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Content: JOURNAL OF THE
VOLUME 71, NUMBER 9
Guest Editorials No Time for Hysteria, Leslie L. Alexander .................................................................. 821
The Private Physician and Cost Containment, Charles H. Epps, Jr
..822
President's Column
The Song of the Nightingale, Robert E. Dawson .
823
Professional News .
826
Original Communications Five Year Study of Postpartum Hemorrhage: Queen of Angels Hospital, 1973-1977, Leroy R. Weekes and Shobhana Gandhi .829
Immunosuppressive Therapy of Ocular Disease, W. Benton Boone and Lewis Slater .837
Experience of a Sickle Cell Screening Program in Baltimore, Joseph M. Miller and Deborah C. Davis .
839
Urethritis Attributable to Neisseria meningitidis, Group X: A Case Report, James E. Gregory, Rose Crook, and George Keeler .845
skin lesions of the Extensor Surfaces of Interphalangeal Joints: Surgical Approach, Thomas Ray Vecchione
847
Loiasis: Report of Three Cases and Literature Review, Rose Delores Gibbs .853
Dysthyroid Ophthalmopathy: An Update, Lois A. Young .855
Slipping Rib Syndrome, James Bass, Jr, Hutai C. Pan, and Ronald H. Fegelman .863
Benign Breast Lesions, Oluvole G. Ajao .867
Effects of Maternal-Fetal Monitoring on Pregnancy outcome in a High Risk Pregnant Population, Ernest Loyd Hopkins, Clara M. Fleet, and Gloria Jane Marie Rose .869
Mucocutaneous Lymph Node Syndrome Without Exanthema: A Case Report, Joseph C. Schutt-Aine, Jean-Claucde Comeal, Neelam Sood, and Stanley M. Sinkford .873
The Unrewarding Results of Curative Therapy in Esophageal Cancer, W. A. Bethune and P. P. Kulmar .875
Preventive Psychiatry in the Board of Education, Carl C. Bell .881
Medical History The Challenges Ahead, W. Montague Cobb ................................................................. 887
Charles Richard Drew, MD, 1904-1950, Mrs. Donald Parks ................................................... 893
Brief Child Abuse: A Black Perspective Utilizing a Social-Psychological Model, Hugh F. Butts ........................ 899
Roentgenogram of the Month Cystic Lung, Harr C. Press, Jr, Stanley M. Sinkford, Samuel B. Rosser, and Kathleen G. Cantwell ..... Information for Authors .................... Membership Application .917
........ 903 911
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Advertisers' Index Page 922
Classified Ads Page 921
JOURNAL OF THE
Associaton
JNMA EDITORIAL OFFICE 1720 Massachusetts Avenue, N.W., Washington, D.C. 20036 (202) 659-9623
Editor Calvin C. Sampson, M.D. Editor Emeritus W. Montague Cobb, M.D. Administrative Assistant Jean Johnson Publication Committee Alma R. George, M.D., Chairperson Barrington B. Barnes, M.D. Maurice Rabb, M.D. Philip M. Smith, M.D. Assistant Editors Leslie L. Alexander, M.D. Alyce C. Gullattee, M.D. Axel C. Hansen, M.D. Editorial Board William E. Allen, M.D. Charles A.P. Brown, M.D. Arthur H. Coleman, M.D. Charles H. Epps, M.D. L. Julian Haywood, M.D. Samuel L. Kountz, M.D. LaSalle D. Leffall, M.D. Edwin H. Mitchell Henry Paul, M.D. Clyde W. Phillips, M.D. Samuel U. Rodgers, M.D. Roland B. Scott, M.D. Earl Belle Smith, M.D. Leroy R. Swift, M.D. H. Phillip Venable, M.D. Emerson C. Walden, M.D. M. Lorenzo Walker, M.D. Leroy R. Weekes, M.D. James M. Whittico, Jr., M.D. Roland B. Williams, M.D. Jane C. Wright, M.D. Asa G. Yancey, M.D.
