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Presents the author's travel experience across the U.S. using a motor house. Description on the vehicle he used for the travel; Companion of the author; Photographs of some of the places he passed by; Description of the places he see on the way.

THERE evidently lurks in the soul of every American an intense yearning to see China. Beginning in the fall of 1971 down to the time in which I write, a week does not pass without my receiving a letter, phone call, or personal query, in varying styles, the essence of which is "How can I get a visa to China?"The variations on the theme are many. Many are straightforward travel enthusiasts who have been everywhere and are accustomed to the habit that an American tourist is surely welcome everywhere, and now want to add China to their travel list.Other queries fall into the category of "I was there in 1941 and I cannot believe that the flies, beggars, famine, etc, have stopped. I want to go look again."Still others have varied reasons:"I collect porcelains and...""I have to give a report for my book club about

THE NEW University of Missouri-Kansas City School of Medicine graduated its "charter" class in the Spring of 1976. This class represented the original group of high school graduates who entered six years earlier. From the considerable experience of these past six years, augmented by my own 32 years as a physician, surely I have learned something regarding either health, illness, education, or, remotely, wisdom. However, the more experience I have, the less I am certain that I know the message.TODAY'S MEDICINEAt this point in my career, I should be accumulating a supply of useful homilies. However, the truth is that the farther I go along the path of experience, the less I seem to know for sure. It was a bit discouraging to offer this information to these new, enthusiastic medical school graduates and their proud families. In fact, it is probably anti-intellectual to admit the basic truth:

THE MORNING paper reports that fuel shortage is making the "all-electric" home a considerable liability to the pocket-book. The details, in brief, are that ten years ago the power and light companies endorsed vigorously—in fact, huckstered—the advantages of cheap, clean, efficient electrical power as the way of the future for the ideal home. Now, ten years later, these same companies have looked in their energy cupboard and found electricity is still a clean source of heating but not at all cheap; in fact, said the news article, electricity was found so very dear that the utility companies are urging home conversion to oil or coal.This interesting example of inability to see the future, even when all signs were available a brief ten years earlier, readily is criticized by all of us as an example of an industry's lack of sensitivity to the public good and as an example of

THE SUDDEN opening of China to foreign visitors following the pingpong event of 1971 created an entire new school of China watchers. Thousands became instant authorities following their 21-day travel immersion. Most of us could base our knowledge only on what we saw and heard in our three-week period, and we new China watchers were filled with briefings by Responsible Members of revolutionary committees. It was not a matter of brainwashing or misled thinking; the messages given in the briefings were in part propaganda, but they were equally an accurate report on what policies were operational in China. The American who returned home and reported that there was an intense spirit of "serve the peasant," "serve the peasant, workers, and soldiers," and "go down to the countryside and help the poor peasant" was not misled.The strength of Mao Zedong's messages was multiplied by the effectiveness of the communist system.

Describes the practice of medicine in China, as of 1972, in compliance of a national policy mandating a total national obligation to implement the teachings or policies of Mao Tse-tung, particularly of acupuncture anesthesia. Integration of modern medicine with traditional Chinese medicine; Use of therapeutic acupuncture in the country; Medical cases which involved the use acupuncture anesthesia for treatment.

• The responsibilities of physicians, whether they be generalists or internists, are identical In the evolution of medical care in the United States, the terms "family doctor," "general practitioner," and "internist" will all become synonymous. There is considerable feeling that a man finishing medical school with the present training program simply cannot have mastered the broad aspects of family medical care. There appear to be three approaches to the solution of this medical education problem. First, there is the increasing opportunity for continuation of formal education throughout the career of the physician. Second, there is the stimulus in the requirements for membership in the American Academy of General Practice. Lastly, there is the requirement of a twoyear residency in general practice, following the internship. All of these seem to be attempts to "patch" a system of education which is not accomplishing the fundamental obligation: to prepare a physician for his role as "the family doctor."

A program to train students for practice as family physicians must satisfy certain stringent requirements. The family physician's practice is not limited to internal medicine, and his training must be much broader. It must provide experience in obstetrics, pediatrics, and psychiatry. It must prepare him to deal with emergencies in a way that will facilitate, not hamper, the subsequent work of the specialist. The program wherever instituted must have an adequate administrative framework. It should lead to certification and should offer the physician an opportunity to achieve status, honor, and recognition not only before the laity but before the eyes of his professional colleagues. This can be achieved by replacing the present 12-month internship with a 24-month program based on internal medicine but broadened to give the necessary range of experience.

The effect of venous tourniquets, abdominal binders, and glyceryl trinitrate on the apex cardiogram (ACG) was studied in ten normal subjects and in 40 patients with ischemic heart disease (IHD). These agents were effective in reducing the amplitude of the "a" wave in patients with IHD. In normal subjects abdominal binder and tourniquets did not cause any changes in the ACG. Five patients with IHD had elevated left ventricular end-diastolic pressure at rest and all three methods were effective in reducing this pressure to the control levels with a decrease in the amplitude of the "a" wave. In these five patients, cardiac output and intraarterial pressure were not changed during the test.

