MEMORIAL E. COWLES ANDRUS BY BENJAMIN M. BAKER, M.D. AND RICHARD S. ROSS, M.D.
E. Cowles Andrus, Professor Emeritus of Medicine, an internationally known cardiologist and a member of the Johns Hopkins Medical School faculty for more than 50 years, died quietly at home on Sunday, March 26, 1978. Born in Kaatsban, New York in 1896, he received his bachelor's degree from Oberlin College in 1916 and the M.A. degree the following year. After graduating from Hopkins medical school in 1921, he continued his training as a member of the house staff. His specialization in cardiology began when E. P. Carter, then in charge of the "Cardiographic Laboratory," encouraged him to study abroad for the two years immediately following his assistant residency. He was awarded a Research Fellowship at the National Institute for Medical Research and University College in London, where Sir Thomas Lewis's early work on electrocardiographic and other methods of studying the heart beat was attracting wide attention. The next year he spent as a Visiting Fellow at the University of Vienna, then returned to the Hopkins house staff in 1925. After completing a two-year term as Resident Physician, he entered into private practice and became a member of the part-time faculty. "Parttime" is an inadequate description of the countless hours he devoted to the causes of education, clinical care, and research at The Johns Hopkins Medical Institutions. Dr. Andrus's years of association with the Bulletin of the Johns Hopkins Hospital, of which he was twice Managing Editor (1930-1934, 1947-1949), his role as Assistant Dean of the Medical Faculty (1929-1934), and his many years of service as Physician-in-Charge of the Adult Cardiac Clinic are only a few examples of such contributions. His earliest work in medical science concerned the influence of pH change on heart rate: a study begun while he was at Oberlin and published while he was a medical student working in Howell's laboratory. This was the beginning of a lifelong interest in the physiology of cardiac rhythm. In 1921, Andrus and Carter demonstrated that rise in pH produced an increase in heart rate and an acceleration in conduction. These and related findings led him to propose that the rhythmic polarization and depolarization of cardiac membrane underlying the heart beat was the result of a transmembrane gradient in hydrogen ion concentration. The theory was correct but oversimplified, insofar as others later showed that pH played a secondary role to the primary one mediated by transmembrane potassium flux. xxix
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Later, while in Sir Henry Dale's laboratory in London, he established that changes in pH and in CO2 concentrations greatly altered chronotropic responses to adrenalin and vagal stimulation. The correctness of his results was rediscovered by successive generations of investigators and those results endure today. Many of the early studies depended on what would now be regarded as astonishingly simple preparations. The arrangements, however, were often ingenious. For example, in 1928 Andrus and Carter needed to drive a perfused heart at a given rate and to introduce an additional stimulus after a controlled interval. To do this they enlisted Harold Wheeler in the Department of Physics and together designed a device which amplified the cardiac action current to the point where it could activate a magnet. This triggered the fall of a pendulum which in the course of its arc could close any one of a number of switches and thereby deliver a stimulus at the needed time. Using this device, they discovered that in the presence of vagal stimulation a single shock delivered at the end of the refractory period regularly produced atrial fibrillation. Beginning with his years in combined research and practice, Dr. Andrus's interests became much more wide-ranging. For example, in 1940, he and Philip Hill demonstrated that "angiotonin," i.e., angiotensin, provoked constriction of coronary arteries and conspicuously increased cardiac output in heart-lung preparations. This observation was overlooked for 20 years but, when confirmed by others, contributed to the conclusion that the augmented cardiac output associated with elevated angiotensin levels is one of the contributing causes of sustained hypertension. Because he was active in laboratory and animal research as well as clinical investigation, he was able in the second World War to bring a combination of talents to the practical problems of aviation medicine. He served as a consultant in this field to the National Research Council and subsequently headed a number of its scientific committees. From 1944 to 1946 he was Chief of the Division of Medicine in the Office of Scientific Research and Development. For these and other wartime services, President Truman awarded Dr. Andrus the Certificate of Merit. In the postwar period, as efforts were made to preserve some of the research programs and facilities that had been created during the war, he played an important part in planning the gradual enlargement of the National Institutes of Health: no one was more expert in the difficult task of promoting communication between laymen and medical scientists. Cowles Andrus served as Special Consultant to the Surgeon General from 1946 on, Chairman of the NIH Cardiovascular Study Section from 1946 to 1952, and Senior Scientific Advisor to the National Heart Institute from 1957 to 1962, to name but a few of many responsible positions.
MEMORIAL
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These varied tasks were by no means a substitute for the practice of clinical cardiology. Thus, in the 1950s, his collaboration with Dr. Alfred Blalock led to a series of papers that helped to establish the principles of selection and surgical treatment of patients with mitral stenosis. At the same time, he was a leader in the affairs of the American Heart Association, serving as a member of its Board of Directors from 1950 to 1956 and as its President, 1954-1955. He was active in the founding of the Inter-American and International Cardiological Societies, and served on the Councils of both bodies. His colleagues will remember him for the precision of his speaking and writing; his sentences were perfect, with the right word selected for every purpose. He had a fine sense of humor and enjoyed spirited conversation with his friends, many of whom were outside of medicine. His conversation was enriched by his broad education, experience, and reading in German as well as in English. His major interests outside of medicine were his church which he served as elder, golf which he played with enthusiasm, and music which he enjoyed by listening, singing and playing the lute. Dr. Andrus was a warm, stimulating and steadfast friend. As a teacher and peer he was always ready to share the wealth of his knowledge and imagination. His research was meticulous and sound. His guidance of students and young investigators was tirelessly patient; and he was willing to spend hours in the discussion of results brought to him by a novice. His administration was an extraordinary example of putting first things first. Cowles's care of patients was a combination of wisdom and gentleness.
