(Circulation. 2000;102:1062.)
© 2000 American Heart Association, Inc.
Special Report |
From the Division of Cardiology, Department of Medicine, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY.
Correspondence and Reprint requests to Jeffrey Fisher, MD, 311 East 72nd Street, New York, NY 10021.
| Abstract |
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Key Words: American Heart Association periodicals history of medicine
| Introduction |
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In 1937, the AHA honored Conner, who was a founder and first president of the New York Heart Association and AHA, with its first named annual lectureship. Shortly before his death, he was awarded the prestigious Gold Heart Award by the AHA in honor of his pioneering work in organizing and perpetuating the AHA. After Conners death, the February 1951 issue of Circulation was dedicated to his memory.2 Scholars have recently drawn attention to his myriad seminal contributions.3 4
In this article, I will present previously unpublished biographic material on Dr Conner and document that he fashioned his career in the "Oslerian tradition" (L.A. Conner, unpublished data, 1945).5
| The Portrait |
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This portrait was painted by Charles C. Curran in 1948 to honor the last surviving original faculty member of CUMC on its golden anniversary, and it is distinctly different from the other portraits that hang in the York Avenue corridor. The other portraits have light backgrounds; Conner sits in darkness on a throne-like chair. The other men wear business suits or white laboratory coats; Conner wears an academic gown with the green medical hood around his shoulders. The portrait is similar to the "The Four Doctors" of Hopkins (Welch, Halsted, Kelly, and Osler) painted by Sargent. Conners red Cornell tie is reminiscent of Oslers scarlet scarf, and his hands are positioned like Oslers, confirming the notion that Conner emulated the "Chief." More importantly, by the depth and breadth of his accomplishments and equanimity, Dr Lewis A. Conner richly merits the sobriquet "Cornells Osler."
| Biographic Sketch |
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Lewis attended the Chenault School in Louisville and, as a Yale undergraduate, joined Chi Phi Fraternity and traveled across the country as the lead baritone for the Glee Club (L.A. Conner, unpublished data, 1945). On graduation in 1887 (the dates on the plaque are incorrect), he entered Columbias College of Physicians and Surgeons. Conners circle included his cousins Lewis Atterbury Stimson (the prominent surgeon who was among the first to employ the Listerian technique in the United States), Julia Stimson (who married Dr Alfred Loomis, the renowned chest physician), and Olive Atterbury (who married the Dutch platoon scion Killaen van Renessalaer) (L.A. Conner, unpublished data, 1945).
Conner received his MD degree from Columbia in 1890 and interned at New York Hospital (NYH). This was followed by 2 years of postgraduate study in Vienna, Heidelberg, Munich, and Kiel (under Professor Quinke) and service in the Spanish-American War (L.A. Conner, unpublished data, 1945).
Conner married Emma Witt Harris, the granddaughter of US Senator Ira Harris, who was a friend of Lincolns. The Conners had 4 children: Katharine Atterbury (b. 1901), William Harris (b. 1905), Edith Harris (b. 1908), and Sylvia Colt (b. 1910). Sadly, Emma died in 1921, but soon thereafter Dr Conner met Dr Laila Ann Coston, a surgeon decades his junior, whom he married 2 years later. Their only child, Ann Atterbury Conner (now Ann Conner Powers), resides in New England and is the only living Conner child.
Dr Conners family life was far from blissful. Although daughter Katharine (schooled at the home of J.P. Morgan, who was a patient of Conners) fared well, son William disappointed his father by dropping out of Yale. Edith was developmentally delayed, institutionalized, and died in her forties. Sylvia (Tibby) struggled with emotional problems.
