September 2005 Newsletter - Milwaukee Academy of Medicine

ILWAUKEE ACADEMY
OF MEDICINE
Vo l u m e X I I I / S e p t e m b e r 20 0 5
September 20 th , 2005:
Bedside Rationing:
Inevitable or Immoral?
Bedside rationing - deciding to withhold a treatment
from one patient because another patient might need it
more - is not all that distant a memory as a common problem
in medicine. When the first dialysis machine was made available
for patients, Life Magazine described the difficult decisions
that a selection committee had to make in deciding who
would be chosen to have the precious resource of dialysis in
an article titled “They Decide Who Lives and Who Dies.”
Contemporary physicians have often been taught that
rationing at the bedside is immoral. We are to be patient
advocates, not guardians of society’s resources. We have also
been taught that saving resources on one patient will not
necessarily result in the availability for more resources for
another patient.
But Susan Dorr Goold, MD, MHSA, MA, our September
guest speaker, doesn’t agree that bedside rationing is necessarily
immoral. Dr. Dorr Goold is Director of the University of
Michigan’s Bioethics Program and Associate Professor of Internal
Medicine and Health Management and Policy. She will explain how
rationing currently occurs in multiple ways and at multiple levels in the
U.S. health care system, why rationing is inevitable and how it should
be done openly and with moral integrity. Once you hear Dr. Dorr
Goold, you won’t think about the “R” word the same way again.
October 18 th , 2005 :
AIDS: Are We Losing
the Fight?
The incidence rate of Human
Immunodeficiency Virus (HIV) infection
is rising in Wisconsin and the United
States for the first time in a decade.
Meanwhile, the pandemic advances rapidly in
Africa, Eastern Europe and Asia. Why has US
progress stalled, and how did we fail to prevent
a global pandemic of enormous human
and economic impact?
James Vergeront, MD is the Director of
the Wisconsin HIV/AIDS program, overseeing
surveillance, prevention and treatment
programs since 1979. He will provide an
overview of past lessons and future opportunities. He
will be followed by 3 panelists (Bevan Baker, CHE,
David Fisk, MD and Karen Ivantic-Doucette, MSN,
APN-BC, ACRN) exploring international, urban public
health and medical care practice implications of the
pandemic.
Come and consider your role in the fight
against a pandemic that the WHO’s
Director General has called “the benchmark
by which our generation will be judged.”
2005-2006 MEETING DATES
Fall 2005: September 20 • October 18 • November 15
Winter/Spring 2006: January 17 • February 21 • March 21 • April 18 • May 16
MEETING LOCATION: University Club of Milwaukee • 924 East Wells Street • 6:00 p.m. cocktails • 6.30 p.m. dinner • 7:30 p.m. speaker presentation
8701 Watertown Plank Road • Milwaukee, WI 53226 • 414.456.8249 • fax 414.456.6537 • email milwacademyofmed@execpc.com • website www.milwacademyofmedicine.org

From the Academy’s Rare Book Collection
William Beaumont (1785-1853).
Experiments and Observations
on the Gastric Juice, and the
Physiology of Digestion.
Plattsburgh, F.P. Allen, 1833.
Jesse S. Myer (1873-1913).
The Life and Letters of
Dr. William Beaumont,
Including Hitherto Unpublished
Data Concerning the Case of
Alexis St. Martin.
St. Louis, C.V. Mosby Company, 1912.
Andrew Combe (1797-1847).
The Principles of Physiology
Applied to the Preservation of Health,
and to the Improvement of Physical
and Mental Education: From the
Seventh Edinburgh Edition.
New York, Fowlers and Wells, 1854.
Review by H.D. Kerr, M.D.
Three of the Academy’s holdings
intertwine on the subject of early
explorations in digestive physiology.
William Beaumont’s celebrated work
describing his investigations
is well known to
most physicians
and is one of the
cornerstones
of medical
physiology.
It is also
a fine
example
to all of
how to
m a k e
the most
of a bad
situation.
