Ruefully, the ranks of our elder statesmen continue to thin, not merely as a consequence of biological processes, but also abetted by the ravages of illness. James Edward Eckenhoff became one of these casualties on November 25, 1996, close to his homestead in La Porte, Indiana. Jim was one of those second generation anesthesiologists of this century. How many of the present generation can evoke his visage or even recall his major research activities? Nonetheless, the lack of a clear image cannot efface his hidden influence on our everyday clinical practice. Figure 1
Jim was born on April 2, 1915, in Easton, Maryland, one of several sons of sturdy Teutonic stock, the surname Eckenhoff loosely translated as the “corner house.” Surely with parental sacrifice, he attended Transylvania College (Crawford W. Long entered the Medical Department there in 1837), and graduated from the University of Kentucky in 1937. There, he met and married Bonnie Youngerman, and they ultimately became the parents of four sons. Going east to Philadelphia, Pennsylvania, they endured the rigors of the University of Pennsylvania Medical School; young Eckenhoff did not go unnoticed by the faculty. Medical school was followed by a stint abroad in the US Army where Jim served essentially as an untrained anesthetist to the 107th Evacuation Hospital. This kind of endeavor pleased Jim. Consequently, as a result of correspondence and encouragement by several of the great teachers at the University of Pennsylvania, Jim embarked on that still nascent profession of anesthesiology. A. N. Richards, Carl F. Schmidt, I. S. Ravdin, and Julius H. Comroe had long harbored the idea of a division of anesthesiology with the fortuitous result that Robert Dunning Dripps, Jr. was appointed in charge at the University of Pennsylvania Hospital.
On being mustered out of service, Jim was awarded a fellowship in the Harrison Department of Surgical Research. When first I met him early in 1946, he was studying the vicissitudes of the coronary artery circulation in the dog, first, by an injection and dissection technique, and then via changes in blood flow induced by metabolic and hemodynamic alterations. At the time, Schmidt's department of pharmacology had as its principal foci the physiology and pharmacology of the major vascular beds and pulmonary function. In addition to Comroe, the names Dumke, Lambertsen, Kety, Harmel, Forster, and many others come to mind. Eck's conclusions about the coronary circulation in the dog presaged the essential data now accepted with regard to the human circulation. Pari passu, S. S. Kety had defined the basics of the cerebral circulation in man using the Fick principle and nitrous oxide uptake by the brain. This work was the immediate precursor of our knowledge of uptake and distribution of inhalation anesthetics in humans. Amidst this ferment, Eckenhoff would lead a team from several institutions to measure the coronary circulation in man, similarly using the nitrous oxide method.
In the early 1950s, Eckenhoff's second major Arbeit became the elucidation of the actions of N-allylnormophine in reversing the respiratory depression induced by opioids, a forerunner of our presently effective naloxone and the mixed opioid agonist-antagonists. Logically, other studies ensued on the effects of opioids on central opioid and oxygen chemoreceptors. In 1952, after a consultantship in anesthesiology to the World Health Organization Center in Copenhagen, Denmark, Eck returned to this country to promulgate the concept of management of barbiturate poisoning by supportive, physiologic means rather than resort to the more dangerous analeptics. The Danes had established a barbiturate poisoning center with this kind of philosophy in mind.
In 1962, Eckenhoff relinquished the Editor-in-Chief position of Anesthesiology to take sabbatical leave in the United Kingdom to investigate the physiologic implications of deliberate hypotension. The English anaesthetists, in contrast to those in this country, had used this technique extensively to diminish blood loss during anesthesia, by means of autonomic system blocking agents and positioning of the body. Within 1 year's span, the effects of this method were portrayed by Eckenhoff: overall oxygen delivery, cerebral blood flow, pulmonary gas exchange, and related changes that defined the benefits and limitations of this kind of physiologic trespass. This effort led to his becoming a Hunterian Professor at the Royal College of Surgeons in 1965. As a consequence, he was considered for appointment to one of the major British anaesthesia professorial appointments, but the family chose to return home.
On return to Pennsylvania, Eck served as Vice Chairman of the Department headed by R. D. Dripps, then acknowledged as one of the leading programs in the country. Although courted by more than a few universities, Eck in 1966 chose to become Professor and Chair at Northwestern University. Such were his accomplishments that in 1970, the regents and faculty of the school chose him as their Dean. He held that post until 1989.
Hardly a national or international honor escaped Jim Eckenhoff's laureate-crowned brow, nor can the wealth and breadth of his many other accomplishments be presented here. Truly we have lost a steadfast friend, compatriot, and leader. He leaves us with Jane Mackey, his spouse since 1973 and three sons: Edward Alvin, a healthcare executive; Walter Leroy, a prominent Chicago architect; and Roderic George, currently an Associate Professor of Anesthesiology at the University of Pennsylvania.
Leroy D. Vandam, M.D.