In good times, Dr and Mrs Conner enjoyed music and, for many years, Conner was the baritone soloist at St Bartholomews Church in Manhattan. In later life, progressive deafness curtailed his music. Fortunately, he was able to compensate clinically because of his training in Europe. He used his hands to detect murmurs and championed direct auscultation with a sounding towel, astounding students with his genius at the detection of murmurs which they, with their stethoscopes, had failed to appreciate.4 6 7
When he retired from Burke, Dr and Mrs Conner relocated to Greenwich Village to be near their children and the "old" New York Hospital where Dr Conners early medical years were spent. Conner died in 1950 after a cerebrovascular accident and is buried in Katonah, NY (Ann Conner Powers, personal communication, 1995).
| Conners Work |
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Conner succeeded Dr W. Gilman Thompson to the Chair of Medicine at Cornell and continued his Oslerian vision of medicine: compassionate and complete patient care, intensive bedside instruction, scholarship aimed at improving diagnosis and treatment, and innovation in teaching and organization for postgraduate education. Conners tenure occurred during turbulent times: sandwiched between a Great War and a Great Depression were Suffragette movement, Prohibition, and the Roaring Twenties.
In 1916, the CUMC faculty under Conner concluded that students were not exposed to a large segment of the patient population and that patients were suffering from noncomprehensive treatment. Accordingly, the Cornell Pay Clinic was created. The principles of ambulatory and preventive medicine, as well as the importance of psychological factors in medical disorders, were stressed. The Pay Clinic offered the patients personal care at a fraction of a private physicians office fee, with the dignity of appointments and supervision by senior staff physicians. Conner selected Dr Connie Guion, a CUMC graduate and enthusiastic Oslerian, to run the Pay Clinic, which 75 years later is thriving as Cornell Internal Medical Associates.
Dr Irving S. Wright, a past president of the AHA, was a student of Conners at CUMC and recalled an exercise Conner used when teaching physical diagnosis. Conner would have the students examine the patients without obtaining a history to sharpen their examination skills. At the end of one exercise, he pointed to a small mole behind the patients ear and reminded them that the detection of a neglected lesion like a melanoma might be more prognostically important than the presenting complaint.8
Conners medical interests were varied, and he contributed to medical literature for more than half a century. Like Osler, Conner had training in laboratory medicine and pathology, and his early studies involved clinicopathologic correlation. As expected in the preantibiotic age, much of Conners early work involved infectious disease.4
Conner was among the first to bring attention to the syndrome of occult thromboembolic disease. He speculated that sporadic fever in the course of a protracted illness like typhoid, with subsequent bed rest, might be secondary to thrombophlebitis and/or acute pulmonary embolism.4 His seminal investigation in this field led to a highly publicized consultation into the extensive deep femoral venous thrombosis of Mayor John F. Harlan of New York City9 and a presentation of his 30-year experience to a prominent New England postgraduate assembly.4
Another of Conners interests was functional cardiac disease. During the First World War as a brigadier general in the reserve medical corps, he supervised and catalogued the cardiovascular symptoms and signs of recruits, an undertaking recommended to President Wilson by Osler.10 Conner was struck by the prevalence and severity of "irritable heart" syndrome in recruits, writing "from the very first day of the army heart examinations, however this neurosis obtruded itself on the consciousness of the examiner in no uncertain manner. It was far away the commonest [sic] disorder encountered and transcended in interest and importance all other heart affectations combined."11
Conners paper, "The Psychic Factor in Cardiac Disorder," which was delivered at the New York Academy of Medicine in 1920 and published in JAMA4 was his most extensively read article. Six decades later, it remains a uniquely terse and germane analysis of panic disorder and functional cardiovascular symptoms and is as relevant today as when first written.
By 1916, deaths from cardiovascular disease eclipsed those from tuberculosis, and there were a large number of "cardiac cripples"patients with moderate to severe rheumatic valvular heart disease who continued to suffer "breakdowns" precipitated by their strenuous occupations as manual laborers. Armed with these facts, Dr Haven Emerson, the New York City Health Commissioner, called for action.12
Conner and Dr Nan Gilbert Seymour opened the combined Trade School and Convalescent Home for Cardiac Convalescents in Sharon, Connecticut. After medical stabilization and cardiac rehabilitation, patients underwent retraining in less physically arduous occupations. The Sharon Convalescent Home was subsequently merged into the Winifred Masterson Burke Rehabilitation Hospital in White Plains, New York. Burke was founded in 1915 at Conners urging by James Masterson Burke, Conners patient and friend. Today, the Burke Rehabilitation Hospital is a leader in physical rehabilitation and scientific investigation with 150 inpatient beds, a busy outpatient service, and an active research institute.
