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OFFICIAL 

ILLINOIS 


JOURNAL dF THE 

state Medical! s> 


Rapes a community hospital study „ . . 25 
Bedside barium enema; a new approach . . . 29 
Pediatric perplexities: orgaisophosp hate poisoning 
Case reposts coronary artery surgery . . . 36 


Table of contents . . . 1 
President's page . . . 53 




is (gr 0; 




Illinois Medical Journal 


JULY, 1978 

Vol. 154, No. 1 

CONTENTS 

4 

Abstracts of Board of Trustees Actions 



Clinical Articles 

25 Rape: A Community Hospital Study 

By Pedro A. Poma, M.D., and Robert C. Stepto, M.D. 

29 Bedside Barium Enema: A New Approach 

By Samuel C. Balderman, M.D., Krishnan Sriram, M.D., and 
Arthur G. Michel, M.D. 


Rheumatology Rounds 

22 Painful Anterior Shoulder Mass With Calcification 

L. F. Layfer, M.D., and J. V. Jones, M.D., Contributing Co-Editors 


Pediatric Perplexities 

32 Organophosphate Poisoning 

Ruth Andrea Seeler, M.D., Contributing Editor 
By Iqbal A. Memon, M.D. 


Surgical Grand Rounds 

36 Case Report: Coronary Artery Surgery 

John M. Beal, M.D., Contributing Editor 


President’s Page 

53 Mandatory CME 

Davdd S. Fox, M.D. 


(Contents continued on overleaf) 


for July, 1978 


1 


CONTENTS (continued) 


Features 

6 EKG of the Month 

11 Clinics for Crippled Children 

12 Pulse of the ISMS Auxiliary 

15 Illinois Society, American Association 
of Medical Assistants 

16 Obituaries 

42 ISMS Guide to Continuing Medical 

Education 

44 Classified Advertising 

51 Doctor’s News 

54 Physician Recruitment 

Staff 

Managing Editor Richard A. Ott 

Assistant Editor Mariann M. Stephens 

Executive Administrator Roger N. White 

(Cover by Jane and C. R. Bushwaller) 


PUBLICATIONS COMMITTEE 

Herschel Browns, M.D., Chicago, Chairman 
Kenneth A. Hurst, M.D., Naperville 
Robert P. Johnson, M.D., Springfield 
Alfred J. Kiessel, M.D., Decatur 
Harold J. Lasky, M.D., Chicago 


Editorial Board 

J. William Roddick, Jr., M.D., Chairman 
Eli L. Borkon, M.D., Carbondale 
Daniel R. Cunningham, M.D., Wilmette 
Raymond A. Dieter, Jr., M.D., Glen Ellyn 
James G. Ekeberg, M.D., Palatine 
Ediz Z. Ezdinli, M.D., Kenilworth 
Carl Neuholf, M.D., Peoria 
Constantine S. Soter, M.D., Arlington Heights 
Donald D. VanFossan, M.D., Springfield 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Maternal Death Studies: 

Robert R. Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth Andrea Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 
Contributor in Immunopathology : Richard J. Ablin, Ph.D., Chicago 
Contributor in Rheumatology: L. F. Layfer, M.D., Chicago 


ILLINOIS STATE 
MEDICAL SOCIETY 

OFFICERS 

David S. Fox, M.D., President 
826 E. 61st St., Chicago 60637 
P. John Seward, M.D., President-Elect 
310 N. Wyman St., Rockford 61101 
Herschel Browns, M.D., 1st Vice-President 
4600 N. Ravenswood, Chicago 60640 
G. W. Giebelhausen, M.D., 2nd Vice-President 
1101 Main St., Peoria 61606 
Audley F. Connor, Jr., M.D., Secretary-Treasurer 
7531 S. Stony Island Ave., Chicago 60649 

HOUSE OF DELEGATES 

Cyril C. Wiggishoff, M.D., Speaker 
25 E. Washington, Chicago 60602 
Robert P. Johnson, M.D., Vice-Speaker 
108 Maple Grove, Springfield 62707 

TRUSTEES 

1st District: 1980, John J. Ring, M.D. 
511 Hawley, Mundelein 60060 
2nd District: 1980, Allan L. Goslin, M.D. 

712 N. Bloomington, Streator 61364 
3rd District: 1979, Alfred Clementi, M.D. 
675 W. Central Rd., Arlington Heights 60005 
3rd District: 1980, Raymond J. Des Rosiers, M.D. 

1044 N. Francisco, Chicago 60622 
3rd District: 1979, Robert T. Fox, M.D. 
2136 Robincrest, Glenview 60025 
3rd District, 1979, Jere Freidheim, M.D. 

3050 S. Wallace, Chicago 60616 
3rd District: 1981, Morris T. Friedell, M.D. 
7531 S. Stony Island Ave., Chicago 60649 
3rd District: 1981, Henrietta Herbolsheimer, M.D. 
5528 S. Hyde Park Blvd., Apt. 1202, Chicago 60637 
3rd District: 1981, Lawrence L. Hirsch, M.D. 

2434 Grace St., Chicago 60618 
3rd District: 1980, Harold J. Lasky, M.D. 
55 E. Washington, Chicago 60602 
3rd District: 1980, Richard N. Rovner, M.D. 

645 N. Michigan, Suite 920, Chicago 60611 
3rd District: 1980, Joseph C. Sherrick, M.D. 

303 E. Superior, Chicago 60611 
4th District: 1979, Fred Z. White, M.D. 

723 N. Second St., Chillicothe 61523 
5th District: 1979, P. F. Mahon, M.D. 
800 E. Carpenter, Springfield 62702 
6th District: 1981, Robert R. Hartman, M.D. 
1515 A. W. Walnut, Jacksonville 62650 
7th District: 1979, Alfred J. Kiessel, M.D. 

1 Powers Lane PL, Decatur 62522 
8th District: 1979, James Laidlaw, M.D. 
104 W. Clark, Champaign 61820 
9th District: 1981, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1981, Julian W. Buser, M.D. 
6600 W. Main St., Belleville 62223 
11th District: 1980, Kenneth A. Hurst, M.D. 

52 Bunting Lane, Naperville 60540 
12th District: 1980, Joseph Perez, M.D. 
5670 E. State St., Rockford 61108 
Trustee- At-Large: George T. Wilkins, M.D. 

3165 Myrtle, Granite City 62040 
Chairman of the Board: Robert R. Hartman, M.D. 

1515 A. W. Walnut, Jacksonville 62650 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of IMJ are listed in the Current Contents /Clinical Practice. 

Published by the Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603 (312-782-1654) 
Copyright, 1978. The Illinois State Medical Society. All material subject to this copyright may be photo- 
copied for the noncommercial purpose of scientific or educational advancement. 

Subscription S8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. S10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada S8.50. U.S. Single current copies available at S1.00 (§1.10 by mail), back issues §1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 

the Illinois Medical Journal is published by the Illinois State Medical Society as an educational and 
professional informational magazine and distributed as a benefit of membership in the Illinois State Medical 
Society. Its intent is to keep members current in medical knowledge and is a part of a continuing medical 
education program. Socioeconomic matters, affecting as they do a changing pattern in the proper delivery of 
medical care, are considered an inherent element in medical education. 


PERFORMANCE. PROVEN 
EFFECTIVENESS WITHIN A 
WIDE SAFETY MARGIN. 



While Roche Laboratories already 
knows more about the performance of 
Librium than anyone else, we keep on 
learning every day. 

For example, the highly favorable 
benefits' to- risk ratio of Librium is a welL 
documented matter of record. 

And, of course, the specific calm' 
ing action of Librium has been demon- 
strated in millions of patients around the 
world. In a large number of these patients, 
Librium was used concomitantly with other 
primary medications. 

Proven performance within a wide safety margin. Basically, that’s what Librium 
is all about. 


LIBRIUM* 

chlordiazepoxide HCI/Roche 

THE ANXIETY-SPECIFIC 


Before prescribing, please consult complete 
product information, a summary of which fol- 
lows: 

Indications: Relief of anxiety and tension occur- 
ring alone or accompanying various disease 
states. Efficacy beyond four months not estab- 
lished by systematic clinical studies. Periodic 
reassessment of therapy recommended. 
Contraindications: Patients with known hyper- 
sensitivity to the drug. 

Warnings: Warn patients that mental and/or 
physical abilities required for tasks such as driv- 
ing or operating machinery may be impaired, as 
may be mental alertness in children, and that 
concomitant use with alcohol or CNS de- 
pressants may have an additive effect. Though 
physical and psychological dependence have 
rarely been reported on recommended doses, 
use caution in administering to addiction-prone 
individuals or those who might increase dosage; 
withdrawal symptoms (including convulsions), 
following discontinuation of the drug and similar 
to those seen with barbiturates, have been re- 
ported. 

Usage in Pregnancy: Use of minor tran- 
quilizers during first trimester should 
almost always be avoided because of 
increased risk of congenital malforma- 


tions as suggested in several studies. 
Consider possibility of pregnancy when 
instituting therapy; advise patients to 
discuss therapy if they intend to or do 
become pregnant. 

Precautions: In the elderly and debilitated, and 
in children over six, limit to smallest effective 
dosage (initially 10 mg or less per day) to pre- 
clude ataxia or oversedation, increasing gradu- 
ally as needed and tolerated. Not recom- 
mended in children under six. Though generally 
not recommended, if combination therapy with 
other psychotropics seems indicated, carefully 
consider individual pharmacologic effects, par- 
ticularly in use of potentiating drugs such as 
MAO inhibitors and phenothiazines. Observe 
usual precautions in presence of impaired renal 
or hepatic function. Paradoxical reactions (e.g., 
excitement, stimulation and acute rage) have 
been reported in psychiatric patients and 
hyperactive aggressive children. Employ usual 
precautions in treatment of anxiety states with 
evidence of impending depression; suicidal ten- 
dencies may be present and protective mea- 
sures necessary. Variable effects on blood 
coagulation have been reported very rarely in 
patients receiving the drug and oral anticoagu- 
lants; causal relationship has not been estab- 
lished clinically. 


Adverse Reactions: Drowsiness, ataxia and con- 
fusion may occur, especially in the elderly and 
debilitated. These are reversible in most in- 
stances by proper dosage adjustment, but are 
also occasionally observed at the lower dosage 
ranges. In a few instances syncope has been 
reported. Also encountered are isolated in- 
stances of skin eruptions, edema, minor 
menstrual irregularities, nausea and constipa- 
tion, extrapyramidal symptoms, increased and 
decreaspd libido — all infrequent and generally 
controlled with dosage reduction; changes in 
EEG patterns (low-voltage fast activity) may ap- 
pear during and after treatment; blood dys- 
crasias (including agranulocytosis), jaundice 
and hepatic dysfunction have been reported 
occasionally, making periodic blood counts and 
liver function tests advisable during protracted 
therapy. 

Supplied: Librium® Capsules containing 5 mg, 

10 mg or 25 mg chlordiazepoxide HCI. Libritabs® 
Tablets containing 5 mg, 10 mg or 25 mg 
chlordiazepoxide. 



Roche Products Inc. 
Manati, Puerto Rico 00701 


Abstracts of Board Actions 


June 3, 1978 Chicago 

These abstracts are published so that members of the Illinois State Medical Society may keep advised of the actions 
of the Board of Trustees. It covers only major actions and is not intended as a detailed report. Full minutes of the 
meetings are available upon any member’s request at the headquarters office of ISMS. 


Medicare Peer Review 

ISMS has contracted with Electronic Data Systems (EDS) to provide peer review 
and professional relations services if HEW awards EDS a contract to administer 
Medicare Part B in Illinois. Under HEW's plan, one carrier will be selected to 
administer the program throughout the state. The carrier selected will begin op- 
erations April 1, 1979, in Cook County and July 1, 1979, in the remainder of the 
state. The peer review reimbursement rate would be $38, with county societies re- 
ceiving $35 per review and ISMS retaining $3 to cover administrative costs. This 
is similar to the ISMS contract with Wisconsin Physicians* Service to perform 
peer review, facilities review and professional relations on behalf of the 
CHAMPUS program in Illinois. 

Medicaid 

ISMS will assist the Illinois Department of Public Aid in securing the ser- 
vices of six physicians to review the practices of some 49 physicians suspected 
of prescription abuse of drugs such as Talwin and PBZ. However, ISMS will urge 
the reviewing physicians-who will be deputized as IDPA agents-to withdraw from 
the reviews if : (1) IDPA demands fiscal records; or (2) The physician being in- 
vestigated refuses to produce medical records because he does not have the pa- 
tient's consent. IDPA will be responsible for securing patient authorization in 
such cases. Findings of the reviews will be presented to the State Medical Advis- 
ory Committee. 

The Society will present objections to a proposed IDPA rule which would limit 
reimbursement of physicians earning $25,000 or more per quarter from Medicaid to 
80% of the statewide pricing screens. The level of statewide pricing screens is 
dependent upon the action which the General Assembly takes regarding the gov- 
ernor's proposed $20 million increase in physician reimbursement. 

ISMS will provide legal assistance if court action results from an upcoming 
IDPA audit of a Chicago physician's Medicaid billings. ISMS assistance will be 
limited to an effort to protect the physician-patient relationship and confi- 
dentiality of medical records. Because the court decision could impact on all 
Illinois physicians, ISMS involvement falls within guidelines governing legal 
assistance adopted by the Board last August. 

Statewide PSRO Council 

The Executive Committee was authorized to designate two ISMS representatives 
to the Statewide PSRO Council. Prior to submitting the nominations the Society 
will consult with the governor to discuss his appointments to the Council. HEW 
has requested the broadest possible physician representation (specialties and 
practice settings). Membership on the Council will consist of 2 physicians des- 
ignated by ISMS; 2 physicians designated by Illinois Hospital Association; 1 
physician representative from each PSRO in Illinois and 4 public representa- 
tives, at least two of whom will be appointed by the governor. The PSRO Council 
will coordinate PSRO activities, disseminate relevant data concerning the pro- 
gram, and assist in evaluating PSRO performance and assuring compliance. 

(Continued on page 47) 


4 


Illinois Medical Journal 


ime is the test of all things 





BRIEF SUMMARY 

Indications: Oral potassium therapy for the prevention and treatment ol 
hypokalemia which may occur secondary to diuretic or corticosteroid 
administration. May be used in the treatment of cardiac arrhythmias due 
to digitalis intoxication. 

Contraindications: Severe renal impairment with oliguria or azotemia, 
untreated Addison's disease, adynamia episodica hereditaria, acute 
dehydration, heat cramps and hyperkalemia from any cause. 
Precautions: Potassium intoxication by oral administration 
rarely occurs in patients with normal kidney function, however, 
potassium supplements must be administered with caution, 
since the amount of the deficiency or daily dosage is not 
accurately known. Frequent checks of the clinical status of 
the patient, and periodic ECG and/or serum potassium 
levels should be made. High serum concentrations of 
potassium ion may cause death through cardiac 
depression, arrhythmias or arrest. This drug should 
be used with caution in the presence of cardiac 
disease. 

In hypokalemic states, especially in pa- 
tients on a low-salt diet, hypochloremic 
alkalosis is a possibility that may require 
chloride as well as potassium 
supplementation. 

Adverse Reactions: Nausea, vomiting, 
diarrhea, and abdominal discomfort 
have been reported. The most se- 
vere adverse effect is hyper- 
kalemia. 

Overdosage: Potassium intoxica- 
tion may result from overdosage 
of potassium or from therapeutic 
dosage in conditions stated under 
“Contraindications”. Hyperkale- 
mia, when detected, must be 
treated immediately because le- 
thal levels can be reached in a few 
hours. 


Kaon Elixir 

>otassium qluconate) 

20 mEq per 15 ml 


WARREN-TEED 

LABORATORIES, INC. 

DIVISION OF ADRIA LABORATORIES INC. 

COLUMBUS, OHIO 43215 




elvg of the month 


John F. Moran, M.S., M.D., David L. Fishman, M.D., 
Patrick J. Scanlon, M.D., Sarah A. Johnson, M.D., 
John R. Tobin, M.S., M.D., and Rolf M. Gunnar, M.S., M.D. 
Section of Cardiology, Department of Medicine, 

Loyola University Stritch School of Medicine 


This patient is a five-week-olcl infant who presents with symptoms of congestive 
heart failure. He was the product of a normal labor and delivery although a 
tachycardia of 200 beats per minute was once recorded. Noiv his mother noted 
breathlessness and difficulty in feeding. Physical examination showed hepato- 
megaly, a tachycardia of 215 beats per minute, and a grade 3/6 systolic cardiac 
murmur at the base of the heart. This ECG was taken. 






2 -A iff* aA aA aA ^ l '’~ p/- f.y ^y py ^y (S t 

' 11 * 111 ’ 

V V -V /V ; v /V /V /V yV JV 


i 


2 


5 


v' iV. AA vV. JV.vV.xVv/V’. A/, A/. 


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a a aAaa aa aa ama am - / 

RV4 


Questions: 


1. The ECG shows: 

A. Atrial flutter with 2:1 atrioventricular 
block, an atrial rate of 430 beats per min- 
ute. 

B. Atrial tachycardia with 2:1 atrioventricu- 
lar block. 

C. Right ventricular hypertrophy. 

D. Left ventricular hypertrophy. 


E. Findings compatible with a ventricular 
septal defect. 

2. Management of this young patient could 
include : 

A. Digitalis. 

B. Quinidine. 

C. DC cardioversion. 

D. Cardiac catheterization. 

E. All of the above. 

( Continued on page 46) 


6 


Illinois Medical Journal 



Health Care Achievement Awards 


Dear Doctor: 

Critics contend that the private health care sec- 
tor talks about its problems, but rarely does any- 
thing positive about them. 

The media, government, consumer groups and 
others demand results. Congressman Dan Rosten- 
kowski (D., III.) who, by virtue of being Chairman 
of the Health Subcommittee of the Committee on 
Ways and Means, can help change the course of 
our health care system, put it this way: “ The 
health care industry must recognize that if it proves 
unwilling or unable to immediately address the 
problem of rising costs, it cannot reasonably object 
to government initiatives.” 

The 1978 Blue Cross and Blue Shield Symposi- 
um on November 15 is designed to demonstrate 
that the private health care sector not only can, but 
is tackling its problems. This will be achieved by 
recognizing initiatives that have been made by the 
private sector in dealing with areas of health costs, 
quality and/or accessibility. This recognition will 
bring a great deal of public attention to the initia- 
tives that are being carried out by the private sec- 
tor — placing the private sector in a far more favor- 
able light than it is currently perceived! 

You are invited to tell us about your actions that 
are designed to have a positive impact on the cost, 
quality and/or accessibility of health care services. 

The entries will be judged by a five-member 
panel comprised of representatives from the Illinois 
Hospital Association, Illinois State Medical Society, 
Chicago Hospital Council, Chicago Medical Society 
and the Illinois Clinic Managers Association. 

Entries will be divided into three groups with 
awards being given in each category. The groups 
include hospitals, physicians and employers. 

Full details of the competition and how to com- 
plete an entry appear on this page in the adjoining 
column. 

We hope that you will submit an entry because 
we believe that our Symposium III will do much to 
rebuild confidence in the private health care sector. 

Sincerely, 

Richard F. O’Connell 

Vice President 

Public Affairs 

Blue Cross and Blue Shield 


The purpose of the Health Care Achievement 
Awards is to demonstrate that the private sector is 
making significant progress in dealing with the is- 
sues of health care costs, quality and/or accessibil- 
ity as well as to give deserved recognition to those 
individuals, institutions and employers responsible 
for outstanding achievements in these areas. 

Health Care Achievement Awards will be pre- 
sented in three categories: hospitals, physicians and 
employers. For physicians, the three categories are 
solo practitioners, group practices and prepaid 
groups practices (including foundations for medi- 
cal care). Clinic managers, along with medical di- 
rectors, may be cited in the case of group practices 
and prepaid groups. 

Entries will be judged on the impact a described 
program or effort has made on the cost, quality 
and/or accessibility of health care services. An 
award, for example, might be given for a program 
that promotes a less costly type of health care with- 
out sacrificing quality such as an out-patient surgi- 
cal program. An award could be given for the es- 
tablishment of a medical clinic in a rural area that 
would improve the accessibility of health care ser- 
vices for area residents. A third example would be 
an award for an employee physical fitness program. 

The panel of judges will contact you if additional 
information is required after an entry is submitted. 
For further details on the Health Care Achievement 
Awards, please contact Doreen Molloy at (312) 
661-4279. 

Entries should be mailed to Health Care Achieve- 
ment Awards, 14th Floor, Blue Cross and Blue 
Shield, 233 North Michigan Avenue, Chicago, Illi- 
nois 60601. 

Entries must be received by September 15, 1978. 


(This report is a service to the physicians of Illinois) 



ASK BLUE SHIELD . . . ABOUT MEDICARE 


Name of Physician Important 
On Medicare Claim 

In order to process a Medicare claim, it is essen- 
tial that the physician who rendered the service is 
identified by his first and last name. The name of 
the group, or a listing of the physicians in the 
group, is not sufficient information for identifica- 
tion since each physician is assigned his own Medi- 
care provider number. 

When the multiple listing billing form is used, 
the name of the specific physician who rendered 
the service should be underlined in ink or bold 
pencil, circled or otherwise precisely identified on 
the bill. 

The best method of identification is to affix the 
physician s imprinted Medicare label on the bill, 
available from the Medicare carrier. Identification 
of the physician is especially important following 
the passage of the Sunshine Act by the government, 
since it permits the public disclosure of Medicare 
payments to physicians. 

Failure to provide proper physician identification 
results in the delay of the claim and perhaps pay- 
ments listed erroneously as having been made to 
a particular physician. 

Gallium-67 Citrate Scan 

This diagnostic procedure involves the use of 
Gallium-67 Citrate in demonstrating the presence 
and extent of such malignancies as lymphomas, 
Hodgkins disease and bronchogenic carcinoma. 

Program payment may be made for medical 
imaging procedures when performed with Gallium- 
67 Citrate, if the scan is performed with Gallium-67 
Citrate produced by a manufacturer that has FDA 
approval for this radiopharmaceutical, and, if the 
scan is also reasonable and necessary for the indi- 
vidual patient. To date, the FDA has only approved 
this radiopharmaceutical as manufactured by the 
New England Nuclear Corporation (effective May 
17, 1976) and Diagnostic Isotopes, Inc., (effective 
December 16, 1977 ) . If the FDA approves Gallium- 
67 Citrate produced by other manufacturers, pay- 
ment may also be made for scans performed on or 
after the effective date of approval, which utilize 
Gallium-67 Citrate produced by such manufac- 
turers. 

Changes in Participation and 
Certification of Laboratory Procedures 

Notices were received from the Medicare Bureau 
of the following changes in participation and cer- 
tification of procedures of laboratories in the Medi- 
care program: 


Approved for Participation: 

Dav-Kim Portable X-Ray, 409 Barnsley Place, 
Northbrook, Illinois 60062 (Provider Number 14- 
9817 ) has been approved as a supplier of portable 
X-ray services under the Medicare program. The 
effective date of coverage is January 23, 1978. 

Liberty Portable X-Ray, 5339 South Major, Chi- 
cago 60638 (Provider Number 14-9816) has been 
approved as a supplier of portable X-ray services 
under the Medicare program. The effective date of 
coverage is July 25, 1977. 

Notification of Closing: 

Peterson Clinical Laboratory, 2424 West Peter- 
son, Chicago 60645 (Provider Number 14-8159) 
closed, effective April 30, 1978. No payment can 
be made under the health insurance program for 
services rendered on or after the effective closing 
date. 

Changes in Approved Procedures: 

Bowers Laboratory, 7318 Madison Street, Forest 
Park is no longer approved to perform Procedure 
330-Chemistry-Other, effective May 1, 1978. The 
laboratory is still approved to perform procedures 
in Bacteriology, Parasitology, Serology, Routine 
Chemistry, Clinical Microscopy, Blood Group and 
Rh. Rh Titers, Hematology, and EKG Services. 

F & M Medical Laboratory, Inc., 4554 North 
Broadway, Chicago is no longer approved to per- 
form Procedure 130-Parasitology, 330-Chemistry- 
Other, and 710-EKG Services. These deletions are 
effective May 1, 1978. The laboratory is still ap- 
proved to perform procedures in Bacteriology, 
Serology, Chemistry-Routine, Clinical Microscopy, 
Hematology, and Blood Group & Rh. 

Royal Medical Laboratory, 3940 West Division 
Street, Chicago is no longer approved to perform 
Procedures 120-Mycology; 130-Parasitology; and 
510 Rh Typing. The deletions were effective April 
13, 1978. The laboratory is still approved to perform 
procedures in Serology, Chemistry-Routine; Clin- 
ical Mycroscopy, Hematology and Diagnostic Cy- 
tology. 

Clearing Industrial Clinic, 5548 West 55th Street, 
Chicago is no longer approved to perform Proce- 
dure 330-Chemistry-Other, effective April 13, 1978. 
The laboratory is approved to perform procedures 
in Serology, Routine Chemistry, Clinical Micro- 
scopy and Hematology. 

Franklin Park Medical Laboratory, Inc., 9711 
West Grand, Franklin Park, Illinois 60131 is no 
longer approved to perform Procedure 330-Chem- 
istry-Other. The laboratory is approved to perform 
Procedures 400-Hematology and 710-EKG services. 


(This report is a service to the physicians of Illinois) 


What’s new at 
Bio-Science Chicago? 




Always the latest 
specialized diagnostic tests. 

Chemistry 

Anti-convulsant group 
Cadmium in blood 
Darvon® 

Ferritin in serum 

Free erythrocyte protoporphyrins 
Pyridoxal phosphate (B 6 ) 

Riboflavin (B 2 
Succinimides in serum 
Theophylline 

Uroporphyrinogen-1-synthetase 
Clonopin 

Endocrinology 

Androstenedione in serum 
Calcitonin 
C-Peptide 
Estriol in serum 
Placental Estriol in urine 
HCG-0-subunit 
Pregnanetriol in urine (GLC) 

Prolactin 

17-OH Progesterone in 
serum 

Thyroglobulin in serum 
25-Hydroxy Vitamin D 
Estradiol Receptor 
Assay by 
Scatchard Plot 
Progesterone 
Receptor 
Assay 


Immunochemistry 

Anti-extractable nuclear antigen 
(Anti-ENA) 

Fungus antibody group 
Gentamicin 

Intrinsic factor antibodies 
Tobramycin 
Anti-tissue antibodies 
HLA-B27 


Bio-Science 

Laboratories 

Chicago Branch 
770 Burr Oak Drive 
Westmont, II 60559 
(312) 887-9800 


Bio-Science 


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S. Elgin • 
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N. Aurora* 'Naperville 



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i Algonquin Cary Fort Sheridan 

Huntley* • I DeerfieldJi!5!\ 

~ ICarpentersville Barrington,^ ^ .Glencoe I 
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Manhattan I 


Elwood 

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.Wilmington 


Beecher, 
Peotone* 


Lostant OLeonore Streator , Q 

n o« ORansom ,, ° 

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Monmouth 

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NDERSON 

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Port o 
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Stronghurst • Roseville 


SparlandO o Varnao 

,acon ^ 

Toluca 

Washburn 


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LIVINGSTON 

Rutland ^ on 9 Point 0de ,U 

O CaberyO 

Cornell EmingtonO 


Dwight* 

Campuso 



O Bourbonnais Bradley • 

Essex • ■ Momence 

Kankakee q 

Reddick • o Aroma Park I 

0 W. Kankakee 

Herscner St. Anne • 

Or 


Princeville Chillicothey WOODFORD MinonM 
0 Dun!ap 0 Rome o Benson 

Brimfield r 
Elmwood , Peoria 


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Flanagan 


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El Vista • Htsjtfetamora- . n( jton El Paso 

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Fairbury Forrest 

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Watseka 


Gilman 


Sheldon 


WHEN YOU CAN’T RULE OUT STAPH, CONSIDEF 

TEGOPEN 

(cloxacillin sodium) 


“THE PENICILLIN OF TODAY” 


■ Effective against nonpenicillinase-producing staphylococci, 
beta-hemolytic streptococci, and pneumococci.f 

fNOTE: The choice of Tegopen should take into consideration the fact that it has been shown to be effective only in the treatment 
of infections caused by pneumococci. Group A beta-hemolytic streptococci, and penicillin G-resistant and penicillin G-sensitive 
staphylococci. If the bacteriology report later indicates that the infection is due to an organism other than a penicillin G-resistant 
staphylococcus sensitive to cloxacillin sodium, the physician is advised to continue therapy with a drug other than cloxacillin sodium 
or any other penicillinase-resistant semisynthetic penicillin. The clinical significance of in vitro data is unknown. 

■ 10 times more active against strep than staph. 

■ Well absorbed from the G.I. tract.t 

^Maximum absorption occurs when Tegopen is taken on an empty stomach, preferably 1-2 hrs. before meals. 



Please see brief summary 
for prescribing information. 


Brief Summary of Prescribing Information 
Combined TEGOPEN® (cloxacillin sodium) 

Capsules and Oral Solution 

For complete information, consult Official Package 
Circular. ( 1 2 ) TEGOPEN 9/ 1 1 /75 

Indications: Although the principal indication for cloxa- 
cillin sodium is in the treatment of infections due to 
penicillinase-producing staphylococci, it may be used to 
initiate therapy in such patients in whom a staphylococcal 
infection is suspected. (See Important Note below.) 

Bacteriologic studies to determine the causative organ- 
isms and their sensitivity to cloxacillin sodium should be 
performed. 

Important Note: When it is judged necessary that treat- 
ment be initiated before definitive culture and sensitivity 
results are known, the choice of cloxacillin sodium should 
take into consideration the fact that it has been shown to 
be effective only in the treatment of infections caused by 
pneumococci. Group A beta-hemolytic streptococci, and 
penicillin G-resistanl and penicillin G-sensitive staphy- 
lococci. If the bacteriology report later indicates the 
infection is due to an organism other than a penicillin 
G-resistant staphylococcus sensitive to cloxacillin sodium, 
the physician is advised to continue therapy with a drug 
other than cloxacillin sodium or any other penicillinase- 
resistant semi-synthetic penicillin. 

Recent studies have reported that the percentage of 
staphylococcal isolates resistant to penicillin G outside 
the hospital is increasing, approximating the high per- 
centage of resistant staphylococcal isolates found in the 
hospital. For this reason, it is recommended that a peni- 
cillinase-resistant penicillin be used as initial therapy for 
any suspected staphylococcal infection until culture and 
sensitivity results are known. 

Cloxacillin sodium is a compound that acts through a 
mechanism similar to that of methicillin against penicillin 
G-resistant staphylococci. Strains of staphylococci resis- 
tant to methicillin have existed in nature and it is known 
that the number of these strains reported has been increas- 
ing. Such strains of staphylococci have been capable of 
producing serious disease, in some instances resulting in 
fatality. Because of this, there is concern that widespread 
use of the penicillinase-resistant penicillins may result in 
the appearance of an increasing number of staphylococcal 
strains which are resistant to these penicillins. 

Methicillin-resistant strains are almost always resistant 
to all other penicillinase-resistant penicillins (cross- 
resistance with cephalosporin derivatives also occurs 
frequently). Resistance to any penicillinase-resistant peni- 
cillin should be interpreted as evidence of clinical resis- 
tance to all, in spite of the fact that minor variations in 
in vitro sensitivity may be encountered when more than 
one penicillinase-resistant penicillin is tested against the 
same strain of staphylococcus. 

Contraindications: A history of a previous hypersensi- 
tivity reaction toany of the penicillins is a contraindication. 
Warning: Serious and occasionally fatal hypersensitivity 
(anaphylactoid) reactions have been reported in patients 
on penicillin therapy. Although anaphylaxis is more fre- 
quent following parenteral therapy it has occurred in 
patients on oral penicillins. These reactions are more apt 
to occur in individuals with a history of sensitivity to 
multiple allergens. 

There have been well documented reports of individuals 
with a history of penicillin hypersensitivity reactions who 
have experienced severe hypersensitivity reactions when 
treated with a cephalosporin. Before therapy with a peni- 
cillin, careful inquiry should be made concerning previous 
hypersensitivity reactions to penicillins, cephalosporins, 
and other allergens. If an allergic reaction occurs, the drug 
should be discontinued and the patient treated with the 
usual agents, e.g., pressor amines, antihistamines, and 
corticosteroids. 

Safety for use in pregnancy has not been established. 
Precautions: The possibility of the occurrence of super- 
infections with mycotic organisms or other pathogens 
should be kept in mind when using this compound, as with 
other antibiotics. If superinfection occurs during therapy, 
appropriate measures should be taken. 

As with any potent drug, periodic assessment of organ 
system function, including renal, hepatic, and hemato- 
poietic, should be made during long-term therapy. 
Adverse Reactions: Gastrointestinal disturbances, such 
as nausea, epigastric discomfort, flatulence, and loose 
stools, have been noted by some patients. Mildly elevated 
SGOT levels (less than 100 units) have been reported in a 
fewpatients for whom pretherapeutic determinations were 
not made. Skin rashes and allergic symptoms, including 
wheezing and sneezing, have occasionally been encoun- 
tered. Eosinophilia, with or without overt allergic mani- 
festations, has been noted in some patients during therapy. 
Usual Dosage: Adults: 230 mg. q.6h. 

Children: 50mg./Kg./day in equally divided doses q.6h. 
Children weighing more than 20 Kg. shouid be given the 
adult dose. Administer on empty stomach for maximum 
absorption. 

N.B.: INFECTIONS CAUSED BY GROUP A BETA- 
HEMOLYTIC STREPTOCOCCI SHOULD BE 
TREATED FOR AT LEAST 10 DAYS TO HELP PRE- 
VENT THE OCCURRENCE OF ACUTE RHEUMATIC 
FEVER OR ACUTE GLOMERULONEPHRITIS. 
Supplied: Capsules— 250 mg. in bottles of 100, 500 mg. in 
bottles of 100. Oral Solution — 125 mg. /5 ml. in 100 ml. and 
200 ml. bottles. 


BRISTOL® 


BRISTOL LABORATORIES 
Division of Bristol-Myers Company 
Syracuse, New York 13201 


Clinics for Crippled Children 
Listed for August 


Twenty-nine clinics for Illinois’ physically handicapped 
children have been scheduled for August by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will count nineteen general clinics 
providing diagnostic orthopedic, pediatric, speech and 
hearing examination, along with medical social and nurs- 
ing services. There will be nine special clinics for chil- 
dren with cardiac conditions and one for children with 
cerebral palsy. Any private physician may refer to or 
bring to a convenient clinic any child or children for 
whom he may want examination or consultative services. 


August 1 Park Ridge Cardiac— Lutheran General Hospi- 
tal 

August 2 Hinsdale— Hinsdale Sanitarium 
August 3 Sterling— Community General Hospital 
August 3 Lake County Cardiac— Victory Memorial Hos- 
pital 

August 4 Division Cardiac— U. of I. at the Medical Cen- 
ter 

August 8 Peoria— St. Francis Hospital 
August 8 East St. Louis— Christian Welfare Hospital 
August 9 Rockford— St. Anthony’s Hospital 
August 9 Champaign— McKinley Hospital 
August 9 Joliet— St. Joseph’s Hospital 
August 10 Springfield— St. John’s Hospital 
August 10 Kankakee General— St. Mary’s Hospital 
August 11 Chicago Heights Cardiac— St. James Hospital 
August 14 Peoria Cardiac— St. Francis Hospital 
August 15 Rock Island— Moline Public Hospital 
August 15 Belleville— St. Elizabeth’s Hospital 
August 16 Springfield Ped-Neuro— St. John’s Hospital 
August 16 Chicago Heights General— St. James Hospital 
August 17 Rockford— Rockford Memorial Hospital 
August 17 Bloomington— Mennonite Hospital 
August 17 Elmhurst Cardiac— Memorial Hospital of Du- 
Page County 

August 18 Kankakee Cardiac— St. Mary’s Hospital 

August 21 Maywood— Loyola Medical Center 

August 22 Peoria— St. Francis Hospital 

August 23 Aurora MM— St. Joseph Mercy Hospital 

August 24 Litchfield— St. Francis Hospital 

August 25 Evanston— St. Francis Hospital 

August 25 Chicago Heights Cardiac— St. James Hospital 

August 28 Peoria Cardiac— St. Francis Hospital 

The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. In carrying on its program, 
the Division works cooperatively with local medical so- 
cieties, hospitals, the Illinois Children’s Hospital-School, 
civic and fraternal clubs, visiting nurse association, local 
social and welfare agencies, local chapters of the National 
Foundation and other interested groups. In all cases, the 
work of the Division is intended to extend and supple- 
ment, not supplant, activities of other agencies, either 
public or private, state or local, carried on in behalf of 
crippled children. 


for July, 1978 


1! 



\ 

of the ISMS auxiliary 

Mrs. Eugene Vickery, Editor 

J 




Growth Patterns 


New Officers Introduced 


Mrs. Earl V. Klaren, President, ISMSA 

The Illinois State Medical Society Auxiliary 
elected three new vice presidents at the April 
meeting: Mrs. Harlan Failor, Mrs. Don Hinder- 
liter and Mrs. Harold Keegan. 

Pat Failor, First Vice President (Membership) 
will be responsible for encouraging new mem- 
berships. Pat has been a member of the ISMSA 
Board of Directors for seven years. She has served 
as Public Affairs Chairman, a Director, (respon- 
sible for members-at-large) Treasurer, Third 
Vice President (Communications) and president 
of the Champaign County Medical Auxiliary. 

As Second Vice President (Programs) , Mrs. 
Don Hinderliter is available to county medical 
society auxiliaries with pertinent information 
and will serve as our liaison with the AMA 
Auxiliary Project Bank. Diane holds degrees 
from Northern Illinois University and the Rock- 
ford Memorial School of Nursing. She served as 
president of the Ogle County Medical Auxiliary, 
1975-78, and ISMSA State Health Education and 
Health Manpower Chairman in 1976-77. Diane’s 
husband Doctor Don Hinderliter, a family prac- 
titioner, is currently ISMS Public Affairs Com- 
mittee Chairman. 



Pictured above, top row, 1-r, First Vice President Pat 
Failor and Director Jean Hodges. Bottom row, Diane 
Hinderliter, Second Vice President and Third Vice 
President Bonnie Keegan. 

Mrs. Harold Keegan, Third Vice President 
(Communications) will assist constituent auxil- 
iaries in communications efforts and publica- 
tions. Bonnie, who edited PULSE for three years 
and is the immediate past Community Health 
Chairman, is well-versed in public relations. 
Bonnie and her husband, Doctor Harold Keegan, 
a neurosurgeon, live in Kankakee with their four 
children. She is the former president of the Kan- 
kakee County Auxiliary, as well as chairman of 
community health and special projects. 

Our new vice presidents are anxious to help 
county efforts. Please call upon them to help you 
make the most of auxiliary involvement. Better 
yet, take advantage of the opportunity to meet 
them at Fall Conference in September. 


12 


Illinois Medical Journal 



Medical Records and Patient Care 
To Highlight Annual Symposium 

By Magda Brown, Chairman, Public Relations 


The American Association of Medical Assis- 
tants, Illinois Society, will hold an all-day educa- 
tional program on Sunday, September 17, 1978. 
The program will be held at the Continental 
Regency Hotel, 500 Hamilton Blvd., Peoria, 
from 9 a.m. until 4 p.m. 

The symposium represents an annual culmina- 
tion of daily efforts to define and disseminate an 
understanding of the nature and function of the 
medical office staff. 

Physician-employers are asked to encourage 
their office stalf to attend this diversified, educa- 
tional program. The program, coordinated by 
the Peoria Chapter, is designed to be of interest 
to medical personnel in all capacities. 

Application has been filed with the American 
Association of Medical Assistants for CEU (con- 
tinuing education unit) credits. 

Following registration and coffee at 8:30 a.m., 
the morning segment will be devoted to the im- 
portance of accurate medical record keeping in 
the doctor’s office. A medical record instructor 
will explore the number one phase of record 
keeping: confidentiality. 

A slide presentation on rare diseases of the 
ears, nose and throat will accompany a lecture 
on treatment and office care. The speaker for this 


segment is a well known ENT specialist. 

The afternoon segment following noon lunch- 
eon will deal with office surgery. Changes and 
improvements in general and thoracic surgery 
as well as handling the post surgical patient in 
the office will be discussed by a panel of prom- 
inent surgeons. 

Miss Pauline Klarich, chairman, and members 
of the Peoria chapter will welcome registrants at 
a hospitality-welcome party on Saturday, Septem- 
ber 16, 1978 at 6:30 p.m. in the hotel. Refresh- 
ments will be served. 

Registration package includes refreshment Sat- 
urday evening, coffee/rolls Sunday morning and 
luncheon Sunday noon, in addition to the all day 
educational seminar. 

Advanced registration for members before 
September 1, 1978 will cost $12.50. Member reg- 
istration after that date is $15.00. Students will 
be charged $6.00, and non-members, $15.00. 
(Registrants are advised to contact the hotel 
in advance for overnight accommodations.) 

Please complete the coupon below and mail 
to: Airs. Mary Palmer, 1925 W. Calendar Street, 
Peoria, 111. 61604. (309) 676-5438. Make check 
payable to: AAMA, Illinois Society, Symposium. 


“The Pocketbook of Knowledge” 


Member of AAMA: / 

Name yes no 


Address 


for July, 197S 


15 


Obituaries 


““Alvarez, Walter C., San Francisco, California, died 
June 18, 1978, at the age of 93. He was a 1905 grad- 
uate of Cooper Medical College, San Francisco. Dr. 
Alvarez practiced medicine for 70 years, and formerly 
wrote a medical column for the Chicago Sun-Times. 

““Bond, Ian H., Ormond Beach, Florida, died October 
28, 1977 at the age of 80. Dr. Bond was a 1928 grad- 
uate of Rush Medical School. 


* “Colwell, Arthur, Evanston, died June 14, 1978, at the 
age of 80. A 1922 graduate of Rush Medical College, 
Dr. Colwell was chairman of Northwestern University 
Medical School’s department of medicine for 15 years. 
In his long association with Northwestern Memorial 
Hospital, Dr. Colwell practiced internal medicine and 
was named president of the American Diabetes Asso- 
ciation in 1955. Dr. Colwell was a founder and president 
of the Chicago Diabetes Association. 

“Elmer, Raymond F., Colorado, died June 4, 1978, at 
the age of 86. Dr. Elmer was a 1915 Chicago Medical 
School graduate. 

““Garside, Earl, Chicago, died June 7, 1978, at the age 
of 78. He was a 1923 graduate of the University of 
Oklahoma. Dr. Garside was a surgeon and former chief 
of staff at Augustana Hospital. 


“Goldstein, I. Irwin, Chicago, died May 23, 1978, at the 
age of 64. Dr. Goldstein was a 1939 graduate of Stritch 
School of Medicine. 


“Hastings, J. W., Aledo, died June 5, 1978, at the age 
of 62. He was a 1942 graduate of the University of 
Illinois, Abraham Lincoln School of Medicine. Dr. Hast- 
ings had held many offices in the Mercer County Medi- 
cal Society, and served as secretary at the time of his 
death. He was also the chief of surgery at Mercer Coun- 
ty Hospital. 


“Karg, Frank P., Western Springs, died May 18, 1978. 


““Kenyon, Allan T., Chicago, died May 26, 1978, at the 
age of 77. He was a 1926 graduate of Rush Medical Col- 
lege. Dr. Kenyon was professor emeritus at the Pritzker 
School of Medicine. At the time of his retirement in 
1966, Dr. Kenyon was head of the department of en- 
docrinology. 


Kirson, Celia, New York, died June 18, 1978, at the age 
of 85. Dr. Kirson was an attending psychiatrist at Man- 
teno State Hospital. 


“Lang, Theodore, Rockford, died April 12, 1978, at the 
age of 73. He was a 1929 graduate of the University of 
Vienna, Austria. Dr. Lang was formerly affiliated with 
St. Ann’s Hospital, 1933-1972, and served as head of the 
department of radiology. 

““Lenit, Oscar, Florida, died May 30, 1978, at the age 
of 88. A 1914 graduate of the University of Illinois, Dr. 
Lenit was formerly on the staff of American Hospital. 

“Slaughter, Wayne B., Idaho, died June 21, 1978, at the 
age of 70. A 1934 graduate of the University of Nebras- 
ka and former Chicago surgeon, Dr. Slaughter served as 
a faculty member at Loyola University. He was also 
chairman of the department of plastic surgery at Mercy 
Hospital. 

“Steinberg, D. Louis, Elgin, died April 27, 1978, at the 
age of 75. Dr. Steinberg graduated from the University 
of Illinois in 1931. 

“Strauser, Emory Ross, Dixon, died May 16, 1978, at the 
age of 82. Dr. Strauser was a 1932 graduate of the Uni- 
versity of Chicago, Pritzker School of Medicine. 

““Sugar, Roy Thomas, Chicago, died May 12, 1978, at 
the age of 82. He was a 1926 graduate of the University 
of Illinois, Abraham Lincoln School of Medicine. 

“Suslick, Alvin, Evanston, died May 22, 1978, at the age 
of 53. Dr. Suslick was a 1950 graduate of the University 
of Illinois. 

““Thiell, James E., Rockford, died May 23, 1978, at the 
age of 87. Dr. Thiell was a 1915 graduate of the Uni- 
versity of Illinois. 

“Urban, Francis E., Chicago, died December 11, 1977, 
at the age of 71. Dr. Urban was a 1933 graduate of the 
Stritch School of Medicine. 

““Welden, Edmund A., Summit, died January 21, 1978, 
at the age of 91. Dr. Welden was a 1917 graduate of 
the University of Illinois. 

““Zaus, Earl Alfred, Chicago, died April 21, 1978, at 
the age of 82. He was a 1922 graduate of Rush Medical 
School and was formerly affiliated with Cook County 
Hospital. 

“Zeller, Michael, Skokie, died November 5, 1977, at the 
age of 78. Dr. Zeller was a 1925 graduate of North- 
western University Medical School. 

° Indicates ISMS member. 

““ Indicates member of the ISMS Fifty Year Club. 


16 


Illinois Medical Journal 


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18 


Illinois Medical Journal 




I’m just a That is what depressed individuals 

• * ■ - may feel is the substance of 

laaow OT wnai their being. There is no pleasure, 

I used to be.” no joy — nothing grows — and in the 

cold shadow of depression their 
activities are inhibited, while ini- 
tiative may be eroded or des- 
troyed. The tragedy is that they 


can see that others are able to 
live on the brighter side but they, 
themselves, cannot reach it on 
their own. 

Your experience in treating 
depression, and Tofranil-PIVS 
can help light the way. 


Tofranil- PM* 

imipramine pamoate Geigy 

Unsurpassed effectiveness 
among tricyclics in relieving symptoms 
of anxious depression. 


Before prescribing Tofranil-PM, please review a summary of the 
prescribing information on the back of this page. 


Tofranil-PM' 

imipramine pamoate 

As anxiety, agitation, sleep 
disturbances, and other 
depressive symptoms are 
relieved, mood and motivation 
may be markedly improved. 

Patients are usually alert and 
capable of functioning at more 
normal levels of behavior. 


Tofranil-PM® 

brand of imipramine pamoate 


Indications: For the relief of symptoms of depression. 
Endogenous depression is more likely to be alleviated 
than other depressive states. 

Contraindications: The concomitant use of monoamine 
oxidase inhibiting compounds is contraindicated. Hyper- 
pyretic crises or severe convulsive seizures may occur in 
patients receiving such combinations. The potentiation of 
adverse effects can be serious, or even fatal. When it is 
desired to substitute Tofranil-PM. brand of imipramine 
pamoate, in patients receiving a monoamine oxidase in- 
hibitor, as long an interval should elapse as the clinical 
situation will allow, with a minimum of 14 days. Initial 
dosage should be low and increases should be gradual 
and cautiously prescribed. The drug is contraindicated 
during the acute recovery period after a myocardial infarc- 
tion. Patients with a known hypersensitivity to this com- 
pound should not be given the drug. The possibility of 
cross-sensitivity to other dibenzazepine compounds 
should be kept in mind. 

Warnings: Usage in Pregnancy: Safe use of imipramine 
during pregnancy and lactation has not been established; 
therefore, in administering the drug to pregnant patients, 
nursing mothers, or women of childbearing potential, the 
potential benefits must be weighed against the possible 
hazards. Animal reproduction studies have yielded incon- 
clusive results. There have been clinical reports of con- 
genital malformation associated with the use of this drug, 
but a causal relationship has not been confirmed. 

Extreme caution should be used when this drug is given 
to: 

— patients with cardiovascular disease because of the 
possibility of conduction defects, arrhythmias, myocar- 
dial infarction, strokes and tachycardia; 

— patients with increased intraocular pressure, history of 
urinary retention, or history of narrow-angle glaucoma 
because of the drug’s anticholinergic properties; 

— hyperthyroid patients or those on thyroid medication 
because of the possibility of cardiovascular toxicity; 

— patients with a history of seizure disorder because this 
drug has been shown to lower the seizure threshold; 

— patients receiving guanethidine or similar agents since 
imipramine may block the pharmacologic effects of 
these drugs. 

Since imipramine may impair the mental and/or physical 
abilities required for the performance of potentially 
hazardous tasks such as operating an automobile or 
machinery, the patient should be cautioned accordingly. 
Usage in Children: Tofranil-PM, brand of imipramine 
pamoate, should not be used in children of any age be- 
cause of the increased potential for acute overdosage 
due to the high unit potency (75 mg., 100 mg., 125 mg. 
and 150 mg.). Each capsule contains imipramine 
pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150 
mg. imipramine hydrochloride 

Precautions: It should be kept in mind that the possibility 
of suicide in seriously depressed patients is inherent in 


Geigy 


Tofranil-PM encourages patient 
compliance because one 
capsule lasts from bedtime to 
bedtime. 

Good results are usually seen 
at the starting dose of one 
75-mg capsule h.s. 

For many patients, dosage can 
be safely increased to 150 mg 
daily. 


the illness and may persist until significant remission oc- 
curs. Such patients should be carefully supervised during 
the early phase of treatment with Tofranil-PM. brand of 
imipramine pamoate, and may require hospitalization. 
Prescriptions should be written for the smallest amount 
feasible. 

Hypomamc or manic episodes may occur, particularly in 
patients with cyclic disorders. Such reactions may neces- 
sitate discontinuation of the drug. If needed, Tofranil-PM, 
brand of imipramine pamoate, may be resumed in lower 
dosage when these episodes are relieved. Administration 
of a tranquilizer may be useful in controlling such 
episodes. 

Prior to elective surgery, imipramine should be discon- 
tinued for as long as the clinical situation will allow. 

An activation of the psychosis may occasionally be ob- 
served in schizophrenic patients and may require reduc- 
tion of dosage and the addition of a phenothiazine. 

In occasional susceptible patients or in those receiving 
anticholinergic drugs (including antiparkinsonism agents) 
in addition, the atropine-like effects may become more 
pronounced (e g., paralytic ileus). Close supervision and 
careful adjustment of dosage is required when this drug is 
administered concomitantly with anticholinergic or sym- 
pathomimetic drugs 

Avoid the use of preparations, such as decongestants 
and local anesthetics, which contain any sympathomimet- 
ic amine (e.g., adrenalin, noradrenalm), since it has been 
reported that tricyclic antidepressants can potentiate the 
effects of catecholamines. 

Patients should be warned that the concomitant use of 
alcoholic beverages may be associated with exaggerated 
effects 

Both elevation and lowering of blood sugar levels have 
been reported. 

Concurrent administration of imipramine with electroshock 
therapy may increase the hazards; such treatment should 
be limited to those patients for whom it is essential, since 
there is limited clinical experience. 

Adverse Reactions: Note Although the listing which fol- 
lows includes a few adverse reactions which have not 
been reported with this specific drug, the pharmacological 
similarities among the tricyclic antidepressant drugs re- 
quire that each of the reactions be considered when imip- 
ramine is administered. 

Cardiovascular: Hypotension, hypertension, tachycardia, 
palpitation, myocardial infarction, arrhythmias, heart block, 
stroke, falls. 

Psychiatric: Confusional states (especially in the elderly) 
with hallucinations, disorientation, delusions; anxiety, 
restlessness, agitation; insomnia and nightmares; 
hypomania; exacerbation of psychosis. 

Neurological: dumbness, tingling, paresthesias of ex- 
tremities; incoordination, ataxia, tremors; peripheral 
neuropathy; extrapyramidal symptoms; seizures, altera- 
tions in EEG patterns; tinnitus. 

Anticholinergic: Dry mouth, and, rarely, associated sub- 
lingual adenitis; blurred vision, disturbances of accommo- 
dation, mydriasis; constipation, paralytic ileus; urinary re- 
tention, delayed micturition, dilation of the urinary tract. 
Allergic: Skin rash, petechiae, urticaria, itching, photosen- 


As with all tricyclics, sedation 
may occur. Please caution 
patients against driving or oper- 
ating dangerous machinery. 

Each capsule contains 
imipramine pamoate equivalen 
to 75, 100, 125 or 150 mg of 
imipramine hydrochloride. 


sitization (avoid excessive exposure to sunlight); edema I 
(general or of face and tongue); drug fever; cross- 
sensitivity with desipramine. 

Hematologic Bone marrow depression including agran- 1 
ulocytosis; eosmophilia; purpura; thrombocytopenia. 
Leukocyte and differential counts should be performed in 
any patient who develops fever and sore throat during 
therapy; the drug should be discontinued if there is evi- ! 
dence of pathological neutrophil depression. 
Gastrointestinal Nausea and vomiting, anorexia, epigas- j 
trie distress, diarrhea; peculiar taste, stomatitis, abdomina 
cramps, black tongue. 

Endocrine: Gynecomastia in the male; breast enlarge- 
ment and galactorrhea in the female; increased or de- 
creased libido, impotence; testicular swelling; elevation or 
depression of blood sugar levels. 

Other: Jaundice (simulating obstructive); altered liver 
function; weight gain or loss: perspiration; flushing; uri- 
nary frequency; drowsiness, dizziness, weakness and 
fatigue; headache; parotid swelling; alopecia. 

Withdrawal Symptoms: Though not indicative of addiction i 
abrupt cessation of treatment after prolonged therapy 
may produce nausea, headache and malaise. 

Dosage and Administration: In adult outpatients, 
therapy should be initiated on a once-a-day basis with 75 
mg./day. This may be increased to 150 mg. /day which is i 
the dose level which usually obtains optimum response. If 
necessary, dosage may be increased to 200 mg./day. 
Dosage should be modified as necessary by clinical re- 
sponse and any evidence of intolerance. Daily dosage 
may be given at bedtime, or in some patients in divided 
daily doses. 

Hospitalized patients should be started on a once-a-day 
basis with 100-150 mg. day and may be increased to 200 : 
mg./day. Dosage should be increased to 250-300 mg. day 
if there is no response after two weeks. 

Following remission, maintenance medication may be re- 
quired for a longer period of time at the lowest dose that 
will maintain remission. The usual adult maintenance 
dosage is 75-150 mg./day on a once-a-day basis, prefer- 
ably at bedtime 

In adolescent and geriatric patients, capsules of Tofranil- | 
PM, brand of imipramine pamoate, may be used when 
total daily dosage is established at 75 mg. or higher. It is 
generally unnecessary to exceed 100 mg./day in these 
patients. This dosage may be given once a day at bed- 
time or, if needed, in divided daily doses. 

How Supplied: Tofranil-PM, brand of imipramine 
pamoate Capsules of 75, 100, 125 and 150 mg. (Each 
capsule contains imipramine pamoate equivalent to 75, 
100. 125 or 150 mg. of imipramine hydrochloride.) 

(B) 98-146-840-A(9/75) 667120 

For complete details, including dosage and adminis- 
tration. please refer to the full prescribing information 

GEIGY Pharmaceuticals 
Division of CIBA-GEIGY Corporation 
Ardsley. New York 10502 

Printed in U.S.A. (10-77) TO 12889 


Manuscript Information 


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for July, 1978 


21 




Rheumatology Rounds 

L. F. Layfer, M.D., and J. V. Jones, M.D., Contributing Co-Editors 


Painful Anterior Shoulder Mass 
With Calcification 


A 61 -year-old housewife presented with a pain- 
ful anterior shoulder mass. Four months pre- 
viously she had noted onset of right shoulder 
pain while lifting groceries. The symptoms were 
exacerbated by forward flexion of the arm. Grad- 
ually range of motion became restricted in all 
directions due to severe pain, which localized 
anteriorly to a newly developed tender bulging 
mass. The pain was worse at night, especially 
when she slept on the shoulder, and would oc- 
casionally radiate down the outer aspect of the 
arm. 

She denied a history of local trauma or un- 
usual stress. Her right wrist had been fractured 
two years earlier, but healed without residual 
symptoms. She had no other joint complaints. 
Further past history and systems review were 
noncontributory. 

On examination, a tender, compressible ill- 
defined swelling was present anterior to the cora- 
coid process on the right. No heat or redness 
were noted. The short and long heads of the bi- 
ceps were tender, and Yergasons sign (reistance 
against llexion and supination of the forearm 
designed to stress the biceps) was positive for 
tenderness localized to the mass. Active range of 
motion was less than passive range of motion in 
all directions, and both were limited by pain. 
Palpation of the deltoid, acromion, supraspina- 
tous, infraspinatous and lateral pectoral areas 
revealed no tenderness. There were no axillary 
nodes. Other joints were normal to examination. 

Laboratory 

Sedimentation rate was 10 mm/hr. Rheuma- 
toid factor was negative. SMA 18 and complete 
blood count were normal. X-ray of the right 
shoulder is shown in Figure 1. X-ray of the 
right wrist was normal. 

Comment 

Calcium deposits in tendons, ligaments and 


joint capsules are a frequent asymptomatic radio- 
logic finding. Acute episodes of bursitis and ten- 
donitis, and rarely, synovitis, are associated with 
such calcific deposits. Such deposits have been 
shown to be in the form of calcium hydroxy 
apatite crystals. 1 Deposits near the rotation cuff 
of the shoulder are those best known to clin- 
icians. These occur in 3% of an unselected pop- 
ulation. 2 They frequently give acute episodes of 
subacromial or subdeltoid bursitis with pain on 
abduction and tenderness under the acromial 
tip. Deposits are also commonly seen in other 
shoulder tendons, 3 and near the greater trachan- 
ters of the hip. 4 Smaller calcifications have been 
infrequently seen in tendons and ligaments near 
the wrist, elbow, knees, ankles and the inter- 
phalangeal joints of the hands and feet, where 
they may also cause inflammation. 4 

Attacks are heralded by pain and tenderness 
near the site of the calcific deposit, where a bursa 
may form. The reason why a dormant deposit 
suddenly causes onset of acute inflammation is 
not known. Apatite crystals, like urates, cause 
inflammation when injected into soft tissues, 
but may lie inert in some tissues for a time. 
Clinically the attacks may be acute and gout-like 
in nature 5 or more local and chronic as in a 
“tennis elbow.’’ A localized area of tenderness 
near the calcium is usually found, but pain on 
motion of the neighboring joint simulating in- 
tra-articular disease is frequent. 

It is not known whether tendon degeneration 
precedes the deposits or vice versa. No metabolic 
or hormonal abnormalities have been demon- 
strated. Some patients have involvement of mul- 
tiple sites and recurrent attacks suggesting some 
underlying systemic abnormality. 6 Deposits have 
been found to cause gout-like attacks in patients 
on dialysis for chronic renal failure. 7 This sug- 
gests a metabolic abnormality. 

Oral anti-inflammatory agents may be tried 
but are generally ineffective. Aspiration of the 
bursa, if well defined, may result in calcium 
crystal removal and subsequent relief. Injection 


99 


Illinois Medical Journal 



Figure 1 

The dense calcific deposit can be seen moving midi- 
cally as the arm moves from external rotation (A), to 
internal rotation (B), placing the mass anterior. 


of a lidocaine and steroid combination into the 
areas of tenderness usually results in prompt 
relief of symptoms and may be curative. Healing 
is often associated with spontaneous reabsorp- 
tion of the calcium. Deposits may recur, and 
surgical removal may be necessary. Colchicine 
has been effective in the inflammation associated 
with chronic renal failure. 7 

Conclusion 

Calcium deposit on X-ray lead to a diagnosis 
of calcific tendonitis in an unusual position, 
probably the short head of the biceps. The bi- 
ceps tendonitis and anterior bursitis were 
thought secondary to apatite induced soft tissue 
inflammation near the coracoid where the short 
head of biceps inserts. A 22-gauge needle was 
placed into the ill-defined mass and 2 ml. of 
fluid containing chalky-white granules were re- 
moved. A lidocaine and steroid solution was in- 
jected into the area and brought rapid pain re- 
lief. Normal range of motion was restored, which 
demonstrated an absence of underlying adhesive 


capsulitis (frozen shoulder) which sometimes 
accompanies such lesions. The patient had only 
minimal pain the next day, and on six month 
follow-up was entirely asymptomatic. ◄ 

References 

1. McCarty, D. J. and Gatter, R. A.: “Recurrent Acute 
Inflammation Associated with Focal Apatite Crystal 
Deposition,” Arth. and Rheum., 9:804-819, 1966. 

2. Bosworth, B. M.: “Calcium Deposits in the Shoulder 
and Subacromial Deposits,” JAMA, 116:2477-2482, 1941. 

3. Goldenbert, R. R. and Leventhal, G. S.: “Supratro- 
chanteric Calcification,” J. Bone Joint Surg., 18:205- 
211, 1936. 

4. Key, J. A.: “Calcium Deposits in the Vicinity of the 
Shoulder and Other Joints,” Annals of Surgery, 129: 
737-755, 1949. 

5. Thompson, G. R., Ting, Y. M„ Riggs, G. A., et al .: 
“Calcific Tendonitis and Soft Tissue Calcification Re- 
sembling Gout,” JAMA, 203:122-130, 1968. 

6. Finals, R. S. and Short, C. L.: “Calcific Periarthritis 
Involving Multiple Sites,” Arth. and Rheum., 9:566- 
574, 1966. 

7. Moskowitz, R. W., Vertes, V., Schwartz, A., et al.: 
“Crystal Induced Inflammation Associated with Chron- 
ic Renal Failure Treated with Periodic Hemodialysis,” 
Am. J. Med., 47:450-460, 1969. 


for July, 1978 


23 


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Illinois Medical Journal 




Rape: A Community Hospital Study 

Pedro A. Poma, M.D. and Robert C. Stepto, M.D., Ph.D. /Chicago 


Rape is a violent crime that has increased in incidence (Federal Bureau of 
Investigation— 1975). Illinois Law (PA 79-564, effective January 1, 1976) mandated 
the Illinois Department of Public Health to prescribe minimum standards, rules 
and regulations for emergency care of alleged rape victims in Illinois. 

Before the law became effective, private practitioners were not usually aware 
of the circumstances of rape and the requirements of rape victim management. 


The records of women admitted for treatment 
to the Emergency Room (ER) at Mount Sinai 
Hospital Medical Center of Chicago between 
January 1, 1974 and December 31, 1975, have 
been studied carefully. Multiple variables were 


PEDRO A. POMA, M.D., is an assistant professor of obstetrics 
and gynecology affiliated with Rush Medical College in Chi- 
cago. Doctor Poma is vice-chairman of the department of 
obstetrics and gynecology at Mount Sinai Hospital and Medical 
Center. He is a consultant in gynecology at the Loyola Univer- 
sity Sexual Dysfunction Clinic and former director of the ob- 
stetrics and gynecology clinics for Cook County Hospital. 

ROBERT C. STEPTO, M.D., is a profes- 
sor of obstetrics and gynecology at 
Rush Medical College and the chairman 
of the department of obstetrics and 
gynecology at Mount Sinai Hospital 
and Medical Center. Doctor Stepto 
has received certificates of recognition 
from the University of Chicago Alumnai 
Association and HEW, and lists his 
most active interests in the field of 
gynecologic oncology and endocrinology. 


noted and constitute the basis for this report. 
The hospital is located in Chicago’s inner city. 

During the study period, when an alleged rape 
victim presented in the ER, the ER nurse would 
guide her into a private room. Here the surgical 
resident evaluated her specifically for life-threat- 
ening conditions and extragenital injuries. The 
gynecological resident would then take a history 
and perform sexological examination, evidence 
collection, prophylaxis and therapy when indi- 
cated. The nurse remained in the room through- 
out the procedure. Other tests and specialty con- 
sultations were done when necessary. 

Results 

During the study period, 236 women were at- 
tended in the ER for the complaint of rape. The 
incidence of reported rape was higher during 
the summer months (mean 26) when compared 
to other months (mean 17) . Age of alleged rape 
victims ranged from three to 47 years. Forty-five 
(19%) were younger than 16 and only two were 
older than 45; 114 women had never been preg- 
nant. 



for July, 1978 


25 


Time and Place 

Rape allegedly occurs more commonly during 
the dark hours. In this study, 66 incidents were 
reported during daylight hours (6 a.m.-6 p.m.) . 
Fifty per cent of all cases occurred in the street; 
27% in the victim’s home and 23% in a car. 


Number of Attackers 

According to the alleged victims, 29.6% (70) 
of the incidents were associated with multiple at- 
tackers, usually two (in 41 cases), but there was 
one case where 15 persons abused the victim. Of 
the cases studied, 166 reported a single attacker 
and nine reported multiple attacks. The attacks 
were vaginal only in 204 cases; there were nine 
oral or rectal intercourse attacks. In one case 
contact was only oral and 22 victims reported no 
penile insertion; ejaculation occurred at peri- 
neum. There were eight cases of incest and 54 of 
the victims knew their attackers. 


Method 

The method used by the attacker was recorded 
in 107 of the cases studied. In 43 cases there was 
either verbal threat to harm others (seven) , or 
physical harm to the victim (36) . In eight cases 
drugs and alcohol were used. Weapons were used 
in 56 cases (38 instances: guns; 13 instances: 
knives; two instances: candle holders and in 
three instances: bricks) . 

There were reports of seven cases in which 
either a girlfriend or boyfriend took the victim 
to the attackers. A rear-end collision was used to 
start contact with the victim in one case. In 
three cases the victim returned home to find a 
burglar; 15 victims told us that they were robbed 
following attack. 


Interval 

The interval between the alleged attack and 
arrival in ER ranged from 14 minutes to 65 
hours. In 68 cases this information was not avail- 
able. In 147 cases, the interval was shorter than 
five hours; in four cases longer than 24 hours. 
Eighty-eight percent of the women in this study 
were single; 159 alleged victims were accom- 
panied to the ER by a female (usually the vic- 
tim’s mother) and 64 by a male (usually the 
victim’s husband). Only 13 victims came for 
treatment alone. 


Pregnancy Risk 

At the time of attack 22 victims were pre- 
menarchal and 171 were at different phases of 
their menstrual cycle (18 were menstruating; 62 
in the first half of their cycle, 10 at midcycle, 81 
in the second half of the cycle) . Pregnancy was 
diagnosed in 19 cases (14 at three months or 
less, one in the second trimester, and four in the 
third trimester) . Six victims were in the post- 
partum period, three were postmenopausal and 
15 had hysterectomy before the incident. There- 
for, 176 victims were at risk of pregnancy. Of 
these women, 75.30% (128) were not using con- 
traceptive measures when attacked; seven had 
been sterilized, and 35 were employing tempo- 
rary methods of contraception. 

Injuries Resulting from Attack 

There was no evidence of physical injury in 
136 cases; 42.37% suffered injuries (121 extra- 
genital injuries and 49 genital injuries) . In some 
cases more than one type of injury was sustained. 
Abrasions were more common than lacerations 
and hematomas. 

Extragenital Injuries 

Abrasions were more common on the upper 
and lower extremities, face and back. Hematomas 
were most often incurred in the face. Lacera- 
tions were present at the head, face, extremities 
and neck. 

Genital Injuries 

Abrasions were common in the vagina and 
vulva. Hematomas were seen usually in the vulva 
and lacerations were noted at the vulva, vagina 
and perineum. There were 25 cases where the 
hymen was described as intact; one of these 
women was pregnant, two others presented with 
the tail of an IUD evident. 

Other 

Severe psychological reaction was exhibited by 
nine victims, characterized especially by over 
stimulation and aggression. In five cases there 
was history of lost consciousness. 

Severe injuries required hospitalization for 
three patients; one of these victims required 
blood transfusions. Alcohol intake was obvious 
in five cases and drug usage was admitted or sus- 
pected in three. According to relatives, two of 
the alleged victims had previous psychiatric treat- 


26 


Illinois Medical Journal 


ment. Mental retardation was evident in two 
cases. 

Semen Studies 

There was no information of semen evaluation 
in 121 records. Pelvic examination was not done 
(either because the alleged victim refused it or 
because of the young age of the victim) in 32 
cases. Records for 83 illustrated the presence of 
semen— in 65 it was motile and in 18 semen was 
non-mot ile. Specimens were taken from the pos- 
terior vaginal fornix. 

Venereal Disease Prophylaxis 

There was no documentation of any therapy 
in seven records. Penicillin was used intramus- 
cularly in 205 cases, tetracycline in 12, spectomy- 
cin in eight, erythromycin in four. There were 
five recorded instances of previous allergy to 
penicillin. 

Pregnaney Prevention 

There were 101 cases not at risk and one pa- 
tient who refused prophylaxis against pregnancy. 
Seven had just menstruated and considered at no 
risk. Of the 127 patients who agreed to medica- 
tion, 96 received ethylbestrol orally, 20 had pro- 
gestins orally and 11 intramuscularly. There 
was no evidence of pregnancy in this group, but 
the follow-up has not been satisfactory. 

ER Admission — Discharge Interval 

This information was not available in 50 rec- 
ords. Three women were admitted to the hospi- 
tal. In 137 cases the interval was less than two 
hours. In 42 cases the interval was up to four 
hours. During this period of time X-ray studies 
were clone in 21 cases and superficial laceration 
suturing in 13 cases. Medical consultation was re- 
quired in three cases (i.e. glucosuria) and psy- 
chiatric consultation was necessary in four cases. 

Discussion 

Rape is one of the least reported violent 
crimes, probably because social pressures and up- 
bringing place the victim (usually female) in a 
very difficult situation and holds her responsible 
for the incident. This is exacerbated when, as 
in most instances, she is the only witness or may 
have previously met the assailant, or dated him. 
Due to social stigma attached to this crime, rape 
is almost never reported in more affluent com- 


munities. We hope women who do not report 
assault are aware of the consequences and obtain 
appropriate care and counselling. 

Rape can happen to anyone, at any age or 
place, but the recorded incidence is usually high- 
er during reproductive years. In this study only 
19% were younger than 16 years. Massey 1 re- 
ported 24%, Hayman and Lanza 2 36%. The as- 
sault occurs commonly in the victim’s home, and 
very rarely at a friend’s home. In the latter situa- 
tion the victim may have more difficulty in estab- 
lishing her claim. 

The approach or techniques used by the at- 
tacked or attackers are multiple, according to 
Burgess and Holstrom, 3 and on some occasions 
a known or trusted person escorted the victim 
to the attackers. In other cases rape followed 
another intended crime, e.g., burglary. Often 
enough the rape is committed by more than one 
aggressor. Women in this study were aware of 
the need for medical services; most of them came 
to our ER within five hours. This is the ideal 
time for detecting motile sperm and to initiate 
other therapy or prophylaxis. Others were held 
by their assailant and/or were not aware of the 
services provided. 

The authors stress the individual’s right to 
seek ami receive these services and treatment 
even if the “victim’s decision” is not to report 
the incident to the authorities. 

The evaluation of menstrual status and con- 
traceptive measures in our study group revealed 
a need for prophylaxis in relation to unwanted 
pregnancy, even when the risk is small. Most of 
these patients agreed to medication to temporar- 
ily change the condition of their endometrium 
and prevent nidation, and also penicillin for 
VI) prophylaxis. Injuries noted were 71% extra- 
genital, 29% genital. Extragenital injuries were 
more common, Burgess and Holstrom 3 reported 
60%, Robinson 29% 4 and Massey 10. 6%. 1 Geni- 
tal injuries were 39%, 8.5%, and 5.2% in those 
series, respectively. 

Rape is not a medical diagnosis. The court 
decides if rape occurred. The presence of semen 
is not legally required to establish rape. Mem- 
bers of the health team have responsibility to 
provide evidence. The ability to collect this type 
of evidence must be reinforced because it is not 
usually taught. The collected specimens must be 
properly identified and handled according to a 
very rigid protocol if they are going to have any 
value in court. The presence of semen can estab- 
lish the fact that intercourse happened sometime 
before examination. The problem remains for 


for July, 1978 


21 


the courts to decide if this occurred voluntarily. 
G. F. Sensabaugh 5 reported that gelelectrophore- 
sis evaluation of seminal enzymes may facilitate 
individual identification with 95% probability. 
Under the present court system, the alleged as- 
sailant may refuse the testing. 

We consider the treatment provided at our in- 
stitution efficient and expedient, with medical 
and psychological needs attended. The prophy- 
laxis for venereal disease appears satisfactory, but 
the severe secondary effects of commonly used 
medications to alter the condition of the endo- 
metrium to prevent nidation do not. The use 
of intramuscularly administered progestrin or 
parental estrogens may be more appropriate, but 
there is still the possibility of secondary effects 
in a few cases and patients should be made aware 
of the reported association with congenital mal- 
formations. 

The victims advocacy program appears the 
most important step into complete victim man- 
agement. The feminist movement, the establish- 
ment of “sex squads”— vounteer citizen groups 
providing protection, counselling and ‘hot lines’ 
—and increased societal awareness have all im- 
proved the handling and reporting of this crime. 


Regular meetings of concerned health team 
members involved in the counselling and man- 
agement of rape victims may further improve 
their standard of care. There has been such a 
program initiated in this institution. Complete 
eradication will require successful treatment 
centers for the aggressors, and societal attitudinal 
changes in relation to sexual attitudes and stereo- 
typed roles. 

Sex is something one does with another person, 
not to another person. Rape is a violent crime; 
an aggressive act that violates the rights of an- 
other person. ◄ 

References 

1. Massey, J. B., Garcia, C. R., Emich, J. R.: “Manage- 
ment of Sexually Assaulted Females,” Obstetrics £r 
Gynecology, 38, No. 1:29-36, 1971. 

2. Hayman, C. R., and Lanza, C.: “Sexual Assault on 
Women and Girls,” Am. J. Ob. Gyn., 109, No. 3:480-86, 
1971. 

3. Burgess, A. W., and Holstrom, L. L.: Rape: Victims 
of a Crisis, Robert J. Brady Co., pub., Maryland, 1974. 

4. Robinson, H., Sherrod, D. B. and MacCarney, C. M.: 
“Review of Child Molestation and Alleged Rape 
Cases,” Am. J. Ob. Gyn., 110, No. 3:405-6, 1971. 

5. Sensabaugh, G. F.: Conference on Chemistry and 

Spectroscopy, Los Angeles, California, 1975. 


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28 


Illinois Medical Journal 


A New Approach 

Bedside Barium Enema 

By Samuel C. Balderman, M.D., Krishnan Sriram, M.D. and 
Arthur G. Michel, M.D. /Chicago 

The general surgeon is often confronted with a patient who has massive lower 
gastrointestinal bleeding and presents diagnostic and therapeutic problems. The 
typical patient is an elderly individual who is brought to the emergency room by 
his relatives, or is transferred from a nursing home. He or she may be in poor 
physical condition ivith low blood pressure and thready pulse. After preliminary 
resuscitative measures in the ER the patient is transferred to the intensive care 
unit while preparations are made for diagnostic studies such as barium enema or 
an angiogram. A proctoscopy is, of course, done first. 

In many instances the patient’s poor general condition precludes transport to 
the radiology department for diagnostic studies. We suggest in this communica- 
tion the use of barium enema at the bedside. The procedure is simple to perform 
and is often diagnostic and therapeutic. 

A catheter with a 30cc balloon is introduced 
into the rectum and the btdb inflated with nor- 
mal saline or air. About 1500 to 2000cc of the 
barium solution is slowly introduced and the 
patient closely observed for any discomfort. Cau- 
tion must be exercised to avoid perforation of 
the bowel. The patient is sequentially rotated 
from a left lateral to supine and right lateral 
positions. The plastic bag with barium solution 
is kept at a height of four feet from the bed. A 


SAMUEL C. BALDERMAN, M.D., is a 
cardiothoracic surgeon affiliated with 
the Loyola University Stritch School of 
Medicine. He is a board certified gen- 
eral surgeon, and a fellow in cardiac 
surgery. 


KRISHNAN SRIRAM, M.D., is a clinical 
instructor in surgery at the University 
of Health Sciences/Chicago Medical 
School. He is affiliated with the Vet- 
erans Administration Hospital in north 
Chicago. 


ARTHUR G. MICHEL, M.D., is a general surgeon and director 
of Surgical Intensive Care at Michael Reese Hospital and 
Medical Center in Chicago. Doctor Michel is also a fellow of 
the American College of Surgeons. 



scout film of the abdomen is taken with catheter 
still in place. 

The barium solution is empirically left in the 
colon for 60 minutes. Then the plastic bag is 
placed on the floor to facilitate re-collection of 
the solution. The balloon is deflated and catheter 
removed. 

A post-evacuation film may also be obtained. 
Case One 

A 79-year-old white male was admitted to the 
hospital with a 24-hour history of lower gastro- 
intestinal bleeding. It was his first episode of 
this nature. 

The patient had a history of atrial fibrillation 
and left cerebrovascular accident some months 
before admission. The condition had since par- 
tially resolved and he was on digoxin and 
quinidine. 

Physical examination revealed a frail, elderly 
individual with a pulse of 120/minute and BP 
of 90/60 mmHg. There was tenderness without 
rebound in the left lower quadrant. Rectal ex- 
amination revealed fresh blood and blood clots 
but no mass. A naso-gastric tube was inserted; 
the aspirate was clear. The patient was initially 
managed in the ward. However, massive rectal 
bleeding continued and the hematocrit remained 
at 25% despite rapid blood transfusion. The pa- 
tient was transferred to the intensive care unit 
at which time he continued to be tachycardic 
with a systolic BP of 60 mmHg. His hemoglobin 
was 7.6 Gms% and hematocrit 24%. EKG was 


for July , 1978 


29 



Figure 1 


Photograph of bedside barium enema showing mul- 
tiple diverticuli in the descending and sigmoid por- 
tions of colon. 


read as “acute coronary insufficiency.” 

Proctoscopy was difficult and inconclusive be- 
cause of excessive bleeding. Angiography was de- 
ferred because the patient was elderly, in shock 
and obviously had severe atherosclerosis (pre- 
vious history of cerebrovascular accident) . 

Barium enema was administered at the bed- 
side and the roentgenogram showed multiple 
diverticuli in the descending and sigmoid por- 
tions of the colon (see Figure 1). The bleeding 
stopped soon after administration of the barium 
solution. The patient had received 5 units of 
blood. 

He continued to improve. There was no re- 
currence of bleeding. He was discharged without 
elective surgery. 

Case Two 

A 66-year-old black male, a known alcoholic 
with a previous history of myocardial infarc- 
tion, was admitted to the intensive care unit 
with a two-day history of passing bloody stools. 


The stools were described as containing both 
bright red blood and maroon-colored clots. His 
past history was unremarkable except for ap- 
pendectomy in childhood. 

Upon admission his blood pressure was 90/60 
mmHg and pulse 140/minute. Hemoglobin was 
14.4 Gms% and hematocrit 43%. Prothrombin 
and partial thromboplastin times were within 
normal limits. The gastric aspirate was clear. 

Gastroscopy done the next morning revealed 
a duodenal ulcer at the apex of the duodenal 
bulb. The ulcer was not actively bleeding and 
there were no varices. The nasogastric tube was 
not re-inserted after gastroscopy. The patient was 
started on oral milk and Maalox®. 

Proctoscopy at bedside showed fresh blood and 
maroon-colored clots in the rectum but was 
otherwise negative. Bedside barium enema 
showed no mass lesions or diverticuli. 

Bleeding per rectum continued on the second 
day after admission. Hemoglobin fell to 8*5 
Gms%. A total of 10 units of blood were admin- 
istered over a period of 16 hours. Pulse rate per- 
sisted at 120/minute. It was decided that surgery 
was necessary. At surgery, a bleeding duodenal 
ulcer was found. Partial gastrectomy with Bill- 
roth II anastomisis and vagotomy was done. The 
post-operative course was uneventful. 

Discussion 

Localization of bleeding within the gastroin- 
testinal tract can be very taxing. While proc- 
toscopy and barium enema are useful in the 
localization of a lower GI bleed, angiography 
is most accurate. 1 Nusbaum and associates (1969) 
have clearly demonstrated the safety and useful- 
ness of percutaneous retrograde angiography in 
localizing bleeding of as little as 0.5 ml/min- 
ute. 2 However, in an elderly patient with mul- 
tiple medical problems, especially atherosclerosis, 
angiography may be contraindicated. The suc- 
cess rate in such patients is also poor. 3 In such 
an event, barium enema is a useful alternate 
diagnostic measure. Needless to say, if angiog- 
raphy should follow barium enema the retained 
barium makes the radiologist’s task very difficult. 
The latter should therefore be done only after 
deciding not to perform an angiogram. 

While the most common cause of all rectal 
bleeding is carcinoma, massive rectal bleeding 
is most often due to diverticulosis. 4 Fortunately, 
compared to other lesions like polyps, diver- 
ticulosis is easily demonstrated radiographically. 
Barium enema will not usually identify the site 


30 


Illinois Medical Journal 


of bleeding but the presence of cliverticulosis in- 
fluences subsequent patient management. 

Barium enema can be therapeutic, as illus- 
trated by Case One. Adams (1970) reported ces- 
sation of massive rectal bleeding after the use 
of barium enema in 2b out of 28 episodes in 22 
patients. 3 * 5 While there is no clear explanation 
for this effect, two factors may be considered, 
namely, pressure by the barium solution produc- 
ing tamponade and a direct hemostatic action by 
the barium sulfate. The former seems more prob- 
able, as the effect is often immediate. It has been 
calculated that an intraluminal pressure of about 
90 nmiHg is produced when barium enema is 
administered. 6 As hydrostatic pressuie is the most 
likely reason for the therapeutic effect of barium 
enema, it seems justifiable to use saline instead 
of barium solution if angiography is contem- 
plated. 7 

Once rectal bleeding is controlled the patient 
can undergo a thorough gastrointestinal work-up 
with no urgency. Elective surgery was not done 
on Case One because of his poor general condi- 
tion, though others believe that it should be 
done. 8 - 9 However, if the patient continues to 
bleed, emergency laparotomy must be performed 
without undue delay. 

The technique of bedside barium enema 
helped considerably in the management of these 
two patients. In the first patient, cliverticulosis 
was revealed and the procedure stopped the 
bleeding. In the second patient, a diagnostic 
problem, the presence of a lower gastrointestinal 
lesion was ruled out with reasonable certainty. 

To summarize, although ideally performed in 
the radiology department, barium enema can be 
easily and safely performed at bedside even in 
poor risk and unstable patients. It helps con- 
siderably in pre-operative evaluation and is thei- 
apeutic in many instances. It is our hope that 
bedside barium enema examination might be 
used more often. 


References 

1. Casarella, W. J., Ranter, I. E„ and Seaman, W. B.: 
“Rightsided Colonic Diverticula as a Cause of Acute 
Rectal Hemorrhage, N. Engl. J. Med., 286:450-453, 
1972. 

2. Nusbaum, M., Baum, S„ and Blakemore, W. S.: “Clin- 
ical Experience with the Diagnosis and Management 
of Gastrointestinal Hemorrhage by Selective Mesenteric 
Catheterization,” Ann. Surg. 170:506-514, 1969. 

3. Drapanas, T„ Pennington, D. G„ Kappleman, M., and 

Lindsey, E. S.: “Emergency Subtotal Colectomy,” Ann. 

Surg., 177:519-526, 1973. 


4. Nocr, R. J., Hamilton, J. E„ Williams, D. J., and 
Broughton, D. S.: “Rectal Hemorrhage: Moderate and 
Severe,” Ann, Surg., 155:794-805, 1969. 

5. Adams, ). T.: “Therapeutic Barium Enema for Mas- 
sive Diverticular Bleeding,” Arch. Surg., 101:457-460, 
1970. 

6. Noveroske, R. J.: “Intracolonic Pressures During Bari- 
um Enema Examination,” Amer. J. Roentgen., 91:852- 
863, 1964. 

7. Eisenberg, H„ Laufer, I., and Skillman, J. J.: “Ar- 
teriographic Diagnosis and Management of Suspected 
Colonic Diverticular Hemorrhage,” Gastroenterology, 
64:1091-1100, 1973. 

8. Asch, M. J., and Markowitz, A. M.: "Diverticulitis 
Coli: A Surgical Appraisal,” Surgery, 62:239-247, 1967. 

9. Ulin, A. W„ Sokolic, I. H„ and Thompson, C.: “Mas- 
sive Hemorrhage from Diverticulitis of the Colon, 
Ann. Int. Med., 50:1395-1406, 1959. 


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For confidential consideration forward letter or resume 
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for July, 197 S 


31 


Pediatric Perplexities 

Ruth Andrea Seeler, M.D., Contributing Editor 


The Pediatric Perplexities series analyzes slightly uncommon pediatric disorders 
which require prompt diagnosis and specific management modalities. The editor 
welcomes suggested topics and questions from interested readers. 


Organophosphate Poisoning 

By Iqbal A. Memon, M.D. /Chicago 


Accidental ingestion of poisons is a major pediatric problem and cause for 
hospitalization. The vast majority of toxic ingestions can be managed only with 
general supportive measures for there are often no specific antidotes. The pedia- 
trician must know those potentially lethal compounds for which a specific anti- 
dote exists and can be life saving. Ingestion or contact with organophosphorous 
materials can be rapidly fatal , and produces a specific group of signs and symp- 
toms that when recognized clinically allow for accurate diagnosis and immedi- 
ate institution of appropriate antidotal therapy A 2 


A 14i/9 month old black male was brought to 
the emergency room of Cook County Hospital by 
his mother approximately five hours after he 
had ingested an “ant killer.” The solution, con- 
tained in a soda pop bottle in the bathroom, had 
been borrowed from a neighbor’s large con- 
tainer. The child simply picked up the bottle 
and ingested an unknown quantity. Approxi- 
mately 30 minutes later the child vomited and 
his mother gave him some milk. Three hours 
after ingestion it was noted that the child had 
noisy and rapid respirations. He became lethargic 
and was brought to the emergency room. 

Physical examination revealed a comatose 
child with copious secretions from the pharynx, 
mouth, and nose. He was not responding to 
painful stimuli and the pupils were markedly 
miotic. Blood pressure was 114/42 mmHg, pulse 
160/min regular, and respiratory rate 50/min. 
The patient was flaccid with an occasional 


IQBAL A. MEMON, M.D., is a resident in the department of 
pediatrics of Cook County Hospitai in Chicago. 


fisciculation of voluntary muscles. The deep 
tendon reflexes were absent. Coarse rales were 
heard throughout both lung fields. 

The diagnosis of organophosphorous poison- 
ing was suspected and the child was admitted 
to the pediatric intensive care unit. Intravenous 
fluids were started, he was given oxygen, suc- 
tioned and placed on continuous EKG monitor- 
ing. Intravenous atropine 0.05 mg/kg was re- 
peated every 15 minutes for a total of 5 doses 
until the clinical signs of atropinization, fever, 
urinary retention, and dilated pupils were evi- 
dent. An additional three doses of the atropine 
sulfate had to be given at approximately six 
hour intervals. The indications for subsequent 
atropine administration were the reappearance 
of miosis and decrease in alertness. Pralidoxime 
in a dose of 20 mg/kg was administered intra- 
venously along with the third dose of atropine 
and with the sixth dose of atropine (six hours 
after admission) . The child showed progressive 
improvement in the level of consciousness and 
increase in motor tone. The first effects of 
therapy were noticed following the third dose of 
atropine and the first dose of Pralidoxime. This 


32 


Illinois Medical Journal 


therapy was continued as the patient began to 
do well and vital signs remained stable. 

Blood for toxicological analysis confirmed or- 
ganophosphorous compound ingestion by the 
determination of the cholinesterase level of 15 
Rappaport units, the normal being greater than 
50 units. This was subsequently substantiated 
by the mother who was able to locate the 
original container. It listed an organophosphor- 
ous compound. 

Second Case Report 

A 21-month-old black male was brought to 
emergency room of another hospital after drink- 
ing an unknown “roach spray.” Idle “roach 
spray” had been borrowed from a neighbor and 
placed in a bottle which was left near the bath- 
tub. The child picked up the bottle and in- 
gested an unknown quantity. The original con- 
tainer had been discarded by the neighbor. 
Within 10-15 minutes the child began to gag 
and started to drool. Soon he became drowsy 
and was rushed to the nearest emergency room 
where he was found to be semi-comatose ap- 
proximately 30-minutes after the ingestion. They 
noted copious secretions from the mouth and 
heard rales throughout the lung field. Gastric 
lavage was performed with normal saline, and 
intravenous fluids started prior to transfer to 
our hospital. Upon arrival 3 i / 2 hours after inges- 
tion he was comatose, barely responded to pain- 
ful stimuli, and had copious secretions from 
the mouth and nose. The child had three watery 
stools within ten minutes of arrival. 

Physical examination revealed a blood pres- 
sure of 110/70 mmHg, the pupils were equal 
but pinpoint in size. Extremities were flaccid 
and voluntary muscles fisciculations were noted. 
The deep tendon reflexes were absent. The 
previously noted rales were heard throughout 
both lung fields. 

The child was admitted to the pediatric inten- 
sive care unit where he was intubated and suc- 
tioned thoroughly. Continuous EKG monitoring 
was established. Atropine sulfate was admin- 
istered intravenously and repeated at 15 minute 
intervals for three doses. Pralidoxime was also 
given with the subsequent atropine doses at 
three and six hours after admission. The patient 
was maintained on a respirator because the 
blood gas determinations showed anoxia and 
acidosis accompanying an irregular and inade- 
quate respiratory effort. After institution of the 
atropine and Pralidoxime the muscle fiscicula- 


tion stopped, muscle tone increased, and the 
level of consciousness improved. After six hours 
the child was extubatecl and thereafter main- 
tained normal blood gas tensions without ven- 
tilator assistance. 

Because of the admission for ingestion a rou- 
tine whole blood lead level was done, which was 
80 micrograms percent and he subsequently re- 
ceived a course of chelation therapy with calcium 
EDTA and dimercaprol (BAL) . 

Discussion 

There are many varieties of alkyl-phosphate 
compounds which are highly toxic due to phos- 
phyorylation which inhibits the enzyme acetyl- 
cholinesterase. 2 This leads to accumulation of 
acetyl choline at the autonomic cholinergic nerve 
endings, both peripherally and centrally. The 
net result is continuous stimulation followed by 
inhibition. Organic phosphate compounds are 
readily absorbed through the intact skin, by 
inhalation through the lungs or absorption 
through the gastrointestinal tract. Doses as low 
as 0.1 mg/kg of parathione (a common insecti- 
cide on farms) have been lethal. 3 These com- 
pounds are used in the manufacture of a multi- 
tude of insecticide products which are widely 
used in homes and on farms. 

The signs and symptoms of organophosphate 
poisoning occur within minutes or hours, but 
may be delayed up to 24 hours after exposure. 
The severity of the symptoms depends upon the 
amount of enzyme, inhibition, which can be 
confirmed by an assay of serum cholinesterase 
activity. However, one does not need the labora- 
tory diagnosis, in the presence of the signs and 
symptoms, to make the diagnosis and institute 
therapy. The signs and symptoms of organophos- 
phorous poisoning are the results of effector 
sites stimulation of cholinergic centers. These 
include the central nervous system, somatic 
nerves, ganglionic synapses of the autonomic 
nerves, the para-sympathetic nerve endings, and 
sympathetic innervation of the sweat glands. 
The initial symptoms are due to over-stimulation 
which is followed by paralysis. Major signs and 
symptoms are summarized in Table 1. 

For a successful outcome one must maintain 
good tissue oxygenation, which may require 
intubation and respiratory support in addition 
to frequent suctioning. One must avoid further 
exposure, and attempt to remove the organo- 
phosphorous by gastric lavage if it was ingested. 
The skin must be washed thoroughly if ex- 


for July, 1978 


33 


Table 1* 

SIGNS AND SYMPTOMS OF 
ORGANOPHOSPHATE COMPOUND POISONING 


EYE 

Pupils 

Lacrimal glands 
Bronchial tree 

Cardiovascular system 

Gastro-intestinal System 
Sweat glands 
Salivary glands 
Urinary bladder 
Sympathetic ganglion 
Skeletal system 
Central nervous system 


Decrease in intraoccular pressure 
Miosis 

Increased secretion 

Bronchoconstriction, dyspnea increased secretions, cough, cyanosis 
pulmonary edema 

Bradycardia, decreased cardiac out put, hypotension, blood vessel 
dilation except for pulmonary and coronary vessels 
Vomiting, cramps, watery and explosive diarrhea 

Increased secretions 

Frequent- voiding 

Tachycardia, elevated blood pressure 
Fasciculation, decreased muscle tone 

Restlessness, tremor, drowsiness, generalized weakness, coma, absent 
deep tendon reflexes, respiratory center depression 


# Modified from Namba, et al .2 


posure occurred through cutaneous contact. 
Atropine sulfate is given intravenously in a close 
oi 0.05 mg/kg and should be repeated every 15 
minutes, along with continuous electrocardio- 
gram monitoring for arrythmias. 4 Atropine is 
required in exceedingly large doses in this inges- 
tion as compared to the atropine requirement 
for usual clinical states. When atropinization 
is achieved (as indicated by dilation of the 
pupils, tachycardia, dry mouth, and hot flushed 
skin) the further doses of atropine are withheld 
until symptoms recur. It is important to correct 
any hypoxemia or acidosis, as their presence in- 
creases the risk of ventricular fibrillation sec- 
ondary to the atropine therapy. 

I he specific antidote, pralidoxime, not only 
prevents but reverses phosphorylation of the 
acetyl-cholinesterase enzymes. This drug is used 
as an adjunct to atropine and is not a substitute. 
Pralidoxime is a quaternary amine and thus does 
not cross the blood brain barrier. For this rea- 
son, it is not thought to ameliorate the central 
nervous system effects of organic phosphorous 
compounds. 1 ’ 5-7 However, recent studies indicate 
the presence of a low concentration of pralidox- 
ime in the central nervous system. 8 Clinical ob- 
servations of prompt recovery from coma and 
control of convulsions in cases of organophos- 
phorous poisoning following the use of pralidox- 
ime provides some evidence against the earlier 
speculation that it did not enter the central 
nervous system. 9 ’ 10 The drug is usually admin- 


istered intravenously in a dose of 10-12 mg/kg. 
Although it can be given intramuscularly, the 
absorption time may vary, which is why the 
preferable route of administration is intra- 
venous. The dose may be repeated at one or 
two hour intervals or may be given by a con- 
tinuous drip of 0.5 mg/hour until all symptoms 
are resolved. Side effects are very uncommon 
with the therapeutic dose. In unusually high 
doses, they are manifested by nausea, dizziness, 
diplopia, and impairment of accomodation. In 
the desperately ill child with organophosphorous 
poisoning these side effects are not a major 
drawback. 

When managing a case of acute organophos- 
phorous ingestion, it is important not to ad- 
minister any other drugs which will potentiate 
the toxicity of the organophosphorous com- 
pounds, such as narcotics, phenothiazines, and 
theophyline derivatives. 11 

Further Considerations 

One must remember that symptoms may recur 
after the patient responds to atropine and 
pralidoxime. It is not unusual, as was observed 
in our patient, to require additional doses at 
3-6 hours following initial response. These pa- 
tients require close monitoring for an additional 
24 hours after the last dose of atropine and 
pralidoxime. The toxicology laboratory can be 
invaluable for diagnostic confirmation. Organo- 


34 


Illinois Medical Journal 


phosphorous compounds may be detected in 
the gastric lavage, urine, or clothing. The pri- 
mary blood test used to determine organophos- 
phorous poisoning is the serum cholinesterase 
level. Remember the toxicology laboratory will 
be much more efficient in confirming the diag- 
nosis if the signs and symptoms are listed on 
the laboratory requisition, or if they are aware 
that organophosphorous poisoning is suspected. 
The determination of cholinesterase levels in 
the serum anti in the erythrocytes is the major 
confirmatory test. The cholinesterase levels with- 
in the erythrocytes are more accurate and are 
the preferred method, but they are technically 
more difficult and expensive to do. The serum 
levels are more simple and the results more 
readily available. A normal cholinesterase level 
excludes organophosphorous poisoning. The 
clinical signs and symptoms of organophos- 
phorous poisoning do not occur until after 50% 
of the cholinesterase enzymes have been inac- 
tivated. 2 Levels in the 20%-50% range of normal 
would indicate mild poisoning; 10%-20% mod- 
erate, and less than 10% severe poisoning. Cor- 
relation is seen only early in the disease because 
during the recovery phase the cholinesterase 
levels rise rather slowly. 

Nevertheless, the clinical signs and symptoms 
are so distinctive that the laboratory is merely 
a confirmatory test and not needed for clinical 
management. 

Final Remarks 

In both our patients, the material was ob- 
tained from a neighbor or friend. Subsequent 
questioning determined that the insecticides had 
originally been packaged in large containers 
intended for use by exterminators in houses 
and apartments. Buying it in bulk provides a 
much cheaper source than the brand name 
products which are available in small house- 
hold packages. In both cases, a friend or neigh- 
bor generously loaned the family some of their 
“left over” insecticides and these were placed 
in soda pop bottles and left in situations where 
children could easily pick them up. These pa- 
tients dramatically point out that ingestion in 
children tragically occurs because the toxic sub- 
stances that are placed in containers are de- 
signed to hold food and beverages. Part of 
modern pediatrics should include parental in- 
struction on prevention of ingestion as part of 
routine health maintenance. Such discussions 
should include not only where to keep toxic 
substances and safety latches, but also the danger 
of unlabeled compounds in soda pop bottles. 


References 

1. Koelle, G. B.: Anticholinesterase Agents, Goodman, 
L. S., Gilman, A., Eds., MacMillan, New York, at 445, 
1975. 

2. Narnba, T„ Nolte, C. T„ Jackrel, J., et al. : “Poisoning 
Due to Organophosphate Insecticides,” Am. J. Med., 
50:475, 1971. 

3. Gleason, M., Gosselin, R., Hodge, H.: Clinical Toxi- 
cology of Commercial Products. Parathion, at 183, 
Williams and Wilkins Go., Baltimore, 1969. 

4. Hayes, W.: “Epidemiology and General Management 
of Poisoning by Pesticides,” Ped. Clin. N. Am., 17:629, 
1970. 

5. Ruthland, J. I’.: “The Effect of Some Oximens in 
Sarin Poisoning,” Brit. J. Pharmacol., 13:399, 1958. 

6. Hobbiger, F„ and Sadler, P. W.: “Protection Against 
Lethal Organophosphate Poisoning by Quaternary 
Pyridine Aldoxime,” Brit. J. Pharmacol., 14:192, 1959. 

7. Schaumann, W.: "Maximal Inhibition of Cholines- 
terase in the Central Nervous System,” Brit. J. Phar- 
macol., 15:432, I960. 

8. Firemark, H„ Barlow, C. F., and Roth, L. J.: “The 
Penetration of 2- PAM into Brain and the Effect of 
Cholinesterase Inhibitors on its Transport,” /. Pharm. 
Exp. Therapeu., 145:252, 1964. 

9. Narnba, T„ Hiraki, K.: “PAM (Pyridine-2-Aldoxime 
Methiodide) Therapy For Alkylphosphate Poisoning,” 
JAMA, 166:1834, 1958. 

10. Funckes, A. J.: “Treatment of Severe Parathion 

Poisoning with 2-Pyridine Aldoxine Methiodide (2- 
PAM) ,” Arch. Environ. Hlth., (Chicago) , 1:404, 1960. 

11. Gains, T. B.: “Poisoning by Organophosphorous 

Pesticides Potentiated by Phenothiazine Derivatives,” 
Sci., 138:1260, 1962. 


ISMS Travel Program 

Only one of the ISMS travel programs scheduled 
for 1978 remain open for reservations: the East- 
ern Mediterranean Air/Sea Cruise (Oct. 25- 
Nov. 7) . Information on the 1979 programs will 
appear in the next issue. 

Descriptive brochures will be mailed five months 
in advance. Reservations cannot be accepted 
without the official form printed in these bro- 
chures. Individuals outside a member’s immedi- 
ate family will be placed on standby status until 
all ISMS members have had reasonable time to 
make reservations. Promotional expenses con- 
nected with these programs are paid for by the 
tour operator. For further information, contact 
ISMS headquarters. 


for July, 1978 


35 



Surgical Grand, Rounds are held weekly on Tuesday at 5:00 p.m. in the Offield 
Auditorium of the Passavant Pavilion of Northwestern Memorial Hospital. Pa- 
tient presentations from Northwestern Memorial Hospital and the Veterans Ad- 
ministration Lakeside Llospital form the basis of the discussions. This case report 
was part of the Surgical Grand Rounds of January 17, 197S. 


Case Report 

Coronary Artery Surgery 


Dr. John Beal: One of the most exciting re- 
cent medical developments has been the intro- 
duction of coronary artery surgery, but it has 
brought considerable controversy. A current se- 
ries of publications has left uncertainty in the 
minds of many as to the real value of coronary 
aitery bypass, an operation that is being done 
with increasing frequency. Doctor Michaelis has 
assembled a panel to discuss the merits of coro- 
nary artery bypass, the issues in the controversy, 
and to analyze the effectiveness of bypass sur- 
gery in coronary artery disease. 

Dr. Lawrence Michaelis: Coronary artery by- 
pass, in which a segment of saphenous vein is 
used to bypass obstructed coronary arteries, will 
be pet formed approximately 70 to 80 thousand 
times in the United States this year. The cost is, 
of course, staggering; however, the implications 
of the operation are also staggering. Before I 
discuss the surgical indications, I shall review the 
surgical anatomy of coronary arteries. 


Normal coronary artery anatomy is variable. 
We usually talk about three major coronary ar- 
teries because the left main coronary artery bi- 
furcates early. It provides a left anterior descend- 
ing coronary artery and a circumflex coronary 
artery, which distribute vessels to the lateral 
border of the left ventricle. The right coronary 
artery is dominant in about 70 % of the popula- 
tion. Dominance in the right coronary artery de- 
pends on the blood supply to the posterior in- 
terventricular septum. The posterior descending 
coronary artery, which in 70 % of people is the 
terminal branch of the right coronary artery, 
supplies the back of the left ventricle. For all 
practical purposes, blood supply to the right ven- 
tricle is not very important; there is enough col- 
lateral in most people with normal pulmonary 
artery pressure so that complete occlusion of the 
right coronary artery can occur without much 
damage to the right ventricle. From the practical 
standpoint, we are considering the left ventricle 


36 


Illinois Medical Journal 


only. About 15% of the population has a domi- 
nant left coronary artery and their right coro- 
nary artery is not important in terms of the 
physiology of their ventricular contraction. An 
additional 15% or so of the population has a 
balanced circulation. When we talk about triple 
vessel disease, we refer to the left anterior de- 
scending coronary artery, the circumflex coro- 
nary artery and its branches and the posterior 
descending. 


Operative Indications 

When is the operation indicated? There are 
several things upon which even the most conser- 
vative cardiologists will agree. (1) The opera- 
tion relieves pain by revascularizing ischemic 
myocardium. There have been a number of 
placebo operations or operations with question- 
able value. Suffice it to say the Vineberg opera- 
tion (internal mammary artery ligation) and 
the Beck procedures (sclerosing of the epicar- 
dium) were said to relieve pain. They were very 
powerful placeboes, hut were not nearly as ef- 
fective as coronary artery bypass in relieving 
anginal pain. Probably somewhere between 90 
and 95% of the people who have coronary ar- 
tery bypass have either complete relief or great 
improvement in their angina. The high inci- 
dence of occluded grafts in people with persis- 
tent pain provides further evidence that the re- 
vascularization itself is the reason for the relief 
of their pain. Most people with recurrent an- 
gina have occluded grafts. 

The surgery is also indicated for significant 
obstruction of the left main coronary artery. A 
number of studies have attempted to randomize 
patients. Significant obstruction of the left main 
coronary artery is the finding that ends the ran- 
dom nature of the analysis. Infarctions caused 
by obstruction of the left main coronary artery 
are very often fatal. Left main coronary obstruc- 
tion accounts for only five to eight percent of 
coronary disease cases, but it is an important con- 
sideration and one that should be excluded from 
any consideration of medical management. 

Thirdly, the operation is indicated in unstable 
angina with impending myocardial infarction. 
This is the most questionable category because, 
like cardiogenic shock, unstable angina must be 
defined. By definition, unstable angina is any 
change in previous stable angina. Certainly, 
when there is good indication that a myocardial 
infarction is imminent or that the angina pat- 
tern has changed to such an extent that medical 


management is not relieving it, almost all car- 
diologists concur that the operation is indicated. 


Contraindications 

When is the operation not called for? The op- 
eration is not indicated in two situations. The 
operation does not improve ventricular function. 
In other words, you cannot revascularize dead 
muscle. This does not mean that the operation 
was not indicated in the presence of left ventric- 
ular dysfunction, but it is not indicated per se 
for revascularization. It does not improve ven- 
tricular dysfunction caused by previously in- 
farcted muscle. The operation is not indicated 
in the presence of diffuse small vessel disease. 
Adequate distal runoff is essential to perform 
bypass grafts. 

There are two basic situations in which the 
operative indications are still uncertain. These 
are cardiogenic shock and whether the operation 
prolongs life. 

Cardiogenic shock is, once again, also open to 
definition. There are people who have reported 
very good results in cardiogenic shock and others 
have reported dismal results. The few centers 
that are attacking cardiogenic shock vigorously 
with clear criteria have survival rates in the 
range of 20-30%, which is a very high mortality 
rate. They are operating under the assumption 
that their patients are going to have a much 
higher mortality rate without an operation. This 
is a major commitment for a medical center to 
take when studying cardiogenic shock. 

The problems nationwide have been homo- 
geneous criteria for cardiogenic shock and the 
timing of the operation. Statistically, it has not 
been proven that the operation is indicated. The 
overwhelming question, however, is whether or 
not coronary artery bypass grafting will prolong 
life. This seems like a very simple question. 

The first problem is to find a prospective ran- 
domized study and a number of such studies 
have been proposed. We were involved in a 1972 
study at the National Institutes of Health. Our 
results were typical. 

The study was set up so the people were ran- 
domized after they had been studied. Those ran- 
domized to the operative groups said, “Thanks, 
great, go along with the operation.” People who 
were randomized to the medical group said, 
“Thank you very much; I’m withdrawing from 
the study,” and went someplace else to have an 
operation. We are not at the point where people 


for July , 1978 


37 


want the operation when they have angina and 
will not stay in the studies. 

Risk Considerations 

Next, I want to discuss the risk consideration 
in coronary artery disease. What increases the 
surgical risk. First, obviously, is the extent of 
the coronary artery disease, as well as anatomical 
and technical considerations in performing the 
operation. These were more formidable four or 
live years ago than they are now, because the 
operative technique itself has improved. Next is 
left ventricidar function. Obviously, if someone 
has a very good ventricle, he is going to tolerate 
the operation better than someone with very 
marginal left ventricular function. We assess 
left ventricular performance preoperatively by 
a number of means, ventriculography, ejection 
fractions, left ventricular end-diastolic pressure 
and presence or absence of congestive heart fail- 
ure. 

Associated heart disease is another factor. If 
someone has a ventricular aneurysm and mitral 
regurgitation, he is at higher risk. Consider the 
condition of the patient’s angina— has it been 
stable, or has it been unstable? Recent myocar- 
dial infarction is another factor. There is. evi- 
dence that the operation’s risks increase tremen- 
dously if you operate within four to six weeks 
ol a myocardial infarction. We make every effort 
to postpone surgery in people who have had a 
recent myocardial infarction. 

Finally, the skill of the surgical team is im- 
portant The team includes scrub nurses, pump 
technicians, operating room circulating nurses, 
house staff and surgical intensive care unit 
nurses. It has been very clearly shown that in 
centers where the whole team has cared for these 
patients on a regular basis, and the operation is 
done with lrequency, better results are obtained 
than when the operation is done sporadically. 

Pertinent Research 

An article from the New England Journal of 
Medicine based on a cooperative study with the 
VA has caused wide comment. In this VA study, 
310 patients were in a medical group and 286 
patients were in a surgical group. This was a 
prospective randomized study carried out in sev- 
en or eight VA centers throughout the United 
States. All patients agreed to stay in the study. 
All patients had angiographic evidence of sig- 
nificant obstruction of one or more coronary ar- 
teries. I his was defined as a 50% reduction in 


lumen diameter, which is supposed to equal 
75% reduction in cross sectional area of a vessel. 
Therefore, all had radiographic evidence of at 
least one obstructed coronary artery. 

The VA study involved only chronic, stable 
angina. All of the standard surgical criteria were 
excluded. Excluded patients were those with any 
kind of myocardial infarction the last six 
months, any question of unstable angina, con- 
gestive heart failure in the last three weeks, any 
kind of associated heart disease, severe diabetes, 
hypertension in which the diastolic blood pres- 
sure was greater than 100 on therapy, and sig- 
nificant left ventricular dysfunction. The people 
in the study had good ventricles and chronic 
stable angina. The results three years after the 
operation were identical, in this VA study, for 
the surgical group and for the medical group. 
This is what has been presented in the news- 
papers. 

