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HEALTH SCIENCES LIBBARX

UNIVERSITY OF MARY.LANQ

BALTIMORE

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in 2011 with funding from

LYRASIS IVIembers and Sloan Foundation

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January, 1971 volume 56 • number

PUBLISHED FOUR TIMES A YEAR
JANUARY, APRIL, JULY AND OCTOBER

SCHOOL OF MEDICINE OF THE UNIVERSITY OF MARYLAND
AND THE MEDICAL ALUMNI ASSOCIATION

Second class mailing privileg^mfflorized at Baltimore, Maryland

Volume 56

Number 1

JANUARY, 1971

HEALTH SCIENCES LIBRARY

UNIVERSITY OP MARYLAND

BALTIMORE

BULLETIN

JOHN A. WAGNER, B.S., M.D.

Chief Editor

JAN K. WALKER

Managing Editor

EDITORIAL BOARD
Edward F. Cotter, M.D.

George Entwisie, B.S., M.D.

Robert B. Goldstein, M.D.

John C. Krantz. Jr., Se. D.. Ph. D.

Arlic Mansberger, M.D.

William H. Mosberg, B.S.. M.D.

Francis W. O'Brien

John H. Moxley, ill, M.D.
(ex •officio)

Theodore Kardash, M.D.
(ex-officio)

School of Medicine
University of Maryland

Policy — The Bulletin of the School of Medicine University of
Maryland contains scientific articles of general clinical interest, orig-
inal scientific research in medical or related fields, reviews, editorials,
and book reviews. A special section is devoted to news of Alumni of
the School of Medicine, University of Maryland.

Manuscripts — All manuscripts for publication, news items, books and
monographs for review, and correspondence relating to editorial policy
should be addressed to Dr. John A. Wagner, Editor, Bulletin of
the School of Medicine, University of Maryland, 31 S. Greene
Street, Baltimore 1, Md. Manuscripts should be typewritten double
spaced and accompanied by a bibliography conforming to the style estab-
lished by the American Medical Association Cumulative Index Mcdicus.
For example, the reference to an article should appear in the following
order : author, title, name of journal, volume number, pages included,
and date. Reference to books should appear as follows : author, title,
edition, pages, publisher, and date published. A reasonable number of
illustrations will be furnished free.

Reprints — At the time the galley proof is returned to the author, the
publisher will insert an order form for reprints which are purchased
directly from the publisher. Any delay in the return of this order form
may result in considerable additional expense in obtaining reprints.

Alumni Association News — The Bulletin publishes as a separate
section, items concerning the University of Maryland Alumni and their
Association. Members and friends are urged to contribute news items
which should be sent to Dr. John A. Wagner, Editor, Bulletin of
the School of Medicine, University of Maryland, 31 S. Greene
Street, Baltimore, Md. 21201.

Subscriptions — The Bulletin is issued 4 times a year. Its subscrip-
tion price per annum, post paid is $3.00 ; single copies, $.75, when avail-
able. Active members of the Medical Alumni Association receive the
Bulletin in connection with the payment of annual membership dues.
Non-Alumni subscriptions should be made payable to the University
of Maryland and remitted through the office of Miss Jan K. Walker,
Managing Editor.

Advertising — The Bulletin accepts a limited number of advertise-
ments. Rates may be obtained upon application to Miss Jan K. Walker,
Managing Editor, Davidge Hall, School of Medicine, 522 W. Lombard
St., Baltimore, Md. 21201.

i 54.-5319?

BULLETIN School of Medicine
University of Maryland

VOLUME 56

JANUARY, 1971

NUMBER 1

Community Mental Health

FACT and FANCY

A Hypothetical Interview

EUGENE B. BRODY, M.D.*

The term, "community mental health,"
is heard everywhere these days. Just what
does it mean?

This term refers first to a system of
mental health services. Such services in-
clude the diagnosis and treatment of peo-
ple who have identifiable emotional or
mental disabilities, i.e., those who can be
labelled as "patients."

Second, the term refers to the mental
health of the community, itself — the na-
ture of the social system rather than of
the individuals who make it up. There are
problems in defining a "community" and
measuring its "health." However, consid-
erable research has been done in this field
and many people do regard the mentally
and emotionally ill, at least in part, as
casualties of the social system. They be-
lieve, therefore, that the most effective
mass prevention of such illness or dis-

* Professor and Chairman, Dept. of Ps>'chiatry,
Director, Institute of Psychiatry and Human Behavior.
University of Maryland School of Medicine, Baltimore
Campus.

ability will require changes in the society
or community.

This has been a source of conflict with-
in the staffs of some urban mental health
centers. Some have felt that more time
and energy should be devoted to changing
the presumed casualty-producing aspects
of society. Others, more oriented to ill-
ness, such as psychiatrically trained phy-
sicians, have been inclined to emphasize
service to those already defined as patients
or potential patients. This may be because
psychiatrists see mental disturbances
among the well-to-do and educated as well
as the poor and deprived, and are not so
ready to attribute most such suffering to
social ills. It is a particular issue now be-
cause the main thrust of community men-
tal health programs is toward the poor.

Even within the National Institute of
Mental Health, which provides initial
funding for most programs, there have
been persistent policy differences in this
respect. At the top echelon talk has been
largely of prevention and social change.

January, 1971

At the bottom level of regional adminis-
trators, who actually inspect programs,
the emphasis has been mainly on the pro-
vision of conventional services to pre-
viously deprived populations.

What makes community mental
health treatment services different
from other psychiatric services?

At the very end of the delivery system
nothing is basically different. There are
still a help-seeker and a helper, whether
the encounter is individually or in groups.
The helper does his job by talking or list-
ening or by administering drugs or some
other physical treatment. All of the forms
of individual, group and family psycho-
therapy, milieu therapy in the hospital,
counselling of various kinds, social work
assistance and so on, may be found in
any large psychiatric center whether or
not it carries a "community" label. It is
also important to remember that while
we know a great deal about reducing dis-
ability, we still do not know the basic
causes of the major mental health ill-
nesses. It is these, such as schizophrenia,
which make up the bulk of the hos-
pitalized population, and there exists no
definitive easily applied treatment for
them.

The major distinguishing feature of
community mental health services, then,
is less a matter of treatment than of or-
ganization. This is neither unique nor his-
torically new. The idea of a service for
geographically defined "catchment area,"
for example, is a basic feature of the
health systems of several European coun-
tries. In a city such as Baltimore with a
mobile inner city population it may not
be so easy as in more stable societies to
adhere strictly to the patient's address as
means of determining his eligibility for
services.

Another aspect of organization is the
availability as part of a single system, of

a spectrum of services. The components
of this spectrum, defined by the National
Institute of Mental Health, are inpatient,
outpatient, partial hospitalization, emer-
gencies, consultation, and education.
Again this spectrum has been present for
years in most large departments of psy-
chiatry. However, it is hoped that in the
community centers the linkage of a range
of services will make it possible to main-
tain continuity of care, with the patient
seeing the same helper or team of thera-
pists, whether he is cared for on an ambu-
latory, outpatient basis or within the hos-
pital.

Accessibility Is Important

The third aspect is physical and psy-
chological accessibility. The idea of treat-
ing a patient close to home so that he
doesn't break his ties with family and
neighborhood, rather than sending him
away to the hospital on the edge of town,
is an important part of the community
concept. I believe that the idea is right
and look forward to the day when patients
will come in and out of psychiatric units
just as general hospitals. I also like the
idea of rapid crisis intervention in the
home, itself — a method successfully used
by Dr. Querido in Amsterdam. On the
other hand, until more definitive treat-
ments for major disorders are discovered,
there will always be those who will re-
quire a prolonged period of rehabilitation
in a setting removed from that in which
their troubles began. Furthermore, many
who come into psychiatric units with acute
disturbances, such as delirium tremens
for example, are drifters and social iso-
lates without families or similar ties. Re-
habilitation for them is often a matter of
building from the ground up and the
stable community of a relatively isolated
institution could in the long run be more
supportive than the atmosphere of a rapid
turn-over city-based hospital.

Volume 56, No. 1

Psychological accessibility also involves
a special aspect of providing mental health
services for the poor and socially ex-
cluded. Here I refer to the use of people
who can speak the "language" of the
neighborhoods and who are able in their
counselling to recognize the social and
economic contributions to emotional dis-
orders. Such neighborhood counselors or
health aides have been trained and em-
ployed by a number of programs. They
have been immensely useful, but centers
such as that at the Lincoln Hospital in the
Bronx where studies have been made also
report significant difficulties. For example,
their identification with local socioeco-
nomic problems and their need to be
part of the general upward thrust of pre-
viously deprived groups sometimes makes
it difficult for them to recognize signs of
severe mental illness and they often tend
to attribute them to immediate circum-
stances. Also their close relationships
with others in the neighborhood may
make it difficult for them to be objective;
conversely, it has sometimes inhibited
people who might know them or their
families, so they haven't been able to talk
so freely to them as to a more highly
trained stranger.

How does prevention fit into the
community mental health concept?

This is potentially the most exciting
feature of the community concept but its
implementation is the most difficult. Pre-
vention has been divided into three cate-
gories. So-called tertiary or third-level
prevention refers to nothing more than
adequate treatment aimed at the preven-
tion of disability. This, while very im-
portant, is a part of all medical or psychi-
atric services. Secondary prevention
brings us closer to the community idea.
This refers mainly to early case-finding.
For every person identified as psychotic,
for example, there are probably several

managing to survive outside the treatment
network. For many it is probably just as
well since we can't change them anyway.
Others, however, may be found before
their illness has progressed too far. Many
of these can be helped to lead more satis-
fying and productive lives, and above all,
their impact on their families may be
reduced. This is one way of reducing the
social transmission of mental illness. So
case-finding or outreach activities may be
aimed at locating people with a variety
of disorders who are afraid of seeking
help, or are ignorant of resources, or don't
know that they are sick. One problem is
that case-finding, which can be done by
relatively unskilled personnel, can swamp
existing facilities and outrun the supply
of highly trained therapists. In other
words, added case-finding without added
facilities may be less than useful.

Identify Potential Cases

Consultation to the courts, the police,
the schools and other institutions can
identify potentially disturbed people early
and help initiate remedial programs. Sev-
eral members of our faculty, for example,
work with the courts and are often able
to prevent inappropriate legal dispositions
of psychiatrically sick off'enders. Psychi-
atrists and psychologists in our children's
division have worked for several years
with selected public schools in the inner
city area. Consultation with teachers and
others who function as surrogate parents
may strengthen the process of healthy so-
cialization and thus have primary pre-
ventive value.

Primary prevention, clearly, means
avoiding the development of sick or mal-
adaptive ways of thinking, feeling and
acting in the first place. Perhaps the most
fundamental aspects of primary preven-
tion of psychiatric disturbance are really
not tasks of mental health workers at all.
They involve, for example, ensuring re-

January, 1971

sponsible parenthood. The limitation of
children to loving and healthy parents
who want and are able to care for them
would probably do more to reduce the
incidence of mental illness than any other
measure I can imagine.

This leads us to the broader issues of
primary prevention, all of which involve
society as a whole rather than the health
or mental health professions in particular.
For example, it has been estimated that
almost 20 per cent of those in large public
mental institutions throughout the coun-
try are there because of defects associated
with events during their mother's preg-
nancies, the birth process or their first
months of extra-uterine life. These defects
are the consequences of malnutrition, in-
fections, other illness and trauma. At first
glance one thinks that the remedies are in
the hands of obstetricians and pediatric-
ians. These health problems, however, are
significantly associated with poverty, ig-
norance and lack of basic resources.
Should the health worker then devote his
energies to attacking the problems of
poverty?

Gender Identity Critical

As another example, it is well estab-
lished that the achievement of an ade-
quate gender identity, i.e. as a male or
female, requires an available role model
in the person of the parent of the same
sex. The failure of such identity-forma-
tion appears to have particularly severe
consequences, promoting vulnerability to
a variety of psychiatric problems, in boys.
The absence of a self-confident economi-
cally adequate father as a role model has
in the past been frequently noted in the
poorer strata of the black community.
This has, to an important degree, been a
consequence of racial discrimination mak-
ing it impossible for men to obtain ade-
quate education and jobs. Should the
mental health worker, then, fight against

discrimination as part of his preventive
job?

There is some reason to believe that
social powerlessness while not causing
major mental illness does promote feel-
ings of hopelessness, despair, lack of
initiative, feelings of futility about long-
range planning, and vulnerability to self-
narcotizing behavior. Should mental
health workers spend time to help open
channels of communications between the
people their clinics are to serve and city
hall? Should they become involved in
struggles against expressways which
threaten dislocation? Should they help
tenants' groups fight against retaliatory
eviction by landlords?

These are illustrations of the dilemmas
posed to community mental health pro-
grams by the challenge of preventive pub-
lic health oriented psychiatry. These di-
lemmas will not be easily solved, and
they are important contributors to the
turbulence which has been characteristic
of such centers as they have been develop-
ing in urban centers throughout the na-
tion. It seems likely, on one hand, that
health workers who are visible to their
clients as allies in the struggle for a better
life will be more psychologically accessi-
ble to them as counsellors and therapists.
Experiences of successful self-determina-
tion and autonomy can certainly do much
for personality growth and development.
On the other hand, the concomitant tend-
ency to politicize all health activities can
easily result in blindness to our ignorance
about basic causes of illness and malfunc-
tion, and neglect of the large mass of
patients whose already existing psychi-
atric problems will remain fundamentally
untouched by social-preventive activities.

Pros and Cons

So, there is something to be said on
both sides and program directors will
have to decide where to place their major

Volume 56, A'O. 1

efforts. My own feeling is that the com-
munity mental health staff should docu-
ment, whenever possible, the role of pre-
ventable social problems in producing psy-
chiatric disability. It should be prepared
to offer consultation to community lead-
ers and agencies in remedying these con-
ditions. Even more, members of the staff
may well assist groups in achieving their
social goals, and certainly the center staff
should be clearly identified as on the side
of the community in its efforts toward
self-development and freedom of oppor-
tunity. On the other hand I don't think
that the energies of highly trained pro-
fessionals should be diverted to this goal
any more than the job of doctors who
identified the mosquito as the malarial
vector was to clear the swamps. Their so-
cial responsibility was to alert govern-
ments and communities to the importance
of swamp clearing, and to insist that it
be carried out — but not to stop their pri-
mary tasks to do it themselves.

Dr. Eugene B. Brody

January, 1971

One unfortunate consequence of inap-
propriate politicization can be the alien-
ation of highly trained professional peo-
ple who prefer to confine their work to
their areas of technical competence and
whose contributions are essential if any
health program is to be worthy of the
name. This last factor also becomes im-
portant because the outreach, social ac-
tion, and simpler counselling activities of
a program require the development of less
educated "paramedical" workers. These
people in programs throughout the coun-
try have wanted a greater share of the
decision-making power, and more control
over policy and administration. They have
had particular leverage since they usually
come from the communities the programs
are designed to serve, and thus regard
themselves as representing the commu-
nity. The fact that others in the "catch-
ment area" don't agree and that local jur-
isdictional disputes then arise further
complicates the problem of administration
and direction. These and related issues
have turned community health and men-
tal health programs into political football
in several large cities.

What is the role of a university de-
partment of psychiatry in com-
munity mental health programs?

The traditional social role of the uni-
versity medical center has been the long-
range one: the production of professional
manpower without which health services
cannot be maintained, and the produc-
tion of new knowledge without which they
will be ineffective. The pursuit of these
goals constitutes the most fundamental
kind of service; they are basic to every-
thing else. Another way of saying it is
that research is the imaginative form of
compassion. But it isn't so easy to sepa-
rate research and education from direct
clinical care. Society needs doctors,
nurses, social workers and others who

know and are interested in the community
and in the problems of the city. If a uni-
versity is to place its students and resi-
dents in a community mental health pro-
gram it must be able to ensure the pro-
fessional adequacy of that program. It
cannot do so without a measure of influ-
ence on the administration and particu-
larly on the recruitment and employment
of senior professional people. There is
also a mutuality here. The community
program in this era of a seller's market
cannot hope to attract adequate profes-
sional staff without the attraction of the
university association. It cannot operate
extensive services without the participa-
tion of students of medicine, social work,
psychology and nursing, and without the
assistance of residents in psychiatry.

All of these considerations mean that
new and imaginative patterns of collab-
oration between states (responsible for
providing service and disbursing tax funds
for the purpose) and university medical
centers will have to be evolved. Premature
crystallization or polarization of opinion
on either side can impair the orderly evo-
lution of a system which will provide op-
timum care at the same time that it pro-
vides a setting for the training of much
needed helping personnel. They mean,
also, that the collaborative pattern must
include a mechanism for participation by
community representatives. In this way
the health programs will remain ps^ho-
logically accessible to the people they are
designed to serve, and responsive to their
changing needs.

GROWS NEARER COMPLETION— A maze of steel fabrication forms the North Hos-
pital building in mid-December as it approaches completion. University Hospital can be
seen adjacent to the construction which has a decorative fence painted by local artists
to enhance the beauty of the construction area.

Volume 56, No. 1

Managing Editor Named

The Editorial Board of the Bulletin has
announced the appointment of Miss Jan
Katherine Walker as Managing Editor
effective January 1, 1971.

A native of Jacksonville, Fla., and an
alumna of Florida State University, Miss
Walker is a professional editor, coming to
the University of Maryland from the
American National Red Cross where she
served as an Information Specialist writer
in the Office of Public Relations. Miss
Walker has also had considerable experi-
ence in newspaper work including having
served three years as a staff writer with
the Associated Press in Atlanta, Ga., and
Birmingham, Ala.

Her academic career is distinguished
by her membership in Theta Sigma Phi,
a professional society for women in
journalism and communications, in Phi
Alpha Theta, national honorary society
for students of history, and the American
Alumni Council. Miss Walker's current
interests will be in assisting the Editorial
Board in further improving the quality of
the Bulletin and assisting the Editor in
broadening its influence in behalf of fac-
ulty and school.

Miss Walker will serve in a fulltime
capacity with offices in Davidge Hall,
School of Medicine, 522 W. Lombard.

Dean Names Committee

In an effort to improve communication
with the people who live near University
Hospital, many of whom depend on the
hospital as their primary source of medi-
cal care. Dean John H. Moxley, III, has
formed a Community Advisory Com-
mittee.

In announcing the formation of the
committee. Dr. Moxley, who will act as
chairman of the group, explained that the
Medical School is in the process of re-
viewing many of its programs, including
service programs that directly afl'ect neigh-
borhood people.

"We are reorganizing our ambulatory
services, including our emergency depart-
ment, in anticipation of the greatly en-
larged facilities that will be available for
this purpose when the new North Hospital
Building is completed in late 1972," he
said. "We need to exchange ideas with
the community about this reorganization.

And, there are many local problems that
can be solved much more easily through a
joint committee of the Medical School and
the community — safety, traffic, job train-
ing and recruitment, for example. I feel
sure that this committee can exert a very
considerable influence in improving the
quality of life in this community."

Other members of the committee in-
clude:

Thomas Seaborn, assistant director
and community relations director of the
West Baltimore Civic Association; mem-
ber of the executive committee of the
Safety First Club of Maryland, and or-
ganizer and director of the West Side
Community Club.

Myrtle McCullers, acting chairman
of the Neighborhood Advisory Council
for the Inner City Community and Mental
Health Program. The council acts as a
group of consultants for the program in

January, 1971

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

decisions on new locations for mental
health centers in the city, choice of new
staff members, and issues involving inno-
vations in delivery of mental health care.

Yusuf Karrieam, community or-
ganizer for the Foresight Community
Council, a Model Cities field office.

Father Thomas J. Donnellan, ad-
ministrator of St. Peter the Apostle
Church.

Dr. Eugene B. Brody, professor and
chairman of the department of psychiatry,

University of Maryland School of Medi-
cine, and director of The Psychiatric In-
stitute.

Dr. William Spicer, Jr., associate
dean for health care programs. University
of Maryland School of Medicine.

Dr. George H. Yeager, director, Uni-
versity of Maryland Hospital.

Dr. J. Tyson Tildon, research assist-
ant professor in pediatrics and assistant
professor in biochemistry. University of
Maryland School of Medicine.

Dermatology Wins Award

Dr. Harry M. Robinson, head of the
division of dermatology, has received the
American Academy of Dermatology's
Gold Award for Excellence in Teaching
and Research.

The award, citing Dr. Robinson for his
pioneering efforts in dermatological re-
habilitation, was presented at the acad-
emy's recent annual meeting where the
division's exhibit won top honors. Dr.
Robinson was assisted in preparing the
exhibit by Dr. Carolyn J. Pass and
Dr. Emanuel H. Silverstein.

Dr. Robinson and his staff are con-
cerned in rehabilitating what he calls
"dermatological cripples" — people who
are incapacitated for work by skin dis-
orders ranging from acne to cancer.

Two years ago, Dr. Robinson estab-

lished the nation's first clinic designed to
rehabilitate workers who were out of jobs
because of skin disorders.

"We have helped dropouts return to
school and helped young adults who had
given up hope of returning to work," he
said. "We have rehabilitated 82 per cent
of the patients our unit accepted for care.
Not only were their skin disorders allevi-
ated, but they are now economically inde-
pendent."

A result of his research is an index of
dermatological disability which takes into
account evaluations of a dermatologist,
vocational counselor, social worker and
psychologist and standardizes terms used
to describe degrees of disability. It is also
helpful in predicting the rehabilitation po-
tential of the patient.

Vflhimc 56, No. 1

MEDICAL SCHOOL SECTION

'Dean

Im^LETTER

Dear Alumni and Friends of the Medical School:

The University of Maryland, like many other educational in-
stitutions, is undergoing significant change. These changes
stem in great part from the unprecedented growth experienced
by higher education in our country in the past decade or two.
How to continue to grow without completely destroying the interpersonal re-
lationships involved in the educational process is one of the major challenges
of the day. The universities' attempts to seek a solution has led them to de-
velop programs centered around a series of decentralized campuses — -in Col-
lege Park, Catonsville, Princess Anne and Baltimore. Each campus will be
directed by a Chancellor with the Office of the President as an over-all um-
brella agency coordinating the growth and development of the total university.
Dr. Albin O. Kuhn, who has been the Chancellor at Catonsville and Balti-
more, will be moving to the Baltimore Campus fulltime in the near future.
The new organization augurs well for the medical center in that for the first
time there will be a fulltime chancellor to supervise and coordinate the many
activities of this professional school campus and to provide an on-going inter-
face with developments throughout the university.

It is unfortunate that at this time of great change Dr. William Long (Class
of 1937) has for personal reasons found it necessary to resign from the Board
of Regents. Dr. Long, who was chairman of the Regents Baltimore Campus
Committee, was an advocate of and catalyst for growth and development here
in Baltimore. Further, as a loyal graduate of the Medical School he has been
of enormous help to the school and to me personally. I have on several oc-
casions discussed medical school matters with Dr. Long and have always
benefitted by his thoughtful and sage advice. Whoever is chosen to succeed
him will have very large shoes to fill. All of us here wish him well in the
future and extend to him a heartfelt thank-you for all that he has done.

With best wishes,

Sincerely yours.

'John H. Moxley, M.D.
Dean

January, 1971

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Adolescent Medicine Division

Dr. Heald

Adolescents have unique problems, but
one usually not brought to light is that
adolescence is the time when many seri-
ous diseases develop.

Dr. Felix P. Heald, Director of the
new division of adolescent medicine at
the School of Medi-
cine, reports psycho-
social and develop-
mental problems are
common, but less rec-
ognized problems of
hypertension, othero-
sclerosis, and obesity
also begin to appear
during the teenage years. Addiction to
tobacco, alcohol, and drugs has become
increasingly common during middle to
late teens.

"The need for specialized physicians in
adolescent medicine is becoming more
and more important." he relates. "Teen-
agers are shuffled from ward to ward in
medical centers. Sometimes he is cared for
by the department of pediatrics, other
times he's treated in adult wards. Pedi-
atricians or other physicians tend to han-
dle the adolescent in a mother-child re-
lationship, directing discussion to the
mother as if the child weren't present.
Privacy is needed in order to create an
atmosphere of confidence and trust. The
physical examination must be thorough,
yet sensitive — especially for the adoles-
cent girl."

With the appointment of Dr. Heald,
Maryland became the sixth institution in
the United States to conduct training and
research in adolescent medicine. Univer-
sity Hospital's new north wing, now under
construction, will devote its eighth floor

to this specialty.

The whole idea of adolescent medicine
is a young one. In the past few years,
however, more and more people are be-
coming interested in the field. Dr. Heald
says that there are already a number of
pediatricians who limit their practices to
the adolescent.

Dr. Heald was the first to train in ado-
lescent medicine, having received his
training at the Children's Hospital in Bos-
ton. He established a department of ado-
lescent medicine at the Children's Hos-
pital in Washington. D.C., and has taught
pediatrics at Harvard Medical School.
Georgetown University School of Medi-
cine, and most recently at George Wash-
ington University. Prior to his move to
Baltimore, he was professor and chair-
man of the department of pediatrics at
George Washington University and pedi-
atrician-in-chief at the Children's Hospital
in Washington, D.C.

He is president of the Society of Ado-
lescent Medicine, participated in the
White House Conference on Nutrition in
1969, and is a member of the Joint Com-
mission on Mental Health for Children,
Inc., Task Force III, the Society for Pedi-
atric Research, and the American Pedi-
atric Society. His name appears on more
than 70 scientific publications.

"If you took a group of eight-year-old
children," Dr. Heald says, "shaved their
heads, removed all of their clothing, and
lined them up with their backs to you;
you couldn't distinguish between male
and female. If you took the same group
ten years later, I'll bet you can tell the
difference. That's what adolescent medi-
cine is all about."

Volume 56, No. 1

MEDICAL SCHOOL SECTION

Dr. Trump Heads Pathology

Dr. Benjamin F. Trump, formerly Pro-
fessor of Pathology, Duke University
Medical Center, Durham, N. C, has been
appointed Professor and Head, Depart-
men of Pathology.

Prior to his September 1970 Maryland
School of Medicine appointment, he had
been a professor of pathology at Duke
since 1967. He replaces Dr. Robert
Schultz, professor of Pathology, who be-
came acting head when Dr. Harlan Firm-
inger stepped down as department head
on July 1, 1967.

Dr. Benjamin Trump

The pathologist has a balanced interest
in patient care, teaching and research.
Concurrent with his other duties. Dr.

Trump will assume administrative and
professional responsibility for operations
of Hospital Clinical Laboratories.

"We are delighted to have Dr. Benja-
min Trump join the School of Medicine
faculty. He brings to Maryland a distin-
guished career as an investigator as well
as a deep understanding of the teaching
and service functions of a department of
pathology," said Dean John H. Moxley,
III.

"His presence, and the staff that he is
recruiting to the University, will provide
us with a balanced effort in pathology.
This type of balance becomes increasingly
important when one views the department
of pathology as the primary bridge be-
tween the teaching and investigative thrust
of the preclinical departments dealing pri-
marily with the cell and subcellular struc-
tures, and the efforts of the clinical de-
partments in the application of principles
of pathophysiology to the disease process.
It is in the area of pathology that these
two types of efforts must be interdigi-
tated," he added.

Dr. Trump said, "The primary goal of
the Department of Pathology is the under-
taking of human disease with emphasis
on mechanisms and changes occurring at
the subcellular level and in molecular
terms. An all around approach to the
study of pathology, the department cor-
relates gross and clinical pathology with
changes at the molecular level. The scope
of training ranges from forensic pathology
and toxicology to modem diversified
training in clinical pathology, anatomic
pathology, neuropathology, surgical path-
ology and experimental pathology," out-
lined the new department head.

Januarx, 1971

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Teaching Aspect Excellent

He continued, "The teaching aspect of
the department here is excellent. I hope
to augment existing programs through
new ideas broadening both the areas of
clinical and experimental pathology."

Dr. Trump will also be director of re-
search for the Shock Trauma Center.

"Our program at the Trauma Center
makes possible the study of human dis-
eases at autopsy with modern techniqv.es.
In this program we'll be dealing with cell
injury as it relates to shock," he added.

Other areas in which greater investiga-
tions will be forthcoming are those of en-
vironmental pathology to study the effects
of chemical agents such as industrial tox-
ins, pollutants and pesticides on mem-
brane structures and in marine pathology.
In marine pathobiology studies are con-
ducted to determine the role of environ-
mental toxins on marine animal systems.
Several marine animal systems provide
important models for study of cellular re-
actions to injury.

A native of Kansas City, Mo., Dr.
Trump received his B.A. degree from the
University of Missouri and his M.D. from
the University of Kansas School of Medi-
cine. His internship in pathology was at
the University of Kansas Medical Center,
1957-58; he was a resident-fellow. De-
partment of Pathology, University of

Kansas Medical Center, 1958-59; a re-
search associate in Anatomy, University
of Washington School of Medicine,
Seattle, Washington, 1959-60. and a
trainee in experimental pathology, Uni-
versity of Washington School of Medicine,
1960-61.

His first academic appointment was
1961-63 when he was named as an in-
vestigator in experimental pathology. Of-
fice of the Scientific Director, Armed
Forces Institute of Pathology, Washing-
ton, D. C; from 1963-65 he was As-
sistant Professor of Pathology, University
of Washington School of Medicine, and
in 1965 he joined the staflf of Duke Uni-
versity Medical Center as an Associate
Professor of Pathology.

Dr. Trump served in the Medical Corps,
United States Army Reserve, 1958-64,
and was on active duty from August 15,
1961 to August 12, 1963, Armed Forces
Institute of Pathology.

He is a member of the American As-
sociation for the Advancement of Science;
the Electron Microscope Society of
America; the International Academy of
Pathology; the Histochemical Society;
American Association of Pathologists and
Bacteriologists; American Society of Ex-
perimental Pathology; American Associa-
tion of University Professors; American
Society for Cell Biology; and the Ameri-
can Society of Microbiology.

Volume 56, No. 1

The Maryland Obstetrical and Gyneco-
logical Society has elected Dr. Umberto
VillaSanta, associate professor of ob-
stetrics and gynecol-
ogy, as president for
1971.

Others elected were:
Dr. James P. Durkin,
assistant professor of
m^^^-'-'^jl^ obstetrics and gynecol-

W^r iA ogy> !*•*• Jerome Glow-

Dr. VillaSanta acki, director of ob-
tetrics and gynecology at Franklin Square
Hospital; delegate-at-large, Dr. Albert H.
Dudley, Jr., assistant in gynecology and ob-
stetrics at The Johns Hopkins School of
Medicine.

Goldstein Named
to Editorial Board

Dr. Robert O. Goldstein, a Baltimore uro-
logist and parttime teacher at University
Hospital, has been named to the editorial
board of the Bulletin by the Board of Direc-
tors of the Medical Alumni Association.

Dr. Goldstein fills the alumni representa-
tive quota on the alumni publication's board.
He is very active in alumni affairs as a mem-
ber of the medical alumni association, the
Baltimore Alumni Association of the Uni-
versity of Maryland, and as a representative
to the University of Maryland Alumni Gen-
eral Council.

Dr. Edward F. Cotter Is Honored

Dr. Edward F. Cotter, associate professor
of medicine, has been honored at a testi-
monial dinner by the Department of Medi-
cine in recognition of his special contribu-
tions to the medical school and the De-
partment.

"Through his efforts the educational pro-
gram at the Maryland General Hospital was
reorganized and developed," said Dr. Theo-
dore E. Woodward, head of the Department
of Medicine. "He deserves the lion's share
of credit for growth of the affiliations in in-
ternal medicine between our respective hos-
pitals."

Dr. Cotter

Dr. Cotter, who recently retired as Head
of the Division of Introduction to Medicine
(Physical Diagnosis) for sophomore medi-
cal students, received a University of Mary-
land chair with an inscribed plate which
read:

"Edward F. Cotter, M.D., F.A.C.P.:
From Friends And Associates Who Know
Him As A Wise Physician And Humble
Gentleman. In Recognition Of His Excel-
lent Record As Chief Medical Resident
1939-40, A Distinguished Career As
Practitioner And Leadership In Teaching
Of Physical Diagnosis."

January, 1971

BULLETIN OF THE SCHOOL OF MEDDICINE, UNIVERSITY OF MARYLAND

A member of the Class of 1935, he is
among Dr. T. Nelson Cary, Dr. William
Love and others who have been honored by
the Department at an academic dinner for
senior faculty and staff members.

Dr. Raiti Heads Hormone
Research Agency

Dr. Salvatore Raiti of London, England,
has recently become director of the Na-
tional Pituitary Agency, based at the School
of Medicine.

Funded by the National Institute of Arth-
ritis and Metabolic Diseases, the agency each
year collects about 80,000 human pituitary
glands from which it prepares growth hor-
mone for distribution to investigators
throughout the country for clinical research
on certain kinds of dwarfism in children.

Dr. Haiti

"The growth hormone extracted from one
pituitary gland, a pea-sized gland at the base
of the brain, is only enough for treatment
of one individual for three or four days,"
Dr. Raiti explained. "It takes many glands
to determine the growth pattern and metabo-
lism in one patient. With more than 10,000
children suffering from hypopituitary dwarf-

ism and many more who have other types of
dwarfism, much more growth hormone is
needed, and so investigators are searching
for ways to synthesize it."

He added, "In the Department of Pedi-
atrics, we are studying dwarfism and com-
paring the effectiveness of different forms of
therapy. But there are many more problems
to be studied. For example, why are some
children small from the time of birth? Is
this owing to hormone deficiency or to nu-
tritional problems during pregnancy? Would
such babies benefit from growth hormone
given during the first year of life? Would
babies of diabetic mothers benefit from
growth hormone given early in life?"

In discussing other hormonal problems of
childhood. Dr. Raiti said, "We do not know
why the normal time of puberty is after the
tenth year. Understanding the mechanism of
puberty might lead to more effective treat-
ment for very early or very late puberty."

Another endocrinologist who recently
joined Dr. Raiti's staff, Dr. Fima Lifshitz,
is participating in these studies.

"We see from 15 to 20 children a week
with such hormonal problems as hypopitui-
tary dwarfism, thyroid and adrenal disorders,
abnormal puberty, and diabetes mellitus.
Since many of the basic problems in pedi-
atrics can be answered only in the labor-
atory, research techniques for measure-
ments of hormones and other body con-
stituents are being set up."

The new NPA director is an associate pro-
fessor and director of pediatric endocrinol-
ogy in the School of Medicine and at Uni-
versity Hospital. He received his medical de-
gree at the University of Queensland, Aus-
tralia, and trained in pediatrics in Australia,
Edinburgh and London.

In 1963, he was a fellow in the steroid
training program at the Worchester Founda-
tion, Shrewsbury, Mass. From 1964-67 he
was a fellow in pediatric endocrinology at
the Johns Hopkins Hospital and School of
Medicine. He then returned to England as
senior lecturer and consultant endocrinolo-
gist at London University's Institute of Child
Health and the Hospital for Sick Children.

Volume 56, No. 1

MEDICAL SCHOOL SECTION

Accreditation Granted

The continuing education program of
the University of Maryland School of
Medicine has been granted full accredita-
tion by the American Medical Associa-
tion's Council on Medical Education.

In a letter received by the Dean, the
Council stated: "In the annual listing
'Continuing Education Courses for Physi-
cians,' which will appear in the August 2,
1971, issue of the Journal of the Ameri-
can Medical Association, courses of the
University of Maryland School of Medi-
cine will be specifically designated as
courses offered by an accredited institu-
tion."

The Council will periodically review all
accredited institutions, probably at three
or four year intervals once the accredita-
tion program has been fully implemented.

Ophthalmology Receives Funds

The Department of Ophthalmology has
received an unrestricted grant of $5,000
from Research to Prevent Blindness, Inc.,
to support and accelerate intensive studies
of the eye and its diseases.

"The unrestricted nature of the gr^nt
permits our investigators to pursue new
ideas for which other funds are not avail-
able," said Dr. R. D. Richards, head of
the department.

The University of Maryland has re-
ceived $10,000 in unrestricted grants
from RPB over the past two years. Na-
tionwide RPB has made grants amounting
to more than $1.5 at 43 medical schools
and has channeled more than $16 million
into construction of modern eye research
centers.

You, foo. Can Receive
the BULLETIN Postpaid!

The Bulletin is published four times a year, jointly by the
Faculty of the School of Medicine of the University of Mary-
land and the Medical Alumni Association. Active members
of the Medical Alumni Association receive the Bulletin
upon the payment of annual membership dues which include
the yeady subscription fee of the Bulletin.

All members of the Faculty who are not members of the
Medical Alumni Association and other friends of the Medical
School are invited to subscribe to the Bulletin. The sub-
scription fee is $3.00 per annum, postpaid. Make check pay-
able to the University of Maryland and mail it to

MISS JAN K. WALKER

522 W. LOMBARD ST.

BALTIMORE, MD. 21201

January, 1971

The U.ofM. Medical Alumni
SALUTE

Dr. Margaret B. Ballard of Union, West
Virginia, doctor and historian, is now well
into her second career and recently received
the C. Samuel Kistler Travel Award in rec-
ognition of her "outstanding contributions"
to the West Virginia travel industry.

At the presentation of the award, Gov.
Arch A. Moore of West Virginia spoke of
Dr. Ballard's great love and affection for
the state and her energy and enthusiasm in
promoting the state. The award is given an-
nually to an individual or group making out-
standing contributions to the state's travel
industry.

"For the first time in more than 70 years,
I'm speechless," said the University of Mary-
land School of Medicine graduate upon ac-
cepting the award at the Governor's Con-
ference on Travel.

Following graduation in 1926, Dr. Ballard
completed residency in Obstetrics and Gyne-
cology and for many years taught her spe-
cialty at the School of Medicine. One of

her outstanding contributions was her con-
tinued interest and enthusiasm for the con-
troversial planned parenthood movement.
She has lived to see her ideas and efforts
take form of a now accepted facet of mod-
ern society.

Because of her profound and continuing
interest in history, Dr. Ballard became the
author of an important volume on the his-
tory of the University of Maryland which is
entitled "A University Is Born" published
in 1965.

Shortly after her book was published "Dr.
Maggie" retired from active practice de-
voting her interest and energy to historical
research and to the promoting of the many
interesting aspects of her home state.

The School of Medicine and its Alumni
Association are happy to recognize Dr. Bal-
lard's continuing academic interest and
achievement, and extends herewith its salute
and congratulations on a continuing active
and non-academic career.

Exhibit Illustrating Pioneering Efforts in Dermatological Rehabilitation Wins Award

i Volume 56, No. 1

ALUMNI ASSOCIATION SECTION

President's Letter

OFFICERS

President

Theodore Kardash, M.D.

President-EIect

f:DWARD F. Cotter, M.D.

Vice-Presidents

Irving Burka, M.D.
John C. Hamrick, M.D.
He.njamin M. Stein, M.D.

Secretary

Robert B. Goldstein, M.D.

Treasurer

Arlie R. Mansberger, M.D.

Executive Director

William H. Triplett, M.D.

Executive Administrator

Francis W. O'Brien

Executive Secretary

Louise P. Girkin

Members of Board

Martin E. Strobel, M.D.
Henry H. Startzman, Jr., M.D.
Kyle Y. Swisher, Jr., M.D.
William J. R. Dunseath, M.D.
William H. Mosberg, Jr., M.D.
Charles E. Shaw, M.D.
Joan Raskin, M.D.
Donald T. Lewers, M.D.
Cliff Ratliff, M.D.

Dear Fellow Alumni:

In the past there have been many problems in connection
with the publication of the Bulletin. By the employment of
fulltime people we hope that we can give better service to all
who receive the Bulletin. I welcome any suggestions or com-
ments on how we can improve this publication. I would like
to make one suggestion and that is to encourage sending to
the Alumni Office your biographical sketch.

I consider it of importance to inform you that the School
of Medicine and the Medical Alumni Association are working
closely together to improve the future publication of the
Bulletin. Recently a Managing Editor was hired on a fulltime
basis as the first step toward looking at what changes should
be considered. The Managing Editor will have a small staff
and all indications are that future Bulletins will be sent to
you early in each quarter of the year.

The response to the Davidge Hall Restoration Fund Drive
is encouraging and I suggest to those Alumni who have not
had the opportunity to contribute to consider doing so over
the period of five years that we plan to run this Fund drive.
I wish to thank those who have already contributed to the
Fund and who have made pledges for the years to come.

Sincerely,

Ex-officio Members
Board of Directors

Lewis P. Gundry, M.D.

Wilfred H. Townshend, Jr., M.D.

John H. Moxley, III, M.D.

Theodore Kardash, M.D.
President

January, 1971

(^lass

NOTES

Your achievements, fellow alumnus, are
of interest to your classmates. They consti-
tute a reward to the faculty, are a challenge
to the younger physicians, and are an item
of prestige for the University. Please cooper-
ate with us by forwarding news of yourself
or any alumnus to the Bulletin. Thank you.

CLASS OF 1929

Dr. Jacob H. Conn, assistant professor
emeritus of psychiatry at Johns Hopkins
University Medical School, has received the
Gold Medal Award for his contributions to
Scientific Hypnosis.

The 1929 University of Maryland Medi-
cal School graduate was a fellow in psychia-
try at the Phipps Clinic, Johns Hopkins Hos-
pital (1931-33) and was in charge of sex
research at the Children's Psychiatric Serv-
ice from 1937-40. He was the first practicing
psychiatrist in Maryland to be certified in
1935 by the American Board of Psychiatry
and Neurology.

He was acting chief medical officer of the
Supreme Bench of Baltimore, past president
of the Maryland Association of Private
Practicing Psychiatrists, consultants to the
United States District Court Public Health
Service and the Veterans Administration.

Dr. Conn was the recipient of the 1960
award for the best clinical contribution to
scientific hypnosis, the 1961 Raginsky
Bronze Plaque, the 1964 Schneck Award,
the 1966 S.C.E.H. Presidential Award, and

the 1968 award for the best paper in clinical
hypnosis.

His latest recognition came at the Society
for Clinical and Experimental Hypnosis
22nd annual meeting.

CLASS OF 1936
Dr. Benjamin H. Issacs has announced the
change of his office address from 1261 E.
Belyedere Avenue in Baltimore to Mercy
Hospital, 301 St. Paul Place, for the prac-
tice of Otolaryngology. He is currently serv-
ing as the president of the Maryland Ear,
Nose and Throat Society.

CLASS OF 1952
Dr. Robert A. Douglas closed his Home-
stead, Fla., office in May 1970 and went to
Belgium for training to be a Medical Mis-
sionary in Africa. He is expected to be out
of the country for at least four years.

CLASS OF 1965
Dr. Sanford Levin, 15141 Middlegate Rd.,
Silver Spring, Md., recently discharged from
the Army where he was a pediatrician at the
United States Military Academy and hos-
pital commander at Stewart Air Force Base,
has joined a pediatric corporation in Laurel,
Md.

He has been appointed as clinical instruc-
tor in pediatrics at George Washington
Medical School and has staff privileges at
Children's Hospital in Washington and Holy
Cross Hospital of Silver Spring.

Volume 56. No. 1

Beatl)S

Dr, Irving J. Cohen, 62, former executive
vice president of the Maimonides Medical
Center, Brooklyn, N.Y., and assistant chief
medical director for planning at the Veter-
ans Administration, died October 29, 1970.

Dr. Cohen, a native of Brooklyn, received
his M.D. degree in 1930 from the University
of Maryland Medical School. Following in-
ternship in pediatrics at Massachusetts Gen-
eral Hospital in Boston, he served as assist-
ant resident in pediatrics at Children's Hos-
pital, Philadelphia; as pediatrics resident at
Beth-El Hospital, and then as executive
physician at the Brooklyn Hebrew Orphan-
age.

During WW II he was in the Army Medi-
cal Corps, and after the war became an as-
sistant clinical director at the VA hospital in
the Bronx. In 1952 he became manager of
the VA hospital in Baltimore and two years
later became deputy director of all VA hos-
pitals.

From 1959 until he resigned from the post
in 1962, he served as the assistant VA chief
medical director of planning. His leadership
in medical care for the chronically ill earned
him high commendation.

In 1962 he joined Maimonides as execu-
tive vice president, which under his adminis-
tration, became internationally known. Its
community mental health center was one of
the first in the nation.

He retired from Maimonides in 1969.
However, he still served as consultant to the
Maimonides VA, and the Department of
Health, Education and Welfare until his
death.

He was graduated from Oilman School .in
1953, attended Lehigh University and re-
ceived his M.D. degree in 1962 from the
University of Maryland School of Medicine.

Dr. Carozza was known for his work and
research in infectious medicine. He did ex-
tensive research into the way certain bac-
terial toxins influence the defense systems of
the body and how the body resists such in-
fluences.

Early in his career. Dr. Carozza served as
a fellow in international medicine for the
University of Maryland in Lahore, Pakistan.
Another academic pursuit was the study of
the history of medicine. He was a fellow of
the Institute for the History of Medicine at
the Johns Hopkins medical school and was
instrumental in organizing a Society for the
History of Medicine at the University of
Maryland medical school.

Dr. John A. Buchness, a Catonsville, Md.,
physician, died November 18, 1970 at age
78.

Dr. Buchness, a specialist in Industrial
Medicine and Surgery, was graduated from
the University of Maryland Medical School
in 1919. He attended Loyola High School
and Loyola College and was later active in
the Alumni Associations of both schools.

In addition to his medical practice. Dr.
Buchness was a noted Philatelist, winning
several honors for his collection of Lithu-
anian stamps. He was a 50-year member of
both the Medical and Chirugical Faculty of
Maryland and the American Legion.

Dr. Frank A. Carozza, Jr., assistant pro-
fessor of medicine at University of Mary-
land Medical School and head of the Di-
vision of Physical Diagnosis, died October
30, 1970 at age 35.

Dr. William Wallace Walker, a general sur-
geon who practiced for more than 45 years
in Baltimore hospitals, died December 2,
1970 at age 72.

January, 1971

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

A graduate of the University of Mary-
land Medical School, he began his practice
in Baltimore in 1923. His internship was at
Mercy and University Hospitals and he later
practiced at Franklin Square, North Charles,
Maryland General, Bon Secours and Luther-
an Hospitals.

He also served as an associate professor
of surgical anatomy at the University of
Maryland Medical School.

CLASS OF 1898 BMC
Dr. Arthur M. Loope, 217 Sherbourne Rd.,
Syracuse, N.Y., died June 26, 1970 at age
94. He is survived by a daughter, Mrs. Jor-
dan A. Zimmerman.

CLASS OF 1903 P&S
Dr. C. Melvin Coon, Star Route, Milan,
Pa., died April 1970 at age 94.

CLASS OF 1903
Dr. George S. M. Kiefifer, 1010 Leeds Ave.,
Baltimore, Md., died July 1970.

CLASS OF 1908
Dr. Frederick Snyder, 44 Clinton Ave.,
Kingston, N.Y., died February 24, 1970 at
age 88.

CLASS OF 1908 P&S
Dr. George Davis, 28 S. Church Street,
Waynesboro, Pa., died recently.

Dr. Oscar T. Barber, 145 Temple St., Fre-
donia, N.Y., died August 26, 1970.

CLASS OF 1909
Dr. Clarence Irving Benson, Box 123, Port
Deposit, Md., died September 2, 1970.

CLASS OF 1912 P&S
Dr. Leonard O. Schwartz, 3421 Pennsyl-
vania Ave., Weirton, W. Va., died in June
1970 at age 83.

CLASS OF 1912 BMC
Dr. William T. Rumage, Sr., 171 Vose
Ave., South Orange, N.J., died April 25,
1970 at age 83. He is survived by his wife.

CLASS OF 1912
Dr. Dawson Orme George died December
21, 1970.

CLASS OF 1914
Dr. Lowrie W. Blake, 5609 7th Ave. Dr.
West, Bradenton, Fla., died September 10,
1970.

CLASS OF 1917
Dr. Milton Cumin, 130 Slade Ave., Apt.
306, Baltimore, Md., died recently.

CLASS OF 1918
Dr. Thomas C. Speake, 211 Lynhurst Dr.,
Ormond Beach, Fla., died October 9, 1970
at age 77.

CLASS OF 1919
Dr. C. Wilbur Stewart, 6 East Read St.,
Baltimore, Md., died October 16, 1970 at
age 74.

CLASS OF 1923
Dr. Joseph M. Gutowski, 433 Brace Ave.,
Perth Amboy, N.J., died July 28, 1970.

CLASS OF 1925
Dr. Cecil M. Hall, 608 Strain Building,
Great Falls, Mont., died in November, 1970.

Dr. Morris Albert Jacobs, 1010 North
Point Rd., Baltimore, Md., died September
20, 1970.

CLASS OF 1926

Dr. Henry DeVincentis, 285 Henry St.,
Orange, N.J., died in September 1970.

Dr. Harry Anker, 4445 Coldbath Ave.,
Sherman Oaks, Calif., has died at age 66.

CLASS OF 1927
Dr. Herbert Reifschneider, Chestertown,

Md., died November 28, 1970.

CLASS OF 1929
Dr. Fred L. DeBarbieri, 4723 Park Heights
Ave., Baltimore, Md., died January 12, 1970
at age 70.

(Cont'd, on page xiv)

Volume 56, No. 1

ALUMNI NEWS REPOUT

TO THE BULLETIN:

I would like to report the following:

SUGGESTIONS FOR NEWS ITEMS

American Board Certification
Change of Address
Change of Office
Residency Appointment
Research Completed
News of Another Alumnus
Academic Appointment
Interesting Historic Photographs

January, 1971

Name.

Address-

Class-

Send to

Dr. John A. Wagner, Editor
Bulletin — School of Medicine
University of Maryland
31 S. Greene St.
Baltimore, Md. 21201

BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

CLASS OF 1932
Dr. Maxwell Herman Shack, Patton State
Hospital, Patton, Calif., died recently.

CLASS OF 1934
Dr. Nathan Rudo, Mt. Zion Hospital Medi-
cal Center. San Francisco, Calif., died Au-
gust 29, 1970.

CLASS OF 1935

Dr. Gerard P. Hammill, Vanadium Road,
Pittsburgh, Pa., died October 21, 197C.

Dr. J. B. Anderson, 12 West Wing, Doc-
tors Bldg., Asheville, N.C., died August 7,
1970.

CLASS OF 1936

Dr. Joseph E. Bush, 117 S. Main St.,
Hampstead, Md., died October 25, 1970.

Dr. Saul Karpel, 190 Montauk Ave., New
London, Conn., died July 2, 1970 at age 60.

CLASS OF 1937

Dr. Robert F. Cooney, 512 Lackawanna
Ave., Mayfield, Pa., died July 16, 1970.

Dr. Thomas D'Amico, 208 Passaic Ave.,
Passiac, N.J., died recently.

CLASS OF 1943
Dr. William Henry Pomeroy, 1852 Po-
quonock Ave., Poquonock, Conn., died Oc-
tober 5, 1970.

CLASS OF 1944
Dr. David T. Rees, 702 Montgomery Ave.,
Cumberland, Md., died April 8, 1970.

CLASS OF 1946
Dr. Clemmer M. Peck, 480 Monterey Ave.,
Los Gatos, Calif., died in September 1970.

CLASS OF 1951
Dr. Guy Reeser, Jr., St. Michaels, Md.,
died October 1, 1970 at age 47.

Support

Davidge Hall
Restoration

Fund

Send Contributions To:

Alumni Association
Room 102, Davidge Hall
University of Maryland
School of Medicine
Baltimore, Maryland 21201

Volume 56, No. 1

TAYLOR MANOR HOSPITAL

For Psychiatric Diagnosis and Treatment

IRVING J. TAYLOR, M.D.
MEDICAL DIRECTOR

ELLICOTT CITY, MD.
PHONE: HO 5-3322

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2501 eWYNNS FALLS PARKWAY
BALTIMORE, MARYLAND 21216

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Telephone: 669-9300

The

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26th & SissoN Streets

Baltimore, Maryland 21211

Phones: BElmont 5-8600-01-02

Symbols in a life of
psychic tension

M.A.

class of '66

Ph.D.

thesis ... in progress

G.i.

series and complete
examination normal

(persistent indigestion)

Valium^

(diazepam)

2-mg, 5-mg, 10-mg tablets
t.i.d. and h.s.

for relief of psychic

tension and resultant

somatic symptoms

within the first day

for some patients

Before prescribing, please consult
complete product information, a
summary of which follows:
Indications: Tension and anxiety
states; somatic complaints which are
concomitants of emotional factors;
psychoneurotic states manifested by
tension, anxiety, apprehension,
fatigue, depressive symptoms or
agitation; acute agitation, tremor,
delirium tremens and hallucinosis
due to acute alcohol withdrawal; ad-
junctively in skeletal muscle spasm
due to reflex spasm to local pathol-
ogy, spasticity caused by upper
motor neuron disorders, athetosis,
stiff-man syndrome, convulsive
disorders (not for sole therapy).
Contraindicated: Known hypersensi-
tivity to the drug. Children under 6
months of age. Acute narrow angle
glaucoma.

Warnings: Not of value in psychotic
patients. Caution against hazardous
occupations requiring complete
mental alertness. When used ad-
junctively in convulsive disorders,

possibility of increase in frequency
and/or severity of grand mal seizures
may require increased dosage of
standard anticonvulsant medication;
abrupt withdrawal may be associated
with temporary increase in frequency
and/ or severity of seizures. Advise
against simultaneous ingestion of
alcohol and other CNS depressants.
Withdrawal symptoms have occurred
following abrupt discontinuance.
Keep addiction-prone individuals
under careful surveillance because of
their predisposition to habituation
and dependence. In pregnancy, lac-
tation or women of childbearing age,
weigh potential benefit against pos-
sible hazard.

Precautions: If combined with other
psychotropics or anticonvulsants,
consider carefully pharmacology of
agents employed. Usual precautions
indicated in patients severely de-
pressed, or with latent depression,
or with suicidal tendencies. Observe
usual precautions in impaired renal
or hepatic function. Limit dosage to

smallest effective amount in elderly
and debilitated to preclude ataxia or
oversedation.

