Alfred P. Fishman

56th APS President (1983-1984)
Alfred P. Fishman

In 1961 Alfred Fishman began a more than twenty-five year association with the journals and publications of APS when he joined the Editorial Board of Physiological Reviews. He came with experience. From 1958 to 1963 he had been on the board of the Journal of Clinical Investigation, and in 1960 he was appointed to the boards of both Circulation (1960-65, 1966-70, and 1971-75) and Circulation Research (1960-65, 1966-70, and 1971-). By the end of his six years with Physiological Reviews (1961-67) he was serving as editor of Physiology for Physicians (1966-69) and of the series "Physiology in Medicine" (1969-79) in the New England Journal of Medicine, both sponsored by APS. He next became chairman of the Editorial Board of the Handbook of Physiology, where he served for five years (1967-72) and from which he moved to the Publications Committee of the Society (1972-81). From 1975-1981 he was chairman of this committee, and in 1979 he became editor of the Handbook volumes on respiratory physiology. In 1981 he was appointed editor of the Journal of Applied Physiology. From this rather considerable range of activities, Fishman will be known and remembered mainly for having sponsored and guided the reorganization of the Society's journals. His contributions to APS, however, have not been limited to its publications. He was chairman of the Program Committee (1965-68) and of the Task Force on Programming (1976), and he served on the Task Force on Clinical Physiology (1974-75), the Long-Range Planning Task Force (1980-84), and the Centennial Celebration Committee, which he has chaired since 1985. He also served as chairman of the committee to find a successor to Orr Reynolds. Chosen president elect in 1982, he became the only president in recent times who had not served previously as a member of Council.

As president of APS, Fishman made a deliberate attempt to alter the way its international counterpart, IUPS, is managed, with particular reference to composition of the IUPS Council and its programs and commissions. The U.S. National Committee of the IUPS was also "challenged" to assume its proper role in international science. To this end, the APS Council offered to collaborate with IUPS to create an international physiological journal.

He was born in New York City and educated first at the University of Michigan (A.B., 1938; M.S., 1939) and then at the University of Louisville (M.D., 1943). For two years he was a captain in the U.S. Army, for a time assigned to the Tropical Disease Center in North Carolina. Then after the series of fellowships he has described below he joined the faculty of the College of Physicians and Surgeons of Columbia University in 1953, where he held the rank of associate professor of medicine from 1958 to 1966. On his move to the University of Chicago in 1966 he became professor of medicine as well as director of the Division of Cardiovascular Disease in the hospital and director of the Cardiovascular Institute. Three years later (1969) he went to the University of Philadelphia as professor of medicine and director of the Cardiovascular-Pulmonary Division of the Department of Medicine. For seven years (1969-76) he served also as associate dean of the School of Medicine. Since 1972 he has been the William Maul Measey Professor of Medicine.

In 1980 Fishman was elected to membership in the Institute of Medicine of NAS and since 1982 has served on its Advisory Committee on Health Science Policy. He is an honorary fellow of the American College of Cardiology (1971) and the American College of Chest Physicians (1972) and has received the Jacobi Medallion from the Mt. Sinai Medical Center (1979), the Distinguished Achievement Award of AHA (1980), and the Distinguished Alumnus Award from the University of Louisville (1984). He has been honored by some twenty named lectureships, including two in honor of Louis N. Katz (1973 and 1975). He has been a visiting professor at the University of Sheffield in England (1965), Harvard (1970), the University of Tennessee (1971), Oxford University as the First Resident Litchfield Lecturer (1972-73), the School of Medicine of Washington University in St. Louis (1973), Johns Hopkins University and the University of Maryland (1974), two universities in Brazil (1976), Mt. Sinai Hospital in New York (1978), the University of Zurich (1978), Yale and Boston Universities (1979), and in Hawaii (1980).

Shortly after he became a member of APS in 1950, Fishman was elected to membership in the American Society for Clinical Investigation (1953) and the American College of Physicians (1954; fellow, 1959). He is also a fellow of AAAS and has served as chairperson of its Section on Medical Sciences (1985-86). He has been a member of the Harvey Society (New York, 1954-78) and the American College of Cardiology (1971-80); he is currently a member of the Royal Society of Medicine (London, 1958-), the Association of American Physicians (1962-), the American College of Chest Physicians (1969-), and the American Thoracic Society (1970-). He, Weir Mitchell, Landis, and Berliner are the only former presidents of APS who have qualified for membership in that delightful and exclusive anachronism, the Interurban Clinical Club.

