out about minority rights. "We efore ter to go to Homer G. Phillips Hospital, were segregated," says Ginnie. "The thinking there were more opportunities blacks had their own building and they long, [Ernie] outgrew the there for blacks. He was hired as a had to walk almost a mile to catch the technician status and serologist; hi s wife to be, a spirited young bus. The work conditions were bad and office clerk named Virginia "Ginnie" policies were overbeari ng." became an imp011ant, Cayson, worked across the hall from his The blacks went on strike and Ernie contributing member of lab. was their spokesman. At 5 feet 9 inches Ginnie was determined to date the shy, and 150 pounds, Ernie did not cut an im the Kornberg group . .. handsome Ernie, and tried to get his atten posing figure. But his convictions were more often tfum not, his tion by moving her desk so she could strong and he was effective; the blacks i~fallible watch him work. Eventually he asked her won control of the plant , and their work intuition was as for a date. "Ernie was not what I would ing conditions improved. When the strike as his experiments." call a very soc ial person," says Ginnie, a ended , Ernie was promoted to foreman. youthful, attractive woman who still lives He stayed at the small arms plant until in the hou se she and Ernie bought 30 1945, when he and Ginnie, who was hi s Paul Berg years ago. "He would be content to sit at wife by now, left for Chicago to look for my house and talk to my mother while I work. After working as a machinist for a while, Ernie returned to St. Louis and ipant , there's no question about it ," says once again got a job in the Washington Kornberg , who is continuing his DNA University Department of Surgery. He research at Stanford. "He was a fine ex pe was to stay at the university the rest of rimentalist, very intelligent, and had the his profess ional life. capacity to help students and fellows and Ernie had already established himself participate in a very effective way." as an able technician through his prev io us Robert Lehman was a postdoctoral work at the university. His first opportu fellow when he joined the prize-winning nity at formal experimentation came team. He vividly remembers the experi 4'E when Arthur Kornberg , M. D. , head of the ence . "We all came in early and left late," rme microbiology department, hired him as he says . "We recognized that this was was afraid the black hi s research ass istant in 1953. Kornberg's a very ex citing time. Ernie wa s very help group was looking for the enzyme respon ful in teac hing me some techniques that students would experience sible for the sy nthe sis of DNA, the genet 1didn't know at all." Ernie and Lehman social isolation. He would ic building block just analyzed by Watson became close friends and maintained that and Crick . The group found the en zy me relationship the rest of Ernie's life . give them the politics of that joins small precursor molecules "Ernie was an extra-kindly man ," says survival ... I miss Ernie which, when linked in a long chain, form Lehman, who left for Stanford with DNA , using an "old" (preformed) strand Kornberg and is still there today. "He was .. . tremendously. There are of DNA as a mold or template . really very sensitive and a very tactful in times when I wish I Six years later, after 17 papers were dividual who, 30 years ago, despite the could call him . . ." published on the subject (Ernie co fact th at he was black, managed to over authored several), the found ation was come prejudice that was ambient at that laid for our present unders tanding of the time ." biochemistry of DNA replication . The dis When Kornberg moved to Stanford, he Robert Lee I covery won Kornberg and hi s group a invited Ernie to join him . But Ernie chose .. . Nobel Pri ze. "Ernie Simms was a partic to stay in St. Louis and joined the division 24 L ' i of dermatology. Herman Eisen was head help determine the amino acid sequences Osterland says Ernie's teaching abilities and asked Ernie to accompany him when of some of these antibodies and guided were just as valuable as his scientific and he moved to the Department of Micro several research students in the laboratory technical abilities. "He was most effective biology. A member of Eisen's group, toward the successful achievement of this on a one-to-one basis. He was the person Maria Michaelides, was particularly fond goal. "An interesting result was that a type that, for years, the students turned to. of Ernie. "I cared a lot about him," she of immunoglobulin chain was discovered, He invariably had the answers and if he says, her voice soft in reverence. "He was and this made it possible ultimately for didn't, he would find them. Ernie was very good in meticulous work and imagi others to work out the organization of the quiet, but with a sparkle," concludes native with new approaches that would genes that encode a family of proteins Osterland. "It was a characteristic that is ~ make something work. He was very good known as lambda, or immunoglobulin both hard to describe and to duplicate." with his hands, and he would question light chains," says Eisen, who is now at "Ernie enjoyed the medical students ~ everything. the Massachusetts Institute ofTechnology. very much," says Michaelides. "He got "His role in many cases was that of a "Ernie played an important role in that such pleasure from them. Clearly, the devil's advocate," she continues, "which effort. " minority students felt they had an open was very important in a large lab. And he Kirk Osterland, M.D., now Thorp Pro door to him. Everybody did." would never accept anything as a given. fessor of Medicine at McGill University, When the number of black students He would say, 'How do you know that?'. collaborated with Eisen's team during this began to increase in the late J960s, Ernie .. It was an eye-opener, and at times it was time. He explains what it was like to work assumed a supportive role, similar to the frustrating. But it was important to see with Ernie: "He hall a good grasp of the one he had years before at the small arms that what you did was really foolproof. " basic nuts and bolts. He understood in plant. "It was an easy kind of support . In Eisen's lab, Ernie again proved him strumentation better than most others. If and not obvious black separatism," says self to be a major contributor to important you broke it , he could fix it. He often kept Julian Mosley, M.D. '72, the school's sec research, this time in the field of immu colleagues out of technical difficulties. ond black graduate. "He was just there to nology. The Eisen group was trying to And," he adds, "he had the insight to support the black students so they knew find out why a single antigen could cause extrapolate information from established they had someone." the production of such a variety of anti research and apply it to new research, "Ernie was afraid the black students ..,. 1' .bodies, and whether a small region of a which is a great strength." would experience social isolation," says protein would be enough to stimulate mul Robert Lee, Ph. D., assistant dean for tiple antibodies. In an attempt to answer minority student affairs and a close A( this question, Ernie added a small mole friend of Ernie's. "He would give them cule to a protein under study, then con the politics of survival." '"' , structed a sophisticated apparatus that Lee's friendship with Ernie began 13 ~ t permitted this modified protein to be sepa years ago when Lee came to the univer rated for further study. " Ernie constructed sity. He was 28 years old and the newly - ,o".... r .... . an extraordinary column chromatographic appointed coordinator for minority setup with the largest dependable auto affairs. He turned to Ernie for advice matic fraction collector then available, in and support. Ernie would visit Lee's order to get enough pure monosubstituted rme office, park himselfin one of two protein," says David Schlessinger, Ph . D., was an extra-kindly man. chairs that sat across from Lee's desk, and who was Ernie's colleague in the depart talk for hours, using a plastic paper clip ment. "The preparation worked, and He was really very holder as an ashtray for his endless series evoked very heterogeneous antibodies. sensitive and a very tactful of cigarettes. The minimal determinant for a hetero ") miss Ernie tremendously," says Lee. geneous response was thus shown to be individual who, 30 years 'There are times when I wish) could call ,. . quite small." ago, despite thefact that he him and say 'Let me come sit in your of Ernie's abilities and insights paid off in fice for a minute. ' His office was a haven a related research venture. It was known was black, managed ofrest for me." that persons with a type of cancer known to overcome prejudice that It was a haven for many people. Over as multiple myeloma produced large was ambient at that time." the years, students, colleagues, faculty amounts of antibodies. Ernie helped dem and staff filed into Ernie's office to chat. onstrate that these proteins were, in fact, Many remember him as he sat there, legs bona fide antibody molecules of excep Robert Lehman crossed at the knee and a cigarette be tional purity and uniformity. He sub tween his fingers. Sometimes, while lis sequently embarked on a major effort to tening, he would put a finger to his mouth 25 until 2 or 3 in the morning," says Marsha. rank of research assistant professor in "And Daddy always looked after people. 