VOL. XXXII, NO. 9 JUNE 1961 IN THIS ISSUE Airway Resistance Minnesota Medical Foundation Index Issue Editorial Staff W. ALBERT SULLIVAN, JR., M.D. Edito1' EIVIND HOFF, JR. Managing Editor ELLEN Y. SIEGELMAN Copy Editor Board of Editors E. B. BROWN, JR., Ph.D. GERARD W. FRAWLEY WESLEY W. SPINK, LEE WATTENBERG, M.D. M.D. Administrative Sponsors University of Minnesota Hospitals RAY M. AMBERG, Director Minnesota Medical Foundation President Vice-President JOHN A. ANDERSON, M.D., Secretary-Treasurer EIVIND HOFF, JR., Executive Director ARNOLD LAZAROW, M.D., COHRIN H. HODGSON, M.D., University of Minnesota Medical School President University of Minnesota ROBERT B. HOWARD, M.D., Dean College of Medical Sciences N. L. GAULT, JR., M.D. O. MEREDITH WILSON, H. MEAD CAVERT, M.D. WILLIAM FLEESON, M.D. RICHARD M. MAGRAW, M.D. Assistant Deans Minnesota Medical Alumni Association President Vice-President NEIL M. PALM, MD., Vice-President JAMES C. MANKEY, M.D., Secretary ROBERT H. MONAHAN, M.D., Treasurer SHELDON M. LAGAARD, M.D., CHARLES J. BECK, M.D., UNIVERSITY OF MINNESOTA Medical Bulletin Official Publication of UNIVERSITY OF MINNESOTA HOSPITALS MINNESOTA MEDICAL FOUNDATION MINNESOTA MEDICAL ALUMNI ASSOCIATION Circulation this issue 2,600 VOLUME XXXII June 1961 NUMBER 9 CONTENTS STAFF MEETING REPORTS Changes in Airway Resistance Following Intravenously Administered D-tubocurarine HUGH D. WESTGATE, M.D., J. R. GORDON, M.D., AND FREDERIf:K H. VAN BERGEN, M.D. .'378 MINNESOTA MEDICAL FOUNDATION ROSTER .398 SUBJECT and AUTHOR INDEXES, VOLS. :31 and:32 DR. GEORGE E. FAHR PROJECT MEDICAL FOUNDATION BEQUEST CLASS OF J 960 408 .416 418 .. 423 Published monthly from October to June at Minneapolis, Minn. Editorial offices: 1342 Mayo Memorial, University of Minnesota, Minneapolis 14, Minnesota. Spcond Class Postage Paid at Minneanolis, Minnesota. -1 ~ Staff Meeting Report 1.. 't , 1 Changes in Airway Resistance Following Intravenously Administered D-tubocurarine * Hugh D. Westgate, M.D., M.S.,t J. R. Gordon, M.D.,t and Frederick H. Van Bergen, M.D., M.S.§ INTRODUCTION The use of curare in modern clinical medicine began with the treatment bv \Vest in 1932 1 and Burman in 1939 2 of the spasms associated with tetanus and neuromuscular diseases. In 1942 Griffith and Johnson:1 described the use of d-tubocurarine as an adjuvant to general anesthesia. This report was followed by others on what now has become curare's primary medicinal function-muscle relaxation during anesthesia. West 4 administered curare to patients with muscular spasticity and described what today are considered the secondary effects of curare administration: bright red cutaneous flush, tachycardia, and systolic hypotension. He also described a case of alleged laryngospasm and stated that "curarine exerts a spasmodic action on bronchial musculature."·-, In 1936 he exposed guinea pig lungs and noted that curarine caused the lungs to blanch and lose their elasticity, and increased the minimum pressure of distention fourfold. n Hugh D. Westgate In the same year he described the effects of curare administration in these words: "Patient takes short breaths and becomes cyanotic. He is unable to draw air into his lungs due to inspiratory obstruction which responds to adrenalin. At autopsy one usually sees massive lung collapse."7 Harvey and Masland" observed mild respiratory difficulty, mainly on inspiration, in patients who had received 4.5 mg. cu°This report was given at the Staff Meeting of the Univ('rsity of Minnf"sota Hospitals on June 9, 1961. tMedieal Fellow, Department of Anesthesiology :f:lnstruetor, Department of Anesthesiology §Profes."lr and Head, Department of Anesthesiology 378 1 1 1 1 THE MEDICAL BULLETIN rare intravenously over a three-minute period; this respiratory distress was brief and responded to treatment with epinephrine. Cole,H in 1946, stated that laryngospasm did not occur in patients given curare for tracheal intubation, but he added that pronounced difficulty was encountered in ventilating the lungs of these patients during the five minutes following intubation. <:yanosis, unimproved by 100 per cent oxygen, was also present for this period. In the same year, however, Griffith 1 0 reported only three cases of bronchospasm in 700 instances of anesthesia involving d-tubocurarine as the relaxing agent. In 19.52 Landmesser et a1. 11 measured the expiratory tidal volume of nine patients who had received rapid intravenous injections of 1.5 to 24 mg. d-tubocurarine. The lungs of each of these patients were ventilated by a respirator set at a constant delivery pressure and rate. In one patient a decreased expiratory tidal volume was noted, the decrease being attributed to a decrease in bronchial diameter due to d-tubocurarine. Using a radiographic technique on dogs, Kilburn 12 was not able to demonstrate any change in bronchial diameter following the intravenous administration of d-tubocurarine or succinylcholine. The purpose of our study was to evaluate the effect on airway resistance of d-tubocurarine administered intravenously to human subjects as an adjuvant to general anesthesia. METHODS Twenty-three patients scheduled for elective surgical operations were studied. Weights of the patients varied between 50.8 and 9004 Kg., and their ages ranged from 21 to 75 years. None of the patients had any history of allergy, and all were free from clinical or laboratory evidence of cardiopulmonary disease. Data from patients who showed increased secretions during the study period were discarded. Preoperative medication consisted of pentobarbital, 100 to 200 mg. by mouth the night before surgery and 4 mg/Kg body weight given intramuscularly 90 minutes prior to the induction of anesthesia. Fifteen minutes before the induction of anesthesia, atropine sulfate, .01 mg/Kg body weight, was given jntravenously. A 2..5 per cent solution of thiopental sodium was administered intravenously in 5 m1. increments to a total dose of 4.4 mg/Kg body weight. To facilitate tracheal intubation, a translaryngeal injection of 1..5 m1. of 5 per cent hexylcaine hydrochloride was given. A second dose of thiopental equal to the first 379 THE MEDICAL BULLETIN Fig. 1 Representative tmcing showing airway presslll't', intraesophagal press1II'e, n>spiratoJ'Y How rate. anel J'C'spiratory vlllllllle. ~80 THE MEDICAL BULLETIN was administered while the patient breathed oxygen via a face mask. The trachea was intubated, using in all cases the same No. 8 cuffed portex endotracheal tube. After a closed anesthetic system was established, the patient's lungs were ventilated with a Bird Assistor/Controller." The appropriate tidal volume and respiratory rate were determined from the Radford nomogram,la and these, along with the peak How rate for each patient, were kept constant throughout the test period. Intra-esophageal pressure was measured by means of a catheter and balloon made according to the technique of Mead et al. 14 The balloon was filled with 1.5 ml. helium, and the open end of the catheter was attached to a Sanborn differential transducer. t All balloons were individually tested for degree of damping, the maximal response time of the system being 0.02 seconds. Similarly constructed systems gave a 100 per cent response up to a frequency of 35 cycles per second when filled with helium. Airway pressure was measured by the same transducer connected to the oral end of the endotracheal tube by a polyethylene catheter. A Lilly pneumotachometer, t interposed between the patient's endotracheal tube and the inspiratory-expiratory valves of the circle absorption system, measured respiratory How rates. Respiratory volume was obtained by electrically integrating the respiratory How rate. Intra-esophageal pressure, airway pressure, respiratory How rate, and volume were recorded on a four-channel Sanborn polyviso recorder. § Transpulmonary pressure was detected by a Sanborn differential strain gauge as the difference between airway pressure and intra-esophageal pressure (Figs. 1 and 2). These elements were recorded 30 and 3,5 minutes after controlled ventilation had been instituted, when a constant anesthetic state was considered to be in effect. When values for airway resistance and static lung compliance obtained at the 30 and 35 minute intervals were observed to be statistically similar, d-tubocurarine, 0.44 mg/Kg body weight, was given intravenously in a Single rapid injection. Recordings then were made every five minutes for a total of four to six recordings. Thereupon d-tubocurarine, 0.22 mg/Kg was given as before, and two or three additional recordings were made. All studies were completed prior to surgical stimulation of the patient. °Bird (Mark 4) Assistor/Controller. Bird Oxygen Breathing E(luipnwllt. Inc., 218 Fremont, San Francisco ,5, California tSanborn Model 268 B, Sanborn Co., Waltham 54, Massachusetts :j:Technitrol Flometer 115-F-I, Technitrol Engineering Co., Medical Instrument Division, 2751 North Fourth Street, Philadelphia 33, Pennsylvania §Sanborn Model 154-IOOB, Sanborn Co., Waltham 54, Massachusetts 381 THE MEDICAL HULLETIN , I I ,._,. ,~ +-H..-+-i c:,jt~,+-H-++H·-+-l-+-,I...;....... .I ii~' -+~Hi+.+!'I1H+-+"1·4'+"hH-d--H-l4+·h."iff!.1-H++ja'·1-++t\;l~;r • I. .' I Fig. 2 Representative tracing showing transpllimonary pressure, respiratory Row rate, and fCspiratory volume. Airway resistance, in centimeters of water per liter per second, was calculated by using the standard formula: R= A t:::. P B t:::.Q (Fig. 3), where t:::.Q is measured at points of elIual expiratory and inspiratory volume and where the point on the inspiratory volume curve corresponds to the peak inspiratory How rate. RESULTS Airway resistance values for the 2.3 patients are shown in 382 TIlE JVIEUICAL BULLETIN f- Table 1. Resistance changes of seven patients were subjected to more detailed analysis and are listed in Table 2. It was found that the patients could be divided into four groups on the basis of severity and duration of changes in airway resistance after administration of d-tubocurarine. =t:::t:=t::=+~-kI'.+H+++-f+-H:-';tK=F1t1'I'r~J:.~!~~-:-I\~t-~ " , i --Ht-+--t--r-TI"'I.. ..... IIII 1.1aii : . ". ; -I",' If 1""1..-' ... ,- --_ ;-, .. .' ; r- I .. Ii· - .. '1.0' ..... """ 8~. '/ r- 11_ • 10: , :1.... '\. " , II-' l*1I1 • o• - 6100114, Fig. 3 Patiellt tracing showing transpulmonary pressure, respiratory flow rate, and respiratory volume. Resistance of the lung is computed as the change in transpulmonic pressure (A) divided by the flow rate (B). 383 TABLE (,:J (Y.J """ ; • 1 AIRWAY RESISTANCE CHANGES IN CM. H,O/L/SEC. FOLLOWING INTRAVENOUS D-TUBOCURARINE No. Age (Years) Weight (Kilograms) Amount of D-Tubo ( Milligrams) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 48 35 37 43 68 73 .50 41 66 .57 69 68 41 68 60.3 59.4 62 67 54 79.4 57 64 68 68 90.4 79.8 66.2 66 30 27 27 33 24 36 24 30 30 30 39 36 30 30 15. 16. 17. 18. 61 21 48 27 71.2 65.3 78.0 81.6 33 30 36 36 19. 20. 21. 75 64 65 57.2 83.9 59.9 22. 23. 52 58 50.8 83.9 , , • • , Resistance (ll. P /Q) in em. H,O /L/sec. I 0 0 .5 10 1.5 20 25 30 7.34 7.31 6.22 6 ..54 10.95 8.71 19.82 7.5,5 10.16 7.35 6.09 8 ..53 .5.98 8.27 8.39 7.1.5 6.34 6.30 11.12 8.86 18.8.3 7.75 10.23 7.14 5.12 8.25 4.78 7.91 8.15 8.08 6.88 6.46 10.32 8.69 19.38 7.10 10.11 7.09 5.38 7.26 4.23 7.34 8.10 8.20 6.90 6..50 10.46 9 ..55 19.37 7.11 10.20 7.00 .5.02 8.64 4.17 7.16 6.91 - - 9.11 7.35 5.04 6.89 11.44 8.14 19.43 7 ..5,5 10.25 7.84 5.83 9.00 6.15 9.08 8.56 10.32 4.13 10.40 12.65 10.47 3.72 9.57 12.40 11.94 3.67 9.22 11.70 11.8.5 4.8,5 10.79 12.65 10.91 4.88 11.02 12.49 10.61 3.40 9 ..51 11.36 24 36 30 7.93 15.42 8.68 7.79 14.95 8.71 7.59 18.71 20.27 10.98 18.12 23.50 10.49 16.41 23.30 1.5.84 21 36 10.63 10.67 7.04 11.10 5.30 11.02 5.22 8.02 9.53 .. Time in Minutes from 2nd D-Tubo Injection 1.5 5 10 ,-Time in Minutes from d-Tubocurarine Injection-.., 6 ..58 8.58 19.28 7.80 7.89 8.70 6.42 gd· ->.. • 10.82 10.50 19.47 7.14 - 4.9.5 7.60 4.23 - 6.88 - 10.91 • • 8.93 11.07 6.66 11.09 7.56 19.13 4.83 8.93 6.93 .5.04 7.63 6.42 6.67 8.02 12.74 3.37 12..52 .5.20 12..52 11.34 11.21 10.78 15.11 15.51 7.47 1.5.75 11.01 16.10 9.74 - .., :I: ~ - ...? ...t: n ~ ;> t"' 7.80 tl: q - - t"' t"' M .., ... Z 9.63 - - 14.94 9.10 7.08 6.80 10.8.5 7.42 18.53 6.28 10.06 6.97 7.3,5 7.94 3.89 6.84 7.64 - 15.76 • .~ a-...J-",. " ,til- ~ ,,~ r m. Ii t Ii 'hi. I. * r., ,fT 1#1'* t ttliJPn, ttl, ......, .. :S• • r-- 0 "----, No. Mean Group 1 4. 6. 13. 19.28 Group 11 18. 17. 12.65 10.40 Group 111 19. 21. 