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BU Publications The Arena
1967-04
The Arena: April 1967
https://hdl.handle.net/2144/17875 Boston University
THE ARENA
Student American Medical Association Boston University School of Medicine
• . REPC3RT: THE BSNS . - ^
On F r i d a y , March 1 0 t h , Dr. Hans-Lukas Teuber, Chairman of Psychology a t MIT, . spoke t o t h e BSNS on " B r a i n Mechanisms and P e r c e p t i o n " . Dr. Teuber i n d i c a t e d t h a t t h e r e a r e t h r e e important a s p e c t s of p e r c e p t i o n : PRESENTATION o f the i n p u t ;
COMPENSATION, as the adjustment t o one's own movement i n space; and REPRESENTATION, or t h e a b i l i t y t o draw a map. These p r o c e s s e s a r e s u g g e s t i v e o f t h r e e s e p a r a t e mechanisms, as i n d i c a t e d i n s p e c i f i c i n t e r f e r e n c e w i t h each r e s p e c t i v e l y by:
l ) d e s t r u c t i o n of the o c c i p i t a l l o b e , 2 ) deep d e s t r u c t i o n of the f r o n t a l l o b e , and 3 ) d e s t r u c t i o n of c e r t a i n p a r i e t a l a r e a s , although i t i s by no means i n s i s t e d t h a t t h e s e s p e c i f i c a r e a s a r e the l o c i of s u c h f u n c t i o n s .
I n d i c u s s i n g t h e p r o c e s s o f p r e s e n t a t i o n Dr. Teuber used c l i n i c a l examples o f v i s u a l d e f e c t s , and e x p e r i m e n t a l d a t a from t h e work of Hubel, W i e s e l and L e t t v i n v on s i n g l e c e l l s i n t h e v i s u a l c o r t e x . Dr. Teuber i l l u s t r a t e d two t y p e s o f c e l l s , d e s c r i b e d by Hubel i n the v i s u a l s y s t e m : "spot d e t e c t o r s " and " l i n e d e t e c t o r s " , w i t h examples of s p e c i f i c o c c i p i t a l l o b e l e s i o n s .
White ( v i s u a l ) n o i s e , e q u i v a l e n t t o t h e "snow" on a t e l e v i s i o n s c r e e n ^ produces a l t e r n a t i n g c l o c k w i s e and c o u n t e r - c l o c k w i s e r o t a t o r y phenomena, a s s e e n by normal humans. P a t i e n t s w i t h scotoma, a d i s c r e t e , v i s u a l ( c o r t i c a l ) l e s i o n , and consequent s m a l l f i e l d d e f e c t , s e e r o t a t o r y motion everywhere' except i n the a r e a o f t h e f i e l d mapping t h e i r l e s i o n , where t h e y s e e o s c i l l a t i n g s p e c k s , Mcnkeys d e p r i v e d o f t h e i r e n t i r e o c c i p i t a l l o b e s were once thought t o be merd "photon r e c e p t o r s " , d i s t i n - g u i s h i n g o n l y degrees o f b r i g h t n e s s . I t has r e c e n t l y been shown t h a t s u c h animals d i s t i n g i i i s h spots from a l l shades 6 f grey, ' •
l i n e d e t e c t o r s , or v i s u a l c o r t i c a l c e l l s responding t o l i n e s , a r e i n t e r e s t e d i n t h e l i n e and i t s o r i e n t a t i o n i n the f i e l d , i r r e s p e c t i v e o f i t s l e n g t h . V i c t i m s o f scotoma who look a t o p t i c a l p a t t e r n s , such as b l a c k and "white'' l i n e s converging on a p o i n t , s e e the expected c o n c e n t r i c r i p p l i n g e f f e c t everywhere e x c e p t i n t h e a r e a o f t h e i r d e f e c t , where they s e e merely t h e s t a t i o n a r y l i n e s . The "completion phenomenon" i s o p e r a t i v e h e r e , i n w h i c h m i s s i n g p i e c e s of t h e l i n e a r e i g n o r e d and a r e f i l l e d i n by such c e l l s as operate' f o r continuous l i n e s o n l y .
V e r t i c a l d e t e c t o r s a r e a t h i r d group of c e l l s w h i c h demonstrate another p r o - p e r t y o f r e t i n o - c o r t i c a l o r g a n i z a t i o n . The r e c e p t i v e f i e l d s of . r e t i n a l g a n g l i o n c e l l s a r e composed of an e x c i t a t o r y c e n t e r and an i n h i b i t o r y s u r r o u n d , A t a h i g h e r l e v e l c o r t i c a l c e l l s responding t o v e r t i c a l s o n l y f i r e r e p e t i t i v e l y when the l i n e impinges on a v e r t i c a l s e r i e s o f r e t i n a l e x c i t a t o r y c e n t e r s , and f i r e s l e s s r a p i d l y when r o t a t i o n p l a c e s a s i g n i f i c a n t p o r t i o n o f the l i n e o u t s i d e t h e e x c i t a t o r y c e n t e r i n t h e i n h i b i t o r y s u r r o u n d , Dr, Teuber terms t h e performance o f s u c h h i e r a r c h i c a l systems w h i c h b u i l d up t h e i n p u t , as "cascade s p e c i f i c a t i o i j o f i n p u t " , A f u r t h e r c o m p l i c a t i o n , w h i c h l e a d s t o a c o n s i d e r a t i o n of COMPENSATION, i s t h e f a c t t h a t
v e r t i c a l s remain y a r t i o a l when t h e head i s t i l t e d , . ^ ( c o n ' t , p. 2 ) ' . ^
•
A p r i l 1967
- 2 - BSNS ( c o n ' t . )
The octopus, a r a d i a l l y symmetrical animal, has an eye w h i c h by the n a t u r e o f i t s s l i t a p e r t u r e and c o u n t e r r o t a t i o n movement o r g a n i z e s t h e environment i n t o
v e r t i c a l s and h o r i z o n t a l s , Such animals can be q u i c k l y t r a i n e d t o respond t o v e r t i c a l s and h o r i z o n t a l s i n t h e i r v i s u a l f i e l d s . They l o s e a l l s u c h a b i l i t i e s , however, when t h e i r s t a t o c y s t s (analogous t o human s t a t o l i t h s ) a r e removed. Human eyes don't t i l t v e r y much, but can a d j u s t l i n e s t o t h e v e r t i c a l when t h e body a x i s i s t i l t e d . T h i s a b i l i t y i s i n t e r f e r e d w i t h t o a marked degree i n humans by a deep f r o n t a l l e s i o n , Dr, Teuber i n d i c a t e d t h a t each v o l u n t a r y move i s accompanied not o n l y by a d i s c h a r g e p r e p a r i n g muscles, but by a " c o r o l l a r y d i s c h a r g e " t o s e n s o r y f i e l d s , p r e j u d g i n g t o a degree t h e i n p u t .