With the
m e d i c a l
know ledge
of the times
he could not
“cure” or “fix”
Alexis St. Martin’s
gastrocutaneous fistula, a large
tangential wound produced by
an accidental gunshot blast of
“powder and duck shot”
received from a distance of
three feet. In the next eleven
years at a series of army posts,
he assembled an impressive
body of information about the
details of his patient’s digestive
processes. His book was published
in his adopted hometown,
Plattsburgh, NY, with the help of
his brother, Dr. Samuel Beaumont,
a former newspaper publisher. The
text described the entire series of
238 experiments in detail. From the
beginning isolated on Mackinac
Island, 100 miles from any other
physician, Beaumont sought
help and advice in this unique
research opportunity by correspondence
and personal meetings
with his superiors in the
Army and with faculty members at
Yale, Columbia and the University of
Virginia. His initial experiments were
published in the Medical Recorder and
were well received. “Life and Letters” is
well worth reading for views of those
times and as a study in determination.
Combe’s work, first published in
1831, went through numerous editions
and was a very popular reference covering
areas related especially to the brain,
circulation, lungs, muscle, and skin. He
continued this work with “The
Physiology of Digestion” (1837 and not
part of the Rare Book Collection), giving
a “current status” approach to the
subject of human digestion (1) He
reviewed theories of the digestive
process from ancient times to the
present day. These included the
Hippocratic view that digestion was
accomplished by heat and was a kind of
concoction or stewing. Others advocated
fermentation, or a putrefication
process, or triturition (reduction to fine
particles by grinding or rubbing), or
“chymical” solution of the food in the
gastric juice. He provided a useful historical
perspective for Renaissance
investigations on digestion as well as
Beaumont’s work. He noted that
Beaumont’s work was “scarcely known”
in Britain and summarized the experiments
in full and enthusiastic detail.
He gave Beaumont full credit for making
a giant step forward in expanding
knowledge of human digestion. His
book undoubtedly explained and popularized
Beaumont’s work to a large
European professional readership and
enhanced Beaumont’s reputation.
Beaumont, educated in Vermont in
the system prevalent in those days of
reading medicine followed by apprenticeship,
was aware of the digestive
experiments of the Italian scientist,
Lazarro Spallanzani (1729-1799).
These are described in Combe’s book.
Spallanzani, after preliminary animal
experiments, swallowed already chewed
bread enclosed in sewn cloth bags, then
recovered the bags and found them
intact but empty. Suspecting a chemical
process, he next encased chewed
bread in tiny perforated wooden capsules.
He swallowed several to examine
whether grinding was involved in the
primary process. The capsules were
recovered undamaged. The bread was
2

again gone. His method may have
inspired Beaumont. Although gastric
fluid investigations of three European
patients with gastrocutaneous fistulas
had been described, no one had
approached digestion with the comprehensive
and thorough manner
employed by Beaumont.
Combe died at a young age of consumption
but made good on his childhood
goal that “I’ll no be naething” .
His name is found on the lists of
“Significant Scots” (2). His clear comprehensible
writing reflected his own
desire to live a life of “thorough and
benevolent usefulness.” St. Martin, far
from being disabled, worked as a woodcutter
and a farmer and died at age 86.
After one visit to see Dr. Beaumont at
Ft. Crawford on the Mississippi near
Prairie du Chien, the former voyageur
paddled his wife and children back to
Montreal by canoe. Beaumont is
memorialized in several medical museums
and a number of institutions
including the William Beaumont Army
Medical Center in El Paso, Texas. The
medical center cafeteria is named the
“St Martin Dining Facility.”
References:
1. The Physiology of Digestion,
Andrew Combe, 1837.
http://www.gastolab.net/ghe1.htm
2. Significant Scots, Andrew Combe.
http://www.electricscotland.com/
history/other/combe_andrew.htm
3

The Father of Endocrinology
By James M. Cerletty, M.D.
George Washington is often referred to
as the “father of our country”. He
married Martha Custis, a widow, who had
borne four children in her first marriage.
Martha had no children in her marriage to
George. Some have deduced that he was
sterile. So George was not literally the
father of our country.
The “father” of the field of
Endocrinology also deserves mixed credit
for his title as the “father.” He is the nineteenth
century physician, Dr. Charles
Brown-Sequard. He was born in 1817 in
Mauritius of French and American parents.
He taught at Harvard in the 1860s
and practiced medicine in New York the
following decade. 1
He was interested in the nervous system,
and is remembered by an eponym for a
syndrome remembered only by a handful
of physicians, invariably neurologists. To
spare you from looking it up, a unilateral
spinal cord lesion leads to ipsilateral motor
disturbance with impairment of proprioception
and contralateral loss of pain and
temperature appreciation below the lesion.