1968.) He liked to see young people grow up and "Many pec'ple who had been associated do well." with Ernie thought something ought to be Phillip says his father was his best done to recognize his singular service and friend. Knowing Ernie liked to read, contribution over the years," says Eisen. grade-schooler Phillip would bring him a "Being black and moving up is one thing, book a week from the school library. "I and being without the proper credentials HE didn't even know what the title was, or is another. But overcoming both hurdles is anything about it. I would just pull a book really quite extraordinary. It seemed en mle t . .. from the shelf, bring it home for him and tirely appropriate that he should be recog was an exceptionally he would read it. He loved to read, but he nized by more than a research ladder ap appealing and interested was probably al so doing it to make me pointment. And everyone who saw the happy. " case we put together agreed. " .. . . friend . .. But no one gets Phillip remembers that his mother, not Osterland was al so a key figure in the tenure at a major university Ernie, was the disciplinarian when hc and campaign. He and several others con Marsha were growing up. "Even when he tacted people Ernie had worked with and for being a nice guy. It was was mad , he didn't know how to have a the response was immediate: More than his scientific acumen and bad temper," he says about his father. "A 100 letters were received from scientists achievements that curse word might slip out if he was yell all over the world. "1 wasn't prepared for ing at me, but he so seldom swore that, if it myself, that there were that many scien qualified him. " he did, it was so funny that I would laugh, tists that supported the idea," says Oster and the argument would be over." land. "It was such an extraordinary set Marsha agrees that her father was a soft of letters." David Schlessinger touch. "When we would go to parties and One letter was written by Paul Berg, parents would come to pick us up, every Ph. D., who met Ernie when he first began one always wanted Daddy," she says. working with Kornberg, and describes and smite, a fan of wrinkles deepening "First of all, he never got there on time. the corners of his dark , intelligent eyes . Then he would sit and talk to the parents. "Ernie loved to talk," says Michael And then the kids would say, 'Oh come ides, who visited his office several on and dance.' He would, and we would times herself. "1 would ask him one get another hal f-hour or 45 minutes." question and be in his office for half an Young people seemed to be attracted - \ j hour. He used to read very much and he to Ernie, and he, in turn, was attracted to knew a lot about a lot of different things. " them. Friends of Marsha's and Phillip's Ernie particularly liked to talk sports; would frequently ask "Pops" for help with it wasn't uncommon for him to invite sev their homework. And he was always hap eral friends to his house to watch football py to comply. Ginnie recalled one in "E rme on TV When he came home from work stance a few years ago: "Ernie and I were and I were having dinner each day, the first thing he did was read having dinner with friends. One friend the sports page. He also liked to fish and was a student who was having trouble with friends. One friend frequently took his family and others to a with her algebra. When dinner was over, was a student who was Minnesota lake in his search for crappie. Ernie took her aside and helped her with And when Ernie wasn't fishing, he was her homework. That woman later told me having trouble with her golfing. Or bowling. And his co-workers that he helped her pass a difficult exam." homework . ... That often joined him. His colleagues recognized that Ernie woman later told me But his family came before anything liked to see students do well. This trait, else. His daughter, Marsha, is 32 and an combined with his ability as a scientist, that he helped her pass attorney with a Manhattan law firm. Phil impressed those who knew him. He had a difficult exam. " lip, 25, works in Washington University's risen to the top, they said, even without Clinical Sciences Research Building. the benefit of a college degree. So in Both remember their father as a kind, 1972, they decided to reward Ernie as best Virginia (Ginnie) Simms even-tempered, gentle man. "Daddy and I they knew how - they sought to get him would sit up at night and read, sometimes tenure. (Eisen had already given him the 1 26 him thi s way: " I still remember how as pointments . He was hospit ali zed sev tonished I was at how rapidly and effi eral times. "I couldn 't even see him in ciently he learn ed the language, the skill s, th e hospital , there were so many and the sophistication of biochemistry/ people visiting him in his room," says microbiology," the letter states. "Before Ginnie. "He had cards , Aowers and long , he outgrew the technician status and baskets of fruit everywhere. And there became an important , contributing mem he'd be, just sitting on th e bed with his ber of th e Kornberg group. He was an legs crossed , four or fi ve others sitting equ al in all ph ases of the projects, techni on the bed with him . I just stood at the call y and int ell ectu all y. When Ernie said door and waved to him ." f _ - "He something about an ex periment , you When Ernie was released,he went back could count on it and more often than not was the person thatfor to work. Joseph Davi e, M. D., Ph.D., the hi s intuition was as infallible as hi s years, the students turned new department head, encouraged him experiments. " because he recognized how much Ernie The lett ers were taken before the exec u to. He invariably had the contributed to th e lab, and how mu ch tive fac ulty, and Ernie's appointment was answers, and ifhe didn't, he enjoyed being there . unanimously approved. he would find them ... His When Ernie di ed , hundreds carn e from ... , "It was an in credible thing that they di d all over the country 10 pay their respects, anything ," says Osterland. "They were a basic brilliance could not and Ginnie still talk s about the many tele con serva tive group and we threw them phone calls she got from people who quite a curveball. But Ernie did it, and he be suppressed." knew him.The fl ag on Broo kin gs Tower did it in a league th at is as tough a league was lowered in hi s honor, and Chancellor as anyw here in the world. His ba sic bril William H. Danforth wrote a letter to Gin li ance could not be suppressed." nie that she treasures. And at Ernie's re Schless inger agreed that Ernie wouldn 't Kirk Osterland quest, his body was donated to the School have gotten tenure unless he had deserved of Medicine. it. "Ernie was an exceptionally appealing In a lot of ways, Ernie is still livin g, at and interested friend for the whole sc ien at first she didn't kn ow Ernie was bl ack. least in the hea rt s and minds of th ose who tifi c community at Washington Universit y. "Ernie had very li ght skin ," she says. kn ew him. There are more tangible signs, But no one gets tenure at a major uni ver "This girl said she went into her admi s as well. The worn green couch in hi s sit y for being a nice guy. It wa s hi s scien sion s interview thinking she wo uldn't office, where many a stud ent and col tific ac um en and achievements th at qu al have a chance with a white interviewer. league res ted , conversed, consu Ited , is ifie d him ." Ernie sensed this and gentl y told her he sti II there. A research assoc iate st iII keeps i Lee says Ernie, though pleased , was was black. The girl told me th at she re his notes, and hi s perso nnel file in the De humbl e about the appointment. "He was laxed, and she apparentl y di d very well partment of Mi crobi ology and Immunol embarrassed by, sensiti ve to, and co n during the interview. She was very grate ogy is full of ph otograph s and mementos. -f sc ious of other junior fac ulty who we re ful to Ernie. " "Ernie has cont ributed measurably to bu stin g thei r bUllS to get tenure, " he Ernie was charac teri sti ca ll y meti culous Washington Uni ve rsit y's reputation for re ex pl ain s. in reviewing admissions ap pli cati ons, and search preemin ence," says Julian Fleisch After the appointment, Ernie continued would often take th em home so he could man , Ph . D., a good fri end and colleague. to teac h and do research. He became read them more th oroughl y. Ginnie says "The uni ve rsit y has profit ed from his more active as a member of the medi cal he would sit at th eir kitchen table and re presence here." • school admissions committee, a pos iti on view the paperwork for hours at a time. A narrative describing Ernie's life and scien he thoroughly enjoyed . "He seemed Another favorit e spot for reading was tific contributions, wrillen by David Schles .. to have an intuitive ability to assess the bedroom; he would li e on the bed with singer and Julian Fleischman, conn'ibuted strengths and possible weaknesses of an his reading materi al spread before him substanrially to this story. applicant," says John Herweg, M.D., as on the Aoor. Ernie was lying like thaI, the soc iate dean. "He was particul arly effec newspaper spread out in front of him, tiv e in evaluating minority applica nt s. when he died of a heart all ac k on Sep When Ernie stated th at he felt an applicant tember II , 19 83. could make it at Washington Uni ve rsit y, Ernie began to get sick in 198 1. He the committee accepted th e applicant ." suffered fro m transient isc hemi c allacks Ginnie remembers one bl ack student and , because hi s me mory was affect ed, who , after Ernie's death , told her that kept notes so he wouldn 't forget ap 27 NEWSBRIEFS Mallinckrodt Institute of nals for traditional purposes by emissions from radioactive I.; .\ Ii II ion Radiology has already had to such as word processing and compounds. (C U11 p1l h'.· Iink its computers together. dissemination of text, the in A prototype for such a sys Thus, the campus-wide net stitute is engaged in research tem was installed in Mallin .,' '01"1 ill(1' work will expand the scope of which will ultimately provide ckrodt in 1984. Looking like :-0 Mallinckrodt's ongoing re for the manipulation and a chimera ofTY sets, a Xerox ,-.ClT.- "flU" ..t search into computer net transmission of thousands machine and the control panel t . working and put the institute of X-ray images per day. of a jumbo jet, the $400,000 Lin \.