E. Cowles Andrus, Professor Emeritus of Medicine, an internationally known cardiologist and a member of the Johns Hopkins Medical School faculty for more than 50 years, died quietly at home on Sunday, March 26, 1978. Born in Kaatsban, New York in 1896, he received his bachelor's degree from Oberlin College in 1916 and the M.A. degree the following year. After graduating from Hopkins medical school in 1921, he continued his training as a member of the house staff. His specialization in cardiology began when E. P. Carter, then in charge of the "Cardiographic Laboratory," encouraged him to study abroad for the two years immediately following his assistant residency. He was awarded a Research Fellowship at the National Institute for Medical Research and University College in London, where Sir Thomas Lewis's early work on electrocardiographic and other methods of studying the heart beat was attracting wide attention. The next year he spent as a Visiting Fellow at the University of Vienna, then returned to the Hopkins house staff in 1925. After completing a two-year term as Resident Physician, he entered into private practice and became a member of the part-time faculty. "Parttime" is an inadequate description of the countless hours he devoted to the causes of education, clinical care, and research at The Johns Hopkins Medical Institutions. Dr. Andrus's years of association with the Bulletin of the Johns Hopkins Hospital, of which he was twice Managing Editor (1930-1934, 1947-1949), his role as Assistant Dean of the Medical Faculty (1929-1934), and his many years of service as Physician-in-Charge of the Adult Cardiac Clinic are only a few examples of such contributions. His earliest work in medical science concerned the influence of pH change on heart rate: a study begun while he was at Oberlin and published while he was a medical student working in Howell's laboratory. This was the beginning of a lifelong interest in the physiology of cardiac rhythm. In 1921, Andrus and Carter demonstrated that rise in pH produced an increase in heart rate and an acceleration in conduction. These and related findings led him to propose that the rhythmic polarization and depolarization of cardiac membrane underlying the heart beat was the result of a transmembrane gradient in hydrogen ion concentration. The theory was correct but oversimplified, insofar as others later showed that pH played a secondary role to the primary one mediated by transmembrane potassium flux. xxix
xxx
MEMORIAL
Later, while in Sir Henry Dale's laboratory in London, he established that changes in pH and in CO2 concentrations greatly altered chronotropic responses to adrenalin and vagal stimulation. The correctness of his results was rediscovered by successive generations of investigators and those results endure today. Many of the early studies depended on what would now be regarded as astonishingly simple preparations. The arrangements, however, were often ingenious. For example, in 1928 Andrus and Carter needed to drive a perfused heart at a given rate and to introduce an additional stimulus after a controlled interval. To do this they enlisted Harold Wheeler in the Department of Physics and together designed a device which amplified the cardiac action current to the point where it could activate a magnet. This triggered the fall of a pendulum which in the course of its arc could close any one of a number of switches and thereby deliver a stimulus at the needed time. Using this device, they discovered that in the presence of vagal stimulation a single shock delivered at the end of the refractory period regularly produced atrial fibrillation. Beginning with his years in combined research and practice, Dr. Andrus's interests became much more wide-ranging. For example, in 1940, he and Philip Hill demonstrated that "angiotonin," i.e., angiotensin, provoked constriction of coronary arteries and conspicuously increased cardiac output in heart-lung preparations. This observation was overlooked for 20 years but, when confirmed by others, contributed to the conclusion that the augmented cardiac output associated with elevated angiotensin levels is one of the contributing causes of sustained hypertension. Because he was active in laboratory and animal research as well as clinical investigation, he was able in the second World War to bring a combination of talents to the practical problems of aviation medicine. He served as a consultant in this field to the National Research Council and subsequently headed a number of its scientific committees. From 1944 to 1946 he was Chief of the Division of Medicine in the Office of Scientific Research and Development. For these and other wartime services, President Truman awarded Dr. Andrus the Certificate of Merit. In the postwar period, as efforts were made to preserve some of the research programs and facilities that had been created during the war, he played an important part in planning the gradual enlargement of the National Institutes of Health: no one was more expert in the difficult task of promoting communication between laymen and medical scientists. Cowles Andrus served as Special Consultant to the Surgeon General from 1946 on, Chairman of the NIH Cardiovascular Study Section from 1946 to 1952, and Senior Scientific Advisor to the National Heart Institute from 1957 to 1962, to name but a few of many responsible positions.
MEMORIAL
XXXi
These varied tasks were by no means a substitute for the practice of clinical cardiology. Thus, in the 1950s, his collaboration with Dr. Alfred Blalock led to a series of papers that helped to establish the principles of selection and surgical treatment of patients with mitral stenosis. At the same time, he was a leader in the affairs of the American Heart Association, serving as a member of its Board of Directors from 1950 to 1956 and as its President, 1954-1955. He was active in the founding of the Inter-American and International Cardiological Societies, and served on the Councils of both bodies. His colleagues will remember him for the precision of his speaking and writing; his sentences were perfect, with the right word selected for every purpose. He had a fine sense of humor and enjoyed spirited conversation with his friends, many of whom were outside of medicine. His conversation was enriched by his broad education, experience, and reading in German as well as in English. His major interests outside of medicine were his church which he served as elder, golf which he played with enthusiasm, and music which he enjoyed by listening, singing and playing the lute. Dr. Andrus was a warm, stimulating and steadfast friend. As a teacher and peer he was always ready to share the wealth of his knowledge and imagination. His research was meticulous and sound. His guidance of students and young investigators was tirelessly patient; and he was willing to spend hours in the discussion of results brought to him by a novice. His administration was an extraordinary example of putting first things first. Cowles's care of patients was a combination of wisdom and gentleness.
