Initial Appearances Research Articles

The Moral Obligation to Be Intelligent: Selected Essays

Bringing together the thoughts of one of American literature s sharpest cultural critics, this compendium will open the eyes of a whole new audience to the work of Lionel Trilling. Trilling was a strenuous thinker who was proud to think too much. As an intellectual he did not spare his own kind, and though he did not consider himself a rationalist, he was grounded in the world.This collection features 32 of Trilling s essays on a range of topics, from Jane Austen to George Orwell and from the Kinsey Report to Lolita. Also included are Trilling s seminal essays Art and Neurosis and Manners, Morals, and the Novel. Many of the pieces made their initial appearances in periodicals such as Partisan Review and Commentary; most were later reprinted in essay collections. This new gathering of his writings demonstrates again Trilling s patient, thorough style. Considering the problems of life in art, literature, culture, and intellectual lifewas, to him, a vital occupation, even if he did not expect to get anything as simple or encouraging as answers. The intellectual journey was the true goal.No matter the subject, Trilling s arguments come together easily, as if constructing complicated defenses and attacks were singularly simple for his well-honed mind. The more he wrote on a subject and the more intricate his reasoning, the more clear that subject became; his elaboration is all function and no filler. Wrestling with Trilling s challenging work still yields rewards today, his ideas speaking to issues that transcend decades and even centuries.

Descartes on the Objective Reality of Materially False Ideas

The Standard Interpretation of Descartes on material falsity states that Descartes believed that materially false ideas (MFIs) lack objective reality [realitas objectiva]. The argument for the Standard Interpretation depends on a statement from the Third Meditation that MFIs are caused by nothing. This statement, in conjunction with a causal principle introduced by Descartes, seems to entail that MFIs lack objective reality. However, the Standard Interpretation is incorrect. First, I argue that, despite initial appearances, the manner in which Descartes understands the proposition that MFIs are caused by nothing does not entail that they lack objective reality. Secondly, I argue that Descartes is committed to the objective reality of MFIs because of his quasi-scholastic explanation of MFIs.

The Debate on the Resurrection of the Dead: an Incident From the Ministry of the Historical Jesus?

Despite initial appearances, Jesus' debate with the Sadducees over the resurrection of the dead does have good reason for being considered authentic. The pericope is clearly not a pure creation by Mark. Indeed, the criteria of discontinuity and coher ence argue for a basic historicity. The pericope is discontinuous (1) with the ten dency of the synoptic tradition to multiply dispute stories involving Pharisees, not Sadducees; (2) with the topics usually handled in dispute stories; (3) with the way Christians trcated and grounded the general resurrection; (4) with the texts used by Jews to ground the resurrection. While the general resurrection was not a direct topic of Jesus' preaching, it does cohere with and is implied hy some of his escha tological pronouncements: e.g. Mt. 8.11 par.; Lk. 14.14; Mt. 11.21-24 par.; Mt. 12 41-42 par.; Mk 9.43-47 par.; Mk 14.25.

Natural progression of osteochondritis dissecans of the humeral capitellum: initial observations.

To determine the earliest findings, subsequent changes, and natural course of osteochondritis dissecans of the humeral capitellum. Among 95 patients with osteochondritis dissecans of the humeral capitellum, 16 (mean age, 12.5 years) were selected for this retrospective study because they seemed to have early osteochondritis dissecans and had been followed up without any surgical treatment for 6 months or more (mean, 3.5 years). The initial imaging appearances of the 16 patients' lesions were divided into two types: localized subchondral bone flattening without fragments in seven, and nondisplaced fragments in nine. Patients with lesion flattening had younger ages and significantly shorter durations of symptoms, and most had open growth plates. In five of the seven with flattening, new bone formed over the flattened bone, and the fragments united after arm motion reduction. In contrast, patients with nondisplaced fragments at clinical presentation had longer durations of symptoms with continued arm motion, and their nondisplaced fragments failed to unite. The earliest feature of osteochondritis dissecans is subchondral bone flattening, over which new bone subsequently forms. The new bone then can unite with the underlying bone. However, if subjected to repetitive forces over a given time, unstable fragments develop. These fragments, even if not yet displaced, are unable to unite.

Is a science of psychotherapy possible? Subjectivity problems.