~ l in closer touch with the rest of Mallinckrodt's radiologists Ray tel Multimodality Read the campus. already capture images elec ing Station consumes X-ray iliUI DEC The nation's largest center tronically and feed them into films, digitizes them, and for diagnostic and therapeutic computers. Such images are displays the resulting images radiology, Mallinckrodt in digital form - each dot on one of its monitors. Using .. ashington University houses research laboratories is represented by a number the keyboard, radiologists can and Digital Equip and facilities for perfomling proportional to its intensity. enhance an image to bring out ment Corporation X-ray and other imaging pro The digital images include details not readily visible have signed an agreement to cedures for patients from the computed tomography (CT) on the film. develop a computing network Washington University Medi scans and magnetic resonance They can transmit images for both the Hilltop and Medi cal Center's hospitals. This images (MR I - also referred to terminals in the emergency cal campuses to support ad commitment to computers to as NMR), made with radio room and the new cardiac vanced picture communica- greater than that of any other waves in a strong magnetic care unit at Barnes Hospital. • I Thus, a cardiac care physi cian can view a patient's X-rays on a terminal minutes after the films are developed. "Our concept is that com puter technology is develop ing quickly," says Gilbert lost, M. D., associate profes sor of radiology, "and that or dinary computer terminals wi" not be sophisticated enough for the physician of the future. What will be re quired will be a more sophisti cated workstation with a com puter within it. With its commitment to computers and plethora of pictures, Mallinckrodt is ripe for a new method of storing images. Presently the institute R. Gilbert jost is testing a Raytel jukebox tions as well as high-speed radiology department in the field instead of with X-rays. a coffin-shaped box that holds text transmission. A major world - reflects the exten There are also ultrasound and dispenses 50 8-inch opti theme of the agreement is the sive use of computers in images in digital form; digital cal discs. development of advanced pro research, diagnosis, and man vascular images, formed by "We are confident that this fessional workstations. The agement of patient records. comparing X-ray pictures of is going to be an important .~ ) workstations wi II be capable Mallinckrodt's expertise blood vessels with and with X-ray storage method of the of transmitting pictures as in networking has contributed out contrast material; and future," says Jost, "so we are well as symbols and graphs to the groundwork for the de positron emission tomogra learning more about how the between the university'S two sign of the campus-wide com phy (PET) images, which are optical disk jukeboxes should campuses and several aca puter network. As well as biochemical and physiologi be designed and incorporated demic divisions. linking computers and termi cal maps of the body created into our network ." • 28 ·. chief resident. Later, he com t'''' Pl°t'~itlf'nt the Distinguished Eagle Scout tor. We are very fortunate in pleted a Picker fellowship Award from the National this transition to be able to of Sf. I Juui. in the graduate sc hool s of Council, Boy Scouts of Amer turn to Dr. Evens, one who business admini stration and ica. He is currently a director. has long been involved with ell i J(It°(·I1·~ education at Washington or trustee, of Boatmen's Bank and dedicated to Children's University. in SI. Louis , Hea lth Care Net Hospital. " I()~pilal In 1971, at the age of 31, work, the Soci ety of Nuclear Children's Hosp it al, which Evens was named head of the Medicine, the American opened in 1984 , is a 235-bed Department of Radiology at Roentgen Ray Society, and pediatric health ca re facility onald G. Evens, M.D. Washington Univ ers ity the Washington University owned by an independent '64 , has been appoint School of Medicine. He Medical Center. Board of Trustees. Evens suc ed president and chief has served as president of Due to his int erests in busi ceeds Linn B. Perk in s, who executive officer of Chil the Society of Chairmen of ness and radiology, Evens has joined Children's Hospital as - , dren's Hospital. Head of the Academic Radiology Depart served as a consultant to in executive director in 1970 and Department of Radiology at ments, the Mi ssouri Radio dustry, medical centers, uni was named president in 1984. Washington University logical Society, and as a versities , and governmental School of Medi cine, Evens member of many committees organizations including the ~ will continue to occupy that for the American Medical National In stitut es of Health, position. Evens' appointment Association, the National the states of New York and \~)IUlllp(,I'!-I .(,('( It-d for Ily p(, .. i(,JI~i()1I B('~('a lo..h lderly people frolll the SI. Louis area <.Ire needed as volunteers for a national study that wi II show whether they benefit from treatment for systolic hypertension. Washington Univ ersity School ofMedi cine i~ one of 17 national cen ters participating in the study, called the Systolic Hyperten sion in the Elderly Program (SHEP). The project is fund ed by the National Heart , Ronald G. Evens Lung , <.Ind Bl ood Institute and was announced by Andrew E. Academy of Sciences, and the California, Congress, and the th e National Institute on Newman, chairman of the National Institutes of Health. province of Ontario, Canada. Agin g. hospital 's Board of Trustees. Evens was the first Mis "Dr. Ron Evens has been Principal investigator of Evens, a native of Hercu sourian to head the medical Chairman of the Children's th e local study is H. Mitchell laneum , Mi ssouri , received radiation advisory committee Hos pital Advisory Committee Perry Jr., M. D., professor of his bachelor's degree in eco of the U.S. Food and Drug of the Medical Staff since its medicine and director of the nomics. Graduating first in Administration's Bureau of inception," sa id Newman, hyperten sion division at the hi s medical school class , he Radiological Health. He also "and he is well known to the School of Medicine and a trained at Barnes Hospital and serv es on the editorial staffs Children's Hospital family. ph ys ician at Barnes Hospital. Mallinckrodt Institute of of four radiological journals. He is an eminent physician The study is being con Radiology, where he wa s In 1984, Evens was given and an excellent administra ducted in cooper<.ltion with 29 .. St. Louis University School monitored, returning initially Dalsky noted that Ameri- be done through the Section of Medicine. for visits every two/three can women consume an aver- of Applied Physiology to de- SHEP is designed to weeks, and then every three age of about 500 milli grams termine the fitne ss .level of toe answer a question that has months. The SHEP medical of calcium a day, when they each participant. long been debated among team will work closely with should take from 1,000 to Volunteers in the control physicians: whether lowering th e participants' private 1,500 milligram s daily to group will visit the university systolic blood pressure with physicians. maintain a positive calcium for testing at regular intervals drugs will decrease heart The SHEP clinic is located balance. Increasi ng the daily during the study. Subjects in attacks and stroke. Al so, in the medical building at intake of calcium may slow the exercise group will meet researchers will investigate JOON . Euclid Ave. Parking is the rate of bone loss , but exer- three to four times a week to r .. whether medication can favor- free and, if necessary, partici- cise is one of the few ways to exercise one hour under the ~ , ably affect memory and men- pants can be ass isted with replace bone mass that has supervision of university exer . tal powers in people aged 60 travel expenses . been lost, she said. cise physiologists. Exercises and older, and whether lower- More information about Currently, Dalsky and will be designed to strengthen ing systolic blood pressu re SHEP is available through other researchers at Washing- bones by placing stress on improves the quality of their Sharon Carmody or Gerri ton University Medical Cen- th em, and will include walk- j lives. Barton, 314-367-2547. ter are completing a study that ing, treadmill walking, jog- -I ~ Systolic hypertension will show whether bone los s ging, bicycling and rowing. . .. occurs when the top number can be restored by combining Exercise programs will be of the blood pressure mea- \\(HUl a special exercise program adjusted to each participant's surement is J60 or above and n ~(·("{I(·d with an increased dail y intake ability. or the boltom number is less of calcium. More information about th e fUI" t~,\, than 90 mm Hg. Millions of They will continue that study is available through Americans have the condi- ( )stt"Upo.'o~i!"i approach with the new study, the Section of Applied tion, which is.believed to in- this time combining exercise Physiology, 314-362-2399 crease the risk of heart attack ~hl(h ' with increased intake of cal- or 362-2396. and stroke, major causes of cium in hopes of learning if it illness and death . Systolic is possible to reverse bone . 1. I blood pressure generally rises R esearchers at Washing- loss during the early post- with age. ton University School menopausal period , when Suth".'