Forrest Adams is a descendant of Presidents John Adams (1735–1826) and John Quincy Adams (1767–1848), both of whom had long lives for the era into which they were born, which may indicate the role of genetics in his longevity. Both his grandparents and great grandparents lived into their 80s and 90s. Even as a medical student, he became interested in hereditary disorders and wrote an article before graduation, which was published approximately 1 year later, as the first article in his extensive bibliography. Indeed, the hereditary disorder that he described now bears his name, being the description of what became known as the Adams-Oliver syndrome. (1) This has to be a rare distinction for one so young at the time. The disorder consists of aplasia cutis congenita, in association with terminal transverse defects of the limbs and (in the first case he saw) a skull defect. The limb defects are not dissimilar to those seen with amniotic band syndrome. It is fair to say that Forrest Adams was (and is) a polymath (“a person of great learning in several fields of study”). Not only did he continue to be interested in genetics, he then spent time investigating infectious diseases, before moving on to pediatric cardiology and later to pulmonary physiology. As I found out in a recent telephone conversation, Dr Adams, at the age of 94 (going on 95), remembers in considerable detail many of the circumstances that led to his important contributions.⇓
Forrest Adams was born (in 1919) and raised in Minneapolis, Minnesota, where he went to medical school and graduated in 1943. Soon after this, his eponymous article was published and shortly after that he published an article on the role of rubella in pregnancy, causing congenital malformations. (2) In addition to working with Dr Albert Sabin (of polio vaccine fame), he later published several articles on toxoplasmosis, before switching his attention from infectious disease to pediatric cardiology. He was probably the first person to pass a catheter into the heart of a newborn, which may have been somewhat inadvertent in the first case (a neonate with omphalocele). (3) Subsequently, he developed a cardiac catheterization program at the University of Minnesota (having joined the faculty in 1948 after 2 years military service in the Navy) and worked collaboratively with Dr C. Walton Lillehei (the father of open heart surgery). His work in these areas led to him receiving the MS degree in 1949. Not only was he productive academically, he also had 8 children!
In 1952, he was recruited to join the faculty of the newly formed medical school at the University of California at Los Angeles (UCLA), where he was appointed Associate Professor of Pediatrics. At UCLA, he created a Division of Pediatric Cardiology, which rapidly grew in size and attracted many foreign postdoctoral physicians to pursue further training. Faculty were involved with teaching, patient care, and research. Not long after he moved to UCLA, Professor John Lind from the Karolinska Institute in Stockholm, Sweden (see the profile by Oh, published in NeoReviews in 2008) paid a visit and described the studies that he and Petter Karlberg were doing to study the fetal and neonatal cardiovascular system. This stimulated Dr Adams to spend 3 months in 1956 and 6 months in 1957 with Drs Lind and Karlberg in Stockholm, doing research on fetal and neonatal cardiopulmonary function. He wrote five articles with Dr Lind and one with Dr Karlberg.
Even if he had done nothing else in his career, the work he did as a pediatric cardiologist clearly made a significant contribution to the health and well-being of countless neonates with congenital heart disease. He became one of the founding members of the Sub-Board of Pediatric Cardiology of the American Board of Pediatrics in 1961 and later was elected the Chair of the Sub-Board in 1967–1969. Incidentally, he was President of the Western Society for Pediatric Research for 1962–1963 and President of the American College of Cardiology for 1971–1972.
Lung Fluid and the Larynx
The research that Dr Adams did in Stockholm served as the basis for his research during the next 20 years, a time of remarkable advances in our understanding of the neonate. During this time, more than 75 postdoctoral physicians received training or pursued research with him at UCLA.
One of the people who had worked with fetal lambs was Geoffrey Dawes in Oxford, England, with whom Forrest had spent some time (see the profile by Phibbs, published in NeoReviews in 2007). It was in Dr Dawes laboratory that Dr Adams noticed accumulation of fluid in the fetal trachea. He attracted Dr Bernard Towers who was in Cambridge, England, at the time (and had published an article about amniotic fluid and the fetal lung in 1959 ) to move to UCLA, and they worked on the origin, composition, and control of lung fluid. This resulted in one of my most unforgettable moments, as a fellow in neonatology, at the American Pediatric Society, Society for Pediatric Research meeting in 1966, when Dr Towers presented cine-radiographs of fetal lambs, showing that the larynx acted as a sphincter to allow lung fluid to build up in the trachea before spilling into the amniotic fluid. Before this time, it had been “accepted wisdom” that amniotic fluid flowed into and out of the lung. Their work on the sphincteric mechanism of the larynx was published in 1967. (5) Dr Adams et al (6) showed that the pH of lung fluid was markedly different (6.4) than that of amniotic fluid (7.1) and blood of the fetus. Only under circumstances of asphyxia did amniotic fluid (usually meconium-stained amniotic fluid) gain access to the lung.
