Fuller Albright

Born 1900-01-12
Died 1969-12-08

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American physician and endocrinologist, born January 12, 1900, Buffalo, New York State; died December 8, 1969, Massachusetts General Hospital, Boston.

Biography of Fuller Albright

Fuller Albright

”As with eggs, there is no such thing as a poor doctor, doctors are either good or bad,” declared Fuller Albright, who disdained mediocrity throughout his wide-ranging career in the exploration of metabolism and endocrinology.

Fuller Albright grew up in a happy New England home, the son of a financier and philanthropist. He studied at Harvard, where he received his medical degree in 1924. He subsequently specialised in internal medicine at the Johns Hopkins Hospital, Baltimore, and in Vienna. Among the teachers whose influence he emphasised were Joseph C. Aub, (1890-1973), Warfield Longcope, J. Howard Means and Walter Bauer. But more than anybody he admired the Jewish Austrian pathologist Jakob Erdheim (1874-1837) with whom he spent a year from 1928. "Quite simply, he knew more about human disease than any other living man" was his evaluation of Erdheim. Erdheim’s name also occurs in the discussion about the priority of the Cushing syndrome, or adrenal cortex carcinoma. It was Albright who, in 1943, coined the term Cushing’s syndrome to this disturbance. Erdheim’s photograph was one of very few in Albright’s album.

Albright’s alma mater was Harvard, where he spent most of his career as chief of the department of endocrinology in the medical clinic, which was headed by J. Howard Means, the distinguished thyroidea clinician. He was associate professor from 1942 to 1961. Wanting no administrative burden, he refused to become full professor.

Albright’s interest in calcium metabolism began in the famous department 4 at the Massachusetts General Hospital. In 1927 he worked as resident assistant with Ellsworth at the Johns Hopkins and then went to Berlin, where he worked with Hermann Zondek (1887-1979) and concentrated his efforts on the hypophysis.

On his return to the U.S.A. he received an appointment to the medical faculty at Harvard in 1930, and then spent the rest of his career at the Famous Massachusetts General Hospital, where he founded a biological laboratory. He built a distinguished clinic for clinical endocrinology, and also established a clinic for ovarian dysfunction and a stone clinic – the Quarry, thus mixing the clinic and the laboratory. He won world renown for his clinical investigations and popularised the study of metabolic imbalances. He was also famous for his circle diagrams for making working hypothesises: ”Any theory is better than no theory”.

Albright did extensive research in many fields of endocrinology, among them parathyroid disease, bone metabolism and disturbances of sex hormones. He participated in the initial clinical application of steroid therapy, and turned attention to the side effects of these strong drugs. His investigations received much acclaim and he received several important academic awards. He was justly reckoned a father figure in his speciality. Among his students were Edward Conrad Reifenstein (1908-1975), Hirsch Wolf Sulkowitch (1906-), Cockrill, Frederic Crosby Bartter (1914-1985), Russel Fraser, W. Parson, Charles Hoyt Burnett (1913-1967) and Harry Fitch Klinefelter (1912-).

Albright and his colleagues in 1942 reported three patients with a new entity, which they named ”pseudohypoparathyroidism”. By 1952 they had seen several more persons with the same phenotype but lacking any evidence of metabolic dysfunction. They termed this condition ”pseudo- pseudohypoparathyroidism”. Reports concerning these disorders accumulated and many authors preferred the eponymic title ”Albright hereditary osteodystrophy”. The use of this convention generated confusion with Albright polystotic fibrous dysplasia, or the McCune-Albright syndrome, which is a completely separate disorder. This problem has been compounded as the single eponym, Albright, is often employed indiscriminately for either condition.

His many discoveries are described in his 118 publications. Some times he was the first to describe a new syndrome, in other cases his was not the first, but the best and most complete report of a disease. His ”favourite” disease was Cushing’s syndrome which, after his detailed studies might as well have been called Albright-Cushing syndrome.

