The CyberDoc project: using portable computing to enhance a community-based primary care clerkship.

In July 1995, MCP-Hahnemann School of Medicine of the Allegheny University of the Health Sciences introduced its first-ever required clerkship in family medicine. It was decided that computer skills and applications would be an integral part of this rotation, and a special program, CyberDoc, was developed for the clerkship by some of the university's informatics professionals and family medicine faculty. CyberDoc is a suite of laptop-computer applications, based almost exclusively on "off-the-shelf" database and connectivity programs and designed expressly for students at community-based training sites. CyberDoc allows faculty members to track students' progress at off-site clerkships, and allows the students to access pharmaceutical and drug-interaction databases, the university's online academic information system (including MEDLINE), all basic Internet functions, e-mail, and an array of other applications. The authors briefly describe the background, goals, and structure of the CyberDoc project, as well as the preliminary outcomes of CyberDoc's pilot year.

Goodbye to all that: centennial cycles in academic medicine.

In the 1990s, medicine and medical education face great changes and dislocations both traumatic and transforming. But similar crises and upheavals were faced by physicians and medical educators in the 1790s and 1890s. As each of these centuries drew to a close, great changes took place in medicine. The author describes these centennial cycles, concentrating on the last 200 years of academic medicine as it faced the vicissitudes of change in "the nineties." He focuses first on the 1790s and the influence of the French Revolution on medicine, then discusses the reforms in medical education that began in the 1890s and that led to the so-called Flexnerian reforms early in the twentieth century. Finally, he considers the 1990s, drawing parallels between the crises of earlier centuries and the situation of American medicine on the cusp of the twenty-first century. He argues that today's leaders in academe ignore the narratives of past medical metamorphoses at their peril, and that while having an understanding of the past will not enable leaders to forestall the future, it can prepare them for it.

The pathogenesis of the low pleural fluid pH in esophageal rupture.

To determine the possible mechanisms responsible for the low pH pleural effusion associated with esophageal rupture we evaluated the following possibilities: (1) gastric acid reflux, (2) bacterial metabolism, and (3) leukocyte metabolism. Neither elimination of gastric hydrogen ion contribution by distal esophageal ligation nor elimination of bacteria with antibiotics prevented the progressive fall in pleural fluid pH after esophageal rupture. Only elimination of polymorphonuclear leukocytes from the pleural space by rendering animals leukopenic with nitrogen mustard, prevented a low pH effusion after esophageal rupture. It appears that pleural fluid leukocyte metabolism is primarily responsible for the low pH effusion associated with esophageal rupture.

Robert Koch and American medicine.

The centenary of Robert Koch's discovery of the tubercle bacillus is an appropriate occasion for a reconsideration of the American reception of Koch's bacteriologic investigations. At the time of the U.S. centennial in 1876 American views on infectious disease were disparate and ill-formed. The news of Koch's initial tuberculosis investigations stirred controversy in the inchoate American medical community. By the late 1880s, however, his ideas and techniques achieved widespread acceptance and by the time an aging Koch travelled to the United States in 1908 the American medical community had been transformed. New and divisive theoretical issues had become prominent. Koch was now in conflict with a medical establishment resistant to ideas incongruent with its native ideas.