It has been thought that cardiac rehabilitation in the United States did not begin until the 1940s and cardiac psychology in the 1960s. However, in the broadest sense, Conner and Seymour began cardiac rehabilitation and cardiac psychology many decades earlier. With our present understanding of the importance of depression and social isolation in the prognosis of patients with heart disease, the goals and achievements of the Sharon School and the public health and rehabilitative movement that ensued are notable.
Concomitant with Conner and Seymours work, Dr Hubert C. Guile and Miss Mary E. Wadly established the first Cardiac Clinic at Bellevue Hospital in 1911 for the medical and social supervision of chronic rheumatics. The endeavors of Conner, Guile, and Wadly grew into an association concerned with the management and systematic care of patients with heart disease. The culmination of these efforts, at Conners initiation, was the establishment of The Society for the Prevention and Relief of Heart Disease in 1915. The Society later changed its name to the New York Heart Association. By 1924, a national association, the AHA, was established. Dr Conner served as the first President of both.
Given the controversy over specialization in American medicine at the time, Conner was an ideal first president. His educational background, academic position, clinical reputation, scholarship, social connections, and presidency of the Association of American Physicians rendered the fledgling Heart Associations unassailable under his leadership.
Conner founded Americas first medical subspecialty journal, The American Heart Journal, in 1925 and served as editor-in-chief for 12 years. He was assisted by his wife, Dr Laila Coston-Conner. The original editorial board included Henry A. Christian, Alfred E. Cohn, George Dock, James B. Herrick, Emanuel Libman, John H. Musser, G. Canby Robinson, Joseph Sailer, William S. Thayer, Paul D. White, Carl J. Wiggers, Frank N. Wilson, and others.
One exciting event in Conners career was when he spoke at a meeting at the New York Academy of Medicine in 1931. He shared the podium with his former CUMC student Soma Weiss and the acclaimed author of the small book Conner had carried throughout his career to teach ECGs, Sir Thomas Lewis, whose journal Heart served as the model for Conners American Heart Journal.
The creation of the AHA and American Heart Journal (and its successor, Circulation) undoubtedly has had a major effect on the care and outcome of patients with heart disease for the past 75 years. For his leadership, the AHA honored Conner in 1937 by creating its first annual lectureship in his name. The first AHA Conner lecture was given in 1938 by former CUMC colleague Carl J. Wiggers. Over the past 60 years, the AHA annual sessions have begun with memorable Conner Memorial lectures by such speakers as Nobel laureates Richards, Lown, Brown, and Goldstein, Conners student Irvine H. Page, Hamman, Edwards, Goldblatt, Katz, Stead, McKusick, Comroe, Blumgart and Freedberg, Lillihei, Rudolph, Fishman, Kirklin, Shepherd, Hoffman, Braunwald, Wessler, Feigenbaum, Wagner, Ross, Fisch, Frederickson, Gorlin, Fuster and, in 1997, David Satcher on the importance of public health in cardiovascular diseasea full cycle back to Dr Conners métier.
Conner retired as Chairman in 1932 at the age of 65, which coincided with the opening of the new uptown campus of NYH-CUMC. He continued to practice at NYH, serve as editor-in-chief of the American Heart Journal, and publish in peer-reviewed journals. He also became president of the Burke Foundation. In 1942, he retired from private practice and became the Burke Rehabilitation Hospitals medical director, as well as the Foundation president, filling in for a staff called to war. He retired from both positions in 1946 (personal communication, Ann Conner Powers).
| The Osler-Conner Connection |
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Both married socially prominent women and both experienced the tragedy of losing a grown child. They were admired for their equanimity and shared a good sense of humor; Osler relished practical jokes, whereas Conners humor was tongue-in-cheek.
They spent their careers training students and residents in the integration of science and art in medicine and were on the original faculties of a new breed of American medical schools established at 2 new universities founded by self-made Quaker businessmen who envisioned European-like universities with broad curricula and accessibility to the common man and woman. The first presidents of Hopkins and Cornell, Daniel Coit Gilman and Andrew Dickson White, were Yale classmates who traveled to Europe together and were impressed by the importance of scientific training and its application to medicine.
