focus, therefore,
must be directed toward this age group, in rural America and areas of low income. especially Routine reimmunization at 1 year of age must be incor¬ porated into any such program. Screening of children prior to school entry provides a valuable tool for iden¬ tifying and vaccinating susceptible children as well as assessing the success of preschool programs. Incidence of measles in states with mandatory school immunization requirements has been noted to be lower.2 Intensified sur¬ veillance and epidemic control must be established.6 Roger M. Barkin, MD, MPH
Denver
1. Sencer DJ, Dull HB, Langmuir AD: Epidemiologic basis for eradication of measles in 1967. Public Health Rep 82:253-256, 1967. 2. Center for Disease Control: Measles Surveillance, Report No. 9. Department of Health, Education, and Welfare, Publication No. (Center for Disease Control) 74-8253, August 1973. 3. National Center for Health Statistics: Summary Report, Final Mortality Statistics, 1972. Monthly Vital Statistics Report 23:2-7 (November), 1974. 4. Barkin RM: Measles mortality: An analysis of the primary cause of death. Am J Dis Child, to be published. 5. Center for Disease Control: US Immunization Survey: 1973. Department of Health, Education, and Welfare, Publication No. (CDC) 74-8221. Atlanta, Center for Disease Control, 1974. 6. Conrad JL, Wallace R, Witte JJ: The epidemiologic rationale for the failure to eradicate measles in the United States. Am J Pub Health 61:2304-2310, 1971.
Bicyclists In
Beware
forthcoming
issue of Archives of Neurology, Eckdescribe three patients in whom ulnar neuropathy resulted from prolonged bicycle riding with consequent compression of the ulnar nerve at the wrist. The authors report one case in detail as follows: a
man
et al1
A 22-year-old student had ridden a bicycle across the United States, covering approximately 3,000 miles in 30 days. On or about the tenth day of the trip he noted the onset of weakness in both hands, not associated with any sensory disturbance. There was no associated pain in the neck or arms.
The notable findings on examination were limited to the hands. There was bilateral weakness and atrophy of the dorsal interossei, the abductor digiti minimi, and the adductor pollicis muscles. The flexor carpi ulnaris muscles were normal bilaterally. Detailed sensory testing in the hands showed no deficits. The tendon reflexes in the upper extremities were equal and active. There was no tenderness on palpation of the ulnar nerves, either at the wrist or the elbow. The ulnar nerves did not appear to be thickened to palpa¬ tion. The patient was advised to abstain from bicycle riding for the next several months, and on subsequent follow-up he showed im¬ provement of strength and muscle function. The atrophy was less
prominent.
In summary, this
patient clearly demonstrated evidence bilateral ulnar nerve lesion at the wrist with involve¬ ment only of the deep palmar branches of the ulnar nerves. of
a
In the other two
patients, ulnar neuropathy consequent prolonged bicycle riding had also developed. Their con¬ ditions also improved spontaneously when they refrained from cycling.
to
,
Although the authors do not describe the type of handle¬ bars used by their patient-riders, it might be assumed that the bars were low slung as on racing bikes. With handle¬ bars in that position, the rider puts strong pressure on the hands, wrists, and forearms as the legs thrust downward on
the
pedals.
Hugh H.
Hussey, MD
1. Eckman PB, Perlstein G, Altrocchi PH: Ulnar neuropathy in bicycle riders. Arch Neurol 32:130-131, 1975.
The Humanization of Medicine Medicine is becoming more and more dehumanized as machines and apparatus take over the tasks of diagnosis and therapy. The laboratory, the x-ray, the computer, the various invasive techniques are increasingly important in what we fondly call scientific medicine. As machines encroach more and more on the practice of medicine, we tend to lose sight of the person. The doctor-patient relationship, always the object of lip service, gets obscured in the welter of diagnostic tests. Yet perhaps the very complexity of modern scientific medicine, in a sort of backlash, is serving to focus attention on personal involvement, not merely between doctor and patient, but between doctor and patient and society. Some problems of the person have in the past few years received considerable attention in the lay and professional press, particularly those problems that we call ethical\p=m-\abortion,euthanasia, transplantation, human experimentation, genetic engineering, and the like. These topics go far beyond any one-to-one doctor-patient relationships and involve all of society. They force us to reenter the older humanistic areas of thought. What are the rights and duties of the individual ? Of the group ? Of the physi¬ cian, patient, and society? Of the weak and the strong, of majorities and minorities, of the haves and the have-nots? How much power may the group exert over the individual ? What is the proper or right or best way to spend money that is always in short supply? How shall we order our priorities ? These age-old questions have until recently been con¬ sidered as largely academic, suitable for discussion in col¬ lege classes or dormitory bull sessions; or as topics con¬ cerning which old fogies write letters that "view with alarm." These questions fall into the domain of philosophy and sociology. But there is a further dimension. Only the intellectually myopic believe that ethical and social prob¬ lems, while particularly acute today, are unique to the present. The historian knows that despite differing con¬ texts, virtually all the present day dilemmas have, in their essence, occurred in the past. To the disciplines of philoso¬ phy, sociology, and politico-economic relationships, we must add the discipline of history, without which any solutions will necessarily lack both balance and depth.