!"i Cr("alt" Researchers here will of Medicine are see k- bone loss may occur at a rate ( )'·ClI pat iuna I enroll 300 men and women ing women who started two to three times hi gher than L aged 60 and older with iso- menopause within the last normal. ~Iedi('in(· lated systolic hypertension, five years for a new study on Volunteers mu st be in th eir and will select participants osteoporosis. The two-year first five years of menopause , I)".) f(·~ ~( .I'S11 iI ) through blood pre ssure study is sponsored by the Sec- and must be non-smokers and screenings at sites throughout tion of Applied Physiology in fairly sedentary. Volunteers the St. Loui s area. Nationally, the Department of Medicine. will not be paid but will re- I ecturers on trends in so me 200,000 people will be The work is funded by the ceive all tests and calcium occupational medicine screened to find a total of National Institute on Aging, supplements free. ~ will speak to area phy 5,000 participants. part of the Nati onal Institutes Bone density of the spine sicians and students as part Participants will be fol- of Health. and hip will be measured of a new vi si ting profes sor lowed for a minimum of five Osteoporosis is a serious in all participants by Dal sky ship created by pioneering years and will receive free bone di so rder that primarily and Stanley Birge, M.D., a St. Louis physician Richard physicals, medications, lab- affects women, said Gail P re searcher with th e Div ision Sutter, M.D. '35, and hi s oratory tests and electrocar- Dalsky, Ph .D., principal of Bone and Mineral Metab- wife Belly. diograms. Approximately investigator and a research in- olism and The Program on The Richard and Belty half of the participants will be structor in medicine at Wa sh- Aging at Jewish Hospital. The Sutter Visiting Professorship given active medica tions . All ington University School of measurements will be per- in Occupational Medicine has active medications used in the Medicine. Two factors asso- formed using dual photon ab- been established at Washing study are approved drugs that ciated with osteoporosis are sorptiometry, a non-invasive, ton University School of Med are commonly used to trea t an inadequate amount of cal- highly se nsitive technique icine . Guest lecturers wi II hypertension. cium in the diet and a lack that involves minimum radia- address such topics in occu- Volunteers will be carefully of physical ac tivity. tion exposure. Tests also will pational medicine as env iron 30 _.', ment of the workplace and in a continuing nati onal stud y it s effect on employee hea lth, that compares standard treat preventive medicine, safety ment for insulin-dependent ... , . .. factors, and emergency and diabetes with newer fo rms of definitive surgical care and re treatment. habilitati on of the industrially Washington Universi ty is ill and injured. one of 21 medical centers " Ri chard and Betty Sutter currentl y participating in th e are peopl e of rare vision ," Di abetes Cont ro l and Compli sa id William H. Danforth , cati ons Trial (DCCT), spon M.D. , chancellor of Washing so red by the Nati onal In stitute ton University. "In establish of Arthritis, Di abetes, and Di in g thi s vi siting professor gestive and Kidney Di seases. - 1- ship, th ey have provided a Thirteen subjects are bein g valu abl e tool for educating followed at Washington Uni th e medi cal community, as versity, with 278 participatin g well as thousands of employ throughout the country As ers and employees , about th e the project continues , each import ance of occupational center seeks an additional 30 health. " 40 patients for furth er stud y Sutter is founder of the The stud y is designed to Sutter Clini c, which he estab hel p scientists better und er Ii shed in 1946 to function as sland the associati on between the medical department for efforts to control bl ood glu St. Loui s-area industries. The cose levels and the ea rly eye . clini c at 819 Locust Street kidney and nerve compl ica provided outpatient health ti ons of diabete~ . Spec ifica lly. ca re for more than 1500 co m th ey hope to learn whether pa nies. Sutter was director keepin g blood g lucose levels of the clinic until 1984, when Dr. and Mrs. Richard Sutler (front), M. Kenlon King (Iefl) , as near to non-diabeti c levels it was bought by Barnes and Samuel Guze (right) as poss ible is a rea li sti c goal, Hos pit al. and whether it will prevent , Sutter continues to serve a~ traum a unit from 194 1-45. At sory committee. de lay or re ssen th e severit y a consultant at the clinic. He th at time, industrial medi cine Sutter is a charter and of complications caused by -,. also is a lecturer in industri al ,was primarily emergency care life member of the William diabetes. medi cin e and rehabilitation in for on-th e-job injuries, but Greenleaf Eliot Society. To be eligible for th e th e Department of Preventive Sutter has seen the field In 1978, he recei ved th e pres DCCT, volunteers mu st be be Medicin e at Washington Uni evolve to a preventive medi ti gious Health Achievement tween the ages of 13 and 40, versit y, and is on the clinica l cine approach, encompass in g in Industry Award of th e have had insul in-depend ent staffs of Barnes, Deaconess industri al hygiene and job Ameri can Occupational Medi di abetes for at least one year and Lutheran hospital s. safety. He was in strumental in cal Association. but no more th an 15 years, ! At th e 198 5 alumn i re o bt aining board certificati on and have no adva nced eye, ( uni on, Was hin glon Uni ve rsity for the spec ialty, and has bee n kidn ey or nervous system School of Medicine prese nted a diplomate since 1956 on the \()III..h·er~ complications of di abetes. him with it s Alumni Achi eve Boa rd of Preventive Medi cine They must be free of medi ca l ment Award for contributions in Occ upational Medicin e . Suug-hl fur or psychological probl ems to th e community, the univer Occupational medicine that would make it diffic ult or sity and the field of medicine. pro bably reached its greatest Diah('lr"s Sludy unsafe to participate in th e Sutter pioneered occupa prominence, he notes, with study, and should not be pl an ti onal medi cine (formerly th e es tabli shment in 1972 nin g to become pregnant fo r kn own as industrial medi of th e Occ upational Safety esearchers at Was hing at least two years. Al so, th ey ) cine) , opening the Sutter and Health Administrati on ton University School must be willing to fo ll ow Clinic in 1946 after com (OSHA). Sutter was a mem Rof Medi cine are see k th e necessary stud y respon manding a World War II ber of OSH As national advi in g vo lunteers to parti cipate sibilities, including record 31 keeping and home testll1 g of imental group will be seen Fi:oi('hha("h surface of the mw,c le exactly blood or urine. They must frequently by a physician at th e point of nerve-mu sc le live close enough to St. Loui s until they have achieved satis contact. Fischbac h bel ieves n.'("(·i, ..... -- . ."... to keep appointments at the factory blood glucose levels th at the nerve in structs the medical center. and have adjusted to th e new -\." a I·d~ mu scle, in some way, to in All eli gible volunteers will daily routine , and then once a crease the production of new be given a complete prelimi month for routine checkup. acetylcholine receptors and to ,. nary medical examination Volunteers in both groups erald D. Fischbach, insert them al th e point of free of charge to determine will receive expert care free MD , Edi son Pro nerve contact. whether they are eligible to of charge from one of the Gfessor and head of the Fischbach's tea m ha~ iso parti cipate in the project. leading diabetes centers in the Department of Anatomy and lated a molec ul e from brain The DCCT will compare country. The care will include Neurobiology, has re ce ived tissue that may be responsible two forms of diabetes treat periodic examin ations for a McKnight Award for for thi s instructive or trophic men t. ne ither of which has early eye. kidney and nerve Research Projects. The effect. He is currently puri a proven ad va ntage over the complication s, and immedi McKnight Foundation ini fy i ng larger amounts of the other. Volunteers mu st be ate specialized care should tiated the McKnight Awards molecule and further charac ., ~ willing to be assigned to any complications of diabetes for Research Projects in 1977 terizing it s actions. either the standard treatment arise during the course of the to encourage experienced and This mol ecule, or class of group or an experimental study. In case of a move to gifted inv estigators to direct molecules, may be important trea tment group on a random another section of the coun more of their efforts to th e not only at the neuromuscular basis. try. efforts will be made to basic mechanisms of memory junction, but also at synapses Volunteers assigned to the continue participation at and diseases affecting mem within the brain. Knowledge f standard treatment group will another center. ory. Fischbach will receive of its composition will enable be treated with techniques The local study is directed $150.000 over a three-year Fi sc hbach and his research curren tly used by specialists by Julio V Santiago, M.D .. period for his research project group to sy nthesize it and in diabetes. The standard professor of pediatrics and as titl ed, "Synapse Formation: eventually show wh ere and ' r' treatment includes one or two sociate professor of medicine: Induction of Postsynaptic when in the nervous system injections of insulin a day. and Ne il H. White , MD , Chemoreceptors. " the molecule is acti ve. diet. daily glucose monitor assistant professor of pediat Fischbach and his as so Most recently, Fi schbach in g, a formal educational rics. Santiago and White are ciates are investigating events received the Ja cob A. Javits re view of different aspects on staff at Barnes and Chil that occur within a few hours Center of Excellence in of diabetes ca re , and routine dren's hospital s. They are after an em bryonic nerve cell Neurosciences Award. This checkups every three months. working in collaboration with contacts an embryonic mu s $750,000 yearly grant will Volunteers ass igned to the Michael Noetzel, MD.. assis cle. A cluster of re ceptors that provide tive years' support experimental treatment group tant professor of neurology recognize the transmitter, for departmental research. • will be asked to use some and pediatrics; Joseph Olk. acetylcholine, appears on th e newer techniques to try to M. D.. Ri chard Escoffery. achieve lower blood glucose MD , and Gilbert