Faculty Bibliography

Strawberries imported from Mexico and processed in California have caused 153 cases of hepatitis A infection among schoolchildren and adults in Michigan, federal health officials said yesterday. Thousands more children in five other states - Arizona, California, Georgia, Iowa and Tennessee - may also be at risk, and they are being advised to get gamma globulin shots to help prevent the viral liver ailment, which generally causes a mild illness, the health officials said at a news conference in Washington. The officials sought to reassure the public about any concern over the risk of contracting hepatitis infection from strawberries, saying that no other clusters of cases had been found and that fresh strawberries were not implicated. The source of the contamination is not yet known

In forensic pathology, the investigation of a mass disaster inevitably thrusts a doctor into the national spotlight. For Dr. Brian D. Blackbourne, the San Diego County medical examiner, the call came last week, when he began the grim task of leading the team of pathologists who are performing autopsies on the 39 members of a millennialist group who committed mass suicide in Rancho Santa Fe, Calif. But none of those cases have brought the national attention that Dr. Blackbourne has recently received. To the public, which saw Dr. Blackbourne in televised news conferences after the suicides, the bearded medical examiner has been a picture of calm. He has handled questions in a straightforward manner, speaking succinctly and to the point and without the confusion or histrionics that some doctors have shown under similar circumstances. ''He is the dream medical examiner, because he is extremely competent,'' said Dr. Guido Majno, retired chief of pathology at the University of Massachusetts in Worcester, where Dr. Blackbourne had his office when he was chief medical examiner in Massachusetts for seven years. In 1989, Dr. Blackbourne left for San Diego because Massachusetts made severe cuts in the office's budget

SETTING: Incident patients with active tuberculosis (TB) resistant to two or more drugs in New York City hospitals in 1992. OBJECTIVE: To examine the New York-wide distribution of Public Health Research Institute (PHRI) strain W of Mycobacterium tuberculosis, an extremely drug-resistant strain identified by a 17-band Southern hybridization pattern using IS6110, during the peak tuberculosis year of 1992. We also compared strain W with other strains frequently observed in New York. DESIGN: Blinded retrospective study of stored M. tuberculosis cultures by restriction fragment length polymorphism (RFLP) DNA fingerprinting, and chart review. RESULTS: We found 112 cultures with the strain W fingerprint and 8 variants in 21 hospitals among incident patients hospitalized in 1992. Almost all isolates were resistant to four first-line drugs and kanamycin. This single strain made up at least 22% of New York City multiple-drug-resistant (MDR) TB in 1992, far more than any other strain. Almost all W-strain cases were acquired immune deficiency syndrome (AIDS) patients. The cluster is the most drug-resistant cluster identified in New York and the largest IS6110 fingerprint cluster identified anywhere to date. CONCLUSION: Because recommended four-drug therapy will not sterilise this very resistant strain, there was a city-wide nosocomial outbreak of W-strain TB in the early 1990s among New York AIDS patients. Other frequently seen strains were either also very resistant, or, surprisingly, pansusceptible. Individual MDR strains can be spread widely in situations where AIDS and TB are both common

The combination of phenobarbital and alcohol that at least some members of a cult apparently took to commit suicide in Rancho Santa Fe, Calif., is well known to be a lethal mixture. Phenobarbital is a barbiturate drug that doctors have long prescribed for its sedative and anti-seizure properties. Doctors generally warn patients taking phenobarbital or other barbiturates not to take alcohol, which can increase greatly the barbiturate's sedative and depressant effects on brain activity. Among those who died in Rancho Santa Fe, at least some had apparently mixed the phenobarbital with pudding or apple sauce and then taken it with vodka, said Dr. Brian Blackbourne, the San Diego County Medical Examiner

On a blistering August afternoon in 1948, a conservative journalist accused a liberal former government official of belonging to the Communist Party a decade before. The journalist was Whittaker Chambers, an editor at Time magazine; the former official was Alger Hiss, then president of the Carnegie Foundation for International Peace. Chambers' testimony before the rabidly right-wing House Un-American Activities Committee set off a political firestorm that smolders to this day. Was Hiss a traitor or the victim of a right-wing witch hunt? Was Chambers a liar or a born-again patriot with a crucial story to tell? Sam Tanenhaus devotes about half of his splendid biography to these questions, and his verdict is clear: Chambers told the truth. Yet it is the other half of his book, apart from the Hiss case, that constitutes the more interesting and original part of the story. The Whittaker Chambers we meet in these pages is a brooding loner who sees every human event as a struggle between good and evil, with nothing in between. He is both a relentless crusader and a perfect fatalist - always ready for battle, fully prepared for defeat. Born outside New York City in 1901, Chambers grew up amid lunacy and pain. His only sibling committed suicide, his grandmother roamed the house with a hatchet and his bisexual father often deserted the family for months. A talented but troubled young man, Chambers withdrew from Columbia University after writing a "blasphemous" play and then lost his job at the New York Public Library when stolen books were found in his locker. In 1925 he joined the infant Communist Party, barely 7,000 strong. "He was used to being outnumbered," writes Tanenhaus. "He had at last found his church."

