Goldman, Alfred, Vertical File

Alfred Goldman, born in St. Louis on October 6, 1895, attended public schools in the city and won a scholarship to Washington University where he received three degrees: an A.B. in 1916, an M.S. in physiology in 1922, and an M.D. in 1920. An excellent scholar, he was elected to Phi Beta Kappa and Alpha Omega Alpha. Medicine fascinated him as an intellectual pursuit and as a means to help others. He also was a sports enthusiast and enjoyed vigorous athletic activity, playing varsity basketball in college and remaining physically active throughout his life. Bowling, golf and fishing were his favorite diversions.

His medical career was spent entirely in St. Louis as a physician in private practice and at the Washington University School of Medicine as Professor of Clinical Medicine, and Director of Medical Chest Service. Goldman is remembered as an extraordinarily skillful physician and colleague. Students appreciated his effectiveness in imparting clinical skills during their rotations with him. He retained close attachments to many associates from the early years of his career until the end of his life.

The spirit of critical inquiry characterizing his professional career came in part from a rigorous training in physiology. His research always reflected a depth of interest in the patient and his drive for scholarship of the highest quality. His earliest scientific discovery dispelled myths about the effect of chilling on the development of upper respiratory disease. As a medical student, Goldman participated in experiments on chilling with his classmates, Stuart Mudd and Samuel Grant. Their findings proved that exposure to cold produced vaso-constriction in the mucous membranes of the nose and throat, a significant fact in treating diseases of the respiratory tract and one quoted widely in the literature.

The work on chilling had a larger impact because it led to the earliest definitive studies of acid-base changes during hyperventilation. During chilling, the investigators exposed themselves unclothed to temperatures of 4 degrees celsius, and in this situation, hyperventilation occurred regularly. Goldman observed that the reaction of his urine always was alkaline following chilling. Although some effects of hyperventilation were known previously, the physiology of tetany due to hyperventilation was completely unknown. Tetany, the hyperexitability of nerves and muscles, is now known to be due to a decrease in concentration of extracellular ionized calcium. Goldman and Grant used a metronome to pace breathing frequency to induce marked alkalosis, and on several occasions, Goldman hyperventilated to the point of generalized tetany. The two worked out physiological alterations accompanying the marked loss of carbon dioxide and realized that a decrease in ionized calcium likely produced the tetany although technical difficulties precluded measurement of ionized calcium.

With his deep understanding of hyperventilation, it is not surprising that Goldman was the first to recognize hysterical hyperventilation and tetany in patients. His clinical description was published in the Journal of the American Medical Association in 1922. Goldman applied the appropriate therapy to some of the earliest patients recognized. This therapy, simple rebreathing into a closed container such as a paper bag, continues to be the preferred therapy for hysterical hyperventilation.

Goldman also investigated pulmonary arteriovenous fistulas. He was the first to recognize the relationship of this disorder to the Rendu-Osler-Weber type of familial arteriovenous fistulas.

The effects of environmental inhalant upon the lung attracted Goldman's attention and he wrote an important paper on sulfric-acid fume poisoning. In addition, he was one of the earliest workers to recognize pneumonconiosis in the tungsten carbide industry, and suggested that the principal offending agent in this type of pulmonary fibrosis was cobalt, a suggestion since confirmed by other workers. He served as consultant physician to Koch Hospital in St. Louis at the time of earliest drug therapy in tuberculosis and was responsible for inclusion of many St. Louis patients in the drug trials. He was given Viomycin by the Pfizer Company in 1949 and realized its effectiveness. Recognizing one of the earliest examples of sedormid purpura, he reported the incident to the pharmaceutical firm and was advised that it probably was coincidence and not worth publishing. Within a year, however, there were at least a dozen reports in the literature documenting similar toxicity to the drug, and he regretted not publishing his early report.

Goldman took an active role in the American College of Chest Physicians, serving as president during 1964-65; presenting papers and participating in symposia in many states and abroad, including Austria, Switzerland, Ireland, Thailand, Hong Kong, Japan, Hawaii, Mexico, and Central America. He died on November 25, 1973.

*From a memorial article by John A. Pierce, M.D, March, 1974 (modified for the finding aid, 2005).