LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES

DR. DEREK DENNY-BROWN, OBE, MD, DPHIL, FRCP, 1901-1981 An Appreciation by R.W. GILLIAT Chairman, University Department of Clinical Neurology The National Hospital Queen Square, London, England

With the death of Dr. Denny-Brown on April 20th, 1981, many of us in clinical neurology feel that we have lost a father-figure, someone to whom we could bring our professional and scientific problems for an opinion different from other opinions, based on his unique experience of the physiology and pathology of the nervous system as well as of clinical neurology. There can be few people whose influence on the neurology of this century has been greater, or whose pupils can have derived more strongly the feeling of having been changed by their experience. Derek Ernest Denny-Brown was born in Christchurch, New Zealand on June 1st, 1901. He qualified in med­ icine from the University of Otago in 1924, and became a demonstrator in anatomy. In 1925 he obtained a Beit Memorial Fellowship to work with Sir Charles Sherrington at Oxford. As a PhD student (albeit a medically- qualified one), it must have been a daunting experience to join Sherring­ ton's group which then included such figures as Sybil Cooper, R.S. Creed, and E.G.T. Liddell. His time at Oxford was in fact an astonishingly productive one, resulting in 14 papers in addition to his D.Phil thesis. These included the classical papers with Cooper and Sherrington on the flexor reflex, analysing fractionation, occlusion and facilitation, and leading to the concept of the subliminal fringe. Equally important was Denny-Brown's work with Liddell on the stretch reflex, and his work on red and white muscle, from which came his view of reflex postural contraction as the result of a slow, repetitive motor-unit discharge

Vol. 8 No. 4 NOVEMBER 1981 —271 Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.22, on 27 Sep 2021 at 06:40:01, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0317167100043377 THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES

occurring particularly in red, slowly- clinical training. In 1931 he became which he acted as consultant neuro­ contracting muscles, and stabilised by registrar to outpatients, subsequently logist in India and South East Asia. a balance between excitatory and moving to Guy's Hospital where he From this period came his interest in inhibitory afferents. The steps by was registrar to Charles Symonds until nutritional deficiency disorders and in which this conclusion was reached are his appointment to the consultant staff thiamine-deficiency neuropathy in par­ clearly summarised in the book en­ at Queen Square and at St. Barthol­ ticular. titled 'Reflex Activity of the Spinal omew's Hospital in 1935. In 1936 he Returning to Harvard in 1946 he Cord* by Creed, Denny-Brown, Eccles, gave the Goulstonian Lectures at the became James Jackson Putman Pro­ Liddell and Sherrington, published in Royal College of Physicians and in the fessor of Neurology, a chair which he 1932. same year received a Rockefeller held until 1967. These years, during From his experience at Oxford Travelling Fellowship to work with which he directed the Harvard Neuro­ Denny-Brown derived not only his John Fulton at Yale. From this year logical Unit at the Boston City Hospi­ abiding interest in posture and move­ came his expertise in operating on tal, probably represent his greatest ment but also the Sherringtonian monkeys, and his interest in primate contribution to the clinical neurology principle that the physiological me­ research as a method of providing a of our time. First of all, he saw clearly thod is most effective when firmly better understanding of human move­ that neurology must be separate not linked to histological studies of the ment disorders. only from internal medicine but also same system. His friendship with Returning to England in 1937, from psychiatry, and that while the Charles Sherrington was something Denny-Brown resumed his practice neurologist must derive his inspiration which remained a source of pleasure and teaching at Queen Square and and raison d'etre from the patient, and animation throughout his life. embarked on his study of human skills in neuropathology and physiolo­ In 1928 Denny-Brown was ap­ fibrillation and fasciculation with gy were the weapons he needed to pointed Resident Medical Officer to Pennybacker, followed by his study of make original contributions to the the National Hospital for Nervous myotonia with Nevin. In 1939 he subject. He was one of the first to Diseases at Queen Square. At that accepted the directorship of the Har­ recognise the importance of neuro- time the senior staff of the hospital vard Neurological Unit at the Boston chemistry, and in his Shattuck Lecture included Gordon Holmes and Klnnier City Hospital, but the arrangements in 1952 he used current work in this Wilson; among the junior consultant were disrupted by the outbreak of field to illustrate his theme that staff were Walshe, Adie, Riddoch and World War II, and Denny-Brown, neurology and the neurosciences had Symonds. The registrar (a neurologist- together with other Queen Square grown up, and had become a defined in-training responsible for organising neurologists, moved to the Military and distinct subject within medicine. the outpatient clinics) was MacDonald Hospital for Head Injuries at Oxford In fact, the neurological unit at the Critchley, and the pathologist was and then into uniform. This period Boston City Hospital at that time Godwin Greenfield. Of all Denny- gave him the opportunity to return attracted some of the most brilliant Brown's teachers at Queen Square, the briefly to the physiology laboratory at young men in American medicine, and one who influenced him most was Oxford to work on concussion in Denny-Brown's influence on the sub­ Gordon Holmes. Denny-Brown sub­ experimental animals with Ritchie sequent development of American sequently wrote, "He (Holmes) had Russell. neurology was as much through these discovered early in his studies that the In 1941 Denny-Brown was released academic clinicians who had worked elicitatlon of scientific data at the from the British Army at the express with him, as through his own writings. bedside required a discipline of meth­ request of Dr. Conant, the President of By the early 1960s he could write, "Out od as rigid as that of the laboratory. Harvard University, in order to take of 41 university departments in the This he never tired of demanding of his up his appointment in the Medical United States, 19 (almost half) had house officers and clinical clerks. School. As a wartime project Denny- departmental chairmen who had the Others would discourse on the scholar­ Brown proceeded to study the effect of major part of their training in the ly aspects of varieties of disease, to trauma of peripheral nerves, collabor­ neurological unit of the Boston City which Holmes would also add pearls ating with Charles Brenner, Margaret Hospital". from his enormous experience, but Doherty and Raymond Adams. In the In 1960 Denny-Brown was invited what one gained particularly from him course of this work Denny-Brown to be the first holder ofthe new chair of was an abiding interest in the how of identified segmental demyelination as clinical neurology which was to be symptomatology, and ways of eliciting being the morphological change re­ established by the University of Lon­ physical signs that gave them infallible sponsible for conduction block, a don at Queen Square. Refusing the significance." concept which was subsequently to post with great regret, on grounds of For Denny-Brown the years at prove of great importance to our age, he wrote in characteristic fashion Queen Square were as important as understanding of generalised peripher­ to the Dean at Queen Square a long those at Oxford. With his immense al neuropathy and of central demyelin­ letter which has been preserved, setting capacity for hard work, he was soon ation. In 1945 Denny-Brown was given out his views on the training of undertaking research (with Graeme leave from Harvard for further mili­ academic neurologists, and asking Robertson) as well as completing his tary service in the British Army, during many shrewd questions. Who would