A l l s u c h compensation phenomena, a s Dr, Teuber pointed o u t , a r e c o n t i n g e n t on v o l u n t a r y , o r s e l f - p r o d u c e d motion. An experiment which i l l u s t r a t e s t h i s p o i n t i s one i n which two c a t s were brought up from b i r t h i n a modified " c e n t r i f u g e " e n v i r o n - ment, i n w h i c h one c a t was the "walker", p r o p e l l i n g t h e r i d e r . When removed from t h i s environment t h e w a l k e r was p e r f e c t l y a t home i n a complex w o r l d , but the r i d e r was q u i t e h e l p l e s s f o r s e v e r a l days, bumping i n t o o b j e c t s w i t h o u t e x h i b i t i n g , how-
e v e r , any g r o s s motor a b n o r m a l i t i e s . Monkeys r e a r e d w i t h o u t s i g h t o f t h e i r hands a r e e n t i r e l y s u r p r i s e d by the v i s u a l d i s c o v e r y , and t h e hand, w e l l c o n t r o l l e d out of s i g h t , cannot be c o n t r C l l e d i n view f o r about seven d a y s . C u r i o u s l y , t h e r e i s no s h o r t e n i n g o f t h e time p e r i o d (hence no l e a r n i n g i n v o l v e d ) when t h e o t h e r hand i s t" brought t o view.
The t h i r d and most obscure p e r c e p t u a l mechanism i s t h a t o f REHIESENTATION, which seems t o be somewhat independent of v i s i o n , s i n c e p a r i e t a l l o b e l e s i o n s i n t e r f e r e i n t the same way w i t h human performance i n following both t a c t i l e and v i s i b l e maps, - Such p a r i e t a l l e s i o n s were genereilly though t o produce " v i s u a l s p a c i a l a g n o s i a " ,
but the mechanism o f r e p r e s e n t a t i o n i s o b v i o u s l y more c o m p l i c a t e d , having t o do • - w i t h l e a r n i n g and symbolic a c t i v i t y ,
A s m a l l but important group attended the March 2 i i t h meeting of the BSNS where Dr, Samuel Bogoch, A s s o c i a t e P r o f e s s o r of B i o c h e m i s t r y and P s y c h i a t r y a t Boston U n i v e r s i t y , spoke on " B r a i n P r o t e i n s and tfemory",
Dr, Bogoch i n d i c a t e d t h a t the r e c e n t impetus t o r e s e a r c h on t h e b i o c h e m i s t r y of the nervous system comes, as i n o t h e r f i e l d s of b i o c h e m i s t r y and b i o l o g y ; from t h e n i c e l y demonstrated a s s o c i a t i o n of the g e n e t i c code and t h e DNA macromolecule.
Dr. Bogoch h y p o t h e s i z e d t h a t i t was r e a s o n a b l e t o s u s p e c t an analogous method of
• e x p e r i e n t i a l c o d i n g i n raacromolecues of nervous t i s s u e . F u r t h e r impetus to the e j q j l o r a t i o n o f a b i o c h e m i c a l c o r r e l a t e o f "memory" i s the e v i d e n c e o f e l e c t r o s h o c k of i n h i b i t o r s o f p r o t e i n s y n t h e s i s and o f s u c h drugs a s Sodium a n y t a l as dramatic manipulators o f memory.
:•' Dr. Bogoch c i t e d r e a s o n s f o r the r e l a t i v e i n f a n c y o f s u c h s t u d i e s i n t h e s u p e r s t i t i o n s about the cranium a s the r e s i d e n c e o f " s p i r i t s " , and i n the g e n e r a l taboos hampering t h e study of mental phenomena,
t At the p r e s e n t time the o n l y p o s s i b l e d e f i n i t i o n s o f memory a r e o p e r a t i o n a l , having t o do w i t h c o n d i t i o n i n g ( p a v l o v i a n ) or i n s t r u m e n t a l ( s k i n n e r i a n ) psychology.
The two have i n common, however, an e x p l a n a t i o n i n the simple model:
s t i m u l u s -> organism •> r e s p o n s e , ^ ' Systems used t o study^ the s t i m u l u s - response model and r e l a t e d phenomena range among immunological and t i s s u e c u l t u r e systems, p a r t s o f nervous systems and e n t i r e animals from paramecia t o worms, mice and men. A l l t h e s e systems e x h i b i t i n common the e r r o r phenomenon, and indeed we imply a memory phenomenon or a coded response 1 when we t a l k of the immunological^"anamnestic r e s p o n s e " of t h e body's p r o t e c t i v e
antibody mechanism. Even t h i s system c a n be made t o e r r i n r e c o g n i t i o n of minimally u n f a m i l i a r molecues.
I n such as t h e w e l l - s t u d i e d v i s u a l systems of mammals and amphibia s e v e r a l fundamental s t e p s a r e r e c o g n i z e d . Two o f t h e e a r l i e s t s t e p s i n v o l v e " r e c e p t i o n " and
( c o n ' t , p, 3 ) ^
BSNS
" t r a n s d u c t i o n " , or i n the above c a s e the c o n v e r s i o n of rhodopsin t o r e t i n i n e and p r o t e i n by v i s i b l e l i g h t . Dr. Bogoch emphasized t h a t the key t o memory l i e s i n t h e c h e m i s t r y o f t r a n s d u c t i o n , a s t e p which i n e v e r y known i n s t a n c e i s s u b j e c t t o f e e d - back from p o r t i o n s of the b r a i n r e g u l a t i n g the amount and the s o r t o f v i s u a l s t i m u l i t o w h i c h th'i crganism "wishes" to a t t e n d . Dr. Bogoch f u r t h e r stated t h a t any theory of mem.ciy raast take i n t o account a t l e a s t t h r e e major s e t s o f o b s e r v a t i o n s : l ) t h a t e l e c t r i c a l shock f o l l o w i n g a l e a r n i n g e x p e r i e n c e a f t e r a f i x e d p e r i o d o f time no l o n g e r haii ths ef.fact of producing amnesia f o r t h a t experience, 2 ) t h a t s u r g i c a l ablaticjt). .-of.,.-three-fourths of t h e b r a i n may not d i s t r u b memory I'i^nction ( i n d i c a t i n g •
•the li)-;.e.lyho.od. of redunicncy), 3 ) t h a t pharmacological experiments using DFP and o t h e r c h e m i c a l substances c a n s e l e c t i v e l y i m p a i r memory, d i f f e r e n t i a t i n g between a t t e n t i o n and s t o r a g e phenomena.
