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Cornell University Medical College's required third-year clerkship in public health offers a unique educational experience well received by faculty and students. Within a two-week period, a combination of field trips, seminars, lectures, required reading, and a research paper enables students to gain familiarity with a broad range of issues by placing them in situations exposing them to relevant problems and solutions. Nearly all students find some aspect of either the field trips or seminars provocative. Some are motivated to plan follow-up electives. A similar course using local resources could be offered elsewhere.

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The New York Hospital has enjoyed a long, rich history in the development of American health care. AIDS has made relevant an understanding of the failures and successes achieved during past epidemics. Innovations in disease prevention and patient care have been essential in the conquest of pestilence. However, public indifference toward the people at greatest risk for these diseases has traditionally delayed attempts to prevent significant loss of life and socioeconomic destruction.

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Clinical and radiological techniques were used to examine the lumbar movements of 11 male subjects with no history of low back pain. The clinical techniques were shown liable to large errors, particularly where distances between skin marks were measured. The use of an inclinator was the only clinical technique found to be reproducible by different observers. Comparison with the radiological techniques showed that the clinical measures only gave indices of back movement which did not reflect true intervertebral movement.

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Twelve patients underwent direct coronary artery streptokinase thrombolysis during acute evolving myocardial infarction. Ten patients had restoration of orthograde pulmonary blood flow. Eight patients had significant myocardial salvage and clinical stabilization. Nine patients had subsequent coronary artery bypass surgery with no major hematological or cardiac complications. Five of these had surgery performed immediately. Two patients with no myocardial salvage after streptokinase had urgent surgery because of other critical coronary lesions. Seven patients with thrombolytic salvage of myocardium underwent urgent coronary artery bypass surgery without incident. The occurrence of two reinfarctions in streptokinase-improved patients waiting for surgery suggests that delay is unwarranted and coronary bypass surgery is needed to insure success.

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A variety of substituent groups has been attached to the exocyclic imine function of 2-imino-3-methylthiazolidine (1) in a search for metabolic precursors of this potent inhibitor of the enzyme indoleethylamine N-methyltransferase (INMT) which would exhibit superior pharmacodynamic properties in animals. It has been determined that chemically stable derivatives of 1 based on succinic, nicotinic, and N-acylated amino acids, although they lack in vitro efficacy, are potent inhibitors of INMT when administered orally or intravenously to rabbits. Metabolic studies carried out with 14C-labeled N,N'-bix(3-methyl-2-thiazolidinylidene)succinamide (3) have established that conversion of this compound to 1 occurs both in the whole rabbit and in the isolated rabbit liver. 1 itself has been shown to be metabolically inert in rabbits, being excreted primarily in the urine.

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Physicians' awareness of economic factors in clinical decision-making at one large urban university medical center was studied by a 50-item questionnaire. Their dollar estimates were considered correct if within +/- 20 per cent of the true October 1976 figure. Eighty-one per cent of the house staff and all of the attendings correctly estimated the daily semi-private room rate, but only 15 per cent of each group correctly estimated the charge for a serum potassium. Roughly half of the questions concerning various third-party benefit plans were answered correctly. These results are consistent with those of the few previous studies. If the findings are generally applicable, they may suggest that a directed teaching program in simple economic facts and principles may be useful at all levels of physician training.

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PIP: Only a generation ago, health conditions in China were similar to those found in the least developed nations; but today, Chinese mortality rates resemble those found in the most highly industrialized nations. The incidence of infectious diseases and other diseases associated with deprivation has decreased markedly, especially in urban areas, and degenerative diseases are now a major health concern in China. In Peking cardiac disease is the leading cause of death and 45% of these deaths are due to strokes. While China has made great strides in improving sanitation and hygiene standards, efforts to control chronic diseases have not been as effective. Little effort has been made to collect information on health problems at the national level, and this dearth of information prevents effective planning for the continuing services needed for the treatment of individuals with chronic disease. These observations on the state of public health in China were made by 2 groups of medical personnel who visited China for several weeks in 1978 and toured medical facilities in 7 cities and 3 communes. The visitors also noted that most deliveries of babies in rural areas are performed by trained midwives and that most urban women deliver at hospitals. In the urban areas many women are sterilized after the 2nd birth. Most childhood diseases are under control, but respiratory tract infections and mastoiditis are still common problems. Acupuncture as an anesthetic for major surgery is widely used. A table comparing cardiovascular and cancer mortality rates in China and the U.S. is included.^ieng

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Syntheses of a large number of mono- and bicyclic, as well as a few tricyclic, amidine derivatives related to 2,3,4,6,7,8,-hexahydropyrrolo[1,2-a]pyrimidine (DBN) are reported. In vitro potencies for inhibition of the enzyme indolamine N-methyltransferase (INMT) from rabbit and human lung are presented. Four bicyclic amidine derivatives and 11 monocyclic derivatives were found to be equal or superior to DBN in in vitro potencies. With the bicyclic amidines, increasing ring size or introduction of substituents reduced activity. Among the monocyclic analogues, the most potent representatives were five- or six-membered systems with an exocyclic imino group, combined with methyl of ethyl substituents on the endocyclic nitrogen. Introduction of additonal substituents decreased inhibitory potency. 2,3,5,6-Tetrahydro-8H-imidazo[2,1-c][1,4]thiazine and 3-methyl-2-iminothiazolidine have been shown to cause inhibition of lung INMT when administered orally to rabbits.

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Although the term comprehensive care has gone out of fashion in medical education, the concept has had a resurgence in attempts to teach primary care and family practice. Review of the early experiments in the teaching of comprehensive care in the 1950s reveals that much that was learned then is not being applied today. Surveys of medical school teaching and graduate training in primary care make it seem likely that there will be insufficient practitioners in the foreseeable future to meet the public need for personal physicians. Restructuring of both medical curricula and the delivery systems for personal health services may be necessary to apply effectively what has long been known about the teaching and practice of comprehensive primary care.

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