Two sorts of subjectivity problems are discussed. The 1st concerns the characterization of psychotherapy as an attempt to alter clients' meanings. The 2nd concerns the seemingly subjective nature of value judgments about psychotherapy outcomes. It is argued that despite initial appearances, neither of these problems poses an insuperable difficulty for transforming the discipline of psychotherapy into a genuine science.

Is a science of psychotherapy possible? Subjectivity problems.

Two sorts of subjectivity problems are discussed. The 1st concerns the characterization of psychotherapy as an attempt to alter clients' meanings. The 2nd concerns the seemingly subjective nature of value judgments about psychotherapy outcomes. It is argued that despite initial appearances, neither of these problems poses an insuperable difficulty for transforming the discipline of psychotherapy into a genuine science.

Clinical appearances, healing patterns, risk factors, and outcomes of horses with fungal keratitis: 53 cases (1978-1996)

Objective To compare initial clinical appearances, healing mechanisms, risk factors, and outcomes of horses with fungal keratitis. Design Retrospective analysis. Animals 52 horses (53 eyes) with fungal keratitis. Procedure Medical records and clinical photographs of eyes were reviewed. Keratomycoses were categorized on the basis of clinical appearance at initial examination and pattern of healing. Results Five distinct forms of mycotic keratitis were recognized. Of 53 affected eyes, 34 (64%) retained sight and had varying degrees of corneal scarring after treatment, 6 (11%) had a cosmetic appearance but were blind, and 13 (25%) were enucleated. Bacterial-like ulcers were the most frequent type and the most difficult for predicting outcome. Eyes affected by superficial fungal keratitis were likely to be chronically infected and to require debridement and extended treatment but usually healed with minimal scarring. Keratomycosis with a surrounding furrow resulted in a grave prognosis. Aspergillus organisms were isolated from 9 of 10 such eyes. Cake-frosting material was a positive prognostic sign. Fungal corneal stromal abscesses tended to be caused by yeast. Clinical Implications This information will aid practitioners in recognizing various forms of fungal keratitis and guide them when making therapeutic decisions and prognoses for affected horses. (J AM Med Assoc 1998;213:105-112)

Efficacy of Ivermectin againstStrongyloides stercoralisInfection in Jirds (Meriones unguiculatus)

Sithithaworn, P., Fujimaki, Y., Mitsui, Y., Prasanthong, R., Yutanawiboonchai, W., and Aoki, Y. 1998. Efficacy of ivermectin againstStrongyloides stercoralisinfection in jirds(Meriones unguiculatus). Experimental Parasitology89, 205–212. The activity and distribution of ivermectin (IVM), a broad spectrum anthelmintic for various nematodes and arthropods, was tested againstStrongyloides stercoralisinfection in the jird(Meriones unguiculatus.)The pattern of IVM concentration in the serum of jirds after either low- (200 μg/kg) or high-dose (1000 μg/kg) treatment by intraperitoneal injection showed a typical single-peak profile with the maximum drug levels detected at 1 h followed by a rapid decline to undetectable values by 48 h posttreatment. With equivalent IVM doses, the serum levels in male jirds were significantly higher than those observed in female jirds at 1 and 12 h posttreatment (P< 0.05). Low-dose IVM treatment of either male or female jirds, in comparison with that of the respective control groups, produced no observable effect on the adult worm burden or the parasite fecundity. The curative dose forS. stercoralisin both sexes of animals was achieved when using the high dose of 1000 μg/kg of IVM. The area under the curve calculated from the serum-concentration profiles in males was significantly higher than that for females after the high-dose treatment of IVM (P< 0.05). By low-dose treatment, a significantly lower adult worm burden was observed in males compared with that in females (P< 0.05), and this difference correlated with the higher serum levels of IVM in male animals. The distribution of IVM in the jird after high-dose treatment was characterized by initial appearances at 1 h of maximum levels of the drug in the serum and intestinal content. The maximum level in the feces was reached at 12 h posttreatment and rapidly declined thereafter. The level in the intestinal tissue was comparatively much lower than that in the intestinal content and the feces. The half-life of IVM in the intestinal content (49.5 h) was longer than those in the serum, feces, and intestinal tissue (6.53–13.07 h). Analyses of the relationship between the peak serum IVM occurring at 1 h posttreatment and the adult worm recovery revealed that the minimal serum concentration associated with clearance of the adult worm from the jird was approximately 0.65 μg/ml. The jird-S. stercoralismodel has not only made studies on various aspects of parasite biology possible, but also provided anin vivosystem to examine the efficacy as well as the mode of action of IVM against this intestinal nematode.