C a n d i d a t e s among macromolecules s u i t a b l e f o r coding memory must, a c c o r d i n g t o Dr. Bogoch., s a t i s f y a t l e a s t s i x r e q u i r e m e n t s , t h o s e o f : l ) h e t e r o g e n e i t y , 2 ) l o c a - t i o n i n h i s t o l o g i c a l ] y d i s t i n c t p o r t i o n s of t h e nervous system, 3> developmental p a t t e r n cciisonant w i t h development o f f u n c t i o n , k) c o n s i s t e n t b i o c h e m i c a l and psycho- l o g i c a l pathology, 5 ) behavior s e n s i t i v i t y as a supporting molecule and 6 ) l e a r n i n g s e n s i t i v i t y as a coding molecule. Dr. Bogoch i n d i c a t e d t h a t b r a i n g l y c o p r o t e i n s and g a n g l i o s i d e s a r e good c a n d i d a t e s , s a t i s f y i n g a l l r e q u i r e m e n t s ; H i s own e x p e r i m e n t s , a n a l y s i n g t h e g l y c o p r o t e i n f r a c t i o n s obtained from whole pigeon b r a i n s o f a n i m a l s whose i n s t r u m e n t a l ( s k i n n e r box) l e a r n i n g i s of h i g h a c c u r a c y and h i g h l y r e p r o d u c e - . a b l e , r e v e a l t h a t c e r t a i n groups of g l y c o p r o t e i n s (among s i x t e e n major groups i d e n - t i f i e d ) show s i g n i f i c a n t changes w i t h l e a r n i n g . As compared t o pigeons c o n t r o l l e d f o r s i z e , age, d i e t , and e:q3erience, the t r a i n e d pigeons had s i g n i f i c a n t l y i n c r e a s e d b r a i n w e i g h t , and e x h i b i t e d a q u a l i t a t i v e (and q u a n t i t a t i v e ) s h i f t i n g l y c o p r o t e i n s from an a d j a c e n t group t o i t s neighbor on the b a s i s of DEAE c e l l u l o s e column e l u t i o n . These changes were v e r y dramatic i n pigeon b r a i n s from a n i m a l s showing r e c e n t
l e a r n i n g . Furthermore, the number o f m i l l i g r a m s weight of t h e s e b r a i n p r o t e i n s ' w a s l i n e a r l y r e l a t e d t o the p e r c e n t o f c o r r e c t r e s p o n s e s (number of p e c k s ) . Changes i n another group of p r o t e i n s were r e l a t e d to age, c o r r e l a t i n g w i t h the p r e n a t a l p r o - l i f e r a t i o n o f d e n d r i t e s i n t o t h e c o r t i c a l s u b s t a n c e . .
Dr, Bogoch acknowledged t h a t t h e problems of l o c a l i z a t i o n o f t h e s e g l y c o p r o t e i n s and t h e n a t u r e of t h e i r manufacture i s f a r from c l e a r , and t h a t r a d i o a c t i v e i n c o r - p o r a t i o n s t u d i e s have r e c e n t l y been undertaken w i t h t h e o b j e c t a c t u a l l y t o demon- s t r a t e t h e l o c a t i o n of t h e c h e m i c a l c o d e r s of memory,
N.B, Due t o incompatable d i f f e r e n c e s i n c l a s s s c h e d u l e s between the f i r s t and s e c - ond y e a r s t h e s p r i n g seminars have been scheduled a t S:00 p.m. i n the a f t e r n o o n , a t w h i c h meetings s h e r r y \-riLll be s e r v e d .
On a subsequent day, soon t o be announced, J e r r y K r a s n e r , e l e c t r i c a l e n g i n e e r , mathematician and p h y s i o l o g y s t u d e n t w i l l speak on some a s p e c t o f C y b e r n e t i c s ,
Another s c h e d u l e d speaker i s our own v i c e - p r e s i d e n t , George Fishraan, who w i l l d i s c u s s ( a s I have i t b e f o r e me) "The U l t r a v i o l e t Theory of t h e Nose", a s a v o r y t o p i c , indeed I
STUDENT COUNCIL . On Thursday, May I j t h , t h e S t u d e n t C o u n c i l h e l d e l e c t i o n s . The f o l l o w i n g w i l l hold o f f i c e next y e a r ;
P r e s i d e n t — P e t e r Henderson
V i c e P r e s i d e n t — B i l l Grace . S e c r e t a r y - T r e a s u r e r — D e n n y Byrne . •
A VENTURE INTO THE CGMMUNITI
W i t h i n the p a s t s i x weeks two dozen Boston U n i v e r s i t y Medical Students provided medical and d e n t a l s e r v i c e s t o f a m i l i e s i n the South End i n a unique f a s h i o n through a community h e a l t h p r o j e c t i n i t i a t e d by the Student H e a l t h O r g a n i z a t i o n s . T h i r d and F o u r t h y e a r s t u d e n t s , and two Boston U n i v e r s i t y graduate s t u d e n t d e n t i s t s , performed thorough h i s t o r i e s , p h y s i c a l , d e n t a l and u r i n e e x a m i n a t i o n s , under the s u p e r v i s i o n of D r s . B r i g h t , Healey and E l l i o t t from Boston C i t y H o s p i t a l and D r s , B r e y f u s and Hass o f the Home Medical S e r v i c e , Nursing, s o c i a l work, f i r s t and second y e a r Boston U n i v e r s i t y s t u d e n t s , and s e v e r a l community workers cooperated i n t h i s u n d e r t a k i n g . F o r t y c h i l d r e n i n a l l were examined i n i m p r o v i s e d though comfor- t a b l e c u b i c l e s i n the S a l v a t i o n Array's South End Boys' C l u b , w h i c h became a kind of community c l i n i c f o r the e v e n i n g . Arrangements f o r medical and d e n t a l follow-up were made then or soon t h e r e a f t e r .
