HARVARD GAZETTE ARCHIVES
Faculty of Medicine - Memorial Minute:
Alexander Sandor Nadas
Alexander Sandor Nadas, M.D., born in Budapest on Nov. 12, 1913, died in his sleep at home (Needham, Mass.) May 16, 2000. He was a founder of the field of pediatric cardiology. Alexander Nadas resided with his family in Budapest through medical school in 1937, but with the impending war in Europe in December 1938, he came alone to the United States. He was met at the boat by one of his father's friends who edited a Hungarian newspaper in New York. Good fortune struck when he moved to International House where he met his wife-to-be, Elizabeth McClearen. About nine months later, his parents joined him in New York City, where his mother, who was a milliner in Budapest, opened a store on Madison Avenue.
In the years between medical school in Budapest (M.D. 1937) and his departure for America, he had six months of post graduate study under Dr. Paul Wood, an eminent British cardiologist, and afterward, another six months in pathology in Geneva. Those experiences allowed him to become multilingual, always with an accent that was readily understandable but with a measured pace of speaking. They also provided him with the best possible training in cardiology.
The next phase of his life in America was to study for Board accreditation so that he could practice medicine. In order to obtain practical experience he worked for a cardiologist at Montefiore Hospital in New York. Then, after passing the examination, he became a rotating intern in Cleveland, and subsequently trained in pediatrics under Dr. Clement Smith, then Chair of pediatrics at Children's Hospital in Detroit. In 1941-1942, he was a resident in pediatrics at Massachusetts Memorial Hospital. In 1942, he became a volunteer outpatient resident at Children's Hospital, Boston where his clinical skills were outstanding, and widely appreciated. From 1943-1945 he moved to Michigan as Chief Resident in Pediatrics under Dr. Smith. There he earned another M.D. degree from Wayne University in 1945.
After completing training, he moved to Greenfield, Mass., as a practicing pediatrician for the next five years. In 1949, Dr. Charles Janeway, then Chief of Pediatrics at Children's Hospital invited Dr. Nadas to develop a program in pediatric cardiology. In the words of his long-time colleague, Dr. Donald Fyler, "it was an adventurous and clairvoyant appointment." Dr. Nadas spent one year in adult cardiology under Drs. Samuel A. Levine and Lewis Dexter at the Peter Bent Brigham Hospital, after his appointment at Children's Hospital. He was also a Fulbright Professor of Pediatrics at the University of Groningren, Netherlands.
Dr. Nadas' first publication described the ultimate effects of pregnancy on rheumatic heart disease (1944). The first paper in association with the cardiac surgeons was in 1956, followed by a succession of studies on the pathophysiology of congenital heart disease that included a landmark paper in association with one of his fellows, Dr. Jacqueline Noonan, that described the hypoplastic, left heart syndrome.
When Dr. Robert Gross successfully ligated a patent ductus artereosus in 1939 and then resected a coarctation of the aorta in 1945, hope for the correction of other congenital cardiac defects spurred cardiologists to become more proficient in diagnosing and understanding congenital heart disease. Dr. Nadas possessed the clinical acumen to diagnose many cardiac defects, and with the contribution of Dr. Abraham Rudolph's physiologic studies in the catheterization laboratory, was able to understand the patho-physiology of the various cardiac lesions. When open-heart surgery became a reality, pediatric cardiology became an exciting field and Dr. Nadas was ready to play a pivotal role. Ever mindful of the need for interdisciplinary studies, he recruited Drs. Richard and Stella van Praagh, whose understanding of the embryology of the heart, and their meticulous descriptions of anomalies, informed the cardiac surgeons of the detailed nature of malformations. He was concerned with follow-up of all the patients, and contributed to the literature. The epidemiology of cardiovascular disorders was another focus of interest, in association with Drs. Miettinen, Ellison and Newburger.
A notable turning point in the Nadas career occurred in 1972, when Dr. Aldo Castaneda was appointed Chief of Cardiac Surgery. The remarkable sharing relationship between the pediatrician, Nadas, and surgeon, Castaneda, is best described in the words of Castaneda. "He was a charming, typically Hungarian gentleman, obviously very intelligent and with an exquisite sense of humor. We hit it off immediately and during the subsequent ten years did not have a single incident or important disagreement... Alex proved at times more aggressive than we surgeons - for example, he repeatedly urged us to begin a program of anatomical correction of transpositions of the great arteries soon after birth."