What Are the Advantages of Hyperproof-like Reasoning Systems?

Hyperproof is one of the first systems to permit and encourage reasoning across heterogeneous media. Its advocates argue that it has merits over and above the obvious pragmatic and cognitive ones. This paper suggests analysing Hyperproof-like systems in terms of languages interpreted over a common conceptual scheme and translation relations between logical expressions in such languages. This analysis shows that, despite initial appearances, Hyperproof has no real theoretical merits apart from its admittedly important pragmatic advantages.

Fregean Innocence

Abstract: Frege's account of opacity is based on two attractive ideas: every meaningful expression has a sense (Sinn) that determines the expression's semantic value (Bedeutung); and the semantic value of a‘that’‐clause is the thought expressed by its embedded sentence. Considerations of compositionality led Frege to a more problematic view: inside ‘that’‐clauses, an expression does not have its customary Bedeutung. But contrary to initial appearances, compositionality does not entail a familiar substitutivity principle. And Fregeans can exploit this point in a way that lets them reject Bedeutung‐shifting.

Melkersson-Rosenthal Syndrome and Crohnʼs Disease

In 1985, a 19-year-old woman had clinical features suggesting anorectal Crohn's disease. Two years later, swelling of the vulva associated with perianal swelling developed. The clinical manifestations responded to oral prednisone until 1989, when she returned with a swelling of the upper lip, a polypoid lesion of the oral buccal mucosa, and swelling of the anus and vulva. The lip biopsy demonstrated granulomas. The illness failed to respond to systemic immunosuppressive therapy, wider consultation was made, and the diagnosis of the Melkersson-Rosenthal syndrome was made. Such an appearance of this rare condition is unusual. We describe her case and discuss the literature, raising the possibility that the Melkersson-Rosenthal syndrome and Crohn's disease are the same condition with different initial clinical appearances.

Assessing Commitment in the United States and Japan: A Comment on Besser

W hether Japanese workers are more committed to their employing organizations than are U.S. workers has been the subject of considerable comparative research and speculation. Besser reviews our research (Cole 1979; Lincoln and Kalleberg 1985, 1990) on this topic and reaches two major conclusions. First, she argues that U.S. manufacturing employees are more committed than are Japanese workers in terms of work attitudes, like loyalty and identification, even though the Japanese display more committed behaviors, like absenteeism and quit rates. The Japanese advantage in behavioral allegedly stems largely from social pressures (e.g., pressures to conform to work group norms) rather than individual loyalty to, identification with, or involvement in the organization. Second, Besser alleges that we selectively interpreted our data to support the hypothesis of an commitment gap favoring the Japanese. Besser's first point is a plausible alternative interpretation of the evidence, although it is not our interpretation. However, we feel there is no basis for her second claim. Besser's quote from Lincoln and Kalleberg (p. 876) illustrates our awareness of the distinction between and behavioral aspects of and our recognition that behavioral is rooted in social norms and pressures. Clearly, there is no precise relationship between attitudes and behavior. Cole (1979, p. 235) is also explicit on this point. Besser's arguments along these lines are consistent with the tone of our work. Where we and Besser differ on this issue is primarily in rhetoric and in different understandings of commitment. Consider, for example, Besser's discussion of the measure based on whether a worker would look for another job if his/her current employer experienced a prolonged decline in business (Whitehill and Takezawa 1968; Takezawa and Whitehill 1981). While the answers to this question suggest that the Japanese are responding to external pressures by staying with their employer (although the penalties for changing jobs in Japan are not so severe as Besser describes), we think that the calculus Besser describes is consistent with our own understanding of the concept of commitment. We can use the Toyota example to make the same point. Describing Toyota's Georgetown plant, Besser argues that low rates of absenteeism do not necessarily indicate a highly committed work force (p. 879). Surely absenteeism in Japanese-managed plants is held by peer pressures and other factors unrelated to attitudes of individuals. At the same time, many of the normative and team-based controls for which Japanese organizations are famous could not function without a high degree of individual acceptance and compliance. We explicitly acknowledge that behavioral in the Japanese workplace has both structural and sources; portraying our work as extreme attitudinal determinism is inaccurate. Moreover, despite initial appearances from survey data, most evidence does not support the conclusion that American manufacturing workers feel greater personal loyalty to their firms than do Japanese workers, or that structural controls wholly explain the Japanese advantage in behavioral commitment. Besser performs a useful service by underscoring the distinction between and behavioral dimensions of commitment, and by reminding us that we should always ask: to what? In recent work, Lincoln and Kalleberg (1993) distinguish between identifi* Direct all correspondence to: Arne L. Kalleberg, Department of Sociology, CB #3210 Hamilton Hall, University of North Carolina, Chapel Hill, NC 27599-3210.

