Faculty Bibliography

Last April in Houston, Mr. [Alexander M. Haig Jr.] underwent a triple bypass heart operation. The surgery is usually done to relieve symptoms of arteriosclerosis but not to cure the disease. Deposits of fatty substances narrowed three of the coronary arteries that nourish Mr. Haig's heart. With the flow of blood obstructed, his heart could not receive enough oxygen at certain times. The specific medical reasons for Mr. Haig's operation are not publicly known. Presumably Mr. Haig suffered from attacks of angina, the squeezing-type of pain that occurs in the chest, usually beneath the sternum or breast bone, and sometimes in the jaw or arm. Angina generally results from a diminished blood supply to the heart cells. Also, it is not publicly known whether there are limitations on Mr. Haig's physical activities. Further, it is not known what standard cardiological tests, if any, were done to measure the success of Mr. Haig's bypass surgery. Many Resume Stressful Jobs

Leprosy bacteria, unlike many other organisms, cannot be grown on artificial media in the laboratory. But, in 1971, researchers in Louisiana found that leprosy bacteria could infect nine-banded armadillos in the laboratory with a variety that mimicked lepromatous leprosy, the severest form in humans. Now armadillos provide the large numbers of bacteria needed to develop an experimental vaccine. The second stage - selecting the preparation to be tried as an experimental leprosy vaccine - is expected to begin next year, according to Dr. Hubert Sansarricq, who heads the health organization's leprosy program here and who taught me about leprosy when we worked in Upper Volta. When the World Health Organization began its leprosy vaccine program in 1974, the best scientific guess was that the vaccine must include killed leprosy bacteria as well as a chemical called an adjuvant to boost its immunizing power. But a pleasant surprise came from evidence showing that the preparations with killed leprosy bacteria alone had much stronger immunizing properties than originally imagined

Another psychiatrist, Dr. Steve Pieczenik, said on a separate CBS News program: ''Their emotional status, their psychological response, is showing that they are coming to their end point, that they are tired, they are exhausted, and they would like to keep on hoping and believing but they just don't have that much more to hope and believe on.'' Dr. Pieczenik, speaking again on ABC News, said that many hostages were depressed and felt abandoned. However, Dr. Frank Ochberg, who appeared on the same ABC program, said that although he detected ''a great deal of sadness,'' he was less convinced than Dr. Pieczenik about the degree of the hostages' depression. Dr. Pieczenik contended on ABC News that all 52 will be ''hostages for the rest of their lives.'' Psychiatrists interviewed by The New York Times disagreed, saying that, depending on the psychological factors in each case, some of the hostages might not suffer permanent damage.

USUALLY it is only the family members, and sometimes the physician, of someone killed by a sudden, unexpected injury who are left to wonder, ''What if he had got to the hospital sooner?'' But during the last year, so much publicity surrounded the murders and attempted murders of famous people that nearly everyone has been vividly reminded of the fragility of life, as well as the importance of time in receiving emergency medical care. Among the incidents: - Last week, the surgeon who accompanied Dr. Herman Tarnower from his Purchase, N.Y., home, where he was shot four times on March 10, to St. Agnes Hospital in White Plains, said he ''might have survived'' if he had been moved immediately instead of having to wait 10 or 15 minutes for an ambulance. Despite the unknowns involved, Doctors and patients will probably continue occasionally to say that a particular individual would have survived ''if only he had been treated sooner.'' Sometimes that is true. Other times it is more a rationalization of one's own sense of helplessness than an accurate reflection of how things would have changed if the patient had been treated sooner.

One such group, the Club of Mainz in West Germany, limits its membership to 100 international leaders in disaster medicine who have promoted research and published on the subject. The Club of Mainz was founded in 1976, largely through the efforts of two doctors, Prof. Rudolf Frey of the Johannes Gutenberg University in Mainz and Dr. Peter Safar of the University of Pittsburgh. Next May in Pittsburgh, the group will hold its second world congress with the cooperation of the World Health Organization, the International Committee of the Red Cross, and several other groups. Disaster medicine now is a discipline for which universities in London, Paris, Brussels and Bordeaux, among others, are granting academic credits. Formal courses are directed at studying the pattern of medical problems that emerge from disasters as well as in organizing teams to respond to them. At the same time, the scope of disaster medicine is enlarging to include the health problems of refugees and victims of famine.