But there are some considerations about the 
VA study that are very clear and are very impor- 
tant. The first real consideration is the number 
of grafts that were performed in these patients. 
I his study is now three years old and showed 
an average of 1.9 bypasses per patient and no 
patient received more than three grafts. In most 
centers today, the average number of grafts per- 
formed is greater than 2.5 and it is not unusual 
to perform four or five bypass grafts in a patient 
in an effort for complete revascularization. 

The next objection to the VA study is graft 
patency. In the VA study, 69% of all the grafts 
studied postoperatively were patent. Twelve per- 
cent of the patients had no patent grafts at all. 
Nineteen percent of the single bypass patients 
had occlusion of their grafts. Most centers re- 
ported over 85% in graft patency. As high as 
88% has been recorded 6 to 12 months postop- 
eratively and I would say 92 to 95% of patients 
should have at least one patent graft. The graft 
patency in the VA study is unacceptable by pres- 
ent cardiac surgical criteria. 

The VA study reported an operative mortality 
of 5.6%. The surgical risk in this group of pa- 
tients should have been 1 to 2% because patients 
with unstable angina, left main disease, recent 
myocardial infarctions and left ventricular dys- 
function had been eliminated. By their criteria, 
in the last two years, we have not lost a patient 
in this hospital in people with chronic stable 
angina. 1 hus, a very high operative mortality 
rate was reported for this group of VA patients. 
Ot course, that high mortality rate affected the 


38 


Illinois Medical Journal 


initial survival. 

Another objection to the VA study is their 
statistical techniques. Seventeen percent of the 
original patient population selected for medical 
therapy experienced worsened symptoms and 
were transferred to the surgical group. If they 
died, they were considered surgical deaths, not 
medical deaths. These patients were considered 
lost to follow-up for the medical group. 

In addition, the VA study failed to mention 
a large subgroup. The largest subgroup of the 
VA study were people with triple vessel disease 
and some left ventricular dysfunction. These pa- 
tients were presented to the American Associa- 
tion of Thoracic Surgery in 1977. Survival of 
85% in the surgical group and 76% in the medi- 
cal group was reported at 54 months. This is 
considered statistically significant. The editorials 
made no mention of the finding that the triple 
by-pass patients with some left ventricular dys- 
function had a statistically significant better 
chance after operation than they did after medi- 
cal therapy. 

With that background, Doctor Lesch will con- 
tinue the discussion from a cardiologist’s view- 
point. 

Dr. Michael Lesch: The search for absolutes 
in the press and among ourselves has led to 
polarization, which I think has been counter- 
productive. There is to my knowledge no study 
in the medical literature which proves the value 
of penicillin therapy in pneumococcal pneumo- 
nia. It was so obvious and that was that. There 
is a lot invested in coronary surgery and I would 
like to go through some philosophical ap- 
proaches. The data is the same. Rather than be a 
proponent or an opponent, I would like to look 
at this in a rational way and try to tell you as 
a practicing cardiologist what we do in a center 
where very good surgery is available. 

The left main coronary disease issue should 
be put to rest. There is no question that surgery 
is the therapy of choice there. 

The issue about the treatment of intractable 
pain has been met by the surgical/medical car- 
diologic community with the appropriate an- 
swers. Surgeons and cardiologists have shown 
that the operation is unequivocably the best 
available treatment for angina or is certainly a 
very adequate substitute for drug therapy which 
frees the patient of a number of constraints. It is 
society’s duty to determine whether that’s worth 
$15,000 per patient. That is, if in fact we’re talk- 
ing about the distribution of medical resources 


and the government does what they did in Cana- 
da. There they say essentially: “We have X mil- 
lion dollars of money for medicine. Doctors, you 
decide how you are going to spend it.” Then the 
discussion departs from the medical point of 
view and becomes a socio-economic discussion. 

I think there is no question that the operation 
is the most effective treatment of pain. The story 
of placeboes should be put to rest. In all of the 
previous operation, etc., the placebo effect usual- 
ly lasted less than three months. In the studies 
that have been reported today on coronary pa- 
tients, pain relief clearly lasts for more than 
three months— it lasts for years. The results are 
, not due to placebo effect. 

There are also people who say that their sur- 
,’rgery is successful because it interrupts perivascu- 
lar nerves. They conclude that any operation 
should be successful, whether it is successful 
grafting or not. This simply has not been proven. 
Probably the major objection is that approxi- 
mately 50% of those patients reporting com- 
plete symptomatic relief, who have all grafts 
patent at recatheterization, have persistently 
positive exercise tests. Those who are familiar 
with any exercise testing know that there are 
about “25 pat reasons we will give for false posi- 
tives.” I simply interpret this as another reason 
for a false positive. 

An interesting study at the recent American 
Heart Association meeting showed that examina- 
tion of all exercise tests— isolating everybody 
with a positive test— uncovered 15 or 20% “false 
positives” insofar as ischemic heart disease was 
concerned. But if you look at the broader pic- 
ture of heart disease, left ventricular hypertrophy 
due to hypertension, aortic valve disease, mitral 
valve disease, cardiomiography, myocarditis, etc., 
the false positive rate drops to zero. In other 
words, if you have a positive exercise test, the 
likelihood of not having heart disease is next to 
zero. The likelihood of having specific coronary 
disease is about 85%. When one considers the 
pericardities of operation, manipulation of the 
heart and the various operative effects, I’m not 
at all surprised at this positive test. 

So, therefore, in terms of pain relief, it’s clear- 
ly good. The question is: how do you define 
intractable? There are physicians who will not 
accept that a patient requires surgery or accept 
intractable pain until the man is literally dead. 
I find it somewhat difficult to deal with the ab- 
solute terminology of intractability. I would sug- 
gest that a number of variables have to be taken 


for July, 197S 


39 


into account. These include the patient’s life- 
style, his age, his acceptance of surgery and his 
vascular anatomy. 

For argument sake, consider a 49-year-old man 
with a perfectly good anatomical set-up for the 
operation. He might be a laborer or an execu- 
tive who is under a lot of stress and simply finds 
it unreasonable to be gobbling pills, which I 
consider a perfectly acceptable reason for sur- 
gery. If on the other hand, he tells me, “It 
doesn’t bother me, I will take one nitroglycerin 
every hour and I’m perfectly happy to do so,” I 
have accomplished the same thing in terms of 
symptomatic relief. The number ot pills is not a 
reasonable cut-olf. You cannot say that a patient 
who takes more than 10 pills a day must have 
surgery; less than 10 pills, surgery is not indi- 
cated. I think the goal of medical therapy is to 
make the patient very comfortable, and we can 
frequently do that. If the means to that end re- 
quires an unacceptable, constant reliance on 
drugs, etc., then the patient is certainly a can- 
didate for surgery. This is where the art of medi- 
cine comes in. It’s no longer the science. 

Second Major Issue 

The prolongation of life issue is more difficult. 
The mortality rate for patients with coronary 
artery disease who have been treated medically 
has improved markedly in the past 15 years. 
Therefore, any study of surgical therapy must 
consider this change in medical treatment. While 
a new form of surgical therapy has been intro- 
duced, medical therapy has also become more 
effective in the aggressive treatment of arrhythmi- 
as and concepts of pre- and postcoronary 
care. Therefore, the medical therapy of patients 
with coronary disease is changing also. 

Concerning the VA study, I agree that is was 
weak. In addition, the quality of the angiograms 
was poor. Some angiographers refused to review 
them. Coronary angiography in 1978 is far su- 
perior to what it was in 1971. Also, there is no 
question that surgical mortality is related to 
time and experience of the surgical team with 
the operation. We now have better techniques 
for protection of the left ventricle during sur- 
gery. For example, until three or four years ago, 
the preparation for surgery included withdrawal 
of propranolol because most cardiologists feared 
a decompensated ventricle at the time of surgery. 
Now we are not discontinuing propranolol and 
the rate of intraoperative myocardial infarction 
is decreasing. 


Some Support Samples 

There is a definite implication that coronary 
artery bypass is prolonging life. The examples 
that I give are the following: 

A 39-year-old man with proximal vessel dis- 
ease in all three vessels, almost complete obstruc- 
tion lesions in the right, left anterior descending, 
and circumflex, with no collaterals. It is reason- 
able to suggest surgery for him. It is extremely 
likely that this man will have an infarction at 
some time in the next ten years. He is certainly 
no worse off with the operation and the grafts 
seem to be remaining patent for a considerable 
period of time. 

Conversely, a 75-year-old man who has one 
proximal lesion, whose primary disease is distal 
and who has adequate collaterals, is not a can- 
didate for operation. 

I wish that I had some data to support our 
conviction about the management of patients 
who fall in groups between these two examples, 
but I am unaware of such information. From 
available information, the younger the patient, 
the more proximal the lesions, the less the in- 
volvement of the distal circulation, the fewer col- 
laterals, the more I favor operating to prolong 
life. Data is not available to support this atti- 
tude and I don’t believe we are going to get it. 
We are unable to establish studies that random- 
ize people to having no therapy. 

Another aspect of the VA study that should 
be said is that the quality of surgery was not 
good. Three or four hospitals contributed most 
of the mortality. Results of surgery at Hines and 
Stanford VA Hospitals were good. But when you 
have 25% of the hospitals responsible for 85% 
of the surgery and almost none of the mortality 
and then another 25% of the hospitals are re- 
sponsible for less than 10% of the surgery, but 
95% of the mortality in the total study group, it 
is difficult to accept the conclusions in such a 
study. 

Medical therapy is not without its problems. 
Exercise mills are being created around the 
country for the treatment of coronary disease al- 
though there is no convincing data that exercise 
has any role in the secondary prevention of coro- 
nary disease. Nothing has ever been published 
that shows that exercising in a patient who has 
coronary disease will prevent or retard disease 
progression. However, if you question a hundred 
people in an exercise program after an infarct, 
they are quite convinced they are getting specific 
therapy. I find this just as reprehensible as by- 


40 


Illinois Medical Journal 


pass surgery for single vessel disease ol the right 
coronary in patients who are asymptomatic. 

We are in a quandry. The treatment of an 
gina is not clearly defined. One has to take the 
best data that is available and then make a value 
judgment. When we recommend surgery, I tell 
patients that this is my best judgment. That’s 
the best I can do. 

Dr. John Sanders: I would like to show, lor 
the purpose of comparison, results from other 
series. The first study is from Houston, Texas, 
where the quality over the years has been excel- 
lent. The Baylor College series follows a span of 
over 1,000 patients, all of whom have been fol- 
lowed beyond five years. It has the advantage of 
being a year or two years longer in follow-up 
than the VA study. Of these, there was a virtual 
equal mix of two and three vessel coronary dis- 
ease. The balance of these are single vessel and 
greater than three vessel coronary disease. Their 
operative mortality from a group operated on in 
the early seventies was still 3.5%. Now, this 
would be somewhat improved. Their overall five- 
year survival was 90%, which was better than 
the shorter term follow-up of the VA group. 
Their five-year survival in patients who have 
good left ventricular function was even better— 
93%. 

The patency rates in the Baylor College study 
were done at between six months and a year. 
There was an 87% overall patency rate, that is 
to say, 87% of all grafts performed were patent 
versus 69% of the VA series. That constitutes 
nearly a 20% difference in patency rate. Eighty- 
one percent had all grafts patent versus 54% in 
the VA group. 

The follow-up from the Brigham series was 
just shy of six years. The residts at that time 
showed that for single vessel bypass we expect 
97.8% survival. It does exclude suicide, auto ac- 
cidents, cancer deaths and deaths not related to 
coronary artery disease. From the coronary stand- 
point we can say that we have a 97.8% survival 
of single vessel disease for patients 5.5 years 
after operation. I think that even a good medical 
group would certainly not fare statistically sig- 
nificantly better than this. 

Patients who have had coronary bypass sur- 
gery for three vessel disease anticipate a better 
than 90% survival rate at five and six years. The 
overall survival for all patients bypassed in this 
series, which comprises almost 600 patients, was 
better than 90% at six years. This was compar- 
able to the Baylor series. We now consider the 


operative mortality for elective coronary surgery 
somewhere between 1 and 2%, which is quite 
acceptable for any major operative procedure. 


References 

1. Murphy, M. L„ Hultgren, H. N., Detre, K., et al. : 
Treatment of Chronic Stable Angina: A Preliminary 
Report of Survival Data of the Randomized Veterans 
Administration Cooperative Study,” N. Eng. J. Med., 
297:620-627, 1977. 

2. Laurie, G. M., Morris, G. C., Jr., et al.: “Results of 
Coronary Bypass More Than 5 Years After Operation 
in 434 Patients,” Am. J. Cardiology, 40:665-672, 1977. 

3. Cohn, L. H., Collins, J. J., Jr.: “Improved Long-Term 
Survival Following Aorto-coronary Bypass for Ad- 
vanced Coronary Artery Disease,” Am. J. Surg., 129: 
380-385, 1975. 


COOK COUNTY 
Graduate School of Medicine 

CONTINUING EDUCATION COURSES 
STARTING DATES— 1978 

RADIATION SAFETY IN DIAG. RADIOLOGY. 3 days, July 24 
SPECIALTY REVIEW MEDICINE, CERTIFYING, July 30 & August 6 
STATE & NAT’L. BD. REV. BASIC, August 6 & 

CLINICAL, August 14 

NEUROLOGY, PART II, CLINICAL, September 11 
QUALITY ASSURANCE EVALUATION, 3 days, September 14 
SPECIALTY REVIEW ORTHOPAEDICS, August 25 
ESSENTIALS OF ELECTROCARDIOGRAPHY, 5 days, September 18 
EKG FOR ANESTHESIOLOGISTS, 5 days, September 18 
SPECIALTY REVIEW DERMATOLOGY, 5 days, September 25 
SPECIALTY REVIEW OBSTETRICS & GYNECOLOGY, September 25 
CURRENT TOPICS IN INTERNAL MEDICINE, September 25 
SEXUAL MEDICINE, 5 days, September 25 
CLINICAL & LABORATORY DIAGNOSIS OF HEMORRHAGIC AND 
THROMBOTIC DISORDERS, 2 days, October 20 
MANAGEMENT OF COMMON FRACTURES, 5 days, October 23 
SPECIALTY REVIEW SURGERY, PART I, October 23 
RECENT ADVANCES IN PSYCHIATRY, 5 days, October 23 

Information concerning numerous other continuation courses 
available upon request. 

Address : 

REGISTRAR, 707 South Wood Street, 

Chicago, III. 60612 


for July, 1978 


41 


ISMS Guide to 
Continuing Medical Education 

Compiled for Illinois physicians by the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
55 E. Monroe St., Suite 3510 • Chicago, IL 60603 • (312) 236-6110 



Items for this Calendar must be received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. r 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication date. Some- 
times, cancellations or changes in date, place or time occur loo late to be corrected before publication. You are urged 
to contact the sponsoring organization to confirm information given below. 6 


AUGUST 


Emergency Medicine 

SEVENTH ANNUAL TRAUMA CRITICAL CARE 
SYMPOSIUM 

For: All emergency medical personnel. Lecture/tech 
nique sessions, Chicago, IL. Beginning dates: 8/31. 
9/1. Fee: $70. Reg. limit: 800. Sponsor: Illinois 
Department of Public Health Services, Division of 
Emergency Medical Services, 160 North LaSalle, Chi 
cago, IL 60601. Co-Sponsors: American Trauma So 
ciety, Illinois Chapter; Emergency Department Nurses 
Association, Illinois Chapter. Contact: Penny Finn, 
Coordinator, 525 West Jefferson, Springfield IL 62761 
Phone: 217-785-2080. 


Family Medicine 

PRIMARY CARE: A VIEW TOWARD THE 80’S 
For: Family Physicians, Internists, Pediatricians. 3 
day conference (>/ 2 day each day), August 17-19, 
Interlaken Lodge/Villas, Lake Geneva, Wisconsin. CME 
credit: AMA, Category 1, 15 hours. Fee: $80. Spon- 
sor: Dept, of Medical Education, Ravenswood Hospital 
Medical Center, 4550 No. Winchester, Chicago, IL 
60640. Contact: Mara Harrington, Secretary. Tele- 
phone: 312-878-4300. 

Internal Medicine 

STATE & NATIONAL BOARD REVIEW, BASIC 
For: Internists. 6 */ 2 day lecture, August 6-12, Chi 
cago, IL. Speaker: Sheldon S. Waldstein, M.D. CME 
Credit: AAFP Prescribed, 58 hours; AMA Category 1. 
58 hours. Fee: $275. Reg. limit: 150. Sponsor: Cook 
County Graduate School of Medicine, 707 South Wood 
Street, Chicago, IL 60612. Contact: Robert J Baker 
M.D., Dean. Phone: 312-733-2800. 

Internal Medicine 

STATE & NATIONAL BOARD REVIEW, CLINICAL 

For: Internists, family practitioners. Lecture, August 
14-19, Chicago, IL. Speaker: Sheldon S. Waldstein, 
M.D., CME credit: AAFP Prescribed, 53 hours; AMA 
Category 1, 53 hours. Fee: $250. Reg. limit: 150. 
Sponsor: Cook County Graduate School of Medicine, 
707 South Wood Street, Chicago, IL 60612. Contact: 
Robert J. Baker, M.D., Dean. Phone: 312-733-2800 


Internal Medicine 

THE HOLISTIC APPROACH IN THE CARE OF THE 
INDIVIDUAL WITH MALIGNANCY 

For: Physicians, residents, interns. 1-hour lecture, 
August 23, 11:00 a. m. -12:00 noon (lunch follows), 
Auditorium, Martha Washington Hospital 4055 N. 
Western, Chicago, IL. Speaker: John Louis, M.D., 
Professor of Medicine, University of Health Sciences, 
Chicago Medical School. Reg. deadline: 8/22. Reg. 
limit: none. Fee: none. CME Credit: AAFP Elective, 
1 hour; AMA Category 1, 1 hour. Sponsor: Medical 
Staff of Martha Washington Hospital. Contact: Fer- 
nando Villa, M.D. Phone: 312-583-9000 x 331 


Orthopaedics 

SPECIALTY REVIEW IN ORTHOPAEDICS 
For: Orthopaedists. 7 day lecture, August 13-19, Chi- 
cago, IL. Speaker: Peter C. Altner, M.D. CME credit: 
AAFP Elective. 64 hours; AMA Category 1. 64 hours 
Fee: $275. Reg. limit: 350. Sponsor: Cook County 
Graduate School of Medicine, 707 South Wood Street, 
Chicago, IL 60612. Contact: Robert J. Baker, M D 
Dean. Phone: 312-733-2800. 


Physical Medicine ir Rehabilitation 

ELECTROMYOGRAPHY & CLINICAL 
NEUROPHYSIOLOGY 

For: Physiatrists & interested Physicians. 3-day course, 
August 16-18, Chicago, IL. CME credit: AMA Category 
1, 21 hours. Reg. limit: 40. Fee: $175, physicians; 
$90, residents. Sponsor: Rehabilitation Institute of 
Chicago, 345 E. Superior St., Chicago, IL 60611. 
Co-Sponsor: American Academy of Physical Medicine 
& Rehabilitation. Contact: Victoria Severson, AAPM&R 
Telephone: 312 236-9512. 


SEPTEMBER 


Cancer 

FIFTH ANNUAL CHICAGO SYMPOSIUM “CANCER 
IMMUNOLOGY: EXPERIMENTAL AND CLINICAL” 

For: Oncologists, Surgeons, Internists, Hematologists 
3-day symposium, September 13-15, Pick-Congress 
Hotel, Chicago. Speaker: George Mathe, M.D., Direc- 
tor, Institute of Cancerologie Et D’lmmunogenetique, 
Paris. CME credit: AMA Category 1, 16 hours Reg 
deadline: 9/1. Reg. limit: 200. Fee: $70. Sponsor: 
ITR Biomedical Research of the University of Illinois 
115 So. Sangamon St., Chicago, IL. Co-Sponsors: 
Illinois Cancer Council, American Cancer Society. 
Contact: Nancy Piekarski. Telephone: 312-996 -4688. 


Clinical Laboratory Correlation 

For: Physicians. Lecture/Discussion, Sept. '78-June 
'79, (Thursdays, bi-weekly), Mattoon. IL CME credit: 
AMA Category 1. Fee: none. Reg. limit: none. Spon- 
sor: Sarah Bush Lincoln Health Center, R.R. 16, Box 
372, Mattoon, IL 61938. Contact: Byron Ruskin, M D 
Telephone: 217-258-2514. 


Hypnosis 

WORKSHOP ON CLINICAL HYPNOSIS 

For: Phvsicians. Dentists, Psychologists. 4-day work- 
shop, September 14-17, Chicago, IL. CME credit: 
AMA Category 1, 25 hours; Academy of General Den- 
tistry, 25 hours. Fee: $225. Reg. limit: none. Spon- 
sor: American Society of Clinical Hypnosis — Education 
and Research Foundation, 2400 E. Devon Ave Suite 
218, Des Plaines, IL 60018. Contact: William F. Hoff- 
man, Jr. Telephone: 312-297-3317, 


Infectious Disease/Urology 

21ST MEDICAL/SURGICAL SEMINAR FOR 
LAKE COUNTY 

For: M.D.'s, D.D.S.’s, R.N.'s, Rh.P.’s Seminar, 

September 20, 8:00 AM-1:00 PM, Waukegan, IL 
CME credit: AAFP Elective, 5 hours; AMA Category 
1, 5 hours. Reg. deadline: 9/20. Reg. limit: none. 
Fee: $2.50, staff; $5.00, non-staff. Sponsor: St. 
Therese Hospital, 2615 Washington, Waukegan. IL 
60085. Contact: R. M. Adelman. Telephone: 312-688- 
5800. 


Internal Medicine 

CARDIAC EMERGENCY 

For: all Physicians. Symposium, September 26, 

Vandalia, IL. CME credit: AAFP Elective, 3 hours: 
AMA Category 1, 3 hours. Reg. limit: none. Sponsor: 
Southern Illinois University School of Medicine P 0 
Box 3926, Springfield, IL 62708. Contact: Lorrain 
Stephenson. Telephone: 217-782-7711. 


Internal Medici ; 

IMMUNOLOGY AND IMMUNODEFICIENCIES 
DISORDERS 

For: all Physicians. Symposium, September i 
Quincy, IL. CME credit: AAFP Elective, 4 hou 
AMA Category 1, 4 hours. Reg. limit: none. Spons 
Southern Illinois University School of Medicine, P 
Box 3926, Springfield, IL 62708. Contact: Lorra 
Stephenson. Telephone: 217-782-7711. 

Internal Medicii 
MANAGEMENT pF OFFICE UROLOGICAL PROBLEMS 

For: all Physicians. Symposium, September 14 H 
Carmel, IL. CME credit: AAFP Elective, 4 hours;' Al 
Category 1, 4 hours. Keg. limit: none. Sponsor: Sou 
ern Illinois University School of Medicine, P.0 E 
3926, Springfield, IL 62708. Contact: Lorraine Sti 
henson. Telephone: 217-782-7711. 

Internal Medicii 

UPDATE ON CLINICAL IMMUNOLOGY SYMPOSIUM 
(RESCHEDULED) 

For all Physicians. Symposium, September 7, Carbo 
dale, IL. CME credit: AAFP Elective, 4 hours; Af 
Category 1, 4 hours. Reg. limit: none. Spons< 
Southern Illinois University School of Medicine, P. 
Box 3926, Springfield, IL 62708. Contact: Lorrai 
Stephenson. Telephone: 217-782-7711. 

Internal Medicii 
PERSPECTIVES IN CHRONIC MEDICINE 

For: M.D.'s. 4 day course, September 20-23, Chicag 
IL. Sponsor: American College of Physicians, 42' 
Pine St., Philadelphia, PA 19104. Cosponsor: Nort 
western University Medical School. CME Credit: Ak 
Category 1, 24 hours. Reg. limit: 80. Fee: Al 
member/FACP/ residents, $216; ACP Associate, $10 
215^2^13^120 Contact: Linda Salsinger. Phon 

Medicir 

A STEP-BY-STEP APPROACH IN THE 
DIAGNOSIS OF ANEMIA 

For: Physicians, residents, interns. Lecture, Septer 
ber 20, 11:00 a m. -12:00 noon (lunch follows), Auc 
torium, Martha Washington Hospital, 4055 N. Wester 
Chicago, IL. Speaker: John Louis, M.D., Profe 
sor of Medicine, University of Health Science 
Chicago Medical School. CME Credit: AAFP Electiv 
1 hour, AMA Category 1, 1 hour. Fee: none. Rei 
limit: none. Reg. deadline: 9/19. Sponsor: Medic 
Staff of Martha Washington Hospital. Contact: Fe 
nando Villa, M.D. Phone: 312-583-9000 x 331. 

Medicine, Surger 

INTRAVENOUS HYPERALIMENTATION & DISEASE 

For: all interested Physicians. Lecture, September 1! 
7.45 p.m., Chicago, IL. Speaker: Stanley J. Dudric 
M.D., Professor & Chairman, Dept, of Surgery, Un 
versify of Texas Medical School, Houston. CME credi 
AMA Category 1, 2 hours. Reg. deadline: none. Fe. 

Sponsor: Louis A. Weiss Memorial Hospita 
4646 No. Marine Dr., Chicago, IL 60640. Co-Sponso 
Alfred A. Strauss Memorial Lecture. Contact: Barry 
Millman. Telephone: 312-878-8700 x 304. 


Occupational Medicin 


42 


FALL SEMINAR 
For: Physicians, Nurses, Hygienists, 1 Vi -day seminai 
September 8-9, East Moline, IL. CME Credit: AAF 
Elective, 8 hours; AMA Category 1, 8 hours. Fee: $3C 
Reg. limit: none. Sponsor: Central States Occups 
tional Medical Assn., 119 Shabbona Drive, Par 

747* 8*1 24* 60466 ‘ Contaet: Rita Packer. Phone: 312 


Illinois Medical Journal 


Ophthalmology 

IABETIC RETINOPATHY SYMPOSIUM, 

RACTICAL ASPECTS 

or: M.D.’s, residents. 1-day symposium, September 
9, 8:00 a. m. -5:00 p.m., Chicago, IL. Speaker: 
elipe U. Huamonte, M.D. Sponsor: University of llli- 
ois Eye & Ear Infirmary, 1855 W. Taylor, Chicago, 
L 60612. CME Credit: AMA Category 1. Fee: $100. 
eg. limit: none. Contact: Dawn Fischer. Phone: 312- 
96-8023. 


Ophthalmology 

EMI-ANNUAL COURSE FOR ANTERIOR AND 
OSTERIOR SEGMENT VITRECTOMY 

or: Ophthalmologists. 2-day course, September 22- 
3, University of Illinois Eye & Ear Infirmary, Chi 
ago, IL. CME credit: AMA Category 1, 16 hours, 
leg. limit: 15. Fee: $250. Sponsor: Dept, of Oph 
halmology, University of Illinois, 1855 W. Taylor, 
Ihicago IL 60612. Contact: Carmen Carrasco. Tele- 
ihone: 312-996 8024. 


Orthopedics 

JACK INJURIES & BACK PAIN RELATED TO SPORTS 
NJURIES . 

•or: all Physicians. Symposium, September 13, Wood 
<iver, IL. Keg. limit: none. CME credii: AMA Cate- 
gory 1, 4 hours: AAFP Elective, 4 hours. Sponsor: 
Southern Illinois University School of Medicine, P.O 
3ox 3926, Springfield, IL 62708. Contact: Lorraine 
Stephenson. Telephone: 217-782-7711. 


Pediatrics 

PEDIATRIC REVIEW 

For: all Physicians. Symposium, September 28, Sparta, 
IL. CME credit: AALP Elective, 4 hours; AMA Cate- 
gory 1, 4 hours. Reg. limit: none. Sponsor: Southern 
Illinois University School of Medicine, P.0. Box 
3926. Springfield, IL 62708. Contact: Lorraine Step 
henson. Telephone: 217 782-7711. 


Pediatrics 

SECOND ANNUAL SYMPOSIUM ON MEDICAL 
GENETICS 

For: all Physicians. 1-day symposium, September 15, 
Springfield, IL. CME credit: AAFP Elective, 7 hours, 
AMA Category 1, 7 hours. Reg. limit: none. Sponsor: 
Southern Illinois University School of Medicine, P.O. 
Box 3926, Springfield, IL 62708. Contact: Lorraine 
Stephenson. Telephone: 217-782-7711. 


Pediatrics / Obstetrics 

CLEFT CONCEPT MULTI-DISCIPLINARY CONCEPT 
TREATMENT AND MANAGEMENT OF THE 
CLEFT LIP/PALATE PATIENT 

For: Obstetricians, Pediatricians. 1-day symposium, 
September 20, 9:00 a m. -4:00 p.m., Chicago, IL. 
CME Credit: AMA Category 1, 6 hours. Fee: $35. 
Reg. deadline: 9/10. Contact: Eugene V. Tanski, 
M.D., 845 N. Michigan, Suite 925W, Chicago, IL 
60611. Phone: 312-642-4619. 


Physical Medicine ir Rehabilitation 
THIRD ANNUAL COURSE ON MANAGEMENT OF THE 
SPINAL CORD INJURED PATIENT 

For: Physicians & professionals in acute spinal cord 
management. 5-day course, September 11-15, Chi- 
cago, IL. CME credit: AMA Category 1, 32 hours. 
Fee: $200, physicians; $125, residents. Reg. limit: 
115. Sponsor: Rehabilitation Institute of Chicago, 

345 E. Superior St., Chicago, IL 60611. Co-Sponsor: 
American Academy of Physical Medicine and Rehabili- 
tation. Contact: Victoria Severson, AAPM&R, 30 No. 
Michigan, Chicago, IL 60611. Telephone: 312-236- 
9512. 


Physical Medicine <Lr Rehabilitation 

PERSPECTIVES IN CHRONIC MEDICINE 

For: Physiatrists & Family Physicians. 4 day course, 
September 20-23, Chicago, IL. Reg. deadline: 8/31. 
CME credit: AMA Category 1. 20 hours. Reg. limit: 
80. Fee: $200, physicians; $150, residents, nurses, 
allied health personnel. Sponsor: Rehabilitation In- 
stitute of Chicago, 345 E. Superior St., Chicago. IL 
60611. Co-Sponsors: American Academy of Physical 
Medicine & Rehabilitation, American College of Phy- 
sicians, Northwestern University Medical School. Con- 
tact: Victoria Severson, AAPM&R, 30 No. Michigan, 
Chicago, IL 60611. Telephone: 312-236-9512. 


VISITING PROFESSOR PROGRAM 

For: Physicians, students, residents. Lecture, Sept. 
'78-May '79 (2nd Wednesday/mo.), 9:00 AM 4:00PM, 
VA Hospital, The Chicago Medical School, North Chi- 
cago, IL. CME credit: AMA Category 1, 5 hours (ea. 
session). Reg. limit: none. Reg. deadlina: none. 
Fee: none. Sponsor: Dept, of Surgery, UHS/CMS, VA 
Hospital, North Chicago, IL 60064. Contact: Karen 
Jcnasson. Telephone: 312 473-9200 x 202. 

Surgery 

PRE OPERATIVE CARE OF THE SURGICAL PATIENT 

For: all Physicians. Symposium, September 21, East 
St. Louis, IL. CME credit: AAFP Elective, 4 hours; 
AMA Category 1, 4 hours. Reg. limit: none Sponsor: 
Southern Illinois University School of Medicine, P.0. 
Box 3926, Springfield, IL 62708. Contact: Lorraine 
Stephenson Telephone: 217-782 7711. 

Surgery 

INTRAVENOUS ALIMENTATION AND DISEASE 

For: Physicians. 1-hour lecture, September 19, 7:30 
p.m., Wallach Auditorium, Weiss Memorial Hospital, 
4646 N. Marine Dr., Chicago, IL 60640. Speaker: 
Stanley J. Dudrick, M.D., Professor and Chairman of 
Surgery, University of Texas Medical School, Houston. 
CME Credit: AMA Category 1. Fee: none. Reg. dead- 
line: none. Sponsor: Louis A. Weiss Memorial Hospi 
tal. Cosponsor: Dept, of Surgery, University of llli 
nois. Contact: Anita Robins. Phone: 312-878 8700 
x 455. 

Surgery, Family /General Practice, 
Emergency Medicine 

COMMON PROBLEMS IN HAND INJURIES 

For: Practicing Physicians/Surgeons. 1-day symposium, 
September 23, 8:30 a m. -5:00 p.m., St. Louis, MO. 
Sponsor: Continuing Medical Education, Washington 
University School of Medicine, Box 8063, 660 S. 
Euclid, St. Louis, MO 63110. CME Credit: AAFP 
Elective, 6.5 hours; AMA Category 1, 6.5 hours; AOA, 
6.5 hours. Fee: $60. Reg. limit: 150. Contact: 
Loretta Giacoletto. Phone: 314 454-3873. 

Thoracic Diseases and Internal Medicine 

SCREENING PROGRAMS IN EARLY DIAGNOSIS OF 
LUNG CANCER 

For: Physicians, residents. Lecture, September 6, 

Auditorium, Martha Washington Hospital, 4U55 N. 
Western Ave., Chicago, IL 60618 Speaker: David 
R. Sanderson, M.D., Mayo Medical School, Rochester, 
MN. CME credit: AAFP Elective, 1 hour; AMA Cate- 
gory 1, 1 hour. Reg. limit: none. Fee: none. Sponsor: 
Martha Washington Hospital Medical Staff. Contact: 
Fernando Villa, M.D. Telephone: 312-583-9000 x 331. 

OCTOBER 

Biomed 

FOURTH ANNUAL MEDICAL PHOTOGRAPHY 
WORKSHOP 

For: all physicians. 1-day symposium /workshop, Oc- 
tober 28, Springfield, IL. Sponsor: SIU School of 
Medicine, P.0. Box 3926, Springfield, IL 62708. 
CME Credit: AAFP Elective, 6 hours; AMA Category 
1, 6 hours. Reg. limit: none. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 

Diabetes 

RECENT ADVANCES IN DIABETES 

For: residents and attending staff. Lecture, October 
25, 11:00 a m. (lunch follows), Martha Washington 
Hospital, 4055 N. Western, Chicago, IL 60618. 
Speaker: Arthur H. Rubenstein, M.D., Professor and 
Associate Chairman, Dept, of Medicine, The University 
of Chicago. CME Credit: AAFP Elective, 1 hour; AMA 
Category 1, 1 hour. Fee: none. Reg. limit: none. 
Reg. deadline: 10/24. Sponsor: Martha Washington 
Hospital. Contact: Fernando Villa, M.D. Phone: 312- 
583-9000 x 331. 

Hypnosis 

ANNUAL WORKSHOP ON CLINICAL HYPNOSIS 

For: Physicians, Dentists, Psychologists. 3-day work- 
shop, October 9-11, St. Louis, MO. Sponsor: Ameri- 
can Society of Clinical Hypnosis, 2400 E. Devon, 
Suite 218, Des Plaines, IL 60018. CME Credit: AMA 
Category 1, 24 hours. Fee: $225. Reg. limit: none. 
Cosponsor: American Society of Clinical Hypnosis — 
Education and Research Foundation. Contact: William 
Hoffman, Jr. Phone: 312-297-3317. 

Internal Medicine 

DIABETES MELITUS 

For: all Physicians. Symposium, October 5, Mt. Ver- 
non, IL. CME Credit: AAFP Elective, 4 hours; AMA 
Category 1, 4 hours. Sponsor: SIU School of Medi- 
cine, P.O. Box 3926, Springfield, IL 62708. Reg. 
limit: none. Contact: Lorraine Stephenson. Phone: 
217-782 7711. 


Internal Medicine, Family Practice, 

Pediatrics 

CLINICAL ALLERGY FOR PRACTICING PHYSICIANS 

For: Physicians. 3-day symposium, October 5-7, St. 
Louis, MO. Sponsor: Continuing Medical Education, 
Washington University School of Medicine, Box 8063, 
660 S. Euclid, St. Louis, MO 63110. CME Credit: 
AAFP Elective, 16 hours; AMA Category 1, 16 hours; 
AOA, 16 hours. Fee: $150. Reg. limit: 150. Con- 
tact: Loretta Giacoletto. Phone: 314-454-3873. 

Medicine and Surgery 

MEDICAL AND SURGICAL APPROACHES TO 
ACUTE COLON AND RECTAL DISEASES 

For: Physicians. Symposium, October 26, Hillsboro, 
IL. Sponsor: SIU School of Medicine, P.O. "Box 
3926, Springfield, IL 62708. CME Credit: AAFP Elec- 
tive, 4 hours; AMA Category 1, 4 hours. Reg. limit: 
none. Contact: Lorraine Stephenson. Phone: 217-782- 
7711. 

Neurology 

NEUROLOGY UPDATE 

For: Physicians. Symposium, October 7, Pittsfield, IL. 
Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. CME Credit: AAFP Elective, 
4 hours; AMA Category 1, 4 hours. Reg. limit: none. 
Contact: Lorraine Stephenson. Phone: 217-782-7711. 

Neurotology 

CLINICAL NEUROTOLOGY 

For: Otologists, Neurotologists. 4-day course, October 
16-19, Chicago, IL. Speaker: Nicholas Torok, M.D. 
Sponsor: Dept, of Otolaryngology, ALS.M., Illinois 
Eye & Ear Infirmary, Neurotology Section, 1855 W. 
Taylor, Chicago, IL 60612. Cosponsor: American 

Neurotology Society. CME Credit: AMA Category 1, 
28 hours. Fee: $300. Contact: Nicholas Torok, M.D. 
Phone: 312-996 6517. 

Psychiatry 

ILLINOIS PSYCHIATRIC SOCIETY 5th ANNUAL FALL 
WEEKEND MEETING 

For: Psychiatrists, other physicians. 3-day lecture/ 
workshop, October 6-8, Hyatt Regency O’Hare, Chi- 
cago, IL. Sponsor: Illinois Psychiatric Society, 55 E. 
Monroe, Suite 3510, Chicago, IL 60603. CME Credit: 
AMA Category 1, 13.5 hours. Fee: $35. Reg. limit: 
none. Reg. deadline: 9/25. Contact: Wendy Smith. 
Phone: 312-782-1654. 

Surgery 

CLINICAL CONGRESS 

For: Physicians. 5 day lecture, October 16-20, San 
Francisco, CA. Sponsor: American College of Sur- 
geons, 55 E. Erie, Chicago, IL 60611. CME Credit: 
AMA Category 1. Contact: Ginny Clark. Phone: 312- 
664-4050. 


RECENT CME ACCREDITATION 
RECOMMENDATIONS 

The ISMS Committee on CME Ac- 
creditation has recently recom- 
mended to LCCME approval of the 
CME programs of the following in- 
situations: 

Alexian Brothers Medical Center 
Elk Grove Village 
Central DuPage Hospital 
Winfield 

Chicago Pediatric Society 
Community Memorial General 
Hospital 
LaGrange 

Cook County Hospital 
Chicago 

DuPage County Medical Society 
Lombard 

Henrotin Hospital 
Chicago 

Institute for Psychoanalysis 
Chicago 

Rockford Memorial Hospital 
Roosevelt Memorial Hospital 
Chicago 


for July, 1978 


43 


CLASSIFIED ADVERTISING 


POSITIONS & PRACTICE OPPORTUNITIES 


FULL TIME PHYSICIAN for Industrial Clinic in Skokie. Surgical ex- 
perience needed. Salary negotiable. Must have Illinois license. Call 
(312) 674-4800, Mrs. McCubbin. 


EMERGENCY DEPARTMENT PHYSICIAN: Become part of an expand- 
ing, dynamic multispecialty clinic in midwest university community 
of 100,000. Excellent salary, benefits. Write or call Medical Director 
Carle Clinic, Urbana, IL 61801, (217) 337-3239. 


GYNECOLOGIST NEEDED for new fully operational multi-specialty 
clinic in Libertyville. For information call 312-362-9097. 


OPPORTUNITIES FOR PHYSICIANS IN INDIANA— There are several 
excellent openings among the Indiana State Hospitals at various 
locations throughout the state for psychiatrists and physicians of 
other specialties, at most experience levels. A newly-revised salary 
schedule offers a very competitive income plus a generous package 
of fringe benefits. An adjunct practice is possible beyond the reg- 
ular working hours and on-call responsibilities. Please reply with a 
copy of the c.v. to: Farabee & Associates, Inc., P.O. Box 472, Mur- 
ray, KY 42071 or call (collect) (502) 753-9772. Farabee is retained by 
the Indiana Department of Mental Health. 


ACADEMIC DIRECTOR, INTERNAL MEDICINE: University of Illinois 
affiliated community hospital seeks individual to be responsible 
for undergraduate, graduate and continuing medical education, and 
administration of residency and outpatient center. Physician we seek 
must be American Board of Internal Medicine certified. In return 
we offer a challenging and rewarding experience plus a competi- 
tive salary and benefit program. Send resume in complete con- 
fidence to: Box 917, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago 


WANTED: INDUSTRIAL PHYSICIAN: Unusual opportunity for Illi- 

nois licensed physician. Full time industrial work with minor 
traumatic surgery and physical examinations. Regular hours. Ad- 
vancement for right person. Staging salary negotiable. Write to 
Box 920, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago, 60603. 


PHYSICIAN WANTED: Family Practitioner, Board Eligible or Certified, 
full time position. Chicago suburban group with complete diagnostic 
facilities. Excellent starting compensation. Profit sharing and pension 
program. Pleasant working conditions. Capable interested medical 
associates. Convenient location, regular hours, good hospital affilia- 
tion, vacations. Insurance benefits include life, hospitalization, cata- 
strophic medical expense, disability and malpractice. Medical Society 
and hospital dues paid by corporation. Call collect: Eugene J. Scharba, 
M.D., or Administrator, Thomsen Clinic, Ltd. (312) 849-2400 


ORTHOPEDIC SURGEON who desires to locate in a rural area of 
southern Illinois needed to serve two community hospitals. One 
hour from St. Louis. Good educational system for children. Excellent 
recreation. Reply: T. K. Janssen, Administrator, Washington County 
Hospital, Nashville, Illinois 62263. 


WANTED-M.D. certified Family Practice, to direct and establish 
Family Practice Residency. Please reply to Box 927, c/o IMJ 55 E 
Monroe, Suite 3510, Chicago, 60603 


ENT SPECIALIST needed in a large, fast growing Chicago suburb. 
No other ENT speciaiist in town. Very favorable terms. Send resume 
to Box 926, c/o IMJ, 55 E. Monroe, Chicago, Illinois 60603. 


DERMATOLOGIST needed for a large, fast growing Chicago :-uburb. 
Solo practice. Ideal for a second office. Office space available in a 
new medical complex Very favorable terms. Send resume to Box 
928, c/o IMJ, 55 E. Monroe, Chicago, Illinois 60603. 


OVERHEAD MOUNTING? WORKING LONG HOURS? Consider work- 
ing in a University Health Service. 40 hour week-positive fringe 
benefits including generous vacation times. Illinois license. Equal 
oppcrtun^y/afFirmative action employer. Contact: M. M. Torray AA D 
Illinois State University, Normal, Illinois 61761. Tel.: 309-438-8655’! 

PHYSICIAN WANTED: Internist, board certified, full time to join 
Chicago suburban group with complete diagnostic facilities. Excellent 
starting compensation profit sharing and pension program. Pleasant 
working conditions. Capable, interested medical associates. Con- 
venient location, regular hours and good hospital affiliations, vaca- 
;°" S ' n J urance kf. neFif s '"elude Life, Hospitalization, Catastrophic 
Medica Expense, Disability for Illness and Accident and AAalpractice 
Medical society and hospital dues paid by corporation. Call collect- 

(31 9 2l n 849 J 2400 herba ' M '°' ° f Administrator ' Thomsen Clinic, Ltd. 


MATTOON-CHARLESTON, ILLINOIS. Sara Bush Lincoln Health Cen 
ter Emergency Department has July opening for qualified physician 
Guarantee $50, 000455, 000 with ideal working conditions and sched 
ule Send curriculum vitae to Stephen Allin, M.D., Emergency De 

free "T - 80Ch3?5-i?98 2^ for d^ads. 2 ' Matt °° n ' " lin ° iS 6,938 ° r Ca " ,o11 


FAMILY PRACTITIONER — To associate with one senior general prac- 
titioner and one surgeon in rural southern Illinois. Excellent educa- 
tional system and recreation. Financially sound community. One hour 
from St. Louis. JCAH 72-bed hospital in Nashville. Association avail- 
able now. Contact: T. K. Janssen, Administrator, Washington County 
Hospital, Nashville, Illinois, (618) 327-8236. 


PHYSICIAN WITH EMPATHY TOWARD COLLEGE AGE population to 
practice general medicine in 38 bed accredited hospital with large 
outpatient clinic. Salary negotiable. Excellent fringe benefits. Contact 
L. W. Combs, M.D., Director, Purdue University Student Hospital, 
West Lafayette, IN 47907, (317) 749-2441. Equal access/equal op- 
portunity employer. 


FOR SALE, LEASE OR RENT 


MEDICAL OF f ICE SUITE FOR RENT ' Lincoln-Belmont Bldg. 715- 
1200 square feet, available at once in full service, elevator active 
professional building. Call Gary Solomon, (312) 334-5400. 


MEDICAL CENTER FOR RENT. Complete and ready to open. 4300 sq. 
ft. at 2301 E. 95fh Street, Chicago. Large waiting rm„ 18 exam rms., 
x-ray rm., central a/c & heat. Call Gary Solomon, (312) 334-5400. 


3UI I C 


Tor internist, rediatrician. Psychologist, Psy- 
chiatnst or other medical practice. Suite is located in a high 

quality building with a growing medical community situated across 
from a major hospital. The complex already includes an outstanding 
lab. X-ray facility, pharmacy and 16 professionals. Arrangement 
provides flexibility for the new tenant to share a suite with an 

existing practice, to have office built in newly created bare space 
i in ,he owr >ership and direction of the com- 

plex. STRONG Property Managers, Ltd. Agents, 201 W. Springfield 
Champaign, IL 61820. (217) 356-2617. ' 


SPACIOUS Northside Lakeview area medical office for rent. Newly 
remodeled. Five examining rooms, carpeted. Large furnished waiting 
room. Available now. Interested in Spanish speaking doctors only. 
Growing Spanish speaking area. Near Ashland-Lincoln and Belmont. 
Pharmacy space also availble, if desired. Please contact: Dr. Pedro 
O. Cabrera (Dentist) at 1442 W. Belmont or call (312) 528-0068. 


rv/l\ 3MLC: 


O -year-o a established general practice and clinic. Fully 
equipped and furnished. Clinic and practice can accommodate two 
doctors Contact: Bob Billa, 2931 East Southcross Blvd., San Antonio, 


ISLE-MEDICAL SUITE available in prestigious modern building lo- 
cated on Kt. 53 in Lisle. X-ray facilities on premises. Zone controlled 
heating and air conditioning. Ample parking. Call 969-2850. 


SITUATIONS WANTED 


DIAGNOSTIC RADIOLOGY— Board eligible. Well trained in ultra- 
AT scan ‘ Part or ful1 Time- Also for film reading. Call (312) 

/ / I -oU/ 6. 


oln '«nn E .? Dy ^ ale ' 39 years-Psychiatry, M.D., D.P.M., 

PJAL.p.(C), ABPN, With total ten years of wide experience in Psy- 
chiatry with Illinois license looking for place in private practice or 
a salaried |ob. 


h?v> P 'a V ' REDDY - F emale, 34 years-OB-GYN, M.D., M.R.C.O.G. 
■ on i~vm n ? an ® oard Certified with Illinois license. Total ten years 
in Ob-GYN. Looking for place in private practice or a salaried iob. 
Please contact Dr. P. J. Reddy, Union Hospital, Moose Jaw, Sas- 
katchewan, Canada. Office-(3Q6) 692-18 41; Home-(306) 693-3288. 

fc?oo| D a CE t T u IED r RA ?, IOL ° G !i ST ' 40 ' 9 ra< ^ ua Te of American medical 
school available for film reading in office, clinic or home Daily 

Mil/ UP m 6 !7' C ! . if de ? ired - Excellent references. Please contact 
^ ed L cal Journal ' Bo * N °- 930, 55 East Monroe, Chicago, 
Illinois 60603. 


44 


Illinois Medical Journal 


GUARANTY FUND CERTIFICATE 


GUARANTY FUND CERTIFICATE issued by the Illinois State Medical 
Inter-Insurance Exchange for sale. Coverage $100,000/$300,000. Class 
5, Specialty: Otorhinolaryngology. Original purchase price $6,840.00. 
Interested: Contact Olawale O. Idewu, M.D. 9204 South Commercial 
Avenue, Chicago, Illinois 60617; Tel. (312) 735-8033 or 734-4243. 


GUARANTY FUND CERTIFICATE: Class 4, Territory 1 for $1 Million/ 
$1 Million. Moving out of state. Purchase price $2572 in 1976. 
Please reply to Box 921, c/o IMJ, 55 E. Monroe, Suite 3510, Chi- 
cago 60603. 


ISMIE GUARANTY FUND CERTIFICATE: Price (original) $6024.00. 

Specialty: OB-GYN, Class V, Territory II. Have moved out of Illinois. 
Discount price. Will be available, Thomas T.H. Lin, M.D. 175 N. Jack- 
son Ave., Suite 208, San Jose, CA 95116, (408) 251-5205. 


GUARANTY FUND CERTIFICATE: Class 8 Inter-Insurance Exchange 
Certificate for sale (previously class 5). Call 266-1977, 9-5 P.M. 


ILLINOIS STATE MEDICAL INTER-INSURANCE EXCHANGE Guaranty 
Fund Certificate #1160 Territory II Class 5 (1 mil/1 mil) OB-GYN 
for sale. Orig. price $6024. Best offer. Left state. Contact. M. Hos- 
seinipour, M.D., c/o P.O. Box 681, Williamson, W.Va. 25661. (606) 
237-1020 or 237-1083. 


GUARANTY FUND CERTIFICATE for sale at discount. Phone (312) 
579-0133. 


ILLINOIS STATE MEDICAL INTER-INSURANCE EXCHANGE Guaranty 
Fund Certificate for sale. Territory 1 Class 1— Purchase price $772. 
Best offer. Please contact Mrs. Burton at 388-8052. 


GUARANTY FUND CERTIFICATE issued by the Illinois State Medical 
Inter-Insurance Exchange for sale. Coverage $100,000/$300,000. 
Original purchase price $6,024.00. Interested call (312) 963-8777 or 
920-8792. 


GUARANTY FUND CERTIFICATE— Anesthesiologist relocating. Class 5, 
1,000,000/1,000,000 coverage. Original price 10,000— purchase price 
8000.00 or best offer. Favorable conditions may be arranged. Send 
inquiries to Box 922, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago, 
60603. 


GUARANTY FUND CERTIFICATE for sale. This certificate is worth 
$3096 toward your purchase of any Class III, IV or V certificate. 
Will discount price. Call evenings 312-293-1993. 


FOR SALE: Illinois Medical Inter-Insurance Exchange Guaranty 

Fund Certificate, 100,000/300,000, Class 1, Terr. I. Cost 1977, one 
thousand-thirty two dollars ($1032.00). Contact: Hans F. Waecker, 
D.O., 5200 S. Ellis Ave., Chicago 60615. 


IM J and ISMS are not acting as brokers or agents; this is provided 
as a membership service. 



for July, 1978 


45 



EKG 


(Continued from page 6) 

Answers: 1. A 2. E. 

The EGG shows atrial flutter with 2:1 atrio- 
ventricular block. The atrial rate is 430 and the 
ventricular response is 215 beats per minute, re- 
spectively. The sharp flutter waves are seen best 
in the right precordial leads, notably RV 4 , or the 
V 4 position on the right precordium. In an older 
patient, the tall R waves in lead V, and RV 4 
would indicate right ventricular hypertrophy. 
However, at this age, the R wave in RV 4 can go 
to 12 mm and the R wave in V, to 20mm. This 
is due to the normal right ventricular preponder- 
ance seen in the first months of life. Digitalis 
was given and the ventricular response slowed, 
but the atrial flutter did not convert to sinus 
rhythm. Ouinidine, 15mg every six hours, was 
added with further control of the heart rate but 
without conversion to sinus rhythm. Since atrial 
flutter is so rare in normal hearts, it was decided 
to do a right heart catheterization to rule out any 


left to right shunts and measure pressures in the 
pulmonary artery, right ventricle, right atrium, 
and pulmonary capillary wedge position. All 
pressures were normal. A small left to right shunt 
was found at the atrial level and was felt to be 
compatible with a patent foramen ovale or small 
atrial septal defect. Direct current cardioversion 
at 7 watt-seconds converted the atrial flutter to 
normal sinus rhythm. Maintenance digitalis and 
qninidine were eventually discontinued. The 
child has continued normally and now, at age 
four years, has a normal chest X-ray and ECG. 
Ehis patient had a normal heart by catheter 
studies and in follow-up examinations. The 
etiology of the atrial flutter was never explained. 
This shows that the significance of atrial flutter 
is closely bound to the underlying cardiac pathol- 
ogy- 


The new pension law permits you 
to retain over five times as much money 
as you might expect. 

Ask yourself : 

1. Am I really getting the very best 
pension advice? 

2. Are my advisers technically 
expert in pension 
consultation? 



FREE INITIAL CONSULTATION 


American Society Pension Actuaries 
Consultants to the Chicago Medical Society Employees Pension Plan 
National Association Pension Consultants 



Mann, Levine & Weiss, Ltd. 3525 W. Peterson, Chicago, IL 60659 

(312) 539-7820 Pension Consultants a,ld Plan Desi ^ ners (312) 539-7820 


46 


Illinois Medical Journal 


Abstracts of Board Actions 

(Continued from page 4) 

In other PSRO-related action, ISMS will introduce a resolution at the AMA An- 
nual Meeting-June 18-22 in St. Louis-urging AMA to seek legislation that would 
exempt PSROs from the Freedom of Inf ormat ion Act . AU.S. District Court recently- 
declared that a Washington, D.C.-area PSRO is an "agent" of the federal govern- 
ment and thereby is required to disclose identified PSRO data under the Infor- 
mation Act. In outlining procedures to alleviate the breach of confidentiality 
problem, the court pointed out that the remedy lies with Congress, not the 
courts. 

’79 Board Meeting Dates 

The 1979 Board of Trustees meeting schedule is: 

Jan. 27-28 — Palmer House or Ambassador West 
Mar. 10-11 — (location not yet determined) 

May 5-9 — Palmer House (Annual Meeting of House of Delegates) 

June 14 — (one-day session devoted primarily to council &: committee appointments plus 

emergency items) 

Sept. 15-16 — Ambassador West 

Nov. 9-11 —Holiday Inn, Decatur (Interim Session of House of Delegates) 

Liaison Committee With Bar Association 

ISMS and Illinois Bar Association will each name three representatives to a 
Liaison Committee to resolve increasing problems between physicians and law- 
yers. The Chicago Medical Society and Chicage Bar Association will be invited to 
each name two members. ISMS representatives will include: Drs. Mike Murphy, 
Belleville ; Robert Fox, Glenview; and Donald Aaronson, Chicago. 

AMA Jail Project 

ISMS will be one of 10 state medical societies added to the list of participants 
in the AMA Program to Improve Health Care in Jails. The Society will receive a 
$5,000 grant from the Law Enforcement Assistance Administration— through AMA-to 
set up and administer the project. 

AMA Dues Billing 

The Board endorsed the AMA Criteria for Dues Billing & Remittance which states: 

Each society receiving AMA dues should forward AMA dues and a list of the payers of the dues 
within 30 days of receipt of the dues. All dues collected within the last 30 days prior to the 
AMA delinquency date should be forwarded in time to reach the AMA prior to that delinquency 
date. > 

By agreeing to the criteria, ISMS will be reimbursed by the AMA on the follow- 
ing formula basis: 

2% of dues received by the AMA no later than January 15. 

1.5% of dues received by AMA no later than February 15. 

1% of dues received by AMA no later than March 15. 

.5% of dues received by AMA after March 15. 

The foregoing will be shared on an equitable basis with those component so- 
cieties involved in the billing process. 

CME Accreditation 

ISMS will seek accreditation to grant Category I credit for CME programs. This 
will allow the Society more freedom in programming and eliminate the need to se- 
cure co-sponsors for programs in order to offer the Category I credit. Accredi- 
tation is granted by the National Liaison Committee on Continuing Medical Edu- 
cation. 


for July, 1978 


47 


IDPA Drug Manual 

The following drugs were approved for inclusion in the IDPA Drug Manual: Lim- 
bitrol , Depakene (Valproic Acid), Theodur, Hydergine R-Oral tablets (automat- 
ic), Ocusert, Benylin Cough Syrup (automatic), Deconamine (list to Chlorphen- 
iramine), Decubitex (under dermatological preparations) and Metamucil (21 02 . 
dose available) . 

Designated Products 

Next month, the Illinois Dangerous Drugs Commission is expected to act on pro- 
posed scheduling of Talwin into Schedule II of the Controlled Substances Act . . . 
and review a proposal by the Dangerous Drugs Advisory Committee to classify the 
drug as a "designated product." 


Conference on Cost Effectiveness 

The ISMS Task Force on Cost Effectiveness will sponsor a June 14 conference on 
health care costs. The session— a followup to a similar program last February— 
will be attended by representatives of labor, management, insurance, banking, 
local and state government. Focus of the day-long session will be the role of 
physicians and hospitals in cost containment. 


Appointments/Nominations 

Several hundred ISMS members were appointed to one-year terms on the Society's 
various councils and committees for 1978-79. Appointed Council chairmen were: 
Drs . Norman Frank , Clarendon Hills, Affiliate Societies ; Michael Murray. Olney, 
Economics and Peer Review; Charles McHugh. Chicago, Education and Manpower; 
Tassos Nassos, Chicago, Governmental Affairs; Eugene Vickery. Lena, Medical- 
Legal ; Glen Tomlinson, Lincoln, Medical Service ; Arthur Traugott . Urbana, Men- 
tal Health and Addiction; and Mack Hollowell, Charleston, Public Relations and 
Membership Services. 


Legislation 

The Board voted to oppose the following pending legislation which would: 

• Amend current certificate-of-need law to conform to federal provisions and extend the defini- 
tion of health care facilities to kidney treatment centers. Local health planning agencies 
would be required to coordinate planning procedures with provisions of the federal Social 
Security Act and Public Law 93-641. 

• Reduce the IDPA appropriation for medical assistance by $54 million. 

® Add to the list of grounds for suspension or revocation of a license the suspension or termina- 
tion from participation in Medicaid, provided such suspension was based on gross and willful 
misconduct. If it appears impossible to defeat this bill, ISMS will seek to remove provisions 
referring to suspension from Medicaid as grounds for revocation of a license. 


The Board voted to support pending legislation which would: 

» Allow license renewal fees currently earmarked only for the Medical Disciplinary Board — to 
be used for costs related to license renewal and administration of licensing requirements per- 
taining to continuing medical education. 

® Direct Title XIX Public Aid payments for treatment in state medical facilities into the Mental 
Health Fund administered by IDMHDD. This would allow greater flexibility in the use of 
these funds to provide patient care. 

® Appropriate an addition $20 million in Fiscal ’79 for Medicaid payments to physicians. 


48 


Illinois Medical Journal 


Pending a favorable review by legal counsel, ISMS will support a proposal which 
would allow a plea of "guilty, mitigated by mental illness," in criminal cases. 
The Board agreed that this proposal— embodied in HB 2755— was more acceptable than 
another bill which would eliminate the current plea of "not guilty by reason of 
insanity. " 

ISMS will vigorously work to amend legislation dealing with a new Mental Health 
Code to insure that hospital admission (including voluntary certification), 
treatment and discharge procedures for mental or physical illness shall be— with- 
out except ion-the responsibility of a physician licensed to practice medicine 
in all its branches. The pending legislation allows non-medical personnel to 
participate in involuntary commitment procedures. 

ISMS will seek to amend legislation which would permit emergency medical per- 
sonnel to perform procedures without direct physician authorization when condi- 
tions prevent direct voice contact with a hospital or physician supervisor. ISMS 
will attempt to limit such activity to procedures specif ically listed in the pro- 
tocol books required for study prior to certification. 

The Illinois Constitution requires abolition of the personal property tax. A 
proposal pending in the General Assembly would institute an income tax on corpo- 
rations and partnerships as well as other entities as a method of replacing rev- 
enue lost through abolition of the property tax. ISMS will oppose the bill-HB 
2418-and support an amendment calling for a two-year delay on any action to re- 
place the property tax. 

ISMS will send a delegation to Washington to meet with Illinois Senators and 
voice objection to SR 2410 which would extend cert if icate-of-need to physician 
offices. 


Ambulatory Surgical Treatment Centers 

The Board endorsed the concept of allowing Ambulatory Surgical Treatment Cen- 
ters (ASTC) to maintain repositories for controlled substances provided such 
repositories are registered and maintained in keeping with current regulations. 
Presently, ASTCs may have a limited pharmacy and each physician practicing at a 
center may have his own supply. The Board agreed that more stringent rules are 
necessary and authorized the Council on Mental Health and Addiction to draft 
amendatory legislation if needed. 


Alcoholism 

ISMS will seek to amend Illinois statutes so that physicians may treat minors 
for alcohol intoxication without parental consent. A legislative interpreta- 
tion of alcohol as a drug will be necessary to include intoxication as a form of 
drug abuse, thereby allowing confidential treatment. 

The Board voted to encourage the IDMHDD's Division of Alcoholism to prepare a 
program for physicians to use in educating women as to the health risks posed to 
a fetus by moderate to heavy consumption of alcohol during pregnancy. The Board 
also directed the Council on Mental Health and Addiction to consider working 
with the Dangerous Drugs Commission in formulating a similar program concerning 
risks to the fetus posed by other drug usage during pregnancy. 

ISMS will distribute to members an insert for the Physician Desk Reference 
explaining the interaction effect of alcoholic beverages with commonly-pre- 
scribed medications. Costs of printing and distribution will be covered by an 
educational grant from the IDMHDD Division of Alcoholism. 


for July , 197S 


49 



IMPAC 


ILLINOIS MEDICAL POLITICAL ACTION COMMITTEE 

55 East Monroe Street 
Chicago, Illinois 60603 
312/782 1963 


WHFRF ARF YOUR CANDIDATES? 


Fellow Physicians: 

It is July, 1978. By the time your read this the spring session of the 
General Assembly will have ended. Incumbent legislators and newcomers alike will 
be home in their districts organizing for the fall election campaigns. Are you 
organized to help the best candidates get elected? 

Across II 1 inois, physicians and their spouses are voluntarily and tempo- 
rarily uniting to form physician candidate support committees. Physicians through- 
out Illinois take part in the elective process by supporting the candidates of their 
own preferences. Through this support, physicians influence the selection of those 
who ultimately decide what course government is to follow. Through active parti- 
cipation, physicians can effectively contribute toward assuring that there will 
be an open channel of communication between medicine and government when legisla- 
tion is being considered that will affect the profession and the public. Remember, 
in today's society, politics cannot be separated from government. To have a voice 
in government, political activity is necessary. And in this case political activ- 
ity doesn't just mean giving money. Money helps but money by itself doesn't win 
elections. Elections are won by votes and those votes are won by the hard work 
of many people. Physicians and their families must be well organized to provide 
the help that will elect superior candidates. 

IMPAC can help you organize. For further information write: IMPAC, 

55 East Monroe Street, Chicago, Illinois 60603. And do so now>so that you can 
organize immediately to provide maximum support to the candidates of your choice. 


n -0. 

Herbert Sohn, M.D. 

Chairman 


P.S. If you are not a member of IMPAC please join immediately. Only through ac- 
tive participation in our organization can we implement good legislation. 

Contributions are not limited to the suggested amount. Neither the Illinois State Medical Society nor the AMA will favor or disadvantage anyone 
based upon the amounts of or failure to make pac contributions. Copies of IMPAC & AMPAC reports are filed with and are available for purchase 
from the Federal Election Commission, Washington, D.C. Contributions are subject to the limitations of FEC regulations. Sections 110.1, 110.2 
i 110.5. (Federal regulations require this notice.) IMPAC reports are also filed with the State Board of Elections, and are or will be available 
for purchase from the State Board of Elections, 1020 South Spring Street, Springfield, Illinois 62704. 



50 


Illinois Aledical Journal 


*Doct<to& Tteurt 

LICENSES ONCE ISSUED, MUST BE RENEWED— It recently has been noted before the 
Medical Examining Committee of the Department of Registration and 
Education that some physicians may be practicing with expired licenses. 

Licenses, once issued, must be renewed every two years, on the first of 
July, even-numbered years. 

Technically, if a license is not so renewed a physician is practicing with- 
out a license. During such practice, it is conceivable that professional liabil- 
ity insurance, even though purchased, will not provide coverage or defense 
against claims. 

In addition, several instances have been identified in which a physician’s 
spouse or office personnel have renewed a deceased person’s license. 

License renewal is accomplished through the Medical Examining Com- 
mittee, Department of Registration and Education, 628 East Adams, Spring- 
field, Illinois 62786. If one has not received a renewal notice for July 1, 
1978, please write or call immediately (217) 782-7934. 

It is recommended that physicians bring this to the attention of their 
fellow practitioners, to their hospital staff members, and to their county 
medical societies. If a physician has not renewed his license since it was 
issued, and it was issued prior to July 1, 1976, it may very well have lapsed. 
Serious problems could ensue. 

HOSPITAL CME OPPORTUNITY-The Ohio Medical Education Network (OMEN) has an- 
nounced that memberships are available for the 1978-79 program schedule. 
OMEN is a telephone network for physicians, supplying CME lectures from 
the Ohio State University. One hour of AM A Category 1 credit is available 
for each of 30 weekly programs, which are broadcast at 11:00 a.m. for one 
hour. Ten Illinois hospitals currently hold membership in OMEN. 

The programs are conducted for small group seminars, and consist of a 
30 minute lecture and 30 minute discussion through a closed-circuit ampli- 
fied telephone. Cost to interested hospitals is determined on a sliding scale 
based upon bed capacity. Visual aids and outlines are mailed to participat- 
ing hospitals one week before each session. The deadline for membership 
application is July 26, 1978, but a limited number of late applications may 
be accepted. For further information on specific lectures and costs, contact: 
Arthur Bartfray, CCME, A-352 Starling-Loving, 320 W. 10th Ave., Colum- 
bus, Ohio 43210. 

NATIONAL CONFERENCE ON THE IMPAIRED PHYSICIAN— The third AMA conference 
on treatment of physicians impaired due to alcoholism, drug dependence or 
mental illness will be held September 29-October 1 at the Sheraton Ritz 
Hotel in Minneapolis, Minnesota. Conference participants will attend lec- 
tures and workshops regarding programs sponsored by state medical so- 
cieties, hospitals and medical boards, and participate in discussion groups 
on all aspects of the problem. For further information, please contact: AMA, 
Department of Meeting Services, 535 N. Dearborn St., Chicago, 60610, 
before September 8, 1978. 

COST VICTORY REPORTED— Rockford Memorial Hospital has announced a reduction in 
its daily room rates by $1.50 per day, for private and semi-private rooms in 
medical/surgical, pediatric and rehabilitation units. In announcing the de- 
crease, spokesmen attributed the savings in comprehensive professional 
liability insurance premiums this year, due to favorable claims-experience. 


for July, 1978 


51 


UPCOMING MEETINGS— The World Federation of Nuclear Medicine and Biology will hold 
their second international congress September 17-21, in Washington, D.C. 
Approximately 3,000 nuclear medicine specialists from six continents are 
expected to attend. Further information may be obtained by writing: 
WFNMB Second International Congress, 1629 K Street, N.W., Suite 700, 
Washington, D.C. 20006. 

The American Academy of Occupational Medicine and American Acad- 
emy of Industrial Hygiene will hold their joint annual meeting September 
19-22 in Williamsburg, Virginia. The regular scientific sessions on Septem- 
ber 20-22 will be preceded by two postgraduate seminars on the first day 
of the conference. For further information contact the American Academy 
of Occupational Medicine, 150 N. Wacker Dr., Chicago 60606. 


PHYSICIANS IN THE NEWS— Silvio Aladjem, M.D., Chicago, is the new professor and chair- 
man of the department of obstetrics and gynecology for Loyola University 
Medical Center in Maywood. . . . Frederick D. Malkinson, M.D., Chicago, 
has been elected to serve as vice president for the Society for Investigative 
Dermatology. . . . The Illinois Society of Pathologists has elected new 
officers. John G. Dietrich, M.D., Springfield, Peter J. Soto, M.D., Belleville, 
Marshall H. Short, M.D., River Forest, and James C. Pritchard, M.D., 
Geneva, will form the new roster of officers. 

Robert J. Becker, M.D., Joliet, recently received the sixth annual 
Clemens von Pirquet award from Georgetown University in Washington, 
D.C. The award recognizes work as a national lobbyist in legislation regard- 
ing the Clean Air Bill, drug reform measures and issues related to im- 
munologic and allergic health problems. . . . The Chicago Society of Indus- 
trial Medicine and Surgery recently elected Meredith E. Keller, M.D., to 
serve as their new president. Other new officers included John J. Brosnan, 
M.D., vice president and Robert S. Kassriel, M.D., Secretary-Treasurer. 

Four Chicago plastic surgical resident physicians recently received 
awards for research papers presented to the Chicago Society of Plastic Sur- 
gery. First place awards were given to William Georgis, M.D., and John O. 
Kucan, M.D. Frank Madda, M.D., and Raymond E. Shively, M.D., received 
second place awards for their work. 

AN ERROR— COMPOUNDED— In the May Doctor’s News, erroneous information was con- 
tained in the item entitled “Controlled Substance Update.” The June issue 
unsuccessfully attempted to correct the error, but again the facts were in- 
advertently misstated. This is regretted and apologies are extended. 

The story, based upon Dangerous Drugs Commission information, should 
have stated that there is a proposal to place Phencyclidine (PCP) and 
Pentazocine (Talwin) in Schedule II. Currently PCP is in Schedule III; 
Pentazocine is not scheduled on the current Controlled Substance List. 
This proposal has been published in the “Illinois Register” and will be 
acted upon by the Dangerous Drugs Commission (DDC) at its August 1, 
meeting. Interested parties may send comments to the DDC, 300 N. State 
Street, Chicago, 60610. DDC action will be reported in forthcoming issues. 


52 


Illinois Medical Journal 


President’s Page 


Mandatory CME 



This month marked the first license renewal period requiring evidence of CME 
credits. Although the requirement is reasonable, it has been sharply criticized by 
some physicians. Perhaps the criticism reflected an “off-the-cuff” reaction rather 
than thoughtful consideration of the details or the alternative. 

The alternative was re-examination. In this age of public accountability, the 
drive to impose a re-examination requirement had gained considerable momen- 
tum before it was diffused by enactment of the CME law. 

Most physicians agree that CME is needed to keep abreast of developments in 
their particular fields of medicine. In fact, surveys indicate that the majority of 
physicians voluntarily have been logging enough credits to meet the requirement. 
For these physicians, the Illinois law merely demands documentation of on- 
going activities. 

The requirement of 100 hours every two years should not prove burdensome 
even to those few physicians who largely have ignored CME opportunities. It 
averages out to a total of less than one hour per week! 

Obviously, mandatory CME is an acceptable alternative to re-examination for 
relicensure. In addition, it represents a documented effort by physicians to main- 
tain the highest possible standard of care. This enhances the profession’s credibil- 
ity— our most effective weapon in the fight to retain our professional freedom. ◄ 



David S. Fox, M.D., President 


for July, 1978 


53 




Physician Recruitment Program 


In an effort to reduce the number of towns in Illinois needing physicians, the Physician Recruitment Program and the Doctor’s 
Job Fair , are publishing synopses in the Journal. 

Physicians who are seeking a place to practice or who know of any out-of-state physicians seeking an Illinois residence are 
asked to notify the Program. 

Any areas wishing to be listed should contact: Mrs. E. Duffy, Physician Recruitment Program, ISMS, 55 E. Monroe Suite 3510 
Chicago, 60603. 


CHICAGO: Opportunities Available for Family Prac- 
titioners in a single specialty clinic setting. Associa- 
tion as a satellite facility with a 265 bed community 
hospital. Opportunity to build own practice with fi- 
nancial assistance available. Contact: Teryl R. File- 
bark, 1044 N. Francisco Ave., Chicago 60622. (312) 278- 
8800. (9) 

CHICAGO (desirable suburb) : Older general prac- 
titioner has excellent office facilities to share with 
younger G.P. Objective: need help with practice. 
Younger man may have guarantee to take over prac- 
tice in near future. Hospital staff appointment avail- 
able. All replies confidential. Box MK, Physician Re- 
cruitment Program, ISMS. (9) 

ELGIN: Psychiatrist, % time position with CMHC. 
Provide leadership and direction of medical and psy- 
chiatric aspects of clinical program, consult with staff, 
provide direct service to a wide variety of patients. 
Experience: past residency, preferably Board certified. 
Resume and salary requirements would be helpful to: 
Jack Crook, Director of Programs, Fox Valley Mental 
Health Center, 384 Division, Elgin, 60120, (312) 695- 
1115. (10) 

FAIRBURY: Population 3,500. Rural area serving a 
population of more than 16,000. Excellent practice op- 
portunity for family practitioner or internist inter- 
ested in family practice. Enjoy life and your practice 
in an area which offers excellent facilities and, a per- 
sonal, friendly atmosphere; join the staff of 112-bed 
JCAH accredited community hospital. Write: Frank 
Brady, Administrator, Fairbury Hospital, Fairbury, 
61739, or call collect (815) 692-2346. (10) 

FORT MADISON, IOWA: Openings for 2-4 FP/GP, 
Ped., in growing industrial city of 16,000 serving 70,000 
on Mississippi River. Solo, partnership, clinic avail- 
able. Substantial salary, other incentive. U. of la. near, 
excellent living area, 125 bed accredited hospital. Con- 
tact Donald A. Buckert, Fort Madison Community 
Hospital, Fort Madison, la. 52627. (319) 372-6530. (7) 

FREEPORT: Internist-general internist or internist 
with sub-specialty, board certified or eligible to join 
multi-specialty group in community of 35,000 in North- 
ern Illinois. Excellent salary first year then partner- 
ship. Excellent retirement and fringe benefits. Send 
curriculum vita and references to K. H. Shons, Busi- 
ness Manager, Freeport Medical Clinic, Ltd., 3103 West 
Stephenson Road, Freeport, 61032. (815) 235-6131 (7) 

HERRIN: Population 10,000. Trade area 40,000. Located 
in beautiful vacationland of Southern Illinois, near 
major university and medical school. Family Practice 
and OB-Gyn needed. Solo or clinic available. Excel- 
lent financial program provided. Modern well equipped 


hospital. Call collect or write, Larry Feil, Herrin Hos- 
pital, Herrin, 62948— Tel. (618) 942-4710. (7) 

MENDOTA: General practice, second physician for 
Wholistic Health Center of Mendota, Illinois. Innova- 
tive program with additional staff for counseling and 
patient education. Excellent local hospital. Future 
openings available in five other Wholistic Health Cen- 
ters in the planning stage. Call or write : Lucy Young, 
M.D., 607 Tenth Ave., Mendota, 61342. (815) 539- 
3888 (7) 

MINIER: General or family practitioner for rich agri- 
cultural area near Bloomington. Large practice wait- 
ing due to death of doctor. Office with X-ray and other 
equipment, very reasonable. Unusual opportunity. Con- 
tact: Harvey Graff, Minier 61759. (309) 392-2345 or 
392-2120. (10) 

OSWEGO: Family physician or internist to join group 
of four in a small town primary care clinic. Two full- 
service hospitals nearby. One hour west of Chicago. 
Dr. A. Haan, Oswego, 60543. (312) 554-8431. (11) 

OTTAWA: Opening in fields of Internal Medicine 
and Family Practice with multi-specialty group of 
nine physicians. Community, 20,000 plus. 154 bed hos- 
pital under five years old. Latest equipment One and 
one-half hours from Chicago and Peoria. Near State 
Parks. Excellent school system. Close to Jr. College 
and State Universities. Salary negotiable. CONTACT: 
Mrs. Van Buren, Ottawa Medical Center, 313 W. 
Madison, Ottawa 61350. (815) 433-1010. (10) 

PEORIA: Emergency physician — Unique opportunity 
to start on the ground floor with fee-for-service group 
in 550-bed medical center seeing 27,000 ER visits. Need 
career-minded physician for three 16-hour shifts per 
week with four weeks paid vacation. Compensation 
57K with excellent corporate benefits plus incentive 
compensation. Flexible scheduling to allow individual 
pursuits in university town of 250,000 in Central Illi- 
nois. Contact: Hospital Emergency Physicians S.C., 
221 Northeast Glen Oak, Peoria, 61636; phone 309- 
672-4974. (8) 

UNION COUNTY: Population 17,000. Clinic and office 
facilities available for family practitioner and physi- 
cian of internal medicine. Special Care Unit under 
construction in County Hospital. Nearby cities of Car- 
bondale and Cape Girardeau 25 miles away. Recrea- 
tional facilities plentiful. Contact: E. A. Helfrich, 517 
N. Main, Anna, 62906 AC 618-833-5155. (7) 

WAUKEGAN: Population 67,000, northern Chicago 
Suburb. Newly remodeled medical center near hos- 
pital. Looking for Internist, Family Physician. Contact 
Washington Center, 1515 AVashington St., Waukegan 
60085, Y. Lee, M.D. 312-336-2221 or 729-5407. (9) 


54 


Illinois Medical Journal 





Blood levels as fast as an elixi 

Wjl ; ■ 

With minimal gastric irritation 


*Please see complete prescribing information, a summary of which follows. 


r 

IESCRIPTION: iiltrl 

:ach green and white hard gelatin capsule contains theophylline USP anhy- 
rous, 200 mg., in a micro-pulverized form. Each brown and white hard gelatin 
apsule contains 100 mg. The elixir contains 80 mg. theophylline per 15 ml. 
n a 20% alcohol elixir (approximately 20 calories, 0.9 gm carbohydrate per 
ablespoonful). 

tCTION: Theophylline is a methylxanthine which relaxes the smooth muscu- 
ature of the bronchioles through its inhibition of the conversion of cyclic 
denosine monophosphate to adenosine monophosphate by phosphodiester- 
ise. It also has diuretic, cardiotonic, and CNS stimulant effects. 

NDtCATIONS: Bronkodyl is indicated for symptomatic relaxation of bronchiolar 
pasm in the chronic obstructive bronchopulmonary diseases; e g., bronchial 
isthma, chronic bronchitis and pulmonary emphysema. 

CONTRAINDICATIONS: Bronkodyl is contraindicated in persons known to 
lave had serious idiosyncratic responses to theophylline, its salts, or the other 
nethyixanthines, theobromine, or caffeine and may be contraindicated in peptic 
(leer. 

WARNINGS: All methylxanthines should be used with caution in children and in 
>thers who are currently taking bronchodilator products, especially in rectal 
losage form, which may contain theophylline or related drugs. 

JSAGE IN PREGNANCY: Although theophylline has been used for many 
fears, with no evidence of adverse fetal effect or teratogenicity, its safety in 
iregnancy has not been established. Therefore use of Bronkodyl during lacta- 
ion or in women of childbearing potential requires that possible benefits of the 
Irug be weighed against possible hazards to fetus or child. 

3 RECAUTIONS: Bronkodyl should be used with caution in patients with cardiac 
sr circulatory disease. 


ADVERSE REACTIONS: Gastrointestinal: Epigastric distress, nausea, vomit- 
ing. Cardiovascular: palpitations. CNS: Insomnia, restlessness, irritability, con- 
vulsion. 

DOSAGE AND ADMINISTRATION: Adults: Usual dosage of Bronkodyl is 200 
mg. every 6 hours (four doses in each 24 hours). This dosage may be adjusted 
to reflect individual clinical response as an indication of slow or rapid metab- 
olism of the drug. If adverse reactions are encountered, each dose may be 
reduced, or the interval between doses may be lengthened, or both. If clinical 
response is not satisfactory, indicating possible rapid inactivation of the drug, 
dosage may be gradually increased to achieve the desired response. In some 
instances of either too slow or too rapid metabolism, plasma levels of theo- 
phylline should be determined and dosage adjusted accordingly to achieve 
levels above 10 mcg/ml, but not to exceed 20 meg/ ml. 

Dosage in Children: Usual dosage should be based on administration of 10 mg 
per kg per 24 hours, divided in 4 doses per day, given every 6 hours. As this may 
not be possible with use of the capsules, Bronkodyl elixir may be used. Theo- 
phylline saliva levels (approximately 60% of simultaneous blood levels), may 
facilitate dosage adjustments, especially in children, to obtain appropriate 
response. 

HOW SUPPLIED: „ 

Bronkodyl 100 mg., brown and white capsules in 100s, Code #1831. 

Bronkodyl 200 mg., green and white capsules in 100s, Code #1833. 

Bronkodyl Elixir, 80 mg. per 15 ml, in pints, Code #1835. 


BREON LABORATORIES INC. 

90 Park Avenue, New York, N Y 10016 





Wanted Movies of Ceremony, 
But Both Factions Are 

Aug, 2C wm 


WASHINGTON, March 10, 
1971— The Senate approved 


ITHPLEA TO TRANSLATi 
CHARTER INTO DEEDS 

illWHEDlPE 


"If we fail to use it,” he declared , ! ' v: "3 

to the solemn final meeting of the 
delegates, ‘we shall, betray all of 

those who have died in order that = -g ■ 

we might meet here in freedom and gg| feg I 

safety to create it.’ MMS ■ 

“If we seek to use it selfishly-for I 

the advantage of any one nation or BE SB ■ 

any small group of nations-we ■ ■ ■ ■ 

shall be ’equally guilty of that be- 
trayal.” atom KB 

Fervent Interpolation AMS S 

The President, speaking in the 

auditorium of the War Memorial flBBA &yg|j A 

Opera House, built in memory of |A— » IBS BKw^LJB 

sons of the Golden Gate city who AAM S3 AHfli 

gave their lives in the first World. : . . . 

War, in which he himself served, r ; & 

seemed to give unconscious expres- f v - ' 

sion to the solemn feeling of the 1 WASHINGTON, JanV 27, 

the signing of 

half a hope, half a prayer: ° A the peace agreement in 

; M 0b, what a great day this cah IParis today, and after re- 

jtSt b1?Se the pknars “iving a report from the 

the' .President accompanied the Secretary of the Army that 


President Hails ‘Great 


Social Security Bill Is Signer, 
Gives Pensions to Aged , Jo 


of Ratification 
at HisHome Without 
Women Witnesses. 


oosevelt Approves Message Intended to Benefit 30, 
Persons When States Adopt Cooperating Laws-H 
the Measure ‘Cornerstone’ of His Economic Prog 


MILITANTS VEXED AT PRIVACY. 


SENATE APPROVES 
18-YEAR OLDVOTE 
INALL ELECTIONS 


Amendment to Constitution 
is Sent to House, Where 
Passage is Expected 


WASHINGTON, Aug. 
The Social Security Bill, 
a broad program of unen 
insurance and old age 
and counted upon to be: 
20,000,000 persons, becai 
day when it was signed 
dent Roosevelt in the p 
those chiefly responsible 
ting it through •< ~ 

Mr. sevelt cal 
“the ec erstone 


PATIENT PACKAGE INSERTS: A 
CONCEPT WHOSE TIME HAS COME? 


The consumers right to know is an ir- 
reversible and desirable trend of the 
Seventies. It extends, and properly, to a 
patient’s right to know more about his 
or her prescription medications. One 
way, gaining favor, is through patient 
package inserts. Wisely-prepared and 
properly distributed when medically in- 
dicated, they could markedly improve 
patient knowledge and drug therapy- 
laudable goals by anyone’s standards. 

The PMA endorses these goals and 
will work with government, the health 
professions and consumers to achieve 
them. 

The Advanta ges 

The concept holds promise of benefits: 
better patient understanding of the 
product prescribed, better adherence 
to the treatment plan, and more aware- 
ness of possible side reactions. 

Every doctor has had patients 
who fail to finish antibiotic regimens 
because they feel better. Some patients 
assume that if one tranquilizer or 
analgesic is good, two may be twice as 
good. Still others fail to report dizzi- 
ness while on antihypertensive therapy 
—and so on. 

Problems like these might arise 
less often if the patient received writ- 
ten information in addition to verbal 
instructions. Some studies suggest 
that patients are more receptive to 
such materials, and they more often 
understand the verbal instructions and 
follow them, when inserts are used. 

The Disadvanta ges 

There are also some potential prob- 
lems. Obviously, the inserts must be 
clearly phrased, without extraneous or 
complex detail. How much information 


is enough? How can it be kept current? 
Should all patients receive the same 
information? Should inserts be in- 
cluded with all drugs? Should only 
potential problems be listed or are 
patients better off with a “fair balance” 
presentation that describes usefulness 
as well as drawbacks? 

These and similar questions 
require answers, since model inserts 
have yet to be properly developed and 
tested. Despite the need for these 
studies, the FDA is proceeding pre- 
maturely with inserts on selected 
products. We think the Congress is the 
only place where the matter can be 
given the proper legal status and 
direction, particularly since it repre- 
sents a conceptual change in the legal, 
medical and social framework of the 
nation’s prescription drug information 
system. 

The Solution 

The PMA believes that carefully- 
devised pilot studies of various kinds 
of inserts are needed. They should be 
developed and implemented with full 
participation by doctors, pharmacists, 
consumers, communications experts 
and the drug industry. Such studies 
will provide reliable pathways to 
follow, so that inserts will be useful 
aids to medical practice. 

And particularly we think that 
you should be closely involved in this 
debate and in these studies and deci- 
sions. Otherwise, people with less 
experience and qualifications may 
control the purposes, content and use 
of a tool with considerable promise for 
improved patient care. It could make a 
difference in your practice tomorrow, 
and more importantly, in the health 
of your patients. 


BMk 

THE PHARMACEUTICAL MANUFACTURERS ASSOCIATION 
1155 FIFTEENTH ST, N, W„ WASHINGTON, D C 20005 


for July , 1978 


57 


7 " -"n 




y _ v 



Illinois Medical Journal 


YOUR ADVERTISERS 


Our advertisers serve the Medical Profession and support your Journal. 
All advertisers are approved by your Journal Committee. It will help 
you and your society to mention your Journal when writing them. 

Space Representatives 

United Media Associates, Inc., 16 Bruce Park Avenue, Greenwich, Conn. 06830 


Pharmaceuticals 


55 

Breon Laboratories 

13-14 

Mead Johnson Laboratories 


Bronkodyl 


Colace 

Vasodilan 

10-11 

Bristol Laboratories 

3 

Roche Laboratories 


Tegopen 


Div. of Hoffman-LaRoche 




Librium 

Cover 2 

Burroughs Wellcome Company 




Empirin Compound with Codeine 

Covers 3&4 

Roche Laboratories 
Div. of Hoffman-LaRoche 

19-20 

Geigy Pharmaceuticals 


Valium 


Div. of Ciba-Geigy Corp. 

Tofranil — P.M. 

17 

Upjohn Pharmaceuticals 

Tolinase 

24 

Eli Lilly and Company 

5 

Warren Teed Laboratories 


Darvon 


Kaon 

Insurance 



45 

Medical Protective Co. 

21 

Parker Aleshire and Co. 


Professional Liability Ins. 


Group Insurance 

Services and Continuing Education 


9 

Bio Science Laboratories 

42-43 

ISMS Guide to Continuing 


Laboratory Service 


Medical Education 

7-8 

Blue Cross and Blue Shield 

18 

Jobst Laboratories 


Report 


Measuring VPGs 



46 

Mann Levine & Weiss 

31 

Blue Cross and Blue Shield 


Pension Consultants 


Assistant Medical Director Wanted 

56-57 

Pharmaceutical Manufacturers 

44-45 

Classified Advertising 


Association 



Patient Package Inserts 

41 

Cook County Graduate School 

28 

U.S. Army 


Continuing Medical Education 


Recruitment 


58 


Illiriois Medical Journal 


Before prescribing, please consult complete product infor- 
mation, a summary of which follows: 

The effectiveness of Valium (diazepam) in long-term use, that is, 
more than 4 months, has not been assessed by systematic clini- 
cal studies. The physician should periodically reassess the 
usefulness of the drug for the individual patient. 
Contraindications: Tablets in children under 6 months of age; 
known hypersensitivity; acute narrow angle glaucoma; may be 
used in patients with open angle glaucoma who are receiving 
appropriate therapy. 

Warnings: As with most CNS-acting drugs, caution against 
hazardous occupations requiring complete mental alertness 
(e g., operating machinery, driving). Withdrawal symptoms (simi- 
lar to those with barbiturates, alcohol) have occurred following 
abrupt discontinuance (convulsions, tremor, abdominal/muscle 
cramps, vomiting, sweating). Keep addiction-prone individuals 
(drug addicts or alcoholics) under careful surveillance because 
of predisposition to habituation/dependence. 

Usage in Pregnancy: Use of minor tranquilizers 
during first trimester should almost always be 
avoided because of increased risk of congeni- 
tal malformations, as suggested in several 
studies. Consider possibility of pregnancy 
when instituting therapy; advise patients to 
discuss therapy if they intend to or do become 
pregnant. 

ORAL Advise patients against simultaneous ingestion of alcohol 
and other CNS depressants. 

Not of value in treatment of psychotic patients; should not be 
employed in lieu of appropriate treatment. When using oral form 
adjunctively in convulsive disorders, possibility of increase in fre- 
quency and/or severity of grand mal seizures may require in- 
crease in dosage of standard anticonvulsant medication; abrupt 
withdrawal in such cases may be associated with temporary in- 
crease in frequency and/or severity of seizures. 

INJECTABLE: To reduce the possibility of venous thrombosis, 
phlebitis, local irritation, swelling, and, rarely, vascular impair- 
ment when used I.V.: inject slowly, taking at least one minute for 
each 5 mg (1 ml) given: do not use small veins, i.e., dorsum of 
hand or wrist , use extreme care to avoid intra-arterial administra- 
tion or extravasation. Do not mix or dilute Valium with other solu- 
tions or drugs in syringe or infusion flask. If it is not feasible to 
administer Valium directly I.V., it may be injected slowly through 
the infusion tubing as close as possible to the vein insertion 
Administer with extreme care to elderly, very ill, those with limited 
pulmonary reserve because of possibility of apnea and/or car- 
diac arrest, concomitant use of barbiturates, alcohol or other 
CNS depressants increases depression with increased risk of 
apnea; have resuscitative facilities available. When used with 
narcotic analgesic eliminate or reduce narcotic dosage at least 
1/3, administer in small increments. Should not be administered 
to patients in shock, coma, acute alcoholic intoxication with de- 
pression of vital signs. 

Has precipitated tonic status epilepticus in patients treated for 
petit mal status or petit mal variant status. 

Withdrawal symptoms (similar to those with barbiturates, alcohol) 
have occurred following abrupt discontinuance (convulsions, 
tremor, abdominal/muscle cramps, vomiting, sweating). Keep 
addiction-prone individuals under careful surveillance because of 
predisposition to habituation/dependence. Not recommended for 
OB use. 

Efficacy/safety not established in neonates (age 30 days or less); 
prolonged CNS depression observed. In children, give slowly (up 
to 0.25 mg/kg over 3 minutes) to avoid apnea or prolonged 
somnolence; can be repeated after 15 to 30 minutes. If no relief 
after third administration, appropriate adjunctive therapy is rec- 
ommended. 

Precautions: If combined with other psychotropics or anticon- 
vulsants, carefully consider individual pharmacologic effects — 
particularly with known compounds which may potentiate action 
of Valium (diazepam), i.e., phenothiazines, narcotics, barbi- 
turates, MAO inhibitors and antidepressants. Protective measures 
indicated in highly anxious patients with accompanying depres- 
sion who may have suicidal tendencies. Observe usual precau- 
tions in impaired hepatic function; avoid accumulation in patients 
with compromised kidney function. Limit oral dosage to smallest 
effective amount in elderly and debilitated to preclude ataxia or 


oversedation (initially 2 to 2’/2 mg once or twice daily, increasing 
gradually as needed or tolerated). 

INJECTABLE: Although promptly controlled, seizures may return; 
readminister if necessary; not recommended for long-term main- 
tenance therapy. Laryngospasm/increased cough reflex are 
possible during peroral endoscopic procedures; use topical 
anesthetic, have necessary countermeasures available. 
Hypotension or muscular weakness possible, particularly when 
used with narcotics, barbiturates or alcohol. Use lower doses 
(2 to 5 mg) for elderly/debilitated. 

Adverse Reactions: Side effects most commonly reported were, 
drowsiness, fatigue, ataxia. Infrequently encountered were con- 
fusion, constipation, depression, diplopia, dysarthria, headache, 
hypotension, incontinence, jaundice, changes in libido, nausea, 
changes in salivation, skin rash, slurred speech, tremor, urinary 
retention, vertigo, blurred vision. Paradoxical reactions such as 
acute hyperexcited states, anxiety, hallucinations, increased 
muscle spasticity, insomnia, rage, sleep disturbances and stimu- 
lation have been reported; should these occur, discontinue drug. 
Because of isolated reports of neutropenia and jaundice, 
periodic blood counts, liver function tests advisable during long- 
term therapy. Minor changes in EEG patterns, usually low-voltage 
fast activity, have been observed in patients during and after 
Valium (diazepam) therapy and are of no known significance. 
INJECTABLE Venous thrombosis/phlebitis at injection site, hypoac- 
tivity, syncope, bradycardia, cardiovascular collapse, nystagmus, 
urticaria, hiccups, neutropenia. 

In peroral endoscopic procedures, coughing, depressed respira- 
tion, dyspnea, hyperventilation, laryngospasm/pain in throat or 
chest have been reported. 

Management of Overdosage: Manifestations include somno- 
lence, confusion, coma, diminished reflexes. Monitor respiration, 
pulse, blood pressure; employ general supportive measures, I.V. 
fluids, adequate airway. Use levarterenol or metaraminol for 
hypotension, caffeine and sodium benzoate for CNS-depressive 
effects. Dialysis is of limited value. 

Supplied: Tablets, 2 mg, 5 mg and 10 mg, bottles of 100 and 
500; Tel-E-Dose® (unit dose) packages of 100, available in trays 
of 4 reverse-numbered boxes of 25, and in boxes containing 
10 strips of 10; Prescription Paks of 50, available singly and in 
trays of 10. Ampuls, 2 ml, boxes of 10; Vials, 10 ml, boxes of 1; 
Tel-E-Ject® (disposable syringes), 2 ml, boxes of 10. Each ml 
contains 5 mg diazepam, compounded with 40% propylene 
glycol, 10% ethyl alcohol, 5% sodium benzoate and benzoic acid 
as buffers, and 1.5% benzyl alcohol as preservative. 


Roche Laboratories 

Division of Hoffmann-La Roche Inc. 

Nutley, New Jersey 07110 




2-MG, 5-MG, 
10-MG SCORED 
TABLETS 
TEL-E-DOSE® 
REVERSE- 
NUMBER PACKS 
2-ML TEL-E-JECT® 
DISPOSABLE 
SYRINGES 
2-ML AMPULS 
10-ML VIALS 


ONLY \ALIUM (diazepam) 

GIVES YOU “THIS CHOICE OF DOSAGE 
FORMS AND FLEXIBILITY 



PSYCHOTHERAPEUTIC 

SKELETAL MUSCLE 
RELAXANTT 


ONLY 


to 


HAS THESE TWO 
DISTINCT EFFECTS 


Please see preceding page for a summary of product information. / ROCHE 



% Illinois 
J . Medical 

ca 

1 Journal 

J OFFICIAL JOURNAL OF THE 

ILLINOIS STATE MEDICAL SOCIETY Volume 154, No. 2, August, 1978 



nmune complexes 
nd human disease 
(part one of a 
three-part 
comprehensive 
rerview): Seminars 
immunopathology 
and oncology 



Computerized whole 
body tomography: 
Surgical 
grand rounds 



The university 
medical school 
reaching to the 
community physician: 
Academic and 
community physicians 
form a beneficial 
alliance 


President's page ... 105 
Table of contents ... 59 


J 


r 






J L 



Neosporh 
Ointment 

(Polymyxin B-Bacitracin-Neomycii 


Neomycin 

Staphylococcus 

Haemophilus 

Klebsiella 

Aerobacter 

Escherichia 

Proteus 

Corynebacterium 

Streptococcus 

Pneumococcus 



This potent broad-spectrum antibacterial 
provides overlapping action to help combat 
infection caused by common susceptible pathoge 
(including staph and strep). The petrolatum bas 
is gently occlusive, protective and 
enhances spreading. 


Staphylococcus 

Corynebacterium 

Streptococcus 

Pneumococcus 


Pseudomonas 

Haemophilus 

Klebsiella 

Aerobacter 

Escherichia 



Wellcome 


Burroughs Wellcome < 

Research Triangle Par 1 
North Carolina 27709 


In vitro overlapping antibacterial action of 
Neosporin® Ointment (polymyxin B-badtracin-neomycin). 


Neosporin 

Ointment 

(Polymyxin B- Bacitracin-Neomycin) 


Each gram contains: Aerosporin® brand Polymyxin B 
Sulfate 5,000 units; zinc bacitracin 400 units; neomycin 
sulfate 5 mg (equivalent to 3.5 mg neomycin base); 
special white petrolatum qs; in tubes of 1 oz and 1/2 oz 
and 1/32 oz (approx.) foil packets. 

WARNING; Because of the potential hazard of nephro- 
toxicity and ototoxicity due to neomycin, care should be 
exercised when using this product in treating extensive 
burns, trophic ulceration and other extensive conditions 
where absorption of neomycin is possible. In burns 
where more than 20 percent of the body surface is 


affected, especially if the patient has impaired renal 
function or is receiving other aminoglycoside anti- 
biotics concurrently, not more than one application a 
day is recommended. 

When using neomycin-containing products to control 
secondary infection in the chronic dermatoses, 
it should be borne in mind that the skin is 
more liable to become sensitized to many substances, 
including neomycin. The manifestation of sensitization to 
neomycin is usually a low grade reddening with swelling, 
dry scaling and itching; it may be manifest simply as 
failure to heal. During long-term use of neomycin- 
containing products, periodic examination for such 
signs is advisable and the patient should be told to 
discontinue the product if they are observed. These 
symptoms regress quickly on withdrawing the medica- 
tion. Neomycin-containing applications should be 
avoided for that patient thereafter. 


PRECAUTIONS: As with other antibacterial preparatio 
prolonged use may result in overgrowth of nonsus- 
ceptible organisms, including fungi. Appropriate meast 
should be taken if this occurs. 

ADVERSE REACTIONS; Neomycin is a not uncommon j 
cutaneous sensitizer. Articles in the current literature 
indicate an increase in the prevalence of persons 
allergic to neomycin. Ototoxicity and nephrotoxicity 
have been reported (see Warning section). 

Complete literature available on request from Profes- 
sional Services Dept. PML. 





Illinois Medical Journal 

AUGUST, 1978 Vol. 154, No. 2 CONTENTS 


Clinical Articles 

79 Carcinoma Arising In a Thyroglossal Duct Cyst 

By Phillip L. Cacioppo, M.D., and Mohin T. Samaraweera, M.D. 


Special Articles 

81 The University Medical School Reaching to the Community Physician 

By Richard L. Byyny, M.D., Linda K. Gunzburger, M.S., 

Chase P. Kimball, M.D., Mark Siegler, M.D., and Alvin R. Tarlov, M.D. 


Seminars in Immunopathology and Oncology 

Richard J. Ablin, Ph.D., Contributing Editor 

85 Immune Complexes and Human Disease 

By Brian S. Andrews, BSc(Med), and Ronald Penny, M.D. 


Surgical Grand Rounds 

90 Computerized Whole Body Tomography 

John M. Beal, M.D., Contributing Editor 


President’s Page 

105 The Illinois Voluntary Effort 

David S. Fox, M.D. 


(Contents continued on overleaf) 


for August, 1978 


59 



CONTENTS (continued) 





Features 


61 

Clinics for Crippled Children 

63 

EKG of the Month 

67 

Viewbox 

72 

New Pharmaceutical Specialties 

73 

Obituaries 

75 

Ask a Consultant 

95 

Housestaff News 

96 

Pulse of the ISMS Auxiliary 

98 

Guest Editorial 

103 

Doctor’s News 

108 

Illinois Society, American 
Association of Medical Assistants 

109 

Classified Advertising 

111 

ISMS Guide to Continuing Medical 
Education 

115 

Staff 

Physician Recruitment 


Managing Editor Richard A. Ott 

Assistant Editor Mariann M. Stephens 

Executive Administrator Roger N. White 


(Cover by Jane and C. R. Bushwaller) 

PUBLICATIONS COMMITTEE 

Herschel Browns, M.D., Chicago, Chairman 
Kenneth A. Hurst, M.D., Naperville 
Robert P. Johnson, M.D., Springfield 
Alfred J. Kiessel, M.D., Decatur 
Harold J. Lasky, M.D., Chicago 

Editorial Board 

J. William Roddick, Jr., M.D., Springfield, Chairman 
Eli L. Borkon, M.D., Carbondale 
Daniel R. Cunningham, M.D., Wilmette 
Raymond A. Dieter, Jr., M.D., Glen Ellyn 
James G. Ekeberg, M.D., Palatine 
Ediz Z. Ezdinli, M.D., Kenilworth 
Carl Neuhoff, M.D., Peoria 
Constantine S. Soter, M.D., Arlington Heights 
Donald D. VanFossan, M.D., Springfield 

Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Maternal Death Studies: 

Robert R. Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth Andrea Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 
Contributor in Immunopathology: Richard J. Ablin, Ph.D., Chicago 
Contributor in Rheumatology: L. F. Layfer, M.D., Chicago 


ILLINOIS STATE 
MEDICAL SOCIETY 

OFFICERS 

David S. Fox, M.D., President 
826 E. 61st St., Chicago 60637 
P. John Seward, M.D., President-Elect 
310 N. Wyman St., Rockford 61101 
Herschel Browns, M.D., 1st Vice-President 
4600 N. Ravenswood, Chicago 60640 
G. W. Giebelhausen, M.D., 2nd Vice-President 
1101 Main St., Peoria 61606 
Audley F. Connor, Jr., M.D., Secretary-Treasurer 
7531 S. Stony Island Ave., Chicago 60649 

HOUSE OF DELEGATES 

Cyril C. Wiggishoff, M.D., Speaker 
25 E. Washington, Chicago 60602 
Robert P. Johnson, M.D., Vice-Speaker 
108 Maple Grove, Springfield 62707 

TRUSTEES 

1st District: 1980, John J. Ring, M.D. 
511 Hawley, Mundelein 60060 
2nd District: 1980, Allan L. Goslin, M.D. 

712 N. Bloomington, Streator 61364 
3rd District: 1979, Alfred Clementi, M.D. 
675 W. Central Rd., Arlington Heights 60005 
3rd District: 1980, Raymond J. Des Rosiers, M.D. 

1044 N. Francisco, Chicago 60622 
3rd District: 1979, Robert T. Fox, M.D. 
2136 Robincrest, Glenview 60025 
3rd District, 1979, Jere Freidheim, M.D. 

3050 S. Wallace, Chicago 60616 
3rd District: 1981, Morris T. Friedell, M.D. 
7531 S. Stony Island Ave., Chicago 60649 
3rd District: 1981, Henrietta Herbolsheimer, M.D. 
5528 S. Hyde Park Blvd., Apt. 1202, Chicago 60637 
3rd District: 1981, Lawrence L. Hirsch, M.D. 

2434 Grace St., Chicago 60618 
3rd District: 1980, Harold J. Lasky, M.D. 
55 E. Washington, Chicago 60602 
3rd District: 1980, Richard N. Rovner, M.D. 

645 N. Michigan, Suite 920, Chicago 60611 
3rd District: 1980, Joseph C. Sherrick, M.D. 

303 E. Superior, Chicago 60611 
4th District: 1979, Fred Z. White, M.D. 

723 N. Second St., Chillicothe 61523 
5th District: 1979, P. F. Mahon, M.D. 
800 E. Carpenter, Springfield 62702 
6th District: 1981, Robert R. Hartman, M.D. 
1515 A. W. Walnut, Jacksonville 62650 
7th District: 1979, Alfred J. Kiessel, M.D. 

1 Powers Lane PL, Decatur 62522 
8th District: 1979, James Laidlaw, M.D. 
104 W. Clark, Champaign 61820 
9th District: 1981, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1981, Julian W. Buser, M.D. 
6600 W. Main St., Belleville 62223 
11th District: 1980, Kenneth A. Hurst, M.D. 

52 Bunting Lane, Naperville 60540 
12th District: 1980, Joseph Perez, M.D. 
5670 E. State St., Rockford 61108 
Trustee- At-Large: George T. Wilkins, M.D. 

3165 Myrtle, Granite City 62040 
Chairman of the Board: Robert R. Hartman, M.D. 

1515 A. W. Walnut, Jacksonville 62650 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of IMJ are listed in the Current Contents /Clinical Practice. 

Published by the Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603 (312-782-1654) 
Copyright, 1978. The Illinois State Medical Society. All material subject to this copyright may be photo- 
copied for the noncommercial purpose of scientific or educational advancement. 

Subscription $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. $10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada $8.50. U.S. Single current copies available at $1.00 ($1.10 by mail), back issues $1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 

The Illinois Medical Journal is published by the Illinois State Medical Society as an educational and 
professional informational magazine and distributed as a benefit of membership in the Illinois State Medical 
Society. Its intent is to keep members current in medical knowledge and is a part of a continuing medical 
education program. Socioeconomic matters, affecting as they do a changing pattern in the proper delivery of 
medical care, are considered an inherent element in medical education. 


Clinics for Crippled Children 

Thirty-six clinics for Illinois’ physically handicapped 
children have been scheduled for September by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will count twenty-five general clinics 
providing diagnostic orthopedic, pediatric, speech and 
hearing examination, along with medical, social and nurs- 
ing services. There will be nine special clinics for chil- 
dren with cardiac conditions and two for children with 
cerebral palsy. Any private physician may refer to or bring 
to a convenient clinic any child or children for whom he 
may want examination or consultative services. 

September 1 Division Cardiac— U. of I. at the Medical 
Center 

September 5 Park Ridge Cardiac— Lutheran General Hos- 


September 

September 

September 

September 


pital 

6 Hinsdale— Hinsdale Sanitarium 

7 Effingham— St. Anthony's Mem. Hosp. 


7 Sterling— Community General Hospital 
7 Lake County Cardiac— Victory Memorial 
Hospital 

September 8 Chicago Heights Cardiac— St. James Hosp. 
September 11 Peoria Cardiac— St. Francis Hospital 
September 12 Carrollton— Boyd Memorial Hospital 
September 12 Peoria— St. Francis Hospital 
September 12 E. St. Louis— Christian Welfare Hosp. 
September 13 Carmi— Carmi Township Hospital 
September 13 Rock Island Cerebral Palsy— Foundation for 
Crippled Children and Adults 
September 13 Champaign-Urbana— McKinley Hospital 
September 13 Joliet— St. Joseph's Hospital 
September 13 Chicago Heights General— St. James Hosp. 
September 14 Springfield— St. John’s Hospital 
September 15 Kankakee Cardiac— St. Mary’s Hospital 
September 18 Maywood— Loyola Medical Center 
September 19 Anna— Union County Hospital 
September 19 Rock Island— Moline Public Hospital 
September 19 Decatur— Decatur Memorial Hospital 
September 19 Belleville— St. Elizabeth's Hospital 
September 20 Centralia— St. Mary’s Hospital 
September 20 Springfield Ped-Neuro— St. John's Hosp. 
September 20 Evergreen Park— Little Company of Mary 
Hospital 

September 21 Rockford— Rockford Memorial Hospital 
September 21 Elmhurst Cardiac— Memorial Hospital of 
DuPage County 

September 22 Chicago Heights Cardiac— St. James Hos- 
pital 

September 25 Peoria Cardiac— St. Francis Hospital 
September 26 Peoria— St. Francis Hospital 
September 26 Alton— Alton Memorial Hospital 
September 27 Elgin— Sherman Hospital 
September 27 Chicago Heights Gen.— St. James Hospital 
September 28 West Frankfort— Union Hospital 
September 28 Macomb— McDonough District Hospital 
The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. In carrying on its program, 
the Division works cooperatively with local medical so- 
cieties, hospitals, the Illinois Children’s Hospital-School, 
civic and fraternal clubs, visiting nurse associations, local 
social and welfare agencies, local chapters of the National 
Foundation and other interested groups. In all cases, the 
work of the Division is intended to extend and supple- 
ment, not supplant, activities of other agencies, either 
public or private, state or local, carried on in behalf of 
crippled children. 


for August, 197 8 


Librax 

Each capsule contains 5 mg 
chlordiazepoxide HCI and 2.5 mg clidinium Br. 

Please consult complete prescribing information, a 
summary of which follows: 

Indications: Based on a review of this drug by the 
National Academy of Sciences — National Research 
Council and/or other information, FDA has classified 
the indications as follows: 

“Possibly" effective: as adjunctive therapy in the 
treatment of peptic ulcer and in the treatment of the 
irritable bowel syndrome (irritable colon, spastic 
colon, mucous colitis) and acute enterocolitis. 

Final classification of the less-than-effective indica- 
tions requires further investigation. 