In regional associations and the parent AHA, Fishman has long been active in a variety of capacities. He has served on the Executive Committees of the Council on Cerebrovascular Disease (1966-70), the Basic Science Council (1969-80), and the Research Council (1977-79). He has been a member also of the Council on Circulation (1968-80), the Central Committee (1970-), and two different Program Committees (1970-72 and 1970-73); he is currently chairman of the Council on Cardiopulmonary Disease (1972-).

Editorial responsibilities Fishman has assumed outside the scope of the APS include the boards of Medicina Thoracalis (Switzerland, 1962-70), Medcom (1972-), Merck Manual (1972-), Annual Review of Physiology (1977-82), and International Journal of Cardiology (1981-); he also serves on the International Editorial Board of the Cambridge Encyclopedia of the Life Sciences (1984-).

Fishman began service to federal scientific agencies at the top, as consultant to the Executive Office of the President of the United States (1961-69). He has served with a number of study sections, task forces, and workshops of the National Heart, Lung and Blood Institute, in many instances as chairman. From 1977 to 1979 he was special advisor to the director of the Heart Institute. He has provided consultation to, among others, the chancellor of the University of Missouri in Kansas City, the Governor of Pennsylvania, the VA Hospital at Dartmouth Medical School, the National Center for Health Statistics, and the trustees of Lankenau Medical Research Center. For two years (1968-70) he was chairman of the Board of Cardiovascular-Pulmonary Training and Research Grants of the U.S. Veterans Administration.

The training that prepared Fishman for his career in science he has described as follows:
"My research training included a fellowship in pathology at Mt. Sinai Hospital in New York with Paul Klemperer, who at that time was busy discovering the collagen vascular diseases (1946-47). The following year (1948-49) I spent with Louis N. Katz (president of the APS, 1957-58) at the Michael Reese Hospital in Chicago and then became one of the first Established Investigators of the American Heart Association. A special board supervised my training for the next five years through successive experience in the laboratories of Andre Cournand and D. W. Richards at Bellevue Hospital, Homer W. Smith at New York University, E. M. Landis and J. R. Pappenheimer at Harvard, and then back to the Cournand-Richards laboratory. A few years thereafter the Nobel Prize in Physiology and Medicine was awarded to Cournand, Richards, and Forssman."

"In 1955 I established a cardiorespiratory laboratory in the Department of Medicine at the Columbia-Presbyterian Medical Center, where research was predominantly on humans, but where lungfish, dogs, goats, sheep, and pigs were also the subjects of study. In 1949 I began to spend each summer at the Mount Desert Island Biological Laboratory where I learned how to work with marine animals. After Homer Smith's death (1962), I assumed leadership of research in the "kidney shed." This lasted until 1966 when I left Columbia University to succeed Katz as director of the Cardiovascular Institute at the Michael Reese Hospital of the University of Chicago."

"One additional important element in my research training was the year (1964-65) spent with Geoffrey S. Dawes at the Nuffield Institute, Oxford, England. The year was given to studies of fetal circulation and the placenta. It rounded out the experience I had accumulated in regulation of the pulmonary circulation and introduced me to the other end of the spectrum where regulatory mechanisms are much brisker and technically much more difficult to examine."

As this account indicates, Fishman's main research interests have involved the integrated responses made by intact organisms, ranging from lungfish to humans. He has been particularly studying those regulatory mechanisms that promote the interplay among respiration, circulation, and blood. These obviously are examples both of homeostasis and of adaptation, and analyzing them relies heavily on the approach of comparative biology. An abbreviated summary of Fishman's comments on his favorite papers follows. "The first paper (1) introduced the artificial kidney to the United States. Kolff had developed a bizarre apparatus for dialysis of blood, which I undertook to test on humans about to die of renal failures. To everyone's surprise, the apparatus proved effective. The second paper (2) settled a controversy over the use of the Fick principle to determine cardiac output and redressed a serious mistake made earlier by the Cournand-Richards laboratory. My experience studying fish kidneys in Maine is typified by the next paper (3). The study of patients with pulmonary emphysema (4) began my interest in control of breathing, which continues now with use of much more sophisticated techniques (13). In 1956 we were successful in recording for the first time in an operating room the events of the cardiac cycle previously documented only in laboratory animals (5). Two years later we were using the Fick principle to study collateral circulation in human subjects (6). A systematic approach to control of the human pulmonary circulation began with a study of the effects of hypoxia and exercise (7) but eventually included hypercapnia, mechanical factors, and disturbances of acid-base balance. The paper with Dawes and his associates (8) was among the first to describe similarities and differences between the lung and placenta. My first important published experience with the lungfish is included (9); I believe ours is the only laboratory in this country that receives a regular supply of these fish from Africa. In 1969 we began to use tracers for studying movement of macromolecules across the alveolar-capillary barrier (11). Two papers, different from the others are included: the Physiological Reviews article with Heinemann proved to be prophetic of current attention to nonrespiratory functions of the lung (10), whereas the other, a source of great personal pleasure, marks the splitting into sections of the American Journal of Physiology (12). Fortunately it seems to have worked out well. The remaining three papers represent our current research programs (13-15)."