Because of his respected reputation in
clinical medicine and research, he was
invited to present a paper in Paris in June
1889. Dr. Brown-Sequard presented this
paper at the Societe de Biologie of Paris.
“He reported that he had injected himself
with aqueous extracts of guinea pig and
dog testes and had experienced enhancement
of physical strength, a heightened
intellectual capacity and an increased sexual
potency.” 2
His sensational presentation added spice
to the Paris meeting. The French newspaper,
“Le Matin,” said that the doctor
claimed “he looked 30 years younger than
his stated age.” 2 Brown-Sequard also told
the audience that he could urinate at least
one-third distance farther than before. A
modern skeptic would ask whether he
could write his initials in the snow. Was this
the fountain of youth?
“Pleas for injections poured into
Brown-Sequard’s office from elderly men
all over Europe. The more excited the public
became about the ‘elixir’, the more bitter
and indignant were the scoffers.” 2
The rage for such treatment quickly
spread throughout France and the continent.
Not everyone joined the bandwagon.
A German Medical Journal writer said his
“fantastic experiments must best be
regarded as senile aberrations.” 2 Critics
said that any benefit from the dogs’ gonads
was a fantasy. In later years, he was castigated
as a charlatan for his views.
Brown-Sequard’s paper led to the start
of organo-therapy, which flourished in the
mid-twentieth century. Switzerland was
the center of treatment with extracts of
gonads of animals. Many celebrities, royalty,
officials of various governments and
church leaders were said to have sought
such treatment. This “therapy” still is used,
administered by modern day charlatans.
But his paper was not in vain. It indirectly
led the way to effective treatments.
Serendipity played a major role. In the
spring of 1888, the report of the Clinical
Society of London’s “Committee on
Myxedema” (severe hypothyroidism) was
published. 3,4 The symptoms and findings
of severe hypothyroidism had been known
for years, but the cause was unclear. In earlier
years, some thought the thyroid was a
filter to remove “impurities” from the system;
that the gland produced a beneficial
material was never suspected. However, the
Committee on Myxedema strongly
inferred that this disease appeared to be
associated with destruction or loss of function
of the thyroid gland. 3,4
George R. Murray, a young British
physician, had been a student of Victor
Horsley, another prominent neurologist,
who had been a member of the Committee
on Myxedema. Horsely surgically removed
the thyroid gland from dogs, which died in
a few days, most likely from tetany due to
surgical hypoparathroidism. 3 Sheep who
had thyroidectomies “became even dumber
than they were before the surgery.” 3
Monkeys, the only primates studied, lived
much longer but over time, developed apathy,
hypothermia and “imbecility.” 2
In 1888, likely moved by these studies
and Brown-Sequard’s treatments, the 26
year-old George Murray injected an extract
of a sheep’s thyroid into a patient with
myxedema with gradual, but eventually
dramatic improvement in the patient’s
condition. Three years later, he treated
another patient with injections of extract
of sheep thyroid. The before and after
treatment photos are below.
Dr. Brown-Sequard
4

Within a short period of time, it was
realized that injections of thyroid extract
were not required. A quarter of a cup of
diced sheep thyroid orally led to the
treatment and resolution of severe
hypothyroidism.
In some ways, it was fortunate that
the problem was the thyroid. In general
the endocrine glands are constantly producing
their hormones to insure physiologic
response, often with a diurnal
surge. There is a very small reservoir of
hormone in most of the endocrine
glands. For example, the two adrenal
glands, if removed, contain less than
three or four milligrams of cortisone,
minute compared to the 30 milligrams
required to treat adrenal insufficiency.
The thyroid gland has slightly more of a
reservoir of hormone than the other
endocrine glands, so positive effects
could be expected. Testicles of dogs,
taken orally or by injection might have
“helped” Brown-Sequard, but they will
not help you or anyone else hit 73 home
runs this year.
References:
1. The Columbia Encyclopedia, 5 th
edition Houghton Mifflin Co. 1975,
p. 379
2. Wilson, Jean. Charles Edouard
Brown-Sequard and the Centennial
of Endocrinology. J Clin Endo &
Metabolism Vol 71, No. 6, 1990
3. Murray, G. Note on the treatment of
myxoedema by hypodermic injections
of an extract of the thyroid
gland of a sheep. British Med Journal.