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/15/2015
Where can the physician acquire some insight into hu¬ manistic areas as they relate to medicine? At the present moment a few medical schools, especially the newer ones, devote a small part of the curriculum to social and ethical aspects of medicine and to some facets of medical human¬ ism. But at best this provides only the barest smattering, and in any case does not reach the practicing physician. To explore the possibility of remedying this and to bring the practicing physician into close contact with the humani¬ ties, an extraordinary experiment is currently under way. Last year a pilot study funded by the National Endowment for the Humanities made a brilliant start toward what may become a major reorientation of medical education. It aimed not merely to bring the practicing physician back to school —for this is nothing new, since postgraduate courses do it all the time—but to bring him back to expose him to philosophy, sociology, and history as they relate to medi¬ cine. This is truly an innovation. Last year applicants far outnumbered the available places. In three widely separate universities, small groups of prac¬ titioners (with occasional administrators or nurses) attended summer workshops of four weeks' duration, spending the time in intensive reading and discussion under the guidance of prominent scholars. As a sometime observer of this program I can testify to the earnestness and enthusiasm with which the participants broadened their mental outlook, clarified their own thinking and their own intellectual pre¬ suppositions, and secured insight into broader contexts that envelop doctor and patient and society. This year the program will be extended with five sep¬ arate seminars instead of the initial three. As was the case last year each group will meet for four weeks. As before, enrollment will be limited to 12 to 15 in each group. The successful applicants will receive fellowship stipends of up to $1,500. While all the study groups will discuss the humanistic aspects of medicine, the specific orientation of each group will relate to the special interests of its leader. The academic appointments of each of these leaders will give a clue to the orientation. The dates, locations, and the leaders with their specialties are as
follows:
June 2-June 30, University of Pennsylvania, Philadelphia; Renée Fox, PhD, Professor of Sociology. June 23-July 18, Ohio State University, Columbus; John C. Burnham, PhD, Professor of the History of Medicine.
June 29-July 25, Indiana University, Bloomington; Wil¬
liam May, PhD, Professor of Religious Studies. (Seminar to be held in Williamstown, Mass.) July 27-Aug 22, Georgetown University, Washington, DC; Leon Kass, MD, Research Professor of Bioethics, Ken¬ nedy Institute. (Seminar to be held in Williamstown, Mass.) Sept 8-Oct 3, University of Texas Medical Branch, Galveston; H. Tristram Engelhardt, Jr., MD, PhD, Professor of the Philosophy of Medicine. A more specific and detailed announcement has appeared in our medical news section (Feb 10). Interested phy¬ sicians should write directly to the leader of whichever group exerts the most appeal; brochures are available. The deadline for applications is April 1, except for the Galveston meeting where it is May 19. Choices will be made by
April
8
(or May 26).
King, MD Contributing Editor
Lester S.
Scan the Contents A reader of any periodical does well first to scan the table of contents, to spot articles that may hold special interest for
him. This is all the more important for physician-readers who receive so much to read and have so little time to do it. Science, one of the giants of scientific journalism, is read by many physicians principally for its letters, editorials, articles, and news and comment. Yet, if the physician-reader scans the contents of "reports," he will sometimes find messages of immense interest. Witness the item by Pirkle and Carstens (185:1062-1064, 1974) describing the pathologic findings in six patients who died suddenly as a result of blockade of small pulmonary arteries and arterioles by
platelet aggregates. Scanning the table of contents of reports in the Dec 13, 1974, issue gave the impression that several reports would yield matters of important clinical value. Alas, they did not. They were either so esoteric as to baffle most physicians or were related to animal experimentation that carried little or clinical interest. Ah well, you can't always win. After issue did come on Friday the 13th.
