Lives of the fellows

Abner McGehee Harvey

b.30 July 1911 d.8 May 1998
AB Washington and Lee Univ(1930) MD Johns Hopkins Univ(1934) Hon ScD Washington and Lee Univ(1949) Hon ScD Univ of Arkansas(1950) ScD Medical College of Ohio(1976) FRCP(1985)

Abner McGehee Harvey was chairman of the department of medicine at Johns Hopkins Medical School and physician-in-chief of Johns Hopkins Hospital. He grew up in Little Rock, Arkansas, graduated from Washington and Lee University and went on to study medicine at Johns Hopkins University School of Medicine, qualifying in 1934. At Johns Hopkins he came under the influence of William H Welch, E K Marshall and Warfield T Longcope, Louis V Hamman and Robert Austrian, among others.

After three years on the medical residency staff at Johns Hopkins he worked for two years at the National Institute for Medical Research, London, in the laboratory of Sir Henry Dale [Munk’s Roll, Vol.VI, p.130], where Lindor Brown [Munk’s Roll, Vol.VI, p.72] was his mentor and collaborator in studies of the neuromuscular junction. After a year (1939 to 1940) spent at the Johnson Foundation for Biophysics of the University of Pennsylvania, he returned to Johns Hopkins as resident physician in the Osler Medical Clinic, headed by Warfield T Longcope.

In 1941 AMH assumed a faculty position in the department of medicine at Vanderbilt University, Nashville. His tenure there was cut short by Pearl Harbour. For three years during the Second World War, AMH served with the 118th General Hospital (a Hopkins unit) in Australia and New Guinea. During a long staging in Sydney, Australia, AMH made contacts with the clinicians at Sydney Hospital and the researchers at the research institute associated with that hospital. There he met and worked on peripheral nerve injuries with Stephen Kuffler.

AMH returned from the South Pacific in 1945 and, while still in the army, was assigned to Johns Hopkins to work on the effects of organophosphate nerve gases on neuromuscular transmission. AMH was still in uniform when it was announced that he was to succeed Longcope in the distinguished position first filled for 16 years by Sir William Osler [Munk’s Roll, Vol.IV, p.295].

AMH was 34 years old when he assumed the chairmanship of medicine at Johns Hopkins; he was not quite 62 when he stepped down in 1973 to pursue his second career in medical history. The 27 years that AMH was physician-in-chief were critical ones, for medicine in general, for Johns Hopkins Hospital and for the department of medicine, the largest department of Johns Hopkins University. AMH had a major impact in all three domains. The department of medicine that AMH took over in 1946 was divided into three research divisions according to a structure that had been established by Llewellys F Barker, Osler’s immediate successor as chief. These were the biological division (dealing with infectious diseases), the physiological division (including the heart station, especially electrocardiography) and the chemical division (including endocrinology, metabolism and renal disease).

Subspecialization was not highly developed in Baltimore and at Johns Hopkins, possibly following the model set by Osler. Harvey built specialty divisions within the department of medicine without loosing the primary focus on general medicine. Particularly to the credit of AMH were the ‘unconventional’ divisions that he initiated: those of biomedical engineering, clinical pharmacology and medical genetics.

AMH’s research experience meant he recognised the importance of biophysics and biomedical engineering to clinical research. AMH was important in the recruitment of Detlev Bronk as president of Johns Hopkins University and in the establishment of the department of biophysics in the University and the medical school. In the department of medicine he established a division of biomedical engineering under Samuel A Talbot which evolved into the pioneering department of biomedical engineering, headed by Richard J Johns.

The division of clinical pharmacology, another pioneering endeavour, was a natural outgrowth of AMH’s admiration for E K Marshall and Sir Henry Dale and his recognition of the desirability of a programme connecting the preclinical and clinical departments.

Medical genetics was institutionalized as a clinical, teaching and research division of the department of medicine in 1957 when AMH asked Victor McKusick to assume directorship of the multifaceted chronic disease outpatient clinic created by J Earle Moore.

As director of the department of medicine, AMH’s teaching and clinical work were inextricably connected. He consulted on a daily basis with the resident physician concerning problem patients. Through teaching at bedside rounds, conducted three mornings a week by rotation on the several inpatient units of the Osler Medical Clinic, he had contact with all the medical students and all the house officers: an estimated 2100 students and almost 500 house officers. For many years he also conducted that highly visible test of clinical acumen and judgement, the weekly clinical pathological conference (CPC). In both his bedside teaching and in the CPCs, AMH developed a distinctive diagnostic approach: careful eliciting of clinical information, followed by an organized, systematic, rational analysis. The steps of the analysis were to identify particularly salient features of a difficult problem in differential diagnosis, assemble the known causes of the feature and assess how the other findings in the case supported or refuted that diagnostic possibility. Such was the approach he also used in his monograph Differential diagnosis - the interpretation of clinical evidence (Philadelphia, W B Saunders & Co., 1955).

The Harvey method of clinical diagnosis was later extended in scope as the central theme of his textbook, The principles and practice of medicine (New York, Appleton-Century-Crofts, 1968). Osler had initiated this textbook in 1892 while at Hopkins and, up to the eighth edition (1914), continued it as a one-man book. The textbook was resurrected by AMH as a one-department multi-authored opus after being out of print for almost twenty years.

In 1954, AMH’s personal clinical scholarship resulted in a classic monograph on systemic lupus erythematosus, co-authored with Shulman, Tumulty, Conley and Schoenrich, Medicine, 33: 291. This much cited review involved 138 patients studied in the Osler Clinic and opened up a modern era in the investigation and treatment of the disorder.

After he stepped down from the directorship of the department in 1973, AMH continued to edit Medicine and devoted the last 25 years of his life to the history of clinical science. His interest in history and his personal participation in medical science from 1930 put him in an ideal position to put into perspective the events of this exciting era and the century that preceded it.

In addition to many papers, AMH’s historical books included; Adventures in medical research, a century of discovery at Johns Hopkins (Baltimore, Md, The Johns Hopkins University Press, 1976); Two centuries of American medicine 1776 - 1976 (Philadelphia, W B Saunders & Co., 1976 [with J B Bordley III]); Science at the bedside: clinical research in American medicine 1905 - 1945 (Baltimore, Md, The Johns Hopkins University Press, 1981); A model of its kind(Baltimore, Md, The Johns Hopkins University Press, 1989 [a two volume centennial history of Johns Hopkins Medicine, with Brieger, Abrams, and McKusick]); Osler’s legacy: the department of medicine at Johns Hopkins 1889-1989 (Baltimore, Md, Department of Medicine, Johns Hopkins University, 1990 [with McKusick and Stobo]). He wrote the official histories of three societies; the Interurban Clinical Club, the American Clinical and Climatological Association and the Association of American Physicians. He also wrote a history of the Commonwealth Fund.

In 1941 AMH married Elizabeth (‘E’) Treide, who also graduated from Johns Hopkins Medical School. They had four outstanding children, of whom two are physicians. He succumbed to a stroke at Johns Hopkins Hospital where he had worked until 48 hours before his death.

Victor McKusick

(Volume XI, page 252)

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