7.93 8.68 - S.D. Mean S.D. ,--5"-----. Mean S.D. S.E. - - 11.44 19.43 9.08 .40 .32 .07 10.95 19.82 8.27 .50 .51 .30 .28 .13 12.40 9.57 .42 .25 11.70 9.22 .25 .32 7.79 8.71 .24 .41 .24 f' . . . , . I I 2 TABLE AIRWAY RESISTANCE CHANGES IN CM. H20/L/SEC. OF REPRESENTATIVE CASES FROM GROUPS I TO ,-0"_____ U! ,--lO"~ ,--15'f~ III ,--20"~ Mean S.D. S.E. ,--25"---. Mean S.D. S.E. .27 .34 .13 10.46 19.37 7.10 .21 .13 .33 .23 .17 .19 10.82 19.47 .25 .77 .27 .34 .30 .60 .23 .45 11.36 9.51 .14 .ll .18 .33 9.63 .09 .13 10.49 .55 23.3 1.31 .31 .79 Mean S.D. S.E. Mean S.D. S.E. .32 .30 .14 11.12 18.93 7.91 .32 .29 .06 .26 .22 .02 10.32 19.38 7.34 .40 .60 .25 .23 .33 .20 .21 12.65 10.79 .12 .52 .18 .41 12.49 11.02 '7.59 .59 20.27 1.58 .37 .89 10.98 23.5 .34 .77 .24 .50 TABLE 3 HISTAMINE BLOOD LEVELS BEFORE AND AFTER INTRAVENOUSLY ADMINISTERED D-TUBOCURARIN3 IN PATIENTS ANESTHETIZED WITH THIOPENTAL SODIUM AND NITROUS OXIDE Wt. (Kg.) Amount of D-Tubo (Milligrams) Blood Sample Before Curare. Histamine in /Lgm/cc Blood Sample After Curare. Age (Yrs.) /Lgm/cc ~b-;a 2 3 4 41 48 72 52 39 72.6 52 97 21 45 30 40 0.042 0.106 0.052 0.093 0.043 0.108 0.049 0.094 -0.001 +0.002 -0.003 +0.001 5 6 7 8 19 49 74 75 53 52 45.4 64.9 30 30 24 30 0.092 0.024 0.045 0.096 0.142 0.061 0.060 0.144 +0.050 +0.037 +0.015 +0.048 11.3 8.4 3.4 10.8 9 57 82.6 40 0.058 0.026 -0.032 7.2 10 52 45.4 21 0.058 0.042 -0.016 3.6 II 48 95.7 45 0.1l8 0.072 -0.046 10.4 No. I .u " . , ,.; L , , "' . Histamine in • • [T] Clinical Signs .23 .45 .68 .23 ,.,,,, None None None None None None None None Chest erythema, BP fal! 160/80-100/70 Questionable erythema, BP fal! 200/100~160/95 Generalized erythema, BP fal! 120/75--80/50, prolonged expiration • • , ''" I THE MEDICAL BULLETIN Group I, consisting of 14 patients, showed either a steady small decrease in pulmonary resistance or a fairly constant resistance value. No statistically significant differences existed among recordings. Two examples from this group are shown in Figure 4. 12 r xr x~/patient 114 x x u CL> __x x 10 (f) "-.J "- x_~ o (\J I 8 x____ E u x-<-- Patient 1113 x_ _ x c 6 CL> U C C 0+(f) ~ 4 0:: GROUP 2 5 10 15 20 25 Time in Minutes Following Curare Injection Fig. 4 Group I, patients who showed a steady small decrease in lung resistance or a fairly constant pulmonary resistance value. The resistance changes in the four patients in Group II showed the basic tendencies of Group I superimposed on which was an increase in resistance, maximal bv 1.5 minutes and resolved by 20 minutes following the administration of dtubocurarine. (See Figure 5) . .'386 1, 1 THE MEDICAL BULLETIN u (Lj (f) '-l '- o N I E u c (Lj u 8 c o < f) (JJ (Lj cr: G GROUP 2 4 - 5 10 TIme 15 in 20 25 Minutes Followi ng Curare Injection Fig. .5 GIOUp II, patients showing the basic tendencies of Group I with a superimposed increase in resistance, maximal by 1.5 minutes and resolved by 20 minutes, following d-tubocnrarine admistration. Group III, consisting of three patients, demonstrated the most dramatic airway resistance changes (Fig. 6). An increased resistance was evident at five minutes and maximal at ten minutes. Patient 21, despite therapy, still had clinical signs of bronchial constriction eighteen hours after the study. Patient 19, some four hours after the study, had subjective difficulty in inspiring, although no adventitious sounds were present in the lung fields. 387 THE MEDICAL BULLETIN ,1 24 x---__ -x u (l) (J) "-.J 1 22 #21 "- oN I x E 20 u c: (l) u c: o 12 +- x (J) (J) (l) 0::: X 10 8 ~ l---X GROUP 3 5 10 15 20 Time in Minutes Following Curare Injection Fig. 6 Group III, patients who demonstrated a marked change in pulmonary airway resistance followin~ the intravenous administration of d-tubocurarine. The two patients who make up Group IV are those who do not fit into any other group. (Figs. 7 and 8). 388 THE MEDICAL BULLETIN 12 x <..i OJ (f) "- 10 -l "0 N I E 8 x............... u x c OJ u c - 6 0 ( f) IOmg. Curare Given (f) OJ a: 4 >, 0 3: .... « GROUP 4 PatienP*22 2 O L - - _ - l - _ - - - l_ _--l..-_-----l._ _....l-_---l.- o 20 15 20 10 Ti me in Minutes Following Curare Injection 5 Fig. 7 Patient in Group IV requiring a second dose of d-tubocurarine. The change in resistance was secondary to the onset of spontaneous respirations. DISCUSSION Fry,L) Cherniak,16 and Marshall,17 and their respective associates, as well as numerous other workers, have shown that changes in intrapleural pressure are accurately reflected by changes in intra-esophageal pressure regardless of patient position. In preliminary work we also demonstrated that the relative change in esophageal pressure between inspiration and expiration for anyone individual was independent of the patient's 389 THE MEDICAL BULLETIN position. Because of these findings and because of the greateJ; ease in handling supine anesthetized patients, all patients were in the supine position when studied. 16 ~x x u C]) , ·1 If) ....... -.J 14 ....... oN :r: E 12 u c C]) u 10 c x o +- If) If) C]) 0:: GROUP 4 Patient # 23 5 10 Time Following 15 20 25 in Minutes Cu rare Injection Fig. 8 Patient in Group IV displaying a marked rise in resistance probably secondary to an excessive amount of endobronchial mucus. Airway pressure is the pressure acting on the lung and extrapulmonary elements. The esophageal pressure, since it reflects intrapleural pressure, is that portion of the airway pressure transmitted through the lung which acts on the chest wall and diaphragm. Therefore, the pressure acting on the lung itself is 390 1 1 THE MEDICAL BULLETIN the airway pressure minus the esophageal pressure, and the resistance to air flow calculated by means of this differential pressure is taken to equal the resistance of the lung. In speaking of pulmonary resistance we are considering a number of components as well as the resistance offered by the elastic qualities of the lung tissue. Resistance offered in overcoming the inertia of the inspired gas and overcoming the airway opening pressure is one. Resistance due to the viscosity of the lung tissue (that is, the resistance offered as tissue planes move on one another as the lung expands) is another. The inhaled gas has a certain resistive component dependent upon the viscosity of the gas and type of flow. As the flow rate increases, the viscosity of the gas increases, and thus the resistance will increase. A change from laminar to turbulent flow will also alter the resistance, since the resistance of a laminar flow is related to the viscosity of the gas, whereas the resistance of a turbulent flow is related to the density of the gas. Excessive secretions in the tracheobronchial tree will increase airway resistance by changing surface tension and by physically narrowing the tracheobronchial diameter. It has been shown that 2.5 per cent of the total lung resistance is due to the above factors. The remaining 75 per cent arises from the resistance to air flow offered by the tracheobronchial tree.l~ This is the segment that can rapidly be changedeither passively, by collapse of the lung due to pneumothorax, or actively, by chemical substances such as histamine, acetylcholine, or eqinephrin. Small changes in the diameter of the bronchioles cause marked alterations in resistance, in accordance with Poiseuille's Law, which relates resistance to the reciprocal of the fourth power of the radius. Neither nitrous oxide, nor 5 per cent carbon dioxide in oxygen, l~ nor 100 per cent oxygen given for periods up to ten minutesl~ has any effect on airway resistance. Atropine has been observed by Kilburnl~ to constrict and lengthen bronchioles in dogs. Since all the factors affecting lung resistance except the bore of the tracheobronchial airways were kept constant, and since pulmonary compliance also remained unchanged, we can conclude that any change in pulmonary resistance following the administration of d-tubocurarine must have been due to a change in the tracheobronchial diameter. The values given in Table 1 for pulmonary resistance l l at zero minutes are considered greater than the commonly given values of 1.2 to 3.5 em. of water per liter per second for individ- 391 THE MEDICAL BULLETIN uals respmng spontaneously.!!J In an attempt to explain this disparity, we measured pulmonary resistance in two patients before and after they were subjected to endotracheal intubation. Both patients were breathing spontaneously, and in both cases the pulmonary resistance was doubled following tracheal intubation. The degree of change in resistance caused by the endotracheal tube depends predominantly upon the difference between the diameter of the endotracheal tube and the diameter of the portion of the airway which it replaces. Since, in all cases, the endotracheal tube decreased the lumen of the airway, an increase in airway resistance was to be expected. After intubation, respiration became passive on the patient's part and changed from negative pressure breathing to positive pressure breathing. Air now entering the tracheobronchial tree must exert sufficient transmural pressure to overcome the elastic resistance of the lung tissue which is no longer opposed by the active outward movemen~ of the chest wall and diaphragm. Also the diameter of the bronchi are narrowest at the onset of positive pressure inspiration as the lung is in the resting expiratory position. 1!J,20 Although the flow rate was kept constant during the studies on anyone patient and an attempt was made to keep the actual flow rate within a physiological range,20 any increase in flow rate above the patient's normal flow rate would give a higher resistance value than would be expected in patients breathing spontaneously. One or any combination of these factors could be responsible for the initial high resistance values seen in the patients studied. The greatest number of patients fell into Group I, and these showed a steady small decrease in lung resistance or else a fairly constant pulmonary resistance value. In this group the administration of d-tubocurarine did not affect the pulmonary resistance (Fig. 4). Following ventilatory control all patients gave relatively high airway resistance values. In most cases this high airway resistance decreased quickly to a constant value, but in some cases a period of rapid adaptation to positive pressure ventilation was followed by a prolonged period of a very small but constant decrease in the airway resistance. The time referred to as 0 minutes in Tables 1 and 2 (i.e., 30 minutes after ventilatory control had been established) was the time when the two resistance values were statistically similar. Those patients in Group I who showed a steady small decrease in lung resistance might have still been in this adaptive phase. 392 1· ... • 1 1 •. • . , • 1· •. . 1 . 1. 1 . THE MEDICAL BULLETIN D-tubocurarine, through its properties of blocking parasympathetic ganglia, may have blocked the stretch reflex of the vagi, thereby increasing the diameter of the bronchioles.:n Widdicombe~~·2a showed that these stretch receptors were located in the bronchioles. Under positive pressure ventilation, intravenous acetylcholine or histamine caused bronchoconstriction by increasing the frequency of discharge and shortening of the time of onset of discharges from these slowly adapting stretch receptors.~1 The work of Dawes and Comroe~l indicates that the afferent pathway of this reflex is via the vagus nerves. Guyton~4 has shown that curare, by blocking impulse transmission over the vagus nerve through parasympathetic ganglionic blockade, can obtund this reflex. With the loss of this reflex, passive distention of the bronchioles would then cause a lowering of resistance by increasing the total lung volume.~'· The changes in airway resistance seen in the patients comprising Group II (Fig. .5) can be explained in terms of the three known actions of curare: neuromuscular blockade, histamine release, and ganglionic blockade. The important observations here are: first, the sudden rise in rcsistance; second, the small (though statistically significant) magnitude of the rise; and third, the rapid return to pre-elevation resistance values. It is unlikely that ganglionic blockade could be responsible for a rise in resistance, because such a blockade would have to involve the sympathetic ganglia, leaving parasympathetic ganglionic transmission intact.~4.~(; No cvidence exists for sympathetic ganglionic blockade by d-tubocurarine in doses of the magnitude used here. Also parasympathetic ganglia are paralyzed with much smaller doses, and Guyton has shown that the vagi are particularly sensitive to this block.