no
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/15/2015
all,
the Science
Hugh H. Hussey, MD
must be directed toward this age group, in rural America and areas of low income. especially Routine reimmunization at 1 year of age must be incor¬ porated into any such program. Screening of children prior to school entry provides a valuable tool for iden¬ tifying and vaccinating susceptible children as well as assessing the success of preschool programs. Incidence of measles in states with mandatory school immunization requirements has been noted to be lower.2 Intensified sur¬ veillance and epidemic control must be established.6 Roger M. Barkin, MD, MPH
Denver
1. Sencer DJ, Dull HB, Langmuir AD: Epidemiologic basis for eradication of measles in 1967. Public Health Rep 82:253-256, 1967. 2. Center for Disease Control: Measles Surveillance, Report No. 9. Department of Health, Education, and Welfare, Publication No. (Center for Disease Control) 74-8253, August 1973. 3. National Center for Health Statistics: Summary Report, Final Mortality Statistics, 1972. Monthly Vital Statistics Report 23:2-7 (November), 1974. 4. Barkin RM: Measles mortality: An analysis of the primary cause of death. Am J Dis Child, to be published. 5. Center for Disease Control: US Immunization Survey: 1973. Department of Health, Education, and Welfare, Publication No. (CDC) 74-8221. Atlanta, Center for Disease Control, 1974. 6. Conrad JL, Wallace R, Witte JJ: The epidemiologic rationale for the failure to eradicate measles in the United States. Am J Pub Health 61:2304-2310, 1971.
Bicyclists In
Beware
forthcoming
issue of Archives of Neurology, Eckdescribe three patients in whom ulnar neuropathy resulted from prolonged bicycle riding with consequent compression of the ulnar nerve at the wrist. The authors report one case in detail as follows: a
man
et al1
A 22-year-old student had ridden a bicycle across the United States, covering approximately 3,000 miles in 30 days. On or about the tenth day of the trip he noted the onset of weakness in both hands, not associated with any sensory disturbance. There was no associated pain in the neck or arms.
The notable findings on examination were limited to the hands. There was bilateral weakness and atrophy of the dorsal interossei, the abductor digiti minimi, and the adductor pollicis muscles. The flexor carpi ulnaris muscles were normal bilaterally. Detailed sensory testing in the hands showed no deficits. The tendon reflexes in the upper extremities were equal and active. There was no tenderness on palpation of the ulnar nerves, either at the wrist or the elbow. The ulnar nerves did not appear to be thickened to palpa¬ tion. The patient was advised to abstain from bicycle riding for the next several months, and on subsequent follow-up he showed im¬ provement of strength and muscle function. The atrophy was less
prominent.
In summary, this
patient clearly demonstrated evidence bilateral ulnar nerve lesion at the wrist with involve¬ ment only of the deep palmar branches of the ulnar nerves. of
a
In the other two
patients, ulnar neuropathy consequent prolonged bicycle riding had also developed. Their con¬ ditions also improved spontaneously when they refrained from cycling.
to
,
Although the authors do not describe the type of handle¬ bars used by their patient-riders, it might be assumed that the bars were low slung as on racing bikes. With handle¬ bars in that position, the rider puts strong pressure on the hands, wrists, and forearms as the legs thrust downward on
the
pedals.
Hugh H.
Hussey, MD
1. Eckman PB, Perlstein G, Altrocchi PH: Ulnar neuropathy in bicycle riders. Arch Neurol 32:130-131, 1975.
The Humanization of Medicine Medicine is becoming more and more dehumanized as machines and apparatus take over the tasks of diagnosis and therapy. The laboratory, the x-ray, the computer, the various invasive techniques are increasingly important in what we fondly call scientific medicine. As machines encroach more and more on the practice of medicine, we tend to lose sight of the person. The doctor-patient relationship, always the object of lip service, gets obscured in the welter of diagnostic tests. Yet perhaps the very complexity of modern scientific medicine, in a sort of backlash, is serving to focus attention on personal involvement, not merely between doctor and patient, but between doctor and patient and society. Some problems of the person have in the past few years received considerable attention in the lay and professional press, particularly those problems that we call ethical\p=m-\abortion,euthanasia, transplantation, human experimentation, genetic engineering, and the like. These topics go far beyond any one-to-one doctor-patient relationships and involve all of society. They force us to reenter the older humanistic areas of thought. What are the rights and duties of the individual ? Of the group ? Of the physi¬ cian, patient, and society? Of the weak and the strong, of majorities and minorities, of the haves and the have-nots? How much power may the group exert over the individual ? What is the proper or right or best way to spend money that is always in short supply? How shall we order our priorities ? These age-old questions have until recently been con¬ sidered as largely academic, suitable for discussion in col¬ lege classes or dormitory bull sessions; or as topics con¬ cerning which old fogies write letters that "view with alarm." These questions fall into the domain of philosophy and sociology. But there is a further dimension. Only the intellectually myopic believe that ethical and social prob¬ lems, while particularly acute today, are unique to the present. The historian knows that despite differing con¬ texts, virtually all the present day dilemmas have, in their essence, occurred in the past. To the disciplines of philoso¬ phy, sociology, and politico-economic relationships, we must add the discipline of history, without which any solutions will necessarily lack both balance and depth.