Contraindications: Glaucoma; prostatic hypertrophy, be- 
nign bladder neck obstruction; hypersensitivity to chlor- 
diazepoxide HCI and/or clidinium Br 
Warnings: Caution patients about possible combined ef- 
fects with alcohol and other CNS depressants, and 
against hazardous occupations requiring complete mental 
alertness (e g., operating machinery, driving). Physical and 
psychological dependence rarely reported on recom- 
mended doses, but use caution in administering Librium® 
(chlordiazepoxide HCI) to known addiction-prone individu- 
als or those who might increase dosage; withdrawal symp- 
toms (including convulsions) reported following discon- 
tinuation of the drug. 

Usage in Pregnancy: Use of minor tranquilizers 
during first trimester should almost always be 
avoided because of increased risk of congenital 
malformations as suggested in several studies. 
Consider possibility of pregnancy when institut- 
ing therapy. Advise patients to discuss therapy if 
they intend to or do become pregnant. 

As with all anticholinergics, inhibition of lactation may occur 
Precautions: In elderly and debilitated, limit dosage to 
smallest effective amount to preclude ataxia, oversedation, 
confusion (no more than 2 capsules/day initially, increase 
gradually as needed and tolerated). Though generally not 
recommended, if combination therapy with other psycho- 
tropics seems indicated, carefully consider pharmacology 
of agents, particularly potentiating drugs such as MAO in- 
hibitors, phenothiazines. Observe usual precautions in 
presence of impaired renal or hepatic function. Paradoxi- 
cal reactions reported in psychiatric patients. Employ 
usual precautions in treating anxiety states with evidence 
of impending depression; suicidal tendencies may be 
present and protective measures necessary. Variable ef- 
fects on blood coagulation reported very rarely in patients 
receiving the drug and oral anticoagulants; causal rela- 
tionship not established. 

Adverse Reactions: No side effects or manifestations not 
seen with either compound alone reported with Librax, 
When chlordiazepoxide HCI is used alone, drowsiness, 
ataxia, confusion may occur, especially in elderly and de- 
bilitated; avoidable in most cases by proper dosage ad- 
justment, but also occasionally observed at lower dosage 
ranges. Syncope reported in a few instances. Also 
encountered: isolated instances of skin eruptions, edema, 
minor menstrual irregularities, nausea and constipation, 
extrapyramidal symptoms, increased and decreased 
libido — all infrequent, generally controlled with dosage re- 
duction; changes in EEG patterns may appear during and 
after treatment; blood dyscrasias (including agranulo- 
cytosis), jaundice, hepatic dysfunction reported occasion- 
ally with chlordiazepoxide HCI, making periodic blood 
counts and liver function tests advisable during protracted 
therapy. Adverse effects reported with Librax typical of 
anticholinergic agents, /.e. , dryness of mouth, blurring of 
vision, urinary hesitancy, constipation. Constipation has 
occurred most often when Librax therapy is combined 
with other spasmolytics and/or low residue diets. 



Roche Products Inc. 
Manati, Puerto Rico 00701 



In treating certain G.I. disorders 


Librax is unique among G.I. 

* IJk :r v. 


antisecretory and affispasmodic actions of 
QUARZA|JXclidiniuin Br; for adjunctive therapy 
of irritable bowel syndrome*and duodenal ulcer. 


Librax has been evaluated as possibly effective for this indication. 
Please see brief summary of prescribing information on preceding page 


r 






















■ ^ 


7 

x 



of tlie iTiontli 



t 

V 

S 









John F. Moran. M.S.. M.D.. David L. Fishman. M.D., 


Thi 

s pa 

tien 

is 

a 67 

Patrick J. Scanlon, M.D., Sarah A. Johnson, M.D., 
John R. Tobin, M.S., M.D., and Rolf M. Gunnar, M.S., M.D. 
Section of Cardiology, Department of Medicine, 

Loyola University Stritch School of Medicine 

-year-old man who was in good health until he sustained 


an acute inferior xcall myocardial infarction. He made an uneventful recovery 
from this myocardial infarction. However , during the subsequent twelve months, 
he teas hospitalized four times for palpitations arid mild congestive heart failure. 
His complaints xoere palpitations, fatigue and some dyspnea. Each time his 
physical examination xvas significaxxt for a normal blood pressure, a tachycardia 
of 140 beats per minute, a gallop rhythm and bibasilar rales on pulmonary 
examination. The simultaneous V 1 -2-V 5 rhythm strip electrocardiogram shown 
occurred on his most recent admission. Physical examination was the same as on 
earlier hospitalizations. His blood pressure was 136/86 and the tachycardia was 
136 beats per minute. Cardiac catheterization was considered on this admission. 



Questions: 

1. The ECG shows: 

A. Atrial fibrillation with complete left 
bundle branch block. 

B. Complete atrioventricular dissociation. 

C. Ventricular tachycardia. 

D. Atrial tachycardia with the Wolf-Park- 
inson-White syndrome. 

E. Fasicular ventricular tachycardia. 

2. Which of the following treatments have 


been used for recurrent ventricular tachy- 
cardia? 

A. Direct current cardioversion. 

B. Intravenous lidocaine 
Procainamide 
Quinidine 

C. Beta adrenergic blockade (Propranolol) 
Diphenylhydantoin (Dilantin) , Disopy- 
ramide (Norpace) 

D. Aritificial pacemakers, epicardial map- 
ping open heart surgery. 

E. All of the above. 

(Continued on page 107) 


for August, 1978 


63 




The first 20 days 

• Catapres lowers blood pressure promptly. 

• No contraindications. 

• Some patients may have dry mouth, drowsiness, 
and sedation. Tell them that these tend to diminish 
with continued use. 

• Giving the larger part of the divided dose at 
bedtime can help alleviate drowsiness and sed 

The next 20 years 

• Lowered blood pressure. 

• Little impotence, depression or postural hypote 

• No fatal hepatotoxicity in over a decade o 
worldwide use. 

• Broad therapeutic dosage range to ke 
changing dosage needs over the yea 

* Tolerance may develop in some patients, m 
necessitating a reevaluation of therapy, jf 

* ' 

For full details on adverse reactions, warnings, and 
precautions, see brief summary of the prescribing 
information on last page of this advertisement. 

■ : T. > jK29r ■ 




Oyazide 


capsule contains 50 mg. of Dyrenium - (brand of 
erene) and 25 mg. of hydrochlorothiazide. 


takes Sense in 

lypertension 


Before prescribing, see complete prescribing informa- 
tion in SK&F Co. literature or PDR. A brief summary 
follows: 


Warning 

This drug is not indicated for initial therapy of edema 
or hypertension Edema or hypertension requires 
therapy titrated to the individual. If this combination 
represents the dosage so determined, its use may 
be more convenient in patient management Treat- 
ment of hypertension and edema is not static, but 
must be reevaluated as conditions in each patient 
warrant 


Contraindications: Further use in anuria, progressive 
renal or hepatic dysfunction, hyperkalemia Pre-existing 
elevated serum potassium. Hypersensitivity to either 
component or other sulfonamide-derived drugs 
Warnings: Do not use potassium supplements, dietary 
or otherwise, unless hypokalemia develops or dietary 
intake of potassium is markedly impaired. If supple- 
mentary potassium is needed, potassium tablets should 
not be used Hyperkalemia can occur, and has been 
associated with cardiac irregularities. It is more likely in 
the severely ill, with urine volume lessthan one liter/day, 
the elderly and diabetics with suspected or confirmed 
renal insufficiency. Periodically, serum K+ levels should 
be determined. If hyperkalemia develops, substitute a 
thiazide alone, restrict K+ intake Associated widened 
QRS complex or arrhythmia requires prompt additional 
therapy. Thiazides cross the placental barrier and appear 
in cord blood Use in pregnancy requires weighing 
anticipated benefits against possible hazards, including 
fetal or neonatal jaundice, thrombocytopenia, other 
adverse reactions seen in adults. Thiazides appear and 
triamterene may appear in breast milk. If their use is 
essential, the patient should stop nursing. Adequate 
information on use in children is not available 


Precautions: Do periodic serum electrolyte determina- 
tions (particularly important in patients vomiting exces- 
sively or receiving parenteral fluids) Periodic BUN and 
serum creatinine determinations should be made, 
especially in the elderly, diabetics or those with sus- 
pected or confirmed renal insufficiency. Watch for signs 
of impending coma in severe liver disease. If spiro- 
nolactone is used concomitantly, determine serum K+ 
frequently; both can cause K + retention and elevated 
serum K+ Two deaths have been reported with such 
concomitant therapy (in one. recommended dosage was 
exceeded, in the other serum electrolytes were not 
properly monitored). Observe regularly for possible 
blood dyscrasias. liver damage, other idiosyncratic 
reactions Blood dyscrasias have been reported in 
patients receiving triamterene, and leukopenia, throm- 
bocytopenia, agranulocytosis, and aplastic anemia have 
been reported with thiazides. Triamterene is a weak folic 
acid antagonist. Do periodic blood studies in cirrhotics 
with splenomegaly. Antihypertensive effect may be 
enhanced in post-sympathectomy patients. Use cau- 
tiously in surgical patients. The following may occur: 
transient elevated BUN or creatinine or both, hyper- 
glycemia and glycosuria (diabetic insulin requirements 
may be altered), hyperuricemia and gout, digitalis 
intoxication (in hypokalemia), decreasing alkali reserve 
with possible metabolic acidosis Dyazide' interferes 
with fluorescent measurement of quinidine 
Adverse Reactions: Muscle cramps, weakness, dizzi- 
ness, headache, dry mouth, anaphylaxis, rash, urticaria, 
photosensitivity, purpura, other dermatological condi- 
tions; nausea and vomiting, diarrhea, constipation, other 
gastrointestinal disturbances Necrotizing vasculitis, 
paresthesias, icterus, pancreatitis, xanthopsia and, rarely, 
allergic pneumonitis have occurred with thiazides alone. 
Supplied: Bottles of 100 and 1000 capsules; Single Unit 
Packages of 100 (intended for institutional use only). 


SK&F CO. 

a SmithKIine company 


Carolina, P R. 00630 



Blue Cross® 
Blue Shield® 



FOR 



Announcement on PAT Program and Ambulatory Surgery 


An announcement urging the development or 
further implementation of two cost-effective benefit 
programs — Pre-Admission Testing for surgical pa- 
tients (PAT) and Ambulatory Surgery when pro- 
cedures are appropriate — has been mailed to hospi- 
tal Administrators and Chiefs of Staff by the Illinois 
Blue Cross and Blue Shield Plan. 

Over the co-signatures of Plan officers Richard C. 
Shaw, M.D., Vice President and Medical Director, 
and Mr. Robert S. Petersen, Senior Vice President, 
Provider Affairs, the announcement states: 

“Two benefits pioneered by hospitals and their 
medical staffs and Blue Cross and Blue Shield are 
receiving increased attention as examples of pro- 
grams that can ensure quality care while being cost 
effective. These programs are Pre-Admission Test- 
ing for surgical patients and Ambulatory Surgery. 

“Many hospitals have such programs; unfortu- 
nately, not all; and those that are available are 
often not used as frequently as they could be. 

“We urge you and your colleagues to take a new 
look at these programs; develop them if they do 
not now exist in your hospital; and see if there 
aren’t opportunities to increase their utilization, if 
they do exist. 

Supplement to Medical Assistants' 
Handbook to Be Distributed 

The Supplement to the Second Edition of Blue 
Shield’s Medical Assistants’ Handbook has been 
completed and single copies will be mailed to phy- 
sicians’ offices by the Illinois Blue Cross and Blue 
Shield Plan. Mailing is expected to be completed 
by August 31. 

The Supplement was prepared by the Profession- 
al Relations Department of the Plan to serve as an 
interim guide for medical assistants until the Third 
Edition of the Handbook is published. 

It contains new information on several Blue 
Shield topics, and revises certain information in the 
Medical Assistants’ Handbook, Second Edition, 
which was distributed to medical assistants in Tune, 
1976. 

The new 50-page publication reviews instruc- 
tions on the proper completion of service reports, 
with special attention given to the new Blue Shield 


“We at Blue Cross-Blue Shield will also be look- 
ing at the programs by monitoring utilization to 
identify services which could have been appropri- 
ately carried out in Ambulatory Surgical settings 
or on a Pre-Admission Testing basis. We will re- 
view claims with you, when our monitoring indi- 
cates cases in which there may have been poten- 
tial savings by utilizing one of these programs,” the 
announcement emphasized. 

As guidelines for the two programs, the an- 
nouncement stated that the Medical Department 
has prepared a list of surgical procedures which 
often can be performed on an Ambulatory basis, 
and a similar list of elective surgical procedures for 
which Pre-Admission Testing is usually appropri- 
ate. Copies of the lists were enclosed with the an- 
nouncement. 

The announcement concluded with the statement 
that further information and assistance on estab- 
lishing programs or expanding their utilization will 
be available by contacting either the Medical or 
Provider Affairs Department, Blue Cross and Blue 
Shield, 233 North Michigan Ave., Chicago, Illinois 
60601. 


Physician’s Service Report and Radiology Service 
Report forms. It also includes changes in reporting 
anesthesia services; certain changes in coverages 
for special groups; information on contacting our 
Professional Relations Representatives; Outpatient 
Emergency Care; and a new Directory of Blue 
Shield Plans. 

An entire section of the Supplement illustrates 
the proper completion of service reports for a num- 
ber of specific procedures including: surgery, ser- 
vices of a surgical assistant, fracture care, medical 
care, consultation, anesthesia, diagnostic X-ray, 
radiation therapy, psychiatric care, laboratory ser- 
vices and intensive medical care. 

Explanations are given on special coverages in- 
cluding Supplemental Major Medical and Compre- 
hensive Major Medical. 

Changes in benefits for certain special groups are 
summarized, including: the Illinois Health Im- 
provement Association; Bell Telephone; the Motor 
Groups; Federal Employees Program, United Mine 
Workers of America and State of Illinois Employees. 


(This report is a service to the physicians of Illinois) 





ASK BLUE SHIELD . . . ABOUT MEDICARE 


Medicare Home Health Coverage 

Medicare covers certain services rendered to 
homebound patients by Medicare-certified Home' 
Health Agencies when the services are ordered by 
the physician. Medicare provides for up to 100 
visits per benefit period under Part A, and up to 
100 visits per calendar year under Part B, when the 
services being rendered meet home health coverage 
criteria. 

The services which would qualify for coverage 
are intermittent skilled nursing care, skilled phys- 
ical therapy, and skilled speech therapy. In addition, 
when any of these three services are being ren- 
dered, Medicare may also cover occupational ther- 
apy, services of home health aides, medical social 
services, and medical supplies and equipment. 

Conditions to be Met 

Even though a person is entitled to Medicare, 
there are several conditions that must be met be- 
fore home health services are covered. These are: 

1. The patient must be confined to his/her home; 

2. The services must be medically reasonable 
and necessary for the treatment of an illness 
or injury; 

3. There must be a need for at least one skilled 
service; and, 

4. The services must be rendered on an inter- 
mittent basis — as least once every sixty (60) 
days. 

Part A Hospital Insurance will pay 100% of any 
and all home health care services, including medical 
supplies and the rental of equipment, providing a 
patient meets the three day prior qualifying hospi- 
tal stay requirement, and the attending physician 
puts the orders and plan of treatment in writing 
within 14 days of discharge from the hospital. 

Part B Medical Insurance will pay 100% of any 
and all services, including medical supplies and the 
rental of equipment, after the patient has met the 
current Part B deductible amount and providing 
the attending physician has the plan of treatment 
in writing prior to the Agency’s submission of the 
initial Medicare claim. 

Future articles will provide further details on cov- 
ered home health care. 

Changes in Participation and 
Certification of Laboratory Procedures 

Notices were received from the Medicare Bureau 
of the following changes in participation and cer- 
tification of procedures of laboratories in the Medi- 
care program: 


Relocation: 

Rhodes Medical Laboratory, Inc. (Provider Num- 
ber 14-8344) is now located at 1420 North Mil- 
waukee Ave., Chicago, Illinois 60622. 

Changes in Approved Specialties or Subspecialties: 

LaSalle Scientific Medical Laboratory, 914 West 
Diversey Parkway, Chicago, Illinois 60614 (Provid- 
er Number 14-8307) is no longer approved to per- 
form Procedure 710-EKG Services, effective August 
1, 1978. The laboratory is still approved to perform 
Procedures 110-Bacteriology; 200-Serology; 130- 
Parasitology; 300-Chemistry; 400-Hematology; 510- 
Blood Group and Rh and 520-Rh Titers; 610-Tissue 
and 630-Diagnostic Cytology. 

Cicero Lake Laboratories, Inc., 4801 West Lake 
Street, Chicago, Illinois 60644 (Provider Number 
14-8302) is no longer approved to perform Proce- 
dure 710-EKG Services, effective August 1, 1978. 
The laboratory is approved to perform Procedures 
110-Bacteriology; 200-Serology; 310- Routine Chem- 
istry; 320-Clinical Microscopy; 400-Hematology; 
510-Blood Group and Rh; 630-Diagnostic Cytology. 

Alpha Medical Laboratories, Inc., 7110 West 
127th Street, Palos Heights, Illinois (Provider Num- 
ber 14-8222) is no longer approved to perform Pro- 
cedure 630-Diagnostic Cytology, effective August 1, 
1978. The laboratory is approved to perform Pro- 
cedures 100-Bacteriology; 200-Serology; 400-Hema- 
tology; 310-Routine Chemistry; 320-Clinical Micro- 
scopy; 710-EKG Services. 

Kendon Medical Laboratory, Inc., 8625 South 
Cicero Ave., Chicago, Illinois 60652 (Provider Num- 
ber 14-8052) is no longer approved to perform Pro- 
cedure 330-Chemistry Other, effective August 1, 
1978. The laboratory is approved to perform Proce- 
dures 110-Bacteriology; 300-Chemistry Routine; 
200-Serology; 320-Clinical Microscopy; 400-Hema- 
tology; 710-EKG Services. 

Avenue Medical Laboratory, 16234 St. Louis Ave., 
Chicago, Illinois 60743 (Provider Number 14-8050) 
is no longer approved to perform Procedure 120- 
Mycology, effective August 1, 1978. The laboratory 
is approved to perform Procedures 110-Bacteriol- 
ogy; 130-Parasitology; 200-Serology; 300-Chemistry; 
400-Hematology; 510-Blood Group and Rh; 710- 
EKG Services. 

Northbrook Community Laboratories, Inc., 1775 
Walters Ave., Northbrook, Illinois 60002 (Provider 
Number 14-8023) is no longer approved to perform 
Procedure 330-Chemistry-Other, effective August 1, 
1978. The laboratory is approved to perform Proce- 
dures 110-Bacteriology; 130-Parasitology; 200-Serol- 
ogy; 400-Hematology; 710-EKG Services. 


(This report is a service to the physicians oj Illinois) 



Only Jobst supports are custom made from 
precise measurements of the individual 
extremity. 


ass 


Jobst 9 

Venous Pressure Gradient Supports 

These measured, custom-made therapeutic elastic supports have carried the 
Jobst name to the four corners of the world. Prescription only, the supports 
can be engineered with counterpressures of 25, 30, 40 or 50 mm, Hg at the 
ankle, decreasing proximally along the venous pressure gradient. They are 
available in knee-length, full-leg, waist-height and lymphedema sleeve styles. 
The waist-height Jobst Pregnancy Leotard deserves special mention because 
each one is custom made with an expandable panel according to the patient's 
own measurements. 


Contact your local Jobst Service Center for complete details. 

^|® JOBST CHICAGO SERVICE CENTER 


Chicago, Illinois 60602 

Suite 2101, Pittsfield Bldg. 
55 E. Washington Street 
31 2/346-0446 


for August, 1978 


71 



For detailed information regarding indications, dosage, 
contraindications and adverse reactions, refer to the 
manufacturer’s package insert or brochure. 

New Single Drugs— Drugs not previously known, includ- 
ing new salts. 

Duplicate Single Drugs— Drugs marketed by more than 
one manufacturer. 

Combination Products— Drugs consisting of two or more 
active ingredients. 

New Dosage Forms— Of a previously introduced product. 

The following new drugs have been marketed: 


COMBINATION PRODUCTS 


ROBITUSSIN-DAC 

Manufacturer: 

Composition: 


Indications: 

Dosage: 

Supplied: 


A. H. Robins Company 
5 ml contains 

Guaifenesin 100 mg 

Pseudoephedrine HC1 30 mg 
Codeine Phosphate 10 mg 
Alcohol 1.4% 

Nasal congestion and cough 
One or two teaspoonful qid 
Bottle, pint 


ANDRESTRAC 2-10 

Manufacturer: 

Composition: 


Indications: 

Dosage: 

Supplied: 


Androgen/Estrogen Comb. Rx 
The Central Pharmacal Co. 


Each ml 

Testosterone 10 mg 

Estrone 2 mg 

Sod. Carboxymetyl- 

cellulose 2 mg 

Methylcellulose 0.2 mg 

Providone 0.2 mg 

Dioctyl sod. 

sulfosuccinate 0.15 mg 


Postpartum breast engorgement 
im, cyclic administration 
Multiple dose vial, 10 ml 


SK-65 APAP 

Manufacturer: 

Composition: 

Indications: 

Dosage: 

Supplied: 


Non-narcotic analgesic Rx 
Smith Kline & French 
Laboratories 

Propoxyphene HC1 65 mg 

Acetaminophen 650 mg 

Relief of mild to moderate pain 
One tablet every four hours 
Tablets 


DEMI-REGROTON 

Manufacturer: 

Composition: 

Indications: 

Contraindication: 

Dosage: 

Supplied: 

MOBIGESIC 

Manufacturer: 

Composition: 


Indications: 

Dosage: 

Supplied: 


Hypotensive Rx 
USV Laboratories 
Chlorthalidone 25 mg 

Reserpine 0.125 mg 

Hypertension 

Mental depression, severe renal 

and hepatic diseases 

Titrate individually, usual dose 

1 tablet daily 

Tablets 

Analgesic o.t.c. 
B. F. Ascher & Co., Inc. 
Magnesium salycylate 300 mg 
Phenyltoloxamine 
citrate 30 mg 

Pain associated with various con- 
ditions 

Depending on painful condition 
Tablets 


SK-APAP With Codeine 

Manufacturer: 

Composition: 

Indication: 

Dosage: 

Supplied: 


Narcotic Analgesic Rx 
Smith Kline & French 
Laboratories 

Acetaminophen 325 mg 

Codeine 15, 30 and 60 mg 
Mild to moderate pain 
Adjust to severity of pain 
Usual dose 1 to 2 tablets every 
four hours 
Tablets 


TRIAMINICIN 

ALLERGY 

Manufacturer: 

Composition: 


Indications: 

Dosage: 

Supplied: 


Antihistamine Cold Prep, o.t.c. 

Dorsey Laboratories 
Phenylpropanolamine 
HC1 37.5 mg 

Chlorpheniramine 

maleate 4.0 mg 

Temporary relief of nasal de- 
congestion caused by allergy 
Depending on patient’s response 
Tablets 


NEW DOSAGE FORMS 


ORNADE 2 

Manufacturer: 

Composition: 

Indications: 

Dosage: 


Supplied: 


Nasal Decongestant o.t.c 
Smith Kline & French 
Laboratories 

Phenylpropanolamine HC1 
Chlorpheniramine maleate 
Relief of common cold 
Children: 1 teaspoonful q.i.d. 

for ages 6 to 12 
1/2 teaspoonful q.i.d. 
for ages 2 to 6 

Adidts: 2 teaspoonfuls q.i.d. 

Bottles, 4 oz 


72 


Illinois Medical Journal 


Obituaries 


“ “Abrahams, Samuel, Chicago, died June 16, at the age 
of 80. He was a 1923 graduate of the University of 
Illinois and has held a position on the medical staff of 
Northwestern Memorial Hospital for many years. Dr. 
Abrahams was a co-founder of the Multiple Sclerosis 
Foundation of Chicago. 

“Brown, Amos Jerome, Chicago, died July 7, at the age 
of 57. He was a 1943 graduate of Northwestern Uni- 
versity. Dr. Brown was the associate general medical 
director for the Western Electric Company and Michael 
Reese Medical Center as well as a member of several 
ISMS committees. He also served as chairman of the 
American Occupational Medical Assn. Committee on 
Alcohol and Drug Abuse. 

“Green, R. Gregory, Rockford, died July 11, at the age 
of 64. He was a 1942 graduate of St. Louis LTniversity. 
Dr. Green was a past president of the Winnebago Coun- 
ty Medical Society and of the Central States Industrial 
Medical Society. 

““Greenburg, Ira E., Florida, died June 9, at the age of 
91. A 1910 graduate of Northwestern University, Dr. 
Greenburg had been a former secretary of the Engle- 
wood Hospital staff. 

Littner, Michael M., Chicago, died June 30, 1978. 

Moran, Clement J., Elmhurst, died April 25, at the age 
of 77. Dr. Moran was a staff physician and surgeon for 
20 years at Hines VA Hospital. 

““Pickett, William J., Chicago, died April 22, at the age 
of 85. Dr. Pickett was a 1916 graduate and staff physi- 
cian at Loyola University Medical School. He was also 
affiliated with Cook County Hospital where he taught 
surgery and held a staff position. 

Plank, Joseph Raymond, Marion, died May 2, at the 
age of 73. 

“Schlicksup, Edward P., Peoria, died July 3, at the age 
of 59. He was a 1946 graduate of the Stritch School of 
Medicine. Dr. Schlicksup was chief of urology at St. 
Francis Hospital. 

““Schmitz, Henry L., Florida, died June 27, at the age 
of 80. He was a 1926 graduate of Harvard Medical 
School. Before his retirement Dr. Schmitz was affiliated 
with Mercy Hospital and served as professor of medi- 
cine at Loyola University. He was also a fellow of the 
American College of Physicians. 

Schwartz, Martin L., California, died July 6, at the age 
of 68. He was a graduate and later a trustee of the 
Chicago Medical School. Dr. Schwartz was a member of 
the staff at Michael Reese Hospital and director of the 
Abraham Levenson Foundation for mentally retarded 
children. 

“Shay, Sujint S., Peoria, died June 19, at the age of 39. 
Dr. Shay was a 1964 graduate of Chiengmai Medical 
School, Thailand. He was a clinical professor of medicine 
at the Peoria School of Medicine and assistant medical 
director for cardiac care at Methodist Hospital of Cen- 
tral Illinois. 


“Stearn, Anne M., Elgin, died July 1, at the age of 38. 
Dr. Stearn was a 1964 graduate of Cornell University. 

“Stearn, Burton, Elgin, died July 1, at the age of 43. He 
was a 1962 graduate of Northwestern University. 

Drs. Anne and Burton Stearn who, shared a career in 
medicine, both specialized in otolaryngology. The 
Stearns’ deaths resulted from a tragic airplane crash. 

““Stevenson, Edgar McLean, Bloomington, died July 8, 
at the age of 80. Dr. Stevenson was a 1923 University of 
Michigan graduate. During his career as a physician he 
received many awards, including the Spirit of McLean 
award and the Edgar Stevenson Hall at the Illinois 
Wesleyan University, which was dedicated in 1965. Dr. 
Stevenson was a former president of the McLean County 
Medical Society and a staff member at Brokaw Menonite 
and St. Joseph’s Hospital Medical Center. 

“Sokolowski, Joseph F., Chicago, died July 19, at the 
age of 76. He was a 1929 graduate of the Stritch School 
of Medicine. 

Vinci, Anthony J., Chicago, died April 19, at the age 
of 64. 

Winston, W. Maurice, Phoenix, died May 30, at the age 
of 80. Dr. Winston was a practicing physician in Chi- 
cago Heights and Harvey. 

* Indicates ISMS member. 

00 Indicates member of the ISMS Fifty Year Club. 


CHIEF 

PHYSICIAN 

Full time position with major South Chi- 
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niently to city or south suburban living. 

Complete in-plant facilities with nearby 
consultative and hospital services avail- 
able. 

In addition to attractive compensation, 
this position carries an excellent corporate 
benefits package. 

Please reply with curriculum vitae and/or 
professional history to Box 932, IMJ, 55 E. 
Monroe, Suite 3510, 60603. 

An Equal Opportunity Employer M/F 


for August , 1978 


73 


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WHEN YOU CAN’T RULE OUT STAPH, CONSIDER 


TEGOPEN 

(doxadllin sodium) 

“THE PENICILLIN OF TODAY” 


■ Effective against nonpenicillinase-producing staphylococci, 
beta-hemolytic streptococci, and pneumococci.t 

fNOTE: The choice of Tegopen should take into consideration the fact that it has been shown to be effective only in the treatment 
of infections caused by pneumococci. Group A beta-hemolytic streptococci, and penicillin G-resistant and penicillin G-sensitive 
staphylococci. If the bacteriology report later indicates that the infection is due to an organism other than a penicillin G-resistant 
staphylococcus sensitive to cloxacillin sodium, the physician is advised to continue therapy with a drug other than cloxacillin sodium 
or any other penicillinase-resistant semisynthetic penicillin. The clinical significance of in vitro data is unknown. 

■ 10 times more active against strep than staph. 

■ Well absorbed from the G.I. tract.J 

^Maximum absorption occurs when Tegopen is taken on an empty stomach, preferably 1-2 hrs. before meals. 



Please see brief summary 
for prescribing information. 




Brief Summary of Prescribing Information 
Combined TEGOPEN® Icloxacillin sodium) 

Capsules and Oral Solution 

For complete information, consult Official Package 
Circular, ( 12) TEGOPEN 9/1 1/75 

Indications: Although the principal indication for cloxa- 
cillin sodium is in the treatment of infections due to 
penicillinase-producing staphylococci, it may be used to 
initiate therapy in such patients in whom a staphylococcal 
infection is suspected. (See Important Note below.) 

Bacteriologic studies to determine the causative organ- 
isms and their sensitivity to cloxacillin sodium should be 
performed. 

important Note: When it is judged necessary that treat- 
ment be initialed before definitive culture and sensitivity 
results are known, the choice of cloxacillin sodium should 
take into consideration the fact that it has been shown to 
be effective only in the treatment of infections caused by 
pneumococci. Group A beta-hemolytic streptococci, and 
penicillin G-resistant and penicillin G-sensitive staphy- 
lococci. If the bacteriology report later indicates the 
infection is due to an organism other than a penicillin 
G-resistant staphylococcus sensitive to cloxacillin sodium, 
the physician is advised to continue therapy with a drug 
other than cloxacillin sodium or any other penicillinase- 
resistant semi-synthetic penicillin 

Recent studies have reported that the percentage of 
staphylococcal isolates resistant to penicillin G outside 
the hospital is increasing, approximating the high per- 
centage of resistant staphylococcal isolates found in the 
hospital. For this reason, it is recommended that a peni- 
cillinase-resistant penicillin be used as initial therapy for 
any suspected staphylococcal infection until culture and 
sensitivity results are known. 

Cloxacillin sodium is a compound that acts through a 
mechanism similar to that of methicillin against penicillin 
G-resistant staphylococci. Strains of staphylococci resis- 
tant to methicillin have existed in nature and it is known 
that the number of these strains reported has been increas- 
ing. Such strains of staphylococci have been capable of 
producing serious disease, in some instances resulting in 
fatality. Because of this, there is concern that widespread 
use of the penicillinase-resistant penicillins may result in 
the appearance of an increasing number of staphylococcal 
strains which are resistant to these penicillins. 

Methicillin-resistant strains are almost always resistant 
to all other penicillinase-resistant penicillins (cross- 
resistance with cephalosporin derivatives also occurs 
frequently). Resistance to any penicillinase-resistant peni- 
cillin should be interpreted as evidence of clinical resis- 
tance to all, in spite of the fact that minor variations in 
in vitro sensitivity may be encountered when more than 
one penicillinase-resistant penicillin is tested against the 
same strain of staphylococcus. 

Contraindications: A history of a previous hypersensi- 
tivity reaction toany of the penicillins is a contraindication. 
Warning: Serious and occasionally fatal hypersensitivity 
(anaphylactoid) reactions have been reported in patients 
on penicillin therapy. Although anaphylaxis is more fre- 
quent following parenteral therapy it has occurred in 
patients on oral penicillins. These reactions are more apt 
to occur in individuals with a history of sensitivity to 
multiple allergens. 

There have been well documented reports of individuals 
with a history of penicillin hypersensitivity reactions who 
have experienced severe hypersensitivity reactions when 
treated with a cephalosporin. Before therapy with a peni- 
cillin, careful inquiry should be made concerning previous 
hypersensitivity reactions to penicillins, cephalosporins, 
and other allergens. If an allergic reaction occurs, the drug 
should be discontinued and the patient treated with the 
usual agents, e.g., pressor amines, antihistamines, and 
corticosteroids. 

Safety for use in pregnancy has not been established. 
Precautions: The possibility of the occurrence of super- 
infections with mycotic organisms or other pathogens 
should be kept in mind when using this compound, as with 
other antibiotics. If superinfection occurs during therapy, 
appropriate measures should be taken. 

As with any potent drug, periodic assessment of organ 
system function, including renal, hepatic, and hemato- 
poietic, should be made during long-term therapy. 
Adverse Reactions: Gastrointestinal disturbances, such 
as nausea, epigastric discomfort, flatulence, and loose 
stools, have been noted by some patients. Mildly elevated 
SGOT levels (less than 100 units) have been reported in a 
few patientsfor whom pretherapeutic determinations were 
not made. Skin rashes and allergic symptoms, including 
wheezing and sneezing, have occasionally been encoun- 
tered. Eosinophilia, with or without overt allergic mani- 
festations, has been noted in some patients during therapy. 
Usual Dosage: Adults: 250 mg. q.6h. 

Children: 50 mg. /Kg. /day in equally divided doses q.6h. 
Children weighing more than 20 Kg. shouid be given the 
adult dose. Administer on empty stomach for maximum 
absorption. 

N.B.: INFECTIONS CAUSED BY GROUP A BETA- 
HEMOLYTIC STREPTOCOCCI SHOULD BE 
TREATED FOR AT LEAST 10 DAYS TO HELP PRE- 
VENT THE OCCURRENCE OF ACUTE RHEUMATIC 
FEVER OR ACUTE GLOMERULONEPHRITIS. 
Supplied: Capsules — 250 mg. in bottles of 100, 500 mg. in 
bottles of 100. Oral Solution — 125 mg. /5ml. in 100 ml. and 
200 ml. bottles. 


BRISTOL® 


BRISTOL LABORATORIES 
Division of Bristol-Myers Company 
Syracuse, New York 13201 


Ask the Consultant 

“Ask the Consultant” is a new IMJ feature. 
Readers are encouraged to ivrite with clinical 
questions for which they have not been able to 
find solutions. The questions will be forwarded 
to the IMJ Editorial Board. Board members will 
provide responses, or find specialists to find solu- 
tions. Interested readers are asked to write IMJ, 
55 E. Monroe, Suite 3510, Chicago 60603. Please 
specify that your question is for the “Ask the 
Consultant” column. 


What can be done to reduce the risks in 
non-cardiac surgery in patients with coronary 
artery disease? 

In spite of much improvement in anesthesia 
and surgery in recent years and the improve- 
ments in post-operative care, morbidity and 
mortality remain inordinately high in non- 
cardiac surgical procedures for patients with 
coronary artery disease as compared to patients 
of similar age without heart disease. These pa- 
tients with a damaged cardiovascular system are 
prone to more risk with any surgical procedure. 
The hypotension, hypoxemia, infection and 
thrombo-embolic problems often associated with 
surgery are especially hazardous in an already 
damaged heart. 

Realizing all this, careful monitoring of 
cardiac and hemodynamic status both during 
and after surgery to avoid hypotension, volume 
overload and maintain IV fluid requirements 
with stable cardiac rhythm, will permit surgery 
to be done without undo risk. 

Avoid digitalis when there is no congestive 
failure or atrial tachycardia in the operative 
period. Usually a temporary pacemaker may not 
be needed and propranolol may gradually be 
discontinued. If cardiac surgical expertise is 
available, sometimes bypass surgery woidd be 
desirable before the non-cardiac surgery is done. 
(For more information, see: Hills L. David, 
Cohn Peter F.: “Noncardiac Surgery in Patients 
With Coronary Artery Disease,” Arch. Internal 
Med., 138:972, 1978.) 


75 



contains no aspirin 


tablets 

Dkirvocet-NKX) © 



lOO mg. Darvon-NVopoxyphe 
650 mg. acetaminophen 


Hli 

Additional information available 
to the profession on request from 
Eli Lilly and Company 
Indianapolis, Indiana 46206 

700565 

Eli Lilly and Company, Inc. 
Carolina, Puerto Rico 00630 




76 


Illinois Medical Journal 






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78 


Illinois Medical Journal 




Carcinoma Arising 
In a Thyroglossal Duct Cyst 

By Phillip L. Cacioppo, M.D. and Mohin T. Samaraweera, M.D./ 

Evanston and Chicago 

Primary carcinoma arising in a thyroglossal duct is rare , but this case again 
demonstrates the necessity for excision of all thyroglossal duct remnants. The 
differentiation of midline and lateral ectopic thyroid tissue is discussed. 


Although rare, carcinoma arising in the thy- 
roid tissue present in a thyroglossal duct cyst has 
been long recognized. The true pathology is 
seldom diagnosed preoperatively. It is seen in a 
female to male ratio of 2 : 1 . 1 Most are papillary 


PHILLIP CACIOPPO, M.D., is a clinical assistant professor of sur- 
gery affiliated with the Loyola University Stritch School of 
Medicine. Doctor Cacioppo is also an attending surgeon at St. 
Francis Hospital in Evanston and director of the blood flow 
laboratory at that institution. He is a board certified general 
surgeon. 


MOHIN T. SAMARAWEERA, M.D., is a 
pathologist affiliated with Resurrection 
Hospital in Chicago. He is board cer- 
tified in both anatomical and surgical 
pathology. 



lesions, other histologies have been reported. 2 

Case Report: A 24-year-old white female pre- 
sented with the history of a midline upper neck 
mass increasing in size over the seven months 
prior to admission. No pain or dysphagia was 
associated with the mass. The clinical impression 
was that of a thyroglossal duct cyst. Pre-operative 
I 131 radioisotope thyroid scan and function 
studies (T 3 and T 4 ) were normal. At explora- 
tion the mass appeared cystic and lobulated, in 
the classic location for a thyroglossal duct cyst. 
There was no attachment to the thyroid gland. 
An enlarged adjacent lymph node was hyper- 
plastic without tumor, and a standard Sistrunk 
procedure was performed. 3 Grossly, the cyst was 
multiloculated and filled with yellow gelatinous 
material. The lining was smooth except for one 
focus of friable papillary material adjacent to 
the hyoid bone. Histologic diagnosis was that of 
mixed papillary and follicular adenocarcinoma, 
predominantly papillary, containing psammoma 
bodies with normal thyroid tissue present. (Fig- 


for August , 1978 


79 



Figure 1 

Photomicrograph showing mixed papillary and fol- 
licular adenocarcinoma of thyroid tissue. Psammoma 
bodies are present. 


ures 1 and 2) There was no extension through 
the cyst wall, which was lined by cuboidal epithe- 
lium. 

Discussion 

The occurrence of carcinoma arising in a thy- 
roglossal duct remnant has been shown to be 
one in 128 by Nachlas 4 and two in 130 by Clioy. 5 
Since thyroglossal duct cysts are unusual the 
finding of carcinoma is exceedingly rare. An ex- 
cellent review of the entire subject by LiVolsi 
et al., G found normal thyroid tissue in varying 
amounts up to 64%. Although lateral ectopic 
thyroid tissue is accepted as metastatic disease, 
midline ectopic thyroid is considered benign un- 
less specific histologic evidence of malignancy is 
noted. Most carcinomas arising in median ectopic 
thyroid tissue are papillary adenocarcinoma. 1 - 2 
Significant other histologies, however, including 
squamous cell carcinoma and mixed papillary 
and follicular carcinoma, have been included in 
21% of cases reported by Bhagavan. 2 

Controversy has arisen only in distinguishing 
true ectopic thyroid tissue from metastatic cystic 
carcinoma. In the presence of normal thyroid 
tissue at the site of the lesion, it is reasonable to 
assume that carcinoma has arisen in ectopic 
tissue. 7 

Management 

The management of a carcinoma arising in a 
thyroglossal duct cyst is basically the Sistrunk 
procedure 3 with evaluation of the adjacent nodal 



Fjgure 2 

Photomicrograph showing cystic component and nor- 
mal thyroid tissue. 


tissue and of the thyroid gland with careful post- 
operative monitors for local recurrence. Presence 
of suspicious or positive nodes should be the 
criteria for nodal dissection. If the thyroid gland 
is normal to palpation and scan, it is generally 
felt that total thyroidectomy is not advised. 1 > 2 > 6 
If the thyroid gland is abnormal, then the lesions 
must be treated as a primary thyroid neoplasm or 
at least a multicentric disease. Survival is excel- 
lent with this plan of management. 1 - 6 The care 
of this disease as in adenocarcinoma of the thy- 
roid gland itself must be continued over a 20- 
year followup because of the natural history of 
adenocarcinoma originating in thyroid tissue. 8 ◄ 

References 

1. Jaques, D. A., Chambers, R. G., Oertel, J. E.: ‘‘Thyro- 
glossal Tract Carcinoma,” Am. J. Surg., 120:439-446, 
1970. 

2. Bhagavan, B. S., Rai, O. R., Weinberg, T.: “Carcinoma 
of Thyroglossal Duct Cyst,” Surgery , 67:281-292, 1970. 

3. Sistrunk, W. E.: “Technique of Removal of Cysts and 
Sinuses of the Thyroglossal Duct,” Surg. Gynec. fa 
Obst., 46:109, 1928. 

4. Nachlas, N. E.: “Thyroglossal Duct Cysts,” Ann. Otol. 
Rhinol. Laryngol., 59:381, 1950. 

5. Choy, F. J., Ward, R., Richardson, R.: “Carcinoma of 
the Thyroglossal Duct,” Am. J. Surg. 108:361, 1964. 

6. LiVolsi, V. A., Perzin, K. H., Savetsky, L.: “Carcinoma 
Arising in Median Ectopic Thyroid (Including Thyro- 
glossal Duct Tissue,” Cancer , 34:1303-1315, 1974. 

7. Nuttall, F. Q.: “Cystic Metastases From Papillary Ade- 
nocarcinoma of the Thyroid with Comments Concern- 
ing Carcinoma Associated with Thyroglossal Rem- 
nants,” Am. J. Surg., 109:500-505, 1965. 

8. Frazell, E. K., Foote, F. W„ Jr.: “Papillary Carcinoma 
of the Thyroid,” Cancer , 11:895, 1958. 


80 


Illinois Medical Journal 


The University Medical School 
Reaching to the Community Physician 

By Richard L. Byyny, M.D., Linda K. Gunzburger, M.S., Chase P. Kimball, M.D., 

Mark Siegler, M.D., and Alvin R. Tarlov, M.D./Chicago 


In our new era of health care planning and system implementation, the Uni- 
versity of Chicago is establishing a regional network of community hospitals 
which provides a means by which continuing medical education is available to 
the practicing community physician. Based on a firm academic tradition, the 
Medical School has found it necessary to form relationships with community hos- 
pitals. These relationships not only provide learning programs for physicians but 
offer valuable learning experiences for medical students, interns, and residents. 
To obtain quality health care it is necessary to extend the education in medicine 
beyond the ivalls of the medical school. Through joint cooperation the university 
physician can aid the community physician in management of difficult cases and 
in referrals. However, the community physician is needed to provide the setting 
and guidance depicting primary and secondary community health care. 


This is a time when the attention of the na- 
tion and medicine in general is turning toward 
the organization of health resources in an efEort 


RICHARD L. BYYNY, M.D., is an internist currently affiliated 
with the University of Colorado Medical Center in Denver, 
where he is head of the division of general internal medicine 
and vice-chairman of the department of medicine. At this writ- 
ing, Doctor Byyny was director of the section of general in- 
ternal medicine at the University of Chicago. 

LINDA K. GUNZBURGER, M.S., is an evaluator-educator, special 
track curriculum and coordinator of the division of continuing 
medical education at the Loyola University-Stritch School of 
Medicine. At this writing, Ms. Gunzburger was educational 
coordinator at the University of Chicago office of postgraduate 
medical education. 

CHASE P. KIMBALL, M.D., is a professor of psychiatry and 
medicine in the University of Chicago division of biological 
sciences. Doctor Kimball specializes in psychosomatic medicine. 

MARK SIEGLER, M.D., is an assistant professor at the Uni- 
versity of Chicago department of medicine. Doctor Siegler is 
also a diplomat of the American Board of Internal Medicine. 

ALVIN R. TARLOV, M.D., F.A.C.P., is chairman of the depart- 
ment of medicine at the University of Chicago. 


to distribute these more efficaciously for the pre- 
vention, detection, and remediation of illness 
and disease. Academic centers geared to address 
themselves, their faculties and services to the 
technology of the biomedical revolution of the 
past quarter century may suddenly find them- 
selves helplessly deficient in their wherewithal 
to face what are doubtless the major challenges 
of the next quarter century. 

As the University of Chicago, similar to other 
major universities, emerges into this new era of 
health education, research, and service it finds its 
resources in most every respect woefully inade- 
quate to help plan for and synthesize plans to 
accommodate itself to the changing social and 
consequent political and financial patterns of 
this medical evolution. 

Academic medical centers will become increas- 
ingly involved in all levels of education and 
training. This will require simultaneous solu- 
tions to problems regarding the type of students 
appropriate for such careers, the setting in which 
they should be taught, the content of their edu- 
cation and training and the allocation of public 
and private resources to this enterprise. How- 
ever, the critical component in this process will 
be the teachers. It is this group which must 
select future students, create model settings in 


for August , 1978 


81 


which they are to be taught, define a curriculum 
relevant to the needs of their patients, provide 
opportunities for continuing education and train- 
ing which focus on improving the outcome of 
patient care, and assure that sufficient resources 
are available to carry out these tasks. 1 

It is within the frameworks of continuity and 
change that we believe many university medical 
schools in the 1970’s share comon features, in- 
cluding abiding commitments to excellence in 
the care of patients, in the training of undergrad- 
uate and postgraduate students, and in the dis- 
covery of new information through basic and 
clinic research. 2 Thus, it is our hope that the ex- 
perience at the University of Chicago will be 
helpful to other medical schools as they develop 
within their own unique settings an approach to 
a pressing need in medical education in the 
1970’s, the strengthening of training programs. 

The University of Chicago System- 
Background 

A medical school at the University of Chicago 
was not established until 1927, although one had 
been proposed even before the university was 
founded in 1893. This 34-year delay between con- 
ception and realization allowed the developers 
of the medical school to create an institution 
whose organization incorporated major advances 
in American medical education and also reflected 
the philosophical orientation of the University 
of Chicago. The unique organizational features 
of the new medical school included a true uni- 
versity medical school; a true full-time, fully- 
salaried medical faculty; university ownership 
and management of a general hospital with both 
inpatient and outpatient facilities; a major com- 
mitment to research and the generation of new 
information within the context of patient care 
and clinical teaching and a belief in a functional 
division of labor within medical school depart- 
ments. 

This pattern of organization resulted in a 
remarkably effective system of medical educa- 
tion and practice, which lent itself easily to the 
introduction of innovations and change. Thus, 
for example, in 1928 the Department of Medi- 
cine at the University of Chicago incorporated 
the subspecialty system of practice, which an- 
tedated by two decades the national movement 
in this direction. Following World War II the 
existence of strong subspecialty sections within 
the department of medicine proved an ideal ar- 
rangement for capitalizing on the availability of 


government funds for research and training, and 
the system was further strengthened. These funds 
were usually dispensed through categorical in- 
stitutes of the NIH, and categorical sections of a 
large department of medicine were able to com- 
pete with special effectiveness for these grants. 

Forty years of experience with the subspecialty 
system has allowed the University of Chicago 
ample opportunity to appreciate the strengths 
and weaknesses of this system. 3 

Community Hospitals Relationships 

Three years ago, general internal medicine 
initiated relationships with several community 
hospitals to the south of the university for the 
purpose of assisting them in continuing medical 
education programs in their hospitals, as well as 
for the purpose of fostering referral of patients 
to the university hospital. This program has 
subsequently grown in scope to include many 
of the clinical departments and is now coordinat- 
ed by a multi-departmental committee on com- 
munity health affairs and hospitals appointed by 
the Dean. The educational programs in each of 
six community hospitals are coordinated by one 
member of the faculty from the university, five 
of whom are of the Department of Medicine, 
two of these from the section of general internal 
medicine. 

Since 1972, we became interested in develop- 
ing mutually beneficial relationships with hun- 
dreds of privately practicing physicians and their 
hospitals. The physicians, and their patients 
most accessible to us were to the south and south- 
west in a 30 mile hemicircle of the university. 
Contact was made through the hospitals where 
these physicians were privileged. Programs have 
been developed whereby we provide continuing 
education (lectures, grand rounds, clinical path- 
ological conferences) for the medical staff in 
their hospital, and in turn the physicians use 
our staff and facilities for consultation and for 
direct transfer of patients requiring tertiary, or 
complicated, care. 4 

Office of Postgraduate Medical Education 

With funding from the National Fund for 
Medical Education, the University of Chicago 
was able to establish an Office of Postgraduate 
Medical Education in 1974 and begin to con- 
ceptualize an advanced training program in gen- 
eral internal medicine. The Office enables the 
synthesis and integration of all present post- 


82 


Illinois Medical Journal 


graduate activities and continuing education pro- 
grams in health related services at the University 
of Chicago. 

These programs serve to bolster the commu- 
nity hospitals’ attempts to recruit younger staff 
members, but also keep general physicians 
abreast of contemporary developments in medi- 
cine, surgery, obstetrics-gynecology and psychol- 
ogy. 1'he university departments have also es- 
tablished consultation activities at these hospi- 
tals. 

The Office is also planning refinements in the 
educational program, particularly in the area of 
methodology. Utilizing a now basic methodo- 
logical approach to the field of continuing medi- 
cal education, each of our coordinators, with the 
assistance of our Department of Education, is 
attempting to determine the specific needs of 
the medical staff in each of these hospitals and 
to develop the objectives of the educational pro- 
gram based upon these. 

The university has taken the initial steps 
necessary for implementing the Office of Post- 
graduate Medical Education. The educational 
program director brings expertise in educational 
methods to the content program that our con- 
sultants identify. Such an individual assists co- 
ordinators and consultants in selecting appro- 
priate methods by which to convey content 
material. In addition, the director identifies those 
areas within a given hospital program where in- 
tegration and synthesis could be achieved. As 
programs are developed at several hospitals, the 
director will identify in what ways individual 
hospital programs might be related to one an- 
other. For example, in the event that several hos- 
pitals develop family medicine residency pro- 
grams, it is possible that part of the didactic 
course work in these programs might be given 
on the university campus. 

The program director is responsible for the 
intramural continuing education program at the 
University of Chicago and is challenged to seek 
ways to relate these to the extramural programs. 
Similarly the director works with other programs 
coordinated by the Committee on Community 
Health Affairs and Hospitals, e.g., the cancer 
control program. The director is expected to de- 
vise methods of evaluating the educational and 
referral programs and to assist in whatever in- 
vestigative activities the commitee might propose 
for evaluating health needs and resources in the 
area of a particular community hospital. The 
director inaugurates and/or participates in grant 
applications to private and public agencies with 


a view toward developing resources of the Office 
and in developing the advanced training pro- 
gram in General Internal Medicine. 

Advanced Training Program in 
Genera] Internal Medicine 

The section of general internal medicine has 
established a two-year advanced training pro- 
gram which is designed to prepare internists for 
positions in academic general internal medicine, 
or for positions as directors of medical education 
in community hospitals. Three years of training 
in internal medicine (internship plus two years 
of residency) is a prerequisite. The objectives of 
the training program include the definition and 
development of the skills of a general internist, 
the acquisition of skills and techniques of edu- 
cation, training in the methodology of evaluation 
research, and experience in the organization and 
utilization of biomedical information systems. 

The development of outstanding clinical skills 
will be emphasized because we believe that the 
most effective general internal medicine educator 
will be one who is acknowledged by students 
and colleagues to be an exceptionally skillful 
physician. This program will not merely extend 
the existing residency program, but will concen- 
trate in areas that are not well treated in the 
present residency. These special areas include 
training in the organization and management of 
more effective ambulatory internal medicine; the 
heretofore underemphasized skills and respon- 
sibilities required of a principal physician to 
solicit, coordinate and clinically evaluate the 
opinions and recomendations of multiple con- 
sultants in a complex medical situation and ar- 
rive at a wise course of action; a special aware- 
ness and knowledge of clinical pharmacology 
which would allow one to practice and teach a 
more precise and scientific therapeutics; the 
organization and direction of intensive care 
units; and experience in the special knowledge 
and techniques required for effective consulta- 
tion on surgical patients. 

The acquisition of the skills and techniques of 
education will be an important part of the ad- 
vanced training program. The expertise of the 
Department of Education at the university will 
be enlisted to instruct the trainee on methods of 
planning, teaching, and evaluating programs in 
undergraduate, graduate and postgraduate edu- 
cation. 

Instruction will be provided in the methodol- 
ogy of evaluation research and cost-benefit anal- 


for August , 1978 


83 


ysis, and its application to health-care systems 
and to quality-care assessment. The instruction 
in these areas will be provided by the School of 
Social Service Administration and the Center for 
Health Administration Studies of the Graduate 
School of Business, at the University of Chicago. 

In cooperation with the School of Library 
Science, the trainees will gain experience in the 
planning, organization and management of li- 
braries and biomedical information systems. 

Finally, all trainees will be required to under- 
take independent investigation in one of the 
areas emphasized above. Some of the trainees may 
wish to pursue an advanced degree (either a 
Masters or a Doctorate) in one of the depart- 
ments of the university affiliated with this pro- 
gram. 5 


The Need for a Regional Approach 

Primary medical training cannot adequately be 
incorporated only within its campus clinics, or 
in medically underserved areas without address- 
ing the varying health concerns of inner-city and 
non-urban communities. While significant re- 
sources have been directed since the mid-1960’s 
into inner-city areas, little substantive work has 
been accomplished in the smaller, non-urban 
communities. Concern is for programs that link 
non-urban area institutions with the resources 
of the university medical center. Coordination 
of urban and more distant non-urban institutions 
of necessity requires planning and resource allo- 
cations from a regional perspective. 

The university considers that a) development 
of “communiversity” relationships will favorably 
support its on-campus teaching and research re- 
quirements for large, referral specialty patient 
populations, and b) provide off-campus oppor- 
tunity for its faculty and students in the areas 
of health policy planning and research. 6 


Conclusion 

By our regionally reaching to the community 
physicians, their continuing education would be 
built into the character of their professional 
lives, and would become natural, a habit. They 
could assist in teaching our students and resi- 
dents within their own practices, they might at- 
tend conferences, seminars, and courses at the 
University Hospital, and they would undoubted- 


ly use our subspecialty consultation services and 
refer patients to the university for specialized 
care. The epidemiology and demography of ill- 
ness in their setting may provide research oppor- 
tunities for scientists at the university. ■< 

References 

1. Chase Patterson Kimball, M.D.: “The Challenge of 
Medicine in the ’70’s: Health Care through Education.” 
JAMA, Vol. 216, No. 13, 1971. 

2. Daniel C. Tosteson, M.D.: “The Right to Know: Public 
Education for Health.” Journal of Medical Education, 
Vol. 50, pages 117-123, 1975. 

3. R. L. Byyny, M.D., M. Siegler, M.D. and A. R. Tarlov, 
M.D.: “Development of General Internal Medicine at 
the University of Chicago.” To be published in JAMA. 

4. Edward Rubenstein, M.D.: “Continuing Medical Edu- 
cation at Stanford: The Back-to-Medical School Pro- 
gram.” Journal of Medical Education, Vol. 48, No. 10, 
pages 911-918, 1973. 

5. John G. Freymann: The American Health Care Sys- 
tem: Its Genesis and Trajectory. New York: Medcom, 
Inc., 1974. 

6. “University of Chicago Regional Study Strengthening 
Medical Care through Institutional Development, In- 
stitutional Interrelations and Medical Education”: a 
Proposal prepared by the Committee on Community 
Health Affairs and Hospitals, University of Chicago, 
Pritzker School of Medicine, June, 1975. 


COOK COUNTY 
Graduate School of Medicine 

CONTINUING EDUCATION COURSES 
STARTING DATES— 1978 

SPECIALTY REVIEW MEDICINE, CERTIFYING, August 6 
SPECIALTY REVIEW ORTHOPAEDICS, August 25 
ESSENTIALS OF ELECTROCARDIOGRAPHY, 5 days, September 18 
EKG FOR ANESTHESIOLOGISTS, 5 days, September 18 
SPECIALTY REVIEW DERMATOLOGY, 5 days, September 25 
SPECIALTY REVIEW OBSTETRICS & GYNECOLOGY, September 25 
CURRENT TOPICS IN INTERNAL MEDICINE, September 25 
SEXUAL MEDICINE, 5 days, September 25 
NEUROLOGY, PART II, CLINICAL, October 9 
QUALITY ASSURANCE EVALUATION, 3 days, October 12 
CLINICAL & LABORATORY DIAGNOSIS OF HEMORRHAGIC AND 
THROMBOTIC DISORDERS, 2 days, October 20 
MANAGEMENT OF COMMON FRACTURES, 5 days, October 23 
SPECIALTY REVIEW SURGERY, PART I, October 23 
RECENT ADVANCES IN PSYCHIATRY, 5 days, October 23 
RECERTIFICATION REVIEW IN OB-GYN, 5 days, October 30 
RECENT ADVANCES IN NEUROLOGY, 5 days, November 13 

Information concerning numerous other continuation courses 
available upon request. 

Address : 

REGISTRAR, 707 South Wood Street, 

Chicago, III. 60612 


84 


Illinois Medical Journal 



Seminars In Immunopathology 
and Oncology 

Richard J. Ablin, Ph.D., Contributing Editor 


Immune Complexes and Human Disease 

By Brian S. Andrews, BSc (Med) and Ronald Penny, M.D. /Sydney, Australia 


This is the first of three parts in a special overview series for the “Seminars in 
Immunopathology and Oncology.” In part one, Doctors Penny and Andrews 
delineate the historical background to immune complex research. Part two, ex- 
ploring detection of immune complexes, will be published in the September IMJ. 


When a foreign, exogenous antigen enters the 
body, a specific binding protein (antibody) is 
formed to eliminate it. Under normal circum- 
stances, the combination of antigen (Ag) with 
antibody (Ab) results in the formation of an 
immune complex (IC) which is rapidly cleared 
from serum and tissues by the phagocytic sys- 
tem. However, complexes sometimes continue to 


BRIAN S. ANDREWS, BSc(Med), MB, 
BS, FRACP, is an assistant professor of 
medicine affiliated with the University 
of Virginia. He graduated MB BS, from 
the University of Sydney Medical 
School in Sydney Australia. Doctor 
Andrews is a fellow of the Royal 
Australian College of Physicians. 

RONALD PENNY, M.D., F.R.A.C.P., 

F.R.C.P.A., is an associate professor of 
medicine and director of the depart- 
ment of Immunology at the University 
of New South Wales at St. Vincent's 
Hospital in Sydney, Anstralia. Doctor 
Penny initiated his research in im- 
munology and immunopathology at the 
Institute of Cancer Research at New 
York's Columbia University. 


circulate, deposit on vascular basement mem- 
branes and result in an inflammatory reaction. 
In other situations, endogenous or auto-antigens 
are associated with formation of excessive quan- 
tities of Ab resulting in similar ICs and typified 
by systemic lupus erythematosus (SEE) . 

As IC formation represents a normal immune 
clearance mechanism for Ag, it is clear that cir- 
culating IC’s only result in clinically overt dis- 
ease under certain circumstances. If ICs are to 
be incriminated in the pathogenesis of a specific 
disease, certain ideal criteria should be estab- 
lished: (a) an Ag should be identified; (b) an 
IC containing both Ag and Ab should be demon- 
strated in serum and tissues; (c) the pathogenic 
nature of the circulating IC should be estab- 
lished, e.g., ability to activate complement (C) ; 
and (d) the level of circulating ICs should 
parallel clinical disease activity. 

Acute serum sickness represents the prototype 
of a human IC disease produced by an exogenous 
Ag. It was first described in 1905 by von Pirquet 
and Schick 1 who proposed the basic underlying 
mechanisms. These were subsequently validated 
by both Germuth 2 and Dixon and colleagues. 3 
Rabbits were immunized with a single large in- 
jection of bovine serum albumin (“one shot 
serum sickness”) and at the onset of Ab produc- 
tion developed an acute serum sickness reaction. 




for August, 1978 


85 


Abbreviations 


Ab 

Antibody 

A g 

Antigen 

C 

Complement 

IC (s) 

Immune Complex (es) 

Ig 

Immunoglobulin 

GN 

Glomerulonephritis 

MPS 

Mononuclear phagocytic system 

PEG 

Polyethylene glycol 

PMN 

Polymorphonuclear leukocyte 

RA 

Rheumatoid arthritis 

RF 

Rheumatoid factor 

RIA 

Radioimmune assay 

SLE 

Systemic lupus erythematosus 


This was characterized by a proliferative glomer- 
ulonephritis (GN) and generalized necrotizing 
vasculitis, associated with circulating and tissue 
ICs and reduction in total hemolytic C. The 
components of the circulating IC, namely bovine 
serum albumin, rabbit Ab and C were identified 
within the glomerulus and vessel walls. While 
the polymorphonuclear leukocyte (PMN) com- 


prised the predominant inflammatory cell in the 
vasculitic lesions, marked endothelial prolifera- 
tion without a cellular infiltrate characterized 
the glomerular lesion. As this model was not 
representative of the typical acute GN in hu- 
mans, an attempt was then made to produce a 
more representative model in rabbits using daily 
injections of bovine serum albumin. The aim 
was to maintain a continuous level of circulat- 
ing antigen-antibody complexes. 4 Chronic serum 
sickness developed when circulating complexes 
persisted for more than two weeks. In contrast 
to the acute serum sickness model, the glomeru- 
lar lesion was associated with a marked cellular 
infiltrate and electron dense basement mem- 
brane deposits which persisted for six to twelve 
months following cessation of the antigenic chal- 
lenge. 

Thus, an IC disease was produced in experi- 
mental animals by the introduction of an exo- 
genous Ag. Circulating IC’s were formed which 
were able to activate serum C and result in a 
tissue inflammatory reaction. The latter, how- 
ever, was influenced by the nature and the quan- 
tity of circulating IC’s. 4 


Immune Complex Disease in Animals 


Chronic viral infection in genetically suscep- 
tible animals may result in IC disease, usually 
manifested as GN and vasculitis. Commonly 
recognized viral agents in the mouse include 
lymphocytic choriomeningitis, lactic dehydro- 
genase and a variety of oncornaviruses. In the 
horse, “equine anemia” virus has been identified 
and in the mink, “Aleutian disease” virus. 5 

The New Zealand Black/White FI hybrid 
female mouse chronically harbors oncornaviruses 
and develops a disease similar to human SLE 
associated with severe proliferative GN. Impaired 
T-cell function in these mice may be related to 
either reduced suppressor T-cell or increased 
helper T-cell activity leading to B-cell over-ac- 
tivity and excessive Ab production. Antibodies 
are directed against exogenous [viral] and endo- 
genous [nuclear, T cell, erythrocyte] antigens and 
may result in the formation of circulating ICs. 6 
In two further murine models, the BXSB and 
the MRL/1, circulating ICs have been identified 
by the Raji cell radioimmunoassay (RIA) , mixed 
cryoglobulins and C activation. 7 Immune com- 


plex GN and vasculitis result in death by four 
to five months. In the BXSB, there is a clear 
male predilection whereas a slight female pre- 
dilection exists in the MRL/1. 

Viruses may persist in the circulation as ICs, 
maintain their infectivity and ability to repli- 
cate, and act as a continual source of Ag in the 
production of circulating viral Ag-Ab com- 
plexes. 8 Oncornaviral Ag’s incorporated into the 
host genome in man and mouse may result in 
formation of antigenic nuclear material. This 
material, composed of host and viral nucleic 
acids, may be able to elicit an Ab response in 
the host. 

Conversely, genetic factors may predispose to 
chronicity of viremia and expression of an IC 
disease. Predominance of male disease in the 
BXSB, early onset of IC disease in New Zealand 
Black/White FI males following castration and 
delayed disease onset in castrated females to- 
gether with the female predominance in human 
SLE, all suggest a hormonal influence in the 
modulation of disease expression. 9 


86 


Illinois Medical Journal 


Factors Influencing the Develoinpent of an Immune Complex Disease 


(A) Clearance of Circulating Immune 
Complexes 

(1) The nature of the immune complex: Most 
circulating ICs appear to be cleared from serum 
by fixed and circulating mononuclear phago- 
cytic cells which possess C and Fc surface recep- 
tors. Pathogenetic ICs sometimes deposit on 
vascular basement membranes, activate serum C 
and initiate an inflammatory cellular infiltrate. 
Pathogenic complexes (19S, MW 10 6 daltons) 
usually are soluble, 10 not readily phagocytosed 
and circulate in slight to moderate Ag excess. 11 
Larger complexes are quickly cleared by the 
mononuclear phagocytic system (MPS) , while 
smaller non-C fixing complexes (7S) are cleared 
by spleen although they may also be fixed in 
glomeruli, blood vessels and choroid plexus. 12 
Low affinity Ab containing complexes appear to 
be less efficiently cleared by the MPS. 12 

With respect to the antigenic moiety, large 
Ag’s (e.g. viral particles, circulating DNA) may 
be rapidly eliminated without Ab while a small 
single dose of Ag (e.g., bovine serum albumin) 
may not persist in sufficient quantities to form 
pathogenic complexes when Ab is produced. 13 
Potent Ag’s evoke a high titer antibody response 
where IC disease is unlikely to develop, usually 
with rapid Ag elimination. In addition, weak 
Ag’s may result in formation of pathogenic com- 
plexes via production of reduced amounts of 
Ab and/or low affinity Ab. 14 A low affinity Ab 
response may be genetically determined via link- 
age to the immune response (Ir) gene, and in 
this respect, IC disease may have a genetic basis. 
Although it is tempting to speculate on the quan- 
tity and function of the Ab produced, in par- 
ticular the relationship to the gene, there is only 
sparse data linking the HLA system in man with 
the development of IC disease. 15 

(2) Mononuclear phagocytic system (MPS): 
This name replaces the older term, reticulo- 
endothelial system, and refers collectively to cir- 
culating monocytes and fixed tissue macrophages. 
Clearance of ICs by the MPS appears to be a 
function of the degree of lattice formation and 
the presence of specific Ig subclasses IgG] and 
IgG 3 within the complex. 11 In experimental 
serum sickness, 99% of ICs are eliminated by 
the MPS, predominantly by hepatic Kupffer 
cells, leaving less than 1% to produce any tissue 


damage. 4 In man, unlike the experimental ani- 
mal, it cannot be assumed that the MPS is fully 
functional at the onset of clinical IC disease. 
Clearance of ICs appears to be independent of 
C receptor binding and requires an intact Fc 
region on the IgG within the complex for recog- 
nition by the MPS surface Fc receptors. 16 At the 
onset of acute serum sickness, hepatic Kupffer 
cells are saturated by ICs and are unable to clear 
further circulating ICs, allowing complexes to 
remain for longer periods in serum. 4 Corticoster- 
oids prolong the circulation time of injected 
performed ICs. 17 In chronic serum sickness GN, 
steroids increase the uptake of ICs by the 
glomerular mesangium possibly by decreasing 
basement membrane permeability to the ICs. 18 
It is possible that the most philogistic IC’s may 
never enter the circulation or if so are rapidly 
removed such that the ICs detected in serum 
may only reflect the presence of injurious com- 
plexes in other tissue sites. 

(B) Mechanisms of Immune Complex 
Localization in Tissues 

Immune complex deposition on vascular base- 
ment membranes appears to coincide with a 
local increase in capillary permeability. This 
may result from (a) vasoactive amines released 
locally from basophils and platelets producing 
endothelial retraction 19 or (b) endothelial dam- 
age related to ischemia or ongoing inflamma- 
tion. 20 Once the vascular integrity is breached 
by an inflammatory process, circulating com- 
plexes are probably readily deposited. Immune 
complexes do not appear to adhere to nor do 
they appear to be phagocystosed by vascular 
endothelium although if endothelial C and Fc 
receptors existed, these could help to localize 
complexes. Demonstration of glomerular C3b 
receptors, 21 although localized to the epithelial 
side of the basement membrane, 22 may still con- 
tribute to IC localization. 

Various non-immunologic factors are involved 
in IC deposition. These can be readily appreci- 
ated in human leukocytoclastic vasculitis, where 
IC deposition is most prominent in the lower 
limb and over areas of pressure. 23 Prolonged 
contact time between endothelium, circulating 
cells, especially platelets, and ICs appears to 
influence IC deposition. A reduced dermal capil- 


for August, 1978 


87 


lary blood How rate may follow (a) an increase 
in intravennlar and intracapillary pressure (grav- 
ity, venous obstruction) , (b) reduced body sur- 
face temperature, (c) a local increase in blood 
viscosity and (d) vasodilation. A propensity to 
intravascular coagulation with fibrin deposition 
and platelet aggregation is associated with de- 
creased How rate. 23 Endothelial damage de novo 
may result in decreasing plasminogen activator 
synthesis leading to impaired local fibrinolysis 
and decreased clearance of fibrin deposits. 24 

The anatomy of the local circulation influences 
1C deposition. Glomerulus, choroid plexus, syno- 
vium, and uveal tract share a high blood flow/ 
unit tissue mass and all produce an ultrafiltrate 
of plasma. These sites can potentially trap large 
quantities of circulating iCs and are high risk 
sites in man. A charge similarity between Clq 
and exposed collagen in vascular basement mem- 
branes based on similar amino acid sequences 
may allow circulating Clq reactive complexes to 
bind to exposed collagen, secreted in part by 
endothelial cells. 25 

(C) Mediators of Immune Complex 
Induced Inflammation 

(1) Platelets: Human platelets possess receptors 
for the Fc portion of IgG but not for C3. 26 Com- 
plexes appear to bind to circulating platelets, 
resulting in aggregation and release of nucleo- 
tides, vasoactive amines and the pro-coagulant 
platelet factor three. 27 In addition, thrombin, 
ADP, exposed collagen, prostaglandins, and 
platelet-activating factor (PAF) , which is re- 
leased from basophils and mast cells, can all 
cause platelet aggregation. 28 Basic proteins re- 
leased from platelets and PMNs are capable of 
increasing vascular permeability. While the role 
of platelets in human IC deposition is unclear, 
they are involved in IC deposition in experimen- 
tal acute serum sickness 27 Pretreatment of ex- 
perimental animals with antihistamines reduces 
IC deposition. 20 Cyproheptadine or hydroxyzine 
clioloride, used in a diphtheria epidemic in con- 
junction with diphtheria anti-toxin, reduced the 


*The asterisk indicates the activated state of 
the molecule. (Standard World Health Organiza- 
tion N omenclature is a bar over the molecular 
symbol as shown in the figures herein. Because 
reproduction of this nomenclature in the text 
was not feasible, the bar is herein represented 
by an asterisk.) 


incidence of serum sickness reactions by seven 
fold over that which developed in controls. 29 
This observation suggested that the vasoactive 
amines, histamine and serotonin, did play a role 
in IC deposition in man. 

(2) Polymorphonuclear Leukocytes: PMNs 

comprise the dominant primary cellular re- 
sponse to tissue ICs. Their entry is mediated via 
components of the C system. 30 In the Arthus re- 
action, PMNs predominate in the four hour 
lesion and are progressively replaced by mono- 
nuclear cells, comprising 50% of the cellular in- 
filtrate by 24 hours. However, cutaneous allergic 
vasculitis in man is associated with a prolonged 
PMN tissue response which persists together with 
tissue ICs for up to four days. 31 This difference 
may be related to continual IC deposition or to 
local IC formation or possibly a superimposed 
Schwartzmann-type reaction. Experimentally in- 
duced neutropenia or thrombocytopenia abol- 
ishes the generalized vasculitis in the acute serum 
sickness model, but does not influence the GN. 
This would indicate that PMNs or platelets are 
not a prerequisite for the renal lesion. 32 

PMNs undergo chemotaxis to the site of IC 
deposition under the influence of C567, # C5a 
and to a lesser extent C3a. 33 In addition, other 
less potent chemotactic agents are liberated dur- 
ing the inflammatory process (basic lysosomal 
proteins, kallikrein, plasminogen activator, fibrin 
degradation products) . 33 Complexes bind to Fc 
and C3b receptors on the neutrophil. They un- 
dergo phagocytosis which results in a release of 
lysosomal enzymes. 34 Extracellular release of ly- 
sosomal contents (collagenase, elastase, cationic 
proteins, hydrogen ions, etc.) and possibly su- 
peroxides, singlet oxygen and peroxide cause 
further tissue damage and exacerbate the in- 
flammatory response. These increase vascular 
permeability, degranulate mast cells and initiate 
in vivo coagulation via thromboplastin genera- 
tion. 35 ’ 36 

(3) Complement System: Immune complexes 
activate the classical and alternative C pathway, 
with the former generally predominating. Com- 
plexes containing IgM and IgG (especially IgGj 
and IgG 3 ) activate the classical C pathway while 
IgA complexes, like zymosan, endotoxin and 
initiating factor (factor I) the alternative C 
pathway. 37 The presence of the early sequence 
components Clq, C4 and C2 at this tissue site 
indicate classical pathway activation. Properdin 
factors B and D indicate alternative pathway 
activation. 38 Large amounts of C3 are detected 
in tissues undoubtedly because C3 represents the 


88 


Illinois Medical Journal 


amplification step in the C cascade with the high- 
est level of any C component in serum. 

Activation products of C are responsible for: 

• C3b mediated immune adherence of ICs to 
PMNs, eosinophils, and mononuclear phago- 
cytes. 37 C4b plays a lesser role in immune ad- 
hence. In addition, binding of ICs via a C 
receptor can resnlt in exocytosis of lysosomal 
granules: 

• Chemotaxis of leukocytes mediated via 
C567,* C5a, and C3a. 33 > 37 It has been implied 
that C fragments may also be associated with 
lymphocyte chemotaxis; 39 

• Formation of the anaphylatoxins C3a and 
C5a, which lead to release of granules from 
basophils and mast cells; 37 

• Cell lysis from surface binding of the ter- 
minal C components either following direct bind- 
ing of Ab to an Ag on the cell surface or via a 
“bystander reaction” where preformed ICs pas- 
sively bind to the cell membrane leading to C 
activation; 

• Activation of B-lymphocytes by C3 break- 
down products. 40 

(4) Coagulation, fibrinolysis and the kinin sys- 
tem: While earlier evidence suggested that ICs 
could activate Hageman factor (Factor XII) di- 
rectly resulting in coagulation, this now appears 
not to be so. 41 However, the role of ICs with 
fixed Clq have not been fully studied with re- 
spect to their ability to bind factor XII. 42 Indi- 
rectly initiated coagulation resulting from throm- 
boplastin generation, release of lysosomal 
contents or via exposure of basement membrane 
collagen appears to be the chief mechanism for 
in vivo coagulation. 36 The proteolytic enzyme 
plasmin in addition to degrading fibrinogin- 
fibrin complexes appears to generate kinins and 
activate the C system by proteolysis of Cl and 
C3. 42 

(5) Lymphocytes: Experimentally, ICs may sup- 
press and enhance lymphocyte activation. 35 > 43 > 44 
At the B-cell level, IC’s can modulate B-cell 
function depending on the stage of differentia- 
tion and the nature of its surface receptors. In 
general, ICs result in B-cell inactivation 43 re- 
quiring for this action an intact Fc region on 
the Ab. This suggests that B-cell inactivation oc- 
curs by binding of the IC to the lymphocyte Fc 
receptor. In addition, excess quantities of Ag or 
ICs presumably related to the complexed Ag can 
inhibit specific Ab production by lymphocytes. 

With respect to T-cell function, ICs similarly 
appear to inhibit overall T-cell function. They 


may do so by inhibiting helper T-cell activity or 
by activation of suppressor T-cells. 45 Recent 
T-cell subsets have been found to bind the Fc 
region of IgM (Tu) 46 or the Fc region of IgG 
(Ty) , 46 Binding of ICs containing IgM or IgG 
antibody may thus lead to the generation of 
helper or suppressor cell activity respectively. In 
addition, ICs may abrogate the proliferative re- 
sponse of mouse spleen cells to both B- and T- 
cell mitogens. 47 ICs immobilized on plastic sur- 
faces inhibit blastogenesis, while suspensions of 
the same ICs are not inhibitory. 48 

With respect to the effect of ICs on lympho- 
cyte function in human disease, most data re- 
lates to their role as “blocking factors” in malig- 
nancy. 47 Immune complexes may inhibit the 
T-cell cytotoxic response to tumor cells by spe- 
cific activation of suppressor T-cells. They may 
inhibit T-cell function by binding the complexed 
tumor Ag to the T-cell surface antigen receptor. 
Third, they may inhibit B-cell function and Ab 
production by cross-linking B-cells via binding 
to their receptors. 35 

The role of the tissue lymphocyte in IC-medi- 
ated tissue injury is unclear. However, it has 
been demonstrated that B-type lymphoblastoid 
cells and activated T-lymphocytes undergo chem- 
otaxis to C components and specific Ag respec- 
tively. 47 In cutaneous lymphocytic vasculitis, a 
perivascular lymphocytic infiltrate is associated 
with IC deposition, but again lymphocyte func- 
tion is unknown. 48 - 49 

Further, ICs may modulate the immune re- 
sponse via the formation of anti-idiotypic Ab. 50 
These Ab’s bind to the Ag combining sites on 
specific Ab and in addition react with the Ag 
receptor on the lymphocyte surface. 51 Thus, ICs 
can possess anti-receptor activity with their bind- 
ing leading to impaired function of a specific 
receptor-bearing cell which may be either B- or 
T-cell. 


This concludes part one of our three part 
series on immune complexes and human disease. 
Part two is scheduled for the September issue. A 
complete list of references is available upon re- 
quest to: Illinois Medical Journal, 55 E. Monroe, 
Suite 3510, Chicago 60603. 


for August, 1978 


89 



Surgical Grand Rounds are held weekly on Tuesday at 5:00 p.m. in the Offield 
Auditorium of the Passavant Pavilion of Northwester n Memorial Hospital. Pa- 
tient presentations from Northwestern Memorial Hospital and the Veterans Ad- 
ministration Lakeside Hospital form the basis of the discussions. This case report 
was part of the Surgical Grand Rounds of June 5 , 1977 . 


Computerized Whole Body Tomography 


Dr. Harvey L. Neiman: In 1972, Godfrey 
Hounsfield and his co-workers at the EMI lab- 
oratories in London, England, announced the 
development of the first computerized tomo- 
graphic unit for clinical use. This first genera- 
tion machine was a dedicated brain scanner, 
and systems for scanning other parts of the body 
were developed shortly thereafter. 

The clinical unit for brain scanning was ac- 
tually quite crude in the sense that the scanning 
times were very long— on the order of five 
minutes. Time for reconstruction of the image 
was also very long, and therefore the clinical 
applications of this method were limited. The 
possibilities of whole-body scanning were theo- 
retically so exciting, however, that numerous 
technical advances proceeded rapidly, such that 
scanning times are now in the 2 to 20 second 
range in clinically available units. 

I would like to briefly review the concept of 
CT scanning, a little about the physics, and then 
primarily to discuss case material which is illus- 
trative of the present clinical indications. CT 
scanners are conceptually similar and the major 
components of all manufacturers’ products have 
much in common. This discussion applies to 
most of the currently available CT models. 

In a CT system, the patient is placed in the 
center of an X-ray gantry. The gantry houses 
an X-ray tube and a series of detectors which are 
directly opposite the X-ray source and which 
have the ability to move synchronously with it. 


The detectors are of two varieties. Scintillation 
detectors consist of a luminescent crystal such as 
activated sodium iodide or bismuth germinate 
and an optically coupled photomultiplier tube. 
Gas detectors, usually xenon, can also be utilized. 

Presently, the most commonly utilized instru- 
ment uses a fan shaped beam of X-rays which 
has an angle of 10°. To obtain a cross-sectional 
image, the X-ray source, as well as a group of 
30 detectors, move synchronously in a linear 
fashion across the patient. The X-ray tube and 
detectors are then rotated 10° and the proce- 
dure repeated until the volume of tissue is 
viewed from 180°. This system allows the com- 
pletion of a scan in under 20 seconds. 

Head scanners can utilize longer scanning 
times, since motion can be prevented by stabil- 
izing the head. In the abdomen and chest how- 
ever, faster scans are needed to prevent motion 
unsharpness from peristaltic activity, respiratory 
motion, etc. A “third generation scanner” util- 
izes a fan shaped beam of approximately 30° 
and a large number of gas detectors (approxi- 
mately 300) . The X-ray tube and detectors 
rotate continuously about the patient without 
any linear motion. These systems scan one sec- 
tion in approximately 5 seconds. There are 
obvious clinical advantages to this scanning 
time. However, there are disadvantages in the 
potential for creating artifacts and the need for 
more carefully synchronizing the detector array. 
A further refinement consists of a stationary 


90 


Illinois Medical Journal 


ling of approximately 600 detectors with only 
the X-ray tube rotating about the patient. 

The second major component, of course, is 
the computer. Assume that a very narrow X-ray 
beam traverses an individual at a specific point. 
A portion of that X-ray beam is attenuated 
and a portion of it passes through the individual 
and then impinges upon a detector which con- 
verts the energy ultimately to an electrical im- 
pulse. A known amount of X-ray energy is 
therefore sent out. A detectable amount is re- 
corded and the difference between the two is 
an absorbed dose. The data obtained by this 
method for a specific core of tissue gives a 
“profile” of the attenuation of X-rays in the 
tissue traversed. Each point is ultimately “looked 
at” from 180 different angles. These profiles 
then provide the necessary information to recon- 
struct by an appropriate algorithm, i.e., “filtered 
back projection,” the attenuation coefficient for 
each point within an object studied. The elec- 
trical information is recorded in a digital format 
by a computer. A line printer can then produce 
a numerical printout of the absorption coefficient 
for each picture element that has been recon- 
structed. In a clinical setting, however, this 
information is converted into an analog optical 
image which is viewed on a television monitor 
and then photographed. 

The third major component of a CT system 
is the console where the operator can com- 
municate with the computers and X-ray units 
and where the reconstructed image appears on 
the television screen for viewing. 

The X-ray attenuation characteristics of tissues 
have been set such that water is 0 Hounsfield 
units, dense bone is + 1,000 Hounsfield units 
and air is — 1,000 Hounsfield units. A shade of 
gray, or for that matter a color, can be assigned 
to a range of Hounsfield units such that the 
viewed image is a recognizable anatomic cross- 
section. 

Specific Utilizations 

Obviously, in the central nervous system the 
use of computed tomography is well established. 
I think that most physicians would agree that 
few medical instruments have revolutionized the 
practice of a subspeciality of medicine, namely 
the neurologic sciences, as has the CT head unit. 
I would like to concentrate however, on the use 
of CT in the thorax, abdomen, and pelvis. 

The first illustration is through the midthorax. 

(Fig. 1) I think that you can readily appreciate 


the heart and pulmonary vascularity. At the 
present time with 2 second to 18 second scan- 
ners, studies of the heart are not possible. Ex- 
tremely fast scanners, however, gated to the 
ECG, are being developed. 

There are several indications for computed 
tomography of the mediastinum. (1) Not in- 
frequently, a lesion may be partially hidden 
by the mediastinum. This is particularly true 
in the left lower lobe. Computed tomography 
gives a clear demonstration of these lesions 
without superimposed normal structures. (2) 
Differentiation of a large pulmonary vascular 
structure from hilar lymphadenopathy particu- 
larly by using contrast enhancement. (3) Stag- 
ing of mediastinal tumors. Subcarinal lymph 
nodes are particularly well visualized when they 
enlarge and encroach on the azygoesophageal 
recess. Pariesophageal and internal mammary 
lymph nodes are also well seen. (4) Charac- 
terization of mediastinal lesions (Fig. 2) by 
their attenuation coefficient. This is particularly 
helpful in diagnosing lesions containing fat 
such as a prominent pericardial fat pad. Thoracic 
aortic aneurysms and aortic disections also lend 
themselves to identification by computed to- 
mography. (5) Computed tomography’s cross- 
sectional approach allows for a different view- 
point of a questionably abnormal mediastinum. 
This is particularly helpful where a mediastinal 
contour is equivocal and standard radiography 
is unable to sort out tortous or dilated great 
vessels from normal mediastinal structures. (6) 
Evaluation of previously nonvisible structures. 
The diaphragmatic crura are well seen in com- 
puted tomography. Abnormalities such as hema- 
tomas and enlarged lymph nodes in this area 
can also be evaluated. 

In the pulmonary parenchyma, the major 
contribution of computed tomography is in the 
detection of otherwise occult pulmonary nodules. 
CT has proven to be most useful in diagnosing 
nodules located just beneath the pleura, ad- 
jacent to the heart or mediastinum, and the 
costophrenic angles. Initial experience indicates 
that computed tomography detects more nodules 
than either chest radiography or conventional 
whole lung tomography. Computed body tomog- 
raphy should be utilized for complete evalua- 
tion in those patients whose specific therapeutic 
modality is to be chosen based on the presence 
or absence of pulmonary metastases. In addi- 
tion, where a parenchymal resection is con- 
templated based on the presence of a single 
nodide, CT may detect further metastatic de- 
posits. 


for August , 1978 


91 



Fig. 1 

Note the heart and pulmonary vascularity. At this 
window level and width mediastinal detail is not 
obtained. 



Fig. 2 

Normal upper abdomen — not the excellent visualiza- 
tion of the body and tail of the pancreas (arrow- 
heads), the aorta (arrow), and adjacent inferior 
vena cava are well seen. The superior mesenteric 
artery is seen as a grey dot just ventral to the aorta. 


Abdominal Examination 

.At this time, computed tomography appears 
to show some of the most exciting possibilities 
in the abdomen. It appears to nicely comple- 
ment presently available imaging modalities. It 
has outstanding potential in staging of intra- 
abdominal masses as it exquisitely defines tissue 
planes. Obesity and intestinal gas are not a 
problem and therefore the technique is useful 
in those individuals where ultrasound fails. By 
convention, CT scans in the abdomen are dis- 
played as though one is viewing the transected 
specimen from the feet towards the head. In a 
supine scan therefore, the patient’s left is on 
the viewer’s right (Fig. 2) . 

T he pancreas lies in the upper abdomen with 
the head adjacent to the second portion of the 
duodenum. The duodenal sweep is displayed 
by having the patient ingest oral iodinated 
contrast material. The uncinate process is seen 
just posterior to the superior mesenteric vessels. 
The body of the pancreas is located ventral to 
the superior mesenteric artery. The splenic vein 
lies dorsal to the body and tail of the pancreas. 
The pancreatic tail may be variable in its loca- 
tion, but usually lies close to the hilum of the 
spleen. The peripancreatic fat, which is of a 
lower (.1 density than the pancreas, aids in 
visualization of this organ. The diagnosis of 
carcinoma of the pancreas is based on the 


presence of a localized mass, alteration in the 
uniform tapering of the pancreas, obliteration 
of the posterior peripancreatic fat plane, and 
an indistinct pancreatic margin. Obviously, the 
presence of secondary signs of a mass are also 
quite helpful; dilation of the biliary ducts or 
pancreatic duct, distension of the gallbladder, 
or presence of liver metastasis. 

Acute pancreatitis tends to have diffuse in- 
volvement and slightly decreased density of the 
gland. If the disease process is focal, however, 
the appearance is similar to carcinoma. The 
clinical information should aid in differentia- 
tion. The minute calcifications of chronic pan- 
creatitis are easily seen. Pancreatic pseudocysts 
are easily detected by CT with the pseudocyst 
having a decreased attenuation coefficient (Fig. 
3) . Early studies indicate that computed tomog- 
raphic scanning of the pancreas has an accuracy 
in the range of 85% 

Liver Scans 

The normal liver appears as a homogenous 
structure that has a higher density than that 
of the other intra-abdominal organs. Within the 
liver, linear branching structures are present 
which represent the intrahepatic vascularity, 
particularly the portal vein and its branches. 
Normal intrahepatic biliary radicals are not 
visible. 

Solitary masses from hepatocellular carcinoma. 


92 


Illinois Medical Journal 




Fig. 3 

The low attenuation of the fluid within a pancreatic 
pseudocyst (arrow) allows for a high degree of 
sensitivity in detection of this entity. 



Fig. 4 


Marked inhomogeneity of the liver is indicative of 
diffuse metastatic involvement. Compare the appear- 
ance of the liver with that in Fig. 3. 


or metastasis are readily detected. Similarly, 
multiple defects within the liver from metastatic 
disease can be seen with a high degree of sensi- 
tivity. Primary and metastatic neoplasms within 
the liver appear as focal areas of slightly dimin- 
ished density. (Fig. 4) Most are well marginated, 
although some have an indistinct margin with 
the remaining portion of the liver. Injection of 
iodinated contrast material frequently accentu- 
ates the liver-tumor interface and makes detec- 
tion easier. Other space occupying lesions such 
as abscesses, cysts, and hematomas can also be 
detected by computed tomography and their 
attenuation coefficient suggests a specific diag- 
nosis. 

Computed tomography is able to detect varia- 
tions in size or shape of the liver but otherwise 
cirrhosis cannot be diagnosed by this method. 
The exception is the fatty infiltration stage of 
cirrhosis when the liver has a diminished at- 
tenuation. Ascites is easily seen and CT serves 
therefore, as an adjunctive means of diagnosis 
in equivocal cases. Dilated intraphepatic biliary 
radicals, as well as a dilated common bile duct, 
can be detected by CT. The method is of obvi- 
ous value in the differentiation of obstructive 
from nonobstructive jaundice. The accuracy of 
diagnosis in this setting is approximately 90%. 

Uses in Kidney Disease 

The kidney is another area where CT scan- 
ning has proved to be very useful. CT compli- 
ments other imaging techniques in the workup 


of a renal mass. It is particularly useful in those 
cases where the diagnosis by ultrasound is 
equivocal or where the lesion cannot be seen 
because of technical factors. Solitary masses 
within the kidney can be easily detected by 
computed tomography and the nature of the 
mass lesion specified. Additionally, CT can aid 
in the pre-operative staging of renal cell 
carcinoma. The presence of periaortic adeno- 
pathy, liver metastasis, and renal vein involve- 
ment can all be suggested. Cystic lesions within 
the kidney present as a characteristic finding 
with an attenuation coefficient in the range of 
water. CT frequently demonstrates multiple 
cystic lesions when previous studies have demon- 
strated only a solitary cyst and similarly, the 
presence of an unsuspected renal mass is occa- 
sionally noted in a patient being scanned for a 
different clinical indication. 

The presence of hydronephrosis can also be 
detected in the patient with nonfunctioning 
kidneys and nonvisualization on routine radio- 
graphic studies. Perinephric masses, such as 
hematoma and abscess can be diagnosed with a 
high degree of accuracy. 

The adrenal gland can be visualized con- 
sistently and CT scanning is probably the non- 
invasive imaging technique for this organ. The 
technique should prove highly accurate for the 
diagnosis of pheochromocytoma and adrenal 
carcinoma. The accuracy in patients with adrenal 
adenoma and hyperplasia has not yet been 
determined. 


for August , 1978 


93 



Computed tomography has made a significant 
contribution in the detection of periaortic adeno- 
pathy, particularly in evaluating lymph node 
enlargement as seen with Hodgkin’s disease and 
non-Hodgkin’s lymphoma. It is less accurate 
in those neoplasms where the metastatic de- 
posits do not enlarge lymph nodes; in these 
situations, lymphangiography better delineates 
nodal architecture. CT also provides a con- 
venient and accurate means for follow up in 
patients with lymphoma following therapy. 

The accuracy of CT in evaluating the presence 
of lymphoma in the spleen, liver, and mesenteric 
lymph nodes is unknown. Retroperitoneal hem- 
orrhage, abscess and primary tumors can also 
be detected with a very high degree of accuracy. 
Intra-abdominal abscesses such as subphrenic 
and subhepatic lesions additionally, can be 
studied with computed tomography. 

Although ultrasound is the primary imaging 
modality in the female pelvis, it does have 
certain limitations and therefore computed to- 
mography is of value in the evaluation of both 
the female and male pelvis. Specifically, CT is 
able to define rather exactly, normal tissue 


planes and in particular, the pelvic side walls. 
CT aids in the staging of bladder tumors and 
that spread of neoplasm beyond the bladder 
wall is easily seen. Staging of the lesion with 
CT has abvious implications in the planning of 
a radiation therapy field. The position of the 
ureters with respect to a pelvic mass can also 
be determined following the administration of 
intravenous contrast material. 

Although the uterus and ovaries can be vis- 
ualized by CT, this procedure remains adjunc- 
tive to ultrasound with respect to imaging these 
structures. Similarly the prostate can be visual- 
ized by both modalities, but probably ultra- 
sound remains the imaging technique of choice. 

There are numerous other anatomic areas 
where CT has tremendous potential. For ex- 
ample, we are presently evaluating computed 
tomography in staging laryngeal neoplasms. In- 
volvement of cartilagenous structures and sub- 
glottic extension should be detectable. Abnor- 
malities of the spine, particularly spinal stenosis, 
can be diagnosed by CT and this cross-sectional 
approach gives a new dimension to imaging 
techniques. ◄ 



94 


Illinois Medical Journal 




Report on the 1978 
AMA-RPS Annual Meeting 


By Linda L. Hughey, M.D. /Wilmette 

This is a monthly column which welcomes contributions, comments, and ques- 
tions from interested readers. Address all correspondence to Dr. Linda Hughey, 
c/o the Illinois Medical Journal, 55 E. Monroe, Chicago, III. 60603. 


The AMA-RPS meeting- in St. Louis was at- 
tended by 76 residents; 66 were official delegates. 
Illinois had six delegates of its allotted eleven. 
Any Illinois resident & member of the AMA in 
attendance woidd have been eligible for delegate 
status. 

Twenty three states were represented as fol- 
lows: Alabama (2) , Arizona (4) , California (5) , 
Colorado (2), Connecticut (1), Florida (6), Il- 
linois (6), Indiana (3), Iowa (1), Massachu- 
setts (1), Michigan (3), Minnesota (4), Ne- 
braska (2), New York (1), North Carolina (1), 
Pennsylvania (7) , South Carolina (3) , Tennes- 
see (1), Texas (13), Virginia (1), Washington 
(2), Washington, D.C. (1), W. Virginia (1), 
Wisconsin (4), Canal Zone (1). 

Residents hailed from a wide variety of spe- 
cialty programs: Family Medicine (11), Internal 
Medicine (9), General Surgery, OB/GYN (5), 
Emergency Medicine, Psychiatry & Radiology 
(4) , Anesthesia & Orthopedic Surgery (3) , Neu- 
rologic Surgery, Neurology, Pathology (2) , & one 
resident each from Allergy, Dematology, Oto- 
laryngology, & Social Pediatrics. Obviously a 
wide range of specialties was represented, but an 
even wider geographic distribution is needed. 

The convention included workshops on the 
impaired physician, cost containment, teaching 
skills, & organizational skills. After evening re- 
ceptions & visits with state delegations, the resi- 
dents scattered all over the city of St. Louis to 
sample night life under the Silver Arch. 

The following Illinois residents attended as 
delegates: 

James DeBord, University of Illinois; 

Linda Hughey, University of Chicago; 

Ira Isaacson, Northwestern University; 

Benjamin LeCompte III, Rush-Pres. St. 

Luke’s; 

James McCreary, University of llinois and 

Alan M. Sadov, Rush-Pres St. Luke’s 


Illinois will be well represented on the Govern- 
ing Council in the coming year. Dr. DeBord sits 
on the AMA Council on Scientific Affairs. Dr. 
Hughey was elected Secretary-Editor of the na- 
tional AMA/RPS. 

The majority of the RPS delegates had never 
attended an AMA convention before. That is 
the nature of the RPS— a young, rapidly chang- 
ing group with a lot of room for new ideas and 
new faces. The Illinois RPS is seeking people in- 
terested in involvement at both state & national 
levels. If interested, you may contact Ira Isaacson, 
who is chairman of the Illinois RPS, at the ISMS 
office. 

Attending a convention guarantees that you 
will at least meet interesting people, learn a bit 
about the politics of health care delivery, and 
find that residents share many common concerns. 
At most you may even walk away with a national 
office or some solutions to those shared prob- 
lems. We shall look forward to hearing from you. 


A Call for Newsbits 

Does your housestaff have any projects, prob- 
lems, or headaches that might be of general in- 
terest? Please drop a note to Dr. Linda Hughey 
via the ISMS at 55 E. Monroe, Chicago, IL 
60603. Resident activities may be publicized in 
this colunm. Furthermore, we may be able to 
help with problems either through the ISMS or 
AMA services to members. Please keep us posted, 
and we shall try in turn to keep you posted on 
useful events & services. 


for August, 1978 


95 



\ 

of the ISMS auxiliary 

Mrs. Eugene Vickery, Editor 

J 


Growth Patterns 



National Convention Scenes 


Mrs. Earl V. Klaren, President, ISMSA 

These photos tell the story of a productive na- 
tional convention in St. Louis in June. I hope 
they’ll also bring a reminder to attend our own 
Fall Conference, September 19, 1978, at the 
Sheraton Northbrook Hotel. Fall Conference for 
the northern counties will center on “The Fam- 
ily in Question: Can It Survive?” An excellent 
roster of speakers will provoke your interest— and 
perhaps some solutions. 


Illinois Tops in Nation 
in AMA-ERF Contributions 

Mrs. Selig Hodes, (L) AMA-ERF State Chairman, and 
Mrs. Karl Reddies, Co-chairman, proudly display the 
achievement award they received during the National 
Convention in St. Louis. Illinois topped all other states in 
total contribution to American Medical Association Edu- 
cation and Research Foundation. 

This is the fourth year that Illinois has won top hon- 
ors. The Auxiliary appreciates the terrific cooperation and 
contributions of the Illinois State Medical Society in this 
project. 



Presidents 

Past — Present — and Future 

(L-R) Mrs. Edward Szewczyk, immediate past president 
of ISMSA; Mrs. Earl Klaren, 1978-79 president; and Mrs. 
R. S. Hoover, president-elect, paused for this picture dur- 
ing the Illinois State Breakfast in St. Louis during the 
AMA Convention. 


9G 


Illinois Medical Journal 



Several of t lie delegates, alternates and members attending the AMA Auxiliary Convention in St. Louis June 18- 
21 were (left to right) , Front row: Mrs. William Hodges, Mrs. Edward Szewczyk, past president; Mrs. Earl Klaren, 
ISMSA president, Mrs. Selig Hodes, Mrs. Karl Reddies. Second row: Mrs. Eugene Leonard, Mrs. Willard Scrivner, 
Mrs. Harlan English, Mrs. Wendell Roller, Mrs. Eugene Vickery. Standing (3rd row): Mrs. Henry Schorr, Mrs. 
August Martinucci, Mrs. Frank Holman, and Mrs. Norman Taylor. 



Ogle County Auxiliary 
Wins Regional Award 
At National Convention 


Mrs. Don Hinderliter, president of Ogle County Medical 
Auxiliary and newly elected 2nd Vice President of ISMS 
Auxiliary, was in St. Louis to receive her county’s AMA- 
ERI*’ award. Ogle County has nine members and they 
worked very hard to raise $212.00 per member for AMA- 
ERF. They were North Central's highest contributor and 
ranked second in the whole United States. Ogle is one of 
our newest counties, organized in 1975, and we’re all very 
proud of them! 


MICHAEL REESE 
HEALTH PLAN 

has an immediate opening 
for a full-time 
Obstetrician-Gynecologist 

One who is board eligible or board 
certified and interested in prac- 
ticing on the staff of a pres- 
tigious teaching medical center. 
Our health plan (HMO) provides 
pre-paid comprehensive inpatient 
and outpatient care to 12,500 pa- 
tients at the Michael Reese Medi- 
cal Center. 

Salary and benefits are generous. 
For further details, please contact 
Dr. Joseph Sh u I ruff. Medical Di- 
rector. 


ii 


MICHAEL REESE HEALTH PLAN 

3055 COTTAGE GROVE 
CHICAGO, IL 60616 
Phone (312) 791-2852 


Equal opportunity employer m/f , 


for August, 197 S 


97 


How to Swim With Sharks: A Primer 


Actually, nobody wants to swim with sharks. 
It is not an acknowledged sport, and it is neither 
enjoyable nor exhilarating. These instructions 
are written primarily for the benefit of those 
who, by virtue of their occupation, find they 
must swim and find that the water is infested 
with sharks. 

It is of obvious importance to learn that the 
waters are shark infested before commencing to 
swim. It is safe to assume that this initial deter- 
mination has already been made. If the waters 
were clearly not shark infested, this would be of 
little interest or value. If the waters were shark 
infested, the naive swimmer is by now probably 
beyond help; at the very least he has doubtless 
lost any interest in learning how to swim with 
sharks. 

Finally, swimming with sharks is like any other 
skill: it cannot be learned from books alone; 
the novice must practice in order to develop the 
skill. The following rules simply set forth the 
fundamental principles which, if followed, will 
make it possible to survive while becoming ex- 
pert through practice. 

Mules 

1. Assume unidentified fish are sharks— Not 
all sharks look like sharks, and some fish which 
are not sharks sometimes act like sharks. Unless 
you have witnessed docile behavior in their pres- 
ence or shed blood on more than one occasion, it 
is best to assume an unknown species is a shark. 
Inexperienced swimmers have been badly man- 
gled by assuming that docile behavior in the 
absence of blood indicates that the fish is not a 
shark. 

2. Do not bleed— It is a cardinal principle that 
if you are injured either by accident or by intent 
you must not bleed. Experience shows that bleed- 
ing prompts an even more aggressive attack and 
will often provoke the participation of sharks 
which are uninvolved or, as noted above, are 
usually docile. 

Admittedly, it is difficult not to bleed when in- 


jured. Indeed, at first this may seem impossible. 
Diligent practice, however, will permit the ex- 
perienced swimmer to sustain a serious lacera- 
tion without bleeding and without even exhibit- 
ing any loss of composure. This hemostatic re- 
flex can in part be conditioned, but there may be 
constitutional aspects as well. Those who cannot 
learn to control their bleeding should not at- 
tempt to swim with sharks, for the peril is too 
great. 

The control of bleeding has a positive protec- 
tive element for the swimmer. The shark will be 
confused as to whether or not his attack has in- 
jured you, and confusion is to the swimmer’s 
advantage. On the other hand, the shark may 
know he has injured you and be puzzled as to 
why you do not bleed or show distress. This also 
has a profound effect on sharks. They begin 
questioning their own potency or, alternatively, 
believe the swimmer to have supernatural pow- 
ers. 

3. Counter any aggression promptly.— Sharks 
rarely attack a swimmer without warning. Usual- 
ly there is some tenative, exploratory aggressive 
action. It is important that the swimmer recog- 
nizes that this behavior is a prelude to an attack 
and takes prompt and vigorous remedial action. 
The appropriate countermove is a sharp blow 
to the nose. Almost invariably this will prevent 
a full-scale attack, for it makes it clear that you 
understand the shark’s intentions and are pre- 
pared to use whatever force is necessary to repel 
his aggressive actions. 

Some swimmers mistakenly believe that an in- 
gratiating attitude will dispell an attack under 
these circumstances. This is not correct: such a 
response provokes a shark attack. Those who 
hold this erroneous view can usually be identified 
by their missing limb. 

4. Get out if someone is bleeding.— If a swim- 
mer (or shark) has been injured and is bleeding, 
get out of the water promptly. The presence of 
blood and the thrashing of water will elicit ag- 
gressive behavior even in the most docile of 
sharks. This latter group, poorly skilled in at- 


98 


Illinois Medical Journal 


tacking, often behaves irrationally and may at- 
tack uninvolved swimmers or sharks. Some are 
so inept that in the confusion they injure them- 
selves. 

No useful purpose is served in attempting to 
rescue the injured swimmer. He either will or 
will not survive the attack, and your intervention 
cannot protect him once blood has been shed. 
Those who survive such an attack rarely venture 
to swim with sharks again, an attitude which is 
readily understandable. 

The lack of effective countermeasures to a 
fully developed shark attack emphasizes the 
importance of the earlier rules. 

5. Use anticipatory retaliation.— A constant 
danger to the skilled swimmer is that the sharks 
will forget that he is skilled and may attack in 
error. Some sharks have notoriously poor mem- 
ories in this regard. This memory loss can be 
prevented by a program of anticipatory retalia- 
tion. The skilled swimmer should engage in 
these activities periodically, and the periods 
should be less than the memory span of the 
shark. Thus, it is not possible to state fixed in- 
tervals. The procedure may need to be repeated 
frequently with forgetful sharks and need be 
done only once for sharks with total recall. 

The procedure is essential the same as de- 
scribed under under rule three— a sharp blow to 
the nose. Here, however, the blow is unexpected 
and serves to remind the shark that you are both 
alert and unafraid. Swimmers should take care 
not to injure the shark and draw blood during 
this exercise for two reasons: First, sharks often 
bleed profusely, and this leads to the chaotic 
situation described under rule four. Second, if 
swimmers act in this fashion it may not be pos- 
sible to distinguish swimmers from sharks. In- 
deed, renegade swimmers are far worse than 
sharks, for none of the rules or measures de- 
scribed here is effective in controlling: their 
aggressive behavior. 

6. Disorganize an organized attack— Usually 
sharks are sufficiently self-centered that they do 


not act in concert against a swimmer. This lack 
of organization greatly reduces the risk of swim- 
ming among sharks. However, upon occasion the 
sharks may launch a coordinated attack upon a 
swimmer or even upon one of their number. 
While the latter event is of no particular con- 
cern to a swimmer, it is essential that one know 
how to handle an organized shark attack directed 
against a swimmer. 

The proper strategy is diversion. Sharks can 
be diverted from their organized attack in one of 
two ways. First, sharks as a group are especially 
prone to internal discussion. An experienced 
swimmer can divert an organized attack by in- 
troducing something, often something minor or 
trivial, which sets the sharks to fighting among 
themselves. Usually by the time the internal con- 
flict is settled the sharks cannot even recall what 
they were setting about to do, much less get or- 
ganized to do it. 

A second mechanism of diversion is to intro- 
duce something which so enrages the members 
of the group that they begin to lash out in all 
directions, even attacking inanimate objects in 
their fury. 

What should be introduced? Unfortunately, 
different things prompt internal dissension or 
blind fury in different groups of sharks. Here one 
must be experienced in dealing with a given 
group of sharks, for what enrages one group will 
pass unnoted by another. 

It is scarcely necessary to state that it is un- 
ethical for a swimmer under attack by a group 
of sharks to counter the attack by diverting 
them to another swimmer. It is, however, com- 
mon to see this done by novice swimmers and by 
sharks when they fall under a concerted attack. 

X 

“How to Swim with Sharks,” came into the 
Journal offices anonymously, with a single 
note reading “Perspectives in Biology and Med- 
cine. Summer, 1973.” If our readers have 
knowledge of authorship, the information will 
be gladly acknowledged, and credit given in 
a forthcoming issue. 


for August, 1978 


99 


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100 


Illinois Medical Journal 


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(Continued from page 67) 

Diagnosis: Bronchogenic carcinoma of left 
upper lung. 

Figures 1 and 2 were read in the emergency 
room as normal. Indeed, there is no fracture or 
dislocation present. There is, however, a large 
radiodensity occupying most of the visible lung 
field. This mass is present on both internal and 
external rotation films. The patient was called 
back to the hospital on the following day and 
chest film (Figure 3) showed a huge left lung 
mass. This proved to be a bronchogenic car- 
cinoma and was responsible for the patient’s 
symptoms. 

The moral to this story is to avoid focusing 
(either mentally or visually) solely on your 
original suspicions. Because shoulder films were 
ordered, the orginal film reader looked only at 
the bones. She saw no fracture or dislocation 
and so interpreted the films as normal. The 
large mass was missed not because it is a subtle 
or difficult finding, but because no one directed 
attention away from their primary considera- 
tion. Examine ALL of the film. It just takes 
an extra few seconds. 



Figure 3 

Bronchogenic carcinoma occupying left upper lung. 


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for August , 1978 


101 




IMPAC 

ILLINOIS MEDICAL POLITICAL ACTION COMMITTEE 

55 East Monroe Street 
Chicago, Illinois 60603 
312/782-1963 


Dear Doctor: 

A recently released Washington survey indicated that in the next four years, 
physicians will become the most politically powerful group in the county. 

This was attributed to three factors: 

1 ) physicians are thought to he creditable ; 

2 ) physicians are united in their efforts ; and 

3) physicians acre willing to use their time and money 
to support causes they are interested in. 

As Chairman of the Illinois Medical Political Action Committee, I find this 
survey particularly interesting since half of the physicians in Illinois 
have not taken the easiest step in achieving a goal to which we, as citizens 
and physicians, must be committed -- good government. Fifty percent of my 
fellow physicians have not yet joined IMPAC. 

In these days of double-digit inflation and ever-increasing government regu- 
lation of our lives, no single item can be higher on our priority list than 
electing top quality people to government service. IMPAC is committed to 
this goal and you can help by joining. Mail your check to: IMPAC, 55 East 
Monroe Street, Suite 3510, Chicago, Illinois 60603. 

Remember, IMPAC is scrupulously non-partisan. We contribute to good candidates 
without regard for political party affiliation. 