~4 This pattern can be attributed to the neuromuscular blocking effect of curare. The normal peak action of d-tubocurarine occurs five to ten minutes after administration. Following the injection of d-tubocurarine the tone of the intercostal muscles and the diaphragm is lost, and the intrapleural pressure (intra-esophageal) rises from a negative value to very close to zero. The elastic property of the lung, unopposed by the tone of the diaphragm and intercostal muscles, tends to collapse it toward the hilum, narrowing the bronchial tree and perhaps even entirely collapsing scattered terminal segments. This then raises the resistance to airflow until by the adaptive mechanisms already described the previous resistance level is attained. Because of the prolonged increase in airway resistance and the magnitude of the reaction of those patients in Group III 393 THE MEDICAL BULLETIN (Fig. 6), an explanation7 involving the neuromuscular blocking effect of curare as offered to account for the resistance changes in group two is not adequate. No measurement of blood histamine was made on these patients, but we have shown that d-tubocurarine is capable of elevating blood histamine under similar test conditions (Table 3). Histamine uptake by end organs related to the tracheobronchial tree is suggested as the cause of this type of reaction. Bouhays and co-workers 27 have shown that hexamethonium given to asthmatic patients prior to histamine aerosol inhalation completely prevents the bronchosconstriction which normally results. These workers have also shown that epinephrine aerosol inhalation prior to the histamine aerosol modifies the bronchoconstriction. Atropine has also been reported to diminish the bronchoconstrictor response. 28 This work adds support to the proposition that the bronchoconstriction induced by histamine is mediated through a neurogenic mechanism or reflex. 27 Ganglion cells are known to exist in the bronchial walls, and like the stretch receptors, they are approximated to preganglionic vagal fibres. 2 !l Herxheimer has shown that hexamethonium protected guinea pigs against anaphylactoid- and histamine-induced shock,30 CurrY:l1 demonstrated the protective effect of hexamethonium on histamine and methacholine action in humans. It has been suggested that a functional disorder of autonomic nerve structures in the bronchial walls may be important in the pathogenesis of bronchial asthma as wel1. 27 We can offer no evidence as to the underlying mechanism of the reaction. Whether or not any of the previously mentioned conditions existed in our patients cannot be proved from these studies. We do know, however, that none of our patients showed clinical evidence of cardiopulmonary disease and none had any history of allergy. Another possible explanation of the reaction is that d-tubocurarine may directly sensitize the end organs in certain individuals. The possibility that the individuals in this group had latent hypersensitivity to histamine or in effect latent asthma cannot be excluded. Any degree of bronchial obstruction before histamine release bv curare-such as edema of the bronchial endothelium, hypert;ophy of bronchial smooth muscle, and endobronchial mucus-would accentuate the effect of bronchial narrowing by histamine, since resistance is inversely proportional to the fourth power of the radius. Patient 22 (Fig. 7) required additional d-tubocurarine at the fifteen-minute period when she began to inspire spontaneous394 1. { :.• • 1 THE MEDICAL BULLETIN ly. As controlled positive pressure ventilation was re-established, the resistance returned to the initial level. The resistance changes seen in patient 23 (Fig. 8) cannot be completely explained. The rise occurred too late to be due to histamine release, and its magnitude was much too great to be produced by neuromuscular blockade of the chest wall and diaphragmatic muscles. A mucus plug or increasing narrowing of the bronchioles by retained mucus gives a similar picture. Twenty patients each received a second dose of d-tubocurarine, and it can be seen from Table 1 that the subsequent airway resistance changes were quite varied. Few conclusions can be drawn as the study time interval following the second dose of d-tubocurarine was too short to allow any pattern in resistance changes to develop. Nevertheless, increases in ahway resistance of a magnitude comparable to those seen in Group III patients were observed (Patient 2). Secondary airway resistance changes showed no correlation with the primary changes. SUMMARY AND CONCLUSIONS The effect on pulmonary airway resistance of a .44 mg/Kg body weight dose of d-tubocurarine administered as a single intravenous injection has been evaluated. Twenty-three patients free of cardiopulmonary disease and having no history of allergy comprised the study group. An elevated airway resistance resulted in seven cases. In four cases the elevation was minimal and was felt to be due to the passive collapse of bronchioles resulting from the paralysis of the intercostal and diaphragmatic muscles. In three cases the elevated airway resistance was believed to be due to histamine uptake by effector end organs located in bronchial walls; the histamine release was presumably produced by intravenous d-tubocurarine. Two patients had airway resistance changes which did not appear to be directly related to d-tubocurarine administration. No correlation between age, weight, or total d-tubocurarine and type or degree of airway resistance change was observed. REFERENCES 1. West, R.: Intravenous Curarine in the Treatment of Tetanus, Lancet 1: 12, 1936. 2. Burman, M.S.: Therapeutic Useof Curare and Erythroidin Hydrochloride for Spastic and Dystonic States, Arch. Neurol. & Psychiat. 41 :307, 1939. 3. Griffith, H. R. and Johnson, G. E.: The Use of Curare in General Anesthesia, Anesthesiology 3:418, 1942. 39.5 THE MEDICAL BULLETIN 4. West, R.: Pharmacology and Therapeutics of Curare and its Constituents, Proc. Roy. Soc. Med. 28:565, 1934-5. 5. West, R.: Pharmacological Study of Derivatives of Two Specimens of Tubo-Curare, Arch. internat. pharmacodyn. 56:81, 1937. 6. vVest. R.: Action of Curarine on Respiratory Mechanisms, J. Physiol. 91 :437, 1938. 7. West, R.: Action of Curarine on Respiration, Lancet 1 :432, Feb. 19, 1938. 8. Harvey, A. M. and Masland, R. L.: Actions of Curarizing Preparations in the Human, J. Phannacol. & ExpeI. Therap. 73:304, 1941. 9. 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G.: Respiratory Reflexes from Trachea and Bronchi of Cat, J. PhysioI. 123:55, 1954. 23. Widdicombe, J. G.: Respiratory Reflexes Excited by Inflation of Lungs, J. PhysioI. 123:105, 1954. 24. Guyton, A. C. and Reeder, R. C.: Quantitative Studies on the Autonomic Actions of Curare, J. PharnncoI. & Exper. Therap. 98: 188, 1950. 25. Marshall, R.: The Physical Properties of the Lungs in Relation to the Subdivisions of Lung Volume, CHn. Sc. 16:507, 19.54. 26. Goodman, L. S. and Gilman, A.: The Pharmacological Basis of Therapeutics, ed. 2, New York, Macmillan Co., 1955, p. 604. 27. Bouhays, A.; Jonnason, R.; Lichtneckert, S.; Lindell, S. E.; Lundgren, C.; Lundin, G.; and Ringquist, T. R.: Effects of Histamine on Pulmonary Ventilation in Man, CHn. Sc. 19:75, 1960. 28. Michelson, A. L.; Hollander, W.; and Lowell, F. C.: The Effect of 5-Hydroxytryptamine (Serotonin) on the Respiration of Nonasthmatic and Asthmatic Subjects, J. Lab. & CHn. Med. 51 :57, 1958. 29. Kuntz, A.: The Autonomic Nervous System, Philadelphia, Lea & Febiger, ed. 4, 1953, p. 184. 30. Herxheimer, H.: Bronchoconstrictor Agents and their Antagonists in the Intact Guinea Pig, Arch. internat. pharmacodyn. 106:,'371, 1956. 397 Minnesota Medical Foundation Membership Roster Patron Members for Distinguished Service Donald J. Cowling Gerald T. Mullin Patron Members Bertram S. Adams Donald C. Balfour, Sr. John C. Benson Mrs. Frank W. Bowman Otto Bremer Mrs. Paul Brooks Mrs. Austen S. Cargill Homer P. Clark Mrs. Teresa Cohen Mrs. Norman A. Cook C. D. Creevy Rollin E. Cutts O Bruce Dayton Mrs. Grace B. Dayton Paul Dwan Lyle A. French Mrs. Sarah Gault Sander Genis Edward Haglin Miss Anne E. Hellesen John M. Hollern Carl W. Jones William J. Kay George B. Leonard N. Logan Leven Harold Lieberman Mrs. Harold Lieherman Richard C. Lilly Mrs. Edith Linoff W. C. MacFarlane Leo J. Madsen Samuel H. Maslon Mrs. Helen T. Morrison K. W. McKee William L. McKnight Miss Alice M. O'Brien I. A. 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Hill Louis W. & Maud Hill Foundation H. P. Hindteraker Lerner B. Hinshaw Herbert M. Hirsch Claude R. Hitchcock John J. Hochfilzer R. V. Hodapp Lucien R. Hodges H.O.Holf F. W. Hoffbauer Lucille Hoilund Wallace W. Hollcy" Roy G. Holly C. H. Holmstrom John E. Holt G. Wendell Hopkins Emerson E. Hoppes Wayne L. Hoseth William H. Houlton Gordon W. Hovde Ruth F. Hovde C. E. Howard Elna M. Howard Robert B. Howard S. E. Howard Carter W. Howell L. J. Hoyer William J. Hruza R. W. Huher E. G. Huhin E. R. Hudec" Arthur B. Hunt Edward G. Hustad Charles Hymes Anthony Iannone Walter Indeck " Also Life Member 403 THE MEDICAL BULLETIN Annual Members (continued) J. E. Indihar R. J. Jackman Charles E. Jacobson, Jr. Clarence Jacobson· Wyman E. Jacobson Jay Jacoby D. E. Jaeger Manuel O. Jaffe Harriet D. James George W. Janda Allen G. Janecky J. R. Jannach Martin E. Janssen AlanR. Jay Herman H. Jensen Nathan K. Jensen Reynold A. Jensen· Richard E. Jensen J. E. Jenson Bourne Jerome H. J. Jeronimus W. G. Johanson Henry A. Johnsen, Jr. C. Laurence Johnson Douglas L. Johnson Einer Wesley Johnson, Jr. Eugene A. Johnson Frank E. Johnson John A. Johnson Ray A. Johnson Victor Johnson Luverne W. Johnsrud Richard H. Jones Joseph Jorgens A. N. Joseph George T. Joyce Allen S. Judd E. S. Judd Leonard L. Kallestad Dennis J. Kane Earl R. Kanne Bernard J. Kaplan J. Jacob Kaplan C. I. Karleen E. M. Kasper Harold Katkov Herschel J. Kaufman Harold W. Keairnes Donald L. Kegaries Paul J. Keith Ted Keller Roger E. Kelley Vincent C. Kelley Edward H. Kelly John F. Kelly William D. Kelly B. J. Kennedy Ralph Kernkamp Ancel Keys· R. R. Kierland Frank Kiesler • Also Life Member 404 E. A. Kilbride Ceorge Kimmel Archihald D. Kincaid Lyndon M. King, Jr. W. 'l. Kinney Thomas J. Kinsella· L. B. Kiriluk Llovd H. Klefstad Ilo;acc D. Kleino Lowell H. Kleven Christian R. Klimt )';dward K. Kloos Frank R. Klune Halph T. Knight· W. A. Knight, Jr. Hobert R. Koefoot Fred H. Koenecke Arthur A. H. Koepsell lIl'nnan J. Kooiker I h-'llrV A. Korda Michael Kosiak Frederic J. Kottke· H. J. Kotval Carl D. Koutsky George F. Kowallis hhu D. Krafchllk Walter E. Krafft Arnold J. Kremen ThOlTlas K. Krczowski William Krivit l.arry Kruger Frank H. Krusen \V. G. Kubicek Anne C. Kuhn Warren L. Knmp David B. Kuris Bradley W. Kusske Hoswith I. Lade John S. Ladue Sheldon M. Lagaard Mrs. Alhina Phillips Lambert Leonard A. Lang· William A. Lange n. G. Lannin L. N. Lano Frank W. Larst'll Eva Jane Larsono Leonard W. Larsono Leighton W. Larson Lester E. Larson 0 Oliver E. H. Larson Paul N. Larson 0 K. E. Latterell Donald J. Lawler Arnold Lazarow G. E. Ledfors J. S. Lee Hubert W. Lee Thomas J. Lehar Harold R. Leland· M. E. Lenander Edith M. Lentz Gilbert Gordon Lenz J. Paul Leonard Richard G. Lester Robert D. Letsou J. H. Leversee Alfred G. Levin Jules D. Levin N. M. Levine· George X. Levitt· Barton L. Lewis Herman C. Lichstein Dagfinn Lie A. G. Liedloff Nathan Lifson W. B. Light C. Walton Lillehei James P. Lillehei Richard C. Lillehei Ludvig Lima, Jr. Carl John Lind, Jr. Maurice L. Lindhlom Robert Lindell Charles E. Lindemann Russell C. Lindgren· Douglas T. Lindsay E. H. Lindstrom Gardner Lindzey John H. Linner Paul W. Linner H. P. Lippman· Mark B. Listerud Robert B. Litin Arthur G. Litman Neil N. Litman Robert E. Litman M. B. Llewellyn Paul H. Lober Karl A. Lofgren S. V. Lofsness Dennis E. Lofstrom James E. Lofstrom John Logothetis Merle Loken George L. Loomis Frederick H. Loll James M. Louisell E.R.Lowe Elizabeth C. Lowry Jeanette K. Lowry Thomas Lowry Stanley Lundblad Karl R. Lundeberg C. W. Lundquist Virgil J. P. Lundquist Warren L. Macaulay D. C. MacKinnon Lloyd D. MacLean Gordon C. MacRae A. E. Magnuson· J THE MEDICAL BULLETIN Annual Members (continued) f Richard Magraw D. G.Mahle Edgar L. Makowski E. T. Maitland Sheldon C. Mandel James C. Mankey Frank D. Manno David M. Marcley George H. Marking Donald C. Martin D. L. Martin G. M. Martin George R. Martin Carlos Martinez C. L. Martinson Elmer J. Martinson Joseph S. Massee James C. Masson O James K. Matayoshi Roland W. Matson Hamlin Mattson William P. Maverlis Donald M. Mayberg Charles W. Mayo William F. Mazzitello Donovan L. McCain Malcolm A. McCannei 0 Francis M. McCarten A. M. McCarthy Donald McCarthyO R. James McCellan C. N. McCloud D. P. McCormick M. Donald McGeary Elizabeth A. McGrew Brian J. McGroarty Richard B. McHugh Frank F. McKean John M. McKelvey C. A. McKinlayo F. S. McKinney Leroy C. McLaren Charles E. McLennan John M. McLinden B. J. Mears Fredrick B. Mears Sidney H. Medof Paul E. Meehl Rohert L. Meller George T. Mellinger J. Mendez T. B. Merner Robert L. Merrick R. W. Merrill W. A. Merritt P. F. Meyer Henry H. Michel o R. P. Michels Henry E. Michelson o James L. Michie A. S. Midthune V. E. Mikkelson Fletcher A. Miller H. A. Miller, Jr. Harold D. Miller Harold E. Miller Harry Arthur Miller J. C. Miller R. Drew Miller