Grand. levels . Initi al ly, they will be M.D.. assistant clinical pro asked to spend a few days in fe ssors of ophthalmology; the hospital to learn to man and Isaac Boniuk , M.D., as age the new treatment. The sociate clinical professor of techniques in clude insulin ophthalmology. Noetze l is on given either with an in sulin staff at Barnes and Children's pump or with multiple daily hospitals. The ophthalmol injections. diet and blood glu ogists are all members of Ret cose monitoring. Their formal ina Consultants in the Wash educational review will cover ington University Medical different aspects of diabetes Center. ca re. as well as how to use the More information is avail pump or a program of multi abl e through the DCCT offi ce ple injections. and how to at Wa sh ington University adjust insulin doses or meal Med ical Center (telephone plans. Volunteers in the exper- 314-454-6051 ) Gerald D. Fischbach 32 ·-, ulty for this honor. Over the intern ship at Johns Hopkins brain and that specificall y years, $420,000 has been Hospit al and a residency in induces sy napses betwe~n ~ contributed by the Medical urology at Duke University. nerve and muscle. Since the A scholarship program in Alumni Association to the He received the doctor of di scovery at Washington Uni physical therapy has been medical school in the name jurisprude nce degree from versity in the early 1950s of a created at the School of Medi of these honorees. Roy R. th e Washington University mol ec ul e ca ll ed nerve growth cine by Electro-Med Health Peterson , Ph. D., professor of School of Law in 198 I and factor (NGF) by Rita Levi Industries of Miami. The first anatomy and neurobiology, was admitted to th e Missouri Montalcini, M.D. , th ere has reci pients of the $ I ,000 schol captured his fou rth award as Bar in 19 83. been a great interest in finding -.., -' arships are Carol Eldridge Teacher of th e Yea r. David and chemica ll y defining I' ofGalJatin, 1enn. , and Sue Goldring, M.D. '40, profes The eight h annual James molecule~ important in th e I Berres of Kenosha, Wis. The sor of pediatrics. and Elliot E. L. O'Leary Prize for Re development and mainte annual awards are based on Abbey. MD. , FHS, clinical search in Neuroscience has nance of the nervous system. - 1-'" . financial need, academic assistant professor of medi been awa rded to two students Using novel combin ati ons achievement and clinical cine (oncology), were se at Washington University of biochemical techniques, promise. lected from th e clini cal facul School of Medicine. Usdin purified the molecule , . Electro-Med Health Indus ty. Goldring led the grad uat John F. Olsen , a Ph.D. can over a million-fold and has tries, which supplies physical in g class in the Declaration of didate in the neural sc ience now begun st udi es to ana lyze therapists. is ow ned by phys Geneva, an oath of al legiance program in th e Division of its chemistry. This informa f r ical therapists Sy and Phyllis to th e profession that was in Biology and Bi omed ica l Sci tion is an essential first step Lehman. Their son, Ri chard augurated by th e class of 1984 ences. and Ted Usdin, an in understanding the role C. Lehman, M. D., is a resi because of their wish to rein M.D.! Ph.D. ca ndid ate at th e of such mol ec ul es, which are dent in orth opedic surgery stitute a pledge aki n to the School of Medici ne, received believed to be fundamental at Washin gton University Hippocratic Oath. the pri ze at the medical to health , and quite probably School of Medicine. school's an nu al neuroscience to disease of th e brain . Saul Boyarsky, M.D., symposium. The O'Leary The O ' Leary Prize was Charles L. Clements, J. D., professor of genit o Prize recognizes th e most established in memory of th e M.D., delivered the School of urinary surgery. has been original and important accom eminent neurosc ientist James Medicine's 1985 commence re-elected to the General plishments in neuroscience L. 0 'Leary, M. D.!Ph. D, ment address. Clements, clin Committee of Rev ision of research by a pre- or postdoc a professor and head of the ical assistant professor in the United States Pharma toral student at Washington Department of Neurology community health at Albert copeial Convention, Inc., University. at Washington University Einstein College of Medi ci ne, and is chairman of the Olsen's research exam ines School of Medicin e. described his experiences de Committee on Urology. how the brain processes com liverin g medical care in Cen Boyarsky has served as plex sensory signa ls to pro Brian Andrew Hills , tral America and ex horted the professor of genitourinary duce appropriate adapt ive Ph.D., professor of anes graduating class to be "physi surgery and professor of bio behaviors . Studies are con thesiology and ph ysiology cian/citizens," bringing moral medical engineering at Wash ducted in bats, which use at the Uni vers it y of Texas order in whatever sphere they ington University since 1970. biosonar or echo locati on to Medical School at Houston, ultimately practice. A for mer He was head of th e Division na vigate and catch prey in the delivered the ninth annual helicopter pilot in Vietnam , of Urologica l Surgery at the dark . Olsen found that , ini I. Jerome Fiance Lecture. Clements is th e auth or of School of Med icine from tially, processing of th ese Hi] Is is an internati onal ly Wimess to Ww: 1970-73, and associate pro complex signals occurs in the recognized expert on th e At the commencement fe ssor of ph armacology from part of the brain th at se nds th e physical properties and bio ceremoni es, the Teacher of 1970-80. He is currently on information to th e cerebral physics of lungs. the Year Awards were staff at Barnes Hospit al. cortex. His work ha s pro Hills is recogni zed for announced by Sheldon E. Boyarsky holds bachelor vided insight into how and observations about the phys Litwin, M.D. '85, class presi of science and doctor of where complex se nsory pro iologic behavior of surfac dent. These award s, inaugu medicine degrees from th e cessing begins, and has in tant, an important surface lin rated in 1966, have become University ofVermonl. He creased general understand ing in the lung. An inadequate an institution at th e School of hel d a fellowship in su rgery in g of how the brain works in amount of surfactant material Medicine. Since 1970, eac h at the University of Vermont humans and other mammals. in the lungs is thought to be a class has selected one pre and another in ph ysiology at Usdin has purified a pep major cause of death in pre clin ical and two clinical fac- New York Uni ve rsi ty, with an tide that is found only in th e mature infants. He is also an ]3 expert on gas transfer across and neck surgeon at UCLA and is the first woman chosen An Oncology Dental Sup- the lungs and on the medical hospitals and clinics. Before to lead th e association in its port Clinic to provide treat- aspects of deep-sea diving, joining UCLA, he was as so- I08-year hi story. She will ment for patients receiving or and has served as a consultant ciate professor of surgery and take office th is fall. Weldon anticipating radiation treat- to the National Aeronautics chairman of the Division of is recognized nationally as ment to the head and neck and Space Administration on Otolaryngology at Vanderbilt a spokesperson on issues area has been establ ished decompression sickness in University School of Medi- in medical education and by the Washington University astronauts. cine. He has also been on the biomedical research . and on School of Dental Medicine. He recei ved an under- faculty of the University of legislation affecting health The new service will be oper graduate degree in physical Chicago School of Medicine. care , especially its costs. ated in conjunction with the sciences and a graduate de- The lecture and library ded- School's Departments of gree in chemi stry at Cam- ication ceremonies honored "First-Year Slice of Life," Diagnost ic Services and Max- bridge University. He studied the late Joseph H. Ogura, a photo essay featured in the illofacial Prosthetics and will chemical engineering at Lon- M.D., who was Lindburg Pro- Spring 1985 issue of Outlook, be supervised by Michael don University and later re- fessor and head of the Depart- has been awarded a si lver Shrout , instructor of oral cei ved his doctorate in phys- ment of Otolaryngology at medal by a professional pub- diagnosis and radiology at the iology at Adelaide University Washington University li c relations group supporting School of Dental Medicine. in Austral ia. Before joining School of Medicine when colleges and universities. The In announcing establish- ~ the University of Texas at he died in 1983. The Ogura Council for Advancement and ment of the new dental ser- Houston, Hill s taught at Lectureship was established Support of Edu cation (CASE) vice, Dean George D. Self- Brown University. Duke Uni- in 1977 in hi s honor. selected the WU entry, rid ge said that the service versity and the University of created by photographer is intended primarily for Texas Med ical Branch at Gal- Virginia V. Weldon, Cheryl Ungar, from among patients who do not prese ntly veston. M.D., deputy vice chancellor th ose in th e 1985 CASE Rec- have a private dentist treating of Washington University ognition Program for Photo- them or for those who are in Paul H. Ward, M.D., School of Medicine, has re- communications Via Print. SI. Loui s to receive medical delivered the 1985 Joseph H. cei ved an honorary doctor of Ungar's photo essay depicted treatment and whose own Ogura Lecture. Ward is pro- humane letters degree from first-year medical student dentists are not available. fessor of surgery and chief Rush University in Chicago. Karen Scharenberg. selected Faculty members of the of the Division of Head and Weldon received the honor- as typical of students in their School of Dental Medicine -j Neck Surgery at the Uni- ary doctorate at a recent spe- pre-clinical years. will provide all phases