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Giants in Chest Medicine |

Giants in Chest MedicineGiants in Chest Medicine: John F. Murray, MD FREE TO VIEW

Philip C. Hopewell, MD
Author and Funding Information

Philip C. Hopewell, MD, is from the Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco.

CORRESPONDENCE TO: Philip C. Hopewell, MD, San Francisco General Hospital, Room 5K1, San Francisco, CA 94110; e-mail: phil.hopewell@ucsf.edu


CONFLICT OF INTEREST: None declared.

Editor’s Note: This series recognizes and highlights the accomplishments of individuals who have contributed greatly to chest medicine. To watch the interview with Dr Murray, go to journal.publications.chestnet.org.

ADDITIONAL INFORMATION: See video interview of Dr Murray online at http://dx.doi.org/10.1378/chest.15-2005.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1123-1125. doi:10.1378/chest.15-2005
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Published online

Saturday rounds in an academic center are generally conducted with the house staff having one eye on the clock and the other on the attending physician, the unspoken thought being, “Can we hurry this along so we can get out of here?” However, this was not the prevailing attitude when John F. Murray, MD, was attending in the medical ICU at San Francisco General Hospital. Dr Murray used Saturday mornings to discuss some aspect of clinical respiratory physiology that was illustrated by a patient in the unit, making the physiologic principles relevant to critically ill patients. The value of these sessions was not lost even on the most sleep-deprived interns and residents, and they were widely regarded as extraordinary learning experiences.

Giants in Chest Medicine: John F. Murray, MD

Running Time: 40:34

I start with this local example of Dr Murray’s contributions because it illustrates some of the qualities that made him a transformative figure in modern pulmonary medicine: clear thinking and critical analysis, clear speaking, and clear writing. At least in my estimation, it is because of his clear thinking, with that same clarity carried through his writing and speaking, that people listen to what he has to say.

I used the descriptor “transformative” before, and I think it is an apt term to describe Dr Murray’s important contributions. Leaving aside his list of publications (he began publishing in 1957 and has not stopped yet), I would like to concentrate on his contributions in four areas:

  • • The creation of the Division of Lung Disease (DLD) in the (now) National Heart, Lung and Blood Institute

  • • Training in pulmonary medicine

  • • Leadership in the American Thoracic Society (ATS), including editing the society’s journal

  • • Recognition of the importance of pulmonary disease in people with HIV infection

Although the National Heart Institute was created in 1948, it was not until 20 years later, through an intensive lobbying campaign led by Julius Comroe, MD, and backed by Dr Murray and Jay Nadel, MD, among others, that a lung institute was given equal billing with the heart institute to form the National Heart and Lung Institute. Similarly, advocacy by Drs Murray and Nadel contributed to the naming of Claude Lenfant, MD, as the first director of the DLD. Notably, Dr Lenfant went on to be the director of the National Heart, Lung and Blood Institute for 21 years.

In the early 1970s, Dr Murray led a committee of prominent pulmonologists charged with assessing the size of the workforce in pulmonary medicine and projecting future needs for specialists. The group forecast a substantial deficit in pulmonary specialists in the near future, and the group’s report prompted the scaling up of training programs and increasing funding to support the training. Recognizing that additional academic faculty were needed to staff the increasing training capacity, Dr Murray was instrumental in the creation of the National Pulmonary Faculty Training Program funded by the DLD.

Specialty training in the early 1970s was an ad hoc affair. The process of selecting trainees and the content of training programs were largely open to program directors’ discretion. To standardize the process of trainee selection, Dr Murray catalyzed the creation of the Western Uniform Acceptance Date program, involving four western training programs. Other institutions subsequently joined, and the program became the pulmonary matching program, the first subspecialty matching program in the country.

Dr Murray was also involved in early efforts to standardize the content of training programs. Working with a group of other clinical training program directors, they published the first guidelines for pulmonary training programs (“Attributes of the Subspecialist in Internal Medicine and Guidelines for Training in Pulmonary Diseases”).

Dr Murray played an important role in the evolution of the ATS. He assumed the editorship of the society’s journal in 1974 and proceeded to enlarge the scope and size of the editorial board as well as to insist on application of rigorous criteria in judging manuscripts. He sought and published a broader range of papers than had been customary for the journal. Importantly, during his editorship, Dr Murray took a leading role with the International Committee of Medical Journal Editors. A committee of the International Committee of Medical Journal Editors, chaired by Dr Murray, met in Vancouver, British Columbia, Canada, and agreed to implement a unified set of requirements for manuscripts. This meeting led to the establishment of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Part of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals is the reference style, known as the “Vancouver style” after the meeting site.