Won't you join us in this important activity? 

Herbert Sohn, M.D. 

Chairman 


Contributions are not limited to the suggested amount. Neither the Illinois State Medical Society nor the AHA will favor or disadvantage anyone 
based upon the amounts of or failure to make pac contributions. Copies of IMPAC S AMPAC reports are filed with and are available for purchase 
from the Federal Election Commission, Washington, D.C. Contributions are subject to the limitations of FEC regulations. Sections 110.1, 110.2 
& 110.5. (Federal regulations require this notice.) IMPAC reports are also filed with the State Board of Elections, and are or will be available 
for purchase from the State Board of Elections, 1020 South Spring Street, Springfield, Illinois 62704. 


102 


Illinois Medical Journal 





*D octets Ttewt 

IPS TO HOLD FIFTH ANNUAL FALL WEEKEND MEETING-The Illinois Psychiatric So- 
ciety will hold its Fifth Annual Fall Weekend Meeting from October 6-8, 
at the Chicago Hyatt Regency O’Hare. 

Jerome S. Beigler, M.D., president and Melvin Prosen, program chairman, 
have announced that the three-day session will feature symposia, work- 
shops, lectures and film presentations on a variety of clinical and socio- 
economic issues. Those who participate in the entire program will be en- 
titled to receive 14 hours of AMA Category 1 CME credit. 

For further information, please contact Wendy J. Smith at the Society’s 
offices, 55 East Monroe, Suite 3510, Chicago 60603 (312-782-1654). 

INTERSTATE SCIENTIFIC ASSEMBLY ANNOUNCED-The 63rd Annual International Sci- 
entific Assembly of the Interstate Postgraduate Medical Association is 
scheduled for October 23-26 at the Washington Hilton Hotel in Washing- 
ton, D.C. The program of clinical discussion and instruction is designed 
for primary care physicians practicing in the U.S. and Canada. For further 
information, please contact Alton Ochsner, M.D., program chairman, Inter- 
state Postgraduate Medical Association, P.O. Box 1109, Madison, WI 53701. 

LAST INTRAV TRIP FOR 1978— One of the ISMS travel programs for 1978 remains open 
for reservations. Persons interested in the West Indies Air/Sea Christmas 
Cruise scheduled for December 19-27, 1978, should contact the ISMS head- 
quarters as soon as possible. Information on 1979 programs will be avail- 
able in the near future. 

DEATH AWARENESS CONSORTIUM ANNOUNCED-The Illinois Funeral Directors As- 
sociation will sponsor a special program for health care professionals on 
September 20, from 9:30 a.m. to 4:30 p.m., in the Chicago Room at McCor- 
mick Place. The program, which is co-sponsored by ISMS, will feature 
speakers on coping with sudden death and mourning, a wholistic approach 
to grief and health care and several other topics. Interested persons should 
contact the Illinois Funeral Directors Association, 1045 Outer Park Drive, 
Suite 120, Springfield, 62704. A self-addressed, stamped envelope with pre- 
payment is requested. The registration fee is $12.00, and $18.00 for both 
the seminar and luncheon. 

I QUIT SMOKING CLINICS —The Illinois Interagency Council on Smoking and Disease and 
the American Cancer Society will sponsor a series of clinics in coming 
months. Clinics are also scheduled in cooperation with the Chicago De- 
partment of Health, and several will be held in Chicago suburbs and Rock- 
ford. For further information, contact the Illinois Interagency Council on 
Smoking and Disease, 20 N. Wacker Drive, Room 1240, Chicago 60606 
(312-346-4675). 

SNAKE-BITE CENTER— The Antivenin Committee of the American Association of Zoolog- 
ical Parks and Aquariums has announced that a 24-hour Antivenin Index 
Center is available to physicians seeking antidotes for snakebites. The cen- 
ter maintains a catalog of snake-bite antivenins stocked in North American 
zoos, laboratories and related institutions. They can inform treating physi- 
cians of the nearest sources and make arrangements for emergency delivery. 
Physicians who encounter this problem are asked to determine the scien- 
tific and vernacular name of the snake involved, and call 405-271-5454 to 
obtain the necessary information. 


for August, 1978 


103 


CALL FOR ABSTRACTS— The American College of Chest Physicians invites abstracts for the 
International Conference on Occupational Lung Disease, which will be 
held February 27-March 2, 1979, at the Hyatt Regency-Embarcadero in 
San Francisco. Papers on all aspects, including particle deposition, lung de- 
fenses, epidemiology and pathology are requested. They should not exceed 
600 words in length and must be received by September 11, 1978. For 
further information, please write: Chairman, Scientific Program Committee, 
International Conference on Occupational Lung Disease, c/o ACCP, 911 
Busse Highway, Park Ridge, IL 60068. 

PHYSICIANS IN THE NEWS-Clifton L. Reeder, M.D., Park Ridge, was installed as 1978- 
79 president of the Chicago Medical Society. Doctor Reeder is the chief 
executive officer and medical director of Bodimetric Profiles Division, Amer- 
ican Service, Chicago, and also medical director and director of Bodimetric 
Profiles, Canada, Ltd. 

The Chicago Medical Society also announced that Lawrence L. Hirsch, 
M.D., Chicago, is their new president-elect. Doctor Hirsch, a member of 
the ISMS Board of Trustees and chairman of the Policy Committee, is the 
former chairman of the ISMS Publications Committee and current chairman 
of the department of family medicine at the Chicago Medical School. 
Robert C. Hamilton, M.D., Chicago, was named chairman of the CMS 
Council, and Finley W. Brown, Jr., M.D., was elected vice chairman. Frank- 
lin Lounsbury, M.D., River Forest and John P. Harrod, Jr., M.D., Chicago, 
were renamed to their respective posts as secretary and treasurer of the 
Society. 

Bertram B. Moss, M.D., Chicago, has been named co-director of the Illi- 
nois Masonic Medical Center Family Practice Center in Chicago. Doctor 
Moss, former director of the St. Joseph Hospital Family Health Center, was 
also appointed an adjunct associate professor of aging health care services 
for the UI School of Public Health. . . . The University of Illinois House 
Staff Association has elected new officers. James McCreary, M.D., Cicero, 
was elected president, Lawrence Pankau, M.D., Chicago, vice president and 
Mary Louise Kaminski, M.D., Chicago, secretary-treasurer of the 460-mem- 
ber association. 

The Chicago Laryngological and Otological Society has elected George 
A. Sisson, M.D., Chicago to serve as their 1978-79 president. William M. 
Gatti, M.D., Bannockburn and Jack D. Clemis, M.D., Wilmette, were 
elected vice president and secretary-treasurer respectively. 

The medical staff at Jackson Park Hospital has elected Leonard I. Silver- 
man, M.D., Chicago, to serve as their new president. . . . The citizens of 
Chicago’s twelfth congressional district have chosen Gilbert Bogen, M.D., 
a Chicago psychiatrist, to oppose republican incumbent U.S. Rep. Philip M. 
Crane in the November elections. . . . New officers of the Chicago Gyneco- 
logical Society are: Robert E. Lane, M.D., Northbrook, president, Herman 
A. Strauss, M.D., Chicago vice president, Michael P. MacLaverty, M.D., 
Chicago, president-elect, Uwe W. Freese, M.D., Chicago, treasurer, An- 
tonio Scommegna, M.D., Chicago, secretary and Holden K. Farrar, Jr., M.D., 
Winnetka, assistant secretary. 

RESOLUTIONS DEADLINE— Proposed resolutions for the Interim Meeting of the ISMS House 
of Delegates must be postmarked no later than September 2, 1978, in order 
to be published in the 1MJ. In accordance with a resolution passed at the 
1978 Annual Meeting resolutions will be published in the Journal by author 
and subject only. 

The final deadline for resolutions for the 1978 Interim meeting is October 
7, 1978. Resolutions received after that date will be considered late resolu- 
tions and require special action for possible consideration. 


104 


Illinois Medical Journal 



The Voluntary Effort (VE) to check the 
health cost spiral appears to be working. 

Statistics released last month reveal that hos- 
pital costs rose at the equivalent of a 12.7% 
annual rate during the first four months of this 
year— down from a nearly 16% rate last year. 
In April, the 11.3% annualized rate of increase 
was the lowest of any month since 1974. While 
these figures are encouraging, they represent only 
a short-term decrease that will be increasingly 
difficult to hold and improve upon over the 
long run. 

The goal of the VE— launched last Novem- 
ber by AMA, AHA and Federation of Ameri- 
can Hospitals— was to reduce hospital rate in- 
creases by 2% both this year and next. Its 
success thus far is largely attributable to the 
program’s growing momentum at the state level. 

Illinois is a good example. ISMS and the 
Illinois Hospital Association have united their 
cost containment programs and formed a steer- 
ing committee to direct the VE in Illinois. In 
addition, the ISMS Task Force on Cost Effec- 
tiveness is continuing its activities and will serve 
as a valuable resource body for the steering 
committee. This type of cooperation within the 
health care “industry” serves to deflate the 
Carter Administration’s charge that the VE is 
merely a charade to stall implementation of 
federal controls. 


Obviously, the VE now must be viewed as a 
positive commitment. Nonetheless, the Admin- 
istration’s attempted power grab continues along 
with a move to undermine our initiatives. A 
classic example was the Justice Department’s 
recent refusal— at the urging of HEW— to grant 
anti-trust exemptions to the VE. 

If the Administration succeeds in ramming 
a mandatory hospital cost containment bill 
through Congress, it is reasonable to assume 
that physicians’ fees will be the next target. 
Newly-installed AMA President Dr. Thomas 
Nesbitt acknowledged that possibility when he 
urged physicians to cut the rate of fee in- 
creases by one percent for each of the next two 
years. That formula— which parallels the VE 
goal— would bring the rate of fee escalation 
close to the “all items” rate of the Consumer 
Price Index. 

The Administration has not yet convinced 
Congress that federal cost controls are needed. 
However, the Congressional viewpoint could 
radically change if year-end totals for the VE 
fall short of target. 

The private sector of the health care system 
has made significant progress toward a solu- 
tion to the cost problem. However, the ultimate 
success of this effort— and the future of our sys- 
tem— depends upon the combined efforts of 
each hospital and you, the practicing physicians. 






David S. Fox, M.D., President 


105 


for August, 1978 


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EKG 

(Continued from page 63) 

Answers: 1. B & C 2. E 

The electrocardiogram shows a tachycardia 
with a wide QRS complex. The QRS duration 
is approximately 0.14 seconds and the rate is 
136 beats per minute. The black marks in lead 
II mark out P waves which indicate atrioven- 
tricular dissociation. This plus the wide based 
QRS complex suggests that this is a ventricular 
tachycardia. The RR cycles are not precisely 
regular but this is not unusual in ventricular 
tachycardia. The presence of sinus P waves at 
a rate of 86 beats per minute rules out atrial 
fibrillation as a consideration as well as atrial 
tachycardia. A fasicular ventricular tachycardia 
would have a normal QRS duration and a QRS 
contour suggesting incomplete right bundle 
branch block. This tachycardia is thought to 
arise in the posterior division of the left bundle 
branch. The QRS contour of the ventricular 
tachycardia in this patient resembles left bundle 
branch block. Therefore, the focus of the 
ventricular tachycardia is probably in the right 
ventricle. This patient subsequently underwent 
cardiac catheterization and coronary angiography 
to evaluate his cardiac anatomy. The coronary 
arteriogram showed a totally occluded right 
coronary artery and a discreet paradoxically con- 
tracting posterior left ventricular aneurysm. All 
of the intracardiac pressures were within normal 
limits. Surgery did not seem justified on the 
basis of his cardiac anatomy since the distal 
right coronary artery was not well visualized and 
the posterior left ventricular aneurysm was too 
small. A decision was made to treat the patient 
with medications utilizing drug levels to maxi- 
mally tolerated doses. On a combination of 
Procainamide, 750 mg. Q 6 hours and Diso- 
pyramide, 200 mg. Q 6 hours with Lanoxin and 
Lasix, the tachycardias were controlled. The pa- 
tient was gradually ambulated and subsequently 
was discharged from the hospital. He continues 
to do well without further tachycardias at eight 
months of follow-up. The prognosis in cases 
of ventricular tachycardia is related to the 
severity of the underlying heart disease, that is, 
congestive heart failure or Digitalis intoxication 
or the severity of coronary artery disease. In 
this patient’s case, he only had single vessel 
coronary artery and his left ventricular function 
in sinus rhythm were normal. 


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Along the Track of Education 

By Magda Brown, Publicity Chairman 


The American Association of Medical Assis- 
tants— Illinois Society, offers a well-rounded edu- 
cational day for medical office staff on Sunday, 
October 1, 1978. The program is scheduled from 
8:30 a.m. until 4:00 p.m. at the Ramada Inn, 
500 W. River Road, Elgin, 111. (312-695-3000) 

Greetings by Mrs. Leslie Lee, President, 
AAMA Illinois Society and by Ms. Mary Wool- 
cott, President, Kane County Chapter, will open 
the days program. The meeting is coordinated 
by the Kane County Chapter under the direc- 
tion of Mrs. Phyllis Harwood, CMA-AC. 

Thomas R. Harwood, M.D., a pathologist and 
associate professor at Northwestern University 
medical and dental schools, will present a talk 
entitled “On The Track of Better Utilization of 
the Medical Laboratory.” He will consider the 
purposes of lab. tests, interpretation of results, 
and utilizing tests in patient care. 

Daniel Weiler, Assistant State’s Attorney from 
Kane County and a member of the local, state, 
and national bar associations will discuss “Phy- 
sician Liens, Estate Filings, and Closing a Medi- 
cal Office Upon Death or Retirement of a 
Physician.” He will stress the importance of 
estate filings, what the medical office assistant 


should know regarding them, the procedures 
to be followed and the rights of patients under 
these conditions. 

“Current Bookkeeping Procedures” by Mr. 
David Hofer, a certified public accountant and 
field consultant for Medidentic, Inc., will focus 
in on bookkeeping methods utilized exclusively 
in medical offices. These include pegboard sys- 
tems— both in check writing and daysheet jour- 
nals, payroll procedures and requirements, quar- 
terly payroll reports, balancing bank statements, 
and balancing and collection of accounts re- 
ceivable. 

Application has been filed with the American 
Association of Medical Assistants for considera- 
tion of awarding Continuing Education Units 
for the above listed subjects. 

Registration fee includes luncheon. Before 
September 15th the cost for members is $10.00, 
students: $7.50, and non-members: $12.50. Late 
registration fee for members is $12.50, students: 
$10.00, and non-members: $15.00. Please make 
check payable to: AAMA, Illinois Society, Per- 
sonal Development. Mail it with the form below 
to: Mrs. Phyllis Harwood, 1142 Florimond Dr., 
Elgin, 60120 (312-742-6804). The registration 
deadline is September 25, 1978. 


please detach 


Name 


Address 


AAMA Member 


yes / no 


County Chapter 




108 


Illinois Medical Journal 


CLASSIFIED ADVERTISING 


POSITIONS & PRACTICE OPPORTUNITIES 


FULL TIME PHYSICIAN for Industrial Clinic in Skokie. Surgical ex- 
perience needed. Salary negotiable. Must have Illinois license. Call 
(312) 674-4800, Mrs. McCubbin. 


OPPORTUNITIES FOR PHYSICIANS IN INDIANA— There are several 
excellent openings among the Indiana State Hospitals at various 
locations throughout the state for psychiatrists and physicians of 
other specialties, at most experience levels. A newly-revised salary 
schedule offers a very competitive income plus a generous package 
of fringe benefits. An adjunct practice is possible beyond the reg- 
ular working hours and on-call responsibilities. Please reply with a 
copy of the c.v. to: Farabee & Associates, Inc., P.O. Box 472, Mur- 
ray, KY 42071 or call (collect) (502) 753-9772. Farabee is retained by 
the Indiana Department of Mental Health. 


ACADEMIC DIRECTOR, INTERNAL MEDICINE: University of Illinois 
affiliated community hospital seeks individual to be responsible 
for undergraduate, graduate and continuing medical education, and 
administration of residency and outpatient center. Physician we seek 
must be American Board of Internal Medicine certified. In return 
we offer a challenging and rewarding experience plus a competi- 
tive salary and benefit program. Send resume in complete con- 
fidence to: Box 917, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago 
60603. 


WANTED: INDUSTRIAL PHYSICIAN: Unusual opportunity for Illi- 
nois licensed physician. Full time industrial work with minor 
traumatic surgery and physical examinations. Regular hours. Ad- 
vancement for right person. Starting salary negotiable. Write to 
Box 920, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago, 60603. 


ORTHOPEDIC SURGEON who desires to locate in a rural area of 
southern Illinois needed to serve two community hospitals. One 
hour from St. Louis. Good educational system for children. Excellent 
recreation. Reply: T. K. Janssen, Administrator, Washington County 
Hospital, Nashville, Illinois 62263. 


WANTED— M.D., certified Family Practice, to direct and establish 
Family Practice Residency. Please reply to Box 927, c/o IMJ, 55 E. 
Monroe, Suite 3510, Chicago, 60603. 


ENT SPECIALIST needed in a large, fast growing Chicago suburb. 
No other ENT specialist in town. Very favorable terms. Send resume 
to Box 926, c/o IMJ, 55 E. Monroe, Chicago, Illinois 60603. 


DERMATOLOGIST needed for a large, fast growing Chicago suburb. 
Solo practice. Ideal for a second office. Office space available in a 
new medical complex. Very favorable terms. Send resume to Box 
928, c/o IMJ, 55 E. Monroe, Chicago, Illinois 60603. 


OVERHEAD MOUNTING? WORKING LONG HOURS? Consider work- 
ing in a University Health Service. 40 hour week— positive fringe 
benefits including generous vacation times. Illinois license. Equal 
opportunity/affirmative action employer. Contact: M. M. Torray, M.D., 
Illinois State University, Normal, Illinois 61761. Tel.: 309-438-8655. 


MATTOON-CHARLESTON, ILLINOIS. Sara Bush Lincoln Health Cen- 
ter Emergency Department has July opening for qualified physician. 
Guarantee $50,000-$55,000 with ideal working conditions and sched- 
ule. Send curriculum vitae to Stephen Allin, M.D., Emergency De- 
partment Director, P.O. Box 372, Mattoon, Illinois 61938 or call toll 
free 1-800-325-3982 for details. 


EMERGENCY DEPARTMENT PHYSICIAN: Become part of an expand- 
ing, dynamic multispecialty clinic in midwest university community 
of 100,000. Excellent salary, benefits. Write or call Medical Director, 
Carle Clinic, Urbana, IL 61801, (217) 337-3239. 


FAMILY PRACTITIONER-To associate with one senior general prac- 
titioner and one surgeon in rural southern Illinois. Excellent educa- 
tional system and recreation. Financially sound community. One hour 
from St. Louis. JCAH 72-bed hospital in Nashville. Association avail- 
able now. Contact: T. K. Janssen, Administrator, Washington County 
Hospital, Nashville, Illinois, (618) 327-8236. 


PHYSICIAN WITH EMPATHY TOWARD COLLEGE AGE population to 
practice general medicine in 38 bed accredited hospital with large 
outpatient clinic. Salary negotiable. Excellent fringe benefits. Contact 

L. W. Combs, M.D., Director, Purdue University Student Hospital, 
West Lafayette, IN 47907, (317) 749-2441. Equal access/equal op- 
portunity employer. 


PRIMARY CARE PHYSICIAN: We seek a primary care physician, spe- 
cialist or generalist, for JCAH-accredited hospital in central Illinois. 
Population: 4,500— service area 19,000. Hospital affilated with a 
major medical center and teaching hospital which provides oppor- 
tunities for continuing medical education and support activities, 
ensuring against professional isolation. Hospital will furnish office 
in building on grounds and guaranteed base salary, plus other 
amenities. For further information write: Box 931, c/o IMJ, 55 E. 
Monroe, Suite 3510, Chicago, III. 60603. 


FAMILY PRACTICE PHYSICIAN who is interested in obstetrics 
wanted to do primary care. $42,000 plus fringes (IRS-approved 
profit sharing plan) to start. Contact H. Osmus, Administrator, 
Hedges Clinic S.C., 222 Colorado, Frankfort, IL 60423; or (815) 
469-2123. 


ILLINOIS— PEORIA— Interviewing career Emergency Physicians for 
full-time openings starting immediately and Jan. 1. Opportunity to 
join young ACEP oriented physicians' group in 550-bed Medical- 
Surgical Hospital affiliated with Peoria School of Medicine. Good 
specialty backup. Flexible scheduling. Superior compensation with 
liberal fringe benefits including malpractice. Contact H. T. Stratton, 

M.D.; Methodist Medical Center, 221 NE Monroe, Peoria, IL 61636; 
(309) 672-4974 or (309) 672-5501. 


CHILD PSYCHIATRIST— Full or part time. Modern residential treat- 
ment center for children & adolescents. Write or call Jose R. 
Sanchez, M.D., Medical Director, Chicago-Read Mental Health Center, 
4200 N. Oak Park Ave., Chicago, III 60634. (312) 794-4000. 


PEDIATRICIAN— Full or part time. Modern residential treatment 
center for children & adolescents. Write or call Jose R. Sanchez, 

M. D., Medical Director, Chicago-Read Mental Health Center, 4200 

N. Oak Park Ave., Chicago, III. 60634. (312) 794-4000. 


PSYCHIATRIST— Adult Inpatient Services. Full or part time, for 
modern residential facility: Write or call Jose R. Sanchez, M.D., 
Medical Director, Chicago-Read Mental Health Center, 4200 N. Oak 
Park Ave., Chicago, III. 60634. (312) 794-4000. 


GENERAL PRACTITIONER, FAMILY PRACTITIONER, needed for rural 
Illinois town near metropolitan area. Private office, full equipment 
and established practice available for sale or lease. Write: James R. 
Hastings, Executor, 301 NW 2nd St., Aledo, Illinois 61231, or tele- 
phone (309) 582-5388. 


FOR SALE, LEASE OR RENT 


MEDICAL OFFICE SUITE FOR RENT, Lincoln-Belmont Bldg. 715- 
1200 square feet, available at once in full service, elevator, active 
professional building. Call Gary Solomon, (312) 334-5400. 


MEDICAL CENTER FOR RENT. Complete and ready to open. 4300 sq. 
ft. at 2301 E. 95th Street, Chicago. Large waiting rm., 18 exam rms., 
x-ray rm., central a/c & heat. Call Gary Solomon, (312) 334-5400. 


SUITE TO LEASE for Internist, Pediatrician, Psychologist, Psy- 
chiatrist or other medical practice. Suite is located in a high 

quality building with a growing medical community situated across 
from a major hospital. The complex already includes an outstanding 
lab. X-ray facility, pharmacy and 16 professionals. Arrangement 
provides flexibility for the new tenant to share a suite with an 

existing practice, to have office built in newly created bare space 
and to participate in the ownership and direction of the com- 

plex. STRONG Property Managers, Ltd. Agents, 201 W. Springfield, 
Champaign, IL 61820. (217) 356-2617. 


SPACIOUS Northside Lakeview area medical office for rent. Newly 
remodeled. Five examining rooms, carpeted. Large furnished waiting 
room. Available now. Interested in Spanish speaking doctors only. 
Growing Spanish speaking area. Near Ashland-Lincoln and Belmont. 
Pharmacy space also availble, if desired. Please contact: Dr. Pedro 

O. Cabrera (Dentist) at 1442 W. Belmont or call (312) 528-0068. 


FOR SALE: 31 -year-old established general practice and clinic. Fully 
equipped and furnished. Clinic and practice can accommodate two 
doctors. Contact: Bob Billa, 2931 East Southcross Blvd., San Antonio, 
Texas 78212. 


LISLE-MEDICAL SUITE available in prestigious modern building lo- 
cated on Rt. 53 in Lisle. X-ray facilities on premises. Zone controlled 
heating and air conditioning. Ample parking. Call 969-2850. 


for August , 1978 


109 


FOR SALE: Solo or Group Practice/south western Chicago suburb. 
Comprehensive Medical Center: Internal Medicine, OB-GYN, Pedi- 
atrics, Optometry, Dental, X-ray Equipment, Medical Lab and Phar- 
macy. 7000 sq ft., 15 fully equipped examining rooms plus business 
offices. Private parking. Estimated Annual Gross Income: middle six 
figures. Negotiable financing. Outstanding opportunity with excel- 
lent potential. Please direct inquires to: Box #933, c/o ILLINOIS 
MEDICAL JOURNAL, 55 E. Monroe, Chicago, IL 60603. 


RANCH-STYLE MODERN MEDICAL-DENTAL BUILDING FOR RENT: 

Customized facilities to meet every medical and dental need. 
Ideal for family physician or group practice. 1500 to 2500 sq. ft. 
available. Armitage and Damen area, Chicago. Near St. Mary of 
Nazarene Hospital. Present physician re-locating leaving well estab- 
lished practice. (312) 472-5126 or 338-9347. 


GENERAL PRACTICE FOR SALE: Excellent quality practice including 
industrial medicine. Northwest Suburban location with community 
hospital. Sale due to illness — Seller will assist in transition with 
hospital privileges, employees, etc. Contact Mark Gorman at 3916- 
67th Street, Kenosha, Wisconsin 53142. 414-654-9166. 


SITUATIONS WANTED 


DR. P. J. REDDY-Male, 39 years-Psychiatry, M.D., D.P.M., 

F.R.C.P.(C), ABPN, with total ten years of wide experience in Psy- 
chiatry with Illinois license looking for place in private practice or 
a salaried job. 


DR. P. V. REDDY-Female, 34 years-OB-GYN, M.D., M.R.C.O.G. 
(U.K.), American Board Certified with Illinois license. Total ten years 
in OB-GYN. Looking for place in private practice or a salaried iob. 
Please contact Dr. P. J. Reddy, Union Hospital, Moose Jaw, Sas- 
katchewan, Canada. Office— (306) 692-1841; Home— (306) 693-3288. 


BOARD CERTIFIED RADIOLOGIST, 40, graduate of American medical 
school available for film reading in office, clinic or home. Daily 
pick-up service if desired. Excellent references. Please contact 
Illinois Medical Journal, Box No. 930, 55 East Monroe, Chicago, 
Illinois 60603. 


INTERNIST— 29, university trained seeks partnership or group prac- 
tice opportunity in Chicago area. Available July 1979. Box 929 or 
phone (312) 280-1156 after 6 pm. 


CERTIFIED PHYSICIAN'S ASSISTANT with excellent medical, re- 
search and administrative background and experience. Available for 
Chicago or suburbs. Reply Box 934, c/o Illinois Medical Journal, 
55 E. Monroe, Chicago, IL 60603. 


MISCELLANEOUS 


REAL ESTATE MANAGEMENT: You are a professional but are you a 
professional landlord? We are Professional Landlords who can man- 
age your property completely so that you can devote full time to 
your profession. If you own apartment complexes, office buildings 
or shopping centers, our management skills can reduce your ex- 
penses and maximize your cash flow. COMBINED CAPITAL ASSOC., 
Suite 2015 Tribune Tower, 435 No. Michigan Ave., Chicago, IL 
60611. Tel. (312) 337-6655. 


GUARANTY FUND CERTIFICATE 


GUARANTY FUND CERTIFICATE for sale. This certificate is worth 
$3096 toward your purchase of any Class III, IV or V certificate. 
Will discount price. Call evenings 312-293-1993. 


FOR SALE: III inois Medical Inter-Insurance Exchange Guaranty 

Fund Certificate, 100,000/300,000, Class 1, Terr. I. Cost 1977, one 
thousand-thirty two dollars ($1032.00). Contact: Hans F. Waecker, 
D.O., 5200 S. Ellis Ave., Chicago 60615. 


GUARANTY FUND CERTIFICATE: Wanted to purchase-Guaranty Fund 
Certificates for the Illinois State Medical Inter Insurance Exchange- 
call (312) 423-4499. 


GUARANTY FUND CERTIFICATE for Territory II, Class 3-amount 
$2572.00— for sale. Please contact: V. J. Kelly, M.D., Cisco Lake 
Road, Watersmeet, Ml 49969; (906) 358-4640. 


GUARANTY FUND CERTIFICATE for sale. Class 5, Territory II, 
Original Cost $4792.00. Coverage: $100,000/300,000. Asking price: 
$3,000, negotiable. Contact Dr. Ignacio A. Chaves, 108 Crass St., 
Dongola, IL 62926; (618) 827-4488. 


GUARANTY FUND CERTIFICATE, No. 214, Illinois State Medical 
Inter-Insurance Exchange. Contact James R. Hastings, Executor, 
Estate of James W. Hastings, M.D., 301 NW 2nd Street, Aledo, 
Illinois 61231. Phone 309-582-5388. 


GUARANTY FUND CERTIFICATE for sale: Class 5, territory II for 
$1 ,000,000/$! ,000,000 coverage, purchase price $6,024.00. For sale 
for $4,500.00. For information call (816) 364-5255, or write to 
Professional Anesthesia Services, Inc., 416 North Seventh, St. Joseph, 
MO 64501. 


IMJ and ISMS are not acting as brokers or agents; this is provided 
as a membership service. 


ISMS Travel Program 

Only one of the ISMS travel programs scheduled 
for 1978 remains open for reservations: the West 
Indies Air/Sea Christmas Cruise (Dec. 19-27, 
1978). Information on the 1979 programs will 
appear in the next issue. 


Descriptive brochures will be mailed five months 
in advance. Reservations cannot be accepted 
without the official form printed in these bro- 
chures. Individuals outside a member’s immedi- 
ate family will be placed on standby status until 
all ISMS members have had reasonable time to 
make reservations. Promotional expenses con- 
nected with these programs are paid for by the 
tour operator. For further information, contact 
ISMS headquarters. 


GUARANTY FUND CERTIFICATE: Class 8 Inter-Insurance Exchange 
Certificate for sale (previously class 5). Call 266-1977, 9-5 P.M. 


GUARANTY FUND CERTIFICATE for sale at discount. Phone (312) 
579-0133. 


ILLINOIS STATE MEDICAL INTER-INSURANCE EXCHANGE Guaranty 
Fund Certificate for sale. Territory 1 Class 1— Purchase price $772. 
Best offer. Please contact Mrs. Burton at 388-8052. 


GUARANTY FUND CERTIFICATE issued by the Illinois State Medical 
Inter-Insurance Exchange for sale. Coverage $100,000/$300,000. 
Original purchase price $6,024.00. Interested call (312) 963-8777 or 
920-8792. 


GUARANTY FUND CERTIFICATE— Anesthesiologist relocating. Class 5, 
1,000,000/1,000,000 coverage. Original price 10,000— purchase price 
8000.00 or best offer. Favorable conditions may be arranged. Send 
inquiries to Box 922, c/o IMJ, 55 E. Monroe, Suite 3510, Chicago, 
60603. 


110 


Illinois Medical Journal 




ISMS Guide to 
Continuing Medical Education 

Compiled for Illinois physicians by the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
55 E. Monroe St., Suite 3510 • Chicago, IL 60603 • (312) 236-6110 



Items for this Calendar must be received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication date. Some- 
times, cancellations or changes in date, place or time occur too late to be corrected before publication. You are urged 
to contact the sponsoring organization to confirm information given below. 


SEPTEMBER 


Anesthesiologi / 

EKG FOR ANESTHESIOLOGISTS 
For: Anesthesiologists. Lecture, beginning Sept. 18, 
Chicago. Speaker: Alon P. Winnie, M.D. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612.. Fee: $225. Reg. limit: 
35. CME Credit: AMA Category 1, 35 hours. Contact: 
Robert Baker, M.D. Phone: 312-733-2800. 

Dermatology 

SPECIALTY REVIEW COURSE IN DERMATOLOGY 

For: Dermatologists. Lecture, beginning Sept. 25, 
Chicago. Speaker: Marshall Blankenship, M.D. Spon- 
sor: Cook County Graduate School of Medicine, 707 
South Wood St., Chicago 60612. Fee: $225. Reg. 
limit: 75. CME Credit: AMA Category 1, 35 hours. 
Contact: Robert Baker, M.D. Phone: 312-733-2800. 

Family Practice 

ESSENTIALS OF ELECTROCARDIOGRAPHY 
For: Family Practitioners. Lecture, beginning Sept. 
18, Chicago. Speaker: Kenneth Rosen, M.D. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $225. Reg. limit: 50. 
CME Credit: AAFP Prescribed, 35 hours; AMA Cate- 
gory 1, 35 hours. Contact: Robert Baker, M.D. Phone: 
312-733-2800. 

Infectious Disease/Urology 

21ST MEDICAL/SURGICAL SEMINAR FOR 
LAKE COUNTY 

For: M.D.’s, D.D.S.’s, R.N.’s, Rh.P.'s Seminar, 

September 20, 8:00 AM-1:00 PM, Waukegan, IL 
CME credit: AAFP Elective, 5 hours; AMA Category 
1, 5 hours. Reg. deadline: 9/20. Reg. limit: none. 
Fee: $2.50, staff; $5.00, non-staff. Sponsor: St. 
Therese Hospital, 2615 Washington, Waukegan, IL 
60085. Contact: R. M. Adelman. Telephone: 312-688 
5800. 

Internal Medicine 

OBESITY AND DIABETES— A PERPLEXING 
ODD COUPLE 

For: M.D.’s, residents. Lecture, Sept. 27, 11:00 a.m., 
Auditorium, Martha Washington Hospital, 4055 North 
Western Ave., Chicago 60618. Cosponsor: Pfizer Lab- 
oratories. Speaker: Karl E. Sussman, M.D., Profes- 
sor of Medicine, University of Colorado, Denver. Reg. 
deadline: 9/26. Reg. limit: none. Fee: none. CME 
Credit: AAFP Elective, 1 hour; AMA Category 1, 1 
hour. Contact: Fernando Villa, M.D. Phone: 312-583- 
9000 x 331. 

Medical Genetics 

2ND ANNUAL SYMPOSIUM ON MEDICAL GENETICS 
For: Physicians, nurses, social workers. Symposium, 
Sept. 15, 8:30-4:30 p.m., Springfield, IL. Fee: $55. 
Reg. limit, none. CME Credit: AAFP Elective, 5 hours; 
AMA Category 1, 5 hours; INA applied for. Sponsor: 
SIU School of Medicine, P.0. Box 3926, Springfield, 
IL 62708. Contact: Lorraine Stephenson. Phone: 217- 
782-7711. 

Medicine 

CURRENT TOPICS IN INTERNAL MEDICINE 

For: Internists, Family Practitioners. Lecture, begin- 
ning September 25, Chicago. Speaker: Sheldon Wald- 
stein, M.D. Sponsor: Cook County Graduate School of 
Medicine, 707 South Wood St., Chicago 60612. Fee: 
$225. Reg. limit: 100. CME Credit: AMA Category 1, 
40 hours. Contact: Robert Baker, M.D. Phone: 312- 
733-2800. 

Neurology 

NEUROLOGY, PART II, CLINICAL 
For: Neurologists, Psychiatrists. Lecture, beginning 
Sept. 11, Chicago. Speaker: Neil Allen, M.D. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $250. Reg. limit: 150. 
CME Credit: AMA Category 1, 44 hours. Contact: 
Robert Baker, M.D. Phone: 312-733-2800. 


Obstetrics <b Gynecology 

SPECIALTY REVIEW IN OB-GYNE 

For: Obstetricians, Gynecologists. Lecture, beginning 
Sept. 25, Chicago. Sponsor: Cook County Graduate 
School of Medicine, 707 South Wood St., Chicago 
60612. Fee: $400. Reg. limit: 200. CME Credit: AMA 
Category 1, 83 hours. Contact: Robert Baker, M.D. 
Phone: 312-733 2800. 

DEPARTMENTAL MEETING 

For: Obstetricians, Gynecologists. Lecture, Sept. 1, 
8:00 a.m., Evanston. Sponsor: St. Francis Hospital, 
355 Ridge Ave., Evanston, IL 60202. Reg. limit: 
none. CME Credit: AMA Category 2, 1 hour. Contact: 
Mitchel Byrne, M.D. Phone: 312-492-6227. 
GYNECOLOGICAL LAPAROSCOPY 
For: Gynecologists. 3-day lecture, beginning Sept. 13, 
Illinois Masonic Hospital, Chicago. Speaker: John 
Barton, M.D. Sponsor: Cook County Graduate School 
of Medicine, 707 South Wood St., Chicago 60612. 
Fee: $300. Reg. limit: 8. CME Credit: AMA Category 
1, 18 hours. Contact: Robert Baker, M.D. Phone: 
312-733-2800. 

INFECTIONS 

For: Gynecologists. Lecture, Sept. 8, 8:00 a.m., St. 
Francis Hospital, 355 Ridge Ave., Evanston, IL 60202. 
Speaker: H. Price, M.D. Sponsor: St. Francis Hospi- 
tal. CME Credit: AMA Category 2, 1 hour. Contact: 
Mitchel Byrne, M.D. Phone: 312-492-6227. 
GYNECOLOGICAL INFECTIONS AND USE OF 
ANTIBIOTICS 

For: Gynecologists. Lecture, Sept. 15, 8:00 a.m., St. 
Francis Hospital, 355 Ridge Ave., Evanston, IL 60202. 
Speaker: H. Price, M.D. Sponsor: St. Francis Hospi- 
tal. CME Credit: AMA Category 2, 1 hour. Contact: 
Mitchel Byrne, M.D. Phone: 312-492-6227. 
HIRSUTISM AND ADRENOGENITAL SYNDROME 
For: Gynecologists. Lecture, Sept. 22, 8:00 a.m., St. 
Francis Hospital, 355 Ridge Ave., Evanston, IL 60202. 
Speaker: R. Kissel, M.D. Sponsor: St. Francis Hospi- 
tal. CME Credit: AMA Category 2, 1 hour. Contact: 
Mitchel Byrne, M.D. Phone: 312-492-6227. 
DEPARTMENTAL MEETING 

For: Gynecologists. Lecture, Sept. 29, St. Francis 
Hospital, 355 Ridge Ave., Evanston, IL 60202. 
Sponsor: St. Francis Hospital. CME Credit: AMA 
Category 2, 1 hour. Contact: Mitchel Byrne, M.D. 
Phone: 312-492-6227. 

Orthopedic Surgery, Pathology 

A SHORT COURSE ON BONE TUMORS 

For: Orthopods, Pathologists. 2>/ 2 day course/work- 
shop, Sept. 14-16, Chicago. Sponsor: Rush-Presby- 
terian-St. Luke’s Medical Center, Office of Continu- 
ing Education, Academic Facility, 600 S. Paulina 
St., Chicago 60612. Fee: $300. Reg. limit: 60. CME 
Credit: AMA Category 1, 15 hours. Contact: Jeffrey 
Norman. Phone: 312-942-7095. 


Pediatrics 

SOLVING DIFFICULT PROBLEMS IN AMBULATORY 
PEDIATRICS: A MULTIDISCIPLINARY APPROACH 
For: Pediatricians. 3-day lecture, Sept. 21-23, The 
Kellogg Center for Continuing Education, MSU. CME 
Credit: AMA Category 1, 16 hours. Contact: Confer- 
ences and Institutes, 50 Kellogg Center, MSU, East 
Lansing, Michigan 48824. Phone: 517-355-4588. 


SEXUAL MEDICINE 


Psychiatry 


For: Psychiatrists, Neurologists. Lecture, beginning 
Sept. 25, Chicago. Speaker: Domeena Renshaw, M.D. 
Sponsor: Cook County Graduate School of Medicine, 
707 South Wood Street, Chicago 60612. Fee: $250. 
Reg. limit: 100. CME Credit: AAFP Prescribed, 40 
hours; AMA Category 1, 40 hours. Contact: Robert 
Baker, M.D. Phone: 312-733-2800. 


Radiography 

QUALITY ASSURANCE EVALUATION OF THE 
RADIATION DEPARTMENT 

For: Radiologists. 3-day lecture, beginning Sept. 14, 
Chicago. Speaker: Theodore Fields, M.S. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $200. Reg. limit: 75. 
CME Credit: AMA Category 1, 24 hours. Contact: 
Robert Baker, M.D. Phone 312-733-2800. 

Surgery 

FIBEROPTIC ESOPHAGOGASTRIC ENDOSCOPY 

For: Surgeons, Internists. Lecture, beginning Sept. 
18, Chicago. Speaker: C. Thomas Bombeck, M.D. 
Sponsor: Cook County Graduate School of Medicine, 
707 South Wood St., Chicago 60612. Fee: $300. 
Reg. limit: 15. CME Credit: AMA Category 1, 19 
hours. Contact: Robert Baker, M.D. Phone: 312-733- 
2800. 

FIBEROPTIC COLONOSCOPY 

For: Surgeons, Internists, Family Practitioners. 3-day 
lecture, beginning Sept. 13, Chicago. Speaker: Her- 
and Abcarian, M.D. Sponsor: Cook County Graduate 
School of Medicine, 707 South Wood St., Chicago 
60612. Fee: $300. Reg. limit: 15. CME Credit: AMA 
Category 1, 19y 2 hours. Contact: Robert Baker, M.D. 
Phone: 312-733-2800. 

TREATMENT OF THE INJURED HAND 
For: Surgeons. 1-day course. Sept. 9, Chicago. 

Sponsor: Rush-Presbyterian-St. Luke’s Medical Center, 
Office of Continuing Education, 600 South Paulina 
St., Chicago 60612. Fee: resident, $50; Rush Net- 
work physician, $80; other physician, $100. CME 
Credit: AMA Category 1, 7 hours. Contact: Office of 
Continuing Education. Phone: 312-942-7095. 
MICROSURGICAL WORKSHOP 

For: Surgeons. 1-day workshop, Sept. 8 or Sept. 10, 
Chicago. Speaker: Robert Schenck, M.D., Associate 
Professor and Director, Hand Surgery Section. Spon- 
sor: Rush-Presbyterian-St. Luke’s Medical Center, 

Office of Continuing Education, 600 South Paulina 
St., Chicago 60612. Fee: $125. CME Credit: AMA 
Category 1, 8 hours. Contact: Mrs. Woodfork. Phone: 
312-942-7095. 


OCTOBER 


IMMUNOLOGIC INJURY 


Allergy 


For: Family Practitioners, Allergists. Lecture, Oct. 18, 
2:00 p.m., Itasca Country Club. Speaker: Chester R. 
Zeiss Jr., M.D., Asst. Professor of Medicine, North- 
western University Medical School. Sponsor: DuPage 
County Medical Society, 26 W. St. Charles Road, 
Lombard, IL 60148. Reg. deadline: 10/16. Fee: none. 
Reg. limit: none. CME Credit: AAFP Elective, 2 hours; 
AMA Category 1, 2 hours. Contact: Lillian Widmer. 
Phone: 312-495-4050. 

Biomed 


FOURTH ANNUAL MEDICAL PHOTOGRAPHY 
WORKSHOP 

For: all physicians. 1-day symposium /workshop, Oc- 
tober 28, Springfield, IL. Sponsor: SIU School of 
Medicine, P.0. Box 3926, Springfield, IL 62708. 
CME Credit: AAFP Elective, 6 hours; AMA Category 
1, 6 hours. Reg. limit: none. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 

Diabetes 

RECENT ADVANCES IN DIABETES 

For: residents and attending staff. Lecture, October 
25, 11:00 a.m. (lunch follows), Martha Washington 
Hospital, 4055 N. W^tern, Chicago, IL 60618. 
Speaker: Arthur H. Rubenstein, M.D., Professor and 
Associate Chairman, Dept, of Medicine, The University 
of Chicago. CME Credit: AAFP Elective, 1 hour; AMA 
Category 1, 1 hour. Fee: none. Reg. limit: none. 
Reg. deadline: 10/24. Sponsor: Martha Washington 
Hospital. Contact: Fernando Villa, M.D. Phone: 312- 
583-9000 x 331. 


for August , 1978 


111 


Internal Medicine, Family Practice, 

Pediatrics 

CLINICAL ALLERGY FOR PRACTICING PHYSICIANS 
For: Physicians. 3-day symposium, October b-/, M. 
Louis, MO. Sponsor: Continuing Medical Education, 
Washington University School of Medicine, Box 8063, 
660 S Euclid, St. Louis, MO 63110. CME Credit. 
AAFP Elective, 16 hours; AMA Category 1, 16 hours; 
AOA, 16 hours. Fee: $150. Reg. limit: 150. Con- 
tact: Loretta Giacoletto. Phone: 314-454-38/3. 

Internal Medicine 
CLINICAL & LABORATORY DIAGNOSIS OF 
HEMORRHAGIC 4 THROMBOTIC DISORDERS 
For: Internists, Hematologists. Lecture, beginning 

Oct. 20, Chicago. Speaker: Hau C. Kwaan, M.D. 
Sponsor:’ Cook County Graduate School of Medicine, 
707 South Wood St., Chicago 60612. Fee: $150. 
Reg. limit: none. CME Credit: AMA Category 1, 16 
hours. Contact: Robert Baker, M.D. Phone: 312-733- 

Medical Photography 

FOURTH ANNUAL MEDICAL PHOTOGRAPHY 
WORKSHOP j , u . , 

For: M.D.’s, office staff. 1-day workshop, Oct. 28, 
Springfield, IL. Sponsor: SIU School of Medicine, 
801 N. Rutledge, P.O. Box 3926, Springfield, IL. 
Fee: $55-pre. Reg. limit: none. CME Credit: AMA 
Category 1, 6 hours. Contact: Lorraine Stephenson. 
Phone: 217-782-7711. 

Medicine and Surgery 

MEDICAL AND SURGICAL APPROACHES TO 
ACUTE COLON AND RECTAL DISEASES 
For- Physicians. Symposium, October 26, Hillsboro, 
IL. Sponsor: SIU School of Medicine, P.O. Box 
3926, Springfield, IL 62708. CME Credit: AAFP Elec- 
tive, 4 hours; AMA Category 1, 4 hours. Reg. limit: 
none. Contact: Lorraine Stephenson. Phone: 217-782- 

Neurology 

NEUROLOGY UPDATE 

For: Physicians. Symposium, October 7, Pittsfield, IL. 
Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. CME Credit: AAFP Elective, 
4 hours; AMA Category 1, 4 hours. Reg. limit: none. 
Contact: Lorraine Stephenson. Phone: 217-782-7711. 

Neurotology 


RECENT ADVANCES IN PSYCHIATRY 

For: Psychiatrists. Lecture, beginning Oct. Li, om- 
cago. Speaker: Domeena Renshaw, M.D. Sponsor: 

Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $225. Reg. limit: 
125. CME Credit: AMA Category 1, 40 hours. Con- 
tact: Robert Baker, M.D. Phone: 312-733-2800. 

Psychiatry 

ILLINOIS PSYCHIATRIC SOCIETY 5th ANNUAL FALL 
WEEKEND MEETING „ , , . 

For: Psychiatrists, other physicians. 3-day lecture/ 
workshop, October 6-8, Hyatt Regency O’Hare, Chi- 
cago, IL. Sponsor: Illinois Psychiatric Society, 55 E. 
Monroe, Suite 3510, Chicago, IL 60603. CME Credit. 
AMA Category 1, 13.5 hours. Fee: $35. Reg. limit: 
none. Reg. deadline: 9/25. Contact: Wendy Smith. 
Phone: 312-782-1654. 

Radiology 

DIAGNOSTIC IMAGING OF THE GASTROINTESTINAL 
TRACT „ , 

For: Radiologists. 4-day course, Oct. 12-15, Lake of 
the Ozarks, MO. Sponsor: American College of Radi- 
ology. Fee: $225. CME Credit: AMA Category 1, 13 
hours. Contact: Walter Whitehouse, M.D., Dept, of 
Rad , U of Michigan Hospital, Ann Arbor, Michigan 
48109. 

Surgery 

SPECIALTY REVIEW IN GENERAL SURGERY, PART I 

For: Surgeons. Lecture, beginning Oct. 23, Chicago. 
Speaker: Robert Baker, M.D. Sponsor: Cook County 
Graduate School of Medicine, 707 South Wood St., 
Chicago 60612. Fee: $425. Reg. limit: 400. CME 
Credit: AMA Category 1, 94 hours. Contact: Robert 
Baker, M.D. Phone: 312-733-2800. 

Surgery 

CLINICAL CONGRESS „„ „ 

For: Physicians. 5-day lecture, October 16-20, San 
Francisco, CA. Sponsor: American College of Sur- 
geons, 55 E. Erie, Chicago, IL 60611. CME Credit: 
AMA Category 1. Contact: Ginny Clark. Phone: 312- 
664-4050. 


NOVEMBER 

Anesthesia 


CLINICAL NEUROTOLOGY 

For: Otologists, Neurotologists. 4-day course, October 
16-19, Chicago, IL. Speaker: Nicholas Torok, M.D. 
Sponsor: Dept, of Otolaryngology, AlS.M., Illinois 
Eye & Ear Infirmary, Neurotology Section, 1855 W. 
Taylor, Chicago, IL 60612. Cosponsor: American 

Neurotology Society. CME Credit: AMA Category 1, 
28 hours. Fee: $300. Contact: Nicholas Torok, M.D. 
Phone: 312-996 6517. 

Obstetrics b Gynecology 
RECERTIFICATION REVIEW IN OB-GYN 
For: Obstetricians, Gynecologists. Lecture, beginning 
Oct. 30, Chicago. Sponsor: Cook County Graduate 
School of Medicine, 707 South Wood St., Chicago 
60612. Fee: $225. Reg. limit: none. CME Credit: 
AMA Category 1, 40 hours. Contact: Robert Baker, 
M.D. Phone: 312-733-2800. 

Orthopaedics 

MANAGEMENT OF COMMON FRACTURES 

For: Family Practitioners. Lecture, beginning Oct. 23, 
Chicago. Speaker: Peter Altner, M.D. Sponsor: Cook 
County Graduate School of Medicine, 707 South Wood 
St., Chicago 60612. Fee: $225. Reg. limit: 50. CME 
Credit: AAFP Prescribed, 35 hours; AMA Category 1, 
35 hours. Contact: Robert Baker, M.D. Phone: 312- 
733-2800. 

Psychiatry 

DISTINGUISHED LECTURE SERIES 

For: Psychiatrists, mental health professionals, lec- 
ture, Oct. 18, 8:00 p.m., Offield Auditorium, Pas- 
savant Pavilion, 303 E. Superior, Chicago. Speaker: 
Daniel Offer, M.D., Professor of Psychiatry, U of C. 
Sponsor: Institute of Psychiatry, Northwestern Me- 
morial Hospital and Dept, of Psychiatry and Be- 
havioral Sciences, NUMS. Reg. limit: none. CME 
Credit:- AMA Category 1, IV 2 hours. Fee: none. 
Contact: Leon Diamond. Phone: 312-649-8058. 
GENERAL PSYCHIATRY STUDY GROUP 
For: Psychiatrists, study group, 1st Sat. of mo., 9:00 
a. m. -12:00 noon, Institute of Psychiatry, 320 E. 
Huron, Rm. 2011, Chicago. Sponsor: Institute of 

Psychiatry, Northwestern Memorial Hospital and Dept, 
of Psychiatry and Behavioral Sciences, NUMS. Reg. 
limit: 20. Fee: $150. CME Credit: AMA Category 1, 
24 hours. Reg. deadline: 9/30. Contact: Leon Dia- 
mond. Phone: 312-649-8058. 

PSYCHOANALYTIC STUDY GROUP 
For: Psychiatrists. Study group, 3rd Sat. of m., 
9:00 a. m. -12:00 noon, Institute of Psychiatry, 320 
E. Huron, Rm. 2011, Chicago. Sponsor: Institute of 
Psychiatry, Northwestern Memorial Hospital and Dept, 
of Psychiatry and Behavioral Sciences, NUMS. Reg. 
limit: 20. Fee: $150. CME Credit: AMA Category 1, 
24 hours. Reg. deadline: 9/30. Contact: Leon Dia- 
mond. Phone: 312-649-8058. 


REGIONAL ANESTHESIA 

For: Anesthesiologists. Lecture, beginning Nov. 13, 
Chicago. Speakers: Vincent Collins, M.D. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $325. Reg. limit: 
10. CME Credit: AMA Category 1, 40 hours. Contact: 
Robert Baker, M.D. Phone: 312-733-2800. 

Family Medicine 

MANAGEMENT OF THE ACUTE CARDIAC PATIENT 

For: Family Practitioners. Lecture, beginning Nov. 29, 
Chicago. Speaker: Kenneth Rosen, M.D. Sponsor: 
Cook County Graduate School of Medicine, 707 South 
Wood St., Chicago 60612. Fee: $175. Reg. limit: 
75. CME Credit: AMA Category 1, 21 hours. Contact: 
Robert Baker, M.D. Phone: 312-733-2800. 

Internal Medicine 

RESPIRATORY DISEASE 

For: M.D. 's. Symposium, Nov. 30, Jacksonville, IL 
Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. Reg. limit: none. CME Credit: 
AAFP Elective, 4 hours; AMA Category 1, 4 hours. 
Contact: Lorraine Stephenson. Phone: 217-782-7711. 

CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

For: M.D.’s. Symposium, Nov. 8, Harrisburg, IL. 

Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. Reg. limit: none. CME Credit: 

AMA Category, 1, 4 hours; AAFP Elective. 4 hours. 

Contact: Lorraine Stephenson. Phone: 217-782-7711. 

BLOOD GASES-ELECTROLYTE IMBALANCE- 
HYPERALIMENTATION 

For: M.D.’s. Symposium, Nov. 4, Highland, IL. 

Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. Reg. limit: none. CME Credit: 

AMA Category 1, 4 hours; AAFP Elective, 4 hours. 

Contact: Lorraine Stephenson. Phone: 217-782-7711. 

6TH ANNUAL WEBER MEDICAL CLINIC 

For: M.D.’s. Clinic, Nov. 4, Olney, IL. Sponsor: 
SIU School of Medicine, P.O. Box 3926, Springfield, 
IL 62708. Reg. limit: none. CME Credit: AMA Cate- 
gory 1, 4 hours; AAFP Elective, 4 hours. Contact: 
Lorraine Stephenson. Phone: 217-782-7711. 

DIAGNOSIS AND TREATMENT OF 
ANAEROBIC INFECTIONS OF THE LUNG 

For: M.D.'s, residents. Lecture, Nov. 15, 11:00 a.m., 
Auditorium, Martha Washington Hospital, 4055 North 
Western Ave., Chicago 60618. Speaker: Haragopal 
Thadepalli, M.D., Martin Luther King, Jr. General 
Hospital, Los Angeles, CA. Reg. deadline: 11/14. 
Fee: none. CME Credit: AMA Category 1, 1 hour; 
AAFP Elective, 1 hour. Contact: Fernando Villa, M.D. 
Phone: 312-583-9000 ext. 331. 


Internal Medicine, Family Medicine 

EMERGENCY CARDIOLOGY- 

DIAGNOSIS AND THERAPY . 

For: M.D.’s. Symposium, Nov. 30-Dec. 1, St. Louis, 
MO. Sponsor: Continuing Medical Education, Wash- 
ington University School of Medicine, Box 8063, 660 
S Euclid, St. Louis, MO 63110. Fee: $120. Reg. 
limit: 150. CME Credit: AMA Category 1, 12 hours; 
AAFP Elective, 12 hours. Contact: Loretta Giacoletto. 
Phone: 314-454-3873. 

Medicine 

ADVANCES IN MEDICINE 

For: Internists. Lecture, beginning Nov. 13, Chicago. 
Speaker: Sheldon Waldstein, M.D. Sponsor: Cook 

County Graduate School of Medicine, 707 South Wood 
St., Chicago 60612. Fee: $225. Reg. limit: 100. 
CME Credit: AMA Category 1, 35 hours. Contact: 
Robert Baker, M.D. Phone: 312-733-2800. 

Neurology 

RECENT ADVANCES IN NEUROLOGY 

For: Neurologists. Lecture, beginning Nov. 13, Chi- 
cago. Speaker: Neil Allen, M.D. Sponsor: Cook County 
Graduate School of Medicine, 707 South Wood St., 
Chicago 60612. Fee: $225. Reg. limit: 75. CME 
Credit: AMA Category 1, 40 hours. Contact: Robert 
Baker, M.D. Phone: 312-733-2800. 

Obstetrics b Gynecology 

ADVANCES IN OBSTETRICS & GYNECOLOGY 

For: Obstetricians, Gynecologists. Lecture, beginning 
Nov. 30, Chicago. Sponsor: Cook County Graduate 
School of Medicine, 707 South Wood St., Chicago 
60612. Fee: $175. Reg. limit: 100. CME Credit: 
AMA Category 1, 24 hours. Contact: Robert Baker, 
M.D. Phone: 312-733-2800. 

OB/GYN IN GENERAL PRACTICE 
For: M.D.’s. Symposium, Nov. 16, Mt. Vernon, IL. 
Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. Reg. limit: none. CME Credit: 
AMA Category 1, 4 hours; AAFP Elective, 4 hours. 
Contact: Lorraine Stephenson. Phone: 217-782-7711. 
MANAGEMENT OF HIGH RISK OBSTETRICAL & 
NEWBORN PROBLEMS . . 

For: Obstetricians, Pediatricians. Lecture, beginning 
Nov. 13, Chicago. Sponsor: Cook County Graduate 
School of Medicine, 707 South Wood St., Chicago 
60612. Fee: $250. Reg. limit: 100. CME Credit: 
AMA Category 1, 50 hours. Contact: Robert Baker, 
M.D. Phone: 312-733-2800. 


Ophthalmology 

CLINICAL UPDATE IN GLAUCOMA AND 
CORNEAL AND EXTERNAL DISEASE 

For: Ophthalmologists. Lecture, Nov. 9-10, Chicago. 
Sponsor: Dept, of Ophthalmology, U of 1, 1855 W. 
Taylor, Chicago 60612. Fee: $150. Reg. limit: 60. 
CME Credit: AMA Category 1. Contact: Carmen Car- 
rasco. Phone: 312-996-8023. 

Orthopedics 


RHEUMATOLOGY AND JOINT RECONSTRUCTION 

For: M.D.’s. Symposium, Nov. 9, Quincy, IL. Sponsor: 
SIU School of Medicine, P.O. Box 3926, Springfield, 
IL 62708. Reg. limit: none. CME Credit: AMA Cate- 
gory 1, 4 hours; AAFP Elective, 4 hours. Contact: 
Lorraine Stephenson. Phone: 217-782-7711. 


SPINAL PROBLEMS 

For: M.D.’s. Symposium, Nov. 15, Belleville, IL. 
Sponsor: SIU School of Medicine, P.O. Box 3926, 
Springfield, IL 62708. Reg. limit: none. CME Credit: 
AMA Category 1, 4 hours; AAFP Elective, 4 hours. 




I n.rnlnn Cfonhoncdn 


m . 017 707.7711 


Psychiatry 

DIAGNOSIS & MANAGEMENT OF EMOTIONAL 
PROBLEMS IN CHILDREN & ADULTS 

For: Family Practitioners. Lecture, beginning Nov. 
20, Chicago. Speaker: Domeena Renshaw, M.D. Spon- 
sor: Cook County Graduate School of Medicine, 707 
South Wood St., Chicago, 60612. Fee: $150. Reg. 
limit: 100. CME Credit: AAFP Prescribed, 17 hours; 
AMA Category 1, 17 hours. Contact: Robert Baker, 
M.D. Phone: 312-733-2800. 

Surgery 

SPECIALTY REVIEW IN SURGERY, PART II 

For: Surgeons. Lecture, beginning Nov. 'Ll, Chicago. 
Speaker: Robert Baker, M.D. Sponsor: Cook County 
Graduate School of Medicine, 707 South Wood St., 
Chicago 60612. Fee: $425. Reg. limit: 300. CME 
Credit: AMA Category 1, 99 hours. Contact: Robert 
Baker, M.D. Phone: 312-733-2800. 

Urology 

104TH ANNUAL MEETING OF 

SOUTHERN ILLINOIS MEDICAL ASSOCIATION 

For: M.D.'s. Lecture, Nov. 9, Village of Muddy, IL. 
Sponsor: Southern Illinois Medical Association. Co- 
sponsor: Illinois Academy of Family Physicians. Reg. 
deadline: none. Fee: none. Reg. limit: none. CME 
Credit: AMA Category 1, 4 hours. Contact: Dale 
Rosenberg, M.D., Suite 3*E, 6401 W. Main St., 
Belleville, IL. Phone: 618-398-5600. 


112 


Illinois Medical Journal 


lie Great Laxative Escape 







Colace means escape— from laxative stimulation, 
from laxative harshness, from laxative habit 
Colace gently helps soften stools for easy, pain- 
less, unstrained elimination. It s the great laxative 
escape, from infancy to old age, Available ip 100 
and 50 mg. capsules. Syrup or flqbia 


PHARMACEUTICAL DIVISION 


<fel 978 Mead Johnson & Company • Cvansvtlie. Indiana &7/S' 1 U S A. J578- 1 




Ibis islmatic 

isn’t lorried about his next breath... 



he’s active 
he’s effectively 
maintained on 



contoins theophylline (onhydrous) 150 mg 
and glyceryl guoiocolote (guaifenesin) 

90 mg. Elixir: alcohol 15% 


• theophylline for effective 
around-the-clock 
bronchodilotor therapy 

• 100% free theophylline 

Indications: For the sympromaric relief of bronchosposric 
conditions such os bronchial asthma, chronic bronchiris, and 
pulmonary emphysema. 

Warnings: Do nor administer more frequently than every 
6 hours, or within 12 hours after rectal dose of any prep- 
aration containing theophylline or aminophylline. Do nor 
give other compounds containing xanthine derivatives 
concurrently. 

Precautions: Use with caution in patients with cardiac 
disease, hepatic or renal impairment. Concurrent adminis- 
tration with certain antibiotics, i.e. clindamycin, erythromy- 
cin, rroleandomycin, may result in higher serum levels of 
rheophylline. Plasma prothrombin and factor V may 
increase, bur any clinical effecr is likely to be small. Merabo- 
lires of guaifenesin may contribute to increased urinary 
5-hydroxyindoleaceric acid readings, when derermined 
with nirrosonaphrol reagent. Safe use in pregnancy has nor 
been established. Use in case of pregnancy only when 
clearly needed. 

Adverse Reactions: Theophylline may exert some stimulat- 
ing effecr on the central nervous system. Its administration 
may cause local irritation of the gastric mucosa, with possi- 
ble gastric discomfort, nausea, and vomiting. The frequency 
of adverse reactions is related to the serum rheophylline 
level and is nor usually a problem or serum rheophylline 
levels below 20 jttg/ml. 

How Supplied : Capsules in bottles of 1 00 and 1 000 and 
unit-dose packs of 100: Elixir in borrles of 1 pinr and 1 gallon. 
See packa g e insert for complete prescribin g informorion . 



PHARMACEUTICAL DIVISION 

©1978 Mead Johnson & Company Evansville. Indiana 47721 U.S.A. MJL 6-4220F 



Physician Recruitment Program 


In an effort to reduce the number of towns in Illinois needing physicians, ' the Physician Recruitment Program and the Doctor’s 
Job Fair, are publishing synopses in the Journal. 

Physicians who are seeking a place to practice or who know of any out-of-state physicians seeking an Illinois residence are 
asked to notify the Program. 

Any areas wishing to be listed should contact: Mrs. E. Duffy, Physician Recruitment Program, ISMS, 55 E. Monroe, Suite 5510, 
Chicago, 60605. 


ARCOLA: Wanted- American trained P.P. to join es- 
tablished F.P. in active practice. Must do some O.B. 
Guaranteed salary and benefits. Eventual partnership. 
Robert N. Arrol, M.D., 126 S. Locust, Areola, 61910. 
(217) 268-4444, or 268-4404. (12) 

ATKINSON: Due to recent death of town’s physician, 
a modern clinic with all facilities is available to a 
family physician who wants security and a wonderful 
place to practice. Hammond Henry Hospital only 8 
miles away. Excellent grade and high schools and near 
Black Hawk Junior College. 30 miles to Quad City 
area, 140 miles to Chicago and 60 miles from Peoria. 
All recreational facilities nearby. CONTACT: John W. 
Ellis, Mayor, Atkinson 61235. (309) 936-7566. (12) 

CHICAGO: Opportunities Available for Family Prac- 
titioners in a single specialty clinic setting. Associa- 
tion as a satellite facility with a 265 bed community 
hospital. Opportunity to build own practice with fi- 
nancial assistance available. Contact: Teryl R. File- 
bark, 1044 N. Francisco Ave., Chicago 60622. (312) 278- 
8800. (9) 


CHICAGO (desirable suburb) : Older general prac- 
titioner has excellent office facilities to share with 
younger G.P. Objective: need help with practice. 
Younger man may have guarantee to take over prac- 
tice in near future. Hospital staff appointment avail- 
able. All replies confidential. Box MK, Physician Re- 
cruitment Program, ISMS. (9) 


ELGIN: Psychiatrist, % time position with CMHC. 
Provide leadership and direction of medical and psy- 
chiatric aspects of clinical program, consult with staff, 
provide direct service to a wide variety of patients. 
Experience: past residency, preferably Board certified. 
Resume and salary requirements would be helpful to: 
Jack Crook, Director of Programs, Fox Valley Mental 
Health Center, 384 Division, Elgin, 60120, (312) 695- 
1115. (10) 


FAIRBURY: Population 3,500. Rural area serving a 
population of more than 16,000. Excellent practice op- 
portunity for family practitioner or internist inter- 
ested in family practice. Enjoy life and your practice 
in an area which offers excellent facilities and a per- 


sonal, friendly atmosphere; join the staff of 112-bed 
JCAH accredited community hospital. Write: Frank 
Brady, Administrator, Fairbury Hospital, Fairbury, 
61739, or call collect (815) 692-2346. (10) 

LISLE: Physician needed to assist me in handling my 
very extensive private family practice. Salary open, 
good opportunity for this relationship to merge into 
a partnership association. CONTACT: M. Sinkovits, 
4513 Lincoln Ave., Lisle 60532. (312) 968-2735. (12) 

MINIER: General or family practitioner for rich agri- 
cultural area near Bloomington. Large practice wait- 
ing due to death of doctor. Office with X-ray and other 
equipment, very reasonable. Unusual opportunity. Con- 
tact: Harvey Graff, Minier 61759. (309) 392-2345 or 
392-2120. (10) 

OSWEGO: Family physician or internist to join group 
of four in a small town primary care clinic. Two full- 
service hospitals nearby. One hour west of Chicago. 
Dr. A. Haan, Oswego, 60543. (312) 554-8431. (11) 

OTTAWA: Opening in fields of Internal Medicine 
and Family Practice with multi -specialty group of 
nine physicians. Community, 20,000 plus. 154 bed hos- 
pital under five years old. Latest equipment One and 
one-half hours from Chicago and Peoria. Near State 
Parks. Excellent school system. Close to Jr. College 
and State Universities. Salary negotiable. CONTACT: 
Mrs. Van Buren, Ottawa Medical Center, 313 W. 
Madison, Ottawa 61350. (815) 433-1010. (10) 

PEORIA: Emergency physician — Unique opportunity 
to start on the ground floor with fee-for-service group 
in 550-bed medical center seeing 27,000 ER visits. Need 
career-minded physician for three 16-hour shifts per 
week with four weeks paid vacation. Compensation 
57K with excellent corporate benefits plus incentive 
compensation. Flexible scheduling to allow individual 
pursuits in university town of 250,000 in Central Illi- 
nois. Contact: Hospital Emergency Physicians S.C., 
221 Northeast Glen Oak, Peoria, 61636; phone 309- 
672-4974. (8) 

WAUKEGAN: Population 67,000, northern Chicago 
Suburb. Newly remodeled medical center near hos- 
pital. Looking for Internist, Family Physician. Contact 
Washington Center, 1515 Washington St., Waukegan 
60085, Y. Lee, M.D. 312-336-2221 or 729-5407. (9) 


for August , 1978 


115 


~F 'N 







Illinois Medical Journal 


YOUR ADVERTISERS 


Our advertisers serve the Medical Profession and support your Journal. 
All advertisers are approved by your Journal Committee. It will help 
you and your society to mention your Journal when writing them. 

Space Representatives 

United Media Associates, Inc., 16 Bruce Park Avenue, Greenwich, Conn. 06830 


Pharmaceuticals 


64-66 

Boehringer Ingelheim 

61-62 

Roche Laboratories 


Catapres 


Div. of Hoffman-LaRoche 




Librax 

74-75 

Bristol Laboratories 
Div. of Bristol-Myers Co. 

Covers 3&4 

Roche Laboratories 


T eg open 

Div. of Hoffman-LaRoche 

Cover 2 

Burroughs Wellcome Co. 


Librium 


Neosporin 

68 

Smith Kline and French Labs. 

76 

Eli Lilly and Company 


Div. of SmithKline Corp. 


Darvon 


Dyazide 

113-114 

Mead Johnson Laboratories 




Colace 

78 

Upjohn Pharmaceuticals 


Quibron 


Tolinase 

Insurance 



94 

Medical Protective Co. 

100 

Parker Aleshire and Co. 


Professional Liability Ins. 


Group Insurance 

Services and Continuing Education 


69-70 

Blue Cross and Blue Shield 

71 

Jobst Laboratories 


Report 


Venous Pressure Gradient Supports 

109 

Classified Advertising 

101 

Mann, Levine & Weiss 




Pension Consultants 

84 

Cook County Graduate School 




Continuing Medical Education 

97 

Michael Reese Hospital and 

77 

Illinois Bell Telephone Company 

Practice Opportunity 


Med. Cntr. 

Position Opportunity 

106 

INTRAV 

100 

Oak Forest Hospital 


West Indies Air/Sea Cruise 


Position Opportunity 

111 

ISMS Guide to Continuing 

107 

S-Tek 


Medical Education 


Data Systems 


116 


Illinois Medical Journal 


Librium 


chlordiazepoxide HCI /Roche 



□ Proven antianxiety performance 

□ An unsurpassed safety record 

□ Predictable patient response 

□ Minimal effect on mental acuity at 
recommended doses 

□ Minimal interference with many 
primary medications, such as antacids, 
anticholinergics, diuretics, cardiac 
glycosides and antihypertensive agents 


Before prescribing, please consult complete product infor- 
mation, a summary of which follows: 

Indications: Relief of anxiety and tension occurring alone 
or accompanying various disease states. Efficacy beyond 
four months not established by systematic clinical studies. 
Periodic reassessment of therapy recommended. 

Contraindications: Patients with known hypersensitivity 
to the drug. 

Warnings: Warn patients that mental and/or physical abil- 
ities required for tasks such as driving or operating ma- 
chinery may be impaired, as may be mental alertness in chil- 
dren, and that concomitant use with alcohol or CNS depres- 
sants may have an additive effect. Though physical and psy- 
chological dependence have rarely been reported on recom- 
mended doses, use caution in administering to addiction- 
prone individuals or those who might increase dosage; with- 
drawal symptoms (including convulsions), following discon- 
tinuation of the drug and similar to those seen with barbi- 
turates, have been reported. 

Usage in Pregnancy: Use of minor tranquilizers during 
first trimester should almost always be avoided be- 
cause of increased risk of congenital malformations as 
suggested in several studies. Consider possibility of 
pregnancy when instituting therapy; advise patients 
to discuss therapy if they intend to or do become 
pregnant. 

Precautions: In the elderly and debilitated, and in chil- 
dren over six, limit to smallest effective dosage (initially 10 
mg or less per day) to preclude ataxia or oversedation, in- 
creasing gradually as needed and tolerated. Not recom- 
mended in children under six. Though generally not recom- 
mended, if combination therapy with other psycho- 
tropics seems indicated, carefully consider individual phar- 
macologic effects, particularly in use of potentiating drugs 
such as MAO inhibitors and phenothiazines. Observe usual 
precautions in presence of impaired renal or hepatic func- 
tion. Paradoxical reactions (e. q. , excitement, stimulation and 


acute rage) have been reported in psychiatric patients and 
hyperactive aggressive children. Employ usual precautions in 
treatment of anxiety states with evidence of impending de- 
pression; suicidal tendencies may be present and protective 
measures necessary. Variable effects on blood coagulation 
have been reported very rarely in patients receiving the drug 
and oral anticoagulants; causal relationship has not been es- 
tablished clinically. 

Adverse Reactions: Drowsiness, ataxia and confusion 
may occur, especially in the elderly and debilitated. These 
are reversible in most instances by proper dosage adjust- 
ment, but are also occasionally observed at the lower dos- 
age ranges. In a few instances syncope has been reported. 
Also encountered are isolated instances of skin eruptions, 
edema, minor menstrual irregularities, nausea and constipa- 
tion, extrapyramidal symptoms, increased and decreased 
libido— all infrequent and generally controlled with dosage re- 
duction; changes in EEG patterns (low-voltage fast activity) 
may appear during and after treatment; blood dyscrasias (in- 
cluding agranulocytosis), jaundice and hepatic dysfunction 
have been reported occasionally, making periodic blood 
counts and liver function tests advisable during protracted 
therapy. 

Usual Daily Dosage: Individualize for maximum beneficial 
effects. Oral— Adults: Mild and moderate anxiety and ten- 
sion, 5 or 10 mg t.i.d. or q.i.d.; severe states, 20 or 25 mg 
t.i.d. or q.i.d. Geriatric patients: 5 mg b i d. to q.i.d. (See 
Precautions. ) 

Supplied: Librium ® (chlordiazepoxide HCI) Capsules, 5 
mg, 10 mg and 25 mg— bottles of 100 and 500; Tel-E-Dose® 
packages of 100, available in trays of 4 reverse-number- 
ed boxes of 25, and in boxes containing 10 strips of 10; 
Prescription Paks of 50, available singly and in trays 
of 10. Libritabs ®(chlordiazepoxide) Tablets, 5 mg, / 

10 mg and 25 mg— bottles of 100 and 500. With re- 
spect to clinical activity, capsules and tab- y' 

lets are indistinguishable. / 


synonymous with relief of anxiety 


ROCHE 


Roche Products Inc. 
Manati, Puerto Rico 00701 


Please see following page. 



Libnum 


r"" ' 


|§ 


1 1 : 


■ 








VOT.IIMF 154 Yr. 1978 


Stubbed for No(s). 

Nu mber 3 , SEPT . 

For Further Information, 
please inquire of the 
Reference Librarian 




=> Illinois 
Medical 
Journal 


=1 


OFFICIAL JOURNAL OF THE 
ILLINOIS STATE MEDICAL SOCIETY 




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Neomycin 

Staphylococcus 

Haemophilus 

Klebsiella 

Aerobacter 


Neosporin 
Ointment 


(Polymyxin B-Bacitracin-Neomycin 

This potent broad-spectrum antibacterial 
provides overlapping action to help combat 
infection caused by common susceptible pathogen: 
(including staph and strep). The petrolatum base 
is gently occlusive, protective and 
Polymyxin B enhances spreading. 


Escherichia 

Proteus 

Corynebacterium 

Streptococcus 

Pneumococcus 


Staphylococcus 

Corynebacterium 

Streptococcus 

Pneumococcus 


Pseudomonas 

Haemophilus 

Klebsiella 

Aerobacter 

Escherichia 



Wellcome 


/ Burroughs Wellcome Cc 

/ Research Triangle Park 
/ North Carolina 27709 


In vitro overlapping antibacterial action of 
Neosporin* Ointment (polymyxin B-bacitracin-neomycin). 


Neosporin 

Ointment 

(Polymyxin B- Bacitracin-Neomycin) 

Each gram contains: Aerosporin® brand Polymyxin B 
Sulfate 5,000 units; zinc bacitracin 400 units; neomycin 
sulfate 5 mg (equivalent to 3.5 mg neomycin base); 
special white petrolatum qs; in tubes of 1 oz and 1/2 oz 
and 1/32 oz (approx.) foil packets. 

WARNING; Because of the potential hazard of nephro- 
toxicity and ototoxicity due to neomycin, care should be 
exercised when using this product in treating extensive 
burns, trophic ulceration and other extensive conditions 
where absorption of neomycin is possible. In burns 
where more than 20 percent of the body surface is 


affected, especially if the patient has impaired renal 
function or is receiving other aminoglycoside anti- 
biotics concurrently, not more than one application a 
day is recommended. 

When using neomycin-containing products to control 
secondary infection in the chronic dermatoses, 
it should be borne in mind that the skin is 
more liable to become sensitized to many substances, 
including neomycin. The manifestation of sensitization to 
neomycin is usually a low grade reddening with swelling, 
dry scaling and itching; it may be manifest simply as 
failure to heal. During long-term use of neomycin- 
containing products, periodic examination for such 
signs is advisable and the patient should be told to 
discontinue the product if they are observed. These 
symptoms regress quickly on withdrawing the medica- 
tion. Neomycin-containing applications should be 
avoided for that patient thereafter. 


PRECAUTIONS; As with other antibacterial preparations 
prolonged use may result in overgrowth of nonsus- 
ceptible organisms, including fungi. Appropriate measure: 
should be taken if this occurs. 

ADVERSE REACTIONS: Neomycin is a not uncommon 
cutaneous sensitizer. Articles in the current literature 
indicate an increase in the prevalence of persons 
allergic to neomycin. Ototoxicity and nephrotoxicity 
have been reported (see Warning section). 

Complete literature available on request from Profes- 
sional Services Dept. PML. 







Blue Cross® 
Blue Shield® 




FOR 



Utilization of Cost-Effective Programs 


Illinois Blue Cross and Blue Shield is urging; phy- 
sicians, hospital administrators and all providers of 
patient care to utilize as extensively as possible the 
Plan’s cost effective programs to conserve hospital 
and medical care expenses. 

In the August issue of the “Blue Cross and Blue 
Shield Report for Illinois Physicians,” the Pre-Ad- 
mission Testing program for surgical patients 
(PAT) and the Ambulatory Surgery program were 
described and their cost-saving advantages empha- 
sized. 




Two additional cost-effective programs of the 
Plan — Coordinated Home Care and the Extended 
Care Facility program — are summarized below: 

Further information on these programs is avail- 
able from the Public Relations Department of Blue 
Cross and Blue Shield, 233 North Michigan Ave., 
Chicago, Illinois 60601. 

Coordinated Home Care: Many hospital patients 
are going home earlier, because of Blue Cross and 
Blue Shield’s Coordinated Home Care benefit pro- 
gram. With the doctor’s permission, patients who 
are Blue Cross-Blue Shield members may be re- 
leased directly into a program of recuperation and 
treatment at home where further medical and nurs- 
ing care is provided. 

The program is coordinated through the par- 
ticipating hospital in which the patient is receiving 
care and a participating Home Health Agency. It 
serves a two-fold purpose: The patient recuperates 
in the comfortable surroundings of his home, and 
the costs of care are reduced substantially in elimi- 
nating the expenses of a prolonged hospital stay. 

A total of 58 hospitals and 32 home nursing agen- 
cies participate in this program. Many Blue Cross 
and Blue Shield subscribers are automatically cov- 
ered for Coordinated Home Care. 


To be eligible for the program, a patient must 
be directed into the program by his or her physi- 
cian; require nursing service with continued hospi- 
tal services or supplies; have inpatient hospital 
benefit days available under Blue Cross and doctor 
) visits available under Blue Shield; be discharged 
from the hospital directly into the program; want 
to be cared for at home, have an adequate home 
situation; and require care directly related to the 


condition that required hospitalization. 

Blue Cross will pay for the services of a visiting 
nurse and physical therapy from the participating 
agency and for such services as medication, dress- 
ings, medical supplies, lab tests and x-rays from a 
participating hospital. 

Blue Shield will pay the Usual and Customary 
fee of the attending physician for visits to the pa- 
tient’s home and for one office visit while the pa- 
tient is under the Coordinated Home Care program. 

The maximum number of Coordinated Home 
Care visits allowed are three for each unused hos- 
pital benefit day in a subscriber’s Blue Cross cer- 
tificate. For example, if a certificate provides for 
120 days of hospital benefits and only 60 days are 
spent in the hospital, the patient has 180 eligible 
days for Coordinated Home Care, provided the 
need is acute and vertified by the attending physi- 
cian. Each visit by the attending physician counts 
as one benefit day. In all cases, vertification of need 
is required every 30 days. 

Extended Care Facility Program: Blue Cross and 
Blue Shield’s Extended Care Facility program is 
designed to maintain quality care while holding 
down costs. An Extended Care Facility is a special- 
ly qualified facility staffed and equipped to pro- 
vide comprehensive post-acute hospital and rehabil- 
itative inpatient care after an early transfer from a 
hospital. It must have a contract with the Plan at 
the time the Blue Cross member is admitted. 

An Extended Care Facility may be recommended 
for a patient after surgery or a serious illness when 
the extensive services of a general hospital are not 
required for a successful recovery. A supportive or 
maintenance level of care, residential care and 
custodial care are not covered. 

The Extended Care Facility program increases 
the amount of benefit days for Blue Cross and Blue 
Shield subscribers. Benefits entitle the patient-sub- 
scriber to two days of care for each unused hospital 
benefit day under Blue Cross. Blue Shield pays for 
physician visits on the same basis as inhospital 
visits — with each visit counting as one daily visit. 

A total of 57 facilities now qualify as Blue Cross- 
approved Extended Care Facilities. The names and 
locations of the facilities are available from Blue 
Cross and Blue Shield. 




(This report is a service to the physicians of Illinois) 



ASK BLUE SHIELD . . . ABOUT MEDICARE 


Daily Visit Charges for 
inpatient Hospital Visits 

Physicians frequently submit Medicare claims, or 
bill their patients, for hospital visits charging a sin- 
gle, inclusive daily visit rate for each day the pa- 
tient is hospitalized. If a patient is hospitalized for 
30 days, for instance, the charge would be for 30 
visits. 

It is the responsibility of the physician to provide 
adequate documentation of these visits ; an entry 
should be made in the hospital record that indicates 
the date of each visit. Physicians may feel that, 
since they are responsible for the total care of a 
patient, this entitles them to reimbursement for 
every day that the patient is hospitalized, even 
though on certain days no identifiable service was 
rendered. Payment for medical care or medical 
management on this basis would be in conflict with 
Medicare coverage rules which state that “the phy- 
sician must examine the patient in person or is able 
to visualize some aspect of the patient’s condition 
without the interposition of a third person’s judge- 
ment.” 

A rule of the hospital that the physician is re- 
quired to visit patients daily is not considered a 
sufficient basis for the carrier to pay each daily 
visit. Acceptable documentation would be a physi- 
cian’s progress notes indicating the dates he visited 
the patient, or an entry in the physician’s orders. In 
a teaching hospital setting, the medical record must 
contain signed or countersigned notes by the su- 
pervisory physician who is billing for the visits. 

The Medicare carrier does not always check rou- 
tinely for hospital record documentation. However, 
in cases where a complaint of nonrendition of ser- 
vices is received, the records of that physician will 
be reviewed. Payment may be denied if the review 
fails to show the necessary documentation, or, if 
the review is on a postpayment basis, a physician 
could be asked to refund a payment. Proper docu- 
mentation always provides proof of visits made in 
case a patient raises a question with the Medicare 
carriers or his Social Security office regarding 
charges billed for visits. 


Changes in Participation and 
Certification of Laboratory Procedures 

Notices were received from the Medicare Bureau 
of the following changes in participation and cer- 
tification of tests and procedures of laboratories in 
the Medicare program: 

Approved for Participation: 

Cos Building Laboratory, 2500 Ridge Road, 


Evanston, 111. 60201 (Provider Number 14-8355) 
has been approved for participation in the Medi- 
care program, effective April 13, 1978. The labora- 
tory is approved to perform the following tests 
and procedures: 130-Parasitology; 200-Serology; 
310-Routine Chemistry; 320-Clinical Microscopy; 
630-Diagnostic Cytology; 710-EKG Services. 

Changes in Approved Tests and Procedures: 

Island Medical Laboratory, Inc., 8452 Stony Is- 
land Ave., Chicago, 111. 60617 (Provider Number 
14-5247) has been approved to perform Procedure 
630-Diagnostic Cytology, effective January 15, 1978. 
The laboratory is also approved to perform Proce- 
dure 110-Bacteriology; Procedure 200-Serology; 
Procedure 310-Chemistry Routine; Procedure 320 
Clinical Microscopy; Procedure 400-Hematology; 
Procedure 510-Blood Group and Rh Typing. 

Greenview Clinical Laboratories, Inc., 2752 West 
Fullerton Ave., Chicago, 111. 60647 (Provider Num- 
ber 14-8239) is no longer approved to perform 
Procedures 330-Chemistry-Other and 510-Blood 
Group and Rh Typing. The laboratory is approved 
to perform Procedures 110-Bacteriology; 310-Chem- 
istry Routine; 320-Clinical Microscopy; 200-Serol- 
ogy; 130-Parasitology; 510-Blood Group and Rh 
Typing; 710-EKG Services; 630-Diagnostic Cytol- 
ogy. 

Ace Diagnostic Limited, 1411 West Irving Park 
Road, Chicago, 111. 60613 (Provider Number 14- 
8293) is longer approved to perform Procedures 
130-Parasitology and 330-Chemistry-Other. The lab- 
oratory is approved to perform Procedures 110-Bac- 
teriology; 200-Serology; 310-Chemistry Routine; 
320-Clinical Microscopy; 510-Blood Group and Rh 
Typing; 630-Diagnostic Cytology; 710-EKG Ser- 
vices; 400-Serology. 

Lius Medical Laboratory, Inc., 1429 West Irving 
Park Road, Chicago, 111. 60613 (Provider Number 
14-8320) is no longer approved to perform Proce- 
dures 130-Parasitology; 330-Chemistry-Other and 
510-Blood Group and Rh Typing. The laboratory is 
approved to perform Procedures 110-Bacteriology; 
200-Serology; 310-Routine Chemistry; 320-Clinical 
Microscopy and 630-Diagnostic Cytology. 

St. Luke Family Health Center, Inc., 1414 South 
Indiana Ave., Chicago, 111. 60605 (Provider Num- 
ber 14-8343) is no longer approved to perform Pro- 
cedures 330-Chemistry-Other; 510-Blood Group and 
Rh Typing; 630-Diagnostic Cytology; and 710-EKG 
Services. The laboratory is approved to perform 
Procedures 110-Bacteriology; 130-Parasitology; 200- 
Serology; 310-Routine Chemistry; 320-Clinical 
Microscopy; and 400-Hematologv. 


(This report is a service to the physicians of Illinois) 



Illinois Medical Journal 

OCTOBER, 1978 Vol. 154, No. 4 CONTENTS 


Reference Issue 


203 

ISMS Organization 

205 

Constitution and Rylaws 

217 

Policy Manual 

231 

House of Delegates 

236 

ISMS Councils and Committees 

247 

ISMS Services 

254 

Ancillary Organizations 

263 

Illinois State Government and Agencies 

281 

Medical Legal Information 

286 

Index to the Reference Section 

Special Reports 

288 

ISMS Legislative Update 

304 

Report of the Illinois AMA Delegation 

Delegates Handbook, 1978 Interim Session 

296 

Delegates’ Roster 

299 

County Medical Society Officers 

307 

Schedule of Meetings 

309 

Resolutions 


Surgical Grand Rounds 

317 Case Report: Torsion of the Testis 

John M. Beal, M.D., Contributing Editor 


Rheumatology Rounds 

320 Acute Unilateral Ankle Swelling With Fever 

L. F. Layfer, M.D., arid J. V. Jones, M.D., Contributing Co-Editors 

Clinical Articles 

324 Case Report: Phencyclidine Psychosis 

By Beverly J. Fauman, M.D., and Michael A. Fauman, M.D. 


President s Page 

313 Interim Session To Focus on Key Issues 

David S. Fox, M.D. 

(Contents continued on overleaf) 


for October, 197S 


177 


CONTENTS (continued) 


Features 


179 

Clinics for Crippled Children 

185 

Viewbox 

188 

EKG of the Month 

190 

Obituaries 

192 

Guest Editorial 

198 

Pulse of the ISMS Auxiliary 

200 

ISMS Guide to Continuing Medical 
Education 

311 

Doctor s News 

314 

Physician Recruitment 

322 

Housestaff News 

326 

Classified Advertising 


Staff 

Managing Editor Richard A. Ott 

Assistant Editor Mariann M. Stephens 

Executive Administrator Roger N. White 

(Cover by Alicia Albanese Kolton) 

PUBLICATIONS COMMITTEE 

Herschel Browns, M.D., Chicago, Chairman 
Kenneth A. Hurst, M.D., Naperville 
Robert P. Johnson, M.D., Springfield 
Alfred J. Kiessel, M.D., Decatur 
Harold J. Lasky, M.D., Chicago 


Editorial Board 

J. William Roddick, Jr., M.D., Springfield, Chairman 
Eli L. Borkon, M.D., Carbondale 
Daniel R. Cunningham, M.D., Wilmette 
Raymond A. Dieter, Jr., M.D., Glen Ellyn 
James G. Ekeberg, M.D., Palatine 
Ediz Z. Ezdinli, M.D., Kenilworth 
Carl Neuhoff, M.D., Peoria 
Constantine S. Soter, M.D., Arlington Heights 
Donald D. VanFossan, M.D., Springfield 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Maternal Death Studies: 

Robert R. Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth Andrea Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 
Contributor in Immunopathology : Richard J. Ablin, Ph.D., Chicago 
Contributor in Rheumatology: L. F. Layfer, M.D., Chicago 


ILLINOIS STATE 
MEDICAL SOCIETY 

OFFICERS 

David S. Fox, M.D., President 
826 E. 61st St., Chicago 60637 
P. John Seward, M.D., President-Elect 
310 N. Wyman St., Rockford 61101 
Herschel Browns, M.D., 1st Vice-President 
4600 N. Ravenswood, Chicago 60640 
G. W. Giebelhausen, M.D., 2nd Vice-President 
1101 Main St., Peoria 61606 
Audley F. Connor, Jr., M.D., Secretary-Treasurer 
7531 S. Stony Island Ave., Chicago 60649 

HOUSE OF DELEGATES 

Cyril C. Wiggishoff, M.D., Speaker 
25 E. Washington, Chicago 60602 
Robert P. Johnson, M.D., Vice-Speaker 
108 Maple Grove, Springfield 62707 

TRUSTEES 

1st District: 1980, John J. Ring, M.D. 
511 Hawley, Mundelein 60060 
2nd District: 1980, Allan L. Goslin, M.D. 

712 N. Bloomington, Streator 61364 
3rd District: 1979, Alfred dementi, M.D. 
675 W. Central Rd., Arlington Heights 60005 
3rd District: 1980, Raymond J. Des Rosiers, M.D. 

1044 N. Francisco, Chicago 60622 
3rd District: 1979, Robert T. Fox, M.D. 
2136 Robincrest, Glenview 60025 
3rd District, 1979, Jere Freidheim, M.D. 

3050 S. Wallace, Chicago 60616 
3rd District: 1981, Morris T. Friedell, M.D. 
7531 S. Stony Island Ave., Chicago 60649 
3rd District: 1981, Henrietta Herbolsheimer, M.D. 

1700 E. 56th St., Chicago 60637 
3rd District: 1981, Lawrence L. Hirsch, M.D. 

2434 Grace St., Chicago 60618 
3rd District: 1980, Harold J. Lasky, M.D. 
55 E. Washington, Chicago 60602 
3rd District: 1980, Richard N. Rovner, M.D. 

645 N. Michigan, Suite 920, Chicago 60611 
3rd District: 1980, Joseph C. Sherrick, M.D. 

303 E. Superior, Chicago 60611 
4th District: 1979, Fred Z. White, M.D. 

723 N. Second St., Chilliccthe 61523 
5th District: 1979, P. F. Mahon, M.D. 
800 E. Carpenter, Springfield 62702 
6th District: 1981, Robert R. Hartman, M.D. 
1515 A. W. Walnut, Jacksonville 62650 
7th District: 1979, Alfred J. Kiessel, M.D. 

1 Powers Lane PL, Decatur 62522 
8th District: 1979, James Laidlaw, M.D. 
104 W. Clark, Champaign 61820 
9th District: 1981, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1981, Julian W. Buser, M.D. 
6600 W. Main St., Belleville 62223 
11th District: 1980, Kenneth A. Hurst, M.D. 

52 Bunting Lane, Naperville 60540 
12th District: 1980, Joseph Perez, M.D. 
5670 E. State St., Rockford 61108 
Trustee- At-Large: George T. Wilkins, M.D. 
27 Glen Echo Dr., Edwardsville 62025 
Chairman of the Board: Robert R. Hartman, M.D. 

1515 A. W. Walnut, Jacksonville 62650 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of IMJ are listed in the Current Contents /Clinical Practice. 

Published by the Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603 (312-782-1654) 
Copyright, 1978. The Illinois State Medical Society. All material subject to this copyright may be photo- 
copied for the noncommercial purpose of scientific or educational advancement. 

Subscription S8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. $10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada $8.50. U.S. Single current copies available at $1.00 ($1.10 by mail), back issues $1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 55 E. Monroe St., Chicago, 111. 60603. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 

The Illinois Medical Journal is published by the Illinois State Medical Society as an educational and 
professional informational magazine and distributed as a benefit of membership in the Illinois State Medical 
Society. Its intent is to keep members current in medical knowledge and is a part of a continuing medical 
education program. Socioeconomic matters, affecting as they do a changing pattern in the proper delivery of 
medical care, are considered an inherent element in medical education. 


Clinics for Crippled Children 
Listed for November 

Thirty-four clinics for Illinois’ physically handicapped 
children have been scheduled for November by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will count twenty-four general clinics 
providing diagnostic orthopedic, pediatric, speech and 
hearing examination, along with medical, social and nurs- 
ing services. There will be nine special clinics for chil- 
dren with cardiac conditions and two for children with 
cerebral palsy. Any private physician may refer to or 
bring to a convenient clinic any child or children for 
whom he may want examination or consultative services. 


November 1 
November 1 
November 2 
November 2 
November 2 
November 2 

November 3 

November 7 

November 8 
November 8 
November 8 
November 9 
November 9 
November 9 
November 10 

November 13 
November 14 
November 14 
November 15 
November 15 
November 15 
November 15 
November 15 

November 15 
November 16 

November 17 

November 17 
November 20 
November 21 
November 21 
November 21 
November 27 
November 28 
November 28 


Hinsdale— Hinsdale Sanitarium 
Mt. Vernon— Good Samaritan Hospital 
Effingham— St. Anthony Memorial Hospital 
Pittsfield— Illini Community Hospital 
Sterling— Community General Hospital 
Lake County Cardiac— Victory Memorial 
Hospital 

Division Cardiac— U. of I. at the Medical 
Center 

Park Ridge Cardiac— Lutheran General Hos- 
pital 

Champaign— McKinley Hospital 
Joliet— St. Joseph’s Hospital 
Chicago Heights Gen.— St. James Hospital 
DuQuoin— Marshall Browning Hospital 
Springfield— St. John’s Hospital 
Macomb— McDonough District Hospital 
Chicago Heights Cardiac— St. James Hos- 
pital 

Peoria Cardiac— St. Francis Hospital 

Peoria— St. Francis Hospital 

East St. Louis— Christian Welfare Hospital 

Centralia— St. Mary’s Hospital 

Rockford— St. Anthony’s Hospital 

Springfield Ped-Neuro— St. John’s Hospital 

Elgin— Sherman Hospital 

Evergreen Park— Little Company of Mary 

Hospital 

Chicago Heights Gen.— St. James Hospital 
Elmhurst Cardiac— Memorial Hospital of 
DuPage County 

Chicago Heights Cardiac— St. James Hos- 
pital 

Kankakee Cardiac— St. Mary’s Hospital 
Maywood— Loyola Medical Center 
Rock Island— Moline Public Hospital 
Decatur— Decatur Memorial Hospital 
Belleville— St. Elizabeth’s Hospital 
Peoria Cardiac— St. Francis Hospital 
Peoria— St. Francis Hospital 
Alton— Alton Memorial Hospital 


The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. In carrying on its program, 
the Division works cooperatively with local medical so- 
cieties, hospitals, the Illinois Children’s Hospital-School, 
civic and fraternal clubs, visiting nurse associations, local 
social and welfare agencies, local chapters of the National 
Foundation and other interested groups. In all cases, the 
work of the Division is intended to extend and supple- 
ment, not supplant, activities of other agencies, either 
public or private, state or local, carried on in behalf of 
crippled children. 


Librax 

Each capsule contains 5 mg 
chlordiazepoxide HCl and 2.5 mg clidinium Br. 

Please consult complete prescribing information, a 
summary of which follows: 

Indications: Based on a review of this drug by the 
National Academy of Sciences— National Research 
Council and/or other information, FDA has classified 
the indications as follows: 

"Possibly" effective: as adjunctive therapy in the 
treatment of peptic ulcer and in the treatment of the 
irritable bowel syndrome (irritable colon, spastic 
colon, mucous colitis) and acute enterocolitis. 

Final classification of the less-than-effective indica- 
tions requires further investigation. 

Contraindications: Glaucoma; prostatic hypertrophy, be- 
nign bladder neck obstruction; hypersensitivity to chlor- 
diazepoxide HCl and/or clidinium Br. 

Warnings: Caution patients about possible combined ef- 
fects with alcohol and other CNS depressants, and 
against hazardous occupations requiring complete mental 
alertness (e g., operating machinery, driving). Physical and 
psychological dependence rarely reported on recom- 
mended doses, but use caution in administering Librium® 
(chlordiazepoxide HCl) to known addiction-prone individu- 
als or those who might increase dosage; withdrawal symp- 
toms (including convulsions) reported following discon- 
tinuation of the drug. 

Usage In Pregnancy: Use of minor tranquilizers 
during first trimester should almost always be 
avoided because of increased risk of congenital 
malformations as suggested in several studies. 
Consider possibility of pregnancy when institut- 
ing therapy. Advise patients to discuss therapy if 
they intend to or do become pregnant. 

As with all anticholinergics, inhibition of lactation may occur. 
Precautions: In elderly and debilitated, limit dosage to 
smallest effective amount to preclude ataxia, oversedation, 
confusion (no more than 2 capsules/day initially; increase 
gradually as needed and tolerated). Though generally not 
recommended, if combination therapy with other psycho- 
tropics seems indicated, carefully consider pharmacology 
of agents, particularly potentiating drugs such as MAO in- 
hibitors, phenothiazines. Observe usual precautions in 
presence of impaired renal or hepatic function. Paradoxi- 
cal reactions reported in psychiatric patients. Employ 
usual precautions in treating anxiety states with evidence 
of impending depression; suicidal tendencies may be 
present and protective measures necessary. Variable ef- 
fects on blood coagulation reported very rarely in patients 
receiving the drug and oral anticoagulants; causal rela- 
tionship not established. 

Adverse Reactions: No side effects or manifestations not 
seen with either compound alone reported with Librax. 

When chlordiazepoxide HCl is used alone, drowsiness, 
ataxia, confusion may occur, especially in elderly and de- 
bilitated; avoidable in most cases by proper dosage ad- 
justment, but also occasionally observed at lower dosage 
ranges. Syncope reported in a few instances. Also 
encountered: isolated instances of skin eruptions, edema, 
minor menstrual irregularities, nausea and constipation, 
extrapyramidal symptoms, increased and decreased 
libido— all infrequent, generally controlled with dosage re- 
duction; changes in EEG patterns may appear during and 
after treatment; blood dyscrasias (including agranulo- 
cytosis), jaundice, hepatic dysfunction reported occasion- 
ally with chlordiazepoxide HCl, making periodic blood 
counts and liver function tests advisable during protracted 
therapy. Adverse effects reported with Librax typical of 
anticholinergic agents, i.e . , dryness of mouth, blurring of 
vision, urinary hesitancy, constipation. Constipation has 
occurred most often when Librax therapy is combined 
with other spasmolytics and/or low residue diets. 


for October, 1978 



ROCHE 


Roche Products Inc. 
Manati, Puerto Rico 00701 


179 



In treating certain G.I. disorders 

ice your therapeutic ex^ec 
with the triple benefits of 

Adjunctive 


Each capsule contains 
5 mg chlordiazepoxide HC1 
and 2.5 mg clidinium Br. 


Librax is unique among ui. medications 
in providing the specific antianxiety action of 
RllJM (chlordiazepoxide HC1) as well as the potent 
antisecretory and antispasmodic actions of 
\RZAN ‘ (clidinium Br) for adjunctive therapy 
of irritable bowel syndrome*and duodenal ulcer." 


Librax has been evaluated as possibly effective tor this indication. 
Please see brief summary of prescribing information on preceding page 


Your diagnosis is firm: 

Primary Hypertension.* 

*;■ ■■ His future is in your hands now. The 
next 20 days are decisive. 

What are the odds against that future? 
The sad fact is, half of America’s hyper- 
tensives drop out of treatment. 1 - 

Ydu can improve those odds. We can 
help you. Here’s hoyv: 

1 v COUNSEL: Talk to, your patient 
about the disease and its conse- 
quences— about the problem of . 
strokes, heart attacks, and kidney 
failure. Emphasize the need for tak- 
ing the medication you’ve chosen, , 
daily, and for the rest of your patient’s 
life. Teach your patient about the 
drugs you prescribe— their effects 
ana side effects. The more he knows, 
the more he’ll be involved. 

2 . CATAPRES® (clonidine hydro- 
chloride): because the data snow that 
people stay with it. It has a high 
adherence rate. 2 There are good 
and substantial reasons why pa- 
tients stay with Catapres — read 
them on the next pages. 

Counsel... and Catapres. They can 
help change the odds against your 
patient's future. And to change them 
even more, ask us for these from 
your Boehringer representative; 

—A major new film on Methods 
of Compliance 

— A useful and extensive monograph 
on compliance • f 

— The Onesti paper 
— Patient Aid Booklet 
— Patient worksheets 
— Patient Reminder Postcards 
—Other effective compliance 
enhancers 


V "By repeated determinations of the basal blood pres- 
sure,* 1 and once the medical history, physical examina- 
tion, including funduscopic and routine laboratory tests, + 
have been completed, one is usually able to exclude sec- 
ondary causes and to be reasonably comfortable with a 
diagnosis of primary or essential hypertension. 

**The National Hypertension Program Study Committee, 
in September, 1972, recommended blood pressures ex- 
ceeding 140/90 mm Hg be regarded as excessive for adult 
Americans under age 50. The World Health Committee 
ceiling has been 160/95' mm Hg. 

+Hematocrit, urinalysis, creatinine (or urea nitrogen), tri- 
glycerides, cholesterol, uric aciql, plasma glucose, serum 
potassium; electrocardiogram, and chest x-ray. 

Please see bri^f summary of prescribing information on last 
page of advertisement for warnings, precautions, and , 
adverse reactions. 






■ Tablets of 0.1 and 0.2 mg 

CatapreSfctonidsne HO) 

can helpyou 
shape his world 


For most hypertensives, you need only two drugs... 
a diuretic and Catapres. 

Start with either, depending on your judgment. 

If you’ve come to expect 
only this much of Catapres... 

1. smooth lowering of blood pressure 

2. effective for all degrees of hypertension (mild to 
moderate in potency) 

3 . brain, heart, and kidney blood flow preserved 

Ask for more of Catapres® 

1. no contraindications 

2. low incidence of depression and 
orthostatic hypotension 

3 . normal hemodynamics 

4 . no fatal hepatotoxicity 

5 . excellent record of compliance 

Most common side effects are dry mouth, drowsiness, and sedation, 
which generally tend to diminish with time. 

Please see brief summary of prescribing information on last page of 
advertisement for warnings, precautions, and adverse reactions. 



fclonidine HCI) 


It gives you more than you expect of Catapres 



■ Tablets of 0.1 and 0.2 mg 

CatapreS'fctonidineHCI) 

can help you 
shape nis world 

Counsel... and Catapres. They can help change 
the odds against your patient’s future. And to 
change them even more, ask us for these from 
your Boehringer representative: 

— A major new film on Methods of Compliance 

— A useful and extensive monograph 
on compliance 
— The Onesti paper 
— Patient Aid Booklet 
— Patient worksheets 
— Patient Reminder Postcards 
—Other effective compliance 
enhancers 


References * 

1. Wilber JA, Barrow JS: Am J Med, 52:653-663, 1972. 

2. Data on file at Boehringer Ingelheim Ltd. 


Catapres^ brand of 
clonidine hydrochloride 

Tablets of 0.1 mg and 0.2 mg 

Indication: The drug is indicated in the treatment of 
hypertension. As an antihypertensive drug, Catapres 
(clonidine hydrochloride) is mild to moderate in potency. 

It may be employed in a general treatment program 
with a diuretic and/or other antihypertensive agents 
as needed for proper patient response. 

Warnings: Tolerance may develop in some patients 
necessitating a reevaluation of therapy. 

Usage in Pregnancy: In view of embryotoxic findings in 
animals, and since information on possible adverse 
effects in pregnant women is limited to uncontrolled 
clinical data, the drug is not recommended in women 
who are or may become pregnant unless the potential 
benefits outweigh the potential risk to mother and fetus. 
Usage in Children: No clinical experience is available 
with the use of Catapres (clonidine hydrochloride) in 
children. 

Precautions: When discontinuing Catapres (clonidine 
hydrochloride), reduce the dose gradually over 2 to 

4 days to avoid a possible rapid rise in blood pressure 
and associated subjective symptoms such as nervous- 
ness, agitation, and headache Patients should be 
instructed not to discontinue therapy without consulting 
their physician. Rare instances of hypertensive encepha- 
lopathy and death have been recorded after cessation 
of clonidine hydrochloride therapy. A causal relation- 
ship has not been established in these cases. It has 
been demonstrated that an excessive rise in blood pres- 
sure, should it occur, can be reversed by resumption 

of clonidine hydrochloride therapy or by intrave- 
nous phentolamme. Patients who engage in poten- 
tially hazardous activities, such as operating machinery 
or driving, should be advised of the sedative effect. 

This drug may enhance the CNS-depressive effects of 
alcohol, barbiturates and other sedatives. Like any other 
agent lowering blood pressure, clonidine hydrochloride 
should be used with caution in patients with severe 
coronary insufficiency, recent myocardial infarction, 
cerebrovascular disease or chronic renal failure. 

As an integral part of their overall long-term care, 
patients treated with Catapres (clonidine hydrochloride) 
should receive periodic eye examinations. While, 
except for some dryness of the eyes, no drug-related 
abnormal ophthalmologic findings have been recorded 
with Catapres (clonidine hydrochloride), in several 
studies the drug produced a dose-dependent increase 
in the incidence and severity of spontaneously occur- 
ring retinal degeneration in albino rats treated for 
6 months or longer. 

Adverse Reactions: The most common reactions are 
dry mouth, drowsiness and sedation. Constipation, 
dizziness, headache, and fatigue have been reported. 
Generally these effects tend to diminish with continued 
therapy. The following reactions have been associated 
with the drug, some of them rarely. (In some instances 
an exact causal relationship has not been established.) 
These include: Anorexia, malaise, nausea, vomiting, 
parotid pain, mild transient abnormalities in liver func- 
tion tests; one report of possible drug-induced hepa- 
titis without icterus and hyperbilirubinemia in a patient 
receiving clonidine hydrochloride, chlorthalidone and 
papaverine hydrochloride. Weight gain, transient eleva- 
tion of blood glucose, or serum creatine phosphokinase: 
congestive heart failure, Raynaud's phenomenon; vivid 
dreams or nightmares, insomnia, other behavioral 
changes, nervousness, restlessness, anxiety and mental . 
depression. Also rash, angioneurotic edema, hives, 
urticaria, thinning of the hair, pruritus not associated 
with a rash, impotence, urinary retention, increased 
sensitivity to alcohol, dryness, itching or burning of the 
eyes, dryness of the nasal mucosa, pallor, gyneco- 
mastia, weakly positive Coombs' test, asymptomatic 
electrocardiographic abnormalities manifested as 
Wenckebach period or ventricular trigeminy. 

Overdosage: Profound hypotension, weakness, somno- 
lence. diminished or absent reflexes and vomiting fol- 
lowed the accidental ingestion of Catapres (clonidine 
hydrochloride) by several children from 19 months to 

5 years of age. Gastric lavage and administration of an 
analeptic and vasopressor led to complete recovery 
within 24 hours. Tolazoline in intravenous doses of 

10 mg at 30-minute intervals usually abolishes all ef- 
fects of Catapres (clonidine hydrochloride) overdosage. 

How Supplied: Catapres, brand of clonidine hydro- 
chloride, is available as 0.1 mg (tan) and 0.2 mg 
(orange) oval, sinqle-scored tablets in bottles of 100 
and 1000. 

For complete details, please see full prescribing 
information. 

Under license from Boehringer Ingelheim GmbH 



Boehringer 

Ingelheim 


Boehringer Ingelheim Ltd. 
Ridgefield, CT 06877 


Distributed by 
Boehringer Ingelheim Ltd. 
Ridgefield, CT 06877 






Leon Love, M.D./Chairman/Department of Radiology 
Loyola University Stritch School of Medicine 


This month's case report urns contributed by Michael Fine, M.D., an assistant 
professor of radiology and Enrique Palacios, M.D., a professor of radiology, 
affiliated with the Loyola University Medical Center. 


This 8-year-old male presented to the Emergency Room with a history of head 
trauma folloiving a seizure. A frontal and lateral skull x-ray were obtained. 



What’s Your Diagnosis? 

The findings are consistent with: 

(A) Calcified tumor 

(B) Post-inflammatory calcifications 

(C) Sturge-Weber syndrome 

(D) Radio-opaque material in the hair 

(Continued on page 323) 


for October, 1978 


185 




Wild bea 



offending allergen? 





