Norbert Goormaghtigh
Norbert Goormaghtigh (14 February 1890 – 2 January 1960) was the Rector of the University of Ghent from 1947 to 1950. (1) He was a Belgian pathologist credited with the discovery of the function of the smooth muscle cells in the part of the kidney which he named the juxtaglomerular apparatus. He concluded that the smooth muscle cells were endocrine cells. They secreted a substance which he concluded directly or indirectly caused arterial blood vessels to constrict. It was the smooth muscle cells of the kidney that were responsible for an increase in blood pressure.
In 1947 Norbert Goormaghtigh and Harry Goldblatt were jointly nominated for the Nobel Prize in Physiology or Medicine. (2) The evaluation comments were:
Goormaghtigh: ... his discovery of muscular afibrillar cells, which would be at the origin of arterial hypertension of renal origin.
Authors Eknoyan, Rubens and Lameire have described Norbert Goormaghtigh’s work with respect to the juxtaglomerular apparatus of the kidney as “a landmark in the history of medicine.” (3)
Image Norbert Goormaghtigh
Early life and education
Norbert Goormaghtigh was born in Ostend to Oscar Franciscus Goormaghtigh, a marine mechanical engineer, and Victorine Eugenia Bouva. He was the oldest of three children. Norbert was a brilliant student at school. By the age of 16 he had completed the necessary university admission requirements. It was during his third year at the University of Ghent that his interests swung toward medicine. He completed each year to his seventh year with great distinction. For the years 1912-1914 he was awarded the Belgian King Albert’s medal for first in anatomic-physiological or biological science. On July 13, 1913 Goormaghtigh graduated as a doctor in medicine, surgery and delivery. He was 23 years old. (4 )
The First World War
In August 1914, Norbert was mobilized as a Medical Officer of a battalion and retreated with the Belgian army from Antwerp to the northwest of Belgium. It was to a field hospital at Hoogstade. He worked here through most of the war. During the offensives, when the wounded arrived in great numbers, Goormaghtigh often operated from 10 to 12 hours per day. The quiet moments were devoted to research. He carried out his research in a makeshift laboratory where he installed his microscope. It was there that he formed the basis of his scientific career. (5) When he examined a patient, Dr. Goormaghtigh noted the symptoms of the patient on admission and also during the follow up. When the patient died, he removed and fixed the adrenal glands in formalin in order to examine them later on. Goormaghtigh was able to make deductions from examining tissues from men whose history he knew about. He was able to see samples from men who had experienced stress from battle injuries. He could see changes during stress that took place in the cells of the body. The changes were more pronounced if the stress was prolonged. The stress caused malfunction or other problems. (4) Goormaghtigh continued his study and description of changes in the adrenal cortex. In 1922, he obtained the degree of “special doctor”.\ (4)which allowed him to become a professor at the Faculty of Medicine of the University of Ghent and to teach pathology. (6)
Medical Research
The enzyme renin which has a key role in the regulation of blood pressure. At the time of Goormaghtigh’s initial research it was unknown where renin was produced in the kidney, the conditions which caused it to be produced or what kind of substance it was. (4) In the 1930’s Norbert Goormaghtigh and Harry Goldblatt were both working on the origin of the renin in the kidneys. Through experiments which partially restricted the blood flow to the kidney with clamps, the decreased blood flow, and the corresponding decreased oxygen supply to the kidneys, called ischemia, corresponded with a rise in blood pressure. (4) Goormaghtigh studied the cells within the kidney under conditions of ischemia. In conditions of renal ischemia, he found an abnormal increase in the normal number of juxtaglomerular cells (hypertrophy) causing an increase in volume of the juxtaglomerular apparatus (hyperplasia). He also found an increase in the number of renin containing granules in these cells (hypergranulation). (4) Goormaghtigh traced the period during which the granules formed. During the clamping procedure the body reacted as if there was a loss of blood pressure and needed to compensate by raising blood pressure. (4) The granular reaction in the afibrillar cells preceded a rise in blood pressure. There was a cause and effect relationship between the granular arterioles reaction and a rise in blood pressure. The smooth muscular cells, having an endocrine function, intervene directly or indirectly in the formation of a blood vessel constricting substance in heightened quantity in the clamped kidney. (4) Goormaghtigh showed that the action of renin in inducing an increase in blood pressure was not rapid like the action of adrenalin in the blood. It was slow and progressive. As well, once the excess of the blood vessel constricting substance had ended, the return to normal was not immediate and could even become a chronic condition. (7)
Goormaghtigh published 113 works over a period of 43 years. Further areas of interest were the thyroid, ovaries, lymphatic system, menstrual cycle, the protein folliculin, cancer, tumours, vitamin D, lesions, Bright’s disease, high blood pressure, crush syndrome and diseases of the kidney. (9)
Academic career
In the academic year 1935-1936 Goormaghtigh was dean of the Faculty of Medicine. In 1947 he he was appointed to a three-year term as Rector of the University of Ghent. At the beginning of 1949, a social service for students was established on his initiative , an important contribution to the democratisation process of higher education. This service was, among other things, for the award of scholarships, the search for housing and student jobs and for an on-site restaurant. [8]
Personal life At Hoogstade, during the First World War, Goormaghtigh met his wife, the English nurse Mabel Lawrence. (3) (4) They raised two children.