Editorial Advisory Board Jesse B. Barber, Jr., M.D. Louis Bernard, M.D. Walter Booker, M.D. Kermit R. Brown, M.D. Winston Bryant, M.D. John T. Chissell, M.D. Ezra Davidson, M.D. Bennie Davis, M.D. Henry Foster, M.D. Alyce C. Gullattee, M.D. Lucille C. Gunning, M.D. Capt. Bernett Johnson A. Paul Kelly, M.D. Arganey L. Lucas, M.D. William E. Matory, M.D. W. Alexander Miles, M.D. Raymond 0. Pierce, M.D. Dazelle Simpson, M.D. Hubert Skinner, M.D. Hazel M. Swann, M.D. Appleton-Century-Crofts Periodicals Division 292 Madison Avenue New York, New York 10017 (212) 532-1700 Publisher David Stires Associate Publisher Linnea Elliott Managing Editor Denise Goodwin Advertising Sales Representatives Eastern Region Donald A. Muglia Sheila Sinkking MidwestlWest \ John Cahill (312) 655-1618 Production Manager Harold Horowitz Senior Editor Claire Johnson
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 9, 1979
Who are the real black leaders? What are black Americans doing in the arts? Where are blacks making the most progress? When did the big changes happen? How are black Americans doing financially? NEW * ENLARGED * UP-TO-DATE
answers these and hundreds of other questions Edited by Mabel M. Smythe
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"For 'getting it all together' under
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PRENTICE-HALL Englewood Cliffs. N.J.07632
817
Medical Education Meharry Medical College Nashville, Tennessee Dr. Alphonzo Jordon (MD, Me- harry, '46) served as Alpha Omega Alpha Visiting Professor the week of March 25, 1979. Dr. Jordan conducted rounds and seminars, and gave the annual Alpha Omega Alpha Lecture. He is associate professor of medicine and director of the Adult cardiac catheterization Laboratory at the Albert Einstein College of Medicine in the Bronx, NY. Past AOA Visiting Professors were Dr. W. Lester Henry of Howard University, and Dr. Edward S. Cooper of the University of Pennsylvania. Faculty AOA initiate was Dr. C. E. McGruder (MD, Meharry, '52), who is associate professor of obstetricsgynecology at Meharry. Alumni initiates were Dr. Harold W. Jordan (MD, Meharry, '62), professor and chairman of the Department of Psychiatry at Meharry and formerly Commissioner of Mental Health for the State of Tennessee, Dr. Robert E. Dawson (MD, Meharry, '43), president-elect of the NMA and a member of Meharry's Board of Tristees, and Dr. H. Nehemiah Cooper (MD, Meharry, '54) of Monrovia, Liberia. Student initiates from the senior class included Houston Bogus, Barbara Bo7eman, Don Hirsbrunner, Robert Murray, Frank Page, William Rutledge, Jerome Spruill, and William Zoghbi. Third year initiates were Robert Lee, Thomas McKeon, Scott Miller, Herman Savage, and Michael Woodcock. Senior student Frank Bowden, IlI is chapter president. Deaths Dr. R. Leonard Tillman (PhD, Howard '74) of Washington, DC, died on January 23, 1979, of an acute heart attack. He was 45.
Born on April 24, 1933, in Helm, Mississippi, of Annie Mae Tillman and the late Cornelius Tillman, Sr, Dr. Tillman attended public schools in St. Louis. He received the BS degree from Fisk University in Nashville, Tennessee in 1956, and the MS degree in experimental pathology from Washington University, St. Louis, in 1967. He was appointed instructor in pathology at Howard University in 1967, where he developed and headed the Division of Electron Microscopy. He was appointed assistant professor in 1974. Dr. Tillman held membership in many scholarly and academic organizations. These included Kappa Alpha Psi, the American Association for the Advancement of Science, the Washington Society of Electron Microscopy, the American Association of Electron Microscopy, and the Afro-American Institute for Historic Preservation and Community Development. He contributed many scientific articles to medical literature, some of which have appeared in this Journal. Dr. Tillman is survived by two sons, Marc Leonard and Patrick Alex; his mother, Annie Mae; three sisters, Dortha McHenry, Ozzie Taylor, Mae Jefferson; and one brother, Cornelius, Jr. Dr. Joseph N. Dodson (MD, Howard, '28), of Washington, DC, died at Georgetown University Hospital (Washington, DC) following a stroke. He was 76. Dr. Dodson was a lifelong resident of the District of Columbia. Following graduation from Howard University College of Medicine in 1928, he served an internship and residency at Freedmen's Hospital. He began the private practice of medicine in 1930, specializing in allergy. He was on the staff of the Allergy Clinic at Freedmen's Hospital and served as a physician for the DC public schools for several years. He also served as physician at the old Claredge House Senior Citizen's Home in Washington. His practice spanned a period of 40 years. He retired in 1970. Dr. Dodson was a founding member of the Epiphany Catholic Chuirch, where he served on the Parish Council Continued on page 908
tabktsc IelixirCv
mild to
modierate to
moderate pain severe pain