Side Effects: Drowsiness, confusion,
diplopia, hypotension, changes in
libido, nausea, fatigue, depression,
dysarthria, jaundice, skin rash,
ataxia, constipation, headache, in-
continence, changes in salivation,
slurred speech, tremor, vertigo,
urinary retention, blurred vision.
Paradoxical reactions such as acute
hyperexcited states, anxiety, halluci-
nations, increased muscle spasticity,
insomnia, rage, sleep disturbances,
stimulation, have been reported;
should these occur, discontinue
drug. Isolated reports of neutropenia,
jaundice; periodic blood counts and
liver function tests advisable during
long-term therapy.

Roche

LABORATORIES
Division of Holtmann-La Roche Inc.
Nutley, New Jersey 07110

April, 1971 VOLUME 56 • number 2

PUBLISHED FOUR TIMES A YEAR
JANUARY, APRIL, JULY AND OCTOBER

JOINTLY BY THE FACULTY OF THE

AND THE MEDICAL ALUMNI ASSOCIATION

Second class mailing privilege authorized at Baltimore, Maryland

Volume 56

Number 2

APRIL, 1971

BULLETIN School of Medicine

University of Maryland

JOHN A. WAGNER, B.S., M.D.

Chi«( Editor

JAN K. WALKER

Managing Editor

EDITORIAL BOARD
Edward F. Coffer, M.D.

George Entwisle, B.S., M.D.

Robert B. Goldstein, M.D.

John C. Krantz. Jr.. Sc. D., Ph. D.

Arlie Mansberger. M.D.

William H. Mosberg. B.S., M.D.

Francis W. O'Brien

John H. Moxley. III. M.D.
(ex-officio)

Theodore Kardash, M.D.
(ei- officio)

Manuscripts — All manuscripts for publication, news items, books and
monographs for review, and correspondence relating to editorial policy
should be addressed to Dr. John A. Wagner, Editor, Bulletin of
the School of Medicine, University of Maryland, 31 S. Greene
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BULLETIN School of Medicine
University of Maryland

VOLUME 56 APRIL, 1971 NUMBER 2

TABLE OF CONTENTS

Alumni Day 1971 12

Only One Door— The Community Pediatric Center 13

Teenage Mothers 21

Profile . . . Humanitarian, Physician, Mother 24

Ramsay Named 28

Ambulatory Nursing 32

The Electrodiagnosis of Neuromuscular Disease 33

Frank Kemble, M.D., M.R.C.P.

Dean's Letter ■

Faculty Appointments and Promotions '•

President's Letter '"

Fifty Year Graduates '^

Alumni Day Class Captains '^

Deaths v

April, 1971 11

ALUMNI DAY

THURSDAY, JUNE 3, 1971

MEDICAL ALUMNI ASSOCIATION

MORNING PROGRAM

9:30 a.m. Registration - Coffee Davidge Hall

10:00 a.m. Opening of Alumni Day Chemical Hall

Report to Alumni

John H. Moxley III, M.D.

Dean, School of Medicine

Theodore Kardash, M.D.

President, Medical Alumni Association, Presiding

10:30 a.m.

Assistant Dean's presentation to Alumni on student selection admission policies
and changes in the School of Medicine curriculum

11:30 a.m.

Presentation to Alumni on Davidge Hall Restoration Plan

12:00 noon

Annual Alumni business meeting and presentation of
Alumni Gold Key Honor Award

1:00 p.m. Alumni Complimentary Luncheon Psychiatric Institute

Gymnasium
5 th Floor

EVENING PROGRAM

6:00 p.m. Lord Baltimore Hotel

Reception for 50 Year Graduates

and Graduating Class of 1971

7:00 p.m. Annual Alumni Banquet Lord Baltimore Hotel

Ballroom

12 Volume 56, No. 2

Not long ago in the Inner City, a
mother who wanted to get complete
medical services for her sick child might
have had to pass through the doorways
of five or ten different clinics and wait
a couple of hours in each.

Today for many mothers the only door
necessary is the single one leading into
the University of Maryland Community
Pediatric Center, located in an old textile
office building at 412 West Redwood
Street.

And, indeed the center belongs to the

Only

One

Door

The Community
Pediatric Center

children.

"Our charge by legislation is to provide
health care to a designated population
from zero to their nineteenth birthday.
Since we are with the University it is also
within the spirit and desire of legislation
that we look at new ways to offer com-
prehensive care in a more effective, more
efficient way. As an euphemism ... to
have new ways to do more things
efficiently for the same or less cost," said
Dr. George A. Lentz, Director of the
center.

April, 1971

"In the early days we used to talk
about the three 'Cs' that went along with
our charge and operation — continuity,
comprehensivity and community. In other
words, continuing comprehensive health
care to a designated community. And,
this also implies community participation
in the program," explained John Gleason,
CPC administrator.

Last year approximately 10,000 chil-
dren were registered for care at the center.
The area served is bounded by Mulberry
Street, Greene, Pratt and Sharp Streets,
down to Howard to Middle Branch and
then to Gwynns Falls, around Carroll
Park to Carey Street, across Baltimore
Street to Fremont Avenue and finally
north to Mulberry.

Prior to the existence of the CPC the
children in the adjacent area had to go
from one doctor to another, from one
clinic to another if their families wanted
to secure sound medical services. Treat-
ment occurred by symptom with little
regard for the child as a person.

ELIGIBILITY

"In addition to the geographic eligi-
bility, the family's income must fall with-
in certain economic levels," stated Mr.
Gleason. "The division between pre-
ventive and comprehensive care is often
subtle, but when the child reaches a point
where prevention and diagnosis cease
and treatment begins, in order to be
eligible for treatment they must fall
within the levels set by the Baltimore City
Health Department.

The income levels apply to four clinics
that operate with the cooperation of the
Baltimore City Health Department. Other
community pediatric clinics are operated
by the Greater Baltimore Medical Center,
Sinai Hospital, and Baltimore City
Hospitals. The income eligibility levels
were set at the beginning of the project

and in spite of cost of living increases
have not been changed.

"A family of two which would be a
mother and a child, in our case, must
fall within an income level of $1,800 and
it goes up so that a family of ten — a
mother, father and eight children or
whatever combination — should fall with-
in an income level of $6,500 a year,"
said Mr. Gleason.

Is there any possibility of eliminating
the income requirement?

"We'd like to see this income criteria
for eligibility eliminated, just saying that
anyone who lives within the area is
eligible. Our observations of what happens
here and who comes here indicate that
the difference between prevention and
treatment for those who don't fall within
the economic levels would not be so great
that we couldn't take care of them," Mr.
Gleason explained.

Volume 56, No. 2

How does the center distinguish be-
tween preventive and comprehensive care?

"The way we distinguish between the
two is what we refer to as child health
supervision which is ongoing supervision
of the well child — periodic checkups,
plus inoculations — preventive care of
that sort and diagnosis. But where pre-
vention and diagnosis cease and actual
treatment of a diagnosed complaint be-
gins we still carry the responsibility for
referring that child to a source of help
that can treat the child. This care is
paid for by Medicaid, insurance or the
family," said Mr. Gleason.

PROBLEMS CREATED

"Economic requirements create too
many problems," said Dr. Lentz. "It
forces the decision making process on the
person at the reception desk as to whether
the person according to his eligibility
is to be treated , . . and before long you
begin to spHt hairs. You make mothers
angry . . . you only need to make one
or two people angry a day over techni-
calities and you destroy your purpose. She
may be over the income limit, but be-
cause of great extenuating circumstances
that really don't become apparent, such
as social problems, everything else . . .
well one's hands are tied. Then you get
into the business 'We can see your child
if he has an illness type of problem,' in
other words, if she comes with a problem
we can take care of it on an emergency
walk-in situation but we can't help if he's
not ill. And, we can't follow the child in
a longitudinal care program."

Mr. Gleason added, "Just on the score
that you never turn away a sick child you
can handle it in the emergency walk-in
situation ... for an acute illness; but then
if you adhere to this income scale thing
maybe you can't take care of that child
on a long-term basis."

CARE PROVIDED

There are three levels of service at the
center.

Emergency Walk-In: Total emergency
care is provided for those who come into
the center. If the child has a runny nose,
fever, convulsions . . . this area is like
a regular outpatient department.

Health Supervision and Total Pre-
ventive Care: Youngsters have a sched-
uled visit planned for the second, third,
fourth, sixth and ninth months the first
year, twice the second, and yearly there-
after. During the visits the child re-
ceives health supervision including
physical measurements such as height and
weight which are compared against a
standard growth curve chart. The parent
during these visits routinely sees the nu-
tritionist, and there also is a standard
program for them to see a dentist at
particular times in the whole health care
plan.

Another part is a blood or hemoglobin
screening for anemia and a quick psycho-
logical test, the Denver Developmental
test, is given by the nurse. The nurse
does the interviewing, looking at any
problems that the mother has, putting
them all together and then calling a doctor
for consultation. Immunizations are also
given in this phase.

Extra Diagnostic Services: Should a
special problem be detected in either of
the first two areas, the child is referred
to a speciality clinic. Among the clinics
at the center are allergy and ophthal-
mology and in some instances the child
may be referred to a regular clinic at the
University. However, a number of the
CPC staff physicians have special talents,
special skills and they take it upon them-
selves to man the speciality clinics and
follow up the kids in chronic care situa-
tions.

April, 1971

"The kids for instance who have
muscular skeletal disabilities and so forth
are sent to me," said Dr. Lentz, "and I
usually consult or see them. If a youngster
has behavioral problems, Dr. McCaffrey
sees those; we have an adolescent program
where we follow teenage pregnancies and
we're in the process of evolving a drug
clinic. Again, serving the population in
our area."

CPC STAFF

The center, which opened its doors in
1967, is staffed by about 85 professionals
including physicians, nurses, dentists,
social workers, nutritionists and psycho-
logists, psychiatrists, radiologists, ophthal-
mologists, obstetricians, gynecologists,
cardiologists and orthopedists. Some are
fulltime, others parttime on a retainer
per clinic basis.

In addition to Dr. Lentz, the center is
administered by Dr. Ray Hepner, director
of research, and Dr. Prasanna Nair, di-
rector of education. The center operates
under the Department of Pediatrics
headed by Dr. Marvin Cornblath.

Is there any volunteer work at the
CPC?

"There are volunteers from the com-
munity— The Citizens Council. Ifs a
very active Citizens Council that has been
developed slowly and has been playing
an important role. We're looking more
and more to them to help us define and
to help us know what they see as needs
in the community in which we are called
upon to serve. These are mothers from
our population," said Dr. Lentz.

CENTER UNIQUE

One uniqueness of the center is the
nursing staff.

"Most centers have as their nursing
staff, clinic nurses who are indigenous to
the unit," stressed Dr. Lentz. "We are
among the few who have public health
nurses who are by training 'the family
practitioner of nursing or family advo-
cate.' "

Each of the nurses is assigned to a
certain census tract and they go when
possible, when needed and regularly to
visit the homes in their area. They are
on a first name basis with these families
and know the problems of the grand-
mother, the brother, the father — the entire
home situation. Two days a week Nurse
"A" is in the field visiting her assigned
census tract and then two days a week
she's in the clinic when children from
her area are scheduled for child health
supervision appointments.

"Another thing that takes place here,
too, is that when those children from a
given census tract come in for their
health supervision appointments, the
Baltimore City Health Department Public
Health nurse who is assigned to that
census tract is usually here to be with the
families as is our PH nurse," added Mr.
Gleason.

The Baltimore City Health Department
nurse has responsibility for all members
of the family not just the children. The

Volume 56, No. 2

duties of the two often overlap but also
are well coordinated.

"For instance if Mrs. Jones, the patient
and her family have a problem and our
nurse detects this in talking with the
mother or notices something herself dur-
ing her home visits, our nurse will call
her city nurse colleague and tell her
about the problem and find out what
she can do about it or she'll seek consul-
tation with someone at the CPC," said
Dr. Lentz.

He continued, "Many times I'll suggest
to the nurse that they (the family) might
contact a certain doctor or clinic or that
she ask the social worker where Mrs.
Jones can get what she needs. The nurse

will either relate that to Mrs. Jones
directly or to the Baltimore City nurse.
This is not by accident, but by design and
there is constant conferencing between
these nurses. This is why I say our center
has a uniqueness to its services."

All of the centers working with the
Baltimore City Health Department have
relationships which make them different.

CPC ROLE

"Ours is affiliated with the University
of Maryland School of Medicine and the
University Health Sciences Campus so
that we have an added role — the responsi-
bility of education in addition to service.
Medical, Dental, Nursing and Social

Work students are able to take part and
observe the operation. So, our program
here is not just service alone. Research
is a smaller part of the overall, total
effort of the people here," said the CPC
director.

Mr. Gleason explained that "the edu-
cation and research are based upon the
service in that educationally the center is
an effort to provide an exemplary instance
of health care for the student and the
house staff."

The research is also service related
because it is directed to evaluating the
service being provided at the CPC. Multi-
phasic screening that is undertaken in
five area schools provides data on cardiac
examinations, vision testing and blood
testing for anemia.

"One means of determining the center's
effectiveness — just a piece in measuring
the total effectiveness — can be shown
through a program in which it was dis-
covered one quarter of the boys in one
school had anemia. We're not saying it
was our operation alone but at least the
input was used to educate the responsible
authorities about the need for adequate
school lunch programs. Now the number
of anemia cases is down to about eight
per cent. So, the collection of data,
which is a research tool, documented
proof of the problem and resulted in our
staff being able to help in alleviating the
problem. That's a small piece in the total
impact on the community."

INNER CITY YOUTH

Inner City youth are plagued not only
by the difficulties of growing up in a con-
fused world, but also by an almost un-
believable excess of disease and dislo-
cation over surburban counterparts. And.
hospitals are filled with children from
these areas suffering from such illnesses
as diarrhea dehydration or old-fashioned

April, 1971

pneumonia which are "totally anachron-
istic."

"We're doing widescale evaluation of
hospitalization rates trying to compare
our service population with a similar
population that doesn't have our services.
As for dislocations, it is not uncommon
that we see dislocated families. The in-
come levels are very low and many times
there is only one parent at home. We find
the young girl going to school and the
grandmother caring for the child. This is a
social type situation," related Dr. Lentz.

A large percentage of the beds in
pediatric wards throughout the city are
filled with children from the Inner City.

"It's safe to say you won't see as many
kids from our census tracts or our re-
sponsible area in hospitals as you would
from other similar areas that don't have
our services. Because if the youngster
comes here with diarrhea or it's the very

beginning of diarrhea or a cold there's
no limitation to his coming back for treat-
ment," explained the CPC head.

"I saw a youngster today and have
seen him every day for the past five days.
He's a small baby and had diarrhea but
we were able to keep on top and follow-
up through our Public Health nurse. So
there's no question we prevented an ad-
mission. Ordinarily he might not have
been taken to a doctor until maybe the
third day of the illness," said Dr. Lentz.

REDUCE ADMISSIONS

For the quarter ending December 31,
1970 with almost 1,500 visits at the
center, only 39 cases were hospital ad-
missions. This is about 12 persons out of
500 and many of those were emergency
walk-in cases who hadn't been seen
previously.

"I definitely think we have had an im-
pact on hospitalization. Dr. Stine. head
of program evaluation, is looking at this
in more concrete terms. What we're talk-
ing about here are subjective observations
and impressions, however, which are
pretty reliable," said Dr. Lentz.

"We have very close supervision of
health care problems and one of the
things is that the youngster doesn't have
to go back to a regular outpatient clinic,
hospital clinic etc. where it's busy and
he must wait and have the burden of the
expense," pointed out the CPC director.
"So many different kinds of things can
be handled right here under one roof.
There's no shuffling them about from
clinic to clinic and from location to lo-
cation."

Last year statistics show that there
were 67.000 contacts between patients
and professional staff. In other words, dur-
ing approximately 25,000 patient visits
(not individuals but patients coming for
treatment) there were 67,000 professional

Volume 56, No. 2

contacts. Each child that came to the
center on the average saw a doctor, nu-
tritionist, social worker and psychologist.

CPC GOALS

Dr. Ray Hepner, director of the CPC
when it was established, once stated the
center's goals as striving "to make contact
with children in the area and assure that
they receive the preventive and curative
services needed, not to duplicate or to
replace any existing services, but to assure
through coordination that the objective —
a better coming generation than the last
one — is achieved."

Some methods through which the
center is trying to "make contact" with
the deprived families:

— A school heart disease screening
program whereby heart specialists use a
special electronic device for rapid heart
examination.

— The installation of computers at the
center to make treatment and services
easy and less time consuming.

— Door to door visits by public health
nurses and consultants.

— Publication of a monthly newsletter

to instruct people in basic health care and
proper living. The newsletter carries
simple, but nutritious meals and tips on
child behavior.

— Counseling on how to buy food at
reasonable prices, how to prevent food
wastage, how to use leftovers, and how
to get the most out of the food stamp pro-
gram.

— Mothers are taught how to nurse
babies properly, how to prevent home
accidents, how to combat infant problems
such as teething, diaper changing, etc.

BETTER GENERATION

In line with creating a "better coming
generation" Dr. Lentz remarked:

"I think that what one is talking about
is that if you are able to improve the
overall health of the child — lower the
morbidity of disease, lower the absen-
teeism in schools, and work with schools
in evaluation of learning disabilities . . .
in that way improving a child's health and
helping them with their education —
that you have an adolescent, a young
adult who will be better off than a person
who was sick with his chronic problems
not cared for, who missed school and
perhaps had problems of identification."

Another way of putting this, said Mr.
Glcason, is "that if we can raise the level
of these children's physical, mental and
emotional well-being they are that much
better able to cope with the problems of
growing up in the kind of environment
they must face every day."

"I think if we have social work to
look at the family problems and try to
help people with their marital problems
and if we work with the schools to im-
prove or work with their learning and be-
havior, we are making efforts to assist the
families in their family organization or
structure. The very fact that we have
a citizens council creates a sense of re-

April, 1971

sponsibility or helps people help them-
selves. If parents see that people are
willing to help them and are available
then there's a different outlook on the
part of the family, and that's what you
really change," said the director.

"If the child is healthier and goes to
school and you help him with his school
problems so that he does better in school,
then you have less problems at home.
The family home situation is improved,
i.e. the better chance of a youngster
growing up in a more supportive, total-
istic manner of being better equipped
to meet adulthood," explained Dr. Lentz.

CPC'S FUTURE

What about the role of the CPC in the
future?

"I think that there will be an attempt
to coordinate — and I'm in favor of it
100 per cent — our cooperation with other
project grants that involve maternal and

infant programs with family practice pro-
grams— adult programs. I see the di-
rection as a family centered program. It
would be my greatest desire if this unit
were responsible and had obligations and
responsibilities for, not just the children
we already serve but their families. There
is no way we can provide total health
care for everybody but if we can improve
the family health in the World Health
Organization's definition of more than
just the absence of disease but better liv-
ing ... we can be the patient-family
advocate with the political community,"
Dr. Lentz observed.

"This area needs help ... we can docu-
ment that there's lead in the houses and
that the heat is bad, and so forth . . .
become the family advocate to improve
a segment of the population. A nice
measure of success might be the re-
duction of crime in the area," concluded
the center's director.

Volume 56, No. 2

v-y

TEACHING MOTHERS— Dr. Misbah Khan, center, directs a discussion with mothers-to-be
about contraception, sex, how to care for a baby and many other subjects during classes
once a week at Edgar Allan Poe Schools No. 1 and No. lA. Looking on as Dr. Khan talks
is, left, Mrs. Hargrove, teacher of family living and home economics, and, right. Dr. Cicely
Williams, visiting professor of pediatrics, University of Maryland.

Teenage Mothers

Students at Edgar Allan Poe Schools
No. 1 and No. lA study the basic three
R's, but share a unique status requiring
special education — a need fulfilled by
staff and students from the University
of Maryland School of Medicine.

Not too long ago these girls who are
pregnant mothers ranging in age from 12
to 20 would not have been permitted to
finish their basic education. Today these
schools, a junior and senior high, are
operated exclusively for pregnant girls
or girls who have recently given birth. The
schools have a total combined enroll-
ment of approximately 3,000.

Since the summer of 1969, the Com-
munity Pediatrics staff as well as medical
students have augmented the curriculum
through once a week classes at each
school. Every girl takes a course entitled
"Laboratory for Effective Living" which
is divided into three units taught by staff
and students from the University in col-
laboration with the school's family living
and home economics teacher.

"People are receiving education about
birth prevention but the young girl who is
already pregnant is often forgotten," said
Dr. Misbah Khan, coordinator of pedi-
atric ambulatory services at University

April, 1971

Hospital. 'The main purpose of our pro-
gram is to prevent the birth of a second
unwanted child."

The course's family living unit stresses
personal, medical, and nutritional care
during the prenatal period, care of the
infant, and includes discussion of contra-
ception, sex information and education.

"These girls are very immature," re-
marked Dr. Eric Fine, chief resident in
Community Pediatrics. "Some girls think
that a baby at birth comes from the navel.
It is our desire to give these girls con-
tinuing health education, and to help cor-
rect any misconceptions they might have
in regard to a variety of health related
subjects."

Dr. Khan explained, "Some of the
girls, especially the junior high girls don't
even know how they became pregnant,
let alone what to expect during pregnancy.
We know of one mother who told her
daughter that you die seven times when
you go into labor. With information like
that, how can you expect a child to go
through her pregnancy without great ap-
prehension?"

The section on family relationships
focuses on the role of the student in the
family structure and attempts to help the
girl understand her responsibilities as a
teenage mother. In a home management
section the girl is given pointers on
budgets and managing a home with
emphasis on purchasing techniques and
distribution of household responsibilities.

Dr. Khan leads the discussions which
cover topics suggested by the girls them-
selves.

"Topics range from drugs to family
planning, jobs, money, taxes, etc.," com-
mented Dr. Khan. "Some of the medical
students assisted in answering questions
regarding drugs."

Questions for the next lecture-dis-

cussion are submitted during the ensuing
week.

Following each laboratory session six
to eight of the girls who are nearest their
delivery dates are given tours of the
delivery room at University Hospital and
Maryland General Hospital. At Mary-
land General the girls are shown slides
by the nursing staff illustrating what
happens in the labor room and through
delivery. These tours are planned and
conducted by the nursing supervisors,
Mrs. Lois Hundertmark and Mrs. M. E.
Messner, University Hospital, and Mrs.
B. Thornton, Maryland General Hospital.

"The cooperation we receive from the
two nursing staffs makes the visits dy-
namic and invaluable in helping the girls
understand pregnancy. The girls become
familiar with the delivery room area, then
they see the nursery. This is to help re-
move any of the girls' fears about giving
birth," stressed Dr. Khan.

Mrs. Vivian E. Washington, principal
of the two schools, describes the girls as
"eager to learn."

Last summer, the Department of Pedi-
atrics, through Dr. Khan's efforts, se-
cured jobs for 14 of these young mothers
in the hospital's pediatric department as
Neighborhood Youth Corps workers.

The two Baltimore schools are open
a 10-month school year plus a six-week
summer session for girls who want to
make up fourth quarter work. The girls
carry a normal school load and get
social and medical counseling.

A student transfers to the Poe School
from her regular school and attends until
she delivers, when she is out from four
to six weeks. After her post partum
checkup, she returns to Poe School and
is transferred to a regular school at an ap-
propriate time in the school year, usually
at the end of the quarter or semester.

Volume 56, No. 2

Those girls who Hve in a certain area
of the city are eligible for free medical
care from the University's Community
Pediatric Center (CPC), until they be-
come 19 years old. Prenatal care is ad-
ministered by the University Hospital's
Department of Obstetrics and Gyne-
cology.

At the CPC, each teenage mother-to-
be is assigned a freshman medical student
who serves as her patient advocate, who
follows her through his four years of
medical school. Dr. Prasanna Nair, as-
sistant professor of pediatrics, is in charge
of the program.

The program is advantageous to both
mother and medical student. The teenage
mother benefits by having her patient
advocate see that she gets proper at-
tention and medical care when she needs
it. The medical student is notified when
the young mother goes into labor and
he helps her through the traumatic shock
of delivery. Thus, he has the opportunity
to establish rapport with a patient in the
first year of his medical education; most
medical students don't have this oppor-
tunity to work with patients so early in
their training. The medical student also
has a chance to become acquainted with
the social aspects relating to his patient's
history as well as learn to function
effectively as a member of a team made
up of a public health nurse, social worker
and nutritionist. After the child is born,
the student maintains a follow-up contact
with the mother and the child during his
remaining years at the University.

Dr. Oscar Stine, associate professor of
pediatrics, has done studies on prema-
turity rate and frequency of death of
infants born to girls who attended School

No. 1 and those bom to girls who did
not. Twelve per cent of the infants bom
to mothers who attended school weighed
less than five pounds while 23 per cent
of the infants bom to the control group
were of low birth weight.

In one year. Dr. Stine found that there
were 13 deaths among babies born to
girls who did not attend the school, arid
no deaths of babies born to mothers who
attended Poe School. Another year
yielded similar results, pointing up the
importance of concern for the mothers'
nutritional, emotional, educational and
medical experience. Dr. Stine found that
infant mortality was greatest for the very
young mothers, for those from the poorest
neighborhoods, and for those mothers
who did not receive prenatal care.

Dr. Stine also convenes a Council for
Teenage Parents during which representa-
tives from the schools of social work,
nursing and medicine meet once every
two months to stimulate further campus
involvement with the problems relating
to teenage parents.

Dr. Khan added, "We try to give them
facts to prevent another unwanted baby.
This program is already too late to pre-
vent one unwanted pregnancy. The
challenge is to prevent another one from
happening. We give them the facts. They
decide their own destiny."

The first edition of the school news-
paper expressed the sentiments of many
of the girls. On the cover, a stork grips
in his beak the traditional baby bundle,
with the words, "The Raven," printed on
it. And, on the last page was Poe's
refrain,

"NEVERMORE."

April, 1971

Profile . . .

Humanitarian,

Physician and

Mother

dt ^

Dr. Misbah Khan

There is no pursuit more worthwhile
in life than man's service for another.

"The need for the world today is man's
humanity to man. The decade 1960-69
was the age when men began to contem-
plate the welfare of all human beings and
the 70's have the opportunity to see this
concept emerge," predicted Dr. Misbah
Khan, Director of Community Programs
and Assistant Professor of Pediatrics,
shortly before returning to West Pakistan.

She added, "The challenge is not
technical or even scientific advancements,
but in reaching out to the hearts of men,
to stir that longing in every human being
to do something good."

Dr. Khan, mother of four children
ranging in age from six to 11, left her
native West Pakistan almost five years
ago to come to the United States for
further formal training in pediatrics and
public health. Since that time she has
become "the spirit and one of the most
dynamic forces in the University of Mary-
land Department of Pediatrics."

Dressed in her native sari, her serene
face, long black hair pulled in a bun and
gentle manners are perhaps contradictory
to her constant drive and concern for all
human beings. However, she feels just
as much at home in Baltimore counseling
teenage mothers on health practices, con-
traception and prevention of teenage
pregnancies as she did expounding the
values of infant care to a farmer's wife
in West Pakistan where she was bom.

Her typical day is packed with co-
ordinating community projects and even
though she has a busy schedule she's
never too busy for a mother, child,
student, or visitor to consult her. Dr.
Khan sees no other way than to involve
herself in community programs. Her
husband and children live with her in
Baltimore.

Dr. Marvin Cornblath, Professor and
Head, Department of Pediatrics, called
Dr. Khan "one of the most unusual hu-
manitarians . . . women . . . physicians,
human beings and mothers . . . it's been a

Volume 56, No. 2

privilege to know and work with her.
You go through life and only meet one
person like her. She has the ultimate
concern for every human being by doing,
not planning ... by doing what she can
to help each and every one.

"She is the spirit and one of the most
dynamic forces in our department. As my
first chief resident she worked with a
total house staff of nine . . . it's now up
to 21 and by July it'll be 28. As we've
added new staff Dr. Khan has found five
meaningful jobs for them in which they,
the staff, the patient and the medical
student have always gained, or benefitted.

"She is an irreplaceable loss. We'll con-
tinue to seek and achieve our missions
and goals, but we'll never be able to do,
without her, what we could have done
with her."

"She's a beautiful person . . ."

"Dr. Khan is one of our most active
and effective teachers at the student and
house officer level. She is a catalyst among
the various paramedical personnel as re-
lates to the patient and has taught all
of us what the 'team' approach to the
patient and his problem really is," said
Dean John H. Moxley, III. "Her talents
and personality will be missed when she
returns to West Pakistan."

Dr. Khan served as pediatrician to
the United Christian Hospital in Lahore
from October 1962 to June 1966 as well
as being the only pediatrician at the West
Pakistan Research and Evaluation Center
in Lulliani. She came to the United States
in 1966 to obtain additional formal train-
ing in pediatrics and in public health. Dr.
Khan holds certification from the Ameri-
can Board of Pediatrics and has a master's
degree in Public Health from Johns
Hopkins School of Hygiene and Public
Health. She has been on the Pediatrics

faculty for two years and has been in
charge of developing, evaluating and
implementing community programs in the
Department of Pediatrics, University of
Maryland School of Medicine.

Under the direction of Dr. Cornblath
and Dr. Khan, a wide spectrum of com-
munity programs have been initiated and
implemented. With Dr. Khan's return to
Pakistan at the end of March, Drs. Murray
Kappelman and Eric Fine will assume
these responsibilities.

"Perhaps the inner cities, ghettos, and
slums with their unforgiveable living con-
ditions for the masses of people exist
as they are today because we are what
we are. The changes may lie in the
out-reaching hands of the students today,
the builders of the future who have not
yet reached the pinnacle of their contri-
butions nor inflexibly established their
beliefs nor have had their say as have
some of their professors," the Pakistani
physician observed.

Dr. Khan made the preceding observa-
tion in establishing a home care program
in which pediatric patients can be treated
with much more thoroughness and with
less expense at home than in a hospital.
In such a program better perspective is
obtained of the child's total needs.

"As a teacher, we fail our students
if we teach them only the pathology of
disease. We neglect them if we do not
invest an awareness of all the facets of
the circumstances that surround the child
at the time of his illness," she explained.

Dr. Khan continued, "The child and
his illness are immeasurably affected by
the family constellation, the home con-
dition, the hygiene, the plumbing, the
roaches, rats, the physical and mental
health of the family members as well as
the neighbors. There is an area to be

April, 1971

covered in obtaining the history of the
ill child which is rarely taught in the
medical schools and rarely observed by
those people involved in the child's care;
the quality of the child's life,"

Speaking of her work with the preg-
nant girls at Edgar Allan Poe Schools
No. 1 and No. lA. Dr. Khan said:

"This is the time when these young
girls need the most help. They need infor-
mation on prenatal care, advice on how
to plan for their lives and most of all
how to prevent further unwanted pregnan-
cies. You can't shut your eyes and ignore
these girls. They need help not condem-
nation. It is easier to condemn them
than it is to take care of their problems."

The objectives of the teenage mother
program are to augment the school's
educational program, provide antenatal
and well baby care as well as impart in-
formation regarding family planning, job
objectives, planning for the future, better
utilization of existing services, and sex
education.

Other community programs in which
Dr. Khan plays a role:

Maryland State School for the Blind —
The Department of Pediatrics since June
1969 has undertaken the total medical
care of the State of Maryland's blind
children registered at the school. This in-
volves delivery of comprehensive health
services including psychiatry, dentistry,
nutrition and obesity studies as well as
the use of nurse practitioners.

The Community Pediatric Center —
This center offers comprehensive medical
services to a child population of about
10,000 children. This program involves
service, education and research as well
as continuing evaluation.

Citizen's Council — In line with the Uni-
versity of Maryland's deep commitment
to the inner city community a Citizens
Council was established consisting of
parents using Pediatric Services, com-
munity leaders, representatives of service
personnel in the Department as well as
representatives of community agencies.

HOUSE STAFF 1968-69— Dr. Misbah Khan is shown with other members of the Department
of Pediatric's house staff when she was Chief Resident. Front row, left to right. Dr. Jane
.McCaffery, Dr. (iary Fleming, Dr. Marvin Cornblath, professor and head. Department of Pedi-
atrics, Dr. Khan, and Dr. Eric Fine. Back row, left to right. Dr. Robert Gingell, Dr. Shih-Wen
Huang, Dr. Kenneth Koskinen, Dr. John Ignatowski, and Dr. Theodore Wolfe.

Volume 56, No. 2

You are cordially invited to attend

THE FIRST ANNUAL

MISBAH KHAN

LECTURE IN PROBLEMS OF
WORLD HEALTH

SponioreJ by

The Pediatric Di-p.irlment
UNIVERSITY OF MARYLAND

SCHOOL OF MEDICINE

12 NOON

THURSDAY. FEBRUARY 25, 1971

CONrtRENCr. ROOM 1-704

UNIVERSITY or MARYLAND HOSPITAL

BALTIMORE, MARYLVND

"This certificate is presented to Dr.
Misbah Khan in recognition and in ap-
preciation of her immeasurable contri-
butions to the Department of Pediatrics,
to mothers, to children, to the community
and to the State of Maryland. Teacher,
friend, physician, humanitarian, citizen
of the world . . . Dr. Khan's place in the
department and in our hearts will be
forever honored for her compassionate
service to all. A woman of action, gentle
but firm, dynamic yet patient Misbah
Khan's foremost concern is always man's
humanity to man. Her example, her con-
tributions, her devotion, her achievements
will remain always as a goal for all to
emulate."

February 25, 1971

Marvin Cornblath
Professor and Head
Department of Pediatrics

Fellowship in the Maryland State
Health Department — In October 1970 a
program was begun with the State Health
Department in which resident physicians
become acquainted with problems of the
community and administrative medicine.

Neighborhood Youth Corps In-School
Program — In April 1970 a program was
initiated for 16 high school youngsters
in areas of service such as nursing, secre-
tarial, laboratory, child life, etc.

Dr. Khan cannot stress enough the im-
portance of infant and child care. When
she returns to her home she hopes to
begin a program of comprehensive ma-
ternal and child health services on family
planning and family health in rural
villages.

"To preach birth control to a woman
in the village who knows nothing about
childhood diseases, nutritional values and
preventive medicine is wrong," said Dr.

Khan.

She says the basic needs of health
measures in Pakistan are water supply,
waste disposal and compulsory immuniza-
tion.

"We need legislative measures to give
health care the first priority," she said.
"The need of Pakistan is in implementing
ways to train health aides and utilizing
available resources from the women of
the village so they can staff village clinics
and augment the shortage of doctors.
She said that 93 per cent of the country's
population is concentrated in villages.

Dr. Khan, who will be chief of pedi-
atrics. United Christian Hospital, Lahore,
West Pakistan, would like to see two
things accomplished in her country dur-
ing her lifetime: compulsory immuniza-
tion and compulsory education.

She concluded: "Values and needs of
human beings are the same everywhere."

April, 1971

RAMSAY NAMED

Dr. Ramsay

Dr. Frederick J. Ramsay has been named
Assistant Dean, Student Affairs, by Dean
John H. Moxley, III.

He succeeds Dr. George A. Lentz, Jr.,

who has assumed the directorship of the
Community Pediatrics Center (CPC) full-
time.

"The Office of Student Affairs is the pri-
mary link between the students, the faculty,
the administration, the alumni and other
groups," said Dr. Ramsay.

He added. "We are charged with the
responsibility of overseeing the distribution
of scholarships, loans and grants in aid;
the management of student activities;
scheduling senior elective opportunities and
miscellaneous registrar functions, and for
both personal and professional counseling."

Dr. Ramsay chairs the Advancement
Committee, Student Activities Committee,
the Scholarship and Loan Committee, and
the Honors and Graduation Committee. He
is a member of the Curriculum Committee,
the Internship Advisory Committee and the
Senior Elective Committee.

"Future plans call for the establishment
of a housing bureau, a job placement service
and an extensive student advisory system,"
said Dr. Ramsay.

In July 1970, Dr. Ramsay was named the
first director of the Office of Research in
Medical Education. It was established to
study the school's present curriculum and
to plan changes that would fit the needs
of changing medical practice and the de-
mands of a changing society.

Dr. Ramsay, who taught Anatomy at the
medical school from 1964-69, spent a year
at the Center for the Study of Medical
Education conducted by the University of
Illinois School of Medicine in Chicago.

In addition to directing the Office of Re-
search in Medical Education he has con-
tinued to teach embryology.

The Baltimore native, also an ordained
Episcopal minister, was raised on the
McDonogh campus where his father, A.
Ogden Ramsay, has taught Biology for
over 40 years. He himself earned a bache-
lor's degree in Biology at Washington and
Lee University, Lexington, Va., and re-
ceived M.S. and Ph.D. degrees in Anatomy
and a M.E.D. in Medical Education from
the University of Illinois School of Medi-
cine.

Also a Baltimore native, Dr. Lentz suc-
ceeds Dr. Ray Hepner, who is now Di-
rector of Research for the CPC.

Dr. Lentz received his M.D. from the
University of Maryland School of Medicine
in 1957 after attending Johns Hopkins Uni-
versity for his A.B. degree. He interned, held
his Pediatric residency and later a fellow-
ship in Physical Medicine Rehabilitation at
the University of Maryland Hospital. He
was assistant professor of Pediatrics 1964-
68. Currently he is an assistant professor.
Physical Medicine and Rehabilitation, and
an associate professor of Pediatrics.

His hospital appointments include: chief,
Department of Pediatrics, Lutheran Hospi-
tal, 1964-67; pediatrician, James L. Kernan
Hospital for Crippled Children, and pedia-
trician. University of Maryland Hospital.
He is also medical director. United Cerebral
Palsy Center of Baltimore, Inc., and di-
rector, Mental Retardation Center.

Vohiine 56, No. 2

Would you, could you
on a boat?

Eat Green Eggs
and Ham . . .

April, 1971

Volutne 56, No. 2

Anything Is Possible
In the World of Kids

JFT OfRTRUW UF HMt£\
CE AU mill! B(AJCS AMD
IV HFt Mac HOMF IT
" " T TWOWHKS

' IT TOOH ALMOST
'THlVWnKMOftl tOPUll
imfcf FIATMtRS

(JOmiUOl WAS SOPF

On the 5th Floor
Pediatrics Ward

AT UNIVERSITY HOSPITAL

'^ Dr. Seuss Drawings designed by Carol Stretch and painted by
Joseph Ford, both art students.

April, 1971 31

AMBULATORY NURSING

The Department of Ambulatory Nurs-
ing Services is undergoing a period of
change as the University Health Science
Center begins to respond to the need for
improving the delivery of health services
and the health manpower shortage.

"Because there is an increasing empha-
sis on ambulator}' care as well as an in-
crease in the number of patients, the
Ambulatory Health Services staff has
sought more effective means of delivering
the best health care to the greatest num-
ber of people," stated Dr. William S.
Spicer, associate dean for Health Care
Programs. "Among the ways this may
be achieved are through Nurse Oinics
and further education of the nurse."

In present and future programs, the
Ambulatory Nurse may participate as a
nurse practitioner or care team leader,
and may supervise preventive mainte-
nance and surveillance clinics for chronic
diseases, direct screening and triage
functions. She may also provide leader-
ship in community health situations,
specialty emergency and treatment roles,
patient education and family planning.

"With the creation of new educational
programs, careers, primary and specialty
health care teams, the nurse will play
an expanded, pivotal role in the six C's
of good care: continuity, coordination,
compassion, competence, comprehensive-
ness, and community responsibility and
involvement," Dr. Spicer added.

In November, Dr. Samuel T. R. Revell.
chief of the Medical Clinic. Mrs. Rachel
Booth, RN, associate director of Nurs-
ing, and Mrs. Rose Rieger, RN, team
leader for the Medical Clinic, with the
cooperation of the nurses on her team,
initiated plans for a "Nurse Clinic" in
Ambulatory Services. A group of patients
with the diagnosis of diabetes mellitus

was selected for the first clinic. A proto-
col outlining patient care was developed.

In the Nurse Clinic the physician
makes the initial diagnosis, prescribes
specific therapy, and refers select patients
to the nurse. The nurse accepts the re-
ferral, provides a continuing surveillance
of the disease and promotes the mainte-
nance of health through observation and
teaching. Plans have been made to refer
the patient back to the physician for
periodic examinations and consultations.

"Nurses and physicians have recog-
nized the need to determine their func-
tions and roles in order to maximize the
utilization of each profession. It is be-
coming increasingly evident that compe-
tent professional nurses can make tre-
mendous and independent contributions
to the maintenance care of patients with
such chronic diseases as obesity, hyper-
tension, diabetes mellitus, pulmonary dis-
ease and psychosomatic disorders," Dr.
Spicer explained.

At the University of Maryland, an ex-
tensive staff development program in
Ambulatory Nursing is being planned to
prepare nurses for their responsibilities in
this area. A staff development committee,
formed last year, is offering lecture series,
conferences, films and classes on subjects
basic to progressive nursing.

One of the presentations which was
given by Drs. Leonard Scherlis, Jerry
Salan and other members of the Division
of Cardiology was on intensive coronary
care. In a series of ten demonstrations,
the nurses learned about cardiopulmo-
nar>' resuscitation, coronary artery disease,
electrocardiography, and aarhythmias in
order to extend effective therapy for
cardiac emergencies from the intensive
care units to Ambulatory Services and,
hopefully in the future, into the com-
munity.

Volume 56. No. 2

The Electrodiagnosis of
Neuromuscular Disease

Frank Kemble, M.D., M.R.C.P.

Neuromuscular disorders are caused by
diseases of the lower motor and sensory
neurones. They are best diagnosed by
clinical criteria but when clinical differ-
entiation is difficult, then reliance must

Instrumentation

AVERAGER.

be placed upon electrodiagnostic, histo-
logical and biochemical investigations. '

This article describes the basic electro-
diagnostic procedures together with their
usefulness and limitations in differentiat-
ing neuromuscular disease.

OSCILLOSCOPE.

trigger input

for timebase.

STIMULATOR.

AMPLIFIER.

ISOLATING
TRANSFORMER

[or unit]

VDXSt

fflrcro

recording
elect rodes.

stimulating
electrodes.

Fig. 1

The above diagram of the equipment
layout (Fig. 1) is fairly self explanatory.
An averaging device or an oscilloscope
may be used for recording nerve and
motor unit potentials.

Electrodiagnostic Procedures

A simple classification of electrodiag-
nostic neuromuscular procedures is given
below. These will then be described more
fully in the text.

April, 1971

A. Nerve Conduction

1. Sensory and motor conduction

2. (H) reflex testing

3. Strength-duration curves

B. Muscle Sampling

Sensory and Motor Nerve Conduction:

The technique for measuring nerve
conduction involves applying a stimulus
to a peripheral nerve and then recording
the transmitted nerve or muscle action
potential so that a conduction time or
latency is obtained between the stimulus
artifact and the action potential.

The stimulus is a product of current
duration and strength, the latter being
measured in either amperes or volts.
Either one of the three variables, i.e.,
time, amperage, or voltage, can be varied
leaving the other two constant.

The availability of peripheral nerves
for testing depends upon their relation-
ship to the surface of the extremity.

This means that some nerves are
particularly accessible to testing, such
as the median and ulnar nerves in the
arms, the common peroneal and pos-
terior tibial nerves in the legs, and the
facial nerves. Other nerves are more
difficult to test because they lie some-
what deeper, buried within the soft
tissues of the extremities. These in-
clude the radial and musculocutaneous
nerves in the arm and the femoral and
sciatic nerves in the leg. Conduction
is extremely difficult to measure in
nerves other than those listed above.

The relationship of peripheral nerves
to the surface also limits the extent to
which nerve conduction can be measured
along their course. The following is a list
of peripheral nerves and the extent to
which conduction can be measured along
their course:

median nerve — digits up to the axilla
ulnar nerve — digits up to the axilla
radial nerve — digits up to the axilla
common peroneal nerve — digit up to

the sciatic notch
posterior tibial nerve — digit up to the

sciatic notch
femoral nerve — mid thigh up to the

groin
facial nerve — the stylomastoid foramen

to the facial musculature

Typical muscle action potential (A- ampli-
tude 3000^;^ V) and sensory nerve action po-
tential (B-Amplitude 100^ V).

Fig. 2

Sensory and motor conduction can
both be measured in peripheral nerves.
Sensory conduction may be affected (de-
layed) before motor conduction in many
neuropathies and, therefore, may be a
more sensitive indicator of disease than
motor conduction. However, a sensory
nerve action potential (SNAP) is between
25 to 200 times smaller than a muscle

Volume 56, No. 2

action potential (MAP) and is, therefore,
more difficult to record (Fig. 2). Sensory
recording is further complicated by the
fact that snap's decrease in amplitude
with increase in age and with lowering
of limb temperature, therefore under
these two conditions (age and low
temperature), measurement of the small
snap's can be extremely difficult and
inaccurate. These problems can be over-
come to some extent by warming limbs
before testing and by summating re-
sponses on an averaging device which
summates any constant baseline abnorm-
ality and rejects inconstant variations
from the baseline.

Reduced peripheral nerve conduction
is the most obvious measure of peripheral
nerve disease. Less constant abnormalities
include decrease in the amplitude of the
MAP and SNAP, increase in their dur-
ation and alterations in refractory periods
with paired stimuli.

Nerve fiber conduction velocity is pro-
portional to nerve fiber diameter, the
fastest conducting fibers being those of
the largest diameter (nerve liber diameter
in fji X 6 — the velocity of conduction
in meters/second).

There are two likely conditions which
cause reduced conductive velocity. The
first is segmental demyelination, either
limited to a segment of a nerve fiber or
affecting the nerve fiber along the whole of
its course. The second is regeneration of
nerve fibers after Wallerian degeneration.
(This must presume that all fibers in a
peripheral nerve degenerated initially,
since theoretically only a few fibers of
normal diameter need to survive for nerve
conduction to be maintained. This latter
state of affairs sometimes occurs in motor
neuron disease and poliomyelitis, i.e.,
diseases which involve the anterior horn
cells).

Detailed steps in the measurement of
median nerve conduction will now be
described since the basic technique is
similar for other peripheral nerves.

1. Make sure that the limb is warm
which means that either the surface
temperature must be over 30 °C or the
room temperature must be over 26 °C.

2. Apply a weak stimulus to the
skin above the wrist and find the point
which will evoke the maximal visible
twitch of the thenar muscles. Mark the
stimulating point and the one of maxi-
mal muscular twitch, and then repeat
using the same technique medial to
the bicipital tendon at the elbow and
at the axilla. These "stimulating" points
can now be used for stimulating (motor
conduction) and for recording (sensory
conduction), since we now know that
at these points the median nerve is
at its closest to the surface.

3. Evoke a SNAP by stimulating
either the index finger or all of the
median innervated fingers with ring
electrodes and record the evoked re-
sponse at the wrist, elbow, and axilla.
The conduction times are measured
from the onset of the stimulus artifact
on the oscilloscope to the peak of the
initial positive (downward) deflection
of the SNAP. These conduction times
are measured upon an oscilloscope or
averaging device which has two beams,
one of the beams being used to record
the SNAP, the other being used to
record a time base measured in milli-
seconds (1,000th of a second).

4. Measure the distances between
the proximal ring electrode and the
distal electrode of the pair of recording
electrodes at the wrist, elbow, and
axilla. These measurements are usually
made in centimeters by using a metal
tape measure.

April, 1971

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Volume 56, No. 2

5. There are now available three
conduction times (Fig. 3) which
represent sensory conduction between
finger and wrist, finger and elbow, the
finger and axilla respectively. Con-
duction times between the wrist and
elbow and between the elbow and
axilla can now be calculated by simple
subtraction. These conduction times
in milliseconds are now divided into
the conduction distance in centimeters
which gives a velocity measured in
centimeters per millisecond or which
can, in turn, be completely multiplied
by 1,000 to give a velocity in meters
per second. It must always be re-
membered that theoretically the sensory
velocity measures the rate of con-
duction of the fastest (largest) digital
sensory nerve fiber. Sensory conduction
can also be measured up the arm fol-
lowing stimulation of the median nerve
trunk at the wrist.

6. Motor conduction can be meas-
ured in a similar way, if it is remem-
bered that on this occasion we are
stimulating at either the axilla, elbow,
or wrist and recording over the thenar
muscles, and also remember that the
terminal motor conduction time is a
compound time, not simply resulting
from nerve conduction but also result-
ing from conduction in the terminal
branches of the fibers of the median
nerve together with delay at the neuro-
muscular junction. It can, therefore,
only be used empirically as a measure-
ment of neuromuscular conduction
against a set of normal values.

7. Approximate normal values for
median nerve conduction:

Distal motor latency — 2 to 4
msec.

Motor conduction, wrist to el-
bow— 56 ±10 M/sec

Motor conduction, elbow to
axilla— 65 ± 10 M/Sec

Sensory velocity, finger to wrist
—60 ± 10 M/Sec

Sensory velocity, wrist to elbow
—62 ± 10 M/Sec

Sensory velocity, elbow to axilla

—72 ± 10 M/Sec

Radial and ulnar nerve conduction can
be measured in a similar way to median
nerve conduction. When measuring in the
legs it must be remembered that con-
duction is slightly reduced in the per-
ipheral nerves of the leg compared with
the arms.

Abnormalities of Nerve Conduction
may involve many peripheral nerves,
single nerves or only segments of one
peripheral nerve.

Localized delay is seen in the so-
called "entrapment" neuropathies, such
as in the median nerve at the wrist
in the carpal tunnel syndrome, the
ulnar nerve at the elbow, and the
lateral popliteal at the head of the
fibula. The conduction measured in
other segments of these nerves is
normal.

Generalized delay in all of the
measurable nerve segments is seen in
the aff"ected nerves of polyneuropathies
or mononeuropathies.

Marginal or no delay of nerve con-
duction is seen in either radicular les-
ions or in lesions involving either the
dorsal root ganglion cells or the an-
terior horn cells. It should be noted
that the evoked muscle action potential
may be polyphasic in all three of the
above groups compared with normal
potentials.

April, 1971

SPINAL CORD

^A-V

2msec
MiiiiiiinniiniiiiiiiiK

Fig. 4

A — "H" reflex testing; The stimulus at S evokes a response recorded by R.
B to G show the recorded H and M responses with increasing stimulus strength.

"H" Reflex Testing

"H" reflex testing is the electrophysio-
logical equivalent of the tendon jerk
(muscle stretch reflex). The basic
principle is that a weak threshold stimulus
which is lower than that used to stimulate
motor fibers will evoke a response. "H",
at a latency of approximately 25 to 30
milliseconds from the stimulus artifact
(B to D — Fig. 4). This is due to con-
duction proximally along the spindle
afl"erent tibers, across the monsynaptic
junction of these fibers with the anterior
horn cells, and then down the motor nerve
fibers to cause a muscular twitch in the
triceps surae muscle. Upon increasing the
threshold of this weak stimulus, a second
response is recorded which has a much
shorter latency (E to G — Fig. 4). This is
the direct response from stimulating the

motor nerves to the triceps surae muscle
and is called the "M" response. The
amplitude of the M or muscle response
increases with increasing strength of the
electrical stimulus and, in turn, the ampli-
tude of the '"H" or late response de-
creases. The practical significance of this
reflex is that the "H" wave amplitude
is increased and the "H" reflex cycle to
paired stimuli is abnormal in extra-pyra-
midal or pyramidal tract lesions, and the
reflex may be abolished or delayed by
diseases which afl'cct the muscle spindle
or nerves.

Strength Duration Curves

Strength-duration curves (S-D curves)
have been supplanted in the majority of
instances by a combination of muscle
sampling and nerve conduction which are

Volume 56, No. 2

50 mA^

totally denervated
muscle

stimulus
intensity

partially denervated
muscle

chronaxie

rheobase

100 msec.

Typical strength
muscle.

current
duration

Fig. 5
duration curves in normal muscle, partially and completely denervated

simpler and probably technically easier
to perform. Strength-duration curves are
interpreted by utilizing certain neuro-
physiological principles. Firstly, tissues
vary in their excitatory thresholds and
also in their decay rates. Secondly, the
decay rate is a measurement of the in-
creased duration of stimulus needed as
the stimulus threshold reduces. Thirdly,
muscle fibers have a low decay rate and a
high excitatory threshold and are best
stimulated by long duration currents (see
Fig. 5). Nerve fibers have a high decay
rate and low excitatory threshold and,
therefore, respond better to short duration
stimuli (see Fig. 5).

The significance of strength duration
curves is that they indicate denervation
and were used for following the pattern
of regeneration following denervation. As
can be seen in the diagram (Fig. 5), a
partially denervated muscle will exhibit a

curve which is intermediate between the
strength duration curves for totally de-
nervated and normal muscle. Totally de-
nervated muscle gives a S-D curve equiva-
lent to that of isolated muscle.

The chronaxie and rheobase are
measurements used to quantitate strength
duration curves. The chronaxie is the
duration of current needed to cause
muscular contraction by using a current
strength of twice the rheobase. The rheo-
base is the lowest strength of current
needed to stimulate a particular muscle
regardless of the duration of the current
flow.

Normal muscles respond vigorously to
Faradic stimulation (A/C) for as long
as the current is passing. They respond
to Galvanic stimulation (D/C) only
when the current is made or broken. In
a lower motor neuron lesion, there is no
response to Faradism after 5-7 days be-

April, 1971

cause of the short current duration (Fig.
5), but there is a response to Galvanism
which, however, requires a stronger
current than in the normal muscle (see
S-D curve complete denervatcd muscle
in Fig. 5). This change of response to
Faradic and Galvanic stimulation by de-
nervatcd muscle is called the reaction of
degeneration. It has been supplanted by
charting strength/duration curves, and in
practical terms the latter have been sup-
planted by muscle sampling and nerve
conduction studies.

Muscle Sampling

Muscle sampling is performed by in-
serting a needle recording electrode into
the muscle to be tested and electrical
activity is observed upon an oscilloscope.
The instrumentation is no different from
that used for conduction studies other
than the fact that the time base is "com-
pressed" by using 20 msec, to cover ap-
proximately 1 cm. instead of 1 msec/cm.
as with nerve conduction. The oscillo-
scope tracing is set to run continuously so
that immediately the trace "runs off" one
end of the oscilloscope it then reappears
at the opposite end. This enables visuali-
zation of many MUP's together.