In the American-financed immunization program in West Africa, the vaccine was unexpectedly delayed in shipment from the United States. On its arrival in West Africa, we could not be sure of its potency. Once there, it was supposed to be kept cold by butane gas-fueled refrigerators that were placed in the rear compartments of trucks that officials of the United States Agency for International Development had designed for the immunization program. Dr. Rafe H. Henderson, an epidemiologist colleague who carried on with the measles immunization program when I left West Africa, reminded me of our experience the other day. Now, as head of W.H.O.'s global immunization program, Dr. Henderson is responsible for keeping the vaccine cold chain intact. The tags are known as ''the spies in the fridge,'' and their technological espionage may maintain the cold chain to prevent many of the five million deaths. If so, it will be further proof of a medical adage: vaccines are the best health bargain.

Dr. Guberan compared the statistics of deaths from all types of heart disease, not just heart attacks, in Switzerland from 1951 to 1976. He showed a 43 percent decline in deaths from all types of heart disease among Swiss women and a 22 percent decline among Swiss men. Dr. Guberan said that the 43 percent decline in deaths of Swiss women was unequaled in the 13 other countries for which he analyzed the data for the same period. The decline in heart-disease deaths in Switzerland was associated with the growth of economic prosperity, Dr. Guberan said. Dr. Guberan said in an interview that because no separate data were available on deaths from heart attacks in Switzerland from 1951 to 1968, he could not compare the specific changes in heartattack deaths in those years with the data for the following years. Both his and the World Health Organization study showed that there was little change in heart-attack deaths from 1968 to 1977 in Switzerland.

The man was unconscious. The contracted muscles throughout his body twitched violently. His hands were held fixed like claws. If we were in an emergency room, drugs like Valium and Dilantin could be injected into a vein to halt the seizure. But the man was on a church bench. His legs, rigid, were stretched under the pew. The narrow space made it difficult to maneuever, but several other wedding guests helped me move him to the aisle. We placed a jacket under his head as a pillow. We sought information from the man's parents or friends, but no one responded. Another physician joined the scene. With no drugs available, we were powerless to stop the seizure. Someone offered a large comb to hold his tongue, but we rejected its use as too risky. It was also doubtful that we could have inserted it into the victim's mouth. Even if we had, the man might have choked from a broken tooth of the comb. Or the comb tooth might have pierced his mouth and caused bleeding. Some guests told me that they had reacted initially to the man's cries by thinking they were somehow part of the service. The priest said later that this was his first such experience and he simply was unsure of how to procede. ''Should I continue celebrating a wedding while a man was dying in my church?'' he said he asked himself. Meanwhile, the man's parents arrived at the reception late, and after we explained what happened, we directed them to the hospital. On returning, they attributed the attack to the son's eating habits, saying that he had little to eat the previous day. Other guests asked if that could be so. We expressed skepticism.

Dr. Flier said that there was currently no way to estimate the percentage of obese people who might have the enzyme abnormality. The prevailing scientific opinion is that overeating is the primary cause of obesity because obese people eat more than thin people. However, Dr. Flier said, ''The scientific data for that is remarkably weak and some studies have shown that obese individuals as a group do not eat more than thin people.'' Dr. Flier added that ''we all know thin people who overeat by anyone's standard as well as overweight people who don't seem to overeat. I see them at lunch every day. A lot more needs to be learned to explain such apparent inconsistencies.'' Previous studies have shown that different people gain different amounts of weight from a given caloric intake. ''Our findings point to a new direction for research into obesity,'' Dr. Flier said. ''The focus should be enlarged to include altered metabolism of food by the body, not just overeating, as the cause of obesity. Our finding provides a biochemical tool for studying this in great detail.''