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TODAY THE THESIS requirement in higher education is an accepted academic tradition. Despite an absence of controlled studies about its efficacy, few seem to take issue with its validity. In the medical school this "ultimate obstacle" has been distilled by many departments into a "term paper requirement." Not uniformly perceived as a relished opportunity by all medical students, here too, educational effectiveness has yet to be documented. The following report describes how in the Department of Pediatrics at the Ohio State University College of Medicine a long-standing term paper requirement was modified to accomplish specific objectives providing both subjective and objective evidence concerning the efficacy of modification. The techniques are seen as having somewhat broader implications. Background In early 1950's, a number of pediatric departments began encouraging their students to seek out the overall impact of disease upon a child, his family, and his community. Concurrently, attempts to kindle in-depth

OF the many papers printed since 1812 in the medical periodical now known as the New England Journal of Medicine, hardly a score qualify as contributions of sufficient importance to be included in bibliographic listings designed to illustrate the progress of medicine. The Journal, like most publications of its type, contained few original contributions of particular value during its first hundred years, for most physicians had not developed the habit of documenting their unusual experiences and often they had to be urged to do so by their fellow practitioners. The Journal, however, offered a relatively easy and rapid means of . . .

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Although the following Notes may appear elementary to practised writers, over thirty years' experience as an editor has convinced me that many authors need guidance in the preparation of their manuscripts and illustrations for publication and in dealing with their proofs.

istration of Chiropractic in the New York City Medicaid Program," by Julius Dintenfass, D.C., in Medical Care 11 (1): 40-51, January February, 1973.7 The fundamental issue here is whether an article that describes the historical evolution, the administrative physiology, the distribution of payments, the level of participation, and the legal entanglements within the chiropractic program of New York City Medicaid deserves publication in an official journal of the American Public Health Association. In their dissent from the editorial decision to print the article, respected and thoughtful colleagues invoke, inter alia, AMA and APHA resolutions in opposition to chiropractic. Their expressed concern deserves serious and comprehensive response.

Every physician should know how to prepare a paper for presentation at a medical meeting or publication in a medical journal. Perhaps the most convincing reason for this is an altruistic one. Since writing is the only means the medical profession has of universally disseminating knowledge concerning new therapeutic concepts, medical discoveries, or clinical experience, it is the moral obligation of every physician who has made an original scientific observation, or has formulated from his own experience a new medical theory, to publish it for the information of his colleagues, and the ultimate benefit of mankind. Another good motive for writing medical articles is a purely selfish one. In addition to the sheer joy derived from effective self-expression, the physician who prepares an article on a certain subject broadens his own knowledge of that subject, for, before he can present his material in a comprehensive manner, he must have a

The unusual occurrence of two psychosomatic papers (pages 13 and 16) in a single issue of this Journal might suggest that they are of special interest, exceptional importance or exemplary design — or perhaps that the Journal simply has become more receptive to such contributions. Unfortunately, none of these seem to be the case. Rather, the articles are typical of certain psychosomatic studies that from time to time appeal to editors because they seem "more scientific" than usual. Indeed, they may even inspire editorials on their exceptional scientific quality and praise for scholarly refutation of earlier claims of psychosomatic relations. . . .

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The American Board of Legal Medicine was incorporated in 1951. Its membership is limited to doctors who also possess a degree in law or who have had at least five years' medicolegal experience. Since its founding, this organization has sponsored a number of meetings. This book represents a collection of papers presented at these meetings on a number of medicolegal subjects. The papers themselves may be said to represent the expression of opinions of the men who have taken the time and trouble to present a point of view. Individually, the papers are of uneven quality. Collectively, they are of interest as they reflect the character of the sponsoring organization.

The title of this paper may seem rather an ambitious one, since the study of vital and social statistics, and their application to the comparative study of races and nations, is almost too new to furnish many principles that may serve as bases of induction. However, I purpose to state in a fragmentary way a few notes and observations bearing on the subject. More than usual experience as a traveller has brought me in contact with various races of men under different mesological conditions. Experience and observation in this line show that, in spite of physical and moral varieties, there exists practically, for the physician, but one people, since there are no wide differences, biologically or medically speaking, in the human species; and the infirmities of men, notwithstanding their physical inequalities and the extensive range of the nosological table, are much the same the world over, no matter whether they

This book is the 42nd in a series of public health papers published by the World Health Organization. In summary fashion it deals with the collection of perinatal epidemiological and statistical data, specific perinatal medical problems, the organization of care, and the required directions of perinatal training and research. Reading this book reacquaints one with the painful process of making decisions and recommendations by committee and the rapidity with which our technical world moves, dating some of the statements in this relatively recent publication. Most of the recommendations made in this book will find wide agreement among working perinatologists. There is even a recommendation that in the basic training of every physician "the time allocated to neonatology should be between a quarter and a third of that devoted to pediatrics." There are some portions of the book that are not particularly helpful. The discussion of the clinical terminology surrounding hyaline