' . • 


Copyright ©1978, Schenng Corporation. All 





\ unique clinical option... 
from Schering allergy research 


Optimine 

jbrand of 

azatadine 

maleate 


1 mg. tablets 


Long-acting antihistamine relief 


B.I.D.dosage provides sustained symptomatic relief for up 
to 24 hours. Helps to keep patients adequately controlled 


Prolonged duration of antihistamine action is inherent in the 
molecular structure. . . not due to tablet coatings or other 
slow release processes 


B.I.D. effectiveness 

Patients can fit OPTIMINE into morning and evening 
routines... no need to carry medication. The easy-to-titrate, 
scored 1 mg. tablet permits dosage flexibility to meet 
individual patient requirements 


No dyes 

Contains no sensitizing dyes with their potential for causing 
allergic reactions 

Optimine A practical antihistamine 

to help allergy patients stay on therapy 


CONTRAINDICATIONS Use in Newborn or Premature in- 
fants This drug should not be used in newborn or pre- 
mature infants 

Use in Nursin g Mothers Because of the higher risk ot anti- 
histamines for infants generally and for newborns and 
prematures in particular, antihistamine therapy is contrain- 
dicated in nursing mothers. 

Use in Lower Respiratory Disease: Antihistamines should 
NOT be used to treat lower respiratory tract symptoms 
including asthma 

Antihistamines are also contraindicated in the following 
conditions hypersensitivity to azatadine maleate and other 
antihistamines of similar chemical structure, monoamine 
oxidase inhibitor therapy (See DRUG INTERACTIONS 
Section) 

WARNINGS Antihistamines should be used with consid- 
erable caution in patients with narrow angle glaucoma, 
stenosing peptic ulcer, pyloroduodenal obstruction, 
symptomatic prostatic hypertrophy, bladder neck 
obstruction 

Use in Children In infants and children especially, anti- 
histamines in overdosa ae may cause hallucinations, con- 
vulsions, or death 

As in adults, antihistamines may dimmish mental alertness 
in children. In the young child, particularly, they may pro- 
duce excitation 

OPTIMINE TABLETS ARE NOT INTENDED FOR USE IN 
CHILDREN UNDER 12 YEARS OF AGE 
Use in Pre g nanc y Experience with this drug in pregnant 
women is inadequate to determine whether there exists a 
potential for harm to the developing fetus. 

Use with CNS Depressants Azatadine maleate has additive 
effects with alcohol and other CNS depressants (hypnotics, 
sedatives, tranquilizers, etc ). 

Use in Activities Requirin g Mental Alertness Patients 
should be warned about engaging in activities requiring 
mental alertness, such as driving a car or operating appli- 
ances, machinery, etc. 

Use in the Elderl y ( approximately 60 years or older ) Anti- 
histamines are more likely to cause dizziness, sedation, 
and hypotension in elderly patients 

PRECAUTIONS Azatadine maleate has an atropine-like ac- 
tion and, therefore, should be used with caution in patients 
with a history of bronchial asthma, increased intraocular 
pressure, hyperthyroidism, cardiovascular disease, 
hypertension 

DRUG INTERACTIONS MAO inhibitors prolong and inten- 
sify the anticholinergic (drying) effects of antihistamines 
ADVERSE REACTIONS The most frequent adverse reac- 
tions are underlined. 

General Urticaria, drug rash, anaphylactic shock, photo- 
sensitivity. excessive perspiration, chills, dryness of mouth, 
nose, and throat. 

Cardiovascular System Hypotension, headache, palpita- 
tions, tachycardia, extrasystoles 

Hematologic System Hemolytic anemia, thrombocyto- 
penia, agranulocytosis. 

Nervous System Sedation , sleepiness , dizziness , dis- 
turbed coordination , fatigue, confusion, restlessness, exci- 
tation, nervousness, tremor, irritability, insomnia, euphoria, 
paresthesias, blurred vision, diplopia, vertigo, tinnitus, 
acute labyrinthitis, hysteria, neuritis, convulsions. 
Gastrointestinal System Epig astric distress , anorexia, 
nausea, vomiting, diarrhea, constipation. 

Genitourinary System Urinary frequency, difficult urina- 
tion, urinary retention, early menses 
Respiratory System: Thickenin g of bronchial secretions , 
tightness of chest and wheezing, nasal stuffiness. 
OVERDOSAGE Antihistamine overdosage reactions may 
vary from central nervous system depression to stimula- 
tion. Stimulation is particularly likely in children. Atropine- 
like signs and symptoms (dry mouth, fixed, dilated pupils; 
flushing, and gastrointestinal symptoms) may also occur. 

If vomitin g has not occurred spontaneousl y, the patient 
should be induced to vomit This is best done by having 
him drink a glass of water or milk after which he should be 
made to gag Precautions against aspiration must be taken, 
especially in infants and children 

If vomitin g is unsuccessful , gastric lavage is indicated 
within three hours after ingestion and even later if large 
amounts of milk or cream were given beforehand Isotonic 
and 'k isotonic saline is the lavage solution of choice. 

Saline cathartics , such as milk of magnesia, draw water 
into the bowel by osmosis and therefore are valuable for 
their action in rapid dilution of bowel content. 

Stimulants should not be used 
Vasopressors may be used to treat hypotension 
FEBRUARY 1977 11055010 

For more complete details, consult package insert or 
Schering literature available from your Schering Represen- 
tative of Professional Services Department, Schering Cor- 
poration. Kenilworth. New Jersey 07033 

Schering Corporation 
Kenilworth. New Jersey 07033 



8202-0000 R 


/ 






















* 


7 

v 



of the iTTonth 

f 

V 










John F. Moran, M.S.. M.D.. David J. Hale. M.D.. 







Patrick J. Scanlon, M.D., Sarah A. Johnson, M.D., 
John R. Tobin, M.S., M.D., and Rolf M. Gunnar, M.S., M.D. 


Section of Cardiology, Department of Medicine, 
Loyola University Stritch School of Medicine- 


1 his is a 60-year-old man who came to the office complaining of worsening 
shortness of breath over the past six months. This progressed and was followed 
by paroxysmal nocturnal dyspnea and orthopnea. Past medical history was sig- 
nificant for inferior ivall myocardial infarction eight years earlier. Physical ex- 
amination demonstrated a grade 4/6 holosystolic murmur at the apex followed 
by a loud ventricular gallow ( S 3 ). Cardiac catheterization demonstrated moderate 
pulmonary hypertension 50/20 with an elevated pulmonary capillary wedge pres- 
sure. The left ventricular angiogram showed severe mitral valvular regurgitation 
with an enlarged left atrium. The pulmonary veins ivere also visualized. Rupture 
of the papillary muscles of the mitral valve was suspected. Coronary arteriogram 
showed a 100 % right coronary artery obstruction with few plaques in the left 
system. Open heart surgery with mitral valve replacement was performed. This 
long lead II rhythm strip was obtained on the first day following the surgery. 



1. The ECG shows: 

A. Premature atrial beats. 

B. Paroxysmal junctional tachycardia. 

C. Intermittent atypical complete left bun- 
dle branch block. 

D. Cycle dependent left anterior hemiblock. 

E. ST-T wave changes. 


2. Treatment should include: 

A. An increase in digitalis medication. 

B. Quinidine 300 mg. every six hours orally. 

C. Atropine 0.4 mg. intravenously. 

D. Direct current cardioversion. 

E. Temporary demand pacemaker as pro- 
phylaxis for sudden asystole. 

( Continued on page 328) 


188 


Illinois Medical Journal 











l I 





4 ««; 


Dyazide 

Each capsule contains 50 mg. of Dyrenium® (brand of 
triamterene) and 25 mg. of hydrochlorothiazide. 

Makes Sense in 
Hypertension* 


Before prescribing, see complete prescribing informa- 
tion in SK&F Co. literature or PDR. A brief summary 
follows: 


Warning 

This drug is not indicated for initial therapy of edema 
or hypertension. Edema or hypertension requires 
therapy titrated to the individual If this combination 
represents the dosage so determined, its use may 
be more convenient in patient management Treat- 
ment of hypertension and edema is not static, but 
must be reevaluated as conditions in each patient 
warrant 


Contraindications: Further use in anuria, progressive 
renal or hepatic dysfunction, hyperkalemia Pre-existing 
elevated serum potassium Hypersensitivity to either 
component or other sulfonamide-derived drugs 
Warnings: Do not use potassium supplements, dietary 
or otherwise, unless hypokalemia develops or dietary 
intake of potassium is markedly impaired. If supple- 
mentary potassium is needed, potassium tablets should 
not be used Hyperkalemia can occur, and has been 
associated with cardiac irregularities. It is more likely in 
the severely ill, with urine volume less than one liter/day, 
the elderly and diabetics with suspected or confirmed 
renal insufficiency Periodically, serum K+ levels should 
be determined If hyperkalemia develops, substitute a 
thiazide alone, restrict K+ intake Associated widened 
QRS complex or arrhythmia requires prompt additional 
therapy. Thiazides cross the placental barrier and appear 
in cord blood Use in pregnancy requires weighing 
anticipated benefits against possible hazards, including 
fetal or neonatal jaundice, thrombocytopenia, other 
adverse reactions seen in adults Thiazides appear and 
triamterene may appear in breast milk If their use is 
essential, the patient should stop nursing Adequate 
information on use in children is not available 
Precautions: Do periodic serum electrolyte determina- 
tions (particularly important in patients vomiting exces- 
sively or receiving parenteral fluids) Periodic BUN and 
serum creatinine determinations should be made, 
especially in the elderly, diabetics or those with sus- 
pected or confirmed renal insufficiency Watch for signs 
of impending coma in severe liver disease If spiro- 
nolactone is used concomitantly, determine serum K + 
frequently; both can cause K+ retention and elevated 
serum K + . Two deaths have been reported with such 
concomitant therapy (in one, recommended dosage was 
exceeded, in the other serum electrolytes were not 
properly monitored). Observe regularly for possible 
blood dyscrasias, liver damage, other idiosyncratic 
reactions. Blood dyscrasias have been reported in 
patients receiving triamterene, and leukopenia, throm- 
bocytopenia, agranulocytosis, and aplastic anemia have 
been reported with thiazides Triamterene is a weak folic 
acid antagonist Do periodic blood studies in cirrhotics 
with splenomegaly Antihypertensive effect may be 
enhanced in post-sympathectomy patients Use cau- 
tiously in surgical patients The following may occur: 
transient elevated BUN or creatinine or both, hyper- 
glycemia and glycosuria (diabetic insulin requirements 
may be altered), hyperuricemia and gout, digitalis 
intoxication (in hypokalemia), decreasing alkali reserve 
with possible metabolic acidosis Dyazide' interferes 
with fluorescent measurement of quinidine 
Adverse Reactions: Muscle cramps, weakness, dizzi- 
ness, headache, dry mouth; anaphylaxis, rash, urticaria, 
photosensitivity, purpura, other dermatological condi- 
tions; nausea and vomiting, diarrhea, constipation, other 
gastrointestinal disturbances. Necrotizing vasculitis, 
paresthesias, icterus, pancreatitis, xanthopsia and, rarely, 
allergic pneumonitis have occurred with thiazides alone 
Supplied: Bottles of 100 and 1000 capsules; Single Unit 
Packages of 100 (intended for institutional use only) 


SK&F CO. 

a SmithKSine company 

Carolina, P R 00630 



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Obituaries 

““Berard, LeRoy, H., Oak Park, died September 6, 
1978, at the age of 80. He was a 1929 graduate of the 
Rush Medical College. During his medical career, Dr. 
Berard served on the staff of Cook County Hospital and 
the Chicago Tuberculosis Sanitarium. 

Brown, Cabot, San Francisco, died on September 17, 
1978, at the age of 76. Dr. Brown was a former Chi- 
cagoan. 

* “Hardin, Parker C., Rockford, died August 25, 1978, at 
the age of 78. A 1927 graduate of Harvard, Dr. Hardin 
was a Diplomate with the American Board of Surgery 
and a Fellow of the American College of Surgeons. 

Hollander, Fredrerick G., California, died at the age of 
67. Dr. Hollander was a former Chicago resident. 

“Janda, Rudolph W., La Grange Park, died September 
5, 1978, at the age of 58. Dr. Janda was a 1944 graduate 
of the University of Chicago. 

“Kochenski, Richard V., Chicago, died on September 10, 
1978. He was a 1935 graduate of the Chicago Medical 
School. 

“Lewis, Calvin I., Glencoe, died September 20, 1978 at 
the age of 63. Dr. Lewis graduated from the University 
of Illinois in 1941. He was affiliated with St. Therese 
Hospital in Waukegan. 

Lloyd, Donald, Elgin, died August 23, 1978, at the age 
of 61. He was a graduate of Northwestern Medical 
School. Dr. Lloyd was a past president of the Sherman 
Hospital Medical Staff. 

“Mizock, Albert, Chicago, died August 31, 1978, at the 
age of 72. Dr. Mizock was a 1934 graduate of the Chi- 
cago Medical School. During his years of practice, Dr. 
Mizock was on the staff of Walther Memorial and Cen- 
tral Community Hospitals. 

Oberschneider, Paul, Elgin, died August 9, 1978, at the 
age of 58. 

““Richter, Oscar, Chicago, died September 6, 1978, at 
the age of 77. He was a 1927 graduate of the University 
of Chicago. Dr. Richter held staff positions on Belmont 
and St. Anne’s Hospitals. 

“Schmidt, Richard H., Chicago, died September 10, 
1978, at the age of 58. Prior to his death, Dr. Schmidt 
was a radiologist on the staff of Illinois Masonic Medical 
Center. Formerly a resident of Valparaiso, Indiana, he 
was director of radiology at Porter Memorial Hospital. 

Simunich, William A., Phoenix, Arizona, died August 10, 
1978, at the age of 83. A former Chicagoan, Dr. Simunich 
served on the Staff of Mercy Hospital and the Lewis 
Memorial Maternity Center. 

Ziegler, Rudolph, Oregon, died in an accident on August 
10, 1978 at the age of 61. A former Chicagoan, Dr. 
Ziegler was an official of the Fellows of International 
College of Physicians. He was a graduate of the Chicago 
Medical College. 

0 Indicates ISMS member. 

°® Indicates member of the ISMS Fifty Year Club. 



190 


Illinois Medical Journal 



Angina 

freedom 

fighter.. 


Burroughs Wellcome Co. 

Research Triangle Park 
Wellcome North Carolina 27709 


Cardilate® (erythrityl tetranltrate) 

INDICATIONS: For the prophylaxis and long-term treatment of patients with frequent 
or recurrent anginal pain and reduced exercise tolerance associated with angina pec- 
toris, rather than for the treatment of the acute attack of angina pectoris, since its 
onset is somewhat slower than that of nitroglycerin 

PRECAUTIONS: As with other effective nitrites, some fall in blood pressure may occur 
with large doses. 

Caution should be observed in administering the drug to patients with a history of re- 
cent cerebral hemorrhage, because of the vasodilation which occurs in the area 
Although therapy permits more normal activity, the patient should not be allowed to 
misinterpret freedom from anginal attacks as a signal to drop all restrictions. 

SIDE EFFECTS: No serious side effects have been reported In sublingual therapy, a 
tingling sensation (like that of nitroglycerin) may sometimes be noted at the point of 
tablet contact with the mucous membrane. If objectionable, this may be mitigated by 
placing the tablet in the buccal pouch. As with nitroglycerin or other effective nitrates, 
temporary vascular headache may occur during the first few days of therapy This 
can be controlled by temporary dosage reduction in order to allow adjustments of the 
cerebral hemodynamics to the initial marked cerebral vasodilation These headaches 
usually disappear within one week of continuous therapy but may be minimized by the 
administration of analgesics. 

Mild gastrointestinal disturbances occur occasionally with larger doses and may be 
controlled by reducing the dose temporarily 

DOSAGE: Therapy may be initiated with 10 mg sublingually prior to each anticipated 
physical or emotional stress and at bedtime for patients subject to nocturnal attacks 
The dose may be increased or decreased as needed. 

HOW SUPPLIED: 10 mg chewable scored tablets, bottle of 100 Also 5, 10 and 15 mg 
oral/sublingual scored tablets in bottles of 100 10 mg oral / sublingual scored tablets 
also supplied in bottle of 1,000. 

Also available: Cardilate®-P (Erythrityl Tetranitrate with Phenobarbital)* Tablets 
(Scored). 

(•Warning— may be habit-forming.) 


1. Taken sublingually, Cardilate® (erythrityl 
tetranitrate) begins to work within 5 minutes, 
eliminating or reducing frequency and severity 
of anginal pain for up to two hours. 

2. Fear of pain, a major deterrent to achieving 
acceptable (and desirable) levels of activity, in- 
cluding sex, may be allayed with Cardilate. Ef- 
fective prophylaxis and improved exercise 
tolerance help toward normalizing the lives of 
anginal patients. 

Cardilate 

(erythrityl tetranitrate) 


Guest Editorial 


Marketplace Choice as Deterrent 
To Government Price Controls 


Editor’s Note: The guest editorial below was submitted by the American Medi- 
cal Association for your consideration with the following comment: 

Alain G. Enthoven, the noted Stanford University ecomonist, recently told 
the AMA Board of Trustees , “We’re on the track to an increasingly regulated 
system (of health-care delivery).” 

He added , “The alternative to increasing government regulation is a system 
of incentives for economy and fair-market competition as recommended by your 
National Commission on the Cost of Medical Care.” 


The AMA-created National Commission on 
the Cost of Medical Care has opened up a new 
horizon by emphasizing the need to restore the 
concept of free-marketplace choice in health-care 
delivery. 

What does that mean? 

Well, picture the delivery system as a market- 
place where producers and consumers handle 
their transactions through insurers, private and 
public. The Cost Commission report recommends 
that producers and consumers have direct impact 
on decisions made in their behalf. 

Consumers want to buy services at a lower an- 
nual rate of cost growth than the 1 1% it has aver- 
aged since 1966. 

However, the marketplace right now is not 
functioning well. It was flexible in the days when 
consumers paid the producer directly. But the 
patterns of coverage offered by today’s middle- 
man insurers are largely standardized in benefits 
and therefore in costs. 

The Cost Commission report suggests ways in 
which those patterns can be stimulated to offer 
a latitude and freedom of choice. 

For instance, employees could choose among 
health-care plans in terms of premium price, 
whereas employer contributions to premiums 
would be the same for any plan. The employee 
selecting a plan less expensive than the employer 
contribution would either be reimbursed for the 
difference or receive additional benefits. 

The report makes this general observation: 

“Reliance on market mechanisms can lead to 
cost-effective production of output, and permit 
consumer preferences to play a key role in de- 


termining what goods and services are available.” 

Unfortunately, this leeway cannot control costs 
all by itself. Nor does the marketplace assure 
care to the poor and uninformed, and their 
health-care costs could continue to rise sharply. 

Hence, there must be some reliance on pro- 
vider self-regulation and on local regulation if 
the overall tab is to be kept in line. No federal 
controls are recommended by the report. 

Self-regulation would include cost-containment 
initiatives in the private sector of care, among 
third-party payers, and in medical practice. Says 
the report: 

“In the past, providers have considered pri- 
marily the medical needs of their patients. The 
Commission believes that providers must now 
take steps to make cost-effective utilization rec- 
ommendations without sacrificing the quality of 
care. There are a number of programs that can 
be undertaken within the health-care system 
that are not dependent on major changes in 
the delivery system.” 

The chief value of the report is that it brings 
many ideas and groups together in a coordi- 
nated program for genuine action. Some of the 
ideas are old but have never been implemented. 
Group responsibilities include those placed on 
the consumer. 

The upshot could be a momentum that would 
head off arbitrary, unwieldy federal formulas 
for cost containment. Developed after a year 
and a half of intensive study and effort, the 
Cost Commission report presents credible al- 
ternatives to those formulas. ■< 

AMA 


192 


Illinois Medical Journal 


This asthmatic 

isn’t worried about his next hreath... 



he’s active 
he’s effectively 
maintained on 



contains theophylline (anhydrous) 1 50 mg 
and glyceryl guaiocolote (guaifenesin) 

90 mg. Elixir: olcohol 15% 


• theophylline for effective 
around-the-clock 
bronchodilator therapy 

• 100% free theophylline 

Indications: For the symptomatic relief of bronchosposric 
conditions such as bronchial asthma, chronic bronchitis, and 
pulmonary emphysema. 

Warnings: Do nor administer more frequently than every 
6 hours, or within 12 hours after rectal dose of any prep- 
aration containing theophylline or ammophylline. Do nor 
give other compounds containing xanthine derivatives 
concurrently. 

Precautions: Use with caution in patients with cardiac 
disease, hepatic or renal impairment. Concurrent adminis- 
tration with certain antibiotics, i.e. clindamycin, erythromy- 
cin, rroleandomycin, may result in higher serum levels of 
theophylline. Plasma prothrombin and factor V may 
increase, bur any clinical effect is likely to be small. Metabo- 
lites of guaifenesin may contribute to increased urinary 
5-hydroxyindoleaceric ocid readings, when determined 
with nirrosonaphrol reagenr. Safe use in pregnancy has nor 
been established. Use in case of pregnancy only when 
clearly needed. 

Adverse Reactions: Theophylline may exert some stimulat- 
ing effect on the central nervous system. Its administration 
may couse local irritation of the gastric mucosa, with possi- 
ble gastric discomfort, nausea, and vomiting. The frequency 
of adverse reactions is related to the serum theophylline 
level and is nor usually a problem at serum theophylline 
levels below 20 /xg/ml. 

How Supplied : Capsules in bottles of 1 00 and 1 000 ond 
unit-dose packs of 100; Elixir in bottles of 1 pint and 1 gallon. 
See packa g e insert for complete prescribin g information . 



Ill 


PHARMACEUTICAL DIVISION 


©1978 Mead Johnson & Company • Evansville, Indiana 4772 1 U.S.A. MJL 8-4294R 



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Is Morocco and Kenya. Wander the narrow streets of the Casbahs in 
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charmers and soothsayers. Roam 
the vast game parks of Kenya by 
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zebra and lion on film. Relax at 
luxurious lodges or take a trip into 
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native artifacts to start your own 
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for October, 1978 


195 










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196 


Illinois Medical Journal 


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Illinois Bell 


for October , 1978 


197 



of the ISMS auxiliary 


Mrs. Eucene Vickery, Editor 




Growth Patterns 


Medical Marriage: 

Joys and Sorrows 


Mrs. Earl V. Klaren, President, ISMSA 

The American Medical Association Auxiliary Convention was held June 18- 
21 in St. Louis , Missouri. Those who atte?ided have reported a valuable educa- 
tional experience. The following piece is excerpted from the AMAA publication, 
“Facets,” detailing one presentation from that meeting. It reports several interest- 
ing comments on medical marriage. 

A five-member panel, moderated by Peter A. 

Martin, M.D., clinical professor of psychiatry at 
Michigan and Wayne State University Medical 
Schools and member of the AMA Section Coun- 
cil on Psychiatry, examined the special stresses a 
medical career places on a marriage. 

Mrs. Mary Glasgow, a physician’s wife who is 
a poet and artist, presented a personal view of 
the medical marriage in a talk she humorously 
titled “On Being Married to God.” “You can 
never escape his fan club,” nor the “phonecalls 
at all hours,” she said in noting the annoyances 
of the medical marriage. But, she said, these are 
balanced by special benefits. “There is a real 
pleasure in the role of ‘Frau Doctor’ or ‘Frau 
Professor,’ ” she maintained. Because a medical 
career is so demanding of the physician’s time 
and energy, the nonphysician member of a cou- 


ple may feel cheated. But, said Mrs. Glasgow, if 
the spouse has a positive attitude, these prob- 
lems can be overcome. “The woman who consid- 
ers herself entitled to the good things in life” 
such as a fulfilling home life and a career, “seems 
to be the one who gets those things,” she said. 

Ellen M. Berman, M.D., Director, Division of 
Family Study, University of Pennsylvania, dis- 
cussed the stages of adult development, explain- 
ing how these stages relate to the physician’s time 
frame and how they can affect relationships. 
“Each decade asks us different things, and this 
affects our marriage greatly,” she noted. 

Stephanie Cavanaugh, M.D., assistant profes- 
sor of psychiatry, Rush Medical School, Chicago, 
discusse'd the socialization process taking place 
in medical schools. Dr. Cavanaugh drew upon 
her professional experience as well as personal 



198 


Illinois Medical Journal 


experience with her physician-husband. “Medi- 
cal school and residency training programs are 
still structured in such a way that time for a 
personal life is almost non-existent,’’ she said. 

That structure is slowly changing, she noted, 
adding that in the meantime, spouses should 
“build a solid support system of friends, family, 
neighbors, and household help.” and have “grati- 
fying activities and careers outside the home.” 

H. Waldo Bird, clinical professor of psychi- 
atry at St. Louis University, provided an inside 
view of the marriage counseling therapy room. 
After detailing the warning signs of problems in 
a marriage, Dr. Bird offered an unbeat view of 
a marriage relationship. “There really is no more 
optimal situation for two people to learn who 
they are than in the framework of marriage,” lie 
said. 

Special Note 

Fall Conference for the southern counties will 
be held Thursday, November 9, J 978, at the 
Belleville Ramada Inn. For further information 
about the exciting program, as well as reserva- 
tions, please contact program co-chairmen Mrs. 
Thomas Meirink or Mrs. Andrew Gregowicz, 
both of Belleville. 


ISMS Travel Programs 

The following ISMS-sponsored travel programs 
have been scheduled for 1979: 

Feb. 27-Mar. 13— Africa (Morocco/Kenya) 

June 24- July 5— Rhine Cruise (Munich, Rhine 
River, Brussels) 

July 30-Aug. 12— European Adventure (Paris, 
Interlacken, Florence) 

Sept. 2-15— Danube Cruise (Vienna to Istan- 
bul) 

Reservations cannot be accepted without the 
official form printed in promotional brochures, 
which will be mailed to all ISMS members and 
auxiliary at least five months in advance. Indi- 
viduals outside a member’s immediate family 
will be placed on standby status until all ISMS 
members have had reasonable time to make 
reservations. Promotional expenses connected 
with these programs are paid by tour operators. 
For further information, please contact ISMS 
headquarters. 


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for October, 1978 


199 



ISMS Guide to 
Continuing Medical Education 

Compiled for Illinois physicians bv the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
55 E. Monroe St., Suite 3510 • Chicago, IL 60603 • (312) 236-6110 



Items for this Calendar must be received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication dale. Some- 
times, cancellations or changes in dale, place or time occur too late to be corrected before publication. You are urged 
to contact the sponsoring organization to confirm information given below. 


NOVEMBER 


Family Medicine 

UPDATE— PRIMARY CARE MEDICINE 

For: GP's FP’s, Internists. Lectures, Nov. 3 & 17, 
Chicago. Sponsor: Grant Hospital, 550 W. Webster, 
Chicago 60614. Fee: none. Reg. limit: 200. CME 
Credit: AMA Category 1, 2 hours. Contact: P. Colon. 
Phone: 312-883-2112. 


Family Therapy 


WORKING WITH FAMILIES IN A 
GENERAL MEDICAL PRACTICE 

For: MD's, medical health practitioners. Seminar 

series, Nov. '78-June ’79, Oak Park. Speakers: James 
McCoy, MD, Charles Kramer, MD. Sponsor: Center 
tor Family Studies/The Family Institute of Chicago, 
10 E. Huron, Chicago 60611. Cosponsors: Institute 
of Psychiatry, Northwestern Memorial Hospital, North- 
western University Medical School. Contact: Jeanne 
Robinson. Phone: 312-649 7285. 

Family Therapy 

SEVENTH ANNUAL FALL CONFERENCE: 

CHANGING THE FAMILY BELIEF SYSTEM 

For: MD's. 2-day conference, Nov. 3-4, 9:30 a m - 
4:30 p.m., Chicago. Speaker Peggy Papp, ACSW. 
Sponsor: Center for Family Studies/The Family In- 
stitute of Chicago, 10 E. Huron, Chicago 60611. 
Cosponsors: Institute of Psychiatry, Northwestern 

Memorial Hospital, Northwestern University Medical 
School. CME Credit: AMA Category 1, 12 hours. 

Contact: Wendy Brockington. Phone: 312-649-7285. 

Family Therapy 

PARADOXICAL TECHNIQUES IN FAMILY THERAPY 

For: MD’s. 1-day workshop, Nov. 16, Chicago. Speak- 
er: Robert Mark, Ph.D. Sponsor: Center for Family 
Studies/The Family Institute of Chicago, 10 E. 
Huron, Chicago 60611. Cosponsors: Institute of Psy- 
chiatry, Northwestern Memorial Hospital, Northwestern 
University Medical School. CME Credit: AMA Category 
1, 6 hours. Contact: Wendy Brockington. Phone: 312- 
649-7285. 


Forensic Medicine 

REVIEW OF CURRENT FORENSIC PATHOLOGY CASES 

For: MD's, DDS’s, LIB'S. Workshop/ lecture, Thurs- 
days, 2:00 p.m., Chicago. Sponsor: Office of the 
Medical Examiner, Cook County, llinois, 1828 W. Polk 
St., Chicago 60612. Fee: none. Reg. limit: 50. 
Contact: Robert Stein, MD. Phone: 312-443-5017. 

Infections and Antibiotics 

UPDATE ON COMMON INFECTIONS AND ANTIBIOTICS 

For: Primary care physicians. Lecture, Nov. 29, 

Rockford. Sponsor: Dept, of Family Practice, Rock- 
ford School of Medicine, Office for Continuing Edu- 
cation, 1601 Parkview Ave., Rockford, IL 61101. 
Fee: $10. Reg. limit: none. CME Credit: AMA Cate- 
gory 1. Contact: Jacqueline Parochka. Phone: 815- 
987-7140. 


Infectious Diseases 

RECENT ADVANCES IN INFECTIOUS DISEASES 

For: MD’s, residents, students. Lecture series, Nov. 
'78-May '79, Rockford. Sponsors: Division of Infec- 
tious Diseases, Rockford School of Medicine, Office 
for Continuing Education, 1601 Parkview Ave., Rock- 
ford, IL 61101. Fee: $25. Reg. limit: none. CME 
Credit: AMA Category 1, 18 hours. Contact: Jac- 

queline Parochka. Phone: 815-987-7140. 


Internal Medicine 


Medicine 


B'OOD GASES— ELECTROLYTE IMBALANCE- 
HYPERALIMENTATION 

For: MD’s, office staff. Symposium, Nov. 14, 6:00- 
10:00 p.m., Highland. Sponsor: SIU School of Medi- 
cine, 801 No. Rutledge, P.0. Box 3926, Springfield, 
IL 62708. Fee: $25 pre. Reg. limit: none. CME 
Credit: AMA Category 1, 4 hours. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 


Medical/Legal 

23rd MEDICAL/LEGAL SEMINAR FOR LAKE COUNTY 

For: MD’s, DDS's, nurses, pharmacists, pharmaceu- 
tical representatives, ancillary medical personnel. 1- 
day seminar, Nov. 15, Waukegan. Sponsor: St. 

Therese Hospital, 2615 Washington, Waukegan, IL 
60085. Reg. deadline: 11/13. Fee: $2.50. Reg. 

limit: none. CME Credit: AMA Category 1, 5 hours; 
AAFP Elective, 5 hours; AOA, 5 hours. Contact: 
R. M. Adelman, DDS, MD, JD. Phone: 312-688-5800. 

Medicine 

CARDIOLOGY CONFERENCE 

For: open. Case presentations, Saturdays, 8:00 a.m., 
Nov. '78-June '79, Evanston. Sponsor: St. Francis 
Hospital, 355 Ridge Ave., Evanston, IL 60202. Fee: 
none. Reg. limit: none. Contact: Mitchel Byrne, MD. 
Phone: 312-492-6227. 


Medicine 

NEWER ANTIBIOTICS FOR GRAM-NEGATIVE 
INFECTIONS 

For: MD’s, interns. Lecture, Nov. 22, 11:00 a m., 
Chicago. Speaker: Mary Carruthers, MD. Sponsor: 
Martha Washington Hospital, 4055 No. Western Ave., 
Chicago 60618. Fee: none. Reg. limit: none. CME 
Credit: AMA Category 1, 1 hour; AAFP Elective, 1 
hour. Contact: Fernando Villa, MD. Phone: 312-583- 
9000 x 331. 


CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

For: MD's, office staff. Symposium, Nov. 8, 1:00- 
5:00 p.m., Herrin. Sponsor: SIU School of Medicine, 
801 No. Rutledge, P.O. Box 3926, Springfield, IL 
62708. Fee: $25 pre. Reg. limit: none. CME Credit: 
AMA Category 1, 4 hours. Contact: Lorraine Stephen- 
son. Phone: 217-782-7711. 


Medicine 

Gl CONFERENCE 

For: open. Lecture series, Nov. '78-March '79, Satur- 
days, Evanston. Speaker: Fernando Villa, MD. Spon- 
sor: St. Francis Hospital, 355 Ridge Ave., Evanston, 
IL 60202. Fee: none. Reg. limit: none. Contact: 
Mitchel Byrne, MD. Phone: 312-492-6227. 

Medicine 

BI-WEEKLY CLINICAL CONFERENCE 

For: MD’s, DDS's. Seminar Series, Thursdays, 8:00 
a.m., Nov. '78-May '79, Mattoon. Sponsor: Sarah 
Bush Lincoln Health Center, Route 16, Mattoon, IL 
61938. Fee: none. CME Credit: AMA Category 1. 
Contact: Byron Ruskin, MD. Phone: 217-258-2514. 


Medicine 


Gl CONFERENCE 

For: open. Lecture series, Nov. '78-June '79, Thurs- 
days, 3:00 p.m., Evanston. Speaker: David Johnson, 
MD. Sponsor: St. Francis Hospital, 355 Ridge Ave., 
Evanston, IL 60202. Fee: none. Reg. limit: none. 
Contact: Mitchel Byrne, MD. Phone: 312-492-6227. 


Antibiotic Therapy — Medicine 

ANTIBIOTIC CHOICES AND HOW TO MAKE THEM 

For: MD’s, interns. Lecture, Nov. 15, 11:00 a.m.- 
12:00 noon, Chicago. Speaker: Mary Carruthers, MD. 
Fee: none. Reg. limit: none. CME Credt: AMA Cate- 
gory 1, 1 hour; AAFP Elective, 1 hour. Contact: 
Fernando Villa, MD. Phone: 312-583-9000 x 331. 


Medicine 

NEUROLOGY CONFERENCE 

For: open. Lecture series, Nov. '78-June '79, 2nd/ 

4th Tuesday, Evanston. Speaker: M. M. Ilahi, MD. 
Sponsor: St. Francis Hospital, 355 Ridge Ave., 

Evanston, IL 60202. Reg. limit: none. Fee: none. 
Contact: Mitchel Byrne, MD. Phone: 312-492-6227. 

Medicine 

NEPHROLOGY 

For: open. Lecture series, Nov. '78 June '79, 2nd/ 

4th Wednesday, Evanston. Sponsor: St. Francis Hos- 
pital, 355 Ridge Ave., Evanston, IL 60202. Fee: 

none. Reg. limit: none. Contact: Mitchel Byrne, MD. 
Phone: 312-492 6227. 

Medicine 

PULMONARY DISEASES CONFERENCE 
For: open. Lecture series, Nov. '78-June '79, 1st/ 

3rd Tuesdays, Evanston. Speaker: M. J. Kim, MD. 
Sponsor: St. Francis Hospital, 355 Ridge Ave., Evan- 
ston, IL 60202. Reg. limit: none. Contact: Mitchel 
Byrne, MD Phone: 312-492 6227. 

Medicine 

RESPIRATORY DISEASE 

For: MD’s, office staff. Symposium, Nov. 30, 1:00- 
5:00 p.m., Jacksonville. Sponsor: SIU School of 

Medicine, 801 No. Rutledge, P.O. Box 3926, Spring- 
field, IL 62708. Fee: $25 pre. CME Credit: AMA 
Category 1, 4 hours. Contact: Lorraine Stephenson. 
Phone: 217 782 7711. 


Obstetrics /Gynecology 

OBSTETRICS/GYNECOLOGY IN GENERAL PRACTICE 
For: MD’s, office staff. Symposium, Nov. 16, 7:00- 
10:00 p.m., Mt. Vernon. Sponsor: SIU School of 
Medicine, 801 No. Rutledge Ave., P.O. Box 3926, 
Springfield, IL 62708. Fee: $25 pre. Reg. limit: 
none. CME Credit: AMA Category 1, 3 hours. Con- 
tact: Lorraine Stephenson. Phone: 217-782-7711. 

Obstetrics/Gynecology 

PERINATAL MEDICINE SYMPOSIUM 
For: MD’s, office staff. Symposium, Nov. 9, 8:00- 
4:30 p.m., Springfield. Sponsor: SIU School of Medi- 
cine, 801 No. Rutledge, P.O. Box 3926, Springfield, 
IL 62708. Fee: $55 pre. Reg. limit: none. CME 
Credit: AMA Category 1, 6 hours. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 

Pediatric Allergy 

ALFRED S. TRAISMAN MEMORIAL LECTURE 

For: MD's. Lecture Nov. 8, 12:00 noon, Chicago. 
Speaker: Harvey Colten, MD. Sponsor: Children's Me- 
morial Hospital, 707 W. Fullerton, Chicago 60614. 
Fee: none. Reg. limit: none. CME Credit: AMA Cate- 
gory 1, 1 hour; AAFP Elective, 1 hour. Contact: 
Howard Traisman, M.D. Phone: 312-869-4300. 

Pediatrics 

PRIMARY CARE PEDIATRICS— A GENERAL OVERVIEW 
For: Pediatricians, GP's, FP’s. Lecture, Nov. -Jan., 
2nd/4th Wednesday, Chicago. Sponsor: Grant Hos- 
pital, 550 W. Webster, Chicago 60614. Fee: none. 
Reg. limit: none. CME Credit: AMA Category 1. 
Contact: P. Colon. Phone: 312-883-2112. 


200 


Illinois Medical Journal 


Psychiatry, Psychology 

SETTING UP A SEX CLINIC 

For: MD's, Psychiatrists. Lecture, Nov. 15, 1:00- 
4:00 p.m., Forest Park. Speaker: Domeena Renshaw, 
MO. Sponsor: Riveredge Hospital Foundation, 8311 W. 
Roosevelt Road, Forest Park, IL 60130. Fee: $15. 
CME Credit: AMA Category 1, 3 hours. Contact: 
Susan Cosgrove. Phone: 312-771-7000. 


Surgery 

ENTERAL & PARENTERAL HYPERALIMENTATION 

For: MD's, office staff. Symposium, Nov. 1, 8:00- 
5:00 pm., Springfield. Sponsor: SIU School of 

Medicine, 801 No. Rutledge, P.O. Box 3926, Spring- 
field, IL 62708. Fee: $55 pre. Reg. limit: none. 
CME Credit: AMA Category 1, 6 hours. Contact: 
Lorraine Stephenson. Phone: 217-782-7711. 


Surgery 

SPINAL PROBLEMS 

For: MD’s, office staff. Symposium, Nov. 15, 8:00- 
12 00 noon, Belleville. Sponsor: SIU School of Medi- 
cine, 801 No. Rutledge, P.O. Box 3926, Springfield, 
IL 62708. Fee: $25 pre. Reg. limit: none. CME 

Credit: AMA Category 1, 4 hours. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 

Surgery 

RHEUMATOLOGY & JOINT RECONSTRUCTION 

For: MD’s, office staff. Symposium, Nov. 9, 3:00- 
8:00 p m., Quincy. Sponsor: SIU School of Medi- 
cine, 801 No. Rutledge, P.O. Box 3926, Springfield, 
IL 62708. Fee: $28 pre. Reg. limit: none. CME 

Credit: AMA Category 1, 4 hours. Contact: Lorraine 
Stephenson. Phone: 217-782-7711. 

Surgery — Medicine 

TUMOR CONFERENCE 

For: open. Weekly lecture, Thursdays, 12:00 noon, 

Evanston. Sponsor: St. Francis Hospital, 355 Ridge 
Ave., Evanston, IL 60202. Fee: none. Reg. limit: 

none. Contact: Mitchel Byrne, MD. Phone: 312-492- 
6227. 

Parent-Infant Bonding and Child Abuse 

PROMOTION OF PARENT-INFANT BONDING— 

AN EFFECTIVE STEP TOWARD PREVENTION OF 
CHILD ABUSE 

For: MD’s, nurses, social workers. Symposium, Nov. 
2, 8:00 a. m. -4:00 p.m., Champaign. Sponsor: Carle 
Clinic Association and Carle Foundation, Education 
Dept., 602 W. University, Urbana, IL 61801. Cospon- 
sor: Ul School of Clinical Medicine. Fee: $25. Reg. 
limit: none. CME Credit: AMA Category 1, 6 hours; 
AAFP Elective, 6 hours. Contact: Annette Lansford, 
MD. Phone: 217-337-3100. 


DECEMBER 


Colposcopy 

COLPOSCOPY 

For: MD’s. Conference, Dec. 8-9, Chicago. Sponsor: 
Northwestern University Medical School, Alumni 
Center for Continuing Education, 301 E. Chicago 
Ave., Chicago 60611. Fee: $150. CME Credit: AMA 
Category 1, 12 hours. Contact: James Dyson, Ph.D. 
Phone: 312-649 8533. 


Family Medicine 

UPDATE— PRIMARY CARE MEDICINE 

For: GP’s, FP's, Internists. Lectures, Dec. 12 & 15, 
8:00 a.m., Chicago. Sponsor: Grant Hospital, 550 
W. Webster, Chicago 60614. Fee: none. Reg. limit: 
none. CME Credit: AMA Category 1, 2 hours. Con- 
tact: P. Colon. Phone: 312 883-2112. 

Family Therapy 

TECHNIQUES FOR WORKING WITH 
SEVERELY DISTURBED FAMILIES 

For: MD's. Workshop, Dec. 1, 9:30-4:30 p.m., Chi- 
cago. Speaker: Froma Walsh, Ph.D. Sponsor: Center 
for Family Studies/The Family Institute of Chicago, 
10 E. Huron St., Chicago 60611. Cosponsors: Insti- 
tute of Psychiatry, Northwestern Memorial Hospital, 
Northwestern University Medical School. CME Credit: 
AMA Category 1, 6 hours. Contact: Wendy Brocking- 
ton. Phone: 312-649 7285. 


Forensic Medicine 

REVIEW OF CURRENT FORENSIC PATHOLOGY CASES 

For: MD's, DDS’s, LIB’S. Workshop/ lecture, Thurs- 
days, 2:00 p.m., Chicago. Sponsor: Office of the 
Medical Examiner, Cook County, Illinois, Chicago. 
Fee: none. Reg. limit: 50. Contact: Robert Stein, 
MD. Phone: 312-443 5017. 


Internal Medicine 

JAUNDICE 

For: MD’s, office staff. Symposium, Dec. 7, 1:00- 
5:00 p.m., DuQuoin. Sponsor: SIU School of Medi- 
cine, 801 No. Rutledge, P.O. Box 3926, Springfield, 
IL. Fee: $25 pre. Reg. limit: none. CME Credit: 
AMA Category 1, 4 hours. Contact: Lorraine Stephen- 
son. Phone: 217-782 7711. 


Obstetrics/Gynecology 

OBSTETRICS & OFFICE GYNECOLOGY 
For: MD’s, office staff. Symposium, Dec. 7, 5:00- 
9:00 p.m., Lawrenceville. Sponsor: SIU School of 
Medicine, 801 No. Rutledge, P.O. Box 3926, Spring 
field, IL 62708. Fee: $25 pre. Reg. limit: none. 
CME Credit: AMA Category 1, 4 hours. Contact: 
Lorraine Stephenson. Phone: 217 782-7711. 


Psychiatry 


OFFICE PSYCHIATRY 

For: MD’s, office staff. Symposium, Dec. 14, 7:00- 
10:00 p.m., Effingham. Sponsor: SIU School of 

Medicine, 801 No. Rutledge, P.O. Box 3926, Spring- 
field, IL 62708. Fee: $25 pre. Reg. limit: none. 
CME Credit: AMA Category 1, 3 hours. Contact: Lor- 
raine Stephenson. Phone: 217 782-7711. 


Psychiatry 


INTRODUCTION TO THE ART OF SELF-CARE & 
CONFLICT MANAGEMENT 

For: Psychiatrists, MD's. Lecture, Dec. 20, 1:00- 
4:00 p.m., Forest Park. Speaker: Yetta Bernhard, MS. 
Sponsor: Riveredge Hospital Foundation, 8311 W. 
Roosevelt Road, Forest Park, IL 60130. Fee: $15. 
CME Credit: AMA Category 1, 3 hours. Contact: Susan 
Cosgrove. Phone: 312-771-7000. 


Introduction to CME Techniques 
Two-day intensive workshop, Dec. 
1-2. For: Hospital DME’s, Program 
Chairmen, Medical Faculty, CME 
Planners. Leaders: Donald F. Poc- 
hyly, M.D., and Leonard S. Stein, 
Ph.D. Sponsor: ICCME. Oak Brook 
Hyatt House, Oak Brook, IL. Cred- 
it: AMA and IL license Category 1, 
14 hours. Contact: Diane Wolnie- 
wicz, ICCME, 55 E. Monroe, Chi- 
cago 60603. Phone: (312) 236- 
6110. 


RECENT CME ACCREDITATION 
RECOMMENDATIONS 
The ISMS Committee on CME Ac- 
creditation has recently recom- 
mended to Liaison Committee-CME 
approval of the CME programs of 
the following institutions. 

Elgin Mental Health Center 
Elgin 

Highland Park Hospital 
Highland Park 
Illinois Heart Association 
Springfield 

Illinois Masonic Medical Center 
Chicago 

Illinois Thoracic Surgical Society 
Chicago 

Memorial Hospital of DuPage 
County 
Elmhurst 

Riveredge Hospital 
Forest Park 
St. Elizabeth’s Hospital 
Chicago 

St. Francis Hospital 
Blue Island 

SwedishAmerican Hospital 
Rockford 


JANUARY 


Family Medicine 

ETHICAL ISSUES IN CRITICAL CARE 
For: GP's. Lecture, Jan. 10, 2:00-5:00 p.m., Chicago. 
Sponsor: The University of Chicago Medical Center, 
Frontiers of Medicine, 950 E. 59th St., Box 451, 
Chicago 60637. Fee: $20. Reg. limit: none. CME 
Credit: AMA Category 1, 3 hours; AAFP Elective, 3 
hours. Contact: Elaine Ehrman. Phone: 312-947-5777. 

Family Medicine 

UPDATE— PRIMARY CARE MEDICINE 

For: GP's, FP's, Internists. Lectures, Jan. 5 & 26, 
8:00 a.m., Chicago. Sponsor: Grant Hospital, 550 
W. Webster, Chicago 60614. Fee: none. Reg. limit: 
none. CME Credit: AMA Category 1, 2 hours. Con- 
tact: P. Colon. Phone: 312-883-2112. 

Family Therapy 

PROBLEM-CENTERED SYSTEMS THERAPY- 
ASSESSMENT 

For: MD’s. 2-day workshop, Jan. 18 & 19, 9:30 a.m- 
4:30 p.m., Chicago. Speaker: William Pinsof, Ph D. 
Sponsor: Center for Family Studies/The Family Insti- 
tute of Chicago, 10 E. Huron, Chicago 60611. Co- 
sponsor: Institute of Psychiatry, Northwestern Memo- 
rial Hospital, Northwestern University Medical School. 
Reg. limit: 100. CME Credit: AMA Category 1, 12 
hours. Contact: Wendy Brockington. Phone: 312-649- 
7285. 


Family Therapy 

PERSONAL/PROFESSIONAL GROWTH WORKSHOP FOR 
THERAPISTS: WITH OR WITHOUT PARTNERS 

For: MD's, therapists. Seminar, Jan. 25, 26, 27, 
Oak Park. Speaker: Charles Kramer, MD. Sponsor: 
Center for Family Studies/The Family Institute of 
Chicago, 10 E. Huron, Chicago 60611. Cosponsors: 
Institute of Psychiatry, Northwestern Memorial Hos- 
pital, Northwestern University Medical School. Reg. 
limit: 16. CME Credit: AMA Category 1, 17 hours. 
Contact: Wendy Brockington. Phone: 312-649-7285. 


Family Therapy 

LAW IN THE EVERYDAY PRACTICE OF 
PSYCHOTHERAPY 

For: MD’s. Workshop, Jan. 26 & 27, 9:30-4:30 p.m., 
Chicago. Speaker: Sandra Nye, JD, MSW. Sponsor: 
Center for Family Studies/The Family Institute of 
Chicago, 10 E. Huron, Chicago 60611. Cosponsors: 
Institute of Psychiatry, Northwestern Memorial Hos- 
pital, Northwestern University Medical School. Reg. 
limit: 40. CME Credit: AMA Category 1, 12 hours. 
Contact: Wendy Brockington. Phone: 312-649-7285. 

Forensic Medicine 

REVIEW OF CURRENT FORENSIC PATHOLOGY CASES 
For: MD’s, DDS’s, LIB’s. Workshop/lecture, Thurs- 
days, 2:00 p.m., Chicago. Sponsor: Office of the 
Medical Examiner, Cook County, Illinois, 1828 W. 
Polk St., Chicago 60612. Fee: none. Reg. limit: 50. 
Contact: Robert Stein, MD. Phone: 312 443 5017. 


Medicine 

14th ANNUAL MEETING 

For: FP's. Symposium/workshop, Jan. 14-19, Las 
Vegas, Nevada. Speaker: Michael De Bakey, MD. Fee: 
$250. Reg. limit: none. CME Credit: AMA Category 
1, 40 hours. Sponsor: American Society of Con- 
temporary Medicine and Surgery, 6 No. Michigan 
Ave., Chicago 60602. Contact: John Bellows, MD. 
Phone: 312-236-4673. 


Ophthalmology 

14th ANNUAL SCIENTIFIC ASSEMBLY 
For: Ophthalmologists. Seminars/lectures/workshops, 
Jan. 14-19, Las Vegas, Nevada. Sponsor: American 
Society of Contemporary Ophthalmology, 6 No. Michi- 
gan Ave., Chicago 60602. Fee: $250. Reg. limit: 
none. CME Credit: AMA Category 1, 40 hours. Con- 
tact: John Bellows, MD. Phone: 312-236-4673. 

Ophthalmology 

THE ROLE OF THE PRIMARY PHYSICIAN IN 
EYE CARE 

For: FP’s, Internists, Pediatricians. Workshop, 3 ses- 
sions in 1979, Chicago. Sponsor: Dept, of Ophthalm- 
ology, University of Illinois, 1855 W. Taylor, Chicago 
60612. Fee: $200/session. Reg. limit: 40. CME 
Credit: AMA Category 1. Contact: Carmen Carrasco. 
Phone: 312-996 8023. 


Psychiatry /Psychology 

NARCISSISTIC FACTORS IN PSYCHOTHERAPY 
For: MD's, Psychiatrists. Lecture, Jan. 17, 1:00- 
4:00 p.m., Forest Park. Speaker: Arnold Goldberg, 
MD. Sponsor: Riveredge Hospital Foundation, 8311 W. 
Roosevelt Rd., Forest Park 60130. Fee: $15. CME 
Credit: AMA Category 1, 3 hours. Contact: Susan 
Cosgrove. Phone: 312-771-7000. 


for October , 197S 


201 


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202 


Illinois Medical Journal 



ISMS ORGANIZATION 


History of Founding and Expansion 


Twenty-nine physicians met in Springfield 
June 4, 1850, to organize on a permanent basis 
the Illinois State Medical Society, which had been 
started informally 10 years earlier. The founders 
were concerned with the solution of ethical, scien- 
tific, legislative and economic problems. The first 
Constitution and Bylaws and the first Code of 
Medical Ethics were adopted, the first legislative 
committee was appointed, and a resolution out- 
lining the beginnings of interprofessional relations 
was approved. 

The Legislative Committee was instructed to 
“memorialize the legislature at its next session, 
praying the enactment of a statute providing for 
the registration of Births, Deaths and Marriages.” 
The resolution ruled that “members of the Society 
will discourage the sale of patent or secret nos- 
trums on the part of Druggists and Apothecaries 
throughout the State, and will patronize insofar 
as practicable, only those who abstain from the 
sale of such patent or secret nostrums.” 

The first full time secretary of the Society was 
Dr. Harold M. Camp who served for over 35 
years until his death in 1959. The first executive 
administrator, Robert I,. Richards, was employed 
at the time the office was moved to Chicago in 
1960 and served until February, 1966. After an 
interim service by Dr. George F. Lull, Mr. Roger 
N. White was selected as Executive Administrator 
in May, 1968. 

The Society published the early transactions in 
book form presenting not only the minutes of the 
House of Delegates, but also all scientific papers 


given at each annual convention. In 1899 a new 
era of communications began, for at that time, 
the Illinois Medical Journal was established and 
became the first “official organ of the Society.” 

Dr. G. N. Kreider was its first editor and served 
until 1913, followed by Dr. Clyde D. Pence with 
Dr. Henry G. Olds as the first managing editor. 
Dr. Charles G. Whalen became editor in 1919 and 
he and Dr. Olds served until they died in 1940. 
Dr. Camp followed Dr. Whalen, and Dr. Theodore 
R. Van Dellen was the editor for 18 years ending 
1977. Subsequently, an Editorial Board was estab- 
lished to review and determine clinical content for 
the 1MJ. The Editorial Board reports to the ISMS 
Publications Committee. 

Dr. Whalen spearheaded many important activi- 
ties in medicine, and has been called “the outstand- 
ing champion of the medical profession in its 
economic contacts.” He has been credited as one 
of the first medical editors to blast “the socializa- 
tion of medicine in this country.” In 1922, he wrote 
extensively on state medicine, workmen's compen- 
sation, compulsory health insurance, free hospital- 
ization and federal aid. 

The first Fifty Year Club in the United States 
was announced by the Illinois Medical Journal in 
1938. 

The fourth largest medical society in the coun- 
try has developed from these embryonic begin- 
nings. This edition of the Illinois Medical Journal 
offers you an opportunity to contrast the extensive 
services available to the membership today with 
those offered in the past. 


for October, 1978 


203 


ISMS Organization 


Principles Of Medical Ethics 


Preamble: These principles are intended to aid 
physicians individually and collectively in main- 
taining a high level of ethical conduct. They are 
not laws but standards by which a physician 
may determine the propriety of his conduct in 
his relationship with patients, with colleagues, 
with members of allied professions, and with the 
public. 

Section 1 — The principal objective of the medi- 
cal profession is to render service to humanity 
with full respect for the dignity of man. Physicians 
should merit the confidence of patients entrusted 
to their care, rendering to each a full measure of 
service and devotion. 

Section 2 — Physicians should strive continually 
to improve medical knowledge and skill, and 
should make available to their patients and col- 
leagues the benefits of their professional attain- 
ments. 

Section 3 — A physician should practice a method 
of healing founded on a scientific basis; and he 
should not voluntarily associate professionally with 
anyone who violates this principle. 

Section 4 — The medical profession should safe- 
guard the public and itself against physicians 
deficient in moral character or professional compe- 
tence. Physicians should observe all laws, uphold 
the dignity and honor of the profession and 
accept its self-imposed disciplines. They should 
expose, without hesitation, illegal or unethical con- 
duct of fellow members of the profession. 

Section 5 — A physician may choose whom he 
will serve. In an emergency, however, he should 
render service to the best of his ability. Having 
undertaken the care of a patient, he may not 
neglect him; and unless he has been discharged he 
may discontinue his services only after giving 


adequate notice. He should not solicit patients. 

Section 6 — A physician should not dispose of his 
services under terms or conditions which tend to 
interfere with or impair the free and complete 
exercise of his medical judgment and skill or tend 
to cause a deterioration of the quality of medical 
care. 

Section 7 — In the practice of medicine a physician 
should limit the source of his professional income 
to medical services actually rendered by him, or 
under his supervision, to his patients. His fee 
should be commensurate with the services rendered 
and the patient’s ability to pay. He should neither 
pay nor receive a commission for referral of pa- 
tients. Drugs, remedies or appliances may be 
dispensed or supplied by the physician provided 
it is in the best interests of the patient. 

Section 8 — A physician should seek consultation 
upon request, in doubtful or difficult cases; or 
whenever it appears that the quality of medical 
service may be enhanced thereby. 

Section 9 — A physician may not reveal the 
confidences entrusted to him in the course of 
medical attendance, or the deficiencies he may 
observe in the character of patients, unless he 
is required to do so by law or unless it becomes 
necessary in order to protect the welfare of the 
individual or of the community. 

Section 10 — The honored ideals of the medical 
profession imply that the responsibilities of the 
physician extend not only to the individual, but 
also to society where these responsibilities 'deserve 
his interest and participation in activities which 
have the purpose of improving both the health 
and the well-being of the individual and the 
community. 


204 


Illinois Medical Journal 


ILLINOIS STATE MEDICAL SOCIETY 


Constitution And Bylaws 


Adopted, 1903 


As Amended, 1978 


CONSTITUTION 


ARTICLE I. NAME 

The name and title of this organization shall be the 
Illinois State Medical Society. 

ARTICLE II. PURPOSES OF THE SOCIETY 
The purposes of this Society are to promote the science 
and art of medicine, to protect the public health, to 
elevate the standards of medical education and to unite 
the medical profession behind these purposes; to pro- 
mote similar interests in the component societies and to 
unite with similar organizations in other states and terri- 
tories of the United States to form the American Medical 
Association. The Society shall inform the public and the 
profession concerning the advancements in medical science 
and the advantages of proper medical care. 

ARTICLE III. COMPONENT SOCIETIES 
Component societies shall consist of those county medical 
societies which hold charters from this Society. 


ARTICLE VI. OFFICERS 

The officers of this Society shall be a president, a presi- 
dent-elect, a first vice president, a second vice president, 
a secretary-treasurer, a speaker and vice speaker of the 
House of Delegates, and such trustees and other officers 
as the Bylaws may provide. 


ARTICLE VII. BOARD OF TRUSTEES 


The Board of Trustees, whose duties are executive and 
judicial, shall have charge of all property and all finan- 
cial affairs of the Society, and shall perform such other 
duties as are prescribed by law governing the directors 
of corporations, or as may be prescribed in the Bylaws. 


ARTICLE VIII. CONVENTIONS AND MEETINGS 
The Society shall hold an annual convention during which 
there shall be a business meeting of the House of Dele- 
gates which shall be open to all registered members. 


ARTICLE IV. COMPOSITION OF THE SOCIETY 
The Society shall consist of active members and such 
other members as the Bylaws may provide. 

ARTICLE V. HOUSE OF DELEGATES 
Section 1. The House of Delegates shall be the legislative 
body of the Illinois State Medical Society, and unless 
otherwise herein provided, its deliberations shall be bind- 
ing upon the officers, including the Board of Trustees. 
The House of Delegates shall set the basic policy and 
philosophy of the Society. 

Section 2. The House of Delegates shall elect the general 
officers, except as otherwise provided in the Bylaws. 


ARTICLE IX. THE SEAL 

This Society shall have a common seal with power to 
break, change or renew the same when necessary. 

ARTICLE X. AMENDMENTS 
The House of Delegates may amend this Constitution at 
any annual or interim business meeting of the House of 
Delegates provided that the amendment shall have been 
proposed at a preceding annual or interim business meet- 
ing, and that two-thirds of the members of the House of 
Delegates seated concur in the amendment. 


BYLAWS 


CHAPTER I. MEMBERSHIP 

Section 1. Members. Members shall consist of Regular 
members, Associate members, Emeritus members. Retired 
members, Service members, Distinguished members, In- 
training members and Student members. Members enjoy 
full rights and privileges, including the right to vote and 
hold office and are counted in determining the strength of 
the Society’s Delegation to the American Medical Associa- 
tion. 

A. Regular Members. Regular members shall be those 
physicians licensed to practice medicine in all its 
branches in the State of Illinois, who are either resi- 
dents of the State of Illinois or who practice principal- 


ly in Illinois, are persons of good moral character and 
professional standing and members of their ISMS com- 
ponent society. 

Members in good standing moving out of Illinois may 
retain membership (not to exceed one year) in the 
Illinois State Medical Society until they are accepted 
into membership in the medical society of the state to 
which they have moved. 

Physicians serving as full-time employees of the Ameri- 
can Medical Association and other physicians licensed 
in one of the states or territories of the United States 
but not licensed in Illinois may become regular mem- 
bers although they are not actively engaged in the 
practice of medicine. 


for October, 1978 


205 


Constitution 



B. Associate Members. Associate members are physicians 
who hold the degree of Doctor of Medicine, who 
have a hospital permit to practice medicine in the 
State of Illinois and are members of their component 
medical society. 

C. Emeritus Members. Emeritus members are those who 
have been regular members in good standing for 
thirty-five years and have reached or will have reached 
the age of seventy before the next fiscal year of the 
Society, have made written application which is re- 
ceived by their component society prior to December 
31 and have been recommended by their component 
society for emeritus status. Such membership shall be 
effective January first of the year following election. 
Credit for membership in other Amedican Medical 
Association constituent societies shall be accorded trans- 
ferees, provided they have been members of the So- 
ciety for at least five years. 

D. Retired Members. Retired members shall consist of 
those who have been regular members and who by 
reason of age or incapacity have retired from active 
practice and who upon application and recommenda- 
tion from their component society have been made 
retired members. Retired status is not available to 
physicians who assume compensated positions after re- 
tiring from medical practice. 

E. Service Members. Physicians serving as medical officers 
in the United States Governmental Services, who are 
members of a component society, so long as they 
are engaged actively fulltime in their respective serv- 
ice, and thereafter if they have been retired on ac- 
count of age or physical disability, shall be elected to 
service membership. 

F. Disti?iguished Members. Physicians of Illinois or other 
states or foreign countries who have risen to promi- 
nence in the profession, teachers of medicine or of 
the sciences allied to medicine, not eligible for regu- 
lar membership, or members of associated arts and 
sciences, who have made significant contributions to 
medicine may be nominated by any member of the 
House of Delegates and may be elected by the House 
at any annual convention by a two-thirds affirmative 
vote of those present and voting. They shall not be 
considered as members in determining the number 
of delegates to the American Medical Association, but 
they may participate in all other society activities. 

G. In-Training Members. In-training members are per- 
sons who are medical school graduates, of good moral 
character and professional standing and serving an 
internship or residency approved by the American 
Medical Association in the State of Illinois and are 
members, of a component medical society. Membership 
shall end at the end of the year in which training is 
terminated. Following this, in-training members may 
apply for regular membership through their com- 
ponent society. 

H. Student Members. Student members are those who are 
currently enrolled in an Illinois medical school or are 
Illinois residents enrolled in an approved medical 
school within the boundaries of the United States, are 
of good moral character, professional and academic 
standing and student members of a component society. 

Section 2. Discrimination of Membership. Membership 

in the Illinois State Medical Society shall not be denied 

or abridged because of color, creed, race, religion, sex or 

ethnic origin. 

Section 3. Tenure and Termination. 

A. Tenure of Membership. The name of a physician on 


a properly certified roster of members of a compon- 
ent society which has paid its annual assessments, 
shall be prima facie evidence of membership in this 
society. The member shall retain his membership so 
long as he complies with the provisions of this Con- 
stitution and Bylaws and with the Principles of 
Medical Ethics of the American Medical Association. 
A member shall hold only one type of membership 
at any one time. 

B. Termination of Membership. Any person who is under 
sentence of suspension or expulsion from a component 
society shall not be entitled to any of the rights or 
benefits of the society nor shall he be permitted to 
take part in any of the proceedings until he has been 
reinstated. Suspension will in no way affect insurance 
benefits. 

A member whose dues are unpaid by March 31 of the 
current year ceases to be in good standing and shall be 
notified of his delinquency by the secretary. A mem- 
ber whose dues or assessments remain unpaid on April 
30 of the current year shall automatically be dropped 
from membership. An individual who has forfeited 
membership for non-payment of dues or assessments 
may be reinstated as a member before two years have 
elapsed, providing, in the interim, he has not been 
guilty of conduct prejudicial to membership, by the 
full payment of all dues or assessments in arrears from 
the date that he was last in good standing. If two or 
more years have elapsed since he was a member in 
good standing, he will be required to make application 
as a new member. 

Any member in good standing who resigns voluntarily 
by December 31 of any year may be reinstated within 
one year of his resignation by paying all dues and as- 
sessments that fell due during the period that his 
membership lapsed. If more than one year has elapsed 
since his resignation, he must apply as a new member. 
Any past member who regains membership by pay- 
ment of all dues and assessments in arrears shall be 
eligible for membership benefits only to the extent and 
in the same manner as a new member initially joining 
the society. 

CHAPTER II. DUES, FUNDS AND ASSESSMENTS 
Section 1. Dues. Annual dues may be levied by the 
House of Delegates on each class of membership. The 
amount of dues shall be recommended by the Board 
of Trustees and shall be fixed by the House of Delegates 
at the Annual Meeting and shall include the dues and/or 
assessments approved by the House of Delegates of the 
American Medical Association. These shall include the an- 
nual subscription to the Illinois Medical Journal which 
shall be at least fifty percent of the regular subscription 
price of the Journal. Only Regular, Associate, In-training 
and Student members shall be assessed annual dues. Dues 
for its members shall be forwarded by the component 
society prior to March 31 of each year. 

Section 2. Reduction and Remission of Dues. Physi- 
cians in private practice of medicine may be given a 
fifty percent reduction in dues during the first year of 
practice, upon recommendation of their component so- 
ciety. Physicians approved for membership after June 30 
shall pay one-half the annual dues for that year. The 
Board of Trustees may authorize remission of dues of 
any member on recommendation of his component society 
for good reason. In such cases the secretary shall recom- 
mend remission of dues by the American Medical Associa- 
tion. Emeritus members, Retired members, Service mem- 
bers and Distinguished members are not required to 
pay dues. 


206 


Illinois Medical Journal 



Section 3. Assessments and Funds. In addition to dues, 
assessments may be made on dues-paying members as may 
be recommended by the Board of Trustees and approved 
by the House of Delegates. Unless specifically indicated as 
voluntary, any assessment passed by the ISMS House of 
Delegates shall be considered a part of a member’s dues 
for the purposes of membership in this organization. 

CHAPTER III. 

EDUCATIONAL AND SCIENTIFIC PROGRAMS 

Educational and scientific programs shall be provided by 
the Society at such times and places as recommended by 
the Board of Trustees and approved by the House of 
Delegates. 

CHAPTER IV. HOUSE OF DELEGATES 

Section 1. Composition. The voting membership of the 
House of Delegates shall consist of 1) delegates elected 
by component societies, 2) the President, 3) the President- 
elect, 4) the Vice Presidents, 5) the Secretary-Treasurer, 
6) the Speaker and Vice Speaker, 7) Trustees, and 8) one 
delegate elected by the Resident Physicians Section and 
one delegate elected by the Student Business Session. 

Those having the privilege of the floor without vote are 
past trustees, past presidents, past speakers, general officers 
of the American Medical Association, and one representa- 
tive from each member organization of the Council on 
Affiliate Societies. 

Section 2. Delegates. Each component society shall be 
entitled to send one of its members to the House of 
Delegates each year for each seventy-five members, not 
to include student members, and one for a major frac- 
tion thereof, but each component society which has made 
its annual report and paid its assessment as provided 
for in this Constitution and Bylaws shall be entitled 
to one delegate. The number of delegates to which any 
component society is entitled shall be determined by the 
number of members of the component society on mem- 
bership rolls of the Illinois State Medical Society as of 
December 31 of the preceding year. The term of office of 
a delegate shall begin January first following his elec- 
tion and shall be for two years, or until his successor 
has been elected. Component societies with only one 
delegate may elect for one year. 

Section 3. Affiliate Group Delegates. There shall be a 
Resident Physicians Section and a Student Business Ses- 
sion, which shall be open, respectively, to all in-training 
and medical student members of ISMS. The business of 
each organization shall be conducted by a governing coun- 
cil in accordance with bylaws approved by the ISMS 
House of Delegates. The governing council of each or- 
ganization shall include one delegate with vote in the 
ISMS House of Delegates and one alternate delegate. 

Section 4. Time and Place of Meeting. The House of 
Delegates shall meet twice each year. These two meetings 
shall be designated as the annual meeting and the interim 
meeting. The time and place of both shall be as the House 
determines, except that the interim meeting should not 
exceed three days and it should be held in a district 
other than where the annual meeting is held. 

Section 5. Quorum. Fifty delegates representing no less 
than twenty component societies shall constitute a quorum 
for the transaction of business. 

Section 6. Special meetings. Special meetings of the 
House of Delegates may be called by a majority of the 
Board of Trustees or upon petition of twenty compon- 
ent societies. When a special meeting is called, the sec- 
retary shall mail a notice to the last known address of 
each member of the House of Delegates at least ten days 


before the special meeting is to be held. The notice 
shall specify the time and place of the meeting and 
the purpose for which the meeting is called. The meeting 
shall not consider any business except that for which 
it was called. 


Section 7. Registration. Before being seated at any annual 
or special session, each delegate or his alternate shall 
deposit with the Reference Committee on Credentials a 
certificate signed by the President and/or the Secretary 
of his component society stating that the delegate or 
alternate has been regularly elected to the House of 
Delegates. A delegate or his alternate may be seated 
without credentials, provided he is properly identified 
and is certified to the secretary of the Illinois State 
Medical Society. Whenever a delegate or his alternate 
are unable to attend a particular meeting, the compon- 
ent society may select and certify a substitute delegate 
who shall have the same powers and duties as did the 
delegate. A delegate whose credentials have been accepted 
by the Reference Committee on Credentials and whose 
name has been placed on the roll of the House, shall 
remain a delegate until the final adjournment of that 
session. If a delegate, once seated, is unable to be present 
for reasons acceptable to the Committee on Credentials, 
an alternate may be certified by the committee. After the 
alternate has been seated, he cannot be replaced for that 
session. 


Section 8. District Division. The House of Delegates shall 
divide the state into districts, specifying which counties 
each district shall include. 

Section 9. Order of Procedure. The order of business of 
the House of Delegates shall be determined by the 
Speaker, subject to approval by the Reference Commit- 
tee on Rules and Order of Business. Sturgis Standard 
Code of Parliamentary Procedure, Current Edition, shall 
be the guide for all procedure when not in conflict with 
the Constitution and Bylaws. 

Section 10. Privilege of the Floor. The House of Dele- 
gates by two-thirds vote of those present and voting, 
may extend an invitation to address the House to any 
person who in its judgment might assist in its delibera- 
tions. 

Section 11. Introduction of Resolutions and Other Busi- 
ness. All resolutions must be introduced by a voting mem- 
ber of the House. Resolutions submitted nine weeks prior 
to the annual or interim meeting of the House will be 
listed in the delegates handbook citing author and subject 
only; a full copy of all resolutions will be mailed to the 
delegates. Resolutions to be mailed to the delegates prior 
to the annual or interim meeting must be received at 
ISMS headquarters four weeks prior to the annual or 
interim meeting. Resolutions received after the above date 
except those originating from the RPS or SBS business 
sessions, must be approved by the Committee on Rules 
and Order of Business or by a two-thirds vote of the 
House of Delegates before they will be considered as busi- 
ness of the House. Resolutions presented from the busi- 
ness meeting of the Resident Physician Section or the 
Student Business Session may be presented for considera- 
tion by the House of Delegates at any time before the 
close of business of the first day session of the House of 
Delegates. 

Reports of committees, councils and officers should be 
informational and should not contain requests for House 
action. Recommendations of committees, councils and of- 
ficers should be submitted to the House in resolution 
form. Reports, resolutions and requests for action after 
the opening of the first session of the House of Delegates 
shall require for consideration a two-thirds affirmative 
vote. 


for October , 1978 


207 


Constitution 



CHAPTER V. ELECTION OF OFFICERS 
Section 1. Officers. The officers of this Society shall con- 
sist of the president, president-elect, first and second vice 
presidents, secretary-treasurer, speaker and vice speaker, 
twenty-one trustees and one trustee-at-large. 

Section 2. Elections. All elections shall be by ballot except 
when there is only one candidate for a given office, then 
election may be by voice vote. 

The majority of votes cast shall be necessary to elect. 

The election of officers, delegates and alternate dele- 
gates to the AMA, shall follow the completion of action 
on current and old business at the final session of the 
House of Delegates. 

Section 3. Terms of Office. The president-elect, vice- 
presidents, secretary-treasurer, the speaker and vice speaker 
shall be elected annually by the House of Delegates to 
serve for a term of one year. 

Members of the Board of Trustees shall be elected 
by the House of Delegates to serve for a term of three 
years. The number of consecutive terms that may be 
served by a trustee is limited to three. This shall become 
effective July 1, 1975, and shall not have retroactive ap- 
plication. 

The speaker and vice speaker shall not be elected for 
more than two consecutive terms to their respective 
offices; they shall be elected from the membership of 
the House of Delegates. 

The president-elect shall be inducted into the office 
of president by the retiring president during the final 
session of the House of Delegates. After assuming office 
at the adjournment of the annual business meeting, he 
shall continue in office until his successor has been elected 
and installed. Following his retirement as president, he 
shall automatically become trustee-at-large for a term 
of one year. 

CHAPTER VI. DUTIES OF OFFICERS 

Section 1. The President. The president of the Illinois 
State Medical Society shall lead the Society in all its 
functions. He shall deliver an annual address at such 
time as may be arranged, and perform such other duties 
as custom and parliamentary usage may require. 

Section 2. The President-Elect. The president-elect shall 
serve as the chairman of the Committee on Planning and 
Priorities. 

Section 3. The Vice Presidents. The vice presidents shall 
act for and perform such duties for the president as he 
shall direct. They shall, when so acting, implement and 
advance the programs and policies of the president. 

In the event of the president’s death, resignation or 
removal from office, the first vice president shall succeed 
to the presidency. 

In the event of a vacancy in the office of first vice 
president, the second vice president will become first vice 
president. 

Section 4. Successor to President-Elect. In the case of 
death, resignation, or removal from office of the presi- 
dent-elect, the office shall be filled by the House of 
Delegates at the next annual convention by election at 
a time recommended by the Reference Committee on 
Rules and Order of Business. 

Section 5. The Speaker. The speaker, who shall be versed 
in parliamentary procedure, shall preside at the meetings 
of the House of Delegates and shall perform such duties 
as custom and parliamentary usage require. 

He shall appoint all committees of the House of 
Delegates. 


He shall seek the advice of officers and trustees. 

He shall be a member of the Committee on Constitu- 
tion and Bylaws. 

Section 6. The Vice Speaker. The vice speaker shall pre- 
side for the speaker in the latter’s absence at his re- 
quest. In case of death, or resignation of the speaker, the 
vice-speaker shall serve during the unexpired term. 
Section 7. The Secretary-Treasurer. In addition to the 
rights and duties ordinarily devolving on the secretary 
of a corporation by law, custom or parliamentary usage, 
and those granted or imposed in other provisions of the 
Constitution and these Bylaws, the secretary-treasurer 
shall be the official custodian of all securities and the 
income therefrom owned by the Society, subject to the 
direction and disposition of the Board of Trustees. He 
shall be a member of the Finance Committee of the 
Board of Trustees. 

The Board of Trustees may select a bank or trust 
company to act as custodian in the place of the secretary- 
treasurer, of all or any part of such securities and to act 
as agent of the Society in collecting the income therefrom. 

He shall perform such other duties as may be directed 
by the House of Delegates or by the Board of Trustees. 

In the event of a vacancy in the office of the secretary- 
treasurer, the Board of Trustees shall fill the vacancy 
until the next annual election. 

Section 8. Delegates and Alternate Delegates to the Amer- 
ican Medical Association. Members of the Illinois State 
Medical Society’s delegation to the American Medical 
Association are officers of this society and, as such, share 
jointly with the Board of Trustees the responsibility for 
carrying out policies established by the ISMS House of 
Delegates as they pertain to the AMA activities. 

Members of the delegation are responsible for par- 
ticipating actively in the House of Delegates of ISMS and 
the AMA to the extent allowed under the bylaw's of each 
organization. They are responsible for submitting to the 
AMA appropriate resolutions and they are obliged to seek 
passage of these resolutions in the AMA House of Dele- 
gates until such time as circumstances and/or additional 
facts make continued effort impractical or impossible. 

CHAPTER VII. THE BOARD OF TRUSTEES 
Section 1. Composition. The Board of Trustees shall con- 
sist of: twenty-one trustees elected by the House of Dele- 
gates, one trustee-at-large (the retiring president, who 
shall serve a term of one year), the president, the presi- 
dent-elect, the speaker and vice speaker of the House of 
Delegates, the first vice president and second vice presi- 
dent, and the secretary-treasurer. Ten trustees shall be 
chosen from District 3 and one from each of the other 
eleven districts. 

The trustee districts of the Illinois State Medical Society 
shall be: 

First District— Counties of Kane, Lake, McHenry. 

Second District— Counties of Bureau, LaSalle, Livingston, 
Marshall, Putnam, Woodford. 

Third District— Cook County. 

Fourth District— Counties of Fulton, Hancock, Henderson, 
Henry, Knox, McDonough, Mercer, Peoria, Rock Island, 
Schuyler, Stark, Warren. 

Fifth District— Counties of DeWitt, Logan, McLean, Ma- 
son, Menard, Montgomery, Sangamon, Tazewell. 

Sixth District— Counties of Adams, Brow'n, Calhoun, Cass, 
Greene, Jersey, Macoupin, Madison, Morgan, Pike, Scott. 
Seventh District— Counties of Bond, Christian, Clay, Clin- 
ton, Effingham, Fayette, Macon, Marion, Moultrie, Piatt, 
Shelby. 


208 


Illinois Medical Journal 



Eighth District— Counties o£ Champaign, Clark, Coles, 
Crawford, Cumberland, Douglas, Edgar, Jasper, Law- 
rence, Richland, Vermilion. 

Ninth District— Counties of Alexander, Edwards, Frank- 
lin, Gallatin, Hamilton, Hardin, Jackson, Jefferson, 
Johnson, Massac, Pope, Pulaski, Saline, Union, Wabash, 
Wayne, White, Williamson. 

Tenth District— Counties of Monroe, Perry, Randolph, St. 
Clair, Washington. 

Eleventh District— Counties of DuPage, Ford, Grundy, 
Iroquois, Kankakee, Kendall, Will. 

Twelfth District— Counties of Boone, Carroll, DeKalb, Jo 
Daviess, Lee, Ogle, Stephenson, Whiteside, Winnebago. 

Section 2. Duties. The duties of the Board of Trustees are 

executive, custodial and judicial. 

A. Executive Duties. The Board of Trustees shall imple- 
ment all mandates from the House of Delegates except 
in matters of jjroperty or finance when it shall have 
sole authority. 

The Board of Trustees may establish a not-for-profit 
corporation of physicians known as the Illinois Foun- 
dation for Medical Care. 

The Board of Trustees may request a report from 
any committee in the interim between meetings of 
the House of Delegates. 

B. Custodial Duties. The Board of Trustees shall have 
charge and control of all property of whatsoever na- 
ture belonging to the Society, and of all funds from 
whatsoever source belonging to the Society. 

No person shall expend or use for any purpose 
money belonging to the Society without the approval 
of the Board of Trustees. 

All money received by the Board of Trustees and 
its agents, resulting from the duties assigned them, 
shall be paid into the treasury of the Society, and all 
orders on the treasury for disbursement of money 
shall be approved by the Board. 

The Board of Trustees shall formulate rules govern- 
ing the expenditure of money to meet the necessary 
running expenses and fixed charges of the Society. 

All acts of the House of Delegates involving the 
expenditure, appropriation or use in any manner of 
money, or the acquisition or disposal in any manner 
of property of any kind belonging to the Society, must 
be approved by the Board of Trustees before same 
shall become effective. 

Funds may be appropriated to encourage scientific 
investigation, medical education or any other purpose 
deemed proper and approved by the Board of Trustees. 

C. Judicial Duties. The Board of Trustees shall be the 
board of censors of the Society. It shall have jurisdic- 
tion over all questions of ethics and in the interpreta- 
tion of the laws of the Society. It shall consider all 
questions involving the rights and standing of mem- 
bers, whether in relation to other members, to com- 
ponent societies, or to this Society. 

All questions of an ethical nature before the House 
of Delegates or the general scientific meetings, shall 
be referred to the Board of Trustees without discus- 
sion. The Board shall hear and decide all questions 
of procedure affecting the conduct of members on 
which an appeal is taken from the decision of a com- 
ponent society. 

The decision of the Board of Trustees shall be final 
except that an appeal may be taken by a member 
charged with misconduct as provided for in the Con- 
stitution and Bylaws of the American Medical 
Association. 


Section 3. Executive Administrator. The Board of Trus- 
tees shall employ an executive administrator (who, when 
he shall be a physician, may be designated as the execu- 
tive vice-president) whose duties shall be determined by 
the Board. He shall be responsible to the chairman of 
the Board. The Board shall review at each of its meet- 
ings the interim activities of the administrator. The 
Board also shall employ such other people as are needed 
for the conduct of the affairs of the Society. 

Section 4. Meetings. The Board of Trustees shall meet 
daily during the annual convention of the Society, and 
at such other times as necessity may require, subject to 
the call of the chairman, or on the petition of the ma- 
jority of the Trustees. 

Section 5. Organization. 

A. Chairman. The Board of Trustees shall meet on the 
last day of the annual convention and elect from 
among its members a chairman. He shall hold office 
for one year and may succeed himself for one addi- 
tional year. The immediate past president shall tem- 
porarily assume the responsibilities of the Chairman of 
the Board in the latter’s absence. 

B. Duties of the Chairman. The chairman of the Board 
of Trustees shall prepare an agenda and shall preside 
at all meetings of the Board. He shall make an an- 
nual report to the House of Delegates. He shall be 
chairman of the Executive Committee. He shall present 
the report of the actions of the Executive Committee 
to the Board. 

Section 6. Quorum. Eleven members of the Board of 
Trustees from at least seven districts shall constitute a 
quorum for the transaction of business. 

Section 7. County Societies. The Board of Trustees shall 
have authority to organize the physicians of two or more 
counties into societies to be suitably designated, and these 
societies, when organized and chartered, shall be entitled 
to all rights and privileges provided for component socie- 
ties until such counties shall be organized separately. 
Section 8. Publication. The Board of Trustees shall pro- 
vide and superintend the publication and the distribution 
of all proceedings, transactions and memoirs of the So- 
ciety, and shall have authority to appoint an editor and 
such assistants as it deems necessary. 

Section 9. Bonding. The Board of Trustees shall provide 
at the expense of the Society, adequate bond for those 
officers and employees of the Society it considers require 
bonding. 

Section 10. Duties of Trustees. Each trustee shall be the 
organizer, consultant, advisor, administrator and speaker 
for the members of his district, and represent the Society 
as well as the members of his district at the Board 
meetings. 

Each trustee should visit the societies in his district 
at least once a year. He shall make an annual report of 
his work and the condition of the profession in each 
society in his district to the Board of Trustees and to 
the House of Delegates. 

Where his district is composed of more than one 
county, the trustee shall be an ex-officio member of all 
district committees. He shall report to the Board of Trus- 
tees the actions of the component societies in reports of 
these committees. 

The necessary traveling expenses incurred by such trus- 
tee in the line of the duties herein imposed, may be 
allowed by the Board of Trustees upon presentation of 
a properly itemized statement. 

Section 11. Vacancies. If during the interval between two 
annual conventions, sickness, death, or removal from 


for October, 1978 


209 


the state or district, or any other reason prevents a trus- 
tee from attending the duties of his district, or if he shall 
be absent from two consecutive meetings of the Board, 
his office may be declared vacant at the discretion of the 
Board. The Board shall have the authority to fill the 
vacancy for the period between the date at which the 
office was declared vacant and the next annual meeting 
of the House of Delegates. 

Section 12. The Benevolence Fund. Each year the Board 
shall appropriate from the funds of this Society such 
sum or sums as it may deem proper to be held in a 
fund to be known as ‘‘The Benevolence Fund.” This 
fund is established and shall be used only for the assistance 
or relief of needy members of this Society, their widows, 
widowers, or minor children. The assets shall be held 
in the treasury of this Society in a separate fund. Dona- 
tions or bequests to the Benevolence Fund automatically 
become a part of these assets. 

Section 13. Audit and Financial Statement. The Board of 
Trustees shall employ annually a certified public account- 
ant to audit all accounts of the Society, and present a 
statement of same in its annual report to the House of 
Delegates. 

This report also shall specify the character and cost 
of all publications of the Society during the year, and 
the amount of all other property belonging to the 
Society under its control, with such suggestions as it 
may deem necessary. 

CHAPTER VIII. DISTRICT COMMITTEES 

Each trustee district which is composed of more than 
one county, shall have an Ethical Relations Committee, 
a Peer Review Committee, and such other committees 
as required to provide to each component society those 
services the component society may not be able to provide 
for itself. District committees shall function only at the 
request of a component society within the district. 

Complaints initially received by district committees 
shall be referred immediately to the component society 
for action. 

District committees shall be governed by the procedural 
rules and regulations governing the counterpart state 
society committee or by these Bylaws. 

Reports of findings and recommendations of these 
district committees shall be made to the component 
society which requested action. 

The district trustee shall include a summary of the 
activities of each of these committees and the findings 
in general, in his annual report to the House of Delegates. 

The committee members shall be elected at a meeting 
of the delegates of the district called by the trustee of the 
district, before or during the annual convention of the 
Illinois State Medical Society. Chairmen of the commit- 
tees shall be designated by the trustee of the district, and 
the trustee shall be an ex-officio member of each com- 
mittee. 

CHAPTER IX. COMMITTEES 
Section 1. Committee Structure. The committee structure 
of the Illinois State Medical Society shall be as follows: 

A. Councils (standing committees) 

B. House of Delegates Committees 

C. Board of Trustees Committees 

D. Ethical Relations Committee (Chapter XI of these 
Bylaws) 

Section 2. Councils. 

A. The Medical-Legal Council shall be concerned in the 
areas of: 


1. Liaison with the Illinois Bar Association 

2. Liaison with courts, particularly where impartial 
medical testimony is involved. 

3. Implementation of the Impartial Medical Testimony 
Rule 

4. Legal aspects of medical practice other than in 
the area of mental health 

5. Licensing and standards of practice. 

6. Quackery 

7. Anatomical gifts and organ transplants 

B. The Council on Governmental Affairs shall be con- 
cerned in the areas of: 

1. Federal and state legislation— analysis and com- 
munication 

2. Legislative liaison— both state and federal 

3. Political education 

C. The Council on Education and Manpower shall be 
concerned in the areas of: 

1. Liaison with medical schools, curricula, etc. 

2. Health manpower and training 

3. Internships, residencies, etc. 

4. Scientific assembly 

5. Student loans 

6. Liaison with American Medical Student Association 

7. Continuing Medical Education 

D. The Council on Economics and Peer Review shall be 
concerned in the areas of: 

1. Relations with governmental purchase of care pro- 
grams (Medicare, Medicaid, Vocational Rehabili- 
tation, etc.) 

2. Relations with prepayment, insurance and other 
third party plans. 

3. Fees and fee adjudication 

4. Health care cost and utilization 

5. Peer Review (Part 2 of Chapter XII of these 
Bylaws) 

E. The Council on Medical Service shall be concerned in 
the areas of social and medical services and in environ- 
mental and community health. 

F. The Council on Public Relations and Membership 
Services shall be concerned in the areas of: 

1. Publicity and promotion 

2. News media relations 

3. Exhibits and public service programming 

4. Religion and medicine 

5. New member orientation and membership benefit 
explanation 

G. The Council on Mental Health and Addiction shall be 
concerned in the areas of: 

1. Facilities and services 

2. Liaison with Department of Mental Health 

3. Legal aspects of commitment, etc. 

4. Narcotics and dangerous drugs 

5. Alcoholism 

H. The Council on Affiliate Societies shall be concerned in 
the areas of: 

1. Liaison between the affiliate society and ISMS. 

2. Scientific resource information and advice to ISMS. 

3. Consultation to other councils, e.g., postgraduate 
education, health care delivery, publicity, legislation. 

4. Advances of medical science in special fields. 


210 


Illinois Medical Journal 



I. Planning and Priorities Committee. This committee 
shall review the ongoing plans and programs, establish 
appropriate priorities and develop plans for future pro- 
grams. In the discharge of its duties, it should assist the 
President-Elect in the formation of his objectives for 
accomplishment during his term as President. The Pres- 
ident-Elect shall serve as the chairman of the commit- 
tee. 

Section 3. Organization of Councils. 

A. Councils and the chairmen thereof shall be appointed 
by the Board of Trustees. 

B. Each Council shall have authority to request the 
Board of Trustees to appoint subcommittees under 
the councils for any purpose within the functions of 
the Council. A member of the Council shall be de- 
signated as chairman of each subcommittee and shall 
be selected by the Board of Trustees. Each subcommit- 
tee shall be used only for the specific purpose or pur- 
poses assigned to it and shall terminate as soon as 
its final report has been made or at the direction of 
the Board. The chairman of a Council may not serve 
as chairman of any subcommittee of the Council. 

C. Members of the Illinois State Medical Society (who 
are not voting members of the Board of Trustees) may 
be appointed to serve as chairmen or members of 
any council or committee. Students nominated by Illi- 
nois Chapters of the American Medical Student Asso- 
ciation, or other recognized student organizations 
approved by the Illinois State Medical Society Board 
of Trustees to serve with Illinois State Medical Society 
members on appropriate committees, may by action 
of the Board of Trustees, be accorded membership 
in this classification for the term of the committee 
appointment. Such members shall be permitted full 
privileges of committee membership, including (with 
the permission of the House of Delegates) the right to 
speak on the floor of the House, but to have no vote 
out of committee. Voting members of the Board of 
Trustees may serve as advisory members to any coun- 
cil or committee. 

Recommendations for membership on any commit- 
tee may be submitted to the Board of Trustees by 
the House of Delegates, or in writing by any mem- 
ber of the Society. 

A state committee which reviews the decisions of a 
similar committee of a component society may not have 
as a member one who currently serves on the same 
committee of a component society or district. 

D. Each Council shall submit for adoption a budget for 
the ensuing year which shall include any subcom- 
mittees, and the Board of Trustees shall determine 
the appropriation for each Council. Requests for addi- 
tional funds must be approved by the Board before 
they are committed. 


G. Vacancies on any council or subcommittee thereof 
may be fdled or membership therein may be enlarged 
or decreased by the Board of Trustees. The areas of 
concern of councils may also be enlarged or decreased 
by the Board of Trustees. 

H. The chairman of a council or subcommittee thereof, 
when he considers it expedient and with the consent 
of two-thirds of the members of the council, may 
conduct business or hold meetings by mail or bv 
conference call, provided all members of the council 
are given opportunity to participate, that minutes of 
the transactions are recorded, approved by members 
participating, and circulated among all members. 

I. Reports of subcommittees shall be made by the chair- 
man to the council under which they are operating. 

Reports of council activities shall include recom- 
mendations on reports and requests from subcommit- 
tees, and shall be made to the Board of Trustees by 
the chairman of the council. 

The chairman of any subcommittee may request the 
Board of Trustees to allow him, or any member of 
his subcommittee, to appear before the Board and 
to be heard. 

All councils shall submit to the House of Delegates 
written reports summarizing all actions. Requests for 
House action or recommendations affecting medical 
society policy must be submitted to the House in 
resolution form. 

J. Affiliate Societies 

1. Qualifications. Affiliate societies shall be those recog- 
nized societies of Illinois 

a) as may be approved by the Board of Trustees 

b) which desire representation on the Council on 
Affiliate Societies 

2. Representation. Each affiliate society shall be en- 
titled to one member on the council. This repre- 
sentative shall be a member of ISMS. 

Section 4. House of Delegates Committees. House of Dele- 
gates Committees of the Illinois State Medical Society shall 

be as follows: 

A. Committee on Credentials shall consider all ques- 
tions regarding the registration and credentials of the 
delegates. It shall distribute and receive the attend- 
ance slips for each session of the House of Delegates 
and perform any other duties assigned to it. 

B. Committee on Rules and Order of Business shall con- 
sider all matters regarding rules governing action, 
method of procedure and order of business for the 
House of Delegates. 


E. The president of the Society, the speaker of the House 
and the chairman of the Board shall be ex-officio mem- 
bers without vote of the various Councils, and may 
attend all committee meetings. 

F. Terms of office of members of the councils shall be 
one year, but may be terminated at any time at the 
discretion of the Board. No member of a council shall 
serve more than five consecutive one-year terms. 


C. Committee on Tellers and Sergeants-at-Arms shall: 

1. Serve the speaker of the House of Delegates. 

2. Distribute, collect and tally votes when a ballot is 
taken or a numerical tally is required. 

3. Certify those in attendance in closed or executive 
sessions of the House of Delegates. 

D. Committee on Changes in the Constitution and Bylaws 
shall consider all proposed amendments to the Con- 


for October , 197S 


211 


Constitution 



stitution and Bylaws. The chairman of the Trustees 
Committee on Constitution and Bylaws, or his repre- 
sentative, shall serve in an advisory capacity to this 
reference committee and shall attend all sessions, in- 
cluding the executive sessions of the reference com- 
mittee, to assist in the preparation of the report of 
the committee to the House of Delegates. 

E. Ad hoc committees may be appointed by the speaker 
of the House of Delegates as the needs arise and any 
member of the Illinois State Medical Society may serve 
upon such committee. The number appointed to 
such committees shall be at the discretion of the 
speaker and the term of the committee shall be for 
such duration as is necessary to complete the task 
assigned but shall not exceed a duration of one year. 
Between meetings of the House of Delegates ad hoc 
committees shall report to the Board of Trustees, 
keeping it informed of all current activities. 

F. Such other reference committees as the speaker shall 
deem necessary to conduct the business of the House, 
or consider the reports of officers, trustees, executive 
administrator, the reports of committees pertaining 
to administrative activities, economic activities, scien- 
tific activities, public relations activities and legisla- 
tive activities, as well as such resolutions, reports, and 
proposals as shall be brought before the House of 
Delegates. 

Section 5. Organization of House of Delegates Commit- 
tees. 

A. Immediately after the organization of the House of 
Delegates at each annual or special meeting, the 
speaker shall announce the appointment, from among 
the members of the House, of such committees as 
may be deemed expedient by the House of Delegates. 

Each committee shall consist of five or more mem- 
bers unless otherwise provided, the chairman to be 
announced by the speaker. These committees shall 
serve during the meeting at which they are appointed. 

B. References, resolutions, measures and propositions pre- 
sented to the House of Delegates shall be referred to 
the appropriate committee, which shall report to the 
House of Delegates before final action shall be taken. 
A two-thirds affirmative vote of the House of Dele- 
gates shall be required to suspend this rule. 

C. Each reference committee shall, as soon as possible 
after the adjournment of each session, or during the 
session if necessary, take up and consider such busi- 
ness as may have been referred to it, and shall report 
on same at the next session, or when called upon 
to do so. 

Section 6. Board of Trustees Committees. The Board of 

Trustees shall form the following committees within 

itself: 

A. The Executive Committee shall consist of the president, 
president-elect, the first vice president, the chairman of 
the Board, the chairman of the Finance and Medical 
Benevolence Committee, the secretary-treasurer, the 
trustee-at-large, and the immediate past chairman of 
the Board, provided he is still a trustee. If the immedi- 
ate past-chairman of the Board is no longer a trustee, 
the chairman of the Policy Committee shall be a mem- 


ber of the Executive Committee. The chairman of the 
Illinois Delegation to the American Medical Associa- 
tion, or the secretary in his absence, shall serve as an 
ex-officio member of the Executive Committee without 
vote. 

The Board of Trustees may delegate to the Execu- 
tive Committee any authority which it possesses and 
may authorize it to act in any given situation. In 
all matters of routine administration, special plans, 
policy, endorsement or expenditure it shall report to 
and request approval of the Board. It shall receive 
the reports of the Finance and Medical Benevolence 
Committee and Policy Committee and make recom- 
mendations concerning them to the Board. It shall 
furnish a report of its actions to the Board at each 
meeting. 

B. The Finance and Medical Benevolence Committee 
shall consist of the secretary-treasurer of the Society 
and three members of the Board appointed by the 
chairman. It shall develop for approval of the Board 
through the Executive Committee, a budget for the 
fiscal year. It shall supervise the financial transactions 
of the Society. It shall make recommendations to the 
Board for the control and investment of the funds 
of the Illinois State Medical Society. 

This committee shall also: 

1. Examine applications to the Society for assistance 
under the Medical Benevolence to determine eligi- 
bility for assistance; 

2. Keep the names of the beneficiaries confidential 
and known only to the committee; 

3. Recommend the allotment for each recipient; and 

4. If funds available become inadequate to meet dis- 
bursements, request the Board of Trustees to ap- 
propriate sufficient funds to support the program 
until the next budget appropriation. 

C. The Policy Committee shall consist of three mem- 
bers of the Board appointed by the chairman. It 
shall continually review past and current proceedings 
of the House of Delegates to determine the estab- 
lished policies of the Illinois State Medical Society. It 
shall make recommendations for future policy by 
Board resolution to the House of Delegates. 

D. The Ethical Relations Committee shall be constituted 
and function as stipulated in Chapter XI, Discipline, 
Part 2, Illinois State Medical Society procedures. 

E. The Committee on Constitution and Bylaws shall con- 
sist of five members, the Speaker of the House and 
four members appointed by the Chairman of the 
Board. It shall: 

1. Receive from individual members, county societies, 
committees, the Board of Trustees, and the House 
of Delegates, all suggestions and proposals for modi- 
fication of the Constitution and Bylaws. 

2. Prepare for the consideration of the House of Dele- 
gates, all changes in the Constitution and Bylaws. 

3. Maintain constant surveillance of both documents 
to keep them current, effective and consistent with 
the policies of the House of Delegates. 

F. The Committee on Publications shall be composed 
of five members of the Board of Trustees, and shall 


212 


Illinois Medical Journal 



be responsible for the production of the Illinois 
Medical Journal. 

It shall recommend to the Board of Trustees all 
policies governing the editorial, business and produc- 
tion aspects of the Journal. It shall supervise the edi- 
tor in the selection and preparation of all copy, and 
it shall establish standards for the editorial content. 

It shall establish advertising policies, rates, stand- 
ards, and shall review all new accounts prior to ac- 
ceptance, and shall approve reprint and circulation 
policies. 

It shall conduct a periodic review of the printer’s 
contract and solicit bids as indicated. It shall establish 
format, cover, type faces and general layout of the 
Journal. 

It shall review, edit and supervise the publication 
of other materials as directed by the Board of Trustees. 


G. The Advisory Committee to the Auxiliary shall consist 
of the immediate past president as chairman, the 
president and the chairman of the Board of Trustees. 

The committee shall provide advice and assistance 
to the president of the Auxiliary in her program for 
the year, and shall assist her in interpreting the 
activities of the Illinois State Medical Society. 

H. The Board of Trustees may from time to time ap- 
point such ad hoc committees as it may deem neces- 
sary but the duration of such committees shall be 
temporary and they shall function only for the speci- 
fic purpose assigned and shall be terminated as soon 
as final reports have been made or at the direction 
of the Board. 

Section 7. Powers of the Board of Trustees. The Board 
of Trustees shall have power to increase or decrease the 
number of its committees, to change the area of concern 
of such committees, to enlarge or decrease membership 
and to fill vacancies thereon. 

Section 8. Term of Membership. The term of the mem- 
bers of the Board of Trustees Committees shall be for 
a duration of one year and they shall be selected by the 
Board annually immediately after the election of officers. 


CHAPTER X. COUNTY SOCIETIES 

Section 1. All county societies now in affiliation with this 
Society, or those which may hereafter be organized in this 
state, which have adopted principles of organization in 
harmony with this Constitution and Bylaws, shall upon 
application to and approval by the Board of Trustees, 
receive a charter from and thereby become a component 
part of this Society, and members thereof shall become 
members of this Society and the American Medical 
Association. 


Section 2. Charters shall be issued only on approval of 
the Board, and shall be signed by the president and the 
secretary of this Society. 

The Board shall have authority to revoke the charter 
of any component society whose actions are in conflict 
with the letter and spirit of this Constitution and Bylaws. 

Section 3. Only one component medical society shall be 
chartered in any county. 


Section 4. Every registered physician holding the title of 
Doctor of Medicine or its equivalent, who either (1) 
resides in the jurisdiction of a component society, or (2) 
resides in a state other than Illinois but practices prin- 
cipally in the jurisdiction of a component society and 
who is of good moral character and professional standing, 
shall be eligible to membership in that component society. 

The component county society shall be the sole judge 
of the qualifications of its members, subject only to the 
stipulations contained in the Constitution and Bylaws. 

Section 5. Any physician who has been disciplined by any 
action of a component society and believes he has not 
had a fair trial, shall have the right of appeal to the 
Board of Trustees. 

Section 6. When a member in good standing in a com- 
ponent society changes his residence to another county 
in this state, such change of residence shall terminate his 
membership in such component society. (This ruling shall 
not apply to members in military service or in the service 
of the State or the United States government.) 

Such member shall be entitled, upon his request, to a 
statement from his former secretary as to his standing. 
This statement of standing shall be issued without cost 
to the applicant. 

He shall present this statement to the component so- 
ciety of the county to which he removes and it shall ac- 
company his application for membership. The board of 
censors of the society receiving this application shall give 
this statement of prior standing due consideration before 
accepting or rejecting his application for membership. 

Section 7. A physician living on or near a county line, 
or practicing partly or totally in an adjacent county, may 
hold his membership in the county most convenient for 
him, provided he submits written authorization to that 
society from the component society in whose jurisdiction 
he resides. 


Section 8. The secretary of each component society shall 
keep a roster of its members, in which shall be shown 
the full name, address, college and date of graduation, 
date of license to practice in this state, and such other 
information as may be deemed necessary. In keeping such 
a roster the secretary shall note any changes in the per- 
sonnel of the profession by death or by removal to or 
from the county. When requested, he shall furnish on 
blanks supplied him for the purpose, an official report 
containing such information for the secretary of this 
Society and likewise for the trustee of the district in 
which his county is situated. 

Section 9. The secretary of each component society shall 
forward an annual report consisting of a roster of mem- 
bers as of December 31 of the preceding year and a list 
of current officers, delegates and alternate delegates to the 
secretary of this society no later than 90 days prior to 
the annual meeting. 

Section 10. Any component society which fails to transmit 
the dues collected from its members prior to March 31 
shall be held as suspended and none of its members shall 
be permitted to participate in any of the business or pro- 
ceedings of the Society or of the House of Delegates until 
such requirements have been met. 

Section 11. The Constitution and Bylaws of the Illinois 
State Medical Society and of the American Medical Asso- 
ciation, together with the Principles of Medical Ethics 


for October , 1978 


213 


Constitution 



of the American Medical Association, shall be binding 
upon members of the component societies. 


CHAPTER XI. DISCIPLINE 

PART 1. COMPONENT SOCIETY PROCEDURE 

Section 1. Local Ethical Relations Committee. Each com- 
ponent society may have, either by appointment or elec- 
tion, an Ethical Relations Committee, whose duty it shall 
be to prosecute formal charges of unethical conduct. In 
the event that the county society does not have such a 
committee, the district Ethical Relations Committee shall 
function in its behalf. 

All parties may have legal counsel present to advise 
and counsel them during the proceedings, but such coun- 
sel may not participate in the proceedings, and may be 
excluded from the hearing by the chairman or by vote 
of the committee. 

The component society Ethical Relations Committee 
may establish reasonable rules of procedure, and they 
shall not be bound by the technical rules of evidence as 
the same pertain in courts of law. In all proceedings be- 
fore such Ethical Relations Committees, the complainant, 
the accused and all witnesses before the committee shall 
be placed under oath. 

The Committee shall evaluate acts by the standards 
established by the House of Delegates of the American 
Medical Association (specifically known as the Principles 
of Medical Ethics of the American Medical Association), 
and by such additional standards as shall be incorporated 
in the Constitution and Bylaws of the Illinois State Medi- 
cal Society and/or the county medical society. 

Section 2. Offenses. Any member of a component society 
shall be subject to censure, suspension or expulsion by 
such component society when: 

A. He has been adjudged guilty by proper civil authori- 
ties of a criminal offense involving moral turpitude, or 

B. He has been adjudged guilty by his component so- 
ciety in accordance with the procedural requirement 
of these bylaws: 

1. of a gross misconduct as a physician, or 

2. of a violation of the Constitution or Bylaws of his 
component society, or of the Illinois State Medical 
Society, or of the Principles of Medical Ethics pro- 
mulgated from time to time by the American Med- 
ical Association. 

Section 3. Formal Written Charges Presented to the Illi- 
nois State Medical Society. Formal, written charges received 
by the Illinois State Medical Society shall be referred di- 
rectly to the secretary of the component society of which 
the charged individual is a member or to the district 
Ethical Relations Committee in the event that the com- 
ponent society does not have an Ethical Relations Com- 
mittee. 

Section 4. Principles of Justice. The following principles of 
justice shall guide the Ethical Relations Committee in all 
disciplinary procedures. 

A. A charged individual is presumed to be innocent until 
he has been proven guilty. 

B. No proceeding shall be initiated under this Part I until 
formal written charges have been filed with the secre- 
tary of the component society or the district Ethical 


Relations Committee, as the case may be. Thereafter, 
said formal written charges must be presented under 
oath or affirmation by the complaining party before 
the Ethical Relations Committee of the component 
society or the district Ethical Relations Committee, as 
the case may be. 

C. A hearing shall be held by the committee within 30 
days after the formal written charges have been filed, 
unless continued by the chairman of the committee 
upon good cause shown. 

D. In the event that a component society's Ethical Rela- 
tions Committee does not make a reasonable effort to 
hold the hearing within the time period, including 
reasonably granted continuances, either the complain- 
ing party or the physician, against whom formal writ- 
ten charges have been brought, may appeal for relief 
and hearing to the district Ethical Relations Commit- 
tee, which will determine the reasonableness of the 
effort. 

E. The individual against whom formal charges have been 
filed shall be sent a copy of said charges by certified 
mail at least 10 days before the date set for the hearing, 
together with a statement of the rights of the charged 
individual as follows: 

1 . to be represented by any member of the society as 
counsel and that he may have legal counsel present; 

2. to cross-examine witnesses; 

3. to offer in evidence any pertinent records or docu- 
ments; 

4. to object to any testimony or exhibits offered in 
evidence; 

5. to address the hearing body in his own behalf; 

(5. to be tried only on the specific charges filed; 

7. to have stricken from the record any improper testi- 
mony or exhibits; 

8. to appeal to the Board of Trustees of the Illinois 
State Medical Society. 

Section 5. Records. A comprehensive stenographic record, 
tape recording or its equivalent of the entire proceedings, 
together with all exhibits, must be kept for reference, and 
shall be available until final adjudication has been made. 

In the event of an appeal being taken from the verdict 
of the local or district Ethical Relations Committee, the 
stenographic record, tape recording or its equivalent, of 
the entire proceedings shall be forwarded by certified mail 
to the Board of Trustees of the ISMS at least ten days 
prior to the date the appeal is to be heard. 

If the component society fails to provide the record 
on appeal, the Ethical Relations Committee of Illinois 
State Medical Society shall find the charged individual 
not guilty. 

Section 6. Verdict. The committee, sitting as a hearing 
body, shall recommend the charged individual be found 
either guilty or not guilty. If the verdict is guilty, the 
hearing body shall recommend censure, suspension or ex- 
pulsion. 

The findings of the hearing body must be presented to 
the component county society for approval or rejection. 
The charged individual must be notified by certified mail 
at least ten days before the date set for the meeting at 
which this action will be taken. If the findings of the com- 
ponent society are against the charged individual, the 
secretary of the component society shall acquaint the 
charged individual by certified mail, with his right of 
appeal within thirty days to the Board of Trustees of the 
Illinois State Medical Society. 


214 


Illinois Medical Journal 



PART 2. ILLINOIS STATE MEDICAL 
SOCIETY PROCEDURES 

Section 1. Illinois State Medical Society Ethical Relations 
Committee. The Board of Trustees shall appoint from 
its members, an Ethical Relations Committee to review 
decisions of the component society involving the inter- 
pretation of the Principles of Medical Ethics, violations 
of the Constitution and Bylaws of the Illinois State Medi- 
cal Society or its component societies, and charges of mis- 
conduct of members of the Society. 

Section 2. Appeals from Component Society Verdicts. 
Appeals received by the Illinois State Medical Society 
Board of Trustees shall be referred to the Ethical Rela- 
tions Committee of the Board for review. (Appeals must 
be accompanied by a comprehensive stenographic record 
tape recording or its equivalent, of the entire proceedings 
taken before the component county society together with 
all exhibits submitted in evidence. If the component 
county society fails to provide the record on appeal, the 
Ethical Relations Committee of the Illinois State Medical 
Society shall find the accused “not guilty’’) . The commit- 
tee shall notify the accused and the secretary of the com- 
ponent society by certified mail at least thirty days prior 
to the date set for the hearing of the appeal. The chair- 
man of the committee shall preside over the hearing in 
accordance with the rules established by the Board of 
Trustees. 

Section 3. Verdict. The Ethical Relations Committee of 
the Board of Trustees shall hear any new and pertinent 
evidence any interested party desires to present, and at 
the conclusion of the trial the decision of the component 
society shall be affirmed, overruled or sent back to the 
component society for reconsideration. 

Section 4. Notification and right of appeal. The secretary 
of the Society shall notify the defendant and the secre- 
tary of the component society wherein the defendant holds 
membership, of the action of the Board. In the event of 
a decision against the accused he shall have the right to 
appeal the decision to the Judicial Council of the Ameri- 
can Medical Association and the secretary of the State 
Society shall so notify the accused of this right. 


