Faculty Bibliography

The spasmodic tightening up of coronary arteries deprives the heart muscle of the oxygen upon which it depends to pump blood to the cells of the body. The length of time the coronary artery remains in spasm, as well as the spasm's severity, determines whether an individual suffers only pain or a real heart attack. If a spasm lasts more than a few minutes, it can also produce a heart attack, in which a portion of heart muscle dies from oxygen deprivation, or cause potentially fatal abnormalities of the heartbeat. Documentation of the role of coronary artery spasms came only in the last decade, through coronary arteriography studies. By studying the heart during actual attacks of chest pain, cardiologists found that angina could result from transient impairment of the blood supply through the coronary arteries, and that such angina attacks could occur in normal arteries as well as those blocked by the deposits of fat that characterize arteriosclerosis. Now, through many studies, it is clear that spasm can cause a type of angina - Prinzmetal's angina -named for Dr. Myron Prinzmetal, a cardiologist in Los Angeles who described it in 1959. Such patients usually experience angina at rest, not on exertion. However, Prinzmetal's angina accounts for only about 1 percent of all cases of angina

It is now clear that beta blockers are one of those infrequent advances that revolutionize the practice of medicine. They are ''one of the major therapeutic advances of this century,'' according to a textbook on the beta blockers by Dr. William H. Frishman, a cardiologist at Albert Einstein College of Medicine in the Bronx. And Dr. Sidney Alexander of the Lahey Clinic in Boston calls them ''perhaps the most significant advance in the treatment of coronary disease since the discovery of nitroglycerin,'' first used in 1879 to treat the chest pains of angina. The beta blockers, or the beta adrenergic blocking drugs, derive their name bec ause they thwart the effects of adrenaline, or epinephrine, one of the hormones that helps r egulate the body's sympathetic nervous system. This is one part of the body's so-called autonomic nervous system. The other is the pa rasympathetic nervous system, and it is involved chiefly with the c onservation a nd restoration of energy in the body. The five beta blockers marketed in the United States are propranolol, atenolol, timolol, metoprolol and nadolol. All five are approved for the treatment of hypertension, and, although they all are effective against angina, the F.D.A. has approved only propanolol and nadolol for that use. The physician's selection from among them depends on choosing the least undesirable side effects, ease of finding and giving the appropriate dosage, and cost. It appears that all beta blockers are effective for heart and circulatory disorders. However, the F.D.A., as is its usual policy, has required proof of each beta blocker's efficacy and safety for each use. Useful in Other Conditions

One such disease was called ''the English sweating sickness'' or ''English sweat.'' From 1486 to 1551 in England, there were five major epidemics of an acute and often fatal illness. It was characterized by chills and profuse sweating. It was often accompanied by vomiting and peculiar sensations in the chest and abdomen. Because von Economo's disease occurred about the same time as a pandemic of influenza A, some experts wonder if it was an unusual manifestation of that common viral illness. However, a point against that possibility is that the complication of Parkinson's disease has not been linked to other epidemics of influenza A. Another disease, ''trembles,'' victimized settlers in the Mississippi valley in the 18th and 19th centu ries, producing abdominal pain, nausea, vomiting, fever and i ntense thirst. Coma and convulsions appeared late in the course of th e most severe cases. Trembles resulted from consuming milk, milk products or me at from cattle afflicted with the disease. Now trembles is presume d to have been caused by a toxin found in a plant called white snake root. Trembles disappeared as the native vegetation in pastures was replaced by agricultural varieties

A leader in health education, Dr. Lee used $8,000 won in a poker game to help finance legislation to control venereal disease. Dr. Lee's provocative statements were not limited to medical subjects. In 1964, at a conference on the future of the family at the University of California Medical Center in San Francisco, he said: ''The male needs a long tether and the wife is well advised to see that he gets it. Men really suffer in marriage more than do women.'' Yet he said he was not out to abolish the family because there was ''no better device for raising children.'' Russel Van Arsdale Lee was born in 1895 in Spanish Fork, Ut ah, where his father was a Presbyterian minister. In an autobiographical article in Medical World News in 1973, Dr. Le e said that he was delivered by a Harvard physician who was exil ed to his home town because of ''intermittent alcoholism.'' Dr. L ee said that after his own birth this doctor was recalled from the l ocal bar to deliver his twin brother. Dropped Engineering Plan Dr. Lee's group met active opposition from members of the Palo Alto community. Elsewhere, the concept of group practice was slow to catch on. Dr. Lee said one reason for the delay was the condemnation of group practice by A.M.A. officials as ''nothing but a device for fee-splitting.'' His Chief Disappointment

The committee warned that doctors should not automatically resort to drugs in treating mildly high blood pressure. ''The first line of treatment should be observation,'' the committee said, ''perhaps combined with general health measures such as weight reduction and restrictions of salt intake, though the evidence for the effectiveness of such measures is still lacking.'' Low Rate of Death The committee, in recognizing that ''a very great advance'' had been made toward increasing public awareness of hypertension and inducing people to seek diagnosis and therapy, said that much more scientific evidence ''is still needed before safe, effective and economic control of high blood pressure and its complications can be achieved'' for the community. Dr. [Michael H. Alderman] said in an interview that he considered the primary challenge in hypertension research the development of ways to identify which groups were likely to benefit from drug therapy. Now, he said, ''If everyone with mild hypertension were treated with drugs, then a large number of persons who are not at risk of developing complications would be treated without any hope of benefit.'' Benefits May Outweigh Risks