The next step is to observe for spon-
taneous electrical activity in the muscle
at rest after, but not during, insertion of
the needle electrode. Normally a muscle
is absolutely silent at rest but in patho-
logical conditions abnormalities may be
found such as fibrillation potentials,
positive sharp waves, fasciculation po-
tentials and myotonic discharges.

Fibrillation potentials (Fig. 6) indi-
cate denervation, are found five days
after denervation has commenced and
are found at their most profuse level
between 15 and 20 days following
denervation. They may persist for
months or even years. They exhibit a

Fig. 6

Fibrillation potentials and a positive sharp
wave.

high pitched crackling noise on the
audio link from the oscilloscope and
repeat themselves regularly, like the
crackling of fat in a frying pan. The
following are parameters of fibrillation
potentials :

a. amplitude, 10 to 600 microvolts
(average less than 100 micro-
volts)

b. duration. 1 to 2 msec.

c. disphasic and occasionally tri-
phasic

d. 2 to 30 second intervals (aver-
age 10 second intervals)

Positive sharp waves (Fig. 6) also
indicate denervation and have been at-
tributed to the synchronous discharge
of a number of denervated muscle
fibers, compared with a fibrillation po-
tential arising from a single completely
denervated muscle fiber. They have a
dull, thud-like sound on the audio link
from the oscilloscope. The following
are parameters of these positive sharp
waves:

a. variable voltage

b. duration up to 100 msec.

c. disphasic

d. 2 to 100 second intervals

Fasciculation potentials are at-
tributed to the spontaneous firing of

Volume 56. No. 2

motor units. They are found in the
presence of denervation (especially in
anterior horn cell degeneration), nerve
root "irritation," and in benign
myokymia. They, therefore, may or
may not indicate denervation when
found on their own.

Fig. 7

A polyphasic motor occurring in a denerva-
tion fasciculation, together with fibrillation
potentials.

Denervation fasciculations (Fig. 7)
have the same parameters as the poly-
phasic potentials evoked by voluntary
contraction. One exception is the large
(often > 10 mV) fasciculation po-
tentials sometimes seen in anterior horn
cell degeneration and less often in
chronic neuropathies.

Fig. 8

Triplets of triphasic potentials occurring in
fasciculations of motor root irritation.

In nerve root irritation, the fascicula-
tion potentials are usually di- or tri-
phasic and not polyphasic. They
characteristically tend to occur in
groups of 2 or 3, called doublets or
triplets (Fig. 8).

^^^^^^!^^B

■

^ss^^^^^^i

Fig. 9

A group of normal MUP's occurring in a
fasciculation of benign myokymia.

In benign myokymia, the fasciculation
potentials may not be polyphasic if
recorded with a bipolar needle elec-
trode. They tend to occur as a cluster
of spontaneously but normally formed
MUP's (fig. 9). Contraction fascicula-
tions appear as groups of normal
MUP's evoked by minimal movement
and are therefore not spontaneous.

Fig. 10

Spontaneous myotonic discharge of simple
short duration action potentials.

Myotonic discharge occurs spon-
taneously and wanes both in amplitude
and frequency with a sound like a dive
bomber. The individual action po-
tential parameters may vary between
a normal muscle action potential and
a fibrillation potential, and some of
these are probably due to sarcolemmal
membrane abnormality. The most
characteristic potentials are of short
duration and of low voltage (Fig. 10).
Prolonged myotonic discharge is

April, 1971

characteristic of clinical myotonia.
Repetitive high frequency discharge
which is unsustained can be found in
clinical myotonia but also in other
neuromuscular disorders and even in
apparently normal persons.

Having observed the absence or
presence of electrophysiological activity
at rest in the muscle to be tested, we now
proceed to observe if there are any motor
unit potentials following contraction by
the patient of the muscle against the in-
serted needle recording electrode. By
this means, scattered, individually dis-
persed, motor unit potentials may be re-
corded. These can be observed and photo-
graphed for parameters such as the ampli-
tude, duration, number of phases, etc.

The characteristic normal motor
unit potential evoked by muscular con-
traction has the following parameters,
however, these can vary considerably
with different muscles.

amplitude, 100 to 2,000 microvolts

duration, 5 to 15 msec.

number of phases, 2 to 4 (usually 3)

recur at 2 to 25 second intervals

They have a plunk-like sound on the
radio link from the oscilloscope.

There are 2 types of abnormal motor
unit potentials, both of which are poly-
phasic, and indicate neuromuscular
disease. One type consists of polyphasic
muscle action potentials with similar
parameters to normal MUP's other
than the extra number of phases.

\r f f /:z3

SIMPLE MONOPOLAR NEEDLE
RECORDING ELECTRODE WITH
DISTANT INDIFFERENT ELECTRODE.

"MONOPOLAR" CONCENTRIC
NEEDLE RECORDING ELECTRODE.

BIPOLAR CONCENTRIC NEEDLE
RECORDING ELECTRODE.

Fig. 11

Volume 56, No. 2

These potentials probably indicate rein-
nervation and their parameters are
listed below.

amplitude. 20 to 5,000 microvolts

duration, 2-25 msec.

number of phases, 5-25

recur at 2 to 50 second intervals

They have a typically rasping char-
acter on the audio link from the oscillo-
scope.

It has been stated that these poly-
phasic potentials occur in between 1
and 12 per cent of normal individuals,
but they are not usually found when
using bipolar needle electrodes which
considerably limit the pickup or record-
ing area (see Fig. 11). It may well be
that the previous description of poly-
phasic potentials occurring in normal
individuals was due to distant record-
ing by simple monopolar or mono-
polar concentric needle electrodes from
a greater area than when recorded with
bipolar electrodes. Thus, a distant po-
tential superimposed upon one lying
closer to the needle would give the
appearance of simple single polyphasic
potential. Giant polyphasic units with
amplitudes of over 10 millivolts are
often found in anterior horn cell de-
generations. These giant units occur
less often with more peripheral de-
nervation and subsequent regeneration
with peripheral sprouting; e.g., in
chronic polyneurophathies.

The second type of abnormal motor
unit potentials are of low amplitude
and short duration and are character-
istic of primary muscular disease. Their
parameters are at the lower end of
the normal range for muscle action
potentials with regard to amplitude and
duration. They may even simulate
fibrillation potentials (100 microvolts
amplitude and 1-2 seconds duration),

although they obviously occur only on
volition. They have a characteristic
high pitched noise and many of them
are polyphasic.

The pattern of motor unit potentials is
now observed following a maximal
sustained voluntary contraction by the
patient. There are three typical patterns.

Fig. 12

Development of maximum muscular
contraction in a normal muscle (Fig.
12) gives a typical crowded grouping
of MUP's with similar amplitudes.

Fig. 13

Denervation is characterized by a
marked reduction of the total number
of motor units on maximum muscular
contraction (Fig. 13). Many of the
surviving motor units are polyphasic
and smaller than normal in the early
stages of the disease. Later the pattern
changes in that the surviving polyphasic
units may be of larger than normal
amplitude. This pattern is often de-
scribed as a discrete motor unit pattern.

Fig. 14

Potentials characteristic of primary
muscular disease are reduced in ampli-
tude and duration (Fig. 14). When
many of these MUP's are evoked by a
maximum muscular contraction, they
give an appearance of being crowded
together (more MUP's per con-
traction).

April, 1971

Typical Findings in Various
Neuromuscular Diseases

Typical electrophysiological findings in
neuromuscular diseases are tabulated be-
low.

A. Peripheral Neuropathy

1 . nerve conduction

a. This is usually impaired after
one or two weeks (sometimes
earlier)

b. Sensory conduction is impaired
more than motor conduction
but often the former can only
be tested satisfactorily in the
arms since no SNAP's are re-
cordable in the legs.

c. All of the nerve segments be-
low the elbow show a pro-
portionate decrease of nerve
conduction, while axillary con-
duction may be normal.

2. muscle sampling

a. Spontaneous fibrillation po-
tentials, positive waves and
fasciculation potentials appear
after the first week. On mini-
mal muscular contraction poly-
phasic motor units are seen and
on full muscular contraction a
discrete motor unit pattern
occurs.

B. Mononeuropathies (e.g., polyarteritis
nodosa)

Nerve conduction and muscle sampling
findings are similar in all respects to those
found in polyneuropathy except that they
are limited to the distribution of one
peripheral nerve.

C. Entrapment Neuropathies
1 . Nerve conduction

a. There is a localized reduction
of motor and sensory con-
duction at the site of entrap-

ment with normal proximal and
distal conduction. In the
median nerve there is delayed
conduction across the wrist in
the carpal tunnel syndrome,
but normal conduction may be
found both distally and proxi-
mally. In practice, it is not
easy to measure conduction
just across the wrist or in the
fingers alone, therefore a signifi-
cant finding is taken as delayed
conduction below the wrist,
which is the average of normal
conduction distal to the carpal
ligament and delayed con-
duction across the carpal liga-
ment.

b. muscle sampling — exhibits ab-
normalities which are identical
to those described in A and B.

D. Proximal neurogenic lesions are those
lesions which afifect the anterior horn
cells and the motor roots, e.g., disc
lesions.

1. Nerve conduction. Usually this is
normal or only minimally reduced
but in rare instances can be com-
pletely absent. The explanation for
these findings is that conduction
is measured along peripheral
nerves which receive their inner-
vation from more than one spinal
cord segment. If all of the motor
nerve fibers from one spinal cord
level were lost, conduction would
still be preserved in any given
peripheral motor nerve since con-
duction would be maintained
along fibers from adjacent spinal
cord segments.

2. Muscle sampling. If the anterior
horn cells or the motor nerve roots
are affected, sampling abnormali-
ties similar to those described in

Volume 56, No. 2

A, B, and C may be found. Giant
polyphasic potentials of 10 milli-
volts are seen more often with
proximal neurogenic lesions and
motor root lesions are often as-
sociated with coupling or tripling
of simple diphasic or triphasic
motor unit potentials.

It should be noted that a
sensory radiculopathy usu-
ally cannot be diagnosed by
electromyography since there
will be no sampling ab-
normalities and sensory con-
duction will be normal or, in
rare instances, completely
lost.

E. Clinical Myotonia

1 . Nerve conduction — normal

2. Muscle sampling — A rapid volley
of motor unit potentials of short
duration and low amplitude are
evoked simply by inserting the
needle into the affected muscle.
These sound like a dive bomber
(piston engine) on the audio link
from the oscilloscope. These myo-
tonic bursts seem to occur more
or less spontaneously although, of
course, they may be due to irri-
tation due to minor movements
of the point of the needle. They
are sustained although they tend
to wane. Unsustained high fre-
quency discharges are seen in
other diseases of the motor unit
and even in apparently normal
persons.

F. Primary Muscle Disease

I . Nerve conduction — Normal

2. Muscle sampling — The motor
unit potentials characteristically
tend to approach the parameters
of fibrillation potentials which are
those of a single muscle fiber, i.e.,
they are of short duration and of
low amplitude. Typically they have
a high pitched sound on the audio
link from the oscilloscope and ap-
pear as small units densely
grouped together. Some of the
units on minimal volition seem to
to be polyphasic. There is no
spontaneous activity at rest.

It is rare that one can differenti-
ate between a polymyositis and
a dystrophy or myopathy. In oc-
casional cases, fibrillation po-
tentials may be found in polymy-
ositis, and these are sometimes
attributed to the fact that edema
surrounding the muscle fibers may
cause compression and denerva-
tion of fine intramuscular nerve
terminals.

G. Myasthenia gravis and the myasthenic
syndrome.

These findings are described under the
assumption that a myasthenic syndrome
can exist without other evidence of neuro-
genic disease. A peripheral nerve such
as the median or ulnar, is usually stimu-
lated while examining for myasthenia. It
should be noted that all of the neuro-
physiological investigations may be
normal in myasthenia gravis.

The table shows the characteristic
electrophysical changes in normal per-
sons and in patients with myasthenia
gravis and the myasthenic syndrome.

April, 1971

Investigation

Normal

Myasthenia Gravis Myasthenic Syndrome

1. Muscle sampling

N N

2. Nerve conduction

N N
(may get some delay
of distal motor
latency in severe
myasthenia)

3. Amplitude single
MUP evoked by
nerve stimulation

4. Repetitive stimuli

Repetitive stimuli are delivered to
the nerve for an estimated period and
the MUP's are recorded in order to

N Small

(or slightly reduced)

see whether there are any alterations of
their amplitude (Fig. 15). The tests
are then repeated following "tensilon"
(edrophonium chloride).

NORMAL

M.G.

M.S.

3/sec
for 1-5 sec

IX FALL IN AMPLITUDE
OF THE MUP AT 2SD.

MORE THAN 7% FALL IN
AMPLITUDE OF THE MUP.

POSSIBLE RISE IN
AMPLITUDE OF THE MUP

30/sec
for 1-5sec

40% FALL IN AMPLITUDE
OF THE >rUP AT 2SD.*

MORE THAN 40% FALL IN
AMPLITUDE OF THE MUP.*

1007= RISE IN AMPLITUDE
OF THE MUP.

a. and b. after
tensilon

RETURNS TO NORMAL.

LITTLE EFFECT.

Fig. 15

Volume 56, No. 2

The response in normal patients and
in patients with myasthenia is variable
at faster rates of stimulation. An initial
rise of up to 10% or a fall may occur

5. Paired stimuli

in normal persons although eventually
there is a decrement. In myasthenia
gravis a variable rise or fall of ampli-
tude may occur at 30 stimuli per
second.

2-5 msec.

200

SECOND

RESPONSE

AS A 7o OF 100

THE FIRST

RESPONSE.

20 msec.

lOsec,

'NORMAL

10^

10-

10^

,10

hOC-^ INTERVAL BETWEEN STIMULI, MSEC.

Fig. 16

Characteristic curves may be obtained
for each of these groups (Fig. 16). A
conditioning stimulus is applied to peri-
pheral nerve and amplitude of the evoked
MUP is measured. Paired stimuli are
then applied to the nerve at increasing
intervals of time. The amplitude of the
second of each pair of stimuli is measured

as a per cent of the conditioning stimulus.
The responses of MUP's to paired
stimuli and to repetitive stimuli at slow
rates are probably the best means for
electrodiagnosis of and for differentiation
between normal persons, patients with
myasthenia gravis and the myasthenic
syndrome.

April. 1971

Dr. I rank Keinble was graduated
from Manchester University in England.
He trained initially in Internal Medi-
cine, then in Electromyography and later
in Neurology. Dr. Kemble, who has been
in the Department of Neurology at the
University of Maryland School of Medi-
cine three years, was Chief Resident
1969-70 and is now working as a Clinical
Fellow. His special interest is in neuro-
muscular diseases and in the clinical
applications of neurophysiology.

{

Conclusion

The electrodiagnostic procedures de-
scribed in this article help to differentiate
neuromuscular diseases when clinical

evaluation is difficult. They should always
be used in conjunction with clinical, histo-
logical and biochemical evidence in order
to fully differentiate the patient's disorder.

REFERENCES

1. Buchthal. F. and Rosenfalk, A.: Evoked
potentials and conduction in human sensory
nerves. Brain Res. 3, No. 1, 1966.

2. Kemble, F. and Peiris, O. A.: General ob-
servations on Sensory Conduction in the
normal adult median nerve. Electromyographv
7: p. 127-140, 1967.

3. Kemble, F.: Conduction in the normal
adult median nerve: The different effect of
aging in men and women. Electromyography
7: p. 275-288, 1967.

4. Mayer, R. F. and Mawdsley, C: Studies
in man and cat of the significance of the
H wave. J. Neuol.. Neurosurg. and Psychiat ,
Vol. 28, p. 201-211, 1965.

5. Mayer, R. F. and Mawdsley C: Nerve

conduction in alcoholic polyneuropathy. Brain,
Vol. 88, Part II, p. 335-356, 1965.

6. Mayer, R. F.: Peripheral nerve function
in Vitamin B-12 deficiency. Arch. Neurol., Vol.
13. p. 355-361. 1965.

7. Kemble, F.: Electrodiagnosis of the carpal
tunnel syndrome. J. Neurol., Neurosurg.,
Psychiat., Vol. 31, p. 23, 1968.

8. Taverner, D. and Kemble, F., and Cohen,
S. B.: Prognosis and treatment of idiopathic
facial (Bell's) Palsy. Brit. Med. J. 4, p. 581-
572. 1967.

9. Lambert, E. H.: Defects of neuromuscular
transmission in syndromes other than myas-
thenia gravis. Ann. N. Y. Acad. Sci., 135, Art.
1, p. 367.

Volume 56, No. 2

MEDICAL SCHOOL SECTION

Dear Alumni and Friends of the Medical School:

The financial crisis that exists in most American medical
schools is now receiving national attention. Hardly a week
passes without mention of it in the news media and frequent
reference to the situation occurs in the legislative bodies of
our states and in Washington. The crisis has been precipitated by both a
cutback in federal funding and by a change in the federal priorities regarding
how federal funds are to be spent in the health area.

For the past 20 years medical education has increasingly been financed
indirectly. Financed indirectly via the support of biomedical research. Whether
or not this approach to funding was sound need not concern us here. What
must concern us is that federal biomedical research funds have permitted
medical schools to expand into new programs, have catalyzed a rise in
quality of medical education and have permitted the development of academic
medical centers which are very important to our society. They did this by
providing support for individuals not only involved in research but also
involved in teaching and patient care.

The crisis is magnified by its timing. It is hitting medical schools at a time
when multiple new demands are being placed upon them. Demands to increase
class size, to increase the admission rate of socioeconomically deprived students,
to involve ourselves in meeting the needs of our surrounding communities,
and to help approach the overall problems facing our country in the organi-
zation and delivery of health care. The schools stand ready to move forward
in each of these areas but they cannot move without support.

The situation at our school is doubly difficult. We are being hit hard by the
federal cutbacks while we continue to suffer from less than adequate state
support. The medical school will not be in a position to meet the multiple
demands that so desperately require attention, unless both the state and
federal support improve, improve quickly and significantly. I would encourage
all alumni to bring the current financial plight of medical education to the
attention of as many people as possible in the hope that the message will reach
those who have the power to correct it.

Sinfiereb: yours

/John H. Moxley III
Dean

April, 1971

Faculty Appointments and Promotions

Dean John H. Moxley has announced the
following faculty promotions and appoint-
ments in the School of Medicine through
January 1971.

Dr. Leeds E. Katzen has been appointed
Director of Medical Education in Ophthal-
mology— Mercy Hospital. Mrs. Rachel Booth

is now Associate Director, Ambulatory Care
Nursing.

Appointed Professor were: Dr. Franklin
L. Angell, Radiology; Dr. Eugene Rosem-
berg, Pediatrics; Dr. Felix Heald, Pediatrics,
and Dr. Gardner Smith, Surgery (Baltimore
City Hospital).

Promoted to the rank of Associate Pro-
fessor were: Dr. Irving I. Kessler, Pre-
ventive Medicine; Dr. Genevieve M. Mata-
noski, Preventive Medicine; Dr. Lewis H.
Kuller, Preventive Medicine, and Dr.
Sheldon E. Greisman, Physiology. Associate
Professor appointments include: Dr. Ira
Wexler, Neurology; Dr. Richard A. Currie,
Surgery; Dr. Peter Chodoflf, Anesthesiology,
and Dr. Daniel S. Ruchkin, Physiology &
Computer Science Center.

Mr. Otto Payton was named Assistant
Professor and Acting Head of Physical
Therapy.

Promoted to Assistant Professor were:
Dr. William D. Lynn, Surgery; Dr. Arthur
\. Serpick, Medicine; Dr. Pradman K.
Qusba, Pharmacology; Dr. Donald H. Dembo,
Medicine, and Dr. Misbah Khan, Pediatrics.
Appointed Assistant Professor were: Dr.
Robert M. Beazley, Surgery; Dr. Willy N.
Pachas, Medicine; Dr. Eleanor Jantz, Psy-
chiatry; Dr. Willem Bosma, Psychiatry; Dr.
Brigita M. Krompholz, Preventive Medicine;
Dr. Robert W. Sherwin, Preventive Medi-
cine; Dr. Clarence W. Hardiman, Physical
Therapy; Dr. Edward C. Knoblock, Medicine;
Dr. Magdi G. Henein, Surgery; Dr. Gary
Nobel, Surgery; Dr. James E. Olsson, Clinical

Pathology; Dr. Lorence A. Gutterman, Medi-
cine; Dr. Sidney Marks, Surgery; Dr. Wolf-
gang J. Mergner, Pathology; Dr. Nathan B.
Hyman, Radiology; Dr. Ranier M. E. Engel,
Surgery, and Dr. Herbert Schwartz, Surgery.

Dr. Frederick J. Balsam, Rehabilitation
Medicine, and Dr. Sheppard Kaplow, Anes-
thesiology, were promoted to Assistant
Clinical Professor.

New Instructors include: Dr. Perry Austin,
Medicine; Dr. Young Chun, Medicine; Dr.
Kenneth Gray, Medicine; Dr. Bruce T. Brian,
Medicine; Miss Barbara Fleming, Psychiatric
Social Work; Mr. Robert Ude, Physical
Therapy/ Anatomy; Mrs. Judy Waldman,
Psychiatric Social Work; Dr. Allan T. Leffler
III, Pediatrics; Dr. Sylvester Steriofif,
Surgery; Dr. Henry R, Herbert, Preventive
Medicine; Dr. Simon C. Beaudet, Rehabili-
tation Medicine; Dr. Larry A. Snyder, Radi-
ology; Dr. Samuel Andelman, Radiology;
Dr. Edwin J. Goldman, Anesthesiology; Dr.
Robert Hoffenberg, Anesthesiology; Dr. Cecil
B. Calderon, Pathology, and Dr. Edward W.
Stockblower, Rehabilitation Medicine.

Clinical Instructors are: Dr. Martin L.
Lipson, Ophthalmology; Dr. Andrew D.
Logue, Psychiatry, and Dr. Patricia N.
Carver, Psychiatry.

Mr. Joseph J. Dombrowski has been named
research associate in Pharmacology; Dr.
Mitsuhiro Yanagida in Biochemistry; Mrs.
Joan M. Starr, Psychiatry; Dr. Kaumo U.
Laiho, Pathology; Dr. Henry Joseph
Wehman, Pediatrics; Mr. Robert E. Pender-
grass. Pathology; Dr. Joseph E. McDade,
Microbiology; Mrs. Mary Smith, Pathology;
Mrs. Jane Dees, Pathology, and Dr. V. S.
Sethi, Pharmacology.

Dr. Belur S. Bhagavan is a Visiting As-
sistant Professor and Visiting Clinical As-
sistant Professors are Dr. Victor A. Frazekas
and Dr. Andrew J. Saladino, both in Path-
ology.

Volume 56, No. 2

^^MkA.! / .^:

ALUMM ASSOCIATION SECTION

President's Letter

OFFICERS

President

Theodore Kardash, M.D.

Dear Fellow Alumni,

President-Elect

Edward F. Cotter, M.D.

Vice-Presidents

Irving Burka, M.D.
John C. Hamrick, M.D.

Benjamin M. Stein, M.D.

Secretary

Robert B. Goldstein, M.D.

Treasurer

Arlie R. Mansberger, M.D.

Executive Director

William H. Triplett, M.D.

Executive Administrator

Francis W. O'Brien

Executive Secretary

Louise P. Girkin

Members of Board

Ex-oflficio Members
Board of Directors

Lewis P. Gundry, M.D.

Wilfred H. Townshend, Jr., M.D.

John H. Moxley, III, M.D.

My year as President of the Medical Alumni Association
passed very quickly. It appears that as President you just
about become familiar with the office when it is time to
depart. I have sincerely enjoyed my year as President, and
I wish at this time to express my gratitude to the officers
and Board of Directors of the Medical Alumni Association
and to all who have so willingly helped when called upon
to work within the year. I especially wish to commend the
Davidge Hall Restoration Committee and the committee who
will select a nominee for our annual Gold Key Award. I
also wish to congratulate Dr. Edward F. Cotter, my friend and
associate for many years, on his pending year of office as
President of the Medical Alumni Association.

Final plans for Alumni Day, June 3, 1971, appear in
another section of this Bulletin.

It has been an honor and a pleasure to serve as your
President and I look forward to continue to serve as ex-officio
for the next two years.

Sincerely,

Theodore Kardash, M.D?

President

Medical Alumni Association

April, 1971

50 Year Graduates

Bruce Barnes. M.D.
107 Pine St.,
Seaford. Del. 19973

Carl Fisher Benson, M.D.
5111 YorkRd.,
Baltimore. Md. 21212

John R. Bernardo, M.D.
198 High St.,
Bristol, R. I. 02809

Vincent Bonfiglia, M.D.
4010 W. 21st St.,
Los Angeles, Calif. 90018

Earl E. Broadrup, M.D.
Park Terrace, Apt. B36,
Aberdeen, Md. 21001

Oscar Costa-Mandry, M.D.
1613 Sta Bibiana,
Rio Piedras, P. R. 00926

Samuel H. Culver, M.D.
2308 South Rd.,
Baltimore, Md. 21209

Herman J. Dorf, M.D.
7404 Liberty Rd.,
Baltimore. Md. 21207

Charles F. Fisher, M.D.

321 W. Main St.,

Clarksburg, W. Va. 26301

Waynesboro, Pa. 17268
John W. Guyton, M.D.

c/o W. L. Guyton,

130W. Main St.,
Albert Jaffe, M.D.

130Slade Ave.,

Baltimore, Md. 21208
George R. Joyner, M.D.

133 Chestnut St.,

Suffolk, Va. 23434
Frank A. Pacienza, M.D.

700 N. Charles St.,

Baltimore, Md. 21201

Moses Paulson, M.D.
1 1 E. Chase St.,
Baltimore, Md. 21218

Edgar A. P. Peters, M.D.
394 Bergen Ave.,
Jersey City, N. J. 07304

Jos. POKORNY, M.D.

2200 E. Madison St.,
Baltimore, Md. 21205

Francis A. Reynolds, M.D.
43 Cottage St.,
Athol, Mass. 01331

Harold A. Romilly, M.D.
16701 Seneca Ave.,
Lakewood, Ohio 44107

Louis M. Timko, M.D.
3015 Ripley Rd.,
Cleveland, Ohio 44 120

Herman E. Wangler, M.D.
616 S.E. 18th St.,
Ft. Lauderdale, Fla. 33316

George E. Wells, M.D.
4100 Edmondson Ave.,
Baltimore, Md. 21229

William F. Weinkauf, M.D.
Corunna, Mich. 48817

Mortimer H. Williams, M.D.
711 Med. Arts Bldg.,
Roanoke, Va. 24011

ALUMNI DAY CLASS CAPTAINS

1921 Moses Paulson, M.D.

1926 Walter C. Merkel, M.D.

1931 Emmanuel A. Schuminek, M.D.

1936 Gibson J. Wells, M.D.

1941 PiERSON M. Checket, M.D.

1946 James A. Roberts, M.D.

1951 William G. Esmond, M.D.

1956 G. Edward Reahl, Jr., M.D.

1961 Francis A. Clark, Jr., M.D.

1966 Richard M. Susel, M.D.

Members of the Class 1921 will be
honored guests at the Alumni banquet and
will receive their certificates of a half cen-
tury of service from the President of the
Medical Alumni Association.

Volume 56, No. 2

CLASS OF 1913
Dr. Charles L. Mowrer, 159 W. Washing-
ton St., Hagerstown, Md., died October 8,
1970.

CLASS OF 1913 BMC
Dr. George Pines, 240 S. LaCienga Blvd.,
Beverly Hills, Calif., died December 26,
1970.

CLASS OF 1916
Dr. William T. Ferneyhough, 719 S. Main
St., Reidsville, N. C. died recently.

CLASS OF 1918
Dr. Harley M. Johnson, Box 87, West
Columbia, S. C, died recently.

CLASS OF 1919
Dr. John W. Kellam, Jamesville, Belle
Haven, Va., died June 14, 1970.

CLASS OF 1924
Dr. Joseph G. Miller, 107 W. Saratoga
St., Baltimore, Md., died October 31, 1970.

CLASS OF 1928
Dr. A. L Grollman, 19 Garfield Place,
Cincinnati, Ohio, died recently.

CLASS OF 1929
Dr. Saul Schwartzbach, 1726 Eye St.,
Washington, D. C, died November 1, 1970.

CLASS OF 1934
Dr. Edward S. Hoffman, 7 Brookside Dr.,
Rochester, N. Y., died December 25, 1970.

CLASS OF 1964
Dr. Charles H. Asplen, Peter Bent Brigham
Hospital, Boston, died January 30, 1971 at
age 38.

April, 1971

ALUMNI NEWS REPORT

TO THE BULLETIN:

I would like to report the following:

SUGGESTIONS FOR NEWS ITEMS

American Board Certification
Change of Address
Change of Office
Residency Appointment
Research Completed
News of Another Alumnus
Academic Appointment
Interesting Historic Photographs

Name_

Address^

Class-

Send to

Dr. John A. Wagner, Editor
Bulletin — School of Medicine
University of Maryland
31 S. Greene St.
Baltimore, Md. 21201

Volume 56, No. 2

TAYLOR MANOR HOSPITAL

For Psychiatric Diagnosis and Treatment

IRVING J. TAYLOR, M.D.
MEDICAL DIRECTOR

ELLICOTT CITY. MD.

PHONE: HO 5-3322

Support

Davidge Hall
Restoration

Fund

The

John D. Lucas Printing Co.

26th & SissoN Streets

Baltimore, Maryland 21211

Phones: BElmont 5-8600-01-02

Symbols in a life of
psychic tension

Iwla t%m
class of '66

Ph.D.

thesis ... in progress

series and complete
examination normal

(persistent indigestion)

Valium^

(diazepam)

2-mg, 5-mg, 10-mg tablets
t.i.d. and h.s.

for relief of psychic

tension and resultant

somatic symptoms

within the first day

for some patients

Warnings: Not of value in psychotic
patients. Caution against hazardous
occupations requiring complete
mental alertness. When used ad-
junctively in convulsive disorders,

possibility of increase in frequency
and/or severity of grand mat seizures
may require increased dosage of
standard anticonvulsant medication;
abrupt withdrawal may be associated
with temporary increase in frequency
and/ or severity of seizures. Advise
against simultaneous ingestion of
alcohol and other CNS depressants.
Withdrawal symptoms have occurred
following abrupt discontinuance.
Keep addiction-prone individuals
under careful surveillance because of
their predisposition to habituation
and dependence. In pregnancy, lac-
tation or women of childbearing age,
weigh potential benefit against pos-
sible hazard.

smallest effective amount in elderly
and debilitated to preclude ataxia or
oversedation.

Roche

LABORATORIES

Division of Hof(mann-La Roche Inc.
Nutley, New Jersey 07110

John A. Wagner, B.S., M.D.
Chief Edit "

Jan K. Walk

Managing Edit

editorial boar

George Entwisle, B.S., M.L,

Robert B. Goldstein, JVI.C

John C. Krantz, Jr., Sc.D., PhX

Arlie Mansberger, M.C

William H. Mosberg, B.S., M.C

Francis W. O'Brie

John H. Moxley, III, M.tl
(ex-officil

Edward F. Cottc
ex-offici

Left — Ceiling of
Anatomical Hall gives the illusion of
being coffered by the decorative
plasterwork which has rosettes of
of anthemion, circles, semicircles and
filler lozenges. Right — Ehler's wood-
cut of Davidge Hall as it appeared
in 1873.

BulLetin

PUBLISHED FOUR TIMES A YEAR, JANUARY, APRIL,
JULY AND OCTOBER JOINTLY BY THE FACULTY OF
THE SCHOOL OF MEDICINE OF THE UNIVERSITY OF
MARYLAND AND THE MEDICAL ALUMNI ASSOCIATION.

Davidge Hall Bryden B. Hyde, A.I.A.

Potpourri

Folk Medicine in Maryland George G. Carey, Ph.D.

Black Physicians Emerson C. Walden, M.D.

Nutrition of Children in Developing Countries
Barbara Underwood, M.D.

Dean's Thoughts

Internship List 1971-72

Ambulatory Health William S. Spicer Jr., M.D.

Professors of Surgery 1807-1970 Harry C. Hull, M.D.

Alcoholism in Maryland Willem G. A. Bosma, M.D.

Alumni Day-Graduation 1971

Alumni Activities

1
9
12
16

19
23
24
30
34
43
46
58

Second class mailing privilege authorized at Baltimore, Maryland

davidge hall

Bryden B. Hyde

Rich in tradition and virtually un-
changed in its fabric, Davidge Hail is
rapidly becoming more appreciated as
an integral part of the American medi-
cal heritage.

The original Davidge Hall was razed
some ten years ago to make space for
the Health Sciences Library. The brick
structure had perhaps the largest
double-hung sash window in Baltimore
with its 36 large panes or "lights." A
fire insurance policy dated February
20, 1824 issued by the Baltimore Equit-
able Society (1794) describes the edi-
fice:

To the University of Maryland, upon
the brick building fronting on the
south side of Lombard Street near the
west side of Greene Street sixty feet
and extending back forty feet, being
four stories including basement story.
Also three-story brick stairway at
the back part thereof seventeen feet
by twenty feet also three-story build-
ing at the south end of said stairway
thirty-six feet square, the whole plan
finished having brick cornice.

From the architectural historians' and
preservationists' viewpoint, the loss of
the original Davidge Hall is great. This
indicates the need to preserve and
recondition the present Davidge Hall,
which was renamed from "The Medical
College" or "College Building," to
honor Dr. John B. Davidge, who was
largely responsible for its construction
in 1812.

HISTORY

The Baltimore physicians organized
themselves into the Medical Society of
Baltimore around 1789 and elected
officers. These doctors at the time were
giving lectures on anatomy, the theory
and practice of physic, surgery and
chemistry in their homes.

Around 1800, Dr. John B. Davidge,
who was educated in Europe, delivered
lectures on the principle and practices
of midwifery, and then added practical
surgery and demonstrative anatomy.
Even though less than a dozen students
attended his lectures. Dr. Davidge built

Editor's Note: Davidge Hall is the oldest medical school building in the nation. It is noted for a unique,
classical appearance which typifies the period of classical revival during which it was built. Bryden B.
Hyde, A. I. A., a Baltimore architect, describes the historic edifice in architectural terms and tells why
and how the building was built. His expertise was sought in planning for the restoration of Davidge Hall
and the eventual designation of the structure among sites of national historic interest.

an anatomical hall near the southeast
corner of Liberty and Saratoga streets
and was joined by Dr. John Shaw, who
gave lectures on chemistry. The ana-
tomical lectures were short-lived as the
building was demolished by the popu-
lace and what was described as "ig-
norant neighbors." For the next two to
three years, the anatomical and surgi-
cal lectures were delivered in the
county almshouse.

It was preventive medicine, perhaps,
that first aroused the interest of the
Maryland Legislature in the teaching of
Medicine. Inoculation against smallpox
was introduced into the area by Dr.
James Smith. Upon Dr. Smith's applica-
tion, the Maryland Legislature became
the first to sanction distribution of the
vaccine. In 1809, he was granted a lot-
tery to raise money for the distribution
of the vaccine free for six years.

Anxious to establish medical educa-
tion upon a firm basis, and to afford it
the protection of the law, Drs. Davidge,
Shaw and Cocke applied to the legisla-
ture for the privilege of establishing a
college and on January 20, 1808 an act
was passed by the General Assembly.
The following appeared in the History
of Baltimore City and County, Maryland:
. . . for founding a medical college in
the city or precincts of Baltimore for
instruction of students in the different
branches of medicine . . . by the name
of the College of f^edicine in Mary-
land.

The faculty as suggested by the peti-
tioners was included within the act. At
the same time John Eager Howard,
James McHenry, James Calhoun,
Charles Ridgely of Hampton, William
Gwynn, John Comegys, Charles A.
Warfield, John Crawford, Soloman Burk-
head, John Beale Davidge and Ennals
Martin were appointed commissioners
and authorized to propose a lottery
scheme for raising an amount not ex-
ceeding $40,000 for the college's use.

However, the lottery was not held.
Destitute of everything but an enthusi-
astic spirit, and without a place to
accommodate a class, the faculty lec-
tured in their own dwellings to the first
class of seven pupils. An old frame
schoolhouse was used for anatomy
classes and found to be so cold that
the professor's subjects were frozen.

During the winter of 1809-10 a ballroom
on Commerce St. near Exchange Place
was allowed to be used by its owner,
Mr. Mallet, between the hours 12-2 p.m.
The class increased to 18 and in April
1810 the first degrees of Doctor of
Medicine were conferred on five candi-
dates. Determined to start operations
on their own credit and responsibility,
the managers of the college secured a
lot from John E. Howard on the north-
east corner of Lombard and Greene
streets where they proceeded to build
the needed structures.

Dr. Davidge was selected as the first
dean of the school and under his
leadership a new concept of medical
education was formed: "The science of
medicine could not be successfully
taught under the usual organization of
medical schools; that without the aids
of physiology and pathology, either
associated with anatomy or as a sep-
arate chair institutes, the philosophy of
the body of sickness or in health could
not be understood."

THE ARCHITECT

Robert Carey Long Sr. (1770-1833),
the architect selected for Davidge Hall,
is often confused with his son, Robert
Carey Long Jr., also an excellent archi-
tect. Unlike his son who started his
career as an architect, the senior Long
worked his way up and became the
leading Baltimore-born architect of the
19th century. In the city directories
from 1796-1823 he lists himself as a
carpenter, in 1824 as an architect and

in 1833 as architect and engineer. He
was a carpenter-builder when there
were no architects in town.

In 1798, Long and three others built
the Assembly Room at the northeast
corner of Fayette and Holliday streets
from a design by Col. Nicholas Rogers.
Next Long became associated with the
architects B. F. Latrobe, Maximilen
Godefroy and Robert Mills. Godefroy,
who was trained in France, had much
sought architectural books that weren't
readily available to all architectural
students. Long worked with him on St.
Mary's Seminary Chapel which was de-
signed in 1807 and completed in 1808.
The Bank of Pennsylvania built in 1797
and designed by Latrobe along a Pan-
theon scheme also influenced Long.
Latrobe's designs for the Roman Cath-
olic Cathedral (1808) had an impression
on Long, particularly the dome with the
central skylight which was designed,
but not built.

In turn, Robert Mills was probably
influenced by Long's Davidge Hall dome
and skylight when he designed the First
Baptist Church in 1817. The church
which was demolished in 1878 had a
"lantern" skylight with vertical windows
around it. And, Godefroy was influenced
by Long's dome as shown by his sky-
light on the First Unitarian Church built
in 1817 which was quite similar to the
segmentally glazed one on Davidge
Hall.

When Long designed the Union Bank
in 1807, he drew upon a recent English
publication to update the traditional
square brick structure. He included
such devices as the recessed vestibule
with colonnade screen, the arched re-
cesses with windows and the sculptured
panels and pediment now located in
the Peale Museum garden.

Robert Carey Long, Sr. was an hon-
orary member of the National Academy
of Design, New York, and exhibited
architectural designs there 1827-28. He
also did water colors and one of Mt.
Vernon Place (1829) is in the Maryland
Historical Society collection. He be-
came the patron of Signer Capellano as
sculptor of several panels on St. Paul's
Church in 1815. As a patriot he offered
his services along with his 30 carpen-
ters in the defense of Baltimore in 1814.
They were the only men who functioned
as a unit in building the fortifications for
the city.

Long moved from Conowago St. (now
Lexington St.) near Charles to 16 W.
Hamilton (Hamilton St. Club) before
1824. He built and owned this row of
houses. Except for Davidge Hall and
the Peale Museum (1813), these are the
only vestiges of the "vast number of
edifices both public and private" for
which Long was architect.

His Holliday Street theatre (1813)
also built by Col. James Mosher, his
masterpiece, St. Paul's Church (1817)
in the Greek Doric Order which cost
$126,000, the City Jail (1800), "Calver-
ton" Alms House (1822), Robert Oliver's
resident "Greenmount," and William
Gwynn's residence "Tusculum" (1823)
which was located behind Barnum's
Hotel, have all disappeared, at a great
historic and architectural loss to Balti-
more.

Long died in February 1833.

THE BUILDERS

Records show that Messers. Towson
and Mosher were the builders of
Davidge Hall. Thomas Towson, a stone-
mason, or Henry Towson, a carpenter,
may have been referred to. Col. James
Mosher, who started as a bricklayer,
built many of the better buildings at that
time. The whereabouts of the corner-
stone, which was laid May 7, 1812 by
Col. Howard, is a mystery. The building
was "partly tenantable" by October 1812.

DAVIDGE HALL

Over the main entrance door still
hangs the wooden gilt and black
"clasped hands" fire insurance policy
sign No. 7791 of the Baltimore Equit-
able Society. The $12,000 policy de-

scription dated November 15, 1823

reads:

To the University of Maryland upon
their brick l\/ledical College, fronting
on the north side of Lombard near
the east side of Greene Street 63 feet
and extending back 93 feet one story
high with large dome thereon and
portico in front 10 feet wide with
eight stone pillars to support the
same conveniently laid off and fin-
ished for said purpose.

It is of interest that on the same day
another insurance policy by Baltimore
Equitable for $2,000 was issued for the
building now known as Gray labora-
tory:

To the University of Maryland upon
their brick building near the northeast
side of the Medical College, being
sixty-four feet by thirty-four feet oc-
cupied for a medical museum two
high stories. Plain finished for said
purpose having a brick cornice.
The prospects of the institution
began to improve during this period,
and the medical class increased in num-
bers yearly until in 1825 it numbered
300. In the meantime, "Practice Hall"
and the Baltimore Infirmary had been
created, and a museum established by
the purchase of a valuable pathological
collection of Professor Allen Burns of
Glasgow, Scotland.

,i^'"'' """^■,

•* • ■'
I II I I I

The earliest representation of Dav-
idge Hall known is an engraving taken
from the border of Poppleton's Map of
1820. "After Parthenon of Athens"
should read "After Pantheon in Rome."
An interesting question for historians to
consider is, "Why was a $200,000 build-
ing only insured for $12,000?" The en-
graving shows how little the building
has changed since being built.

The design used by Long for Davidge
Hall is described in The Architecture of
Baltimore by Howland and Spencer:

,.^|K'^^"

The design is a bold one with little
precedent in American architecture.
The main room is a circular ana-
tomical theater (Anatomical Hall),
roofed by a wooden dome. Below is
a room of the same diameter, sixty
feet, originally used for the Chemical
Hall. A section with offices and a li-
brary, in conveniently rectangular
rooms, is added to the front of the
lecture room, between this part of the
composition and the porch. The ex-
terior reveals nothing of the fact that
the main room is round, except for
the very low dome rising above a
high drum. Long's building . . . is one
of the first Pantheon schemes in this
country . . . In some details Long
shows himself to be a very provincial

architect; there is much wasted space
in the interior, particularly at the junc-
tion of the curved theatre and the
outside walls; the portico is wide for
its height; the wooden facade at-
I tached to the brick building presents
a barren appearance with little appro-
priate ornamentation. Perhaps this
latter drawback was dictated by
economy rather than the architect's
taste, for Long would have known that
the Doric Order carries metopes and
triglyphs.

Long demonstrated with the Union
Bank his ability to handle an elaborate
design including sculpture, and it is
said that he intended the long recessed
panel high in the portico wall to receive
a relief sculpture eventually. Although
spaces between circles and squares are
generally wasted in order to gain dra-
matic effect, one wonders whether their
original uses in Davidge Hall may not
have justified them more. Cadavers in
whisky barrels filled dark corners and
a dissection could be performed in some
obscure room unobserved by the public.
Ghouls could secrete a freshly buried
body from St. Paul's cemetery up Wine
Alley through one of several rear doors
into some odd-shaped space.

The building is on a monumental
scale and "in the spirit of simplicity
exemplified by Mills." The walls of
handmade bricks are laid up with fairly
thin joints (three brick courses of eight
inches as is standard today). The rear
wall of the front portico is in the more
formal Flemish Bond with alternate
header (end) and stretcher (side) bricks
in alternating courses. The other walls
including the drum are in common
bond: five stretcher courses are bonded
by the sixth course of headers. Paver
brick in a herringbone pattern were laid
in sand in the portico floor which has a
granite curbing.

hacL^

The exterior walls are generally 18
inches of brick plus plaster on the
inside face. Where the drum is tangent,
the walls increase to 24 inches of brick
plus plaster.

The eight stone Doric columns of the
portico have stone bases and taper to a
smaller diameter at the cap. They are
of four 60-inch high sections plus cap
section, and although the stone has
been painted — perhaps it is a rela-
tively soft Aquia Creek sandstone —
the joints can be seen. The window and
door sills are made of this stone as is
the collar under the lunette windows of
the drum.

The entablature is quite simple and is
the unadorned pediment of narrow
tongue and groove (or possibly shiplap)
boards painted white with the columns.

The entablature is carried along the
sides with an "architectural break" in
the wall expressing the square dome
"base." Wood coping trim occurs above
this on the three-stepped Neo-Greco
pediments occurring on all four sides

of the dome base. Large 33-pane fan-
light windows are centered over the
entablature in these pediments at the

sides. On both side walls centered be-
low this fan light is a large Palladian
window with a narrow wooden frame
which is recessed. Flanking the Pal-
ladian window are a pair of 12-over-12
double-hung sash windows with semi-
circular headed frames which are filled,
as the portico pediment, with horizontal
tongue and groove boards. These also
have 12-inch ground brick arches. First
story windows toward the portico are
the same size sash, but have flat brick
arches. The second story windows are
the same width, but have 8-over-8 lights.

U".

I-C

rnrTri

roafci

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nrmn

Around the dome drum are 16 regu-
larly spaced lunettes with 12-inch brick
arches. Most of these are "blind" and

only every fourth one is a lunette-fan-
light window hinged at the sill into
Anatomical Hall providing both light
and ventilation. Centered on line to the
center of the dome and over every other
one of these lunettes are eight skylights
halfway up the dome, which has a three-
stepped base. These square skylights
conceal circular openings through the
dome and add considerably to the light
given by the 25 pie-shaped segments

of the round central skylight. The
copper-standing seam roof recently in-
stalled duplicates the old tin roof and
the seams all radiate from the center
of the dome. The original roof of the
dome was seen when the tin roof was
removed exposing the wooden shingles
laid over solid wood sheathing. The
sheathing in turn was nailed to radiating
wooden rafters. The roofing contractor,
Nicholas Detorie, states that the con-
struction of this dome and the upper
dome of Godefroy's First Unitarian
Church are similar.

THE INTERIOR

One enters the building through the
large, original double doors, 3 feet wide
by 12 feet high. The original box lock
was stolen within the past five years,
but the keeper is present on the right
door. The floor, now terrazzo, was orig-
inally wood, brick, or square gray and
black marble on a diagonal. Doors off
the entry lead to adjacent offices.

A contemporary and excellent
wooden bust of Dr. John B. Davidge,
probably by William Rush, is in the
entry on a pedestal in a shallow stove-
niche and quite unprotected. Above
and to the left of the bust is an original
clock face with the works missing. To
the right, the L-shaped hall leads to a
long flight of 21 stairs. The wooden
treads have been replaced as well as
the scrolled step-end brackets. The out-
line of the originals, differing in shape
from the replacements, can be seen
outlined in the old paint.

Past the staircase, the corridor leads
to the circular "Chemical Hall" which
is on the ground level. It has a later
herringbone brick floor. (There are
rumors, but no evidence of a part base-
ment). At the top of the stair, a corridor
leads to the top of eight tiers upon
which students are seated for lectures.
The students look down on the rostrum
and forward to a bowed classical
procenium with niches, panels, and a
shelf for statuary surrounding it. The
procenium is closed now and conceals
the six wrought iron doors, damper
handles, etc., of the retorts where
chemical demonstrations were made.

An office at the head of the stairs leads
to the Faculty Alumni Lounge which has
a barrel-vaulted ceiling and is parallel
to the portico. The present ceiling is
below the higher original ceiling. Be-
yond the lounge area the Post Graduate
office has steps which have been parti-
tioned off and an arch and skylight can
be seen.

Around the back, in the northeast
corner, a small wooden stair leads up
the wall of all-header brick and curves
on the inside of this corner only. An-
cient anatomical drawings are displayed
in the adjacent corridor. The pitched
ceiling under the tiers of Anatomical
Hall and above the steps leading to the
hall is the original random width five-
foot four-inch yellow pine tongue and
groove floors with some exposed nail-

• •

• #

Going up the main front stair, there
is a carved skirting board adding a re-
strained embellishment. This stair has
also been partitioned off at the top.
Here a two-panel door with original
wishbone platelach can also be seen.

ANATOMICAL HALL

Upon entering the lowest level of
Anatomical Hall, adjacent low doors
permit access to the space between the
floors and a view of the interesting
framing which is heavy and sound. Four
by four ceiling joists support hand-split

lath and plaster of the flat ceiling of
Chemical Hall below. Supporting these
joists are paired 12' x 16' beams at
approximately 1/3 points of the span of
the drum. These beams are tied (with
wrought iron) perpendicular to a pair
of 12' x 16' beams and also tied at 1/3
points of the span of the drum. Resting
on this mesh are other beams which
support the tier beams, radiating up-
ward.

The most exciting and inspiring
space in Davidge Hall is the Anatomical
Hall. Steps lead up at intervals to the
tiers and the top walkway which has
lunette windows on the floor and niches
where coal stoves once stood on brick
"hearth," their stacks passing through
holes in the brick drum and out beyond
the cornice. Fires were caused in sev-
eral places and is evidenced by charred
timbers.

The ceiling gives the illusion of being
coffered by the decorative plasterwork
which has "rosettes" of anthemion,
circles, semicircles and filler lozenges.
Into this design the circular skylights
find their places, the whole being
beautifully crowned and lit by the huge
central skylight. A chandelier (not the
original) hangs in the center.

LIGHTING

Lighting was at first by oil lamps and
soon after by gas, it appears. R. C.
Long Sr. was one of the founders and
secretary of the Baltimore Gas Com-
pany in 1816. A piece of gas pipe, its
age as yet unknown, exists in one of
the side corridors. Rembrandt Peale
was a pioneer in lighting by gas, and
Long worked with him on it.

pot pourri

family practice

Because of a growing student interest
and concern over the future of a family
practice program at University Hospital,
the Student Council has provided $1,800
for summer precepteeships.

Dr. William Layman, associate direc-
tor of the Division of Family Medicine,
said the funds will be used to sponsor
three students for eight weeks of study
and work with private physicians.

The stipends received by the students
in the program vary between $600-$800
and the degree of knowledge obtained
by the students is as individualized as
the physician working with the student
doctor.

Dr. Layman stated the purpose of the
program as threefold: to interest the
medical student in a career in Family
Medicine; to influence his ultimate place
of practice by exposing him to various
locations in the state that are in need
of physicians, and to involve the student
in a research project in some aspect
of the delivery of health care while he's
out in the community.

Participating in the program this sum-
mer will be freshmen, sophomores
and several juniors. Freshmen students
are required to work in the Family Medi-

cine unit for a week under Dr. Layman's
direction before they begin their pre-
cepteeship. Funding for the preceptee-
ships has come from county medical
societies, the Maryland Academy of
Family Practice Physicians, private
physicians as well as an outside busi-
ness firm. Dr. Layman said that this
summer the Board of Trustees of Wash-
ington County Hospital, Hagerstown,
Md., have voted to provide room and
board for four students serving as
preceptees.

During the student's eight week clini-
cal experience they will shadow their
preceptor during office hours, attending
medical meetings and participating
after hours in emergencies and on
house calls. Two of the students will
also be participating in a study of the
management of primary care problems
in family practice and also the collec-
tion of data on the attitudes of family
physicians with respect to the use of
physicians' assistants.

Dr. Layman said, "Precepteeships are
the oldest method of instruction for
students. There is an interchange of
ideas between the physician and the
student and the student learns by doing
— participating in examinations, emer-
gencies, delivery, intensive care, etc.
It's a one-to-one teaching experience."

grant for genes study

The John A. Hartford Foundation,
Inc. of New York City has awarded a
$293,340 grant to the University of Mary-
land, School of Medicine for joint use
by the Department of Cell Biology and
Pharmacology and the Department of
Pediatrics for research in the area of
gene therapy.

Funds will be used to implement the
proposal entitled "The Use of DNA for
Gene Therapy: Development of a New
Treatment for Inherited Metabolic Dis-
eases." The specifics of the research
were stated by Dr. H. Vasken Aposhian,
professor and chairman, Department of
Cell Biology and Pharmacology, and Dr.

Marvin Cornblath, professor and head,
Department of Pediatrics, in seeking
support from the Foundation as follows:

"Significance of the proposed re-
search: The possible recovery of the
large number of future life years lost
by birth defects and the possibility of
providing a normal or improved life for
patients with non-fatal inherited disease
indicates there is a need for DNA as a
therapeutic agent."

Another important long range goal de-
scribed in the research proposal which
is of mutual interest of the two depart-
ments, is the DNA treatment of insulin
deficient juvenile diabetes.

division of respirat

A division of Respiratory Care has
been formally established within the
Department of Anesthesiology by Fac-
ulty Board approval after such a unit
was operational for about a year.

Dr. Martin I. Gold, medical director
of the unit and professor, stated that
the purpose of the unit is to function
outside the operating room In contrast
to the traditional function of an anes-
thesiologist which operates inside the
operating room.

"Many patients in the hospital need
various degrees of respiratory care.
Some need oxygen, some need humidi-
fication, some have tracheotomies,
others have tubes in their mouth or
noses leading to the windpipe . . . these
patients require certain expertise," Dr.
Gold explained.

Patients presently requiring respi-
rators or ventilators at University Hos-
pital include a 14-year-old girl suffering
from myasthenia gravis who developed
breathing problems; bronchitis and
emphysema cases; post-operative cases
whose bandages and dressings make
breathing difficult; pediatric cases in-
cluding newborn infants, and an over-
dosed narcotic addict. All need re-
spiratory support.

The service shall manage respiratory
care of patients through the use of res-
pirators or ventilators and through

analytical technique such as taking ar-
terial blood and measuring the blood
gases which indicate the lungs are
working with mechanical help. Adjust-
ments are made according to the blood
gas readings so that the respirator can
be adjusted to fulfill the patients' needs.