Z. R. Miller D. Keith Millett J. L. Mills o John E. Minckler Rabbi & Mrs. Albert G. Minda O Raymond K. Minge Minneapolis N europsychiatric Clinic B. D. Mitchell Russell H. Mitchell A. S. Moe Gordon K. Moe John H. Moe· Thomas Moe Johannes K. Moen Herman J. Moerscho Robert Hugh Monahan George E. Moore Walter H. Moran M. E. Mosby Andrew M. Movius John B. Moyer Donald R. Mueller Mark A. Muesing J. R. Mulder A. Eugene Muller John J. Muller John E. Mulvahill Edward S. Murphy Marion 1. Murphy Thomas O. Murphy M. J. Murray Rohert A. Murray Robert J. Murtaugh Elizaheth Mussey J. A. Myers· James Myhre H. B. Nachtigall Arnold E. Naegeli Frank D. Naegeli Ilgvars S. Nagobads V. George Nagobads Leo A. Nash Donald E. Nealy W. S. Neff D. R. Nelimark Carl Gilbert Nelson Douglas A. Nelson E. N. Nelson Kenneth L. Nelson Kenneth R. Nelson Lloyd S. Nelson Maxine O. Nelson Maynard C. Nelson Nonnan A. Nelson Wallace I. Nelson· Samnel Nesbitt· Roland F. Neumann, Jr. Charles Neumeister Cecil E. Newell David J. Nielsen John F. Noble· Donald J. Nollet Robert E. Nord M. A. Nordland, Jr. Martin Nordland· W. F. Nordman Stanley R. Norqnist N. T. Norris W. F. Nnessle A. W. Nuetzman Holand E. Nutting· Malvin J. Nydahl· Katherine A. Nye C. G. Ochsner Orville E. Ockuly John W. O'Donnell M.Ogurak J.Ohage J. H. O'Leary John B. O'Leary Vern C. Olmanson Jack G. Olsen Ralph L. Olsen C. A. Olson C. Kent Olson D. M.Olson Eldon C. Olson R. A. Olson Rohert W. Olson Ruth E. Olson Valentine O'Malley Rnth O'Neal C. P.O'Neill H. P. O'Neill C. L. Oppegaard· E. G. Oppen Earl T. Opstad Harry W. Orme Edward W. Ostergren Carlton L. Onld· C. A. Owen, Jr. Ben Owens Vincent J. Paciotti R. L. Page B. J. Palen Neil Palm Enrique Sanchez PalomeTa Peter J. Pankratz A. A. Papermaster Charles W. Parker Robert L. Parker A. W. Pasek Eric R. Paulson o Also Life Memher 40.5 THE MEDICAL BULLETIN Annual Members (continued) B. F. Pearson R. C. Pedersen Louis Pelner Charles R. Pelzl Thomas A. Peppard' John R. Perkins Harold O. Perry John F. Perry, Jr. John Wm. Perry J. C. Peteler Glenn L. Petersen Rohert T. Petersen Carl A. Peterson Harold O. Peterson ° Helen Peterson Joel L. E. Peterson' John H. Peterson }"farvin G. Peterson Rohert T. Peterson W. E. Peterson Julian V. Petit Thomas G. Petrick W. L. Pew John T. Pewters Walter S. Phares Kenneth A. Phelps' R. H. Picha R. F. Pierson o N. C. Plimpton Harry L. Plotke Kurt Pollak David B. Post Konald A. Prem Robert F. Premer Robert E. Priest James T. Priestley R. K. Proesehel William E. Proffitt Raymond D. Pruitt E. E. Pumala Quain & Ramstad Clinic Wentworth Quast Robert O. B. Quello PaulG. Quie Harley J. Racer Richard B. Raile D. E. Ralston R. M. Ramlow Theodore Rasmussen Otto Raths, Jr. Vcrna Rausch Everett C. Ravits Harold G. Ravits Willis A. Redding John F. Regan E. A. Regnier' Henry J. Reif Richard E. Reiley Milton P. Reiser Elise L. Renning Carl O. Rice ° Also 406 Life Memher Roberta G. Rice L. F. Richdor! Samuel Richman Robert W. Rieman R. E. Risch A. F. Risst'r Wallace P. Ritchie' A. E. Ritt Norton D. Ritz Dean K. Rizer Donald E. Roach Francis Roach Edward W. Roberts O. W. Roherts Rohert E. Roekney C. L. Roholt· Lucy Balian Rorke Mitchell J. Rosenholtz Rohert G. Rossing Robert J. Rotenherg Clarence J. Rowe Phil C. Roy Anthony T. Rozycki Vendela Olson Rucker John G. Rukavina J. G. Rushton A. N. Russeth Elmer M. Rusten Wayne C. Rydhurg Robert E. Rydell Yoshio Sako Samuel T. Sandell Bernard Sandler Karl E. Sandt John B. Sanford M. M. Sarnecki E. R. Sather James G. Sawyer A. M. Shorov Victor Shorov Frederick H. K. Schaafo Raymond W. Scallen Joseph A. Schaefer William F. Scherer Burtrum C. Schiele Fredrick W. Sehilla James R. Schlichting Leonard D. Schloff W. R. Schmidt H. Laurence Schochct \Villiam Schofield Edward Schons D. V. Schoon Hugo F. Schroeckel1stein Alhert J. Schroeder Irwin Schulz \\'iIIiam M. Schulze Leonard M. Schuman Elmer S. Schutz E. Rohert Schwartz Samuel Schwartz Arnold G. Schwyzer Hanns C. Schwyzer Horace G. Scott Rosel T. Seashore Martin A. Segal Milton H. Seifert Thomas Scmba Donald B. Shahon S. J. Shanoski ~Iorse J. Shapiro Robert Shapiro' Sidney K. Shapiro Clark A. Shattuck Andrew Shea Abraham Shedlov J. A. Sheinkopf C. G. Sheppard Lloyd F. Sherman' II arry Shragg John S. Siegel ~1(·lIa H. Sikkema L. O. Simenstad Daniel Simon Werner Simon John B. Simons Ernst Simonson Melvin B. Sinykin David Siperstein G. Skaff Ahhott Skinner Rudolph B. Skogerboe John E. Skogland I van W. Sletten Arthur C. Smid E. A. Smisek Adam M. Smith Archie M. Smith Arthur F. Smith' Baxter A. Smith Duane S. Smith Graham G. Smith Howard R. Snider Suzanne A. Snively R. T. Soderlind Juan Solari Ben Sommerso Nels N. Sonnesyn D. W. Sontag L. W. Sontag J. P. Spano Mitchell W. Spellman Bernard J. Spencer Michael P. Sperl. Jr. Kenath H. Sponsel Joseph L. Sprafka R. G. Sprague Clifford J. Stadem William A. Stafne A. C. Stahr Lorel A. Stapley David State THE MEDICAL BULLETIN Annual Members (continued) Burton H. Stein Sam 1. Stein Sherman T. Stenbcrg H. M. Sterling Donald C. Sterner J. M. Stickney G. Keith Stillwell Robert Stoltz Norman F. Stonc Albert V. Stosser Everett L. Strandell John J. Stransky Gordon E. Strate O Maurice L. Straus Bernard L. Street Edward L. Strem J. H. Strickler J. M. Stickney Harold W. StOllC!,) H. Jerome Stulberg Rodney F. Sturley WalterSubby W. Albert Sullivan R. Dorothy Sundberg N. J. Sundet Janet B. Sutton Harry A. Swedlund H. B. Sweetser, Jr. Orvie J. Swenson J. T. Syverton A. George Tanbara George M. Tangen George T. Tani E. J. Tan'luist, Jr. Leslie W. Tasche" Gerald J. Taylor Henry L. Taylor Kenneth W. Teich William S. Terry Carlo A. Terzuolo Gordon H. Tesch J. P. Tellie Jerome O. Textor Joseph W. Teynor R. D. Thielen John V. Thomas Arthur Thompson F. A. Thompson Stewart C. Thomson Cyril R. Tifft Jan H. Tillisch" R. G. Tinkham Leonard A. Titrud" Louis Tobian, JT. John D. Tobin Lyle Tangen Fernando Torres Benedict B. Trach Bertram L. Trelstad Bror S. Troedsson Richard C. Tucker Richard B. Tudor Robert B. Tudor Nail' Tuna John A. Tweedy Roland L. Udaseo Alfred Uihlein U. R. Ulferts Robert A. Ulstrom Lawrence E. Ulvestad Frank Ungar B. Ure A. L. Vadheim" F. H. Van Bergen H. Van Meier Donald J. Van Ryzin Richard L. Varco oo Jack A. Vennes John E. Verby, Jr. Rohert L. Vernier P. M. Vickers Hildegard .I. Virnig Richard P. Virnig Maurice B. Visscher o Howard A. Vogel Ruth Von Bergen Stanley C. Von Drashek Richard W. Von Korff George W. Waldron R. H. Waldschmidt" S. A. Walker Walter W. Walker" M. O. Wallace Ira O. Wallin Francis M. Walsh Frederick H. Walter Jnn-Chinan Wang Charles T. Wangenstel'J1" Lewis W. Wannamaker Percy A. Ward Herbert E. Warden LorenF. Wasson Alex M. Watson C. J. Watson" Dennis W. Watson S. W. Watson John M. Waugh Edgar A. Webb Lowell W. Weber David Webster Mark .I. Wegleitner Harry Weiner B. A. Weis J. H. Weisberg S. J. Weisman" Lewis J. Weller Herbert S. Wells W. B. Wells John P. Wendland W. T. Wenner" H. A. Wente Gilbert P. Wenzel Stanley P. Wesolowski Catherine C. West James R. West Robert K. West D. E. Westover M. L. Whalen Joseph L. Whelan Walter M. Whitaker Asher A. White Francis M. Whittaker Dexter D. Whittmore W. F. Widen" Rudolph J. Wilkowske George E. Williams J. A. Williams John 1. Williams M. R. Williams W. Lane Williams H. A. Williamson C. A. Wilmot H. E. Wilmot" .I. Allen Wilson Robert K. Wilson Paul Winchell Louis Winer Winona Clinic F. F. Wippermann A. Cabot Wohlrabe Donald E. Wohlrabe Earl H. Wood Robert Woodruff Kenneth R. Woods Thomas D. Wright Merrill B. Yeomans Lanritz S. Ylvisaker H. S. Ylvisaker" Earl G. Yonehiro N. A. Young Thomas O. YoungO Leslie Zieve Bernard Zimmermann Charles W. Zinn Horace H. Zinneman Thomas Ziskin E. Zupanc "Also Life Member 407 INDEX FOR VOLUME 31 and VOLUME 32, 1959-60 and 1960-61 UNIVEHSlTY OF MINNNESOTA MEDiCAL BULLETIN Abdominoperineal Resection, see Long and Bernstein, 31 :384 Ackerman, Norman B., McFee, Arthur S., Wangensteen, Owen H., Diagnosis of Gastric Malignancy by Vivo Balloon Radioautography, 32: :3:34 Action Potential of Spinal Motoneurons, Terzuolo, Carlo A., 32:180 Airway Resistance, see Westgate, Gordon, and Van Bergen, 32:378 Alexander, Carl S., see Hunt, Vincent R; 31:526 Amberg, Ray, Annual Report, University of Minnesota, Hospitals, 1958-1959, 31:2 Amberg, Ray, Biennial Report; Univ. of Minn. Hospitals, 1958-59, 195960, 32:2 Aminopeptidase, see Rosenholtz and Wattenberg, 31:62 Amplatz, Kurt, Percutaneous Arterial Catheterization and its Applieatiems, 31: 339 Anemia, see Yonehiro, Perry, Shahon, Marvin, and Wangensteen, 31:250 Anesthesia, see Tanasichuk, Schultz, Matthews, and Van Bergen, 31 :596 Antibodies, see DeSanto, 31 :494 Antihemophiliac Globulin, see Bentley and Krivit, 31: 166 Annual Report, University of Minnesota Hospitals, 1958-19,59, Ray Amberg, 31:2 Arnesen, Paul M., see Richard D. Grancluist; et aI., 31 :504 Arterial Catheterization, see Amplatz, 31:339 Assay of Antihemophiliac Globulin Activity in the Carrier Female, Herschel P. Bentley, Jr., and William Krivit, 31:166 408 Bacon, Gilbert A. and I\loe, John H., Primary Bone Tumor Study, 194019,56, 32:312 Baker, A. B., Etiologic Factors in Cerebrovascular Disease, 32:212 Baker, Annie Laurie, University Hospitals in the State Welfare Structure, 31 :446 Barr, Robert N., see Kleinman, Herman; et al. 31:263 Bauer, Henry; see Kleinman, Herman; et al 31 :263 Beck, Robert H., Some Issues Facing the American High School, 31: 113 Benson, Ellis S.; see Nelson, Douglas A., 32:260 Bentley, Herschel P., Jr. and Krivit, vVilliam; An Assay of Antihemophiliac Globulin Activity in the Carrier Female, 31: 166 Bernstein, William C.; see Long, David M., 31 :384 Biennial Report; University of Minnesota Hospitals, 1958-59, 1959-60, Ray M. Amberg, 32:2 Binder, G. H., Jr., Evaluation of the Reiter Protein Complement Fixation Test, A New "Treponemal" Test for Syphilis, 31: 106 Blegen, Theodore C., Some Thoughts on the Nature and Meaning of Scholarship, 31 :89 Boies, L. R., Hohmann, Albert, and Sigel, Melvin, Research Studies Related to the Surgical Treatment of Clinical Otosclerosis, 32: 348 Bone Tumor, see Bacon and Moe, 32:312 Bowers, John Z., Observations on Medical Education and Medicine, Here and Abroad 31:413 Breast Cancer Morphology and ~1, 1 i,, • THE MEDICAL BULLETIN Adrenal Corticosterone Elevation in C and D s Mice with Heterotopic Pituitary Isografts, by Erhard Haus, Franz Halberg, Darline D. Smith, and Kathleen Shane Michels, .'32:1.'34 Bridges, Robert A.; Good, Robert A.; Esther F. Freier, Immunoelectrophoretic Characterization of Diseases Associated with Defects in the Immune Response, .'31:.'374 Brown, E. B., Jf. see MacArthur, J. D., .'31:462 Cancer, see Haus, Halberg, Smith and Michels, .'32:1.'34 Cancer, see Kennedy, Theologidcs, Foley, and Fortuny, .'32:294 Cancer of the Pharynx, Jerome A. Hilger, Bradley W. Kusskc, Richard R. Lund, and Frank Van De Water, .'31 :402 Carbon Dioxide Tension, sec MacArthur and Brown, .'31 :462 Carcinoid Syndrome: A Clinical and Biochemical Study, Richard B. Davis, .'32:198 Carotid Endarterectomy, Erich S. Wisiol, Lyle A. French, and Shelley N. Chou, .'32:24.'3 Central Nervous System in Congenital Heart Disease, Maynard M. Cohen, Fernando Torres, Gilbert Frank, and J. T. Jabbour, .'31:.'302 Cerebral Cortex, see Chou, .'31 :.'3.'30 Cerebrovascular Disease, see Baker, .'32:212 Changes in Airway Resistance Following Intravenously Administered DTubocurarine by Hugh D. Westgate, J. R. Gordon, and Frederick H. Van Bergen, .'32:.'378 Chemotherapy, see Kennedy, Theologides, Foley and Fortuny, .'32:294 Child Psychiatry-Retrospect and Prospect, by Leo Kanner, .'31 :290 Chlorothiazide, see Tobian, .'32:82 Chou, Shelley N., Some Aspects of Microelectrode Investigation of the Cerebral Cortex of Cats, 31 :330 Chou, Shelley N., see Erich S. Wisiol, et. aI., 32:243 Chromosomes, see Goodlin, 32: 170 Chronic Osteomyelitis of the Extremities; a Review of Treatment, Richard D. Granquist, Paul M. Arnesen, and John H. Moe, 31 :504 Clinical Studies of Circulating Insulin Binding Antibodies, Lawrence W. DeSanto, 31 :494 Cohen, Maynard M.; Torres, Fernando; Frank, Gilbert; Jabbour, J. T., The Central Nervous System in Congenital Heart Disease, 31 :302 Congential Heart Disease, see Cohen, Torres, Frank and Jabbour, 31 :302 Cooney, Marion K.; see Kleinman, Herman; et. a1. 31:263 Corticosterone, see Haus; Halberg; Smith and Michels, .'32: 134 Creevy, C. D.; see A. Hakim; et. a1. 