of versity of California-Los cial convocation to inaugurate dental treatment for such Angeles (UCLA). He dis- Leo Merrill Henikoff, M.D., Ruthmary K. Deuel, patients, including checkups, cussed peripheral and central as president of Ru sh Univer- M.D., associate professor cleaning, amalgam restora laryngea l paralysis and sity. While at Rush Univer- of pediatrics and neurology, tions, periodontal and en- paresis. sity, Weldon also delivered a received the 9th Annual Re- dodontic th erapy. Prosthetic Immediately after the lec- speech on quality in medical search Award of the National and prosthodontic services, ture. ceremonies were held education during a sy m- Reye's Syndrome Founda- when needed. will be pro- ded icating the Ogura Memo- posium on the role of aca- tion. Deuel was presented this vided by the School's Depart- rial Library. which serves as a demic hea lth centers in the award for a project entitled ment of Maxillofacial Pros- resource for the Department 21 st century. "Surface Coil NMR in Reye thetics. Pati ents prepari ng of Otolaryngology. Weldon is vice preside nt E[lcephalopathy.., for radiation treatment to the Ward is an internat ionally of th e Washington University The National Reye's head and neck area can re- renowned head and neck sur- Medical Center, professor of Syndrome Foundation, Inc. , ceive a pre-radiation dental geon whose research has cen - pediatrics at th e School of is a non-profi t organization exam at the School of Dental tered on laryngeal fun ction Medicine and a physician at with chapters in forty states. Medicine or in a hospital . and pathology, as well as the Barnes and Children's hospi- The N RS F has pioneered the Anyone desiring more body's balance system. He tal s. She joined the faculty in movement to disseminate information on this new has also helped develop ways 1968 as an instructor, and was knowledge about the disease service can contact Shrout at ) to use video monitoring to named professor of pediatrics in an effort to aid in early 314-454-0383. assess laryngeal function. in 1979. diagnosis, and also is commit- A member of the UCLA Currently she is chairman- ted to provide funds for re- faculty since 1968. Ward elect of the Association of search into th e cause, cure, serves as chief attendin g head American Medical Colleges. and prevention of Reye's. 34 T I-I E ALUM I R~PORT nyone who is still can be considerable. For other than returning value for rewards, that's fine, but I active in a profession example, there was a time value received." wouldn't want anyone to get Aafter 50 years is a when he went to St. Louis Selected by the class of the wrong idea - the feet are rarity, considering the hin City Hospital on the W. U. ser 1981 as ClinicalTeacher of still made of clay." drances that time hurls at vice four afternoons a week the Year, Fiance has a flair and Fiance, now professor of physical and mental stamina. and worked on two six-week enthusiasm for teaching that clinical medicine, has a sense But a handful find their pro ward services for junior medi students appreciate. And he, of mission that encompasses fession as enticing as ever cine. In addition to ward ser in turn, values his role as do more than teaching. In 1953, despite the passage of over a vices at Jewish Hospital, he cent: "When my former stu he instituted the Home Care half century since their fledg worked in the pulmonary dents come back from around Program at Jewish Hospital, ling days as beginners. Yet, clinics at Jewish and Barnes the country and greet me as serving II years as its direc I. Jerome Fiance, M.D. '35, hospitals. Later, when he was a former teacher, that's the tor. At that time, says Fiance, has made some concessions: shifted from City Hospital to greatest pleasure I have." it was the first home care pro- "I always say that I'm semi retired now," he says with a chuckle. "I only work 12 hours a day, six days a week." During a late-afternoon interview with Ou/look, his telephone rang every few minutes , so that he finally asked his secretary to hold all calls. Yet, Fiance finds noth ing unusual in this. "[ find medicine to be a vocation and an avocation," he muses. "It is the only hobby I really care about." He attributes this to his "good health, and the fact that the medical school has made it so pleasant for me to practice medicine. "I feel a great debt of gratitude to Washington Uni versity School of Medicine," he continues. "The School I. Jerome Fiance makes it possible for many young physicians in private Barnes ward service, he had a The Fiance Visiting Profes gram west of the Mississippi, practice to continue their six-month pulmonary ward sorship in Pulmonary Medi and it continues to flourish scholarly attitudes toward service three days a week and cine was established in 1976, today. medicine, and to hone their spent many Saturday morn on Fiance's 65th birthday, by Later, in the mid-70s, he skills, by making them part of ings on rounds at Veterans friends and patients. Each and a group of physicians the part-time faculty of the Hospital. "In between times, year, this lectureship enables spent five years running a medical school. This gives I saw private patients. the division of pulmonary clinic in the Jeff-Vander-Lou them an opportunity to enjoy "The amount of time pri medicine to bring in a promi area: "Jeff-Vander-Lou was an all the cultural and scholarly vate doctors give to the teach nent physician for a series inner city area that MacJer happenings, not the least ing service is considerable," of seminars and lectures and Shepard and others were try of which is the stimulating concludes Fiance. "But if you a critique of research pro ing to develop. We felt that intellectual relationship with feel as I feel, and as most of grams. " Doctors are fortu putting a medical office there medical students and house us part-time faculty feel nate," says Fiance. 'They would help attract other staff, and other part-time and that we're getting a quid pro occupy a special place in businesses and professions to full-time faculty." quo - then this service is our society and in the hearts the area." Although the area For part-time faculty like given willingly, and gladly, of people they serve. If [the was never fully rehabilitated, Fiance, the amount of service without thought of anything lectureship] is one of the Fiance and the other physi 35 cians in the group are proud she asked for FIance's help. facilitator and thinks other quality of medicine that I feel of the years spent contribut Subsequently, the Seldin physicians could do the same, I do, and want to do, were ing their services. Professorship in Pulmonary "providing the university it not for my relationship ,.-, ... And as a loyal son of Wash Medicine was established. would give them the same with the School of Medi ington University, Fiance has "Dr. Fiance has the unique feeling that they gave Jerry cine - it would have been seen to it that his alma mater ability to sense when people Fiance - the sa me feeling impossible." has not gone wanting. A are interested in making a gi ft of belonging." He points out For Fiance, the advantages member of the Planned Giv to the School of Medicine ," that not all departments at the of an association with the ing Committee, he has acted says Jack Siefkas, director of School of Medicine follow School of Medicine are clear: as facilitator, enabling many Medical Alumni and Develop the Department of Medicine's "Some physicians in fields of his patients and friends to ment. "Because of their con example in cultivating private other than medicine don't approach the university de fidence in him , he can assist practitioners as part-time fac have the feeling of really be spite their perception of it as them in meeting with the right ulty. "There are tremendous longing to the university fam a "cold, intimidating force. people here and in making advantages for the university ily," he says. "Many want to, There are a lot of people who their decisions about what in developing a cadre of pri but the university has to come feel very warmly toward the to do with their money. By vate physicians who have forward. I f you belong to a university and are interested being supportive and helpful teaching interests and abili family, it's very easy to help .... ' in making a gift," muses to them, everybody benefits: ties, who also have a scholar all members. It becomes FIance, "but they're a little they've satisfied their philan ly attitude toward medicine , the natural thing to do. The reluctant to come forth be thropic interests; Dr. FIance and who are willing to spend School of Medicine has given cause the university looms so enjoys being helpful; and time and effort to participate me a feeling of belonging large in their imagination that naturally, the School of Medi in the teaching programs of when I walk into Barnes they almost become a little cine, and everyone it serves, the medical school. These Hospital , or Jewish Hospital , afraid." For example, one gains . Dr. Fiance's special part-time faculty also make I feel like I belong; I'm of his patients - Mrs. Selma help makes him very impor superb messengers for the home." • .. . Seldin - expressed an inter tant to the School of university in the broad est in .helping the university, Medicine." community. but was unsure as to how. So Fiance relishes hi s role as "I could not practice the Medical AlulTIni RetUlTI for Reunion ore than 200 physi tion, local and national au HLA ge netics in resolution a special citation for distin cians from through thorities discussed issues in of disputed paternity. guished service. out the country re health care financing. Reunion weekend also Recipients of the alumni turned to St. Louis to attend New treatments in the area included a number of soc ial achievement awards include Reunion 1985, sponsored by of heart di sease were also a activities, among them Richard Sutter, MD. '35, the Washington University discussion topic. Faculty a welcoming cocktail