Currently, Dr. Gold has a resident
and inhalation therapists assisting him
in the program. He hopes that upon
completion of the North Hospital a spe-
cial respiratory intensive care unit will
be available where only patients with
respiratory problems would be located,
not spread throughout the hospital as
is currently the situation.

"However, since this is not possible
presently and the patients are still
spread throughout the hospital, we
hope that physicians and nurses can
rotate through the division where they
can learn techniques necessary to give
the patient the best respiratory care
available," said Dr. Gold.

Maryland's Division of Respiratory
Care is among the first to be set up
across the nation.

bressler fund committee grants

The Bressler Fund Committee has ap-
Droved $51,867 for research to be car-
ded out in the Frank C. Bressler Re-
search Laboratory.

A trust fund established by the will
3f the late Frank C. Bressler built and
9quipped the laboratory and income
from the fund makes possible monies
3ach year for research to be carried
out by departments and individuals who
are located in the building.

The following were approved to re-
ceive funding: Joseph W. Burnett, M.D.,
Dermatology/Medicine, $3,500; Edward
J. Donati, Ph.D., Anatomy, $950; Charles

P. Barrett, Ph.D., Anatomy, $1,500;
Stephen R. Max, Ph.D., Neurology,
$6,905; Charles C. C. O'Morchoe, M.D.,
Anatomy, $3,700; A. H. Janoski, M.D.,
Endocrinology/Medicine, $2,512;

Patricia J. O'Morchoe, M.D., Anat-
omy, $4,000; Hugh G. Beebe, M.D.,
Surgery, $2,000; John G. Wiswell, M.D.,
Medicine, $1,200; Priscilla Oilman, M.D.,
Pediatrics, $3,000; Fima Lifshitz, M.D.,
Pediatrics, $3,000; J. Tyson Tildon,
Ph.D., Pediatrics, $6,000; Salvatore Raiti,
M.D., Pediatrics, $4,000; Marvin Corn-
blath, M.D., Pediatrics, $7,600; and Ron-
ald Gutberlet, M.D., Pediatrics, $2,000.

microscopes for students

In an effort to help alleviate the eco-
nomic needs of first and second year
medical students, the Student Council,
Dean's Office and the Medical Alumni
Association have contributed $2,600 to
purchase second-hand microscopes for
loan to these students.

"Today there is a tremendous con-
cern about the delivery of medical care
to the population at large, but there is
a tendency to overlook the needs of the
medical student," said Peter Vash, Stu-
dent Council president, in seeking sup-
port for the project. "One of the more
imminent complications of the student's
education is cost and this problem must
be solved before he can begin to attack
the essentials of medical education."

The $300 provided by the Student
Council, the matching $300 provided by
the .Alumni Association and the $2,000
provided by the Dean's Office provide a
total of $2,600 for the microscope fund
to be administered by the Office of Stu-
dent Affairs. Some 10 microscopes are
now currently available for loan. Second-
hand microscopes cost between $250-
$300.

Vash said that it is the hope of the
Council to donate a similar amount each
year so that eventually incoming stu-
dents will not have to buy or rent their
microscopes unless they wish to do so.

By George G. Carey, Ph.D.

(English Department, University of Md.)

A large segment of folk belief hinges
on the traditional practices carried out
in the area of folk medicine. Belief in
the efficacy of folk healers or "pow-
wows" as they are known in some parts
of Maryland, has fostered an active
trade in folk medicine over the years.

One attempting to gather and study
Maryland's rich bounty of folk beliefs
will find that despite the average per-
son's suspicion that a belief is particu-
lar to one region, in most cases Mary-
land superstitions are known throughout
the country and, In certain instances,
throughout the world.

Conversion plays a salient part in the
area of folk medicine. Presumably all
folk cures suggest ways of turning sick-
ness of some sort into health. In some

instances, the people who propose
these cures swear to their efficacy cit-
ing chapter and verse of cases where
the patient has been miraculously
brought to health.

"Now," reported a Crisfield, Md. man.
"there was this girl and she was burned
real bad, third degree burns and the
flesh just running right off her and so
they said you'd better go and see Miss
Emmy. So they took her down and she
didn't use any ointment or anything.
Just rubbed her hands along those
burns and when that girl healed, there
wasn't one scar on her anywhere."

Inevitably, women like Miss Emmy
became accepted in the community as
people with special powers. In some
parts of the Eastern Shore, they became

Editor's Note: George G. Carey, Ph.D., 36, was born in New Jersey and received his doctorate
degree in English from Indiana University. He has written several books on Maryland folklore,
Maryland Folklore and Folklife, published by Tidewater Publishers, Cambridge, Md. and two other
books. Folklore of the Eastern Shore Watermen and Maryland Legends and Folksongs, will be
published in the Fall. Portions of the text are from Dr. Carey's book, Maryland Folklore and Folklife,
® 1970, Tidewater Publishers, Cambridge, Md.

known as "high women," and their male
counterparts were "high men." Their
cures were many and varied, and
though the white healers seem to be
less in evidence than they were a cen-
,tury ago, black healers still provide
medicine for believers, both black and
white. One such healer is found in
Perryhawkin:
You could probably describe Annie
as a sweet old colored lady who
would help anyone she could. She's
in her late sixties and a hard worker
— one of the best farm hands you
can find to pick tomatoes, beans, cu-
cumbers or anything like that. She
lives on her social security check but
she can't work in the factory in the
summer because of her pension
check. She raised seven boys and
1 seven girls and some of them went
to college. Everyone thinks she's one
of the best people around. And if
you have some minor ailment, a skin
disease or mild sickness, you can
just dial Annie and she'll give you a
remedy.

Here is a clearly defined instance of
traditional folklife patterns fitting them-
selves to modern conventions. Seventy-
five years ago, one would have gone to
the folk practitioner's house to receive
the cure, and probably have her prepare
and apply it. But modern communica-
tions have changed all this. Today one
can dial a folk remedy as simply as one
can dial-a-prayer or the weather.

A practical base often underlies much
of folk medicine. Crude or unappetizing
as some of the cures may sound, time
and tradition have proven them effec-
tive. When prescribed medicine is not
easily come by because there may be
no one to prescribe it, people fall back
on traditional prescriptions. Many of the
cures for colds, coughs, and croup, for
instance, require inhaling a strong
smelling substance. Whereas a doctor
might prescribe a croup kettle filled
with water and benzine. Eastern Shore-
men wear a piece of flannel soaked in
kerosene, and surely the smell from
this garment would act probably more
effectively to open up breathing pas-
sages than a croup kettle. Likewise,
goose grease applied to the chest, as
is done on the Eastern Shore for a chest

cold, would certainly help to lessen the
chance of chill on the chest.

The origin of much of the folk medi-
cine practiced today on the Eastern
Shore derives in part from the large
pharmacopoeias published several hun-
dred years ago. In these thick volumes
appeared long lists of cures, then ac-
cepted as medical fact. But with the
advancement of scientific knowledge,
physicians dropped many of these rem-
edies from their practice. Still the folk
continued to use them, and through the
binding factor or oral tradition, many of
the cures have persisted in time and are
administered today as much as they
were 200 years ago. Then, too, there is
the simple fact that many of these folk
remedies may have more efficacy than
scientists are willing to admit.

One licensed Crisfield doctor actually
deferred to his folk counterpart for the
treatment of warts:
Now there used to be some 'doctors'
in this area who could cure your
warts. There was a time when I had
grown a big horn wart on the end of
my nose and I went to a regular doc-
tor in the village and he wouldn't
touch it. He told me to go see George
Stevenson. Said he could fix me up.
My regular doctor said all he used
was spit and all he did was rub a
little spit around on the wart and it
went away. But in the end I didn't
go; I went to Baltimore instead and
had it burned off.

Some healers miraculously removed
warts by absorbing them into their own
skin. Others had the power to induce
warts as well as remove them.

If a medicinal reason can be offered
for some traditional cures, there is little
rationale that can be applied to the
magic suggested in most of the cures
provided for warts. Here's a few ideas
to get rid of warts.

— Take a kernel of corn and criss-
cross it over the wart nine times.
Then feed the corn to a chicken
and the wart will go away.

— Rub a wart until it bleeds; then
rub the bleeding area with a flan-
nel cloth, until the bleeding stops;
then bury the cloth in the ground,
and when it rots the wart will go
away.

— Tie a knot in a string over the wart
and then throw the string into the
water. When the string rots, the
wart will disappear.

— Find a hollow stump in the woods
with water in it; wash your warts
there and they will go away.

— Take an old dirty penny, rub it on
your warts, and then throw it over
the right shoulder facing the full
moon, and the wart will go away.

— Rub a chicken liver over a wart;
then put the liver in a holly tree
in the woods and the wart will go
away.

Clearly, with folk medicine, the more
common the malady, the more varied
the traditional means of healing it. With
a cold, for instance, one would concoct

a brew of kerosene and sugar, or rub
mutton tallow on the chest, or prepare a
pine shat tea, or grease the temples
and bottoms of feet with beef suet, or
cover the chest with a rag soaked in
turpentine and tallow, or simply wear
a tar rope around the neck.

But, if one were clever, he didn't get
sick. He prevented colds by carrying
an onion around in his pocket all win-
ter, or hanging an asafetida bag around
his neck. Other safeguards were more
elaborate:
To ward off colds: rub down in goose
oil; take a fresh muskrat skin and
sew the bloody side to a red flannel
vest; put the red flannel next to the
skin with the fur side out and wear
until it falls off.

Eastern Shoremen also use a rag
rung out in child's urine around the
throat. Urine also worked as a beautify-
ing agent. Pimples disappeared if the
face was swabbed with a wet baby's
diaper. Fevers subsided when beaten
horseradish was bound to the pulse
or an onion poultice lashed to the head
and feet. A combination of sulphur and
molasses replaced geritol for tired
blood in folk cures.

Common everyday aches, pains and
discomfort likewise found relief in folk
remedies. An axe under the bed pre-
vented sweating, while children were

fed chicken gizzard to curb bedwetting.
A wad of chewed tobacco on bee stings
drew pain out, and placed on cuts it
brought the wound together faster.

A sharks tooth hung down the back
of the neck prevented nosebleeds. If
one occurred, however, the victim could
either chew a piece of brown paper
vigorously or apply a piece of brown
paper with the word STOP written on
it to the roof of the mouth and hold the
Ihead back. Toothaches subsided if a
fried egg were bound to the ear or if
the face were bathed in water boiled
'with a hog jowl bone.

Children's ailments naturally de-
manded the attention of the folk practi-
tioner. A mole's foot dangled from the
child's neck alleviated teething. So did
a thimble rubbed over the gums. For
weak infants, some bathed their heads
*in whiskey to make them gain strength
Ifaster. Mumps subsided when the swell-
'ing was rubbed with the marrow of a
hog's jawbone, or if the soot from a
wood stove was smeared from one side
of the face to the other.

Less well-known afflictions also de-
veloped traditional cures. If a person
contracted worms, pumpkin seeds were
the answer, or else he could wear a
ball of garlic around the neck and say
a prayer. The smell of garlic suffocated
the worms. But if the patient vomited,
it was a sign that the worms had already
gone to the heart.

Eastern Shore traditions also included
a cure for love ills:
// a woman takes a drop of blood
from tier menses and puts it into a
man's drinl<, he will be hooked on
her for life, sexually. For fertility a
man should eat sunflower seeds.

FOLKLORE ARCHIVES

Until recently little had been done to
activate the study and collection of
Maryland folklore. In 1966 the Maryland
Folklore Archive was established at the
University's College Park Campus.
Since then the Archive has become the
repository for more than seven hundred
student and faculty collections, in ex-
cess of ten thousand items of Maryland
folklore.

black physicians

Emerson C. Walden, M.D.

The black doctor is rare and in danger
of becoming extinct, says Dr. Emerson C.
Walden, member of the Board of Re-
gents, if more of them are not trained.

Dr. Walden, who was appointed to the
Board in January 1971, is a practicing
Baltimore surgeon and president-elect
of the National Medical Association. His
sons, Emerson Jr. and Thomas, are first
and second year medical students at
Maryland, School of Medicine.

The 47-year-old surgeon, who fills the
unexpired Board of Regents term of the
late Charles McCormick, has been in
private practice of surgery in Baltimore
since 1951. He is attending surgeon at
Provident, Lutheran and South Balti-
more General Hospitals; Surgeon Out-
patient Department, Johns Hopkins
Hospital and Instructor in Surgical
Nursing, Provident Hospital.

Dr. Walden feels there is a critical
manpower shortage in health and this
can be translated into the black com-
munity: "It is estimated that a need
exists for 50,000 physicians to serve the
American public. If you consider that
blacks are 12-13 per cent of the total
population, then one could reason that
they should be 13 per cent of the phy-
sician population. Providing this were
true, there would be nearly 35,000 black
physicians in this country."

He adds, "However, there are only
6,000 black physicians and that makes

them almost a 'rarity.' There needs to
be some 30,000 additional black physi-
cians from somewhere just to equate the
population quota. If one considers the
total need of 50,000 physicians then the
majority of the need is a black need —
50,000 minus 35,000 leaves 15,000. As a
black physician I am commited to clos-
ing the gap however we can do it."

As president-elect of the NMA Dr.
Walden explains that he and others are
working to do something about the
black shortage in medicine.

"We are empathetic, as a matter of
fact, and we have pushed the para-
medical program, but don't see this as
an answer completely. We don't want to
see all impetus being put on para-
medical people and none on black phy-
sicians, dentists and nurses. We are not
asking for lowering of standards. We are
asking, especially in state supported
schools that blacks be given an oppor-
tunity.

"If I am going all over the country
telling everybody else at state schools
what they should do where blacks are
concerned, I certainly have to talk to
the University of Maryland, whose rec-
ord along with Hopkins, has been poor
in the number of blacks and minorities
admitted and later graduated," said Dr.
Walden referring to his membership on
the Board of Regents.

The native of Cambridge, Md. also
believes that as expounded by the late
Whitney Young there should be a
"Marshall Plan" with regards to blacks.

"We need bending over backwards,
preferential treatment, what ever you

:all it, in this regard to get rid of educa-
ional, economic and political barriers,
30or housing — all the things that have
neant that young blacks do not see
Tiedicine as a life goal," he says.

The National Medical Association has
I program called "Motivation" because
t was found that young blacks do not
lave medicine as a life goal, but see it
is an impossible dream.

"I have frequently told them (blacks),
hat I wasn't born a doctor, it was a
strain to be trained and taught, and
;hat opportunity is for you. I have many
Deople who are black tell me they are
amazed that I am a doctor. The idea
hat you have to spend so much time in
jchool, it costs so much money . . .
n'ou also have to motivate parents. They
3sk 'What do you mean going to medical
school — I don't have that kind of
noney — go out and make a living.' So
/ve've had to motivate a lot of people,
business and educators, into accepting
:he fact that a young black can become
a physician," Dr. Walden explains.

The temper of the times is swinging
:oward the direction where opportunity
should be available to all people Dr.
A/alden believes:

"There is a critical problem in health
/vhich can be ascribed to manpower
shortages and all the way back to the
deprivation of opportunities for all of
Dur people. If more people get into
nedicine, more people will be able to
solve the medical problems. There is a
ot of talk about National Health Insur-
ance, health maintenance organization
3tc., but at the crux of it is going to be
:he guy who delivers the care.

"In the black community, that re-
sponsibility is going to fall back on the
'are black physician, who numbers
3,000, and this figure has stayed at
3,000. If we graduate 1,000 a year, 1,000
die or go into retirement so you never
get ahead.

"Therefore, if you look at the figures
there is a reverse quota almost 99.4 per
:ent white. There are maybe 20 black
students at Maryland and that certainly
doesn't come near 13 per cent. Na-
tionally the NMA has a program called
'Project 75' which is designed by 1975
to have as many blacks in all medical,
dental and nursing schools as are in the
population, that is percentage wise. We

on the Board of Regents, I say 'we',
because it happened after I was ap-
pointed, have what we call 'Project 74'
where the same thing is suppose to
happen here by 1974," said the newly
appointed Regent.

How does Dr. Walden propose the
problem of recruiting and then graduat-
ing more black physicians be solved
within the state's educational system?

"You can't wait for them (black stu-
dents) to come to you. Recruitment must
go into the schools. We've got to be
more than just physicians. When black
physicians are on admissions com-
mittees they should see that more
blacks get admitted; re-evaluate the
entrance exams and requirements . . .
We aren't asking for liquidating or
lowering standards, but certainly broad-
ening the base so that one reaches out
to the black talent that is available.

"The black talent which we (black
physicians) are going to be telling 'Yes,
you apply, you're qualified, you can go.'
There's got to be a willingness that once
a black student gets into medical school,
he will graduate if it takes five years or
six. You can run tutorial programs. This
is the 'Marshall Plan' that is necessary,"
Dr. Walden remarks. "We feel the larger
white communities had this type of
help, this type of preferential treatment
all along. Now it's got to be given to the
black."

Medical schools and larger univer-
sities have in the past had things funded
because of research. Dr. Walden says
a consumer type market now exists and
everybody is crying "where is all this
wonderful American health we're talking
about. It doesn't get delivered to the
grassroots."

He continues, "We think we have the
people but you need more medical
schools, you need larger classes . . .
this means more money. You get back
to the federal government, end the war
and bring money back, take money from
the space program . . . some of our
priorities are a little out of line. The
benefits of those programs notwith-
standing, we think there're a whole lot
of higher priorities at home — it takes
money to buy brains, buy personnel and
build buildings. You don't put up a
medical school and it runs itself. I think
the most important building in a city is

a hospital and the most important per-
son probably is the physician."

"We do not differ on the type of per-
son needed for delivery of medical
care," he carefully points out. "We
want qualified people also, and what-
ever it takes to get that, we want at the
University of Maryland. This is what
we'll be working for as the NMA is
doing nationwide."

The white physician can do more
than he has to get rid of injustices in
housing, jobs and education especially
in organizations which are para-medical,
outside the medical field, according to
Dr. Walden.

"When City Councils vote to cut the
school budget, they (white physicians)
should be writing letters, talking to
congressmen, local, state and national,
about seeing that proper priorities are
established. And, these people fund
programs and institutions designed to
see that every American gets what is
considered the 'American Dream' and
that it doesn't remain a dream for
blacks."

Dr. Walden proposes that, "education
as to opportunities available to blacks
should begin perhaps upon entering
school. There are programs in junior
high and health clubs that support this
orientation. We are beginning to get
schools and types of schools where the
abilities of the individual count more
than the color of your skin. If he can
produce, he moves up."

Both of Dr. Walden's sons weie par-
tipicants in the University's Summer Pro-
gram for prospective medical students.

"They are concerned that sometimes
the people who finish it don't actually
get into school. They would like for all
of the people who participate in the
summer program to move up to the next
step of the ladder. Hopefully, some will
come into the September class and if
not September, some class in some
school," he comments.

Dr. Walden understands many of the
problems in recruiting blacks for en-
trance to the Maryland School of Medi-
cine. As a graduate of Howard, he rec-
ognizes that even two black medical
schools must compete for applicants.

"This is a two-edged sword because
it raises havoc with the traditional black
medical schools, Howard and Meharry.

They must now compete for 'qualified'
blacks. You must put qualified in quotes.
Qualified by whom? The white super-
structure or qualified in terms of their
own life styles with the ability, if taught,
to be physicians. You have to overlook
certain things that have happened in
the past as a result of the black life
style, which has as its basis, injustice.
"We feel that we wouldn't have any
problem getting minority and 'qualified'
minority students to enter medical
schools, receive the disciplines of medi-
cal schools and turn out to be excellent
doctors. I hope the cure for cancer is
not that far away . . . some black young-
ster just might have the cure for cancer
locked up in his brain, and, I say again,
I hope that we're not that far off in find-
ing a cure for cancer," he concludes.

nutrition of cinildren in
developing connmunities

Barbara Underwood, M.D.

Malnutrition among preschool chil-
dren is a fact, not a fantasy, especially
among the poor, illiterate and ignorant
of developing communities throughout
the world.

The term "developing communities"
rather than the more traditional termi-
nology of "developing" countries has
been chosen in order to encompass
many situations which exist today in
the United States. Until very recent
years, the "developed" Western world
focused concern on the poor and ignor-
ant of Latin America, Asia and Africa,
but showed less concern about the
plight of people on reservations, in mi-
grant camps, and in the Appalachias
and Deltas, and even in the accessible
urban ghettos of Baltimore, New York
City and other metropolitan areas.

The toll of malnutrition on the chil-
dren of the world is difficult to assess
accurately. Seldom is fatality attributed
on death certificates to malnutrition.
More often, gastroenteritis, measles,
whooping cough or some respiratory or
other infectious disease is the recorded
killer. Usually, however, chronic under-
nutrition so debilitates the victim that
he is vulnerable to the ravages of an
infection which is tolerated with mini-
mal discomfort in a well-nourished
individual.

Infant mortality rates are five to ten
times higher in countries where Protein
Calorie Malnutrition (PCM) is frequent.
Certainly not all of these deaths are re-
lated to malnutrition, and one can't
isolate malnutrition from other public-
health and medical concerns such as
proper sanitation, immunization, hous-
ing and health care.

The magnitude of the malnutrition
aspect of the problem is dramatized by
focusing only upon mortality in the one
to four age group. Mortality rates in
this age group are 20 to 50 times higher

in many countries than those in the
Western world. This means that less
than y2 the children born alive can be
expected to reach five years of age. It
is not rare for village women in North-
east Brazil and elsewhere to bear 13
live babies, only to have two or three
who survive the pre-school years.

FAMILY PLANNING

In developing countries family plan-
ning programs are currently receiving
much emphasis and financial support.
Such programs which do not consider
this high incidence of mortality in the
preschool years, much of it nutrition-
related, cannot hope to succeed. Un-
less you can offer reasonable assurance
that the children born will live, you can-
not expect a poor woman to limit the
size of her family. A Jordanian mother
brought to a hospital a two-year-old
child in the terminal stages of
marasmic-kwashiorkor. She already had
lost six children with similar symptoms.
When asked why she continued to have
children when she could not afford to
feed and care for them; why didn't she
go to the family planning clinic? She
answered: "You can make me poor by
not letting me have money, or land, or
animals, but you cannot make me poor
by not letting me have children."

Dr. Barbara Underwood, an assistant professor at Columbia University, was the first lecturer in the
recently created "Misbah Khan Lecture in Problems of World Health." Dr. Underwood was affiliated
with the University of Maryland Department of Pediatrics first in 1962-64 as a research associate and
then in 1964-68 as an assistant professor of Pediatrics. She has been at Columbia since 1968.

These deaths in the preschool years
are preventable and reduction in this
needless waste of human life must be of
first priority for health workers inter-
nationally. However, our concern must
not be limited to reducing mortality but
also must extend to reducing morbidity
and the possible permanent effects of
acute and chronic malnutrition on those
children who survive. In these individ-
uals lie the future hopes for raising the
productivity and hence the economic
level of poverty stricken populations
around the world. Such economic de-
velopment is fundamental to achieving
the goal of establishing a peaceful,
reasonably prosperous world com-
munity.

The evidence is quite clear that acute
malnutrition in the first year of life, and
perhaps during the intrauterine period,
can have irreversible effects on organ
development including the very impor-
tant development of the central nervous
system.

The period in development in which
growth in cell number is rapidly occur-
ring appears to be especially vulnerable
to an acute deficiency of calories. De-
priving the organ of sufficient energy
during the period when cells of an or-
gan are being formed (hyperplasia)
results in an irreversible decrease in
the number of cells produced. In con-
trast, calorie deprivation during the
time when cells are growing in size
rather than in number results in a de-
crease in size of cells. Such effects are
reversed by adequate feeding. In sum-
mary, cells of organs may gain in weight
by feeding more calories, but the num-
ber of cells present cannot increase
once the time of growth by hyperplasia
has ceased.

The human brain grows by hyper-
plasia very rapidly during intrauterine
and early postnatal life. Acute malnu-
trition, in this period has been known
to decrease the number of cells in the
brain resulting in altered behavior pat-
terns of children who survive. On the
other hand, acute malnutrition in the
second or subsequent years, which usu-
ally is in the form of kwashiorkor or
marasmic-kwashiorkor, is reversible.
The size but not the number of brain
cells is reduced and most studies show
no permanent impairment in behavioral

patterns. However, the mechanism by
which malnutrition influences subse-
quent behavioral patterns is not known.
It isn't known if the number of brain
cells directly correlates with functional
capacity, i.e., learning ability. At pres-
ent, it is premature to draw conclusions
on the possible permanent effects of
severe, early malnutrition and caution
should be taken in interpreting the lim-
ited data available from human studies
and especially in extrapolations from
data obtained from animal studies.

Acute malnutrition manifested as
marasmus or kwashiorkor affect rela-
tively small numbers of children com-
pared with the masses of children who
are simply chronically undernourished.
These children simply fail to grow at an
expected rate. However, the possible
effects, especially in the preschool
years, of chronic undernutrition in
childhood on the physical and mental
capacity of adult populations are not
known.

Failure to grow at a normal rate after
the first four to six months of life typi-
fies the child populations of poverty-
stricken communities. Nearly all new-
borns in these communities abroad are
breast fed and for about four months
their growth equals or exceeds that of
children of prosperous communities.
Subsequent growth usually falls below
the accepted standard until about the
fourth or fifth year when growth may
again parallel the standard but at a
lower level. The critical period of in-
adequate growth manifested at about

six months corresponds to the time
when breast milk becomes quantita-
tively inadequate to meet calorie needs.
This is realized by most mothers who,
according to cultural dictates, introduce
supplementary feeding at about six to
nine months. Usually the supplementary
food consists of small portions of the
family diet, which may be a spicy curry,
or of a watery gruel which add little
quantitatively or qualitatively toward
meeting the child's real food needs. In
fact, because such food is often pre-
pared and fed under poor sanitary con-
ditions, it may be a significant source
of contaminants leading to diarrheal
disease.

The growth stunting of early child-
hood may never be fully recovered. A
child from a poor family may be re-
tarded by 2 to 4 years in growth achieve-
ment and never fully attain his apparent
genetic potential.

Is it really so important for people
to achieve their full growth potential?
The answer is no when considering
stature only. There are advantages to
populations of "little people" — less
space required, less protoplasmic mass
to support, smaller cars, less material
for clothing, etc. But, data suggest that
the significant growth retardation after
the first year among the poor reflects

the chronic debilitating effects of sub-
adequate nutrition which in turn is
manifested in an increased morbidity.
Most certainly increased morbidity
means decreased productivity.

Malnutrition develops because of
improper food given under unsanitary
conditions. Poverty is part, but not all,
of the problem. Ignorance as to the
food needs of the child and how to sup-
ply these in a wholesome manner within
the cultural context and the economic
potential of the family is the major
cause of preventable malnutrition.

Theoretically, the solution to this
problem is known and the technical
competence to alleviate malnutrition is
available but those concerned have
failed to find practical ways of getting
the message to mothers. Why? Some
solutions which have been tried but
largely failed include:

— Food distribution programs of dry
skim milk, corn-soya mixture, etc.
or food stamp programs. These
meet acute needs but are not long-
term solutions; they do not change
feeding practices and their effect
terminates when the supply is ex-
hausted. Further, they bear the
stigma of charity.

— Lecture courses for mothers by
professionals in traditional die-
tetics. Often these courses bear
little relation to the reality of the
poverty-plagued environment of
the mother.

An effective program has emerged
during the 1960's and has now proven
its practicality and long range effective-
ness in over 17 different countries. The
program known as Mothercraft Centers
or Nutritional Rehabilitation Centers
recognizes certain basic facts about the
environment which breeds malnutrition.

1. Extreme poverty.

2. Illiteracy or ignorance as to the
food needs of children.

3. Limited numbers of trained pro-
fessionals available in relation to
the vast need.

4. Suspicion and distrust of the highly
educated professional by the illiter-
ate and ignorant.

Recognizing these facts, programs are
developed which, as stated by K. King,
attempt to educate mothers "in the best
practical, hygienic feeding practices

for their children that are compatible
with their financial, educational and
food resources." Traditional dietetics,
the meat, milk, egg approach, is useless
in this setting. Familiarity with the cul-
tural and child rearing practices is es-
sential in order that nothing is taught
that the mother cannot immediately put
into practice in her home. Menus must
not only be low-cost and nutritious but
must be tailored to the food practices
of the particular culture. The profes-
sional cannot ram-rod the basic seven
or the basic four concepts of nutrition
down the throats of a distrusting group
of mothers.

Mothercraft Centers making use of
locally available foods and personnel
have successfully eradicated malnutri-
tion as a significant contributor to pre-
school mortality in several communi-
ties. The secret of success is to retain
a low-cost program and to bridge the
gap of apprehension by using com-
munity leaders of limited education;
leaders with whom the mothers can
identify and in whom they trust.

There are some dangers in develop-
ing Mothercraft programs. One tend-
ency is to develop these programs into
sophisticated health centers. The pro-
gram must develop on the local level
at a rate compatible with the com-
munity's ability to support its needs.
The more the program is identified with
the community, the greater its chances
for permanent acceptance.

The underlying philosophy of pre-
venting malnutrition abroad applies
equally well to the "developing com-
munities" in the U.S. Commodity
food programs, school lunch programs
and food stamp programs alone are not
long term solutions. Community action
must institute programs utilizing low
level "teachers" to get the message to
the mother. The Headstart concept has
much merit, but largely ignores the
mother's education and is a bit late in
preventing malnutrition in the critical
first years of life. The gap of apprehen-
sion and suspicion which has devel-
oped among the minority and ghetto
populations can't be completely judged
by health professionals. Local, perhaps
less educated, but wholly dedicated
talent must be tapped to reach these
people.

Recently, the Young Lords of New
York City used unacceptable means to
take over a Church and establish a
breakfast center for preschool children.
Irrespective of their method, they estab-
lished a needed service which was
accepted and welcomed by the com-
munity. Is there not some way this dedi-
cation to improving the lot of the poor
can be tapped and channeled into effec-
tive long range programs? It is the
responsibility of health professionals
to shake off the shackles of traditional
approaches to education and be recep-
tive to creative and what may some-
times appear radically new approaches.
The main ingredient needed is com-
passion and a dedication to serve
needy people.

REFERENCES

LNaeye, R. L., M. M. Diener, H. T.
Harcke, Jr. and W. A. Blanc. Relation
of poverty and race to birth weight
and organ and cell structure in the
newborn. Pediat. Res. 5: 17, 1971.

2. Winick, M. Nutrition and Mental De-
velopment. Med. Clin. N. Amer. 54:
1413, 1970.

3. Winick, M. Fetal Malnutrition. Clin.
Obstetrics and Gynecology 13: 526,
1970.

4. Underwood, B. A. et al. Height,
weight and skin-fold thickness data
collected during a survey of rural and
urban populations of West Pakistan.
Am. J. Clin. Nutr. 20: 694, 1967.

5. Gordon, J. E. Diarrheal disease of
early childhood — worldwide scope
of the problem. Ann. N.Y. Acad. Sci.
176: 9, 1971.

6. A Practical Guide to Combating Mal-
nutrition in the Preschool Child.
Appleton-Century-Crofts, N.Y., 1970.

7. King, K. W. Mothercraft Centers.
Nutr. Rev. 28: 307, 1970.

dean's thoughts

People have often asked me what the
Tiost glaring defect in our health care
system is. In my opinion it is its orga-
lization and delivery system. Often
leaith manpower in terms of sheer
lumbers is pointed out to be the most
::)ressing problem. It is true, we don't
lave enough physicians. There's no
:iuestion that we need more doctors
and all types of allied health personnel.
However, if one looks at the numbers
ust as numbers, one finds that the edu-
:ational system has been producing
Tiore physicians each year; indeed the
'ise in the number of physicians has
actually outstripped proportionately the
rise in population. This is even more
true of nursing and some of the other
allied health professions. The number
Df people trained in these disciplines
juring the past ten years is astronomical.

A major contributor to the problem is
:hat the health care delivery system
Deing used today is essentially decen-
:ralized with "individual" physicians
and "individual" offices. One way to
:ombat this would be to produce enough
'individual" physicians so that they
:ould be distributed equitably. Unfor-
tunately this requires a vast number,
a number perhaps than our society is
/villing to pay to produce. The theory
Dehind this approach is that if the de-
sirable areas of practice become satu-
rated more physicians will begin to
Tiove into the rural and central city
areas.

Some people advocate using new
types of group specialists in new ways;
others advocate a new type of practi-
tioner, or "specialist," called a family
practitioner. Still others advocate using
more allied health professionals, some
using less.

No one knows the answer at this point
in time but one of the values of the
university academic medical center
might be to try some of the various
experiments and see which one comes
out best. The goal to be achieved is a
situation in which the health profes-
sional and the consumer (patient) both
get a reasonable amount of happiness
out of the relationship.
(This is excerpted from an interview
with Dean Moxley which appeared in
The Paper.)

m^-'ml''

1971-72 internships

Alexander, Arnold
Allan, Thomas
Aquilla, Joseph
Balcer, Richard
Barnett, Leslie
Barney, Robert
Beall, Peter
Benson, Brian
Blumberg, Lawrence
Bollino, Anthony

Bondi, Elliott
Bordow, Richard
Bouchelle, William
Bozzuto, James
Brennan, Thomas
Brenner, Elizabeth

Maryland General Hosp.
Baltimore, Md.

Hartford Hosp.
Hartford, Conn.

Mercy Hosp., Inc.
Baltimore, Md.

Maryland General Hosp.
Baltimore, Md.

University of Md. Hosp.
Baltimore, Md.

Greater Balto. Med. Center
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Univ. of Virginia
Charlottesville, Va.

Univ. of Md. Hosp.
Baltimore, Md.

Conemaugh Valley Mem.

Hosp.
Johnstown, Pa.

Maimonides Hosp.
Brooklyn, N.Y.

Mt. Sinai Hosp.
New York, N.Y.

Univ. of Md. Hosp.
Baltimore, Md.

U.S. Public Health Serv.
San Francisco, Calif.

Mercy Hosp., Inc.
Baltimore, Md.

Chicago Wesley Mem. Hosp.
Chicago, III.

Rot./ Med Major
Straight Medicine
Straight Medicine
Rot./Med Major
Straight Medicine
Straight Medicine
Straight Surgery
Rot./Peds Major
Straight Surgery
Family Prac. Res.

Straight Medicine
Straight Medicine
Straight Medicine
Rot./Surgery Major
Straight Medicine
Str. OB-GYN

Jrenner, Robert
prouillet, George
Juckler, Leroy
5yank, Ronald
^ahen, Lucienne

Callahan, Arthur
Damp, Michael
Ghaney, Charles
Clayton, JoAnn
iChang, Margan
iCohen, Daniel
Cohen, Harold
iCohen, Susan
iCorman, Larry
Detrich, Terry

iDobson, Margaret

it
Dubin, Alan

Edelstein, Michael

Eden, Kenneth

Faulkner, Michael

I Feig, Steven

Flax, Fredric

Sinai Hosp., Inc.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

St. Agnes Hosp.
Baltimore, Md.

Sinai Hosp., Inc.
Baltimore, Md.

Massachusetts General

Hosp.
Boston, Mass.

Lenox Hill Hosp.
New York, N.Y.

Geisinger Medical Center
Danville, Pa.

St. Agnes Hosp.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Boston Univ. Hosp.
Boston, Mass.

Univ. of Md. Hosp.
Baltimore, Md.

Sinai Hosp., Inc.
Baltimore, Md.

Children's Hosp.
Los Angeles, Calif.

Mercy Hosp., Inc.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Mercy Hosp., Inc.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Maryland General Hosp.
Baltimore, Md.

Children's Hosp.
Los Angeles, Calif.

Grady Memorial Hosp.
Atlanta, Georgia

Rot./Med Major
Straight Surgery
Rotating

Rotating

Straight Pediatrics

Rot./Surg. Major

Rotating

Straight Pediatrics

Psychiatry Residency

Rotating

Straight Pediatrics

Straight Medicine

Straight Pathology

Psychiatry Residency

Rotating

Rot./OB-GYN Major

Straight Pediatrics

Fleming, Lawrence
Foody, William
Foster, Michel
Fradkin, Maury
Frankel, Joshua
Frey, Jeffrey
Gelrud, Louis
Genut, Abraham
Glass, Burton
Gordon, Edward
Greenspan, Robert
Greifinger, Robert
Grosart, Gary
Haggerty, John
Harper, William
Hartmann, Peter
Herbst, Jerry
Higgins, Ivanhoe
Ho, Ben

Hobelmann, Charles, Jr.
Hofwits, Gwynne
Huber, Stanford
Jarrell, T., Ill

Univ. of Md. Hosp.
Baltimore, Md.

Army Medical Serv. Hosps.
Washington, D.C.

Medical Coll. of Virginia
Richmond, Va.

Grady Memorial Hosp.
Atlanta, Georgia

Sinai Hosp., Inc.
Baltimore, Md.

Washington Hosp. Center
Washington, D.C.

Medical Coll. of Va.
Richmond, Va.

U.S. Public Health Serv.
Baltimore, Md.

Meadowbrook Hosp.
East Meadow, N.Y.

Martland Hosp.
Newark, N.J.

Univ. of Md. Hosp.
Baltimore, Md.

Montefiore Hosp.
Bronx, N.Y.

Hartford Hosp.
Hartford, Conn.

U.S. Public Health Serv.
San Francisco, Calif.

Washington Hosp. Center
Washington, D.C.

Univ. of Md. Hosp.
Baltimore, Md.

Mt. Zion Hosp.

San Francisco, Calif.

Naval Hospitals
Oakland, Calif.

Naval Hospitals
San Diego, Calif.

South Balto. General Hosp.
Baltimore, Md.

Grady Memorial Hosp.
Atlanta, Georgia

Straight Medicine
Straight Surgery
Rot. /Med Major
Rot./OB-GYN Major
Rot./Med Major
Rotating

Straight Medicine
Straight Medicine
Straight Pediatrics
Straight Pediatrics
Straight Medicine
Social Medicine
Straight Medicine
Rot./Surg. Major
Rotating

Family Pract. Res.
Straight Surgery
Rotating
Rotating
Rot./Med Major
Straight Medicine
Rotating
Straight Medicine

Kahan, Sherman
Kay, Jerald
Kay, Rena
Keown, Richard
Kiang, Henry
Klimt, Claudius
Kowalczyk, Wallace
Kramer, John
Krames, Elliot
Krasner, Robert

Lampton, Edward
Lehman, Robert

Linthicum, William
Lissauer, Jack
Magid, Warren
Maloney, Michael
Mattern, Michael
McCann, David
Mentzer, Robert
Mitchell, Jeffery
Monsour, Roy
Moulsdale, James

Maryland General Hosp.
Baltimore, Md.

Cincinnati General Hosp.
Cincinnati, Ohio

Maryland General Hosp.
Baltimore, Md.

Memorial Hosp.
Long Beach, Calif.

Mercy Hosp., Inc.
Baltimore, Md.

Univ. of Miami Affil.
Miami, Florida

Washington Hosp. Center
Washington, D.C.

Mt. Zion Hosp.

San Francisco, Calif.

Nev^ England Medical

Center
Boston, Mass.

Children's Hosp.
Pittsburgh, Pa.

Sheppard & Enoch Pratt

Hosp.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Univ. of Chicago Clinics
Chicago, III.

Univ. of Md. Hosp.
Baltimore, Md.

Mary Imogene Bassett Hosp.
Cooperstown, N.Y.

Univ. of Minnesota
Minneapolis, Minn.

Duke Univ. Med. Center
Durham, North Carolina

Univ. of Virginia
Charlottesville, Va.

Univ. of Md. Hosp.
Baltimore, Md.

York Hosp.
York, Pa.

Univ. of Md. Hosp.
Baltimore, Md.

Straight Medicine
Psychiatry Residency
Psychiatry Residency
Rot./Med Major
Rotating
Rotating

Rot./Anesth. Major
Straight Medicine
Straight OB-GYN
Straight Surgery

Straight Pediatrics
Psychiatry Residency

Family Pract. Res.
Straight Medicine
Rot./Anesth. Major
Straight Medicine
Straight Surgery
Psychiatry Residency
Straight Surgery
Psychiatry Residency
Rotating
Straight Surgery

Neborsky, Robert
Ostroff, Robert
Richards, Rufus
Riffelmacher, Gerald
Rocklin, Donald

Rogers, Paul
Ruebush, Trenton
Sacks, Henry
Samuels, William
Sanders, Michael
Schaffer, Gerald
Schultz, Michael
Schreter, Robert
Schuman, Robert
Schwartz, Susan
Seligmann, Ralph
Shannon, Robert
Sharrock, Robert
Shevitz, Stewart
Shiian, Joel
Silverman, Thomas
Sitaras, P. L.

Grady Memorial Hosp.
Atlanta, Georgia

Highland-Martinez-V.A.
Martinez, Calif.

Highland General Hosp.
Oakland, Calif.

St. Elizabeth's Hosp.
Brighton, Mass.

New England Medical

Center
Boston, Mass.

Unif. of Calif. Hosp.
Los Angeles, Calif.

Univ. of Penn. Hosp.
Philadelphia, Pa.

Maryland General Hosp.
Baltimore, Md.

Mary Imogene Bassett
Cooperstown, N.Y.

Univ. of Md. Hosp.
Baltimore, Md.

Albany Hosp,
Albany, N.Y.

Sinai Hosp., Inc.
Baltimore, Md.

Beth Israel Hosp.
Boston, Mass.

Kaiser Foundation Hosp.
San Francisco, Calif.

Washington Hospital Ctr.
Washington, D.C.

Washington Hosp. Center
Washington, D.C.

Montefiore Hosp.
Bronx, N.Y.

Univ. of Md. Hosp.
Baltimore, Md.

Good Samaritan Hosp.
Portland, Oregon

Greater Balto. Med. Ctr.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

University Hosp.
Cleveland, Ohio

Straight Medicine
Straight Medicine
Rotating

Straight Medicine
Straight Medicine

Straight Pediatrics
Straight Medicine
Rot./Medicine Major
Rot./Psych. Major
OB-GYN Residency
Straight Medicine
Straight Surgery
Psychiatry Residency
Rotating

Rot./Medicine Major
Straight Medicine
Social Medicine
Family Pract. Res.
Rotating
Rotating

Rot./Psych. Major
Straight Surgery

Smith, James
Smyth, Dennis
Steele, Anthony
Steele, Marshall
j Stone, John

Stuart, William
Termini, Benedict
Thompson, Kerry
i Tiffany, Harriet
! Tomie, Sachiko

Tompakov, Harvey
Tompakov, Janee
i Trippe, Bruce
Weinfeld, Robert

Weiss, Kenneth

Whitehead, Robert
Whitman, Walt
Wilson, Nancy

Wirsing, Charles

Woolsey, Carl

United Christian Hosp.
Lehore, West Pakistan

Univ. of Md. Hosp.
Baltimore, Md.

Univ. of Virginia
Charlottesville, Va.

Conemaugh Valley Mem.

Hosp.
Johnstown, Pa.

Univ. of Md. Hosp.
Baltimore, Md.

Mercy Hosp., Inc.
Baltimore, Md.

Army Med. Serv. Hosps.
Washington, D.C.

Albert Einstein
Philadelphia, Pa.

L.A. County USC Med. Ctr.
Los Angeles, Calif.

Mt. Sinai Hosp.
Miami Beach, Fla.

Washington Hosp. Center
Washington, D.C.

George Washington Univ.

Hosp.
Washington, D.C.

Greater Balto. Med. Ctr.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Tucson Med. Educa.

Program
Tucson, Arizona

Seton Psychiatric Institute
and St. Agnes Hosp.
Baltimore, Md.

Univ. of Md. Hosp.
Baltimore, Md.

Straight Pathology
Straight Medicine
Straight Pediatrics
Family Pract. Res.

Straight Medicine
Straight Medicine
Straight Surgery
Straight Pediatrics
Straight Pediatrics
Rot/Medicine Major
Rot./Medicine Major
Straight Medicine
Straight Medicine

OB-GYN Residency

Straight Medicine
Straight Medicine
Rotating

Combined Internship
and Residency Program

OB-GYN Residency

ambulatory health services -a new era

William S. Spicer Jr., M.D.

There can be little doubt in any health
professional's mind that we are in a
period of significant change in the de-
livery of health care. While few of us
expect or desire a total upheaval, we do
anticipate that there will be some
changes in the nature and practice of
medicine, in the methods of payment
for health care delivery, in the utiliza-
tion of other health professionals, and
in the organization of health profes-
sionals for decision-making and quality
of care controls, e.g., peer review. This
is a time, therefore, in which decisions
will be made which will have an impact
on the way physicians presently in prac-
tice are able to carry on their practice

and in which physicians yet to come
will be trained. However, this period of
change will not only affect physicians,
but all other types of health profes-
sionals as well, possibly even including
types not presently available.

Our experience with the so-called
"research revolution," which began ap-
proximately 20 years ago, has been the
discovery that changes which occur in
the medical school will have a profound
effect on the future practice of medi-
cine. From our past experience, we can
recognize that the change from the
training of generalists to the training
of highly-specialized and sub-special-
ized individuals has been a predominent

Editor's Note: Dr. Spicer, associate dean, was named to head the Health Care Programs division
when it was created by Dean John H. Moxley III in October 1969. He received his M.D. degree from
the University of Kansas, School of Medicine.

feature of the past 20 years of
health care delivery. It Is, therefore,
reasonable to assume that if the medical
school once again makes a rather
marked change in its mode of educating
medical students, the impact of this
change will be felt for the next two
decades. For that reason, it is exceed-
ingly important that any changes which
occur in the University of Maryland,
School of Medicine, and in the other
health professional school curriculum
and programs be carefully thought out,
and that every opportunity be made
available for thorough consultation and
coordination with all of the health pro-
fessional members who are concerned.
Now is the time and the opportunity to
bridge some of the gaps between faculty
and alumni, to recognize that there is
little or no room for carping, but a great
need for consultation and constructive
criticism through the establishment of
new lines of communication.

The Medical School is proceeding to
make changes in its own mode of de-
livery of health care, in the education
of its students, and in its relationship
with its surrounding community of both
lay people and health professionals. It
is proceeding on the following postu-
lants:

1. All health professional education
must be founded on the demonstration
of the delivery of optimal health care;

2. We must start from a working defi-
nition of optimal health care for the
future. Our present working or opera-
tional definition of optimal health care
is: Optimal health care for large num-
bers of people is provided by health
care teams and includes these ele-
ments:

a) Detection of symptomatic and
asymptomatic disease and identi-
fication and introduction of indi-
viduals who make up a "popula-
tion" into the health care system.

b) Health maintenance and disease
prevention, including collecting
and maintaining a lifetime history
of health and disease.

c) Education of the consumer for
health maintenance, disease pre-
vention, utilization of available
services and disease therapy.

d) Diagnosis and management of
disease.

e) Coordination of community re-
sources to support individuals and
families.

f) A health care information system
which assures referral, scheduling,
consultation and retrieval of indi-
vidual patient records and data.

g) Quality of care control and system
evaluation.

At the present time, our health care
delivery and educational programs em-
phasize the diagnosis and management
of symptomatic disease. They are
mostly concerned with the sick and very
sick individuals, usually those in hos-
pital beds. Instead, we must develop
concern for all elements of care. Opti-
mal and economically realistic health
care is best delivered to a defined pop-
ulation in a coordinated, hierarchical
system of primary, secondary and ter-
tiary care, with built-in regulation of
flow into and through the different parts
of the system.

For our present purposes, we accept
these definitions of primary, secondary
and tertiary care:

Primary care is the care which the
patient receives when he first ap-
proaches the health services system
and during continued participation,
active or nonactive, in the process of
medical care. Primary care includes
the elements of comprehensiveness,
continuity, prevention, etc. suggested
above. It also includes acute episodic
and emergency care. It is "caring for"
and "caring about" the patient; and
it is the coordinator and advocate of
the patient's movement within the
care system. Primary care does not

always have to be provided by physi-
cians, but it should be supervised
and monitored by them.
Secondary care is specialty consul-
tation. Referral to secondary care
should come from primary care pro-
fessionals. It should normally be on
an ambulatory basis. The patient
should return to primary care upon
the completion of secondary care, or,
in selected instances, continue to re-
ceive secondary care and manage-
ment for a particular problem in con-
junction with overall primary care.
Tertiary care is bed care in an insti-
tution. It is the most misused element
of our present health care system. It
not only increases the cost of the
whole health services system, but
may be harmful and even life-threat-
ening. Its purposes and constraints
must be re-defined.
3. It is very important that we recog-
nize that our working definition implies
an increase in the quantity, as well as
the quality of care.

The vast majority of health care de-
livery is involved with the ambulatory
patient. The intense and growing con-
centration of the health professional
schools with educational and training
programs surrounding the bed patient,
and particularly the bed patient in
highly specialized University Hospital,
has provided all of the students with a
limited view of the practice of medicine.
It would seem apparent that the place
in which change would first occur in the
health educational curricula would there-
fore be in a marked expansion and re-
definition of the ambulatory care serv-
ices.

At the beginning, it is pertinent to
say that we do not believe there is only
one way to deliver optimal health care
and, in fact, we feel strongly that in this
country there should be a multiplicity
of ways. We also feel that our students
should be exposed to as many options
as possible in order for them to make
a reasonable and logical career choice.
For the University Health Science Cen-
ter and its own campus, these options
will be fairly limited. However, through
a broad affiliation program with com-
munity hospitals, group practices, fam-
ily practitioners and voluntary agencies,
it should be possible to provide a co-
ordinated and regional health care edu-
cation program.

In our definition of optimal health
care, we state that delivery of care will
probably be a team effort. There must
be, however, many types of health care
teams. The team concept involves the
coordinated sharing of responsibility by
members of the various health profes-
sions in order to improve the efficiency
and effectiveness of utilization of health
resources, costs and services, and in
order to increase the comprehensive-
ness of health services.

The health care team is not a new
concept, per se. The practicing physi-
cian and his nurse or secretary are
traditional examples of teamwork de-
signed to increase the capacity of the
physician and the quality of care. How-
ever, it is important to note that the
University of Maryland has an obliga-
tion to train all types of health profes-
sionals because of its location in the
heart of the inner-city, thereby develop-
ing teams which can best serve its role
in education and training. These teams
are likely to be large and complex for
two reasons: They must provide a basis
for training a broad variety of both un-
dergraduate and postgraduate health
personnel, e.g., physicians, nurses,
pharmacists, etc.; and, our location in
the heart of the urban complex provides
a population whose health care needs
are large; and the fulfillment of these
needs is critical to the renewal of the
inner-city.

Under the auspices of the Office of
Health Care Programs, a number of
changes are already under way with the
goal of delivering optimal health care.

Primary emphasis is being placed on
Ambulatory Services and, in particular,
on the development of primary care. In
terms of education, our training pro-
grams are now concerned with the ex-
pansion of the role of the nurse and the
pharmacist. In our plans for the devel-
opment of primary care, we are stress-
ing two types, i.e., the development of
a family medicine program and the de-
velopment of a general internist-general
pediatrician-general obstetrician com-
bination primary care unit.

In order to improve the quantity as
well as the quality of health care, our
present activities in ambulatory nursing
services serve as an immediate exam-
ple of change. The role of the nurse is
being expanded with the development
of nurse clinics, nurse practitioner pro-
grams and our fundamental core pro-
gram, which is called the Primary Care
Nurse Program. In this program, the
nurse's role is being altered from one
which is primarily task-oriented to one
which is whole-patient-oriented in close
working cooperation and consultation
with the physician. In reviewing the
seven elements of optimal health care
described earlier, it appears to us that
the primary care nurse should be pre-
pared to make a contribution, to a
greater or lesser extent, to all of the
seven elements. Thus, a further purpose
of this program is to enlarge the role
of the nurse.

Upon completion of the North Hos-
pital Building in 1972, our ambulatory
care space will have been expanded
threefold. We hope that by the time we
move into this new building, most of our
new basic training and educational pro-
grams will have been completed. In-
cluded in these programs are those
directly related to patient care, such as
new training programs and new staffing
patterns in the Emergency Department
and the Out-Patient Department, and
others such as changes in the health
care record system, patient scheduling
and flow and administrative support.

During this period of change, com-
munication plays a vital role in linking
together all the people who are directly
and indirectly concerned. The Ambula-
tory Health Services publishes a News-
letter which attempts to bring to all
personnel the descriptions of changes
now in progress and the opportunities
for their involvement in these changes.
Any alumni interested in following this
program are invited to receive this
newsletter. To be included in our mail-
ing, please contact Mrs. Susan Dilts,
Office of Health Care Programs, Room
551, Howard Hall, 660 West Redwood
Street, Baltimore, Md., 21201; or call
955-7195.

professors of surgery 1807-1970

(a two-part series)

Harry C. Hull, M.D.

John davidge

John Beale Davidge (tenure 1807-12)
was born at Annapolis, Md. in 1768. His
father was an ex-captain in the British
Army and his mother, Honor Howard,
was a relative of Col. John Eager
Howard.

Despite the early loss of his father,
and having little or no funds, he re-
solved to obtain an education. Davidge
inherited some slaves after the death
of a relative, and with further aid from
friends, he was able to enter St. John's
College at Annapolis. He obtained his
master's from St. John's in 1789 and
after a preceptorship under Dr. Murray
of Annapolis, he entered the University
of Edinburgh. It is recorded, however,
that for financial reasons, he obtained
his M.D. at Glasgow University, April
22, 1793 at age 25.

In the same year, he married a Scot,
Wilhelmina Stuart, and moved to Bir-
mingham, England where he practiced
until 1796. He then returned to Baltimore
and settled permanently.

In 1797 an epidemic of yellow fever
struck Baltimore and his views on the
epidemic, published in a volume in
1798, attracted considerable notice. The
doctor remained in the "limelight"
thereafter. As early as 1802 he adver-
tised private courses of lectures to
medical students, which continued an-
nually until they merged with lectures
at the opening of the College of Medi-
cine of Maryland in 1807.

