Lewis Atterbury Conner : Appreciation and Bibliography

Most of Conner’s career was devoted to the New York Hospital and Cornell University Medical College. The New York Hospital was granted a royal charter in 1771 and opened in 1791; in 1877, the hospital moved to a new site that extended from Fifteenth to Sixteenth Streets, west of Fifth Avenue. The Cornell University Medical College, founded in 1898, associated with the New York Hospital in 1927.

Conner had been appointed as an Instructor in Medicine in the original faculty at Cornell in 1898 and became Professor of Clinical Medicine 2 years later. At that time he was also an Attending Physician to the New York Hospital’s House of Relief on Hudson Street and an Assistant Pathologist to the New York Hospital (Figure 2). W. Gilman Thompson, also a graduate of Sheffield Scientific School at Yale, with an MD from Columbia University College of Physicians and Surgeons in 1881, had been Professor of Medicine at Cornell from 1898 until 1916. When Conner succeeded Thompson as Professor and Chairman of Medicine in 1916, the Department of Medicine also included the Russell Sage Institute of Pathology affiliated with the second medical service of Bellevue Hospital, the Cornell Division. As described by Harvey,² the faculty roster included a cross section of fine clinical investigators who contributed to the excellent research productivity of the department in the 1920s. With the opening of the “new” New York Hospital–Cornell Medical Center in 1932, Eugene F. DuBois replaced Conner as Chairman of the Department of Medicine.

Conner’s military experiences extended from service as a private in 1898 during the Spanish-American War to serving as a senior medical officer in the US Army Medical Corps during World War I. The US Army physical examination process during World War I required the US Army to update the 1910 version of its “Rules for Examination of Recruits” and to revise and clarify cardiovascular physical examination standards and terminology. This was the first experience in the United States with an organized and systematic examination of almost 4 million young men. The conventional physical diagnostic wisdom, based on 19th century clinical pathological correlates derived from patients with late-stage disease, was of limited value in these activities.

Conner was chief of the Army Medical Corps Division of Internal Medicine, with the rank of major in 1917. He was involved in the selection and training of cardiovascular specialists whose responsibilities involved the interpretation and clarification of cardiovascular signs and symptoms, reconciling cardiovascular physical findings with the military criteria for fitness for duty. Later in the war, Conner represented the Surgeon General’s office in the implementation of the first Cardiovascular Medical Center at US Army Hospital #9 at Lakewood, NJ. Discharged with the rank of colonel in 1919, he was appointed a brigadier general in the Reserve Corps in 1919.

Conner took “stock of what has been accomplished by all this elaborate effort” in the United States when he presented “Cardiac Diagnosis in the Light of Experiences With Army Physical Examinations” at the Association of American Physicians meeting in Atlantic City in June 1919.³ Clarification of the vague, preexisting cardiovascular physical examination standards and terminology was a major concern. His translation of the wartime lessons learned about cardiac diagnosis, the pathogenesis of cardiac disorders, functional disorders of the heart, and valvular heart disease, in particular mitral regurgitation,⁴ was directed to the problems physicians faced in civil life. Many of his observations and conclusions surfaced in his later publications and in his discussions of papers presented at the American Heart Association meetings.

Early in his career, Conner’s attention was directed to heart disease as a public health problem and to the rehabilitation of cardiac patients. His participation in the development of the heart associations was an expression of his commitment to the “heart movement.” This involvement extended to the establishment of the cardiac convalescent home, cardiac classes, the Trade School for Convalescents, and specialty outpatient clinic programs. Conner’s 1927 rehabilitation article quotes Frederic Brush on the appropriation of public and private funds for the care of cardiac patients, emphasizing the differential cost of care of the cardiac patient in the hospital ($30 per week) compared with the convalescent home ($12 per week) and the special cardiac clinic ($1 per week).

Fye used the term “public health cardiologists” to describe a select group of physicians who were concerned with the provision of both medical and social services to cardiac patients and who played a major role in the establishment and the direction of the US organizations devoted to cardiac disease.⁵ Prevention of heart disease, cardiac disability and rehabilitation, and the social and economic consequences of heart disease were topics added to the traditional concerns about diagnosis and treatment.

Conner was a central figure in these deliberations and activities, and Fye traces Conner’s role within the heart movement from the cardiac clinic to the convalescence of working men with cardiac disease and to the creation of the Association for the Prevention and Relief of Heart Disease in 1915. Conner served as the first president of this group, which brought together physicians and laypersons concerned “about the frequency and social consequences of cardiac disease.”

Introduction of the ECG and the World War I medical experiences accelerated the development of specialists who became “heart men,” and Conner’s wartime observations contributed to the growing epidemiological awareness about the causes and frequency of heart disease in specific age groups and in the population at large. A group of distinguished men and women were involved in the next formative steps, first of the New York Heart Association, and then of the American Heart Association (1924). These were important steps in the development of US cardiology in the early 20th century. Throughout the story, Lewis Conner was present at the beginning.

Conner was the first editor-in-chief of The American Heart Journal, the “official organ of the American Heart Association,” from 1925 until his resignation in 1936 (Figure 3). His editorial entitled “The American Heart Journal” appeared in the first issue of that publication in October 1925, expressing his views of the role of the new journal, with a focus on the “newly awakened” widespread interest in circulatory diseases and the preventative aspects and public health relations of heart diseases.⁷ He cited 2 distinct motivating forces for a new journal. One was the need for a periodical covering the diseases of the heart and the circulation. The other was the conviction that such a journal would be a potent factor in the furtherance of the aims and goals of the American Heart Association, “for the better education of the medical profession in matters relating to the diagnosis, treatment and prevention of heart diseases is the first essential step in the campaign against these diseases.”⁷ Clinical studies, special research, and public health aspects were important subjects to be covered in the American Heart Association publication.