31:4.'34 Current Aspects of Cancer Chemotherapy, B. J. Kennedy; Athanasios Theologides; John Foley; and Ignacio Fortuny, 32:294 DaSilva, Mauricio Martins; see Kleinman, Herman; et. a1. .'31:263 Davis, Richard B., The Carcinoid Syndrome: A Clinical and BioChemical Study, 32:198 Dehydrogenase, see Ungar, .'31 :226 DeSanto, Lawrence W., Clinical Studies of Circulating Insulin Binding Antibodies .'31 :494 Diabetes, see Wells, .'31: 186 Dillon, John F., Interstitial Radium Therapy, .'32:2.'34 Doubly Labeled Water as a Possible Tool for Measurement of Energy and Material Balance, Nathan Lifson, .'31 :218 Effect of Hydrogen Ion Concentration and Carbon Dioxide Tension on Oxyhemoglobin Dissociation, John D. MacArthur and E. B. Brown, Jr., .'31 :462 Effects of Irradiation on the Phospha409 THE MEDICAL BULLETIN tides from Normal and TumorBearing Mice, Theresa C. Lee; Robert J. Salmon; Donn G. Mosser; and Merle K. Loken, 31 :54.5 Egdahl, Richard; see Goetz, Frederick C. et. aI. 31:79 Electron Microscopy of Human Skin, Alvin S. Zelickson, .32:74 Endarterectomy, see Wisiol, French, and Chou, .32:24.3 Endocarditis, see Pankey, 31 :557 Endocrinology, see Wells, .31: 186 Etiologic Factors in Cerebrovascular Disease, A. B. Baker, 32:212 Evaluation of the Reiter Protein Complement Fixation Test, a New "Treponemal" Test for Syphilis, by G. H. Binder, Jr., 31: 106 Fatty Acids, see Tuna, Louden, and Sundeen, 31: 1.34 Fetal Endocrinology, with a Consideration of Diabetes and Pregnancy, Lemen J. Wells, 31: 186 Field Trials with the Lederle-Cox Strains of Live Poliovirus Vaccines: A Short Review, Herman Kleinman, Robert N. Barr, Henry Bauer, Eugene A. Johnson, Mauricio Martins DaSilva, Anne C. Kimball, and Marion K. Cooney, 31 :263 Foley, John; see B. J. Kennedy, et. aI. 32:294 Fortuny, Ignacio; see B. J. Kenn('dy, ct. aI. 32:294 Frank, Gilbert; see Cohen, Maynard M., et. aI. 31 ::302 Freier, Esther F.; sec Robert A. Bridges, et. aI. 31:374 French, Lyle A.; sec M. J. Meier, .31: 611 French, Lyle A.; see Erich S. Wisiol, et. aI. 32: 243 Fritz, Edna L., Nursing Education to Meet Today's Needs, 31:586 Gastric Malignancy; see Ackerman, McFee and Wangensteen: .32:.3.34 Geniculocalcarine Pathways in the Temporal Lobe, John P. \Vendland and Sidney Nerenberg, 31 :482 410 Goetz, Frederick c., Eugene A. Johnson, and Richard Egdahl, Insulin Secretion and the Problem of Insulin Assay, 31:79 Good, Robert A.; see Robert A. Bridges, et. aI. 31 :374 Goodlin, Robert C., Study of Human Chromosomes, 32: 170 Gordon, J. R.; see Hugh D. vVestgate, et. aI. 32:378 Granquist, Richard D., Paul M. Arnesen, and John H. Moe, Chronic Osteomyelitis of the Extremities; A Review of Treatment, .31:504 Hakim, Ali, M. P. Reiser, and C. D. Creevy, Transplantation of Vesical Mucosa to the Intestine: An Experimental Study, 31 :434 Halberg, Franz; see Erhard Haus, et aI. 32: 134 Handwriting; see Meier and French, 31 :611 Hastings, Ruth; see Frederic J. Kottke, et. aI. .32: 114 Haus, Erhard, Franz Halberg, Darline D. Smith and Kathleen Shane Michels, Breast Cancer Morphology and Adrenal Corticosterone Elevation in C and Dk t\lice with Herterotopic Pituitary Isografts, 32: 134 Hcmispinal Anesthesia: Its Applicability and Its Relation to Hypotension in Geriatric Patients, Murray A. Tanasichuk, Earl A. Schultz, James H. Matthews, Frederick H. Van Bergen, 31:.596 High School; see Beck, .31:U3 Hilger, Jerome A., Bradley VV. Kusske, Richard R. Lund and Frank \"1. Van De Water, Cancer of the Pharynx, 31 :402 Histochemical; see Rosenholtz and Wattenberg, 31:62 Hohmann, Albert; see L. R. Boies, et. aI. 32:348 Holland, John J.; sec McLaren, Leroy c., 31:143 Hunt, Vincent R., and Carl S. Alexander, Immunologic and Metabolic , 1 ,, '" THE MEDICAL BULLETIN Aspects of Aminonucleoside Nephrosis, 31 :.526 Hydrogen Ion Concentration, see MacArthur and Brown, .'31 :462 Hypotension; see Schultz, Matthews, Van Bergen, and Tanasichuk, ,'31: .596 Immune Response; see Bridges, Good, and Freier, 31:374 Immunoelectrophoretic Characterization of Diseases Associated with Defects in the Immune Response, by Robert A. Bridges, Robert A. Good, and Esther F. Freier, 31 :374 Immunologic and Metabolic Aspects of Aminonucleoside Nephrosis, Vincent R. Hunt, and Carl S. Alexander, .'31:.526 Insulin; see DeSanto, 31 :494 Insulin Assay, see Goetz, Johnson and Egdahl, .'31 :79 Insulin Secretion and the Problem of Insulin Assay, Frederick C. Goetz, Eugene A. Johnson and Richard Egdahl, 31:79 Interstitial Radium Therapy, John F. Dillon, 32: 234 Irradiation; see Lee, Salmon, Mossl'r, Loken, .'31:.54.5 Jabbour, J. T.; see Maynard l\f. Cohen, et. a!. 31 :,'302 Johnson, Eugene A.; see Frederick C. Goetz, et. aI. 31:79 Johnson, Eugene A.; see Kleinman, Herman, et. a!. 31 :263 Kanner, Leo, Child Psychiatry-Rl'trospect and Prospect, ,'31 :290 Kennedy, B. J., Anthanasios Theologides, John Foley and Ignacio Fortuny, Current Aspects of Cancer Chemotherapy, .'32:294 Kimball, Anne c.; see Herman Kleinman, et. a!. 31:263 Kleinman, Herman, Robert N. Barr, Henry Bauer, Eugene A. Johnson, Mauricio Martins da Silva, Anne C. Kimball and Marion K. Cooney, Field Trials with the Lederle-Cox Strains of Live Poliovirus Vaccines: A Short Review, 31 :263 Kottke, Frederic J., William G. Kubicek, Mildren E. Olson and Ruth H. Hastings, Studies on the Work of the Heart in a Hospital Environment, 32:114 Krivit, William; see Herschel P. Bentley, ,'31:166 Kubicek, vVilliam c.; see Frederic J. Kottke, et. aI. :32: 114 . Kusske, Bradley W.; see Jerome A. Hilger, et. aI. 31 :402 Lee, Theresa C., Robert J. Salmon, Donn G. Mosser and Merle K. Loken, Effects of Irradiation on the Phosphatides from Normal and Tumor-Bearing Mice, 31 :.54.5 Lifson, Nathan, Doubly Labeled Water as a Possible Tool for Measurement of Energy and Material Balance, 31:218 Live Poliovirus Vaccines; see Kleinman, et. aI. 31 :26:3 Loken, Merle K.; see Theresa C. Lec, et. aI. 31:.54.5 Long, David M., Jr., and William C. Bernstein, Sexual Dysfunction Following Abdominoperineal Resection of the Rectum for Cancer: An Anatomic and Physiologic Study, 31 :384 Louden, Mary L.; see Naip Tuna, et. aI. 31: 1,'34 Lumbar Lordosis, sec Schoening, 31: 1.58 Lund, Richard R.; see Jerome A. Hilger, et. aI. 31 :402 . MacArthur, John D., and Brown, E. B. Effects of Hydrogen Ion Concentration and Carbon Dioxide Tension on Oxyhemoglobin Dissociation, ,'31 :462 Marvin, James F.; see Earl G. Yonehio, et. aI. ,'31 :2.50 Maternal Mortality Study; see McKelvey,31:197 Matthews, James H.; see Murray A. Tanasichuk, et. aI. ,'31 :.596 McFee, Arthur S.; see Norman B. 411 THE MEDICAL BULLETIN Ackennan, et. aI. 31 :334 McKelvey, J. L., The Minnesota Maternal Mortality Study, 31: 197 McLaren, LeRoy C., and John J. Holland, Some Aspects of VirusCell Relationship, 31: 143 Measurement of Energy; see Lifson, 31 :218 Medical Citizen, Leo G. Rigler, 32:36 Medical Education; see Bowers, 31:413 Meier, Manfred J., and L. A. French, Quantitative Assessment of Handwriting and Gait in Parkinson's Disease, .'31:611 Michels, Kathleen Shane; see Erhard Haus, et. al. 32: 134 Microelectrode Investigation; see Chou, 31:330 Minnesota Maternal Mortality Study, J. L. McKelvey, .'31: 197 Moe, John H.; see Richard D. Granquist, et. al. 31 :504 Moe, John H.; see Gilbert A. Bacon, 32:312 Morphologic Histochemical Studies of Aminopeptidase in Surgical and Autopsy Specimens, Mitchell Rosenholtz and Lee \V. \Vattenberg, 31:62 Mosser, Donn G.; see Theresa C. Lee, ct. al. 31 :545 Myocardial Ultrastructure; see Nelson, Benson, 32:260 Nelson, Douglas A., and Ellis S. Benson, Observations on Myocardial Ultrastructure, 32: 260 Nerenberg, Sidney; see John P. Wendland, 31 :482 Nephrosis; see Hunt and Alexander, 31:526 Nervous System; see Cohen, Torres, Frank and Jabbour, 31:302 Nursing Education to Meet Today's Needs, Edna L. Fritz, 31:586 Observations on Medical Education, Here and Abroad, John Z. Bowers, 31:413 Observations on Myocardial Ultra412 structure, Douglas A. Nelson, and Ellis S. Benson, 32:260 Observations of Radioactive Iron Uptake by Malignant Tissue and its Possible Relationship to Anemia, Earl G. Yonehiro, John F. Perry, Jr., Donald Shahon, James F. Marvin and Owen H. \Vangensteen, 31:2.50 Olson, Mildred K; see Frederic J. Kottke, et. al. 32: 114 . Osteomyelitis; see Gnm(luist, Arnesen, and Moe, 31:504 Ostosclerosis; see Boies, Hohmann, and Sigel, 32:348 Oxyhemoglobin Dissociation; see MacArthur and Brown, 31:462 Pankey, George A., A Review of Cases Seen at the University of . Minnesota Hospitals, 1939-19.59, 31:557 Parkinson's Disease, see Meier and French, 31 :611 Pelvic Tilt; see Schoening, 31: 158 Percutaneous Arterial Catheterization and its Applications, Kurt Amplatz, 31:339 Perry, John F., Jr.; see Earl G. Yonehiro, et. al. 31 :2.50 Pharynx; see Hilger, Kusske, Lund and Van De Water, 31 :402 Phosphatides; see Lee, Salmon, Mosser, Loken, 31:545 Pituitary Isografts; see Haus, Halberg, Smith and Michels, 32: 134 Pregnancy; see Wells, 31:186 Primary Bone Tumor Study, 19401956, Gilbert A. Bacon and John H. Moe, .'32:.'312 Psychiatry; see Kanner, 31 :290 Quantitative Assessment of Handwriting and Gait in Parkinson's Disease, Manfred J. Meier, and Lyle A. French, 31 :611 Quie, Paul G., and Lewis W. Wannamaker, An Unusual Staphylococcal Product and its Host Interactions, 32:125 Radioactive Iron; see Yonehiro, Perry, , 1 , I ~ THE J\fEDICAL BULLETIN Shahon, Marvin and vVangensteen, 31:250 Radioautography; see Ackerman, McFee, and Wangensteen, 32:3.'34 Radium Therapy; see Dillon, 32:234 Rationale and Teclmirlue for Diagnosis of Gastric Malignancy by In Vivo Balloon Radioautography, Norman B. Ackerman, Arthur S. McFee, and Owen H. Wangensteen, 32 :250 Rectum; see Long amI Bernstein, 31:,'384 Reiser, Milton P.; see A. Hakim, et. aI. .'31:4.'34 Reiter Protein Complement Fixation Test; see Binder, 31 :106 Relationship betwcen Pelvic Tilt and Lumbar Lordosis, Herbert A. Schoening, 31: 158 Research Studies Related to the Surgical Treatment of Clinical Otosclerosis, L. R. Boies, Albert Hohmann, and Melvin Sigel, 32:348 Retrospect and Prospect, Owen H. Wangensteen, 31 :351 Rigler, Leo G., The Medical Citizen, 32:36 RosenhoItz, Mitchell and Wattenberg, Lee W., Morphologic Histochemical Studies of Aminopeptidase in Surgical and Autopsy Specimens, 31:62 Salmon, Robert T.; see Theresa C. Lee, et. aI. 3i :545 Schoening, Herbert A., The Relationship Between Pelvic Tilt and Lumbar Lordosis, 31: 158 Scholarship; see Blegen, 31 :89 Schultz, Earl A.; sec Murray A. Tanasichuk, et. aI. 31 :596 Sexual Dysfunction Following Abdominoperineal Resection of the Rectum for Canccr: An Anatomic and Physiological Study, David M. Long, Jr. and William C. Bernstein, 31 :384 Shahon, Donald; see Earl G. Yonehira, et. aI. 31:250 Sigel, Melvin; see L. R. Boies, ct. aI. 32:348 Skin; see ZeIickson, 32:74 Smith, Darlene D.; sce Erhard Haus, ct. aI. 32: 134 Some Aspects of Microelectrode Investigation of the Cerebral Cortcx of Cats, Shelley N. Chou, 31 :330 Some Aspects of Virus-Ccll Relationships, LeRoy C. McLaren and John J. Holland, 31: 143 Some Issues Facing thc Amcrican High School, Robert H. Bcck, 31: u.'3 Somc thoughts on thc Nature and Meaning of Scholarship, Thcodorc C. Blegcn, ,'31:89 Spinal Motoneurons; see Terzuolo, 32:180 Staphylococcal Products; sce Quie and Wannamaker, 32: 12.5 State Welfare; see Baker, 31 :446 Stokes-Adams Attacks; see Tobian, 32:82 St::dies on "Serum .Fatty Acid~ of Normal AmerIcans and Normal" Japanese, Naip Tuna, Mary L. Louden, and Mary J. Sundeen, 31: 134 Studies on the vVork of the Heart in a Hospital Environment, Frederic T. Kottke, William G. Kubicek, 'Mildred E. Olson, and Ruth Hastings, 32: 114 Study of Human Chromosomes, Robert C. Goodlin, 32:170 Subacute Bacterial Endocarditis: A Review of Cases Seen at the University of Minnesota Hospitals, ] 939-1959, George A. Pankey, 31:5.57 Sundeen, Mary S.; see Naip Tuna, et. aI. 31:134 Surgical Treatment; see Boies, Hohmann and Sigel, 32:348 Syphilis; see Binder, .'31: 106 Tanasichuk, Murray A., Earl A. Schultz, James H. Matthews and Frederick H. Van Bergen, Hemi413 THE MEDICAL BULLETIN spinal Anesthesia: Its Applicability and its Relation to Hypotension in Geriatric Patients, 31:596 Temporal Lobe; see Wendland and Nerenberg, 31 :482 Terzuolo, Carlo A., The Action Potential of Spinal Motoneurons, 32: 180 Theologides, Athanasios; see B. J. Kennedy, et. a1. 32:294 Three-Hydroxysteroid Dehydrogenase Activity in Mammalian Liver, Frank Ungar 31 :226 Tobian, Louis, Treatment of StokesAdams Attacks by Lowering Plasma Potassium with Chlorothiazide, 32: 82 Torres, Fernando; see Maynard M. Cohen, et. a1. 31 :302 Transplantation of Vesical Mucosa to the Intenstine: An Experimental Study, Ali Hakim, Milton P. Reiser, and C. D. Creevy, 31 :434 Treatment of Stokes-Adams Attacks by Lowering Plasma Potassium with Chlorothiazide, Louis Tobian, 32:82 Tubocurarine; see Westgate, Gordon and Van Bergen, 32:378 Tuna, Naip, Mary L. Louden and Mary J. Sundeen, Studies on Serum Fatty Acids of "Normal" Americans and "Normal" Japanese, 31: 134 Ungar, Frank, 3-Hydroxysteroid Dehydrogenase Activity in Mammalian Liver, 31 :226 University Hospitals in the State Welfare Structure, Annie Laurie Baker, 31:446 Unusual Staphylococcal Product and Its Host Interactions, Paul G. Quie and Lewis W. Wannamaker, 32: 125 414 Van Bergen, Frederick H.; see Murray A. Tanasichuk, et. a1. 