Faculty Bibliography

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.

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.

Now scientists in many laboratories have begun to identify the structure, genetic and immunological characteristics of the transplantation antigens. They know that the HLA antigens, as they are called, are situated on the short arm of chromosome 6. There are at least four distinct types of HLA antigen labeled by the letters A through D. Tests for HLA antigens are a standard procedure before the transplantation of an organ. Identical twins have the same antigens, and for those who are unrelated, an attempt is made to match the donor and the recipient's tissue types as closely as possible. Doctors recognize that rejections of a transplanted organ occur even when there is a close tissue match of HLA antigens. Presumably, then, there are other mechanisms that bear on organ transplantation that have yet to be detected. In recent years, doctors have discovered that strong links exist between certain diseases and particular histocompatability antigens. But they do not know why.

Yesterday, in upstate Watervliet, he denounced what he said were his primary opponents' ''below-the-belt'' efforts to portray him as being in failing health. ''In my 34 years of running for public office,'' he said, ''it's the first time I've encountered such a lowlevel campaign.'' ''It's like a brake in your stomach -like someone pulled the emergency cord,'' he said. ''You can't push forward until you stop a moment. Another thing is that even the 10- or 15-second wait for the traffic when you walk in New York City makes a difference. It's very odd. Who knows what it's all about?'' Mr. [Jacob K. Javits] was asked if he could foresee resigning if re-elected. ''No,'' he replied. ''I might walk less and be less mobile, but that has nothing to do with being a Senator, swimming or enjoying life. Work is the greatest therapy for me.''

Among those who have done it was John B.S. Haldane. In an essay, ''On Being One's Own Rabbit,'' he described how he ''got violent 'pins and needles' in his hands, feet and face'' after breathing as fast and deep as he could for two or three minutes and how he once had ''continuous spasm of the hands and face'' for one and a half hours from overbreathing.

In Mr. [Julio Echeverria]'s case, after examining the complicated sequence of events, the Board of Medical Examiners charged that Dr. Jascalevich made a diagnosis of cancer that ''he knew or should have known'' was false, that he mismanaged the case, performed unnecessary surgery, endangered Mr. Echeverria's health and life and subjected him to unnecessary suffering and mental anguish. Mr. [Sidney Goldmann]'s report stated that Dr. Jascalevich operated on Mr. Echeverria three times between July 1974 and April 1975. He began by removing gallstones and an inflamed gall bladder. Mr. Echeverria's recovery after the July 26 operation was complicated by drainage of copious amounts of yellowish bile, abdominal pain, weakness and a 103.8 degree temperature. On Aug. 15, during a visit by Mr. Echeverria to his office, Dr. Jascalevich, according to his office records, claimed to have found a piece of tissue while cleaning Mr. Echeverria's surgical wound. Dr. Jascalevich then sent the tissue, which he identified as a ''gallbladder bed'' specimen, to a laboratory where a pathologist diagnosed ''squamous cell carcinoma.'' Since this type of cancer rarely affects the gall bladder, and even more rarely that of a 30-year-old man, the pathologist immediately re-examined the gall bladder that Dr. [Mario E. Jascalevich] had sent to the laboratory after Mr. Echeverria's first operation. No evidence of cancer was detected and Dr. Jascalevich was informed of the peculiar medical situation. The state, after its review, concluded that Dr. Jascalevich should not have accepted unquestioningly the original pathology report of squamous cell cancer in Mr. Echeverria and that ''tumor should have been the last assumption, not the first.'' The state said Dr. Jascalevich failed to consider the more likely possibility of inflammation of the pancreas and despite his own diagnosis, never attempted to treat Mr. Echeverria for cancer or to consult experts about possible treatments. In his defense, Dr. Jascalevich's counsel contended that the surgeon treated Mr. Echeverria appropriately and that it was ''patently unfair'' to hold the surgeon responsible for altering Mrs. [Revis]'s record, because there were many other theories as to what might have happened.

The disease is Waldenstrom's macroglobulinemia, and it tends to strike men and women in their 50's and 60's by affecting the body's proteins, specifically a component of the antibodies that fight infections. Its cause is unknown. The story of its discovery in 1944 is one of the more fascinating in the history of medicine. Its discovery was relatively late because recognition had to await the invention of modern technology that could distinguish among the body's proteins. Waldenstrom's disease cannot be diagnosed with stethoscopes and the other standard equipment that doctors carry in their black bags. It is one of the few diseases for which the diagnosis can be made only in a laboratory, and nowhere else. Recognition of the disorder was due to Dr. Waldenstrom's unusual interest in bridging basic research with the practice of bedside medicine. Dr. Waldenstrom, a tall, witty man, is a member of an illustrious Swedish medical family. His father, Henning Waldenstrom, was a professor of orthopedic surgery, and his grandfather, Johan, was a professor of internal medicine at Uppsala.

The Health Department is following the disease center's recommendation that a two-gram dose of an antibiotic called Spectinomycin be injected once for patients with PPNG. Dr. [Yehudi M. Felman] said that doctors should take a repeat culture from all patients with gonorrhea ''seven to 14 days after completion of treatment to confirm the cure.'' Last month 17 cases of PPNG were reported in New York, compared with 33 in the preceding four years. ''This is a sharp increase,'' Dr. Felman said. The 17 cases occurred in a period when about 3,300 cases of nonpenicillinresistant gonorrhea were reported. Doctors have reported about 40,000 cases of gonorrhea to the Health Department for each of the last four years.

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.''