His positive views kept the College
of Medicine of Maryland in the fore-
ground of American Medicine. He dis-
agreed with the, then greatest figure in
American medicine, Dr. Benjamin Rush.
Rush's theory held that all diseases
were identical and that one "universal
cure" was appropriate for all. Davidge
convinced his colleagues, however, that
each disease was different and had to
be studied and treated differently. The
rivalry continued to the point of per-
sonal animosity between Rush and
Davidge. "The Maryland Theory" of
Davidge was recognized in prevailing
medical circles throughout the country.

As at the few schools of medicine in
the United States at that time, Davidge,
as did others, wore several hats. At
times he was listed as Professor of
Surgery, Professor of Anatomy and of
Mid-Wifery. Therefore, his writings were
as expected, diverse, and were more
on medical than surgical subjects.

Among his writings were: "Dissertatio
Physiologia de Causis Catamensorum,"
Birmingham, 1794; "Treatise on Yellow
Fever," Baltimore, 1798; "Nosologia

Editor's Note: Dr. Harry C. Hull, M.D., professor clinical surgery, delivered this paper "The
Professors of Surgery, The University of Maryland, School of Medicine 1807-1970," at the l^edical
Staff Meeting, March 18, 1971. Because of its historical interest and length, the paper will appear
in a two-part series in this and a future issue of the Bulletin. Nine men have headed the Department
of Surgery since 1807 and five of them are discussed in the first installment.

\/lethodica," Baltimore, 1812 and 1813;
'Physical Sketches," two volumes, Bal-
timore, 1814 and 1816, and "Treatise
Ipn Amputation," Baltimore, 1818.
I Many of his theoretical views were
Interesting: that phthisis pulmonalis was
scrofula of the lungs; that hemorrhage
^as arrested by retraction of vessels
and not contraction; that menstruation
was a secretion of the uterus excited
by ovarian irritation; that the speculum
uteri should not be used, because it
"smacked of immoral curiosity"; that
yellow fever should not be treated by
bleeding; that yellow fever was non-
contagious but propagated by the at-
mosphere; and that black vomit was a
morbid secretion derived chiefly from
the liver.

Davidge was considered a much bet-
ter speaker than writer. He was revered
by his students and usually received
special applause at the Commence-
ments where he was acclaimed by all
as the "Father of the University."

Described as a short stout man of
florid complexion, homely features,
small hands and feet and graceful car-
riage, his manners were grave, formal
and dignified and his dress very neat.
His influence throughout Maryland was
considerable and he was popular with
his colleagues.

As a surgical technician, he was slow
and cautious. The most important oper-
ations he performed were: amputation
at the shoulder joint, 1793; successful
ligation of the gluteal artery for an
aneurysm; ligation of the carotid artery
for "fungus of the antrum" and extirpa-
tion of the parotid gland, 1823.

The doctor was still active in the
medical school, teaching Anatomy at
the age of 61. In January 1829 he de-
veloped a carcinoma of the antrum. The
lesion progressed rapidly and was ac-
companied by excruiating pain, which
was treated by hugh doses of laudanum
He died at his home on Lexington St.
August 23, 1829.

; It is cogent to note that Cordell in
Volume I, University of Maryland, 1907,
stated: "it is a regrettable fact that his
relations and services to the University
have not suggested to his successors,
some memorial in his honor in the in-
stitution which owes its existence and
a large part of its success to him."

William gibson

William Gibson (tenure 1812-19) was
born in Baltimore, March 14, 1788.
Called by some the "academic vaga-
bond," he was educated at St. John's
and Princeton Colleges. He attended
the University of Pennsylvania Medical
School for a short time. He was not
impressed with that medical school and
was cocky enough to tell his fellow
students that one day he would succeed
Professor Physick in the Chair of Sur-
gery at Pennsylvania. Later his boasting
came true.

At the age of 18, Gibson went to
Scotland and entered the University
of Edinburgh, from which he received
the M.D. degree in 1809 at the age of
21. His inaugural thesis about racial
differences in the human skeleton
brought him much credit. This work was
done in the Munro Museum. After grad-
uation he went to London and became
a pupil of Sir Charles Bell. In 1810 he
returned to Baltimore and at once be-
came active in the profession. In 1812,
at the early age of 24, he was made
Professor of Surgery at the College of
Medicine of Maryland.

During the summer of 1812, political
riots occurred in Baltimore. One man
who sustained a gunshot wound of the
abdomen, was referred to Dr. Gibson,
who litigated the right common iliac
artery close to the aorta, and sutured
several holes in the intestine. Although
the patient died fifteen days later "from
ulceration of the artery and peritoneal
inflammation," this daring operation

established Dr. Gibson's reputation as
a surgeon. During the war of 1812, he
served as a surgeon with the Maryland
troops, in 1814 he returned to Europe.
He was present at the battle of Water-
loo and was wounded at that battle.

Dr. Gibson, described as a rapid and
dexterous operating surgeon, was in-
genious and creative. He was first in
the country to perform suprapubic lith-
otomy, and among the first to perform
lithotripsy. He performed successfully
a caesarean section on the same woman
twice, saving the life of the woman and
both children. Among his accomplish-
ments were: inventing an apparatus for
fractures of the lower jaw; creating a
psuedoarthrosis of the knee joint for
ankylosis and excised ribs; and divid-
ing the recti muscles for strabismus as
early as 1818. His reputation was en-
hanced when he successfully extracted
a rifle ball from Gen. Winfield Scott,
who was wounded at the Battle of
Lundy's Lane.

A prolific writer, two years after ac-
cepting the Chair at Maryland, Gibson
brought out an American edition of "Dr.
Charles Bell's System of Dissection."
The two volumes were "dedicated to
the gentlemen attending the University
of Maryland." His writings continued
after he left Maryland and in addition,
he kept a daily journal for over 60 years,
which at death, amounted to 150 vol-
umes.

Dr. Gibson was a clear and emphatic
lecturer and his demonstrations of sur-
gical anatomy were good, especially
those relating to the neck, hernia and
lithotomy. He had a large collection of
models, casts, pictures, apparatus and
surgical specimens which he used dur-
ing his lectures and demonstrations.

Dr. Gibson, a large and powerful man,
round faced with a ruddy complexion,
was athletic — an expert boxer, horse-
man and trackman. He was vain of his
personal appearance and proud of his
reputation as a teacher and surgeon.
An all around man, he played the violin;
he was fond of botanizing and fishing;
he was an ornithologist and amateur
taxidermist, and he was vivacious and
and possessed great stamina.

In 1819 he was offered the Chair in
Anatomy at the University of Pennsyl-
vania, which he declined. So great was

his reputation, however, and so eager
was the faculty at Pennsylvania to have
him, that the great surgeon, Physick,
was displaced and Gibson was offered
the Chair to replace this famous sur-
geon. He accepted this appointment and
left Maryland in 1819 — the boast of
his student days had come true.

His good work and fame continued
throughout his stay in Philadelphia. He
retired from the Chair at Pennsylvania
and moved to Newport, R.I. While on a
visit to Savannah, Ga., he died, appar-
ently of a heart attack, March 2, 1868,
age 80.

granville s. pattison

Granville Sharp Pattison (tenure 1820-
26) was born near Glasgow, Scotland
in 1792, the son of John Pattison of
Kelvin Grove. He was educated at Glas-
gow University where he was apparently
a brilliant hard working student. At age
18 he was made assistant to Professor
Allan Burns and upon his death was
appointed his successor to the Chair of
Anatomy, Physiology and Surgery in
Anderson Institution, a recently orga-
nized but poorly endowed medical
school at Glasgow. He became a licen-
tiate of The Royal Faculty of Physicians
and Surgeons of Glasgow in 1813.

At Anderson Institution he gained
quite a reputation as a lecturer and
particularly as an anatomist. In Novem-
ber 1818, charges were brought against
him by Dr. Ure, one of his colleagues,
of having committed adultery with his
wife. Dr. Ure obtained a divorce. In
December 1818, a letter arrived from
Pattison's brother John, who lived in

Philadelphia, advising him that there
was probably an opportunity for a man
of his talents at the University of Penn-
sylvania, School of Medicine. The doc-
tor arrived in Nev^ York from Liverpool
July 7, 1819, but due to a shake up of
the Pennsylvania faculty, did not get
the Chair of Anatomy. The Chair was
given to Dr. Philip Syng Physick.

At the University of Pennsylvania Dr.
Nathaniel Chapman developed a marked
dislike for Pattison and began a ven-
detta of maligning and debasement of
him which lasted for years and eventu-
ally caused a duel. Because of Chap-
man's attacks, Pattison accepted no
position at Pennsylvania and he also
declined the offer of a professorship at
Transylvania in Lexington, Ky.

In 1820 at age 28, he was elected to
and accepted the Chair of Surgery at
the University of Maryland. Cordell re-
ports Pattison as infusing new life into
the University of Maryland. He suc-
ceeded in disposing of his anatomical
collection left to him by Professor Burns,
to the University of Maryland for $8,000
and a year later persuaded the faculty
to accommodate it in a new $30,000
hall, which later became a museum for
over 1,000 selected morbid and healthy
specimens.

He was a colorful teacher, with a
Scottish burr, radiating enthusiasm and
confidence that charmed the students
and increased the enrollment. He was
not a good surgeon nor did he write
many articles while in Baltimore.

Pattison was a handsome, vain, well-
dressed man, and quite a hit with the
wives and debutantes of Baltimore, who
oursued him with great success. Mean-
MhWe, Chapman continued his attacks
3n Pattison's character, which eventu-
ally were more than Pattison would
sndure. He went to Philadelphia and
challenged Chapman to a duel. Pro-
cessor Pattison declined because of
age. His brother-in-law, Gen. Thomas
3adwalader of Philadelphia, accepted
:he challenge. Pattison and Cadwalader
net in Delaware April 5, 1823 and Dr.
John B. Davidge was present as sur-
geon. Pattison shot the General in his
'pistol arm," the ball traversing the
3ntire length of the forearm, lodging
n the ulna. Pattison escaped injury, the

General's shot merely piercing the skirt
of his coat.

Many articles have been written about
this duel and the story is "old hat" to
nearly all graduates of the University
of Maryland School of Medicine.

Though Pattison may have been a
roue, a rake, an adventurer and an in-
famous character, he did one important
thing to his credit. He championed bed-
side clinical teaching, for which a hos-
pital was needed. The Baltimore City
Council and banks failed to extend more
credit to the University. Pattison pre-
vailed upon the faculty to extend their
credit and build a hospital. The infir-
mary which was situated on Lombard
Street diagonally across from the medi-
cal school was a four story brick build-
ing and contained 60 beds. Ready for
patients and classes by the Fall term
of 1823, it cost the faculty $14,609 for
construction, plus $2,520 for beds and
furnishings. At the rear of the hospital
was a semi-circular operation theater.

Resident students could obtain room
and board for $300 a year. The fee for
patients for board, nurses and doctors
was $3 per week. Pattison wrote to the
Mother Superior of the Sisters of Char-
ity at Emmitsburg, Md. October 11,
1823 offering to place the management
of the institution under the Sisters. The
Sisters arrived shortly thereafter and
ran the hospital from November 1823
until 1876. This doubtless, thanks to
Pattison, was the first "teaching hos-
pital" in America.

In the Summer of 1826, Pattison went
to Europe and never returned to Balti-
more. In 1827 he accepted the Chair of
Anatomy at the University of London.
He never was a success and complaints
of his inability as a teacher and surgeon
increased to the point that in 1820-31
"his colleagues offered to pay him a
certain stipend for a number of years
if he would retire." He was literally
"drummed out" of the University July
23, 1832.

The doctor returned to America in
1832 having been elected to the Chair
of Anatomy at the new Jefferson Medi-
cal College in Philadelphia. He re-
mained at Jefferson until 1841, when
he resigned to join in the founding of
the Medical Department of the Univer-
sity of New York. For the next ten years

he remained at the University of New
York as Professor of Anatomy until his
death November 12, 1851. His death
was due to complications from obstruc-
tion of the common bile duct.

Granville S. Pattison, a truly attractive,
colorful and tempestuous figure, about
whom much is written, did little or
nothing to advance the progress of
surgery. He was a poor and unimagina-
tive surgeon and not creative in that
field. His writings were limited to the
editing of several hundred anatomical
volumes. Pattison's greatest contribu-
tion to medicine was his conception and
implementation of a teaching hospital
for medical students.

nathan r. smith

Nathan R. Smith (tenure 1827-69) the
famous second son of a famous father,
Dr. Nathan Smith, was born at Cornish,
N.H., May 21, 1797. His elementary edu-
cation was received from private tutors
and at Dartmouth College. His father,
Nathan Smith, the founder of Dartmouth
Medical College in 1798, resigned from
that institution in 1813 to head the fac-
ulty of the Yale Medical School at New
Haven. Nathan Ryno left New Hampshire
with his father and matriculated as a
freshman at Yale in 1813. He received
the A.B. degree in 1817, at the top of his
class. Following graduation he spent
18 months as a tutor for the family of
Thomas Turner, a Virginia gentleman of
wealth and social eminence. During this
short period he developed a strong
attachment for the South, which lasted
his entire life. (Much later in life at age
72, he wrote a short discourse "Legends

of the South, by Somebody, who wishes
to be considered nobody"). After this
sojourn in Virginia, he entered Yale
Medical School and received from Yale
College the M.D. degree in 1820. His
inaugural thesis defended the view,
"that the effects of remedies and dis-
ease are the result of absorption from
the blood stream and not an impression
on the nervous system." His interest in
this subject continued with experiments
that were published in 1827.

Dr. Nathan Smith, a founder or co-
founder of several medical schools,
(Dartmouth, Yale, Bowdoin, Vermont,
Jefferson) together with his son, Na-
than Ryno, founded the University of
Vermont at Burlington in 1820. Dr. N. R.
Smith was appointed to the Chair of
Anatomy and Surgery in 1824. Before
taking over these positions, he took
leave to attend lectures at the Univer-
sity of Pennsylvania, to better prepare
himself. While in attendance, he met
Dr. George McClellan and others, who
were busily engaged in founding Jeffer-
son Medical College. These men were
impressed with young N. R. Smith and
offered him the Chair of Anatomy,
which he accepted. In 1827, after two
years at Jefferson, he was offered the
Chair of Anatomy at the University of
Maryland. Dr. Davidge was then Acting
Professor of Surgery, following Patti-
son's resignation. An exchange was
effected whereby Smith became Profes-
sor of Surgery and Davidge returned to
the Chair of Anatomy.

Dr. N. R. Smith, a good six feet tall,
was a man of commanding, if not dom-
ineering presence. He was clean shaven,
with a Grecian nose, piercing eyes,
shaggy eyebrows and very erect pos-
ture. He usually dressed in a neat black
frock coat. He was myopic and wore
glasses. It was this young dignified
gentleman of 30 years, that with great
enthusiasm, industry and ability, took
over the Chair where he was to remain
over the next four decades.

Upon arrival at Maryland, he had but
one competitor in Baltimore, a Dr.
Jameson. Smith's efforts were so vig-
orous and noteworthy, however, that
he soon had the surgical practice of
Baltimore and Maryland at his disposal.

Smith prepared his lectures with
great care and delivered them without

notes, in a slow deliberate fashion. He
possessed and frequently indulged in
humor and clean stories to the delight
of the students. At times, he carried a
pointer or teaching stick, which he
snapped against his trousers. No wonder,
with his regal carriage, deep set eyes and
bushy brows, he was nicknamed "The
Emperor." Such a stern countenance
as he possessed, was sure to command
the undivided attention of the audience.
His lectures dealt with inflammation,
wounds, burns, ulcers, kidney and blad-
der stones, aneurysms, amputations,
tumors, and a great variety of subjects
now claimed by the specialties. He had
a creative and fertile mind, not shackled
by dogma. His was the glamour course
at the Medical School and many stu-
dents opted to take it a second time, so
impressed were they by the master. His
demonstrations of pathological mate-
rial at lectures was an outstanding
attraction.

He continued to gain in stature over
the years — locally and along the east-
ern seaboard. Overlooked by most of
his biographers, is an outstanding sur-
gical procedure he performed in 1835.
A Mrs. M. Wells from Prince George's
County, came to him for the third or
fourth time, requesting him to operate
for an ulcerating goiter. Together, with
Dr. Potter and others, after having
warned the patient repeatedly of the
dangers, he decided to operate. The
operation was performed in less than
one hour through a vertical incision,
without anesthesia. All of the structures
encountered were minutely described in
his operative note. Unfortunately, the
patient died thirteen days after the op-
eration from sepsis. This was the first
operation for goiter ever performed in
Maryland, and the second such opera-
tion performed in America. This under-
taking is more evidence of his courage
and ability as a surgeon, because doubt-
less he had no mentor to show him
the way.

Several years after his appointment,
there was much unrest in the University
as to its administration, until finally in
September 1837, the Board of Regents
of the University, the governing body
of the University, was dismissed and
replaced by action of the State Legis-
lature, by a Board of Trustees. Smith,

siding with the Regents, withdrew from
the University of Maryland and accepted
a Chair of Practice of Medicine in
Transylvania University at Lexington,
Ky., which at that time, was the leading
medical school of the West. Another
famous surgeon of the era, Dr. Benjamin
Dudley, was then Professor of Surgery
at Transylvania. For three years he
traveled west each fall, returning to
Baltimore to his practice and family
after the four month session. His salary
was recorded at $3,000 a year for the
session. The Transylvania catalogue of
1838 notes that he was touted as one
of the outstanding surgeons of America.

During these three years the Univer-
sity of Maryland had recovered from its
administrative difficulties, and Smith
agreed to resume his Professorship of
Surgery at Maryland, which he held un-
til retirement in 1869. For this long pe-
riod 1841-69 "The Emperor" continued
to dominate the profession of Maryland.
His fame was such that the illustrious
Henry Clay was a guest in his home
and he was an acquaintance of Daniel
Webster.

As a surgeon he was gifted with
"dexterity, speed, great acuteness of
perception and an unusual power of
adaptation to unusual circumstances."
During his tenure, anesthesia was in-
troduced and he was quick to adopt
it, as he was other new techniques in
surgery. Smith invented his own litho-
tome but regarded his anterior splint for
fractures of the lower extremities, as
his greatest medical contribution. This
splint was perfected in 1860 and was
so popular, it was adopted here and
abroad. His thyroidectomy, it seems
should have received more notice.

A prolific writer, he contributed many
articles to the Journals in Maryland,
Pennsylvania, Virginia and the Ameri-
can Journal of Medical Sciences. In
1832 he published a book on the "Sur-
gical Anatomy of Arteries," which was
republished as a second edition in
1835. In 1867 he published a small
monograph on the "Anterior Suspensory
Apparatus in the treatment of fractures
of the lower extremity." He received
acclaim from famous surgeons in Eu-
rope in 1867, including Sir James Paget
and Spencer Wells. He received the
degree of L.L.D. from Princeton in 1862.

Dr. Smith was truly one of the sur-
gical giants of his era and did more
than anyone on the faculty to give pres-
tige to the Medical School. He retired
from the Chair in 1869 and the following
year was elected President of the Med-
ical and Chirurgical Faculty. His last
years were spent with office practice,
reading and writing. Dr. Smith died at
age 80, July 3, 1877 of bladder disease
and the infirmities of old age.

Christopher Johnston

Christopher Johnston (tenure 1869-
80) was born in Baltimore, September
27, 1822. He was educated at St. Mary's
College in Baltimore and at St. Mary's
College in Cincinnati, Ohio. He began
the study of medicine under the pre-
ceptorship of Dr. John Buckler of Bal-
timore.

He spent a great deal of the time in
his student days at the Baltimore Alms-
house. He was awarded the M.D. de-
gree from the University of Maryland
School of Medicine in 1844. After grad-
uation he went to Europe for further
study. This was the first of five visits
to that continent.

Upon return he and Dr. Frick founded
the Maryland Medical Institute, a pre-
paratory school for medicine. He left
again for Europe in 1853 and remained
two years, studying in the clinics of
Paris and Vienna. During that time he
acquired great skill in using micro-
scopes and later became lecturer and
demonstrator at the University on "Ex-
perimental Physiology and Microscopy."
He relinquished this post two years
later to become Professor of Anatomy
at the Dental College, where he served

for seven years. In 1864, he accepted
the position of Professor of Anatomy
and Physiology in the Medical School.

As a result of hiis excellent care of
the Southern wounded at the Battle of
Gettysburg, his fame and practice
greatly increased among the people of
Baltimore. It is of interest to note he
became a friend of the celebrated actor,
Edwin Booth. When Booth had his arm
pierced in the fencing scene in Hamlet,
Johnston was called to care for him.
On the night following the injury, Booth
played Richard III at Fords Grand Opera
House with his arm in splints.

In 1869 at the age of 47 he succeeded
Dr. N. R. Smith as Professor of Surgery
and held the Chair for the next eleven
years.

A slow and meticulous surgeon,
Johnston was particularly sensitive to
cosmetic effect. As a matter of fact, his
longest paper was the section in Ashurts
International Encyclopedia of Surgery
on "Plastic Surgery." The scholarly
paper of eighteen pages had a lengthy
bibliography, but did not report any
experience that the author had with this
specialty.

Johnston was credited with being the
first surgeon in Maryland to completely
excise the upper jaw (1873) and the first
to perform surgery for vesicle exstrophy
(1876). He was active in the small med-
ical and scientific societies and served
as president to several.

At the age of 58 he resigned at Mary-
land but continued actively to practice
surgery. After succeeding Dr. N. R.
Smith, he was the acknowledged leader
of the surgical profession in Baltimore
from 1870 to 1890. He continued travel-
ing in Europe and became master of
the French and German languages.

When Johns Hopkins Hospital opened
he was appointed Consulting Surgeon.
He became enamored of this new insti-
tution, its laboratories, museums and
libraries, so much that he forgot his
alma mater. Despite the fact that he
received his M.D. from Maryland, on
his death, he left his instruments, micro-
scopic apparatus, his cabinet of crys-
tals and entire library to the Johns
Hopkins University.

After some months of poor health,
he died October 11, 1891 at age 69.

faculty news

buxton scholarship

The Senior Class, School of Medicine,
has established a scholarship fund in
memory of the late Dr. Robert W. Bux-
ton, chairman. Department of Surgery.

Paul Rogers, class president, said,
"Initially the Senior Class contributed
$2,500 from the treasury to establish
the medical school's new scholarship
fund. In addition the class sent letters
to faculty, parents and friends asking
for contributions. Hopefully, other grad-
uating classes as well as members of
the 1971 class will make future con-
tributions."

Donations will be put into a special
account in the University's General En-
dowment Fund with the principle re-
maining in the Fund while the interest
is used for an annual scholarship.

Dr. Frederick J. Ramsay, assistant
dean, Student Affairs, will be responsi-
ble each year for selecting the recipient
of the scholarship. He will also make
an annual accounting of money used
from the fund. The only restriction is
that the scholarship must be given a
student based on financial need.

Those wishing to contribute to the
fund should make checks payable to
the "Dr. Robert W. Buxton Scholarship
Fund" and mailed to the Dean's Office,
University of Maryland Medical School,
Lombard and Greene Sts., Baltimore,
Md. 21201.

outstanding faculty

Nine members of the School of Medi-
cine faculty have been honored by the
Student Council for demonstrating an
outstanding quality of inspirational guid-
ance and interest in teaching and prac-
tice of medicine.

Peter Vash, Student Council presi-
dent, explained that each year the
Council selects a single faculty member
whom they felt to be most deserving
and present him or her with a plaque
at a dinner held in his or her honor.

"This year the Council altered the
procedure," said Vash. "We felt that in
any one year there is often several
faculty members and house staff who
have demonstrated an outstanding in-
terest in the teaching and guidance of
students. Moreover, we feel that there
are many faculty or house staff whose
diligent and conscientious teaching
abilities all too frequently go unac-
knowledged."

The following were honored at a din-
ner held at the home of Dean John H.
Moxley III: Marshall L. Rennels, Ph.D.,
assistant professor, Anatomy and Neur-
ology; Charles C. C. O'Morchoe, M.D.,
Ph.D., associate professor. Anatomy;
Mary E. Kirtley, Ph.D., associate profes-
sor. Biochemistry; David B. Ludlum,
Ph.D., professor. Cell Biology and Phar-
macology; Donald Pachuta, M.D., fellow,
Infectious Diseases; William Holden,
M.D., clinical assistant professor. Psy-
chiatry; Robert L. Derbyshire, Ph.D.,
associate professor. Sociology in Psy-
chiatry, and director. Division of Urban
Studies and Group Process; William L.
Stewart, M.D., associate professor and
head. Division of Family Medicine; and
Stuart H. Walker, M.D., professor. Pedi-
atrics.

DR. ELIJAH ADAMS, professor of Bi-
ological Chemistry, has been awarded a
Guggenheim Fellowship for 1971. The
fellowship is for "Experimental Studies
in Synthesis of Peptides." There were
2,363 applications for the fellowships
of which 354 fellows were selected in
the U.S. and Canada. Dr. Adams is cur-
rently on sabbatical leave at Weizmann
Institute of Science at Rehovat, Israel.

DR. MARTIN HELRICH, professor and
chairman of the Department of Anesthe-
siology, has been appointed chairman
of the Advisory Committee of the Food
and Drug Administration.

DR. MORRIS J. WIZENBERG, profes-
sor of Radiology and head of the Divi-
sion of Radiation Therapy, has been
elected president of the IVIaryland Divi-
sion of the American Cancer Society.

DR. JONAS RAPPEPORT, associate
clinical professor of Psychiatry, has
been re-elected president of the Ameri-
can Academy of Psychiatry and the
Law.

DR. MAXWELL WEISMAN, clinical in-
structor of Psychiatry, was appointed to
serve on the National Advisory Com-
mittee on Alcoholism.

DR. ARTHUR L HASKINS, professor
and head of the Department of Ob-
stetrics and Gynecology, has been
elected president of the Association of
Professors of Gynecology and Ob-
stetrics.

DR. EDUARD ASCHER, associate
clinical professor of Psychiatry, is the
recipient of a special award by the
American Group Psychotherapy Asso-
ciation for "meritorious contributions as
an instructor to the Association's
Institutes."

DR. LEONARD SCHERLIS, professor
of Medicine and head of the Division of
Cardiology, has received an award of
merit from the American Heart Associa-
tion. In citing Dr. Scherlis for his work
Dr. William W. L. Glenn, president of
the association, said the Maryland
physician is "a godfather of our cardio-
pulmonary resuscitation program and

of our heart sounds screening program.
Few physician-volunteers have contrib-
uted more in time, effort and results to
our community programs . . ."

DR. JAMES J. LYNCH, associate di-
rector of Psychiatry, has been named a
consultant to the American Psychiatric
Association's Task Force on Behavioral
Therapy. The task force will analyze
behavioral therapy and attempt to in-
corporate it into the medical curriculum.

DR. FRANK RAFFERTY has been ap-
pointed director of the Institute for
Juvenile Research and professor of
Child Psychiatry, University of Illinois
School of Medicine, Chicago, effective
in either July or September. Effective
July 1, Dr. Taghi Modarressi assumed
the position of acting director of Child
Psychiatry.

DR. EUGENE B. BRODY and DR.
ARTHUR LAMB have been appointed
to the Advisory Committee to the De-
partment of Psychiatry, Sinai Hospital.

DR. NATHAN SCHNAPER, associate
clinical professor of Psychiatry, has
been appointed by the State Board of
Education as a member of the Medical
Advisory Committee for the Division of
Vocational Rehabilitation for a term of
three years.

DR. ERLAND NELSON, professor and
head of the Department of Neurology,
has been awarded a $21,000 grant from
the National Institute of Neurological
Diseases and Stroke to continue his
electron microscopic studies of the in-
nervation of brain arteries. He was also
appointed to the Editorial Board of the
Journal of Neuropathology and Experi-
mental Biology.

DR. ARLIE MANSBERGER, acting
head of the Department of Surgery, has
announced the following new appoint-
ments to the department: Dr. Lary
Becker, Dr. Ranier M.E. Engel, Dr.
Richard A. Currie, Dr. Liebe S. Dia-
mond, Dr. Philip J. Ferris, Miss Madeline
Fox, Dr. Magdi G. Henein, Dr. Sidney
Marks, Dr. Gary L. Nobel, Dr. Ronald
L Paul, Dr. Herbert Schwarz and Dr.
Gardner Smith.

LAWRENCE DONNER, Ph.D., assist-
ant professor of Clinical Psychology,
Department of Psychiatry, was elected
Representative at Large by The Mary-
land Psychological Association, April,
1971.

/illem G. A. Bosma, M.D.

In 1968, the Maryland legislature
passed the first comprehensive Alco-
holism Rehabilitation Act in the whole
country, and It now has the most ad-
vanced and imaginative statewide treat-
ment program in the United States.

The law in Maryland hopes to effect
three basic changes in the treatment of
alcoholics. Implicit in it is the idea that
alcoholism is a medical problem: alco-
holics are sick people. The first major
step then, is to take the care of alco-
holics out of the hands of law-enforce-
ment agencies.

Alcoholism has to be fully accepted
as a public health problem and not,
hitherto, primarily a law enforcement re-
sponsibility. Traditionally, across Mary-
land, some considerable percentages of
alcoholics have been managed by law

enforcement and correctional agencies
and institutions. A study in 1965 showed
that approximately one-eighth of the
State's estimated alcoholics had been
so managed. A positive alcoholism pro-
gram must begin by replacing that old
system of management by a different,
more productive system under health
and social service direction.

The second desired change in treat-
ment is for the care of alcoholics to be
taken out of state mental hospitals. For
30 years state mental hospitals have
been the major, almost the only, treat-
ment resource for Maryland's alcoholics,
a patient load they are not equipped to
handle.

Because alcoholism is a massive
community problem, alcoholism pro-
gramming must emphasize decentral-

Dr. Bosma, Director of Alcoholism Programs, University ot Maryland School of Medicine, presented
a paper "Alcoholism and Drug Dependence in Maryland" recently at the First British International
Conference on Alcoholism and Drug Dependence. This is an excerpt from the paper.

ized, local, community service, and
de-emphasize State control and insti-
tutionalization; the alcoholic must be
treated where he lives and works, pre-
ferably as an out-patient.

Alcoholics can and should be treated
in the mainstream of health and social
welfare, along with other sick and
troubled people, and specialized serv-
ices be limited to those not already
provided by existing health and social
agencies.

Leadership for alcoholism program-
ming should properly be a function of
the local health department, and full-
time specialized personnel should be
added to the local health department
staff. In Maryland, every local health
department except one has such spe-
cialized personnel. And, every health
center should make its full range of
services available to alcoholics, pre-
ferably by addition of alcoholism coun-
selors to its staff.

Dedicated non-professional help to
sick alcoholics and their families, serv-
ices to alcoholics in both general and
specialized agencies can and should be
provided by non-professionals, with
little or no drain on the professional
personnel market.

However, public health programs are
needed for certain functions that can't
be achieved by other agencies: for case
finding and early diagnosis, for ex-
ample; for social management of alco-
holics already totally bankrupt physi-
cally, mentally, spiritually, economically
and socially; for medical and nursing
care for the alcoholic in crisis; for pro-
fessional training, and for research.

Thirdly, because it is clear that public
and private "helping people" are not
presently prepared to help alcoholics
and their families, that most of them are
indeed uninformed or misinformed about
alcoholism and its victims, top priority
in the Maryland program is given to
(1) preparing them by educational pro-
grams to take on their respective re-
sponsibilities; and (2) introducing alco-
holism content into the curricula of all
professional schools.

In the history of almost every alco-
holic are accounts of periodic searches
for help, of desperate appeals to physi-
cians, hospitals, clergymen, teachers,
and others — and of meeting with rejec-

tion. To prevent such breakdown of
understanding, alcoholism programs
must work to correct the ignorance and
prejudice of professional workers when
dealing with alcoholics, and give them
expert advice with which to aid alco-
holics, so that the latter can find what
they need when they need it.

If all the thousands of people, such as
doctors, nurses, and social workers,
who make their living in the helping
professions were prepared to identify
and help alcoholic individuals and
families, there would be no "hidden
alcoholics."

For the last year, work has been
under way to develop an interdiscipli-
nary curriculum on Alcoholism and Drug
Abuse for the six post-graduate profes-
sional schools of the University of
Maryland: the Schools of Medicine,
Social Work, Law, Nursing, Dentistry
and Pharmacy. This is the first major
effort in the U.S. to introduce alcoholism
content courses into professional
schools. The attitude of the students to
the seminars and field work has been
most favorable, but some of the admin-
istrations have often been reluctant. The
latter reflect all the attitudes of profes-
sional people and society at large —
attitudes which we have to change if
alcoholics are to get the care they
deserve.

Such a turn-about In attitudes pre-
sents a major challenge to professional
institutions. Much has been done since
enactment of the 1968 law, but even
more needs to be done. The difficulties
have been compounded by the fact that
only limited funds have been made avail-

able by the State of Maryland. The
people of the Division of Alcoholism
Control have had to concentrate on
getting the cooperation of existing
health and social facilities. When these
have not been sufficient, limited new
ones have been established, mainly a
variety of residential facilities for alco-
holics.

University Hospital illustrates how an
existing health facility has been pressed
into the service of providing treatment
for alcoholics. The 600-bed facility
which is not only a service but also a
teaching hospital, contains patients
from all walks of life.

The basic attitude at the hospital is
that treatment processes with the
highest incidence of success are those
that tailor treatment to the individual
needs and resources of the alcoholic
patient. Thus, an alcoholic is met in the
Emergency Room by a counselor who
acts as a screening agent. Together with
the doctor on call, he decides where
the patient will go for treatment. Some
need to go to medical, surgical, psychi-
atric or other specialized services, but
while on these services, they are also
r-een by alcoholism counselors. If the
patient does not require any service
within the hospital, and has no home to
go to, or is too sick to go home but not
sick enough for the hospital itself, he
can be referred to the Quarterway
House. This resident facility is five min-
utes from the hospital and all the serv-
ices of the hospital are available to it.
Doctors make weekly rounds in this
20-bed facility. The average cost per
alcoholic is $5 per day as opposed to
$70 per day in a hospital.

In the Quarterway House, the alco-
holic is first detoxified and if necessary,
made comfortable with some mild tran-
quilizers. He is then actively involved in
a program of education, personal and
group counseling, therapy and voca-
tional rehabilitation. Families and rela-
tives are whenever possible, involved in
the treatment program. The pros and
cons of disulfiram, antabuse, are pre-
sented to him. Many choose this as an
adjunct to staying sober.

The alcoholic stays two weeks in the
Quarterway House. He is then referred
to the Out-Patient Clinic at University
Hospital, and if he is on antabuse to the

Antabuse Group, which meets weekly in
the Quarterway House. Two alcoholic
counselors make regular home visits
and help the patient avail himself of
treatment facilities in his neighborhood.
If the patient is well enough after
having been seen in the Emergency
Room of the hospital, where he some-
times stays up to 24 hours, he can be
sent home. From there an effort is made
to involve him in the various treatment
facilities in his neighborhood, such as
open or closed groups, out-patient
psychiatric services, personal counsel-
ing, after-care clinics, etc.

If a patient has nowhere to go he can
be referred to the Shelter, a 1 20-bed
facility. The Shelter takes Skid-Row
alcoholics and provides them with a
bed, a meal, and some counseling. They
do not have to stop drinking, however,
but it does seem to reduce the amount
they drink. This facility, for what is re-
ferred to as the "chronic alcoholic," is
a most helpful one. Previously, the
chronic alcoholic had been referred to
other agencies, where the assumption
was that he would stop drinking. Neither
party benefitted from this arrangement
and this rather hopeless patient tended
to "clog-up" the facilities so much
needed for patients with better pros-
pects.

The Half-way Houses are for re-
covered alcoholics with a job who need
an interim supportive environment until
they are able to go out on their own.
Half-way Houses are self-supporting as
the patient pays room and board.

It is clear that treatment facilities,
and this goes for all large-scale pro-
grams in the United States, is still based
on rather ineffective treatment modal-
ities. Only 35 to 50 per cent of the
patients benefit from it. Intact, there is
still no definite treatment for alcoholism.
Individual or group psychotherapy,
counseling, antabuse and membership
in Alcoholics Anonymous are still re-
garded as the only hope of cure.

In the meantime, many clinicians are
desperately seeking more successful
treatment methods, including condition-
ing and the use of L.S.D.; up until now,
without success. It is clear that there is
still a long way to go in the treatment of
what is considered America's number
one health problem, health sciences ubrary45

UNIVERSITY OP MARYLAND
BALTIMORE

alumni day 1971

Alumni Day activities this year began
with registration in the entrance of
Davidge Hall at 10 a.m. June 3 and was
followed by a report to the Alumni.

Dr. Theodore Kardash, president of
the Medical Alumni Association, wel-
comed this year's attendees.

Dean John H. Moxley III spoke to the
Alumni about the assets of the School
of Medicine and some of its problems.
Following the Dean's presentation, Dr.
Karl Weaver, associate dean for admis-
sions, and Dr. Frederick J. Ramsay,
assistant dean for student affairs, spoke
on "Student Selection Policies," and
"Curriculum Changes," respectively.
Senior medical student, Robert Shannon,
addressed the group on "Changing
Medical Education."

A special guest speaker was Charles
E. Hackett, vice president. Colonial
Williamsburg, Williamsburg, Va. He com-
mented on the "Davidge Hall Restora-
tion Plan."

At noon the annual business meeting
convened. Dr. Kardash opened the meet-
ing with the presentation of the Gold
Key award to Dr. W. Houston Toulson
'13.

"This honor which you have been kind
enough to bestow on me today has
affected me deeply. I am gratified by
this very fine touch and appreciate it
immensely," said Dr. Toulson in ac-
cepting a plaque and the traditional
gold key.

Dr. M. E. Shamer '10

Dr. Arlie Mansberger '47 presented
the annual financial statement:

MEDICAL ALUMNI ASSOCIATION
FINANCIAL STATEMENT

April 30, 1971

* Assets in Bank Accounts

$25,532.27

* Assets in Investments

43,000.00

Assets in University of

Maryland account

1,206.11

Assets in Petty Cash

40.34

$69,778.72

Receipts April 1-30, 1971

1,406.99

$71,185.71

Disbursements April 1-30,

1971

2,094.80

BALANCE

$69,090.91

* Includes Davidge Hall Fund

The annual election of officers fol-
lowed and presentation of the slate
recommended by the nomination com-
mittee was by Dr. Lewis P. Gundry'28.
The following were elected:
President: Dr. Edward F. Cotter '35
President-elect: Dr. Henry H. Startzman

Jr. '50
Vice-president: Dr. John H. Hornbaker

'30

Dr. Benjamin M. Stein '35

Dr. William S. Womack '48
Secretary: Dr. Robert B. Goldstein '54
Treasurer: Dr. Arlie Mansberger '47

Executive Director: Dr. William H. Trip-

lett'11 BMC
Executive Administrator: Francis W.

O'Brien
Executive Secretary: Louise P. Girken
Members of Board: Dr. William J. R.

Dunseatli '59

Dr. William H. Mosberg Jr. '44

Dr. Charles E. Shaw '44

Dr. Joan Raskin '55

Dr. Donald T. Lewers '64

Dr. Cliff Ratliff '43

Dr. Joseph 8. McLaughlin '56

Dr. Aristides Alevizatos '60

Dr. John F. Strahan '49
Ex-officio Members of Board: Dr. Wil-
fred H. Townshend Jr. '40

Dr. Theodore Kardash '42

Dr. John H. Moxley III, M.D.
Elected to the Nominating Committee:

Dr. Raymond Cunningham '39

Dr. Gibson Wells '36

Dr. J. Howard Franz '42

Dr. O. C. Mandry '21 & Dr. E. A. P. Peters '21

Dr. Raymond Cunningham submitted
for consideration by the alumni group,
an idea to have eight members on the
nominating committee representing
various hospitals in Baltimore who have
alumni practicing in the institution plus
the two past presidents, who are ex-
officio. He also suggested that no one
be considered for president or presi-
dent-elect of the association unless he
had served on the board of directors.
Both of his suggestions will be taken
up at a later date by the Alumni Board

As has been the custom in years past,

the names of classmates who died dur-
ing the past year were read by Dr.
William H. Triplett '11 BMC and a
moment of silence prevailed in honor
of these deceased.

Dr. J. H. Horrjbaker '30 & Dr. M. J. Skovron'31 register.

Dr. Kardash in reporting what had
occurred during his year as president
said that the current alumni active en-
rollment was approximately 2,300 and
that "with these figures there's still
room for more."

Two of the most important aspects of
his term in office were the launching
of the Davidge Hall restoration fund and
reorganization of The Bulletin.

"Plans for the restoration of Davidge
Hall went ahead under the direction of
Dr. Sharrett with some $45,000 made
in cash and pledges in the first six
months. The goal is over $800,000
which we hope to reach by 1975 when
the Alumni Association will be 100
years old," Dr. Kardash remarked.

In reference to the Bulletin reorgani-
zation he said, "For the first time great
guidelines of responsibility have been
established for the Editorial Board, the
Editor and the Managing Editor. The
Dean and the Alumni Association will

endeavor to keep the alumni well in-
formed concerning the activities of the
school, its faculty, its students and
other alumni. We are looking forward
to having a Bulletin that we all can be
proud of which is a quality magazine
that will be interesting, provocative, in-
formative and inspiring."

Dr. Edward F. Cotter was then intro-
duced as the new president of the Med-
ical Alumni Association.

"It will be an honor and privilege for
me to serve as your president next
year. I hope that I can bring to the office
the same dedication as Dr. Kardash
and presidents who preceded him. As
president, I will help preserve the many
traditions of the school, but certainly
not the rigidity that will prevent changes
which we see in our social, political
and economic structure as inevitable,"
said the new president.

Cotter then asked the alumni for in-
creased participation and said he would
always welcome suggestions.

There was no new business so the
meeting adjourned and the alumni
luncheon was held in the Psychiatric
Institute gymnasium.

review

John h. moxley III

In general, I think that I can report a
good year to you. It certainly has not
been perfect, but I believe good. There
are problems at this medical school,
but none I believe are unique to Mary-
land. These problems are shared by all
medical schools today. As a matter of
fact, university medical centers are cur-
rently the focus of at least three irre-
concilable forces; mainly, the student
body, the faculty and the community.

Students are feeling the effects of
growing up in an age of very rapid
change; growing up in a period in which
our society is being somewhat de-
humanized by advances in technology
and science.

The faculty is also trying to come to
gripes with change. Again it's a change
in our society which at least tempo-
rarily, is becoming less interested in
the creation of new knowledge and
more in the application of existing
knowledge. This is a significant change
in the ground rules under which we've
lived for the past 20 years. Although it
was a needed change, the dimensions
of the change are unfortunate, because
while I am service-oriented, I think that
it is unfortunate to dismantle even in
part, a medical research effort that has
produced really fantastic amounts of
new knowledge.

And, the final force that is bearing
upon every medical school in the coun-
try is the community in which they
reside. We reside in an urban com-
munity largely inhabited by poor people.
Largely populated by black citizens
who view us primarily as a purveyor of
health services. They as a part of the
consumer revolution are insisting that
we provide more health services and
better health services. And this gives
rise to some problems. All of these
forces are legitimate, but sometimes it
seems almost impossible to get them
going on the same track in the same
direction.

Now, for discussion of several spe-
cific problem areas which are facing
us and to bring you up to date on what
has happened at the school in the last
year. I will begin with the financial pic-
ture of the school.

Last year, I was able to report that
the school had made a significant ad-
vance in the level of its state support.
This year the results have not been so
favorable. The budget was prepared
with very carefully thought out askings,
was approved on this campus and sent
to College Park. Between then and its
submission to the Legislature, it was
decided that the University would be
funded this year by a formula method.
The same formula was applied to all
schools within the University, and as
you can imagine the results were dis-
astrous. The Medical School budget
was cut more than any other single
school in the University — it was cut by
over two-thirds.

There also has been a great change
in the pattern of funding of medical
education in this country. The Federal
Government has been cutting back
significantly on some of the grants that
went to medical schools and individual
faculty members. Dr. Rogers, the Dean
at Hopkins, and I approached the Gov-
ernor in mid-summer to inform him that
this was reaching critical proportions
and indeed both medical schools might
be in danger if something wasn't done
to correct this situation. The Governor
submitted a special $2 million appro-
priation for medical education which
was to be divided on a per capita basis.
The University of Maryland would have
gotten $1.2 million and Hopkins would
have gotten $800,000.

Again changes were made before
reaching the Legislature. It was decided
that the Maryland portion would be re-
moved from the special appropriation,
increased to $11/2 million and given as
a special appropriation to the entire
University, not just to the Medical
School. Of that special appropriation,
we netted a few hundred thousand dol-
lars which brought us up to approxi-
mately 50 per cent of what we had
initially asked.

Then the Legislature cut the Hopkins
portion. The last day of the Legislative
session, it was too late to add to our
operating budget, the Governor and
Sen. James did manage to get $400,000
into the capital budget earmarked for
the medical school. Now we can re-
model the fifth floor of Howard Hall
which is essential to our expansion pro-
gram. At the same time they managed

to get Hopkins' portion of the special
appropriation re-instated. However, we
are still significantly below what we
thought was reasonable for the growth
and expansion of this medical school.

In terms of expansion, we have ex-
panded by some 37 places over the
period of less than a decade. That may
not seem like a great number, but in
medical education with the expense
and the resources necessary it is a
fairly large number. Over two years ago,
the medical faculty in a public report,
made the commitment to go to an enter-
ing class size of 200 as soon as the
resources were made available. We are
anxious to meet that commitment, but
we cannot expand this school on the
basis of an inadequate budget for the
number of students that we are cur-
rently teaching.

The resources have not been forth-
coming for us to move ahead. We will
need some further capital expansion
and a significant increase in our oper-
ating budget. At the present time, we

ire beginning to put together another
expansion program which will probably
Ue submitted to the Legislature next
tear. A detailed plan for expansion to
boo students per year will be submitted
Lich will line up for them as many
kptions as we can. These include where
fhe Federal Government is liable to
oarticipate and where they won't par-
ticipate, and what the delay may be if
we wait for Federal funding rather than
going straight forward with State fund-
ing.

I want to emphasize for you that the
commitment to expand is here. 1 always
seem to receive questions you haven't
expanded in the last 20 years and that
is not so. This school has expanded as
rapidly as any other medical school in
the country. It is one of the larger medi-
cal centers in the country and will
become larger as soon as we receive
funding necessary to do it in a reason-
able way which will preserve quality of
medical education.

The North Hospital should be com-
pleted some time late in 1972 with
occupancy in January 1973. This will
provide us with significant new clinical
facilities, allow us to finally demolish
the "old University Hospital" which has
been used as an ambulatory facility for
some years, and allow us to provide
reasonable ambulatory services while
expanding our bed services. It will also
provide us with an Emergency Room,
something that we have been without
for the past several years, because 1
do not consider what we operate in the
basement of the University Hospital an
Emergency Room.

The Howard Hall addition, which is
again extremely important for our ex-
pansion, will be a 14-story addition to
the current building. Planning is under
way and working drawings are just
about completed. State funds are in
hand and we have been approved by all
the Federal agencies for funding. How-
ever, we are currently in a $600 million
backlog for medical school, dental
school, and schools of osteopathy con-
struction. If the Congress' version of
the medical school construction act
goes through which will contain $225
million for medical school construction,
we stand a good chance of being
funded. But if the President's budget is
kept, there is only $90 million for medi-

cal school construction and then our
chances are not nearly so great.

During the past year we have been
engaged with the V.A. in such things as
site selection, and such things as trying
to arrive at a price for the site for the
new hospital to be built on our campus.
However, things are moving slowly be-
cause V.A. funding has been tenuous
in the past year. Fortunately for the
school, about two months ago Sen.
Mathias became interested in the need
for the V.A. facility not only for improve-
ment of health care for veterans in
Maryland, but also because he is fully
aware that it is absolutely critical that
we get this facility if we are to in-
crease class size to 200 students. He
has been actively at work and 1 remam
hopeful that in the near future this
project will be kind of given the final
shove and gain its own momentum and
proceed.

In the area of curriculum, we made
a significant change two years ago
when we went to an elective senior
year and put into the curriculum a re-
quired program and Ambulatory Care.
This year the school has moved to
adopt basically a pass-fail system for
the medical school courses.

This past year has not been a good
year for our Family Practice program.
This is the program that was begun in
1960 through the efforts of Dr. Wood-
ward in the Department of Medicine.
At its formation the Division was in the
Department of Medicine, did not have a
defined budget, and was located in the
ambulatory services building which was
very crowded. In part the problems
stem from the Division itself and there
is no question that in part that they
stem from the school. About a year
and a half ago we defined the role of
the Division more firmly so that it could
have its own program and its own

space.

The space problem concerned sep-
aration of the Evaluation Clinic where
patients came in without appointments
to be screened which several years
ago had been combined with the Fam-
ily Practice Clinic. It took over a year
to get to the point where we were re-
organized enough in that building to
separate this function out, and that has
now been done. There is a separate
clinic for screening. The Family Prac-

tice Clinic and Family Practice area is
now defined and is used only by Fam-
ily Practice. Today the division has ties
with both the Department of Medicine
and the Department of Preventive Med-
icine. Steps also have been completed
to define the budget for the Family
Practice Program which is more than
adequate to allow that program to grow.
The American Academy of Family Prac-
tice sent a two-man survey team to the
school to survey our program and make
suggestions as to how we can further
improve this program. That report is
not yet to me and I will take it to the
faculty for their consideration. This
school has had a commitment to the
program, it will continue to have a
commitment to that program. The pro-
gram will be allowed to grow along
with other programs here on the cam-
pus so that the students can have the
opportunity they desire to participate
in various types of clinical training pro-
grams.

I would like to publicly recognize the
great contributions of Dr. William Lay-
man, a family practitioner from Hagers-
town. Dr. Layman took a sabbatical
from his practice and came to Baltimore
and almost single-handedly kept the
Family Practice program functioning
through this difficult period. The school
and the specialty of Family Practice are
very much in his debt.

We have been making an effort to
improve the ambulatory services and to
make them more of a focus of teaching
here on the campus. I don't know how
far we can really go until the North
Hospital is open. Last fall the Ambula-
tory Facility was officially condemned
by the City of Baltimore. A temporary
one-story building is being constructed
immediately behind the Ambulatory Fa-
cility which will allow us to house Family
Practice, Radiology services, and labo-
ratory services. We should be able to
make this transition in January. This
will allow us to expand and to continue
to reorganize as we prepare to move
into the North Hospital.

One final point is that the University
itself is undergoing an administrative
change. It was decided that we would
move from a central president, who
acted essentially as the Chancellor of
the College Park Campus, to a decen-

tralized campus system with each cam-
pus having its own chancellor. Dr. Albin
O. Kuhn who was the Chancellor of both
the new Catonsville campus and this
campus, has decided to move to this
campus fulltime. As with any change in
organization, this one has caused some
difficulties but I continue to believe that
the longterm benefit far outweighs the
immediate difficulties we are having
adjusting to this. This will be the first
time in the history of this campus that
we had someone speaking for us and
for us alone and I can't help but believe
that we will benefit from that voice.

I enjoy very much this opportunity
every year to bring you up to date on
the school. I attempt to do it in as
straightforward a way as possible so
that you will know precisely what some
of the assets of the school are, and
there are many, and also some of the
problems that we face.

Thank you very much.

s:\«f

Mrs. F. W. O'Brien shows photographs of Davidge Hall to Dr. F. A. Reynolds '21. R. A. Young '46. J. H.
Hombaker '30 and O. C. Mandry '21.

Dr. S. V. Tompakov '40 with 1971 graduates,
Mr. and Mrs. H. M. Tompakov, his son and daughter-
in-law, and Mrs. Tompakov.

Dr. G. H. Brouillet '35 and son, George, Jr. '71
discuss graduation exercises.

Dr. D. Hope '40 gives his daughter, Diane, final words
of advice before her graduation from the School of
Nursing. Her mother is a 1939 Maryland Nursing
graduate.

p. Rogers, senior class president, is congratulated
by his wile, also a medical student, and his mother
and lather. Dr. W. B. Rogers '43.

mo^

Or. D. J. Myers '51. W. J. Benavent '46 ana

Dr. A. Saavedra '51 chat before Alumni Day activities

got under way.

Dr Rachael K. Gundry '31, Dr. Elizabeth Acton '43,
Dr. Ruth W. Baldwin '43 and Dr. Evangeline M. Poling
'50 look at a plaque listing all past Gold Key
recipients.

THE PURPO^^
OF THIS JOB IS

. •« f Pv

davidge hall

Charles Hackett

The State of Maryland, the City of
Baltimore, the University, and you, have
in your hands a symbol, and probably
one of the most unique early nineteenth
century buildings in the country. If not
preserved It would be a tremendous loss
to the history of this city.

Historical association with significant
historical movements, great men, or im-
portant events is a basic reason for pre-
serving historic buildings and sites.
Early restorations evoked a feeling of
nostalgia, a romantic and sentimental
longing for the early days and old ways.

Today we emphasize the total picture
much more. Most of the early restora-
tions were concerned mainly with the
exterior of the building and little was
done to recreate an authenic interior or
appropriate setting. The whole preserva-
tion movement is giving us new histori-
cal perspective on our lives and prob-
lems of today and furnishing us with
historical inspiration.

You have a marvelous opportunity
here at Davidge Hall. Its Anatomical
Theatre and Chemical Hall can present
convincingly the very interesting early
history of medical education in this
country. It can offer history of actual
experience. This kind of social history
has a satisfying unity. Historic buildings
properly presented and including au-
thenic exterior settings and carefully fur-
nished rooms cause hundreds of details
to fall into place.

Preservationists must seek living uses
for landmarks — uses that are in keep-

ing with the structures themselves and
will not harm them. Your Davidge Hall
can be much more than just a museum.
It constitutes a living tradition, a highly
visible link between the past and the
ever-evolving present. Certainly your
present and future teachers and stu-
dents cannot help but be impressed and
inspired to lecture and learn in class-
rooms of such historical significance.

For a proper restoration you will need
an overall plan and a great diversity of
skills, training, and talents. Architectural
and historical research must be method-
ical and exact. Drawings and specifica-
tions must be prepared by experts ex-
perienced in this relatively new field of
preservation architecture.