A school of language, of music, of science can have (but may not have, of course) a neutral existence within the community, yet still be a satisfactory member of both community and college. A medical school may also aim for the neutral role by confining its activities to medical student education and to its own internal hospital functions and research programs. However, the nature of a medical school makes possible for it to have a different relationship to its community than any other school within the university. If careful effort and thought are devoted to the premedical years, to the intern and resident programs of the regional hospitals, and, beyond this, to the continuing education of the physicians in private practice, the school could serve as a catalyst—bringing life to a regional medical concept, with values beyond the numerical addition of a medical school to the community.The walls of

During the past several months I have been on leave of absence as a visiting scholar at the National Library of Medicine. The time for contemplation was livened by the opportunity to observe first hand several federal health agencies, to study their relationship to each other, and to review the considerable health legislation of the 89th Congress.What I suggest here is from a private citizen viewpoint, tempered by persistent teaching and practice. I have no rigid belief in the inalterable soundness of what I advocate. Instead, my intent is to stimulate and, hopefully, by give and take, reason and reaction, see result certain missing ingredients in the present medical structure.Regional Medical Programs and National Medical ProgramsThe excitement with launching of the Regional Medical Program (RMP) has obscured partially the substantial evidence that a nationwide, cohesive education program also has a role in the continuing education of 300,000

In September 1971, Paul Dudley White, myself, and our wives were invited to the People's Republic of China by the China Medical Association. We were asked by our Chinese hosts to indicate specific interests, and among these I identified acupuncture. In a previous report in the New England Journal of Medicine1 I described my acupuncture experience in Saigon. Earlier (1946-1947) I had seen the practice of acupuncture and moxa in Japan.The China Medical Association and the many individual physicians could not have been kinder, and made every effort to allow me to see the full range of medical practice in China today.The practice of medicine and the national policy of China are inseparable and this report can only be rational if the political reality is identified.

In a personal visit to the People's Republic of China, as a guest of the China Medical Association (simultaneous invitations were extended to Dr. and Mrs. Paul Dudley White, Dr. and Mrs. Samuel Rosen, Dr. and Mrs. Victor W. Sidel, and my wife, Mary Clark Dimond, and myself) in September 1971, I was asked to list areas in which I had special interest. These were medical education, medical care, and acupuncture. Our hosts did their best to make these areas available. Language is the obvious barrier and one's mobility is defined by the agenda. I was able to visit the following health facilities and in addition have perhaps 30 hours of individual and group discussion with physicians:Kwangtung Provincial People's Hospital, Canton;Hsinhua People's Commune (Hospital, Dispensary, Brigade, Barefoot Doctor), Kwangtung;Tungfanghung Kindergarten (Infirmary, Dispensary), Canton;Canton Deaf-Mute School, Canton;Fu Wai Hospital, Peking;Fan Di Hospital, Peking;Third Teaching Hospital, Peking Medical College, Peking;Peking Medical College (Medicine and Pharmacy), Peking;Textile Mill (Hospital, Dispensary, School, Housing), Peking;Library, China Medical Association, Peking;Library, Chinese Academy of Medical Sciences, Peking;Institute Materia Medica, Chinese Academy of Science, Peking.

The important and difficult appraisal of the role of sympathectomy in the treatment of hypertension and hypertensive heart disease requires all the follow-up information that is available. There has been much discussion of the status of this therapy in the past with ardent advocates and equally ardent opponents. Time and continued interest in constant improvement both of the selection of cases and of the technics will eventually give the answers. Meanwhile we may hope that some effective treatment less severe and radical than either sympathectomy or rigid diets may be introduced to control hypertension or, still better, to prevent it.During the past year there was published a review of the effect of sympathectomy on the blood pressure in hypertension in the case of 292 patients on the public wards of the Massachusetts General Hospital.1 Although the lumbodorsal technic was used on a considerable majority of these patients the

The physician deals with individuals one at a time. It is natural for him to consider group plans or undertakings as alien to his and his patient's welfare. Yet medicine is a public service function and the present social revolution is involving medicine, whether or not the physician desires it. Recent medical organizational and legislative events relate to concepts of comprehensive medicine and personal physician. Health arguments based on substantial differences are shaping the future of physicians and their practice.

Vanadium, as ammonium vanadyl tartrate, was given orally to six subjects. The total number of days of therapy were forty-five, sixty-three, forty-seven, fifty-eight, forty-seven and sixty-eight, and the total amount of vanadium salt administered was 3,450, 4,325, 3,600, 3,875, 1,575 and 4,225 mg. Except for cramps and diarrhea, which occurred when large doses were given, no toxic effects were noted. Varying amounts of vanadium excreted in the urine suggest unpredictable absorption. Statistical changes did not occur in blood lipids, phospholipids, triglycerides and cholesterol, and 17-ketosteroid and 17-hydroxycorticosteroid levels were unchanged.