Were our s e r v i c e s of v a l u e ? Does the p r o j e c t m e r i t r e p e t i t i o n ? Some e l a b o r a t i o n of our purposes and f i n d i n g s would h e l p t o answer t h e s e q u e s t i o n s . Our purposes a r e t h r e e i n number. The f i r s t i s the improvement of h e a l t h . We were l o o k i n g f o r un- detected i l l n e s s or s i g n s o f poor h e a l t h i n supposedly h e a l t h y c h i l d r e n . Of the c h i l d r e n f u l l y examined, Ul% showed pathology r e q u i r i n g d e f i n i t i v e follow-up or treatment. F i f t e e n p e r c e n t had abnormal, p o t e n t i a l l y s e r i o u s f i n d i n g s , and 3^% were diagnosed as w e l l - c h i l d r e n . The d e f i n i t i v e f i n d i n g s i n c l u d e d many eye problems, phimosis, u r i n a r y t r a c t d i s o r d e r s , exogenous o b e s i t y , and p o s s i b l e asthma. A l l the c h i l d r e n had c a r i e s : Q9% had a t l e a s t k c a v i t i e s apparent on e x p l o r a t i o n . These r e s u l t s alone, a l o n g w i t h follow-up which we a r e now a r r a n g i n g , j u s t i f i e d our e f f o r t .
Our second purpose i s e d u c a t i o n - d i r e c t e d toward t h o s e g i v i n g as. w e l l as r e c e i v i n g the examinations. We s e t out t o educate t h e f a m i l i e s a s t o what a thorough medical exam e n t a i l s , and p r o v i d e i n f o r m a t i o n on r e q u e s t r e l a t i n g to t h e r e c o g n i t i o n and p r e v e n t i o n of i l l n e s s , a v a i l a b i l i t y of medical f a c i l i t i e s i n t h i s a r e a , and main- tenance of good h e a l t h . F o r r e a s o n s r e l a t i n g to the complexity o f p r e v e n t i v e medi- c i n e and the s t r u c t u r e of our c u r r i c u l u m we could make o n l y embryonic e f f o r t s i n t h i s a r e a .
I n exchange m e d i c a l , d e n t a l and n u r s i n g s t u d e n t s l e a r n e d about p a r e n t s ' a t t i t u d e s toward d o c t o r s and i l l n e s s , and b a r r i e r s t o good h e a l t h which r e s i d e n t s of low-income a r e a s l i k e the South End f a c e . F o r example, as p a r t of our s o c i a l h i s t o r y , we would ask, what do you do when your boy has a s o r e t h r o a t ? Do you have t r o u b l e o b t a i n i n g a doctor or b r i n g i n g your c h i l d i n t o a c l i n i c when need be? One mother w a i t s about t h r e e days, or the o n s e t of s e v e r e symptoms b e f o r e she b r i n g s h e r s i c k c h i l d i n t o the C i t y H o s p i t a l . Her o n l y complaint i s the long w a i t t o s e e a d o c t o r . We a r e f i n d i n g t h a t most f a m i l i e s s i n c e r e l y a p p r e c i a t e the s e r v i c e s we a r e p r o v i d i n g . I n v a r i a b l y more f a m i l i e s t h a n we can handle i n one n i g h t come f o r an examination, and we must ask the remaining f a m i l i e s t o r e t u r n a t a l a t e r d a t e . I n two sessions, we have examined o n l y 10^ of the a c t i v e membership of the Boys' Club,
Our t h i r d purpose i s to provide a nidus f o r s t u d e n t involvement i n community a f f a i r s . A s i z e a b l e number o f Boston U n i v e r s i t y s t u d e n t s , have expressed such con- c e r n . The t a s k of p r o v i d i n g medical c a r e of q u a l i t y to our f a m i l i e s n e c e s s i t a t e s a c r e a t i v e approach t o t h e community a c r o s s many avenues. To do so we have had t o work w i t h p r i v a t e p e r s o n s , s o c i a l a g e n c i e s , the p u b l i c s c h o o l s , t h e h o s p i t a l s , and
the Medical S c h o o l . The complexity of our involvement w i t h the community i s p r o - p o r t i o n a l to the magnitude o f t h e t a s k we a r e f a c i n g .
Improving community h e a l t h i s a r a t h e r formidable t a s k and has i n s p i r e d a number of c r e a t i v e endeavors t o do so over the p a s t few y e a r s . The Columbia P o i n t P r o j e c t i s one of t h e s e . The major concept o f the new t h i n k i n g u n d e r l y i n g t h e s e p r o j e c t s i s t h a t a c l i n i c must be s e t up r i g h t i n the h e a r t of an urban ghetto i n order t o o b t a i n maximum b e n e f i t f o r i t s r e s i d e n t s . Secondly, a m u l t i d i s c i p l i n a r y team of p h y s i c i a n s , s o c i a l workers and nurses s t a f f i n g t h e s e c l i n i c s p o o l t h e i r a b i l i t i e s t o t r e a t t h e whole p a t i e n t i n a s i n g l e s e r v i c e . T h i r d l y , r o u t i n e examinations a r e made r e a d i l y a v a i l a b l e , and a s c h e d u l e system s e t up to c u t down w a i t i n g t i m e . Thus p r e v e n t i v e
( c o n ' t . p. 5 )
VENTURE ( c o n ' t . )
medicine i n s t e a d o f a c u t e treatment o f emergency c a r e p r a c t i c e may be emphasized,
¥e tixLed t o u t i l i z e t h e s e concepts i n the Boys' Club I ^ o j e c t .
E d u c a t i o n emerges as a prime aim i n our p r o j e c t . I n the p l a n n i n g s t a g e , we b e l i e v e d t h a t t h e poor a r e more prone t o i l l n e s s because they c a n ' t a f f o r d a f a m i l y d o c t o r , good food, o r a c a r t o d r i v e t h e i r c h i l d t o t h e h o s p i t a l i n the middle o f the n i g h t . We have found t o our s u r p r i s e t h a t t h e s o - c a l l e d poor o f the South End have r e a d i e r a c c e s s , p h y s i c a l l y s p e a k i n g , t o c l i n i c s o r medical s e r v i c e s t h a n i n h a b - i t a n t s o f b e t t e r endowed neighborhoods, and t h a t g e n e r a l l y s p e a k i n g , t h e y have
enough money t o feed and c l o t h e t h e i r f a m i l i e s a d e q u a t e l y . The problem i s t h a t many a r e not aware o r convinced o f t h e need t o t r e a t a s o r e t h r o a t , abdominal p a i n , o r f o o t u l c e r w i t h s o l i c i t u d e , o r t o b a l a n c e t h e i r c h i l d r e n ' s d i e t . The p r o v e r b i a l d i s t i n c t i o n between the haves and t h e have-nots i s not a s p e r t i n e n t here a s between t h e knows and know n o t s .