On a blistering August afternoon in 1948, a conservative journalist accused a liberal former government official of belonging to the Communist Party a decade before. The journalist was Whittaker Chambers, an editor at Time magazine; the former official was Alger Hiss, then president of the Carnegie Foundation for International Peace. Chambers' testimony before the rabidly right-wing House Un-American Activities Committee set off a political firestorm that smolders to this day. Was Hiss a traitor or the victim of a right-wing witch hunt? Was Chambers a liar or a born-again patriot with a crucial story to tell? Sam Tanenhaus devotes about half of his splendid biography to these questions, and his verdict is clear: Chambers told the truth. Yet it is the other half of his book, apart from the Hiss case, that constitutes the more interesting and original part of the story. The Whittaker Chambers we meet in these pages is a brooding loner who sees every human event as a struggle between good and evil, with nothing in between. He is both a relentless crusader and a perfect fatalist always ready for battle, fully prepared for defeat. Born outside New York City in 1901, Chambers grew up amid lunacy and pain. His only sibling committed suicide, his grandmother roamed the house with a hatchet, and his bisexual father often deserted the family for months. A talented but troubled young man, Chambers withdrew from Columbia University after writing a "blasphemous" play, and then lost his job at the New York Public Library when stolen books were found in his locker. In 1925 he joined the infant Communist Party, barely 7,000 strong. "He was used to being outnumbered," writes Tanenhaus. "He had at last found his church."

The difficult rehabilitation that President Clinton will face after knee surgery today is discussed. For the next eight weeks or so, Mr. Clinton, who is 50, will be on crutches to keep some weight off his injured leg, Dr. David P. Adkison, the orthopedic surgeon who performed the operation, said at a news conference at the National Naval Medical Center. Through an audio link, Mr. Clinton interrupted the news conference to tell reporters not to give his doctors a hard time about his plans to fly to Helsinki, Finland, on Tuesday for a summit meeting with Boris N. Yeltsin, the Russian President. The meeting will accommodate two ailing leaders. Mr. Yeltsin, 66, is recovering from a heart bypass operation and pneumonia. The tendon joins four muscles in the upper leg and attaches to the kneecap. More than 50 percent of Mr. Clinton's tendon was torn, and the tear was in a pattern that was more complex than usual, Dr. Adkison said. However, that is not expected to prolong Mr. Clinton's rehabilitation. Before the surgery, Mr. Clinton was shown pictures of the damage to his knee

BACKGROUND: A 1991 survey showed high levels of drug resistance among tuberculosis patients in New York, NY. As a result, the tuberculosis control program was strengthened, including expanded use of directly observed therapy and improved infection control. METHODS: We collected isolates from every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1994; results were compared with those in the April 1991 survey. RESULTS: From 1991 to 1994, the number of patients decreased from 466 to 332 patients. The percentage with isolates resistant to 1 or more antituberculosis drugs decreased from 33% to 24% (P < .01); with isolates resistant to at least isoniazid decreased from 26% to 18% (P < .05); and with isolates resistant to both isoniazid and rifampin decreased from 19% to 13% (P < .05). The number of patients with isolates resistant to both isoniazid and rifampin decreased by more than 50%. Among never previously treated patients, the percentage with resistance to 1 or more drugs decreased from 22% in 1991 to 13% in 1994 (P < .05). The number of patients with consistently positive culture results for more than 4 months decreased from 130 to 44. A history of antituberculosis treatment was the strongest predictor of drug resistance (odds ratio = 3.1; P < .001). Human immunodeficiency virus infection was associated with drug resistance among patients who never had been treated for tuberculosis. CONCLUSIONS: Drug-resistant tuberculosis declined significantly in New York City from 1991 to 1994. Measures to control and prevent tuberculosis were associated with a 29% decrease in the proportion of drug resistance and a 52% decrease in the number of patients with multidrug-resistant tuberculosis