Benjamin Carr's Theatrical Career

The remarkable versatility of the European-born composers active in post-Revolutionary America has been amply chronicled in recent years by a number of capable scholars. Collectively, these musicians are often referred to as the Immigrant School: their numbers include such accomplished professionals as Alexander Reinagle, Rayner Taylor, James Hewitt, and Benjamin Carr. Carr, who was born in London, came to Philadelphia in the spring of 1793, where he opened one of the earliest music publishing-retail shops in the United States. The following year his father, Joseph, settled in Baltimore with Benjamin's mother and younger brother to found a similar enterprise. Their combined energies enabled the family virtually to dominate American music publishing for the remainder of the decade. For a time, Benjamin also ran a shop in New York, creating what must surely have been the first chain of music shops in the United States. Although Joseph Carr remained in Baltimore and confined his activities largely to publishing and retailing, Benjamin achieved additional recognition as a composer, performer, and actor. He enjoyed associations with both of the major American theatrical companies active at this time, and he pursued an acting career in both Philadelphia and New York. Benjamin Carr's stage career, which lasted only about three years, did not begin until his American arrival, and many scholars have suggested that his inexperience as an actor ultimately led to the demise of his theatrical activities.' Although contemporary accounts suggest that his initial stage appearances were less polished than those of his

Type X Collagen is Transcriptionally Activated and Specifically Localized During Sternal Cartilage Maturation

Type X collagen is an extracellular matrix protein which is synthesized by chondrocytes when they undergo hypertrophy. We present evidence here that the expression of type X collagen in the developing chick sternum is controlled primarily by transcriptional mechanisms. Using chondrocyte nuclei isolated from 15-,16-,17- and 18-day chick embryonic sterna, nuclear run-off assays demonstrate that type X collagen gene transcription begins at day 16 in chondrocytes isolated from the cephalic portion. This occurs two days prior to mineralization of this tissue as observed by alizarin red staining. The rate of type X transcription increases dramatically through days 17 and 18. Western blot analyses of extracts of freshly isolated sternal chondrocytes from the same stages show that intracellular levels of the type X protein follow the same time course. Immunostaining with a monoclonal antibody specific for type X collagen demonstrates that the initial appearances of hypertrophic cells and pericellular type X collagen occur at embryonic day 16 in the cephalic portion of sterna. Observation of immunostained cephalic sternal sections from day 18 embryos by confocal microscopy reveals that type X collagen is localized in a capsule-like configuration around each hypertrophic chondrocyte.

The chest X ray in Q-fever: a report on 69 cases from the 1989 West Midlands outbreak

Acute and serial chest radiographic appearances of Q-fever in a large UK outbreak in the West Midlands are described. In 69 acute films (taken within 20 days of onset of illness), 10% of films were normal. Appearances in 62 abnormal films were varied and, in contrast to some previous reports, showed no features that might distinguish Q-fever pneumonia from pneumonias of other origins. Analysis of serial films in 47 cases showed that complete radiographic resolution frequently took up to 6 months, longer than has been described previously. Initial appearances deteriorated over the first 2 weeks of radiographic surveillance in 20% of cases. No relationship was found between the extent of radiographic change and the age of the patient or the presence or absence of respiratory symptoms. Age did not affect time to resolution.

A New Ethnohistorical Model for North American Indian Demography

A new ethnohistorical model providing a relative measure for North American demography is discussed. This model correlates initial appearances and final disappearances of individuals identified by name in documentary records with significant demographic events. The model is tested by correlating terminal appearance-disappearance dates of 207 Munsee Indians identified by name in European records between 1630 and 1801 with contemporary wars, epidemics, land loss, and emigration. Disappearance of more than 50 percent of all named Munsees from colonial records between 1680 and 1715 reflects the catastrophic impact of two wars, four epidemics, extensive outmigration, and the loss of more than 70 percent of their homeland through land sales within the relatively brief span of thirty-five years.