Feb 8, 1890 p. 287
4. V.C. Medvei, G. MTP press. Brown-
Sequard and his Organotherapy.
Limited. International Medical
Publishers. 1982, page 289-295
To Sleep
By James M. Cerletty, M.D.
o sleep, perchance to dream; aye,
“Tthere’s the rub.” Thus spoke
Hamlet, and thus do I. The Sabbath is
the day of rest. The goldfinches outside
my open bedroom window waken me
briefly on early spring Sunday mornings
with their chatter. But the sweet
songs of the robins and cardinals
soon lull me back to sleep. A
barking dog interrupts my slumber
only long enough to note
that it is 7 a.m., and I can lie
abed for another two hours.
Not true in Brookfield!
No serenity in this suburb!
It’s eight o’clock on this
sleepy morning, and the
cacophony emitting from
lawn mowers, power saws and
a variety of other multi-decibel
producing machines begins! The dew has
not yet left the grass, and the monsters
are out in force. This somnolent one lays
in bed, rubbing his eyes and picturing
Lucifer himself atop a John Deere. I pray
for a thunderstorm to drive these devils
back to their launching pads, but the
Almighty does not intervene. The Sabbath
is not a day of rest in this community.
If silence is golden, there
is no gold in my neighborhood
on Sunday mornings.
By the way, another of
Shakespeare’s characters said that
he heard a voice cry “Sleep no more!
Macbeth does murder sleep, the innocent
sleep, the sleep that knits up the raveled sleeve of care.”
This guy Macbeth must live in Brookfield!
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S.A.M. – Our Man in Beirut
by Wayne Boulanger, M.D.
Former Columbia Hospital
Chief of Staff
The other day I was going through
a stack of my memorabilia and I
came across a letter from S.A.M. It
had been written in Beirut in January,
1965, having been inspired by a discovery
he had made while roaming
the Lebanese countryside. Re-reading
that letter immediately brought to
mind a serious omission on my part –
that of never having written about
this remarkable Columbia leader of
long ago.
S.A.M.: Sylvanus Archibald Morton
– born in Halifax, Nova Scotia, in
1901, he attended Dalhousie
University and received his M.D. there
in 1926. After a year’s internship at
Victoria General Hospital, he practiced
for a year in Halifax and then
came to the United States for a fellowship
in Radiology at the Mayo Clinic,
eventually ending up in Milwaukee
and at Columbia.
How that came about I have never
heard, but Milwaukee was the beneficiary
of his restless presence for more
than 30 years, until the mid-60’s when
he left to take over the Radiology
Department at the American
University in Beirut.
I first met SAM in 1952 , at which
time he was at the height of his career
– Chairman of Columbia’s Radiology
Department, as well as of Marquette
School of Medicine where he held the
rank of Professor. Columbia Hospital
at that time offered a residency in radiology
and a school for training radiology
technicians, but even that hardly
kept him busy. It certainly didn’t keep
him from getting involved in just
about every activity in and around the
hospital.
For example: in other hospitals the
report of an x-ray examination as dictated
by the radiologists would simply
list the diagnostic possibilities and
stop right there. Not SAM’s reports.
When abnormalities were noted, he
would not only make the diagnosis
without equivocation – he would also
list treatment options in the order of
his personal preference, and heaven
help you, when you walked into the x-
ray department the next morning, if
you hadn’t followed through on his
recommendations explicitly.
Another example of SAM’s involvement
– some of you are old enough to
remember the blizzard of ’47, a late
January fall of heavy, wet snow, which
literally shut down the city for several
days. Buses didn’t run. As a matter of
fact, they stayed wherever they were
stuck, and hospital functions were
limited to surviving until the streets
were cleared. It was several days
before even Maryland Avenue was
navigable. But SAM, the hardy
Canadian that he was, and who lived
in Fox Point, made it to the hospital on
skis every day, not to function as a
radiologist, but as the only licensed
physician in the house, making
rounds, writing orders, and just plain
taking over.
He loved every minute of it.
Under SAM, the Radiology
Department functioned as the staff
gathering place on a daily basis –
almost like a staff lounge with x-ray
view boxes, and when you pulled out
the films you wanted to see that morning,
SAM was there to look over your
shoulder, point out the lesions, and tell
you how to handle them. He also ran
radiation therapy in the days before
cobalt and the linear accelerator. I
often wondered how he could do all
that work and still be in on all the gossip
within miles. And on top of that,
his wanderlust kept him traveling
extensively in his other life as a blue
water sailor. Fortunately, Bob Byrne,
his longtime associate, was able to fill
in for him during his prolonged
absences.