Medical Commentary
“The term “abdominal vagal paraganglia” was first coined by Goormaghtigh to describe minute aggregations of so-called “glomus” tissue associated with the abdominal vagus and its branches, which bear a striking histological similarity to the classical arterial chemoreceptors, the carotid and aortic bodies.” Howe, A. Pac, R.J. and Castro K. “Hypertrophy of Abdominal Vagal Paraganglia Following Chronic Hypoxia: Compared with Carotid Body” Editors: Eyzaguirre, C., Fidone, S.J., Fitzgerald, R.S., Lahiri, S., McDonald, D.M. (Eds.) Arterial Chemoreception. Springer 1990 “Goormaghtigh brought [considerable insights] to his power of morphologic observations. His ability to foresee structural–functional correlates and correctly formulate them is stunning, to say the least, and these were far ahead of their time. It was decades later that they were documented and elucidated.” Eknoyan G., Rubens R. and Lameire N. The Juxtaglomerular Apparatus of Norbert Goormaghtigh - A Critical Appraisal 2009 Oxford University Press “It fell to the Belgian pathologist Norbert Goormaghtigh to recognize the critical relationships, or at least to foresee them, because the definitive experiments were not to be made for another thirty years or more.” Thurau K., Davis J.M. and Haberle D.A. “Renal Blood Flow and Dynamics of Glomerular Filtration: Evolution of a Concept from Carl Ludwig to the Present Day” Editors: Gottschalk C.W., Berliner R.W. and Giebisch G.H. Renal Physiology: People and Ideas American Physiological Society, Springer. 2013 p. 46 “By conventional light microscopic observations alone, Goormaghtigh came to the conclusion that JG [juxtaglomerular] cells were secretory in nature and constituted an endocrine gland. This astute observer further postulated, although evidence was lacking, that the secretory product was the pressor substance, renin. At the present time, on the basis of many observations of other investigators during the intervening decades, both ideas may be considered valid.” Hartroft P.M. “The Juxtaglomerular Complex” Annual review of medicine, 1966 “Of the several investigators who made this possible, Norbert Goormaghtigh was not only one of its first observers but the only one to persevere in its investigation, to recognize and define the critical relationships of the complex he named the juxtaglomerular apparatus, and in what were clearly prescient insights, to foresee correctly many of its functions that were to be documented in the ensuing decades. Goormaghtigh belonged to the class of morphologists who believed that accurate structural studies provided a basis for the undertaking of functional studies.” Lameire N. “Wars, disasters and kidneys” ACTA CLINICA BELGICA. 69(6). p.418-425 2014
Honours (10)
Belgian Knight of the Order of the Crown 1925 Belgian Officer of the Order of the Crown 1932 June 16, 1949 Doctor Honoris Causa from the University of Lille. September 28, 1949 Doctor of Medicine Honoris Causa from the Queen’s University of Belfast November 15, 1949 Honorary membership in the Czech Endocrinological Society in Prague May 12, 1951 Officer of the Legion of Honour of the French Republic July 24, 1953 elected a Full Member of the International Society of Hematology Belgian Officer of the Order of Leopold, awarded 1957 May 8, 1959 Grand Officer of the Order of Leopold b
Selected works relating to the kidney (11)
GOORMAGHTIGH, N. (1930). Le problème de l’hypertension artérielle considéré du point de vue anatomopathologique. Ann. et Bull. Soc. roy. Sc. méd. natur. Brux., 34 : 72-90. GOORMAGHTIGH, N. (1931). Sclérose vasculaire du rein après énervation des sinus carotidiens et section des nerfs dépresseurs. C.R. Soc. Biol., 106 : 1254-1257. GOORMAGHTIGH, N. (1931). La sclérose vasculaire rénale expérimentale du lapin. Ann. Anat. pathol., 8 : 587-604. GOORMAGHTIGH, N. (1932). Les segments neuro-myo-artériels juxtaglomérulaires du rein. Arch. Biol. 43 : 575-591. GOORMAGHTIGH, N. (1937). L’appareil neuro-myo-artériel juxtaglomérulaire du rein; ses réactions en pathologie et ses rapports avec le tube urinifère. C.R. Soc. Biol., 124 : 293-296. GOORMAGHTIGH, N. (1939). Existence of an endocrine gland in the media of the renal arterioles. Proc. Soc. Exp. Biol., 42 : 688-689 GOORMAGHTIGH, N. (1940). Histological changes in the ischemic kidney with special reference to juxtaglomerular apparatus. Amer. J. Path., 16 : 409-416. GOORMAGHTIGH, N. (1940). Les cellules afibrillaires artériolaires dans l’ischémie rénale chez le chien. Rev. belge Sc. méd., 12 : 85-107. GOORMAGHTIGH, N. (1940). Le cycle glandulaire de la cellule endocrine de l’artériole rénale du lapin. Arch. Biol. 51 : 293-311. GOORMAGHTIGH, N. (1941). New facts about the histophysiology of Bright’s disease. Acta brevia Neerland., 11 : 24-27. GOORMAGHTIGH, N. (1941). La doctrine de la cellule musculaire afibrillaire endocrine en pathologie humaine. 