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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

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Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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The Endocrine System

.

Fuller Albright

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The investigative work of Fuller Albright concerned primarily the parathyroid glands, metabolic bone disease, and the relations of the pituitary, adrenal, and gonadal glands. Considered the father of clinical endocrinology, Albright combined beautifully a career of precise laboratory investigation and skilled patient care.

Born to distinguished parents in Buffalo, New York, in 1900, Albright attended a school founded by his father and graduated from Harvard College in 1920 and Harvard Medical School in 1924. His senior thesis, "The Physiology and Physiological Pathology of Calcium," was a paper he later described as the worst he ever wrote. After an internship at Massachusetts General Hospital, Albright spent a year in research there, and then a year at Johns Hopkins Hospital, where he befriended Read Ellsworth, with whom he would collaborate on many studies. John Eager Howard (1981) recalled his first association with these men:

For some reason Ellsworth and Albright accepted me, then a fourth-year medical student, as their workhorse, and a more strenuous pair of masters never existed. I was assigned all sorts of menial tasks, but especially I recall most vividly having to get up in the middle of the night to attend the first patient diagnosed as having idiopathic hypoparathyroidism.

Albright then spent a year in Vienna with the pathologist Jacob Erdheim, of whom he later commented, "I will simply state that he knew more about disease processes than any other living man" (Axelrod, 1970). Albright returned to Massachusetts General Hospital where he remained in practice, teaching, and research.

Author of 118 medical papers and a book entitled The Parathyroid Glands and Metabolic Bone Disease, published in 1948, Albright's contributions to endocrinology included descriptions of (1) idiopathic hypoparathyroidism; (2) secondary hyperparathyroidism; (3) diffuse hyperplasia of the parathyroid glands; (4) the relation of renal stones to hyperparathyroidism, coining the term "nephrocal-cinosis"; (5) the importance of measuring serum protein levels to estimate bound calcium; (6) a "syndrome characterized by osteitis fibrosa disseminata, areas of pigmentation and endocrine dysfunction with precocious puberty in females," known as Albright's syndrome; (7) rickets resistant to vitamin D therapy; (8) the pharmacodynamic effects of vitamin D; (9) nephrocalcinosis with rickets and dwarfism; (10) the pathogenesis of renal tubular acidosis; (11) hypercalcemia with osteoporosis of disuse; (12) postmenopausal osteoporosis; (13) estrogen treatment of osteoporosis in postmenopausal women; (14) pseudohypoparathy-roidism; (15) familial hypoparathyroidism with moniliasis; (16) the danger of immobilization in Paget's disease; (17) the milk-alkali syndrome; (18) pseudo-pseudohyperparathyroidism; (19) idiopathic hypercalciuria; and (20) a categorization of pituitary-gonadal dysfunction based on measurement of urinary gonadotropins. Albright delivered the 1943 Harvey Lecture in which he distinguished the pathogenesis of Cushing's syndrome and the androgenital syndrome.

Albright was a strong advocate of clinical investigation. His ideas on the subject were published in an article entitled "Some of the "Do's" and "Do-Not's" of Clinical Investigation" (Albright, 1944). Of financial support, Albright wrote, "The man and not the project should be endowed." Of medical hypotheses, he thought "any theory is better than none at all," although every theory was subject to change. He utilized arrow-laden diagrams to illustrate many of his points in papers. Of administrative work, which he detested, he wrote, "The desk of a good executive should be clear; that of an investigator should be littered," and he advised that one reserve time each day to think: "If you salvage a few minutes, you will be doing better than most." Albright concluded one paper on osteoporosis with the following statements:

"I have told you more about osteoporosis than I know."

"What I have told you is subject to change without notice."

"I hope I have raised more questions than I have given answers."

"In any case, as usual, a lot more work is necessary."

Albright enjoyed trout fishing in the Adirondack Mountains and bridge with his friends in Boston. He traveled a great deal with his wife and was fond of wearing a tweed jacket, baggy trousers, and a bow tie. He never discussed personalities. He valued integrity and was openly contemptuous of mediocrity in medicine.

But the life of Albright was not without tragedy. At the early age of 36, the tremor of Parkinson's disease appeared, followed by increasingly worse manifestations over the next two decades. His wife was of invaluable support as his dependence on her increased. Members of his profession also came to his aid:

At the M.G.H. his friends did what was necessary. If a shoelace became untied, the nearest person tied it. When he entered the cafeteria, someone would pick up a tray for him and pay for his meal with the money his wife had stuffed into his pocket that morning. The medical student in Albright's one-month elective course would be given the family's second car, if he did not have his own, and was expected to drive his instructor to and from work, write his notes, and hold his stethoscope against the patient's chest. (Axelrod, 1970)

He rarely mentioned his disease, the severity of which prompted him to insist on surgical intervention at age 56. After initial improvement, a complication occurred that left him an invalid in a state of akinetic mutism for 13 years until his death in 1969. With characteristic humor, at age 46, Albright had written that Parkinson's syndrome "does not come under my special medical interests, or else I am sure I would have it solved long ago" (Howard, 1981).

References

  1. Albright F. Some of the "do's" and "do-not's" in clinical investigation. J Clin Invest. 1944;23:921–26.
  2. Axelrod L. Bones, stones and hormones: the contributions of Fuller Albright. New Engl J Med. 1970;283:964–70. [PubMed: 4919084]
  3. Howard JE. Fuller Albright: the endocrinologist's clinical endocrinologist. Perspect Biol Med. 1981;374:81. [PubMed: 7022356]
Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.
Bookshelf ID: NBK700PMID: 21250279
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