All who knew Alex recognized his ardent patriotism for his new country. He once remarked that he was glad to be as far from Nazi-occupied Hungary as possible. He followed American politics religiously. John F. Kennedy was his hero, and he was devastated by the assassination. He was also a student of European politics, and liked to compare the two great revolutions of history, the French and American.
In the words of Dr. Barry Keane, a long-time fellow and associate cardiologist: "I owe my 'life' in pediatric cardiology to him. He was an honorable, true-to-his word person. He taught me to write medical articles on Saturday mornings at his home in Wellesley, including introducing me to the nuances of the English language." He had a litany of sayings: "graveyards are full of indispensable people," "I am a benign autocrat," "old age is not for sissies."
In the 1960s he established a multicentered study of the Natural History of Congenital Heart Defects, designed to provide the data needed to plan treatment of several more common defects. Dr. Donald Fyler, another life-long colleague and friend, pioneered The New England Regional Infant Cardiac Program to integrate medical services for infants with congenital heart disease. Dr. Fyler wrote "admitting that charm, brilliance, wit, discipline and hard work contributed to his resounding success, I believe his spectacular knack in dealing with and understanding people was his greatest advantage."
Long before diversity was recognized as desirable at institutions of higher education, Alex Nadas produced his own cardiac United Nations. He noted that he was an FMG (foreign medical graduate). He is quoted on rounds as remarking that "though we might sound like the United Nations, we sure as hell are going to function better than the United Nations." He was justly proud of his department, which was the first pediatric cardiology program in the United States.
He found time to vacation with his family in Annisquam many summers, where he enjoyed both tennis and swimming. His fondness for movies was legendary, as was his close attention to world news. He listened faithfully to Louis Lyons, Edward R. Murrow, Walter Cronkite and more recently the Lehrer News Hour, where Doris Kearns Goodwin was a favorite.
No reminiscences would be complete without reference to his many dinner parties at Café Budapest where he was well known. The night before he died, he dined there with old friends, including his friend from his Michigan years, Dr. William Fink, and his long-standing colleague at Children's Hospital, Dr. William Berenberg. His neighbor in Wellesley for many years was Dr. John Crigler, chief of endocrinology; their families shared affection and admiration. For many years they commuted together to and from Children's Hospital.
He was a devoted and loyal member of the Children's Hospital family. He served on innumerable committees that included Chair of the Medical Staff, and Member of the Board of Trustees Executive Committee. In order to honor the growth and worldwide recognition of his program, they created the Alexander Nadas Professorship in Pediatric Cardiology at the Harvard Medical School at the time of his retirement in 1984. He was enormously grateful to Children's Hospital for the opportunities provided for him, and ever loyal to his many friends.
In 1964 he was appointed clinical Professor, and in 1969 Professor of Pediatrics at Harvard Medical School. His academic achievements were noted in 255 publications and a classic textbook, "Pediatric Cardiology," first published in 1957, and now with his colleague, Donald Fyler, is in its 4th edition, known as "Nadas' Pediatric Cardiology," and multi-authored by members of Nadas' department. Among his many honors and awards were the Presidency of the American Pediatric Society (1983), and the American Heart Association's Alexander Nadas Lectureship in 1999. The American Heart Association presented him with its coveted Paul Dudley White Award in 2000. The American Academy of Pediatrics gave him their first Founder's Award in Pediatric Cardiology.
No summary of the life of Alex Nadas would be complete without recognition of his devotion to his wife, Elizabeth, who had severe rheumatoid arthritis for years before she died in 1994. His three children in turn were devoted to him, celebrating important anniversaries with parties for his many friends, within and outside of medicine. Betsy (Seamans), Trudi (Murch) and John Nadas were constantly in touch, at least in later years by daily phone calls. A family tragedy devastated Alex, when Betsy's daughter, Annie, was killed in an automobile accident at age 19. Thereafter he became increasingly incapacitated with his kyphosis, and episodes of heart failure, on the basis of injury from two earlier bouts of subacute endocarditis.
In the words of Aldo Castaneda: "All children born with congenital cardiac defects have lost a most valuable friend, who during his entire professional life worked indefatigably on their behalf."
'All children born with congenital cardiac defects have lost a most valuable friend, who during his entire professional life worked indefatigably on their behalf.'