31 :596 Van Bergen, Frederick H.; see Hugh D. Westgate, et. a1. 32:378 Van De Water, Frank; see Jerome A. Hilger, et. a1. 31:402 Vesical Mucosa; see Hakim, Reiser, and Creevy, 31:434 Virus-Cell Relationships; see McLaren and Holland, ·31: 143 \Vangensteen, Owen H.; see Earl G. Yonehiro, et. aI., 31:250 Wangensteen, Owen H., Restrospect and Prospect, 31 :351 Wangensteen, Owen H.; sce Norman B. Ackerman, et. aI., 32:334 \Vannamker, Lewis W.; see Paul G. Quie, 32: 125 Wattenberg, Lee W.; see Mitchell Rosenholtz, 31 :62 Wells, Lemen J., Fetal Endocrinology with a Consideration of Diabetes and Pregnancy, 31: 186 Wendland, John P. and Sidney Nerenberg, The Geniculocalearine ~~~lway in the Temporal Lobe, 31: Westgate, Hugh D., J. R. Gordon, and Frederick H. Van Bergen, Changes in Airway Resistance Following Intravenously Administered D-Tubocurarine, 32: 378 Wisiol, Erich S., Lyle A. French and Shelley N. Chou, Carotid Endarterectomy, 32: 243 Yonehiro, Earl G., John F. Perry, Jr., Donald Shahon, James F. Marvin and Owen H. Wangensteen, Observations of Radioactive Iron Uptake by Malignant Tissue and Its Possible Relationship to Anemia, 31:250 Zelickson, Alvin S., Electron Microscopy of Human Skin, 32:74 1 1 • Medical School News I CLASS OF 1961 HONORED ON RECOGNITION DAY Traditional Recognition Day Exercises were observed June 9 at the Medical School for 114 members of the Class of 1961. The graduating seniors and faculty of the medical school marched in academic procession to Mayo Auditorium were Dr. Chester Scott Keefer, Professor of Medicine at Boston University Medical School, delivered the Recognition Day address. His topic was "The University and Medicine." Dr. Robert B. Howard, Dean of the Medical School, presided at the exercises, and Dr. Wallace H. Cole, (Med. '10), professor emeritus of orthopedic surgery, administered the Declaration of Geneva to the graduates. Dr. Martin G. Bruhl (Med. '61) received the Southern Minnesota Medical Association Award given to the member of the Senior Class who has demonstrated ontstanding proficiency in medicine and surgery. Dr. Fred L. Shapiro (Med. '61) received the Borden Award for significant contributions to research during student years, and G. Nicholas Rogentine, a medical school junior, received the Mediclinics Award for exemplary scholastic and professional achievement. Dr. Edward S. Peterka (Med. '61) was named winner of the Minnesota Dermatological Society Award for writing a meritorious essay on a dermatological topic, and Dr. Ronald D. Guttman (Med. '61) received the Rollin E. Cntts Memorial Award for having demonstrated ontstanding proficiency in surgery. Graduates, parents and guests gathered in the evening for a Senior Class banquet at Coffman Memorial Union. Dr. Donn G. Mosser, Professor of Radiation Therapy, was Master of Ceremonies, and the main address was given by Dr. M. John Murray, Assistant Professor of Medicine. Dr. Evan L. Nelson, Jr., (Meet '61) gave the Class Response. 415 DR. GEORGE E. FAHR TO BE HONORED ON 80th BIRTHDAY Friends and former students of Dr. George E. Fahr are planning a testimonial celebration honoring him at the Universitv of Minnesota Medical School on January 2.5, 1962, the occasion of his 80th birthdav. . Dr. Fahr, emeritus professor of medicine, is widely known as the American disciple of Willem Einthoven, father of electrocardiography. Dr. Fahr's teaching and scientific achievements during 40 years on the faculty at the Medical School are legendary. He retired in 1950, but remains active in Minneapolis medical circles. A committee of physicians whose medical careers he influenced have announced plans to present the Medical School with a portrait of Dr. Fahr, especially painted for the occasion, which will be hung alongside those of other distinguished medical teachers at the Universitv. Papers written by his former students will be presented during a day-long scienGt'orge E. Fahr tific session at the Medical Center. There will be an honorary luncheon and formal dinner in the evening. Dr. Arthur C. Kerkhof, Minneapolis cardiologist, announced the committee has asked for gifts from several hundred former students of Dr. Fahr. Contributions will be used to finance the event, and to endow a George E. Fahr Medical Scholarship, which would be given each year to an outstanding medical student at the University. A festschrift containing all papers on the scientific program, Dr. Fahr's biography, his memoirs of Einthoven, and the evening's main address will be bound and copies given to all who contribute .$30.00 or more. Contributions are welcome and may be sent in care of the Minnesota Medical Foundation, 1342' Mayo Memorial Bldg., University of Minnesota, Minneapolis 14. Make checks payahle to: "Minnesota Medical Foundation, George Fahr Fund." Scientific papers IJy former students of Dr. Fahr are invited. They are limited to 12 minutes' presentation time, and must he douMe spaced on not more than six typewritten pages. Manuscripts must he suhmitted by Octoher 1, 1961 to Dr. A. C. KerkllOf, 601 Medical Arts Bldg., Minneapolis 2, Minn. 416 i 1 ') 1 1 " 1 1 1 1 1 ~ Faculty News ( f ~ fr PHYSIOLOGY Dr. Maurice B. Visscher, professor and head of the department, was elected to the executive board of the National Society for Medical Research at the group's 1961 annual meeting. The Society, established in 1945, is concerned chiefly with promoting public understanding of the methods, needs and accomplishments of medical research. Dr. Robert E. Swanson, assistant professor, was appointed an associate professor of physiology at the University of Oregon Medical School. His appointment was effective June 1, 1961. DERMATOLOGY Dr. Francis W. Lvnch, director of the division, has been elected a correspondiri. g member of the Danish Dermatological Society. MEDICINE Dr. Wesley W. Spink has been certified by the American Board of Microbiology as one nine eminent scientists qualified in public health and medical laboratory microbiology. The American Academy of Microbiology, which announced the certification, recognized Dr. Spink for his discovery of an effective treatment of brucellosis in man. The late Dr. Jerome T. Syverton, former head of the Medical School's department of bacteriology and immunology, who died January 28, 1961, was certified posthumously. ANATOMY At the Annual Meeting of the American College of Chest Physicians in New York on June 25, 1961, Dr. E. A. Boyden, former Head of the Department of Anatomy at Minnesota was awarded an honorary fellowship in the American College of Chest Physicians. Others receiving this honor at the same meeting were Dr. Luther L. Terry, Surgeon General of the United States Public Health Service and Rear Admiral Edward C. Kenney, Surgeon General of the United States Navy. 417 Medical Foundation News MEDICAL FOUNDAnON RECEIVES LARGE BEQUEST The Minnesota Medical Foundation has announced receipt of a be(luest of $215,000 from the estate of the late Arvid Olson, a North Dakota farmer and merchant who died in 1958. It was the largest single gift in the 22-year history of the Foundation, an organization of alumni, physicians, corporations, and citizens providing private support for the University of Minnesota Medical School. Under the terms of the bequest, the Foundation will use the funds to finance medical research in heart disease and cancer. Dr. Arnold Lazarow, Foundation president, said a new program is being formulated which would make the research funds available primarily to meritorious projects and younger scientists at the Medical School. "We will attempt to provide assistance for projects and men who are not vet well known, and therefore ~nable to readilv attract research grants from th~ customary sources," he said. The Foundation's Research Grants Committee, headed by Dr. John A. Anderson, is formulating a new medical research program to be financed bv annual inARNOLD LAZAROW come from the be(luest. Dr. Lazarow called Mr. Olson's bequest "one of the most significant gifts ever received by the Foundation," enabling the organization to launch an entirely new support program for the Medical School. He praised the donor for providing a "local source" of research funds, and said the Foundation hoped to interest other donors in investing gifts for medical research purposes through the Foundation. Mr. Olson's bequest more than tripled the existing assets of the Foundation, which was organized in 1939 to attract and disburse funds for private support of the Medical School. 418 r ft fr t DR. N. L. GAULT TO SPEAK ON MEDICAL FOUNDATION DAY Dr. N. L. Gault, Assistant Dean of the Medical School, will give the annual Minnesota Medical Foundation Day address on September 25, 1961, as the 1961-62 academic year commences. For the past two years, Dr. Gault has been an advisor in medicine to the Seoul National University School of Medicine, Korea, under the' medical teaching exchange program. His wife and family have been with him in Korea during the past two years, and Dr. Gault has been eyewitness to some of the most turbulent ~vents in Korean historv. He will also evaluate the results of the Korean teaching exchange program, which was established in 1954, and which will be concluded in 1961. N. L. GAULT Invitations to Foundation Day events, including ceremonies awarding medical scholarships and the Foundation's 1961 annual luncheon meeting, will be sent to all members in August. FRESHMAN SCHOLARSHIP WINNERS NAMED BY MEDICAL FOUNDATION Minnesota Medical Foundation scholarships of $500 each for work in the University of Minnesota medical school next fall have been won by 14 incoming freshman medical students. The recipients, chosen on the basis of scholastic achievement and financial need, according to Dr. Arnold Lazarow, foundation president, were: Marian R. Karlstrom, David M. Thompson, Yossef Aelony, David Collin, and Guy E. O'Grady, all of Minneapolis, and Dale Von Ruden, St. Paul. Out-state winners of the Minnesota Medical Foundation awards were: Paul Vander Kooi, Herman; Darla Ann Bjork, Austin; James S. Good, Faribault; Darrel L. Lary, Northfield; James J. Nordlund, White Bear Lake; David Raetz, Maple Lake; Elton G. Wing, Trimont, and Daniel J. Murphy, Dallas, Texas. The Minnesota Medical Foundation is a non-profit private organization of alumni, physicians, faculty and friends of the University of Minnesota medical school established in 1939 to assist the school. The foundation awards to students now total $117,000 in scholarship funds to 229 medical students. Awards to sophomore, junior and senior students will be announced later in the year. 4H.l Alumni Notes • 1920 Lillian M. Fink was honored with the University of Minnesota Alumni Service Award. She received the' award on Charter Day, 1961, from Stanley J. Wenberg, Vice President of the University of Minnesota, in recognition of her "intense concern with promoting the interest of the students at the University, particularly women in medicine." She is a past president of the Minnesota Alumnae Association, and has served the parent Minnesota Alumni Association as a member of the Board of Directors for twelve years. • 1922 Leonard W. Larson, Bismarck, N.D., pathologist, was installed as President of the American Medical Association on June 27, 1961, in New York City. He recently received an honorary doctor of science degree from Jamestown College, Jamestown, N.D. LEONARD W. LARSON • 1924 Harvey Nelson, Minneapolis physician, received a University of Minnesota Alumni Service Award on February 23, 1961, the HOth birthday of the University of Minnesota. A past president of Minnesota Alumni Association. Dr. Nelson was cited for furthering closer relations between the association and the University's Board of Regents, and for strengthening the freshman scholarship program. • 1935 Laurentius O. Underdahl, consulting physician at the Mayo Clinic, was elected secretary of the American Diabetes Association at its 21st annual mee"ting recently in New York. • 1937 T. J. Bloedel, Osseo, Minn., is president of Psi chapter, Alpha Kappa Kappa medical fraternity, which held its 63rd annual meeting recently in St. Paul. Secretary-treasurer is Dr. K. O. Nimlos (Med. '46), St. Paul. 420 1 ., "1 1 1 1 1 1 1 THE MEDICAL BULLETIN • 1937 Jerome Hilger, St. Paul, was elected president of the Minnesota Academy of Ophthalmology and Otolaryngology for 1961-62. Dr. Harold Ulvestad (Med. '44) of Minneapolis and Dr. Robert Hugh Monahan (Med. '42) of St. Paul were named vice presidents. Dr. Richard O. Leavenworth (Med. '50) of St. Louis Park was reelected secretary-treasurer. ft • 1939 Jane E. Hodgson, St. Paul obstetrician and gynecologist, spent the month of May teaching and working in a mission hospital operated by the Augustana Lutheran church in Tanganyika, East Africa. She was accompanied by her husband, Dr. Frank W. Quattlebaum, a surgeon. JEROME HILGER • 1942 Virgil J. P. Lundquist, Minneapolis surgeon, has been installed as President of the Minnesota Alumni Association, parent alumni body with 17,000 members representing all colleges within the University of Minnesota. He is also serving as general chairman of the medical alumni campaign to build a medical student center at the Medical School, and recently received a certificate of merit for distinguished service as 19,59-60 president of the Minnesota Medical Alumni Association. • 1944 David D. Daly a consultant in neurology, will leave the Mayo Clinic, Rochester, on August 15, 1961, to join the staff of the new Barrow Neurological Institute, Phoenix, Ariz. He was named chairman of the division of neurology. Dr. Daly joined the staff of the Mavo Clinic in 1951 and had served continuouslv there since. . . • 1953 James R. Jude, resident in surgery at the Johns Hopkins Medical Institutions, Baltimore, Md., was chosen 1961 recipient of the Francis F. Schwentker Award for a research paper entitled "A New Approach to Cardiac Resuscitation." The prize consists of $100 and an inscribed medal, presented annually in recognition of outstanding research work. Dr. Jude has been John Hopkins since 1953, except for two years when he was in active militarv service. 