Editorial

Two founders of ISSHP and distinguished past-Presidents as well, Dr Frederick P Zuspan and Dr Marshall D Lindheimer, remain active members as well as ‘the conscience’ of our Society, so it is appropriate that we should celebrate their award of important honors in 2006. For Dr Zuspan, the Chesley Award from ISSHP and for Dr Lindheimer, Lifetime of Service Awards from both the National Kidney Foundation of Illinois (NKF) and the US Preeclampsia Foundation. This Editorial is based on texts used by Professor John Davison, immediate past-President of ISSHP on the occasion of Dr Zuspan's Chesley Award and Dr Lindheimer's NKF Award. The Editors asked John to retrospectively reference the texts with some of their hallmark publications, from the many hundreds, so as to highlight their remarkable influence and contributions far and wide, specific and general, to basic science and the good practice of medicine, over several decades. Long may Dr's Zuspan and Lindheimer continue to contribute to our Society, which is inordinately proud of them.

Frederick P. Zuspan

The Chesley Award is very special to our Society. It was introduced over 20 years ago, by one of our Presidents, Frederick Zuspan, in honor of Leon Chesley, a pioneer in making serious research inroads into the hypertensive disorders of pregnancy in the 1930's. Leon was the first recipient. Leon attended our Congresses well after his retirement, his last one being in Buenos Aires in 1992, when he was 85, and still productive in the area of the genetics of preeclampsia. Even after that, his interest in our Society never diminished and he was always available to provide advice on any matter – scientific, administrative, political, and he loved to be kept up to date with the gossip as well as the science.

This year, in Lisbon, on the 30^th Anniversary of our Society, I have the privilege to nominate and present the Chesley Award for outstanding research achievements into hypertension in pregnancy to Frederick P. Zuspan. In honoring Fred Zuspan, as we all know him, we pay tribute to his pure integrity, his total commitment and loyalty in all things, his generous nature and his many remarkable achievements. He brings to bear a formidable intellect on all matters, yet is never self-seeking or self-centered, always striving to encourage friends and colleagues, especially the young – “the seedcorn of tomorrow”, as he would say. His belief that undergraduate and postgraduate education are important for all of us, no matter how busy and how senior we are, is always argued cogently and passionately ([1–3]). Young doctors in training under his wing were always encouraged to attend the Meetings and Congresses, with Fred making sure the finances were available. And as you all know, Fred's Foundation (Perinatal Resources Incorporated) now funds our four Zuspan Prizes for the best Young Investigators presenting clinical topics at our Congresses.

Fred was born and raised in Richwood, Ohio on 20 January 1922. He left College prematurely, where he was studying architecture, to enroll for wartime service, first as a bomber pilot and then as a fighter pilot in the Pacific theatre. After the war, the distinguished and decorated First Lieutenant Zuspan resumed his College education and then entered the Ohio State University (OSU) College of Medicine, graduating MD cum Laude in 1951. After local internships and residencies, he consolidated his Obstetric and gynecological clinical experience as Chief of Clinical Sciences at the McDowell Memorial Hospital in Kentucky, then moved to a Fellowship at Case Western Reserve, Cleveland, Ohio before becoming an Assistant Professor there. In 1960 there followed the Chairmanship of the Obstetrics and Gynecology Department at the Medical College of Georgia in Augusta. In 1966 he was invited to be Joseph Bollivar DeLee Professor and Chairman at the prestigious Chicago Lying-In Hospital, a position he held with great distinction until 1975, when he returned to his alma mater to become Chairman at the OSU College of Medicine, attaining Emeritus status in 1991. On 30^th October 1987 the State Governor of Ohio, Richard F Celeste, declared “Dr Frederick P Zuspan Day.”

Fred has already been recognized and honored on all fronts, at home and abroad with Fellowships, Humanitarian Awards and Distinguished Scientist citations. Over the decades, as well as researching in hypertension in pregnancy, being a Chairperson, an Editor, a Board Examiner and an Adviser to a host of organizations, there has also been an amazing input into areas which nowadays we accept as routine or even “old hat.”

As if to set a “marker” for his career and the fostering of this Society, Fred's very first publication in 1953 was on “maternal toxaemia” ([4]). There was to follow a stream of high quality papers embracing new research tools applied to the proper investigation of the pathophysiology and clinical management problems of the hypertensive disorders of pregnancy. Fred's efforts focused on vasoactive peptides, salt loading, the autonomic nervous system, prostaglandins, lipid and glucose metabolism and validation of clinical strategies, including the use of magnesium sulfate ([5–8]).