The rationale for this book appears to be the editor's conviction that medicine should "rediscover" therapeutic uses of marihuana. In an attempt to buttress this thesis, he compiled 25 of the "better professional journal articles" from the past 133 years that pertain to various medicinal or scientific aspects of the drug. Most articles describe personal experiences, therapeutic applications with patients, acute clinical studies, or chemical and pharmacological endeavors. Only Musto's excellent review of the 1937 Marihuana Tax Act is not directly concerned with medical or pharmacological effects of cannabis. After O'Shaughnessy introduced marihuana into the Western pharmacopoeia in 1839 (his report is the first in this book), the drug was promptly recommended for an utterly endless list of disorders. Despite utopian claims, however, wide acceptance never evolved. The editor's primary explanation for this is that recent "recreational" use and the "resultant restrictive federal legislation" functionally ended medical applications of marihuana.

Mr. President and Fellow-members of the Ohio State Medical Society: The subject of fever—in its general aspect—has been deemed worthy of so much labor and study on the part of the physiologist, the pathologist and the clinician, and is of such practical import to all who practice our art in any of its branches, that no apology is necessary, I trust, for bringing one of its numerous phases before this society for consideration. Looking at its most constant and evident symptom—the pyrexia—the physiologist points out, and the pathologist, and clinician confirm the probable •existence of heat-producing, heat controlling and heat dissipating areas, situated in the central nervous system, and influencing by their abnormal action the production of this particular symptom. That the pyrexia, however, does not constitute the disease is quite evident, since, it may be absent, controlled or even eliminated, and yet the patient be far from well. While

Nowadays, we hear a lot about stress. Recently, Asher wrote a delightful comment upon the relationship between stress and organic disease. I quote from his Lettsomian lecture, published in the Lancet 2:417, 1959: "Consider the ubiquitous stress factor, now accepted as the origin of many modern diseases—peptic ulcer, asthma, and ulcerative colitis. Here is a particularly well-written passage of this subject, from the pen of a distinguished physician: 'Peptic ulcer—one of the pestilent camp followers of civilization—one of the penalties we pay for our boasted progress, seems to be more than keeping pace with our advancement, and to be attaching itself especially to certain forms and phases of civilization. There is reason to believe that it is, if not of modern origin, at least of modern growth, and that modern habits and modern modes of life have something to do with its propagation. This is essentially a feverish and fidgetty

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an important cause of industrial disability (Troup, 1965), little discussion of it is given in the standard textbooks of orthopaedics. As the aetiology, pathology, and prognosis are all obscure, this lack of attention is understandable. To many minds acute lower back pain, with or without sciatica, suggests as a first possibility prolapsed lumbar intervertebral disc; to others the "osteopathic lesion" is the common explanation (Stoddard, 1959). This paper represents an attempt to measure the incidence of " acute backs " in one general practice and to note if a cause such as back strain is often present. An effort has also been made to discover if any aspects of the clinical condition have a significant influence on the duration of the initial attack or the liability to recurrence.

Pain may be attacked in the rheumatic diseases (1) centrally, with drugs ranging in efficiency from those which are potentially addictive and under the Dangerous Drugs Act (e.g., pethidine) and are therefore rarely used, down to simple analgesics such as paracetamol; (2) peripherally, by local action, whether it be by applications of heat or cold, by injections of local anaesthetics or anti-inflammatory agents, or by surgery; (3) peripherally, by anti-inflammatory non-analgesic agents taken systemically, such as the corticosteroids; and (4) peripherally, by anti-inflammatory-analgesic-antipyretic agents taken systemically, such as aspirin.The exact sites of action of the pyrazoles, indomethacin, the anthranilic compounds, and other anti-inflammatory-analgesic-antipyretic drugs are as yet uncertain, but along with these methods of attacking the pain-producing areas help must also be given to the distressed mind behind the joints. Faith in the future, cheerfulness, freedom from depression, and the development of a philosophy to deal with the uncertainties of the disease are essential. It has been said that you don't have to be a doctor to treat uncomplicated lobar pneumonia: anybody with a bottle of penicillin in his hands holds the cure. It is the incurable diseases that are really worth treating, and that make demands on the physician. To quote Tuker: "My last word is this. Whoever has the care of a sorely stricken arthritic must encourage him to fulfil himself intellectually and spiritually, and to achieve-no matter what, but to achieve, so that he may nightly lay himself down on his bed of pain looking forward happily to the morrow's task, mind centred upon it, no matter what it is; sticking in stamps, research into anything you like, dabbling with pastel or water colours, writing chatty letters to friends. Anything at all, but let it be for him the most pressing thing of the day, and let him believe that you think it is. Help him and let him live, live fully."This is perhaps the best analgesic of all.