party, Ralph Berg, MD. '26, Ellen Medical Center Alumni Asso members from the Depart a walking tour of downtown Shattuck Loeffel, MD. '35, ciation. A highlight of the ment of Cardiology prese nted St. Louis, and dinners for and John P. Roberts , M.D. reunion was the scientific pro newly released study results each reunion class. The re '45. Alumni/faculty awards gram, which included presen on the effectiveness of t-PA, union concluded with a were prese nted to Edward ..,. . .. tations by faculty members or tissue plasminogen acti dinner/dance, where Alumni Massie , M.D. '35, Elmer Bur and guests of the Washington vator, a drug that stops heart Achievement Awards and rell Brown, MD. '50, and University School ofMedi attacks in progress. There was Alumni Faculty Awards were David Goldring, MD. '40. cine. The program featured also a talk on new technology presented. Marvin H.Brennecke, M.D. research on exercise and its for the surgical treatment of The alumni association pre '30, was awarded the special l:\ benefits to health , especially card iac arrhythmias. Karl H. sented four alumni achieve citation for distinguished in relation to ischemic heart Muench, M.D., amemberof ment awards for contributions service. disease, aging, osteoporosis , the class of 1960 who is now to the association, three Sutter is founder and direc and glucose intolerance and on the faculty at the Univer alumni/faculty awards for tor of the Sutter Clinic, Inc. , " ~ insulin resistance. In addi sity of Miami , discussed career accomplishments and which has provided occupa "'~ , --f). 36 tional medical service to more obstetrics and gynecology in The alumni association ington University School than 1,500 companies in the St. Louis for over 35 years. honored Massie for excel- of Medicine. .... St. Louis metropolitan area She has also provided years lence as a researcher and Goldring had served as since 1946. He continues to of service to the St.Louis teacher. He helped pioneer director of the division of car- serve as a consultant at the community, devoting time the use of computers to inter- diology in the Ilepartmcnt of clinic, bought in 1984 by to the YWCA's Board of pret electrocardiograms, and Pediatrics until 1981, when he Barnes Hospital , and as a lec- Directors, the Social Health spearheaded efforts to expand was named director emeritus. turer in the Department of Association, the Health and and upgrade several coronary He received the 1Ilumni/fac- Preventive Medicine and Pub- Welfare Counc il and the facilities at the medical cen- lIlty award for his service lind lic Health . United Way. ter. He is professor emeritus leadership to improve health Berg is a respected thoracic Roberts is on staff at (clinical) of medicine and clIre and for his work for the surgeon on staff at Sacred St. Luke's and Faith hospitals former chief of the cardiovas- future of education and the fu- Heart Medical Center and in St. Louis. In lIddition to cular clinic at Washington ture ofWashington University. • :;:::? Richard Sutter, M, D, '35 Ralph Berg, M.D. '26 Ellen Loeffel, M.D. '36 John P. Roberts, M.D. '45 ~ Deaconess Medical Center his medical accomplish- University. Brenneke was chosen to in Spokane, Wash. Before ments, he is founder of the Brown is an expert in the receive a special citation for returning to hi s home in National Museum ofTrans- field of hematology and has distinguished service for his Spokane in 1952, he had been port, a one-of-a-kind exhibit served on numerous execu- Illany yellrs of devotion to the chief of thoracic surgery at that preserves dozens of loco- tive committees liS well as lec- people of Hawaii . He was a the Veterans Administration motives and other forms of tured throughout the world. pioneer in "plantation medi- Hospital in Portland , Ore., transportation. He is cur- Presently he is professor of cine," providing mediclli ser and clinical instructor in rently secietary of the Trans- medicine, as well as associate vice to employees of four surgery at the University of port Museum Association , dean for continuing medical sugar companies, their depen- Oregon School of Medicine. and editor of St. Louis education and for post- dents and the rest of the Kauai Loeffel has been practicing Metropolitan Medicine. graduate training at Wash- community. Edward Massie, M.D. '35 Elmer Brown, M.D. '50 David Goldring, M.D. '40 Marvin Brennecke, M.D. '30 >;~~ l 37 ." pi ta I, and from 1964 to 19 66 he was a research associate with th e National In stitutes of Heal th Laboratory of Bio chemistry, Section of Cell ular Physiology, and a surgeon Fredrick Lee Liebolt, with the U.S. Public Health M.D. '30, has endowed a Service. chair in premedical sc iences Subsequently, he was assis at the Uni versity of Arkansas, tant professor of pathology The president and chance llor and in structor in medicine at of UA hosted a dinner in the Washington Un ive rsi ty Liebolt's honor at the Univer School of Medicine. A John sity Club in New York City, and Mar R. Markle Scholar where he resides, in Medical Science, he was Nicholas T. Kouchoukos Donald H. Stewart named associate professor of path () logy and medicine in '40~ School of Medi ci ne, where he internship and residency at 1969 and became director of served as vice-director of the Duke Hospital. Durham. NC, the Central Diagnostic Labo Joe B. Hall, M. D. '48, division of cardiovascular and and the State University of ratories of Barnes Hospital. is governor of the Arkansas th oracic su rgery from) 974-7, New York Upstate Medical In 1973, J arett was pro mot Chapter of the American He had been at UA since 1967 Center in Syracuse. He has ed to professor of pathology College of Physicians, after completing internship served as president of the and medicine and head of the and residency in surgery at Congress of Neurological divi sion of laboratory medi Barnes Hospital. While at Surgeons and other profes cine at Washington Univer :50~ Barnes, he served as assistant sional soc ieti es and has sity, He was named professor resident and later as chief chaired many professional and chairman of the Depart Walter A. German, administrative resident. committees, ment of Pathology and Labo M.D. '51, is pres iden t of A member of AOA, he is Leonard Jarett, M.D. ratory Medicine at Penn in the Missouri State Medica l affiliated with several profes '62, professor and chairman 1980. Association, sional societies and is on the of the Department of Pathol Jarrett is the author of nu Richard R. Dewey, M.D. ed itori al boards of many med ogy and Laboratory Medicine merous medical articles relat '55, is clinical professor of ical publications. His many at the University of Penn sy l ing primarily to his research medicine at Stanford Medi ca l honors include three Ph ysi vania School of Medicine, in di abetes. He is a member School. cian Recogniti on Awards has been named to the newly of the editorial board s of The from the AMA. He has writ created Simon Flexner Chair American Journal ofPathology ten or co-auth ored over 200 in Pathology and Laboratory and the Journal ofClinical oO~ journal articles and over 75 Medicine, Jarrett is also chief Laboratory Analysis, He was abstrac ts. of pathology and laboratory the co-editor of Gradwohls Nicholas T. Kouchokos, Donald H. Stewart, M.D. medi cine at th e Hospital Clinical Laboratory Methods M.D. '61, cum laude , has '61, has been elec ted to a of the University of Penn and Diagnosis, publi shed in been elected president of the three-year term as director sylvania (H P). 1980. As a diabetes re searcher, Washington University Med i of the American Association Jarett holds the B.A . (w ith he has served as a consultant cal Alumni Association for of Neurological Surgeons, honors) and M.D. (c um laude) on the Medical Science Advi 1985-6. Kouchokos recently Stewart is clinical assistant degrees from Rice In sti tut e sory Board of the Ju ven ile returned to Washington Uni professor of neurosurgery at and Washington University Diabetes Foundation, the versity as John M. Shoen berg the Upstate Medical Center School of Medicine, respec Pennsylvania Di abetes Task Professor of Cardiovasc ular and is on staff at Crouse ti ve ly. He was a member of Force, the steering committee Surgery and is chief of car Irvin g Memorial Hospital Alpha Omega Alpha. 1n 1982, of the National Diabetes Re diovascular and thoracic sur and VA Hospit al in Syracuse. he rece ived an honorary M.A, search Interchange, Juvenile gery at Jewish Hospital. After medical studies degree from the Uni versity Diabete s Foundation, and the Previou sly, Kouchokos was at W. U. and St. Thomas' of Pennsylvania. Foundation's Medical Sci ence clinical professor of surgery Hospi tal Medical School in He served his internship Advisory Committee. A mem at University of Alabama London, Stewart compl eted and res idency at Barnes Hos ber of the MetaboIism Study 38 Section of th e National Insti ge ry. He is vice-president for li shed a paper in thelournal of Washington U., he served as tutes of He al th , he hold s th e medical affa irs at the Lei la Oral and Maxilloj(lciaf Surgely, an administrator at Barnes David Rumbough Award of Post Montgomery Hospital August 1984, describing nine Hospital. the 1uvenile Di abetes Founda in Battle Creek , Ml. years' surgical res ults on pa Stephen B. Collins has tion and the Cot love Award of William N. Neubauer, tients who recei ved a man accepted a position with Vol the Academy of Clinical Lab M.D. '69, is serving a two dibular stapl e bone plate. He untary Hospitals of America oratory Ph ys icians and yea r term as chi ef of staff at also received the AMA's 1984 Management Services in Scientists. EI Dorado Medical Center. Phy sician Recognition Award Tampa (FL). VHA Manage He is on th e board of direc tors for Continuing Education. ment Services supports not of severa l medical and philan Stuart R. Schlanger, M.n for-profit hospitals across the thropic organizations and is a '77, completed residency country. member of th e steering com in