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/15/2015
Where can the physician acquire some insight into hu¬ manistic areas as they relate to medicine? At the present moment a few medical schools, especially the newer ones, devote a small part of the curriculum to social and ethical aspects of medicine and to some facets of medical human¬ ism. But at best this provides only the barest smattering, and in any case does not reach the practicing physician. To explore the possibility of remedying this and to bring the practicing physician into close contact with the humani¬ ties, an extraordinary experiment is currently under way. Last year a pilot study funded by the National Endowment for the Humanities made a brilliant start toward what may become a major reorientation of medical education. It aimed not merely to bring the practicing physician back to school —for this is nothing new, since postgraduate courses do it all the time—but to bring him back to expose him to philosophy, sociology, and history as they relate to medi¬ cine. This is truly an innovation. Last year applicants far outnumbered the available places. In three widely separate universities, small groups of prac¬ titioners (with occasional administrators or nurses) attended summer workshops of four weeks' duration, spending the time in intensive reading and discussion under the guidance of prominent scholars. As a sometime observer of this program I can testify to the earnestness and enthusiasm with which the participants broadened their mental outlook, clarified their own thinking and their own intellectual pre¬ suppositions, and secured insight into broader contexts that envelop doctor and patient and society. This year the program will be extended with five sep¬ arate seminars instead of the initial three. As was the case last year each group will meet for four weeks. As before, enrollment will be limited to 12 to 15 in each group. The successful applicants will receive fellowship stipends of up to $1,500. While all the study groups will discuss the humanistic aspects of medicine, the specific orientation of each group will relate to the special interests of its leader. The academic appointments of each of these leaders will give a clue to the orientation. The dates, locations, and the leaders with their specialties are as
follows:
June 2-June 30, University of Pennsylvania, Philadelphia; Renée Fox, PhD, Professor of Sociology. June 23-July 18, Ohio State University, Columbus; John C. Burnham, PhD, Professor of the History of Medicine.
June 29-July 25, Indiana University, Bloomington; Wil¬
liam May, PhD, Professor of Religious Studies. (Seminar to be held in Williamstown, Mass.) July 27-Aug 22, Georgetown University, Washington, DC; Leon Kass, MD, Research Professor of Bioethics, Ken¬ nedy Institute. (Seminar to be held in Williamstown, Mass.) Sept 8-Oct 3, University of Texas Medical Branch, Galveston; H. Tristram Engelhardt, Jr., MD, PhD, Professor of the Philosophy of Medicine. A more specific and detailed announcement has appeared in our medical news section (Feb 10). Interested phy¬ sicians should write directly to the leader of whichever group exerts the most appeal; brochures are available. The deadline for applications is April 1, except for the Galveston meeting where it is May 19. Choices will be made by
April
8
(or May 26).
King, MD Contributing Editor
Lester S.
Scan the Contents A reader of any periodical does well first to scan the table of contents, to spot articles that may hold special interest for
him. This is all the more important for physician-readers who receive so much to read and have so little time to do it. Science, one of the giants of scientific journalism, is read by many physicians principally for its letters, editorials, articles, and news and comment. Yet, if the physician-reader scans the contents of "reports," he will sometimes find messages of immense interest. Witness the item by Pirkle and Carstens (185:1062-1064, 1974) describing the pathologic findings in six patients who died suddenly as a result of blockade of small pulmonary arteries and arterioles by
platelet aggregates. Scanning the table of contents of reports in the Dec 13, 1974, issue gave the impression that several reports would yield matters of important clinical value. Alas, they did not. They were either so esoteric as to baffle most physicians or were related to animal experimentation that carried little or clinical interest. Ah well, you can't always win. After issue did come on Friday the 13th.
no
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/15/2015
all,
the Science
Hugh H. Hussey, MD