Fishman called the future of APS a "troublesome matter." He noted:

"Left to its own devices, I believe that physiology is destined to languish. . . .But the sectionalization of the Society and its journals, with a greater involvement in international physiology, and a recognition that the Society must provide for cellular physiology, integrative biology, and regulatory biology will improve its chances for prospering in the decade ahead. . . . It seems inevitable, too, that physiology will continue to serve as a mainspring of clinical research and medicine."

No one has given the affairs of the Society a more thoughtful concern, or a more dedicated service, than Al Fishman.

Selected Publications

1. Fishman, A. P., I. G. Kroop, H. E. Leiter, and A. Hyman. Experiences with the Kolff artificial kidney. Am. J. Med. 7: 15-34, 1949.

2. Fishman, A. P., J. McClement, A. Himmelstein, and A. Cournand. Effects of acute anoxia on the circulation and respiration in patients with chronic pulmonary disease studied during the "steady state." J. Clin. Invest. 31: 770-781, 1952.

3. Puck, T. T., K. Wasserman, and A. P. Fishman. Some effects of inorganic ions on active transport of phenol red by isolated kidney tubules of the flounder. J. Cell. Comp. Physiol. 40: 73-88, 1952.

4. Fishman, A. P., P. Samet, and A. Cournand. Ventilatory drive in cardiac pulmonary emphysema. Am. J. Med.. 19: 533-548, 1955.

5. Braunwald, E., A. P. Fishman, and A. Cournand. Time relationship of dynamic events in the cardiac chambers, pulmonary artery and aorta in man. Circ. Res. 4: 100-107, 1956.

6. Fishman, A. P., G. M. Turino, M. Brandfonbrener, and A. Himmelstein. The "effective" pulmonary collateral blood flow in man. J. Clin. Invest. 37: 1071-1086, 1958.

7. Fishman, A. P, H. W. Fritts, Jr., and A. Cournand. Effects of acute hypoxia and exercise on the pulmonary circulation. Circulation 22: 204-215, 1960.

8. Campbell, A. G. M., G. S. Dawes, A. P. Fishman, A. I. Hyman, and G. B. James. Placental gas exchange and oxygen consumption. J. Physiol. Lond. 180: 15P-16P, 1965.

9. Jesse, M. J., C. Shub, and A. P. Fishman. Lung and gill ventilation of the African lungfish. Respir. Physiol. 3: 267-287, 1967.

10. Heinemann, H. O., and A. P. Fishman. Nonrespiratory functions of mammalian lung. Physiol. Rev. 49: 1-47, 1969.

11. Pietra, G. G., J. P. Szidon, M. M. Leventahl, and A. P. Fishman. Hemoglobin as a tracer in hemodynamic pulmonary edema. Science Wash. DC 166: 1643-1646, 1969.

12. Fishman, A. P. Journals of the American Physiological Society. Am. J. Physiol. 232 (Cell Physiol. 1): C1-C2, 1977.

13. Pack, A. I., R. G. DeLaney, and A. P. Fishman. Augmentation of phrenic neural activity by increased rates of lung inflation. J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 50: 149-161, 1981.

14. Weber, K. T., J. S. Janicki, S. Shroff, and A. P. Fishman. Contractile mechanics and interaction of the left and right ventricles. Am. J. Cardiol. 47: 686-695, 1981.

15. Fishman, A. P. Endothelium: a distributed organ of diverse capabilities. Ann. NY Acad. Sci. 401: 1-8, 1982.