EDWARD C. REIFENSTEIN, JR.

Even before Ed Reifenstein was born, it was ordered that he would have a long and productive career in medicine. His father practiced medicine until he was almost ninety years old and he retired then only at the gentle and diplomatic insistence of his three doctor sons. What was not ordered, but came about by good fortune, was that Ed’s medical career would be in investigative medicine.

Edward Conrad Reifenstein, Jr., was born in Syracuse, New York in 1908, graduated from the University of Syracuse in 1930 and from the University of Syracuse Medical School (magna cum laude) in 1934. After a rotating internship and a medical residency, he went into psychiatry and became interested in the use of drugs in psychiatric disorders, specifically in exploring the use of the then new amphetamines in the treatment of alcoholism. While doing some research in this area (the subject of some thirteen publications), he began to think of postdoctoral study and research as a career. He was, however, loath to disappoint his father, who fondly hoped that his son would join him in his large practice of internal medicine and psychiatry. Moreover, he had married Esther Tilden at the end of his fourth year of medical school and their son Edward Reifenstein 3rd was born in 1937 while Ed was still a resident in the Syracuse Psychopathic Hospital. Since interns were paid $100 per month in those days and married interns were unheard of, Ed decided on the practical course of action and practiced medicine with his father from 1937 until 1940. In the summer of 1939, however, he took two weeks off to come to Boston with his pregnant wife and his son Edward to take Fuller Albright’s course in clinical endocrinology. That was when the science of endocrinology was in its childhood. Born in Europe, it was growing up in Boston, and just beginning its adolescent growth spurt. It was Ed’s sure and shrewd sense of what would prove to be important which sent his application for postgraduate training in endocrinology to Fuller Albright’s office and lodged it in the “Prospective” folder. He had given clinical practice, and his father’s suggestions, a good trial and knew that he did not want to be a practitioner.

The “Prospective” folder was a fat folder. When a space in Albright’s small group became available, the folder was pulled from the file, the letters were ruffled through, and, guided by no-one-ever-knew-what, Albright would pull one out and instruct his secretary to “Tell him to come if he can get his own money.” If the applicant cared more for intellectual than material sustenance, and if, like Ed, he had a loyal and loving wife who was willing to scrimp and sacrifice, he would drop whatever other plans he might be considering and come. That is how Ed’s keen mind and his great capacity for hard and well-organized work came to be applied in a most fortunate milieu, where they soon resulted in excellent and sustained achievement.

Within the year the United States was at war. The energies of the Albright department were turned toward “metabolic aspects of convalescence including bone and wound healing” as were the energies of endocrine departments in Baltimore, New York, and Montreal. The Macy Foundation sponsored regular conferences at which the several groups met in New York and reported their progress. It fell to Ed, not only to do much of the work of carrying out the metabolic experiments and of administering the metabolic ward, but to edit the proceedings of the Macy Foundation meetings. The results of these labors are historic. The paper by Reifenstein, Albright, and Wells, entitled “The Accumulation, Interpretation and Presentation of Data pertaining to Metabolic Balances, notably those of Calcium, Phosphorus and Nitrogen,” describes the meticulous technique of a good metabolic balance study and shows how to analyze its results intelligently. The fourteen volumes of the Macy Foundation’s reports on “metabolic aspects of convalescence” present, in exceptionally lucid and readable form, most of what we know today about the adrenal response to “stress” and its metabolic consequences, and about the hormonal control of anabolism. The nitrogen and electrolyte losses caused by stress were measured, as were the opposed anabolic actions of testosterone. The separate contributions of stress and of immobilization to atrophy of bone were studied. Totally intravenous feeding (Ed would not have used the term “hyperalimentation”) was explored. Ward IV became a model for metabolic wards all over the country. A less tangible, but no less important, result of the Macy meetings was the tradition they established among all their participants, of freely sharing unpublished ideas and findings. Ed never wavered in this morality, and one of the joys of talking with him at meetings in the years which followed was the candor and generosity with which he shared his immense store of information.

During the war Ed had been declared by Selective Service to be “indispensible” to the Massachusetts General because of the importance to the armed services of the work in which he was engaged, and the obvious inability of Fuller Albright, with his severe physical handicap, to carry it out without him. By the time the war had ended and the Macy Meetings had been discontinued, Ed and Fuller had started on another project of great interest and importance. “The Parathyroids and Metabolic Bone Disease” by Albright and Reifenstein is one of the most remarkable and valuable medical texts written in our time. In an era when medical texts are seldom expected to survive three years without revision, this classic text was reprinted unaltered and widely read for twenty years. (One of the few things Ed had to regret was that because Albright died, and his collaborators were scattered and otherwise occupied, he was not able to revise and update that book). Work on the book was largely finished by 1946, and, the war being over, Albright was able to find able assistants. Ed was 38 years old and ready to cease being an assistant and seek an independent career. He did not leave that department, however, before being immortalized by a new syndrome. In the clinic Ed had observed a patient (Mr. K.) with an unusual kind of testicular defect. After patiently tracking down and examining a large number of Mr. K’s relatives, he described the rare genetic disorder, Reifenstein’s syndrome, which has proved to be of great theoretical interest.

By that time the importance of endocrinology to many branches of medicine had gained recognition, and the Sloan-Kettering Institute, perceiving its relevance to the understanding and treatment of cancer, wanted an endocrinology department and a metabolic ward. Ed became the chief of the endocrine unit and remained there until 1950. During that time he became a consultant to Ayerst McKenna and Harrison, and in 1949 became the director of their division of medical research. Always interested in pharmacology, and particularly in the development and applications of the steroid hormones, he found that the work suited him ideally. Except for three years when he served as director of the Medical Research Institute in Oklahoma City, he continued to do similar work for a time with the Schering Co., but chiefly at the Squibb Medical Research Institute, until his retirement in 1974.

It was during those twenty years that the adrenal and gonadal steroids became available in pure form for clinical use and began to assume their important place in medicine. Just before Ed had left the Massachusetts General Hospital, desoxycorticosterone, estradiol, and testosterone had become available in pellet form. Ed had learned the technique of inserting pellets and before leaving had purchased the equipment and taught his colleagues how to use it. The gonadal steroids, their anabolic actions, their use in the menopause and old age, and later on, their importance as contraceptives remained Ed’s chief interest, although far from his only interest, for the rest of his life. His knowledge of the field was quite extraordinary. He subscribed to twenty-six journals and read and abstracted every one.

Ed’s other interests were climbing mountains, which was reserved largely for summer vacations, preparing spectacular collections of color slides of his trips, and playing the piano, which he did at the end of the day to relax after work, or to enliven evenings with his friends. His home, secluded in the country, was a happy one and he liked to be in it as much as possible. His study, like his mind, was peaceful and orderly: he considered it the most important room in the house, and spent a good deal of time in it. The big desk is near a window which looks out on trees and a lake. The shelves of bound journals reach to the ceiling. A large adjoining closet is filled with filing cabinets and slide cabinets. In the strict physical sense, as well as mentally, Ed kept a vast store of information so ordered that he could instantly find any part of it.

His writing was as well ordered as his mind—scholarly, lucid, and accurate. The same qualities which made him a good organizer and director made him a good editor; they were solid reliability and unshakable integrity, combined with a very shrewd perception of what was sound, what was important, and what was practicable. It is not necessary to tell the readers of “Recent Progress” how much they and the members of the Laurentian meetings have profited from these abilities of Ed’s. (No one who...