CHAPTER XII. PEER REVIEW 

PART 1. COMPONENT SOCIETY PROCEDURE 

Section 1. Local Peer Review Committee. Each compon- 
ent Society shall have, either by appointment or election, 
a Peer Review Committee whose duties it shall be to 
review all proper complaints and inquiries brought be- 
fore it by physicians, patients, institutions, insurance car- 
riers, or government agencies. 

The district peer review committee shall function and 
operate on behalf of any county society which does not 
establish such a committee. 

Section 2. The committee shall consist of a chairman and 
such members representing the various specialties, includ- 
ing family practice, as each individual county society shall 
determine. Such committee should have access to counsel 
from each of the various medical specialties. The com- 
ponent county society may establish reasonable rules of 
procedure but shall not be bound by the technical rules 
of evidence as the same pertains in courts of law. All 
proper complaints shall be reduced to writing and shall 
be signed by the individual making the complaint. 


Section 3. Original complaints received by the Illinois 
State Medical Society shall be referred to the proper 
county society or to the district committee. 


Section 4. The Peer Review Committee shall include the 
functions of the grievance committee, the prepayment 
plans and organizations committee, the mediation com- 
mittee and any other committee having to do with in- 
vestigations and review but shall not replace or super- 
sede the ethical relations committee. 


Section 5. The Peer Review Committee shall initiate con- 
sideration of all complaints and matters filed with it 
within 60 days from the date of filing and shall render 
an opinion within 30 days after the conclusion of the 
hearing. In the event the committee does not follow this 
procedure any party may appeal for relief to the proper 
district committee whose procedure shall be the same 
as is set forth herein for county societies. 


Section 6. The Peer Review Committee shall have no 
disciplinary powers but instead, shall report its findings 
in writing to all parties involved. In the event the in- 
vestigation and study of the committee results in a de- 
termination that there has been a violation of law or 
unethical conduct on the part of any physician, or a 
violation of the Constitution or Bylaws of his compon- 
ent society, or of the Illinois State Medical Society, or 
of the Principles of Medical Ethics promulgated from 
time to time by the American Medical Association, the 
matter shall be referred in writing to the component 
society. 


Section 7. In its study and deliberations the Peer Review 
Committee shall evaluate acts by the standards established 
by the House of Delegates of the American Medical Asso- 
ciation (specifically known as the Principles of Medical 
Ethics of the American Medical Association), and by such 
additional standards as shall be incorporated in the Con- 
sitution and Bylaws of the Illinois State Medical Society 
and/or the county medical society. 


Section 8. Any party to the proceedings considering him- 
self aggrieved by the findings and recommendations of 
the committee shall have the right to appeal through the 
component society to the Illinois State Medical Society. 


Section 9. In the event of an appeal to the Illinois State 
Medical Society, the county society shall send to the 
Illinois State Medical Society a copy of the complaint, 
the exhibits and the opinions of the county or district 
committee. Any appeal hereunder shall be filed with the 
Illinois State Medical Society wihin 30 days after the final 
opinion of the county or district committee has been 
rendered. 


PART 2. ILLINOIS STATE MEDICAL 
SOCIETY PROCEDURES 

Section 1. All appeals received by the Illinois State 
Medical Society shall be referred to the Council on 
Economics and Peer Review, which shall review opinions 
of the county or district peer review committee. The coun- 
cil shall have the power to counsel with and obtain infor- 
mation from medical specialists when appropriate. The 
Council shall have the power to review both the procedural 
and substantive aspects of any appeal before it. 

Section 2. The council upon receiving notice of an ap- 


for October, 1978 


215 


Constitution 



peal shall set the matter for hearing within 30 days after 
the appeal has been filed and at such hearing shall re- 
view the record sent to it from the county society or dis- 
trict society, receive additional pertinent evidence any 
interested party desires to offer and render its conclu- 
sions and findings in writing, copies of which shall be 
mailed to all interested parties. The Peer Review Com- 
mittee shall have no disciplinary powers but instead, shall 
report its findings to all parties involved. The conclu- 
sions and findings shall be advisory only. 

Section 3. The Council on Economics and Peer Review 
of the Illinois State Medical Society shall include the 
functions of the grievance committee, the prepayment 
plans and organizations committee, the mediation com- 
mittee and any other committee having to do with in- 
vestigations and review but shall not replace or supersede 
the ethical relations committee. 

Section 4. In the event the investigation and study of 
the Council results in a determination that there has 
been a violation of law or unethical conduct on the part 
of any physician, or a violation of the Constitution or 
Bylaws of his component society, of the Illinois State 
Medical Society, or of the Principles of Medical Ethics 


promulgated from time to time by the American Medical 
Association, the matter shall be referred in writing back 
to the component society. 

CHAPTER XIII. MISCELLANEOUS 
The fiscal year of this Society shall be from January 1 to 
December 31 inclusive. 


CHAPTER XIV. AMENDMENTS 
The House of Delegates may amend any article of these 
Bylaws by a two-thirds vote of the delegates present at 
any meeting, provided that such amendment shall not 
be acted upon before the day following that on which 
it was introduced. 

CHAPTER XV. PARLIAMENTARY PROCEDURES 
For those matters not covered by the Constitution and By- 
laws of the Illinois State Medical Society, Sturgis Standard 
Code of Parliamentary Procedure, Current Edition, shall 
be the guide for conduct of meetings of the House of Dele- 
gates, Board of Trustees and all councils and committees. 


Index to Constitution and Bylaws 


Ad Hoc Committees 

House of Delegates 212 

Board of Trustees 213 

Advisory Committee to Auxiliary 213 

Affiliate Societies 

Council on 210 

organization 211 

Amedments 

to the Bylaws 216 

to the Constitution 205 

American Medical Association 

membership 205 

Annual Dues, Assessments 206 

Audit and Financial Statement 210 

Benevolence Fund 210 

Board of Trustees 

committees 212 

composition 208 

duties 209 

election by House of Delegates 208 

election of Chairman 209 

meetings 209 

organization 209 

powers of 213 

quorum 209 

term of office 213 

vacanies 209 

Bonding of officers and employees 209 

Bylaws 205 

Changes in the Constitution and Bylaws Committee 211 

Committees 210 

structure 210 

councils 210 

organization 211 

House of Delegates 211 

Board of Trustees 212 

Component Societies 205 

Composition of the Society 205 


Constitution 205 

Constitution and Bylaws, Committee on 211 

Conventions and Meetings 205 

House of Delegates 207 

Councils (standing committees) 

organization of 211 

reports 211 

terms of office 211 

vacancies 211 

County Societies, Organization of 213 

Credentials Committee 211 

Discipline 

Component Society Procedure 214 

State Medical Society Procedure 215 

District Committees 210 

Dues, Funds, and Assessments 206 

Economics and Peer Review, Council on 210 

Education and Manpower, Council on 210 

Education and Scientific Programs 207 

Election of Officers 208 

Ethical Relations Committee 212 

Executive Administrator 209 

Executive Committee 212 

Finance and Medical Benevolence Committee 212 

Governmental Affairs, Council on 210 

House of Delegates 

composition 207 

delegates 207 

district divisions 207 

meetings 207 

order of procedure 207 

term of office 208 

House of Delegates Committees 211 

organization 212 

Medical Service, Council on 210 

Membership 

associate members 206 

discrimination of membership 206 


216 


Illinois Medical Journal 



distinguished members 206 

emeritus members 206 

in-training members 206 

regular members 205 

retired members 206 

service members 206 

student 206 

tenure and termination of membership 206 

Officers 

elections 208 

duties 208 

terms of office 208 

Medical-Legal Council 210 

Mental Health and Addiction, Council on 210 

Miscellaneous 216 


Parliamentary Procedures 216 

Peer Review 

Component Society Procedures 215 

State Medical Society Procedure 215 

Flanning and Priorities Committee 211 

Policy Committee 212 

Publication Committee 212 

Public Relations and Membership Services, Council on ....210 

Resident Physician Section 207 

Reference Committees 211 

Rules and Order of Business Committee 211 

Seal, the 205 

Student Business Session 207 

Tellers and Sergeants-at-arms Committee 211 

ISMS Auxiliary, Advisory Committee to 213 


1978-1979 

Policy Manual 
of the 


Illinois State Medical Society 

“Policy statements shall be defined as guidelines for the management of the Illinois State Medical 
Society affairs, based upon prudence, sound judgment and experience.’’ 

“Rules and regulations may be prepared by the Board of Trustees or by committees, for use in 
the implementation of policy.” 


This manual shall be a guide for officers, trustees, com- 
mittee chairmen and headquarters staff to the stand 
taken by the House of Delegates of the Illinois State 
Medical Society on all issues involving Society policy. 

Its statements shall combine and reconcile the best 
expressions made on all phases of policy involving the 
House of Delegates, the Board of Trustees and the various 
committees. 

All policy statements (except those involving the funds 
of the Society) shall have the approval of the House of 
Delegates, since the Constitution and Bylaws provide in 
ARTICLE V: 

“The House of Delegates shall set the basic policy and 
philosophy of the Society.” 

All policy statements developed during the interval 
between meetings of the House shall be submitted at its 
next meeting for action. The House may: 

(1) approve, amend, or reject— 

(2) refer the statement to the Board for reconsideration 
and subsequent report— 

(3) remand the statement to the committee from which 
it came for further study and report. 

Policy statements for the consideration of the House 
must be presented in resolution form. A member of the 
Illinois State Medical Society may propose policy by re- 
questing any delegate to submit an appropriate resolution. 
1 he Policy Committee will develop policy statements from 
actions of the House of Delegates and, after approval by 
the Board of Trustees, the statements will be published 
in this Policy Manual. 

Temporary policy between meetings of the House is 
determined by the Board. Committees may request Board 
consideration at any time. 


The Illinois State Medical Society shall support policy 
statements approved by the House of Delegates of the 
American Medical Association. 

National policy is the prerogative of the national asso- 
ciation. Until specific contrary action emanates from the 
AMA House of Delegates, the Board of Trustees and the 
officers of the ISMS shall consider all such policy as 
binding. 

Policy action at the state level does not rescind official 
AMA rulings in Illinois. 

The same “chain of command” should exist between 
the county medical society and the ISMS House of Dele- 
gates. Policy established at the State Society level must 
prevail until majority action by the House of Delegates 
has rescinded or reversed the statements. This represents 
“majority rule” and must be followed closely to preserve 
the democratic process. 


PROFESSIONAL POLICIES 
Abortion 

The decision to perform an abortion is a medical mattei 
to be determined by agreement between the patient and 
the physician. Performance of abortions should be carried 
out in accordance with current guidelines as promulgated 
by the House of Delegates. If not in conflict with state 
and federal law, an abortion so performed shall not be 
considered unethical. No physician shall be required to 
perform or participate in an abortion. 


for October , 197S 


217 


Policy Manual 


Acupuncture 

Acupuncture is a surgical procedure and its practice 
should be limited to physicians licensed to practice medi- 
cine in all of its branches and to dentists. 

Alcoholism 

Alcoholism is an illness characterized by preoccupation 
with alcohol and loss of control over its consumption such 
as to lead usually to intoxication if drinking is begun; 
by chronicity; by progression, and by tendency toward 
relapse. It is typically associated with physical disability 
and impaired emotional, occupational and/or social ad- 
justments as a direct consequence of persistent and 
excessive use of alcohol. 

Insurance companies are encouraged to include appro- 
priate coverage for alcoholism in health insurance policies 
similar to coverage for any other illness and general 
hospitals, both public and private, are encouraged to 
accept alcoholic patients (both in-patient and out-patient) 
for detoxification and rehabilitation. 

Alcoholism Education 

The Illinois State Medical Society supports the concept 
that medical schools and hospital training programs 
should expand instruction of students in the treatment 
of acute and chronic alcoholism, as well as its cause and 
prevention; that mental health clinics should enlarge 
their services to include treatment and counseling of 
alcoholics and their families and, where appropriate, col- 
laborate with Alcoholics Anonymous as well as half-way 
houses; that education programs aimed at alcohol abusers 
who are drivers should be encouraged and legal restric- 
tions established to prevent them from holding drivers’ 
licenses; that education of the public (at all age levels) 
regarding the nature of alcohol and its physiologic and 
psychologic effects should be encouraged. 

Ambulance Services 

All ambulance services should meet minimum stand- 
ards as developed from time to time by the Illinois State 
Medical Society and the State of Illinois. 

Athletic Programs 

Children of school age, through the 9th grade, should 
not participate in body contact sports. 

Elementary school children develop better physically 
if activities are informal and not highly competitive. 

Medical supervision of all athletic programs is essential. 

Audits & Surveys 

(Hospital, nursing homes, etc.) 

Audits and surveys which impinge on personal privacy, 
patient care and local hospital trustee and medical de- 
cisions as to management should not be condoned. 

Birth Control 

The preventive medicine approach to the problem of 
unwanted pregnancies should be encouraged through 
family life education in the schools, wider dissemination 
of family planning information, including birth control 
information and devices, and encouragement of research 
in population control methods. 


Blood Procurement 

Inasmuch as blood procurement affects the entire 
community, any blood procurement program should be 
carried out only with the approval of the local county 
medical society involved. 

Communicable Diseases 

Physicians, especially those engaged in public health 
work, should enlighten the public concerning all regula- 
tions and measures for the prevention and control of 
communicable diseases. When an epidemic prevails, a 
physician shall continue his labors without regard to his 
own health. 

Community Health Week 

The medical profession shall provide the scientific 
leadership to focus attention on the health needs of the 
community and to encourage and assist in developing 
Community Health Week activities during the winter or 
spring of the year. 

Comprehensive Health Planning 

Upgrading of local health facilities should he imple- 
mented through Comprehensive Health Planning on a 
home rule basis rather than through metropolitan or- 
iented advisory services. Where a county medical society is 
unable to enter into meaningful participation in areawide 
health services planning, this function may be assumed by 
an appropriate ISMS District Committee or, where the 
appropriate District Committee is unable to act, by the 
Illinois State Medical Society. 

Confidentiality 

Communications received in confidence by physicians 
from patients are privileged: the privilege is that of the 
patient and the physician is the guardian of the privilege 
and must not betray it. Current day social values dictate 
that privileges must be continued in accomplishment of 
the treatment of human illness. Section 9 of the Principles 
of Medical Ethics states that “A physician may not reveal 
the confidences entrusted to him in the course of medical 
attendance, or the deficiencies he may observe in the 
character of patients, unless he is required to do so by 
law or unless it becomes necessary in order to protect the 
welfare of the individual or the community.” The Illinois 
State Medical Society re-affirms its belief in this principle 
and supports activities to guarantee continuation of pri- 
vacy, while recognizing the need for collection of statistical 
data and enforcement activities in the public good. 

The Illinois State Medical Society supports the concept 
of the confidentiality of the doctor-patient relationship as 
it relates to the ambulatory patient record and will take 
an active role in uncovering any violation of the doctor- 
patient confidential relationship by officials and personnel 
of review organizations and will take whatever steps are 
necessary to eliminate the breach of confidence. 

ISMS is in total opposition to the use of the Social 
Security number as a universal number identifier. 

Conflict of Interest 

When a case of conflict of interest arises and is self- 
evident, by the attitude shown by the individual con- 
cerned, it should be referred to the Executive Committee 
of the Board of Trustees of the ISMS for consideration. 


218 


Illinois Medical Journal 



Continuing Education 

Continuing education shall be one of the basic purposes 
of the Illinois State Medical Society for scientific advance- 
ment, humanization of medicine, improvement of med- 
ical public relations, and development of cooperation and 
rapport with the public. The Society should continue to 
support the multi-faceted approach to continuing medical 
education as now endorsed by the Illinois Council on 
Continuing Medical Education. 

ISMS should continue to support the efforts of county 
medical societies in becoming certified for sponsoring 
continuing medical education programs meeting the re- 
quirements promulgated by the Liaison Committee on 
Continuing Medical Education and the regulations of the 
State of Illinois. 

All members should be encouraged to participate in the 
AMA Physician Recognition Award, as presently con- 
stituted, or its equivalent. 

In the certification of educational quality of continuing 
medical education programs, the Illinois State Medical 
Society should have a primary role. Physicians should be 
encouraged to participate in self-assessment test programs 
prior to registering for such hospital courses and other 
learning activities. 

Sponsors of continuing medical education courses 
should provide full disclosure of materials, methods, ob- 
jectives and evaluation procedures of offered courses. 


Cultists, Association with 

The Judicial Council of the American Medical Associa- 
tion has ruled that it is unethical to associate VOLUN- 
TARILY with an individual who practices as a member 
of a “cult.” 


Current Procedural Terminology 

The Illinois State Medical Society endorses the Ameri- 
can Medical Association’s Current Procedural Terminology 
and encourages its use by Illinois physicians. 


Death, Legal Definition of 

ISMS will not support any legislative proposal which 
seeks to define death unless it provides that, based upon 
usual and reasonable standards of medical practice, death 
has occurred when it is determined by a doctor of medi- 
cine that a person has experienced the permanent and ir- 
reversible cessation of the integrated functioning of the 
respiratory, circulatory and nervous system, according to 
the following standards: 

(a) the irreversible cessation of spontaneous respiratory 
and circulatory functions; or 

(b) if artificial means of support preclude reliance on 
item (a) , the irreversible cessation of spontaneous 
brain function, which may be confirmed by a flat 
(isoelectric) electroencephalographic tracing in the 
absence of hypothermia and of barbiturate and 
other nervous system depressants. 


tion, based on what must necessarily be a private matter 
between physician and patient. 


Disaster Control 

Any disaster creates an obvious need for trained per- 
sonnel to aid the sick and injured. Local medical societies 
should cooperate to provide medical self-help programs. 
County societies should provide training for their mem- 
bership in the treatment of mass casualties, radiological 
casualties and in the organization, operation and main- 
tenance of emergency hospitals. 

Discrimination — (see “Freedom of Choice”) 


Drugs, Prescriptions 

Prescription drugs may be dispensed only upon the 
authorization of a physician licensed to practice medicine 
in all its branches. Public health departments should not 
conduct drug dispensing and distribution programs with- 
out direct physician supervision of patients receiving 
medication. 

Substitution of prescribed drugs by pharmacists is op- 
posed, except in cases of extreme emergency, unless there 
be full explanation and agreement by both the patient 
and the doctor. 

The package insert labeling pharmaceutical preparations 
is a guide for the clinical application of the product and 
should not be used as an absolute standard limiting the 
practice of medicine. 


Electromyoneurographic Procedures and 
Examinations 

Clinical electromyoneurographic procedures and exam- 
inations, which inherently involve medical interpretations, 
descriptions of findings, and rendering of diagnostic 
opinions, should be performed only by physicians licensed 
to practice medicine in all its branches and trained in 
these procedures. 


Ethics 

Cases involving ethics shall reach the state society level 
only by means of an appeal. As outlined in the Bylaws, 
the staie society committee shall serve only as an appellate 
body to review such cases. 

Examinations 

All physical examinations should be performed in the 
physician’s office. No examinations should be conducted 
on a group basis unless authorization has been given by 
the local county medical society in a single instance or 
for a specific purpose. 

This general statement does not apply to the industrial 
or occupational health physician in his in-patient activities. 


Death With Dignity 

The Illinois State Medical Society will continue to op- 
pose death with dignity, right-to-die and similar legisla- 


Experimental Medical Procedures 

In order to conform to the ethics of the American 
Medical Association, three requirements must be satisfied 


for October , 1978 


219 


Policy Manual 


Policy Manual 


in connection with the use of experimental drugs or 
procedures: 

1. The voluntary consent of the person on whom the 
experiment is to be performed should be obtained. 

2. The danger of each experiment must be previously 
investigated by animal experimentation. 

3. The experiment must be performed under proper 
medical protection and management. 


Eyes 

Only physicians licensed to practice medicine in all its 
branches are qualified to prescribe or use eye medications; 
only such physicians should continue to be the primary 
entry-point for eye care. ISMS will vigorously oppose any 
attempt in Illinois to give optometrists a license to pre- 
scribe or use medications or to serve as a primary entry- 
point in the provision of eye care. 


Fee Schedules 

No member or committee shall be permitted to approve 
a fee schedule for the Illinois State Medical Society until 
it has been submitted to and approved by the House 
of Delegates or the Board of Trustees. Fees should be 
commensurate with services rendered. 


Foundations for Medical Care 

The Illinois Foundation for Medical Care is a not-for- 
profit corporation established to provide physicians with 
leadership roles in modifying health care delivery in their 
communities, thus assuring quality care at reasonable 
cost. 

The Illinois Foundation for Medical Care is completely 
accountable only to the House of Delegates, through the 
Board of Trustees of ISMS, and to each component so- 
ciety of ISMS. 

Establishment of autonomous county and/or multi- 
county foundations under the sponsorship of local med- 
ical societies is encouraged and, together, local and state 
foundations shall provide a mechanism through which 
foundation-sponsored programs can be developed and ad- 
ministered throughout the state. 

The Illinois Foundation for Medical Care is authorized 
to investigate and, if economically feasible, to implement 
programs for supporting physician organizations endorsed 
by constituent medical societies. Such support is to be in 
the areas of data needs and other specialized activities, 
such as statewide co-ordination, statistical analysis, co- 
ordinated negotiations and support of related state level 
organizations, utilizing public, governmental or private 
funds to reimburse the foundation for such activities. 
Specifically, the IFMC Board is authorized to investigate 
the feasibility of becoming a statewide support center for 
physician organizations endorsed by constituent medical 
societies and to provide administrative support, data proc- 
essing and specialized services to such physician organiza- 
tions. 


Freedom of Choice 

The mutual right of physicians and patients to exer- 
cise freedom of choice in medical matters shall be main- 


tained. This includes the right of the patient to choose 
the physician by whom he will be served, and the right 
of the physician (except in emergencies) to a correspond- 
ing freedom of choice. All members of the Illinois State 
Medical Society enjoy the same rights and privileges and 
are bound by the same obligations and standards of pro- 
fessional conduct. 

ISMS supports the concept of second opinion— only via 
the usual and customary referral pathways guaranteeing 
the free choice of physicians. 


Governmentally Supported Health Facilities 

ISMS should not facilitate the development of govem- 
mentally-supported Health Maintenance Organizations or 
similar practice alternatives which would be discrimina- 
tory against the private or group practice of medicine. 


Health Care — Ancillary Services 

All segments of our population are entitled to and shall 
receive the best health care available. The physicians in 
Illinois are encouraged to cooperate in the implementation 
of any national program meeting with the general policy 
statements of the Society. (This shall be interpreted to 
include health aspects in nursing home care, use of rec- 
reational facilities, environmental health, public health, 
employment problems, problems of migrant workers, etc., 
and any other area which involves the health of the 
people of this state.) 


Health Care Costs 

The public should be educated concerning the differ- 
ence between “health care costs” and “medical care costs.” 
Members of the profession should cooperate with the 
various ancillary groups and should be able to explain 
the cost factors involved in total care. 

ISMS encourages its members to be aware of the cost of 
hospital services, supplies and drugs and encourages phy- 
sicians to receive and review the hospital bill of each 
patient he hospitalizes as a voluntary step toward cost 
containment of health care. 

ISMS is unalterably opposed to governmental control of 
hospital costs and physicians’ fees and reaffirms its faith 
in the private enterprise system which has made the 
United States great and strong and which seeks to make 
health care available to everybody. 

The Illinois State Medical Society encourages cost shar- 
ing by patients in all medical care reimbursement plans. 

Health Careers 

All capable and worthy individuals interested in medi- 
cine as a career shall be encouraged and assisted by the 
Illinois State Medical Society. Those interested in para- 
medical fields shall be provided with all pertinent in- 
formation. 


Health Insurance, Governmental Programs 

The Illinois State Medical Society is opposed to com- 
pulsory governmentally-mandated national health insur- 
ance plans and will continue to point out its dangers and 
disadvantages to the public, including those in which 


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Illinois Medical Journal 



quality of care is compromised. 

Governmental health insurance benefits for mental ill- 
ness should be comparable to benefits for any other medi- 
cal condition. 

Governmental health insurance programs providing re- 
imbursement for medical services under the direction of 
practitioners other than doctors of medicine or osteopathic 
medicine should establish a separate category for such 
reimbursement, with separate payment, and be optional 
to the insured. 

ISMS will actively oppose any state or federal legislation 
which proposes reimbursement under health insurance 
programs of psychologists, social workers or any group of 
individual practitioners without medical supervision. 


Health Insurance, Voluntary Plans 

ISMS endorses the principle of voluntary health insur- 
ance. Fixed fee schedules should be recognized as in- 
demnification to the patient and not necessarily payment 
in full. 

The Illinois State Medical Society supports the concept 
of increased insurance coverage for out-patient diagnostic 
tests. 

Inasmuch as the fee coverage by insurance plans may 
not cover the full fee of the physician, the physician is 
encouraged to develop a prior agreement with the pa- 
tient, such as the “Statement of Understanding.” This will 
outline to the patient his individual responsibility for the 
physician’s fee. 

ISMS objects to third party carriers interfering with the 
practice of medicine and the patient-physician relation- 
ship by: 

Implying to patients that physician’s charges above 
insurance benefit allowances are excessive; 

Suggesting to physicians that insurance company 
reimbursement amounts be accepted as payment in 
full; 

Suggesting that physicians perform alternative sur- 
gical procedures; 

Instituting utilization review of hospital patients in 
the private sector which by-passes local physician re- 
view mechanisms; 

Discriminating against the physician who does not 
have a separate contractual relationship with the car- 
rier and inhibiting the patient’s free choice of phy- 
sician. 

ISMS endorses long-held principles that: 

A contractual relationship that exists between a 
patient and a third party does not involve the physi- 
cian (unless the physician has agreed to such in- 
volvement) ; and 

The third party is not involved in the contract 
existing between the patient and his/her physician 
(unless such involvement has been agreed to by both 
patient and the physician). 


Health Screening by Paramedical Personnel 

Health evaluation, to be adequate, must include a 
physical examination only by or under the direct super- 
vision of a physician licensed to practice medicine in all 
of its branches with physician interpretation of the ap- 
propriateness and reliability of various screening proce- 
dures used. 


Hearing Disorders 

Physicians licensed to practice medicine in all its 
branches remain the primary entry point for the care of 
patients with hearing impairment. 


Hospitals 


Physicians should sponsor and assist in the development 
of all medical staff committees within the hospital. 

The local medical profession should cooperate to 
achieve the accreditation of all eligible hospitals, and 
should encourage the stabilization or reduction of hos- 
pital costs in all areas where they have authority. 

All county medical societies are encouraged to form 
standing committees composed of medical society officers 
and representative officers of all hospital staffs in their 
areas to guarantee a free exchange of information between 
the medical society and hospital staffs related to activities 
of hospitals, medical organizations, governmental and 
quasi-governmental agencies in their community. 

The Illinois State Medical Society encourages the devel- 
opment of local peer review plans for appropriate review 
of utilization of hospital emergency rooms. 


Hospital — Medical Staff — Management 
Relationship 


Any proposal or arrangement between institutional 
management and medical staffs should not conflict with 
the Principles of Medical Ethics or abridge the property 
right endowed upon the individual physicians by the 
Illinois Department of Registration and Education. The 
practice of medicine is the physician’s legal prerogative 
and responsibility. To insure the quality of medical care, 
each hospital has the obligation to cooperate with and 
assist its medical staff in implementing procedures by 
which the quality of medical care in that hospital may 
be maintained by and through its medical staff. 

ISMS is opposed to hospital actions which unilaterally 
stipulate that professional liability insurance is a pre- 
requisite for membership on a medical staff. If a hospital 
proposes to require evidence of professional liability insur- 
ance as a condition of membership on a medical staff, such 
condition should be in accord with rules and requirements 
as established by the organized medical staff of the hospi- 
tal in cooperation with the hospital board of trustees. To 
protect their assets, members of a hospital medical staff 
should be assured of the adequacy (scope and amount) of 
professional liability coverage carried by the hospital as a 
reciprocal disclosure between the staff and hospitals. 

Results of recertification examinations should not be 
the sole criterion used by hospital governing bodies and 
hospital medical staffs in the granting of clinical privileges. 


Hospital Records and Their Availability 

Patient care hospital records contain privileged infor- 
mation of confidential nature. Such records are the prop- 
erty of the hospital; information contained therein is held 
in trust, through a fiduciary relationship, by the hospital. 

Patients, and upon appropriate, written authorization, 
their attorney or succeeding physician, have the right of 
access to these records, with the ability of review and the 
right to copy or receive copies. This access is not afforded 
to patients in cases of psychiatric illness. 


for October, 1978 


221 


Policy Manual 



Upon receipt of proper, written authorization from the 
patient, a copy, abstract or summary shall be provided as 
required, to insurance companies, governmental agencies, 
or other hospitals. 

Patient records utilized by official committees of or- 
ganized medical staffs to accomplish scientific studies of 
morbidity or mortality, utilization review, peer review or 
other patient care improvement activity remain confiden- 
tial and shall not be disclosed to any person outside the 
purview of such committees. 

Where litigation is involved, a physician may be re- 
quired to release medical records in the absence of a 
signed patient authorization. In those instances, a physi- 
cian should ascertain that he is required to release the 
medical records and that the agent so requiring the re- 
lease has the appropriate authority. 


Hospital Staff" Assessments 

The medical staff of a hospital does not have the priv- 
ilege or the right to make compulsory assessments of 
members of the medical staff for building funds, or to 
demand an audit of staff members’ personal financial 
records as a requisite for staff appointments. 


Immunization Programs 

Illinois residents should be provided access to all medi- 
cally indicated immunization. Physicians are requested to 
provide this protection, especially to all children, or to 
encourage the local public health agency to perform this 
function. 

Every school district should have a school health com- 
mittee with at least one physician as a member. County 
advisory school health councils should assist in coordina- 
tion. 

County medical societies should be consulted by health 
departments planning any mass immunization campaign. 
In counties where there is no public health department, 
the Illinois Department of Public Health should contact 
either the county medical society or local physicians 
(whichever is appropriate) for coordination of the im- 
munization program. 

The Illinois Department of Public Health or the Illinois 
State Medical Society should institute whatever is neces- 
sary, including appropriate state indemnification or “ex- 
emption from liability” legislation, to assume or alter the 
liability responsibility during any mass immunization pro- 
gram. 

If private facilities are utilized during a mass immuniza- 
tion campaign, normal reimbursement procedures may be 
employed, but no charge shall be made for the cost of 
vaccine paid for by the federal government. 


Indigent, The Care of the 

Personal medical care is primarily the responsibility of 
the individual. When he is unable to provide this care 
for himself, the responsibility should properly pass to his 
family, the community, the county, the state, and only 
when all these fail, to the federal government, and only in 
conjunction with the other levels of government in the 
order above. 


The determination of medical needs should be made 
by a physician. The determination of eligibility should 
be made at the local level with local administration and 
control. The principle of freedom of choice should be 
preserved. 

Laboratories 

All laboratories providing medical data should be under 
the direct supervision of a physician. 

Marijuana 

ISMS does not endorse the legalization of the possession 
or use of marijuana. 

Since the medical and psychiatric knowledge concerning 
the short-term and long-term effects of cannabis is very 
limited, medical research should be supported by public 
and private resources of the State of Illinois. 

Medical Care, Provision of 

Medical care shall be provided regardless of the ability 
of the patient to pay. Physicians shall not refuse to 
render needed emergency care to any patient. 

Medical Diagnosis and Treatment 

Third parties, including government personnel, insur- 
ance carriers, review organizations and hospital personnel 
should be informed and educated that the Illinois State 
Medical Society endorses the concept that prognosis and 
length of treatment must always be individualized to the 
patient, rather than to the diagnosis. 

Medical Education 

The Illinois State Medical Society supports development 
of innovative curricular and co-curricular programs in 
medical education maintaining a firm foundation in the 
basic sciences. 

Medical Examiners 

ISMS favors a medical examiner system throughout the 
state in preference to a coronor system, wherever practical. 

Medical Psychotherapy 

Medical Psychotherapy is a medical procedure for the 
treatment of mental and physical ailments or illness. It 
involves verbal and non-verbal communications with the 
patient, and always includes continuing medical diagnostic 
evaluation and drug management as indicated. Medical 
psychotherapy may be performed only by a physician 
licensed to practice medicine in all of its branches, who 
has had training in psychiatric medicine. 

Medical Testimony, Expert Witnesses 

An expert medical witness is defined as a physician 
licensed to practice medicine in all its branches having a 
basic educational and professional knowledge as a general 
foundation for testimony and, in addition, having special 
expertise, current personal experience, practical familiar- 
ity, and technical knowledge of the problems that are 


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Illinois Medical Journal 



being considered, as well as alternative forms of treat- 
ment, and is currently active in the practice of the medi- 
cal subject under discussion. 

Any physician licensed to practice medicine in all its 
branches who functions as an expert witness must satisfy 
the definition of an expert witness, that the definition be 
a matter of policy, and that it be considered unethical 
conduct on the part of any physician appearing as an 
expert witness who does not meet this standard. 


Medical Testimony, Impartial 

The ends of justice are served when impartial medical 
witnesses are available to give testimony. The ISMS sup- 
ports this concept and offers its assistance in the pro- 
vision of impartial medical testimony. 


Mental Health 

The Illinois State Medical Society strongly opposes the 
double standard of care in state hospitals and favors 
elimination of permit physicians (unlicensed physicians 
practicing in state institutions). Every effort should be 
made to extend educational opportunities to these permit 
physicians to enable them to achieve full licensure. 

In addition, the Department of Mental Health and 
Developmental Disabilities should adopt a firm policy for 
the continuing education of physicians employed by its 
various mental health centers, allocating state funds neces- 
sary to provide high-quality continuing medical education 
relevant to the needs of these physicians. 

Each constituent county society should cooperate fully 
with and support local units of the Department of Mental 
Health in their patient care efforts, specifically seeking 
to encourage: 

1. Local general hospitals to accept mental health pa- 
tients who can be helped by short-term treatment, 
leaving to state institutions the responsibility for 
such chronic and long-term cases which local hospi- 
tals cannot presently handle. 

2. Local general hospitals and practitioners to retain 
in their own care those geriatric patients who have 
ailments of primarily a physical nature. 

3. Local physicians, local hospitals, and local skilled 
nursing facilities to provide primary and secondary 
care for psychiatric problems to the extent possible; 
given facilities and physician-time available. 

4. Arrangements for emergency mental health care, i.e., 
crisis intervention, to be available areawide. 

All physician or other health service provided to the 
Department of Mental Health, other than that by full- 
time employees, should be on the same fee-for-service 
basis as any other medical service which is paid by the 
patient or third party insurer. 

Involuntary psychiatric hospital certification, initial or 
subsequent, must without exception remain the respon- 
sibility of a physician licensed to practice medicine in all 
of its branches, and a physician licensed to practice medi- 
cine in all its branches should be required to certify the 
discharge of any patient from a psychiatric institution. 


shall prevail as to whether or not the parents should be 
notified of such treatment. 


Multiphasic Screening 

Automated multiphasic health testing and screening 
laboratories are recognized as an extension of services 
available to the physician for the health needs of indi- 
vidual patients. A position statement on multiphasic 
health testing, developed by the ISMS Council on En- 
vironmental and Community Health, and the American 
Medical Association Guidelines for establishing and oper- 
ating such programs are attached as an appendix to the 
Policy Manual. 


Nurses — Shortage 

A severe shortage of graduate nurses continues to im- 
peril the provision of quality patient care. The ISMS sup- 
ports all forms of qualified nursing education and urges 
that all such schools be encouraged to remain in opera- 
tion. 


Nursing Homes 

Every patient receiving long-term nursing care should 
have an attending physician who acknowledges his con- 
tinuing responsibility in writing. Responsible parties, 
preferably the patient or immediate family, should be 
urged to select a physician. 


Nutrition 


Prophylactic use of iron fortified foods is approved in 
accordance with a 7-point statement developed by the Nu- 
trition Committee and the Council on Environmental and 
Community Health in 1971. 


Occupational Health 

Occupational health is an essential ingredient of em- 
ployee welfare. The adoption and development of health 
programs in industry should be encouraged. 

Occupational health will be advanced through the util- 
ization of industrial physicians. 


Optometric Services 

ISMS supports the concept that those performing op- 
tometric services in Veterans Administration facilities 
should be directly responsible to their respective depart- 
ments of ophthalmology. 


Osteopaths, Association with 

Voluntary professional associations with a Doctor of 
Osteopathy are not deemed unethical if the Doctor of 
Osteopathy bases his practice on the same scientific 
principles as those adhered to by members of the Amer- 
ican Medical Association and if he is licensed to practice 
medicine and surgery in all of its branches in Illinois. 


Minors, Medical Treatment of 

Where parental consent is not legally required for 
medical treatment of minors, the physician’s judgment 


Peer Review 

Peer review is the evaluation by practicing physicians 
of the quality, appropriateness and efficiency of services 


for October, 1978 


223 


Policy Manual 



Policy Manual 


ordered or performed by other practicing physicians. It is 
the all-inclusive term for medical review efforts, including 
utilization review, quality of care, competence determina- 
tion and ethical considerations. 

Medical society peer review shall be conducted at the 
local level whenever possible. 


Physician-Patient Relationship 

All committees dealing with the review of physician- 
patient relationship in hospitals and nursing homes are 
urged not to release findings to any third parties except 
by subpoena or court order. Any reports issued by the 
committees involved should he submitted to the chief of 
staff for his disposition. 


Physicians 

The term, "Physician,” may only be applied to one who 
has equivalent qualifications of a “physician licensed to 
practice medicine in all its branches.” The goal of the 
Illinois State Medical Society is to have this definition 
made a part of the Illinois Medical Practice Act. 


Prepayment Plans and Organizations 

It is not within the province of ISMS to act in other 
than an advisory capacity when working with a "third 
party plan,” and its best efforts should be directed to- 
ward supplying guidance, education and communications 
between the membership and the prepayment plans and 
organizations involved. 

The principle of free enterprise as exemplified by pri- 
vate insurance companies and the “Blue” plans is to be 
endorsed. 

Such plans should recognize that free standing medical 
and surgical facilities are acceptable methods of deliver- 
ing high quality health care. Reimbursement for expenses 
incurred as an outpatient in such facilities should be in- 
cluded in the benefits of these plans. 

ISMS is opposed to any legislation which mandates in- 
surance benefits for medical care of psychiatric illness into 
an optional status. 


Prolonging Human Life 

Any legislation which proposes statutory restrictions that 
can intrude into the relationship of the physician and 
his patient and which may interfere with the physician’s 
ability to use his best judgment and training in caring for 
his patient is not in the best interest of either the patient 
or the public and should, therefore, be unrelentingly op- 
posed. 


Psychosurgery 

Psychosurgery refers to those surgical operations which 
irreversibly destroy brain tissue for the primary purpose 
of treating mental disorders. Psychosurgery does not include 
procedures undertaken to treat definable disease states such 
as tumors, epilepsies, aneurysms and chronic pain syn- 
dromes, nor does it include electrical stimulation of the 
brain, such as electroconvulsive therapy. Psychosurgery 


should not be performed without adequate documentation 
of indications, adequate consultation and reasoned consent. 


Public Aid 

The "chain of command and procedure” in handling 
problems arising in the field of public aid shall be 
from the county to the state advisory committee; then 
the state advisory committee shall assume the respon- 
sibility of making the medical program work and co- 
operating with the Illinois Department of Public Aid to 
maintain the best type medical care for the recipients 
of state aid. 

The fees paid by the state/federal programs to physi- 
cians shall be based upon the usual and customary fee 
concept. 

An extensive program of education should be con- 
ducted for the recipients of public aid. This should in- 
clude the intelligent handling of all monies provided. 

Rehabilitation of all recipients should be of paramount 
concern. 


Public Health Departments 

Public Health is the art and science of maintaining, 
protecting and improving the health of the people 
through organized community efforts, including contri- 
butions by voluntary health associations, medical societies 
and other health-oriented groups. 

Full-time modern local health departments adequately 
financed and staffed at the county or multiple county level 
are highly desirable and if available, would be capable of 
providing these services to the people throughout the 
state. It is of paramount importance that such depart- 
ments should be established where none now exist and 
that county medical societies, as well as physicians, should 
give their wholehearted support. 

Local public health service jurisdictions should be con- 
solidated into sufficiently large geographic and population 
districts to achieve program efficiency. 


Public Safety 

Motor vehicle operators should be licensed on the basis 
of the applicant’s physical and mental capacity to oper- 
ate such a vehicle safely. 


Rehabilitation 

All physical rehabilitation activities should be prescribed 
by a physician and the treatment carried out under the 
supervision of a physician. 

Medical societies should render assistance to public and 
private agencies regarding rehabilitation facilities to be 
used and in the selection of patients for these services. 

Insurance carriers should be encouraged to include re- 
habilitation services in their contracts. 


Relative Value 

The Relative Value Study is not a fee schedule and 
is to be used for information only. All fee payments 
should be based on the usual, customary and reasonable 
concept. 

No co-efficient shall be established at the state level. The 


224 


Illinois Medical Journal 



data contained in the study may be used by the ISMS, 
its committees or by any county medical society. 

The study should be revised at appropriate intervals 
upon recommendation of the Relative Value Committee 
with approval of the Board of Trustees. 

Upon request, copies may be furnished third party 
purveyors of health care services. 

Smoking 

The Illinois State Medical Society is opposed to the 
sale of tobacco and tobacco products in hospitals and will 
encourage medical staff action to make hospitals tobacco 
smoke-free. 


Specialty Society Representation 
on ISMS Councils 

For the improvement of communication and the dis- 
cussion of problems of mutual interest and concern, 
closer liaison between specialty societies of medicine and 
the councils of the Board of Trustees is desirable. Repre- 
sentatives to serve in this capacity may be nominated 
by the specialty society, approved by the Board of Trus- 
tees of ISMS, and designated as consultants to the council 
without vote, in compliance with the Bylaws. 

Third Party Intrusion Into Medical Judgment 

Medical judgment and decision-making power of the 


treating physician must not be abrogated by third party 
payors. ISMS is opposed to any third party having the 
power of decision as to medical necessity of services and 
supplies, including hospitalization, over and above the 
judgment of the treating physician. 


Veterans Administration 

It is our belief that a Veterans Administration hospital 
should admit only those patients with service-connected 
disabilities, except in those instances where the veteran 
is financially unable to pay for his medical care and hos- 
pital services, as shown by a means test. 


Violence 

The Illinois State Medical Society opposes the ready 
accessibility to hand guns without evidence of responsibil- 
ity on the part of the possessor and urges strict enforce- 
ment of present federal, state and city laws and that the 
courts, as well as the legislature, impose maximum penal- 
ties on all offenders. 

The Illinois State Medical Society will continue to take 
an active interest in the apprehension and prosecution of 
those persons committing assaults on physicians, including 
the offering of rewards and other incentives in the solu- 
tion of such cases. 


ADMINISTRATIVE POLICIES 


AMA-ERF 

The Illinois State Medical Society’s dues billing form 
shall include the names of all medical schools in Illinois 
so that every member may designate which school is to 
receive his AMA-ERF contribution. 

Assessments 

Compulsory assessments of members of hospital staffs 
for any purpose are unethical and improper. 

Autonomy of County Medical Societies 

In all areas, the county medical society shall be auto- 
nomous, except that no ruling by any county medical 
society shall conflict with the Principles of Medical Ethics 
of the American Medical Association or with the Constitu- 
tion and Bylaws of the Illinois State Medical Society. 

Birth Certificates 

Birth certificates should contain only such items as are 
pertinent to their function. Information recorded on birth 
certificates should not be provided to organizations or 
individuals for other than approved purposes. 

Budgets— ( see “Financial Policies”) 


Committee Appointments 

The chairman of the Board of Trustees and the officers 
of ISMS shall give the trustees an opportunity to recom- 
mend physicians from their districts for appointment to 
various committees. Trustees shall receive the proposed 
list of committee appointments for their consideration and 
review prior to the meeting of the Board at which the 
final committee personnel is to be approved. 

Elective committees should serve for uniform terms of 
office— preferably three years. These terms of office should 
be held on a staggered basis to provide continuity in the 
committee structure. Individual tenure on any committee 
should be limited to a maximum of nine years of con- 
tinuous membership— whether elected or appointed. 

Physicians appointed to an Illinois State Medical So- 
ciety committee must be members in good standing of 
this Society. 


Constitution and Bylaws 

Final copy of any changes made by the House of Del- 
egates in the Constitution and/or the Bylaws shall be 
prepared for publication by the Committee on Constitu- 
tion and Bylaws, in consultation with legal counsel, mak- 
ing sure that the published changes reflect the thinking 
expressed by the action of the House. 


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225 


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Policy Manual 


Co-operation with the American 
Medical Association 

Actions of the AMA House of Delegates are binding 
upon its membership at all levels, county, state and na- 
tional. 

(Since all members of the Illinois State Medical Society 
are also members of the American Medical Association, 
this is universally true in Illinois. The right to disagree, 
the right to protest, the right to become “the loyal oppo- 
sition” is not questioned. However, until such time as the 
AMA House has reversed its decision, it is mandatory that 
the membership abide by the will of the majority.) 


Dues, Recommendation of the Board 
to the House 

The chairman of the Board of Trustees shall place the 
question of dues for the coming year on the agenda for 
consideration by the Board of Trustees in time for the 
Board to present its recommendations to the House of 
Delegates each year. 

Immediately following this meeting, written notice of 
the recommendation regarding dues for the next fiscal 
year shall be mailed to all delegates and alternate dele- 
gates from the component societies, and also to all pres- 
idents and secretaries of county medical societies. This 
recommendation shall also be published in the Illinois 
Medical Journal as a part of the annual report of the 
Chairman of the Board. 


Education, Primary and Secondary 

Primary and secondary education is a community prob- 
lem. In order to retain jurisdiction of these grade schools, 
finances should be raised by taxation at the local level. 


Election of AMA Delegates 

Delegates to the American Medical Association should 
almost without exception be elected from those having 
served first as alternate delegates. 

Facility Medical Boards (Physicians) 

In all legislation which establishes boards for the ad- 
ministration of medical facilities operated by governmental 
units, at least one-third of the board should be physicians 
licensed to practice medicine in all its branches. 


committees must be approved by the ISMS Board of 
Trustees before such funds are spent for election cam- 
paign purposes. 

(4) The expenses of any official representative of the 
ISMS attending any authorized meeting shall be deter- 
mined by the Finance Committee and approved by the 
Board of Trustees. 

(5) Any new project authorized by House action re- 
quiring the expenditure of funds must be accompanied 
by an estimate of the cost and suggested methods of pro- 
viding the necessary funds. 

(6) Budgets submitted to the House by the Board 
should provide for the ensuing fiscal year. 

(7) In addition to fixed reserves, the development of a 
contingency reserve is desirable. 

(8) All financial records shall be available at head- 
quarters office, and may be examined by any member of 
the Society. A semi-annual summary of the financial state- 
ments of the Society shall be mailed to any county so- 
ciety secretary or delegate if requested. A projected budget 
for the next fiscal year shall be mailed to the members 
of the House of Delegates at least 30 days prior to the 
annual convention. These reports shall be in the format 
customarily used in ordinary corporate practice. 

Honoraria For Officers 

The Finance Committee is instructed to evaluate an- 
nually the honoraria paid to ISMS officers and to recom- 
mend appropriate changes to the Board of Trustees for 
consideration and action, reporting any changes to the 
House of Delegates at its next session. 

House of Delegates, Special Meetings of 

When a special meeting of the House of Delegates is 
scheduled which may involve an increase in dues or a 
special assessment, the call for that meeting shall contain 
specific notification of that possibility. 

Individual Rights 

Since this Society believes that a strong America is a 
free America, the rights of an individual, or a group of 
individuals, to openly express themselves cannot be con- 
demned even if one is in complete disagreement, if the 
laws of the land are not violated. To support such con- 
demnation would be inconsistent with this Society’s basic 
philosophy. 


Federal Funds 

When a federal government assistance program is es- 
sential it should be conducted under the administration 
and control of local government. The Society does not 
favor any federal assistance program which removes ad- 
ministrative control from the state or local level. 

Financial Policies 

(1) The Finance Committee is to make budgetary 
recommendations to the Board of Trustees. 

(2) The expenses of any duly elected delegate or 
alternate delegate attending the meetings of the House 
of Delegates of the American Medical Association shall 
not be assumed by the ISMS until he enters his official 
term of office set by the Constitution and Bylaws of the 
AMA. 

(3) ISMS funds used by members campaigning for elec- 
tion as AMA officers, trustees or members of councils or 


Informing the Membership 

The membership of the Illinois State Medical Society 
shall have been properly informed when the following 
items have been accomplished: 

1. Official notice in the Illinois Medical Journal; 

2- Brief notice in Action Report, outlining the issue 
and calling attention to the 1MJ article; and 
3. A letter is sent to all county society presidents, secre- 
taries and county executives. 

ISMS Auxiliary 

Projects in which the Auxiliary participates shall be 
approved by the local county medical society. 

Requests for cooperation between the Auxiliary and the 
Illinois State Medical Society should be channeled through 
the Advisory Committee provided by the Board of 
Trustees. 


226 


Illinois Medical Journal 


ISMS Candidates for AMA Positions 

Selection and/or endorsement of ISMS candidates for 
positions on AMA Board, councils and committees should 
be submitted to the American Medical Association by the 
ISMS Delegation, through its chairman, after consultation 
with the ISMS Board of Trustees or its Executive Com- 
mittee, except in situations wherein positions suddenly be- 
come open, and such consultation is impossible. 

Journal Publications 

The Publications (Journal) Committee, with the ap- 
proval of the Board of Trustees, has authority over the 
publication policy and the screening of all advertisers and 
advertising copy appearing in the Illinois Medical Journal. 


Lay Employees’ Functions 

Policy is established by the House of Delegates. 

Staff shall cooperate with officers and committee chair- 
men in setting up activities and in carrying out all nec- 
essary routine. 

Staff also shall keep new officers and committee chair- 
men aware of policy statements, and assist them in the 
preparation of reports to the House of Delegates to: 

change existing policy 

establish new policy 

request House approval of committee projects and/or 
procedure involving policy. 

Committees shall be informed of their right to set up 
operating rules and regulations. 

Legal Counsel 

The legal counsel of the Illinois State Medical Society 
shall concern himself with official inquiries from officers, 
trustees, committee chairmen and county medical societies. 
Such inquiries shall be channeled through the Executive 
Administrator. 


Legislation 

All matters pertaining to state or federal legislation 
shall be referred to the Governmental Affairs Council 
for consideration and recommendation prior to Board 
of Trustees and/or House of Delegates action. 

Matters pertaining to federal legislation shall be 
checked against recommendations or policies of the Amer- 
ican Medical Association by the Council on Governmental 
Affairs of the Illinois State Medical Society prior to mak- 
ing a recommendation either to the Board of Trustees or 
to the House of Delegates. 

Before any legislation is developed for presentation to 
the Illinois General Assembly, the proposed law shall 
be considered by the Council on Governmental Affairs 
which shall work in close cooperation with any other 
Society committee involved. The instigating committee 
should determine the content of the law and the Gov- 
ernmental Affairs Council primarily should consider re- 
lationship of the proposed legislation to the total legisla- 
tive program. 

Any Council or Committee recommending legislation 
to the attention of the Governmental Affairs Council 
must provide expert witnesses when called upon to test- 
ify before Senate and House Committees in support of, 
or in opposition to, the legislation recommended by the 
Council or Committee. 


Legislative Intrusion into Medical Judgment 

The Illinois State Medical Society opposes any and all 
legislative efforts to interfere with physicians’ judgment 
as to which procedures are appropriate and in the best 
interest of his or her patients and ISMS will work aggres- 
sively to oppose any legislation abridging the physician’s 
prerogatives in this regard. 


Mailing List 

The use of the mailing list of ISMS members must be 
approved by special action of the Board of Trustees. 


Medical Representation in 
Government Planning 


In health programs financed by government funding in 
an Illinois community, there shall be representation at 
the highest policy level by an official representative of 
the State Society and the appropriate county medical 
society involved. Remuneration for services in above pro- 
grams shall follow the policies of the Illinois State Medical 
Society. 

Only those programs which have involved physicians 
at the local level in the planning and development stages 
shall be approved by ISMS. 

Unless physicians appointed to the boards and commit- 
tees of other organizations, such as local Comprehensive 
HealLh Planning “b” agencies, are nominated by their 
local county medical society, such physicians shall not be 
considered “representative” of the medical community. 


Medical Schools 


The Illinois State Medical Society favors admission of 
students into medical schools on the basis of their ability 
to be good medical students and physicians. 


Membership in Paramedical and 
Service Organizations 

Membership in Chambers of Commerce (city, state and 
national) is to be encouraged. This policy extends to the 
individual physician as well as to the component societies. 

The Society recommends that physicians affiliate with 
service clubs, local political action groups and participate 
to the fullest extent possible in affairs affecting the 
health and welfare of the residents of Illinois. 

Membership of Osteopathic Physicians 
in ISMS 

Osteopathic physicians who meet all qualifications for 
membership, base their practice on the same scientific 
principles as those adhered to by members of the AMA, 
and are licensed to practice medicine in all its branches 
in Illinois, may be accepted as active members by the 
county medical societies throughout the state, and he ac- 
corded all privileges of full membership at the county 
and state levels and be so reported to the American Med- 
ical Association for acceptance at that level. 


Placement Service 

Before the Physicians’ Placement Service recommends 
that a town in Illinois be listed as needing a physician, it 
shall be established that the need actually exists; that 
the community can support a physician; that certain 


for October, 1978 


227 


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Policy Manual 


physical assets (office— home— schools, etc.) are available 
for the physician and his family. 

The qualifications of the physician also shall be ascer- 
tained prior to furnishing him with the list of available 
areas in Illinois needing a physician. 

Policy Statements 

Policy statements shall be defined as guidelines for 
the management of the Illinois State Medical Society af- 
fairs, based upon prudence, sound judgment and exper- 
ience. 

Rules and regulations may be prepared by the Board of 
Trustees or by committees, for use in the implementation 
of policy. 


Polls, Opinion 

The Board of Trustees is responsible for ascertaining 
the opinion of members on critical issues facing the so- 
ciety. Periodic membership opinion polls should be con- 
sidered as one means of ascertaining member opinion. 
However, the vote of the House of Delegates shall express 
the opinion of the majority of the Illinois State Medical 
Society membership since delegates are the duly elected 
representatives of their county medical societies and it is 
the responsibility of the delegates to determine the think- 
ing of their constituents so that their voting will express 
this opinion. The majority opinion is expressed in the 
House of Delegates and it should be unnecessary to con- 
duct a membership poll except under very exceptional 
conditions. 


Press 


All county medical societies should be encouraged to 
cooperate with the local press. The public should be pro- 
vided with prompt and accurate information in all health 
fields; the source of this information should be the medi- 
cal profession. 

County medical societies should provide information 
at the local level; the State Society is responsible for press 
releases involving State Society officers or any official 
statements of the Society appearing in the press. 

A code of ethics applicable to medicine and the fourth 
estate should be developed. (That used in the Decatur 
area has been given national recognition by the AMA.) 


Professional Liability 

The Illinois State Medical Society endorses the concept 
of effective peer review in all matters related to the profes- 
sional liability of physicians including the right of individ- 
ual physicians to appear before appropriate peer review 
committees responsible for his liability insurance coverage. 

The Illinois State Medical Society should protect the 
interests of its members by encouraging the provision of 
a guarantee of due process in the bylaws of the Illinois 
State Medical Inter-Insurance Exchange. 


Public Statements 

Only officially designated persons may publicly speak 
for the society. The Chairman of the Board of Trustees, 
at the request of the President, shall designate ISMS 
spokesmen. 

Spokesmen should bear in mind that, as representatives 
of the Society, they should refrain from expressing their 


personal views. Their public statements should be— to the 
best of their ability— in consonance with the Society’s 
policies and positions. 

Publication of Research Data 

In releasing research material for publication in the 
Illinois Medical Journal, or any other media, extreme care 
should be exercised. The welfare and privacy of the pa- 
tient, and the professional reputation of the physician 
should be of primary concern. 

If any question arises, consultation with the Board of 
Trustees is suggested. All such inquiries should be ad- 
dressed to its chairman. 

Public Affairs 

No officer or member of the Board of Trustees should 
be permitted (during his term of office) to allow his name 
as an officer or a member of the Board to be used in 
lists endorsing candidates for public office. Naturally his 
right to this privilege as a private individual is not 
affected. 

Rebates 

In conformity with the AMA Principles of Ethics, 
rebates of any nature to any member, county or regional 
medical society, are unethical. This statement on rebates 
was developed as a result of a letter regarding collection 
services. It read in part: 

“It is our policy to remit to a participating association 
the sum of 10 per cent of the gross book sales to its 
members in addition to 10 per cent of the gross com- 
missions received from collections. A report and ac- 
companying payment is submitted monthly from our 
office.” 

Reference Committee Appointments 

Whenever possible at least two members shall be re- 
tained on all reference committees for the following 
year in order to effect continuity of experience. 

Reference Service 

Physician reference service shall be the responsibility 
of the county medical society. When any such request 
is received at the state society office or by any officer of 
the ISMS, it shall immediately be referred to the secre- 
tary of the county medical society involved. 

Resolutions 

Since the relationship between the Illinois State Medical 
Society and other voluntary physician membership or- 
ganizations is the responsibility of the Board of Trustees, 
the Speaker of the House of Delegates shall refer to the 
Board any resolutions making reference to other voluntary 
physician membership organizations not affiliated with 
ISMS. 

Stationery, Use of Official 

No officer, trustee, committee chairman or staff director 
is to use the official stationery of the Illinois State Medical 
Society for personal statements of any nature. This shall 
pertain especially to the endorsement of any candidate 
for public office. 


228 


Illinois Medical Journal 



Surveys 

The Illinois State Medical Society endorses the prin- 
ciple of mass surveys and encourages the use of this 
method whenever it meets with the approval of the 
local county medical society. 

Any new state program involving more than one county 
society should be submitted to the Board of Trustees 
for initial approval. 


Uniform Health Insurance Claim Form 

The Illinois State Medical Society supports the use of 
the Health Insurance Claim Form developed by the AMA 
Council on Medical Service by all insurance carriers and 
physicians. 


Policy Manual 
APPENDIX 


Multiphasic Health Testing 
Council on Environmental and 
Community Health Statement 



During the recent past there has been an upwelling of 
various automated or multiphasic health testing or screen- 
ing programs. The use of the results of such testing has 
at times led to a false sense of security on the part of 
patients, whereas other programs are being foisted on 
the public with the view to making money with very 
little concern for an individual’s well being. Other pro- 
grams are offered as having direct, immediate and prac- 
tical medical value, without review by a physician. These 
many concerns prompt the necessity of a position state- 
ment on the use and application of such programs. 

There is a place for computer and automated multi- 
phasic testing and screening programs as an extension 
of the services available to the physician as he considers 
each individual case. It is entirely possible that such a 
mechanism will enable a physician to expand his scope 
of operation. 

Forms of automated multiphasic health testing have 
been used by public health agencies and centers for de- 
velopmental research in epidemiology. In these programs, 
asymptomatic control patients have been tested. Testings 
have been done to establish medical priorities or case 
findings in communities. Other testing has been done to 
separate those who probably have certain characteristics 
from those who do not. 

Occupational or industrial health programs have used 
testing programs for the betterment of employees’ health 
and working conditions. Programs such as these, whether 
a pre-employment examination or a study to control 
health hazards, are not necessarily related to medical 
care as such. The physician in charge may or may not 
at the same time be the attending physician of the 
employee. 

As far as automated multiphasic health testing programs 
for individuals are concerned, these programs obtain 
health-related data and act as data collecting sources, 
following a routine using technicians or mechanical and 
electronic devices to determine facts. In several hours a 
variety of tests and measurements can be made which 
may provide a profile of an individual’s physical status. 
Such a profile can be of value to a physician. The testing 
is not diagnosis or interpretation. 

Some individually oriented automated multiphasic 
health testing programs are operated commercially on 
a for-profit basis. Many of these do determine and report 


facts accurately. Some, however, give the appearance of 
encouraging individuals to be tested without a medical 
referral for the tests. Some indicate that when the results 
are compared against standards or norms the individual 
docs not even have to see a physician. Some, in addition, 
perform a battery of tests which are not requested by 
an attending physician. 

The physician’s ethical responsibility is to provide his 
patient with high quality services. He should not utilize 
services of any testing program unless he has the utmost 
confidence in the quality of its services. He must assume 
professional responsibility for the best interest of the 
patient. As a professional man, the physician is entitled 
to compensation for his services. However, he should 
not be engaged in the commercial conduct of a testing 
or screening program and should not make a mark up 
commission or profit on services rendered by others. It 
is not, in itself, unethical for a physician to own an 
automated multiphasic facility or interest. The use the 
physician makes of this ownership may be unethical. 

An attending physician may not receive a rebate, re- 
ferral fee, or commission from a program whose facili- 
ties have been used by his patients. 

An automated health testing facility is a fact finding 
and reporting system. It must be limited to fact finding 
and exclude interpretation. Findings disclosed must be 
interpreted only by physicians. 

Offering a combination of medical and non-medical 
service to the public is to be avoided. The public may 
be confused as to what constitutes reporting a fact and 
what constitutes the making of a medical diagnosis. 

A practicing physician may recommend multiphasic 
health testing where he believes it may be helpful to 
him in the care of his patient. Prudence dictates that 
the physician be selective in recommending or requiring 
patients to utilize the services of an automatic health 
testing facility and not adopt the practice of routinely 
requiring that all patients, or all new patients, undergo 
such testing. When good medical judgment suggests the 
desirability of such testing, the physician should explain 
in general the nature and purpose of the testing. The 
patient must be afforded freedom to choose between 
automated multiphasic health testing facilities, if avail- 
able. Alternatives in the way of single tests should be 
offered patients, where possible and practical. 


for October , 1978 


229 


Policy Manual 



An individual who is tested, or a facility which con- 
ducts these tests, may neither demand that a physician 
accept an individual as a patient nor evaluate the tests 
for the individual. The physician remains free to choose 
whom he will serve. 

A physician employed by an automated multiphasic 
health testing facility, in conformity with well established 
policies, should not dispose of his professional attain- 
ments to any corporation or to a lay body under terms 
or conditions which permit the sale of the services of 
that physician by an agency for fee, nor allow his name 


or the prestige of his professional status as a physician 
to be used in the promotion of a commercial enterprise. 
He should neither aid nor abet an unlicensed individual 
or corporation to practice medicine. 

There is a responsibility for the medical society to 
educate the public regarding indications for and against 
multiphasic health testing, to educate the membership 
of the society regarding ethical responsibilities in these 
matters, and the society must be ready to assist persons 
or corporations that seek advice in setting up multi- 
phasic health testing facilities. 


AMA Guidelines for Establishing and Operating 
Multiphasic Health Testing Programs 


The following guidelines are recommended for use by 
physicians and medical societies in providing technical 
advice and assistance in the planning, development, im- 
plementation, and operation of multiphasic health testing 
programs: 

1. Multiphasic health testing is a method of acquiring, 
storing, collating, and reproducing medical data on 
individual patients. The testing procedures are con- 
sidered to be incomplete health services. Provisions 
must be made for a physician to interpret and eval- 
uate this medical data base as an aid in continuing 
patient care. 

2. The multiphasic testing program should meet ap- 
plicable licensing requirements and be appropriately 
evaluated for quality control. 

3. Physicians must be involved in the planning and 
development of testing programs. 

4. The operation of all MHT programs must be super- 
vised by qualified physicians at the testing center, 
particularly in regard to any abnormal findings, and 
these physicians must see that the patient is instruct- 
ted to obtain medical advice for significant abnormal 
findings. 

5. The system should be designed to make maximum 
use of allied health professionals and should utilize 
technical and automated techniques where justified. 

6. For professional value and economic feasibility, the 
program should include tests that are simple, safe, 
easy to interpret, inexpensive and quick to perform, 


and that have acceptable sensitivity, specificity, high 
predictive value, and patient acceptance. 

7. The testing system should include the following 
criteria: reliability, accuracy of output, saving of 
time of physicians and allied health personnel, ade- 
quate utilization, and sufficient flexibility for custom- 
ization to physician and patient needs. The program 
should establish individual ethnic, geographic, and 
other variations of normal and abnormal patterns. 

8. The program should provide for confidentiality of 
patient data. 

9. The testing program should be used, where feasible, 
to meet otherwise unmet community health needs 
and should be integrated into the continuing health 
care system. 

10. The testing program should be designed to meet 
various objectives such as diagnostic services, health 
maintenance, and guidance in management of on- 
going illness including chronic disease. 

11. Evaluation methodology should be built into the 
program to determine the acceptance and use, yield, 
false positives and false negatives, as well as the long- 
term effects of the program on illness and the need 
and demand for health services. The program should 
include a documented accounting system, at least for 
internal use, and a reasonable cost finding system 
that would allow for cost analysis and cost sum- 
maries. 

12. The program should maintain freedom of choice for 
both the physician and the patient. 


Statement of Understanding 

(between patient and physician ) 


I agree that the determination of professional services 
to be rendered by my doctor and the fees to compensate 
him for these services are matters concerning my doctor 
and me. I understand that I have the primary duty and 
obligation to pay my doctor for his services, notwithstand- 
ing any contract I may have with any third party (be it 
an insurance company, employer, union, government, or 
the like). Neither my doctor nor I will permit any third 


party to determine what medical services I need or what 
fees the doctor should receive in return for these services. 
Any agreement that either of us may have with any third 
party shall not affect our doctor-patient relationship and 
the decisions relating to medical care and fees. Neither my 
doctor nor I, as his patient, are in any way bound by any 
contract the other may have with any third party. 


230 


Illinois Medical Journal 



ISMS HOUSE OF DELEGATES 

OFFICIAL MEMBERS OF THE HOUSE WITH THE RIGHT TO VOTE 
Officers of ISMS 


President— David S. Fox 
826 E. 61st, Chicago 60637 
President-Elect— P. John Seward 
310 N. Wyman, Rockford 61101 
Secretary -Treasurer —Audley F. Connor, Jr. 

7531 Stony Island, Chicago 60649 
First Vice President— Flerschel Browns 
4600 N. Ravenswood, Chicago 60640 
Second Vice President— G. W. Giebelhausen 
1101 Main St., Peoria 61606 
Speaker of the House— Cyril C. Wiggishoff 
25 E. Washington, Chicago 60602 
Vice Speaker of the House— Robert P. Johnson 
108 Maple Grove, Springfield 62707 

Board of Trustees 

Chairman, Board of Trustees— Robert R. Hartman 
1515A W. Walnut, Jacksonville 62650 
1st District— John J. Ring 

511 Hawley, Mundelein 60060 

2nd District— Allan L. Goslin 

712 N. Bloomington, Streator 61364 

3rd District— Alfred Clementi 

675 W. Central Road, Arlington Heights 60005 
Raymond DesRosiers 

1044 N. Francisco, Chicago 60622 

Robert T. Fox 

2136 Robincrest Lane, Glenview 60025 1979 

Jere Friedheim 

3050 S. Wallace, Chicago 60616 1979 

Morris T. Friedell 

7531 Stony Island, Chicago 60649 1981 



4th : 


5th : 


6th 


7th ' 


8th : 

1980 

9th 

< 

1980 

10th 

i 

1979 

11th 

1980 

12th 

t 


Henrietta Herbolsheimer 

1700 E. 56th St., Chicago 60637 1981 

Lawnence L. Hirsch 

2434 Grace, Chicago 60618 1981 

Harold J. I.asky 

55 E. Washington, Chicago 60602 1980 

Richard N. Rovner 

645 N. Michigan, Suite 920, Chicago 60611 1980 

Joseph Sherrick 

303 E. Superior, Chicago 60611 1980 

District— Fred Z. White 

723 N. 2nd St., Chillicothe 61523 1979 

District— Paul F. Mahon 

Dept. Radiology, St. John’s Hospital 

Springfield 62701 1979 

District— Robert R. Hartman 

1515A W. Walnut, Jacksonville 62650 1981 

District— Alfred J. Kiessel 

1 Powers Lane PL, Decatur 62522 1979 

District— James Laidlaw 

104 W. Clark, Champaign 61820 1979 

District— Warren D. Tuttle 

203 N. Vine, Harrisburg 62946 1981 

District— Julian W. Buser 

6600 W. Main, Belleville 62223 1981 

District— Kenneth A. Hurst 
52 Bunting Lane, Naperville 60540 1980 


5670 E. State, Rockford 61108 1980 

Trustee-at-Large— George T. Wilkins, Jr. 

27 Glen Echo Dr., Edwardsville 62025 1979 

Representatives of County Societies 

A complete listing of delegates and alternates to the 
ISMS House appears in the convention program. 


EX-OFFICIO MEMBERS OF THE 
Past Presidents 

J. Ernest Breed 

Everett P. Coleman 1945- 

Edward W. Cannady 

Newton DuPuy 

Harlan English 

Edwin S. Hamilton 

H. Close Hesseltine 

J. M. Ingalls 

Charles J. Jannings, III 

Frank J. Jirka, Jr 

Fredric D. Lake 

Willis I. Lewis 

Burtis E. Montgomery 

Edward A. Piszczek 

Caesar Portes 

Willard C. Scrivner 

Joseph H. Skom 

Leo P. A. Sweeney 

Philip G. Thomsen 

George T. Wilkins, Jr 

Past Trustees 
Earl H. Blair 

Chicago, Trustee of the 3rd District 
Joseph Bordenave, Geneva 
Trustee of the 1st District 
Walter C. Bomemeier 
Chicago, Trustee of the 3rd District 
Herbert Dexheimer 

Belleville, Trustee of the 10th District 
Alfred Faber, Northbrook 
Trustee of the 3rd District 
George E. Giffin 

Princeton, Trustee of the 2nd District 
Arthur F. Goodyear 
Decatur, Trustee of the 7th District 
Lee N. Hamm 

Lincoln, Trustee of the 5th District 


HOUSE WITHOUT THE RIGHT TO VOTE 

Eugene Hoban 

Chicago, Trustee of the 3rd District 
Ross Hutchison, Gibson City 
Trustee of the 11th District 
Eugene P. Johnson 

Casey, Trustee of the 8th District 
Ted LeBoy 

Chicago, Trustee of the 3rd District 
Wm. M. Lees 

Lincolnwood, Trustee of the 3rd District 
A. Edward Livingston 
Bloomington, Trustee of the 5th District 
Joseph R. O’Donnell 

Glen Ellyn, Trustee of the 11th District 
Mather Pfeiffenberger 
Alton, Trustee of the 6th District 
Ralph N. Redmond 
Sterling, Trustee of the 2nd District 
George Shropshear 

Chicago, Trustee of the 3rd District 
Darrell H. Trumpe 

Springfield, Trustee of the 5th District 
Frederick E. Weiss 

Harvey, Trustee of the 3rd District 
Charles K. Wells 

Mt. Vernon, Trustee of the 9th District 
Herman Wing, Chicago 
Trustee of the 3rd District 
Warren W. Young 

Indiana, Trustee of the 3rd District 
Paul P. Youngberg 
Moline, Trustee of the 4th District 

Past Speakers 

Walter C. Bornemeier, Chicago 1961-1964 

Andrew J. Brislen, Chicago 1974-1975 

Edward W. Cannady, Belleville 1964-1967 

Maurice M. Hoeltgen, Chicago 1967-1970 

James A. McDonald, Geneva 1976-1977 

Paul W. Sunderland, Gibson City 1970-1973 


1971 
1946 
1970 

1968 

1964 
1962 
1961 

1976 

1972 

1973 
1975 
1954 

1966 

1965 

1967 

1974 

1977 
1953 

1969 

1978 


Policy Manual 



Policy Manual 




TRUSTEE DISTRICT COMMITTEES 


First District 

John J. Ring, Mundelein, Trustee 
Counties of Kane, Lake, McHenry 


Term 

Ethical Relations Committee Expires 

David Clark, Aurora 1981 

Emanuel Herzon, Elgin 1981 

Gerald Liesen, St. Charles 1979 

A. M. Rosetti, McHenry 1980 

Peer Review Committee 

David Heiberg, Waukegan, Chairman 1981 

Eugene Pitts, Waukegan 1981 

James Pritchard, Geneva 1981 

Peter Vinceguerra, Liber tyville 1981 


Second District 

Allan L. Goslin, Streator, Trustee 

Counties of Bureau, LaSalle, Livingston, Marshall, Put 
nam, Woodford 


Term 

Ethical Relations Committee Expires 

William Erkonen, Streator, Chairman 1980 

Julius Kowalski, Princeton 1980 

Karl T. Deterding, Pontiac 1980 


Peer Review Committee 

Louis Tarsinos, Princeton, Chairman 1979 

James B. Aplington, LaSalle 1979 

Francis J. Brennan, Utica 1979 

Silvio Davito, Spring Valley 1979 

Bernard J. Doyle, LaSalle 1979 

William Ehling, Streator 1980 

P. Lymberopoulis, Princeton 1979 

Rowland Musick, Mendota 1979 

Theodore Mauger, Chatsworth 1981 

Theodore W. Wagenknecht, Streator 1979 


Third District 

Alfred Clementi, Arlington Heights, Trustee 
Raymond DesRosiers, Chicago, Trustee 
Robert T. Fox, Glenview, Trustee 
Jere Freidheim, Chicago, Trustee 
Morris T. Friedell, Chicago, Trustee 
Henrietta Herbolsheimer, Chicago, T rustee 
Lawrence L. Hirsch, Chicago, Trustee 
Harold J. Lasky, Chicago, Trustee 
Richard N. Rovner, Chicago, Trustee 
Joseph C. Sherrick, Chicago, Trustee 


Fourth District 

Fred Z. White, Chillicothe, Trustee 

Counties of Fulton, Hancock, Henderson, Henry, Knox, 
McDonough, Mercer, Peoria, Rock Island, Schuyler, 
Stark, Warren 


Term 

Ethical Relations Committee Expires 

Richard Icenogle, Roseville, Chairman 1980 

John Bowman, Abingdon 1979 

George Burke, Rock Island 1981 


Peer Review Committee 


Donald Dexter, Macomb, Chairman 

William Daugherty, Moline 

Jackson K. Erffmeyer, Galesburg . 

G. W. Giebelhausen, Peoria 

James C. Parsons, Geneseo 

Clarence Ward, Peoria 


1980 

1981 
1979 
1981 
1979 


Fifth District 

Paul F. Mahon, Springfield, Trustee 

Counties of DeWitt, Logan, McLean, Mason, Menard, 
Montgomery, Sangamon, Tazewell 

Term 

Ethical Relations Committee Expires 

Richard H. Sulis, Springfield, Chairman 1980 

Jack Means, Mason City 1981 

A. L. Van Ness, Bloomington 1979 


Peer Review Committee 


James Borgerson, Alt. Pulaski, Chairman 1980 

Robert Price, Bloomington, Co-Chairman 1980 

George Irwin, Bloomington 1979 

Paul Lafata, Springfield 1980 

Alton J. Morris, Springfield 1979 

Robert B. Perry, Lincoln 1979 

James Weimer, Pekin 1979 


Sixth District 

Robert R. Hartman, Jacksonville, Trustee 
Counties of Adams, Brown, Calhoun, Cass, Green, Jersey, 
Macoupin, Aladison, Morgan, Pike, Scott 


Term 

Ethical Relations Committee Expires 

Newton DuPuy, Quincy, Chairman 1980 

Bernard Baalman, Hardin 1981 

Edward K. DuVivier, Alton 1980 

Joseph J. Grandone, Gillespie 1980 

C. B. Lara, Pittsfield 1981 

Robert Roy, Jacksonville 1981 


Peer Review Committee 

Walter Stevenson III, Quincy, Chairman 1980 

E. C. Bone, Jacksonville 1979 

Robert England, Carlinville 1981 

Robert C. Murphy, Quincy 1979 

B. Frank Norbury, Jacksonville 1981 

Edward Ragsdale, Alton 1980 

James Sutherland, Quincy 1980 


for October, 1978 


233 


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Policy Manual 


Seventh District 

Alfred J. Kiessel, Decatur, Trustee 

Counties of Bond, Christian, Clay, Clinton, Effingham, 
Fayette, Macon, Marion, Moultrie, Piatt, Shelby 


Term 

Ethical Relations Committee Expires 

C. R. Daisy, Greenville, Chairman 1981 

D. M. Rames, Vandalia 1979 

Charles Stanley, Decatur 1979 


Peer Review Committee 

Stanley Moore, Vandalia, Chairman 1979 

M. K. Kaufman, Greenville 1980 

H. Gale Zacheis, Decatur 1980 

Walter P. Plassman, Centralia 1979 


Eighth District 

James Laidlaw, Champaign, Trustee 

Counties of Champaign, Clark, Coles, Crawford, Cumber- 
land, Douglas, Edgar, Jasper, Lawrence, Richland, Ver- 
milion 


Ethical Relations Committee 


Term 

Expires 


Mack W. Hollowell, Charleston, Chairman 1980 

James H. Pass, Olney 1981 

Michael Murray, Olney 1979 


Peer Review Committee 

Michael Murray, Olney, Chairman 1979 

E. T. Baumgart, Danville 1980 

George T. Michell, Marshall 1981 

George Perlstein, Champaign 1979 

C. E. Ramsey, Charleston 1979 

Gordon Sprague, Paris 1979 


Ninth District 

Warren D. Tuttle, Harrisburg, Trustee 
Counties of Alexander, Edwards, Franklin, Gallatin, Ham- 
ilton, Hardin, Jackson, Jefferson, Johnson, Massac, Pope, 
Pulaski, Saline, Union, Wabash, Wayne, White, Wil- 
liamson. 


Term 

Ethical Relations Committee Expires 

Alex Goldstein, Harrisburg, Chairman 1979 

Eli Borkon, Carbondale 1980 

Robert Rader, Anna 1980 


Peer Review Committee 

C. J. Jannings, III, Fairfield, Chairman 1979 

Philip D. Boren, Carmi 1980 

Herbert V. Fine, Carterville 1981 

James Heersma, Mt. Vernon 1979 

Harry L. Lewis, Benton 1981 

Charles K. Wells, Mt. Vernon 1979 


Tenth District 

Julian W. Baser, Belleville, Trustee 
Counties of Monroe, Perry, Randolph, St. Clair, Washing- 
ton 


Term 

Ethical Relations Committee Expires 

H. P. Dexheimer, Belleville, Chairman 1979 

Roy Kenney, E. St. Louis 1979 

Edilberto Maglasang, Columbia 1979 

Wm. A. Simmons, Belleville 1979 


Peer Review Committee 


William H. Walton, Belleville, Chairman 1981 

Benjamin Arenas, Belleville 1979 

Ted Bryan, Belleville 1979 

R. W. Jost, Waterloo 1981 

R. E. Schettler, Red Bud 1980 

Ron Welch, Belleville 1981 


Eleventh District 

Kenneth Hurst, Naperville, Trustee 

Counties of DuPage, Ford, Grundy, Iroquois, Kankakee, 
Kendall, Will 


Term 

Ethical Relations Committee Expires 

James Ryan, Kankakee, Chairman 1981 

Lawrence D. Lee, Manhattan 1979 

Merle Otto, Frankfurt 1979 

William C. Perkins, West Chicago 1979 


Peer Review Committee 


James Campbell, Wheaton, Chairman 1981 

James E. Dailey, Watseka 1981 

James Lambert, Joliet 1979 

Guy Pandola, Joliet 1981 

A. G. Parkhurst, Kankakee 1980 

W. H. Brill, Oswego 1980 

Charles G. White, Naperville 1979 


Twelfth District 

Joseph Perez, Rockford, Trustee 

Counties of Boone, Carroll, DeKalb, Jo Daviess, Lee, Ogle, 
Stephenson, Whiteside, Winnebago 


Term 

Ethical Relations Co.mmittee Expires 

John H. Steinkamp, Belvidere, Chairman 1981 

Keith Wrage, Rockford 1980 

Frank Luedke, DeKalb 1981 

John L. Clark, Freeport 1979 


Peer Review Committee 


Keith Wrage, Rockford, Chairman 1980 

Frank Luedke, DeKalb 1981 

John L. Clark, Freeport 1979 

John H. Steinkamp, Belvidere 1981 


234 


Illinois Medical Journal 





Councils of the Illinois State Medical Society 

Councils of the Illinois State Medical Society are appointed by the Chairman of the Board of Trustees subject to 
approval of the Board of Trustees. The councils are composed of such members as are necessary to accomplish the 
purposes of the council. Some committees are composed of members of the Board of Trustees and are designated 
Board Committees. Some free standing committees may report directly to the board and may not be assigned to a coun- 
cil. Task Forces are established to address a particular problem or concern which crosses areas of responsibility of 
the several councils. The task forces report directly to the board, as do representatives to various other agencies. The 
President, President-Elect, Speaker of the House, and Chairman of the Board are, by virtue of their office, ex-officio 
members of all groups. 

COUNCIL ON AFFILIATE SOCIETIES 


Norman M. Frank, Clarendon Hills, Chairman 
111. Chap., Amer. Academy of Family Phy. 
Ronald Albrecht, Chicago 
111. Society of Anesthesiologists 
Robert Anzinger, Chicago 
111. Chap., Amer. Coll, of Emergency Physicians 
Robert Betasso, Ottawa 

111. Chap., Amer. Coll, of Surgeons 
Jack Clemis, Chicago 

Chicago Laryngological & Otological Society 
John Coleman, Chicago 

111. Society of Internal Medicine 
Richard Dukes, Urbana 
111. Chap., American Academy of Pediatrics 
Carl Garfinkle, Arlington Heights 
HI. Association of Ophthalmology 
Jack L. Gibbs, Canton 
111. Surgical Society 
Patrick Guinan, Chicago 
Chicago Urological Society 
John P. Harrod Jr., Chicago 

111. Section, Amer. College of OB-GYN 
B. Jay Hill, Chicago 
111. Radiological Society 
Gerald G. Hoffman, Lake Forest 
111. Society of Pathology 


Martin J. Kaplan, Highland Park 
The Allergy 8c Clinical Immunology Soc. of 111. 

M. Barry Kirschenbaum, Chicago 
111. Dermatological Society 
Robert J. Kramer, Joliet 

111. Soc. of Ophthalmology 8c Otolaryngology 
James F. Kurtz, LaGrange 
111. Orthopaedic Soc. 

Armand Littman, Hines 

111. Chap., Amer. College of Physicians 
Ronald P. Pawl, Chicago 
111. Neurosurgical Society 
J. Roger Powell, Urbana 
111. OB-GYN Society 
David Rothstein, Chicago 
111. Psychiatric Society 

Consultant: 

Harold Lasky, Chicago 
Cyril Wiggishoff, Chicago 

Staff: Division for Specialty Societies 

Responsibilities and Purposes : 

To improve communication and provide liaison with 
the specialty societies; provide specialty consultation to 
other ISMS councils and committees; and to serve as a 
resource unit to ISMS on advances in the medical special- 
ties. 


COUNCIL ON ECONOMICS AND PEER REVIEW 


Michael E. Murray, Olney, Chairman 
William A. Hutchison, Chicago 
Robert E. Knight, Normal 
Herbert E. Natof, Highland Park 
Roger N. Pesch, Wheaton 
Robert Prentice, Springfield 
James J. Rybak, Lincolnshire 
John S. Schweppe, Chicago 
Frank C. Sedlak, Riverside 
Alex Spadoni, Joliet 
Fred A. Tworoger, Chicago 
Ronald G. Welch, Belleville 
Ben Williams, Urbana 

Consultants 
Allan L. Goslin, Streator 
Henrietta Herbolsheimer, Chicago 
Joseph Perez, Rockford 


Resident 

James DeBord, Oak Park 
Student 

Debbie Frei-Lahr, Chicago 
Staff: Division of Medical Services 

Responsibilities and Purposes: 

The Council on Economics & Peer Review shall con- 
cern itself with: 1) relations with the health insurance 
industry and prepayment plans; 2) fees and fee adjudica- 
tion as promulgated by the ISMS; 3) health care cost 
and utilization; 4) new modes of health care delivery 
(prepaid programs, surgicenters, etc., peer review and 
quality of care). 

Committees : 

Peer Review Appeals 
Private Health Insurance 


PEER REVIEW APPEALS COMMITTEE 


Ben Williams, Urbana, Chairman 
Robert E. Knight, Normal 
Robert Prentice, Springfield 
John S. Schweppe, Chicago 
Frank C. Sedlak, Riverside 
Ronald G. Welch, Belleville 
Debbie Frei-Lahr, Chicago 
Staff: Division of Medical Services 


Responsibilities and Purposes : 

The Peer Review Appeals Committee serves as the 
appellate body for peer review in the state. It considers 
cases being appealed from local or district Peer Review 
committees involving quality and cost of medical care. 
The committee also serves as liaison to local peer review 
committees. 


PRIVATE HEALTH INSURANCE COMMITTEE 

Herbert E. Natof, Highland Park, Chairman Responsibilities and Purposes: 

William A. Hutchison, Chicago To conduct ongoing relationships with the private 

Roger N. Pesch, Wheaton health insurance industry and to deal with issues involv- 

James J. Rybak, Lincolnshire ing medical policies, reimbursement and complaints. 

Alex Spadoni, Joliet 

Fred A. Tworoger, Chicago 

James DeBord, Oak Park 

Staff: Division of Medical Services 


COUNCIL ON EDUCATION AND MANPOWER 


Charles T. McHugh, Chicago, Chairman 

Murray Brown, Chicago 

Milda Budrys, Chicago 

Allison Burdick, Jr., Chicago 

John Devitt, Springfield 

William M. Lees, Hines 

Eugene T. Leonard, Rockford 

Joseph P. McKay, Elmhurst 

Pedro Poma, Chicago 

David Roxe, Chicago 

Allen L. Wright, Chicago 

Simon Zivin, Chicago 

Student 

John P. Johnson (Loyola) , Forest Park 
Consultants 

Lawrence Hirsch, Chicago 
Fred Z. White, Chillicothe 

Staff: Division of Education, Manpower and 
Convention Services 


Responsibilities and Purposes: 

The Council on Education and Manpower shall study 
and evaluate all phases of medical education, including 
the development of programs by and for ISMS, and re- 
view programs for paramedical personnel. It shall carry 
to the deans of medical schools recommendations from 
the viewpoint of the practicing physician. It shall evalu- 
ate available postgraduate programs, advise the Illinois 
Dept, of R&E, and review hospital oriented education 
programs. Liaison shall be maintained with medical stu- 
dents and physicians-in-training and with loan programs 
for medical students. Activities regarding physician dis- 
tribution and retention shall also be within the scope of 
the Council, as well as medical licensure as it relates to 
education. 

Committee : 

Physician Recruitment 


GOVERNMENTAL AFFAIRS COUNCIL 


Tassos Nassos, Chicago, Chairman 
Howard Burkhead, Evanston 
James Cavanaugh, Jr., Winnetka 
David Christy, Watseka 
David Clark, Aurora 
Robert England, Carlinville 
Edwin Falloon, Evergreen Park 
Edward G. Ference, Springfield 
William D. Fish, Chicago 
Delbert Hahn, Decatur 
Don Hinderliter, Rochelle 
Frank J. Kresca, Champaign 
Michael Victor, Buffalo Grove 
Walter Whisler, Chicago 

III. Clinic Mgrs. Assoc. Rep. 

Norma de la Cerna, Chicago 

Auxiliary Representative 

Mrs. Byron Weisbaum, Springfield 

Resident Physicians Representative 
Linda Hughey, Chicago 


Student Representative 
Michael I. Kulick, Chicago 

Consultants 

Robert T. Fox, Glenview 
James Laidlaw, Champaign 

Staff: Governmental Affairs Division 

Responsibilities and Purposes: 

1. Keep the Society and its members aware of all state 
and federal legislation and laws affecting the health of 
citizens of Illinois and the practice of medicine in Illinois. 

2. Promulgate legislation to improve the health care of 
citizens of Illinois and the practice of medicine in Illinois. 

3. Co-operate with the AMA in similar programs. 

4. Develop programs to educate the public and the 
Illinois State Medical Society membership in the privi- 
leges and responsibilities of citizenship. 

Committees: 

Ad Hoc Eye Health 
Public Affairs 


AD HOC EYE HEALTH COMMITTEE 

Frank J. Kresca, Champaign, Chairman Frank Snell, Decatur 

Charles Mullenix, Glenview Robert W. Webb, East Alton 

Burton Russman, Chicago 

PUBLIC AFFAIRS COMMITTEE 

Staff: Division of Field Services 

Responsibilities and Purposes : 

The Public Affairs Committee is responsible for educat- 
ing physicians about the political process and encourag- 
ing political involvement. The Committee also provides 
educational material on issues of interest to physicians 
and promotes physician involvement in public affairs 
activity. 


Don Hinderliter, Rochelle, Chairman 
James H. Andersen, Oak Brook 
Theodore Grevas, Rock Island 
Michael P. Phillips, Chicago 
Edward Ragsdale, Godfrey 
Albert W. Ray, Jr., Joliet 
Ronald E. Sumner, Peoria 

Auxiliary Representative 
Mrs. David Clark, Aurora 


for October, 1978 


237 


MEDICAL LEGAL COUNCIL 


Eugene Vickery, Lena, Chairman 
Donald Aaronson, Chicago 
Nelson Borelli, Wilmette 
Leonard Klafta, Joliet 
Guy Matthew, Glen Ellyn 
Morgan Meyer, Lombard 
Michael Murphy, Belleville 
Lawrence K. Richards, Urbana 
Marshall Segal, Chicago 
Sam Sugar, Evanston 

J. Robert Thompson, Chicago (Lab. Services) 

Charles Wells, Mt. Vernon 
Consultant 
Alfred Kiessel, Decatur 
Student Representative 
Joseph Fallon, Oak Park 

Staff: Division of Publications, Medical-Legal and 
Mental Health 

Responsibilities and Purposes : 

The Medical Legal Council shall cooperate with all 


organizations interested in medico-legal problems in order 
to educate members of the profession in medico-legal 
affairs. 

This council shall maintain liaison with the Illinois 
Bar Association and cooperate with the judiciary in both 
federal and state courts within the state of Illinois. It 
shall, when requested by the court, activate the Impartial 
Medical Testimony panel. The stated objective of the 
panel is to provide consultations, judgment and opinions 
in situations in which there is unusual controversy or wide 
divergence of medical opinion. 

The council shall study recommendations for methods 
of elevating and maintaining the standards of medical 
laboratories in Illinois. In addition, the council shall be 
concerned with standards of practice, licensure and quack- 
ery. 

Committees : 

Impartial Medical Testimony 

Laboratory Services 


COMMITTEE ON LABORATORY SERVICES 


J. Robert Thompson, Oak Park, Chairman 
Robert Carrara, Geneva 
Joseph O. Dean, Peoria 
Newell Braatelein, Moline 

Staff: Division of Publications, Medical-Legal and 
Mental Health 


Responsibilities and Purposes: 

The committee shall monitor methods of elevating and 
maintaining the standards of medical laboratories in 
Illinois, encourage the use of medical diagnostic labora- 
tories supervised by duly qualified physicians and encour- 
age each county and district to establish evaluation com- 
mittees. It will cooperate with various state agencies in 
promoting a safe, adequate blood supply for the state. 


COUNCIL ON MENTAL HEALTH AND ADDICTION 


Arthur R. Traugott, Urbana, Chairman 
Douglas R. Bey, Normal 
Anthony Busch, Belleville 
Warren R. Dammers, Harrisburg 
Marvin Dehaan, Wayne 
Thomas E. Kirts, DeKalb 
Geoffrey L. Levy, Arlington Heights 
Edward Senay, Chicago (IPS Liaison ) 

Ronald Shlensky, Chicago 
Patrick Staunton, Oak Park 
James West, Evergreen Park 

(Comm, on Alcoholism & Drug Dependence) 
Arthur Woloshin, Highland Park 

Consultants 

George T. Wilkins, Granite City 
Cyril C. Wiggishoff, Chicago 

Resident Representative 
Jesse Viner, Chicago 

Student Representative 
Brad Epstein, Chicago 


Staff: Division of Publications, Medical-Legal and 
Mental Health 

Responsibilities and Purposes: 

This council shall serve as a source of information 
on mental health matters for ISMS, evaluate informa- 
tion and make recommendations to the Board of Trustees 
on positions ISMS should take on issues in this area, 
and cooperate with institutions, voluntary health agencies, 
state agencies and professional associations in disseminat- 
ing information on mental health, alcoholism and drug 
abuse. 

The council shall be on the alert for misleading or 
fallacious programs and information and recommend 
appropriate action. It shall also be concerned with review- 
ing legislation and regulations related to the field of 
mental health, alcoholism, drug abuse, and hazardous sub- 
stances. 

Committee : 

Alcoholism and Drug Dependence 


238 


Illinois Medical Journal 


COMMITTEE ON ALCOHOLISM AND DRUG DEPENDENCE 


James West, Evergreen Park, Chairman 
Lee Gladstone, Chicago 
Kermit Mehlinger, Chicago 
Reinhold Schuller, Bourbonais 
Edward Senay, Chicago 
George Stanton, Chicago 
W. David Steed, Oak Park 
David Stinson, Rockford 

Consultants 

Linda Hargnett, DDC, Chicago 

Msgr. Ignatius McDermott, Chicago Catholic Charities 
J. Roalda Alderman, Div. of Alcoholism, Chicago 
Mrs. Harold Keegan, ISMS Auxiliary, Kankakee 

Staff: Division of Publications, Medical-Legal and 
Mental Health 

Responsibilities and Purposes: 

The Committee shall work closely with public and 
private agencies on projects aimed at eliminating the mis- 


use of alcohol and drugs. The committee’s functions 
include: (1) study, research and disseminate educational 
information on drugs and alcohol to members of the 
medical profession; (2) cooperate in the dissemination 
of information on the causes, prevention, diagnosis and 
treatment of alcoholism and drug dependence to the 
medical profession and to the public; (3) recommend 
acceptable measures for control of distribution and dis- 
posal of drugs and hazardous substances, exclusive of 
radiation products, and (4) cooperate with official and 
non-official agencies in all matters pertaining to this 
subject. 

In April, 1977, ISMS established the Panel for the 
Impaired Physician. The Panel, which reports to the 
Committee on Alcoholism and Drug Dependence, consists 
of physicians who treat fellow physicians for problems re- 
lated to alcohol or drug dependence, as well as impair- 
ment due to mental or emotional disturbances. Referrals 
to the Panel are initiated through the chairman of the 
Committee on Alcoholism and Drug Dependence. 


COUNCIL ON PUBLIC RELATIONS AND MEMBERSHIP SERVICES 


Mack W. Hollowell, Charleston, Chairman 

James R. Adams, Winnetka 

Robert Boxer, Skokie 

Robert Hamilton, Chicago 

Richard A. Perritt, Chicago 

David Spindel, Chicago 

Peter Vinciguerra, Libertyville 

Consultant: 

Jere Freidheim, Chicago 

Resident: 

Ira Isaacson, Chicago 

Student Member: 

Jerrold B. Leikin, Skokie 


Auxiliary Representative 
Mrs. Harlan Failor, Champaign 

Staff: Division of Public Relations and 
Membership Services 

Responsibilities and Purposes : 

The Council on Public Relations and Membership Ser- 
vices shall plan and execute programs designed to enhance 
the relationship between the media, clergy, general public 
and medical profession. Included shall be health educa- 
tion and socio-economic programs believed to be in the 
best interest of the profession as well as the general public. 
The council shall be responsible for new member orienta- 
tion, exhibits and public service programming. 


COUNCIL ON MEDICAL SERVICES 


Glen Tomlinson, Lincoln, Chairman 
Helen C. Bonbrest, Chicago 
Joan Cummings, Hines 
William W. Curtis, Springfield 
Thomas H. Davison, Chicago 
Herbert B. Fine, Carterville 
Lee Johnson, Litchfield 
A. Everett Joslyn, River Forest 
Garland P. Kirkpatrick, Chicago 
Max Klinghoffer, Elmhurst 
David B. Littman, Highland Park 
Shirley A. Roy, Chicago 
Edward Ryan, Palos Heights 
Joseph D. Winterhalter, Rockford 

Consultants: 

Alfred dementi, Arlington Heights 
Kenneth A. Hurst, Naperville 

Paul Q. Peterson, M.D., Director, IDPH, Springfield 
John J. Ring, Mundelein 


Auxiliary Representative 
Mrs. James Gwaltney, Quincy 

Student Representative 
Mark DuPuis, Westchester 

Staff: Division of Medical Services 

Responsibilities and Purposes: 

The Council initiates and implements programs related 
to health education, medical facilities and services. It also 
maintains liaison with other health care organizations in- 
volved with vocational rehabilitation, Workmen’s Com- 
pensation, aging, the poor, rural areas and emergency 
medical services. 

In addition, the Council and its Committee on Maternal 
Welfare cooperate with the Illinois Department of Public 
Health in the maintenance, protection and improvement 
of the health of the people of Illinois. 

Committees : 

Maternal Welfare 

Committee on Workmen’s Compensation 

Ad Hoc Committee on the Generic Prescribing Law 


for October, 1978 


239 


COMMITTEE ON MATERNAL WELFARE 


Districts Members and Alternates 
( alternates in italics) 

William W. Curtis, Springfield, Chairman 

1. Hugh C. Falls, Lake Forest 
Gan L. Tjiook, Geneva 

2. William J. Farley, Peru 
Carl P. Mattioda, Streator 

3. Alex Kaz, Harvey 
Charles F. Kramer, Glenwood 

4. Ralph Gibson, Peoria 
Raoul E. Reinertsen, Canton 

5. William W. Curtis, Springfield 
Robert Maletich, Springfield 

6. Richard D. Yoder, Alton 
Donald E. Hardbeck, Alton 

7. Herbert W. Thompson, Decatur 


8. J. Roger Powell, Urbana 
John C. Mason, Jr., Danville 

9. William B. Skaggs, Harrisburg 
Urduja Pulido, Murphysboro 

10. Arthur A. Smith, O’Fallon 
Ferdinand J. Mueller, Belleville 

11. John J. McLaughlin, Joliet 
Charles P. Westfall, Elmhurst 

12. John F. Hubbard, Sterling 
Gordon T. Burns, Rockford 

Consultants: 

Robert R. Hartman, Jacksonville 
John Louis, Lake Forest 
Augusta Webster, Chicago 

Staff: Division of Medical Services 


COMMITTEE ON WORKMEN'S COMPENSATION 


Thomas Davison, Chicago, Chairman 
Ernest F. Adams, Peoria 
Harry C. Coblens, Chicago 
Eugene J. Rogers, Chicago 
Vincent Sarley, North Chicago 
Joseph Schiff, Chicago 


Staff: Division of Medical Services 

Responsibilities and Purposes: 

To review how physicians are involved and affected by 
the Workmen’s Compensation system in Illinois. 


AD HOC COMMITTEE ON THE 

Vincent A. Costanzo, Chicago, Chairman 
Raymond Dieter, Glen Ellyn 
Robert P. Johnson, Springfield 
Michael Murphy, Belleville 
Richard H. Suhs, Springfield 


GENERIC PRESCRIBING LAW 

Staff: Division of Medical Services 

Responsibilities and Purposes: 

This Committee is responsible for monitoring the im- 
plementation of the Generic Prescribing Law. 


STATE TECHNICAL ADVISORY COMMITTEE 
ILLINOIS JAIL HEALTH PROGRAM, 1978-1979 


Robert J. Kramer, Joliet, Chairman 
Margaret Connolly, Illinois Nurses Association 
Robert Davison, Illinois State Bar Association 
Lee Johnson, Litchfield 
Courtney Jones, Chicago 

Barbara Lewis, Association of Administration of 
Ambulatory Services 

Cecil Patmon, Illinois Department of Corrections 
Mary Lou Pflum, Division of Ambulatory Care, IDPH 
Tony Slas, Illinois Pharmaceutical Association 


Arthur Tyrrell, Illinois Sheriffs’ Association 
Joseph D. Winterhalter, Jacksonville 

Staff: Division of Medical Services 

Responsibilities and Purposes: 

To provide overall direction to the Illinois Jail Health 
Program and assist jails in adapting their health systems 
to meet national standards for medical care delivery. The 
STAC Committee is an independent body which reports 
to the Council on Medical Services. 


240 


Illinois Medical Journal 


Committees of the 
Board of Trustees 


COMMITTEE ON CONSTITUTION AND BYLAWS 


James Laidlaw, Champaign, Chairman 
Robert T. Fox, Glenview 
Henrietta Herbolsheimer, Chicago 
John J. Ring, Mundelein 
Cyril C. Wiggishoff, Chicago 

Consultant: Legal Counsel 

Staff: Division of Education, Manpower and 
Convention Services 


Responsibilities and Purposes: 

The Committee on Constitution & Bylaws shall: 

1) Receive from individual members, county societies, 
committees, the Board of Trustees and the House of 
Delegates, all suggestions and proposals for modification 
of the Constitution & Bylaws; 

2) Prepare for the consideration of the House of Dele- 
gates, all changes in the Constitution & Bylaws; and 

3) Maintain constant surveillance of both documents to 
keep them current, effective and consistent with the poli- 
cies of the House of Delegates. 


ETHICAL RELATIONS COMMITTEE 


Jere E. Freidheim, Chicago, Chairman Staff: Division of Medical Services 

Julian W. Buser, Belleville 

Morris T. Friedell, Chicago Responsibilities and Purposes: 

G. W. Giebelhausen, Peoria The responsibilities and purposes of this committee 

Paul F. Mahon, Springfield are outlined in CHAPTER XI. DISCIPLINE, Part 2 

Joseph Perez, Rockford Illinois State Medical Society Procedures. 


EXECUTIVE COMMITTEE 


Robert R. Hartman, Jacksonville, Chairman 

David S. Fox, Chicago 

P. John Seward, Rockford 

Herschel Browns, Chicago 

Allan Goslin, Streator 

Audley Connor, Chicago 

George T. Wilkins, Edwardsville 

Robert T. Fox, Glenview 

Ex-Officio (without vote): 

Jack L. Gibbs, Canton 

By Invitation (without vote) 

Cyril C. Wiggishoff, Chicago 

Staff: Division of Administration 

Responsibilities and Purposes: 

The Executive Committee shall consist of the president, 
the president-elect, the first vice president, the chairman 
of the Board, the chairman of the Finance and Medical 
Benevolence Committee, the secretary-treasurer and the 

FINANCE COMMITTEE AND 

Allan L. Goslin, Streator, Chairman 
Alfred Clementi, Arlington Heights 
Audley F. Connor, Sr., Chicago 
Warren D. Tuttle, Harrisburg 

Staff: Division of Administration 

Responsibilities and Purposes : 

The Committee shall consist of the secretary-treasurer 
of the Society and three members of the Board ap- 
pointed by the chairman. It shall develop a budget for 
the fiscal year for approval of the Board through the 
Executive Committee. It shall supervise the financial trans- 
actions of the Society. It shall make recommendations to 


trustee-at-large. The immediate past chairman of the 
Board shall be a member, provided he is still a Trustee. 
If the immediate past chairman is no longer a Trustee, 
the chairman of the Policy Committee shall serve on the 
Executive Committee. 

The chairman of the Illinois Delegation to the Ameri- 
can Medical Association, or the secretary in his absence, 
shall serve as an ex-officio member of the Executive Com- 
mittee without vote. 

It may be given authority to act by the Board of 
Trustees. 

In matters of routine administration, special plans, 
policy, endorsement or expenditure it shall report to and 
request approval of the Board. It shall receive the re- 
ports of the Finance and Policy Committees and make 
recommendations concerning them to the Board. It shall 
furnish a report of its actions to the Board at each 
meeting. 

(Bylaws, Chapter IX, Part 4, Section 2, Paragraph A.) 

MEDICAL BENEVOLENCE 

the Board for the control and investment of the funds 
of the Illinois State Medical Society. 

The Finance Committee shall also be responsible for 
the society’s Medical Benevolence Program and shall: 

1. Examine applications for financial assistance and 
determine eligibility. 

2. Keep the names of the beneficiaries confidential and 
known only to the committee. 

3. Determine the allotment for each recipient. 

4. If funds available become inadequate to meet dis 
bursements, request the Board of Trustees to appropriate 
sufficient funds to support the program until the next 
budget appropriation. 


for October, 1918 


241 


THIRD PARTY PAYMENT PROCESSES COMMITTEE 


P. John Seward, Rockford, Chairman 
Raymond DesRosiers, Chicago 
Allan L. Goslin, Streator 
Richard N. Rovner, Chicago 
Joseph Sherrick, Chicago 
Fred Z. White, Chillicothe 

III. Clinic Mgrs. Assoc. Rep. 

Mr. Sherwin Sern, McHenry 


Staff: Division of Field Services 

Responsibilities and Purposes: 

The Third Party Payment Processes Committee is re- 
sponsible for matters concerning the Illinois Department 
of Public Aid. The Committee deals wih Medicaid reim- 
bursement, administration, and auditing practices. The 
Committee also oversees the Medicaid Membership Ser- 
vices program. 


POLICY COMMITTEE 


Lawrence L. Hirsch, Chicago, Chairman 
Alfred J. Kiessel, Decatur 
Joseph C. Sherrick, Chicago 

Staff: Division of Education, Manpower and 
Convention Services 

Responsibilities and Purposes: 

The Policy Committee shall consist of three members 


of the Board appointed by the chairman. It shall con- 
tinually review past and current proceedings of the House 
of Delegates to determine the established policies of the 
Illinois State Medical Society. It shall make recommen- 
dations for future policy by Board resolution to the House 
of Delegates. 


PUBLICATIONS COMMITTEE 


Herschel Browns, Chicago, Chairman 
Alfred Kiessel, Decatur 
Robert P. Johnson, Springfield 
Kenneth A. Hurst, Naperville 
Harold J. Lasky, Chicago 

Consultant: 

Lawrence L. Hirsch, Chicago 

Staff: Division of Publications, Medical-Legal and 
Mental Health 


It shall establish advertising policies, rates and stan- 
dards, and shall review all new accounts prior to accept- 
ance, and shall approve reprint and circulation policies. 

It shall conduct a periodic review of the printer’s con- 
tract and solicit bids as indicated. It shall establish the 
format, cover, type faces and general layout of the Journal. 

The committee may establish such editorial consulta- 
tion groups as necessary to assist in development of 
clinical articles and shall authorize all regular and spe- 
cial features. 


Responsibilities and Purposes: 

The Publications Committee shall be composed of five 
members of the Board of Trustees, and shall be respon- 
sible for the production of the Illinois Medical Journal 
and other Society publications. 

It shall recommend to the Board of Trustees all poli- 
cies governing the editorial, business and production as- 
pects of the Journal. It shall supervise the editorial board 
in the selection and preparation of all copy, and it shall 
establish standards for the editorial content. 

COMMITTEE 

Henrietta Herbolsheimer, Chicago, Chairman 
Julian Buser, Belleville 
Lawrence L. Hirsch, Chicago 
Paul F. Mahon, Springfield 

Staff: Division of Education, Manpower and 
Convention Services 

Responsibilities and Purposes: 

The Committee on Committees shall consist of three 


IMJ Editorial Board 

J. William Roddick, Jr., Springfield, Chairman 

Eli L. Borkon, Carbondale 

Daniel R. Cunningham, Wilmette 

Raymond A. Dieter, Jr., Glen Ellyn 

James G. Ekeberg, Palatine 

Ediz Z. Ezdinli, Kenilworth 

Carl Neuhoff, Peoria 

Constantine S. Soter, Northbrook 

Donald D. VanFossan, Springfield 

ON COMMITTEES 

members of the Board appointed by the chairman. It 
shall serve to review the purposes, activities and structure 
of any councils or committees at the request of the Board. 

The committee shall recommend such changes in exist- 
ing councils or committees as required to maintain the 
efficient operation of the affairs of the Society. 

The activities and reports of the Committee on Com- 
mittees shall be reviewed by the Executive Committee 
and approved by the Board of Trustees. 


ADVISORY COMMITTEE 

George T. Wilkins, Jr., Edwardsville, Chairman 

David S. Fox, Chicago 

Robert R. Hartman, Jacksonville 

Staff: Division of Administration 


TO ISMS AUXILIARY 

Responsibilities and Purposes: 

The committee shall consist of the immediate past presi- 
dent as chairman, the president, and the chairman of the 
Board. The committee shall provide advice and assistance 
to the president of the ISMS Auxiliary in her program 
for the year, and shall assist her in interpreting the activi- 
ties of the state medical society to the auxiliary members. 


242 


Illinois Medical Journal 


Direct Reporting Committees 

All Board Committees previously noted consist of members of the Board of Trustees. As 
such they function within the activities of the Board. 

Direct Reporting Committees are groups deemed necessary by the Board of Trustees and are 
created by the Board to meet specific challenges. These committees may function with, and 
under, a council, or may report directly to the Board of Trustees. 

While other select committees may be formed from time to time, at the time of publication 
the following groups had been established. 

COMMITTEE ON HEALTH PLANNING 


B. Smith Hopkins, Urbana, Chairman 
Robert A. Clark, Chicago 

Robert D. Dooley, Oak Brook 
Alexander Z. Goldstein, Harrisburg 
Charles J. Jannings, III. Fairfield 
M. Kenneth Kaufmann, Greenville 

C. B. Lara, Pittsfield 
Anthony Raimondi, Chicago 

Consultants; 

Henrietta Herbolsheimer, Chicago 
Alfred J. Kiessel, Decatur 
Fred Z. White, Chillicothe 


Staff: Division of Field Services 

Responsibilities and Purposes: 

The Committee has responsibility for keeping physi- 
cians abreast of all developments in the area of health 
planning and encouraging a leadership role for physicians 
in this important field. The Committee maintains ongoing 
liaison with the State Planning Agency, the Statewide 
Health Coordinating Council, the Health Facilities Plan- 
ning Board and the local areawide health planning agen- 
cies. 