But eventually even his sailing trips
were inadequate to satisfy him, and in
the early 60’s he accepted a position
as Chairman of the Radiology
Department at the American University
in Beirut. From then on he used
Lebanon as his sort of home base for
his travels to Libya, Rhodesia,
Pakistan, Kashmir, and God knows
where.
The subject of that letter he wrote to
me in January, 1965, was a side trip he
made (with Elizabeth in tow as always)
to a small Lebanese village. He
describes his visit to an ancient
church:
“We entered through a door in the
west wall of the now useable church
and came into a good-sized area, say
about twenty by twenty feet square,
with high arched ceiling. The stone
columns that held the roof were old;
several stones lay about with Greek
inscriptions, and in the side of the
north wall was a stone tomb, allegedly
all that was mortal of a Frankish lady,
Anne Boulanger, who was buried there
in the year 1343. It was built up
against the wall, and the sloping cover
is decorated by an ornate Crusader
cross within a circle of arabesques.
The last of the Crusaders were driven
from Lebanon by the Mamluks by
about 1300, but a few stayed on as private
citizens; at any rate, here she lived
and here she died and was buried in
1343.
I climbed up on the roof of the
church and the view was superb. To
the west and south was the village of
Maad, to the north and west lay the
blue sea and coastline extending north
to Tripoli, and in the near distance was
the old town of Betroon where Anne
was supposed to have come from. It is
a town that was ancient when
Columbus discovered America. To the
east and north one looked over the rising
foothills with numerous villages,
and in the far distance rose the brilliantly
white snow-covered range of
the mountains on which stand the
Cedars of Lebanon.
The Boulangers get around.
Regards to all.
S.A.M.”
This article originally appeared in the
Columbia St. Mary’s Physician Staff
Newsletter, December 2004
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Book Reviews
by Nick Owen, M.D.
Cancer and the Kidney
edited by Eric P. Cohen, Oxford University Press, 2005
Professor Leon G. Fine, Royal Free and University
College, London Medical School, London, UK in his
encomium (entitled Forward), sums up Cancer and the
Kidney as describing the totality of the ways that the kidney
reacts to cancer anywhere in the body and its treatment
and yet serves as a series of monographs suitable
both to practicing physicians and biomedical scientists.
A series of well-referenced mountains of information
encased in a slim volume; the epitome of reference.
Population 485
Michael Perry, Harper-Collins, N.Y., 2002
For those of you with ambivalence toward paramedics,
on the one hand positive for comfortgiving,
life-saving missions, on the other for transporting
patients to the wrong hospital or resuscitating
no-code patients, Michael Perry’s little book will
give you a different perspective.
Like physicians, paramedics relate to individual
patients rather than considering themselves as a community
resource and in New Auburn, Wisconsin, (population
485) most patients or their families are personally
known to the paramedics with the resulting
increased intensity of emotions over “wins and losses”.
An educational and delightful twist to healthcare
delivery.
The Status Syndrome: How Social Standing
Affects Our Health and Longevity
Michael Marmot, Times Books, New York, 2004
The Status Syndrome: How Social Standing Affects Our
Health and Longevity is an elaborate evaluation of
the factors which determine quality and length of life
which include genetic, birth and life trauma, nurture
(caloric and attentive), education, social cohesion, wealth,
and position in society. How one feels about one’s self
(one’s standing) is critically affected by employment, by
the degree that one is trusted, and by the degree of stress
associated with the job (high demand-low control; high
effort-low reward).
Marmot examines the importance of these and other
factors in varied populations and demographic experiments.
He shows how the interplay of various factors
contribute to the longevity of populations and to the
health of members of each group.
An interesting exploration of how “we” got to be who
we are.
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Officers and Members
of the Council for 2005
George Walcott, M.D., President
Ralph Schapira, M.D., President-Elect
James Woods, M.D.,
Immediate Past President
Rajiv Varma, M.D., Secretary
Rita Hanson, M.D., Treasurer
Council
Matthew Lee, M.D.
Donald Beaver, D.O.
Committee Chairs
Bioethics
Art Derse, M.D., J.D.
Finance
Rita Hanson, M.D.