Dr Murray also was influential in the structure of the ATS, spearheading the formation of specific scientific assemblies for the purpose of broadening the scientific base of the society and providing an avenue by which younger members could assume leadership positions. As the ATS president in 1981 to 1982, Dr Murray made important strides in securing increased administrative autonomy and fiscal flexibility from the society’s then parent, the American Lung Association. This was a critical step in the process that ultimately led to the society becoming independent.

It did not take long after the first cases of what is now recognized as AIDS were described for Dr Murray to realize that this new disease was going to be a major problem and that the lungs would be frequently involved. Dr Murray received support to convene the first meeting on the pulmonary complications of HIV infection. The investigators and clinicians attending the meeting pooled their experience, and from that pool emerged the outlines of the spectrum of lung disease in HIV infection. This led to a large multicenter study across the United States. Dr Murray went his own way and conducted a series of studies in Africa to examine the spectrum of lung diseases in HIV infection under much different epidemiologic and resource conditions.

Although he ostensibly retired in 1994, Dr Murray has published 40 papers since then and has continued to be actively involved in updating Murray & Nadel’s Textbook of Respiratory Medicine, now in its sixth edition. The book is an ongoing reflection of Dr Murray’s clarity of thought and writing and of his commitment to the application of sound scientific principles to clinical pulmonary medicine.

Murray JF, Dawson AM, Sherlock S. Circulatory changes in chronic liver disease. Am J Med. 1958;24(3):358-367. [CrossRef] [PubMed]
 
Murray JF, Mulder DG. The effects of retrograde portal venous flow following side-to-side portacaval anastomosis: a comparison with end-to-side shunts. J Clin Invest. 1961;40(8):1413-1420. [CrossRef] [PubMed]
 
Murray JF, Gold P, Johnson BL Jr. The circulatory effects of hematocrit variations in normovolemic and hypervolemic dogs. J Clin Invest. 1963;42(7):1150-1159. [CrossRef] [PubMed]
 
Lutch JS, Murray JF. Continuous positive-pressure ventilation: effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med. 1972;76(2):193-202. [CrossRef] [PubMed]
 
Murray JF, Coates EO Jr, Nadel JA, et al. Survey of professional manpower in pulmonary diseases. Am Rev Respir Dis. 1973;107(5):879-881. [PubMed]
 
Murray JF. National pulmonary faculty training program. Am Rev Respir Dis. 1975;112(3):329-330. [PubMed]
 
Hopewell PC, Murray JF. Effects of continuous positive-pressure ventilation in experimental pulmonary edema. J Appl Physiol. 1976;40(4):568-574. [PubMed]
 
Miller RD, Anderson WH, Bates JH, et al. Attributes of the subspecialist in internal medicine and guidelines for training in pulmonary diseases. Am Rev Respir Dis. 1977;116(2):163-165. [PubMed]
 
Huchon GJ, Hopewell PC, Murray JF. Interactions between permeability and hydrostatic pressure in perfused dogs’ lungs. J Appl Physiol. 1981;50(4):905-911. [PubMed]
 
Russell JA, Hoeffel J, Murray JF. Effect of different levels of positive end-expiratory pressure on lung water content. J Appl Physiol. 1982;53(1):9-15. [PubMed]
 
Murray JF, Felton CP, Garay SM, et al. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984;310(25):1682-1688. [CrossRef] [PubMed]
 
Marks JD, Luce JM, Lazar NM, Wu JN, Lipavsky A, Murray JF. Effect of increases in lung volume on clearance of aerosolized solute from human lungs. J Appl Physiol (1985). 1985;59(4):1242-1248. [PubMed]
 
Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson lecture. Am Rev Respir Dis. 1989;140(6):1788-1795. [CrossRef] [PubMed]
 
Daley CL, Mugusi F, Chen LL, et al. Pulmonary complications of HIV infection in Dar es Salaam, Tanzania. Role of bronchoscopy and bronchoalveolar lavage. Am J Respir Crit Care Med. 1996;154(1):105-110. [CrossRef] [PubMed]
 
Samb B, Sow PS, Kony S, et al. Risk factors for negative sputum acid-fast bacilli smears in pulmonary tuberculosis: results from Dakar, Senegal, a city with low HIV seroprevalence. Int J Tuberc Lung Dis. 1999;3(4):330-336. [PubMed]
 
Johnson D, Murray JF. Will to live. New York Rev Books. 2008;55(2):4-8. [PubMed]
 
Johnson D, Murray JF. The patient talks back. New York Rev Books. 2008;55(16):24-27. [PubMed]
 