COMMITTEE ON DRUGS AND THERAPEUTICS 


Vincent A. Costanzo, Jr., Chicago, Chairman 
Norman J. Ehrlich, Chicago 
Arthur R. Marks, Fairfield 
Richard H. Suhs, Springfield 

Consultants: 

Louis Gdalman, R.Pli., Oak Brook 
Kerrison Juniper, Jr., Springfield 

Staff: Division of Education, Manpower and 
Convention Services 

COMMITTEE ON 

William A. Henry, Springfield, Chairman 
Phillip Boren, Carmi 
Charles F. Eddingfield, Carthage 
B. Franklin Lounsbury, Chicago 
Franklin Yanez-Seijo, Chicago 

Consultant: 

Alfred D. dementi, Arlington Heights 
Staff: Division of Medical Services 


Responsibilities and Purposes: 

The Committee shall meet periodically to refine the 
drug list contained in the Drug Manual. It shall work 
with the Illinois Department of Public Aid in an effort 
to keep the Drug Manual current and effective. When sug- 
gestions and comments from the members are submitted 
to the committee, it shall review them and present them 
to the Department of Public Aid when necessary. The 
committee shall also consider other drug matters affecting 
the policy of the medical society. 

i 

INSURANCE 

Responsibilities and Purposes: 

The Committee on Insurance will review society-spon- 
sored insurance programs, which are currently the Tax 
Qualified Retirement Program (Keogh Plan), Retirement 
Investment Program, Group Disability Program, Business 
Overhead Expense Insurance, Group Major Medical Pro- 
gram, Hospital Benefit Program, and Group Life Insur- 
ance. The committee will study these plans, make sug- 
gestions for changes, additions and cancellation of policies, 
and investigate other insurance programs that may bene- 
fit society members. 


PLANNING AND PRIORITIES COMMITTEE 


P. John Seward, Rockford, Chairman 

Phillip Boren, Carmi 

Herschel L. Browns, Chicago 

Alfred Clementi, Arlington Heights 

Howard Fishman, Hines 

David S. Fox, Chicago 

Jack L. Gibbs, Canton 

Robert R. Hartman, Jacksonville 

Lawrence L. Hirsch, Chicago 

Eugene P. Johnson, Casey 

Robert P. Johnson, Springfield 

William M. Lees, Lincolnwood 

Joseph B. Perez, Rockford 

Albert W. Ray, Jr., Joliet 

John J. Ring, Mundelein 


Warren D. Tuttle, Harrisburg 
Fred Z. White, Chillicothe 
Cyril C. Wiggishoff, Chicago 
George T. Wilkins, Edwardsville 

Staff: Division of Administration 

Responsibilities and Purposes: 

The President-Elect shall serve as the Chairman of the 
Committee on Planning and Priorities. This Committee 
shall review the ongoing plans and programs, establish 
appropriate priorities and develop plans for future pro- 
grams. In the discharge of its duties it should assist the 
President-Elect in the formation of his objectives for 
accomplishment during his term as President. 


for October, 1978 


243 


TASK FORCE ON PROFESSIONAL LIABILITY 


Fredric D. Lake, Evanston, Chairman 
Illinois State Medical Society 
George Andrews, Ottawa 
111. Assoc. Osteopathic Physicians 
Thomas Baffes, Park Ridge 
Chgo. Surgical Society 
Marshall L. Blankenship, Homewood 
111. Dermatological Society 
Edmund C. Bolton, Chicago 
111. Chap. Am. Coll, of 
Emergency Phys« 

Phillip D. Boren, Carmi 
Illinois State Medical Society 
Joseph Caminiti, Oak Brook 
111. Hosp. Assoc. 

Clinton L. Compere, Chicago 
111. Orthopaedic Society 
George G. Curl, Oak Park 
Chgo. Urological Society 
David L. Doud, Normal 
Amer. College of Surgeons 
Charles F. Downing, Decatur 
111. Chap., Amer. College of Phys. 
111. Society of Internal Med. 
Thomas P. Driscoll, Chicago 
111. Chap., 

Amer. Academy of Pediatric 
Deane M. Farley, Riverside 
111. OB-GYN Society 


David S. Fox, Chicago 
111. State Medical Society 
Morris T. Friedell, Chicago 
111. State Medical Society 
Herb Gardner, Oak Brook 
111. Hospital Assoc. 

John P. Harrod, Jr., Chicago 
Amer. Coll. OB-GYN, 111. Sec. 
Welland A. Hause, Decatur 
111. Soc. of Pathologists 
Henri Havclala, Chicago 
111. Soc. of Anesthesiologists 
Robert P. Johnson, Springfield 
111. State Medical Society 
Alfred J. Kiessel, Decatur 
111. State Medical Society 
Harold Kirk, Oak Park 
111. Assoc, of Ophthalmology 
Robert E. Knight, Normal 
111. Soc. of Ophth. 8c Otolaryngology 
Harold Lasky, Chicago 
Chicago Radiological Society 
Robert Lindley, Chicago 
Chicago Medical Society 
James H. Mason, Evanston 
111. Surgical Society 
Guy Matthew, Chicago 
111. Radiological Society 
Peter McKinney, Chicago 
Chicago Society of Plastic Surgery 


Tassos Nassos, Chicago 
111. State Medical Society 
Robert O’Leary, Oak Brook 
Illinois Hospital Association 
Clyde Phillips, Chicago 
Cook County Phys. Assoc. 

Mark M. Pomaranc, Chicago 
111. Chap., Amer. Coll, of Phys. 
Karl Richardson, Chicago 
Chicago Dental Society 
David Rothstein, Chicago 
111. Psychiatric Society 
Carlo Scuderi, Chicago 
111. Orthopaedic Society 
Irwin A. Smith, Northbrook 
111. Academy of Family Phys. 
Thomas Starshak, Aurora 
111. State Dental Society 
Thomas Szwed, Chicago 
111. Assoc. Osteo. Phys. & Surgs. 
Walter W. Whisler, Chicago 
111. Neurosurgical Society 
Richard S. Wilbur, Lake Forest 
111. State Medical Society 
Don Wood, Chicago 
Chicago Hospital Council 

Consultants: 

Joel Edelman, Esq. 


TASK FORCE ON COST EFFECTIVENESS 


J. M. Ingalls, M.D., Paris, Chairman (ISMS) 

Mr. Stephen Dorn, Chicago (Chgo. Hosp. Coun.) 

Mr. Martin Drebin, Evanston (111. Hosp. Assoc.) 

David S. Fox, M.D., Chicago (ISMS) 

Robert T. Fox, M.D., Glenview (ISMS) 

Morris T. Friedell, M.D., Chicago (Chgo. Med. Soc.) 

Mr. Peter Goschy, Oak Brook (111. Hosp. Assoc.) 

Mr. Charles Goulet, Chicago (BC-BS) 

Robert R. Hartman, M.D., Jacksonville (ISMS) 

Mr. F. Regis Kenna, Addison (111. Hosp. Assoc.) 

Mr. Robert Lindley, Chicago (Chgo. Med. Soc.) 

Mr. James Mortimer, Chicago (Loop Bank Task Force 
on Health) 


Mr. Gerald Mungerson, Chicago (111. Hosp. Assoc.) 

Mr. Robert O’Leary, Oak Brook (111. Hosp. Assoc.) 
Clifton L. Reeder, M.D., Park Ridge (Chgo. Med. Soc.) 
Mr. Philip J. Sayles, Woodstock (111. Clinic Mgrs. Assoc.) 
Mr. Frank Schwermin, Highland Park, (Chgo. Hosp. 
Coun.) 

Mr. Steve L. Seiler, Lake Forest (111. Hosp. Assoc.) 

P. John Seward, M.D., Rockford (ISMS) 

Richard C. Shaw, M.D., Chicago (BC-BS) 

Mr. James R. Slawny, Chicago (ISMS) 

Mr. Roger N. White, Chicago (ISMS) 


AD HOC HOUSE COMMITTEE TO STUDY REVISIONS 
OF DISCIPLINARY AND PEER REVIEW PROCEDURES 


A. Everett Joslyn, River Forest, Chairman 

James DeBord, Oak Park 

Jere E. Freidheim, Chicago 

Robert R. Hartman, Jacksonville 

Lawrence L. Hirsch, Chicago 

A. Beaumont Johnson, Elgin 

Fredric D. Lake, Evanston 

Michael E. Murray, Olney 

Joseph R. O’Donnell, Glen Ellyn 


Consultant: 

Fred Z. White, Chillicothe 
Staff: Division of Medical Services 

Responsibilities and Purposes: 

This committee was formed at the 1977 annual House 
of Delegates meeting to study and recommend revisions 
in the Society’s disciplinary and peer review procedures. 
It reports directly to the House of Delegates. 


244 


Illinois Medical Journal 


Other Appointments and Representatives 

REPRESENTATIVES TO STUDENT LOAN FUND BOARD 


Jack Gibbs, Canton, Chairman 
Albert G. Bledig, Eldorado 
Thomas Schrepfer, Havana 
Staff: Division of Education, Manpower and 
Convention Services 


Purpose : 

ISMS representatives on the Student Loan Fund Board 
are responsible to the Board of Trustees in matters re- 
lated to administration of the Student Loan Program 
operated jointly with the Illinois Agricultural Association. 


INA-ISMS JOINT PRACTICE COMMITTEE 


James E. Coeur, Carthage 
Robert M. Reardon, Bloomington 
Fred Z. White, Chillicothe 

Staff: Division of Education, Manpower and 
Convention Services 

Responsibilities and Purposes: 

The purposes and objectives of the committee shall be 
to: (1) improve communication between medicine and 


nursing to enhance joint planning and action; (2) ex- 
amine roles and functions in medical and nursing practice 
with definition of new and altered patterns; (3) propose 
changes in educational patterns and relationships that 
would enhance the new role functioning of nurses and 
physicians; (4) define, identify and examine health care 
needs; (5) address the traditional problems which affect 
nurse-physician relationships in order to establish en- 
hanced role functioning, and (6) identify and address the 
ensuing problems related to basic role reorganization. 


ILLINOIS COOPERATIVE 

Audley F. Connor, Chicago 
Joel Edelman, Legal Counsel, ISMS 
Alexander Goldstein, Harrisburg 
Allan L. Goslin, Streator 
Donald H. Hanscom, Hinsdale 
Henrietta Herbolsheimer, Chicago 

ISMS REPRESENTATIVES 

Swanberg Foundation, Quincy 
Robert R. Hartman, Jacksonville 

Liaison to III. Soc. of the Amer. Assoc. 
of Med. Assts. 

J. M. Ingalls, M.D., Paris 

Illinois Council of Home Health Agencies 
Shirley A. Roy, Chicago 
Chicago Alliance for VD Awareness 
Mark DuPuis, Westchester 

Pediatric Coordinating Council 
Daniel Pachman, Chicago 

III. Interagency Coun. on Smoking and Disease 
Charles L. Swarts, Oak Park 


HEALTH DATA SYSTEMS 

James A. McDonald, Geneva 
Joseph R. O’Donnell, Glen Ellyn 
Clifton L. Reeder, Park Ridge 
Roger N. White, Executive Administrator, ISMS 
Ben T. Williams, Urbana 

TO OTHER GROUPS 

Illinois Medical Records Assoc. 

David T. Petty, Chicago 
MD Committee on Optometry 
Samuel Schall, Chicago 

Statewide Cooperating Organizations of the 
Commission on Children 
Daniel Pachman, Chicago 
Illinois Cancer Council 

William M. Lees, Lincolnwood 
Citizens Committee for an Illinois Program to 
Control High Blood Pressure 
David Littman, Glencoe 
U.S. Pharmacopaeia 
Joseph Skom, Chicago 


The Illinois State Medical Society has developed the council and committee structure to facilitate the activities and 
responses of its members. Council and committee members are selected annually, based on suggestions and nominations 
of trustees, delegates, and county medical societies. Appointments are made by the Chairman of the Board of Trustees, 
with approval of the Board. 

Please notify your trustee if you wish to be considered for appointment. The various activities are as listed in the 
Reference section. Members who wish to notify Chairman of the Board of their availability can clip and submit the 
coupon below. 


NAME: 

ADDRESS: CITY: ZIP: 

TELEPHONE: ( ) 

COUNTY MEDICAL SOCIETY: 

MEDICAL SPECIALTY AND TYPE OF PRACTICE 

COMMITTEE IN WHICH INTERESTED: 

EXPERTISE FOR THIS COMMITTEE: 

SEND TO: Chairman, Board of Trustees, Illinois State Medical Society 
55 E. Monroe, Suite 3510, Chicago, IL 60603 


for October, 1978 


245 







ISMS SERVICES 


Pursuit of Obligations 

Constitutional Purposes of the Illinois State 
Medical Society are: 

• to promote the science and art of medicine 

• to protect the public health 

• to evaluate standards of medical education 

• to unite the medical profession behind these 
purposes 

• to unite with similar organizations in other 
states and territories of the United States to 
form the American Medical Association. 

The Society shall inform the public and the pro- 
fession concerning the advancements in medical 
science and the advantages of proper medical care. 

To fulfill these purposes, the Society maintains 
a headquarters office at 55 East Monroe St., Suite 
3510, Chicago, and an office in Springfield at 701 S. 
Second St. Services of the Society, under the general 
supervision of Roger N. White, Executive Adminis- 


trator, are conducted by the following divisions: 

Administration; Public Relations and Member- 
ship Services; Governmental Affairs; Publications, 
Medical Legal and Mental Health; Education, Man- 
power, and Convention Services; Medical Services, 
Field Services, Computer Services and Services to 
Specialty Societies. 

Many and varied are the activities of the 
Society in pursuit of its obligations. Some of 
these activities are major programs of statewide 
(and sometimes national) interest for all citizens; 
others are of special interest to doctors; still 
others are sponsored for specific groups or in- 
dividuals. 

Following are general descriptions of the So- 
ciety’s divisions and the programs, services and 
publications available directly to Society members 
or sponsored for their benefit. 

Specific areas of responsibility and staff assignments 
will be identified to any member upon request. 


DIVISION OF ADMINISTRATION 


The Executive Administrator has the respon- 
sibility and the authority to provide for the 
smooth and efficient functioning of the Illinois 
State Medical Society. 

The implementation of established policy, fiscal 
and budgetary matters, the employment of quali- 
fied personnel and the development and mainten- 
ance of personnel policies are all part of the 
Administrator’s activities. 

He maintains liaison with the Board of Trus- 
tees and assists the chairman in carrying out his 
duties. Close cooperation with the Speaker of the 
House of Delegates and the officers of the Society 
provides a smooth and efficient atmosphere in 
which the Society may function. Cooperation is 
maintained with the Committee on Constitution 
and Bylaws to present to the House all suggested 
changes for official action. The Administrator 
channels all legal inquiries and works with the 


General Legal Counsel to provide guidance to 
the officers, trustees, committee chairmen and 
county medical society officers. 

The headquarters office has been organized by 
divisions to provide the membership of the Society 
with the best professional staff services available. 

The Assistant Executive Administrator serves 
within this Division as a coordinator for programs 
of the state society. Further coordination between 
programs of the State Society and the County Medi- 
cal Societies is achieved through Field Services Rep- 
resentatives. 

The accounting and business service functions of 
the Society are handled by the Business Manager 
as a part of this Division. The Division also main- 
tains tlie membership records and provides a com- 
puterized central dues billing and collection center 
for county medical societies. The Society’s account- 
ing and membership records are handled in close 
coordination with the Secretary-Treasurer under 
policies laid down by the Finance Committee and 
the Board of Trustees. 


DIVISION OF COMPUTER SERVICES 


This Division was established in 1976 as a result of the 
Board of Trustees authorization to purchase a computer 
for the purpose of cataloging claim statistics in conjunc- 
tion with the Hartford Liability Insurance program, spon- 
sored by ISMS. Computer requirements were soon in- 
creased when the doctor-owned Insurance Exchange was 
established that same year. Insurance Services currently 
uses ISMS hardware and operations for its broad variety 
of problems. 

Computer services are provided internally to ISMS for 


its centralized membership dues billing and collection sys- 
tem, financial record keeping and label production for the 
many Society mailings. A physician data base is currently 
being assembled as an information source for our coun- 
cils and committees. 

The Computer Service Division is being organized to 
provide limited time sharing arrangements and services to 
outside organizations. As we complete internal projects 
we shall seek further users in our effort to continue a 
cost effective system. 


for October , 1978 


247 


DIVISION OF EDUCATION, MANPOWER AND 
CONVENTION SERVICES 


The Division of Education and Manpower was estab- 
lished in response to the growing demands created by the 
rapid changes in the education and utilization of physi- 
cians and other health care personnel. A primary respon- 
sibility of the Division is to maintain information on the 
changes in medical education. The Division works in 
concert with the AMA in keeping abreast of changes in 
medical school curricula, and in postgraduate medical 
education. 

In addition, the Division attempts to maintain current 
information on the training and use of such ancillary 
personnel as nurse practitioners and physician’s assistants. 
New and innovative use of personnel are studied and 


DIVISION OF 

The primary responsibility of Field Services is to pro- 
vide liaison, service and education to the Society’s mem- 
bership through Field Service Representatives. Each Field 
Representative has the responsibility for liaison with com- 
ponent societies, allied professions and government agen- 
cies, to insure State Society representation and to provide 
a means for communication; service to the trustees, officers, 
executives, general membership and county medical so- 
cieties; to provide a constant update on ISMS information, 
programs and resources; and education to the general 
membership through the distribution of a wide variety of 
issues affecting the practice of medicine. 

Specific areas of activity include health planning. Presi- 
dent’s Tour, Trustee District meetings, the legislative Key- 
Man program, public affairs activity, Medicaid and Medi- 


GOVERNMENTAL 

As professional medicine strives to maintain the vig- 
orous condition of the public health, the profession is 
vitally and intimately concerned with legislative actions 
of the Illinois General Assembly and the U. S. Congress 
which affect physicians, other members of the healing 
arts, and the lay public. To insure that the best health 
interests of the public and professional interests of the 
physician are served, the Division monitors all state and 
national legislation which affect the health of the indi- 
vidual and his community. 

The monitoring process is designed to present the 
thoughtful views of professional medicine in Illinois on 
specific medically-related pieces of legislation. 

The ISMS Governmental Affairs Council acts as the 
clearing house for legislative proposals recommended by 
specialized ISMS committees; generated by allied groups; 
produced by special interests and introduced by repre- 
sentatives and senators. Such legislation is thoroughly 
analyzed by physician-members of the specialized ISMS 
committee covering the subject matter of the introduced 
legislation. 


recommendations made to the ISMS Board of Trustees as 
to their appropriateness and legality. All information 
maintained by the Division is, of course, available to all 
ISMS members. 

The Division maintains liaison with the Department of 
Registration and Education to ensure that any licensure 
problems may be handled expeditiously. It is also respon- 
sible for coordinating meetings and conventions for all 
divisions, as well as the services and arrangements in- 
cident to the annual and interim sessions and provides 
staff services and the Resident Physicians Section, Student 
Business Session, and the American Association of Medical 
Assistants, Illinois Society. 


FIELD SERVICES 

care membership services, audit assistance, and CHAMPUS 
professional relations. 

Additional division activities include staffing the Third 
Party Payment Processes Committee, which deals with 
Medicaid matters; the Health Planning Committee, which 
closely follows the activities of the State Planning Agency, 
Statewide Health Coordinating Council, Illinois Health 
Facilities Planning Board and local Health Systems Agen- 
cies; and the Public Affairs Committee, which conducts 
activities designed to educate physicians about the polit- 
ical process. 

Staff of the Division attend meetings of governmental 
and professional organizations involved in the above de- 
scribed areas and participate in hearings and programs 
used to develop policy and programs regarding these issues. 


AFFAIRS DIVISION 

Support or Oppose Legislation 

Upon appropriate consideration and recommendation, 
legislation of medical significance in the Illinois Legisla- 
ture is either supported or opposed to protect and pro- 
mote the interests of the public and the profession. 
Pertinent subject matter testimony is presented before 
the House and Senate committees as the bill proceeds 
through the legislative process. 

On-the-scene surveillance of monitored legislation is 
maintained by ISMS legislative representatives. 

Through these essential actions, ISMS plays a meaning- 
ful role in shaping legislation for the betterment of the 
people of Illinois. 

Action similar to the above is taken with respect to 
bills in Congress when they have special significance to 
Illinois physicians. This activity is conducted in concert 
with the American Medical Association. 

Other Activities 

The division also staffs the Ad Hoc Eye Health Com- 
mittee. 


248 


Illinois Medical Journal 


DIVISION OF MEDICAL SERVICES 


To respond to the social and economic issues facing 
physicians, the Division of Medical Services has the re- 
sponsibility for conducting ongoing liaison activities with 
various public, governmental, professional and private 
organizations. Through the Council on Economics and 
Peer Review, and the Council on Medical Services, the 
Division reviews current subjects affecting the physician 
and his relationships with patients, medical facilities, pub- 
lic health programs, and health insurance carriers. The 
products of council meetings may take the form of edu- 
cational seminars, informational materials, legislation, or 
position statements. 

The Division is also responsible for staffing the ISMS 
Committee on Insurance— which monitors the Society’s 
sponsored insurance programs for the membership— and 
the Ethical Relations Committee, which conducts dis- 
ciplinary procedures in accordance with Chapter XI of 
the ISMS Constitution. 

Council on Medical Services 

This council studies issues and recommends actions re- 
lating to maternal welfare, workmen’s compensation, pub- 
lic health, nutrition and school health programs, medical 
facilities, health care delivery systems and the special 
needs of the poor, the elderly, prisoners and those in our 
rural communities. Representatives from the Illinois De- 
partment of Public Health serve as consultants to the 
council providing the necessary expertise to participate 
in developing programs and policies for the public sector. 


Council on Economics and Peer Review 

Principal duties of the Council on Economics and Peer 
Review include keeping abreast of problems which arise 
out of the physician’s relationships with patients and 
third-party payors and monitoring the peer review process 
in our state. These activities are the responsibility of the 
Council’s committees on Private Health Insurance and 
Peer Review Appeals. Serving as consultants to the Coun- 
cil are representatives from the Health Insurance Asso- 
ciation of America (HIAA) and the Illinois Blue Cross/ 
Blue Shield Association. 

Committee on Insurance 

ISMS offers seven insurance plans as benefits to the 
membership. Life, Hospital Benefit, Major Medical, Ex- 
cess Major Medical, Disability, Business Overhead and 
Worker’s Compensation programs are underwritten and 
administered through outside organizations. These are 
monitored, and periodically modified, by the Committee 
to reflect the changing needs of the membership. 

Ethical Relations Committee 

This committee, composed of ISMS Trustees, is respon- 
sible for implementing Chapter XI, the Disciplinary sec- 
tion of the ISMS Constitution. It only meets when a case 
is appealed to the State Society following a hearing at the 
local or District level. 

As new medical delivery systems are developed, the 
Division will expand its activities to prepare physicians 
for the inevitable changes in their practice environment. 


DIVISION OF PUBLICATIONS, MEDICAL-LEGAL, AND 
MENTAL HEALTH 


The Division of Publications, Medical-Legal and Men- 
tal Health is charged with staff responsibility for activities 
associated with the Council on Mental Health and Addic- 
tion, Medical Legal Council, and the Publications Com- 
mittee. Under the councils are several committees and sub- 
committees. In addition, liaison is maintained with many 
public and voluntary organizations, on a formal basis, in 
order to keep abreast of current developments and to 
ensure representation of the Illinois State Medical Society. 
Staff functions include various activities in professional 
liability, as well as work on specific problem areas allied 
to medical-legal concerns. 

Publications 

Total production of all printed materials and publica- 
tions, as well as their distribution, is this division’s re- 
sponsibility, except for distribution of items to selected 
specific groups. Printing and duplicating services are fur- 
nished either through an in-plant shop or outside services 
through competitive bidding. 


In addition, mail room services are provided by this 
division. An addressograph and graphotype are utilized 
as well as a small wing mailer, folder and stuffer, and 
plate burning cabinet. 

Principal among the publications of the society is the 
official organ, the Illinois Medical Journal. The Journal 
is mailed monthly to all members, as well as other se- 
lected individuals, who are urged to read it to keep 
abreast of the scientific, economic, political, legal and 
social developments within the state, as such pertain to 
the practice of medicine. 

“Action Report” is an in-house publication totally pro- 
duced in the ISMS print shop. Special publications, 
brochures, flyers, pamphlets, letters and cards as required 
by the several ISMS and ISMIS divisions to carry forth 
their mission, are produced. 

Needs of groups affiliated with or ancillary to ISMS, 
insofar as reproduction or distribution services are con- 
cerned, are also handled through the division office. 


for October, 1978 


249 


DIVISION OF PUBLIC RELATIONS AND MEMBERSHIP SERVICES 


The Division of Public Relations functions both as an 
outlet to the news media and as a source of information 
for the membership. 

Staff members prepare speeches, slide presentations, 
pamphlets and other materials on a wide range of topics 
to support activities of officers, councils and committees. 
In addition, the Division arranges press conferences and 
prepares news releases to publicize ISMS actions and 
views on major issues. Also, the Division serves as liaison 
to the news media, responding to almost daily requests 
for background information or summaries of society ac- 
tivities. 

Beyond these traditional public relations duties, the 
Division conducts a number of special, highly successful 
projects. Among them are: 

President’s Tour . . . takes the ISMS President to each 
Trustee District and provides an opportunity for mem- 
bers to discuss with the president matters affecting medi- 
cine and the society. An integral part of the “tour” is 


press conferences and media interviews as well as civic 
club speaking engagements arranged by the division. 

Action Report ... is a periodic newsletter which re- 
ports on ISMS activities and major events affecting medi- 
cine. 

AID (Athletics . . . Injury and Disease) . . . assists 
coaches and trainers in prevention, recognition and initial 
treatment of injuries and illnesses. This quarterly sports- 
medicine newsletter is distributed to approximately 2,000 
junior and senior high school coaches and trainers in 
Illinois. 

Radio-TV Speaker’s Bureau . . . provides physicians to 
discuss general medical topics on regularly-scheduled pro- 
grams. In addition, the bureau provides physician speak- 
ers for civic, fraternal, church and community groups. 

Public Service Radio Announcements . . . providing 
general health information are distributed to approxi- 
mately 150 Illinois radio stations. 


DIVISION FOR SPECIALTY SOCIETIES 


The Division for Specialty Societies— established in 
March, 1978 to provide closer liaison with medical spe- 
cialty organizations— provides staff services to four Illinois 
specialty societies with a combined physician membership 
of 2,800. Services also are provided to the Illinois Medical 
Group Management Assn., a group of 150 clinic adminis- 
trators. 

The Division is responsible for handling daily opera- 
tions of the component groups. Its primary responsibilities 
may be divided into the following areas: (1) routine 

office management, correspondence and inquiries; (2) 
meeting arrangements; (3) membership promotion and 
record keeping; and (4) dues collection and accounting 
records. Division staff also handle inquiries from the gen- 
eral public regarding activities of the five organizations. 
The Division also is responsible for preparing member- 
ship newsletters for each group. Staff services are pro- 


vided to the participating organizations on a cost basis. 

An important function of the Division is to maintain 
liaison between ISMS and specialty society officers by for- 
warding copies of ISMS Board of Trustees abstracts, press 
releases and other materials to the specialty organizations. 
The arrangement also permits a close liaison with other 
ISMS divisions whose activities affect specialty society in- 
terests, such as the Division of Publications, Medical- 
Legal and Mental Health and the Governmental Affairs 
Division. 

The Division also staffs the Council on Affiliate So- 
cieties. Composed of representatives from 21 Illinois spe- 
cialty societies, the Council is responsible for improving 
communication and providing liaison with the specialty 
societies; providing specialty consultation to other ISMS 
councils and committees; and serving as a resource unit 
to ISMS on advances in the medical specialties. 


SPECIAL PUBLICATIONS 


Action Report 

“Action Report” is a periodic newsletter published by 
the Illinois State Medical Society. It is distributed to 
members upon request. Purpose of the report is to alert 
physicians to important events or activities affecting the 
practice of medicine. 

A short deadline ensures that important news is dis- 
seminated to the physicians as quickly as possible so that 
appropriate responses may be made. 


On the Legislative Scene 

Emanating from the Springfield Regional Office is a 
weekly newsletter, “On the Legislative Scene,” published 
during the weeks the General Assembly is in session. 

This is produced by the Governmental Affairs Division 
and distributed upon request. It includes up-to-the-minute 
status reports on pending legislation of vital concern to 
medicine in Illinois. This well-received periodical has 
permitted immediate response by ISMS representatives in 
Springfield to specific bills and has alerted physicians to 
the need for involvement in public affairs. 


250 


Illinois Medical Journal 


SCIENTIFIC SPEAKERS BUREAU 


The Illinois State Medical Society, through its 
Scientific Speakers Bureau, aids county societies 
in their efforts to keep members abreast of medi- 
cal advances by conducting postgraduate medical 
education programs in their own areas. This as- 
sistance includes obtaining speakers, preparing and 
mailing notices of meetings, and paying an honor- 
arium and travel expenses. ISMS can also provide 
publicity services upon request. 

It also pays a $50 honorarium and expenses for 
individual speakers obtained by county medical 
societies for their regular meetings. 

The Bureau operates under a grant from Merck, 
Sharpe & Dohme, which provides funds to the 
ISMS Educational and Scientific Foundation for 
the specific purpose of obtaining speakers for 
county medical society meetings. 

In February, 1978, a special adjunct to the Sci- 
entific Speakers Bureau was formed through a grant 


from the Illinois Department of Mental Health and 
Developmental Disabilities, Division of Alcoholism. 
That grant facilitates presentations by a special 
roster of speakers in alcoholism education. 

The following procedures govern use of the 
Bureau: 

1 ) County societies select speakers from a 
roster containing the names of more than 400 
speakers and over 1,000 topics. 

2) Publicity to media in the area of the meet- 
ing will be handled by ISMS upon request of the 
county society. 

3) Postcard notices will be mailed to physicians 
in the county if requested. ISMS will prepare and 
mail notices if the information is received no less 
than three weeks prior to the meeting. 

4) The county medical society program chair- 
man and the speaker are both expected to sub- 
mit to ISMS a report on the meeting and the 
arrangements. 


PHYSICIAN RECRUITMENT & STUDENT LOAN FUND PROGRAMS 


The Illinois State Medical Society not only offers help 
to students who wish to become physicians, but also is 
able to assist the careers of those already licensed to prac- 
tice medicine. 

The society provides this aid through two special activi- 


ties. First is its own Phvsician Recruitment Program & 
Doctor’s Job Fair. Second is the Illinois Medical Student 
Loan Fund Program that the society sponsors in conjunc- 
tion with the Illinois Agricultural Association. 


PHYSICIAN RECRUITMENT PROGRAM 


The Physician Recruitment Program is designed to help 
physicians find a desirable area in which to establish prac- 
tice or to relocate. The program’s purpose is twofold, 
since it is interested also in helping those communities 
which demonstrate need of a physician. 

More than 600 medical doctors have been placed through 
this program since its inception shortly after World War 
II. 

The Physician Recruitment Program maintains an up- 
to-date listing of some 125 “open” areas needing physi- 
cians. 

This service accepts requests from both physicians and 
communities for placement. In addition, physicians are 
referred to the service by a number of organizations, 
among them the American Medical Association and the 
Illinois Agricultural Association. Frequently, responsible 


citizens or overburdened physicians in a community will 
contact the service. 

The Physician Recruitment Program sends a question- 
naire to the applicant physician to obtain information on 
his educational background, his interests and preferences 
of type of practice. Upon return of the questionnaire, the 
physician is sent a complete list of openings. Each opening 
is detailed on its facilities for home life, office space, 
proximity to hospital facilities and other specifics. 

The Physician Recruitment Program offers its assistance 
to all qualified physicians who request it. An applicant 
need not be a member of the state medical society. 

Another important function of the Physician Recruit- 
ment Program is to assist small communities in develop- 
ing programs to attract physicians such as the Doctor’s 
Job Fair. 


ILLINOIS MEDICAL STUDENT LOAN FUND PROGRAM 


The Illinois Medical Student Loan Fund Program is 
designed to help those who have what it takes to become 
a physician, but lack sufficient financial resources or a 
recommendation for medical school. 

Loans to students in need are provided by a joint con- 
tribution from the Illinois State Medical Society and the 
Illinois Agricultural Association. The program offers loans 
up to $750 per semester for four years. The total amount 
of loan funds available varies from year to year, depending 
on repayments into the revolving fund. The amount of 
each individual loan is determined by the student’s current 


financial need. A low interest rate is charged from the 
time the loan is received. The borrower also must insure 
himself for the entire amount of the loan and pay pre- 
miums on the policy. Repayment begins January 1 of the 
fourth year following medical school graduation. 

The program also offers assistance to those who may not 
have financial difficulties, but are denied matriculation 
into medical school because their college grades or Medical 
College Admission Test (MCAT) scores are marginal. The 
board representing the sponsoring organizations of the 
program can recommend candidates annually to the Uni- 


for October, 1978 


251 


versity of Illinois College of Medicine. After careful screen- 
ing to determine whether the applicant has the potential 
to make a good medical student, the board can recom- 
mend him for admittance on the basis of its investigation. 

In return for this assistance from the Medical Student 
Loan Fund Program, the applicant must agree to practice 
medicine in an Illinois town serving a rural popidation. 
Minimum practice time is: 

(1) Freshman student receiving recommendation- 
five years of practice. 

(2) Freshman student receiving financial assistance 
for four years— four years of practice. 

(3) Upper classman already in medical school— one 
year of practice for each year that financial aid is taken 
(one year minimum). 

The applicant may select a practice location of his own 
choice, provided it is in a community that has a demon- 
strated physician shortage. The choice is subject to ap- 
proval by the program’s board. The purpose of this 
agreement is to provide physicians for the rural com- 


IMPARTIAL 

The Impartial Medical Testimony program, in 
which the Illinois State Medical Society partici- 
pates, is designed to elicit objective medical truth 
and facilitate the equitable disposition of cases in 
the courts of Illinois. 

As a technique of judicial administration, im- 
partial medical testimony examiners are ordered 
by the court when there is divergence of medical 
opinion in litigation before the court. An IMT 
examination provides the court with objective, im- 
partial medical data and opinion. 


munities of Illinois. 

To be considered for assistance from the Medical Stu- 
dent Loan Fund Program, an applicant must be recom- 
mended by the presidents of his home county medical 
society and farm bureau. Rules of eligibility require that 
an applicant be a premedical student of at least three years 
college standing; applicants must also complete the re- 
quired American Medical College Admission Service 
forms. This AMCAS application must be on record with 
the University of Illinois Medical School by November 1. 
Illinois residency is required. 

The board of the Medical Student Loan Fund Program 
conducts an annual interview meeting for those students 
who wish to enter medical school the following September. 
Students qualifying for the interview are notified and 
invited in mid-November. Those approved for assistance 
are accepted on a comparative and competitive basis. In- 
formation and applications may be obtained from Roy E. 
Will, Manager, Medical Student Loan Fund Board, 1701 
Towanda Ave., P.O. Box 2901, Bloomington, IL 61701. 


TESTIMONY 

The Illinois State Medical Society played a sig- 
nificant role in the creation and development of 
the IMT program. 

The panel of impartial medical examiners is 
comprised of physicians who are grouped into medi- 
cal specialties. Composition of the panel is reviewed 
periodically to maintain the highest standards for 
the courts of Illinois. 

In 1976 the functions of IMT were expanded to 
provide service to the Supreme Court Attorney 
Registration and Discipline Commission. 


SPONSORED COMMERCIAL INSURANCE PROGRAMS 


Hospital Benefit Plan 

The Hospital Benefit Plan, approved by the 
Board of Trustees March 14, 1971, is available ex- 
clusively as a benefit to ISMS members. The society 
will incur no expense as a result of sponsoring this 
voluntary program. 

The Hospital Benefit Program consists of three 
plans. Plan A provides $25 per day, Plan B pro- 
vides $50 per day and Plan C provides $100 per 
day for each day you are confined in a hospital as 
an in-patient because of an accident or sickness for 
as long as one year. Benefits are provided from the 
first day of in-patient hospital confinement in any 
general hospital which has available 24-hour nurs- 
ing services and has facilities for major surgery. 

All active members of the society, their em- 
ployees and their families are eligible for participa- 
tion during enrollment periods conducted by the 
Administrator, Robinson Administrative Services, 
Inc., 209 S. LaSalle St., Chicago 60604. 

The daily benefits are automatically doubled for 
all participants under age 65 for hospital confine- 
ment due to cancer or hospital confinement in an 
intensive care unit. 

The plan pays regardless of any other insurance 
policies members have, and in addition to Medicare 
and Social Security benefits. Benefits are paid direct- 
ly to the participant and not to a doctor or hospital, 


unless assigned. Benefits are not taxable and there- 
fore need not be included in one’s tax return. 

The coverage is limited to sickness which com- 
mences or accidents which occur while the insurance 
is in force. However, conditions pre-existing the 
effective date of insurance will be covered if the 
participant has not received treatment or medical 
advice during any period of 12 consecutive months 
ending after the effective date of insurance. After 
two years from the effective date of insurance, 
coverage is guaranteed regardless of any pre-existing 
conditions. 

The plan includes these exclusions: war or act 
of war, service in the armed forces of any country 
or international authority at war, pregnancy (in- 
cluding childbirth or resulting complications) , or 
intentionally self inflicted injuries, suicide or at- 
tempted suicide, whether sane or insane. 

Enrollment forms and details about the plan can 
be obtained by calling the Administrators Office, 
collect, at (312) 726-2575. 

Group Disability Program 

The Group Disability Program has been avail- 
able to members since 1947. All eligible members 
of ISMS may apply if under age 55 and regularly 
attending all of the usual duties of their profes- 
sion. The coverage is renewable to age 70 and 
offers three choices— Lifetime Accident and (1) Sick- 


252 


Illinois Medical Journal 


ness payable to age 65, (2) Sickness payable for 
7 years, (3) Sickness payable for 1 year. 

New members under age 40 joining ISMS may 
enroll without evidence of insurability for up to 
$400.00 per month. Benefits under Plan I, (lifetime 
accident, 1 year sickness). The plan offers up to 
$1732.00 per month benefits to members under 50 
and $1300.00 per month benefits to members under 
age 55. 

Benefits of the program are payable regardless of 
any other insurance and no restrictive riders may be 
attached after issuance. The master contract con- 
tains a special renewal condition whereby the in- 
dividual coverage cannot be terminated. 

The program is explained in detail in a brochure 
which is available by writing to the administrator, 
Parker, Aleshire & Co., 9933 Lawler Ave., Skokie 
60077. 

Excess Major Medical Plan 

This Plan has been available to members since 
1975. It is a coverage designed for the truly cata- 
strophic accident or illness condition. The plan 
provides up to $500,000 for medical expenses. It is 
available with a $15,000, $20,000 or $25,000 deduc- 
tible which supplements any Basic Major Medical 
Plan. It may be obtained without evidence of in- 
surability. You have 36 months to accumulate the 
deductible and then the benefits are paid on a 
100% basis for up to 10 full years. 

For additional information, please contact the 
Administrator, Parker, Aleshire & Company, 9933 
Lawler Avenue, Skokie, Illinois 60077. 

Workers’ Compensation Insurance 

The Dodson Savings Plan has been approved by 
the Illinois State Medical Society as a proven way 
to reduce the cost of Workers’ Compensation insur- 
ance when claim costs are held to a minimum. 

Savings for physicians in other areas such as 
Minnesota have frequently been 40% or more. Re- 
turns under this plan depend on the cost of claims 
from physicians who are insured. Policies are issued 
by Casualty Reciprocal Exchange, a member of the 
Dodson Insurance Group, and are standard in all 
respects. Rates are standard and approved for this 
class of employment. Savings are best when safety 
is maintained in all job related activities. 

Savings are paid as earned within about 90 days 
after policy expiration or when payroll audits are 
completed. 

For further details write or call collect to the 
managers, Dodson Insurance Group, P.O. Box 559, 
Kansas City, MO 64141. Phone 816-361-3400. 

Group Major Medical Expense Plan 

The $25,000 Group Major Medical Expense Plan 
designed for the Illinois State Medical Society has 
been in force since 1958. It has a 20% co-insurance 
feature with a $500 or $1,000 deductible, whichever 
the physician selects. For hospital room and board, 
the Plan will pay up to $100 a day and in addition 
up to $150 a day in an intensive care unit. It will 
pay $20 a day in a convalescent home following 


release from a hospital up to 90 days. The Plan 
also provides maximum coverage for the insured 
in the event of mental illness and up to $2,000 for 
dependents. It will also cover a congenital ab- 
normality from the first day of birth after the ef- 
fective date of the contract up to $2,000. 

New members joining ISMS will be allowed to 
enroll without evidence of insurability or health 
statement under age 40 within six months after 
notification of the Plan’s availability. 

The Group Major Medical Expense Plan is out- 
standing and will provide members with protection 
against catastrophic illness. 

Further information may be obtained from the 
administrator, Parker, Aleshire & Co., 9933 Lawler 
Ave., Skokie, 111. 60077. 

Business Overhead Expense Group Plan 

This plan has been available since 1973. Today, 
more than ever, maintaining a medical office is 
costly when one considers the increasing cost of 
rent, employee’s salaries, accountant services, util- 
ities, etc. The sole purpose of the Business Over- 
head Expense Group Plan is to step in and take 
care of overhead expenses during a period when 
the physician is totally disabled as a result of an 
accident or illness. In the evertt of a serious acci- 
dent or illness, the physician can keep his office 
open and retain his personnel with the expenses 
being taken care of by the Business Overhead Ex- 
pense Group Plan. This Program is not to be con- 
fused with the Group Disability Plan which pro- 
vides an earned income for physician to meet his 
personal obligations for the maintenance of his 
home and family. 

Monthly benefits are available up to $3,500.00 
with attractive premiums. Benefits commence on 
the first day provided total disability lasts one (1) 
month or longer. It will continue while totally dis- 
abled for as long as 24 months for any one accident 
or period of sickness. The premiums for this par- 
ticular type of coverage constitute business expenses 
and are deductible under Internal Revenue Service 
Ruling (55-264, I.R.B. 1955-19, p. 8) . 

Further information may be obtained from the 
administrator, Parker, Aleshire &: Co., 9933 Lawler 
Ave., Skokie, 111. 60077. 


Personal Life Insurance Program 

A guaranteed renewable term life insurance pro- 
gram, recommended by the Insurance Committee 
and approved by the Board of Trustees in 1972, is 
available to ISMS members in amounts ranging 
from $10,000 to $200,000. Features of the program 
include guaranteed future purchase options, guar- 
anteed conversion privilege up to age 70, optional 
family insurance benefits, double indemnity and 
disability waiver premium. 

Dividends are applied against premiums and re- 
duce member’s cost. 

For applications and further details, contact the 
administrator: A. W. Ormiston & Co., 175 W. Jack- 
son Blvd., Chicago 60604; phone 312-922-3952. 


for October, 1978 


253 


Ancillary Organizations 

Illinois State Medical Society Auxiliary 


Growth Patterns for 1978-79 

It has been said that “two women with a cause and a 
letterhead can produce stark terror in the hearts of 
sophisticated corporate heads.” 

Witli that thought in mind, one can envision the built- 
in potential of our state medical auxiliary for achieve- 
ment. This is yet more valid when the calibre of its 
members and worth of its goals are taken into account. 

Illinois is one of the few states with an increase in 
auxiliary membership. Our on-going community action 
projects include CPR training in the schools, Immuniza- 
tion Awareness and Education, Safety for the Elderly and 
the Vial of Life program. Our cooperative efforts with 
the Cancer Society and Illinois Heart Association are 
further evidence of involvement and interest in the qual- 
ity of life in our state. 

It seemed only natural that we choose “Fifty-One to 
Grow on” as our theme this year. We boast a newly 
organized county and give a warm welcome to Coles- 
Cumberland. That is growth, indeed; growth of the very 
best kind. 

Each organized county has now filled the position of 
president-elect. Each president-elect is eligible to par- 
ticipate in the leadership training sessions given in Chi- 
cago every October. It would be difficult to describe the 
excellence and effectiveness of “Leadership Confluence.” 

Since the inception of the fall conference concept five 
years ago, interest has grown to engender the possibility 
of regional conferences. We have scheduled two this year, 
in order to test the merit of that idea. 

Our September 19 Fall Conference-North gave emphasis 
to the fact that we are not interested solely in the con- 
cerns of children, but also in the family as a whole. Our 
youth cannot blossom and mature unless nurtured in a 
healthy, balanced environment, and the core of that en- 
vironment must be a warm, harmonious home. 

The broad range of subjects touched upon at the work- 
shop included parenting— how much substitution can 
there be without harm? Personal responsibility for health 
was discussed. Dr. Nelson J. Bradley of the ISMS Panel 
for the Impaired Physician discussed the successful fam- 


ily treatment approach to alcohol and drug-related prob- 
lems. 

The auxiliary presented a new legislative film entitled 
“A Critical Difference” to those assembled. It was pro- 
duced by the legislative department of the AMA, and our 
members were urged to make full use of this effective tool 
during the coming months. It will be available for all, 
and is designed for non-medical persons in our com- 
munities. 

Fall Conference-South is scheduled for Thursday, No- 
vember 9th, at the Ramada Inn, St. Clair Square in 
Relleville, Illinois. Cost Containment is on the agenda, 
along with reports from Leadership Confluence. 

At this point, our future lies before us. There are end- 
less opportunities for challenge and growth, as we work 
to leave the youth and families of Illinois enriched and 
restored through auxiliary’s efforts over the next several 
months. 

Mrs. Earl V. Klaren 
President 


OFFICERS 

President Mrs. Earl V. Klaren, Libertyville 

President-Elect Mrs. R. S. Hoover, Lake Forest 

1st Vice-President 

(Membership) Mrs. Harlan Failor, Champaign 

2nd Vice-President 

(Programs) Mrs. Donald Hinderliter, Rochelle 

3rd Vice-President 

(Communications) ....Mrs. Harold Keegan, Kankakee 

Secretary Mrs. Julian Buser, Belleville 

Corresponding Secretary. .Mrs. Homer Goldstein, Deerfield 
Treasurer Mrs. Robert Webb, Edwardsville 


DIRECTORS 

Mrs. Edward Szewczyk, Belleville 
Mrs. William Hodges, Kankakee 
Mrs. Jaime L. Gomez, Danville 

EXECUTIVE SECRETARY 

Mrs. Robert Swanson 

104 E. Broadway, Suite 5, Monmouth 61462 


COMMITTEE CHAIRMEN 


AMA-ERF Chairman Mrs. Selig Hodes, Forreston 

AMA-ERF Co-Chairman ....Mrs. Karl Reddies, Freeport 

Archives Mrs. Ashvin K. Patel, Bloomington 

Benevolence Mrs. August Martinucci, Joliet 

Bylaws Mrs. Wilson West, Belleville 

Community Health Mrs. James Gwaltney, Quincy 

Communication Mrs. Harold Keegan, Kankakee 

Convention Mrs. Morrison Beers, Lake Forest 

Convention 

Co-Chairman Mrs. Luben Atzeff, Lake Forest 

Editorial Mrs. Eugene Vickery, Lena 

Family Health Mrs. Morris Friedell, Chicago 

Finance Mrs. Reuben Gaines, Wayne 

Health Education and 

Health Manpower Mrs. Gamil Arida, Joliet 


Hospitality Mrs. H. Frank Holman, Belleville 

Hospitality 

Vice-Chairman ....Mrs. Elwoocl Kortemeier, Freeport 
International Health ....Mrs. Eugene Leonard, Rockford 

Legislation Mrs. Byron Weisbaum, Springfield 

Membership Mrs. Harlan Failor, Champaign 

Menrbers-at-Large ...Mrs. Robert Hartman, Jacksonville 

Program Mrs. Don Hinderliter, Rochelle 

Public Affairs Mrs. David Clark, Aurora 

Safety Mrs. Irvin Blumfield, Alton 

SPECIAL COMMITTEES 

Ad Project Mrs. Reuben Gaines, Wayne 


254 


Illinois Medical Journal 


Convention Guidebook 

Revisions Mrs. Edward Szewczyk, Belleville 

Convention Guidebook Revisions 

Co-Chairman Mrs. H. Frank Holman, Belleville 

Spouses of Physicians in 

Training Mrs. Edward Szewczyk, Belleville 

Editorial Mrs. Eugene Vickery, Lena 

Co-Chairman Mrs. Morrison Beers, Lake Forest 

Contributing Reporters Mrs. Irving Frank, DeKalb 

Mrs. Luben Atzeff, Lake Forest 
Mrs. Harold Keegan, Kankakee 

Fall Conference North 

Co-Chairman Mrs. Roberto Arellano, LaSalle 

Fall Conference South 

Co-Chairmen Mrs. Andrew Gregowicz, Belleville 

Mrs. Thomas Meirink, Belleville 
Long Range Planning ..Mrs. R. S. Hoover, Lake Forest 
Mrs. Robert Richardson, Peoria 
Mrs. P. S. B. Sarma, Wilmette 
Mrs. Nicholas Borden, Flossmoor 
Mrs. Willard Scrilvner, Belleville 

Pseudo-Religious Cult 

Awareness Mrs. George Olander, Lake Forest 


Social Services for Benevolence 

Recipients Mrs. Mitchell Spellberg, Chicago 

Legislative Key 

Women . . Mrs. Byron Weisbaum, Springfield, Chairman 

Mrs. Albert Ray, Joliet 
Mrs. Morrison D. Beers, Lake Forest 
Mrs. Edward Dutka, Aurora 
AMAA North Central Region AMA-ERF 


Chairman Mrs. Edward Szewczyk, Belleville 

Parliamentarian Mrs. Francis Graff, Freeport 


REPRESENTATIVES TO ISMS COUNCILS 
AND COMMITTEES 


Benevolence Mrs. August Martinucci, Joliet 

Mrs. Earl V. Klaren, Libertyville 
Governmental Affairs . . Mrs. Byron Weisbaum, Springfield 
Mental Health and 

Addiction Mrs. Harold Keegan, Kankakee 

Public Affairs Mrs. David Clark, Aurora 

Public Relations & 

Membership Mrs. Harlan Failor, Champaign 

Medical Services Mrs. James Gwaltney, Quincy 


DISTRICT COUNCILORS 


2. Mrs. Louis Tarsinos, Princeton 

3. Mrs. Jack Clemis, Wilmette 

4. Mrs. Charles Koivun, Moline 

5. Mrs. Robert Reardon, Bloomington 

6. Mrs. Robert Kooiker, Jacksonville 

7. Mrs. William Simon, Decatur 


8. Mrs. James Laidlaw, Champaign 

9. Mrs. James Heersma, Mt. Vernon 

10. Mrs. Andrew Gregowicz, Belleville 

11. Mrs. Alex Spadoni, Hinsdale 

12. Mrs. John Leonard, Roscoe 


American Association of Medical Assistants 

Illinois Society 


The American Association of Medical Assistants is a 
national, non-profit organization dedicated to the profes- 
sional advancement of medical assistants. This tri-level 
structure— similar to AMA— encompasses local, state and 
national affiliation. 

Membership in the Illinois Society, AAMA, is open to 
medical assistants, office nurses, technicians, secretaries, 
bookkeepers and clerks performing administrative and/or 
clinical duties under the direct supervision of a physician. 
College students attending Medical Assistant Programs 
are encouraged to belong. Physician advisors at all three 
levels assist with educational endeavors. 

The state society’s numerous professional, educational 
programs in various parts of the state offer continuing 
education units (CEU) to its participants. Some of the 
major programs are: 

Traveling Course Regional Seminars, Annual Sympo- 
sium, Personal Development Day and the All Day Work- 
shop held in conjunction with Chicago Medical Society’s 
Midwest Clinical Conference. The Annual three day meet- 
ing in April includes excellent lectures, study programs 
and the culmination of association business during the 
House of Delegates Session. 


The American Association of Medical Assistants en- 
courages advancement of medical assistants by offering a 
certification examination designed to evaluate professional 
competency. Local chapters, in addition to their regularly 
scheduled monthly educational programs, conduct prep- 
aratory classes in terminology, physiology, anatomy, human 
relations, patient contact, medical law and ethics, com- 
munications, bookkeeping, insurance, administrative pro- 
cedures, laboratory orientation and collection methods. 
The certification examination is administered twice a year. 

The medical assistant may become a Certified Medical 
Assistant (CMA) by successfully passing the special board 
examination and meeting qualifying criteria of the Ameri- 
can Association of Medical Assistants. Specialty examina- 
tions are given in Administrative, Clinical and Pediatric 
divisions. For further information about this program con- 
tact the American Association of Medical Assistants, One 
East Wacker Drive, Chicago, Illinois 60601. 

Members interested in independent continuing educa- 
tion through a “home study” program may purchase and 
utilize audio cassettes and workbooks. The president of 
the Illinois Society communicates, via the “Executive 
Memo” (a monthly publication), with nearly 1,000 mem- 


/or October, 1978 


255 


bers giving pertinent information of current activities. 

A quarterly publication “The Illini Cardinal” concen- 
trates on educational topics and is available to all mem- 
bers without additional cost. “The Professional Medical 
Assistant,” the official bi-monthly journal of the associa- 
tion, is largely devoted to original articles written for 
medical assistants by their peers or other professionals in 
related fields. It is an automatic benefit of membership, 
although subscriptions are available for non-members. 
There are many other benefits available (i.e. group in- 
surance) . During the Annual Meeting of AAMA each fall, 
a variety of experts in medical and related fields address 
participants during educational programs and workshops. 

Monthly educational meetings are scheduled in the fol- 
lowing chapers: Cook County-Chicago (downtown). 
Southwest Suburban (Oak Lawn), Northwest (Arlington 
Heights) , Northshore (Skokie), West Cook (River Grove), 
Cook County South (Dolton) , Aux Plaines (Oak Park), 
DuPage (Wheaton) , Coles-Cumberland (Charleston), De- 
Kalb (Sycamore), Jefferson- Hamilton (Mt. Vernon), Kane 
(Elgin), LaSalle, Macon (Decatur), McLean (Blooming- 
ton) , McHenry, Morgan-Scott (Jacksonville) , Randolph 
(Chester), Rock Island, Sangamon (Springfield), St. Clair 
(Belleville) , Spoon River Valley (Canton), Vermilion 
(Danville), Will-Grundy (Joliet) , Shawnee (Harrisburg) . 
Physicians in these areas are asked to encourage their 
medical assistants to join the association and actively par- 
ticipate in the selection of educational programs that will 
enable the members to become better medical assistants. 

For membership information please contact Mrs. Leslie 
Lee, President, Illinois Society, AAMA, 5826 N. Whipple, 
Chicago, IL 60659. 


OFFICERS 

President— Mrs. Leslie Lee, Chicago 
President-Elect— Mrs. Cissy (Moran) Egly, CMA, Joliet 
Immediate Past President— Mrs. Vivian Kraft, CMA-AC, 
Bloomington 

First Vice President— Mrs. Jean Lockenvitz, Bloomington 
Second Vice President— Mrs. Anna Albert, Chicago 
Recording Secretary— Ms Judith A. Miller, CMA-AC, Itasca 
Corresponding Secretary— Mrs. Linda (Katek) Blazer, 
Chicago 

Membership Secretary— Ms Mary Frances Burton, Chicago 
Treasurer— Mrs. Patricia A. Mooney, R.N., Galesburg 
Speaker of the House— Mrs. Luella Mitchell, Chicago 
Vice Speaker of the House— Miss Pauline Klarich, Peoria 
Parliamentary Advisor— Ms. Norma Domanic, LPN, 

New Lenox 

Chaplain— Mrs. Florence Peery, CMA, Chicago 
Chairman, Board of Trustees— Mrs. Ruby Jackson, CMA, 
Chicago 

Education Chairman— Mrs. Vivian Kraft, CMA-AC, 
Bloomington 

Publicity— Mrs. Magda Brown, Skokie 

Physician Advisors 

John L. Wright, M.D., Bloomington, Chairman 
Allison L. Burdick, Sr., M.D., Chicago 
Thomas R. Harwood, M.D., Chicago 
Leslie Schwartz, M.D., Chicago 
Robert Hartman, M.D., Jacksonville 
J. M. Ingalls, M.D., Paris, Liaison to ISMS 


The Educational & Scientific Foundation 


The Educational & Scientific Foundation was founded 
to provide an administrative agency to foster the advance- 
ment of clinical science through: 

1) The initiation of scientific and medical research 
activities. 

2) The collection, evaluation and dissemination of the 
results of research activities to the public. 

3) The implementation and management of projects 
related to medicine for individuals, or organizations seek- 
ing to inform or educate others, or to improve their own 
knowledge. 

The Foundation is a distinct corporate entity which 


has an interlocking Board with the Illinois State Medical 
Society. It is staffed through ISMS headquarters. 

Board of Directors 

George T. Wilkins, Granite City, Chairman 

Audley F. Connor, Jr., Chicago 

David S. Fox, Chicago 

Robert R. Hartman, Jacksonville 

P. John Seward, Rockford 

Staff: Division of Education, Manpower and 
Convention Services. 


Illinois Council on Continuing Medical Education 


This Council was created by the Illinois State Medical 
Society, in co-operation with the state’s eight medical 
schools, to fulfill six purposes: (a) make readily available 
to all Illinois physicians CME programs that will enhance 
patient care; (b) catalog and co-ordinate existing programs 
to eliminate wasteful duplication; (c) encourage develop- 
ment of new CME methods, techniques, and systems; (d) 
help identify the learning needs of Illinois physicians; 
(e) seek out potential CME providers and serve as liaison 
between producers and consumers; and (f) encourage 
Illinois physicians to participate in formal CME programs. 

ICCME was proposed by Dr. Edward W. Cannady in his 
1969 inaugural address as President of ISMS. Following 
careful study, the 1970 House of Delegates approved the 


plan in principle. The next President, Dr. J. Ernest Breed, 
vigorously pursued the idea; after the 1971 House of 
Delegates voted initial funding, he also served as Chairman 
of the Organizing Committee. The Illinois Association of 
Osteopathic Physicians & Surgeons also offers financial 
support for ICCME. 

ICCME was officially chartered by the state as a non- 
profit educational organization in May, 1972, and began 
operations with the appointment of its first Executive 
Director in September, 1972. 

ICCME is unique in three respects: (1) it is the only 
such organization supported by a state medical society and 
staffed by a full-time professional educator; (2) it unites 
the educational resources of the Illinois State Medical 


256 


Illinois Medical Journal 


Society and the state’s medical schools; and (3) inde- 
pendent in action, it serves all interests concerned with 
CME and thus provides a crucial channel of communica- 
tion to co-ordinate the efficient use of all available re- 
sources. 

Current Major Activities: 

1. Sponsor an annual Congress on Continuing Medical 
Education, to involve all elements of the Illinois 
health-care system in the Council’s work. The fifth 
Congress meets April 21-22, 1978. 

2. On behalf of ISMS, perform staff work for accredita- 
tion of intra state CME including advice on prepar- 
ing to apply for accreditation. 

3. Advise hospitals and other organizations on effective 
CME— both informally and through the “Illinois 
Hospital CME Consultation Service.” 

4. Organize workshops on techniques of CME — includ- 
ing an unusual “Workshop on CME Leadership” 
for leaders of hospital medical staffs and medical 
societies. 

5. Develop and publish CME planning aids that offer 
practical advice and important background on effec- 
tive organization of CME. Included are Your Per- 


sonal Learning Plan, a unique handbook offering 
advice on how to plan your learning most effectively; 
and How to Start a CME Program in Your Hospital 
or Medical Society for CME planners. For all items 
now available, request "The Illinois Handbooks on 
CME Planning— Catalog/Order Form.” All publica- 
tions are free to Illinois physicians-M.D. or D.O.— 
upon request; just write the title on your prescrip- 
tion form and mail to ICCME, 55 E. Monroe, Chi- 
cago, IL 60603. 

6. Publish an Illinois CME Case Compendium for hos- 
pital CME case-discussion groups. 

7. Publish a monthly calendar of Illinois CME ac- 
tivities for IMJ. 

Organization & Governance 

Members of the ISMS Executive Committee serve as 
legal members of the ICCME Corporation, set basic policy, 
and elect the Board of Directors. 

The affairs, property, and business of the Council are 
managed by a Board of Directors comprised of: eight 
practicing physicians selected by the ISMS Board of Trus- 
tees; eight academic physicians, one selected by each dean 
of an Illinois medical or osteopathic school; plus the chair- 
man of the ISMS Committee on CME Accreditation. 


Board of Directors 


William Lees, Lincolnwood, President 
Donald F. Pochyly, Chicago, Vice-President 
Ward E. Perrin, Chicago, Secretary 
George Shropshear, Chicago, Treasurer 
Anthony L. Barbato, Maywood 
Ernst Chester Bone, Jacksonville 
Dean Bordeaux, Peoria 
Alfred J. Clementi, Arlington Heights 
Joseph Daddino, Chicago 

COMMITTEE ON 

Dean R. Bordeaux, M.D., Peoria, Chairman 

Philip D. Anderson, Chicago 

Allan C. Campbell, M.D., Peoria 

Julius S. Newman, Aurora 

H. Close Hesseltine, M.D., Chicago, Consultant 

Staff; Illinois Council on Continuing Medical Education 


James E. Dyson, Ph.D., Chicago 

Thomas Henderson, Ph.D., Chicago 

Chase P. Kimball, Chicago 

Boyd McCracken, Greenville 

Harold A. Paul, Chicago 

Mather Pfeiffenberger, Alton 

Lewis W. Tanner, Danville 

D. Dax Taylor, Springfield 

Executive Director: Leonard S. Stein, Ph.D. 

ACCREDITATION 

Responsibilities and Purposes: 

To review reports of institutions which have applied 
for accreditation of their continuing medical education 
activities and make recommendations to the national 
Liaison Committee on Continuing Medical Education. To 
provide liaison with the Illinois Council on Continuing 
Medical Education. 


ILLINOIS CME SPONSORS ACCREDITED 
BY THE LIAISON COMMITTEE ON CONTINUING MEDICAL EDUCATION 
AS OF AUGUST 31, 1978 


The Academy of Cutaneous Surgery— River Forest 
Alfred Adler Institute of Chicago, Inc. 

Augustana Hospital— Chicago 
Belleville Hospital Association for CME 

(Memorial Hospital, St. Elizabeth Hospital) 
Carle Foundation Hospital— Urbana 
Central Community Hospital— Chicago 
Central DuPage Hospital— Winfield 
Chicago College of Osteopathic Medicine 
Chicago Pediatric Society 
Chicago Surgical Society 
Christ Hospital— Oak Lawn 


Columbus-Cuneo-Cabrini Medical Center— Chicago 
Copley Memorial Hospital— Aurora 
Cook County Hospital— Chicago 
DuPage County Medical Society— Lombard 
Elgin Mental Health Center 

FAB 3 -CME (Forkosh Memorial, Belmont Community, 
Bethesda, Bethany Methodist, Thorek Medical 
Center) Chicago 
Forest Hospital— Des Plaines 
Grant Hospital of Chicago 
Henrotin Hospital— Chicago 
Hinsdale Sanitarium & Hospital 


for October , 1978 


257 


Holy Cross Hospital— Chicago 
Illinois Central Community Hospital— Chicago 
Illinois Council on Continuing Medical Education— 
Chicago 

Illinois Heart Association— Springfield 
Illinois Hospital Association— Oak Brook 
Illinois Masonic Medical Center— Chicago 
Illinois Society of Allergy and Clinical Immunology- 
Highland Park 

Illinois. Society of Ophthalmology and Otolaryngology— 
Danville 

Kishwaukee Community Hospital— DeKalb 
Little Company of Mary Hospital— Evergreen Park 
Louise Burg Hospital— Chicago 

Loyola University Stritch School of Medicine— Maywood 

Lutheran General Hospital— Park Ridge 

MacNeal Memorial Hospital— Berwyn 

Manteno State Hospital 

Martha Washington Hospital— Chicago 

Mary Thompson Hospital— Chicago 

Memorial Hospital of DuPage County— Elmhurst 

Mercy Hospital & Medical Center— Chicago 

The Methodist Medical Center of Illinois— Peoria 

Michael Reese Hospital & Medical Center— Chicago 

Mount Sinai Hospital Medical Center of Chicago 

Northwestern University Medical School— Chicago 

North Shore Mental Health Association/ 

Irene Josselyn Clinic— Northfielcl 
Northwest Hospital— Chicago 

Northwest Community Hospital— Arlington Heights 
Norwegian-American Hospital— Chicago 
Oak Eorest Hospital 
Oak Park Hospital 

Ravenswood Hospital Medical Center— Chicago 


Resurrection Hospital— Chicago 
Riveredge Hospital— Forest Park 
Riverside Hospital— Kankakee 
Rock Island Franciscan Medical Center 
Roosevelt Memorial Hospital— Chicago 
Rush Medical College— Chicago 
Sarah Bush Lincoln Health Center— Mattoon 
Sherman Hospital— Elgin 
Silver Cross Hospital— Joliet 
Skokie Valley Community Hospital— Skokie 
South Chicago Community Hospital 
Southern Illinois Medical Association— Belleville 
Southern Illinois LIniversity School of Medicine— 
Springfield 

St. Anthony Hospital— Chicago 

St. Anthony Hospital— Rockford 

St. Elizabeth’s Hospital— Chicago 

St. Elizabeth Hospital— Danville 

St. Elizabeth— Granite City 

St. Francis Hospital-Medical Center— Peoria 

St. Joseph Hospital— Chicago 

St. Joseph Hospital— Elgin 

St. Mary’s Hospital— Streator 

St. Mary of Nazareth Hospital— Chicago 

St. Therese Hospital— Waukegan 

Swedish American Hospital— Rockford 

Swedish Covenant Hospital— Chicago 

Tinley Park Mental Health Center 

University of Chicago Pritzker School of Medicine 

University of Health Sciences/The Chicago Medical School 

University of Illinois College of Medicine 

Weiss Memorial Hospital— Chicago 

Westlake Community Hospital— Melrose Park 

West Suburban Hospital— Oak Park 


Illinois Foundation 

The Illinois Foundation for Medical Care (IFMC) is a 
not-for-profit corporation established in 1971 by action of 
the House of Delegates. Under revised bylaws adopted 
June, 1977, IFMC is operated under direction of a 6-mem- 
ber Board of Directors elected annually by the ISMS 
Board of Trustees. The IFMC currently contracts with 

IFMC Board 

Joseph Sherrick, M.D., Chicago, President 

Robert P. Johnson, M.D., Springfield, Vice-President 

James Laidlaw, M.D., Champaign, Secretary-Treasurer 


for Medical Care 

the Regional Health Resources Center, Urbana, Illinois 
for administrative services. 

IFMC maintains relationships with the several local 
foundations for medical care and is available to serve 
their needs on a cost reimbursement basis. 


of Directors 

Audley F. Connor, M.D., Chicago 
Miller Henderson, M.D., Rockford 
Lawrence L. Hirsch, M.D., Chicago 


258 


Illinois Medical Journal 


Illinois Medical Political Action Committee (IMPAC) 


The Illinois Medical Political Action Commit- 
tee (IMPAC) is a voluntary, non-profit, unin- 
corporated, permanent membership organization 
founded in 1960. IMPAC serves as the unified po- 
litical action arm of Illinois physicians and their 
spouses. It cooperates with others in the healing 
arts professions. Funds collected through IMPAC 
memberships, used in support of candidates, are 
administered independently of other professional 
groups. However, the program is operated in 
harmony with the legislative objectives of the 
Illinois State Medical Society. Individual partici- 
pation in IMPAC is one means by which the 
individual physician and his spouse can effectively 
participate in public affairs. 

IMPAC participates primarily in election con- 
tests for legislative offices — both those in the 


Illinois General Assembly and in the U. S. Con- 
gress. It cooperates in membership solicitation ac- 
tivities with the American Medical Political Action 
Committee (AMPAC). 

IMPAC’s organization consists of a chairman, 
an executive committee, and a council. Political 
action activities are implemented by local physi- 
cian support committees formed on behalf of can- 
didates in U. S. Congressional or other legislative 
districts. Candidate selection and support are de- 
termined on the basis of evaluations and recom- 
mendations submitted to the council and ex- 
ecutive committee by the local committees, thus 
assuring members of a “grass roots” voice in 
IMPAC activities. 

Additional information about IMPAC mav be 
obtained by writing: IMPAC, Suite 3510, 55 E. 
Monroe, Chicago 60603. 


Illinois State Medical Insurance Services, Inc. 


Illinois State Medical Insurance Services is an Illinois 
corporation, formed in March, 1976, all of whose capital 
stock is owned by the Illinois State Medical Society. Its 
sole business is to act as Attorney-in-Fact for the Illinois 
State Medical Inter-Insurance Exchange. 

The Exchange was organized to provide comprehensive 
professional liability insurance for Illinois physicians. Its 
membership is limited to members of the Illinois State 
Medical Society 

Insurance Services provides all the management and 
underwriting services required for the operation of the 
insurance business of the Exchange. It does so under 
Power-of-Attorney granted it by the Exchange in a man- 
agement agreement with an initial term of five years, and 
by each member of the Exchange through his application 
for membership. Under the management agreement the 
Board of Governors of the Exchange prescribes policy to 
be followed in the conduct of the business; within the 
guidelines established by these policy statements, Insurance 
Services manages the business of the Exchange, accepting 
or rejecting applications, determining the form of insur- 
ance policies, handling and disposing of claims, and per- 
forming all related functions. Insurance Services is com- 
pensated by the Exchange on the basis of expense 
reimbursement; it is not anticipated that Insurance Ser- 
vices will produce any operating profit. 

The organization of Insurance Services comprises four 


principal functional divisions: Risk Management and 

Underwriting, Claims, Policyholders and Public Relations, 
and Administrative Services. Advisory and consultative 
services are provided by member physicians through a 
review system organized and directed by the Medical Di- 
rector of Insurance Services. Financial and accounting 
services are provided by staff of the Illinois State Medical 
Society, whose Business Manager serves as Controller of 
Insurance Services. The offices of Illinois State Medical 
Insurance Services, Inc., are at 55 East Monroe Street, 
Suite 3440, Chicago, Illinois 60603. 

Board of Directors 

Phillip D. Boren 
Alfred dementi 
Robert T. Fox 
Robert Hamilton 
J. M. Ingalls 
Warren D. Tuttle 
Roger N. White 

Officers 

Robert T. Fox, Chairman 
Paul E. Singer, President 
Henry Nussbaum, Vice President 
Roger N. White, Secretary -Treasurer 
Phillip D. Boren, Medical Director 


Student Business Session 


Daniel R. Shirey, Maywood (Loyola) Chairman 
W. Joseph Ketcherside, Chicago (University of Chicago) 
Vice Chairman and Treasurer 
Jerry Cohen, Chicago (Northwestern) Secretary 
David Aizuss, Chicago (Northwestern) Delegate 
Jason Chao, Chicago (Northwestern) Alternate Delegate 
John Johnson, Forest Park (Loyola) 

Immediate Past Chairman 


School Representatives 

Chicago Medical School 
Phil Dray, Wilmette 
Loyola University 

Kenneth Stein, Oak Brook 
Northwestern University 
John Deseris, Chicago 


for October , 1978 


259 


Rush Medical School 

David Fletcher, Oak Park 
Southern Illinois University 
David Roszhart, Springfield 
University of Chicago 
Don Flenry, Chicago 
University of Illinois 
Robert Bryg, Chicagc 


The purposes of the Student Business Session shall be 
to encourage and support the active participation of medi- 
cal students in the ISMS and to provide a representation 
of student opinions and ideals in organized medicine. In 
addition, the Student Business Session shall support the 
purposes of ISMS as stated in its constitution. The Student 
Business Session is composed of all student members of 
ISMS. 


Resident Physicians Section 


Ira Isaacson, Chicago, Chairman 

Michael Sadove, Chicago, Vice Chairman and Treasurer 
Linda Hughey, Wilmette, Secretary and Editor 
James DeBord, Oak Park, Delegate 
Anthony Savino, Chicago, Alternate Delegate 

House Staff Organization Representatives 

The Children’s Memorial Hospital 

Cindy Moody and Abby Adams, Chicago 
Illinois Masonic Medical Center 
Brett Cassens, Chicago 
Illinois State Psychiatric Institute 
Stephen R. Cann, Chicago 
Institute for Juvenile Research 
Saroj Goyal, Chicago 
Lutheran General Hospital 
David Cooke, Park Ridge 

Peoria School of Medicine/Methodist Medical Center 
Leslie E. Mathers, III, Peoria 
Rockford School of Medicine/Swedish American Hospital 
Dennis P. Zoller, Rockford 
Rush-Presbyterian-St. Luke’s Medical Center 
Benjamin L. LeCompte, III, Chicago 
Scott Medical Center 
C. A. Schuler, Scott AFB 


St. Francis Hospital (Evanston) 

James Zimmerman, Evanston 
St. Francis Hospital Medical Center 
Richard O’Connor, Peoria 
St. Joseph Hospital 

William Manns, Chicago 
SIU School of Medicine/Carbondale 
Roger Wujek, Carbondale 
SIU School of Medicine/Springfield 
James Apesos, Springfield 
Swedish Covenant Hospital 
Ira Moskowitz, Chicago 
University of Illinois Hospital 
James McCreary, Oak Park 
Veterans Administration/North Chicago 
Krishna Venn, North Chicago 

The purposes of the Resident Physicians Section shall 
be to encourage and support the active participation of 
physicians in training in the Illinois State Medical Society 
and to provide representation of intern-resident opinions 
and ideas in organized medicine. In addition, the Resident 
Physicians Section shall support the purposes of the ISMS, 
as stated in its constitution. All in-training members of 
the ISMS shall be members of the Resident Physicians 
Section, having the right to vote and hold office. 


MEDICAL AND ALLIED HEALTH EDUCATION 

MEDICAL SCHOOLS IN THE STATE OF ILLINOIS 


Chicago Medical School, University of Health Sciences 
2020 W. Ogden Ave., Chicago, 60612 
Northwestern University Medical School 
303 E. Chicago Ave., Chicago, 60611 
University of Chicago-Pritzker School of Medicine 
950 E. 59th Street, Chicago 60637 
University of Illinois College of Medicine* 

Chicago Campus- 

1853 W. Polk Street, Chicago, 60612 


Loyola University, Stritch School of Medicine 
2160 S. First Ave., Maywood, 60153 
Rush Medical College 

1725 W. Harrison St., Chicago 60612 
Southern Illinois LTniversity School of Medicine 
801 N. Rutledge, P.O. 3926, Springfield, 62708 
*Note: This is the parent college for Abraham Lincoln 
School of Medicine, Peoria School of Medicine, Rock- 
ford School of Medicine. 


260 


Illinois Medical Journal 


ALLIED HEALTH EDUCATIONAL PROGRAMS 
accredited by the 

American Medical Association Committee on 
Allied Health Education and Accreditation 


CYTOTECHNOLOGIST 

CHICAGO— Michael Reese Hospital & Medical Center 
Mount Sinai Hospital Medical Center 
University of Chicago— Lying-in-Hospital 

HISTOLOGIC TECHNICIAN 

CHICAGO— Mercy Hospital & Medical Center 

Mount Sinai Hospital & Medical Center 
St. Joseph Hospital 

University of Chicago Hospitals & Clinics 
SPRINGFIELD— St. John’s Hospital 

MEDICAL ASSISTANTS 

BELLEVILLE— Belleville Area College 
CARTHAGE— Robert Morris School 
PALATINE— William Rainey Harper College 
RIVER GROVE-Triton College 

MEDICAL LABORATORY TECHNICIAN 

BELLEVILLE— Belleville Area College 
DANVILLE— St. Elizabeth Hospital 
DIXON-Sauk Valley College 
EAST PEORIA— Illinois Central College 
ELGIN— Sherman Hospital Association 
GODFREY— Lewis & Clark Community College 
MORTON GROVE— Oakton Community College 
OLNEY— Richland Memorial Hospital 
PALOS HILLS— Moraine Valley Community College 
QUINCY— Blessing Hospital 
RIVER GROVE-Triton College 

MEDICAL RECORD ADMINISTRATORS 

CHICAGO— University of Illinois College of Medicine 
NORMAL— Illinois State University 

MEDICAL RECORD TECHNICIAN 

BELLEVILLE— Belleville Area College 
CHICAGO— Central YMCA Community College 
EAST PEORIA— Illinois Central College 
GRAYSLAKE— College of Lake County 
MORTON GROVE— Oakton Community College 
PALOS HILLS— Moraine Valley Community College 

MEDICAL TECHNOLOGIST 

BELLEVILLE— St. Elizabeth Hospital 
BLUE ISLAND— St. Francis Hospital 
CHAMPAIGN— Burnham City Hospital 
CHICAGO— Augustana Hospital & Health Care Center 
Grant Hospital of Chicago 
Holy Cross Hospital 
Illinois Masonic Medical Center 
Louis A. Weiss Memorial Hospital 
Mercy Hospital & Medical Center 


Michael Reese Hospital & Medical Center 
Northwestern University Medical School 
Rush-Presbyterian-St. Luke's Medical Center 
St. Anne’s Hospital 
St. Anthony Hospital 
St. Joseph Hospital 
St. Mary of Nazareth Hospital Center 
University of Illinois College of Medicine 
V. A. Lakeside Hospital 
DANVILLE— Lake View Memorial Hospital 
DECATUR— Decatur Macon County Hospital 
St. Mary’s Hospital 
EVANSTON— Evanston Hospital 
FREEPORT— Freeport Memorial Hospital 
GENEVA— Community Hospital 

GREAT LAKES— U.S. Naval Regional Medical Center 
HINES— V.A. Hospital 

HINSDALE— Hinsdale Sanitarium & Hospital 
JOLIET— Silver Cross Hospital 
St. Joseph Hospital 

MAYWOOD— Foster G. McGaw Hosp./Loyola University 
NORTH CHICAGO— University of Health Sciences/ 
Chicago Medical School 
OAK LAWN— Christ Community Hospital 
OAK PARK— West Suburban Hospital Association 
PARK RIDGE— Lutheran General Hospital 
PEORIA— Methodist Medical Center of Central Illinois 
St. Francis Hospital 
QUINCY— St. Mary’s Hospital 
ROCKFORD— Rockford Memorial Hospital 
St. Anthony Hospital 
Swedish-American Hospital 
SPRINGFIELD— St. John’s Hospital 

Sangamon State University 
URBANA— Carle Foundation Hospital 
WAUKEGAN— St. Therese Hospital 
WINFIELD— Central DuPage Hospital 

NUCLEAR MEDICINE TECHNOLOGY 

CHICAGO— Northwestern Memorial Hospital 

St. Mary of Nazareth Hospital Center 
EVANSTON— Evanston Hospital 
HINES-V. A. Hospital 

PARK RIDGE— Lutheran General Hospital 
RIVER GROVE-Triton College 

OPERATING ROOM TECHNICIAN 

BELLEVILLE— Belleville Area College 
CHAMPAIGN— Parkland College 
EAST PEORIA— Illinois Central College 
MOLINE— Lutheran Hospital 

PALOS HILLS— Moraine Valley Community College 
QUINCY— Blessing Hospital 
RIVER GROVE-Triton College 


for October, 1978 


261 


OCCUPATIONAL THERAPIST 

CHICAGO— University of Illinois College of Medicine 

PHYSICAL THERAPIST 

CHICAGO— Northwestern University Medical School 
University of Health Science/ 

Chicago Medical School 
University of Illinois College of Medicine 

RADIOLOGIC TECHNOLOGIST 

ARLINGTON HTS.— Northwest Community Hospital 
BELLEVILLE— Belleville Area College 
CENTRALIA— St. Mary’s Hospital 
CHAMPAIGN— Parkland College 

CHICAGO— Central YMCA Community College 
Cook County Hospital 
DePaul University 
Henrotin Hospital 
Illinois Masonic Medical Center 
Louis A. Weiss Memorial Hospital 
Malcolm X Community College 
Michael Reese Hospital & Medical Center 
Provident Hospital & Training School 
Ravenswood Hospital Medical Center 
St. Anne’s Hospital 
St. Joseph Hospital 
St. Mary of Nazareth Hospital Center 
South Chicago Community Hospital 
University of Illinois Hospital 
Woodlawn Hospital 
Wright Junior College 

DANVILLE— Lake View Medical Center 
DECATUR— Decatur Macon County Hospital 
DIXON— Sauk Valley College 
EAST PEORIA— Illinois Central College 
ELGIN— St. Joseph Hospital 
EVANSTON— St. Francis Hospital 
GALESBURG— Carl Sandburg College 
GLEN ELLYN —College of DuPage 
GRAYSLAKE— College of Lake County 
HINSDALE— Hinsdale Sanitarium & Hospital 
KANKAKEE— Kankakee Community College 
KEWANEE— Kewanee Public Hospital 
MACOMB— McDonough District Hospital 
MALTA— Kishwaukee College 

MOLINE— Lutheran Hospital; Moline Public Hospital 
MORTON GROVE— Oakton Community College 

NORMAL— Bloomington-Normal School of 
Radiologic Technology 


OLNEY— Richland Memorial Hospital 
PALOS HILLS— Moraine Valley Community College 
PEORIA— St. Francis Hospital 
QUINCY— Blessing Hospital 
St. Mary’s Hospital 
RIVER GROVE-Triton College 
ROCKFORD— Rockford Memorial Hospital 
Swedish American Hospital 
ROCK ISLAND— Rock Island Franciscan Hospital 
SOUTH HOLLAND— Thornton Community College 
SPRINGFIELD— Lincoln Land Community College 
Memorial Medical Center 

RESPIRATORY THERAPIST 

CHAMPAIGN— Parkland College 
CHICAGO— Central YMCA Community College 
Malcolm X College 

Northwestern University affiliated hospitals 
University of Chicago Hospitals & Clinics 
MOLINE— Lutheran Hospital 

PALOS HILLS— Moraine Valley Community College 
RIVER GROVE-Triton College 
ROCKFORD— St. Anthony Hospital 
SPRINGFIELD— Memorial Medical Center 

RESPIRATORY THERAPY TECHNICIAN 

CHAMPAIGN— Parkland College 
CHICAGO— Northwestern Memorial Hospital 

University of Chicago Hospitals and Clinics 
MOLINE— Lutheran Hospital 

PALOS HILLS— Moraine Valley Community College 
QUINCY— St. Mary’s Hospital 
ROCKFORD— Swedish American Hospital 
SPRIN GFIELD— St. John’s Hospital 
WAUKEGAN— Victory Memorial Hospital 

RADIATION THERAPY TECHNICIAN 

CHICAGO— Rush-Presbyterian-St. Luke’s Medical Center 

ELGIN— St. Joseph Hospital 

EVANSTON— Evanston Hospital 

HINES-V. A. Hospital 

MOLINE— Luthern Hospital 

ROCKFORD— Swedish American Hospital 

SPECIALIST IN BLOOD BANK TECHNOLOGY 

CHICAGO— Mount Sinai Hospital Medical Center 

University of Illinois College of Medicine 
SPRINGFIELD— St. John’s Hospital 
PARK RIDGE— Lutheran General Hospital 


262 


Illinois Medical Journal 


ILLINOIS STATE 

The state government is divided into three 
branches— legislative, executive and judicial. The 
legislative power is vested in the General Assem- 
bly, which is composed of the State Senate and 
the House of Representatives (a bicameral as- 
sembly). 

For representation in the General Assembly, 
there are 59 Legislative Districts. Each district 
elects one senator and three representatives. Thus, 
the Senate has 59 members and the House 177. 

Under the new constitution, senators are elected 
for 4 year terms, representatives are elected for 2 
year terms. 

The General Assembly shall convene each year on 
the second Wednesday of January. The General 
Assembly shall be a continuous body during the 
term for which members of the House of Repre- 


GOVERNMENT 

sentatives are elected. The General Assembly’s func- 
tions are to enact, amend, or repeal laws or adopt 
appropriation bills, act on amendments to the 
United States Constitution, and act to remove pub- 
lic officials. 

When the House of Representatives is organized, 
a Speaker or presiding officer is elected for the 
biennium. The presiding officer of the Senate is 
the President of the Senate. To facilitate the han- 
dling of legislation, the members of the Senate 
and House are assigned to designated committees 
to consider bills of like subject matter. These 
committees usually hold public hearings to dis- 
cuss legislation before the measure is taken up 
by the entire House or Senate. There are approxi- 
mately 50 committees. 


EXECUTIVE BRANCH 


The Constitution provides that the Executive 
Department shall consist of the Governor, Lieu- 
tenant Governor, Secretary of State, Comptroller, 
Treasurer, and Attorney General. These elected 
officers of the Executive Branch shall hold office for 


four years, beginning on the second Monday of 
January after their election and, except in the case 
of the Lieutenant Governor, until their successors are 
qualified. They shall be elected at the general elec- 
tion in 1976 and 1978 and every four years thereafter. 


STATE OFFICERS 
1977 


Governor, James R. Thompson, Rep., Chicago 

Lieutenant Governor, Dave O’Neal, Rep., 

Belleville 

Secretary of State, Alan J. Dixon, Dem., Belleville 

LEGISLATIVE 

Legislative Procedure 

Each member of the General Assembly has the 
power to introduce bills or resolutions. When a 
bill is introduced it is read at large a first time, 
ordered printed, and referred to the proper com- 
mittee for consideration, except that in case of 
an emergency, a bill may be advanced without 
reference to committee. If the committee recom- 
mends the bill favorably, it is sent to second read- 
ing when amendments to it can be offered for 
consideration by the entire membership. The bill 
will then be given a third and final reading after 
which it is acted upon by the entire membership of 
the house that is considering it. 

Action by Both Houses 

To pass, the bill must receive the favorable vote 
of the majority of the members elected (89 in 
the House; 30 in the Senate). These bills are 
then sent to the other house where essentially 
the same procedure is followed. 

If, because of amendments in the second house, 
there are two versions of the same bill, confer- 
ence committees may be appointed to work out 


Comptroller, Michael J. Bakalis, Dem., 

Downers Grove 

Treasurer, Donald R. Smith, Rep., Springfield 
Attorney General, William J. Scott, Rep., 
Evanston 

Clerk of the Supreme Court, Clell L. Woods, 
Springfield 

BRANCH 

the differences. Both houses must vote favorably 
on the same version of the bill before it can be 
sent to the Governor for his consideration. 

If the Governor thinks the bill should become 
a law, he will sign it. If the Governor decides 
it would be unwise for the bill to become law, he 
can veto it. If he vetoes the bill, he must file a 
statement of objections. Three-fifths of the mem- 
bers elected to each House can override the veto. 
He can also veto specific items of an appropria- 
tion bill and he may reduce an appropriation. The 
Governor may also return a bill to the Legisla- 
ture with specific recommendations for change, 
thereby obviating the need of vetoing the entire 
bill. 


Note 

A Legislative Directory containing the names and 
addresses of all members of the Illinois General As- 
sembly anil the Illinois Senators and Representa- 
tives in the Congress is available. Requests should 
be directed to: Illinois State Medical Society, 

Regional Office, 701 S. Second St., Springfield 62704. 


for October, 1978 


263 


DEPARTMENT OF CHILDREN AND FAMILY SERVICES 


160 North LaSalle Street, Room 315, Chicago 
One North Old State Capitol Plaza, Springfield 
Margaret M. Kennedy, Director 
John Ryan, Executive Deputy Director 


Director’s Office 

Donald H. Schlosser, Director of Staff Services 
Lee A. Iverson, Director of Educational and 
Rehabilitation Services 

John Petrilli, Director of Technical Assistance and 
Monitoring 


Peter Digre, Director of Planning, Research and 
Evaluation 

Gary Anderson, Director of Management Services 
Paul Freedlund, Administrative Assistant to the Director 
(Springfield) 

Steve Bishop, Administrative Assistant to the Director 
(Chicago) 


DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES 

401 S. Spring St., Springfield, 62706 
160 N. La Salle St., Chicago, 60601 
Robert A. deVito, M.D., Director 
Ivan Pavkovic, M.D., Associate Director 

Richard E. Blanton, Ph.D., Associate Director, Developmental Disabilities Services 
Noble Emde, Administrator for Management Services 
Edwin Goldman, Administrator for Community Services & Interagency Affairs 
Roalda Alderman, Superintendent of Alcoholism 8c Dangerous Drugs Liaison 


Office of the Director 

Robert E. Lanier, Special Assistant 

Meyer Proctor, Chief, Office of Public Information 

Alan E. Grischke, General Counsel 

Douglas I. Carey, Legislative Liaison 

David B. Thomas, Chief Auditor 

Dorothy Ackman, Administrative Assistant 

E. Allen Bernardi, Executive Assistant 

Bernard W. Jones, Deputy Executive Assistant 

Thomas Self, Chief, Systems Design 8c Evaluation 

David Klass, M.D., Research Director 

Jack Saporta, Ph.D., Chief, Training 8c Education 

Robert K. Gray 

Director’s Executive Council Members and 
Regional Administrators 

Richard E. Blanton, Ph.D. 


Noble Emde 
Alan E. Grischke 
Douglas I. Carey 
Edwin Goldman 
Roalda Alderman 
John Meyer 
Arthur Dykstra 

Donald Hart, Region 1A Administrator, Rockford 
James Dalzell, Region IB Administrator, Peoria 
Ivan Pavkovic, M.D., Region 2 Acting Administrator, 
Chicago 

Ugo Formigoni, M.D., Region 3A Administrator, 
Springfield 

Dale Kelton, Ph.D., Region 3B Administrator, Decatur 
Joseph Gruber, Ph.D., Region 4 Acting Administrator, 
Alton 

Robert C. Steck, M.D., Region 5 Administrator, Anna 


STATUTORY BOARDS AND COUNCILS 


1. Commission on Mental Health and 
Developmental Disabilities 

Rep. Richard A. Mugalian, Palatine, Chairman 

Mrs. Judy Buchanan, Bloomington 

Hon. John W. Carroll, Park Ridge 

Mrs. Carolyn Chapman, Belleville 

Sen. Earlean Collins-Grant, Chicago 

Sen. Vince Demuzio, Carlinville 

Dr. Vernon Frazee, Morton Grove 

Mrs. Mary Jeanne Hallstrom, Evanston 

Margaret M. Hastings, Ph.D., Kenilworth 

Sen. Vivian Veach Hickey, Rockford 

Rep. James McPike, Alton 

Sen. John J. Nimrod, Glenview 

Sen. Frank M. Ozinga, Evergreen Park 

Mrs. Rose Poelvoorde, Silvis 

Rep. Penny Pullen, Park Ridge 

Rep. Jim Reilly, Jacksonville 

Hon. Esther Saperstein, Chicago 


Rep. Helen Satterthwaite, Champaign 
Sen. Jack Schaffer, Cary 
Rep. Sam Vinson, Clinton 

2. Psychiatric Advisory Council 

Robert A. deVito, M.D., Chairrnan 
Ray Cunningham, M.D., Chicago 
Jarl Dyrud, M.D., Chicago 
Jan Fawcett, M.D., Chicago 
Daniel X. Freedman, M.D., Chicago 
Daniel Offer, M.D., Chicago 
George H. Pollock, M.D., Chicago 
Melvin Prosen, M.D., Chicago 
Frank T. Rafferty, M.D., Chicago 
Lester H. Rudy, M.D., Chicago 
Jackson Smith, M.D., Hines 
Michael Taylor, M.D., North Chicago 
Terry Travis, M.D., Springfield 
Jack Weinberg, M.D., Chicago 


264 


Illinois Medical Journal 


NON-STATUTORY COUNCILS 


1. Citizens’ Advisory Council on Alcoholism 

Paul B. Musgrove, Peoria, Chairman 
Phillip E. Anderson, Danville 
Fern Asma, M.D., Chicago 
Theodor Bernardy, M.D., Springfield 
Robert A. deVito, M.D., Chicago 
Ted Eilerman, Granite City 
G. W. Grawey, M.D., Peoria 
Walter H. Gregg, Ph.D., Evanston 
Ms. LaVerne M. Hawes, Ghicago 
James Jeffers, Chicago 

Margaret M. Kennedy, A.C.S.W., Springfield 

Julio Cesar Montoya, Chicago 

James H. Oughton, Jr„ Dwight 

William J. Penn, Rockford 

Paul Q. Peterson, M.D., Chicago 

Arthur F. Quern, Springfield 

Maxine Rosenbarger, Ph.D., Carbondale 

Charles J. Rowe, Springfield 


W. David Steed, M.D., Oak Park 
William Thomas, Jr., M.D., Chicago 
James West, M.D., Evergreen Park 

2. Citizens’ Advisory Council for Community Services 

Philip Carlson, Peoria, Chairman 

William N. Frayser, Broadview 

Ms. Peggy B. Fultz, Highland Park 

Ms. Elizabeth Gatlin, Evanston 

Helen Hudlin, Ph.D., East St. I.ouis 

Thomas K. Janssen, Nashville 

Douglas Jansson, Evanston 

Arnold Levin, Ph.D., Chicago 

Paul B. Musgrove, Peoria 

Robert Norris, Evergreen Park 

Samuel A. Patch, Chicago 

Hon. James K. Robinson, Danville 

Brockman Schumacher, Ph.D., Carbondale 

Sister Chaminade Kelley, Springfield 


DANGEROUS DRUGS COMMISSION 


The Drug Abuse Offense and Treatment Act of 1972 (PL 
92-255) made federal funds available to the states for the 
purpose of combating drug abuse. In order to receive such 
funds, a state must submit a plan for implementing and 
evaluating an effective program for drug abuse prevention, 
treatment, and rehabilitation. Further, a single state agen- 
cy must be established as the sole agency for the prepara- 
tion and administration of the plan and allocation of 
funds. 

The Dangerous Drugs commission also licenses and reg- 
ulates all drug treatment, education, prevention and re- 
habilitation programs in the state, except those conducted 
within a licensed hospital. The Commission sets treatment 
standards and issues rules and regulations for the opera- 
tion of drug abuse programs. 

Treatment modalities of programs receiving Dangerous 
Drugs Commission funds include methadone maintenance, 
both residential and out-patient; drug free residential and 
out-patient therapy, and hot-line and crisis referral ser- 
vices. In addition to treatment funding, the Dangerous 
Drugs Commission supports drug counselor training for 

Robert A. deVito, M.D., Chicago, Chairman 

Thomas Kirkpatrick, Jr., Exec. Director 

Joseph Cronin, Springfield 

Patricia D. Craig, R.N., Marion 

Stephen Delanty, Palatine 

Tyrone Fahner, Springfield 

James Jeffers, Chicago 

Margaret Kennedy, A.C.S.W., Springfield 

Paul Q. Peterson, M.D., Springfield 

Arthur Quern, Springfield 

Charles Rowe, Springfield 

Joseph Skom, M.D., Chicago 

Dangerous Drugs Advisory Council 

Rep. L. Michael Getty, Dolton, Chairman 
Mrs. Roalda J. Alderman, Chicago 
Joan Anderson, Springfield 
David Blumenfeld, Esq., Chicago 
Murray C. Brown, M.D., Chicago 
Emanuel M. Cannonito, Esq., Blue Island 
Bernard Carey, Esq., Chicago 
Sen. John A. Davidson, Springfield 


previously drug dependent clients as well as clinical staff 
training. 

Since reliable and timely data are essential in evaluating 
the effectiveness of drug abuse treatment and rehabilita- 
tion methods, the Information Services Section of the 
Commission continually collects, analyzes and applies 
data concerning clinical operations (medical workups, 
demographics) and regulatory methadone maintenance 
(counseling, toxicology, prescription dosages.) The Sec- 
tion also keeps a weekly statewide log for methadone clin- 
ics, a continuing inventory of drug abuse program re- 
sources, and a bank of research data on treatment 
modalities. All information is strictly confidential. 

The Toxicology Division of the Dangerous Drugs Com- 
mission is the state laboratory facility which provides 
drug abuse tests to the state’s total client population. The 
lab is subject to the regulations and standards set by the 
FDA, the National Institute of Drug Abuse and the Com- 
mission itself. 

The Dangerous Drugs Commission is located at Marina 
City Office Building, 300 N. State St., Suite 1500, Chicago, 
60610. Phone (312) 822-9860. 

Hon. John D'Arco, Chicago 
Ms. Joan Elbow, Galesburg 
David Fox, M.D., Chicago 
Norman Garfinkel, Oak Park 
Donna Gleespen, Springfield 
Chief Charles A. Gruber, Quincy 
Rep. George Hudson, Hinsdale 
Rep. Tim Johnson, Urbana 
Ernest E. LeQuatte, R.Ph., Herrin 
Hon. Benjamin S. Mackoff, Chicago 
Michael M. Mihm, Esq., Peoria 
Richard Moy, M.D., Springfield 
Sen. Dawn Clark Netsch, Chicago 
Supt. James O’Grady, Chicago 
Robert W. O’Leary, Esq., Oak Brook 
Ben Palmer, Chicago 
Don Pauli, Ph.D., Chicago 
Sen. James Philip, Downers Grove 
David B. Selig, Esq., Wilmette 
Harry Sholl, Lake Forest 
Jay Ulaneck, Chicago 
Rep. Leroy M. VanDuyne, Joliet 


for October , 197 8 


265 


DEPARTMENT OF PUBLIC AID 

316 South 2nd St., Springfield 
Arthur F. Quern, Director 


The Illinois Department of Public Aid administers the 
federally aided public assistance programs:. Aid to Families 
with Dependent Children; Medical Assistance; and pro- 
vides supplemental financial grants to eligible aged, blind, 
or disabled persons. In addition, the department allocates 
state funds to qualified and requesting governmental 
units for the administration of General Assistance; and in 
cooperation with the U.S. Department of Agriculture, ad- 
ministers the Food Stamp program. 

Administrative Staff 

Lynn D. Carter, Executive Assistant to the Director 
David L. Daniel, Assistant Director 
H. Dickson Buckley, Special Assistant to the Director 
(Legislative Liaison) 

Jane Snowden, Special Assistant to the Director 
(Inter-Agency Liaison) 

Johnetta W. Jordan, Chief, Office of Public Information 
Verne H. Evans, General Counsel, Office of Legal Affairs 
Chief Auditor, Vacant 

Robert G. Wessel, Chief Assistant to the Director for 
Field Operations 

Norman Ryan, General Services Administrator 
Mary Ann Langston, Acting Administrator, Policy & 
Planning 

Jeffrey C. Miller, Medical Assistance Program 
Administrator 


Michael Belletire, Deputy Director, Division of 
Social Services 

Legislative Advisory Committee on Public Aid 

Senator Don A. Moore, Midlothian, Chairman 
Representative Fred J. Smith, Chicago, Vice-Chairman 
Senator Richard H. Newhouse, Chicago 
Senator Frank M. Ozinga, Evergreen Park 
Senator Robert I . Lane, Chicago Heights 
Senator Jack Schaffer, Crystal Lake 
Representative Charles M. Campbell, Danville 
Representative A. C. “Junie” Bartulis, Benld 
Representative Emil Jones, Jr., Chicago 
Representative Monroe L. Flinn, Cahokia 
Representative William L. Kempiners, Joliet 
Representative Robert E. Mann, Chicago 

State Medical Advisory Committee 

Fred Z. White, M.D., Chillicothe, Chairman 

Louis Arp, Jr., M.D., Moline 

Donald Hoard, M.D., Chicago 

F. Paul LaFata, M.D., Springfield, Consultant 

George T. Mitchell, M.D., Marshall 

Robert C. Muehrcke, M.D., Oak Park 

Jacob E. Reisch, M.D., Springfield 

Fred A. Tworoger, M.D., Chicago 

Philip G. Thomsen, M.D., Dolton, Ex Officio 


DEPARTMENT OF PUBLIC HEALTH 

535 West Jefferson St., Springfield 62706 
Paul Q. Peterson, M.D., Director 


Robert S. Gleason, Legal Advisor 
Don Vance, Legislative Liaison 


Office of Management Services 

Associate Director 
James H. Thayer 

Affirmative Action & Voluntary Resource 
Dorothy Friedman 
Budget and Fiscal Operation 
George Akehurst 
Vital Records 
Aaron Vangeison 
Education and Information 
Stan Miles 

Electronic Data Processing 
Thomas Stuckey 
General Services 
Joseph Schweska 
Management Audit 
Walter DeWeese 
Implied Consent 
Angelo Garella 
Public Health Laboratories 
Hugh-bert Eberhard, Chief 

Office of Health Facilities and Quality of Care 

Associate Director 

Patricia A. Nolan, M.D. 

Division of Administration 
Betty J. Williams 

Geriatric and Long Term Care Programs 
William Irvine 


Hospital, Laboratories & Acute Care 
Michael Grobsmith 
Development and Construction 
Aden Clump 

Planning and Conformance 
Raymond Passeri 
Ambulatory Care Review 
Leonard A. Kutilek 
Curriculum Development 
Beth J. Walston 
Division of Dental Health 
William Babeaux, D.D.S. 

Division of Disease Control 
Byron J. Francis, M.D. 

Poison Control 
Karen Gregg 
Renal Dialysis 
Ruth Shriner 

Tuberculosis Control, Lead Poisoning, 
Occupational Health 
A1 Grant 

Venereal Disease Control 
John Meitl 

Communicable Disease 
Russell Martin, D.V.M. 

Division of Family Health, 

Maternal & Child Care 
Patricia Hunt, M.D. 

Vision and Hearing 
Phil Shattuck 


266 


Illinois Medical Journal 


Division of Emergency Medical Services and 
Highway Safety 
Bernard Turnock, M.D. 

Hemophilia 
Ruth Shriner 

Nutrition and Social Services 
Pat Fitzgerald 

Office of Health Planning 

Executive Secretary to the SHC.C. 

Roy Armstrong, Jr. 

Special Assistant for SHPDA 
John A. Napier 

Chief, Div. of Planning Coordination 
John H. Cotner, Ph.D. 

Director, State Center for Healtli Statistics 
Charles Bennett, Ph.D. 

Office of Environmental Health 

Leroy Stratton, Associate Director 
Division of Food & Drugs 
Roy Upham, D.V.M. 

STATUTORY BOARDS 
(Allied with Public 

Long-Term Care Facility Advisory Board 

Marian L. Ascoli, Urbana 

Glenda Ashley, M.D., Chicago 

Louis Brackett, Orlancl Park 

Michael N. Fleming, R.N., Franklin Grove 

Mary Gibb, Evanston 

Robert Johnson, M.D., Springfield 

C. F. Kerchner, Fairfield 

Herbert M. Krauss, Evanston 

Peter Mule, Mundelein 

Catherine L. Roe, Cuba 

Allan Roney, Springfield 

Marie Sadlick, LaGrange Park 

Leon Shlofrock, Chicago 

Ray Unterbrink, Springfield 

June Yeske, Bloomington 

Tom Toberman, Springfield, ex-officio 

Robert Lanier, Springfield, ex-officio 

Leroy Cohnen, Springfield, ex-officio 

Patricia A. Nolan, M.D., Chairperson ex-officio 

Drivers License Medical Advisory Board 

Robert Bettasso, M.D., Ottawa 
General Surgeon 
Joel Kaplan, M.D., Chicago 
Ophthalmologist 

James F. Kurtz, M.D., LaGrange 
Orthopedic Surgeon 
Frank Norbury, M.D., Jacksonville 
Internist 

Ronald P. Pawl, M.D., Chicago 
Neurological Surgery 
Paul Schmidt, M.D., Galva 
Family Physician 
Ronald Shlensky, M.D., Chicago 
Psychiatrist 

Alan J. Stutz, M.D., Springfield 
Therapeutic Radiologist 


Division of Sanitation 
Robert Wheatley 

Division of Milk Control 
Harold McAvoy 

Division of Radiological Health 
Maurice Neuweg, Acting 

Division of Engineering 
Jerry Ackerman 

Division of Nuclear Safety 
Gary Wright 

Office of Health Finance 

Thomas J. Walsh, Ph.D., Associate Director 

Division of Hospital Audit 
James H. Handy 

Division of Research and Development 
Thomas J. Walsh, Ph.D. 