Through our p r o j e c t we have gained mai^ i n s i g h t s i n t o the a r e a o f community med- i c i n e . The medical s t u d e n t s w i l l v i s i t many o f t h e f a m i l i e s ' homes, e i t h e r t o o b t a i n some more i n f o r m a t i o n , or arrange follow-up appointments f o r them. These more
p e r s o n a l c o n f r o n t a t i o n s w i l l p r o v i d e a good o p p o r t u n i t y f o r l e a r n i n g about s o c i a l and c u l t u r a l f a c t o r s underIjring h e a l t h problems. A sophomore found h i m s e l f s i t t i n g a t a n a d v i s o r y c o u n c i l meeting o f the Boys' C l u b , e x p l a i n i n g our g o a l s , and s e e k i n g i t s s u p p o r t . A freshman c o n t a c t e d the p u b l i c h e a l t h department, a l o c a l d e n t a l a s s o c i a t i o n and the p u b l i c s c h o o l s , and o b t a i n e d i n f o r m a t i o n which w i l l a l l o w us t o a r r a n g e l o v T - c o s t o r f r e e d e n t a l follow-up f o r a l l our c h i l d r e n . The p r o j e c t h a s been a v a l u a b l e l e a r n i n g e x p e r i e n c e f o r many o f i t s a c t i v e p a r t i c i p a n t s .
A number o f the s t u d e n t examiners gained a t a n g i b l e and memorable i m p r e s s i o n
of some o f the c o n d i t i o n s o f p o v e r t y and poor h e a l t h i n the Medical S c h o o l community.
One s t u d e n t anonymously d e s c r i b e d h i s r e a c t i o n on an e v a l u a t i o n as f o l l o w s : " I t was a good f e e l i n g t o r e a l l y do something t h a t would b e n e f i t someone e l s e even though I d i d n ' t know what I was doing a t a l l t i m e s . I t was f r u s t r a t i n g i n t h a t I saw s o c i a l pathology, about which I c o u l d do n o t h i n g ; however, i f we p i c k e d up even one c a s e o f unsuspected pathology o f t h e twenty c h i l d r e n examined - t h e evening was e x t r e m e l y s u c c e s s f u l . "
The o r g a n i z e r s o f the p r o j e c t b e l i e v e t h a t a doctor i s o b l i g a t e d , i n h i s r o l e as a h e a l e r and p o s s e s s o r o f t h e t o o l s o f t o t a l h e a l t h c a r e , t o work f o r t h e betterment of community h e a l t h . To t h e s e i n d i v i d u a l s committment t o community h e a l t h i s not a matter o f debate, but a way o f l i f e . We f u r t h e r b e l i e v e t h a t the a l l e v i a t i o n o f p o v e r t y i n t h e United S t a t e s w i l l f o l l o w from and n e c e s s i t a t e the involvement o f more d o c t o r s i n community h e a l t h .
F i n a l l y , we b e l i e v e t h a t a m e d i c a l s c h o o l l i k e w i s e should show a s u b s t a n t i a l con- t i n u o u s c o n c e r n f o r the community i n w h i c h i t i s l o c a t e d . The Home M e d i c a l S e r v i c e , t h e community p s y c h i a t r y program, and forthcoming mental h e a l t h c e n t e r a r e e x p r e s s i o n s of t h i s c o n c e r n , b u t they a r e not enough. The S c h o o l must r e a c h out f u r t h e r t o t h o s e i s l a n d s o f know-nots, who have l i t t l e o r no m o t i v a t i o n t o seek n e c e s s a r y m e d i c a l s e r v i c e s , and t h e r e b y p e r p e t u a t e t h e i r low h e a l t h s t a n d a r d s . S a t e l l i t e c l i n i c s t o be s e t up and s t a f f e d by Boston U n i v e r s i t y Doctors a r e now i n the p l a n n i n g s t a g e , and w i l l h o p e f u l l y soon emerge a s a r e a l i t y .
We a l s o b e l i e v e t h a t the M e d i c a l S c h o o l i s o b l i g a t e d t o t e a c h community h e a l t h w i t h no l e s s q u a l i t y t h a n Medicine o r S u r g e r y . No p h y s i c i a n i s a good one i f he does not make use of some o f i t s i n s i g h t s and t e c h n i q u e s i n e v e r y e x a m i n a t i o n he p e r f o r m s . Community h e a l t h a s a branch o f p r e v e n t i v e medicine cannot be t a u g h t b y l e c t u r e a l o n e ,
as i t i s now, but r e q u i r e s d i r e c t e x p e r i e n c e i n the community. The Home M e d i c a l S e r v i c e attempts t o p r o v i d e t h i s d i r e c t e x p e r i e n c e but i s a l l too s h o r t , and comes
at a time when the s t u d e n t i s preoccupied w i t h h i s p r o f e s s i o n a l l i f e , and imminent i n t e r n s h i p . We hope t h a t an a c t i v e r o l e f o r s t u d e n t s has been i n c o r p o r a t e d i n t o t h e operating d e s i g n o f t h e mental h e a l t h c e n t e r , the p r o s p e c t i v e community c l i n i c s , and other sucYv p r o j e c t s . I f not, t h e Boston U n i v e r s i t y s t u d e n t w i l l once a g a i n be r e l e - gated t o u s a a l i n c i d e n t a l p o s i t i o n i n a l a r g e r e s e a r c h and p a t i e n t - c a r e i n s t i t u t i o n .
