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

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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

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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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of his attitudes and prejudices, the student is better able to treat his patient rationally rather than emotionally. The Comprehensive Medicine Department is also associated with the Center for Community Studies which, under Dr. Herman J. Niebuhr, is attacking many of the social problems of the North Philadelphia area. The Center has recently received a large grant from the Ford Foundation, some of which will go for study of a possible Community Health Center. Artificial Kidney During the summer of 1958, the acquisition of an artificial kidney by the Surgical Research Department extended the special services available at TUH. A special committee was set up headed by Carmen T. Bello, M.D., Associate Professor of Pharmacology and Internal Medicine as chairman, Roger W. Scvy, M.D., Ph.D., Professor and Head of Department of Pharmacology as basic science advisor, Terry T Hayashi, M.D., Associate Professor in Obstetrics and Gynecology, Dominic A. DcLaurenlis, M.D., Associate in Surgery, and William D. Winters, Jr.. M.D., Associate i.n Internal Medicine. This team studied the techniques and principles and solved the technical problems of applying the artificial kidney to the clinical situation. The principles involved in vivodialysis depend on the interposition of a scmipcrmeablc membrane between the patient’s blood and a specially prepared chemical bath. Factors involved determining the direction of flow of ions and molecules across this meinbrancc include concentration gradients, hydrostatic pressures, and the size and configuration of the particles relative to the size of the “pores in the mcmbrancc. Urea, uric acid, creatinine, and other retention products have small molecules and arc freely diffusible.' Water, salts, and glocosc are also freely diffusible allowing for rapid correction of electrolyte abnormalities The membrane is so construced that bacteria, protein, and cellular elements of the blood will not pass through. This differential diffusion is known as dialysis. During dialysis the patient’s heparinized blood is taken from the radial artery to a pumping apparatus that propels the blood under high pressures through twin cellophane coils. These coils are immersed in a tank containing 100 liters of dialyzing fluid. After the blood has crossed the entire length of coil it is returned, dialyzed, to the patient via an available vein. The procedure takes about six hours and as much as 100 grams of urea can be removed from a uremic patient in this time. The surface area of the semipermeable membrane approximates 18,000 square centimeters. The quantity of blood exposed to this membrane during a dialysis is equivalent to fifteen times the patient’s blood volume. The artificial kidney is only an adjunct in the management of renal failure. The best indication for- artificial dialysis is the severe form of acute renal failure which is most likely reversible. It has been and is being used in some medical centers on the patient with chronic renal insufficiency. Presently there is no such program at TUH. Many serious complications can arise from vivodialysis. The artificial kidney is safe and effective only in relation to the knowledge, skill and experience of its operators. 13