Spring 2007
Editorial: Well, death's been here for a long time
Artistry, iconography, and idea in sixteenth-century pre-Vesalian anatomical illustrations During the early 16th century, publications int he field of anatomy began to include printed illustrations, which augmented the instructive capacity of the text. Anatomical illustrations rendered with increasing artistry and accuracy changed the way human anatomy was studied during the European Renaissance. Although the period is commonly remembered for the 1543 publication of De humani corporis fabrica by Andreas Vesalius, many significant publications preceded Vesalius. This essay investigates some of the most notable pre-Vesalian anatomical illustrations, and traces the evolution of artistry, iconography, and idea expressed by anatomical illustrations. Notable authors addressed include Ketham, von Gersdorff, Beregario da Carpi, Brunschwig, Dryander, and Canani. The illustrators who contributed to these publications supplied new ideas that changed the style of anatomical instruction and advanced the science of anatomical investigation.
Consumer-driven health care: Implications for the physician/patient relationship In the United States, we continue to struggle with the elusive health care goals of quality, affordability, and accessibility. The newest health care financing and delivery experiment is the consumer-driven model, which seeks to financially empower and thereby encourage (in many cases, actually force) individuals to exercise much more choice and control regarding the details of their own health care. This emerging paradigm presents a number of significant implications for changes in the future role of physicians within the physician/patient relationship. This article outlines some of the most salient of these potential implications. Commentary: Health Savings accounts—the avoidance of solution
Looking south to find the medicine of my heart It has taken over 7 hours in plane, 12 hours overnight by bus, and 30 minutes squashed in the back of a jeep to finally arrive at the kind of medicine I want to practice. With a Fulbright scholarship in my hand, and a year gleefully stolen between my 3rd year at Medical School of the University of Minnesota, I soak in the values of the Venezuelan health system. With this academic freedom I witness the dramatic social transformation of a country embracing ample philosophy of universal health in medicine. Venezuela has designed a network of free neighborhood clinics that focus on underserved communities, based on experiences from Cuba. To complement my time observing these newest clinics, I am studying at one of the oldest universities in Venezuela, the University of Los Andes.
A trip to Philadelphia "You don't know me, Dr. Fritts," the man on the phone said, "but my colleagues and I know a good deal about you, and in the light of what we know, we believe you are uniquely qualified for a job we need to fill."
Chagas disease: An ancient malady meets the twenty-first century Chagas disease, caused by the parasite Trypanosoma cruzi and transmitted by triatomine bugs, has plagued American societies since the arrival of man to the continents. The pathophysiology of the disease was not worked out until Carlos Chagas discovered the link between triatomines, trypanosomes, and human disease in 1909. Controversy about his findings stalled progress in the field until mid-century and may have cost him the Nobel Prize. Changing epidemiology of Chagas disease is a new challenge facing public health officials as environmental change, rain forest destruction, and massive migration to cities increase the number of people exposed to the parasite. The concentration of people in Latin American cities attracts bugs to urban zones, facilitating vectorial transmission and exacerbating problems of congenital and blood-borne transmission of the disease. The Peruvian city of Arequipa’s struggle with triatomines and human illness illustrates the public health challenges posed by the urbanization of Chagas disease.
The gym Dr. Hostler, an academic pediatrician with sixty-six year old knees hobbled by degenerative arthritis, runs the numbers in a humorous description of her predawn experiences at the gym struggling to postpone the inevitable joint replacement surgery and, maybe even, retrieve one more summer on the tennis court. Three times a week at four o’clock in the morning she works out with a twenty-three year old trainer seeking counsel about his marriage, honeymoon, first home and possible conversion to Judaism. Success is defined by faint praise from the tight-assed physical therapist, advice-seeking about second childhoods from the early morning crones and progression to one hundred pounds on the horizontal leg press.
Lloyd H. ("Holly") Smith, Jr., MD A profile of Dr. Lloyd Hollingsworth ("Holly") Smith, Emeritus Professor and former Chair of the Department of Medicine at UCSF, in recognition of his signal contributions to academic medicine.
Saved by AΩA A man whose temple-hair was becoming gray bragged to me recently that he had graduated MD at Ohio State in 1990. He was momentarily nonplussed when I told him that I had received my MD degree at Western Reserve University in 1935. His eyes mirrored the spinning of his mental calculator. That long-ago day, so difficult for him to imagine, is engraved in my memory. I hope the occasion of graduation is a precious day to remember for all physicians. It is more than a once-in-a-lifetime event for each of us. For me it represented both achievement and challenge. Everything that preceded it made the achievement all the more unforgettable. The challenge was how I was to get home to California from Cleveland after graduation.
Gout, an American Revolutionary War Statesman, and the Tower of London Henry Laurens (1724-1792) was a prominent American revolutionary war statesman from South Carolina. Passages cited from his correspondence and other writings show how his life was affected by gout and illustrate how this disease was perceived in the eighteenth century before more effective therapy became available. Of particular interest are the attacks of gout Laurens experienced while president of the Continental Congress and when serving as an envoy to Holland. It was during the latter assignment that he was captured by the British, charged with high treason, and imprisoned for fifteen months in the Tower of London. His stay there was made more difficult by continual problems with his gout. For Henry Laurens, as this article shows, gout played an important part in his remarkable and unusual story, a story that has earned him a respected place alongside other notable Americans of the revolutionary war period. A solitary act in the Bell Building: Striking a blow for racial desegregation at a Southern medical school The civil rights movement included both highly publicized and subtle and private acts of defiance and resistance. While much of hospital, medical school, and medical society desegregation was achieved via court cases and public demonstrations, it also was fostered by private initiative. In 1959 Dr. William Lynn, Jr., a white southerner, repeatedly washed the words “white” and “colored” off the bathroom doors of one of the research buildings at the Duke University School of Medicine in spite of the opposition of the renowned virologist, Joseph Beard. Beard falsely assumed the culprit was one of the Jewish members of the biochemistry faculty. The story of the desegregation of Duke’s research building involves intertwined elements of racism, anti-semitism, and individual courage.
Diogenes and Marcella: A reflection on homelessness and self-neglect In the current medical literature the term, Diogenes’ Syndrome, is used to describe individuals who are socially-isolated, live in squalor, hoard rubbish, exhibit profound self-neglect and decline all offers of help and assistance. The syndrome has been named after the 4th BCE Greek philosopher, Diogenes of Sinope, an eccentric, enigmatic figure whose life and behavior defied social norms and conventional customs. This essay describes the author’s interaction with a chronically homeless woman (Marcella) whose life, in a number of ways, is reminiscent of that led by Diogenes. Like Diogenes, Marcella is socially-isolated, hoards what appears to be useless trash, is personally neglectful and adamantly refuses all offers of assistance. Above all else, she holds firm to the conviction that her life of extreme poverty and marginalization is the result of a personal choice rather than a mental illness.
POETRY Pinnacle Man #3 Hope's Last Page Potassium 2004 The Man Who Raised Nightingales Dialysis Rounds Tiger Swallowtail Doxycycline An Inconclusive Autopsy
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