Although there is no existing direct correspondence (New York-Presbyterian Hospital-Weill-Cornell Medical Archives, Welch Library, and the McGill-Osler Collection), undoubtedly Osler and Conner had a meaningful relationship: they had mutual friends and colleagues and met professionally. Conner, like Welch and Halsted, graduated from Yale and Columbia and trained at New York Hospital. Conner quoted Osler in his work,14 15 wrote a chapter for one of Oslers texts,4 and Oslers name was heard frequently in the Conner household (Ann Conner Powers, personal communication, 1995). Specifically, Osler and Conner were firmly joined through Stimson, Camac, and Thayer.
Cousin Stimson tried to recruit Osler to a combined University Medical CollegeBellevue Medical College Chairman of Medicine position after the death of Dr Loomis.16 It is possible that had Osler accepted this position, the political crisis that ensued, which created the schism of the University Medical College from New York University, would not have occurred and the Cornell University Medical College would not have been opened in 1898. However, Osler demurred, CUMC was born, and Stimson and Osler remained colleagues. Oslers opinion was sought in developing the "new school"16 and, in 1904, Stimson along with Allbutt, Jacobi, Gilman, and Welch made an address at the opening of a new clinical amphitheater at Hopkins.16
In 1905, Osler organized the "Interurban Clinical Club," which included Camac, Conner, and Meara of CUMC, Janeway of Columbia, Barker and Thayer from Hopkins, and Riesman and Sailer of Philadelphia.
"There could be no doubt of Oslers sound appraisal of the young men active in Internal Medicine in 1905, when one considers the careers of those he chose as charter members of the club. All proved to be outstanding physicians and many made fundamental contributions to the creation of medicines scientific base and to the application of scientific developments to medical practice in this country."17
Meara and Conner were the mentors of Dr Connie Guion, the first female Professor of Clinical Medicine in the United States and the first living American woman physician to have a medical building named in her honor. The importance of Oslers textbook is demonstrated in Dr Guions biography Look to this Day!
"The book which Connie used everyday in her medical school career was Sir William Oslers The Practice of Medicine, a tome of 1500 pages describing every main disease. Let Osler be your bible, Dr Walter Niles told his students, There is no textbook in existence that could compare with his. It will give you a peg in which to hang the physical examination and history of every patient. Moreover, it is filled with philosophy and is excellent reading. Under Dr Niless strict supervision, Connie and her classmates went through Osler page-by-page studying each disease in detail. Although they had yet to see most of the diseases described, by the end of the year they had a working knowledge of each one."18
Dr Charles Camac served as Assistant Resident Physician at Hopkins with Osler and, from 1899 to 1905, he worked closely with Conner as Director of the Laboratory of Clinical Pathology at CUMC and Director of the Outpatient Department at NYH. The Cornell Medical Archives have letters to Camac from Welch, Barker, and Cushing, the latter of whom wrote, "Beloved Camac... Congratulations on your appointment to the new school."
On Camacs death in 1940, Conner wrote that "Osler had the most important influence in the life of the younger man" and "from his earliest association with Osler, Dr Camac acquired the enthusiastic interest in medical history and book collecting, which became one of his main preoccupations. In 1905, he compiled a volume of Counsels and Ideals from the Writings of William Osler... . "19
William Sydney Thayer graduated from Harvard Medical School in 1899, served as a house officer at Massachusetts General Hospital, and succeeded Lafleur as Chief Resident at Hopkins in 1891. He became Chairman of Medicine at Hopkins in 1919. He shared Conners interest in the pathophysiology of cardiopulmonary sounds, worked with Hirschfelder on the third heart sound, coined the term "opening snap" in mitral stenosis, and described the epigastric venous hum associated with cirrhosis of the liver.20 Thayer and Conner were close friends and colleagues and were involved in the inception of the AHA and American Heart Journal.
