Lives of the fellows

Frederic Crosby Bartter

b.10 September 1914 d.5 May 1983
BA Harvard(1935) MD(1940) FRCP*

The son of a Kentish Anglican missionary priest, Fred Bartter was born in the Phillipines but this in no way detracted from his devotion to North America. For he was, as a magna cum laude graduate of Harvard Medical School and as an intern and clinical fellow of the Massachusetts General Hospital, a thorough-going New Englander. A major prop of the US Public Health Service since 1942, Fred became chief of the endocrinology branch of the National Heart and Lung Institute (National Institutes of Health, Bethesda, Maryland) in 1951. He became clinical director of the whole Institute in 1970 and chief of the refurbished hypertension-endocrine branch of the Institute in 1972. His retirement in 1979 came as a shock to his postgraduate alumni because he always seemed so young. He remained very active in academic medicine and it was highly appropriate that he died, suddenly, while contributing to a scientific conference.

Throughout his professional life, Fred Bartter was beset by two conflicting interests. On the one hand he had an intense interest in bone and the behaviour of the parathyroid, and on the other was his interest in sodium metabolism and the control of the plasma volume. The bone dimension was a heavy one if only because Fuller Albright, his mentor at the Harvard Medical School, had, on his death, bequeathed to Fred all his slides pertaining to his studies on bone problems. Fred took this bequest very seriously, possibly more so than Fuller Albright actually intended, because Fred Bartter had a mammoth sense of loyalty which edged into the religious. The need to uphold the Albright cause in bone metabolism consumed an enormous amount of his time. He became a doyen of the field and he made many interesting original contributions to it. He was in much demand as a reviewer and referee but he himself never actually made that contribution which could be regarded as thoroughly original.

By contrast, his activities in the field of sodium metabolism were peppered with new ideas and new data. This was truly his own area and his close friendship with Alexander Leaf and other members of the ‘salt and water’ club must have been seminal. When the relevant active principle in the so-called ‘amorphous fraction’ of adrenocortical extracts was identified as aldosterone by Simpson and Tait in London, England, and when the corresponding clinical syndrome had been so vividly described by Conn from Ann Arbor, Michigan, Fred was galvanized to discover the controlling mechanism for aldosterone secretion. Being a clinician he was fully aware that there were conditions, such as cirrhosis of the liver and the nephrotic syndrome, where hyperaldosteronism was likely to be the dominant factor in explaining the intense sodium retention that intermittently characterizes these conditions, yet he was also aware that, in these conditions, there was no increase in the rate of secretion of cortisol. At that time the pituitary was the ‘conductor’ of the endocrine orchestra so that without an identified pituitary trophic hormone to control aldosterone secretion, it was difficult to identify what the major controlling mechanism was. Naturally various physiologists took up the challenge, in particular James O Davies who also worked at the National Institutes of Health, Bethesda, Maryland.

Fred stuck resolutely to his clinical limb and was able to demonstrate, largely by a series of elegant studies in man, that aldosterone secretion was dominated by changes of plasma volume rather than changes of plasma sodium concentration which had been the favoured candidate amongst the physiologists. This contribution, made against heavy odds intellectually, stands out as Fred Bartter’s academic zenith. He went on to identify a dwarfed negro boy as having bilateral adrenal hyperplasia due to a massive overstimulation of the renin-angiotensin system, whose importance in the control of aldosterone secretion became increasingly evident at that time, the early 1960s. The concept of over-production of renin from a primarily hyperplasic juxta-glomerula apparatus is now entrenched in the appellation ‘Bartter’s stimulus to clinical and experimental research on the renin-aldosterone system. Fred could hardly have wished for a better epitaph. He loved the cut and thrust of academic argument. He was, nonetheless, a real pillar when it came to the validity of scientific data. He would spare nothing to get at the truth. This was so strong as to have the flavour of an almost Christian fervour. Many of this patients will remember, with perhaps a somewhat wry smile, how painstaking and rigorous Bartter’s metabolic requirements were.

But it is a tribute to his endearing personality and his ability to make his ‘subjects’ feel their need to contribute to medical science that Fred managed to complete so many longterm and exacting studies so successfully. He was an intensely religious man and it is this quality when applied to the contentious field of scientific endeavour which shines above all. It is a corollary of these qualities that as a person he was exceptionally generous both with his time and his intellect. He had no sense of envy and little sense of the importance of his own time. He had an impish sense of humour, designed to kindly deflate the pompous, to which he gave expression in his love of mushrooms. To identify thoroughly the bad and thoroughly extol the good were perhaps qualities which led him to become an expert mycologist. Janey, his wife, provided enormous and loving support to Fred’s self-imposed difficult and lifelong academic assignment.

JDH Slater

* He was elected under the special bye-law which provides for the election to the fellowship of "Persons holding a medical qualification, but not members of the College, who have distinguished themselves in the practice of medicine, or in the pursuit of Medical or General Science or Literature..."

(Volume VII, page 24)

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