internal med icine at Formerly. Coll ins was mi tt ee of th e Tu cson Program Creighton Med ical School, an administrator for Lake for Affordable Hea lth Care. Omaha, Nebraska. He is in Charles Memorial Hospital. Neubauer is a general su rgeon private practice in Omaha and He is a past chairman of living in Tu cson, AZ. a.lso has a rural office in Mis th e Louisiana Hospital souri Vall ey, Iowa. Schlanger Association and has served also writes a medical column as board member for many '~oI ~ for a nati onally distributed philanthropic and medical magazine. organi zation s. Richard M. Wachsman, Harold Lee Rush Kent, John S. Dubis has as M.D. '72, has made several M.D. '78, completed training sumed exec ut ive vice pres i Leonard Jarett media appearances and writ last summer in general sur de ncy of Freeman Hospital . ten a pamphlet, "Cocaine gery at the Naval Hospital in Dubis has bee n with the 1arett is a member of the Today," in order to help com San Di ego. Currently, he is hospital for two years. American Society for Clinical bat the use of thi s drug. He is trainin g in cardiothorac ic sur James K. Elrod, president Investigation, the Association a psychiatri st res idin g in Del gery in a program co-spon of th e Willi s-Kni ghton Medi of American Physicians, the Mar, CA. sored by th e Naval Hospital ca l Center (LA), is a tru stee Academy of Clinical Labora Kenneth S. Rotskoff, and UCSD. of th e American Hospital tory Physicians and Scien D.D.S., M.D. '75, moder Frances Allene King, Assoc iati on. He is th e first tists, the American Diabetes ated a session on oral max ill o M.D. '78, is board-certified Loui siana hospital ad min Association, the American facial surgery for the geriatri c in surgery and completed a istrator ever named to the Assoc iation of Pathology, the fellowship in oncologic sur 25 -lllember board. Philadelph ia College of Ph y gery at M. D. Anderson Tumor Elrod has been presid en t of sic ians and Surgeons, and In stitute. King is a member Willi s- Kni ght on Med ical Cen is a Fellow of the College of the Harri s County Med ical ter for 19 years. He is also of American Pathologists. Society and is a general sur preside nt of South Park Hos Harvey S. Kantor, M.D. geon practicing io Houston. pital and DeSoto General '62, is director of the di vision Hospit al in Mansfiel d. of medical mi crobiology, He rece ived hi s und er Department of Pathology, at II \ f' I' IJ' \ I \ (,' ." grad uate ed ucation at Bay lor Chicago Medi cal School. He University. After earning th e is also chi ef of the medical master's degree in HAP from mi crobiol ogy laboratory, Mark Boles, admi ni strator Was hin gton U., he compl eted VAMC. North Chicago. of th e Rehabil itati on Institute tw o years of law sc hool and Lewis H. Koplik, M.D. of Okl ahoma , has been elec t served a residency at Mi s '65, has been elected to the Kenneth S. Rotskoff' ed to th e governin g coun cil sissippi Bapti st Hospital in Board of Directors of the Na of the American Hospit al ] ackson. EI rod has served as ti onal Abortion Federation. patient at a recent clinical Association's Section for president of th e Loui siana Allan J. Goldstein, M.D. congress of the American As Rehabilitation Hospitals . Hospi tal Association and later '67, chairs th e committee on sociation of Oral and Maxillo Boles is a 1976 grad uate of as trustee. Since 1980, he has qual ity ass uran ce of th e Amer facial Surgery Rotskoff, a Ohio State and rece ived the been a member of the AHA ican Academy of Otolaryngol partner in the Orofacial Pain master's degree in health ad House of Delegates. ogy -Head and Neck Sur Center in SI. Lou is, also pub ministration in 1983. While at D. Max Francis, president 39 • of United Hospital Center in has been an administrator of methadone maintenance heart disease and cancer. In Clarksburg (WV) , was vice- there for the past 20 years. programs. 1965, atTerry's urging, Con- chairman/chairman-elect E.H. Lindley, M.D. '40, gress required tobacco com of the West Virginia Chamber died on November 8, 1984. panies to include a warning of Commerce for its 1984-85 IN MEMORIAM Frances M. Love Huck, label on packs of cigarettes. organization year. M.D. '42, died on February In 1971, Terry helped ban Francis did his undergrad- 12, 1985. cigarette ads from radio and uate work at Kansas Wesleyan Ellis Margolin, M.D. '30, Gerald A. Yaeger, M.D. television. University. After obtaining died on April 27, 1985. He '50, died on October 3 J, A former smoker himself, his master's degree in HAP had retired in 1974 after a 1984 . Terry devoted much of the from Washington U., he as- 37-year career on pathology Sister Jeffrey Engelhardt, last two decades of h is Ii fe to sumed presidency of the UHC at Springfield State Hospital M.D. '78, died September warning Americans about the in Clarksburg. He served as in Sykesville, Md. , where a 15 , 1984 . Sister Jeffrey, born dangers of smoking. After president of the Clarksburg library was named in hi s Mary Jane Engelhardt, is the stepping down as surgeon Area Chamber and as a mem- honor. A native of Minsk, only religious sister to have general, he became vice presi ber of the state chamber board Russia, he obtained his under- ever graduated from the dent for medical affairs at the of directors. Francis also graduate education at Johns School of Medicine. She had University of Pennsylvania, served on th e boards of Blue Hopkins. He was an emeritus been a member of the Sisters a post he held until 1971. He Cross-Blue Shield and the member of the AMA, Ameri- of St. Francis of the Holy taught at the medical school West Virginia Hospital can CI inical Society. Interna- Family since 1959, entering there until 1982. From 1973 Association. tional Academy of Pathology, the order at age 18. She re- 80, he was president of Uni- Robert L. Graves is execu- and the Maryland Society of ceived a B.A. in mathematics versity Assoc iates of Wash tive vice-president and CEO Pathologists, of which he from Briar Cliff College ington, a nonprofit consulting of Morton Plant Hospita l in was a charter member. (Iowa) in 1963 and taught firm. From 1980-83 , he was Clearwater, FL. Graves has Carl Zelson, M.D. '30, mathematics and science corporate vice-president for served as an administrator died in December 1984. He classes before entering the medical affairs of ARA Ser there for seven years. had retired in 1975 after a School of Medicine. She vices Inc. of Philadelphia. Graves received his under- career that included caring completed family practice res- A cardiologist, Terry was graduate degree from Mus- for children in what was idency and practiced with the an authority on hypertension. kingum College and is an known in the 1930s as Hell's Medical Mission Sisters His many awards included the adjunct faculty member of Kitchen, on the west side of Clinic for \0 months and later distinguished service award Washington U. School of Manhattan. He became part- became a medical consultant of the American College of Medicine and the University time director of nurseries for to the Sisters of Mercy. Cardiology and the distin ofAlabama at Birmingham. premature infants for the New Sister Jeffrey originated, guished service medal of the A member of the ACHA and York City Board of Health edited and published the first USPHS. licensed nursing home ad- during the 1950s. Later, he national newsletter for reli ministrator, he serves on the was named professor of pedi- gious physicians, "The Life- board of Directors of Hospi- atrics at New York Medical line." She wrote articles for tals Home Health Care of College and director of neo- religious and medical publica- Medical Center Alumni Pinellas County. nate nurseries at Metropol itan tions and served as an edito- Association Box 8049 Ken Jones is assistant Hospital in East Harlem, and rial board member and manu 660 S. Euclid administrator of Mid- at Flower and Fifth Avenue script and book reviewer for St. Louis, M063110 Jefferson County Hospital Hospitals on the Upper East several medical publications. (TX). Formerly, he was asso- Side. Her struggle against meta ciate executive director of At Metropolitan, he con- static breast cancer supplied Nicholas T. Kouchoukos, M.D. '61 Carolina Area Hospital in ducted studies of infants her with dramatic insights on President Puerto Rico. He earned the born to addicted mothers and living and dying. master's degree in HAP found that those born to wom- Luther L. Terry, FHS, Jack Sietl 40 ,.r The new emergency facilities at Barnes Hospital, ajoint wuJertaking between the hospital OIuJ the School ofMedicine, are shown at its recent dedicaluJIl. The newfacility has tripled the size ofthe old unit. Its 21,000 square feet contain expOluJed jcu:ilities for radiology and a total of18 treatme/lt rooms. There is a seven-bed unitfor patients who need extended observation or who are awaiting admission to the hospital. in addition, the facility has an enlarged, improved waiting areafor patients'families. Patients who need to be transported to surgery orpatient floors can be moved without encountering the general traffic on the hospital'sfirstfloor. A drive-through ambulonce port shelters the unloading area Oil the new (lriveway conllecting Wohl and Renard bridges. The project is one ofmany efforts undertaken by Barnes Hospital in 011 attempt Ii) retai" and expand its present role as a premier provider ofmedical care ill the St. LOllis area. in "Medical Marketshare," begillning on page 6, writer Calldace O'Comwr describes the efforts ofall the hospitals at Washillgtoll University Medical Cellter to meet the challellges ofprovidillg medical care illto the 21st century. UNIVERSITY s{JIIO()L ()F MEIlI(JINE ATW,\SIlINGTON lI NIVF.RSITY MF.J)fCAL CENTER 6W SOUTH EUCLID AVENUE ST. LOUIS, MISSOURI 6:·H 10 The Hot Docs are rapidly ascending to "tradition" status at the School ofMedi cine. In this issue's Studentstagefeature beginning on page 10, writer Gail DiBernardo chronicles the history ofthis group with a musical bent.