Temple University School of Medicine - Skull Yearbook (Philadelphia, PA)

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New Frontiers . . . Medical Aid to Less Developed Nations Although the conduct of foreign aid programs is under continual Congressional and public scrutiny, there is little question that such proposals arc necessary, both as moral obligation and political strategy. A genuine desire to assist under privileged nations is evident in many of the technicians, educators and administrators sent abroad, but the question of political policy cannot be ignored, even in so “non-political” a field as medicine. Anyone who goes abroad represents this country and its ethic; his presence alone is a consequence of the humanitarian and political objectives of foreign aid. The demand for concrete evidence of cash assistance is understandable, but the pitfalls of dollar diplomacy are well known. Installation of dazzling equipment is accompanied by instruction in proper maintenance and a reasonable supply of spare parts. Less spectacular but more significant are the improvements made by programs in medical education. Distribution of vaccines, construction of hospitals and field clinics will control epidemics and reduce mortality for the moment, but they are only stopgap measures unless sustained by continuing programs in medical training. Every aid program must be adjusted to the physical and cultural climate of every nation. American medicine, as such, can only be practised in the United States; it cannot be grafted onto another society, no matter how great the medical competence or how ancient the history of practise. successful program must be pragmatic and flexible; so must the people running it. Calcutta Water Malaria Today 11 New Delhi Water

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New Frontiers . . . Aerospace Medicine Men have reached space and medicine must necessarily broaden its endeavors to preserve them in their new and unfamiliar environment. The development of Aerospace Medicine and its increasing complexity can be followed by the projects of past and present. In the World War I era, there were basic studies on human tolerance to lowered oxygen tension, psychologic testing, work on goggles, vision in aging pilots, cockpit lighting and color blindness. In the World War II period, studies were undertaken on color perception, night vision, effects of noise and gunfire on hearing, effects of carbon monoxide in cockpits and decompression sickness. At the present time, research goes on concerning water problems in space flight, planetary environments, weightlessness, algal systems to supply man’s respiratory requirements in space, effects of cosmic radiation, irradiation and bacterial invasion, vectorcardiography, adrenal function and stress, and HYPOXIC HYPOXIA DEMONSTRATION A total of 5 low pressure chambers located at the School of Aerospace Medicine. Brooks AFB, Texas, are used for the purpose of training students such as flight surgeons, flight nurses, physiological training officers and technicians. These chambers will simulate barometric pressure changes at altitudes from sea level up to approximately 200,000 feet. In this picture, the inside observer watches the subject’s performance ability prior to removal of his oxygen mask. Subsequent to the removal of the mask the subject is exposed to a rarified atmosphere which is simulated by the low pressure chamber. SCIENTIFIC WEIGH-IN An altitude chamber technician is immersed in giant water tank while seated on a scale arrangement which weighs him while he is under water. During submersion, the subject’s expired air is collected in a rubberized bag and is later analyzed for nitrogen using the apparatus at die right. retinal damage from nuclear phenomena. Most of the advances in this field have been at the initiation of the military sendees. In 1953, recognition of the tremendous importance of aerospace medicine led to provisions for certification by the American Board of Preventive Medicine in Aviation Medicine. Tims, under the impulse of increased application of private and commercial flying, what began as strictly a military endeavour has attained the formal status of a specialized field of medicine. Requirements for certification are met by a three year residency, including one year leading to a degree of Master of Public Health. Opportunities to practice Aerospace Medicine may be found in the military services, aircraft manufacturing corporations, the NASA, and commercial and federal research laboratories. The demand for physicians can only increase. Research, clinical practice and actual space flight are all open to the adequately trained M.D. His rewards and challenges are figuratively and literally out of this world. 10