Murray JF, Du Melle F, Hopewell PC. Evolution and revolution: the formation of today’s American Thoracic Society, part 1. Am J Respir Crit Care Med. 2012;186(10):948-952. [CrossRef] [PubMed]
 
Murray JF. Epidemiology of human immunodeficiency virus-associated pulmonary disease. Clin Chest Med. 2013;34(2):165-179. [CrossRef] [PubMed]
 
Murray JF. Tuberculosis and high altitude. Worth a try in extensively drug-resistant tuberculosis? Am J Respir Crit Care Med. 2014;189(4):390-393. [CrossRef] [PubMed]
 

Tables

Giants in Chest Medicine: John F. Murray, MD

Running Time: 40:34

Suggested Readings

Murray JF, Dawson AM, Sherlock S. Circulatory changes in chronic liver disease. Am J Med. 1958;24(3):358-367. [CrossRef] [PubMed]
 
Murray JF, Mulder DG. The effects of retrograde portal venous flow following side-to-side portacaval anastomosis: a comparison with end-to-side shunts. J Clin Invest. 1961;40(8):1413-1420. [CrossRef] [PubMed]
 
Murray JF, Gold P, Johnson BL Jr. The circulatory effects of hematocrit variations in normovolemic and hypervolemic dogs. J Clin Invest. 1963;42(7):1150-1159. [CrossRef] [PubMed]
 
Lutch JS, Murray JF. Continuous positive-pressure ventilation: effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med. 1972;76(2):193-202. [CrossRef] [PubMed]
 
Murray JF, Coates EO Jr, Nadel JA, et al. Survey of professional manpower in pulmonary diseases. Am Rev Respir Dis. 1973;107(5):879-881. [PubMed]
 
Murray JF. National pulmonary faculty training program. Am Rev Respir Dis. 1975;112(3):329-330. [PubMed]
 
Hopewell PC, Murray JF. Effects of continuous positive-pressure ventilation in experimental pulmonary edema. J Appl Physiol. 1976;40(4):568-574. [PubMed]
 
Miller RD, Anderson WH, Bates JH, et al. Attributes of the subspecialist in internal medicine and guidelines for training in pulmonary diseases. Am Rev Respir Dis. 1977;116(2):163-165. [PubMed]
 
Huchon GJ, Hopewell PC, Murray JF. Interactions between permeability and hydrostatic pressure in perfused dogs’ lungs. J Appl Physiol. 1981;50(4):905-911. [PubMed]
 
Russell JA, Hoeffel J, Murray JF. Effect of different levels of positive end-expiratory pressure on lung water content. J Appl Physiol. 1982;53(1):9-15. [PubMed]
 
Murray JF, Felton CP, Garay SM, et al. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984;310(25):1682-1688. [CrossRef] [PubMed]
 
Marks JD, Luce JM, Lazar NM, Wu JN, Lipavsky A, Murray JF. Effect of increases in lung volume on clearance of aerosolized solute from human lungs. J Appl Physiol (1985). 1985;59(4):1242-1248. [PubMed]
 
Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson lecture. Am Rev Respir Dis. 1989;140(6):1788-1795. [CrossRef] [PubMed]
 
Daley CL, Mugusi F, Chen LL, et al. Pulmonary complications of HIV infection in Dar es Salaam, Tanzania. Role of bronchoscopy and bronchoalveolar lavage. Am J Respir Crit Care Med. 1996;154(1):105-110. [CrossRef] [PubMed]
 
Samb B, Sow PS, Kony S, et al. Risk factors for negative sputum acid-fast bacilli smears in pulmonary tuberculosis: results from Dakar, Senegal, a city with low HIV seroprevalence. Int J Tuberc Lung Dis. 1999;3(4):330-336. [PubMed]
 
Johnson D, Murray JF. Will to live. New York Rev Books. 2008;55(2):4-8. [PubMed]
 
Johnson D, Murray JF. The patient talks back. New York Rev Books. 2008;55(16):24-27. [PubMed]
 
Murray JF, Du Melle F, Hopewell PC. Evolution and revolution: the formation of today’s American Thoracic Society, part 1. Am J Respir Crit Care Med. 2012;186(10):948-952. [CrossRef] [PubMed]
 
Murray JF. Epidemiology of human immunodeficiency virus-associated pulmonary disease. Clin Chest Med. 2013;34(2):165-179. [CrossRef] [PubMed]
 
Murray JF. Tuberculosis and high altitude. Worth a try in extensively drug-resistant tuberculosis? Am J Respir Crit Care Med. 2014;189(4):390-393. [CrossRef] [PubMed]
 
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