Summary of Prescribing Information Description Tablets: Contain codeine phosphate*: No. 1-7.5 mg. (I/s gr.); No. 2-15 mg. (ј/ gr.); No. 3-30 mg. ('/2 gr.); No. 4-60 mg. (1 gr.)-plus acetaminophen 300 mg. Elixir~Each 5 ml. containa 12 mg. codeine phosphate- plua 120 mg. acetaminophen (alcohol 7%). *Wamrnig: May be habit forming. Actions: Acetaminophen ia an analgesic and antipyretic, codeine an analgesic and antituasive. Contralndlcatlons: Hypersenaitivity to acetaminophen or codeine. Warnings: Drug dependence: Codeine can produce drug dependence of the morphine type and may be abuaed. Dependence and tolerance may develop upon repeated administration; prescribe and administer with same caution appropriate to other oral narcotica. Subject to the Federal Controlled Subatancea Act. Usage in ambulatory patients: Caution patients that codeine may impair mental and/or physical abilities required for performance of potentially hazardous tasks such as driving a car or operating machinery. Interaction with other CNS depressants: Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative-hypnotics or other CNS depressants (including alcohol) with this drug may exhibit additive CNS depression. When such a combination is contemplated, reduce the dose of one or both agents. Usage in pregnancy: Safe use not established. Should not be used in pregnant women unless potential benefits outweigh possible hazards. Pediatric use: Safe dosage of this combination has not been established in children below the age of three. Precautions: Head injury and increased intracranial pressure: RespFiWorrastonrygdoe,presPsaa.n_1t9e0f3fects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure. Narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. Acute abdominal conditions: Codeine or other narcotics may obscure the diagnosis or clinical course of acute abdominal conditions. Special risk patients: Administer with caution to certain patients such as the elderly or debilitated and those with severe impairment of hepatic or renal function, hypothyroidism, Addison's disease, and prostatic hypertrophy or urethral stricture. Advers Reactions: Most frequent: lightheadedness, dizziness, sedation, nausea and vomiting, more prominent in ambulatory than nonambulatory patients; some of these reactions may be alleviated if the patient lies down. Others: euphoria, dysphoria, constipation and pruritus. Dosage and Administraton: Dosage should be adjusted according to the severity of the pain and the response of the patient. It may occasionally be necessary to exceed the usual dosage recommended below in cases of more severe pain or in those patients who have become tolerant to the analgesic effect of narcotics. TYLENOL with Codeine tablets are given orally. The usual adult dose is: Tablets No. 1, No. 2, and No. 3: One or two tablets every four hours as required. Tablets No. 4: One tablet every four hours as required. TYLENOL with Codeine elixir is given orally. The usual doses are Children (3 to 6 years): 1 teaspoonful (5 ml.) 3 or 4 times daily; (7 to 12 years): 2 teaspoonsful (10 ml.) 3 or 4 times daily; (undler 3 years). safe dosage has not been established. Adults: 1 tablespoonful (15 ml.) every 4 hours as needed. Drug Interactions: CNS depressant effect may be additive with that of other CNS depressants. See Warnings. For information on symptoms/treatment of overdosage, see full prescribing information. Full directions for use should be read before administering or prescribing. TYLENOL with Codeine tablets are manufactured by McNeil Laboratories Co., Dorado, Puerto Rico 00646. Caution: Federal law prohibits dispensing without prescription.
Oc McN 1979
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Information for Authors JOURNAL OF THE
Medico
XSINCE 1895
Association
This publication serves as the primary source for enlightening the medical community on specialized clinical research activities related to the health problems of Blacks, as presented to the physician. Of equal importance is the concern given to the application of medical science to improving the health status of Blacks both in the United States and abroad. The journal has the following objectives: * To expand the base of original clinical peer-review literature, recognizing the need for greater dissemination of information. * To offer appropriate and timely recognition of the significant contributions which Black physicians and others are making in the quest by medical science to improve the health of all people. * To sustain interest by member and non-member physicians in the overall goals and objectives of the National Medical Association. In addition to Original Communications, the journal also features on a regular basis: Briefs, Milestones and Trends, President's Column, Guest Editorials, Letters to the Editor, Book Reviews, NMA Activities, Professional News, and a Books Received Column.
Original Communications Contributions, articles by invitation, research Work in progress, peerreviewed, fully documented and referenced. Articles on the state of the art.
Milestones & Trends Recognition of the significant contributions to medical research and health care by black physicians and others.
Briefs Articles of general medical, economic, political, legal, or social interest to physicians.
Professional News Persons, places, and events of current interest, but not of historical magnitude.
Guest Editorials Mainly, contributions by invitation of the Editor.
