William Francis Ganong
Authors: Jeanne Lenzer
Journal: BMJ (2008)

William Francis Ganong, a pioneer in neuroendocrinology, made several seminal contributions to medicine. He helped to elucidate the control mechanisms of aldosterone and the neural control of the renin-angiotensin system, and was a co-discoverer of the Lown-Ganong-Levine syndrome. His touchstone book, Review of Medical Physiology, in its 22nd edition, has been translated into 18 languages and is used by medical students (and students of physiology) around the globe.

Ganong was raised in an academic family—his father was a renowned biologist and his mother a geologist. He enrolled in Harvard College in 1941, planning to become a lawyer in the hope of pursuing a career in public administration. But after the Japanese attack on Pearl Harbour in December 1941, he was drafted into the army, where he was enrolled in a special premedical programme that allowed him to receive his bachelor’s degree from Harvard in 1946 while still in the army.

At the end of the second world war he returned to Cambridge, Massachusetts, where he earned his MD from Harvard in 1949. After working for two years as a house officer at the Peter Bent Brigham Hospital, he was recalled to the army. For the next 18 months he served as a medical officer in Japan and Korea. With six other medical officers, he set up a mobile army surgical hospital, known as a MASH unit, to treat victims of haemorrhagic fever.

Ganong returned to Harvard in 1952, where he undertook postdoctoral training in internal medicine with George W Thorn and surgery with David M Hume. Ganong credited Hume with introducing him to the then “heretical idea that the brain regulated secretions of the pituitary gland.” Ganong said in an interview for the University of California oral archives, that, at the time, the brain and body were taught separately in the medical school curriculum and “neuroendocrinology did not exist as a discipline.”

The first two articles that Ganong co-authored were also published in 1952. The first was a case report in the New England Journal of Medicine on the use of steroids to treat a patient with Guillain-Barre syndrome. The second, entitled “The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action,” was published in Circulation and described what is now known as the Lown-Ganong-Levine syndrome. Ganong confessed his pride in both articles during an interview with the American Physiological Society, saying of the first that he was proud to “have introduced a treatment that proved useful,” and of the second: “I always had a secret ambition to be ‘immortalised’ by having my name attached to a syndrome.” He went on to write over 200 articles and several textbooks.

In 1955 Ganong left Harvard to help set up a new basic science research department at the University of California. He then set his research agenda, which remained a lifelong commitment—“to elucidate the mechanisms regulating aldosterone secretion.” Ganong helped to demonstrate that there was another humoral factor beside ACTH (adrenocorticotropic hormone) that regulated aldosterone secretion. He identified the renin-angiotensin axis as a major regulator of aldosterone, leading him to investigate the control of renin secretion and the neural components of the process. In later years he examined the extravascular renin-angiotensin systems in the brain and the pituitary gland. His work provided insights into hypertension and salt and fluid regulation that formed the basis for the development of drugs to treat hypertension.

Ganong’s research was greatly aided by generous programme project grants from the National Institutes of Health, which awarded him nearly $700 000 annually for 30 years to study the broad discipline of “Neural controlled endocrine function.”

While serving as the chair of the department of physiology at the University of California, San Francisco, from 1970 until 1987, the faculty grew from less than a dozen faculty members to over 80 full time members. The department was named the top physiology department by the National Academy of Sciences in 1982 and 1986. Under Ganong’s leadership, it developed into one of the leading neuroscience programmes in the United States.

Ganong’s research also proved useful for the National Aeronautics and Space Administration (NASA), which awarded him grants to study the effects of gravity on the cardiovascular system.

When Ganong, who preferred to be called Fran by his friends and colleagues, won the Endocrine Society’s award in 2002, a colleague, Neena B Schwartz related some of his secrets of success. He adhered to the “minimalist concept of Occam’s razor in interpreting experimental research.”

Part of Ganong’s success, however, took a far more prosaic form. He confided in Schwartz that he always carried a pack of index cards with him, noting new things in physiology. In this way, said Schwartz, he kept his textbook on physiology “remarkably up to date and fresh.” Another trick in staying up to date reveals an underlying humility in a man who took pride in his work. After lecturing a class of medical students, Ganong offered 25 cents to each student who could identify an error in his book. At the end of the lecture he was “mobbed” by students. He nearly went broke paying them off.

Ruth Ganong, his wife of 59 years, says such modesty was “very typical” of her husband. Even after his retirement in 1999, he continued to get up at 6 am to work on the Review of Medical Physiology right through the evening “seven days a week”—but, she adds, “he made breakfast for me every morning before he started: cereal with four types of fruit.”