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Peter Hugh Forsham

Peter H. Forsham directed the Metabolic Research Unit of the University of California, San Francisco from 1952 until his retirement from the University in 1984. On 15 November 1995 he celebrated his 80th birthday with his daughters Elizabeth and Ann and his former wife, Constance Forsham. Several weeks later, on 5 December 1995, he died suddenly at his residence. Peter Forsham left a remarkable scientific legacy to his colleagues, former students and physicians worldwide who benefited from his many academic accomplishments in endocrinology and diabetes. It was in the latter field particularly that he had a profound impact on the lives and well-being of numerous diabetic patients who owed much to his dedicated care. Diagnosed at the age of nine with insulin-dependent diabetes mellitus, he was among the first to benefit from injections of insulin extracts that had recently been discovered by a Canadian team led by Frederick Banting. Later, as a researcher and physician, Forsham became an early advocate of the concept of avoiding persistent hyperglycemia as a means of preventing the ravages of microvascular diabetic complications. This once-controversial goal of therapy has now been well-established by the results of a large multi-center clinical study known as the Diabetes Control and Complications Trial.

Forsham was born in New Orleans on 15 November 1915. However, just after the end of World War I his family moved to Frankfurt, Germany where he spent his early childhood. It was there in 1925 that he developed juvenile-onset diabetes which required insulin injections over the next 71 years of his life. He attended a French school in Lausanne, Switzerland and earned his bachelor's and master's degrees at Cambridge University in England. In 1939 while doing a research fellowship at Rockefeller University in New York City, World War II began in Europe and he decided to remain in the United States. He was accepted at Harvard Medical College and his career focused on endocrinology. His exceptional talent was rewarded with his being selected as chief of George W. Thorn's research laboratory at the Peter Bent Brigham Hospital in Boston. It was there that his expertise in the use of adrenocorticotropic hormone and the newly available adrenal cortical hormones blossomed.

In 1952 Forsham was appointed director of the Metabolic Research Unit of the University of California, San Francisco. It was here that he organized teams of scientists working with clinicians to make important contributions to the understanding of the pathophysiology of many endocrine and metabolic disorders. His groups were the first to provide a simple screening test to detect Cushing's syndrome which remains a standard diagnostic procedure today and it was in his unit that Edward Biglieri began his exciting discoveries elucidating the role of the adrenal cortex in endocrine hypertension. The diagnosis and treatment of pituitary tumors, adrenal disorders, and “bone and stone” diseases were among the areas in which his research unit made pivotal findings that kept his outpatient endocrine clinic on the cutting edge of rational therapy.

However, it was in the investigation of causes and treatment of diabetes that Forsham may have had the most emotional satisfaction. He pursued this goal with an enthusiasm and vigor that inspired his colleagues and brought about many fruitful results. In his Unit, scientists such as Gerold Grodsky and John Gerich developed radioimmunoassays for the peptide hormones insulin and glucagon respectively, and used these assays to unravel mysteries of the secretion of islet hormones and their roles in clinical disorders of carbohydrate metabolism. It was in the Metabolic Research Unit that Gerold Grodsky adapted the perfused pancreas to document for the first time the biphasic nature of glucose-induced insulin secretion, the dependency of insulin secretion on the presence of calcium, and the importance of metabolism of glucose for its induction of insulin release. When his friend Roger Guillemin graciously provided him with some newly discovered somatostatin, Forsham's metabolism group, under the direction of John Gerich, made some original momentous observations about the role of glucagon in a number of the manifestations of hyperglycemia in humans with diabetes and in the metabolic abnormalities of ketoacidosis and hypoglycemia. In 1975 the Juvenile Diabetes Foundation awarded their most prestigious prize, The Rumbough Research Award, to Gerich and Forsham for these outstanding contributions.

Other major awards to Forsham included the 1977 Man of the Year Award by the Editorial Board of Diabetes Forecast, a publication of the American Diabetes Association, and in 1990 he received the Albert Renold Award of the American Diabetes Association for his outstanding record in teaching and in training young investigators. In his office he kept for many years a book overflowing with impressions from some of the one hundred or more scientific research fellows, clinical trainees and medical students who had come to the Metabolic Unit from all over the United States and many parts of the world. Subsequently, many of these contributors have become university professors, leading clinical endocrinologists, and one is currently the president of Kyoto University in Japan. In this book Forsham emerges as an inspiring, imaginative teacher who provided a relaxed, informal congenial atmosphere for free inquiry and encouragement of individual interest. In the book is a poem “The Torch” dedicated to him by a Greek professor who later became Dean of the University of Athens Medical College. In this poem, a procession travels across the earth, holding a torch treasured by its bearers and carrying the “knowledge, humanity, and universal friendship” originating from Forsham's Unit.

The concept of a torch being passed on is particularly symbolic of Forsham's philosophy. When asked why he continued to teach rather than see more patients “who really need him” his reply was simple. “I could see only so many patients a day! However, through all my students combined, I will be able to see hundreds a day all over the world for years to come.” Forsham passed the research torch to his colleague, John Baxter, in whom he instilled the value of always relating basic science to endocrine disorders. Under Baxter's leadership of the Metabolic Research Unit, the torch of Forsham continues to illuminate the darkness, and enlighten endocrinologists about the action of hormones on a molecular level and how this knowledge can be applied to treatment of endocrine disease.

Peter Forsham was a veteran of 71 years of diabetes who inspired diabetic patients of all ages and was living proof of the ability to succeed in spite of the disorder. He thrived on work and maintained a pace which inspired his students and colleagues. Contacts with all varieties of people invigorated him and he was constantly alert to the slightest hint of concern or need in a colleague, student, employee or patient. He was a master at putting their worry in true perspective and his innate optimism and humor were able to dispel the blackest clouds. It was a privilege to have known him and to have worked with him.

Cited From John H. Karam