Letters To The Editor Responses to articles appearing in the journal and general comments.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 9, 1979
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Manuscripts Contributions will be considered for publication with the understanding that they are solely contributed to the JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION and have not been previously published elsewhere. The original and two copies of the complete manuscript should be submitted. The transmittal letter should designate one author as correspondent. Authors are responsible for all statements made in their work. Accepted manuscripts become the permanent property of the journal. Manuscripts should be submitted to: Calvin C. Sampson, M.D. Editorial Office JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION 1720 Massachusetts Avenue, N.W. Washington, D.C. 20036 All copy must be typewritten, double-spaced, on 8 1/2 x 11 inch, heavy duty white bond paper, with generous margins on each page-at least 1 1/2 inches at the top, bottom, and left, and 1 inch at right. The first page of the manuscript should give the title of the article, name(s) and affiliation(s) of author(s) and any acknowledgements. Titles should be short, specific, and clear, and subtitles may be used as desired. The second page should supply an abstract of not more than 200 words. The abstract replaces a summary and should be a factual (not descriptive) summary of the paper, including the principle conclusions of the article. All pages after the title page should include a running head typed in the upper left-hand corner, consisting of a shortened form of the title and the surname of the senior author. The text should avoid extensive outline formats. References References will be critically examined at the time of editorial review. personal communication should not be included. The style of Index Medicus should be followed in preparing references. References should be numbered consecutively as they appear in the text and arranged in the order of citation, not alphabetically. Listed below, in order, are references to a journal, a book, an edited book, a chapter in an edited book, a
report, a presentation at a meeting, and a government publication, in correct style. 1. Braunwald E: Regulations of the circulation. N Engl J Med 290:11241125, 1974 2. Rishkin A: Classics in Arterial Hypertension. Springfield, Ill, Charles C. Thomas, 1956 3. Moulton FR (ed): Aerobiology. American Association for the Advancement of Science Publication 17. Washington, DC, 1942 4. Irons JR, Denley ML, Sullivan TD: Psittacosis in turkeys and fowls as a source for human infection. In Beaudette FR (ed): Psittacosis: Diagnosis, Epidemiology, and Control. New Brunswick, NJ, Rutgers Univ Press, 1955, pp 44-45 5. Report of the committee on wandering youth. Seattle, Washington, Council of Planning Affiliates, 1973 6. Zyzanski SJ, Jenkins CD, Ryan TJ et al: Emotions, behavior pattern and atherosclerosis. Presented at the Annual Meeting of the American Psychosomatic Society, New Orleans, March 21, 1975 7. US Department of Health, Education, and Welfare, Public Health Service, Bureau of Health Manpower: Health Manpower Perspective: 1967. PHS Publication 1667. Washington, DC, US Government Printing Office, 1967, p 12 Tables Tables should be self-explanatory, clearly organized and supplemental to the text of the manuscript. Each table should include a title, be typed on a separate sheet, and numbered in order of its appearance in the text. Tables should be used to compare or classify information for easier understanding and should not duplicate data included in the text or figures. Illustrations Illustrations should be used only if they clearly increase understanding of the text. Illustrations include all mate- rial which cannot be set in type, such as graphs, charts, line drawings, and tracings. Drawings and graphs should be professionally prepared in black ink on a good grade of white drawing paper. Glossy, black-and-white photographs may be submitted. All illustrations should be unmounted. Each should have a gummed label on the back listing
the figure number, title of manuscript, author(s) and arrow indicating the top. Illustrations should be numbered and cited in the text, and each should have a legend. Permissions Permission must be obtained for use of illustrations and tables from previously published works. Permission must be obtained before an article is submitted, and the letters of permission should accompany the manuscript. The source of the material should be mentioned in an illustration legend or table footnote. Drug Names Generic names should be used. If for any reason the author wishes to cite the brand name of a drug, this can be inserted in parentheses after the generic name. Review and Action Authors will be notified by the Editor or member of the Editorial Board within six to eight weeks concerning the acceptability of a manuscript, but at times longer delays may be unavoidable. All accepted manuscripts are subject to copyediting. Authors will receive either a typescript or galley proof for approval. The author must return the manuscript, with his approval or corrections, within seven days of receipt; after this time, no further changes may be made by the author. Reprints Authors will receive 50 free reprints of their article. After the article is published, a reprint price list will be sent to each author should additional reprints be desired. Instructions for ordering reprints will accompany the list. Book Reviews Each issue will include a section featuring reviews of books of interest. Books for review should be sent to: Calvin C. Sampson, M.D. Editorial Office JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION 1720 Massachusetts Avenue, N.W. Washington, D.C. 20036
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JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 9, 1979
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I hereby apply for (or renewal of) membership in the National Medical Association, and do hereby agree to abide
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