One publication ([9]) of which Fred was particularly proud stemmed from some of the first angiotensin II vascular reactivity studies in the early 1960's with his “dear friend and guru”, Leon Chesley, or Ches, as Fred always called him. Throughout his entire career Fred was a stickler for detail in the laboratory ([10]) and derided sloppiness or short cuts in clinical physiological studies, messages he hammered home to me and others on several occasions.

Throughout the 1960's and into the 1970's with new approaches identified or suggested for better obstetric care, Fred was right in there at the outset: electronic fetal heart monitoring, amniocentesis, decision-making on the place of birth, managing drug addicts, self-monitoring of blood pressure, fine needle aspiration cytology, the use of Hb_A1C for monitoring diabetic pregnancies, urodynamic assessment, the concept of the fetus as a patient and much more, as his amazing Curriculum Vitae testifies ([11–17]). Interestingly, a 1964 review article ([18]) on the treatment of eclampsia, published by Fred and his colleague Dr MC Ward in what would nowadays be called a “low impact Journal” has become enshrined in the world literature, often quoted by Ches, and still a joy to read. Another classic and a favorite of Ches was an article by Fred and British colleagues who undertook a comparison of UK and American management of hypertension in pregnancy in the late 1970's ([19]). In the early 1980's Fred and his colleagues, again with his eye for careful laboratory work, did us all immeasurable service by swiftly debunking the “worm theory” for preeclampsia ([20]).

Over the last 12 years at our Congresses the placenta has quite rightly received much more attention, focusing on spiral artery invasion and the “spin-offs”, endothelial or otherwise, of shallow implantation, a concept first mooted in the 1960's and always holding a fascination for Fred. He and his colleagues actually pursued research in this area in the 1980's ([21]) at a time when today's fully justified experts were having their own difficulty convincing doubters as to the importance of the sequelae of poor placentation. That concept and its many research avenues are now here to stay!

So Fred has influenced what we do today by being at the “cutting edge” all the way along the line. He has a unique international reputation for undertaking and encouraging basic science which has a bearing on clinical problems. Over the years he helped to open up new avenues in research, greatly facilitated by his neatness of thought, clinical know-how, a phenomenal memory and that lovely sense of humor.

All in all, therefore, Fred is a legendary clinician, a leader, a scholar, a giant of a man, a decent human being and much more, who has outstanding research achievements into hypertension in pregnancy as well as service to our Society. His last Congress with us was in 2002 in Toronto. I personally have pined over the years because of the Chesley Award apparently by-passing him. I think that this was rooted in the fact that he, as our 4^th President, instigated and initially personally financed the Award. The Chesley Award, however, is now integral to the fabric and philosophy of our Society.

Fred has always been brave and courageous, going all the way back to his wartime Service, when a very young man, as a pilot and division leader in a fighter squadron. His bravery continues, with him battling with illnesses in recent years. His courage and his approach to life are examples to us all. The time allocated cannot do justice to Fred's life and times and certainly I could never eclipse a wonderful piece of writing by Fred's daughter, Dr Kathryn J. Zuspan, an obstetric anesthesiologist, on the occasion of her father's 80^th birthday ([22]). I urge you all to read it.

Fred cannot be here today. I have truly loved sharing this secret with him now for many weeks. He wishes us well for our 30^th Anniversary here in the beautiful city of Lisbon with our delightful Portuguese hosts. We all send Fred our love and very best regards, and wish him, his wife and his family well.

Please could I ask that Marshall Lindheimer accept the Chesley Award for 2006 on behalf of Fred Zuspan? I know Fred would really appreciate this.

Thank you for your attention.

Marshall D. Lindheimer

It is my pleasure, privilege and, indeed, honor to pay tribute to Marshall Lindheimer. It is, however, a daunting task to pay tribute to a great man, a great human being and a great friend to many of us.

It is over 30 years since I first met Marshall in Montreux, Switzerland at a Congress on Compensatory Renal Hypertrophy. We were in fact introduced by John Hayslett, after he had befriended me, a lowly and lonely Research Fellow, and an only Obstetrician too, amongst a host of distinguished Nephrologists and Renal Physiologists. I was lucky enough to be Marshall's Research Fellow in Chicago in 1977/78 and since then not only have we continued with research collaboration in human pregnancy but I, like many others here tonight, have truly valued Marshall's friendship, encouragement and support.

To honor Marshall is the telling of a legend: a legend of a skilful and compassionate Physician, of a brilliant Scientist, of devotion to his patients and the hospital which he served, of his dedication to the education of all around him and above all else, a legend of total commitment and pure integrity.