Objectivity is not Neutrality: Rhetoric vs. Practice in Peter Novick's That Noble Dream

In general, I believe that skepticism is revealing and not refutable, but that it does not vitiate the pursuit of objectivity. It is worth trying to bring one's beliefs, one's actions, and one's values more under the influence of an impersonal standpoint even without the assurance that this could not be revealed from a still more external standpoint as an illusion. In any case, we seem to have no choice but to make the attempt.... Objectivity and skepticism are closely related: both develop from the idea that there is a real world in which we are contained, and that appearances result from our interactions with the rest of it. We cannot accept these appearances uncritically, but must try to understand what our own constitution contributes to them. To do this we try to develop an idea of the world that includes an explanation of why it initially appears to us as it does. But this idea, since it is we who develop it, is likewise the product of interaction between us and the world, though the interaction is more complicated and more selfconscious than the original one. If the initial appearances cannot be relied upon because they depend on our constitution in ways that we do not fully understand, this more complex data should be open to the same doubts.... However often we may try to step outside of ourselves, something will have to stay behind the lens, something in us will determine the resulting picture, and this will give grounds for doubt that we are getting any closer to reality. The idea of objectivity thus seems to undermine itself.... I want both to defend the possibility of objective ascent [that is, of developing an impersonal standpoint, the from nowhere, a view of the world in which the self is not at the center but is included as merely one among many objects] and to understand its limits. We should keep in mind how incredible it is that such a thing is possible at all. We are encouraged these days to think of ourselves as contingent organisms arbitrarily thrown up by evolution. There is no reason in advance to expect a finite creature like that to be able to do more than accumulate information at the perceptual and conceptual level it occupies by nature. But apparently that is not how things are. Not only can we form the pure idea of a world which contains us and of which our impressions are a part, but we can give this idea a content which takes us very far from our original impressions.... The search for objective knowledge, because of its commitment to a realistic picture, is inescapably subject to skepticism and cannot refute it but must proceed under its shadow. Skepticism, in turn, is a problem only because of the realist claims of objectivity. Thomas Nagel, The View from Nowhere (New York: Oxford University Press, 1986), 7, 67-71.

Epistemological Realism and the Basis of Scepticism1

My aim in this paper is to counter what strikes me as a growing pessimism about our prospects for coming up with a satisfactory theoretical response to scepticism about our knowledge of the external world. Scepticism can easily come to seem the only possible outcome of philosophical reflection on our knowledge of the world. But I think that, when we understand why this is so, we shall see that pessimism about our chances of answering the sceptic is not so well grounded after all. Evidence of pessimism in epistemology is not hard to come by. Barry Stroud, for example, on the basis of a careful examination of various antisceptical strategies, has concluded that scepticism is at least conditionally correct, in the sense that, if the sceptic is allowed to ask his questions about the possibility of knowledge in the way that he wants, the case for returning a negative answer is overwhelming.2 Our best hope for avoiding scepticism, therefore, is to find something wrong with the sceptic's questions, to see how, initial appearances to the contrary, they are less than fully intelligible. The trouble is, they do not seem defective in point of intelligibility and no one has so far succeeded in showing that they are. So even the most promising anti-sceptical strategy is not very promising. Thomas Nagel is even more pessimistic than Stroud. He sees no way of answering the sceptic's questions and no hope of impugning the intelligibility of either his questions or his conclusions. In Nagel's view, the argument goes the other way: the evident intelligibility of the sceptic's questions and conclusions refutes the arcane theories of language verifiability theories of meaning, causal theories of reference, principles of charity-that philosophers have taken to show that the sceptic's questions

