Impersonal medical care. Role of the pathologist in its evolution.

An evaluation of the change in the former close relationship between the patient and his physician, and the contribution of the pathologist to its development, is presented. The effect of these changes on the interest in and care of the patient by all in the hospital in this changing medical scene is decried; the patient loses much. The problem of impersonal care now involves all hospital care and all fields of medicine. The decline of interest in the autopsy and the formalization of this denigration of the autopsy by the Accreditation Commission has done harm to pathology and the care of the patient; the autopsy is still an important quality control of such care. Further, this change in the medical scene has promoted the development of the employee status of the doctor, with its further loss of independence, individual interest, and personalized care by all in the hospital, even the physician, and inevitably has led to his loss of the protection of due process. Seven recommendations are offered to recapture the old one-to-one doctor-patient arrangement, to yield a combination of tender loving and scientific care for the patient. An active effort must be made to reverse the influence of some of the forces working to the disadvantage of doctor and patient in the changing medical scene.

Biochemical study of cardiac valvular tissue. Biosynthesis in vitro of hexosamine-containing substances in bovine heart valve.

1. Two distinct hexosamine-containing substances have been obtained from bovine cardiac valvular tissue which was incubated with labelled glucosamine. These were identified as mucopolysaccharides and glycopeptides respectively, both by the elution pattern from a Sephadex G-50 column and by chemical analysis. 2. In the mucopolysaccharide fraction about 80% of both the total hexosamine and total radioactivity were present; the galactosamine/glucosamine ratio of the amounts was about 1.36. 3. The glycopeptide fractions had about 20% of both total hexosamine and total radioactivity; the galactosamine/glucosamine ratio of amounts was about 0.44. In this fraction, over 15% of radioactivity was present in sialic acid. 4. In contrast with the concentrations of the several chemical components, there were remarkable differences in the biosynthetic activities among the four valves; the tricuspid valve had highest specific radioactivity in all components of both substances, followed then in turn by mitral, aortic and pulmonary valves. 5. Glucosamine in mucopolysaccharides had a rapid rate of turnover, followed then in turn by turnover rates of both glucosamine and galactosamine in glycopeptides, and of galactosamine in mucopolysaccharides. The possible significance of these findings is discussed.