André F. Cournand Biography (1895-1988)
André F. Cournand shared the 1956 Nobel Prize in physiology or medicine with German surgeon Werner Forssmann and American physiologist Dickinson Woodruff Richards, Jr. for pioneering work in the field of cardiac and pulmonary physiology. Cournand helped develop the technique of cardiac catheterization, which permits blood samples to be obtained from the heart for determining cardiac abnormalities.
Cournand was born in Paris on September 24, 1895. His father, Jules Cournand,and his grandfather were both dentists. At age 15, young André beganto accompany his parents to the salon of a physician friend where many internationally known scientists met and discussed issues of their day.
In 1913, Cournand received his bachelor's degree from the University of Paris-Sorbonne, where he also began his medical studies in 1914. But in that yearthe first World War broke out, and many medical professors enlisted in the army. In the spring of 1915, Cournand decided to postpone his studies. In Julyof that year he joined a surgical unit that provided emergency care on the front lines. By 1916 he was trained as an auxiliary battalion surgeon and was serving in the trenches. He didn't return to medical school until 1919. Afterserving as an intern, he received his M.D. in 1930.
Cournand had decided to specialize in upper respiratory diseases and, delaying his entry into private practice, pursued further training in the United States. He joined a residency program at the Tuberculosis Service of the Columbia University College of Physicians and Surgeons at Bellevue Hospital in New York City. He stayed at Columbia for the remainder of his career, rising fromhis initial position as investigator to a full professor in 1951. He became anaturalized citizen of the United States in 1941.
At Bellevue Cournand began what would become a long collaboration with Dickinson W. Richards. Together, they investigated the theories of a Harvard physiologist, Lawrence J. Henderson, who had postulated that the heart, lungs, andcirculatory system are a functional unit designed to transport respiratory gases from the atmosphere to the tissues in the body and back out again.
In order to study respiratory gases and their concentrations in the blood asit passed through the heart, samples ofblood from the heart had to be obtained. At this time, there was no established technique for this task. Catheters--flexible tubes intended to introduce and remove fluids from organs--had beenused for the past 100 years, but only in animal experiments. The safety of catheter use in humans was doubtful. But Cournand was aware that in 1929 a German scientist, Werner Forssmann, had dramatically demonstrated the safety ofcardiac catheterization by performing it on himself. He had inserted a catheter into one of his arm veins and then threaded it into his right atrium. Cournand became convinced of the safety of catheterization after speaking with one of his professors in Paris who had also performed a type of catheterizationon himself, and subsequently scores of others, without any problems.
The Bellevue team experimented on animals for four years, working to standardize the procedure and perfect the equipment they were convinced was necessaryfor their studies of the cardiac system. When at last cardiac catheterization was used to obtain a sample of mixed venous blood in humans, what could previously be only vaguely determined by clinical observation could be physiologically described. Cardiac catheterization not only allows for samples of mixed venous blood to be collected, but it also measures blood pressure in various parts of the cardiac circulatory system--the right atrium, the ventricles,and the arteries--and measures total blood flow and gas concentrations. In short, the functions of the heart and lungs can be fully specified through cardiac catheterization.
During World War II, Cournand led a team of physicians investigating the useof cardiac catheterization on patients suffering from severe circulatory shock resulting from traumatic injury. Obtaining physiological measurements of cardiac output in these patients helped identify the cause of shock--a fall incardiac output and return. As a result of these findings, it was determined that the best treatment for shock was a total blood transfusion rather than simply replacing plasma, which had previously been used and was found to causeanemia.
After the war, Cournand applied the technique of cardiac catheterization to patients with heart and pulmonary diseases. The team continually worked to improve the technique and was able to obtain simultaneous readings of blood pressure in the right ventricle and the pulmonary artery. This allowed for greater diagnostic accuracy of congenital defects as well as evaluations of treatment. Eventually these investigations led to increased understanding of acquired heart diseases and the relation between diseases of the lungs and cardiac function, thus opening up the field of pulmonary heart diseases.
Cournand began to be recognized for his research in the 1940s, when he was invited to speak at and lead various conferences. In 1949 he won the Lasker Award, and in 1952 he was invited by the National Institutes of Health to screengrant applications for the Lung, Heart and Kidney Study Section. Cournand'sincreasing recognition culminated in the fall of 1956 when he was awarded theNobel Prize. In 1958 he was elected to the National Academy of Science.
Cournand retired in 1964 and devoted the years until his death to the study of the social and ethical implications of modern science. He died on February19, 1988, in Great Barrington, Massachusetts.