( c o n ' t . p . 6 )
- 6 -
VENTURE ( c o n ' t . )
Only by p l a n n i n g f o r the p a r t i c i p a t i o n of s t u d e n t s i n t h e s e c l i n i c s and p r o j e c t s , and by o f f e r i n g an i n t e l l e c t u a l l y e x c i t i n g fount of i d e a s i n community h e a l t h , w i l l Boston U n i v e r s i t y s t u d e n t s be encouraged t o become l e a d e r s i n t h i s most important a r e a
Furthermore, over the p a s t t h r e e y e a r s of my e x p e r i e n c e , t h e r e has been a notable l a c k of genuine encouragement o f i n f o r m a l , e x t r a c u r r i c u l a r s t u d e n t e f f o r t s i n com- munity h e a l t h a c t i v i t i e s . I n the p a s t two y e a r s , m e d i c a l s t u d e n t groups have been awarded $ 8 0 0 , 0 0 0 i n O f f i c e of Economic Opportunity grants f o r h e a l t h p r o j e c t s which t h e s e s t u d e n t s have conceived and developed l a r g e l y through t h e i r own. e f f o r t s . The kind of c r e a t i v e and r e f r e s h i n g l y open-minded t h i n k i n g r e f l e c t e d i n 'these new p r o j e c t s should be encouraged and h a r n e s s e d . On the other hand, as m e d i c a l s t u d e n t s , we a r e a r a t h e r a p a t h e t i c , s e l f - c e n t e r e d l o t ; we o u r s e l v e s must t a k e s t a n d s and work f o r the s o l u t i o n s t o b a s i c i s s u e s t h a t f a c e us a l l i n our p r o f e s s i o n .
These a r e the concepts and goals behind the Boys' Club P r o j e c t . I t i s a s m a l l undertaking i n f a c e of a gaping need. We a r e adding p i e c e by p i e c e t o a t a s k which must be expanded and improved immeasurably before we c a n c o n s i d e r i t completed.
B a r r y S i e g e r ' : " BUSM I I I
s t u d e n t H e a l t h O r g a n i z a t i o n
I wake, and the morning b e g i n s . VSy toothpaste-cap f a l l s down the d r a i n . I t does not upset me, f o r I am not p a r a n o i d . I am r e s o l v e d t o t h e f a c t t h a t I am l e g i t i m a t e . I have no d e s i r e s t o s l e e p w i t h my s i s t e r . I have no s i s t e r .
I p u l l the c h a i n on the dragon bowl and wonder a t t h e dozens of D a V i n c i s , the the s c o r e s of S h a k e s p e a r e s , the m i l l i o n s of M a l l o r y s t h a t have been f l u s h e d t o the s e a .
On the d r i v e t o the h o s p i t a l I am c a r e f u l not t o h i t any p i e c e s o f my mind t h a t I have l o s t i n the p a s t . The road i s v i r i l e .
I t i s a bad morning a t the h o s p i t a l . A v e n t r i c u l a r g a l l o p sounds l i k e a ' c a n t e r . A doctor asks me i f Pepsodent i s a cure f o r j a u n d i c e and' I s a y y e s .
My t h i c k white c o a t s h i e l d s me from the d i s e a s e . a l l around me. I am bothered t h a t nothing b o t h e r s me.
I walk towards the s c h o o l i n the a f t e r n o o n . I n o t i c e t h a t the a i r f e e l s
d i f f e r e n t . The a i r i s t h i c k , and smooths over your s k i n e v e n l y . I t i s s p r i n g a i r . My mind l e a v e s medicine. I t i s on women. A woman i s l i k e t h e ocean. Poets say s o . I t h i n k the ocean i s s a l t i e r . Maybe they a r e r i g h t . You c a n get h e p a t i t i s from b o t h .
I s e a t myself i n an a n o v u l a t o r y auditorium t h a t has born naught s i n c e I 8 9 O . I d i d not r e a c h mental menopause t i l l t h i s y e a r . The pause t h a t d e p r e s s e s . A Bausch and Lomb machine p r o j e c t s " E j a c u l a t o r y Competence" i n f o o t h i g h l e t t e r s on a s c r e e n . I am j e a l o u s .
Through a t e a r i n a b l a c k window shade I c a n see o u t s i d e . A b i r d s o a r s low over the s c h o o l . He cannot f l y . He i s merely a good jumper.
P.P.
* THE ROTATION THAT WAS
- 7 -
Freshman and Sophomores should s t a r t p l a n n i n g now f o r c e r t a i n i n t e r e s t i n g and e x c i t i n g programs which a r e g e n e r a l l y a v a i l a b l e f o r - e l e c t i v e time a c t i v i t i e s ,
L o u i s i a n a S t a t e U n i v e r s i t y O f f e r s a two month f e l l o w s h i p i n T r o p i c a l f f e d i c i n e , w h e r e i n t h e y pay your way t o any one of a dozen c e n t r a l or south American c o u n t r i e s Urban o r r u r a l , c l i n i c a l or r e s e a r c h p o s i t i o n s a r e a v a i l a b l e t o studep-ts who have completed t h e i r t h i r d y e a r . A p p l i c a t i o n s should be made now however. One BU s t u d e n t i s going t h i s y e a r .
The Smith, K l i n e & F r e n c h F e l l o w s h i p w i l l support any program o f c l i n i c a l
medicine i n a f a i r l y underdeveloped p a r t o f t h e w o r l d . I n t e r e s t e d s t u d e n t s should s t a r t s e t t i n g up these programs r i g h t now. See t h e p r e s e n t w r i t e r f o r s u g g e s t i o n s .
P r e c e p t o r s h i p s i n g e n e r a l p r a c t i c e a r e a v a i l a b l e i n any p a r t o f the U n i t e d S t a t e s . You r e c e i v e $500, and work with the l o c a l doctor for a period o f 6 or 8 weeks. T h i s may a l l o w you t o a s s e s s r e g i o n s where you might l i k e t o p r a c t i c e , a s w e l l a s t o l e a r n something about the r e a l i t i e s o f g e n e r a l p r a c t i c e .
Any h o s p i t a l i n the US i s f a i r game f o r a r o t a t i o h i n some s p e c i a l t y , o r i n g e n e r a l medicine or s u r g e r y . T h i s would a l l o w you t o l e a r n something about the c i t y and h o s p i t a l you a r e c o n s i d e r i n g f o r i n t e r n s h i p . U s u a l l y summer r o t a t i o n s o n l y a r e o f f e r e d . The s t u d e n t must have a s p e c i f i c p l a n i n mind i n h i s c h o i c e o f a n .. o u t s i d e e l e c t i v e , and make a l l arrangements h i m s e l f .
I t would be v a l u a b l e f o r sophomores t o determine i n the coming months. b e f o r e the t h i r d y e a r b e g i n s , whether t h e i r i n t e r e s t l i e s i n r e s e a r c h or c l i n i c a l medicine, and what p a r t i c u l a r s p e c i a l t y t h e y might l i k e t o p u r s u e . T h i s would h e l p them choose a.
t h e s i s t o p i c a s w e l l a s s t r u c t u r e an E l e c t i v e s Program. Too many j u n i o r s who a r e unsure o f what they want and what i s a v a i l a b l e make mistakes which t h e y cannot undo.