The pinnacle of Conners career occurred on April 21, 1932, when he was the guest of honor at a dinner at the Waldorf-Astoria to celebrate the union of NYH and CUMC and the opening of their new campus on the upper east side. Conner was credited with unifying 3 departments of medicine: NYH, Bellevues second division, and the Cornell Pay Clinic. The speakers at the celebration included Thayer, Riesman, and Cornell president Livingston Farrand. Dr Nellis B. Foster, a student of Oslers and a colleague of Conners, was the toastmaster. Regrets from those unable to attend included the following:
Thayer wrote to Dr Laila Coston-Conner after the party, saying the following:
"Conner is making a very deep impression on his colleagues, an impression which is really immortal, in a sense that it will be carried on long after we are gone and the ideals of those who follow. There are some men, like John Musser and the Chief and Theodore Janeway among them that I have known personally who gave me this sort of feeling, which is so different from the relative coldness with which one appreciates mere scientific accomplishments..."
The above letters are the property of Ann Conner Powers.
The outflow of admiration for Conner did not end at this retirement dinner. The following year he was awarded the University Medal at the Columbia University Commencement for contributions to medical education and in, 1937, the inaugural issue of the "Samaritan," the CUMC yearbook, was dedicated to him as a revered role modelthe physician the students most wanted to emulate.
In 1950, the AHA paid tribute to the "Three Wise Men of the East"Conner, Halsey and Emersonby awarding them their highest symbol of gratitude, the Gold Heart Award, for their role as founders.20 After his death, Conner was lauded as "one of the choice and master spirits of this age, a giant in the earth," whose "place in the history of medicine is assured."21
| Summary |
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| Acknowledgments |
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Received March 15, 2000; revision received April 7, 2000; accepted April 13, 2000.
| References |
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2. Barr DP. Lewis Atterbury Conner, 18671950. Circulation.. 1951;3:163.[Medline] [Order article via Infotrieve]
3. Fye WB. American Cardiology: The History of A Specialty and Its College. Baltimore, Md: The Johns Hopkins University Press; 1996:4158.
4.
Wooley CF, Schneider D, Lerner AA. Lewis Atterbury
Conner: appreciation and bibliography. Circulation. 1998;98:14491455.
5.
Bryan CS. What is the Oslerian tradition? Ann
Int Med. 1994;120:682687.
6. Smith JJ. Lewis Atterbury Conner. Cornell University Medical College Alumni Quarterly. 1974/75;38(2):1214.
7. Acierno LJ. The History of Cardiology. New York, NY: The Parthenon Publishing Group; 1994:478.
8. Fisher J. Dr Irving S. Wright: interview, May 24, 1995 [videotape]. New York, NY: Medical Archives, New York-Presbyterian Hospital, Weill Medical College of Cornell University.
9. New complications in Hylans illness. The New York Times. September 25, 1923;1:1, 3.
10. Wooley CF. From irritable heart to mitral valve prolapse: the Osler connection. Am J Cardiol. 1984;53:870974.[Medline] [Order article via Infotrieve]
11. Conner LA. Cardiac diagnosis in the light of experiences with army physical examinations. Am J Med Sci. 1919;158:773782.
12. Emerson H. The prevention of heart disease: a new practical problem. Boston Med Surg J. 1921;184:587607.
13. Howell JD. The changing face of twentieth century American cardiology. Ann Intern Med. 1986;105:772782.
14. Conner LA. Syphilis of the trachea and bronchi: an analysis of 128 recorded cases and report of a case of syphilis stenosis of the bronchi. Am J Med Sci. 1903;125:5795.
15. Conner LA. A contribution to the symptomatology of thrombophlebitis in typhoid. Arch Intern Med Sci. 1912;X:534559.
16. Cushing H. The Life of Sir William Osler. New York: Oxford University Press; 1940:452, 490, 656.
17. Harvey AM. Science at the Bedside. Baltimore, Md: The Johns Hopkins University Press; 1981:110111, 167170.
18. Campion NR, Stanton RW. Look to this Day! The Lively Education of a Great Woman Doctor: Connie Guion, M.D. Boston, Mass: Little, Brown and Company; 1963:254.
19. Conner LA. Charles Nicoll Banckker Camac, 18681940. Trans Assoc Ame Phys. 1941;56:13.
20. Marvin HM. Three Wise Men From the East [speech]. Courtesy, American Heart Association Library, Dallas, TX; 1950.
21. Marvin HM. Dr. Lewis A. Conner [speech]. Courtesy, American Heart Association Library, Dallas, TX; 1950.
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