Abraham Stone Freedberg

A Stone Freedberg was an American cardiologist whose pioneering research of stomach ulcers helped lay the foundation for the later identification of Helicobacter pylori.

It was no doubt one of the sweetest moments of A Stone Freedberg’s long life when he opened up the Lancet issue of 4 June 1983 to find letters to the editor from Barry J Marshall and J Robin Warren. The two Australian researchers had identified bacteria, now known as Helicobacter pylori, among patients with stomach ulcers.

After reading the exciting news, Freedberg, at the time a 75 year old professor emeritus of cardiology at Harvard Medical School, typed a short letter, beginning: “Dear Dr Marshall: I was very pleased to see the letters from Dr Warren and you on the spiral bacteria in human stomachs. It’s over 40 years since I spent evenings and weekends cutting and staining tissues from stomach operations ….”

Indeed, Freedberg in 1939 had suspected that bacteria might be the cause of ulcers. After countless hours in the laboratory he co-authored a paper on the topic that was mostly ignored or ridiculed—medical experts at the time, and for decades to come, blamed ulcers mainly on stress. Freedberg discontinued his research, which remained mostly forgotten until cited in Marshall’s 1983 letter in the Lancet.

Marshall and Warren, who pursued similar research in the early 1980s, shared the 2005 Nobel prize for medicine or physiology “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.” Marshall, who personally met Freedberg in 1994 and had occasional contact in subsequent years, told the BMJ that the distinguished professor was not envious of the Australians’ success but truly delighted.

“Professor Freedberg was happy because he was vindicated (by us),” he said. “I did not sense any regrets or sour grapes or anything. I think he was pleased to be able to say, and I think rightly so, that he could have won the Nobel prize.”

Abraham Stone Freedberg was born on 30 May 1908, in Salem, Massachusetts, to poor Polish immigrants. After graduating from Harvard in 1929, the young Freedberg, who went by the nickname Al, attended the University of Chicago Medical School, graduating in 1934. Following internship and residency at Chicago’s Cook County Hospital, he trained in pathology and microbiology at Rhode Island Hospital in Providence before switching to cardiology.

In 1939 Freedberg was at Beth Israel Hospital, affiliated to Harvard, studying cardiovascular conditions. He had read about superficial ulcers and other gastrointestinal changes occurring in infectious shock, noticing that some authors referred to the presence of bacteria in the stomach and liver.

Curious, Freedberg received permission to use the hospital pathology lab after 5 pm and at weekends, with the stipulation “that I leave the laboratory and the equipment in the condition in which I found it,” as he recalled in Helicobacter Pioneers, a book of firsthand accounts edited by Marshall. Freedberg collaborated with Louis Barron, a surgeon at Beth Israel, who “offered to persuade his surgical colleagues to give us specimens of resected stomach.”

“I still remember the surprise and good feeling I had when I first saw organisms in the superficial layers of the mucosa of some resected stomachs,” Freedberg wrote, adding that he and Barron studied 35 stomach specimens from patients with duodenal ulcer, gastric ulcer, or carcinoma, finding “organisms in 40% of cases.”

Freedberg suspected that the bacteria were not native to the stomach. But efforts by colleagues to culture the bacteria failed, so he therefore was not able to produce evidence that the bacteria had pathological significance. He and Barron co-authored a paper published in 1940 in the American Journal of Digestive Diseases, which was cited 43 years later by Marshall in the Lancet.

Attempts over the next few years by other researchers to validate Freedberg’s work failed. “I was very upset that my findings weren’t confirmed,” Freedberg told the New York Times in 2005, adding that Herrman Blumgart, research director at Beth Israel, suggested that perhaps he had made a mistake, advising the young researcher to focus on topics that might yield results sooner. Freedberg reluctantly agreed.

Leonard Freedberg, a psychiatrist and Fredberg’s son, told the BMJ: “I am sure he regretted having given up that line of inquiry. He viewed it as one of the ironies of his life.”

Freedberg turned his focus to cardiac physiology, with an emphasis on thyroid disease, publishing widely. In 1951 he was lead author of a paper describing treatment of thyroid cancer with radioactive iodine. “His pioneering work on the use of radioactive iodine to treat thyroid cancer saved many a life,” said Harold Bursztajn, associate clinical professor of psychiatry at Harvard and Freedberg’s long-standing friend. “His work on the relation between the thyroid and the heart informed clinical research and treatment for decades. And there is still a good deal that he touched on as late as 1960 which is unexplored yet may become food for further research on how stress can affect the neuroendocrine system and the heart.”

Freedberg later became chairman of cardiology and internal medicine at what is now Beth Israel Deaconess Medical Center. “He trained generations and generations of researchers,” Dr Bursztajn said. “He was a brilliant researcher, but a clinical researcher. He would do experiments of one.” He retired from the Harvard faculty at 65, but continued practising medicine at Harvard Health Services into his 90s. “He loved being a doctor,” Dr Bursztajn said.

In 1994, when Freedberg was 86, Marshall and Warren travelled to Harvard Medical School to accept the Warren Alpert Foundation Prize. “We had not yet won any prizes,” remembers Dr Marshall. “To meet Professor Freedberg was quite special to us. He was obviously a highly respected professor, and he was spreading the word that our research was important. He treated us with a lot of respect, and it was a pleasure to me.”

Freedberg, whose wife, Beatrice, died in 2000, leaves his sons Leonard and Richard; his brother Milton; four grandsons; and three great-grandchildren.