I recommend you require the services
of an appropriately experienced his-
torian, architect and curator — each of
them liable to be temperamental and
possessive, and together needing an
overall director serving as coordinator,
taskmaster, wet nurse and resident psy-
chiatrist!

When the time comes for the actual
construction work, the builder — and
his representative on the job — must
have sympathy and understanding of
the objective and the ultimate results.
The workmen, down through the lowest
echelon, must be instructed.

I leave you with a piece of advise —
try it. It's worth every penny.

Editors Note: Speeches of other par-
ticipants in Alumni Day will be pub-
lished in a subsequent Bulletin due to
the lack of space in this issue.

)recomnnencennent and awards day
une 4, 1971

Precommencement and Awards cere-
monies for the 1971 graduating class of
the School of Medicine were held at
10 a.m. in the Baltimore Civic Center.

Following an academic procession,
the convocation was given by the Rev.
Carl H. Greenawald and Dr. John H.
Moxley III, welcomed the graduates,
their families and friends. Dean Moxley
then presented the recognition awards
to the following:
Faculty Gold Medal

Trenton K. Ruebush 11
Certificates of Honor
Summa Cum Laude

Trenton K. Ruebush II
Magna Cum Laude

Alan L. Dubin

Lawrence A. Fleming

Brian M. Benson Jr.

Robert A. Schuman
Cum Laude

Michael Y. Faulkner

Gary A. Grosart

Richard A. Bordow

Walter H. Whitman Jr.

Robert L. Brenner

Donald M. Rocklin

Peter W. Beall

Elliotts. H. Bondi

Charles F. Hobelmann Jr.

Leslie B. Barnett

Lucienne A. Cahen

Daniel L. Cohen
Awards were presented as follows:
Balder Scholarship Award
For highest degree of academic achieve-
ment

Daniel L. Cohen
Dr. Wayne W. Babcock Award
For excellence in Surgery

Peter W. Beall
Dr. Jacob E. Finesinger Prize
For excellence in Psychiatry

Robert J. Neborsky
Dr. Leonard M. Hummel Memorial Award
Gold Medal — Outstanding qualifications
in Internal Medicine

Walter Howard Whitman Jr.
Dr. J. Edmund Bradley Pediatric Award
For excellence in Pediatrics

Daniel L. Cohen
Dr. Milton S. Sacks Memorial Award
For excellence in Hematology

Michael Y. Faulkner
Dr. William Alexander Hammond Award
For excellency in Neurology

Leslie B. Barnett
Student Council Certificates

Michael J. Maloney

Paul T. Rogers

Rena V. Kay

Richard A. Bordow

Peter M. Hartmann
S.A.M.A. Golden Apple Award
For interest in medical education and
excellence in Teaching
Clinical Years

John D. Young, M.D., professor and

head. Division of Urology
Preclinical Years

David B. Ludlum, M.D., professor

Cell Biology and Pharmacology
House Officer

Mark Applefeld, M.D., Department of

Medicine
S.A.M.A. Service Awards

Jerry Herbst

Robert M. Shannon
The hooding of graduates and the Hip-
pocratic Oath concluded the cere-
monies.

ALUMNI ASSOCIATION SECTION

OFFICERS

President

Edward F. Cotter '35, M.D.

Pretldenl-elect

Henry H. Slartzman Jr. "50, M.D.

Vice-presidents

John H, Hornbaker '30, M.D.
Benjamin M. Stein '35, M.D.
William S. Womacl< "48, M.D.

Secretary

Robert B. Goldstein '54, M.D.

Treasurer

Arlie Mansberger '47, M.D.

Executive Director

William H. Triplett '11 BMC, M.D.

Executive Administrator

Francis W. O'Brien

Executive Secretary

Louise P. Girken

Members of Board

William J. R. Dunseath '59, M.D.
William H. Mosberg Jr. '44, M.D.
Charles E. Shaw '44, M.D.
Joan Raskin '55, M.D.
Donald T. Lewers '64, M.D.
Cliff Ratliff '43, M.D.
Joseph S. McLaughlin '56, M D.
Arislides Alevizatos '60, M.D.
John F. Strahan '49, M D.

Ex-otficio Members of Board

Wilfred H. Townshend Jr. '40, M.D.
Theodore Kardash '42, M.D.
John H. Moxley III, M.D.

President's Letter

Dear Fellow Alumni:

I wish to pay tribute to Dr. Theodore Kardash and
express the appreciation of the Alumni Association for
his resourceful leadership and wise council as President
of the Alumni Association.

Reorganization of the "Bulletin" has been a major
project this past year. A plan of organization has been
developed and a newly appointed Editorial Board will
approve and evolve a policy and format which will pro-
vide an interesting and informative publication for the
alumni and others interested in the University of Maryland
School of Medicine.

Plans to renovate and have Davidge Hall approved as
a National Historic Shrine are proceeding. The Alumni
are encouraged to contribute generously to this project
which will be a major financial commitment.

The majority of the graduates of our school have estab-
lished themselves as private practitioners in the various
disciplines of Medicine. The Alumni Association is eager
to see that this way of providing health care shall have
continuing success. Unfortunately, segments of our so-
ciety in densely populated urban areas remain outside
this health delivery system. Although we are all involved
to some extent with this problem through our local and
State Medical Societies, the Medical Schools are par-
ticularly under great social and political pressure to be
actively involved and supply leadership to solve the prob-
lem of delivery of health care to this low income group.

While we seek to have our school yield private prac-
titioners of medicine to the community, we must recog-
nize and support the endeavor of Dean John H. Moxley III
and the faculty of the School of Medicine to rapidly ad-
vance the biomedical research potential of our school.

It is hoped that the "Bulletin" will be a medium of
communication of different points of view as our school
grows in prominence, providing practicing physicians,
educators, scientists and scholars to the community and
maintaining great concern for the problems and welfare
of the community.

Please submit your suggestions regarding new activities
and interests pertaining to the future role of the Alumni
Association. Any information about alumni is desired to
help complete our records regarding their activities, in-
terests in medicine and civic affairs and professional
achievement.

Sincerely,

U^tX\

Edward F. Cotter, M.D.
President

ilumni board action

-rancis O'Brien

During the past fiscal year, a number
Df major problems confronted the Medi-
:ai Alumni Association and were con-
sidered for action by the Board of
Directors. Among these were the fol-
owing areas which required the atten-
tion of the Board:

Reorganization of The Bulletin, School
Df Medicine. Selection of a fulltime
Vlanaging Editor and consideration as
10 what changes, if any, should be made
in The Bulletin were of primary concern.
^ new IVlanaging Editor was hired in
January and proceeded to get out the
January and April issues. The Board
considered the first step in reorganiza-
tion was to establish guidelines for the
Editorial Board, the Chief Editor and the
N^anaging Editor. These guidelines are
being formulated and it is believed
when crystallized will provide for a
better publication from the School of
Medicine and the Alumni Association.
As you recall, your April issue arrived
according to schedule as should future
issues because of the reorganization
and hiring of a fulltime Managing Editor.
Problems in the reorganization still exist
but close relations are maintained be-
tween the Dean's Office and the Alumni
to resolve these as soon as possible.

Planning for Alumni Day 1971 was
under discussion by the Board at each
of its meetings. Early in the year an
Alumni committee met with representa-
tives of the Senior Class to obtain their
views on how their classmates felt about
attending the annual Alumni banquet.
The representatives were of the opinion
that the students would prefer that
rather than attending the banquet that
the Alumni donate a sum to their class
fund for loans to future medical stu-
dents. The Board feels that traditionally
the graduating class is invited to the
annual banquet and they offered to con-
tinue this practice. However, the Board
said it is willing to consider the stu-
dents' proposal if it could be shown
this was the feeling of the majority of
the class. It was decided that this year
the graduating class would be invited
to the banquet and the reception for

the 50 year graduates, thereby estab-
lishing a new concept of honoring both
classes. The Board approved loans to
students in the amount of $1,000 and
made a donation of $300 to the Student
Microscope Fund.

Reunion Class Captains were assisted
in contacting their classmates through-
out the year through several letters sent
out from the Alumni Office. In the in-
terest of making Alumni Day evening
shorter, a feature speaker was not
planned so that all those attending the
banquet would have a longer oppor-
tunity to be with their classmates and
friends during that evening.

Another concern of the Board was to
obtain adequate space for your Alumni
Office. At one time it was considered
that the Alumni Office would occupy
the entire second floor of Davidge Hall.
By this means an Alumni Lounge would
be provided for visiting physicians and
their friends along with adequate
office space. However, it became ap-
parent early in the year that this plan
could not be visualized for at least two
more years. Your Alumni Office did
expand slightly on the second floor of
Davidge Hall, but still requires more
space to fully carry out its mission —
to assist the School of Medicine and
its graduates in any way possible. The
subject of office space was discussed
several times by President Kardash and
Dean Moxley and the Board of Directors
went on record to emphasize the desir-
ability of more adequate office facilities
if the Davidge Hall Restoration project
is to succeed.

As you know, at the end of 1970, a
brochure on the plan to restore Davidge
Hall, was sent out to all graduates and
other interested friends. Your Alumni
Office has been receiving on almost a
daily basis, donations for this worthy
fund.

At each Board meeting the financial
report of the Association was received
and approved by the members of the
Board. The Association has a fairly good
financial standing.

Respectfully yours,

/i^ 0'&.

Francis W. O'Brien
Executive Administrator

alumni gold key award

Rolling up his sleeves and plowing
in . . . that's how Dr. William Houston
Toulson, professor Emeritus of Urology,
remembers his part in the growth of
the School of Medicine.

A native of Chestertown. Md., he is
the recipient of the Alumni Honor Award
and Gold Key for 1971.

Despite his lack of direct contact
with the University today, the 1913
School of Medicine graduate is still very
interested in his school, the students
and changes being made in the field
of medicine.

"I have very little contact with the
school. I'm an Emeritus Professor and
when I got out, I got out completely.
There's nothing worse for a department
than to have an old fellow around giv-
ing you new ideas that date back to the
Civil War period," he says smiling. "Dr.
Young (head of the Department of Uro-
logic Surgery) is a very fine chap, a
very personable fellow and very effi-
cient with patients. I've given talks oc-
casionally, but I'm up in my eighties,
and I just haven't got the gumption to
grind out papers like I use to do."

Dr. Toulson graduated from Chester-
town High School and received his
A.B. and master's degree with science
honors from Washington College in
1908 and 1911, respectively.

"When I started work shortly after
I graduated and when I was down at
the clinics, I knew the students by their
first name, where they were from and
something about them. Towards the last
I couldn't remember and it would em-
barrass me when I would go to medical
conventions and some students would
come up to me and say, 'Don't you
recognize me? You taught me in 1947'
or something like that. After you teach
100 of them every year for 34 years
... it just got pretty well out of control,"
says the doctor, who retired as pro-
fessor and head of Maryland's Urology
Department in 1955.

What does he remember as the most
dramatic change that occurred during
his days at Maryland?

"I think the most dramatic was that
during my student days and shortly
after, the University of Maryland, then

known as a proprietary school, under-
went major changes in its growth to
become part of a university."

"As a proprietary school it was
owned by members of the faculty. Dr.
Reichlove, Dr.
Shipley, Dr. Gar-
ner and Dr. Low,
a lot of names
that are in the
old books, really
owned the med-
ical school.
They never real-
ly made any
money out of it,
but they thought
it was their duty to keep the old place
going. In 1910 the Rockefeller Founda-
tion gave money to a commission to be
headed by Dr. Simon Flexner of New
York to make a nationwide survey of
medical schools."

"At that time, there were nine medi-
cal schools in Baltimore City and they
were almost diploma mills. You could
register there and go on and work at
nights as a streetcar conductor. In due
time, you got your degree. The Flexner
Committee came to examine this school
and they found we were deficient in
things like basic sciences and we didn't
have enough hospital beds for the num-
ber of students being taught. We didn't
have enough faculty, especially in basic
science and above all, we had no
University connection. Our monetary
budget was terribly low for a medical
school of our size.

"So in 1913, the University of Mary-
land, Medical School, merged with the
old Baltimore Medical College. In 1915
they merged with the old College of
Physicians and Surgeons on Saratoga
and Calvert streets. About 1920, they
merged with the old Maryland Line
Agricultural College at College Park
forming a university, at least a nucleus
of it. Then the Law School came in,
Pharmacy, Dentistry, Nursing and like."

"It was about 1920 when the Univer-
sity of Maryland really got off to a
university status and then they started
getting a little bit of money from the
state. Year by year it has grown so that

ie University of Maryland, Medical
chool, now is accepted by everyone
f the accrediting agencies and it ranks
mong the finest schools in the
ountry."

"So, I've watched all this during my
fetime and am proud to be a part of
. Of course, I felt as though I was roll-
ig up my sleeve and plowing into the
'hole business, but I hope I contrib-
ted a little something anyhow."

And, indeed Dr. Toulson has con-
ibuted greatly to his school through
is student and teaching years.

Dr. and Mrs. Toulson, who live at
403 Falls Road Terrace, have three
hildren: Mrs. J. Edward Johnston of
altimore; Mrs. Kennon Jayne, New
;anaan, Conn, and William Houston
oulson, Jr. of Washington, D.C. and
1 grandchildren.

The author of numerous monographs
alating to urology and surgery, he is

member of the Baltimore City Medical
■ociety, the Medical and Chirurgical
acuity (president in 1949), the Ameri-
an Urological Association (president
lid-Atlantic section in 1950), the Ameri-
an Association Genito Urinary Sur-
eons, Societe Internationale D'Uro-
jgie and the American College of
lurgeons.

His military record includes two years
1 France in World War I as a captain

in the Medical Corps U.S.A. The first
year with the British Expeditionary
Forces and the second with Evacuation
Hospital No. 8, American Expeditionary
Forces. During World War II he was
consultant to the Selective Service and
Veterans Bureau.

Gold Key Awards have been given
to the following doctors:

1948 — W. Wayne Babcock '93 P & S

1949 — Nolan D. C. Lewis '14

1950 — Arnold J. Tuttle '06

1951 — George E. Bennett '09

1952 — Louis A. Buie '15

1953 — Emil Novak '04
1954— Fred W. Rankin '09

1955 — George W. Rice '16

1956 — Joseph Nataro '25

1957 — Charles Reid Edwards '13

1958 — Norman T. Kirk '10

1959 — Edgar B. Friedenwald '03

1960 — Stanley E. Bradley '38

1961 —Walter D. Wise '06

1962 — Arturo Raymond Casilli '14

1963 — Louis A. M. Krause '17

1964 — Hugh R. Spencer '10

1965 — Theodore McCann Davis '14

1966 — T. Nelson Carey '27

1967 — Eva F. Dodge '25

1968 — Thomas B. Turner '25
1969 — Frank Mason Sones '43

1970 — Abraham Harry Finkelstein '27

ilumni activities

HE 20's AND 30's

DR. LEWIS M. OVERTON '29, asso-
iate professor in the Department of
)rthopaedics. University of New Mexico,
as received a grant to study chronic
'Steomyelitis (bone infection) from the
ipjohn Company. Dr. Overton was chief
'f the Orthopaedic Surgery Department
if Lovelace Clinic from 1947 until he
Dined the medical school faculty at the
Jniversity of New Mexico in 1968.

DR. HERBERT BERGER '32, Staten
sland. New York, has been elected
hairman of the section on medicine of
ne New York Academy of Medicine.

DR. MYRON L. KENLER '33, Miami,
■la., was licensed to practice in Florida
1 1969 and is employed fulltime on the
taff of the University of Miami Student
iealth Service, Coral Gables, Fla.

DR. LOUIS J. KOLODNER '36, assist-

ant professor of surgery, Johns Hopkins
University School of Medicine, delivered
a paper at the Royal Thai Army Hospital
in Bangkok, Thailand, during his world
tour in October and November last year.
The paper was entitled "Some Studies
and Experience in Biliary Tract Sur-
gery."

THE 40's

DR. R. M. N. CROSBY '43 and ROB-
ERT LISTON have received the All
America Features Award for an article
"Dyslexia: What you can and can't do
about it" which appeared in Grade
Teacher, a publication with a large cir-
culation among elementary school
teachers. The award is presented by
the Educational Press Association for
excellence in scientific writing in an
educational journal. Dr. Crosby has also
been appointed to the National Advisory
Committee on Handicapped Children

by the Secretary of Health, Education
and Welfare Richardson. The committee
will administer the new laws on the edu-
cationally handicapped.

DR. ROBERT E. WISE '43, of Boston,
has been re-elected to another three-
year term on the Board of Chancellors
of the American College of Radiology.
He is chairman of the Department of
Diagnostic Radiology at Lahey Clinic,
Boston. Dr. Wise has served as chair-
man of the ACR Commission on Public
Relations for three years and will con-
tinue in this capacity until 1974. The
ACR is a medical association repre-
senting physicians who specialize in the
use of X-rays and other radioactive
substances for diagnostic and thera-
peutic purposes.

THE 50's

DR. MORTON D. KRAMER '55, Balti-
more, Md., has been appointed chief,
Sections of Neurology and Electroen-
cephalography and director of the
Electroencephalography Laboratory in
the Department of Medicine, St. Agnes
Hospital, Baltimore.

THE 60's

DR. LAURENCE R. GALLAGER '62,
Columbia City, Md., has been appointed
associate director of Medical Education
at St. Agnes Hospital, Baltimore. In his
new capacity he is responsible for
planning, developing and organizing
methods of recruiting medical gradu-
ates for the hospital's intern and medi-
cal education program.

DR. GERSHON J. SPECTOR '64, 2255
Lenox Rd., Atlanta, Ga., will join the
Washington University School of Medi-
cine, Department of Otolaryngology, in
St. Louis, Mo. effective August 1, 1971.
He will be an assistant professor of
Otolaryngology.

DR. EARL S. SHOPE '65, has recently
moved to Alumbank, Pa. where he is
working in hematology, clinical path-
ology and general medicine. He is asso-
ciated with a clinic, Medical Associates,
and a hospital, Wimber Hospital, in
Alumbank. Prior to his move he was
associated with the Armed Forces In-
stitute of Pathology, Hematology
Branch, Washington, D.C.

alumni on other faculties

Medical schools list the following
University of Maryland, School of Medi-
cine, alumni on their 1970-71 faculty:

The 20's

Oscar Costa Mandry '21

University of Puerto Rico
Isadore E. Gerber '26

Mt. Sinai School of Medicine

The 30's

Abraham M. Kleinman '30

Mt. Sinai School of Medicine
Victor Montilla '30

University of Puerto Rico
Henry I. Berman '31

University of Louisville
Robert F. Rohm '31

University of Pittsburgh
Alexander Allan Krieger '32

University of Pittsburgh
Kermit E. Osserman '33

Mt. Sinai School of Medicine
Max Needleman '34

Mt. Sinai School of Medicine
Landon Timberlake '34

University of Alabama
Milton H. Adelman '35

Mt. Sinai School of Medicine
Maurice Nataro '37

University of Louisville

Ephraim Roseman '37

University of Louisville
Juan A. Rossello '38

University of Puerto Rico
Donald J. Silberman '38

University of Alabama
Aaron Stein '38

Mt. Sinai School of Medicine
David Kairys '39

Mt. Sinai School of Medicine
Joseph Edwin Schenthal '39

Tulane Medical Center

The 40's

Luis R. Guzman Lopez '40

University of Puerto Rico
Gulliermo Pico '40

University of Puerto Rico
William R. Piatt '40

Washington University, St. Louis
Carl Eliot Rothschild '40

Mt. Sinai School of Medicine
Joseph W. Sloan '40

Mt. Sinai School of Medicine

William I. Wolff '40

Mt. Sinai School of Medicine
Carlos M. Chiques '41

University of Puerto Rico
Joshua M. Perman '41

Mt. Sinai School of Medicine
Robert A. Moses '42

Washington University, St. Louis
Otto C. Phillips '42

University of Pittsburgh
Ramon I. Almodovar '43

University of Puerto Rico
Sherman S. Brinton '43

University of Utah
Aaron N. Finegold '43

University of Pittsburgh
Jose M. Tor-i-es Gomez '43

University of Puerto Rico
Luis M. Isales '43

University of Puerto Rico
Francisco R. Raffucci '43

University of Puerto Rico
Enrique Perez Santiago '43

University of Puerto Rico

Dharma L. Vargas '43

University of Puerto Rico
Ernesto Colon Yordan '43

University of Puerto Rico
Eugene Hayward Conner '45

University of Louisville
J. Howard Latimer '46

University of Utah
Walter M. Wolfe '46

University of Louisville
Pascal D. Spino '47

University of Pittsburgh
George Winokur '47

Washington University, St. Louis
Joseph Aponte '48

University of Puerto Rico
Robert Chamovitz '48

University of Pittsburgh
Guy Donald Niswander '48

Dartmouth Medical School
William G. Thuss, Jr. '48

University of Alabama
Edward W. Stevenson '49

University of Alabama

The 50's

Frederick Shepherd '50

University of Louisville
Law Lamar Ager '51

University of Alabama

Ricardo Mendez Bryan '51

University of Puerto Rico
David M. Kipnis '51

Washington University, St. Louis
Mario R. Garcia Palmierl '51

University of Puerto Rico
Joseph John Noya '54

Tulane Medical Center
Henry B. Higman '55

University of Pittsburgh
Charles Benton Pratt, III '55

University of Tennessee
C. Clark Welling '55

University of Utah
Jerald H. Bennion '56

University of Utah
Paul V. Slater '56

University of Utah
Wilfred F. Holdefer, Jr. '57

University of Alabama
Francisco E. Oliveras '57

University of Puerto Rico
Lynn B. Robinson '57

University of Utah
Richard R. Flynn '58

University of Utah
Richard H. Keller '58

University of Utah
Gilbert Isaacs '59

University of Pittsburgh

The 60's

Franklin Ross Hayden '60

Tulane Medical Center
William E. Latimer '60

University of Utah
Morton Smith '60

Washington University, St. Louis
Andres Acosta '61

University of Puerto Rico
Joseph C. Battaile '61

University of Tennessee
Carlos Girod '61

University of Puerto Rico
David B. Paul '62

University of Pittsburgh
Verne Peterson '62

University of Utah
Hernan Padilla '63

University of Puerto Rico

Brian L. Rasmussen '63
University of Utah

Gustavo Alberto Colon '64
Tulane Medical Center

Sigmund L. Sattenspiel '65
Mt. Sinai School of Medicine

Dana H. Clark '66
University of Utah

W. Bryan Staufer '68
University of Pittsburgh

missing alumni

The following alumni are listed as
missing by the Alumni Office since no
address or record of death is on file.
Alumni having any information about
the following graduates should notify
Col. Francis O'Brien, Medical Alumni
Association, 201 Davidge Hall, Balti-
more, Md. 21201
John Wirt Graham, M.D. '26
Hiilard V. Staten, M.D. '27
Thomas P. Thompson, M.D. '27
Louis J. Levinson, M.D. '28
Paul F. Gersten, M.D. '30
T. H. Tomlinson, Jr., M.D. '32
Frank R. Stephenson, M.D. '32
Matthew M. Cox, M.D. '42
Maurice I. Shub, M.D. '42
H. Bellinger Stafford, M.D. '43
Daniel Bair Lemen, M.D. '45
Joseph Weintraub, M.D. '45
Michael J. Coffey, M.D. '47
James E. Anthony, Jr., M.D. '47
Jay Lewis Bisguyer, M.D. '50
Michael C. J. Sulka, M.D. '50
Martin Wm. Treiber, M.D. '53
Jules B. Ediow, M.D. '53
WilliamR. Cohen, M.D. '56

Samuel J. Mangus, M.D. '56
Harry J. Fitch, M.D. '58
David A. Perras, M.D. '59
William E. Latimer, M.D. '60
William R. Fleming, Jr., M.D. '61
Mayer M. Katz, M.D. '62
Alfred S. C. Ling, M.D. '62
Richard J. Belinic, M.D. '63
Harry A. Spalt, M.D. '63
Mona B. S. Belinic, M.D. '64
John H. Axley, Jr., M.D. '65
Jeffrey L. Brown, M.D. '65
Robert N. Whitlock, M.D. '65
Richard S. Glass, M.D. '66
Augustin K. Gombart, M.D. '66
Thomas M. Hill, M.D. '66
James W. Spence, M.D. '66
Elizabeth A. Abel, M.D. '67
Larry B. Feldman, M.D. '67
George A. Lapes, M.D. '67
Howard R. Rosen, M.D. '67
Donald E. Novicki, M.D. '67
Robert Brull, M.D. '68
Michael J. Deegan, M.D. '68
Charles C. Edwards, M.D. '68
Frank A. Franklin, Jr., M.D. '68
William N. Goldstein, M.D. '68
Charles J. Lancelotta, M.D. '68
Steven F. Manekin, M.D. '68

necrology

Samuel Watson Page, '02 P & S,

Greenwood, S.C., died February 10,

1971.
James G. Blower, 05 P & S, Akron,

Ohio, has died.
Anthony W. Lamy, '08 P & S, Elizabeth,

N.J., died February 1971.
Simon Wickline Hill, '09, Regent, N.D.,

died June 2, 1970.
J. D. Dinsmore, '09 P & S, Nova Scotia,

Canada, has died.
Glen G. Haight, '10 BMC, Audubon,

Minn., died March 27, 1971.
Manuel R. Janer, '12 P & S, New York,

N.Y., has died.
Jesus Maria Buch, '13, Baltimore, Md.,

has died.
Arthur Casilli, '14, Elizabeth, N.J.,

died March 10, 1971
Manuel E. Pujadaz-Diaz, '14 P & S,

Santurce, Puerto Rico, died January

5, 1971.

John Edward Davis, '19, Welch, W. Va.,
died April 19, 1970.

THE 20's AND 30's

Rhea Richardson, '20, Macon, Ga., died

April 4, 1971.
George R. Joyner, '21, Suffolk, Va., has

died.
Walter B. Parks, '24, Gastonia, N.C.,

has died.
Alexander A. Doerner, '35, Pacific

Palisades, Calif., died May 16, 1970.

THE 40's

William Herbert Morrison, '41,

Baltimore, Md., died February 13,

1971.
Granville Hampton Richards, Jr., '43,

Port Deposit, Md., died March 7, 1971.
John B. Davis, '45, Frostburg, Md.,

died October 11, 1970.
John L. Rosenthal, '45, Norfolk, Va.,

has died.

BuLLetin

university of maryland scliool of medicine

Articles do not necessarily reflect the views of the School of
Medicine, the Editorial Board or the Medical Alumni Association.

Policy — The Bulletin of the School of Medicine
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Manuscripts — All manuscripts for publications, news
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shock trauma center

six minutes later

shock trauma nursing

medical student's view

no better place to learn

air-evac helicopters help save lives

today's neglected disease — trauma

Francis Rackeman 2

Judy Bobb, R.N. 7

Clayton Raab 12

Sonia Hughes 14

Lt. Frank Hudson 16

R. Adams Cowley, M.D. 18

potpourri

admissions and curriculum

I changing medical education

Robert Shannon, M.D.

' curriculum changes

Frederick J. Ramsay, Ph.D.

admissions

Karl H. Weaver

academic medical center

John H. Moxley III, M.D.

professors of surgery 1807-1970

Harry C. Hull, M.D.

alumni activities

necrology

Second class mailing privilege authorized at Baltimore, Maryland

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'rancis'Rackemann

The radio call was urgent. A motorist
was trapped in a wrecked automobile on
busy U.S. Route 40 near White Marsh.

Miles from the accident scene on a
routine patrol was a Maryland State Po-
lice helicopter. Responding to the State
Police dispatcher's call for help, the heli-
copter landed within minutes only 150
feet from the wreck on the highway
which had been blocked to traffic by
ground police.

The motorist, whom firemen had to ex-
tricate from the car which had hit a tele-
graph pole, was in deep shock.
' The helicopter pilot and his observer-
: medic partner went to work. One
jconverted the four-passenger helicopter
linto a flying ambulance and the other
prepared the victim for removal from the
scene by placing her on the aircraft's
respirator.

Six minutes later the helicopter with
its unconscious patient landed atop the
multi-story parking garage adjacent to
the University of Maryland Hospital.
Waiting at the heliport were an ambu-
lance and a medical team from the Uni-
versity's unique Center for the Study of
Trauma.

As the ambulance sped down the ramp
and towards the University Hospital's
Emergency Room entrance, a doctor and
a nurse from the shock treatment center
were already administering aid and mak-
ing preliminary evaluations which would
help in making critical decisions about
the patient's care.

At the ambulance entrance a bold red
line painted on the floor guided the arriv-
ing team and victim to the special red
brick building attached to the main hos-
pital and up to the fourth floor recovery
area which is the heart of the center.

The large room contains a raised is-
land nursing station overlooking a dozen
surrounding cubicles each equipped with
modern breathing, suction, monitoring
and other lifesaving devices. Three doc-
tors, two nurses and a technician who
were already checking other critically-ill
patients in the unit gathered around the
new admission.

Lifting the woman carefully onto a
special bed, one doctor connected an au-
tomatic breathing machine to the wom-
an's windpipe. Another inserted a long

plastic tube in an artery to measure
blood pressure, while a third person in-
serted a tube in a vein with its tip reach-
ing the heart. Samples of blood and
urine were taken for analysis in the labo-
ratories operated around-the-clock for
just such care.

Watching the teamwork was Dr. R.
Adams Cowley, director of the nation's
first fully-equipped shock trauma center.

"Violence is on the increase and get-
ting worse. Injuries are becoming more
serious and there's no end in sight,"
said Cowley adding: "With severe multi-
ple injuries, you live or die depending on
how rapidly you are picked up and trans-
ported to a facility where there are ade-
quate personnel and equipment to care
for you immediately on arrival."

Editor's Note; Francis Rackemann is a staff writer for the Baltimore Evening Sun and has written several
articles about the shock trauma unit at Maryland.

A buzzing noise sounded and a nurse
went quickly to a patient whose lifesaving
machine needed adjustment.

"Our first job," said the director, "is
to keep the severely injured and critically
ill alive. Then comes diagnosis and treat-
ment."

Trauma is the medical term for injury
caused by blows, cuts, blasts, suffoca-
tion, shock, poisons and burns. In severe
cases, shock is accompanied by a sharp
drop in blood pressure which leaves a
victim pale and white or blue if the lungs
are affected. Lack of sufficient oxygen in
the bloodstream often leads to a break-
down of kidney, liver, lungs, brain, heart
or other vital organ functions.

University Hospital's Center for the
Study of Trauma is a four-story, red
brick building attached to the main hos-
pital which was designed by Cowley and
his colleagues.

Equipment in the $2.5 million building
ranges from a huge hyperbaric chamber
in the basement for administering pure
oxygen under pressure to patients with
gangrene to equipment that automatically
records respiration, blood pressure,
pulse, temperature and the amount of

oxygen consumed by the body among
other physiological functions.

Research labs are on the third floor
and the fourth is devoted to the shock-
trauma recovering unit where critically ill
emergency cases are treated. The build-
ing is so designed that at least three
more floors can be added.

The center which is manned 24 hours
per day has on its staff 71 doctors,
nurses, laboratory and other technicians
and researchers. Members of the staff
often skip lunch and remain on duty be-
yond their regular hours just to keep
their patients alive.

Miss Elizabeth Scanlan, an associate
director of the nursing for the main hos-
pital, is head of the center's nursing
staff. She helped organize the center's
program.

Of Miss Scanlan, one physician com-
mented: "She has developed a staff of
nurses who are devoted to the kind of
care not often seen. Our nurses work
hard and we cannot compensate them
very well, but you can see the satisfac-
tion of a job well done against over-
whelming odds."

The center staff gives high praise to
the Baltimore Fire Department ambulance
service and to the Maryland State Police
helicopter crews for their "fast, efficient
and cooperative services."

Most of the more than 400 patients
admitted to the unit during the past year
were brought by ambulance, but Dr. Paul
Hanashiro said that without the helicop-
ter service "85 per cent of the 140 pa-
tients brought to us would have been
dead in a general hospital environment."

Maryland State Police acquired its first
helicopter in 1960. It was traded in
1968 for a Bel JetRanger. A second heli-
copter was purchased in January 1970
and a third went into operation in June
1971. The helicopters costing $100,000
each average 130 hours a month of
flying time.

The unmarked aircraft are used also
for tracking criminals and lost people,
solving traffic jams, photographic mis-

sions, spotting lost boats, oil slicks, sto-
len vehicles, rescuing people, searching
for underwater objects, bodies, making
engineering studies and transporting
emergency blood and organs as well as
patients.

Patients remain at the shock-trauma
center anywhere from three days to as
long as three weeks. A man with lockjaw
must be kept paralyzed with drugs to
keep him for convulsing until his tetanus
problem disappears.

Treatment with pure oxygen under
pressure in the center's basement hyper-
baric chamber saved a man's arm from
amputation after gangrene set in stem-
ming from a broken thumb.

Only the most severely injured or criti-
cally ill are admitted to the shock trauma
center for treatment.

"Many of these patients would not be
alive today if we didn't have this pro-
gram," concluded Cowley.

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shock trauma
nursing

Judy Bobb, R.N

Judy Bobb, dressed in a pink surgical
gown, carefully reconstructed the actions
of a shock trauma nurse during a shift in
the intensive care unit when her thoughts
were interrupted by a familiar sound . . .

That's one thing. You become ex-
tremely aware of any helicopter that is in
the air. I've heard every helicopter that's
flown over the unit since I came last Oc-
tober. I always wonder if he is bringing a
patient; if he isn't, why isn't he?

It's fascinating. You learn to identify
your own choppers and when you see
them in the air, if it's the right color, the
right kind and he's heading for the city,
you figure he's been up to something, or
he's going to get involved in something.

Sometimes we hear them from the unit
and you can just imagine in your own
mind what is going on. When you have to
meet a helicopter at the helipad, that's
exciting. It's the kind of thing that you'd
like to have film footage of that you
could show all your family — you crawling
under the chopper. It often seems dra-
matic, but our actions are vital to the life
of the victim.

Editor's Note: Miss Bobb received a bachelor of science in nursing from the University of Colorado.
Before coming to University Hospital in October 1970 she worked in intensive care units at several
Denver. Colo, hospitals.

For a brief moment the young nurse's
speech quickened and became full of an-
ticipation, but after the helicopter could
no longer be heard she returned to her
recitation.

As much experience as I have had in
coronary care — two years in a very quiet,
small intensive care unit — I was use to
shock trauma and all the equipment. But
here, the unit as a whole is overwhelm-
ing. You walk in and you don't know
what to look at first; yet you're looking at
everything and you see all of these peo-
ple hanging in traction with lines all over
their bodies and people scurrying about.

Admission is one of the hardest things
about working in the unit because you
have to satisfy everyone at the same time
and still do the things you have to do.
Most of the time you work on a one-to-
one basis. One nurse is usually responsi-
ble for a single patient; whether you have
more than one patient depends on the
load. Sometimes it gets so busy that
even two of you can't handle the load at
one time.

After working in the unit a while you
can tell when it's about time for an ad-
mission. It's a very nebulous feeling and
it's not something that you can define by
any means. But, you can almost predict
what type of admission will be made. For
instance, admissions for the hyperbaric
chamber come in spurts and after a cer-
tain period of time everyone starts look-
ing for another. Usually within the week
we get one. It is very odd.

Sometimes when you go to work you
just know that you aren't going to get
anybody new — it's not the right weather,
or the right kind of any number of things
that you can't define . . . it's a sixth
sense. Or, you know that the chopper is
going to be flying that night and that
he's going to bring somebody in. If one
person gets the feeling, then everybody
starts watching for an admission. One
nurse in particular is good at predicting
an arrival. If she says there is going to
be a patient, we'll have an admission
within 24 hours, you can guarantee it. If
she says it's going to happen it will.
She's never been wrong since I've known
her.

Usually a resident, a nurse or a corps-
man meet the incoming helicopter and
take with them a box of emergency drugs
and an oxygen tank. You meet the pa-
tient, make a fairly brief evaluation and
then transport them to the ambulance.
The ambulance then drives the victim,
the resident and the nurse to the emer-
gency room and from there the group
goes up to the unit.

We've had as little as five minutes no-
tice from the helicopter that they are
coming. One unit is set up all the time.
All the lines are there, everything that
you need to admit the patient and take
care of him, except his medicines and all
of his intravenous (I.V.) solutions. If you
suspect that another patient is coming, a
second unit is readied so that you're one
ahead. You always have to stay one jump
ahead because it takes from five to ten
minutes to get a unit ready. Working by
yourself it could take as long as 20 min-
utes.

The patient is immediately transferred
from the stretcher to a bed, and then
comes a rapid period of evaluation where
a lot of decisions are made in a very
short period of time. After the initial
crises you start doing the definitive
things like giving blood, deciding if they
need x-rays, surgery, cast or traction.

For example, we had one case with a
stab wound in his chest. He was up in
surgery within 40 minutes and within
that time we cannulated him; but a ven-
ous line in; put an arterial line in; got all
his blood samples; checked his blood
maybe eight or ten times; hooked him up
to the monitor; put another chest tube
in; put a Foley catheter in; typed and
crossed him for seven units of blood;
gave him about four units and sent him
up to surgery, with a couple of phone
calls off and on. And, it took me, two
corpsmen and a medical student to get
all this done. When you get an admission
everybody congregates in the same place
and you end up with one unified action.
Everyone is doing what is absolutely nec-
essary to stabilize the patient immedi-
ately.

If during the evening you get a critical
admission, you must juggle all of the pa-
tient assignments. If the new patient is
fairly stable, then often this reassign-
ment isn't necessary. Most admissions
take a minimum of an hour out of your
time, you can't leave the bedside. This
often takes the remaining time left after
your regular responsibilities. If you must
be with a critical patient continually, an-
other person will watch your patients
along with their own.

During the first couple of hours you
stay pretty close to the patient and every-
one is monitored. The parameters of
the monitor can be set at very close lim-
its so that even a slight change will alert
you. When the alarm goes off somebody
checks. After you have worked there a
while you can tell individual patients —
the alarm is all the same sound — but
you can tell whether it's an alarm that
you have to run for because something
bad has happened or whether somebody
has just rolled over, scratched in the
wrong place, pulled the lead off or whose
temperature has gone up.

If the patient is very critical and ex-
tremely unstable you will probably spend
the rest of the night there until relieved
by the next shift. If the patient should
have a cardiac arrest, again the whole
team comes through.

The first time someone arrested on me
there must have been four nurses and a
doctor there; the minute the patient was
stable everybody disappeared. There was
blood all over the room, the patient
needed to be turned, the bed needed to
be made, and I had medicines to get, but
everybody was gone. I can remember
standing there saying, "Where did you all
go? Come on, I'm not done yet, I need
some more help." I didn't really, but the
feelings of desertion were there and it
was a strange experience.

Most of the rest of the time you can
lose yourself by going off into a corner
where you see no one except for the resi-
dent who is taking care of that patient
for the evening. If you get a critical pa-
tient and there is an emergency, people
emerge from all corners and focus on the
one patient. The minute the emergency is
over, they'll disappear again.

Each person adjusts to the unit at
their own rate. It takes about six months
before you can function without close su-
pervision. You don't know everything, but
you know where to find almost everything
and you know how to find out about
things. This is because of the extraordi-
nary relationship that exists with the res-
idents.

The typical nurse-doctor relationship is
that the doctor is your boss, so to speak.
You take his orders and you question
them only when you are within your nurs-
ing rights to question them. But basi-
cally, you don't have very much to say
about what goes on.

In shock ttjumj you i\ie much more
on an equal level. When you get new res-
idents in who aren't familiar with the
routines of what needs to be done, you
end up being their teacher. This is an
odd relationship for most nurses to be in
— the role of being responsible for
seeing that the resident does it right.
The decisions are still his to make and
his is the medical aspect of it. Some
times you do question what he is doing
and you are expected to be. not just one
jump ahead of him. but at least on an
even keel with him — to ktiow some
things that you do and some things that
you don't do. You end up with a much
greater responsibility for knowing what is
going on with your patient. It's an odd
relationship.

With attending men. generally you go
to them with a question instead of giving
them answers. However, after residents
on the shock trauma unit have been
around awhile you end up more on an
equal par basis. He calls on you for in-
formation that he needs, and you do the
same with him.

Medical students are generally unob-
trusive since they are there to observe.
However, on occasion you get involved in
some of the conferences on patients. If
you have the time you can sit down or go
around with them as they look at the pa-
tient, look at the patient's lab work and
-evaluate all the things that have hap-
pened. I have learned more about what
x-rays should look like since I have been
there than ever before in my nursing ex-
perience.

You begin to pick up trends because
the things you don't see frequently in
other nursing services you get frequently
because of the type of patient admitted
in shock trauma. You begin to classify a
certain group of symptoms and when a
new patient comes into the unit you
watch the course he's taking then decide
among yourselves how long he is going
to be in the unit, whether he's going to
survive nicely, whether it's going to be a
stormy course . . . things of this nature.

Another thing nurses get involved with
is what they call intensive care psy-
chosis. Some patients just don't react fa-
vorably to being confined in a unit where
they don't get much sleep; somebody is
always disturbing them for medications;
they are full of holes where they have
been stuck with needles: they put in a
trachea for breathing and they can't talk
and they sedate the patient. The patient
loses all sense of time and place.

We also see people who withdraw be-
cause they cannot stand all of the noise
and pressure, plus their own fears, their
own worries ... so they withdraw into
themselves and then you don't know why
they are doing that either. It is really a
hard thing to care for.

Some patients leave the unit and their
recovery is fantastic. It's as if immedi-
ately after they go out the door, they
start getting better. With a new stimula-
tion, a new environment and people to
talk to, new sounds, new colors, new
lights and shadows . . . One girl just re-
cently was in a fairly deep coma and the
minute she left us she started talking

again, started recognizing people and
laughing. It was fantastic because she
wasn't doing any of this when she was
with us.

When we come on duty we are briefed
on what has happened on the unit pre-
viously and then are assigned patients.
Tests and other routine are usually es-
tablished on an hourly basis. There are
three categories of patients and they re-
ceive care accordingly. You just go
around in a circle and finish one circuit
then it's tinfie to start another. Usually
you have about ten minutes out of every
hour to do a few of the nice things. The
time varies tremendously with the patient
load.

One of the major differences between
medicine and nursing is in the approach
to the patient. Nurses tend to get in-
volved and they don't see patients as
cases or diseases quite as much as doc-
tors do. Very often, especially on grand
rounds, the chief of the service and the
residents talk about the patient, but they
never talk to him. This is upsetting to me
as a nurse because that person is a per-
son. I may not like him, he may be a dif-
ficult patient, but he is a person never-
theless. How would you feel is somebody
was talking about you, they don't ask
you anything and they don't tell you
anything. When they come around and
you're asleep, they start poking and
pricking you full of holes, testing your re-
flexes and taking off the dressings ... I

resent this for the patient's sake. How-
ever this is fairly typical of a teaching in-
stitution. It has always bothered me and
I guess it always will.

Sometimes the strain gets bad . . .
you see people die or just get worse . . .
people that you don't really know but like
as persons. There are times when you
might lose four or five patients in a short
period and you get very depressed. You
wonder what the heck you are doing; who
does everybody think they are, and you
think you are not doing anything for any-
body.

There are people you can accept will
die because you can just look at their in-
juries and know they don't have much of
a chance. Then there are some patients,
who you think in the beginning were
going to die, look like they are going to
make it and you think maybe you could
save this one . . . then something hap-
pens, it really hurts. You feel a personal
loss and I think everyone feels a little
sense of defeat. You know them as nice
people . . . that's a nursing nice.

A nursing nice means people that
smile, people who don't pull out of re-
straints and people that don't demand a
lot of your time. It's somebody who
doesn't get in your way, somebody who
lets you do what you want to do and
when you want to do it, according to
your schedule, doesn't interfere and
doesn't ask for anything special.

It's nursing with a uniqueness that
can't be duplicated.

medical

student's

view

Clayton Raab

It's enough to scare you to death . . .

Clayton Raab, a sophomore medical
student, had some intensive care expo-
sure while a nursing assistant on the pe-
diatrics intensive care unit during his
freshman year, but he found quite a dif-
ferent situation when he had a summer
position in the shock trauma unit.

Working in the pediatrics intensive
care unit 1 was around many crises, but
we only had maybe one intravenous (I.V.)
line and a respirator. In shock trauma
there are lines for I.V. and central ven-
ous pressure as well as arterial lines . . .
it was just enough to scare me to death.
There are tubes all over and you are ex-
pected to move around the patient and
help change his bed.

The first day I felt very insecure espe-
cially with all the tubes. I was afraid that
I would pull one out unintentionally. I
was given a tour and then my training
iDegan. Now I'm working in the unit
seven nights a week.

A special type of care is involved on
the unit as well as having to work around
a lot of complicated machines. The nurs-
ing procedures I learned on the pedia-
trics ward allowed me to concentrate on
details and probably made it easier for
me to learn faster than other medical
students who don't have experience.
Even after only a month, I was able to
take a patient on my own. You aren't al-
lowed to give medications but you can
run I.V. fluids. Working the 11 p.m. to 7
a.m. shift is quieter than during the day
and the nurses have taken an interest in
helping me learn what is to be learned.
My transition into the unit wasn't as bad
as I originally thought it might be.

Your relationship with the nurses is
unique. It depends upon how critically ill
the patient assigned to you is and what
is happening elsewhere in the unit. When
times get very busy you are given a little
more responsibility than originally be-
cause there is nobody else. I guess that
is actually a way of growing in responsi-
bility. You can't learn anything unless
you've actually done it. You'll never learn
about running fluids by being told and
working under a nurse's supervision you
actually can learn how to do things your-
self.

Many of the patients come into the
unit with trauma, but they are further
traumatized by having people fill them
full of needles . . . even the intensive
care they are given creates problems. It's
a matter of so much care constantly. You
can't sleep because you are being turned
or given medications and the lights are
on. We turn them down at night so it
helps the patient get some rest. Some of
the patients aren't as critical as others
but need supervision, so they are in the
unit.

Ed/tor's Note: The father of two, Clayton Raab is beg/nn/ng his sophomore year in medical school. He
received his B.S. in zoology from the University of Maryland, College Park.

Families of patients are discouraged
from coming in the unit. To see all these
tubes and wires, all the machines going
. . . it just more or less intensifies the
parent's anxiety. For instance, if a doctor
told you that your son was fine after
open heart surgery and you saw him with
an intertracheal tube in his throat and
wires all over him, you would think he
was just about dead. It's a good idea to
keep people out.

It is possible to get involved, but you
can't allow yourself to become too in-
volved with a patient. I have two children
and have seen kids on the pediatrics in-
tensive care unit die. I was surprised
that it didn't upset me . . . it's rather a
strange sensation. I thought I'd really
feel something emotionally for these peo-
ple and especially the kids, but you really
don't. Can you really afford to?

Working in the unit also has made me
sensitive to accidents. You wouldn't
catch me on a motorcycle because of
what I have seen on the ward. There are
a number of automobile accident victims
on the unit too. But we also have other
patients like those who have had open
heart surgery. You would picture the unit
full of badly injured people, but often
times there are those who just need in-
tensive nursing care or they can't find
room for them in another unit.

When word of an admission is received
the cubicle is made ready and the team
goes to meet the helicopter. It's an eerie
feeling, early in the morning when it's
twilight and you see the little light on the
helicopter coming in out of the sky. Every-
body is in their pink gowns and it all
seems like something out of a science fic-
tion movie. In terms of an emergency,
things are handled quite calmly and
efficiently.

This experience has vastly increased
my appreciation of nurses. Because of my
experiences in both units I have shaped
some strong opinions about the type of
nurses that I would like to have looking
after my patients when I'm a physician.

Working every night as I do I have a
chance to quiz the nurses about things
as they rotate through the ward. During
vacation nurses from other services work
on the unit and I have learned many dif-
ferent aspects of nursing from them. You
can appreciate the lack of knowledge and
the amount of knowledge that some
nurses do or don't have. And, you can
see just how serious it could be unless
you know what should be done and what
is considered good care for the patient.
The nurses are given a great amount of
responsibility by physicians and know a
fantastic amount of medicine. They cer-
tainly have taught me a lot.

It's a fascinating place to work and
learn.

no better place to learn

Sonia Hughes

During my junior year I was working in
a pediatric care study witli a little boy
who had transposition of the great ves-
sels— his aorta and pulmonary artery
were switched when he was born. He re-
quired a palliative repair and later had
open heart surgery which I watched. After-
wards I visited him in the shock trauma
unit.

Noting the care given patients in the
unit, Sonia Hughes decided that perhaps
this type of training would enhance her
nursing experience. She is the first nurs-
ing student to work in the unit.

This is a valuable learning experience.
Everyday I learn something new. How-
ever, everyday I become a little more
frustrated at what I don't know, but peo-
ple don't condemn you for your lack of
knowledge. You can ask seemingly the
dumbest questions and someone will take
time to explain even if they must repeat
themselves five times. And, there are ex-
tensive procedure manuals which explain
what is to be done.

Certain procedures done in other parts
of the hospital are done in the unit regu-
larly and there is more opportunity to fol-
low the status of a patient. Working in
the emergency room you see the patient
briefly and he goes to another floor. In
the unit you deal with the patient on an
emergency basis, he may go to surgery,
but then he returns to the unit for care.

A very unique aspect of shock trauma
nursing is learning to know the expecta-
tions and limitations of the equipment
used. They teach you how to autoclave
and clean the machinery as well as ex-
plain how it should function properly.
You must know the workings of the
equipment and be able to spot something
faulty which may be critical to the pa-
tient. Before a respirator is used it is al-
ways checked by the nurse. It's impor-
tant because a respirator can kill a
patient if not used correctly.

One day an admission was made while
I was there. Two medical students and I
stood there and watched. I thought: I'll
never be able to do anything, especially
"that quickly. But it takes time, and I'm
able to do more each day.

Many of the people are young and in
some ways I relate to them. It affects
you no matter what age you are when a
young child or person is injured or ill be-
cause he has not yet lived a full life. This
is because of the value society places on
youth. An older person, you may think
probably has lived a good life, but you
ask: 'Why did this happen to a child?'
You also might think: 'I've been in that
circumstance and it could have been me.'

For example, there are two patients
lying in cubicles next to each other — one
is a child and the other an adult. You
feel for them both and you want to give
them both good care. However, you see
the child lying there attached to a respi-
rator, he's in critical condition and his
prognosis is questionable ... it tears
you up a little more.

Often times you think a patient is re-
covering and when you return to duty a
few days later he has died. This hap-
pened to a patient I had. He was taken
off the respirator and when I came back
he was going back on it; he died the next
day and I never expected that so soon.

Driving and riding in a car makes me
aware more than ever to be cautious. I
often convey my sensitivity to others by
describing what I see in the unit. You
really respect an automobile after seeing
so many accident victims — people who
aren't even dangerous drivers. It's the
other fellow you must look out for. An
automobile is a dangerous weapon, more
so than I ever thought before.

Editor's Note: Miss Hughes is a senior nursing student. Her father, Dr. Lloyd Hughes, is an anesthesi-
o/og/st in Prince George County.

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Working service time on a service floor

' was frustrating because I wanted to be-
come more involved with my patients and
there wasn't time. I hardly knew their

: names. I was just doing a little bit here
and a little bit there. I felt like I was
spread so thin that I wasn't doing any-
thing effectively. Working in the shock
trauma unit is entirely different. There's
the one-to-one relationship with your pa-
tient.

Working on the unit requires a desire
to learn, because there is no way that
you are not. In order to give good care
you have to keep up, you have to be
aware of what's going on with your pa-
tient. It's not something that you can do
from 9-5 p.m. A knowledgeable nurse or
a good nurse is aware of her patient's

' needs. She is not only aware of facts,
but how they relate to him and she has a
working knowledge of equipment as well
as working physiology — how the patient
feels, what is going to influence his re-
covery or his stay in the unit. She has to

, be thorough.

A nurse should always question and
know why something is done for her pa-

>tient. There is more rapport in the shock
trauma unit then in any other unit. It's
much more of a teaching situation and
they are much more willing to teach you.

"They know that I'm a nursing student
and they know that I don't have much

. knowledge of the subject. Most of the
personnel have worked there for quite a
while and have had quite a bit of experi-
ence. One day I asked a doctor what was

-wrong with a child who had open heart
surgery. I wanted to know what the con-
genital defect was. He drew me a pic-

'ture, diagrammed and explained the situ-
ation to mie.

-^iT^

Because I am the first nursing student
to work in the unit, many of my class-
mates question me about what happens
there. They are curious who is being
brought in by the helicopter. However,
many of them comment that they wouldn't
work in the unit.

Before beginning work in the unit I
had certain apprehensions. After accept-
ing the job, I thought perhaps I had
taken a wrong step. I had done some
procedures, but if you've done something
a couple of times you concentrate on the
procedure and not the patient and his re-
action. I didn't have much experience.

I also thought that the nurses were su-
perior and that they would not want to
be bothered by a student. I was pleas-
antly surprised. They are good about
teaching, they understand that I don't
know much, and they are willing to teach
and help me learn. They're great! I'm
really glad I did it and I can't see why
anyone would not want to come and work
in the unit. Because, as far as nursing
care, there's no better place to learn.

air-evac helicopters help save lives

Lt. Frank Hudson
R. A. Cowley, M.D.

"Since some accidents will always oc-
cur, steps must be taken to minimize
human losses resulting from them. . . ."

Over the years, we have watched per-
sons with life threatening injuries or Ill-
ness die at the scene awaiting an ambu-
lance, die on their way to the nearest
hospital or die in that hospital due to in-
adequate facilities, personnel and equip-
ment to offer the necessary immediate
treatment and care for survival.

A study in which the deputy state
medical examiner participated indicates
that roughly 40 per cent of the persons
killed in Maryland die in hospitals . . .
and half of these could likely have been
saved if promptly and properly diagnosed
and treated. One concerned researcher's
comment sums up the problem:

It is essential that we strive for a rea-
sonable balance between the need for
prompt treatment and the better treat-
ment which may be possible if the in-
jured are taken to trauma centers.