421 THE MEDICAL BULLETIN • 1955 Charles Zinn, a native of \Vavzata, Minn., recentlv returned to his home town to become a;sociated in practice'with Drs. W. W. Rieke (Med. '32) and D. W. Feigal (Med. '42). Dr. Zinn interned at Ancker hospital, St. Paul, and has practiced since then at Elk River, Minn. • 1956 M. Donald Olmanson, St. Peter, Minn. physician, accepted a two year appointment as a medical practitioner with the American Medical Center for Burma. There he will be associated with Dr. Gordon Seagrave, the famed "Burma Surgeon," in the Namkham hospital. Mrs. Olmanson and his family will accompany Dr. Olmanson. They were scheduled to leave July 1, • 1957 Joseph H. Eusterman has entered the U.S. Navy and been assigned as a medical officer at the Naval Hospital, Bethesda, Md. • 1959 Ronald J. Nelson was married June 10, 1961 in Los Angeles, Calif. to Miss Ruth Needles of Santa Barbara, Claif. Dr. Nelson is preparing for a career as a medical missionary and is presentlv a surgical resident at the University of Washington. He was president of the 19,59 Class of the Universit~, of Minnesota Medical School. • 1959 Homer H. Russ, who practices in LeCenter, Minn., was appointed LeSueur Countv health officer for 1961 by the board of countv commissioners. 422 r fr f CLASS OF 1960 FACING NEW MEDICAL CHALLENGES Members of the Class of 1960, University of Minnesota Medical School, are scattering far and wide to new assignments and challenges following completion of their internship training. A survey conducted by the MEDICAL BULLETIN, in cooperation with class president Dr. Ken Manick, indicates nearly half of the 122 new doctors (,')3) have elected to enter advanced medical training as residents and fellows. Another large group (3,,)) have launched into general practice of medicine, some on their own, but most in association with established physicians and medical clinics. Twenty are in military service, and the remainder who answered the survev are busv with a ". variety of medical endeavors. Most exciting prospect belongs to Dr. Jim Man!twrdt, who is spending the summer in Alaska, serving as physician accompanying a team of climbers attempting to scale Mt. McKinley, the highest peak in North America. Results of the survey: Eugene L. Acuff received an appointment as a resident in internal medicine at the Mavo Clinic, Rochester, Minn. Paul Albrecht has become ass"ociated with the medical staff at the Sparta Clinic, Sparta, Wisconsin. John G. Albright has begun the general practice of medicine at 220 Iroquois Street, Laurium, Michigan. James R. Allen's plans were uncertain. Loren Anderson is doing research in physiology at Northwestern University. His address is Abbott Hall, 710 N. Lake Shore Drive, Chicago 11, lllinois. Richard O. Anderson will take a residencv in medicinc at the Strong Memorial Hospital, Rochester, New York. Costas Assimacopoulos has begun a residency in surgery at the University of Minnesota Hospitals. Gary H. Babb is now with the U. S. Public Health Service, Indian Division, and is practicing at the U.S.P.H.S. Health Center, White Earth Indian Reservation, White Earth, Minn. He plans a residency in internal medicine following two years of duty with U.S.P.H.S. C. Robert Baker has gone into general practice at 170,'3 Selby Avenue, St. Paul, Minn. David W. Bean is a medical officer in the U. S. Air Force, stationed at Minot Air Force Base, Minot, North Dakota. Donovan L. Beckman has entered the U. S. Navv. His home address is 2216 Elliot Ave. S., Minneapolis 4, "Minn, 423 t THE MEDICAL BULLETIN Roger J. Benjamin has begun a residency in surgery at Ancker Hospital, St. Paul. Julian L. Berman is taking a genetics-pediatrics residency at Children's Hospital, Northwestern University, Chicago, Ill. Ernest T. Bohland has become associated with the Palen Clinic, a group practice in Minneapolis, Minn. His home address is 2021 26th Ave. S., Minneapolis 6, Minn. Jon E. Boline is a Captain in the U. S. Army Medical Corps, stationed at Schofield Barracks, Oahu, Hawaii. Ray I. Brace is joining Dr. Carl Christenson (Med. '59) in private practice at Clinton, Minn. Harold R. Broman, Jr., will practice general medicine in North St. Paul, Minn., in association with Dr. A. E. Muller and Dr. Charles J. Beck (Med. '40). His home address is 2540 E. 19th Ave., North St. Paul, Minn. Robert Dean Bugby has begun a radiology residency at the Minneapolis Veterans Administration Hospital. His home address is 5308 Bloomington Ave., Minneapolis. Tom Casey will take a general practice residency at Contra Costa County Hospital, 2500 Alhambra Ave., Martinez, California. William L. Christian has joined two generalists in a group practice in Austin, Minn. His address is c/o the Medical Building, Austin. C. Carlyle Clawson is taking a residency in pediatrics at the University of Minnesota Hospitals. Sheldon W. Damberg has been appointed a resident in radiology at Minneapolis Veterans Administration Hospital. Joseph Davidson (no response). Lawrence W. DeSanto is taking a residency in internal medicine at the Mayo Clinic, Rochester, Minn. Daniel L. de Ward is taking a residency in ear, nose, and throat at the Mayo Clinic, Rochester, but may be entering military service soon. Robert A. Diamond has entered the U. S. Army as a medical officer. His home address is 3949 Zenith Ave. S., Minneapolis. Owen P. Doyle is taking a surgical residency at the Southern Pacific General Hospital, San Francisco, Calif. Joe Eckert is in the U. S. Air Force and is taking a residency in radiology at Brooke General Hospital, San Antonio, Texas. His address is 322 Artemis Ave., San Antonio. Dale L. Eichelberger is now in the U. S. Navy, as a medical officer with the 3rd Marine Division. His home address is Route I, Box 208, Alexandria, Minn. 424 1 , 1, 1 ~ 1 1 1 t r THE MEDICAL BULLETIN William B. Eilers has gone into general practice in Minot, North Dakota. His address is 1309 Fourth St. N.E., Minot. Orland D. Eliason has begun a residency in urology at Minneapolis Veterans Administration Hospital. He expected a draft call during the summer. James L. Erickson has gone into private practice at 5643 Pia Street, Honolulu 16, Hawaii. James D. Fett (no response). Harold Gambill is taking a residency in internal medicine at Highland Hospital, Oakland, Calif. His address is 2701 14th Ave., Oakland 6, Calif. James G. Garber (no response). Wendell Geary received a staff appointment for general practice at the Berrien County Hospital, Berrien Center, Mich., effective September 1, 1961. Alvan R. Gendein is a resident in psychiatry at Presbyterian St. Luke's Hospital, Chicago, 111. Mace G. Goldfarb will take a pediatrics residency at University of Minnesota Hospitals. His address will be 2246 W. Seventh St., St. Paul 16. Gordon O. Greene has joined two other physicians in a group practice at Arlington, Minn. John A. Grover has begun a two-year assignment with the U. S. Public Health Service. He is stationed at the U.S.P.H.S. Outpatient Clinic, Cleveland, Ohio. Elizabeth M. Haaland is married to Dr. Robert Lee Johnson, Minneapolis, of the class of 1960. Hovald K. Helseth, Jr. has become associated in practice with the Adams Clinic, Chisholm, Minn. John C. Henry (no response). Richard T. Henry is practicing general medicine at Foley, Minn., in association with Dr. Clifford Stiles. Norman P. Herman (no response). Clement N. Herred (no response). Bruce H. Hiller has begun a residency ill psychiatry at University of Minnesota Hospitals. C. John Hodgson accepted an appointment as a resident ill neurology at the Mayo Foundation, Mayo Clinic, Rochester, Minn. His home address is 1517 Durand Court, Rochester. David Hopkins is practicing in partnership with another physician in Tacoma, Washington. His address is c/o MedicalDental Bldg., Brown's Point, Tacoma. Vincent R. Hunt has begun the general practice of medicine at Red Lake Falls, Minn. 425 I THE lIIEDICAL BULLETIN Phil Iversiie is piacticing in association with a group of physicians in North Minneapolis. His address is 7301 Riverdale Road, Minneapolis 12. Clarence A. Jenike is a resident in radiology at St. Joseph's Hospital in Denver, Colo. Alan R. Johnson is in the U. S. Navy and in training at the Naval School of Aviation Medicine, Pensacola, Fla. His home address is 880 20th Ave. S.E., Minneapolis 14, Minn. Arthur G. Johnson is in general practice with the medical staff at Park Region Medical Center, Fergus Falls, Minn. Robert Lee Johnson is taking a residency in internal medicine at the Veterans Administration Hospital, Minneapolis. His address is 2609 9th St. S., Minneapolis. His wife is Dr. Elizabeth M. Haaland. Thomas P. Johnson is taking a residency in psychiatry at the Menninger Clinic, Topeka, Kansas. His address is c/o 1821 Independence Ave. S., Minneapolis 26, Minn. Eugene R. Jonas has begun the general practice of medicine at Ellsworth, Wis. As an intern at Minneapolis General Hospital, he received a citation from the City of Minneapolis for outstanding service rendered the department of police while on emergency ambulance runs. Robert E. Kalina is taking a residency in ophthalmology at the University of Oregon Medical School Hospital, Portland, Oregon. The address is 3181 S.W. Sam Jackson Park Board, Portland 1. Arnold P. Kaplan has begun a residency in medicine at Mt. Sinai Hospital, Minneapolis, Minn. Charles E. Keenan, Jr. (no response). John Clark Kelly is living at 783 Armstrong Ave., St. Paul 2, Minn., while taking a radiology residency at University of Minnesota Hospitals. Tom Kenefick has begun a residency in neurologic surgery at the Mavo Clinic, Rochester, Minn. His address is 1704 Second ·St. S.W., Rochester. William N. Kinney has joined the medical staff of the Little Falls Medical Center, Little Falls, Minn., in the general practice of medicine. James F. Knapp's plans were uncertain. His present address is 118 S. Van Buren Ave., Hopkins, Minn. Robert J. Knip has begun general practice in association with the Hedemark Clinic, Ortonville, Minn. He is the third physician on the staff. 426 1 1 ~ , 1 1 1 1 11 1 THE MEDICAL BULLETIN f• ~ Michael F. Koch is entering military service. His home address is 611 First Street S.W., Wadena, Minnesota. John B. LaLonde (No response) Shirley Lansky was undecided about her next medical assignment. John E. Larkin is taking a residency in surgery at Harvard Medical School, Boston, Mass. His address is c/o Harvard Surgery Service, Boston City Hospital, Boston 18, Mass. Thaddeus J. Lelwica is in the U.S. Air Force. His home address is 1634 Gilmore Avenue, Winona, Minn. Michael D. Levitt is taking a residency in medicine at the Massachusetts Memorial Hospital, Boston, Mass. Morris L. Lommen is practicing general medicine in a threeman medical clinic in Austin, Minn. His address is 309 Fifth Ave. S.W., Austin. Murray W. Lufkin is in the U.S. Navy and under training at the Naval School of Aviation Medicine, Pensacola, Fla. His home address is 330 E. Diamond Lake Road, Minneapolis, Minn. John D. MacArthur has begun a residency in surgery at Peter Bent Brigham Hospital, Boston, Mass. James Duncan MacGibbon has begun practice in Minneapolis in association with Dr. Dean K. Rizer at the Medical Arts Building. Kenneth P. Manick has begun a residency in dermatologv at University of Minnesota Hospitals. His address is 727 E. 14th Street, Minneapolis, Minn. James E. Marquardt is spending the summer as a doctor accompanying a mountaineering expedition on Mt. McKinley, Alaska. He has also received a fellowship in research with the department of surgery, Los Angeles County General Hospital. His address is 1200 N. State Street, Los Angeles 33, Calif. John M. McKelvey has begun a residency in neurology at the University of Minnesota Hospitals, Minneapolis, Minn. John A. McLeod is engaged in general practice in association with the Mesaba Clinic, Chisholm, Minnesota. Fred E. Mecklenburg is taking a residency in obstetrics and gynecology at University of Minnesota Hospitals. Charles B. MerciI is practicing general medicine alone at Mahnomen, Minn. Robert M. Morse has entered the U.S. Air Force, and was to receive his duty assignment on September I, 1961. 