Conner’s legacy extended beyond his academic, writing, and editorial activities. David Barr recalled Conner’s “… preeminence as a teacher can be attested by all graduates of Cornell who came … into contact with his remarkable example and method. His learning, his clinical judgment, and above all, his integrity, made him the idol of the students and particularly of those chosen young men who were permitted to work with him as interns or residents in the wards of the New York Hospital.”⁷

William Paul Thompson was one of these “chosen young men” who worked with Conner as an intern at the “old” New York Hospital before the opening of the New York Hospital–Cornell Medical Center on East 68th Street.

Thompson was born in Iowa in 1907, began medical school at the University of Iowa, and spent the last 2 years at Harvard, where he received his MD degree in 1931.⁹ He was in the last group of interns with Lewis Conner at the “old” New York Hospital, made the move to the medical center when it opened, served there as an assistant resident in medicine, and then worked with cardiologist Dr Harold J. Stewart as the first cardiology resident at the medical center.

Thompson went on to a research fellowship at Harvard from 1934 to 1935, where he was assigned to work with Dr Samuel A. Levine at the Peter Bent Brigham Hospital, and then spent 2 years with Dr Paul Dudley White at the Massachusetts General Hospital. Thompson moved to Los Angeles, Calif, in 1937 and had a distinguished career in the private practice of cardiology with faculty appointments at Loma Linda University from 1938 to 1966 and at the University of Southern California from 1966 to 1974. The American College of Physicians honored him in 1982 as the Dean of Cardiologists in the Los Angeles medical community and one of the outstanding clinical cardiologists in the United States. (Figure 4).

Dr Thompson responded to my request for his recollections of his time with Lewis Conner with the following vignette, dated 10 April, 1990.

The “old” New York Hospital was indeed old when I started my service as an intern on January 1, 1932. The hospital building, located at 8 West 16th Street in New York City, was in fact so old that one was inclined to be suspicious it was the same building in which it began its existence when it was “Founded in 1771 in the Reign of George III,” as its logo proclaimed. The New York Hospital was the second hospital founded in the Colonies, the Pennsylvania Hospital having preceded it.

The Medical Service was located in two large open wards, one for women, the other for men. As an intern, I did my own laboratory work, urine examinations, blood counts, and such, but had no real laboratory, simply a desk in the waiting room between the two wards.

The medical floor was reached by way of an ancient elevator, activated when the passenger within pulled on ropes. It traveled so slowly that the intern, always pressed for time, usually elected to reach his destination by way of the stairs.

The ambulance service, which was then a required part of the internship, consisted of a single electric-powered vehicle with hard rubber tires and an open back in which the intern, in uniform, sat while clutching an upright (Figure 5). Traffic was cleared by the clanging of a gong mounted on the outside of the ambulance and activated by the driver by pumping a lever back and forth. The speed achieved was probably 10 miles per hour, less going uphill.

The inexperience of the intern, freshly out of medical school, was balanced by that of the driver, an old hand who always knew what to tell the intern to do and what disposition to make of the case.

But the service was not as primitive as all this may appear. The rewarding part of the service, and rewarding it was, was the chief, Dr Lewis A. Conner. Rounds with him were a delight, especially when he came from church each Sunday morning dressed in his wing collar, long-tailed jacket, and striped pants.

Dr Conner was tall, straight, with a bald head and red fringes, exceedingly dignified, a scholarly gentleman with never an unkind word toward patients or staff. His physical examinations were meticulous, always ending when he asked the head nurse, who always accompanied him on rounds, for the sounding towel. This was placed by the nurse over the chest of the patient for the purpose of immediate auscultation (Figure 6). Dr Conner always heard more than his staff. In my more mature years, I have often suspected he may have been more influenced by tactile than auditory sensations, much as was the case of Helen Taussig, also quite deaf.

I had the privilege of being Dr Conner’s last intern. The “old” New York Hospital closed its doors on July 31, 1932. The house staff until the opening of the “new” New York Hospital on September 1, 1932, was forced to shift for itself without the vital pay of board, room, and laundry, not an easy task at the depth of the Great Depression.

The new hospital at 525 East 68th Street in New York City provided a profound change, housed in a glittering new building of 27 stories on the East River. Our first lunch was in the Doctors’ Dining Room on the 18th floor overlooking the river. We were seated by the hostess and asked to choose steak or soft-shell crab! Our unheard of bounty, for interns at least, did not last long as the Depression caught up with the Hospital, and we ended sharing the employees’ cafeteria in the basement.

The new hospital was a shiny new environment that made us all happy to feel we “had arrived” in a research atmosphere, but with the retirement of Dr Conner from active teaching on the move uptown, we all lost that superb clinical teaching that made service with Dr Conner such a joy.

This report was supported by the Overstreet Cardiovascular Teaching and Research Laboratory, Division of Cardiology, The Ohio State University College of Medicine. The author wishes to acknowledge Mary Sprague, Assistant Professor of The Ohio State University Health Science Library, for verification of the Conner bibliography and Bari Yardley, Medical Secretary, for manuscript preparation.