LEGIONNAIRE'S disease is only one of the ''new'' diseases that have seemed to crop up continually in the last 20 years or so. There were Lassa fever and Marburg virus disease - both contagious and potentially lethal. There were the Norwalk agent and the whole family of rotaviruses that are a principal cause of diarrheal disease or ''intestinal flu'' among infants throughout the world. Toxic shock syndrome, which became a household word in 1980, looked at first like a totally new disease resulting mainly from the use of ''superabsorbent'' tampons. True, the tampon was often implicated. But the disease's cause, although debate continues over some of the specifics, was a toxin produced by a strain of a common bacterium, Staphylococcus. So perhaps it is not so new after all, but rather akin to an old disease, scarlet fever, which can be caused by certain strains of staphylococci. Beyond that, epidemiology has become much more sophisticated than formerly, so specific causes of common ailments can often be described. For example, the ''Norwalk agent'' was discovered in 1972 in specimens kept since they were collected in an outbreak in Norwalk, Ohio, in 1968

Dr. Dennis S. O'Leary, spokesman for the hospital, said last week that the withdrawal reaction lasted about two hours and was characterized by ''disturbances in mental clarity'' and ''distorted'' perceptions of reality. In an interview today on the ABC News ''Good Morning, America'' program, Dr. O'Leary said that ''a degree of physiological dependence'' was involved. Dr. O'Leary also said that although he did not know how long Justice Rehnquist had taken the drug, he ''presumed'' the drug was responsible for the speech impediments noted by reporters and lawyers at the Court in recent months

Ironically, the very need for new antibiotics points to a problem intrinsic to these drugs and one that may mar the future of the next generation as well. On one hand, few therapies rival the success of antibiotics, which have helped cure millions of people of syphilis, gonorrhea, pneumonia, tuberculosis, meningitis and the myriad of ''staph,'' ''strep'' and other infe ctions that would otherwise be disabling, if not fatal. However , bacteria have shown amazing ingenuity in developing resistance me chanisms that render potent antibiotics ineffective. With each suc cessive wave of antibiotics produced since the sulfa drugs ju st before World War II, organisms have rallied to their biochemical d efenses. Genetic particles conferring resistance to one or sev eral antibiotics can be passed among bacteria by sexual reproduction, and those particles often enable a bacteria to become resistant t o drugs it has never met. The overuse of antibiotics in general, experts point out, exacerbates the resistance phenomenon. At a recent meeting in Geneva, the World Health Organization warned that such overuse and misuse would lead to further lessening of antibiotics' effectiveness, loss of lives and even higher costs of treating infections. In many countries, antibiotics can be bought over the counter without a prescription, leading many people to treat themselves for ailments that do not require their use; some physicians prescribe antibiotics unnecessarily, as in treatment of viral infections for which they are in fact ineffective; in the United States and elsewhere, antibiotics are used in feedstuffs to aid the growth of animals for commercial purposes

For about two hours on Dec. 27, Justice Rehnquist experienced what Dr. O'[Leary] described as ''disturbances in mental clarity'' and ''distorted'' perceptions of reality due to a drug reaction while a patient at the hospital. Earlier, so me journalists and lawyers had noted in court that Justice Rehnq uist's speech was slurred and that he had difficulty in enunciating l ong words. A physician who is an expert in the pharmacology of such drugs and who is not connected with Justice Rehnquist's case said yesterday that Placidyl's effects could be exactly those described by Dr. O'Leary: slurring of speech without affecting rational thinking while under the drug's influence, followed by mental disturbances after discontinuing the drug. That expert also said that he could see circumstances in which another physician would prescribe Placidyl for longer than a week despite the manufacturer's warning

Recently, 12-year-old Todd Cantrell of Dalton, Ga., went to the Soviet Union for the first of a series of injections of yeast RNA, or what his Moscow doctors call Encad. It is an unproved treatment, one of many such treatments for R.P. offered throughout the world. The private Retinitis Pigmentosa Foundation in Baltimore warns in brochures that there is no scientific evidence of Encad's benefits for R.P. The National Eye Institute in Bethesda, Md., agrees. Others even call Encad another laetrile, the purported cancer cure that the medical establishment regards as worthless. The mystique of Encad therapy and the offer of hope has lured at least 50 Americans to Moscow, according to press reports. Yet ''no beneficial effect'' has been found in follow-up examinations of seven s uch patients by Dr. Eliot Berson, an expert in retinis pigmentosa atthe Massachusetts Eye and Ear Infirmary in Bo ston. Three of the sevenhave shown further deterioration, according t o Dr. Berson. Meanwhile, news coverage of Todd's trip has become as controversial as the Encad therapy because eye researchers like Dr. Laties have accused the news media of raising false hopes for Todd and thousands of others who have R.P. Yet the Retinitis Pigmentosa Foundation, which has published brochures saying Encad has no proved value, has not responded aggressively to Todd's story. It has not, for example, issued a press release making its position clear in this particular instance. Should it have done so?