Short abstract
Pioneer of the artificial kidney, renal transplantation, and the treatment of Addison's disease
George Thorn was one of the few medical pioneers to make it into the history books during his own lifetime. He introduced renal dialysis, was the physician to the first kidney transplanters, and brought the Howard Hughes Medical Institute into being. He is, however, most famous for introducing the first effective treatment for Addison's disease.
The English doctor Thomas Addison first recognised the disease that bears his name in 1849, but the condition remained incurable for decades. By the 1920s, patients' lives were prolonged by injecting them with a crude extract of adrenal glands bought from abattoirs. It was impossible to remove the adrenaline (epinephrine) from it, and this made it impossible to give an effective dose.
In 1930 at the Peter Bent Brigham Hospital (now Brigham and Women's Hospital) in Boston, Massachusetts, Thorn devised a method of making an extract of the adrenal cortex (which he called “cortin”) that was free from adrenaline and enabled rats with Addison's disease to live a normal and healthy lifespan. He was 24 at the time. The experiment was so successful that he took the same two rats 1800 miles from Buffalo to New Orleans via New York by train in 1932 (the full lifespan of a rat is about two years), to a meeting of the American Medical Association, injecting them subcutaneously en route. Two years later he published the paper that showed that the treatment worked in patients, though it caused hypoglycaemia and electrolyte imbalance. He improved the treatment further in 1937 when the first synthetic cortisone was made, implanting pellets of it under the skin. Patients no longer needed extra sodium and restricted potassium. In 1949, when better synthetic cortisone became available, he used it to further improve treatment of Addison's.
Figure 1.
Credit: BRIGHAM AND WOMEN'S HOSPITAL
His other major innovations include introducing the artificial kidney to America. This had been pioneered by Willem Kolff in the Netherlands, and Thorn invited him to demonstrate an early model. Kolff felt that, of all American physicians, Thorn was the person best able to make good use of his new device. He perfected it at Brigham, and this kept kidney patients alive. This, in turn, led to the world's first successful kidney transplant, by Thorn's surgical colleague Dr Joe Murray, in 1954. This was five years before immunosuppressive drugs were invented, and the transplant was between identical twins.
Thorn always worked closely with surgeons, and in a pilot operation the previous year he, Murray, and colleagues had tested to see if one person's kidney could filter another person's blood. They did this by placing a fresh cadaver kidney on the thigh of a patient—a South American doctor—with end-stage renal failure, connecting the artery and vein to those of the patient's leg, and covering the whole thing with cellophane. On the 19th day the kidney began a massive output of urine and the patient survived another six months in this surreal state.
Thorn and Murray did their second transplant in 1954 between fraternal twins. This, too, was successful. In 1959, a few months before immuno-suppressive drugs were launched, Thorn told the New York Times, “It will be easier to put a man into space than to do what we did here.”
George Widmer Thorn was born in Buffalo, New York State, in 1906, and graduated in medicine at Buffalo University in 1929, paying for much of his tuition by playing gigs with his banjo. He took an MA in 1942 and was immediately appointed physician-in chief at the Peter Bent Brigham Hospital, a post he held for 30 years.
One of Thorn's patients was the millionaire businessman Howard Hughes, whom Thorn persuaded to set up a trust devoted to medical research. In 1953 the Howard Hughes Medical Institute was founded. Thorn became its research director a few years later and was associated with the institute for nearly 40 years, retiring when he was 84. He said it was difficult dealing with the reclusive Hughes: “The problem very frequently was we could not get a decision from Mr Hughes on what to do. So I would make a recommendation, and if I received no answer in two weeks I would proceed... knowing that my head would get cut off,” he told the Washington Post in 1986.
Thorn was a founding editor of the textbook that is now Harrison's Principles of Internal Medicine. He published 400 papers, many of major importance, on subjects as diverse as acromegaly, Cushing's syndrome, gigantism, the effects of prolonged fasting, diabetes, and the hormone aldosterone.
He played competitive tennis until he was well into old age and only ever became angry on the tennis court.
Predeceased by his first wife, Doris, and his second wife, Claire, he leaves a son and two stepchildren.
George Widmer Thorn, former physician in chief Peter Bent Brigham Hospital, Boston, Massachusetts (b Buffalo, New York State, 1906; q Buffalo University 1929), d 26 June 2004.