From the editor

SECOND OPINION
BY SIDNEY HARRIS

Eyes opened, hearts extended

Kudos on Monique Tello’s Letter from Guatemala [“Eyes Wide Open,” Summer 2002]. It was well written and moving and probably similar to the experience of many medical students rotating outside of the industrialized world, where the “brutal social dichotomy” does indeed exist.

As for the challenge for the rest of us to “fight complacency, to open the closed and contented mind,” many learned and well-meaning social crusaders have tried and failed miserably, being accused of American imperialism, cultural genocide and worse. For an example of the pitfalls inherent in this kind of work, read Death Without Weeping: The Violence of Everyday Life in Brazil about a California social worker who attempted to improve literacy and vaccination among Brazilian children at her own expense and was rewarded with continued expulsions from the country on the grounds of subversive activity.

Sometimes changing the political landscape must precede humanitarian efforts. For this we must look to our political science colleagues for guidance—and hope.

Susan M. Richman, M.D., HS ’83
Guilford, Conn.
The writer is an assistant professor of obstetrics and gynecology and director of the Women’s Center at Yale-New Haven Hospital.

Just the facts

I have become used to accepting regular misstatements of historical fact in Yale Medicine, but the Spring 2002 issue has tried my patience with two certain errors.

On page 7: “Yale scientist E.M. Jellinek pioneered the notion that alcoholism is a disease. …” Not so. Thomas Trotter, a British Royal Navy physician, clearly defined alcoholism as a disease or medical condition in An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body (Bouvier, Philadelphia, 1813). In the United States at about this time Benjamin Rush in Philadelphia was defining alcoholism as a disease.

Charles A. Janeway is presented on page 35 as the person who “discovered gamma globulin deficiency.” This is not true, as the present Dr. Janeway [his son] would be the first to confirm. Ogden Bruton described the syndrome in “Agammaglobulinemia,” Pediatrics, 9, 722-728, 1952. The condition is now known as X-linked agammaglobulinemia (Bruton) and the enzyme affected is known as the Bruton tyrosine kinase.

Our medical school has one of the very best history of medicine faculties in the United States. I urge you to have them review articles which purport to state historical facts before you publish. This would save you the nuisance of chiding like this letter!

Robert J.T. Joy, M.D. ’54
Bethesda, Md.
The writer is emeritus professor, Uniformed Services University of the Health Sciences, Department of Medical History.


Dr. Joy is correct that Drs. Rush and Trotter regarded alcoholism as a disease almost 200 years ago. Jellinek, however, is considered by many to be the most influential proponent of alcoholism as a disease in the 1950s. He presented a disease model for alcoholism, described four classes of drinkers and invented what is known as the “Jellinek curve,” which describes the progression of the disease. His work is considered a major factor in the medical establishment’s acceptance of alcoholism as a disease. Although the World Health Organization had recognized it as a medical problem in 1951, and the American Medical Association (AMA) declared it a treatable illness in 1956, it was only in 1965 that the American Psychiatric Association called alcoholism a disease. The AMA followed suit in 1966.

As for the senior Dr. Janeway’s contributions, his son replies: “I have always resented the claim that Ogden C. Bruton ‘discovered’ X-linked agammaglobulinemia, as my father had collected 13 cases and was about to publish his findings when Col. Bruton published first. Instead of publishing his original work on agammaglobulinemia, my father worked on the intramuscular and intravenous administration of the crude gamma globulin fraction of blood, which he had isolated as part of Dr. Edwin Cohn’s plasma fractionation project during the Second World War.”

More alumni news, please

I am delighted with the “new” Yale Medicine. It’s readable and full of good information.

One disappointment, however. What has happened to alumni news? The undergraduate alumni journal, the Yale Alumni Magazine, ignores the medical school in its alumni section, and the medical journal has only a skimpy bit of news. For those of us whose graduation occurred almost 60 years ago, we are very interested in what is happening to our old colleagues in our class and those around us. More importantly, in the most recent issue, there was nothing before the 50s. Are those of us from the 40s written off? Many of us are still alive and vigorously kicking.

Make the class secretaries get to work and satisfy the old-timers as well as the more recent graduates.

Raymond A. Gagliardi, M.D. ’45
Boca Raton, Fla.

From the Editor:

The state of The System

In the Spring issue of Yale Medicine we promised to report on the state of the Yale System, the school’s eight-decade-old educational model and the subject of some debate earlier this year. As this issue of the magazine evolved over the summer, it became obvious that the topic was to play a starring role and figure prominently in the issue’s three feature articles as well as in our coverage of the June reunions. Wherever we turned, someone was talking about the Yale System.

“Everyone Loves The Yale System. So Why Can’t They All Agree?” details recent initiatives by Dean David A. Kessler, M.D., and others to increase support for teaching at the medical school and explains the controversy that erupted in March after a mailing from a group of students to medical school alumni regarding exam requirements. Among the voices heard were those of more than 500 alumni who wrote passionately about the issue of testing and in doing so wonderfully articulated what it means to become a doctor at Yale. Excerpts from those testimonials appear in “The Yale System Lives! Long Live the Yale System.”

Finally, we take a look at the man who set the Yale System in motion more than 75 years ago. Adapted from a chapter in a new history of the school by former Dean Gerard N. Burrow, M.D. ’58, HS ’66, “A Steam Engine in Pants” chronicles how Milton C. Winternitz, M.D., brought Yale back into the ranks of elite medical schools after a period of decline and gave birth to the Yale System in the process. It’s a fascinating story that sheds light on the origins of the current debate.
Michael Fitzsousa
michael.fitzsousa@yale.edu