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New Frontiers at Temple The editors of this yearbook have tried to chose eight representative examples of various new frontiers being approached at Temple. The following were chosen as they best indicate the new frontiers in both basic science research and clinical medicine, both organic and functional illness. Unfortunately, space unjustly allows such a small sample. The Cardiovascular Research Center The Cardiovascular Clinical Research Center of the Temple University Medical Center was opened in February, 1963. Established by a seven year grant of $1,895,584 by the National Institutes of Health, it is one of several such centers in leading hospitals throughout the country. Designed to provide facilities for multidisciplinc clinical research in the broad field of cardiovascular diseases, the center is directed by William L. Winters, Jr., M.D. The unit is located on the second floor of the Main Building. It provides facilities for ten patients, with a specially trained nursing staff, and a diet kitchen Laboratories provide the means for intensive diagnostic and investigative studies irt the areas of biochemistry, pulmonary function, cardiac catheterization and angiology, renal function and psychosomatic medicine. Four physicans are assigned to the center on a full-time basis: a cardiologist, radiologist, pulmonary physiologist, and a biochemist. Members of the Medical Center Staff, after approval of their project, admit patients to the unit where they arc studied and treated in cooperation with the full-time physicians associated with the center. In return for their cooperation the patients are relieved of any financial obligation to the hospital or their physician while under the care of the center. Dr. Winters stated his goals for the center in his remarks at its dedication. He stated that he expects the center to significantly enchance all phases of research and teaching activity in the cardiovascular field, and to stimulate young investigators to enter clinical research. He emphasized that the most basic goal, of course, is to improve the prevention, diagnosis, and treatment of cardiovascular diseases. Cardiac Surgery About twenty years ago, with the conquest of a few-crippling extracardiac deformities, began the modern era of cardiac surgery. The past ten years have seen rapidly conceived technics applied to many intracardiac lesions and though greeted enthusiastically, meeting in many cases with only temporary success. Too often the blind explorations of digits and instruments within the chambers of the heart led to failure or an early relapse of symptoms. The limits of surgery in the functioning heart have thus been slow to be defined. Yet, the potentialities of a visual repair on a non-functioning heart were readily appreciated. Various methods have been attempted to still the beating heart so that a more accurate procedure can be carried out. Many such attempts have resulted in irreversible damage to cardiac tissue. Hypothermia is one of the more current methods in use but long term appraisal still awaits tabulation. The advent of open heart surgery has enabled thousands of patients to carry on an improved status and in many instances has reversed a life threatening situation. The development and continued efforts to perfect the heart-lung machine have been a milestone in valvular correction and replacement. The surgeon now has the basic armamentarium to attack the defective heart. Yet, much is still left to be learned and perfected concerning this throbbing mass. Cardiovascular efforts at Temple University Hospital have recently expanded to include a cardiac surgery department under the skilled hands of Dr. Pavla and cardiovascular research expansion. The success of such progress depends upon the combined efforts of the contributing departments of radiology and cardiology with its special sub-division of cardiac catheterization. Comprehensive Medicine Clinic In October and November, 1962, Dr. William Steiger, Director of the Comprehensive Medicine Program at Temple, completed a trip sponsored by the World Health Organization through Israel, Czechoslovakia, the Netherlands, and Great Britain. He has made many interesting observations on the medical care in these countries. While the organization, politics, and economics of medical care vary greatly from country to country, the dedication to service of the individual physicians and the ready availability of the most advanced technical know-how was everywhere apparent to Dr. Steiger. In Israel, where half of the population is composed of relatively uninodernized Asians, the emphasis of health services is on sanitation, maternal and infant mortality, tuberculosis, etc. However, in the Netherlands and Great Britain as in the United States, where these problems are already well managed, it is possible to concentrate more on mental illness, chronic disease, and the problems of old age. Dr. Steiger points out that it is with these problems that comprehensive medicine and indeed all general practice must develop means to deal more effectively. He believes that this will be achieved bv the application of the principles which are emphasized to Temple students in Comprehensive Medical Clinic. The Medical Clinic at Temple is unusual in medical education with its emphasis on Comprehensive Medicine. This concept considers patients not as diseases which vary in interest according to their nature (mitral stenosis being more interesting than chronic depression), but as people, each one deserving the utmost interest and concern of the physician. This requires an understanding of patients as people and not just as incidental vehicles for disease processes. The Temple student is stimulated to develop this understanding and to thoughfully observe the reactions of both his patients and himself. By developing self awareness 12