427 I THE l\'1EDICAL BULLETIN Roger D. Morse began the general practice of medicine at LeRoy, Minn., although he anticipated being drafted soon. Ronald A. Moss accepted a residency in pathology at Louisiana State University Medical School, New Orleans, La. Ronald John Nels~n is in the U.S. Air Force. His home adress is 3508 40th Ave. S., Minneapolis 6, Minn. Bruce C. Nydahl is taking a residency in internal medicine at Highland-Alameda County Hospital, and his address is 1340 E. 28th Street, Oakland 6, Calif. John A. Ochsner is taking a residency in urology at Milwaukee County Hospital, Milwaukee, Wis. His address is 3338 W. Highland Blvd., Milwaukee 8, Wis. Barbara Ford Olson is taking a residency in anesthesiology at University Hospitals, Cleveland, Ohio. Richard E. Olson has begun a residency in internal medicine at San Diego County Hospital, San Diego 3, Calif. Betty J. Oseid is taking a pediatric residency at University of Minnesota Hospitals. Henry J. Osekowsky is in general practice at 1074 S. Robert St., St. Paul, Minn. Charles R. Peterson (no response). Willard C. Peterson has begun a residency in dermatology at University of Minnesota Hospitals. Bernard Pollara received a postdoctoral research fellowship from the Arthritis & Rheumatism Foundation, and is conducting research at the University of Minnesota Hospitals while attached to the department of pediatrics. Roger H. Princell is in the U.S. Navy. His home address is 4018 Lyndale Ave. S., Minneapolis 9, Minn. George E. Reisdorf planned to begin general practice somewhere in rural Minnesota. Dennis M. Robertson is in the U.S. Public Health Service, Indian Division, and is practicing at an Indian reservation at Winnebago, Nebraska. Richard G. Rowe is in private practice in Littlefork, Minn., and is doing medical missionary work among Indians in Canada. Elliott L. Rustad has begun a residency in dermatology at University of Minnesota Hospitals. Jerry L. Schottler is taking a residency in surgery at Minneapolis Veterans Hospital. His address is 4916 First Ave. S., Minneapolis, Minn. Peter A. Schunk (no response). 428 1 1 1 1" ~ 11 1 1 1 1 I r ft, THE MEDICAL BULLETIN Sheldon J. Segal is a resident in surgery at Minneapolis Veterans Administration Hospital. Odean M. Severseike has begun general practice in association with the Belzer Clinic, 3809 42nd Ave. S., Minneapolis, Minnesota. David E. Siewert is a resident in medicine at Minneapolis Veterans Administration Hospital. His home address is 313 "c" Street N.E., Brainerd, Minn. Paul M. Silverstein lives at 2246 W. Seventh Street, St. Paul 16, Minn., and is taking a residency in neurology at University of Minnesota Hospitals. Warren F. Sims, Jr., is a resident in obstetrics & gynecology at Mary Fletcher Hospital, Burlington, Vt., where he took his internship. Olof S. Sohlberg has joined his father, Dr. O. I. Sohlberg (Med. '14) in general practice at .56.5 Lowry Medical Arts Bldg., St. Paul, Minn. Richard E. Streu is engaged in general practice in association with Drs. D. B. Frane (Med. '37) and E. Robert Schwartz (Med. 36) at 1206 42nd Ave. N., Minneapolis 12, Minn. James D. Swenson is associated with a group practice in Osage, Iowa. Gerald T. Telander is taking a residency in radiology at the University of California. His address is 67.5 4,5th Ave., San Francisco 21, Calif. Gershom J. Thompson, Jr., is taking a residency in psychiatry at Mayo Clinic, and his address is 1704 Second Street S.W., Rochester, Minn. Ronald L. Villella is in the U.S. Army, and is a resident in pathology at TripIer Army Hospital, Honolulu, Hawaii. His home address is 3932 Cedar Ave., Minneapolis, Minn. Louis A. Vontver is in the U.S. Air Force, stationed at the Tachikawa Air Force Base, Japan. His address is c/o A.P.O. 323, San Francisco, Calif. Darrell T. Weinman received an appointment as a resident in orthopedics at the Mayo Clinic, Rochester, Minn. Martin G. Weisberg (no response). Jon D. Wempner is a U.S. Public Health Service physician at the Indian Hospital, Gallup, New Mexico. L. Ashley Whitesell, Jr. is in general practice in Pineville, Louisiana, attached to the Huey P. Long Charity Hospital in that community. 429 THE MEDICAL BULLETIN Norman P. Wigg is in general practice as an associate of Dr. Walter Krafft (Med. '51) at the SOllthdale Medical Building, Minneapolis, Minn. His home address is 6034 Wentworth Ave. S., Minneapolis 19. Conrad J. Wilkowske is in the U.S. Air Force. His home address is 1803 S. Grove Street, Owatonna, Minn. Edward T. Wong is a resident in internal medicine at the Minneapolis Veterans Administration Hospital. His home address is 4141 Dupont Ave. S., Minneapolis 9, Minn. Philip J. Worrell is in general practice at 3819 W. Broadway, Robbinsdale, Minn., in association with Drs. Roger Lienke (Med. '46), Frank B. Rice (Med. '48), and Donald D. Metz. Thomas Jerry Wright is taking a residency in obstetrics and gynecology at Santa Clara County Hospital, San Jose, Calif. His address is 929 Princess Anne Drive, San Jose 2.5, Calif, MEDICAL FOUNDAnON GIVES CANCER RESEARCH GRANT The Minnesota Medical Foundation has granted $.'500.00 in cancer research funds to Dr. B. J. Kennedy, associate professor of medicine at the University of Minnesota Medical School. The grant is the third made for medical research since the Foundation was reOl'ganized in 1959, and is provided from gifts made in memorv of the late Mrs. Leona Mutch, Minneap·olis. Dr. Kennedy will use the grant to help finance cancer chemotherapy and metabolic studies in ambulatory patients in the V.F.W. Cancer Research Center at the University Hospitals. He said the Foundation grant will provide vital inB. J. KENNEDY terim support for his project until U.S. Public Health Service research funds become available. The Foundation generally grants funds for medical research at times and in situations where primary sources of funds are unavailable. Previous medical research grants made by the Foundation went to Dr. F. C. Goetz and Dr. Donald Duncan for studies related to developing substitutes for insulin in the treatment of diabetes. 430 I r f f THE MEDICAL BULLETIN ALUMNI DEATHS • 1905 Dr. John F. Hendrickson of Minneapolis died May 7, 1961. He was 89 vears old and a member of the American Medical Association fwd a life member of the Hennepin County Medical Societv. • 1913 Dr. Charles Clifford Hawke of Winfield, Kans., died January 13, 1961 of coronary thrombosis. He was a fellow of the American College of Surgeons, a veteran of World War I, and former city commissioner and mayor of Winfield. Dr. Hawke was 75 years old, and was on the staffs of St. Mary's and William Newton Memorial hospitals. 1926 Dr. Mark H. Wall, Mesa, Arizona, died in Januarv 1961 at the age of 62 years. He was a native of Eau Claire, ·Wis., and practiced many years in the Superior area before moving to Arizona. Dr. Wall was organizer and first president of the Arizona Amateur Athletic association, and was a member of the Maricopa (Arizona) County Medical Society. • • 1931 Dr. Max E. Pickworth, San Jose, Calif., died Februarv 14, 1961 of acute coronary thrombosis at the age of 54. He was born in Saskatoon, Canada. He was a specialist certified by the American Board of Surgery and a fellow of the American College of Surgeons. Dr. Pickworth served during World War II, and was a member of the staff of the San Jose Hospital and the O'Connor Hospital. • 1938 Dr. Robert A. Maves died Januarv 31, 1961, in Seattle, Washington, where he was in general practice. He was 46 years old. Dr. Maves was a veteran of World War II, and member of the American Academv of General Practice and American Medical Association. He spent his internship at Minneapolis General Hospital. • 1951 Dr. John Rosiak, Jr., of Minneapolis, died January 12, 1961 at the age of 40 years. Death was caused by a myocardial infarction. Dr. Kosiak interned at the Charles S. Silson Memorial Hospital in Johnson City, N.Y., and was practicing in Minneapolis. He was on the medical staff of St. Mary's Hospital. 4:31 I • 1954 Dr. Kathleen H. Decker died in Los Angeles, Calif. January 9, 1961, of injuries received in an automobile accident. She was 32 years old and a member of the American Medical Association. Dr. Decker had interned at Los Angeles County Hospital, and was later a resident physician and medical staff member there. She was recently associated with the Long Beach Memorial Hospital. Memorial Gifts Memorial gifts to the Minnesota Medical Foundation have been received recently in memory of: Mr. James Gardner Rainey Milwaukee, Wis. Baby Marion Lee Minneapolis, Minn. Mr. Cedric Adams Hopkins, Minnesota Mr. Frederick M. Atkinson Deephaven, Minnesota Mr. Ward Lucas Winona, Minnesota Mr. James Ford Bell Minneapolis, Minnesota Mrs. Louise Heffelfinger Bell Minneapolis, Minnesota Memorial contributions are a practical means of honoring the memory of a friend or loved one, while helping the Minnesota Medical Foundation in the advancement of medical education and research. Appropriate acknowledgements are promptly sent to both donor and family of the deceased. This is the concluding issue of Volume 32 of the Universitv of Minnesota MEDICAL BULLETIN, which has l;een published monthly in nine issues during the 1960-61 academic year. Publication of Volume 33 will begin in Octoher, 1961. 432 1 1 , 1 ~ 1 1 1 1 1 ~ 1 1 I ~ rr COIning Events University of Minnesota Medical School Continuation Medical Education Courses for Physicians University of Minnesota Center for Continuation Study September 18-21 October 2-4 . October 19-21 November 6-10 November 15-17 . r r November 16-18 . January 2-6 January 25-27 Februarv 12-17 March 5-7 March 16-17 April 12-14 April 16-18 April 3D-May 2 Mav 7-9 Mav 10-12 Mav 14-18 May 31-June 2 1961 Pediatrics for Pediatricians Obstetrics for Specialists Dermatology for General Physicians Radiology for Radiologists (U rologic Radiology) Ophthalmology (Refraction) for General Physicians Orthopedics for Orthopedic Surgeons and General Physicians (Hand Surgery) 1962 Intermediate Electrocardiography for General Physicians and Specialists Otolaryngology for Specialists Pediatric Neurology Anesthesia for General Physicians Treatment of Traumatic Injuries Otolaryngology for General Physicians Internal Medicine for Internists Gynecology for General Physicians Ophthalmology for Specialists Surgery for Surgeons Proctology for General Physicians Psychiatry for General Physicians The University of Minnesota reserves the right to change this schedule without notification. Courses are held at the Center for Continuation Study or the Mayo Memorial Auditorium on the campus of the University of Minnesota. Usual tuition fees are $30 for a two-day course, $50 for a three-day course, and $75 for a one-week course. These are subject to change under certain circumstances. Specific announcements are sent out for each course to all members of the Minnesota State Medical Association and to any physicians who request information for a specific course, about six weeks to two months before the date of the course. For further information write to: DIRECTOR DEPT. OF CONTINUATION MEDICAL EDUCATION 1342 MAYO MEMORIAL UNIVERSITY OF MINNESOTA MINNEAPOLIS 14, MINNESOTA I "'C 0 1 1 '0 '0 <>. ~ '" 'c" m.= ~~ o • 0.. .~ ~o ~ ..!'! <>. 0 u c'" -0 .: 8~ '" <II 0 ! ~ f 1 1 A Word About Memorial Gifts The Minnesota Medical Foundation welcomes your memorial contributions when an appropriate occasion arises. Memorial gifts serve the living and pay thoughtful tribute to the memory of a friend or relative. The Foundation will promptly acknowledge your gifts to both the donor and the family of the deceased. The gift will help finance the Foundation's program for the advancement of medical education and research. The Medical School at the University of Minnesota will be the direct beneficiary. . Gifts should be sent to the Minnesota Medical Foundation, 1342 Mayo Memorial, University of Minnesota, Minneapolis 14, Minn. -<_ f 1 ,1 1
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