Still, present policy seems to be to
transport most injured, without regard
for the severity of their injuries, to hospi-
tals whose chief distinction is being near-
est the scene. When or if the receiving
doctor feels the injury is too severe to be
treated in his facility, the patient is
transported to another hospital (provided
he has survived thus far). This adds up
to an appalling waste of time, which can
be ill-afforded by the person with the life
threatening injury or illness.

To help overcome this problem, the
University of Maryland Hospital devel-
oped the Center for the Study of Trauma
thus providing critical patients the best
immediate treatment available in the
country. Treatment centers of this caliber
are enormously expensive and difficult to
staff. As a result one cannot expect rapid
development of additional facilities of
this type; therefore, it is imperative that
safe, rapid transportation be provided
persons with life threatening illness or
injury so the services of the center are
made available to them.

Medical authorities tell us that we
should strive to have the severely injured
in a well-equipped and staffed medical
facility soon after they have been injured
if complications from their injuries are to
be reduced and their lives saved. Indica-
tions are that 30 minutes from the injury
to definitive medical treatment is usually
acceptable with one hour being the out-
side practical limit. With the surface traf-
fic congestion of today and insufficient
medical facilities equipped to handle the
severely injured, the lightweight high-
speed helicopter is the most effective and
economical way to avoid congestion,
cover the distances involved and assure
that highway injured receive needed
treatment in time.

The State Police are duty bound to as-
sure that the lives and safety of all per-
sons in the state are safe-guarded and
when injured or ill come under their
care, they receive the best handling pos-
sible under existing conditions. Their hel-
icopters provide for transport of critical
persons as an extension of normal police
helicopter operations. This provides a
sound fiscal base as existing know-how,
facilities, equipment and personnel are
utilized to the maximum.

Editor's Note: Lt. Frank D. Hudson is chief of the aviation section in the Maryland State Police.

The troopers assigned to the helicop-
ters have completed the Red Cross ad-
vanced first aid course, receive advanced
ambulance attendant training from the
Fire Service Extension, University of
Maryland, and receive an intensive week
of training in the Shock Trauma Unit.

Our cooperative program, one of the
few successful programs of this type in
the country, has been a simple matter of
developing community resources between
the university. State Police and the city
Fire Department Ambulance Service.

State Police records show that 58,672
persons were injured in Maryland from
automobile accidents last year. Of the
787 killed in these accidents, many could
have been saved by fast, efficient heli-
copter service to University Hospital's
Shock Trauma Center.

When persons are injured in an auto-
mobile accident, volunteer fire company
ambulance crews sometimes decide in-
correctly to take the most serious to the
nearest hospital, even though a helicop-
ter is available.

Such a case happened earlier this year
when the helicopter landed near the
scene of an accident. The ambulance
crew decided to take the most serious
case to the nearest hospital. When the
State Police helicopter crew delivered the
less severely injured victim to University
Hospital, the county hospital where the
other victim was taken called for the heli-
copter because they did not have the
necessary life-saving equipment. But it
was too late.

With a top speed of 150 miles per
hour, helicopters can fly from the Mary-
land-Pennsylvania line to University Hos-
pital in less than 15 minutes and less
than an hour from the Eastern Shore. An
ambulance, even with wide-open siren,
would require at least twice as much
time because of traffic congestion espe-

cially on weekends when most accidents
occur. An emergency in Cumberland
would take only an hour to reach Univer-
sity Hospital by helicopter.

Better service can be provided. The
most obvious area that needs strengthen-
ing is the education of and acceptance
by police, ambulance and medical author-
ities to the fact that the best interest of
the patient must be served. Some units
are still guarding what they believe are
their prerogatives, thus causing some
critical patients to be taken to an outly-
ing hospital (and often held there) in-
stead of going directly to a major trauma
unit. Accreditation and categorization of
hospital emergency departments could go
a long way toward solving this problem.
This approach has long been advocated
by the National Research Council's com-
mittee on trauma and shock.

While we learn to better utilize equip-
ment, personnel and systems, more
high-quality emergency facilities with
trauma units will be needed. Quick re-
sponse helicopter service will also be
needed statewide. Tentative studies indi-
cate that as few as seven fully-manned
helicopters are needed for definitive
statewide service.

Why not police helicopters in ambu-
lance service? They complement not
threaten surface units. The safety of the
few victims demanding helicopter trans-
port is compromised when handled rou-
tinely. The police helicopter has been
here for years, their crews are vastly ex-
perienced in applying helicopter support
to civil public service operations. Re-
quired communications also have been
here for years, the police communica-
tions net is one of the finest designated
for rapid emergency communications.
This is an excellent opportunity for the
public to realize a greater return for their
investment in government.

•^'T^

'4^f

■'X>:

■•:rt*.v^

today's neglected disease-traur

R. Adams Cowley, M.D.
Benjamin F. Trump. M.D.

Trauma, a killer of 115,000 persons
annually roams American society virtually
unchecked, picking its victims democrati-
cally; without regard to age, race, color,
or economic status; and except for the
havoc left behind, very little is known
about it. The name comes from the Latin
or Greek for wound or injury.

While trauma has been with us always,
its effect is one of the least recognized
and explored problems facing the physi-
cian today. Because of the increased
tempo of living, it is rapidly changing
from endemic to epidemic proportions
and the National Research Council now
calls it "the neglected disease of modern
society."

Every fourth person will have some
type of accident this year. Every eighth
hospital bed will be occupied by an acci-
dent victim. The most pathetic factor is
that between the ages of 1 and 37 years,
accidents are first in the cause of death,
between the ages of 1 and 48 it is sec-
ond, and if one looks at the overall pic-
ture for all ages, it is fourth. In 1970 the
National Safety Council estimates that
over 49 million Americans were injured
in all types of accidents. They also esti-
mate injuries cost the nation $25 billion
due to loss of wages, time at work, medi-
cal and property expenses.

THE PROBLEM

Severely traumatized individuals are
constantly present in large general hospi-
tals, particularly those associated with
medical schools such as ours. While we
do our best to treat these people, many
deteriorate and die. Unlike most patients,
who are hospitalized for acute or chronic
disease and for whom some type of defi-
nitive therapy and care is planned, the
accident or emergency ill victim becomes
on admission an unwelcome patient since
the hospital family is neither prepared
nor geared to handle his emergency. He
is most likely to be seen by the least ex-
perienced house staff physician, the in-
tern, during a period when time is of the
essence and ripe clinical judgment is es-
sential for his survival. Perhaps even
worse, he is taken from the scene of the
accident to the nearest hospital emer-
gency room where there may not be a
physician on duty and one must be
called.

Today, shock and trauma therapy is
often self-defeating for a number of rea-
sons. Good care seems less than aggres-
sive because young physicians who staff
emergency rooms are ill prepared to
make even the first decisions that may
be life-saving. Decisions are often com-
pounded by a compromise with inade-
quate treatment facilities, by harassment
and pressure on a busy Saturday night
with the intern, alone "on call," and by
the impossibility of consultation because
the senior staff member is busy in the
operation room or treating another emer-
gency on another floor, perhaps busy in
another hospital.

Editor's Note: R. Adams Cowley is professor of thoracic and cardiovascular surgery, chairman of the
Division of Trauma, and program director. Center for the Study of Trauma. He received his M.D. from
the University of Maryland. He is on the National Research Council committee on hyperbaric oxygena-
tion and shock, member of all major surgery and and thoracic surgery societies and author of over
200 articles pertaining to shock-trauma and thoracic-cardiovascular problems. Benjamin F. Trump re-
ceived his M.D. from the University of Kansas School of Medicine. He is a member of many professional
societies including the International Academy of Pathology and is the author of numerous articles and
abstracts in the field.

This present dilemma of emergency
care can be expected because most med-
ical schools have done little to teach
trauma beyond minimal first aid and
have structured trauma education at the
house staff level. Trauma and shock, as
areas of special interest, have attracted
few supporters.

The hospital attitude toward this prob-
lem is one of apathy in failing to provide
the ancillary support so essential for
proper care of the severely ill. In most
hospitals, the emergency room has be-
come the overburdened community out-
patient clinic on nights, weekends, and
holidays making good trauma care an im-
possibility. Chemistry and blood gas lab-
oratories so essential for critical care are
seldom available at night and on week-
ends when the incidence of accidental
injury is greatest. Unavailability of proper
x-rays, inadequate blood bank service,
and the skeletal staffing of physicians
and nurses on holidays, nights and week-
ends, further handicap the experienced
as well as the inexperienced physician.

These factors and many others perpet-
uate the same inadequate teaching, train-
ing and therapy experience year after
year. It is little wonder, then, that young
physicians who are so well trained in
most other aspects of medicine are
poorly equipped to make proper deci-
sions for resuscitation and emergency
care. In the event of disaster or war,
their inexperience in this area could have
a calamitous effect.

The public attitude toward trauma is
one of indifference because in the experi-
ence of the layman the physical injuries
that are seen are usually sudden, muti-
lating, distasteful, gruesome and indica-
tive of unlikely survival. As a result, to
the layman perfunctory treatment is ac-
ceptable! Many people are thus allowed
to die by general consent since the phy-
sician, the hospital and the public have
not accepted their responsibilities in
trying to improve this desperate situa-
tion.

The total treatment of injured people
on the basis of existing information is
also inadequate in most situations. Ther-
apy continues to fall into a pattern of
guesswork because the physician is una-
ble to study the trauma patient who fails
to respond to treatment. Scientific study
and observation, along with good care,
are synonymous with good therapy and
the right of every patient. Inability to col-
lect scientific information on what is tak-
ing place under conditions of therapy can
only result in mediocre patient care. If
scientific observations are not made dur-
ing this period, the experience is lost and
the physician is really not accepting his
responsibility to the patient for he cannot
otherwise guide therapy in the direction
of decreasing mortality and morbidity
due to accidental injury.

Awareness at the University of Mary-
land of these problems has resulted in
the establishment of a Center for the
Study of Trauma, an emergency and
acute care facility designed to combine
the highest development of patient care
and teaching with research facilities that
permit investigation in support of therapy
for the emergency critically ill.

Since 1956 the program has devel-
oped in six major stages:

1. Initially, the project was limited to
the animal experimental laboratory. As
the studies progressed, two important
factors became evident: a) Although ani-
mal experimental work was necessary for
many baseline and model studies, vari-
ance in response of different species in-
dicated the necessity to study injury in
man more directly; b) In order to under-
stand the overall structural pathophysiol-
ogy and biochemical alterations occurring
in the organism, it was necessary to
expand the program to include multidis-
ciplinary support in order to effectively
explore phenomena occurring at the cel-
lular level.

2. On January 1, 1961 an Army pilot
Clinical Shock Trauma Unit program en-
abled a clinical shock-trauma team to de-
velop and make primary investigations
into the mechanism and treatment of

' shock and trauma victims. A two bed
C.S.T.U. for emergency care and resusci-
tation was established and systematized
collection of pertinent data on trauma
and shock patients on a 24-hour basis
was made for the first time anywhere.
Experimental data on animals was used
for support of observations in humans. A
large amount of previously unavailable
clinical, physiological and biochemical
data on patients in various types and
stages of shock and trauma were col-
lected and analyzed which was invaluable

' in developing treatment and care re-
gimes.

3. A cooperative, rapid transportation

system with the Maryland State Police
utilizing helicopters for emergency evacu-
ation of the critically ill was established
with the completion of our FAA approved
all-weather heliport which has been func-
tional since June 1, 1970. A communica-
tion system has also been developed to
monitor the helicopter in flight, the
Shock Trauma Recovery Unit and the
Baltimore City Fire Department ambu-
lance service. The latter transports the
patients from the heliport to the center.
This has resulted in the development of
an interhospital transferral system for
the severe multiple trauma patient whose
problems overwhelm the resources of the
small community hospital. As a result,
we have become the accident receiving
center for the State of Maryland and sur-
rounding areas for patients who demand
immediate multidiscipline resuscitation
and care. Thus, every severely injured
citizen in the state is within one hour of
the center. So far, 261 patients have
been brought to the center by this mod-
ality.

4. By 1963, the development of a
background in shock and trauma enabled
us to obtain a $800,000 National Insti-
tute of Health Research Facility Grant for
a Center for the Study of Trauma. A
matching sum of $1.2 million for con-
struction of the center was successfully
negotiated with the State Legislature.
This center was completed in June, 1969
creating a complete self-contained inte-
grated treatment and study unit for se-
verely injured patients.

5. By our acquisition and installation
of an IBM 1620 computer to assist in
patient care, we have implemented a low
cost, on-line automated system for ac-
quisition and management of physiologi-
cal data from patients in the Shock
Trauma Recovery Unit. This system frees
the nursing staff from much of the time-
consuming record keeping v^^hich is nec-
essary for both patient care and re-
search. We have also developed a data
storage and retrieval system, utilizing
disk files on the IBM 1620 computer.
This aides the investigators in selecting
and organizing patient data collected
from 1962 to the present. The informa-
tion is used to perform data analysis and
to test hypotheses concerning the phe-
nomena involved in shock and trauma.
The ultimate goal is to use this modality
for total automated patient care and is
under continuous development.

6. The trauma program has long been
aware that before therapy can advance
further, more knowledge must be ob-
tained at the cellular level which means
that there must be a study of not only
the cell but also of its components. We
have been remarkably fortunate in ob-
taining the interest and support of Dr.
Benjamin F. Trump, our new chairman of
the Department of Pathology, who plans
to develop the Department of Pathology
with cell injury as the principle focus of
study.

CLINICAL PROGRAM

Our new 12-bed facility, the Shock
Trauma Recovery Unit, has completed its
first full year of operation. Since its
opening, we have demonstrated that we
could increase our functional capacity
from a two-bed unit to a multi-bed facil-
ity without altering our competence to
handle critically III patients. This simulta-
neously provides a training and educa-
tional programs for personnel at all lev-
els— the medical student, the house
officer, the nurse, and the visiting staff —
and finally, research continues in order
to update our current understanding and
management of the critically-ill patient.

Although our patient load increased,
our overall mortality decreased from 34
per cent to 22 per cent. During the first
five months of 1971, we have further in-
creased our patient load and average 40
patients a month with a 20 per cent mor-
tality rate. Admission to the center is re-
stricted to patients with severe multiple
injuries, head trauma, overwhelming sep-
ticemia, refractory shock, gas gangrene
infections, scuba diving accidents or life
threatening trauma. Most of these pa-
tients die in the general hospital setting.
In patients with head injuries alone, we
have decreased the mortality rate over
1968 from 79 per cent to 22 per cent.

We are, therefore, meeting our pro-
gram goals to:

— Extend knowledge on the severely
injured.

— Standardize resuscitation measures
by: a) making results more predicta-
ble since knowledgeable people are
not always available to give treat-
ment, b) formulate rules for the
care of the emergency ill by taking
the newly acquired knowledge and
restructuring it for use by other
groups working in hospitals that
have less advanced facilities and
personnel, c) demonstrate the ad-
vantages and usefulness of a spe-
cialized facility in the care of the
emergency critically ill.

— Clinical testing of therapy under
standard conditions.

RESEARCH

Under the best of circumstances where-
in we are providing rapid transportation
from the scene of the accident, rapid di-
agnosis and treatment and expert multi-
disciplinary care in a facility built for this
purpose, many of our patients still die.
Why? To some day answer this question,
the central theme of the research pro-
gram is to understand the pathophysiol-
ogy of shock and trauma in the human,
with the hope of thereby improving pa-
tient care. Generally, the treatment of
trauma in man has been directed to the
local injury, its cause and correction.
Treatment has seldom been aimed at the
total problem involved; namely, the reac-
tion of body to trauma and the mainte-
nance of life and repair of injury. We
have found that in addition to local dam-
age, the systematic injury resulting from
the breakdown of normal protective bar-
riers leads to liver, pulmonary and renal
complications. Thus infection, hemor-
rhage and other lesions of stress super-
venes and the local lesion has now be-
come a phenomena of general deteriora-
tion and death.

To improve the treatment of the criti-
cally injured, the search to understand
the cause and effect of shock resulting
from trauma which leads to deterioration
of so many body processes has consti-
tuted the basis for our study of injury;
namely, inadequate perfusion induced by
injury produces two major effects at the
organ and cellular level. Subnormal sup-
plies of oxygen and cellular nutrients
caused profound changes in organ and
cellular metabolism, incompatible with
normal function; and failure to remove
certain metabolic products produced by
these changes in metabolism at an ade-
quate rate induce further deterioration.

We have found that the changes in
metabolism and deterioration of tissues
at the cellular level are usually mani-
fested by increased acidosis, by the
change of various enzyme levels in blood
and tissues and by other hypoxic
changes in the body chemistry. In addi-
tion, there is a disruption of the body de-
fense mechanisms which, in turn, affect
auto-regulatory mechanisms in the cell
resulting in further deterioration and
death.

At the present time the important ques-
tions regarding pathophysiology seem to
be at the cellular and subcellular level

and much of the research is directed
toward understanding the cellular re-
sponse to injury. Changes at the cellu-
lar level are reflected by changes at the
organ level; for example, alterations in
kidney cells are associated with altera-
tions in kidney function. The kidney is an
important target organ in shock and
renal failure often results. Improved
methods of treatment are needed to pre-
vent renal failure from becoming a limit-
ing factor in patient survival.

Since many of the cellular alterations
result from hypoxia, the total respiratory
function of the patient is extremely im-
portant. We are monitoring respiratory
function using on-line computer analyzed
data in order to learn more about total
oxygenation from the whole body to the
cell level. Efforts are being directed to im-
prove diagnosis of tissue hypoxia and to,
thereby, improve treatment. Changes in
the lung in shock, sometimes referred to
as the "shocked lung" are poorly under-
stood but may be important in producing
tissue hypoxia. The liver is also an im-
portant site of alteration in shock and in-
creased lysosome formation in death of
cells in the parts of the liver lobule seem
to be responsible for alterations in liver
function, often manifested by jaundice

Figure 1. Electron micrograph of a liver biopsy
from a patient suffering from a head injury. Por-
tions^of three hepatocytes (H,, Hj, H:;) can be
seen. The liver morphology is relatively normal.
The bile canaliculus (Bl) is located at the lower
border of the micrograph and shows microvilli
protuding into the lumen. Occasional lipid drop-
lets (L,,) are seen. The nucleus (Nu) of hepatocyte
1 is seen at the upper left. Stacks of rough sur-
faced endoplasmic reticulum (RER) and mitochon-
dria (M) are seen throughout the cytoplasm.

Figure 2. Electron micrograph of a sample of liver
from a patient who had experienced several
episodes of shock. The chronic nature of the cellu-
lar injury is evidenced here by the large numbers
of autophagic vacuoles (Av), which can also be
referred to as lysosomes or residual bodies. Note
the bile canaliculus (Bl) is distended, and there
is loss of microvilli. The nucleus of hepatocyte 1
(HO is seen at the upper left, and lipid droplets
(L,,), mitochondria (M), and microbodies (Mb) are
seen in the cytoplasm.

and by presence of abnormal enzymes in
the blood stream. Using serial biopsies
and autopsy material, we are trying to
further the understanding of liver altera-
tions in shock.

Research on head injury constitutes an
important feature of many kinds of
trauma, since brain death can occur even
if the remaining portions of the body are
functioning normally. Specifically, efforts
are being directed toward understanding
the role of cerebral edema in producing
brain death. It is possible that some pa-
tients may be saved by preventing exten-
sion of brain damage to other regions.

Thus, the concept of a multidisci-
plinary clinical study of trauma as it
relates to the severity of the injury and
its time duration has not been previously
attempted until the Maryland program
was established. Also prior to this pro-
gram, no attempt had been made to
study injury with emphasis on an exami-
nation of the biochemical, bacteriological,
physiological, microvascular and struc-
tural alterations produced by tissue per-
fusion deficits in order to develop newer
concepts in therapy. As a result, a
trained group of shock research investi-
gators and clinicians have come together
to study and treat shock and trauma in
man without interferring with the resusci-
tation; in fact, our studies improved re-
suscitation.

Basic fundamental information has
been gleaned from the study of over
1,100 patients. The results obtained
from these data and the experience de-
rived from a study of a large population
has done much to assist in the formula-
tion of new concepts of therapy and re-
search.

FUTURE

The aim of the trauma program is to
expand the first major trauma program
in the country by further developing the
present, already established trauma cen-
ter into an eight floor building and to
further implement the concept of the
multidisciplinary team wherein the neuro-
surgeon, the orthopedic surgeon, the
chest surgeon, the internist, and the
anesthesiologist all meet the critically ill
on arrival and use their individual exper-
tise to engage this killer.

In the future the staff will continue to
provide the best care available for the
emergency critically injured patient and
to further develop research techniques to
standardize and improve patient care.
This includes expanding multidisciplinary
research investigations at the total body,
organ and tissue level. A teaching and
training program will be structured at the
medical school, graduate training and
community physician level. And, in addi-
tion, paramedical training programs will
be established for those personnel who
are directly involved with the accident,
such as amublance, state and local po-
lice personnel.

Additional goals for the future are the
orientation of the medical profession to-
wards the urgency of the trauma problem
and the development and modification of
the rapid transportation system utilizing
helicopter support.

Public apathy to the mounting toll
from accidents must be transformed into
an action program, continuing research
and formating emergency facilities to
provide the emergency critically injured
with the best treatment available, imme-
diately.

potpourri

surgery head

George Robert Mason has become the
tenth surgeon to head the Department of
Surgery. School of Medicine, since its be-
ginning in 1807.

In announcing this appointment which
was effective July 1. Dean John H. Mox-
ley III commented:

"We are really thrilled that Dr. Mason
has accepted our offer to become profes-
sor and head of the Department of Sur-
gery. He is not only a distinguished
surgeon but an active teacher and in-
vestigator. These attributes combined
with an interest in the broad problems
facing medical education and medical
service make him a natural for the job of
building the best Department of Surgery
for our school."

Dr. Roy Cohn. acting chairman of sur-
gery at Stanford, in a letter regarding
Mason's appointment called him "one of
the finest young men I have ever seen in
the program. Aside from his personal at-
tractiveness, he has a very broad interest
in the general problems of medicine, as
well as in his own field of abdominal sur-
gery and thoracic surgery." He also pre-
dicted that Mason will be "one of the
leading men in the country."

Mason said his plans include "continu-
ing the fine tradition of clinical teaching
and care presently being offered: devel-
oping research in areas of interest to

myself and others in the department:
exploring different methods of teaching,
and expanding the staff as the hospital
expands."

His interest in medical education has
been evidenced by his work on the elec-
tive curriculum which recently went into
effect at Stanford. "My interest in medi-
cal education is not limited to the stu-
dent: I am also interested in graduate
and postgraduate study." he stated.

The Rochester, N.Y. native received
his B.A. from Oberlin College, his M.D.
with honors from the University of Chi-
cago, and his Ph.D. in physiology from
Stanford.

He completed the residency program
in general and thoracic surgery at Stan-
ford and joined the faculty rising to the
rank of associate professor. While at
Stanford he pursued research in gas-
trointestinal physiology. He was a mem-
ber of committees in charge of surgical
curriculum and also in establishing the
elective curriculum currently being used
at Stanford. Other committee work in-
volved selection of students, surgical in-
ierns and residents and the medical
dean.

Prior to Stanford he served his intern-
ship at the University of Chicago clinics
and- served as flight surgeon in the U.S.
Air Force.

His honors include membership in
Alpha Omega Alpha: diplomate, American
Board of Surgery: diplomate. Board of
Thoracic Surgery: the Giannini Fellow-
ship, and the John and Mary R. Markle
scholarship in academic medicine.

In California, he was affiliated with the
Stanford University Hospital, the Palo
Alto Veterans Administration Hospital
and the Santa Clara Valley Medical Cen-
ter. His professional memberships in-
clude: the Stanford Chapter. Sigma Xi;
the Association for Academic Surgery;
the California Medical Association: the
American Medical Association: the Santa
Clara County Medical Society: the Ameri-
can College of Surgeons: the Society for
Surgery of Alimentary Tract: the Ameri-
can College of Chest Physicians: the San
Francisco Surgical Society: the Bay Area
Vascular Society and the Pacific Coast
Surgical Society.

Dr. and Mrs. Mason attended Oberlin
College together and are the parents of
three children, Douglas, Marcia and
David.

continuing
education

The in-service program for 1971-72
has been announced by Dr. Ephraim T.
Lisansi<y, chairman and director, Commit-
tee on Continuing Education.

The purpose of the program, which is
designed for each enrollee individually, is
to expose the practicing physician to the
most current concepts in the practice of
medicine, surgery and their various spe-
cialties.

Physicians will participate in the de-
partment's routine scheduled program of
rounds, clinics and conferences. He will
be the guest of the division or depart-
ment with which he affiliates. Ample al-
lowance will be made for collateral read-

ing in the library and for attendance at
chief of service rounds, resident rounds
and grand rounds, if desired.

This program also allows for cross-dis-
ciplinary visiting, or the entire period
may be allocated to one specific subject.

Minimum enrollment is for five days
and the training is not available during
June-September. Longer periods may be
arranged with approval of the Committee
on Continuing Medical Education and the
department head involved.

Further information about applications
may be obtained from the Committee on
Continuing Education, 201 Davidge Hall,
522 W. Lombard St., Baltimore. Md., 21201.

1 i-ifti

admissions and curriculum

changing medical education

Ij Robert Shannon, M.D.

There are many differences between
the way we in my generation view the
world and the way you and your genera-
tion view the world. Many of these differ-
ences are not so much experimental as
they are trying, at this point in time, to
live up to the ideals which you have
made for us and yet you are unable to
! fulfill.

The alumni is probably one of the
most important parts in changing the
curriculum. Many of the queries students
are making are related to wondering what
will happen once they get in practice as
compared to what they are being taught.
And, you are the only people who can
help answer that question because you
are working in the community. You pro-
vide the community's needs and work on
its problems as well as deliver medicine.
You are the ones who see 90 per cent of
the patients that are seen in this coun-
try, very few of whom end up in a hospi-
tal. For that reason, you are important in
changing the curriculum of this school.

How do others view Maryland? When
asking what people know about Maryland
School of Medicine they reply that we
have a reputation of being an average
quality clinical school. Much of this is
due to the fact that few of our graduates
go outside the state, most remain at the
school or in the state.

Also, the faculty as a whole has made
no decision as to what they are here to
do other than "educate doctors."

In this day and age most of my col-
leagues and myself find this an inade-
quate answer. Most importantly the ques-
tion that has to be answered is, "What
are our graduates to be trained for?" Are
they to be trained for the medicine of
Flexner and his time? Are they to be
trained for the medicine of the 50's? Or
are they to be trained for the medicine of
the 70's, 80's, 90's and even into the
next century. Frankly, realizing that I will
spend the next 40 years in medical prac-
tice, I would prefer to be trained for that
longer period of time rather than in what
others before me have been taught.

What then does this mean? After mak-
ing the decision about what we have to
be trained for then we must find out how
we accomplish this goal. We don't do
that by saying, "Well, what is everybody
else doing and how does that apply to
us?" We are different. We are Marylan-
ders. Most of the students come from in-
side the state although their educational
experience in college is diversified. But,
we are different as each school is differ-
ent. No one procedure in medical educa-
tion will suffice for all schools.

Therefore, we must experiment. Many
schools have used special programs af-
fecting a small amount of medical stu-
dents to try new teaching methods rather
than moving ahead on a full scale. Some
questions should be asked: What do we
want students to learn? How can we
bring students to learn faster and more
efficiently?

Ed/tor's Note: Drs. Shannon, Ramsay and Weaver delivered their views on admissions and curriculum
during Alumni Day activities. June 3, 1971. Shannon is currently an intern at Montefiore Hospital, Bronx,
N.Y. Ramsay is assistant dean for student affairs and Weaver is associate dean for admissions.

There are kinds of experiments we
must conduct. The elective system which
was started this year in the senior year
is an experiment and its value won't be
known for several years. We are behind
in our willingness to experiment. Other
schools have been using the elective sys-
tem for as much as four years. They
have solidified their program and found it
does work. I have seen other educational
systems, particularly in Colorado, and
have seen other ways of teaching medical
students. I have also met other students
at my level who had experienced other
methods of learning.

Many of the stalwarts of medical edu-
cation— Western Reserve, Harvard and
others — already know that for their type
of people in their type of institution
many of the new methods don't work. We
again still do not know and we cannot
apply their data to what we are talking
about.

You and your colleagues have said
that some of the things you experienced
or were taught in medical school, many
of the same things we are experiencing,
were useless in the real world. This is a
critical factor and the question of rele-
vance to practical day to day practice
must be examined in each one of the
courses. That is one of the major con-
cerns of the student and we need your
help.

No longer can we say that what was
good enough for me will be good enough
for those who come after me. You don't
want that for your children. And we don't
want it for the graduates of the Univer-
sity of Maryland. We must continue mov-
ing toward some better method of edu-
cating those who come behind us.

Generally, we find the faculty, with
notable exceptions, slow to change, irri-
tated by challenge, unwilling to experi-
ment and whose teaching is secondary to
all else. And rewards such as tenure, po-
sition, etc. from what we have observed
place teaching quality far behind other
criteria. This is one of the most perplex-
ing things to us as students.

We have grave questions about the
competency of the graduates — about our
own competency and it's not related to
the elective system. It is related very -
much to the teaching we've received.
This is not the classroom teaching, but
the one-to-one contact which we all know
is the most valuable experience one can

have. This is the opportunity to compare
that one-to-one contact, that clinical im-
pression or clinical method that we read
about in textbooks to actuality.

Many, many of my class, about 34
graduates, are not going out to find out
what else is going on in the world be-
cause they are remaining here. One of
the faculty called this a severe tragedy in
the commentary on education at this
school since this represents a type of in-
breeding. Those who stay will continue to
believe that they have something good
without ever questioning and asking: "Is
what we have the best that we can offer
to the students as an educational proc-
ess and to the people of Maryland as a
major hospital?"

What possibilities do we have in the
way of curriculum models?

There are certain options that can be
taken. One which could come out of the
curriculum meeting (June 13-15) due to
a lack of consensus is that we continue
the same procedures that we have used
over the last several years. This answer
is totally untenable to us as students in
relation to today and the 20th century
and tomorrow and the 20th century.

The systems process requires a tre-
mendous commitment of the faculty and
I question whether we have that commit-
ment from our faculty. This means teach-
ing in a near disciplinary fashion which
requires a lot of time, a great deal of
commitment and a lot of interdisciplinary
meetings to provide the best education to
students.

The elective system is possibly an op-
tion and certainly a problem. There is
something to be gained in moving to an
elective system — freedom for an individ-
ual to make decisions about his further
education. However, if good counseling is
given students or even bad counseling
for that matter, you most often will find
them (students) unwilling to break with
traditional lines. They take the traditional
courses because they feel that this is
what they need.

Credentials for admission are another
important factor to be considered. Every-
one has to use credentials for something.
I I would ask you very seriously to exam-
ine what those credentials set for admit-
tance mean. It has already been well
proven that credentials obtained before
medical school make no guarantee of
performance in medical school outside of
being able to say that a person can gen-
erally handle the workload.

Many of my classmates kiddingly com-
ment that under the present system you
could take a monkey and train him for
the first two years. If one of you would
come with us for a day of classes or
maybe a week of classes and sit for 40
hours you can see for yourself what hap-
pens. Often times the lights are out with
the projector going and having stayed up
until midnight studying, you can't stay
awake under those conditions. Assimila-
tion of facts usually occurs the night be-
fore the exam.

Then, what do our credentials mean?
They mean little in the sense of whether
I we are going to turn out good physicians

or not. They mean only that we have peo-
ple who can assimilate material rapidly,
have done an excellent job of it and have
been selected for it in the education sys-
tem up to that point in time.

Students have been trained well in
memorizing and we do not need to rein-
force it. What we need to reinforce is
something that all you gentlemen took
years in learning — how to approach a pa-
tient who walks in your office with a com-
plaint without lab data, without having
him hospitalized and without having the
confinement you need for examination . . .
how do you determine whether he is ill
or not? Not how do you diagnose the un-
treatable disease, but how do you make
sure that somebody knows how to diag-
nose the treatable disease?

Therefore, you must begin to empha-
size how to use your brains and senses,
all five senses and even the sixth sense
that said: "This is a patient in trouble,
and I can't let him walk out of here." We
are not presently training people for that.
We are training people to see patients as
ihey come into a hospital most often a
severely-ill patient. Many of my col-
leagues, including myself, have missed
many diagnosable, treatable diseases
that we should not have missed. I do not
blame entirely the teaching system at the
University of Maryland, but I also blame
myself because some place along the way
I missed something. The question of
competency here is not so much my fear
of internship, which is very real, but I
wonder if I have received the best educa-
tion available. And I think that is the
question that all of us have to ask our-
seives with respect to this school.

Secondly, are we willing to experiment
to find out better ways of teaching the
incoming professional and to prepare him
to use his brain since the facts will
change and probably be obsolete by the
time he's five years out of his first two
years and even after three years of medi-
cal school? Those are the things we have
to handle — obsolete facts. Are we train-
ing a man to use those faculties which
he will carry with him for the next 40
years in practice?

And finally, are you gentlemen going
to become involved? I sincerely hope you
will because you are the ones that have
at hand many of the answers to ques-
tions that we as undergraduate medical
students are asking.

curriculum changes

Frederick J. Ramsay, Ph.D.

The responsibility of providing a better
education is one that falls on the faculty
of this school. This does not take away
from the education that the present stu-
dents' predecessors had, but there are a
number of things going on in society, in
the profession and in the educational es-
tablishment which conspire to bring
about a need for change.

Some of these changes come from the
sociological media in which we operate: a
requirement for better health care; a re-
quirement for more availability of physi-
cians, which may mean more numbers of
the same number of physicians, but more
available, and systematic changes in the
delivery of health care. People are asking
for the best of available procedures and
techniques in the area of health care.
From a technological point of view we
have more therapeutic agents, new proce-
dures and new techniques which must be
included in our educational process.

On the other hand, in the business of
educating there are new ways to teach,
new ways to do things, new ways to
use computers and programmed instruc-
tion of various sorts including television.
From the profession itself come pres-
sures to change with the eventual loss of
the internship as a part of postgraduate
education and changes in postgraduate
education. Finally, but not unimportantly,
are the students' needs. We have a dif-
ferent brand of student coming to school
today who views the world and his educa-
tion in a different way.

All of these things work together to
produce about four major trends. These
four major trends seem to be paradoxi-
cal, but yet we must deal with them all.

The first trend is the increasing num-
ber of students that we are going to have
to educate, sooner or later. Secondly,
there is going to be an Increase in the
content with shifts In emphasis of what
we teach. Also, there is going to have to
be a shift in how we view a teaching pa-
tient. A patient in our service area is_
teaching material, but he is also a pa-
tient. With the construction of a high-
class delivery system, he's a patient first
and teaching material secondarily. And,

finally there is going to be a relative
shortening of the time for training.

Now the first three problems seem to
require more time, more effort and the
last means we're going to have to com-
pact time and effort. This means that we
are going to have to find new, more
efficient ways to teach.

In 1966 the first curriculum modifica-
tion was introduced in the freshman
year. The organizing principle for that
year was temporal correlation. We hoped
to achieve more efficiency by having
those areas which covered the same kind
of material in anatomy, physiology,
biochemistry and other basic science
courses taught concurrently.

The following year systems teaching
was included in the second semester of
the sophomore year. Then in 1969 we
changed the third and fourth year, so
that the junior year is now clerkships and
medicine, surgery, obstetrics and gyne-
cology, psychiatry and pediatrics. The
senior year has a 12-week block in am-
bulatory care and anesthesiology, radiol-
ogy and ophthalmology and then 24
weeks of free electives that the students
can choose in whatever specialty they are
interested in and wherever they like to
take it.

Some of our changes did not endure.

The first year the method of temporal
correlation simply didn't work very well.
That is not to say we lost it all; we did
retain some of the good things that came
out of it — we've reduced laboratories
considerably and introduced new mate-
rial.

The second year with its systems
teaching in the second semester is hold-
ing up, but is under severe pressure for
change. The third and fourth year seem
to be pretty solid.

For the last two years the curriculum
committee has been studying the first
two years — the so-called basic science
years. It has attempted to find some way
in which we can make that block of time
meet some of the requirements men-
tioned previously. It is an extremely diffi-
cult job to do.

The curriculum committee has recom-
mended setting up three model curricula.

The first of the three models is a
systems approach: for the first two years
everything would be taught in an orienta-
tion around a central core which may be
pathophysiology or some other organizer.
That means that anatomy, biochemistry,
pharmacology, all first and second year
subjects would be combined together to
produce a single unit in a systems ap-
proach.

The second model offered is called the
"basic science, clinical science mix." It
proposes a first year of highly com-
pressed basic science courses. The sec-
ond year puts the students immediately
into clinical areas where they will per-
form tasks that they are capable of con-
ducting while they learn the rest of their
basic science. Then the third and fourth
year will be pretty much as they are now.

The final model is an elective model.
Three or four prerequisite courses that
everyone must take will be established
and then the students will select the
courses and build their own curriculum.
This could be done either of two ways:
alternative tracks to a single goal or al-
ternative tracks to alternative goals. A
basic decision that must be made is: Are
we going to produce different kinds of
M.D.'s, but allow the student to arrive at
that point his own way or shall there be
one "product" at the end of our training
program?

My one regret is that we really haven't
had a chance to tap the alumni. Those
of you who are in the practice of medi-
cine could give us some very valuable in-
sights as to what students need in the
general practice of medicine. We some-
times, I'm afraid, get a little parochial
here because we are so wrapped up in
our own system.

I will try to keep you posted as to
what's happening and where we are
going with the curriculum. It's an excit-
ing time but it also carries with it some
anxieties. Your profession is a very com-
plicated profession and the training for it
is even more complicated.

admissions

Karl H. Weaver, M.D.

Admissions, not only at this school,
but at every medical school in the coun-
try, probably can best be described in
the words "increasing competition." This
is true both for the numbers of individu-
als who are applying to medical schools
and the strength of the credentials that
they present in support of their applica-
tion.

There is no question that the number
of individuals who want a career in medi-
cine far exceeds the number of places
available in today's medical school classes
in the United States. This is a very sad
and tragic situation and certainly repre-
sents a tragic loss of human resources.
What has happened nationally in that ten
year period can be seen below:

First Year

No. Persons Places
Year Applying Available

Applications

1961 14,381 8,483

53,832

1966 18,250 8,991

87,627

1971 26,000'' 11,800'

165,000'=

" estimated

Source: Association of American
leges.

Medical Col-

From 1961 to 1966 there has been a
fairly large increase in the number of in-
dividuals applying to medical schools.
They generated an increasing number of
applications, but during that period there
was a relatively minor increase in the
number of first year places. We have
made a much better progress across the
country in the past five years, but again,
for 1971, 26,000 individuals are apply-
ing for 11,800 places and these 26,000
people are generating 165,000 applica-
tions. That is the national picture.

What has happened here at the School
of Medicine?

First Year

Resident No. Total No.

Total No. Appli- Class Residents Requests

Year Applicants cants Size In Class To Apply

1961 456

1966 621

1971 1,080

173
270
508

100
128

137

N.A. 1,000

100 1,785

134 2,268

As shown above, here again at Mary-
land it is a case of increasing numbers
of individuals applying. In 1961 we had
1,000 people who requested an initial

application. Maryland uses a two-stage
application process. For the second
stage, 456 applicants generated a final
application. In the second stage group
are all Maryland residents and all individ-
uals who identify themselves as legacies.
A legacy is defined as sons or daughters
of graduates of this school. Of the 456
second stage applicants, 173 were Mary-
land residents. At that time (1961) there
were 100 places in the first year class at
the School of Medicine.

Five years later, the figures had grown
— 1,785 requests to apply were received
and that group was reduced to 621 final
applications. In that final application
group were 270 Maryland residents. The
first year class at that time was 128 of
which 100 were residents. This year over
a thousand people generated a final ap-
plication of which 508 were Maryland
residents. There has been an unbelieva-
ble increase in the Maryland resident
pool in the past five years. This year the
class size will be 137 and there will be
three non-residents in the class.

Even though the number of applicants
is increasing, the strength of the creden-
tials that they present is increasing also.
So it's not a case of more people diluting
the strength of the credentials which are
submitted in behalf of their application.
This year was an exceptionally keen and
competitive year and it will most likely
continue to grow keener each year.

The objective data of the applicant
pool applying to enter in 1968 and 1971
is shown below. MCAT stands for Medical
College Admissions Test and GPA is the
over-all grade-point-average calculated
on a 4.0 basis (A is 4.0, B is 3.0, etc.)

Application Pool

1971

MCAT Scores Res/dent Non-resident

Verbal

Quantitative

General

Information

Science

GPA

549
586

550
535
2.93

576
611

576
565
3.24

1968
Res/dent

540
569

561
540
2.82

This increase in numbers has not rep-
resented individuals with less competitive
credentials. In 1968, 323 Maryland resi-
dents applied and 508 applied in 1971.
For 1971 the residents who applied have
essentially the same MCAT scores, but a
higher GPA, and there are 200 more peo-

pie in this pool. Thus, a great segment of
those have very strong credentials. For
comparison, the data of the non-resident
pool for 1971 is also listed.

Because of the increasing strength of
the applicants' credentials it is obvious
that the objective data of the classes
which have been selected would be
changed somewhat as is indicated:

Objective
Entering

Data
Class

MCAT Scores

1962

1966

1971

Verbal

534

542

570

Quantitative

517

580

627

General

Information

528

568

566

Science

521

540

567

GPA

2.80

2.93

3.31

* as of June 4, 1971

Over the past ten years, there has
been a rather marked increase in the
objective data of the first year class.

As an interesting sidelight, look at the
class that was admitted in 1966 and
compare that data with the objective data
of the resident applicant pool for 1971.
This gives you an idea of what has hap-
pened over a five-year-period. The class

that was admitted in 1966 had virtually
the same credentials as the total resident
Maryland pool does for this year.

These data represent the background
within which the Committee on Admis-
sions must make their selections. The
committee is composed of twelve individ-
uals, eight of whom have primary teach-
ing responsibilities in the clinical sci-
ences and four of whom have primary
teaching responsibilities in the preclinical
sciences. The group as a whole reviews
all the credentials that are submitted by
the applicant, paying particular attention
to the academic record; the MCAT
scores; letter of evaluation — which are
usually received from the undergraduate
college premedical committee; the inter-
view, and all other credentials which in-
clude whether a person has an advanced
degree, their job experiences, their activi-
ties at school and their contributions to
their college community. Sometimes age,
and whether they are a legacy are fac-
tors.

Applicants selected from the second
stage are interviewed by one member of
the committee and one member of a pool
comprised of approximately 50 faculty
members, 20 senior students and about
10 house officers who have been se-
lected to conduct interviews. All of these
are individuals who have indicated their
willingness to participate in the admis-
sions process. They submit a written re-
port of the interview as does the com-
mittee member himself. The entire
committee meets once a week during the
application season, which now runs from
early September through March and
sometimes April.

I can't stress the amount of time that
the individual members devote to this.
They devote at least a full day a week
and probably more. Certainly they have
my undying appreciation for the work
that they have done.

All decisions are made by the entire
committee, meeting and reviewing the
particular applicant's credentials at one
time. All of the factors within the appli-
cation are taken into consideration, a full
discussion ensues and then, at some
point in time, the committee makes a yes
or no decision. Essentially what they
have to do is take a pool of about 2,200
applicants, make a yes or no decision
and come up with a class of 137.

The decisions can be alikened to a
clinical decision as much as anything.
The committee examines all of the data
presented and then makes a final deci-
sion in light of that data. As we have
seen, strong competition exists and the
committee must make their decisions in
light of that competition.

One of the problems that exists in all
state universities, all state supported
schools, is the same one v/e are facing at
Maryland. That is, that as the number of
Maryland residents increase — the num-
ber of people applying in the applicant
pool from the state of Maryland — and
certainly as their credentials remain at a
very high level, there will be no question
that the Committee on Admissions will be
able to select fewer and fewer out-of-
state students. Unfortunately this means
that legacies who are from out-of-state
are going to have to compete in the out-
of-state pool. I would predict that over
the next several years, until there is a
significant increase in the class size of
medical schools all over the country, that
the ability of admissions committees to
admit non-state residents to state
schools will be limited.

What has been the number of legacies
who have applied in the past few years?
Figures for the past three years available
are:

Legacy Data

1969

1970

1971

No.

Applying

No.

of Residents

No.

Sent Offer

No.

Withdrawing

In 19G9, 26 legacies applied; 35 in
1970 and 34 in 1971. The number of
Maryland residents, those sent offers and
those who withdrew, is indicated.

The legacy situation is one of which
the Committee on Admissions is aware
and they are very much concerned. But
again, we have to view it in light of the
background of the competition which ex-
ists among the increasing number of ap-
plicants with extremely strong creden-
tials.

What is the prospect for the future?

In 1962, the school increased its class
size from 100 to 128 and in 1968 the
class size expanded to 137. Upon com-
pletion of the North Hospital now under
construction, the class will go to 155
and when the addition to Howard Hall is
complete the entering class will number
163. Data is currently being collected as
to the facilities and resources necessary
to expand the class size to 200. I hope
that day comes much sooner rather than
later.

My plea is that all of us who have a
special interest in medicine, combine our
energies and our individual talents with a
goal to provide the facilities and the re-
sources necessary for the continued ex-
pansion of the School of Medicine and to
allow it to continue to provide a high
quality educational experience.

the academi
medical ce
resent
nd future

)hn H. Moxley III

\\y

It is difficult for many people in our
society to understand the academic medi-
cal center. It is even difficult for many
people who are within the academic med-
ical center to understand it. What hap-
pens is that observers look and at first
glance note that medical schools are
spending large sums of money in educat-
ing a relatively small student body. As-
suming a national medical student body
of 38,000 students, an observer finds
that the total cost per year per medical
student approaches $40,000. Further-
more he notes in return for such large
expenditures, society is receiving only

9,000-10,000 graduating physicians an-
nually.

Unfortunately observers usually do not
go any further and therefore do not real-
ize that the analysis above is simplistic
and very misleading. The reason it is
misleading is that the undergraduate
medical education program — the most
apparent element of the academic medi-
cal center — is also one of the smallest
parts. What you are looking at is an ice-
berg with the medical school being the
only visible part, but where almost all of
the activity takes place underneath. I
refer here to the teaching hospital, to the

Editor's Note: Dean Moxley's remarks are excerpted from a talk delivered to a curriculum meeting held
June 13-15 at College Park.

graduate program that is producing
Ph.D. candidates in the biological sci-
ences, to the ambulatory services, to
basic and clinical research, and to the
clinical laboratories.

Allow me to expand on the concept of
the academic medical center. What are
its responsibilities? First of all in terms
of education we have undergraduate
medical students, graduate medical stu-
dents (interns and residents), graduate
students in the biological sciences, and
several types of postdoctoral students in
both preclinical and clinical departments.
In addition most academic medical cen-
ters are also charged directly or indi-
rectly with the education of various types
of allied health personnel. We at Mary-
land are specifically charged with the
education of physical therapists, medical
technologists and radiology technicians.
Academic medical centers also provide
continuing education for a large number
of health professionals. All of these edu-
cational services are provided by a single
faculty — the medical school faculty.

In terms of patient care it is a fact
that one out of every nine hospitalized
patients is in a university teaching hospi-
tal, that one out of every seven babies
born is delivered in a university teaching
hospital, and that these same hospitals
provide one out of every seven ambula-
tory visits. It has been said that Mary-
land and Hopkins jointly account for ap-
proximately 50 per cent of the daily
physician-patient contacts in the city of
Baltimore. Again let me emphasize that
the patient care is provided or supervised
by the medical school faculty.

What about research? Without recount-
ing all of the incredible benefits of the
biomedical revolution let me simply point
out that as long ago as 1967-68 medical
schools were charged with the spending
of over $473 million for sponsored re-
search. If you add the research effort of
teaching hospitals, you must add another
$150 million. The fruits of this research
have benefited our entire society. Once
again the medical school faculty has
shouldered the responsibility.

Extramural services are a new and
rapidly growing responsibility of aca-
demic medical centers. These services in-
clude participation in the organization
and operation of community health cen-
ters of which our prime example is the
Community Pediatric Center. Also in-
cluded, however, is participation in re-
gional planning efforts where medical
faculty are viewed as important members
of the various committees and as consul-
tants at both the local and national
level.

Participation in public health programs
is yet another important function of the
medical faculty. Local participation can
be seen in the Inner-City Community
Mental Health Program, which literally
would not have gotten off the ground had
it not been for our Department of Psy-
chiatry.

To recapitulate, the activities of the
academic medical center in the United
States can be set forth in the following
terms: education and training for about
275,000 health professionals and tech-
nologists, of whom about 65,000 are
physicians at some stage of their train-
ing; continuing education of over
100,000 practicing physicians; the provi-
sion of over 46 million patient days of
hospital care per year for over 3.5 mil-
lion patients; the delivery and care of
about 450,000 newborns; the provision
of some 17 million ambulatory visits an-
nually; conduct of over $600 million
worth of biomedical research; and the
provision of about $60 million of extra-
mural services. Total expenditures range
somewhere in excess of $4 billion per
year.

With biomedical research in a state of
crisis, with the great deal of activism at
all levels of the educational process, with
the organization and delivery of health
care in ferment, with inflation rampant
and appropriations being reduced and

with almost no money being appropriated
at the federal level directly for under-
graduate medical education, is there any
wonder that medical schools are in the
throes of a very major identity crisis?

So much for the present; what can we
say about the future? Despite the current
ferment I think there are some character-
istics of the future that we can define
and I will now attempt to do so.

First, it is perfectly obvious that the
multiple roles of the academic medical
center will continue. I, for one, do not
see us abandoning any of our current
roles and am equally certain that they
will each continue to grow.

Secondly, the academic medical cen-
ters of this country will increasingly be
viewed as a national resource and will
continue to get a portion of their funds
from the federal government. Despite a
probable growth in support from Wash-
ington, state support will continue to be
critical; the state provides our core sup-
port without which we could not continue
to function. Furthermore, expansion of
the medical center either in terms of stu-
dent body or service to society will be
dependent upon financing by the State of
Maryland. We will therefore remain ac-
countable to the University of Maryland,
the State of Maryland, and to the federal
government. I am also convinced that the
undergraduate medical education pro-
gram will receive increasing attention by
all of our funding sources. No matter
what other changes occur in the health
field, our society is determined to in-
crease the production of physicians.

In terms of planning for the academic
medical center, I have to say that we no
longer have the capability to significantly
alter our total mission. I am often asked
what is the mission of the medical
school? What specific type of physician
are we attempting to produce? As I have
recounted for you, we have many mis-
sions and we are going to have more.
There will have to be many different
types of doctors produced in the future
and they will be produced at academic
medical centers. Increasingly our society
has become dependent upon our total
mission and this dependence is at the
same time important and restrictive.

I do feel strongly, however, that we
have the capability to reorder the priori-
ties within the academic medical center
and I believe they need reordering. I

would like to see us reorder our priorities
and place undergraduate medical educa-
tion at the pinnacle of our activities, ori-
ent all of our other activities around it.
Every activity cannot be directly related
to the undergraduate medical school pro-
gram but we can specifically recognize
undergraduate education as having the
highest call on our resources. We must
demonstrate our renewed interest in the
undergraduate medical education pro-
gram by developing quality control mech-
anisms that will constantly monitor our
progress and assure faculty, students
and society that teaching is our primary
concern and that it is constantly being
upgraded wherever-and however possible.
As a first step I strongly urge that we
immediately develop a peer review of all
of our curricular programs. I am not a
naive individual and I realize that there
will be difficulty in elevating the medical
student program to primacy, much less
develop quality controls for it. I am, how-
ever, convinced of the great importance
of the changes proposed and encourage
rapid action. Change is never easy, but
it is desperately needed.

As we move to reorder our priorities
and as we move to reassess our program
within the academic medical center I
would put forth to you that our ultimate
goal should be the creation of a medical
university. In capsule, what I mean by a
medical university is the development of
multiple curricula leading to the M.D.
degree. These curricula would have their
origins in the undergraduate years and
progression through them would be de-
pendent upon a system of prerequisites;
in other words, there would be no spe-
cific time scale and there would be no
lock-step. Simultaneously we must move
toward opening the majority of our medi-
cal school courses to undergraduate col-
legiate students who do not intend to
proceed to the M.D. degree.

What is the rationale for such a devel-
opment?

At the present time medical students
are introduced to the medical curriculum
at an exceedingly bad time. They are a
very highly selected, indeed too highly
selected, group who have worked ex-
tremely long and hard before coming to
us. They have worked hard in secondary
school to compete for college entrance.
They have then had to turn around and
compete at even a higher level for en-
trance into medical school. They come to
medical school in a somewhat exhausted
state and immediately find that they have
to begin the academic competition all
over again to prepare to compete for an
internship and residency.

In summary, medical students today
are victims of a highly compartmen-
talized, highly competitive educational
system and by the time they reach medi-
cal school the effects of that system
upon them are quite apparent. Their un-
happiness has been labeled as antiintel-
lectualism. I reject this label. In fact I do
not detect any great difference in the
medical school problems concerning to-
day's medical student as compared to
previous generations. Today's student is,
however, more willing to express his or
her concern. What is expressed is the
fact that they feel overwhelmed by the
intensive exposure to the science of med-
icine in the first two years of medical
school. The response of medical faculties
has been to pare down the exposure. I
do not believe that restricting exposure
to the science of medicine is wise for all
indications are that we are going to be
increasingly dependent upon it in the fu-
ture. Why not, therefore, spread the sci-
ence of medicine over a longer time scale
and simultaneously attempt to individual-
ize the exposure as far as possible.

One of the first questions usually
raised when the concept of the medical
university is introduced is whether or not
it would interfere with the American ideal
of a liberal education. I think not, for
several reasons. First, the liberal educa-
tion concept used to be applied only to
the collegiate years. Now, however, the
concept and indeed much of the course
material is presented in secondary
school. Second is the fact that students
of the liberal arts are expected to con-
centrate in a special area for approxi-
mately two of the four collegiate years. I
contend that concentration in human bi-
ology is just as legitimate as concentra-
tion in economics, chemistry, political
science, etc. For some reason it has al-
ways been assumed that human biology
was somehow less relevant to the human
condition. I reject that assumption and
make a plea for a human biology major
at the collegiate level open to all stu-
dents, whether or not they are planning
to continue on to a health professional
education. The basic science courses in
such an environment just might become
more exciting to the students. The major-
ity of the courses in this new major
should be either closely supervised by or
actually taught by a medical school fac-
ulty.