1. La néphrosclérose vasculaire bénigne. Bull. Acad. roy. Méd. Belg., 6 : 380-405. GOORMAGHTIGH, N. (1942). La doctrine de la cellule musculaire afibrillaire endocrine en pathologie humaine. 2. Le rein dans l’éclampsie puerpérale. Bull. Acad. roy. Méd. Belg., 1 : 194-216. GOORMAGHTIGH, N. (1944). La fonction endocrine des artérioles rénales; son rôle dans la pathogénie de l’hypertension artérielle. Rev. belge Sc. méd., 16 : 65-155. GOORMAGHTIGH, N. (1945). Vascular and circulatory changes in renal cortex in the anuric crush-syndrome. Proc. Soc. Exp. Biol. Med., 59 : 303-305. GOORMAGHTIGH, N. (1945). Facts in favour of an endocrine function of the renal arterioles. Journal of pathology and bacteriology, (GB and Ireland) v. LVII. GOORMAGHTIGH, N. (1947). The renal arteriolar changes in the anuric crush-syndrome. Amer. J. Pathol., 23 : 513-529. GOORMAGHTIGH, N. (1948). Over hypertensie. Handelingen van het 33ste Vlaams Natuur- en Geneeskundig Congres, Gent, 28 september 1947. Drukkerij Marcel Hayez, Brussel. GOORMAGHTIGH, N. (1951). La fonction endocrine des artérioles rénales et sa signification. J. Urol., 57 : 467-471. GOORMAGHTIGH, N. (1951). Le mesangium du floculus glomérulaire. Ses réactions dans la glomérulonéphrite aigue et les néphrites hypertensives. J. Urol., 57 : 569-585. GOORMAGHTIGH, N. (1956). Le remaniement de la circulation rénale au cours de la glomérulonéphrite chronique. Rev. belge Path. Méd. exp., 25 : 182-189.
Works Referring to Goormaghtigh’s Medical Research
HARTROFT P.M. “The Juxtaglomerular Complex” Annual review of medicine, 1966 L. VAN BOGAERT: Academy eulogy of Professor Norbert Goormaghtigh (1890-1960). Mem Acad R Med Belgian. 1969 Dec;7(3):89-114. PMID 4935653 HOWE, A. PAC, R.J. AND CASTRO K. “Hypertrophy of Abdominal Vagal Paraganglia Following Chronic Hypoxia: Compared with Carotid Body” Editors: Eyzaguirre, C., Fidone, S.J., Fitzgerald, R.S., Lahiri, S., McDonald, D.M. (Eds.) Arterial Chemoreception. Springer 1990 H. ROELS: Norbert Goormaghtigh and his contribution to the histophysiology of the kidney. J Nephrol. 2003 Nov-Dec;16(6):965-9. PMID 14736028 GEORGE C.R.P. “The cellular history of the glomerulus” J. Nephrology 2003 16: 949 - 957 EKNOYAN G., RUBENS R. AND LAMEIRE N. The Juxtaglomerular Apparatus of Norbert Goormaghtigh - A Critical Appraisal. 2009 Oxford University Press THURAU K., DAVIS J.M. AND HABERLE D.A. “Renal Blood Flow and Dynamics of Glomerular Filtration: Evolution of a Concept from Carl Ludwig to the Present Day” Editors: Gottschalk C.W., Berliner R.W. and Giebisch G.H. Renal Physiology: People and Ideas American Physiological Society, Springer. 2013 p. 46 LAMEIRE N. “Wars, disasters and kidneys” ACTA CLINICA BELGICA. 69(6). p.418-425 2014
References
1. Ghent University - Wikipedia 4.3 List of Rectors 2. <https://www.nobelprize.org/nomination/archive/show.php?id=4140> 3. Eknoyan G., Rubens R. and Lameire N. The Juxtaglomerular Apparatus of Norbert - Goormaghtigh - A Critical Appraisal. 2009 Oxford University Press. 4. H. ROELS: Norbert Goormaghtigh and his contribution to the histophysiology of the kidney. J Nephrol. 2003 Nov-Dec;16(6):965-9. PMID 14736028 5. Varty, David The Life and Medical Work of Norbert Goormaghtigh, Vancouver, Varty & Company Printers. 2016. 25 6. Ibid. 35 7. Ibid. 79 8. 1949 Social Service for Students | UGentMemorie - https://www.ugentmemorie.be/gebeurtenissen/1949-sociale-dienst-voor-studenten 9. L. VAN BOGAERT: Academy eulogy of Professor Norbert Goormaghtigh (1890-1960). Mem Acad R Med Belgian. 1969 Dec;7(3):89-114. PMID 4935653 10. Varty, The Life and Medical Work of Norbert Goormaghtigh, 96-109 11. L. VAN BOGAERT: Academy eulogy of Professor Norbert Goormaghtigh (1890-1960). Mem Acad R Med Belgian. 1969 Dec;7(3):89-114. PMID 4935653
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