I n f a c t , t h i s period o f program s t r u c t u r i n g i s u s u a l l y so c o n f u s i n g , I would suggest t h a t t h e Ad-visory System p r e s e n t l y i n e f f e c t f o r j u n i o r s be made a v a i l a b l e t o
i n t e r e s t e d sophomores.
The Student Health P r o j e c t i s a v a i l a b l e t o a l l Freshmen and Sophomores who .want, t o spend t h e coming summer i n a s t i m u l a t i n g , c h a l l e n g i n g s e t t i n g . Urban and rural-, p o s i t i o n s a r e a v a i l a b l e i n New York C i t y , Chicago, and C a l i f o r n i a . Check t h e SAMA B u l l e t i n board f o r d e t a i l s .
BARRY E . SIEGER BUSM I I I
*
IN MEMORIUM
L i k e d e a t h descended on a h i v e T h i s room where couples p r e s s and s i g h . T h i s c o r d i a l n e s t , of chea-ting t a r t s . T h i s patch of poppy, p e n s e l e s s s t u f f . T a s t e d once, from which I f l y -
Of b e e s a l l s p l e n d i d i n t h e i r n o i s e , I f e e l the p a i n of t h o u g h t l e s s t a l k . And a cloud of smoke but h a l f a l i v e . Which f i l t e r s from the mouths of g i r l s . Whose s o u l s a r e f r e e from a r t and peace.
Whose minds have died ere t h e i r b i r t h . And l i e i n ashes beneath t h e i r c u r l s .
I s cowering now w i t h i n my mind.
To s t r i k e the c o i n of sugared p a i n ; I t f l o w s d i s s o l v e d i n malts and hops.
And l a p s upon the gears t h a t g r i n d .
To the s t r e e t I r u n , upon the s t a i r . And out the room of b l o a t e d g l a n d s . Where none who meet, t r u l y knovr.
And i f t h e y knew, would not c a r e ;
The wheels t h a t move w i t h i n the s h e l l . Whose f a c e i s mine and name I bear, VJho stumbles now along t h e s t r e e t . And g i v e s t o p a s s i n g c a r s a y e l l . Where may-fly tjur-ants s i p t h e i r wine.
And order a l l t o s i l e n t b e .
And so make Mahler Lord of L o r d s , And s t a b l e boy t o puffed-up swine.
That they might hear h i s t r o u b l e d c a l l . I n the f e a r f u l s i l e n c e of t h e p l a c e . Sounding t o the s t a r s and down t o h e l l -
"A plaque, I beg, t o t a k e them a l lI "
( c o n ' t . p . 8)
IM MEMORIUM c o n ' t . . ,
To f r i e n d s I f l y , t h e oaken p o s t s . S e n t i n e l s standing i n the n i g h t . Whose s i l e n t ways have seen my l i f e , A dreamless s l e e p of empty b o a s t s .
- 8 -
I I I
Take c a r e you h u n t e r s o f a h e a r t . That b l e e d s too e a s y f o r your prey;
That begs you hold when near t h e t h r o a t . Or trembling c l o s e Her s e c r e t p a r t
Which f i l l e d t h e s h e e t s and shook my bed. Your thoughts r u n mad upon a day.
With ransom paid t h e l i t t l e man. When She d i d pass f o r h o s t e s s pure.
Who l i v e s w i t h i n my t r o u b l e d s o u l . And e r e you met t h e j o k e r p l a y e d . And feeds upon t h e i r maidenhead. ., And She d i d g i v e Her r o s e away.
But r e s t comes now, f o r scenes were here That p o i s o n snake i t knows no r e s t . Which p l a y w r i g h t - p o e t dared not w r i t e .
L e s t he cease t o w r i t e a t a l l . The comfort o f Her arms more dear Than the p a i n f u l s p r i n g :of a l l h i s a r t . The empty bed which draws h i s warmth And l e t s him l i e awake t o hear
The r e s t l e s s beat o f a n empty h e a r t .
The knowledge o f Her c h i l d i s h time, ; When f a v o r s l e p t w i t h p o t t e r c u r , ' Another head, upon Her b r e a s t .
And now you doze v^on t h a t p l a c e . And k i s s t h e l i p s he k i s s e d b e f o r e ; Your morbid thoughts d i s s o l v e i n peace.
That balm which draws you t o Her f a c e .
Her h a i r s a r e h e r e , upon the w h i t e - Of s h e e t s t h a t f e l t t h e f o r c e of s p o r t ; Of covers t o s s e d i n f r e n z i e d j o y ; Of p i l l o w s t o s s e d i n w i l d d e l i g h t - And w i t h my hand a r e swept away.
To s i l e n t f a l l upon t h e f l o o r . And deep t h e s t i l l n e s s o f my room,
' T i l l She r e t u r n upon the day;
" I am a man, and nothing more;
My song i s played on d i s t a n t drums;
I c r a v e some warmth, a s i l k e n c o r d . To t a k e t h e p l a c e - o f one t h a t t o r e When I was s m a l l and She was g r e a t . And a l l the world was i n Her eye;
I am a man, and nothing l e s s , A world which r u s h e s p a s t Her g a t e .
And b i d me l i g h t my l a n t e r n ' s w i c k . And seek t h e s h e l t e r o f Her nave, A peace t o f i n d beneath h e r a r c h . To k i n d l e k i n d e s s a t my quick;
T h i s g e n t l e s o u l my p r a y e r s t o keep.
T h i s lamb who feeds me o f Her m i l k . T h i s c h i l d of j o y , n o t y e t grown.
The f a i r y guardian of my s l e e p .
And w h i l e She moves, my h e a r t i s s t i l l To hear t h e c r i e s t o r n from my t h r o a t . The s h a r p h i g h notes of music p l a y e d . Without a s c o r e , w i t h o u t a w i l l . The hammers sound, no hand t o tend The l u r c h i n g f u r y o f t h e i r pace, A meter s e t t o chase Her s i g h s .
Which beg r e l e a s e and dread t h e end."
( c o n ' t . p. 9)
- 9 -
I N MEMORIUM con't-.
I V
T h i s clammy pool o f summer's b l o o d , Which s t i c k s and c o o l s and warms a s w e l l , N i g h t t i d e ' s k i s s of•• a b r a z e n wind.