Fund Development
James Stiehl, M.D.
History
Jeffrey Jentzen, M.D.
Raymond C. Zastrow,Jr., M.D.
Membership
Jerome Van Ruiswyk, M.D.
Newsletter
Nicholas Owen, M.D.
H. David Kerr, M.D.
Program
Seth Foldy, M.D.
Executive Director
Amy L. John
Board of Trustees
Physicians
Elaine Drobny, M.D.
Kesavan Kutty, M.D.
John Petersen, M.D.
Peter Sigmann, M.D.
Lay Trustees
Robert Karlman
Carl Knauer
Walt J. Wojcik
Mary Wolverton, J.D.
President’s Comments
Distinguished Achievement Award
Elizabeth Jacobs, M.D. will receive
the Milwaukee Academy of
Medicine’s 2005 Distinguished
Achievement Award at the October
18 th Academy program. The award
is presented annually in recognition
of outstanding contributions to the
Each year the Milwaukee
Academy of Medicine selects a
recipient for our Humanitarian
Award. The Humanitarian Award is
given annually to “an exemplary
individual or group who has significantly
improved the welfare of our
community by virtue of their
courage, tirelessness, compassion
and vision.” The Academy council is
by George Walcott, M.D.
President 2005
The debate over teaching of evolution
and teaching of creationism
is heating up. School is
opening shortly, medical school.
Medical students and doctors have a
front row seat on evolutionary
dynamics. Those of us who have
been in practice for a while have
been witness, could we observe, to
hundreds of thousands of generations
of staphylococcus aureus and
some fewer generations of tuberculosis
organisms. Are we seeing creationism
at work in a “hate “ relationship
with the pharmaceutical
industry, infectious disease specialists,
and the doctors who prescribe
antibiotics? At the time of
Alexander Fleming’s discovery of
penicillin, virtually all staphyloccocal
organisms were exquisitely sensitive.
Younger resident doctors now
refer to their teaching hospitals as
MERSAcenters, methicillin resistant
staph aureus. That single cell organism
without a nucleus, some RNA,
and a cell wall frustrates the scientists
devising ever more powerful
antibiotics and multi-drug programs.
We’re finding that the tuberculosis
organism in immunocompromised
patients and those with
prior tuberculosis treatment are
more likely to be multi-drug resistant,
evolution in action. The
Darwinians would claim most persuasively
that the fittest organisms
mutate, adjust to their environment,
survive and multiply. Many bacteria
succumb to the antibiotic onslaught
but a few because of the hosts’s weak
immunological defenses and perhaps
low antibiotic tissue penetration
endure, spreading through tissue
fluids, respiratory secretions,
and to hospital carriers beyond the
host. While some organisms like the
polio virus are on the brink of
extinction, others such as avian flu
viruses appear abruptly from an
occult reservoir to take their place in
the infectious challenge to mankind,
creationism in action?
advancement of knowledge and
practice of medicine by a Wisconsin
physician. Dr. Jacobs is Professor of
Medicine and Physiology and Chief,
Division of Pulmonary and Critical
Care Medicine at the Medical
College of Wisconsin.
Humanitarian Award Nominees Needed
seeking letters of nomination (by
November 1 st ) for this award which
will be presented at the Annual
Meeting on January 17 th , 2006.
Please contact Amy John in the
Academy office if you would like a
listing of past recipients or more
information on the nomination
process.
To The Membership
We have three requests of all
members of the Academy:
1) Have you heard an outstanding
talk lately at a meeting or course
which ought to be shared with fellow
Academy members? If so, please let
the program committee know.
2) Likewise, have you read a great
book? Tell us and we’ll read it and
review it or better yet, write a review
and we’ll publish it.
3) We’re always looking for original
writing whether medical or general;
send anything you are interested in
sharing.
All communications should be
directed to: Amy John at the
Academy.
Email Reminder
If you have not already done so,
please email your current email
address to the Academy office,
amyjohn@execpc.com, so that you
can be easily contacted for general
correspondence and feedback gathering.
You will not receive program
announcements or the newsletter via
email unless you specifically make
that request. Thank you.
The editors would be happy
to consider any original
submissions from members
for publication.
8701 Watertown Plank Road • Milwaukee, WI 53226 • 414.456.8249 • fax 414.456.6537 • email milwacademyofmed@execpc.com • website www.milwacademyofmedicine.org
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