Effect of Grazing by Canada Geese on the Winter Growth of Rye

Canada geese (Branta canadensis) often graze during the fall and winter in fields of rye that are planted as cover crops to reduce soil erosion and improve soil qualities. I used exclosures to document whether grazing by Canada geese had an adverse impact on rye. In 11 Connecticut fields frequented by geese, the leaf biomass of rye by mid-winter was 535% higher inside exclosures than in grazed portions of the same fields. By spring, rye leaf biomass was 177% higher inside than outside of the exclosures. In another experiment, rye was clipped to simulate grazing by Canada geese to determine whether leaf loss slowed the rye plants' growth during winter and spring. Plants that suffered leaf loss had lower total biomass, leaf and stem biomass, and root biomass than uninjured plants regardless of time during fall and winter when the leaves were clipped. Plants receiving multiple clippings grew slower than those receiving only a single clipping. J. WILDL. MANAGE. 52(1):76-80 Canada geese often graze during the fall and winter in grain fields. The damage they cause by grazing and trampling plants can be substantial (Hunt 1984). The damage, however, may be less than initial appearances suggest because of the growing plants' ability to compensate for damage. Pirnie (1954) was unable to document any loss in wheat yields caused by grazing by Canada geese on dormant wheat plants in Michigan, and Allen et al. (1985) reported losses ?13% in Maryland. Clark and Jarvis (1978) observed no difference in seed production between ryegrass plots which had been grazed by Canada geese and those which had not. In contrast, Kahl and Samson (1984) allowed captive Canada geese to graze on wheat, and in some cases heavy grazing resulted in shorter plants and lower grain yields. Tests with other goose species have not demonstrated that grazing by geese has an adverse impact on the plants. Kear (1963b) noted that grazing on winter oats and winter wheat by a captive flock of graylag (Anser anser) and pinkfooted geese (A. brachyrhynchus) had no effect on grain or straw yields at harvest time. Clipping to simulate goose damage on winter wheat and silage grass also had no effect on harvest yields (Kear 1963b). Cargill and Jefferies (1984) showed that grazing by lesser snow geese (A. caerulescens caerulescens) in a sub-arctic salt marsh incre sed primary production of a stoloniferous grass (Puccinellia phryganodes) and a sedge (Carex subspathacea), possibly by accelerating nitrogen cycling in the marsh. In many parts of North America rye is grown in fields during winter as a cover crop for soil This content downloaded from 207.46.13.101 on Sat, 08 Oct 2016 04:13:19 UTC All use subject to http://about.jstor.org/terms J. Wildl. Manage. 52(1):1988 CANADA GOOSE GRAZING ON RYE * Conover 77 management. The leaves and stems of the cover crop can reduce wind-borne soil erosion by reducing wind velocity at the ground surface (Kohnke and Bertrand 1959), and water-borne soil erosion by intercepting rain drops before they hit the soil (Bennett 1939, Kohnke and Bertrand 1959). The roots reduce erosion by holding the soil (Kohnke and Bertrand 1959). Because rye is usually plowed under, it can maintain or increase the amount of organic matter in the soil (Tisdale and Nelson 1956, Thompson and Kelly 1957, Cook 1962). Rye can also help conserve soluble plant nutrients, especially nitrates. Unless there are growing plants present to absorb them, some of these nutrients will be lost during fall and winter by leaching (Tisdale and Nelson 1956, Cook 1962). Because Canada geese often graze in rye fields during the fall and winter, they may be damaging the rye, thus reducing its beneficial qualities. Unfortunately, little information is available about whether this is a problem or if rye can compensate for any damage inflicted by geese. In this experiment I used exclosures to document whether grazing by Canada geese had an adverse impact on rye in Connecticut fields. I also evaluated the ability of rye plants to compensate for damage by recording the growth of rye biomass following simulated grazing at different intensities and at different times of the

Pulmonary Manifestations of the Clinical Syndrome of Acute Glomerulonephritis and Lung Hemorrhage

The pulmonary manifestations at the time of initial diagnosis were reviewed in 45 patients with the clinical syndrome of acute glomerulonephritis and lung hemorrhage. Initial pulmonary radiographic appearances encompassed a wide variety of abnormalities, and alveolar hemorrhage could not be reliably differentiated from other causes of pulmonary infiltration. The diseases underlying the syndrome included antiglomerular basement membrane (anti-GBM) disease (8/45), a systemic vasculitis (25/45), and idiopathic glomerulonephritis with idiopathic lung hemorrhage (12/45). A variety of acute pulmonary complications were seen, the most common being acute respiratory failure (13/45). Mortality directly due to pulmonary disease was uncommon (3/45 died from fulminant lung hemorrhage). Most deaths were from extrapulmonary manifestations of the underlying disease or infection. Follow-up studies in 22 patients 6 months after initial presentation indicated that although respiratory symptoms (3/22) or pulmonary radiologic abnormalities (5/22) were uncommon, the majority of patients had residual abnormalities on pulmonary function testing (16/22). Thus, the syndrome of alveolar hemorrhage with nephritis is associated with several distinct categories of underlying disease process. The initial chest radiograph is of limited value in differential diagnosis. Although a variety of acute and chronic respiratory complications may be anticipated and contribute significantly to morbidity, mortality is predominantly due to extrapulmonary progression of disease or infection complicating immunosuppressive therapy.