Albright introduced an exceptional method for determining follicle-stimulating hormones (FSH) in his endocrine laboratories. With this process he first was able to distinguish between gonadal dysgenesis (see Morgagni-Turner-Albright syndrome) from other forms of primary amenorrhoea, and partly also separate Klinefelter’s syndrome from other forms of eunuchoidism. Albright and Edward Reifenstein were co-authors with Klinefelter, but Albright let Klinefelter be the main author. The description of the disturbance is in classical Albright style.

A victim of Parkinson’s disease
Fuller Albright got Parkinson’s disease while still in his thirties, but continued working despite his handicap. In an article for the 25th anniversary of his class he wrote in 1946:

”Over the last ten years I have had the interesting experience of observing the course of Parkinson’s syndrome on myself. This condition, in fact, does not belong to my special medical interests, or else I am certain I would have solved it long ago. It disturbs every movement and gives a certain rigidity that makes small talk look strained. The conditions does, though, have its compensations: one is not taken away from interesting work in order to be sent to Burma, one avoids all forms of deadly committee meeting, etc.”

In 1952 Irving Cooper had reported that Parkinson’s disease could be improved through a surgical procedure, chemopallidectomy, in which small quantities of alcohol were injected into those parts of the brainstem from which the rigidity and tremor characterising the disease originates. Albright, now so severely handicapped that he could neither eat, dress, write or speak comprehensively, decided to undergo the operation. He also meant to have observed a reduction of his intellectual capacity.

Cooper, like Albright’s own physician, decided against the operation, but Albright wanted to dare this attempt at a better life. The operation took part in June 1956. The intervention of the right side was followed by freedom from rigidity and tremor on the one side, he could walk better, stand more upright and work reasonably well with the hand. The operation on the other side, however, was followed by massive intracranial haemorrhage. Albright was never again to speak and soon slipped into unconsciousness. He died at the Massachusetts General Hospital thirteen years later.

The scientist and physician
Albright had an amazing ability to exploit the whims of nature and nature’s own experiments in elucidating complex medical connections. His research always concerned disease in man; he never conducted animal experiments to prove a hypothesis. At the same time his research was the basic research in the field, with such a penetrative force that the distinction between basic and applied research was blurred. "Basic research - basic to whom?"

He repeatedly returned to Cushing's syndrome, launching new theories of causation. In one of his last public appearances, when his ability to speech was strongly impaired, he concluded his lecture with a question to the auditorium:

"Who thinks I am right - raise your hand", followed by the question: "Who thinks I am wrong - raise your hand". He must have considered the reaction as meagre, and his final question came as a whiplash: "Who thinks at all?"

He summed up one of his works thus:
"1. I have told you more about osteoporosis than I know. 2. What I have told you is subject to change without notice. 3. I hope I have raised more questions than I have given answers. 4. In any case, as usual, a lot more work is necessary."

In the late 1940s Albright heard that polystotic fibrous dysplasia (McCune-Albright syndrome) had been found in a girl in a country in South America. He had himself transported into the mountains to investigate. At the time he was severely handicapped by Parkinson’s disease.

A selection of quotations:

«A patient who complains of lifelong impotence or lack of libido does not suffer from hormonal lack; a patient with real endocrine insufficiency, e.g., eunuchoidism, has impotence and absent libido, but does not complain of them, but of something more trivial, such as being mistaken for a girl over the telephone.»
Textbook of Medicine, (8th edition, by L. Russel, Cecil and
Robert F. Loeb), «Diseases of the Ductless Glands,» Introduction.

«As with eggs, there is no such thing as a poor doctor, doctors are either good or bad.» Textbook of Medicine, (9th edition, by L. Russel, Cecil and Robert F. Loeb),
«Diseases of the Ductless Glands,» Introduction.

«One cannot possibly practice good medicine and not understand the fundamentals underlying therapy. Few if any rules for therapy are more than 90 per cent correct. If one does not understand the fundamentals, one does more harm in the 10 per cent of instances to which the rules do not apply than one does good in the 90 per cent to which they do apply.»
Textbook of Medicine, (8th edition, by L. Russel, Cecil and
Robert F. Loeb), «Diseases of the Ductless Glands,» Introduction.

We thank Ian Ellis for correcting an error in the original entry.

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