© 2002 American Thoracic Society
Richard Lord Riley, 1911–2001An AppreciationJohns Hopkins University, Baltimore, Maryland Solbert Permutt, M.D., Department of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Johns Hopkins University, Baltimore, MD 21224. E-mail: spermut{at}mail.jhmi.edu Richard Lord Riley was my mentor. He was an aristocrat with impeccable manners. He was always controlled and polite, even in the most intense scientific arguments. Those who know me must realize that for Dick Riley to maintain his refined manners in discussions with me made him a person with ironclad control of his emotions. Riley had a childlike innocence and enthusiasm for science. When people presented their new ideas to him, he just lit up, not unlike a child seeing a new toy. Sometimes it seemed as if he could appreciate the implications even more than the presenter. Moran Campbell tells the following story. After being in Riley's laboratory for a few weeks, fresh from his intense training in physiology with Sampson Wright in England, he and Harry Martin presented to Riley some tracings of the relationship between flow and pressure during a forced expiration. Riley came back to them a few days later with his hands filled with lots of graphs, his mind filled with lots of new ideas, and his heart filled with great enthusiasm. Moran was shocked, shocked: "I have not been brought up to extrapolate wildly from preliminary findings using equipment of questionable reliability." Riley: "In that case, you have come to the wrong place. I have spent my whole life doing just that." It was common knowledge that if you presented a new idea to Riley and he seemed unenthusiastic, forget it! Sometimes, his childlike enthusiasm, coupled with another childlike companion, could be downright dangerous. My daughter, Nina, reminded me of this frightening event. Dick and I used to drive to work together and drop our children off at their schools on the way. Nina says that one winter day, we had not paid much attention to the defroster, so that the windshield got fogged up. What was alarming to her was that we continued to drive, while drawing graphs on the clouded windshield to clarify our position! Riley was a giant in two disparate areas: gas exchange and airborne contagion. There are others in respiratory physiology and medicine who have made more than one great contribution, but what I think is unique about Riley's contributions is that while one is history, the other, more than 50 years later, is of great current interest and focus. His contribution to the understanding of gas exchange, in health and disease, is recognized in all of the histories of respiratory physiology and medicine that have been written in the last forty years. His major contribution was to devise an ingenious and practical method of measuring blood O2 and CO2 tensions with a little bubble that would equilibrate with the gas tension of the blood. This was the only method available for many years. He developed the most ingenious graphic methods of quantifying the role of diffusion and ventilation–perfusion ratios on the alveolar–arterial gradient. Why are his bubbles and graphs no longer used? In his own words: "The culprit: modern technology." The blood gases are now measured by sophisticated electrodes and the graphs have been replaced by the output of modern computers. Not an hour passes in a modern critical care unit without consideration being given to the A–a O2 gradient, and that is pure Riley then and now. When Riley was a medical student at Harvard, he met Mr. William Firth Wells, who proposed the droplet-nucleus theory to explain how a disease could be spread through the air. In Riley's last paper, "What nobody needs to know about airborne infection," published just a few months ago in this journal (2001;163:7–8), he tells the story of how together with Wells, a mad genius (those are Riley's own words), and an obsessively compulsive technician, Cretyl Mills, the three of them initiated one of the most important and convincing experiments ever performed on how a disease is transmitted through the air. Riley's genuine modesty and humility shine through: he gives Wells the credit as the major force behind the work even though Wells was no longer capable of contributing to the prolonged experiment, and Riley is ashamed that Wells's name was not on the paper. Their work showed that patients in a room on one floor of a hospital infected guinea pigs in cages on a floor above when the guinea pigs breathed the air coming from the room where the patients were confined. The technical problems of carrying out that experiment—the work was begun in 1954 and not completed until 1962—were awesome. The complexities were so great that it is understandable why the experiment has never been repeated. But today there is great interest in reproducing the setup of those experiments to study important things that cannot be answered without having just the conditions of Riley's experiment: patients with tuberculosis in one room and guinea pigs in another, with no contact except the air from the patients' room. The great interest is not in seeing whether the experiment of Riley reached the correct conclusion—everyone accepts that. At least two major questions are being asked by Edward Nardell and his Harvard colleagues: how effective is upper air irradiation with UV in comparison with ventilation in decreasing the transmission of tuberculosis, and what are the factors that determine the infection of a given patient? Riley was actively collaborating with Nardell until the day he died, with all of his childlike enthusiasm still intact in his 90th year. Received in original form May 28, 2002; accepted in final form May 29, 2002
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