This tribute has to be sprinkled with some fun in line with Marshall's wit, charm and wonderful sense of humor. I hope to communicate all that we feel about him. Marshall communicates so well with us – in fact, the telephone, the fax and the e-mail were specially invented for him – as we all know from time to time. A few weeks ago Marshall sent me a fax then e‐mailed me to tell me, then called to ask if both had arrived…. all within the space of five minutes!

Marshall was born in Brooklyn, New York on 28 June 1932. He graduated from Cornell University in 1952 with a degree in zoology. He also had wide-ranging interests in the arts, politics, the theatre and history. After 2 years military service he was allowed to undertake further education at an overseas University. In 1960 he graduated in medicine from the University of Geneva and was given the Dean's Award, being in the top 5%. He also met and married Jacqueline, an event that greatly influences the legend. He also learnt to speak French fluently, with an American accent!

His post-registration clinical training in New York was completed in 1965 and was followed by a Research Training Fellowship in Boston. After this he obtained his first senior posts in internal medicine (subspecializing in nephrology) and he declared and developed a specific interest in obstetric medicine, whilst he worked at the Cleveland Metropolitan General Hospital, Case Western Reserve Hospital and Northwestern University (Chicago) Hospital.

In 1970 he was appointed to the staff of the University of Chicago Teaching Hospitals, surviving its competitive promotion/tenure system, to rise through the ranks to full Professor by 1976. This appointment was deliberately designed to span the Department of Medicine (Nephrology Section) and the Department of Obstetrics & Gynecology at the Chicago Lying-In Hospital. For the next 25 years he was Director of the Medical High Risk Clinic of the Chicago Lying-in Hospital and an “Attending Physician” for the maternal-fetal medicine program. That inspirational recruitment was by Fred Zuspan, and Fred, and his successor as Chairman, Arthur Herbst, somehow “oiled the wheels” at the world-renowned Lying-In, such that Marshall could thrive and achieve so much, and help and encourage many others to do so too.

Throughout the world Marshall has pioneered the concept and promoted the cause of close working relationships between Clinicians and Scientists in Obstetrics and in Maternal Medicine. At the outset of his career he had the insight to realize the need for co-operation between specialties when caring for pregnant women. The significance of that risky career development at that time was that he crossed the boundaries between traditional clinical subject areas but thereafter, it was to influence his research work and his clinical practice forever – and throughout the world.

He has made contributions of fundamental importance. His research programs were funded by prestigious US organizations. His reputation for training and encouraging junior staff in early career is widely acknowledged. He promoted US/European/WHO collaborative research with great success, despite his demanding clinical and academic commitments in Chicago. He can still recall how proud he was of his very first publication in 1961 ([23]) on “ischemic pain in the legs”! And, he was equally proud of his “first JCI” in 1969 ([24]), especially so, as it was reporting a very nice investigation in pregnant women of the effect of volume expansion (and posture) on the excretion of sodium, water and urea.

Marshall has this truly unique international reputation because of his ability to do basic scientific work which has a bearing on clinical problems. It is his personal crusade to nurture this bedside-to-bench link that has proved so successful and productive. Over the years he has opened up new avenues in research involving up-to-date laboratory technology which he so ably oversees, co-ordinates and actually understands. Even research at the cellular levels holds no fear for him ([25], [26]). Marshall does in fact have a neatness of thought, an ability to simplify complex topics and formulate hypothesis-driven research, all of which is of course facilitated by his phenomenal memory.

Marshall's human pregnancy research, has described the unique gestational physiological adaptations and how these might impact on or be disturbed further in the presence of disease and/or chronic dysfunction. Investigations have focused on renal hemodynamics, mineralocorticoids, osmoregulation, volume and sodium homeostasis, blood pressure control and acid base balance ([27–33]). In parallel, Marshall's lab, keen to elucidate mechanisms underlying the changes, has undertaken carefully designed and controlled animal model and cellular studies ([34–39]). Literally, tens and tens of papers in high impact Journals have ensued, most with clinical implications. Of interest, the differences between animal and human findings for vasopressin metabolism started the quest towards identifying and solving a rare complication of pregnancy now termed “vasopressin-resistant transient diabetes insipidus of pregnancy” ([40]). To sidetrack a bit, Marshall passionately believes and argues that basic science research much continue to be performed in academic clinical departments where scientists and clinicians should live and work in harmony, whilst accepting that the harmony issue may be difficult to achieve for a variety of reasons! Indeed, Marshall's much publicized Inaugural Lecture as the Foundation Franqui International Visiting Professor at the Universities of Leuven and Liege in 1999 is a classic and he brilliantly argued how we must try to solve the “endangered species status” of the clinical investigator. Marshall's Curriculum Vitae also abounds with beautifully written case reports (almost always with junior faculty), superb editorials, precise and clinically relevant histopathology accounts, book chapters, working group reports and much more, all models of clarity for any aspiring clinician ([41–47]).