Public Health Laboratories 

2121 West Taylor, Chicago, 60612 
134 North 9th Street, Springfield 62706 
P.O. Box 2467, Carbondale 62901 


AND COMMISSIONS 
Health Operations) 

Hazardous Substanees Advisory Council 

Richard C. Reinke, Lemont 
Edward F. O’Toole, Chicago 
Ken Cole, Chicago 
Mrs. Jiffy Johnson, Springfield 

Ambulatory Surgical Treatment Center 
Licensing Board 

Edward A. Brunner, M.D., Skokie 
Dorothy L. Caballero, R.N., Chicago 
Jon M. Dosher, Havana 
Edward D. Gehres, Jr., Decatur 
Donald W. Hugar, D.P.M., River Forest 
Edward J. Jacobs, M.D., Arlington Heights 
Donald Jerome, M.D., Belleville 
Irwin N. Lebow, D.D.S., Normal 
William D. McNobola, M.D., Wilmette 
Peggy Montes, Chicago 
Caryl Towsley Moy, Springfield 
Ruth Surgal, Chicago 

Clinical Laboratory and Blood Bank Advisory Board 

Grant C. Johnson, M.D., Springfield, Chairman 
Thiru Viathanathan, M.D., Skokie 
Wayne N. Leimbach, M.D., Aurora 
Mrs. Dorothea M. Prevo, M.S., Glencoe 
Hugh J. McDonald, Sc.D., Skokie 

Hospital Licensing Board 

Elmer E. Abrahamson, Chicago 
Sister Ann Bailey, Springfield 
Theodor L. Jacobsen, Park Ridge 
Thos. R. Jones, Peoria 
Robert E. Lanier, Springfield 
William M. Lees, M.D., Lincolnwood 
Earl D. Long, D.C., Marion 
M. Frances Nash Terrell, East St. Louis 
Robert H. Reeder, M.D., Geneva 
June Werner, R.N., Evanston 
Marshall Witzel, Wilmette 


for October, 1978 


267 


Radiation Protection Advisory Council 

Larry Lanzl, Ph.D., Chicago, Chairman 

Howard Bulkhead, M.D., Evanston 

Jerome J. Steerman, Urbana 

Seymour Yale, D.D.S., Chicago 

F. E. Demaree, Chicago 

John Rust, D.V.M., Chicago 

Lawrence Levin 

Director of Labor, ex-officio 

Chairman, Commerce Commission, ex-officio 

Illinois Chronic Renal Disease Advisory Committee 

Paul Q. Peterson, M.D., Springfield, Chairman 

Arthur F. Abney, Chicago 

Edmund J. Lewis, M.D., Chicago 

David P. Earle, M.D., Chicago, Consultant 

Alan Ranter, M.D., Chicago 

Robert M. Kark, M.D., Chicago, Consultant 

Robert H. Pflederer, M.D., Peoria 

Franklin D. Schwartz, M.D., Chicago 

Francisco DelGreco, M.D., Chicago 

George Dunea, M.D., Chicago 

Glen Anderson, Chicago 

Alan G. Birtch, M.D., Springfield 

Olga Jonasson, M.D., Chicago 

Dean Stanley, Chicago 

Ewald T. Sorenson, M.D., Rockford 

Harold Schwartz, Lincolnwood 

Richard Bilinsky, M.D., Springfield 

Immunization Advisory Committee 

Mark Lepper, M.D., Hinsdale, Chairman 
John B. Hall, M.D. Chicago 
Joseph R. Kraft, M.D., Chicago 
David Greeley, M.D., Chicago 

Byron J. Francis, M.D., Springfield, Technical Secretary 

James P. Paulissen, M.D., Wheaton 

Daniel J. Pachman, M.D., Chicago 

Loren Boon, M.D., Danvers 

Patricia A. Hunt, M.D., Springfield, Staff 

Health Facilities Planning Board 

Jack T. Knuepfer, Elmhurst, Chairman 

Cornelia West Foley, Rockford 

Nancy B. Jefferson, Chicago 

Robert Petersen, Wheaton 

Mabry Roby, Chicago 

Andrea R. Rozran, Chicago 

Mildred Louise Sammons, East St. Louis 

Jean A. Smith, Manteno 

John M. Stagl, Glenview 

John F. Wayland, LaSalle 

Martin Koldyke, Kenilworth 

Edward Newman, M.D., Chicago 

Paul Q. Peterson, M.D., Chicago, ex-officio 

Robert deVito, M.D., Chicago, ex-officio 

Arthur F. Quern, Springfield, ex-officio 

Tuberculosis Advisory Committee 

Ben Kiningham, Springfield 

Eric Peterson, M.D., Coal Valley 

Mrs. Esther Smith, Chicago 

Virgil Smith, Metropolis 

H. H. Rohrer, M.D., Peoria 

Whitney Addington, M.D., Chicago 

John C. Rogers, Glen Ellyn 

John Weisnar, Cairo 

Advisory Board of Necropsy Service to Coroners 

Thomas H. Hanlon, Arlington Heights 
Welland Hause, M.D., Decatur 
Ronald Kowalski, M.D., Peoria 


Richard H. Lynch, Charleston 
Rae Rairdin, Arlington Heights 
Norman T. Richter, Springfield 
Grover L. Seitzinger, M.D., Danville 
Robert Smith, Jerseyville 
Robert K. Matthews, Chicago 

Statewide Health Coordinating Council 

Alice Adler, Wilmette 

Barbara Anderson, Coal Valley 

Salley D. Berger, Chicago 

Lloyd M. Bertholf, Ph.D., Bloomington 

Timuel D. Black, Chicago 

Paul R. Booth, Chicago 

Curtis K. Brady, Bourbonnais 

John L. Carothers, Chicago 

Julia R. Cihak, R.N., Springfield 

Kenneth W. Cote, Kankakee 

Nicholas Cotsonas, M.D., Peoria 

Doris Dalton, Joliet 

Maria Diaz, Chicago 

Ted Eilerman, Granite City 

John E. Ekblad, Rock Island 

Wilbert Exline, Moline 

Ruth Eyre, Leaf River 

Shirley Flaherty, Elmhurst 

Victoria Gibson, East St. Louis 

Edward Glover, D.C., Peoria 

Eugenia Handler, Carbondale 

Joseph Heimann, Germantown 

Henrietta Herbolsheimer, M.D., Chicago 

Michael S. Holewinski, Chicago 

B. Smith Hopkins, M.D., Urbana 

William Kabisch, Ph.D., Springfield 

Sara Kessler, Decatur 

Judy King, DeKalb 

Mark H. Lepper, M.D., Hinsdale 

Charles Lipe, Springfield 

Sharon Mallek, Chicago 

Cleveland Matthews, Carbondale 

Chester Nosal, Chicago 

Marilyn Nothin, Chicago 

Edward Palmer, Chicago 

James E. Peeples, Peoria 

Esta Pekow, Highland Park 

Edward Perry, O.D., Salem 

Marjorie Quandt, North Chicago 

Robert Quisenberry, Emden 

Hugh Rohrer, M.D., Peoria 

J. Allan Roney, Springfield 

Lois A. Rosen, Chicago 

Sally Safelis, Freeport 

Douglas Spencer, Springfield 

Edward Starr, Oak Park 

Margaret Summers, New Berlin 

John A. Taft, Jr., St. Charles 

John D. Thorpe, D.D.S., LaGrange 

John F. Wayland, LaSalle 

Mollie L. West, Chicago 

Kenneth Wilson, Springfield 

Robert O. Wright, Peoria 

Prevention of Accidental Poisoning in Children 
Advisory Committee 

Byron J. Francis, M.D., M.P.H., Springfield 

J. Keller Mack, M.D., Springfield 

W. L. Crawford, M.D., Rockford 

Paul Pierce, M.D., Alton 

Walter M. Whitaker, M.D., Quincy 

Joseph R. Christian, M.D., Chicago 

John B. Stull, M.D., Olney 


268 


Illinois Medical Journal 


Illinois Health Facilities Authority 

Benjamin Wolfe, Chicago, Executive Director 

Stanford Glass, Winnetka, Chairman 

Roger D. Herrin, D.P.M., Harrisburg, Vice-Chairman 

Charles E. Hayes, Arlington Heights 

Louis G. Alexander, Chicago 

Irene Mills, Decatur 

Tim Miller, Peoria 

Robert Kane, M.D., Herrin 

HMO Advisory Council 

Dean Bordeaux, M.D., Peoria, Acting Chairman 

Sister Marta Goski, Edwardsville 

Henry Kutsch, Chicago 

Roger Murray, R.Ph., Chicago 

E. L. Palmer, Chicago 

Lyn C. Sinclair, R.N., Evanston 

Warren F. Spencer, M.D., Evanston 

Victor Trautmann, M.D., Springfield 

Alcoholism Treatment Licensure Program 
Advisory Board 

Patrick Cullinane, Carbondale, Chairman 
Gene Crooks, Champaign 
Lee Gladstone, M.D., Chicago 
Ben Loudermilk, Jacksonville 
Robert Downs, Oak Park 
Betty Strickland, Park Ridge 
Patricia A. Nolan, M.D., Chairperson , ex-officio 
Roalda J. Alderman, ex-officio 
Dept, of Mental Health and Developmental Disabilities 

Mobile Intensive Care Advisory Board, P.A. 78-1271 

Joseph D. Winterhalter, M.D., Jacksonville, Chairman 

Terrence S. Carden, M.D., Highland Park, Vice-Chairman 

Eugene Cowsert, Wood River 

John Holland, M.D., Springfield 

Kathy LaGreca, R.N., McHenry 

Barbara Lyons, R.N., Waukegan 

Paul Mesnick, M.D., Chicago 

Chief Robert Murray, Bridgeview 

Louis A. Reibling, Ph.D., Belleville 

Susan Weed, Chicago 

Drug Substitution Program Technical Advisory 
Council, P.A., 80-976 

Raymond J. Cicci, R.Ph., Springfield 
Vincent A. Costanzo, R.Ph., M.D., Chicago 
Donald R. Gronewold, R.Ph., Washington 
Dorothy H. Hubler, R.Ph., M.D., Casey 
August P. Lemberger, R.Ph., Ph.D., Chicago 
James T. O’Donnell, R.Ph., Pharm.D., Chicago 
Richard H. Suhs, M.D., Springfield 

Hemophilia Advisory Committee, P.A. 80-859 

Marilyn Hruby, M.D., Chicago 

Naidene Kirwan, Oak Lawn 

Donald E. Ore, D.D.S., Chicago Heights 

William Rushakoff, Chicago 

Dean Stanley, Chicago 

Margaret Telfer, M.D., Chicago 


Robert M. Terzich, Springfield 
Gwendolyn White, M.D., Springfield 


Rape Advisory Board, P.A. 79-564 

Larry S. Boress, Chicago 

Jane Fay, R.N., DeKalb 

Penny Finn, Springfield 

Herb Gardner, Oak Brook 

Michael Grobsmith, Springfield 

Karen Hickman, Chicago 

Karen Kabat, R.N., Springfield 

Max Klinghoffer, M.D., Elmhurst 

Allen N. Koplin, M.D., M.P.H., Springfield 

Goldie Lansky, Chicago 

Nancy Mermelstein, Springfield 

Miriam Moore, R.N., B.S.N., Chicago 

Judy Mostovoy, Park Forest 

Roger Quick, Springfield 

Joseph Rossi, Jr., Chicago 

Fred Schlosser, Jr., Springfield 

Francine Stein, Skokie 

Joseph D. Winterhalter, M.D., Jacksonville 


Advisory Committee for Family Practice Residency 
Act, HB 106. 107; P.A. 84-78, 84-79 

Roy W. Armstrong, Jr., Chicago 
Mrs. John D. Baldwin, Chicago 
John M. Holland, M.D., Springfield 
Martin E. Levitt, D.O., Chicago 
Richard H. Moy, M.D., Springfield 
Jorge Prieto, M.D., Chicago 
Genevieve Alloy Watson, Peoria 
Norman F. Webb, Chicago 
Fred Z. White, M.D., Chillicothe 


Advisory Hospital Council 

Public Agencies 

Robert E. Lanier, Springfield 

Robert G. Wessel, Springfield 

Providers 

Murray Berg, Chicago 
Francis Bihss, M.D., Belleville 
Daniel K. Bloomfield, M.D., Urbana 
David S. Forkosh, M.D., Chicago 
Andrew J. Griffin, M.D., Chicago 
Fredric D. Lake, M.D., Evanston 
Robert M. Magnuson, Elmhurst 
John W. Rice, Chicago 
James P. Streitz, Danville 

Consumers 

Larry Bullock, Chicago 
Margaret Cassin, East St. Louis 
Louise M. Eggert, Oak Lawn 
Hilda E. Frontany, Chicago 
Vera Fina, Riverside 
Susan B. Gende, Moline 
Georgia Gleason, Marselles 
Nancy B. Jefferson, Chicago 
Lee Pravatiner, Chicago 
Geoffrey H. Raymond, Oak Park 


for October, 1978 


269 


NON-STATUTORY BOARDS 

(Allied with Public Health Operations) 


Committee for Revision of the Rules and Regulations 
for the Control of Communicable Diseases 

Byron J. Francis, M.D., Springfield, Chairman 

John B. Hall, M.D., Chicago 

Olga Brolnitsky, M.D., Chicago 

Hugh Rohrer, M.D., Peoria 

Stuart Levin, M.D., Chicago 

Daniel J. Pachman, M.D., Chicago, ex-officio 

Hugh-Bert Everhard, Chicago 

Patricia Hunt, M.D., Springfield 

Advisory Committee for PKU and Other 
Genetically Related Diseases 

Patricia Hunt, M.D., Springfield, Chairman 

Julian Bierman, M.D., Chicago 

John B. Hall, M.D., M.P.H., Chicago 

Edward F. Lis, M.D., Springfield 

Reuben Matalon, M.D., Chicago 

Margaret E. O'Flynn, M.D., Chicago 

Daniel J. Pachman, M.D., Chicago 

Julio Pardo, M.D., Springfield 

Eugene Pergament, M.D., Ph.D., Chicago 

Ira M. Rosenthal, M.D., Chicago 

Parvin Justice, Ph.D., Chicago 

A. R. Sharp., M.D., St. Louis 

Paul Wong, M.D., Chicago 

Hugh-Bert Everhard, Chicago 

Robert T. Martinek, Ph.D., Chicago 

Mindy Pollack, Chicago 

Perinatal Advisory Committee 

Silvio Aladjem, M.D., Chicago, Chairman 

Gail Wilson, Chicago 

John Taft, St. Charles 

John J. Boehm, M.D., Chicago 

Patricia Nolan, M.D., Springfield 

John Madden, M.D., Chicago 

Kofi Amankwah, M.D., Springfield 

Tim Miller, M.D., Peoria 

Gerald Staub, M.D., Rockford 

William Ott, M.D., St. Louis 

Richard Marshall, M.D., St. Louis 

Rosita Pildes, M.D., Chicago 

Merrill W. Huffman, M.D., Urbana 

John R. Powell, M.D., Urbana 

William Hamilton, M.D., Carbondale 

Peter Pleotis, M.D., Arlington Heights 

George Dohrmann, M.D., Chicago 

John Holland, M.D., Springfield 

Gail Scyoc, Alton 


Lillian Runnerstrom, Ph.D., C.N.M., Chicago 
Ben Robbins, M.D., Urbana 
Edward Lis, M.D., Springfield 
Donald Sherline, M.D., Chicago 
Richard M. Nachman, M.D., Chicago 
Helen Simmons, Chicago 
Joseph Orthoefer, D.V.M., Rockford 
William Gottschalk, M.D., Chicago 

Advisory Committee on Pediatric Lead Poisoning 

Fred Z. White, M.D., Chillicothe, Chairman 
A. J. Kiessel, M.D., Decatur, Vice-Chairman 
Ira M. Rosenthal, M.D., Chicago 
Guy A. Pandola, M.D., Joliet 
Eleanor Berman, Ph.D., Chicago 
Henrietta K. Sachs, M.D., Glencoe 
Ronald B. Mack, M.D., Berwyn 
Rowine Hayes-Brown, M.D., Chicago 
Byron J. Francis, M.D., Springfield 
Leroy Stratton, Springfield 

Paul Q. Peterson, M.D., Springfield, Ex-Officio 

Hypertension Advisory Committee 

Eli L. Borkon, M.D., Carbondale, Chairman 

Richard Bilinsky, M.D., Springfield 

Richard Christansen, M.D., Rockford 

Elizabeth Lynch, Springfield 

Ray Restivo, Chicago 

David M. Berkson, M.D., Chicago 

James Schoenberger, M.D., Chicago 

Jeremiah Stamler, M.D., Chicago 

Ella M. Lacey, Carbondale 

George Dunea, M.D., Chicago 

Advisory Committee for the Child Hearing Test Act 

James R. Nelson, Springfield, Exec. Sec. 

Charles Pfotenhauer, Springfield 
Lloyd Mosley, Springfield 
John B. Hall, M.D., Chicago 
Kenneth Mangan, Ed.D., Jacksonville 
Ralph Naunton, M.D., Chicago 
William Plotkin, Ph.D., Chicago 
Paul Rittmanic, Ph.D., Dixon 
Robert K. Simpson, Ph.D., Champaign 
Ann Russell, Chicago 
George Skertich, South Holland 
Bill K. Tilley, Ph.D., Springfield 
William P. Johnson, Ph.D., Jacksonville 
Penny Meyers, Skokie 


POISON CONTROL CENTERS IN ILLINOIS 

For information contact: 

Division of Emergency Medical Services & Highway Safety 
Illinois Department of Public Health 
525 W. Jefferson 
Springfield, 62761 
Phone: (217) 782-5278 


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Illinois Medical Journal 


APPROVED RENAL DIALYSIS FACILITIES, CENTERS AND DIRECTORS 


Illinois Department of Public Health 
Division of Disease Control 

For information contact: 

Mrs. Ruth S. Shriner, ACSW— Coordinator Direct Services 
Programs, Illinois Department of Public Health, 

Room 150, 535 West Jefferson Street, Springfield 62706 
Phone (217) 782-3303 


DEPARTMENT OF REGISTRATION AND EDUCATION 

628 East Adams Street, Springfiield 
55 East Jackson Boulevard, Chicago 


Joan G. Anderson, Director 
Thomas Ortciger, Assistant Director 
Jerry D. Sternstein, Deputy Director-Licensing 
Jacob M. Shapiro, Chief Counsel 
Algis Augustine, Chief Regulatory Officer 


The department is primarily concerned with the regis- 
tration, licensing and enforcement of 30 laws governing 
the different professions, trades and occupations, includ- 
ing the Medical Practice Act. 

The Medical Examining Committee appointed by the 
director of the department operates within the frame- 
work of the act and is charged with the responsibility of 
supervising examinations for licensure and making recom- 
mendations to the Director to grant or refuse to grant 
licenses. The Medical Disciplinary Board hears complaints 
for revocation and suspension of licenses and recommends 
disciplinary action to the Director. 

Medical Examining Committee 

Richard Rovner, M.D., Chicago, Chairperson 


Mays Maxwell, M.D., East St. Louis, Vice-chairperson 

Paul Tullio, D.C., Glen Ellyn, Secretary 

Charles Bobelis, M.D., Dundee 

David Fox, M.D., Chicago 

Robert Behmer, M.D., Rockford 

Medical Disciplinary Board 

Willard C. Scrivner, M.D., Belleville, Chairperson 

George Caleel, D.O., Chicago, Vice-chairperson 

Sam Brinkley, D.C., Alton, Secretary 

Helen C. Bonbrest, M.D., Chicago 

Levon Krikor Topouzian, M.D,, Skokie 

Janies B. Williams, M.D., Chicago 

Raimundo Rodriguez, M.D., Murphysboro 


MEDICAL PRACTICE ACT 


Service on medical committees— Exemption from 
civil liability. § 2b. While serving upon any Medical 
Utilization Committee, Medical Review Committee, 
Patient Care Audit Committee, Medical Care Eval- 
uation Committee, Quality Review Committee, 
Credential Committee, Peer Review Committee or 
any other committee whose purpose, directly or in- 
directly, is internal quality control or medical study 
to reduce morbidity or mortality, or for improving 
patient care within a hospital duly licensed under 
the Hospital Licensing Act, or the improving or 
benefiting of patient care and treatment whether 
within a hospital or not, or for the purpose of pro- 
fessional discipline, any person serving on such com- 
mittee, and any person providing service to such 
committees shall not be liable for civil damages as 
a result of his acts, omissions, decisions, or any other 
conduct in connection with his duties on such com- 
mittees, except those involving willful or wanton 
misconduct. Amended by P.A. 79-1434 § 7, eff. Sept. 
19, 1976; P.A. 80-771, § 3, eff. Oct. 1, 1977. 


Practice by person licensed in another state pend- 
ing examination. § 2c. 

This act does not prohibit the practice of medi- 
cine by a person who is licensed to practice medi- 
cine in all of its branches in any other state of 
the United States or the District of Columbia who 
has applied in writing to the Department, in form 
and substance satisfactory to the Department, for 
a license to practice medicine in all of its branches 
and has complied with all of the provisions of 
Section 13, except the passing of an examination 
which may be given under Section 13, until: 

(a) the expiration of 6 months after the filing of 
such written application, or 

(b) the decision of the Department that the 
applicant has failed to pass an examination with- 
in 6 months or failed without an approved ex- 
cuse to take an examination conducted within 6 
months by the Department, or 

(c) the withdrawal of the application. (Added 
by Act approved July 26, 1971) 


for October, 1978 


271 


Dispensing drugs or medicine— Label.] § 2d. 

Any person licensed under this Act who dis-^ 
penses any drug or medicine shall affix to the 
box, bottle, vessel or package containing the 
same a label indicating (a) the date on which such 
drug or medicine is dispensed; (b) the last name 
of the person dispensing such drug or medicine; 
(c) the directions for use thereof; and (d) the 
proprietary name or names or, if there is none, 
the established name or names of the drug or 
medicine, the dosage and quantity, unless the per- 
son dispensing the drug or medicine determines 
that the health of the person to whom the drug 
or medicine is dispensed requires that such infor- 
mation be omitted. This Section shall not apply 
to drugs or medicines in a package which bears a 
label of the manufacturer containing information 
describing its contents which is in compliance with 
requirements of the Federal Food, Drug and Cos- 
metic Act and the Illinois Food, Drug and Cos- 
metic Act and which is dispensed without con- 
sideration by a practitioner licensed under this Act. 
“Drug” and “medicine” have the meaning ascribed 
to them in the “Pharmacy Practice Act,” approved 
July 11, 1955, as now or hereafter amended. 
Formerly § 2c. Renumbered § 2d by P.A. 77-1849, 
§ 3, eff. July 1, 1972. 

§ 2d5. Minimum standards of professional educa- 
tion. Except as provided in Section 9a of this Act, 
the minimum standards of professional education to 
be enforced by the department in conducting 
examinations and issuing licenses shall be as fol- 
lows: 

1. Practice of Medicine. For the practice of 
medicine in all of its branches: 

(a) For an applicant who is a graduate of a 
medical college before the passage of this Act, 
that such medical college at the time of his gradu- 
ation required as a prerequisite to graduation a 4 
years’ course of instruction of not less than 9 
months each, in such medical college, or its equi- 
valent, the time elapsing between the beginning of 
the first year and the ending of the fourth year hav- 
ing been not less than 40 months, and which was 
reputable and in good standing in the judgment of 
the department; and prior to taking such examina- 
tion said applicant must present proof that he has 
completed a 4 years’ course of instruction in a 
high school or its equivalent as determined by an 
examination conducted by the department. 

(b) For an applicant who is a graduate of a 
medical college after the passage of this Act, that 
such medical college at the time of his gradua- 
tion required as a prerequisite to admission there- 
to 2 years’ course of instruction in a college of 
liberal arts, or its equivalent, or in such medical 
college, and a course of instruction in a medical 
college in the treatment of human ailments, which 
course shall have been not less than 132 weeks 
in duration and shall have been completed within 
a period of not less than 35 months, and in addition 
thereto, a course of clinical training of not less 
than 12 months in a hospital, such college of lib- 
eral arts, medical college and hospital having been 
reputable and in good standing in the judgment of 
the department. The time requirement of not less 
than 132 weeks within a period of 35 months, set 
forth above, may be reduced by the department 
upon recommendation of the Dean of the medical 
school in the case of programs involving students 


with advanced standing. 

(c) For an applicant who is a graduate of a medi- 
cal college or school in another country; that such 
applicant was a resident of this State for a period 
of five years prior to matriculating in such medical 
college or school; that such applicant completed a 
required course of instruction in the treatment of 
human aliments as offered by such college or school 
of medicine, which course shall have been not less 
than 132 weeks in duration and shall have been 
completed within a period of not less than 35 
months; that such applicant has completed a mini- 
mum of three years’ course of instruction in an ac- 
credited college of liberal arts or its equivalent; that 
such applicant submit an application to an Illi- 
nois medical school and submit to such testing 
procedures, including use of nationally recognized 
medical student tests and/or tests devised by the 
individual medical school, to determine equivalency 
of education compared to state norms, such testing 
could be utilized in placement of such applicant at 
a level appropriate to educational achievement; that 
such applicant may be placed by an Illinois medi- 
cal school into the appropriate level of medical 
school, thru internship training, provided that ap- 
plicant agrees to pay, either by a scholarship or 
some other personal means, such tuition and fees 
necessary to complete medical education, and pro- 
vided that such applicant signs a statement in a 
form to be determined by the Department that 
upon successful completion of all licensure require- 
ments applicant intends to practice medicine in this 
State. Upon completion of such course or activity of 
didactic and medical training as specified by an 
accepting medical school, applicant shall be eligible 
for award of an M.D. degree and examination and 
licensing for the practice of medicine in all of its 
branches as provided in this act and upon payment 
of the fee provided in paragraph (a) of sub-section 
4 of Section 4 of this Act. 

(d) Until September 1, 1988, for an applicant 
who has studied medicine at a medical college or 
school located outside the United States; that such 
applicant has completed all of the formal require- 
ments of a foreign medical school except internship 
and/or social service, which course shall have been 
not less than 132 weeks in duration and shall have 
been completed within a period of not less than 
35 months; that such applicant has completed a 
minimum of 3 years’ course of instruction in an 
accredited college of liberal arts or its equivalent; 
that such an applicant has submitted an application 
to a medical school recognized by the Department 
and submitted to such evaluation procedures, in- 
cluding use of nationally recognized medical student 
tests and/or tests devised by the individual medical 
school and that such applicant has satisfactorily 
completed one academic year of supervised clinical 
training under the direction of such medical school; 
and, after completion of said academic year of 
supervised clinical training, that such applicant has 
satisfactorily completed twelve months of post grad- 
uate training in an approved hospital having been 
reputable and in good standing in the judgment of 
the Department; and provided that such applicant 
sign a statement and a form, to be determined by 
the Department, that upon successful completion 
of all license requirements, applicant intends to 
practice medicine in this state. Upon completion of 
such course or activity of didactic and medical 
training as specified by an accepting medical school, 


2 


Illinois Medical Journal 


applicants shall be eligible for examination and 
licensing for the practice of medicine in all of its 
branches as provided in this Act and upon payment 
of the fee provided in paragraph (a) of sub-sec- 
tion 4 of Section 4 of this Act. 

Until September 1, 1988, satisfaction of the re- 
quirements of this sub-section shall be in lieu of 
the completion of any foreign internship and/or 
social service requirements, and no such require- 
ments shall be a condition of licensure as a physi- 
cian in this State. 

Until September 1, 1988, satisfaction of the re- 
quirements of this sub-section shall be in lieu of 
certification by the Educational Council for Foreign 
Medical Graduates, and such certification shall not 
be a condition of licensure as a physician in this 
State for candidates who have completed the re- 
quirements of this sub-section. 

Until September 1, 1988, no hospital licensed by 
the State, or operated by the State or political sub- 
division thereof, or which receive State financial as- 
sistance, directly or indirectly, shall require an 
individual who at the time of his enrollment in a 
medical school outside the United States is a citizen 
of the United States, to satisfy any requirement 
other than those contained in this sub-section prior 
to commencing an internship or residency. 

Until September 1, 1988, a document granted by 
a medical school located outside the United States 
which certifies completion of all of the formal train- 
ing requirements of such foreign medical school 
except internship and/or social service; and satis- 
factory completion of the examination and academic 
year of supervised clinical training at a medical 
school recognized by the Department referred to in 
this sub-section shall be deemed the equivalent of 
the degree of Doctor of Medicine for purposes of 
licensure and practice as a physician in this State 
and shall possess all the rights and privileges there- 
of. 

The Illinois Board of Higher Education may 
make grants to Illinois Medical Schools, public and 
private, for each applicant who commences his 
academic year of supervised clinical training under 
the direction of said medical school. Preference shall 
be given in the award of these grants to Illinois 
residents. The Illinois Board of Higher Education 
shall by regulation adopt reasonable guidelines for 
the distribution of funds authorized by this Act. 
(Added by Act approved Sept. 7, 1974) . 

2. Treating human ailments without drugs or 
medicines and without operative surgery. For the 
practice of any system or method of treating hu- 
man ailments without the use of drugs or medi- 
cines and without operative surgery: 

(a) For an applicant who was a resident stu- 
dent and who is a graduate before July 1, 1926, 
of a professional school, college or institution which 
taught the system or method of treating human 
ailments, which he specifically designated in his 
application as the one he would undertake to prac- 
tice, that such school, college or institution at the 
time of his graduation required as a prerequisite 
to graduation a 3 years’ course of instruction of 
not less than 6 months each, the time elapsing be- 
tween the beginning of the first year and the end- 
ing of the third year having been not less than 22 
months, and which are reputable and in good 
standing in the judgment of the department and 
prior to taking the examination the applicant must 
present proof that he has completed a 4 years’ 


course of instruction in high school, or its equi- 
valent, as determined by an examination conducted 
by the department. 

(b) For an applicant who was a resident stu- 
dent and who is a graduate after July 1, 1926, of 
a professional school, college or institution which 
taught the system or method of treating human 
ailments which he specifically designated in his ap- 
plication as the one which he would undertake to 
practice, that such school, college or institution at 
the time of his graduation required as a prerequi- 
site to admission thereto a 4 years’ course of in- 
struction in a high school, and as a prerequisite to 
graduation therefrom a course of instruction in the 
treatment of- human ailments, of not less than 132 
weeks in duration and shall have been completed 
within a period of not less than 35 months except 
that as to students matriculating or entering upon a 
course of study of any system or method of treating 
human ailments without the use of drugs or medi- 
cines and without operative surgery during the 
years 1940, 1941, 1942, 1943, 1944, 1945,^1946 
and 1947, the said elapsed time shall be not less 
than 32 months, such high school and such school, 
college, institution having been reputable and in 
good standing in the judgment of the department. 

(c) For an applicant who is a matriculant in 
a chiropractic college after September 1, 1969, that 
such applicant shall be required as a prerequisite 
for admission to examine for licensure, to com- 
plete a 2 years’ course of instruction in a liberal 
arts college or its equivalent, and a course of 
instruction in a chiropractic college in the treat- 
ment of human ailments, such course as a pre- 
requisite to graduation therefrom having been not 
less than 132 weeks in duration and shall have 
been completed within a period of not less than 
35 months, such college of liberal arts and chiro- 
practic college having been reputable and in good 
standing in the judgment of the Department. 

3. Midwifery. For the practice of midwifery; 
That he be a graduate of a college of midwifery 
which requires as a prerequisite to admission there- 
to, a one year’s course of instruction in a high 
school or its equivalent, and required as a pre- 
requisite to graduation, a one year’s course in such 
college of midwifery, the time actually spent under 
instruction in such college of midwifery to have 
been not less than 12 months; such high school 
or equivalent school, and such college of mid- 
wifery having been in good standing in the judg- 
ment of the department. 

Without prejudice to licenses heretofore issued 
under this section, no further licenses shall be 
issued under this section after the effective date of 
this amendment. Amended by P.A. 80-368. § 1, eff. 
Oct. 1, 1977. 


Continuing Education 

Continuing education— Recommendations by Ex- 
amining Committee] 

The Department, based on the written recom- 
mendation of the Examining Committee, shall pro- 
mulgate mandatory requirements of continuing ed- 
ucation for persons licensed pursuant to this Act. 
In establishing such recommendations, the Com- 
mittee shall: 

(1) Develop practical and meaningful criteria for 
defining and describing continuing education 


for October, 1978 


273 


requirements which meet, but are not limited 
to, the following specifications: 

(a) Readily available to all practicing physi- 
cians in Illinois without undue commit- 
ment of time away from practice and ex- 
pense on the part of the practitioner. 

(b) Compatible with existing requirements of 
licensing agencies in other states. 

(c) Compatible with the requirements of medi- 
cal specialty boards for recertification of 
specialty status. 

(d) Compatible with the continuing education 
requirements developed by national medi- 
cal specialty societies. 

(e) Compatible with continuing education pro- 
grams and requirements that are developed 
in federally mandated peer review pro- 
grams and as a part of Professional Stan- 
dards Review Organizations. 

(f) Provides for differing requirements for li- 
censees engaged in other than direct pa- 
tient care (example: educators, researchers 
and those engaged in medical administra- 
tion) . 

(g) Provides for compatible requirements for 
licensees in the federal uniformed services, 
those engaged in formal residency and fel- 
lowship training programs, and licensees 
operating under hospital permit licensure. 

(2) Conceive, develop and evaluate procedures, 
materials and systems to carry out the admin- 
istrative requirements of this legislation which 
include, but are not limited to, the following: 

(a) Procedures for prompt and fair evaluation 
of reports of educational achievement sub- 
mitted by licensees. 

(b) Requirements and position descriptions for 
personnel engaged in reviewing and eval- 
uating reports and continuing educational 
achievements submitted by licensees. 

(c) A data recording system for gathering, 
analyzing, storing and retrieving informa- 
tion on individual licensee educational ac- 
complishments. 

(d) Provision for licensee to appeal adverse 
actions and temporary exemptions from 
requirements under unusual circumstances. 

(e) Exemption from legal prosecution of all 
persons responsible for action taken under 
the program. 

(f) Establishment of realistic budgeting and 
cost requirements for the personnel, and 
operational funds necessary to plan, develop 
and operate the program. 

(g) Procedures for surveying and evaluatin 0 
the effectiveness of the program. 

(h) Orderly procedures for adequate notice to 
licensee of pending action that may result 
in non-renewal of license, including pro- 
visions for consultation and assistance in 
time for him to meet the requirements of 
this Act. 

(3) Develop adequate protection for information 
about licensee participation in continuing ed- 
ucation as it pertains to all aspects of practice 
liability and the licensee’s public image and 
his relationships with individual patients. 

(4) Develop an advisory panel for each category of 
licensee to advise and assist the department in 
development and application of continuing 
education criteria, administrative procedures 
and policy. 


(5) Develop procedures for assuring that the ed- 
ucational opportunities available to licensees 
for fulfilling the requirements of this act are 
of appropriate scope, variety, depth and of 
high quality. 

The Department shall enforce these requirements; 
however, the Department shall be empowered to 
waive enforcement of these requirements in locali- 
ties where it is demonstrated that the absence of 
opportunities for such education would interfere 
with the adequacy of medical services in that local- 
ity. Added by P.A. 79-1136, §1, eff. July 1, 1976. 

Revocation and Suspension of License or 
Certificate 

Revocation and suspension of license or certifi- 
cate— Grounds— Limitation— Insanity— Resumption of 
practice on restoration .] 

The Department may revoke, suspend, place 
on probationary status, or take any other discipli- 
nary action as the Department may deem proper 
with regard to the license, certificate or state 
hospital permit of any person issued under this 
Act or under any other Act in this State to prac- 
tice medicine, to practice the treatment of human 
ailments in any manner or to practice midwifery, 
or may refuse to grant a license, certificate or 
state hospital permit under this Act or may grant 
a license, certificate or State hospital permit on 
a probationary status subject to the limitations 
of the probation, and may cause any license or cer- 
tificate which has been the subject of formal dis- 
ciplinary procedure to be marked accordingly on 
the records of any county clerk upon the follow- 
ing grounds: 

1. Performance of an elective abortion in any 
place, locale, facility, or institution other than: 

(a) a facility licensed pursuant to the “Am- 
bulatory Surgical Treatment Center Act” 
as heretofore or hereafter amended; 

(b) an institution licensed pursuant to “An 
Act relating to the inspection, supervision, 
licensing and regulation of hospitals,” 
approved July 1, 1953, as heretofore or 
hereafter amended; or 

(c) an ambulatory surgical treatment center 
or hospitalization care facility maintained 
by the State or any agency thereof, where 
such department or agency has authority 
under law to establish and enforce stan- 
dards for the ambulatory surgical treat- 
ment centers, hospitalization, or care fa- 
cilities under its management and control, 
or 

(d) ambulatory surgical treatment centers, hos- 
pitalization or care facilities maintained 
by the Federal Government; or 

(e) ambulatory surgical treatment centers, hos- 
pitalization or care facilities maintained 
by any university or college established 
under the laws of this State and supported 
principally by public funds raised by 
taxation; 

2. Conviction in this or another state of any 
crime which is a felony under the laws of 
this State or conviction of a felony in a 
federal court, unless such person demonstrates 


274 


Illinois Medical Journal 


to the Department that he has been sufficiently 
rehabilitated to warrant the public trust; 

3. Gross or repeated malpractice resulting in seri- 
ous injury or death of a patient; 

4. Engaging in dishonorable, unethical or un- 
professional conduct of a character likely 
to deceive, defraud, or harm the public; 

5. Obtaining a fee, either directly or indirectly, 
either in money or in the form of anything 
else of value or in the form of financial 
profit as personal compensation, or as com- 
pensation, charge, profit or gain for an em- 
ployer or for any other person or persons, 
on the fraudulent representation that a mani- 
festly incurable condition of sickness, disease 
or injury or any person can be permanently 
cured; 

6. Habitual intemperance in the use of ardent 
spirits, narcotics, or stimulants to such an 
extent as to incapacitate for performance 
of professional duties; 

7. Holding one’s self out to treat human ail- 
ments under any name other than his own, 
or the personation of any other physician; 

8. Employment of fraud, deception or any un- 
lawful means in applying for or securing a 
license, certificate, or state hospital permit 
to practice the treatment of human ailments 
in any manner, to practice midwifery, 
or in passing an examination therefor, or 
willful and fraudulent violation of the rules 
and regulations of the department governing 
examinations; 

9. Holding one’s self out to treat human ail- 
ments by making false statements or by spe- 
cifically designating any disease, or group of 
diseases and making false claims of one’s skill, 
or the efficacy or value of one’s medicine, 
treatment or remedy therefore; 

10. Professional connection or association with, 
or lending one’s name to, another for the 
illegal practice by another of the treatment 
of human ailments as a business, or profes- 
sional connection or association with any 
person, firm, or corporation holding himself, 
themselves, or itself out in any manner con- 
trary to this Act; 

11. Revocation or suspension of a medical li- 
cense in a sister state; 

12. A violation of any provision of this Act or 
of the rules and regulations formulated for 
the administration of this Act; 

13. Except as otherwise provided in Section 
16.01, advertisting or soliciting by himself or 
through another, by means of handbills, pos- 
ters, circulars, stereopticon slides, motion 
pictures, radio, newspapers or in any other 
manner for professional business. 

14. Directly or indirectly giving to or receiving 
from any physician, person, firm or corpora- 
tion any fee, commisson, rebate or other 
form of compensation for any professional 
services not actually and personally rendered. 
Nothing contained in this subsection prohibits 
persons holding valid and current licenses 
under this Act from practicing medicine in 


partnership under a partnership agreement or 
in a corporation authorized by “The Medical 
Corporation Act” as now or hereafter amend- 
ed or as an association authorized by “The 
Professional Association Act” as now or here- 
after amended, or under “The Professional 
Corporation Act” as now or hereafter 
amended, from pooling, sharing, dividing or 
apportioning the fees and monies received by 
them or by the partnership, corporation or 
association in accordance with the partner- 
ship agreement or the policies of the Board 
of Directors of the corporation or association. 
Nothing contained in this subsection shall 
abrogate the right of two or more persons 
holding valid and current licenses under this 
Act to receive adequate compensation for con- 
currently rendering professional services to a 
patient and divide a fee: provided, the pa- 
tient has full knowledge of the division, and 
provided that the division is made in propor- 
tion to the services performed and respon- 
sibility assumed by each. 

15. A finding by the Medical Disciplinary Board 
that the registrant after having his license 
placed on probationary status violated the 
terms of the probation. 

16. All advertising of medical business which is 
intended, or has a tendency, to deceive the 
public or impose upon credulous or ignorant 
persons and so be harmful or injurious to 
public morals or safety. 

17. All advertising of any medicine or of any means 
whereby the monthly menses of women can be 
regulated or reestablished if suppressed. 

18. Abandonment of a patient. 

19. The use of prescription for use of narcotics or 
controlled substances (designated products) in 
any way other than for therapeutic purposes. 

20. Promotion of the sale of drugs, devices, appli- 
ances or goods provided for a patient in such 
manner as to exploit the patient for financial 
gain of the physician. 

21. Offering, undertaking or agreeing to cure or 
treat disease by a secret method, procedure, 
treatment or medicine, or the treating, operat- 
ing or prescribing for any human condition by 
a method, means or procedure which the li- 
censee refuses to divulge upon demand of the 
Department of Registration and Education. 

22. Immoral conduct in practice as a physician, or 
repeated acts of gross misconduct. 

23. Willfully making or filing false records of 
reports in his practice as a physician. 

24. Willful omission to file or record, or willfully 
impeding the filing or recording or inducing 
another person to omit to file or record medi- 
cal reports as required by law. 

25. Solicitation of professional patronage by any 
corporation, agents or persons, or profiting from 
those representing themselves to be agents of 
the licensee. 

26. Gross and willful and continued overcharging 
for professional services, including filing false 
statement for collection of fees for which ser- 
vices are not rendered. 

27. Professional incompetence as manifested by 
poor standards of care or mental incompetency 
as declared by a court of competent jurisdic- 
tion. 

28. Physical illness, including, but not limited to, 


for October, 197S 


275 


deterioration through the aging process, or loss 
of motor skill which results in a physician’s 
inability to practice medicine with reasonable 
judgment, skill or safety. 

All proceedings to suspend, revoke, place on 
probationary status, or take any other dis- 
ciplinary action as the Department may deem 
proper with regard to a license, certificate or 
state hospital permit on any of the foregoing 
grounds, except the ground numbered 8 
(fraudulent groups expected) must be com- 
menced within 3 years next after the conviction 
or commission of any of the acts described 
therein, except as otherwise provided by law; 
but the time during which the holder of the 
license, certificate or state hospital permit was 
without the State of Illinois shall not be in- 
cluded within the 3 years. 

The entry of an order or judgment by any 
circuit court establishing that any person hold- 
ing a license, certificate or state hospital per- 
mit under this Act is a person in need of 
mental treatment operates as a suspension of 
that license, certificate or state hospital permit. 
That person may resume his practice only upon 
a finding by the Medical Disciplinary Board 
that he has been determined to be recovered 
from mental illness by the court and upon the 
Board’s recommendation that he be permitted 
to resume his practice. 

Amended by P.A. 79-1130, § ;. [Nov. 2] 21. 1075, 
P.A. 79-13 1434, § eff. Sept. 19, 1976. 

Listing of name, title, etc. 

Section 16.01. Any person licensed under this Act 
may list his name, title, office hours, address, 
telephone number and any specialty in profes- 
sional and telephone directories; may announce 
by way of a professional card not larger than 
3 Vi inches by 2 inches, only his name, title, de- 
gree, office location, office hours, phone num- 
ber, residence address and phone number and 
any specialty; may list his name, title, address 
and telephone number and any specialty in public 
print limited to the number of lines necessary 
to state that information; may announce his 
change of place of business, absence from, or 
return to business in the same manner; or may 
issue appointment cards to his patients, when 
information thereon is limited to the time and 
place of appointment and that information per- 
mitted on the professional card. Listings in public 
print, in professional and telephone directories 
or announcements of change of place of business, 
absence from, or return to business, may not be 
made in bold faced type. 

Added by act approved July 18, 1967. 

Medical Disciplinary Board 

Illinois State Medical Disciplinary Board.] § 16.02. 

There is hereby created the Illinois State Medical 
Disciplinary Board, (hereinafter referred to as the 
“Board”) . The Board shall consist of 7 members, 
appointed by the Governor by and with advice and 
consent of the Senate. All shall be residents of the 
State, not more than 4 of whom shall be members 
of the same political party. Five members shall be 
physicians licensed to practice medicine in all of 
its branches in Illinois. One member shall be an 
Illinois physician possessing the degree of doctor of 


osteopathy. One member shall be a person licensed 

in Illinois and possessing a chiropractor’s degree. 

a. Of the members of the Board first appointed, 
two shall be appointed for terms of 2 years, two 
shall be appointed for terms of 3 years, and 
three shall be appointed for terms of 4 years. 
Upon the expiration of the term of any mem- 
ber, his successor shall be appointed for a term 
of four years by the Governor by and with the 
advice and consent of the Senate. The Governor 
shall fill any vacancy for the remainder of the 
unexpired term by and with the advice and con- 
sent of the Senate. Upon recommendation of the 
Board, any member of the Board may be re- 
moved by the Governor for misfeasance, malfea- 
sance, or willfull neglect of duty after notice and 
a public hearing unless such notice and hearing 
shall be expressly waived in writing. Each mem- 
ber shall serve on the Board until his successor 
is appointed and qualified. No member of the 
Board shall serve more than two consecutive 
four year terms. 

In making appointments the Governor shall 
attempt to insure that the various social and 
geographic regions of the State of Illinois are 
properly represented. 

In making the designation of persons to act for 
the several professions represented on the Board, 
the Governor shall give due consideration to 
recommendations by members of the respective 
professions and by organizations therein. 

b. The Board shall annually elect one of its mem- 
bers as chairman, one as vice chairman and one 
as secretary. No officer shall be elected more 
than twice in succession to the same office. Each 
officer shall serve until his successor has been 
elected and qualified. 

c. The secretary shall keep a record of the pro- 
ceedings of the Board and shall be custodian of 
all books, documents and papers filed with the 
Board, including the minute book or journal of 
the Board. The secretary or other persons au- 
thorized by the Board may cause copies to be 
made of all minutes and other records and docu- 
ments of the Board and may give certificates of 
the Board to the effect that such copies are 
true copies, and all persons dealing with the 
Board may rely upon such certificates. 

d. Four members of the Board shall constitute a 
quorum. A vacancy in the membership of the 
Board shall not impair the right of a quorum 
to exercise all the rights and perform all the 
duties of the Board. Any action taken by the 
Board under this Act may be authorized by re- 
solution at any regular or special meeting and 
each such resolution shall take effect immedi- 
ately. The Board shall meet at least quarterly. 
The Board is empowered to adopt all rules and 
regulations necessary and incident to the powers 
granted to it under this Act. 

e. Each member, and member-officer, of the Board 
shall receive a per-diem stipend as the Director 
of the Department of Registration and Education, 
hereinafter referred to as the Director, shall 
determine. Each member shall be paid his 
necessary expenses while engaged in the per- 
formance of his duties. 

f. The Director shall, in conformity with the 
‘‘Personnel Code,” as now or hereafter amended, 
select a medical coordinator, who shall not be a 
member of the Board. The medical coordinator 
shall be a physician licensed to practice medicine 


276 


Illinois Medical Journal 


in all of its branches, and the Director shall 
set his rate of compensation. The medical co- 
ordinator shall be the chief enforcement officer 
of the Medical Practice Act and shall serve at 
the will of the Board. 

The Director shall employ, in conformity with 
the Personnel Code, not less than one (1) full 
time investigator for every 5000 physicians li- 
censed to practice medicine in the State. Each 
investigator shall be a college graduate with at 
least two years’ investigative experience or one 
year advanced medical education. Upon the 
written request of the Board, the Director shall 
employ, in conformity with the Personnel Code, 
such other professional, technical, investigative, 
and clerical help, either as a full or part-time 
basis as the Board deems necessary for the 
proper performance of its duties. All employees 
of the Board shall be directed by, and answer- 
able to, the Board with respect to their duties 
and functions. 

g. Upon the specific request of the Board, signed 
by either the chairman, vice chairman, or medi- 
cal coordinator of the Board, the Bureau of 
Drug Compliance, the Office of Professional 
Supervision of the Department of Registration 
and Education, the Illinois Law Enforcement 
Commission, the Illinois Bureau of Investigation, 
the Illinois Legislative Investigating Commission 
shall: 

(1) Make available any and all information that 
they shall have in their possession regarding 
a particular case then under investigation 
by the Board. 

h. Members of the Board shall be immune from 
suit in any action based upon any disciplinary 
proceedings of other acts performed in good 
faith as members of the Board. 

Added by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Suspension or revocation of license or certificate— 
Investigation— Notice— Hearing.] § 17.01 Upon the 
motion of either the Department or the Board or 
upon the verified complaint in writing of any per- 
son setting forth facts which if proven would con- 
stitute grounds for suspension or revocation under 
Section 16 of this Act, the Department shall, 
through the Board, investigate the actions of any 
person, so accused who holds or represents that he 
holds a license or certificate. Such person is here- 
inafter called the accused. 

The Department shall, before suspending, revok- 
ing, placing on probationary status, or taking any 
other disciplinary action as the Department may 
deem proper with regard to any license or certifi- 
cate, at least 30 days prior to the date set for the 
hearing, notify the accused in writing of any 
charges made and the time and place for a hearing 
of the charges before the Board, direct him to file 
his written answer thereto the Board under oath 
within 20 days after the service on him of such no- 
tice and inform him that if he fails to file such an- 
swer default will be taken against him and his li- 
cense or certificate may be suspended, revoked, 
placed on probationary status, or have other disci- 
plinary action, including limiting the scope, nature 
or extent of his practice, as the Department may 
deem proper taken with regard thereto. 

Such written notice and any notice in such pro- 
ceedings thereafter may be served by delivery of 
the same personally to the accused person, or by 
mailing the same by registered or certified mail to 


the address last theretofore specified by the ac- 
cused in his last notification to the Department. 
Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Hearings by board— Continuance— Failure to file 
ansxuer— Disciplinary action— T emporary suspension 
of license without hearing.] § 17.02 At the time 
and place fixed in the notice, the Board provided 
for in this Act shall proceed to hear the charges 
and both the accused person and the complainant 
shall be accorded ample opportunity to present in 
person, or by counsel, such statements, testimony, 
evidence and argument as may be pertinent to the 
charges or to any defense thereto. The Board may 
continue such hearing from time to time. If the 
Board is not sitting at the time and place fixed in 
the notice or at the time and place to which the 
hearing has been continued, the Department shall 
continue such hearing for a period not to exceed 
30 days. 

In case the accused person, after receiving no- 
tice, fails to file an answer, his license or certifi- 
cate may in the discretion of the Director, having 
received first the recommendation of the Board, be 
suspended, revoked, placed on probationary status, 
or the Director may take whatever disciplinary ac- 
tion as he may deem proper, including limiting the 
scope, nature, or extent of said person’s practice, 
without a hearing, if the act or acts charged con- 
stitute sufficient grounds for such action under 
this Act. 

The Board has the authority to recommend to 
the Director that probation be granted or that oth- 
er disciplinary action, including the limitation of 
the scope, nature or extent of a person's practice, 
be taken as it deems proper. If disciplinary action 
other than suspension or revocation is taken, the 
Board may recommend that the Director impose 
reasonable limitations and requirements upon the 
accused registrant to insure compliance with terms 
of the probation or other disciplinary action in- 
cluding, but not limited to, regular reporting by 
the accused to the Department of his actions, plac- 
ing himself under the care of a qualified physician 
for treatment, or limiting his practice in such man- 
ner as the Director may require. 

The Director may temporarily suspend the li- 
cense of a physician without a hearing, simultane- 
ously with the institution of proceedings for a 
hearing provided under this Section if the Director 
finds that evidence in his possession indicates that 
a physician’s continuation in practice would con- 
stitute an immediate danger to the public. In the 
event that the Director suspends, temporarily, the 
license of a physician without a hearing, a hearing 
by the Board must be held within 15 days after 
such suspension has occurred. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Subpoena of witnesses— Administration of oath.] 
§ 17.03 The Board or Department has power to 
subpoena and bring before it any person in this 
State and to take testimony either orally or by de- 
position, or both, with the same fees and mileage 
and in the same manner as is prescribed by law 
for judicial procedure in civil cases. 

The Director, Assistant Director, Superintendent 
of Registration and any member of the Board each 
have power to administer oaths at any hearing 
which the Board or Department is authorized by 
law to conduct. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 


for October, 1978 


277 


Attendance of witnesses and production of books 
and papers.] § 17.04 Any circuit court upon the 
application of the accused person or complainant 
or of the Department or Board, may order the at- 
tendance of witnesses and the production of rele- 
vant books and papers before the Board in any 
hearing relative to the application for or refusal, 
recall, suspension or revocation of a license or cer- 
tificate. The court may compel obedience to its 
order by proceedings for contempt. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1 975. 

Record of proceedings .] § 17.05 The Depart- 
ment, at its expense, shall provide a stenographer 
to take down the testimony and preserve a record 
of all proceedings at the hearing of any case where- 
in a license or certificate may be revoked, sus- 
pended, placed on probationary status, or other 
disciplinary action taken with regard thereto. The 
notice of hearing, complaint and all other docu- 
ments in the nature of pleadings and written mo- 
tions filed in the proceedings, the transcript of 
testimony, the report of the Committee and the 
orders of the Department constitute the record of 
such proceedings. The Department shall furnish a 
transcript of such record to any person interested in 
such hearing upon payment therefor of one dollar 
per page for each original transcript and 50y per 
page for each carbon copy thereof ordered with the 
original; except that the charge for any part of 
such transcript ordereci and paid for previous to 
the writing of the original record thereof shall be 
50ft per page for each carbon copy. 

Amended by P.A. 77-2829, § 34, eff. Dec. 22, 1972; 
P.A. 78-255, § 61, eff. Oct. R 1973. 

Report of findings and recommendations— Motion 
for Rehearing— Certificate of order of revocation, 
suspension, or other disciplinary action.] § 17.06. 
The Board shall present to the Director a written 
report of its findings and recommendations. A copy 
of such report shall be served upon the accused 
person, either personally or by registered or cer- 
tified mail. Within 20 days after such service, the 
accused person may present to the Department his 
motion in writing for a rehearing, which written 
motion shall specify the particular ground therefor. 
If the accused person orders and pays for a tran- 
script of the record as provided in Section 17.05, 
the time elapsing thereafter and before such tran- 
script is ready for delivery to him shall not be 
counted as part of such 20 days. 

At the expiration of the time allowed for filing a 
motion for rehearing the Director may take the ac- 
tion recommended by the Board. Upon the sus- 
pension, revocation, placement on probationary sta 
tus, or the taking of any other disciplinary action, 
including the limiting of the scope, nature, or ex- 
tent of one’s practice, deemed proper by the de- 
partment, with regard to the license, certificate or 
state hospital permit, the accused shall surrender 
his license or certificate to the Department, if or- 
dered to do so by the Department, and upon his 
failure or refusal so to do, the Department may 
seize the same. 

Each certificate of order of revocation, suspen- 
sion, or other disciplinary action shall contain a 
brief, concise statement of the ground or grounds 
upon which the Department’s action is based, as 
well as the specific terms and conditions of such 
action. This document shall be retained as a per- 
manent record by the Board and the Director. 

In those instances where an order of revocation. 


suspension, or other disciplinary action has been 
rendered by virtue of a physician’s physical illness, 
including, but not limited to deterioration through 
the aging process, or loss of motor skill which re- 
sults in a physician’s inability to practice medicine 
with reasonable judgment, skill, or safety, the De- 
partment shall only permit this document, and the 
record of the hearing incident thereto, to be ob- 
served, inspected, viewed, or copied pursuant to 
court order. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Restoration of license or certificate.] § 17.07 
At any time after the suspension, revocation, plac- 
ing on probationary status, or taking disciplinary 
action with regard to any license or certificate, the 
Department may restore it to the accused person, 
or take any other action to reinstate the license to 
good standing, without examination, upon the 
written recommendation of the Board. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Review under Administrative Review Act— Ven- 
ue.] § 17.08 All final administrative decisions of 
the Department are subject to judicial review' pur- 
suant to the provisions of the “Administrative Re- 
view Act”, approved May 8, 1945, and all amend- 
ments and modifications thereof, and the rules 
adopted pursuant thereto. The term “administra- 
tive decision” is defined as in Section 1 of the 
“Administrative Review Act”. 

Such proceedings for judicial review shall be 
commenced in the Circuit Court of the County in 
which the party applying for review resides; but 
if such party is not a resident of this State, the 
venue shall be in Sangamon County. 

The Department shall not be required to certify 
any record to the Court or file any answ'er in 
Court or otherwise appear in any Court in a Judi- 
cial review' proceeding, unless there is filed in the 
Court with the complaint a receipt from the De- 
partment acknowdedging payment of the costs of 
furnishing and certifying the record w-hich costs 
shall be computed at the rate of 20 cents per page 
of such record. Exhibits shall be certified without 
cost. Failure on the part of the Plaintiff to file 
such receipt in Court shall be grounds for dismis- 
sal of the action. During the pendency and hear- 
ing of any and all Judicial proceedings incident to 
such disciplinary action the sanctions imposed upon 
the accused by the Department shall remain in full 
force and effect. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Order of revocation or suspension as prima facie 
evidence.] § 17.09 An order of revocation, suspen- 
sion, placing the license on probationary status, or 
other formal disciplinary action as the Department 
may deem proper, or a certified copy thereof, over 
the seal of the Department and purporting to be 
signed by the Director, is prima facie proof that: 

1. Such signature is the genuine signature of 
the Director; 

2. The Director is duly appointed and qualified; 
and 

3. The Board and the members thereof are 
qualified. 

Such proof may be rebutted. 

Amended by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Action and report of board— Reasons of disagree- 
ment by Director— Necessity for exercise of powers— 
Re-examination or re-hearing.] § 17.10. 

None of the disciplinary functions, pow’ers and 
duties enumerated in this Act shall be exercised by 


278 


Illinois Medical Journal 


the Department except upon the action and report 
in writing of the Board. 

In all instances, under this Act, in which the 
Board has rendered a recommendation to the 
Director with respect to a particular physician, the 
Director shall, in the event that he disagrees with 
or takes action contrary to the recommendation of 
the Board, file with the Board and the Secretary 
of State his specific written reasons of disagree- 
ment with the Board. Such reasons shall be filed 
within 30 days of the occurrence of the Director's 
contrary position having been taken. 

The action and report in writing of a majority 
of the Board designated is sufficient authority 
upon which the Director may act. 

Whenever the Director is satisfied that substan- 
tial justice has not been done either in an exami- 
nation, or in a formal disciplinary action, or refus- 
al to restore a license or certificate, he may order 
a re-examination or re hearing by the same or 
other examiners. 

Amended by P.A. 79-1130, § 1, eff ■ Nov. 21, 1975. 

Confidentiality of information received at hear- 
ings.] § 17.11 In all hearings conducted under this 
Act, information received, pursuant to law, relat- 
ing to any information acquired by a physician in 
attending any patient in a professional character, 
necessary to enable him professionally to serve such 
patient, shall be deemed strictly confidential and 
shall only be made available either as part of the 
record of such hearing or otherwise; (1) when such 
record is required, in its entirety, for purposes of 
judicial review pursuant to this Act; or (2) upon 
the express, written consent of the patient, or in 
the case of his death or disability, of his personal 
representative. 

Added by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Liability for disciplinary action without reason- 
able basis in fact.] § 17.12 In the event that the 
Department’s order of revocation, suspension, plac- 
ing the licensee on probationary status, or other or- 
der of formal disciplinary action is without any 
reasonable basis in fact of any kind, then the State 
of Illinois shall be liable to the injured physician 
for those special damages he has suffered as a di- 
rect result of such order. 

Added by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 

Report of violations— Immunity from liability— 
Assistance in medical competency examinations— 
Hearing officers .] § 17.13 Any physician licensed 
under this Act, the Illinois State Medical Society, 
the Illinois Osteopathic Association, the Chiro- 
practic Association, or any component societies of 
any of these three groups, and any other person, 
may report to the Board any information such phy- 
sician, association, society, or person may have 
which appears to show that a physician is or may 
be in violation of any of the provisions of Section 
16 of the Medical Practice Act. Any such physician, 
association, society or person, participating in good 
faith in the making of a report, under this Act, 
shall have immunity from any liability, civil, crim- 
inal, or that otherwise might result by reason of 
such actions. For the purpose of any proceedings, 
civil or criminal, the good faith of any such physi- 
cian, association, society or persons shall be pre- 
sumed. The Board may request the Illinois State 
Medical Society, the Illinois Osteopathic Associa- 
tion, or the Illinois Chiropractic Association both 
to assist the Board in preparing for or conducting 
any medical competency examination as the Board 
may deem appropriate. The Board shall retain and 


use such hearing officers as it deems necessary. 
Added by P.A. 79-1130, § 1, eff. Nov. 21, 1975. 
Amended by P.A. 80-965, § 1, eff. Sept. 22, 1977. 

Punishment for doing certain acts without li- 
cense.]. § 24. If any person holds himself out to 
the public as being engaged in the diagnosis or 
treatment of ailments of human beings; or sug- 
gests, recommends or prescribes any form of treat- 
ment for the palliation, relief or cure of any phys- 
ical or mental ailment of any person with the 
intention of receiving therefor, either directly or 
indirectly, any fee, gift, or compensation whatso- 
ever; or diagnosticates or attempts to diagnosticate, 
operate upon, profess to heal, prescribe for, or 
otherwise treat any ailment, or supposed ailment, 
of another; or maintains an office for examination 
or treatment of persons afflicted, or alleged or 
supposed to be afflicted, by any ailment; or at- 
taches the title Doctor, Physician, Surgeon, M.D. or 
any other word or abbreviation to his name, indi- 
cating that he is engaged in the treatment of hu- 
man ailments as a business; and does not possess 
a valid license issued by the authority of this State 
to practice the treatment of human ailments in any 
manner, he shall be sentenced as provided in Sec- 
tion 35.1. 

Amended by P.A. 77-2708, § 1, eff. Jan. 1, 1973. 

Physician’s Assistant Act 

Section 1. The purpose and legislative intent of 
this Act is to encourage and promote the more 
effective utilization of the skills of physicians by 
enabling them to delegate certain health tasks to 
physician’s assistants where such delegation is con- 
sistent with the health and welfare of the patient 
and is conducted at the direction of and under the 
responsible supervision of the physician. 

Section 2. This Act shall be known and may be 
cited as the “Physician’s Assistants Practice Act.” 

Section 3. “Physician’s assistant” means any per- 
son not a physician who is certified to perform 
medical procedures under the supervision of per- 
sons licensed to practice under “The Medical Prac- 
tice Act.” A physician’s assistant may perform such 
medical procedures within the specialty of the su- 
pervising physician, except that such physician shall 
exercise such direction, supervision and control over 
such physician's assistants as will assure that patients 
receiving medical care from a physician’s assistant 
shall receive medical care of the highest quality. 
Physician’s assistants shall be capable of performing 
a variety of tasks within the specialty of medical care 
under the supervision of a physician, although the 
physician’s assistant does not possess the level of 
medical knowledge necessary to integrate and in- 
terpret findings. Physician’s assistants cannot exer- 
cise independent judgment for purposes of diagnosis 
and treatment of patients. Nothing in this Act shall 
be construed as relieving any physician of the pro- 
fessional or legal responsibility for the care and 
treatment of persons attended by himself or by 
physician’s assistants under his supervision. Physi- 
cian’s assistants shall have only those powers and 
rights set forth in this Act and the exercise of any 
powers beyond those set forth shall constitute a 
violation of this Act. 

Section 4. No physician's assistant shall use the 
title of doctor or associate with his name any other 
term which would indicate to other persons that he 
is qualified to engage in the general practice of 
medicine. A physician’s assistant shall not be al- 
lowed to bill patients or in any way to charge for 


for October, 1978 


279 


services. Nothing in this Act, however, shall be so 
construed as to prevent the employer of a physi- 
cian’s assistant from charging for services rendered 
by the physician’s assistant. The physician shall fdc 
with the Department notice of employment and 
discharge of the physician’s assistant at the time of 
said employment or discharge. 

Section 5. No more than one physician’s assistant 
shall be employed by a physician. Physician’s as- 
sistants shall be employed only under the super- 
vision of persons licensed to practice under “The 
Medical Practice Act” and engaged in private clin- 
ical practice, or in clinical practice in public health 
or other community health facilities. 

Section 6. Each applicant for a physician’s assis- 
tant certificate shall: 

1. Make application for examination on forms 
prepared and furnished by the Department of Reg- 
istration and Education. 

2. Submit evidence under oath satisfactory to the 
Department that: 

(a) He is 21 years of age or over; 

(b) He is of good moral character; 

(c) He has the preliminary and professional 
education required by this Act; 

(d) He is free of contagious diseases. 

3. Designate specifically the name, location, and 
kind of professional schools, colleges, or institutions 
attended and the courses which he has satisfac- 
torily completed. 

4. Pay to the Department of Registration and 
Education at the time of application, an examina- 
tion fee of $25. The fee for subsequent renewal of 
a certificate without lapse shall be .$15. 

Section 7. Except as otherwise provided in this 
Act, the minimum standards of educational require- 
ments prior to the taking of an examination shall 
consist of the following: 

(a) Successful completion of a 4 year course of 
instruction in a high school, or its equivalent, as 
determined by the examining committee; and 

(b) Successful completion of a specialized course 
for physician’s assistants consisting of not less than 
20 months instruction in any 2 year period; such 
course and the institution or school offering the 
same shall be approved by the examining committee 
provided for in this Act. 

The examining committee shall have the power 
to waive the specialized training provided for in 
this Section, if the committee determines that any 
prior training and experience of the applicant is the 
equivalent of such specialized training. 

Sectio?i S. Registered nurses in the State of Illinois 
may take such examination without completing any 
additional courses of study and shall be issued a 
certificate upon the passage of such examination. 

Section 9. Subject to the provisions of this Act, the 
Department of Registration and Education shall: 

1. Promulgate rules approved by the examining 
committee setting forth standards to be met by a 
school or institution offering a course of training 
for physician’s assistants prior to approval of such 
school or institution. 

2. Promulgate rules approved by the examining 
committee setting forth uniform and reasonable 
standards of instruction, including but not limited 
to specific subjects taught, to be met prior to ap- 
proval of such course of instruction for physician’s 
assistants. 

3. Determine the reputability and good standing 
of such schools or institutions and their course of in- 


struction for physician’s assistants by reference to 
compliance with such rides, provided that no school 
of physician’s assistants that refuses admittance to 
applicants solely on account of race, color, sex, or 
creed shall be considered reputable and in good 
standing. 

4. Prescribe rules for examining candidates for a 
certificate as physician’s assistant. 

5. All examinations provided for by this Act shall 
be conducted under rules and regulations prescribed 
by the Department of Registration and Education. 
Examinations shall be held at least 3 times a year 
at times and places to be determined by the De- 
partment. 

No rule or regulation shall be adopted under this 
Act which allows a physician’s assistant to perform 
any act, task or function primarily performed in the 
lawful practice of optometry under ‘‘The Illinois 
Optometric Practice Act,” approved June 15, 1951, 
as amended. 

Section 10. Upon the satisfactory completion of 
application and examination procedures and com- 
pliance with the applicable rules and regulations of 
the Department of Registration and Education, the 
Department shall issue a physician’s assistant cer- 
tificate to the qualifying applicant. 

Section 11. The Medical Examining Committee of 
the Department of Registration and Education as 
provided in Section 60-a of “The Civil Administra- 
tive Code of Illinois,” approved March 17, 1917, as 
amended, may revoke or withdraw the certificate 
issued under this Act upon any of the following 
grounds: 

1. Conviction in this or another state of any crime 
which is a felony under the law of this State, or 
conviction of a felony in a federal court; 

Z. Gross malpractice resulting in permanent in- 
jury or death of a patient; 

3. Engaging in dishonorable, unethical or unpro- 
fessional conduct of a character likely to deceive, 
defraud or harm the public; 

4. Habitual intemperance in the use of alcohol, 
narcotics or stimulants to such an extent as to in- 
capacitate for performance of professional duties. 

5. Employment of fraud, deception or any unlaw- 
ful means in applying for or securing a certificate as 
a physician’s assistant; 

6. Exceeding the authority delegated to him by 
his employing physician; 

7. A violation of any provisions of this Act or of 
the rules and regulations formulated for its admin- 
istration. 

Section 12. No action of a disciplinary nature 
which is predicated on charges alleging unethical 
or unprofessional conduct of a person who prac- 
tices as a physician’s assistant and which can be 
reasonably expected to affect adversely that person's 
maintenance of his present, or his securing of 
future, employment as such a physician’s assistant 
may be taken by the Department of Registration 
and Education, by any association, or by any person 
unless the physician’s assistant against whom such 
charges are made is afforded the right to be repre- 
sented by legal counsel of his choosing and to 
present any witness, whether an attorney or other- 
wise, to testify on matters relevant to such charges. 

Section 13. Certificates may be revoked or sus- 
pended only in the manner provided by Section 60b 
through 60h inclusive of “The Civil Administra- 
tive Code of Illinois,” approved March 7, 1917, as 
now or hereafter amended. 


280 


Illinois Medical Journal 


Section 14. All final administrative decisions of 
the Department of Registration and Education are 
subject to judicial review pursuant to the provisions 
of the “Administrative Review Act,” approved May 
8, 1945, and all amendments and modifications 
thereof, and the rules adopted pursuant thereto. 
The term “administrative decision” is defined in 
Section 1 of the “Administrative Review Act.” 
Section 15. All certificates issued under this Act 
must be renewed every 2 years after their issuance 
and the examining committee may require a phy- 
sician’s assistant to submit to a mental or physical 
examination at any time felt necessary by the 
examining committee. 

Section 16. No person shall use the title or per- 
form the duties of “physician’s assistant” unless he 


is a qualified holder of a certificate as provided in 
this Act. A certified physician’s assistant shall wear 
on his person a visible identification indicating that 
lie is certified as a physician’s assistant while acting 
in the course of his duties. 

Section 17 . The Medical Examining Committee of 
the Department of Registration and Education shall 
review the provisions of this Act to determine its 
effectiveness and accomplishments and shall solicit 
the cooperation and advice of such public and pri- 
vate agencies as the Committee may deem proper. 
The Committee shall report its findings and recom- 
mendations to the Governor and the General As- 
smbly on January 1, 1980. 

Section IS. This Act takes effect July 1, 1976. 

Section 19. This Act is repealed on June 30, 1981. 


DIVISION OF VOCATIONAL REHABILITATION 

623 East Adams Street 
Springfield, IL 62706 
James S. Jeffers, Director 


The Board of Vocational Rehabilitation is a statutory 
body, established to administer, through one division, the 
state program of vocational rehabilitation pursuant to the 
Federal Vocational Rehabilitation Act, as amended. 


Medical Legal Information 

(Prepared by ISMS Corporate Counsel) 

The purpose of this article is to present to the Illinois medical community a general view of certain medical-legal 
principles and relationships which many physicians may encounter in the ordinary practice of their profession. Be- 
cause this article is intended to provide information of a general nature only, specific problems should be discussed 
with one’s individual attorney. While this presentation is not all-inclusive , it will afford an insight into the more com- 
mon considerations. It should not be construed as presenting legal opinion, rather general cotisiderations. Information is 
intended to be illustrative only and does not establish or imply a standard of care. 


ISMS LEGAL SERVICES 


The Illinois State Medical Society retains, on a con- 
tinuing basis, a corporate counsel to whom the Society 
refers legal questions affecting the membership as a 
whole. ISMS also answers specific inquiries made by the 
component county medical societies when they are of 
general interest to the medical community. Although 


the Illinois State Medical Society does not provide per- 
sonal legal advice to individual members, the Society does 
believe the following information will help further each 
physician’s awareness of certain basic legal principles and 
concepts vital to his practice. 


THE PHYSICIAN-PATIENT RELATIONSHIP 


Contractual Relationship 

In most instances the physician-patient relationship is 
a voluntary, contractual one. Accordingly, physicians are 
required to accept only those patients they elect to treat. 
The professional services rendered on behalf of particu- 
lar patients and the fees compensating the physician for 
those services are to be agreed between the physician and 
the patient. Whenever possible, the physician should dis- 
cuss his fee with the patient in advance of treatment. 


While a physician is free to determine who will be his 
patients, once the physician has undertaken the treatment 
of a particular patient, he is under a legal duty, subject 
to certain exceptions discussed below, to continue his 
attendance so long as the case requires attention. 

A physician may legally terminate his attendance of 
a particular case in several ways: 

1. The contract between the physician and the patient 
expressly limits the scope of treatment; 


for October, 1978 


281 


2. The patient may discharge the physician; 

3. The relationship may end by mutual consent; 

4. The physician may legally terminate his services if 
the patient breaks the contract by failing to observe the 
medical directives of the physician, or does not pay for 
the services rendered. 

When the physician has a reasonable basis to terminate 
his care of the patient, he must provide the patient with 
sufficient, reasonable notice of his intention to withdraw 
so as to enable the patient to secure another physician. 


This notice should be in writing and briefly explain to 
the patient the reason for the intended termination. If 
the patient returns to the attending physician, and has 
been unable to procure other medical assistance, the 
attending physician should not refuse continued treatment 
until a replacement has been secured. Upon request, the 
physician should make copies of his records of the care 
he rendered to the patient available to a new physician 
selected by the patient. 


HOSPITAL PATIENT RECORDS 


Illinois law provides that hospitals in the state shall, 
upon the written demand of any discharged patient, per- 
mit that patient, the patient’s physician or authorized 
attorney to examine and make copies of his medical rec- 
ords. With few exceptions, these disclosure provisions do 
not apply in the case of a psychiatrist-patient relation- 
ship. With respect to the physician’s office records, the 
statute was amended in 1976 to provide that every physi- 
cian shall, upon the demand of any patient who has been 


treated by him, permit the patient’s attorney or physician 
who is currently treating him to examine and copy all 
medical records in connection with the treatment of the 
patient. Psychiatric records are excluded, except when 
ordered by a Court. The physician to whom the request 
is directed must respond within a reasonable time and 
shall be reimbursed by the patient or his representative 
for all reasonable costs resulting from examining or 
duplicating the physician's records. 


NEGLIGENCE LIABILITY OF PHYSICIANS 


Illinois law requires physicians and surgeons to exer- 
cise that degree of reasonable skill as is used in ordinary 
good practice. The failure to exercise such skill will re- 
sult in liability if the patient is thereby injured. 

In recent years, in part through the adoption of new 
laws, but primarily through court decisions, professional 
liability has been significantly expanded. A recent ruling 
of the Illinois Supreme Court, for example, extended 
liability in a certain circumstance for birth defects suf- 
fered by a child as a consequence of an injury its mother 
suffered eight years before the child was conceived. The 
Court reasoned that the defendant hospital and doctor 
should have known that the harm caused the mother 
could have resulted in injury to the child born many 
years later. This case establishes a “chain of accountabil- 
ity” which dramatically increases the doctor’s liability and 
underscores the fact that the problems associated with 
medical malpractice continue to jeopardize the delivery of 
quality medical care. 

The physician is liable for his own negligent acts and 
the negligent acts of all employees subject to his control 
or supervision while acting within the scope of their 
employment. In the case of a partnership, he also may be 
liable for the negligent acts of his partners. 

Today there is simply no existing alternative to car- 
rying adequate liability insurance. However, insurance 
coverage is not a panacea for expanded liability. Each 
physician must undertake affirmative efforts to reduce the 
risks associated with the rendering of health care services. 

The American Medical Association published a pam- 
phlet entitled "Professional Liability and the Physician.” 
Twenty guidelines for preventing malpractice actions are 
set forth in that pamphlet: 

1. The physician must care for every patient with 
scrupulous attention given to the requirements of good 
medical practice. 

2. The physician must know and exercise his legal duty 
to the patient. 

3. The physician must avoid destructive and unethical 
criticism of the work of other physicians. 

4. The physician must keep records which clearly show 
what was done and when it was done and which demon- 
strate that the care given met fully the standards of good 


care as practiced in the community or in similar com- 
munities. If any patient discontinues treatment before he 
should, or fails to follow instructions, the records should 
show it; a good method is to preserve a carbon copy of 
the physician’s letter advising the patient against the un- 
wise course. 

5. A physician must avoid making any statement which 
constitutes, or might be construed as constituting, an ad- 
mission of fault on his part. He should instruct employ- 
ees to make no such statements. 

6. The physician must exercise tact as well as profes- 
sional ability in handling his patients, and should insist 
on a professional consultation if the patient is not doing 
well, if the patient is unhappy and complaining, or if 
the family’s attitude indicates dissatisfaction. 

7. The physician must refrain from over-optimistic 
prognoses. 

8. The physician must advise his patients of any in- 
tended absences from practice and recommend, or make 
available, a qualified substitute. The patient must not 
be abandoned. 

9. The physician must unfailingly secure a consent, in 
writing, for medical and surgical procedures and for 
autopsy. 

10. The physician must carefully select and supervise 
assistants and employees and take great care in delegat- 
ing duties to them. 

11. The physician should limit his practice to those 
fields which are well within his qualifications. 

12. The physician must frequently check the condi- 
tion of his equipment and make use of every available 
safety installation. 

13. The physician should make every effort to reach 
an understanding with his patient in the matter of fees, 
preferably in advance of treatment 

14. The physician must realize that it is dangerous to 
diagnose or prescribe by telephone. 

15. The physician should not sterilize a patient solely 
for the patient’s convenience, except after a complete 
explanation of the procedure and its risks and possible 
complications. He must also first obtain a signed consent 
from the patient and from the patient's spouse, if the pa- 
tient is married. Eugenic sterilization should be performed 


282 


Illinois Medical Journal 


only in conformity with the law of the state, if any. 
Sterilization for therapeutic purposes may be performed 
lawfully with the consent of the patient and preferably 
with the consent of the patient’s spouse, if the patient 
is married. 

16. Except in an actual emergency situation which 
makes it impossible to avoid doing so, a male physician 
should not examine a female patient unless an assistant 
or nurse, or a member of the patient’s family is present. 

17. The physician should exhaugt all reasonable meth- 
ods of securing a diagnosis before embarking upon a 
therapeutic course. 

18. The physician should use conservative and less 
dangerous methods of diagnosis and treatment wherever 
possible, in preference to highly toxic agents or dangerous 
surgical procedures. 

19. The physician should read the manufacturer’s bro- 
chure accompanying a toxic agent to be used for diag- 
nostic or therapeutic purposes and, in addition, should 


ascertain the customary dosage or usage in his area. 

20. The physician should be aware of all the known 
toxic reactions to any drug he uses, together with the 
proper methods for treating such reactions. 

In addition to these general guidelines to good medical 
practice, the physician should keep current and be in 
compliance with hospital regulations and standards en- 
forced by governmental agencies, the Joint Commission 
on Accreditation of Hospitals, and the bylaws of his hos- 
pital and its medical staff. The physician has the respon- 
sibility to maintain good records of his care of his pa- 
tients, to recommend consultation when the advice of a 
specialist is indicated, and to keep his patients informed 
of the progress of their care. The physician, as a member 
of an organized hospital medical staff, also has the duty 
to participate in, and submit to, peer review for purposes 
of monitoring his professional credentials and performance 
and for evaluating the quality and appropriateness of the 
patient care he delivers. 


ILLINOIS CONTROLLED SUBSTANCES ACT 


Under the Illinois Controlled Substances Act, physicians 
who prescribe or dispense various controlled substances are 
required to register with the Illinois Department of Regis- 


tration and Education. Categories of drugs under which 
registration is required are almost identical to those 
established by the Federal DEA. 


LIMITS ON LIABILITY— SPECIAL SITUATIONS 


Under the “Good Samaritan” amendment to the Medi- 
cal Practice Act, physicians who, in good faith provide 
ernergency care without fee to a person, shall not, as a 
result of acts or omissions, except willful or wanton mis- 
conduct, be liable for civil damages. 

The Medical Practice Act further provides that any 
physician, serving on any medical utilization committee, 
medical review committee, or peer review committee shall 


not be liable for civil damages as a result of his acts, or 
omissions, or decisions in connection with his duties on 
such committee, except those acts, omissions or decisions 
which involve willful or wanton misconduct. There are 
cases before the Illinois Courts challenging these grants 
of immunity and the ISMS is monitoring and cooperat- 
ing in the defense of these lawsuits. 


AUTOPSY 


The Illinois Revised Statutes specifically detail the con- 
ditions under which a physician may perform an autopsy. 
Essentially, an autopsy may be performed provided: 

1. The physician has a written authorization from the 
decedent to do so; or 

2. The physician has a written authorization from a 
surviving relative who has the right to determine the 
method for disposing of the body or a next of kin or 
other person who has such right (a “surviving rela- 
tive” means the spouse, an adult child, the parent, 
or an adult brother or sister of the decedent) ; or 

3. The physician has a telegraphic or telephonic au- 
thorization from a surviving relative who has the 
right to determine the method for disposing of the 
body or a next of kin or other person who has such 
right. This last provision is conditioned, however, 
upon the requirement that the telegraphic or tele- 
phonic authorization is verified, in writing, by at 
least two persons who were present at the time and 
place the authorization was received. 

Illinois law specifically provides that where two or more 
persons have equal right to determine the method for dis- 
posing of the body, the authorization of only one such 
person shall be necessary, unless, before the autopsy is 


performed, any others having such equal right shall object 
in writing or, if not physically present in the community 
where the autopsy is to be performed, by telephonic or 
telegraphic communication to the physician by whom the 
autopsy is to be performed. 

While authorization may be given to a physician or 
hospital administrator or his duly authorized representa- 
tive, only a physician shall perform the autopsy. The 
authorized personnel of a hospital or other qualified per- 
sonnel selected by a physician may assist a physician per- 
forming an autopsy. 

The term “written authorization”, provided for above, 
means any printed, typed or handwritten communication 
signed by the person granting the authorization. 

It is important to emphasize that, in Illinois, the heirs' 
and next of kin can bring an action for mutiliation of 
the body of a decedent in those cases in which an autopsy 
is performed without authority or permission. In order to 
avoid the possibility of liability, autopsies should only be 
performed when ordered by the coroner or upon the 
appropriate written consent of the next of kin as specified 
above. (The coroner may order an autopsy directly against 
the wishes of the next of kin) . Cooperation should be 
forth-coming in cases under the Coroner’s jurisdiction. 


for October , 197S 


283 


DEATH 


Since the controversy generated by the Karen Quinlan 
case (New Jersey) ; and the Joseph Saikowicz case (Mas- 
sachusetts) much lias been written about the physician's 
role in determining death. Some states, Kansas and Cali- 
fornia, for example, have adopted special legislation in an 
attempt to “regulate” the legal and medical definitions of 


death and to provide so-called, “death with dignity” 
guarantees. To date, similar laws are not “on the books” 
in Illinois and, at present, the law of our state continues 
to provide that death occurs when in the judgment of 
the physician, there has been irreversible cessation of 
spontaneous vital functions (heart beat and respiration) . 


CONSENT OF MINORS TO MEDICAL TREATMENT 


1. Situations Where Consent Need Not Be Obtained 
For Treatment of a Minor: Whenever a hospital or a 
physician renders emergency treatment or first aid (or a 
licensed dentist renders emergency dental treatment) to a 
minor, consent of the minor’s parent or legal guardian 
need not be obtained if, in the sole opinion of the physi- 
cian, dentist or hospital, the obtaining of consent is not 
reasonably feasible under the circumstances without caus- 
ing a delay which could adversely affect the condition of 
such minor’s health. 

2. Parental Consent for Treatment of a Minor Child 
When Parent is Also a Minor: Illinois law provides that 
any parent, including a parent who is a minor, may give 
his or her consent to the performance upon his or her 
child of a medical or surgical procedure by a physician 
licensed to practice medicine and surgery or a dental pro- 
cedure by a licensed dentist. The consent of such parent 
is not voidable because of his or her minority, and Illi- 
nois law specifically prorides that this parent, who is a 
minor, is deemed to have the same legal capacity to act 
anci shall have the same powers and obligations as has a 
person of legal age. 

The consent to the performance of a medical or surgical 
procedure, by a physician licensed to practice medicine 
and surgery, which is executed by a married person who is 
a minor or by a pregnant woman who is a minor, is not 
voidable because of such minority and Illinois law further 
provides that for such purpose, such married person, who 
is a minor, or such pregnant woman, who is a minor, is 
deemed to have the same legal capacity to act and has the 
same powers and obligations as has a person who has at- 
tained majority (age 18 or older). 


3. Birth Control Services for Minors: Birth control 
services and information may be rendered by' doctors li- 
censed in Illinois to practice medicine in all of its branches 
to any minor who meets any of the following criteria: is 
married; is a parent; is pregnant; has the consent of 
parent or legal guardian; as to whom the failure to pro- 
vide such services would create a serious health hazard; 
or is referred for such services by a physician, clergyman 
or a planned parenthood agency. 

4. Venereal Disease and Drug Use — Consent to 
Treatment By Minor: Illinois law specifically provides 
that a minor, 12 years of age or older, who may have come 
into contact with any venereal disease or who is suffering 
from the use of depressant or stimulant drugs or narcotic 
drugs (as defined in Controlled Substances Acts) , may give 
bis or her own binding consent, which is not later void- 
able, to the furnishing of medical care or counselling re- 
lated to the diagnosis or treatment of such disease or 
addiction. Each incident of venereal disease shall be re- 
ported to the State Department of Public Health or the 
local board of health in accordance with existing regula- 
tions. Illinois law specifically states that the consent of the 
parent, parents, or guardian of such minor, receiving such 
treatment or counselling, shall not be necessary to au- 
thorize the care or counselling which is related to the di- 
agnosis or treatment of such disease or drug or narcotic 
use. 

Any physician who provides diagnosis or treatment to a 
minor patient who has come into contact with any vene- 
real disease or suffers from the use of any drug or nar- 
cotic, referred to above, may, but shall not be obligated to, 
inform the parent, parents or legal guardian of any such 
minor as to the treatment given or needed. 


UNEMPLOYMENT COMPENSATION 


The Illinois Unemployment Compensation law has 
been expanded so that it now includes coverage by phy- 
sicians who employ only one person. This liability was 
discussed at some length in the “Practice Management” 
section of the July, 1973, issue of the Illinois Medical 


Journal. If physicians have specific questions regarding 
the- applicability of unemployment compensation to their 
employees, they should considt the Illinois Department 
of Labor, Division of Unemployment Compensation, or 
their attorney. 


BLOOD LABELING 


The Illinois Blood Labeling Act contains three require- 
ments of particular importance to the medical profession: 

1. No person may administer blood by transfusion in 
Illinois unless the container of such blood is labeled in 
conformity with regulations developed and specified by 
the Illinois Department of Public Health; 

2. When blood is administered by transfusion in Illinois, 
the identification number of the unit of blood must be 
recorded in the patient’s medical record and the label on 
the container of blood may not be removed before or 
during the administration of that blood by transfusion; 


3. As of July 1, 1973, no blood (which has been initially 
acquired by purchase) may be administered by transfusion 
in Illinois unless: 

a. Tbe physician in charge of the treatment of the 
patient to whom the blood is to be administered has 
directed that such purchased blood be administered 
to that patient; and 

b. The physician in charge of the treatment of the 
patient has specified in the patient’s medical record 
bis reason for such action. 


284 


Illinois Medical Journal 


IMMUNIZATION 


In 1972, legislation was passed to eliminate the require- 
ment of smallpox immunization and to add rubella to 
the list of diseases against which there must he immuni- 
zation. 

The 1973 session of the Illinois General Assembly, how- 
ever, eliminated a listing of specific diseases against which 


there must he immunization and transferred responsibility 
for determination of these to the Illinois Department of 
Public Health. Thus, the director will promulgate regula- 
tions, which may change' from time to time, as to those 
diseases against which children will be immunized. This 
affects the School Code and the Communicable Disease 
Act. 


MEDICAL CORPORATIONS 


Until 1963, when the Illinois General Assembly passed 
the Medical Corporation Act. physicians were not aide 
to avail themselves of the legal advantages of doing busi- 
ness as a corporation. A primary reason for forbidding 
the use of the corporate form for doctors was that the 
personal assets of the officers, directors and stockholders 
are generally beyond the reach of creditors, including 
persons who acquire a legal claim against the corporation 
after suffering injury resulting from the actions of the 
agents of the corporation. Because the public wished to 
insure itself of the best medical care, tbe law would not 
permit doctors to insulate themselves from personal mal- 
practice liability by the use of a “corporate shield.” How- 
ever, the Corporation can be sued as the employer and 
the individual doctor-employee can also be sued. 

The corporate form does, however, present certain ad- 
vantages, particularly in the area of taxation. There has 
never been a compelling reason to deny these benefits to 
doctors and other professionals. 

Under the Illinois law, all the shareholders, officers 
and directors of a medical corporation must be licensed 
physicians. In the case of a professional services corpora- 
tion also authorized under current Illinois law, the secre- 
tary of the corporation need not be a physician. 

The corporation must register with the Illinois Depart- 
ment of Registration and Education under whose auspices 
it is permitted to operate, in addition to the requirements 
of filing with the office of the Secretary of State. This law 
explicitly denies physicians working within a corporation 
the right to insulate their personal assets from malpractice 
liability. 

Tax consequences are the primary factors in deter- 
mining the wisdom of incorporation. In an article written 
for the November, 1970, issue of tbe Illinois Bar Journal 
Linscott R. Hanson summarized the advantages of incor- 
poration. Among the major advantages listed were: 

1. Deductability by employees of a portion of their 
sick pay. 

2. Deductability as a corporate business expense of the 
full cost of employee accident and health insurance. 

3. Deductability as a corporate business expense of 
medical payments in excess of insurance. 


4. Lower corporate tax rates for funds to be re-invested 
in the business. 

5. Relatively easy adjustment of ownership percentages. 

6. Avoidance of many probate problems upon the 
death of a practitioner and the avoidance of having to 
create a whole new business as when a partner dies. 

7. Liability limitation, other than for malpractice, to 
the investment in the corporation thus reducing inves- 
tors’ risks. 

8. Miscellaneous pension and profit-sharing tax ad- 
vantages. 

There are also some disadvantages or requirements asso- 
ciated with incorporation, as follows: 

1. Since a corporation is a separate legal entity, there 
are certain minimal requirements necessary “to give life 
and credibility” to t lie corporate form (record keeping: 
governance; etc.) . Simply declaring yourself a corporation 
is not enough; the law requires that you operate in ac- 
cordance with laws governing corporate organizations. 
Occasionally problems can arise and the physician may 
incur costs of legal defense in his dealings with the In- 
ternal Revenue Service and other governmental bodies 
as when they challenge his activities carried out in the 
name of the corporation. 

2. Corporations produce other unique costs as well, in- 
cluding additional social security taxes; corporate fran- 
chise taxes; capital stock and personal property taxes; 
increased state income taxes; state licensing fees; and 
other taxes and fees. 

3. Corporations usually generate higher administrative 
and legal costs. 

4. Corporations are subjected to many state and federal 
laws and regidations. 

Certainly each practitioner, physician and partnership 
should consider the merits of incorporating. The purpose 
here has been to give a brief explanation so that each 
interested physician can receive a general over view of his 
options. A tax specialist should, of course, be consulted 
to review the particulars of each business situation. 


MDs EXCLUDED FROM ‘CERTIFICATE OF NEED’ CONTROLS 


Plans to build, expand, move or sell a hospital, nursing 
home or surgicenter require approval of the State Health 
Facilities Planning Board. 

A provision in the original legislation which would 
have brought physicians’ offices and clinics under "cer- 
tificate of need” regulation was withdrawn because of 
vigorous ISMS opposition. At the federal level, renewed 
efforts are underway to bring all outpatient facilities, in- 
cluding tbe doctor’s office, under tbe provisions of the law. 

This law covers construction or modification plans 
involving an expenditure of more than $150,000, or a 
substantial change in services or bed capacity. 


Under Public Law 93-641, local Health Services Agen- 
cies are to hold public hearings on all applications for 
construction or expansion of facilities before submitting a 
recommendation to the state Health Planning Board for 
final action. 

The state agency is required to study: (1) area size; 
(2) population and growth potential; (3) number of exist- 
ing and planned facilities offering similar services; (4) util- 
ization of existing facilities; (5) availability of alternative 
facilities and services; and, (6) availability of necessary 
personnel. 

Undoubtedly, the role of health planning agencies will 
expand and the physician will feel the effects and influ- 


for October, 1978 


285 


ence of regulations promulgated by these organizations. 
While the private practice of medicine is as yet relatively 
“free” of the jurisdiction of these agencies, the decisions 
of the Board are already reaching out to limit the pur- 
chase of new equipment and the development of new 
services by hospitals and other institutions in which the 


doctor performs many of his professional services. It is 
reasonable to expect that with the current government 
emphases on cost containment in health care, the physi- 
cian’s practice can and will be affected. Therefore, it is in 
each physician’s best interest to monitor these develop- 
ments closely in the months and years ahead. 


CURRENT DEVELOPMENTS IN HEALTH LAW 


The practice of medicine has been subjected to increas- 
ing regulation at all levels of government. At the federal 
level, in addition to HEW, many other agencies are mak- 
ing administrative decisions and promulgating rules and 
regulations which impact upon the physician and his 
practice environment. For example, the Federal Trade 
Commission is investigating the collective activities of 
doctors which may have had an anti competitive or anti- 
consumer result. The pressure is mounting in favor of 
liberal policies permitting advertising of medical services 
and for expanding the role of para-professional groups in 
the delivery of health care. 

At the state and local levels, generic drug substitution 
laws, statutes authorizing the administration of Laetrile 
and other substances and other consumer-oriented legisla- 
tion has been widely adopted. 

In response to these initiatives, the Illinois State Medi- 
cal Society, by action of its Board of Trustees, developed 


a program of legal assistance for its members. This Legal 
Assistance Plan has been approved by the Internal Rev- 
enue Service so as to avoid any jeopardy to the tax 
exempt status of the Society. The Plan will provide legal 
assistance, funded by the Society, in limited circum- 
stances when the legal issue at stake is of such universal 
and important consequence as to affect the rights, not 
only of the individual physician who is a party to the 
litigation or administrative proceedings, but to all mem- 
bers of organized medicine. The Executive Committee of 
the Board acts as a review body to receive written re- 
quests for legal assistance and to evaluate each request 
on its merits. To date, the Society has approved assis- 
tance in several cases and has authorized legal counsel 
to file friend-of-the-court briefs in two lawsuits in which 
legal issues of considerable significance to practicing phy- 
sicians were raised. 


INDEX TO REFERENCE SECTION 


A 

Accreditation, Committee on 257 

Administration, Division of 247 

Affiliate Societies, Council on 236 

Alcoholism and Drug Dependence, Committee on . . .239 
American Association of Medical Assistants, 

Illinois Society 255 

Ancillary Organizations 254 

Autopsy 283 


B 


Benevolence, Committee on Finance and Medical ...241 

Blood Labeling 284 

Board of Trustees, Committees of 241 

Bylaws 205 


C 

Certificate of Need 285 

Children and Family Services, Department of 264 

CME Sponsors, Accredited 257 

Committees— 

Trustee District 233 

(See Specific Committees ) 

Computer Services, Division of 247 


Constitution and Bylaws 205 

Committee on ....241 

Index to 216 

Continuing Medical Education, Illinois Council on . .256 

Cost Effectiveness, Task Force on 244 

Councils of the Illinois State Medical Society 236 

Organization Chart 235 

Current Developments in Health Law 286 


D 

Dangerous Drugs Commission 265 

Direct Reporting Committees 243 

District Committees, Trustee 233 

Drugs and Therapeutics, Committee on 243 

E 


Economics and Peer Review, Council on 236 

Education Programs, Paramedical, Accredited 

(Schools) 261 

Education and Manpower, Council on 237 

Education, Manpower and Convention 

Services, Division 248 

Educational and Scientific Foundation 256 

Ethical Relations Committee 241 

Ethics, Principles of Medical 204 

Executive Committee 241 

Eye Health Committee 237 


286 


Illinois Medical Journal 


F 


Field Services, Division of 248 

Finance and Medical Benevolence Committee 241 

Foundation for Medical Care, Illinois 258 


G 

Generic Prescribing Law, Ad Hoc Committee on ....240 
Governmental Affairs, 

Council on 237 

Division 248 

H 

Health Planning, Committee 243 

Hospital Patient Records 282 

House of Delegates, ISMS 231 

I 

Illinois Controlled Substances Act 283 

Illinois Cooperative Health Data Systems 245 

Illinois Council on Continuing Medical Education ..256 

Illinois Foundation for Medical Care 258 

Illinois Medical Political Action Committee (IMPAC).259 

Illinois Medical Student Loan Fund 251 

Illinois Society, American Association of 

Medical Assistants 255 

Illinois State Government 263 

Department of 

Children and Family Services 264 

Mental Health 264 

Public Aid 266 

Public Health 266 

Registration and Education 271 

Vocational Rehabilitation Division 281 

Illinois State Medical Insurance Services 259 

Illinois State Medical Society Organization 246 

Illinois State Medical Society Services 247 

Immunization 285 

Impartial Medical Testimony 252 

IN A/ISMS Joint Practice Committee 245 

ISMS Auxiliary 254 

Advisory Committee, to the 242 

Insurance, Committee on 243 

Insurance Programs, Sponsored 236 


Laboratory Services, Committee on 

Legal Services, ISMS 

Liability, Limits on 

Loan Fund Program 


238 

281 

283 

251 


M 

Maternal Welfare, Committee on 

Medical Corporations 

Medical and Paramedical Education 

Medical Assistants, American Association of . . 

Medical Ethics, Principles of 

Medical Legal Council 

Medical Legal Information 

Medical Practice Act 

Medical Schools in the State of Illinois 

Medical Services, Council on 

Medical Services, Division of 

Mental Health and Developmental Disabilities, 

Department of 

Mental Health and Addiction, Council on ... 
Minors to Medical Treatment, Consent of . . . 
Multiphasic Testing and Screening 


240 

285 

260 

255 

204 

238 
281 
272 
260 

239 
249 

264 

238 

284 

229 


N 

Negligence and Liability of Physicians 282 

O 

On the Legislative Scene 250 

Organization Chart, ISMS Council 235 

P 

Peer Review Appeals Committee 236 

Physician Recruitment and Student Loan Fund 

Programs 251 

Physicians Assistants 279 

Physician-Patient Relationship 281 

Poison Control Centers 270 

Policy Committee 242 

Policy Manual of ISMS 217 

Principles of Medical Ethics 204 

Private Health Insurance, Committee on 236 

Professional Liability Insurance Program 259 

Professional Liability, Task Force on 244 

Public Affairs, Committee on 237 

Public Aid, Department of 266 

Public Health, Department of 266 

Poison Control Centers 270 

Renal Dialysis 271 

Public Relations and Membership Services, Division of. 250 
Public Relations and Membership Services, Council on. 239 

Publications Committee 242 

Publications, Medical Legal, and Mental Health, 

Division of 249 

R 

Registration and- Education, Department of 271 

Medical Disciplinary Board 271 

Medical Examining Committee 271 

Medical Practice Act 271 

Renal Dialysis Centers and Units 271 

Representatives to Other Groups 245 

Resident Physician Section 260 

Revisions of Disciplinary and Peer Review Procedures, 

Ad Hoc Study Committee on 244 

S 

Scientific Speakers Bureau 251 

Services, ISMS 247 

Services, Legal 281 

Specialty Societies, Division of 250 

Staff Organization Chart 246 

State Technical Advisory Committee, 

Illinois Jail Health Program 240 

Student Business Session 259 

Student Loan Fund Board 251 

T 

Third Party Payment Processes Committee 242 

Trustee District Committees 233 

Trustee Districts Map 232 

U 

Unemployment Compensation 284 

V 

Vocational Rehabilitation, Division of 281 

W 

Workmen’s Compensation, Committee on 240 


for October , 1978 


287 


’78 Legislative Session Marked By Firsts 


Each year, the Illinois General Assembly sets 
goals for itself which are designed to keep the 
legislature functioning smoothly. Some of those 
goals become impossible to fulfill, due to the 
amount and variety of legislation introduced. 
This year, however, the legislature outdid itself 
in keeping to its own deadlines, thereby accom- 
plishing several remarkable firsts. 

1. The legislature adjourned on time. 

2. Most committees were able to keep to their 
own schedules and to accomplish every- 
thing they were supposed to in the time 
they were supposed to do it. 

3. The even-numbered year session of the leg- 
islature is supposed to be limited to bud- 
getary and revenue matters. With only a 
few exceptions that is precisely what the 
legislature limited itself to. 

One of the most “notable exceptions” to this 
statement was the extensive debate on the Equal 
Rights Amendment. All other items were put on 


a back burner, pending the outcome of the ERA 
vote. As has been reported in every newspaper 
in the state, ERA was defeated, but only then 
was the legislature able to move rapidly through 
the remainder of its business. 

A second “notable exception” was a proposal 
in which ISMS was vitally interested— the revi- 
sion of the Mental Health Code. This package 
of bills resulted from almost four years of re- 
search, public hearings, and work by the Gov- 
ernor’s Commission on the Revision of the Men- 
tal Health Code, established by Governor Walk- 
er. The bills were introduced in 1977 and were 
again the subject of weeks of additional study, 
modification, and hearing, which finally culmi- 
nated in their passage on June 30, 1978. 

The legislature is now adjourned until after 
the November elections, when they will recon- 
vene to consider any Thompson vetoes. 

The following is a list of major ISMS legis- 
lation and its status. 


BILL # SPONSOR 


DESCRIPTION 


STATUS AS OF 9-15-78 


HB 2339 Tipsword 
Berman 

HB 2418 House Com. 

on Revenue 


Hospital Rate Review Act 
(See SB 1060) 

Abolishes personal property tax; replaces 
revenues lost with new taxes on corpora- 
tions, partnerships, associations, estates & 
trusts, etc. 


HB 2506 House Human Reinstates permit physicians in mental 
Resources Com. health institutions. 


HB 2625 Ebbesen 
Grotberg 

HB 2794 Yourell 


Permits M.D.’s to use cannabis to treat 
glaucoma or side effects of chemotherapy. 

Abolishes County Hospital Governing 
Commission— gives functions, powers 
& duties to University of Illinois. 


HB 2878 House Human Amends Comprehensive Health Planning 
Resources Com. Act. 

HB 2883 House Human Certificate of Need Legislation 
Resources Com. 

HB 3059 House Human Ambulance Service Act to license & 
Resources Com. regulate ambulances. 


HB 3097 Winchester 
Sangmeister 

HB 3125 E. Barnes 

HB 3157 Redmond 
Leonard 


Amends Acts relating to the establishment 
& maintenance of health departments & 
public health districts. 

Reduces line items in Public Aid 
budget— including medical assistance. 

Adds to list of grounds for revocation of 
medical vendor licenses by Dept, of R & E 
for violations under medical assistance 
program. 


Senate— Second Reading 


In Senate Rules Committee 


Vetoed by the Governor on 
7/3/78 


Signed 9-12-78 


House— Interim Study 


Defeated in the House 


House— Interim Study 


Defeated in House 


Amendatory Veto 
9-15-78 


Held in House Committee 


Amendatory Veto 
9-11-78 


288 


Illinois Medical Jourtial 


BILL # 

SPONSOR 

DESCRIPTION 

STATUS AS OF 9-15-78 

HB 

3158 

Redmond 

Creates Public Aid Fraud Investigation 
Unit within Dept, of Law Enforcement. 

Defeated in the House 

HB 

3160 

Redmond 

Lane 

Requires Public Aid recipient social 
security number be listed on vouchers. 

Defeated on Senate Floor 

HB 

3161 

Redmond 

Leonard 

Requires IDPA to report annually to 
General Assembly on proposed rate 
structure for medical vendors. 

Amendatory Veto 
8-18-78 

HB 

3163 

Redmond 

Requires all departments to act on any 
application within 90 days. 

House— Interim Study 

HB 

3227 

Stiehl 

Schaffer 

Allows use of physician license fee for 
expenses of Medical Examining Committee 
and to monitor CME. 

Signed 6-30-78 

HB 

3296 

Campbell 

Newhouse 

Creates Long Term Care Peer Protection 
Act. 

Signed 8-2-78 

HB 

3399 

Polk 

Amends Blood Bank Act removing require- 
ment that blood bank director must be 
certified by American Board of Pathology. 

In House Rules Committee 

SB 

250 

Netscli 

Sandquist 

Creates new Mental Health Code. 

Signed 9-5-78 

SB 

252 

Nimrod 

Wilier 

Provides for guardian for adults who are 
developmentally disabled or mentally ill. 

Signed 9-5-78 

SB 

253 

Daley 

Beatty 

Creates Human Rights Authority Act to 
“safeguard rights of persons receiving 
mental health or developmental disability 
services.” 

Signed 9-5-78 

SB 

255 

Demuzio 

Mugalian 

Provides all records of persons receiving 
mental health and developmental services 
are confidential and may be disclosed only 
as provided in this Act. 

Amendatory Veto 
9-5-78 

SB 

1060 

Berman 
T ipsword 

Hospital Rate Review Act (comparable to 
HB 2339) . 

Signed 8-7-78 

SB 

1616 

Berning 

Deuster 

Requires consent of parent or guardian of 
persons under 18 prior to administration 
of Laetrile. 

Tabled. 

SB 

1760 

Newhouse 

Yourell 

Increases size of Cook County Hospital 
Governing Commission. 

Defeated on House Floor 

SB 

1761 

Newhouse 

Levin 

Allows Cook County Hospital Governing 
Commission to be reimbursed for services 
to inmates of Cook County jail. 

Passed Senate- 

In House Rules Committee 

SB 

1800 

Lane 

Requires Public Aid recipient social 
security number be listed on vouchers 
(comparable to HB 3160) . 

Defeated in the Senate 

SB 

1822 

Leonard 

Chapman 

Requires IDPA to file annual report with 
General Assembly re. provisions and use of 
medical services and proposed rate struc- 
tures for medical providers (comparable 
to HB 3161) . 

Tabled in House 
Committee 

SB 

1827 

Graham 

Friedland 

Establishes the Pre-Hospital Emergency 
Services Act. 

Signed 7-27-78 

SB 

1850 

D’Arco 

Kucharski 

Reinstates psychiatric care under State 
Employee Group Insurance Act. 

Vetoed by the 
Governor 8-23-78 


for October, 1978 


289 




ILLINOIS MEDICAL POLITICAL ACTION COMMITTEE 

55 East Monroe Street 
Chicago, Illinois 60603 
312/782-1963 


Dear Doctor: 

I'm sure by now that most of you are aware of what IMPAC is, what it does, and 
how it works. I trust that this page has been helpful in broadening your 
understanding of IMPAC, as many of you have joined. 

However, it is extremely disturbing that al 1 of you and your spouses aren't 
members of organized medicine's most active political arm. The IMPAC Council 
believes that those of you who don't belong must want further information 
regarding IMAPC. To provide more information we have developed the brochure 
which immediately follows this letter. Once you've rea.d it, we're sure 
you'll join those of us who fully comprehend the effects of politics on medicine 

I am concluding this letter with your IMPAC membership application. Please 
fill it out now. Then read the brochure. If you agree that IMPAC can help 
open important political doors, mail the application with your membership 
today. Join the thousands of physicians and their spouses who contribute to 
medicine's future. 


Sincerely, 



Herbert Sohn, M.D. 
Chai rman 


IMPAC/AMPA'C Membership 

(check one) 

□ Sustaining, $99 □ Family, $45 □ Regular, $25 □ Auxiliary, $20 

Return to: 

IMPAC, 55 E. Monroe Street, Suite 3510, Chicago, Illinois 60630 


NAME PHONE 


ADDRESS CITY ZIP 

Contributions are not limited to the suggested amount. Neither the Illinois State Medical Society nor the AMA will favor or disadvantage anyon 
based upon the amounts of or failure to make pac contributions. Copies of IMPAC & AMPAC reports are filed with and are available for purchase 
from the Federal Election Commission, Washington, D.C. Contributions are subject to the limitations of FEC regulations. Sections 110.1, 110.2 
& 110.5. (Federal regulations require this notice.) IMPAC reports are also filed with the State Board of Elections, and are or will be availa 
for purchase from the State Board of Elections, 1020 South Spring Street, Springfield, Illinois 62704. 




rftO 



The Who of IMPAC 

You are IMPAC, you and your spouse and other physicians, 
spouses from across Illinois. 


and their 


The What of IMPAC 

IMPAC (The Illinois Medical Political Action 
voice of medicine in Illinois. 


Committee) is the political 


The Why of IMPAC 

IMPAC exists to give the Illinois physician an effective organized 
means of political action by using its funds to: 

1 . Educate and stimulate the voting public; 

2 Support specific candidates, by direct candidate support a d 
’ through organization of candidate support committees. 

IMPAC activities are directed by a 30-member Council, one third of 
whTch i s elected annually at the IMPAC annual meeting Decision 8 
are based on local physician activity on behalf of and interest in 
specific candidates. An additional important concern in the decision 
making process is a realistic appraisal of the district 
and the candidate. 

The How of IMPAC 

IMPAC functions independently of all medical organizations ; an 
societies — national, state and local-as required by Federal law. All 
political activities are supported by voluntary contributions fro 
individual physician members. 


IMPAC is not bound by either Democrat or Republican labels^ 
IMPAC’s goal is to elect the best possible candidates to all offices 
regardless of party. IMPAC’s record is one of support for the man 
and his platform and philosophy, not his party. 








Why Join IMPAC? 

IMPAC gets our foot in their door. 

The future of medicine will be determined in the political arena. Each 
session of the Illinois General Assembly considers hundreds of 
medically-related bills. On the national level, more than 2,500 
medically-related bills are proposed each session. 

The most effective way we can be sure that medicine’s views are 
heard on these complex issues is to be involved in the political 
process which elects the legislators who will debate them 


To be truly effective, IMPAC needs the active support and 
participation of all physicians ... We don’t buy votes. Your 
contributions to IMPAC are used to support candidates from both 
parties who will give us a chance to tell them the facts. 

IMPAC gets you involved. 

Helping medicine tell its story is much more than a monetary 
proposition. IMPAC offers you know-how in evaluating a candidate 
and a campaign, raising money for a candidate, and in general 
provides the most effective means for physicians and their spouses 
to participate in the political and governmental process — areas which 
will ultimately determine how the practice of medicine will be 
structured in the future. 

Local physicians know their own legislators best and IMPAC relies 
heavily on their comments and ideas in making decisions about 
candidate support. 

IMPAC gets YOU Involved! 

You Need IMPAC and IMPAC Needs You 

IMPAC is working hard in bipartisan political activity to insure that 
medicine will be heard. IMPAC lets our representatives know that 
physicians and their spouses are interested in the laws that affect 
the practice of medicine and the health of the people of Illinois. 

You Need IMPAC! 

But success in the area of politics can only be accomplished through 
the concerted contributions and involvement of all the physicians and 
their spouses. An organized chorus of opinion commands attention 
whereas an individual voice often gets unheard. 

Yes, IMPAC needs you! 



The Illinois Medical Political Action Committee 
55 E. Monroe St., Suite 3510, Chicago, Illinois 60603 

(312) 782-1963 




Convention Handbook 


INTERIM 
MEETING 
78 

Wagon Wheel Lodge 
Rockton, Illinois 

Members of the House of Delegates 

Delegates and Alternate Delegates to the Illinois State Medical Society 

Officers of County Medical Societies 

ISMS Delegation to the American Medical Association 

AMA Delegation Report 

Schedule of Meetings 

Committees of the House of Delegates 

Resolutions 



for October , 1978 


295 


Members of the 1978 


Interim Meeting 

House of Delegates 


OFFICERS 


President 

President-Elect 

1st Vice President . . 
2nd Vice President . 
Secretary-Treasurer . 
Speaker of the House 
Vice Speaker 


David S. Fox 

P. John Seward 

Herschel Browns 

. . G. W. Giebelhausen 
Audley F. Connor, Jr. 
. . . .Cyril C. Wiggishoff 
...Robert P. Johnson 


TRUSTEES 


First District 

John J. Ring 

1980 

Second District . . . 


1980 

Third District . . . . 


1979 


Raymond DesRosiers 

1980 


Robert T. Fox 

1979 


Jere E. Freidheim 

1979 


Morris T. Friedell 

1981 


Henrietta Herbolsheimer 

1981 


Lawrence L. Hirsch 

1981 


Harold J. Lasky 

1980 


Richard N. Rovner 

1980 


Joseph Sherrick 1980 

Fourth District Fred Z. White 1979 

Fifth District Paul F. Mahon 1979 

Sixth District Robert R. Hartman 1981 

Seventh District Alfred J. Kiessel 1979 

Eighth District James Laidlaw 1979 

Ninth District Warren D. Tuttle 1981 

Tenth District Julian W. Buser 1981 

Eleventh District Kenneth A. Hurst 1980 

Twelfth District Joseph Perez 1980 

Trustee-at-Large George T. Wilkins, Jr. 


J. Ernest Breed . . . 
Edward W. Cannady 
Everett P. Coleman . 
Newton DuPuy 
Harlan English 
Edwin S. Hamilton . 
H. Close Hesseltine . 

J. M. Ingalls 

C. J. Jannings, III . . 
Frank J. Jirka, Jr. . 


Herschel Browns 
Allison Burdick, Jr. 
Howard C. Burkhead 
David S. Fox 


Earl H. Blair 

Joseph Bordenave . . . 
Walter C. Bornemeier 
Herbert Dexheimer . 

Alfred Faber 

George E. Giffin 

Arthur F. Goodyear . . 

Lee N. Hamm 

Eugene Hoban 

Ross Hutchison 

Eugene P. Johnson . . 
Ted LeBoy 


Past Presidents 

1971 Fredric D. Lake 1975 

1970 Willis I. Lewis 1954 

1945-46 Burtis E. Montgomery 1966 

1968 Edward A. Piszczek 1965 

1964 Caesar Portes 1967 

1962 Willard C. Scrivner 1974 

1961 Joseph H. Skom 1977 

1976 Leo P. A. Sweeney 1953 

1972 Philip G. Thomsen 1969 

1973 George T. Wilkins, Jr 1978 

Delegates to AMA 

Jack L. Gibbs John J. Ring 

Theodore Grevas Joseph H. Skom 

Lawrence L. Hirsch Fred A. Tworoger 

Morgan M. Meyer Charles K. Wells 

Joseph R. O’Donnell 

Past Trustees or