The concept of a medical university
would allow for greater flexibility in medi-
cal education than we have now, or that
will result from any specific curriculum
change that is being proposed here or
elsewhere. It would allow for a shortening
or a lengthening of the high school to
M.D. degree depending upon the desires
of the student, his capability, the quality
of his preparation, and last but not least
his ultimate goal. It would readily permit
the development of specific tracks lead-
ing to the M.D. degree in a specialized
area. This could easily be accomplished
by allowing the medical student and the
collegiate student to move back and forth
across the collegiate-medical school inter-
face which has been a fantastic artificial
barrier in the past. For example, a stu-
dent particularly interested in psychiatry
could begin to pick up early or go back
for courses in the social and behavioral
sciences, or do the same in the rapidly
developing field of neuroscience. One of
the things that worries me about pro-
grams with a special interest is that in-
creasingly as I look around the country

an M.D. with a special interest means
that you spend more of your time with a
certain clinical department while you are
in medical school. I seriously question
the merit of such programs. If a student
is desirous of becoming an internist, is it
best for him to spend four years with the
faculty of internal medicine? No, is my
answer. I believe that there are certain
prerequisites within the large body of
medical science that such a student
should concentrate on, but these are not
necessarily taught best by the Depart-
ment of Internal Medicine. I'm not sin-
gling out the Department of Internal Medi-
cine since the same would be true for
any clinical department. The medical uni-
versity concept would allow the student
to range over the entire spectrum of uni-
versity offerings to best prepare himself
for his career. It would provide us with
opportunities to broaden and not con-
strict the scientific base of medicine.

I believe that there will also be clear-
cut advantages for the preclinical depart-
ments. I am worried over the fate of the
basic sciences in medical school. Almost
all curriculum revisions that have oc-
curred over the last ten years have re-
stricted them. They have restricted them
in time and they have restricted them in
creativity. Up to a point there is merit in
constricting, but then you reach a point
of diminishing returns. I am not certain
that we have reached that point in our
own medical school at the present time,
but I believe that there are some schools
that have done so and that we will reach
it soon.

Because of the changes that have oc-
curred in the preclinical departments at
medical schools, there has been a strong
current of feeling that they should move
to general university campuses. In my
opinion the medical school environment
would suffer, and suffer greatly, if this
were to transpire because I believe we
would lose our primary measurement of
excellence. This primary measurement is
generated by the preclinical faculty and it
applies not only to them but also to the
clinical departments and our clinical ac-
tivities. Without the preclinical depart-
ments in our environment I think we
would run a significant risk of becoming
a trade school. There would also be dis-
advantages to preclinical departments if
they moved to general university cam-
puses because they would lose their

medical, their human, orientation which
is one of their unique characteristics and
one that is extremely important not only
to the medical school but to our society.

The medical university concept would
allow preclinical departments to continue
their identity with medicine and would
also allow them to maintain the integrity
of their discipline. It would in addition
open up to them a wider range of stu-
dents. It would widen their educational
role both in the medical school and in
the undergraduate years and would pro-
vide the stimulation of allowing their
course offerings to be introduced earlier
in the educational continuum from high
school to the M.D. degree.

Now I would like to make a few com-
ments about clinical teaching. One of the
few specifics that I will deal with in
terms of the current curricula that you
are going to be dealing with within the
next few days is that I believe very
strongly that there must be an earlier in-
troduction of clinical content.

In talking with students a word that
continues to come up is "disaffection".
I've not heard a satisfactory definition of
disaffection but as I begin to listen and
put it together one of the things that
comes through is that it is increasingly
difficult for students in the first and sec-
ond years to keep in mind what they are
really here for. What is the goal of their
medical education? I think that this anxi-
ety could be relieved significantly if stu-
dents did have contact with patients
quite early. It also just might stimulate
their interest in science of medicine, al-
though this is not a 100 per cent guar-
antee. It would, however, allow them to
be introduced to the social problems of
medicine at a very early stage, and the
social problems of medicine are with us
now and will be with us increasingly in

the future. It is difficult for a student
who is on a busy university inpatient
service to become involved in the social
problems presented by his patients. If,
however, he was introduced early, when
he did not have the total burden of re-
sponsibility for the care of the patient,
he might gain a lot of insight into these
very important problems.

We must also begin to combine our
educational program with the other
health professional schools on our cam-
pus. Although some progress has been
made in this regard, more effort must be
devoted to bringing our students into
joint educational experiences with stu-
dents in the schools of nursing, phar-
macy, social work and community plan-
ning, and dentistry. In the future a team
approach to health care will be essential
if we are to meet the needs of society.
Nobody, particularly the students, gains
any benefit from the strict educational
isolation currently practiced. There is
more than a touch of irony in the fact
that invariably at commencement the
statement is made that we expect the
various graduates to work closely to-
gether after they graduate.

The teaching and general importance
of ambulatory care has been systemati-
cally shunned by medical faculties since
time immemorial. This downgrading can-
not be allowed to continue when every in-
dication is that more and more health
care can and should be supplied on an
ambulatory basis. For the past two years
the school has been making a major ef-
fort to improve our ambulatory care pro-
grams and an experience in ambulatory
care is now required of all students. De-
spite our efforts, progress in our ambula-
tory care programs has been insufficient.
In part the problem rests in the inade-
quacy of our facilities, but the major
problem here and elsewhere is a very
real resistance to accept the provision
and teaching of ambulatory care as a full
partner of inpatient care in medical edu-
cation. The major thrust in ambulatory
care will continue.

Another development that we are going
to have to come to grips with is the inte-
gration of the undergraduate with the
graduate medical education program.
Graduate medical educational programs
throughout our history have been an ex-
tra-university function. By extra-university
I mean that these programs have been

exclusively controlled by the specialty
boards and not by the faculty. A change
in thinking is now occurring and increas-
ingly efforts are being made to bring
house staff education into a continuum
with undergraduate medical education.
The Council of Medical Education of the
American Medical Association is making
every effort to catalyze the development
of the continuum of education. Specifi-
cally the internship as an isolated year is
to be abolished in 1975. Medical stu-
dents will match into a program of grad-
uate medical education of several years
duration rather than into an isolated year
between medical school and residency.
The senior year of medical school will be-
come a transitional year both in terms of
focus and clinical responsibility. The
focus will be increasingly on a defined
area of medicine.

There is a movement at the present
time, and one that I think is important,
to develop a corporate responsibility for
graduate medical education. By corporate
responsibility I mean that no longer will
an individual clinical chief be totally re-
sponsible for developing his own individ-
ual program. There is going to have to
be evidence for accreditation purposes
that the chiefs of the clinical depart-
ments as a group are looking at the en-
tire spectrum of graduate medical educa-
tion as it occurs in the medical center.
There are very obvious possibilities in re-
gard to quality control here. For instance
a program in surgery is more apt to be a
strong program if there is proven interest
on the part of the chief of pediatrics, the
chief of internal medicine, and so forth
in devising that program. Furthermore it
is highly likely that in the future only
complete graduate medical education
programs will be accerdited. Fragmented
one and two-year partial programs will no
longer qualify.

Additionally there is going to be a very
hard look at free-standing graduate medi-
cal education programs. To again take a
surgical example, many people are begin-
ning to question whether there should be
a free-standing residency program in any
surgical subspecialty in any hospital. I
believe that the direction we are going to
go is to say if there is going to be, for
example, a neurosurgical training pro-
gram in a hospital there must also be a
general surgery training program in the
same hospital, and if there is going to be
a general surgery training program in a
hospital there will also have to be a pro-
gram in internal medicine in that same
hospital. There will probably be at least
one exception in terms of free-standing
programs and that will be in family prac-
tice. In my view these changes in gradu-
ate medical education are long overdue. I
am convinced that they will improve the

quality of graduate medical education
significantly. As a matter of fact the co-
cept of corporate responsibility should
immediately be applied to undergraduate
clinical education. The clinical depart-
ment heads should, as a group, look at
the total range of clinical clerkships that
we offer in our medical school rather
than in isolation defining and worrying
about their own.

Tonight I have presented some
thoughts about where we are now and
some directions for the immediate future.
I have emphasized the need for a re-
newed thrust in undergraduate medical
education, the need for quality control of
medical education, and the concept of
the medical university. By moving 'for-
ward in conquest of these goals we have
the opportunity to develop one of the
most important medical education pro-
grams in the country.

professors of surgery 1807-1907

(part two)

Harry C. Hull, M.D.

There have been some outstanding
professors of surgery during the Univer-
sity of Maryland School of Medicine's ex-
istence. Although the Flexner report of
1910 suggested that the school be dis-
continued, its survival was due to some
of these strong men occupying the chair
of surgery, who gained local, state and
national prominence.

louis mclane tiffany

Louis McLane Tiffany (tenure 1880-
1902) was born October 10, 1844 in
Baltimore, Md. The son of affluent par-
ents, he received his early education in
private schools in New England and
Paris. His maternal grandfather was a
member of President Jackson's cabinet
and was twice minister to Great Britain
under Presidents Jackson and Polk. After
preliminary schooling in Paris, he entered
the University of Cambridge, England,
where he received a B.A. in 1866 and
later earned his M.A. While at Cam-
bridge, he was a noted athlete, particu-
larly in track and field events and always
cherished the large silver bowl awarded
him for his prowess as an athlete.

When he returned to Baltimore in
1866, he entered the University of Mary-
land School of Medicine and received his
M.D. in 1868. During these two years he
was also the office pupil of Dr. Nathan R.

Smith. Following graduation, he served
as resident physician at the Bay View
Asylum (now Baltimore City Hospital).
After completion of the residency, he was
appointed demonstrator in anatomy, both
normal and morbid at the medical
school, and acted in that capacity until
1874. Undoubtedly, this thorough famil-
iarity with gross and morbid anatomy was
of the greatest importance to his eventual
surgical brilliance.

After finishing residency at Bay View
Asylum, he began the private practice of
surgery in Baltimore. At this time medi-
cal schooling was only for two years with
five and a half months each year. He was
the first physician in Baltimore to limit
his practice to surgery.

Naturally strong in fitness, physique
and temperament by education, cultiva-
tion and training, he was admirably
suited for the early surgical success
which he obtained. He was said to have
magnetic personality, charming manners
and a wonderful sense of humor. He was
delightful with children, had a great love
for animals, and enjoyed hunting, fishing
and physical fitness.

In 1874 at age 36, he was appointed
professor of operative surgery and six
years later he was appointed professor of
surgery to succeed Dr. Christopher John-
ston. He became one of the more out-
standing professors of surgery at the
university.

As a lecturer, he was simple, direct,
graphic, never oratorical or rambling. As
a student of that era said, "his manner
was all his own, and in a peculiar way
his lectures were effective, easy to follow,
difficult to forget." This same simplicity
marked his bedside teaching. He had a
high regard for the patient's story, and
was a gentle and excellent clinician, al-
ways inspiring confidence in patients and
students alike.

Ed/tor's Note: The first part of Dr. Hull's article appeared in the July Bulletin.

As an operating surgeon, he was de-
scribed as slow, gentle, deliberate and
purposeful, with profound respect for tis-
sues. He early introduced the newer anti-
septic methods, was meticulously clean
and exacting. He admitted to the value of
the new chemical disinfectants and car-
bolic sprays, but always insisted on the
use of soap and water. He constantly
stressed the danger of tension in wound
closure; was noted for draining nearly all
wounds; and was ambidextrous, switch-
ing the knife from one hand to the other,
lending quite a flourish to his operations.

Tiffany published over 70 papers in
addition to contributing chapters to Den-
nis System of Surgery, The International
Text Book of Surgery, The International
Magazine of Surgery and the Reference
Handbook of Medical Sciences. Among
these were papers on appendicitis, breast
tumors, surgery of blood vessels, surgery
of the cranium, jaws and teeth, cancer of
the rectum, tracheotomy, kidney and
bladder stones, nerve tumors, osteo-
sarcomas, intussusception, splenectomy,
esophagotomy, hernias, gall bladder dis-
ease, to mention a few. He took an active
interest in medical societies and was an
ardent reader of current journals and re-
ports.

Some of his operations are worth not-
ing. In 1878 he performed a temporary
depression of both maxillae for angiosar-
coma of both nares, preceded by trache-
otomy. The patient survived and this feat
received national notice. In 1885 he is
reported as having performed the first
successful nephrolithotomy in America.
In 1886 he performed a successful esoph-
agotomy. In 1893, speaking to the
American Surgical Association, he re-
ported four cases of complete excision of
the gasserian ganglion — three cases were
cured. He was credited with the first suc-
cessful gastroenterostomy performed in
Baltimore in 1892. These reports indi-
cate his courageous, self-confident, and
at times, original approach to the surgery
of his era.

The doctor's ability as a surgeon and
as a man, was further attested by his
election to the presidency of the Ameri-
can Surgical Association and the South-
ern Surgical Association, as well as to
the Baltimore Medical Association, the
Clinical Society and the Medical and Chi-
rurgical Faculty. He was consulting sur-
geon to the Johns Hopkins, St. Joseph

Hospital and the Church Home and In-
firmary.

In 1902 at age 58, after a tenure of
12 years, he resigned the chair of sur-
gery at Maryland because of ill health.

Among the testimonials to the surgeon
was a portrait of him to be placed at the
Medical and Chirurgical Faculty building.

A man of means, he continued his ac-
tive interests in medicine and a limited
surgical practice. He spent a good part
of each year at his summer home. Mount
Custis, Accomac County, Va., where he
died suddenly of a heart attack on Octo-
ber 23, 1916.

randolph winslow

Randolph Winslow (tenure 1902-20)
was born at Hertford, N.C., October 23,
1852. He was the son of Dr. Caleb Wins-
low, a surgeon of note, and his uncle
was Dr. John R. Winslow, a prominent
physician of Baltimore. His early educa-
tion began in North Carolina during the
Civil War. In October 1865 his father
moved the family to Baltimore and
placed Randolph in Rugby Academy. In
1867 he entered Haverford College and
received his A.B. in 1871. Three years
later he received an A.M. (in Greek) from
the same college. He received his M.D.
from the University of Maryland School
of Medicine in 1873, standing at the
head of his class of 46.

After receiving his M.D., he began
practice in Baltimore and also immedi-
ately joined the teaching staff at the Uni-
versity of Maryland. He served succes-
sively as assistant demonstrator of
anatomy (1873-80), demonstrator of

anatomy (1880-86), lecturer on clinical
surgery (1886-91), professor of anatomy
and clinical surgery (1891-1902), and on
the resignation of Dr. Louis Tiffany, he
was appointed professor of surgery at
age 50.

During the 29 years before his ap-
pointment to the chair at Maryland, he
was quite active in medical affairs of the
city. One of the founders of the Woman's
Medical College of Baltimore, he served
as professor of surgery there from
1882-93. He was on the surgical staff of
Baltimore City Hospital (Bay View), Sinai
and others, and served as surgical con-
sultant to the Maryland Training School
for Boys for a quarter of a century.

Winslow went abroad in 1883 and
again in 1906, after accepting the chair,
for postgraduate studies in Vienna, Ber-
lin and Paris.

In addition to his teaching and prac-
tice, he found time to be unusually active
in medical societies, nationally and lo-
cally. He was a member of the University
of Maryland Board of Regents for nearly
30 years (1891-1920), and president of
the Medical and Chirurgical Faculty
(1914). A founder of the Association of
American Medical College, he served on
its executive council for 20 years. Wins-
low was also one of the founders of the
American College of Surgeons (1913).
He held membership in the International
Surgical Association, the Southern Medi-
cal Association, the American Surgical
Association and the Southern Surgical
Association; served as president of the
Southern Surgical Association (1921);
regularly attended the American Medical
Association meetings and was an active
member of the Maryland Historical So-
ciety.

The University of Maryland is in his
debt for his constant devotion to its med-
ical school. Revered by his students they
established the Randolph Surgical So-
ciety in 1911 in his honor. This was an
honorary society, limited to 30 seniors
and stayed in existence for over 20
years. During his tenure he was influen-
tial in the building of what is now the
"old" University Hospital (1896-97).
Too, he was largely responsible for the
merger of the Baltimore Medical College
and the College of Physicians and Sur-
geons into the present School of Medi-
cine of the University of Maryland
(1913-15).

As a founding member of the Associa-
tion of American Medical Colleges, and a
member of its executive council for two
decades, he was in a position to upgrade
the school as to requirements for admis-
sion and extending its curriculum to four
years. In 1892, three years were required
for graduation and in 1895 it took four
years, but the premedical requirements
were practically nil. In 1903, graduation
from a four-year high school was re-
quired for entrance. In 1914, a year of
college work in chemistry, physics, biol-
ogy and either French or German was
part of the entrance requirements. By
1918, students needed two years of col-
lege for entrance.

Winslow, in a testimonial acceptance
speech in 1916, remarked that two years
of premed'cal training was enough be-
cause the length of time was already bur-
densome and should not be extended.
Today some schools are going back to
the two years premedical plan for excep-
tional students to shorten the long period
of training.

The surgeon was portly, of modest
height and a conservative dresser. But
seriously bent, he was a real believer in
scholarship and diligent application on
the part of students. His lectures ripened
through years of practice and were given
with clarity, fluency and force. Instruction
from his European masters such as Lor-
enz, Woelfler, Von Hacker and Billroth
was passed on to his classes with au-
thority. His earnestness and desire to
help students with surgery earned their
highest respect.

As a surgeon, he was thorough, pre-
cise and not spectacular or hasty. He
was among the first surgeons in the
state to practice antiseptic surgery as
known today. Winslow is credited with
many first in Maryland surgical practices:
a pyloric resection for cancer (1885)
only four years after Billroth performed
the first such operation; a vaginal hyster-
ectomy (1888); shortening the uterine
ligaments (1884), and operating success-
fully for gunshot wounds of the intestine
(1893). He subsequently published sev-
eral papers on the latter subject and on
intestinal obstruction. He gave special at-
tention to the thyroid gland and was one
of the early operators for goiter.

His bibliography lists 73 publications
on a variety of subjects which were pub-
lished in national, state and local jour-

nals. Winslow received an honorary L.L.D.
from St. John's College in 1909 and
from the University of Maryland in 1924.

Married at age 25 to Miss Rebecca
Leiper, he sired thirteen children, twelve
of whom survived; three daughters and
nine sons. As busy as he was, his delight
was his home and family. Three of the
nine sons became doctors.

Dr. Winslow retired in 1920, and as
professor emeritus he continued to at-
tend meetings, give lectures and travel.
He died of acute myocardial infarction at
age 85 February 27, 1937.

arthur m. shipley

Arthur M. Shipley (tenure 1920-48)
was born at Harmans in Anne Arundel
County, Md., January 8, 1878. His initial
education was obtained at neighborhood
schools and supplemented by attendance
at Friends Preparatory School in Balti-
more. Without further premedical educa-
tion he entered the University of Mary-
land School of Medicine and graduated in
1902 as honor man. The following two
years he served as intern and resident
for Drs. Tiffany and Martin. In 1904 he
journeyed to Europe to study pathology
under Professor Chiari at the University
of Strasburg accompanied by Dr. Gordon
Wilson, who later became professor of
medicine at Maryland.

Upon his return, Shipley was ap-
pointed medical superintendent of Uni-
versity Hospital, where he served four
years until 1908. He had complete con-
trol of all admissions and could perform
surgery on the patients he selected. This
situation gave Shipley the opportunity to
meet and know referring physicians,

which later was the great source of pa-
tient referral. In 1907 he was apopinted
associate professor of surgery and in
1914 professor of clinical surgery. During
these years he was busy with his practice
and teaching in the medical school.

During World War I, he served in the
United States Army Medical Corps
(1917-19) as chief of the surgical service
of the 8th Evacuation Hospital. Over
14,000 wounded from the battles of Cha-
teau Thierry, Belleau Woods and the Ar-
gonne, are reported to have been treated
at his hospital. In recognition of his fine
war record, he was awarded the Distin-
guished Service Medal.

In 1920, at age 42, he was appointed
professor of surgery at Maryland. The
medical school following the faculty de-
pletion in World War I was at a low ebb.
The buildings were old, the laboratories
ill-equipped, the bed capacity in the old
hospital was inadequate, the hospital was
outdated and the financial support from
the State was parsimonious. Large fresh-
men classes were admitted (130-150)
and shaved down (90-100) for the sec-
ond year. There was no committee on ad-
missions. Though many of the faculty
members were good teachers and excel-
lent clinicians few had ever attended col-
lege. There were few, if any, faculty
members engaged in research for lack of
background and facilities. The education
received was almost entirely clinical.

By 1922 there was a move in high
places to discontinue the medical school.
The surgeon and others lobbied in An-
napolis for many years to save the school
and finally their battles were fruitful. A
new hospital and new nurses' home were
built, and with a legacy from Dr. Frank
C. Bressler, a new science and research
building was possible as was reequip-
ment of laboratories and strengthening of
the faculty. Of greatest importance was a
greatly increased annual support from
the Maryland Legislature. Shipley's ability
as an administrator was well-recognized,
and in 1915 he became acting dean of
the medical school.

In 1907, five years after receiving his
M.D., he wrote a paper in the Hospital
Bulletin entitled "Clinical Teaching." In it
he deplored the many and needless
hours required of students "peering
down the barrels" of microscopes in
pathology. He inquired whether anyone
practicing medicine cut, stained and

mounted tissues in their office. He thought
freshmen students, along with basic sci-
ence courses, should quickly be intro-
duced to bedside teaching and become
acquainted with illness. Today this is fin-
ally being done.

As a teacher, whether at didactic lec-
tures, the operation room or bedside, he
was outstanding. His Thursday noon clin-
ics were always crowded to capacity. A
striking figure of a man over 6 feet 3
inches in height, his entrance always
commanded immediate silence and atten-
tion. His sobriquet "King Arthur" was
apt. Though essentially a kindly person,
he would stand for no foolishness. His
were the days when the chief of surgery
was held in awe and immediate obedi-
ence was expected.

The surgeon did not attend college. He
married in 1909, and having no children
educated himself by constant study at
home. In his conference, it was not unu-
sual for him to quote at length from the
literary masters. He was a great mimic of
pathological states of joints. His lectures
were clear and exceptionally well-orga-
nized. Students looked at him, listened
and then bowed to take notes. He ap-
peared almost as if leading an orchestra.

In the operation room, "wet clinics"
were the custom of that time, students
sat gowned and masked watching sur-
geons operate for hours each morning.
While operating, he would give a well-or-
ganized talk on the subject at hand. He
even fired questions at the students in
the gallery, and few, if any ever slept. He
was fond of being challenged by case
presentations at his Thursday conference,
particularly masses located anywhere. He
would challenge the audience with four
"W's" — Where is it? What is it? What of
it? and What is to be done about it? Then
he would proceed with an excellent dif-
ferential diagnosis — by "calling the roll
of the anatomical structures in the re-
lated area."

He served for over two decades as
chief of surgery at Baltimore City Hospi-
tal. Dr. Thomas Boggs of Johns Hopkins,
who served as chief of medicine at the
Baltimore City Hospital, and Shipley gave
unstintingly of their time to make the
Baltimore City Hospital a valuable teach-
ing arm for both of the medical schools
in the city.

During his tenure, teachers as a whole
received no salary. He enlisted support

of able young men and assigned them
duties on the ward and dispensary. He
was a tyrant to those who, regardless of
reason missed a class, and he never
missed a class unless he was away. Not
often did he compliment his staff and he
was quick to call them on the mat for
tardiness or absenteeism. "King Arthur"
ruled the department as well as the oper-
ating suites. There were no committees
for this and that, but he was approacha-
ble and reasonable. Once a problem
arose and he was informed of the pros
and cons, he made a decision and it
stuck.

Over the years his reputation as
teacher and surgeon grew and he was in
popular demand over the southeastern
seaboard as a speaker. Students long re-
membered his as one of, if not the, out-
standing course in the school. He held
membership in the American Surgical As-
sociation, the Southern Surgical Associa-
tion, the Society of Clinical Surgeons, the
American Association of Thoracic Sur-
gery. Most important, he insisted his
junior members write and publish pa-
pers, and he was instrumental in gaining
their election to the same top medical or-
ganizations. He served as president of
the Medical and Chirurgical Faculty and
as a regent of the American College of
Surgeons.

In addition to his teaching, to which
he was ever faithful, he had a very busy
private practice. He usually operated
upon two or three patients daily, six days
a week, as well as handling nighttime
emergencies two or three times a week.
It was not uncommon for him to have 35
to 60 patients in the hospital concur-
rently. He was autocratic as to use of the
operation rooms and one room was his at
any and all times. He demanded and got
top service above the rest of the staff. As
a surgeon he was an unusually slow but
careful technician. Plagued most of his
life by an intention tremor, he was aware
of his slowness and made up for it down
to and including the dressing, by exceed-
ingly painstaking work. (I think the fast-
est appendectomy I helped him perform
took 55 minutes.) Shipley talked and
taught while he worked which in great
measure compensated the assistant for
his long hours at the operation table. He
was an indefatigable worker, strong phys-
ically and worked long hours most of his
life.

He had little time for non-professional
activities, but did enjoy his trips to New
Brunswick and Canada for fishing. His
only other avocation was his rose and
dahlia gardens.

During his years as professor, he pub-
lished alone and with others over 80
papers, all of a clinical nature. These
contributions were on varied subjects —
pericarditis, lung abscess, empyema ab-
dominable surgery and fractures of
various types. Along with Dr. M. Pin-
coffs, professor of medicine, he published
a paper on the earliest planned removal
of a pheochromocytoma for hypertension
with resultant cure of the patient.

It was during his tenure that subsec-
tions of surgery were planned and imple-
mented with the appointment of heads of
urology, neurosurgery, otolaryngology, or-
thopedics and finally anesthesiology.

Shipley resigned in 1948, many
changes and improvements having taken
place in the medical school and its fac-
ulty during his tenure. He found time to
write, teach, lecture and operate, and he
gained local, statewide and national rec-
ognition. It is a tribute to Dr. Shipley's
industry and tenacity that he, without
any college education, became an out-
standing figure in the surgical world. A
great deal of his time after retirement
was spent in caring for his bedridden
wife. He died in his sleep, apparently
from a cerebral accident, October 16,
1955, at age 77.

Charles r. edwards

Charles Reid Edwards (acting profes-
sor 1948-55) was born in Medley, W.
Va., September 19, 1888. His early edu-
cation was received at a small country

high school in Frederick County, Md.
After working a year or two, he applied
for admission to the University of Mary-
land Medical School where he received
his M.D. in 1913 as an honor student.

Following graduation he served as in-
tern and resident surgeon at the Univer-
sity Hospital under Drs. Winslow and
Sproul. From 1915 to 1917 he was resi-
dent surgeon at the Kernan Hospital for
Crippled Children under Dr. R. Tunstall
Taylor. His first appointment on the
Maryland faculty was as assistant in or-
thopedic surgery. In 1917 he entered the
Army as a first lieutenant and served
overseas with the French in Belfort,
France. He was made a captain upon dis-
charge.

Returning to Baltimore in 1918 he
began the practice of general surgery
and rose through the different ranks to
that of clinical professor of surgery in
1931. Upon retirement of Dr. Arthur Shi-
pley in 1948, he became acting head of
the department and served in this capac-
ity until 1955.

A man of average stature, handsome,
dignified, always impeccably dressed, he
was the epitome of what a surgeon
should look like and what a surgeon
should be. Though not a particularly
good lecturer, he was an excellent
teacher at the bedside and in the opera-
tion room. He was doubtless the most
dexterous surgeon at the University Hos-
pital during his time — smooth, com-
posed, rapid and an almost faultless
technician. At University Hospital he was
the first to perform a number of opera-
tions. Though none were original with
him, he at times made it appear by the
ease of performance that he invented
them. He was first to perform the mod-
ern type of gastrectomy, first to remove
the gallbladder below-upward, first to
perform the Bancroft operation, the De-
vine procedure and the Whipple (pan-
creaticoduodenectomy). He was first to
perform lumbar ganglionectomy for a
number of diseases. He was a strong be-
liever in aseptic anastomoses for gastro-
intestinal lesions.

He possessed great stamina for work
and in later years enjoyed a large prac-
tice. Edwards was well-known throughout
Maryland and a great many doctors and
their families became his patients. It is
recalled that he was an artist as a surgi-
cal consultant to other surgeons, truth-

ful, tactful, leaving the patient and sur-
geon both feeling very well indeed.

Because of his clinical training, the 15
papers he published dealt extensively
with clinical subjects. He enjoyed mem-
berships in a number of societies includ-
ing the American Surgical Association,
the Southern Surgical Association, the
Society of Clinical Surgeons, the Ameri-
can College of Surgeons (serving as a
governor from Maryland for some years),
the Society for Surgery of Trauma as well
as local and state societies. He served as
president of the Baltimore Medical So-
ciety and the Medical and Chirurgical
Faculty of Maryland and vice-president of
the Southern Surgical Association.

As a student he was a member of the
Nu Sigma Nu medical fraternity and was
keenly interested for decades in the af-
fairs of this organization — he was the
"Consultant Father" of Nu Sigma Nu.

He traveled extensively to medical
meetings, and took holiday trips in the
United States and Europe. His favorite
hobby was golf.

Dr. Edwards is another example of a
man with a minimum of premedical edu-
cation, who became a surgeon and
teacher of renown. He resigned as acting
professor of surgery in 1955 and contin-
ued with private practice until several
years before his death. He became ill in
1963 and died February 1, 1965 of car-
cinomatosis originating from cancer of
the prostrate gland.

robert w. buxton

Robert William Buxton (tenure 1955-
70) a native of Joplin, Mo., was born Oc-
tober 3, 1909, the son of Cora (nee

Comer) and Warren Buxton. After prelim-
inary education at the local schools he
matriculated at the University of Kansas
where he received a B.S. in 1931 and his
M.D. in 1936.

Following his graduation from Kansas,
he interned at the Strong Memorial Hos-
pital, Rochester, N.Y., and was an assist-
ant resident in pathology and an assist-
ant resident in surgery. In 1940 he was
appointed resident surgeon at the Gene-
see Hospital in Rochester, N.Y., and the
following year returned to Strong Memo-
rial as resident surgeon.

After completion of a general surgical
residency in New York, he was appointed
resident in thoracic surgery at the Uni-
versity of Michigan. In 1943 the doctor
received an M.S. from Michigan. He re-
mained at the University of Michigan
from 1942 until 1955 serving as an in-
structor in surgery, an assistant profes-
sor of surgery and later as an associate
professor of surgery.

In 1955 at age 46, Buxton was ap-
pointed as the ninth professor of surgery
at the University of Maryland School of
Medicine. He was the first fulltime pro-
fessor appointed to the chair of surgery
at Maryland.

The school since its founding and until
almost Civil War era, was theoretical in
its teaching. After the Civil War, following
the French, the teaching was almost en-
tirely clinical. This dominant clinical ap-
proach lasted until after World War 11. In
the early fifties following the general trend
throughout the nation, the school went
"fulltime." Great increase in funds from
the state, grants from the federal govern-
ment and private sources, proved a great
largess to a school which had been want-
ing for funds or was nearly impoverished
during most of its existence. Now the
school was geared to add to its excellent
clinical record, research and experimental
work. Rapidly all department heads be-
came fulltime as did most of the section
heads and their staffs. Nearly all appoint-
ments were with a salary and ceiling —
overages returning to the various depart-
ments. Curriculum was diligently studied
and changes instituted. Gradually, most
of the parttime staff, who had carried on
the teaching load faithfully for years,
moved to other hospitals.

Into this changed environment Buxton
became the new department head. For
the first time there was a fulltime profes-

sor to devote his entire time to teaching
and the administrative affairs of the de-
partment unencumbered by the necessity
of earning a livelihood by practicing his
profession. The surgeon, well-trained in
experimental as well as clinical medicine,
had a new approach and quickly a more
academic atmosphere prevailed. Fulltime
devotion to the teaching of students and
training of house officers was the object.
The budget for the department of sur-
gery and its sections was around
$60,000 when he arrived. In 1970 the
budget for the department of general
surgery and its specialties was $1.8 mil-
lion. The Maryland Legislature of decades
past could not have dreamed of such
grants to the university. Much of these
funds were necessary for salaries for the
slowly increasing fulltime faculty and
steadily increasing salaries for house of-
ficers, laboratories and expensive equip-
ment with the necessary paramedical
help.

Buxton brought a great deal of enthu-
siasm and energy to his new task. He
was portly, above average height, a con-
servative dresser, of good posture, of
very regular and moderate habits. As a
person he was a warm, courteous,
friendly, industrious man of great stam-
ina. Never vindictive, he was perhaps too
kind on many occasions and not forceful
enough to run the "tight ship," pre-
viously so strongly exemplified by the
many professors who were martinets.
However, he possessed such a great
amount of integrity and seemed to have
such faith in man, that it was hard for
him to think ill of anyone. He was not so
naive as not to recognize poor perform-
ance, but was reluctant to chastise and
chose instead to correct by exemplary
methods.

Teaching was the forte of Dr. Buxton,
at any level of training, and it seemed
equally enjoyable to him whether at the
1 bedside, conference room or auditorium.
He was a frequent visitor and speaker at
other medical schools throughout the
country as well as at national and local
societies. At open conferences he pos-
I sessed the remarkable ability of compre-
i hensive recall on a great variety of sub-
jects.

Probably his most singular contribu-
' tion to the many house officers he
► trained was his teaching of physiology
I and pathological physiology. He was in-

sistent that his trainees think constantly
in this field in their approach to the
correction of disease. His constant query
as regards diagnosis, choice of procedure
or medication advised was, "Why?" His
grasp of the general field of medicine
was extraordinary, and superior to that
of most surgeons. His knowledge of dia-
betes, cardio-respiratory problems, hema-
tologic and other medical disorders was
certainly more than superficial as became
readily apparent at rounds or at confer-
ences. (Personally, I know of no other
professor of surgery in the country who
actually and constantly spent so many
hours teaching.)

He was always available to consult, to
operate, or to assist his resident staff
with surgical problems. Whether the
problem involved surgery of the thorax,
abdomen or periphery, he was equally
adept and masterly. His technical finesse
was such that difficult and complicated
problems in surgery were made to ap-
pear routine. The operations he per-
formed were neat, precise and rapid. As
an assistant to the residents, he was a
superb instructor, and as patient and tol-
erant to the beginner as a master of the
art could be. No surgical procedure re-
gardless of its magnitude seemed out-
wardly to disturb him. Yet, he was no
prima donna and his manners in the op-
eration room were impeccable. He strived
to make each procedure a perfect dem-
onstration of the most proper methods of
performance.

Though his main vocation as well as
avocation was surgery, he did have other
interests. He was a bibliophile and over
the years had invested heavily in a fine
collection of books which included a
number of first editions. He was also
quite a philatelist and quite a gourmet.
He thoroughly enjoyed his planned menus
at the Maryland Club or elsewhere when
entertaining a group of friends. His yearly
trips to Europe stimulated his interest in
wines and he became a connoisseur. He
enjoyed fine music and in lighter mo-
ments admitted to playing the cello in
his youth.

Buxton was a member of over twenty
surgical societies including: the American
Surgical Association, the Society of Uni-
versity Surgeons, Southern Surgical Asso-
ciation, Central Surgical Association, So-
ciety of Vascular Surgery, International
Society of Angiology, American College of

Surgeons (he later was governor to the
College from the state of Maryland). The
Fred Coller Surgical Society, in which he
served as president In 1969, was of par-
ticular interest to him.

The 80-odd publications by the doctor
alone and with other authors revealed his
broad interest in the discipline of sur-
gery.

Dr. Buxton, aged 60, died August 14,
1970 in Timisoara, Rumania, from inju-
ries he received in an automobile acci-
dent August 10, 1970 near that city. He
was vacationing in Europe when the acci-
dent occurred. Memorial services were
held and his remains placed in a vault at
a Baltimore Mausoleum.

references

1. Callcott, G. H.: A History of the University
of Maryland, Maryland Historical Society,
1966.

2. Chew, S. C: Address Commemmorative
of Dr. Nathan R. Smith, Trans. Medical
and Chirurgical Faculty of Maryland,
pp. 7-63, April 1878.

3. Cordell, E. F.: University of Maryland,
1807-1907, Lewis Publishing Co., Vol. I, 1907.

4. Edwards, C. R.: Obituary, Bulletin, School
of Medicine, University of Maryland,

Vol. 50, 1965.

5. Halsted, W. S.: Operative Story of Goiter,
Halsted Papers, Vol. I, 1924.

6. Johnston, C: "Pastic Surgery," International
Encyclopedia of Surgery, Vol. I, pp. 531-549,
1881.

7. Lomas, A. J.: "As It Was in the Beginning,"
Bulletin, School of Medicine, University of
Maryland, Vol. 23, p. 182, 1939.

8. Peter, Robert: The History of the Medical
Department of Transylvania, J. P. Morton
& Company Printers, Louisville, Ky., 1905.

9. Shipley, A. M.: Retirement, Bulletin,
School of Medicine, University of Maryland,
Vol. 33, p. 107, 1948.

10. Shipley, A. M.: "Clinical Teaching," Hospital
Bulletin, University of Maryland, p. 227,
1907-1909.

11. Smith, Emily: The Life and Letters of
Nathan Smith, Yale University Press, 1914.

12. Smith, N. R.: "Extirpation of the Thyroid
Gland," North American Archives of
Medicine and Surgery, 1835.

13. Smith, N. R.: "Treatment of Fractures of
the lower extremity by the use of anterior
suspensory apparatus," Kelly & Piet,
Baltimore, Md. 1867.

14. Tiffany, L. Mc: Biographical tercentenary
of Maryland, p. 317, 1925.

15. Tiffany, L. Mc: Dedication, The Hospital
Bulletin, University of Maryland, pp. 3-10,
12-14, 1914.

16. Warfield, R.: Address in presenting
testimonial to Dr. Winslow, Bulletin, School
of Medicine, University of Maryland,

Vol. 14, pp. 8-19.

17. Winslow, R.: Recordings of Testimonial
Dinner, Bulletin, School of Medicine,
University of Maryland, Vol. I, pp. 112, 1916.

18. Winslow, R,: Hospital Bulletin, University
of Maryland, Vol. IX, 1913.

19. Winslow, R.: Obituary, Bulletin, School of
Medicine, University of Maryland, Vol. I,
p. 12, 1916.

hyperbaric chamber care

Over 50 physicians and graduates of the School oF Medicine attended the American Medical Associa-
tion convention in Atlantic City, June 20-24.

Dr. Edward F. Cotter, president Medical Alumni Association, discusses physician data with Robert J.
Atkins, president, Fisher-Stevens Inc. Atkins' firm secures data on graduates which will be used by
alumni association in keeping in touch with its alumni.

Dr. John C, Dumler Sr.. center. Dr. Theodore Kardash, past president, Medical Alumni Assn., talk to
a guest during a reception given by the Maryland alumni group.

The following School of Medicine grad-
uates attended the AMA convention in At-
lantic City, June 20-24.

.^1 .'

- \

^^^^^rf^^S^I

>srM

BiLi

John F. Cadden '27
Bernard J. Cohen '27
Bernard Friedman '28
Lewis P. Gundry '28
Abraham A. Silver '28
Fred S. Weintraub '28
Herman Cohen '29
John J. Haney '29
Meyer M. Baylus '30
Melvin B. Davis '31
Emmanuel A. Schimunek '31
Arthur G. Siw/inski '31
John C. Dumler '32
Joseph W. Grosh '32
Arthur Karfgin '32
Lauriston L. Keown '33
Hyman Schiff '33
Lawrence J. Cohen '34
Robert H. Dreher '34
William L. Howard '34
Emanuel M. Satulsky '34
Benjamin \. Slegel '34
John Snyder '34
S. Jack Sugar '34
Edward F. Cotter '35
William G. Helfrich '35

D. McClelland Dixon '36
Thomas G. Abbott '37
William A. Dodd '38
Sylvan C. Goodman '38
Raymond M. Cunningham '39
Herbert Lapinsky '39
Leiand B. Stevens '39

T. Edgie Russell Jr. '40
Theodore Kardash '42

E. Roderick Shipley '42
John M. Bloxon III '44
Charles F. O'Donnell '44
George W. Knabe Jr. '49
Max Miller '49
Frederick L. Hatem '51
Harry L. Knipp '51
Leonard H. Flax '53
Albert B. Bradley '55
Peter Thorpe '55
William Dunseath '59
Paul G. Koukoulas '59
Julleta D. Grosh '69

Ali H. Afrookteh

Dr. and Mrs. Lauriston L. Keown

'33 enjoy the reception which over 100 physicians

and their wives attended.

alumni activities

Dr. William H. Triplett BMC '11 was
married September 4 to Mrs. Nola
Banks.

Mrs. Banks, born and raised in North
Carolina, and Dr. Triplett were married in
a country church built by his father in
West Virginia. The grounds and the build-
ing were presented to the Presbyterian
Church by the Triplett family and Dr. Tri-
plett's name is on the cradle roll there.

John W. Robertson '09, Onancock, Va.,
has been honored for his devoted and
outstanding service to the Eastern Shore
community of Virginia. He was presented
a silver bowl to Onancock Mayor A. B.
Hartman in recognition for his 60 years
of general practice in the Virginia com-
munity.

the 30's

Isadore Kaplan '37, director of medi-
cal services for the Chesapeake and Ohio
and Baltimore and Ohio Railroads, has
been elected chairman of the medical
section of the Association of American
Railroads.

John F. Schaefer '38, general practi-
tioner from Catonsville, Md., is the presi-
dent of the Maryland State Medical So-
ciety, formally known as the Medical and
Chirurgical Faculty.

the 40's

Charles Herman Williams '42,
Pasadena, Md., has passed his Diplo-
matic American Board of Family Practice.

Capt. Ralph K. Brooks '43, Medical
Corps, U.S. Navy, has retired after 28
years of active duty and is now serving
as director of medical services for the
Maryland Division of Corrections.

R. V. Rangle '43, who holds a degree
of Juris Doctor from the University of
Baltimore, was recently admitted to the
Maryland Bar.

the 50's

James D. Shepperd Jr. '58 has been
named medical director of the East Balti-
more Medical Plan and assistant profes-
sor of medicine at the Johns Hopkins
University School of Medicine.

the GO'S

Stanley I. Music '66, Jacksonville, Fla.,
is currently an officer with the Epidemio-
logic Intelligence Service, U.S. Public
Health Service for two years.

Robert S. Widmeyer II '68 is an ortho-
paedics resident at Charlotte Memorial
Hospital, Charlotte, N.C.

102 and counting . . .

One hundred years of life is difficult to
realize. Start with the reconstruction
days of the South to Montana in the
1890's, Pancho Villa and the Mexican
campaign, General "Blackjack" Pershing
and World War I, and capsulize the hap-
penings from the Depression to the moon
exploits of the present era.

Sounds fantastic to imagine that an in-
dividual has lived through such momen-
tous times and changes, but it's true.

And, Col. William A. Wickline, M.D.,
who celebrated his 102nd birthday on
August 27, "is still practicing" and par-
ticipating in his second century of activity

"He makes the rounds at the Plum
Tree Convalescent Hospital in San Jose
where he is a patient checking on the
others there," said one of his daughters,
Mrs. Edith Kennedy of Saratoga, Calif.
"My father has a lifetime license; I guess
they never thought he'd live to be 102."

Mrs. Kennedy said that he first day
her father was at Plum Tree he wrote
himself a prescription and asked the
nurse to have it filled. The nurse, con-
fused, called Col. Wickline's physician
and asked what she should do. The phy-
sician replied, "He's a doctor, so I guess
you'd better fill it."

The retired Army Colonel, who was
born August 27, 1869 in Sweet Chaly-
beate Springs, Va., began his life on a
farm and he paints a verbal picture of
days in the South, after the Civil War, by
remembering a large house and the self-
sustaining aspect of life then.

"One room of the house was what you
would call a utility room now, except our
appliances were of a different sort. We
had a loom for weaving material using
yarn processed from wool sheared from
our own sheep. There was an area set
aside for the traveling cobbler to work,
whenever he came to make our shoes.
We raised or grew everything we needed
to live, to clothe and feed ourselves. We
even had maple sugar trees and made
our own syrup," he said.

He graduated from Concord College in
West Virginia and in 1895 from the Col-
lege of Physicians and Surgeons in Balti-
more which is now the University of
Maryland School of Medicine. Wickline is
the oldest living graduate of the medical
school.

He then joined in the exodus to settle
the West and opened his first medical
practice in Montana. Wanting to become
acquainted with the world around him, he
joined the Army in 1900 and was imme-
diately assigned to duty in the Philippine
Campaign.

On the island of Panay, with the 44th
Regiment of Volunteers, for a year, was
the beginning of an Army medical career
that lasted until Aug. 31, 1933. He is
now the oldest living medical officer in
the United States.

Another daughter, Marian E. Wickline
of Danville, Calif., said her father drove a
car until he was 95 and filled out his
own income tax until about a year ago.
He still enjoys keeping up with his own
financial business.

"He visits us on weekends," said Mrs.
Kennedy, "or we take him to Danville to
visit there. He stands perfectly erect, has
a perfect sense of balance and is quite a
great man. At this rate he'll out live us
all."

The agile and alert Wickline speaks
these days of visiting his relatives in Vir-
ginia around the Richmond area, but no
one is sure he will be able to go back. A
thiird daughter, Mrs. Kenneth Bradshaw,
lives in Manson, Wash.

When asked the standard question put
forth to anyone over 80 as to what he at-
tributed his longevity to he replied: "A
good active life and no bad habits. I
don't smoke, I will have an occasional
glass of wine and I do enjoy my coffee.
My main recreation is reading and play-
ing cards. I am a baseball fan and a
rooter for the 49er's."

In an interview on his hundredth birth-
day he expressed pride over the techno-
logical advancements he has witnessed in
his lifetime. He still evidenced his love
for travel and adventure when he com-
mented, "We will receive many dividends
from our moon explorations. Wouldn't
mind going myself but I don't know if I'd
live long enough to make it back."

Two years and several moon launches
later. Col. Wickline is very much alive
and active . . . perhaps he could have
made a moon trip too.

ALUMNI ASSOCIATION SECTION

OFFICERS

President

Edward F. Cotter '35. M.D.

President-elect

Henry H. Start2man Jr. '50, M.D.

Vice-presidents

John H. Hornbaker '30, M.D.
Benjamin M. Stein '35. M.D.
William S. Womack '48, M.D.

Secretary

Robert B. Goldstein "54, M.D.

Treasurer

Arlie Mansberger '47. M.D.

Executive Director

William H. Triplett '11 BMC, M.D.

Executive Administrator
Francis W. O'Brien

Executive Secretary

Louise P Girkin

Members of Board

William J. R. Dunseath '59. M.D.
William H. Mosberg Jr. '44, M.D.
Charles E. Shaw '44. M.D.
Joan Raskin '55, M.D.
Donahj T. Lewers '64, M.D.
Clift Ratlitf '43. M.D.
Joseph S. McLaughlin '56. M.D.
Aristides Alevizatos '60. M.D.
John F. Strahan '49, M D.

Ex-officio Members of Board

Wilfred H. Townshend Jr. '40, M.D.
Theodore Ka'dash '42. M.D.
John H. Moxley III, M.D.

Dear Fellow Alumni:

How to make the Alumni Association more helpful and
useful to the members and indeed to all graduates of the
medical school, has been a chronic question repeatedly de-
liberated by the officers and members of the board. Alumni
Day and the Bulletin have been our main efforts with student
loans an important consideration within our financial re-
sources.

Receptions and cocktail parties at the annual meetings
of the American Medican Association and the Southern
Medical Association have been held in recent years. I can
report favorably about the reception at the AMA meeting
in Atlantic City this past June. More on the meeting is cov-
ered elsewhere with photographs by Francis W. O'Brien,
executive administrator.

As part of the Medical and Chirurgical Faculty of Mary-
land's semiannual meeting Sept. 15-19 in Puerto Rico, we
at the time this goes to press, are planning a luncheon or
reception for Sept. 17 for those attending from Maryland.
Again this year in response to an invitation from Dr. Ben-
jamin M. Stein '35 a group from Maryland will participate
in a meeting Oct. 16 at the Brunswick Hospital Center,
Amityville, N.Y.

The Southern Medical Association will meet in Miami
Nov. 1-4 and a reception will be held Nov. 1 at the Hotel
Fontainebleau. I hope all who are in Florida at this time
will be able to attend.

Alumni in the Washington, D.C. area held their annual
luncheon Sept. 14 at the Statler Hilton.

A number of favorable comments about recent changes
in the Bulletin can be attributed largely to the efforts of
Miss Jan Walker, who was appointed managing editor, Jan-
uary 1971. The Bulletin is a joint effort of the Alumni Asso-
ciation and the medical school. The first Bulletin in this
series was published June 1916 as Bulletin of the Univer-
sity of Maryland School of Medicine and College of Physi-
cians and Surgeons. It was a successor to the Hospital
Bulletin of the University of Maryland, Baltimore Medical
College News and the Journal of the Alumni Association of
the College of Physicians and Surgeons. The first issue was
dedicated to Randolph Winslow, M.D., LL.D., professor of
surgery, University of Maryland. As time progressed the
Bulletin emphasized the publication of scientific articles in
addition to general news about the medical school and the
alumni, but the number of scientific journals increased so
that the need for this as a scientific publication has di-
minished.

In the future, the Bulletin will include articles of general
interest regarding activities of the medical school, the
faculty and alumni, although scientific articles will continue
to be published. The recently appointed Editorial Board con-
sists of Dr. George Entwisle, Dr. Robert B. Goldstein, Dr.
Donald T. Lewers, Dr. Arlie R. Mansberger, Dr. Frederick
J. Ramsay, Dr. Edwin H. Stewart Jr., Dr. Wilfred H. Towns-
hend Jr. and Dr. W. Douglas Weir.

I hope there will be a good response to the letter re-
ceived ifrom the Executive Administrator requesting personal
information which will be of great future assistance. Plans
are under way to change your mail become more per-
sonalized.

With best wishes,

i otuyoAJ

Edward F. Cotter, M.D.
President

students return

necrology

Thomas P. Lloyd '96, Shreveport, La.,

has died.
Frederick V. Beitler '06, Baltimore, Md.,

died July 1, 1971.
Clarence V. Latimer '07, Deposit, N.Y.,

died October 29, 1970.
Charles I. Shaffer '07, Somerset, Pa.,

died March 28, 1971.
Joseph W. Ricketts '09, Ormond Beach,

Fla., died November 4, 1970.

teens

John J. H. Powers '10, Leominster,

Mass., has died.
Gustave A. Gorisse '11, Dayton Ohio,

has died.
Walter S. Niblett '11, Baltimore, Md.,

died May 21, 1971.
W. Frank Gemmill '13, York, Pa.,

has died.
Mark V. Ziegler '15, OIney, Md.,

died July 24, 1971.

Harry Goldmann '16, Baltimore, Md.,

died June 7, 1971.
Maurice C. Wentz '16, York, Pa.,

died January 28, 1971.

the 20's and 30's

Theodore Wollak '27, Scottsdale, Pa.,

has died.
James A. Miller '30, Baltimore, Md.,

died June 1, 1971.
Clyde M. Stutzman '34, Muncy, Pa.,

has died.
Ferdinand Fader '35, East Orange, N.J.

died April 20, 1971.
James B. Moran '36, Providence, R.L,

has died.
Harry F. White '38, Salinas, Calif.,

died April 12, 1971.

the 50's

Thomas W. Skaggs '53, Miami, Fla.,
has died.

BuLLetin

university of maryiand scliool of medicine

Articles do not necessarily reflect the views of the School of
Medicine, the Editorial Board or the Medical Alumni Association.

Policy — The Bulletin of the School of Medicine
University of fi4aryland contains scientific articles of
general clinical interest, original scientific research in
medical or related fields, reviews, editorials, and
book reviews. A special section is devoted to news
of Alumni of the School of Medicine, University of
Maryland.

Manuscripts — All manuscripts for publications, news
items, books and monographs for review, and corre-
spondence relating to editorial policy should be
addressed to Dr. John A. Wagner, Editor, Bulletin of
the School of Medicine, University of Maryland, 31
S. Greene Street, Baltimore 1, Md. Manuscripts should
be typewritten double spaced and accompanied by a
bibliography conforming to the style established by
the American Medical Association Cumulative Index
Medicus. For example, the reference to an article
should appear in the following order: author, title,
name of Journal, volume number, pages included, and
date. Reference to books should appear as follows:
author, title, edition, pages, publisher, and date pub-
lished. A reasonable number of illustrations will be
furnished free.

Reprints — At the time the galley proof is returned
to the author, the publisher will insert an order form

for reprints which are purchased directly from the
publisher. Any delay in the return of this order form
may result in considerable additional expense in
obtaining reprints.

Alumni Association News — The Bulletin publishes
as a separate section. Items concerning the University
of Maryland Alumni and their Association. Members
and friends are urged to contribute news items which
should be sent to Dr. John A. Wagner, Editor, Bulletin
of the School of Medicine, University of Maryland,
31 S. Greene Street, Baltimore, Md. 21201.

Subscriptions — The Bulletin is issued 4 times a
year. Its subscription price per annum, post paid is
$3.00; single copies, $.75, when available. Active
members of the Medical AJumni Association receive
the Bulletin in connection with the payment of annual
membership dues. Non-Alumni subscriptions should
be made payable to the University of Maryland and
remitted through the office of Miss Jan K. Walker,
Managing Editor.

Photo credits: Bill Clark, Philip Szczepan-
ski and The Sunpapers. Design: Bruce
Laine

garamond/pridemark

BALTIMORE

fit" ««cts^

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For Psychiatric Diagnosis and Treatment

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MEDICAL DIRECTOR

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PHONE: HO 5-3322

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