The ramifications of this became clear when, soon thereafter, Gluck, Kulovich, and colleagues (7) were able to demonstrate that one could evaluate amniotic fluid to determine whether the lungs of the fetus were mature. Even more recently, the principle that there is accumulation of lung fluid led to attempts to maintain fetal lung expansion in congenital diaphragmatic hernia by transiently occluding the fetal trachea (in utero). (8)
Surfactant and Respiratory Distress Syndrome
Although he is not always given credit for it, Dr Adams was one of the key figures in associating a lack of surfactant with the respiratory distress syndrome (RDS), which was commonly called hyaline membrane disease at the time (although hyaline membrane disease is really a pathological, rather than clinical, diagnosis). He described both the chemical composition and development of surfactant, as well as methods for its replacement.
One of the physicians who worked with him (and should be familiar to all neonatologists) is Dr Tetsuro Fujiwara. It is interesting to note that his original intent was to study temperature regulation in the neonate, but clearly their work on surfactant took priority. Dr Fujiwara worked with Dr Adams at UCLA for 6 or 7 years before returning to Japan. Between 1963 and 1971, they published 15 articles together. Among the studies they performed, perhaps the most pertinent to this discussion involved using twin lambs to demonstrate that tracheal instillation of “natural surfactant” could prevent respiratory distress, using the twin as a control. (9) After Dr Fujiwara returned to Japan, another Japanese doctor (Machiko Ikegami) became the last of Dr Adams fellows at UCLA. In 1980 they reported on the quantity of natural surfactant necessary to prevent RDS in premature lambs. (10) In that same year, Dr Fujiwara and colleagues in Akita, Japan, reported the successful use of a bovine-derived surfactant in treating human neonates with RDS, published in the Lancet. (11) Dr Fujiwara and Dr Adams then wrote a commentary (basically a review) for the journal Pediatrics entitled “Surfactant for hyaline membrane disease.” (12) The study from Akita triggered an explosion of studies during the 1980s and the eventual licensing of surfactants by the Food and Drug Administration (FDA) starting in 1990. It is obvious that this changed the face of neonatology.
As mentioned earlier, Dr Adams spent time in Stockholm, Sweden, as well as in Oxford and Cambridge in England, among his early travels. However, the number of countries that he visited markedly increased during the years 1960 to 1971, during which time he visited 18 countries giving lectures on cardiology and was a “Goodwill Ambassador” for the United States State Department Cultural Exchange Program. He was further recognized by President Lyndon Johnson, being one of six physicians asked to evaluate the health-care system in South Vietnam. He received honorary membership in the Peruvian and Venezuelan Societies of Cardiology and was named honorary professor in Manila, as well as receiving a presidential certificate of appreciation from the president of the Philippines (Ferdinand Marcos).
In 1976, Dr Adams stepped down from being Head of the Division of Cardiology at UCLA and “retired” in 1978 as Emeritus Professor of Pediatrics (Cardiology). By this time, he had had 75 trainees in pediatric cardiology. It is not completely clear to me why he decided to retire at this time, although he suggested that he was disillusioned by the medical students of the time, who seemed to want “everything handed to them on a plate.” He moved to the island of Kauai in Hawaii to a beachfront property, but after a tsunami hit the island in 1982 he moved back to southern California. From 1984 until 1991, he was a member of the Medical Advisory Committee of the Public Employees Retirement System of California (Cal Pers). He was also the principal investigator for two nationwide manpower studies. The first of these concerned pediatric cardiology and the second dealt with adult cardiology. He maintained his involvement with his textbook of pediatric cardiology “Heart Disease in Infants, Children, and Adolescents,” which he coauthored with Dr Arthur Moss and is now in its eighth edition. This seems to give him particular pleasure.
In his advancing years, he has been a participant in the Wellderly Study at the Scripps Research Institute in San Diego and had his stem cells harvested for investigation regarding longevity.
It is clear from my narrative that Forrest Adams has played a major part in the health and welfare of countless neonates and children. Although he still seems to feel that his greatest contributions were in pediatric cardiology, I think that we in neonatology definitely need to claim him as one of our own. Younger physicians should understand the enormous debt we owe to “those who have gone before.”⇓
Dr Philip has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- Copyright © 2014 by the American Academy of Pediatrics
- Adams FH,
- Oliver GP
- Adams FH
- Fujiwara T,
- Adams FH
- Forrest H. Adams, MD; Physician, Educator, Scientist. Available at: http://forresthadams.wordpress.com/2011/04/22/hello-world/. Accessed April 8, 2014
- Oh W
- Phibbs RH