The muted h e r a l d o f a r i s i n g flood,- . Which c u r l s upon the s t o n e s and s l e e p s . And r u n s wet f i n g e r s on my n e r v e s . And has no word w i t h which t o p l e a d .
That t e r r o r h a l t where on i t c r e e p s . ~
The dawn i t comes and checks my way.
And p l a n t s pink s l i p p e r s on my b l i n d s ; And pushed i n t o rape my eyes
And f o r c e submission t o the day.
That I might, .look upon t h i s e a r t h . Of m a s t e r - s l a v e s t o b o t t l e s dreams.
Of s a l t - l i c k e d s o u l s , both dry and f l a t , Who f e a r t h e chambers o f t h e i P b i r t h .
Oh h o r r i d f a t e t o mold a man.
Whose y e a r s have never seen the boy;
Who l i v e s b u t wizened, never w i s e . And h a s no j o y s t o b r i d g e nor span
The g u l f between h i s world and t h e i r s , A s e a where on a l l s h i p s t h e y s a i l ,
Do s i n k w i t h thought and f l o a t w i t h "wine.
And. have no pennies f o r h i s w a r e s .
Oh s o u l d e p l e t e o f r e a s o n ' s sway.
That l i n g e r s nox-j upon the thought.
Of t a k i n g what the y e a r s have b u i l t . And t e a r i t down w i t h i n the day;
Grab h o l d a g a i n , t h e l i n e i s drawn.
And choose t h e g r e a t and l o n e l y l i f e . Of madness s e t on even k e e l .
Of eyes t h a t see b e f o r e She's gone.
V
Can one hold dear the g e n t l e , t h i n g s - The f r a g i l e grace o f c r y s t a l t r u t h . The p e a c e f u l p l a y . o f summer's r a i n . The j o y xirhich naked b e a u t y b r i n g s . The s t a f f o f h e a l t h , t h e poet, p r o s e . Or music f l o w i n g from a hand-
And y e t deny t h a t q u i e t song.
Which l i v e s w i t h i n a h e a r t w h i c h grows?
To loxre some g i r l w i t h t a n g l e d ' h a i r . Whose b r e a t h , i s taken,by your l e a v e . Who moves t o f i l l your g l a s s , and t h e n . Must answer t a u n t s w i t h b u t a s t a r e ; { So g r e a t a work has c h i l l e d yop c p l d . To t h i n k a l l grim upon t h i s j o k e - A l l honor novr, a noble p r i d e . And y e t a l o n e when you a r e o l d . '
The day b e f o r e t h a t Time began.
The order f o r our world decreed, A h a l f f o r e v e r y h a l f be made;
A woman made f o r e v e r y man.
I walked a l o n e , y e t l i v e d so w e l l , I dared t o l o s e my t x i r t l e s u i t ; The p a i n i t taught t h i s man t o r u n . No l o n g e r c o u l d I f i t my s h e l l , .
Thus when a t n i g h t I l a y i n bed.
While f e e l i n g warm and m i l d l y mad, I missed t h e g e n t l y rQundqd forms Which ended i n Her s l e e p i n g head.
The p a s t i t gnaws w i t h i n my b r a i n . And t r i e s t o keep from Her my h e a r t ; But I s h a l l c a l l f o r Her t o s t a y . And make ray h a l f a whole a g a i n
M i c h a e l Salcman BUSM I I
-10-
T h i r d and F o u r t h Year S k i t s BUSM A p r i l 196?
David Gothard
• R i c h a r d Goldwater
As p a r t of our f i g h t t o b r i n g c u l t u r e t o t h e BUSM, we w i l l now p r e s e n t a r e a d i n g of t h e s o l i l o q u y from a h e r e - t o - f o r e unknown work of t h e bard of Stratford-on-Avon, Siggy S c h u l t z b e r g , T h i s p l a y , which f i g u r e s h i s t o r i c a l l y between the a c t i o n s of Henry I V p a r t i i and Henry Vj p a r t v i i i concerns i t s e l f w i t h t h e change of power a t one o f s o c i e t y ' s o l d e s t i n s t i t u t i o n s and i s e n t i t l e d
The Tragedy o f S a i n t Arnold, Lord Relman Now i s the w i n t e r o f my g r e a t c o n t e n t ;
S h a l l I compare me t o a summers day?
I am the n o b l e s t Relman o f them a l l ' .
S i n c e F r a n z , King o f I n g l e , i s d e p a r t i n ' ; H i s realm becometh Relman's k i n d e r g a r t e ni -But y e t my p l a n s f o r s a i d may be forsook —
Yon Norman h a t h a l e a n and hungry l o o k . " •
A Norman not o f f i e r c e and f l a s h i n g sword, ; T h i s Norman i s a l l b r a i n and s p i n a l cord I -
He t h i n k s too w e l l ; s u c h men a r e dangerous. • And y e t , he h a t h not l e a r n e d the c r u c i a l t r i c k s i e .
To change h i s f a i t h and wed a s h i c k s i e l : ;
But s o f t - what l i g h t through yonder window b r e a k s ? An e l e c t r o l y t e •• From i t s mothers kidney u n t i m e l y dripped I
Thou most base a c i d , b u f f e r e d by t h e s l i n g s and arrows o f
Outrageous r e a c t i o n s t h a t made f a i r Henderson H a s s l e w i t h Bach.
Something i s r o t t e n i n a s t a t e
Where men l e a r r i d i g more t h a n b i c a r b o n a t e I
To pee or not t o pee. Such a q u e s t i o n you shouldn't a s k .
WHAT? How now....brown cow, I ' l l not a l l o w the G I t r a c t t o t a k e a bow F o r I w i l l s t r i v e to put t h e name of kidney • • , ,
- 1 1 -
S k i t s ( c o n ' t . )
On t h e t i p o f l i p s from Boston t o Sidney;
I'm banning j a u n d i c e , u l c e r s , and c h a l a s i a P y r o s i s , F l a t u s , g a l l s t o n e s , and d y s p h a g i a . I n s t e a d w e ' l l l i v e f o r n e p h r o c a l c i n o s i s F o r pyelo and g l o m e r u l o s c l e r o s i s .
W e ' l l l e a r n t h a t f i l l i n g d e f e c t s may imply A tumor o r some staghorn c a l c u l i .
So now, i f you should meet me on t h e ward.
Pray bow and s c r a p e and c a l l me L o r d , F o r I s h a l l be t h e s t u d e n t ' s bane
T i l l Birnam Wood hath come t o Dunsinanel ( E x i t )