He was a lifetime devotee, as we all were, to the great Leon Chesley, the father of hypertension studies in human pregnancy. Marshall, I think, has been an able and natural successor to Leon. Knowing Marshall's strong views on honesty, transparency, taking opportunities and how to behave in academia, it was little wonder that he admired two special qualities in Leon, as essential ingredients for survival and retaining one's sanity – a sense of humor and keeping a sense of fun in our working lives – qualities that Marshall imbues us with too.

It was reassuring for Marshall and his colleagues Jim Roberts and Gary Cunningham that Leon wholeheartedly gave his blessing to them editing new editions ([48]) of his unique one author book “Hypertensive Disorders in Pregnancy”, first published in 1978. Marshall himself co-authored a first and only edition of a unique book “Kidney Function and Disease in Pregnancy” in 1978 with his dear friend Adrian Katz (also being honored this evening) which remains a model on how to tackle a subject area in pregnancy when cognizance of physiological adaptation impacts on understanding dysfunction in its many settings as well as implications for clinical management ([49]). Another scholarly book edited with Bill Barron “Medical Disorders during Pregnancy”, first published in 1991 has run to three editions and easily competes with other obstetric medicine textbooks on the market and has been translated into several languages ([50]).

I am one to have had the privilege of Marshall's collaboration and support. Like many others I have learned from a Master Clinician-Scientist. We became colleagues and dear friends, as did our families. As already mentioned, he just so understands the trials and tribulations of survival in academia and his longstanding advice is still as good as it was when it was first given to me many years ago “when times get tough close your door and write”. He also tells us that “nothing is impossible” but adds, with that twinkle in his eye, that he has “never tried to cancel a subscription to Readers' Digest!”

Over the years Marshall has encouraged, in his unique way, many, many now very successful people. Even today, his encouragement of the young, our future, never wavers. They enjoy his company too – and he, theirs. Many of us have learnt a lot and had great fun organizing and editing Symposia and Meetings with him, when he so generously gives us his time and knowledge ([51–53]).

Marshall Lindheimer is a man of outstanding gifts, both as a Scientist and as a Clinician. He is a leader, a profound and creative thinker and yet the formidable intellect which he brings to bear on all matters is carried lightly and with a great spirit. He always accords respect and attention to the views of others, irrespective of their ultimate value. His realism too is a remarkable quality.

What gives all that he does a definitive stamp is his deep understanding of human decency and his generous nature. Whilst fascinated as a scientist by problems in nephrology, by preeclampsia and by all medical disorders in pregnancy, his clinical practice is concerned with a great deal more than science alone. Beyond the science, there is empathy and the appreciation of the uniqueness of his patients and their families. High standard clinical practice is so important to him. Marshall was particularly proud to be honored by the Royal College of Obstetricians and Gynaecologists in London in 1993 with the award of a Fellowship ad eundem (to the same).

Marshall is an enthusiastic member (and of the ‘conscience’) of many Societies. Uniquely, on the international stage he played a crucial role in the development and growth of the initially vulnerable International Society for the Study of Hypertension in Pregnancy (ISSHP), which he served as Secretary/Treasurer and President and in many other capacities, such that it is now a fully fledged and accepted international Society.

It is wonderful to see so many people here tonight. Marshall likes nothing better than gatherings! Many of you, like me, at Congresses or Meetings, in corridors or at poster sessions, will have been regaled with stories by Marshall in his own special style of telling them and his restless stance, the “Lindheimer pirouette!” His mixed metaphors, “Marshallisms”, have become enshrined in the vocabulary and minds of us all!

In fact, Marshall is always committed and loyal to us all. This, together with his constant search for new challenges, ensures that we will see him for many years to come. In honoring him, the National Kidney Foundation of Illinois allows us all to rejoice in his life of unalloyed fulfillment, his brilliance, his mischievous sense of humor, his service to his patients and that wonderful characteristic of his complete disregard for his own self importance.

The bedrock on which he has built the successful, respected and happy life is the family of which he is justifiably proud. His wife, Jacqueline (Saint Jacqueline to the “cognoscenti!”) and 5 successful achieving children and his grandchildren all give him pride and sustenance – and perhaps a lesser bank balance, but all of them, like us, are so proud of him too.

I doubt I have done justice to this very remarkable man. This accolade is truly deserved.

Thank you for your attention.

Notes

*The rights in a contribution prepared by an employee of the U.K. government department, agency, or other Crown body belong to the Crown and are not subject to United States copyright law.