272 - NOVEMBER 1981 Dr. Derek Denny-Brown: An Appreciation Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.22, on 27 Sep 2021 at 06:40:01, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0317167100043377 LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES

look after the 30 beds he asked, so that between 1957 and 1967, of which membership of many foreign medical the professor did not spend too much Denny-Brown himself was the author societies. He served as President of time in the day-to-day care of patients? or joint author of more than 60. Far both the American Neurological As­ For whom was the teaching? Was it to from stopping his experimental work sociation and the American Associa­ train future academics or busy consul­ in 1967 when he retired from the tion of Neuropathologists. In England tant neurologists in the British Nation­ Harvard chair, he moved to the New he gave the Croonian Lectures at the al Health Service? What, he asked England Regional Primate Research Royal College of Physicians in 1960 ominously, would be the position with Centre, from which he continued to and the Sherrington Lectures at Liver­ regard to neuropathology? Could he publish experimental papers. Some of pool in 1963. He received the Sherring­ be assured that residents would rotate these were written while he was ton medal of the Royal Society of through neuropathology, and that the Fogarty Scholar-in-Residence at the Medicine in London in 1962. new professor would have responsibil­ National Institutes of Health in 1972- His presentations at meetings con­ ity for organising their neuropatho- 3, including his last paper in Brain in tinued long after his official retire­ logical teaching? He wrote "Neuro­ 1973, in which he and Yanagisawa ment, the last one being at the Boston pathology is the essentia] science of established that the area and severity meeting of the American Neurological neurology, and unless the neuropath­ of sensory loss after trigeminal tract Association in September, 1980. By ology laboratory is the place where section in monkeys could be strikingly this time, however, his health, which everybody works in some degree, no modified by pharmacological agents had started to deteriorate several years scientific progress can be made...If such as strychnine or LDopa. earlier, was such that he needed a stick some doubt my insistence on full-time After completing his experimental to stand at the rostrum. In character­ training in neuropathology, ask them studies, Denny-Brown accepted the istic fashion he was particularly irri­ to look up the records of Wilson, task of editing the official history of tated by the way this interfered with his Collier, Holmes, Symonds and Adie." the American Neurological Associa­ presentation of the slides. His last He concluded his letter as follows: "I tion for the centenary of the Associa­ illness, which was a protracted and wish this was all ten years ago, and I tion in 1975. This formidable task, painful one, was faced with indomit­ would have come like a shot. Now involving collation of the biographies able courage, and he continued to there are many complications, but rest of 100 past-presidents, and detailed correspond on scientific matters al­ assured that I would like to come." accounts of the development of neuro­ most to the end. In a letter written a Sadly for the staff at Queen Square, logy in different regions of the United few weeks before his death, he apolo­ Denny-Brown never became their first States, was admirably achieved by gised for the delay in writing, mention­ professor of neurology, but his affec­ Denny-Brown and his assistant editors. ing the difficulty of typing while lying tion for the hospital remained, and he The book contains a short biography flat. gave up much time to advise and help of Denny-Brown himself by his friend The loss sustained by his devoted in the years that followed. and collaborator Joseph Foley, which wife, Sylvia, and by his children is one Meanwhile the output of papers lists his many academic honours. which we all share. For those of us who from the Neurological Unit at the These included honorary degrees had the privilege of his friendship there Boston City Hospital was astonishing; awarded in America, the United King­ is something missing from our world from this small unit some 230 appeared dom and New Zealand, and honorary which cannot easily be replaced.

Gilliat Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.22, on 27 Sep 2021 at 06:40:01, subject to the Cambridge Core terms of use,NOVEMBE available at R 1981 — 273 https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0317167100043377