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The Founding of Pediatric Neurology in America

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The Founding of Pediatric Neurology in America 804 THE FOUNDING OF PEDIATRIC NEUROLOGY IN AMERICA DAVID A. STUMPF, M.D., Ph.D. Departments of Pediatrics and Neurology School of Medicine University of Colorado Health Sciences Center Denver, Colorado T he history ofpediatric neurology is not widely known, although it has been briefly discussed previously."2 Some will argue that it is too early to review this history since the subspecialty is still maturing, and many important pioneering physicians are still active. This account con- siders the evolution of the subspecialty and the individuals involved, but mentions the living only briefly to avoid unwitting offense. Historical re- views of diseases or the science ofthe developing nervous system are avail- able elsewhere.3'9 A hundred years ago, both pediatrics and neurology struggled for an identity apart from general medicine. Pediatric neurology developed inde- pendently within neurology and within pediatrics. Only later was a merger consummated to produce a hybrid subspecialty, taking the best from two exciting areas of medicine and remaining closely affiliated with both. The total history is often an enigma to those who limit their activities to the- parent disciplines. It is unusual for a subspecialty to emphasize such strong ties with two major areas of medicine. Obviously, many physicians devoted significant and perhaps nearly exclusive efforts to the care of nervous system disease in children. The his- torical significance of these individuals is often not measured by their importance in their own time but on the record they left behind in print, physicians they trained, or new concepts they established. BERNARD SACHS (1858-1944): THE FATHER OF PEDIATRIC NEUROLOGY Bernard Sachs (Figure 1) was the Dean of American neurology at the Address for reprint requests: University of Colorado Health Sciences Center, Box C 229, 4200 East Ninth Avenue, Denver, Col. 80262 Bull. N.Y. Acad. Med. PEDIATRIC NEUROLOGYNEUROLOGY805805 Fig. 1 Bernard Sachs (1858-1944): The father of pediatric neurology. Several other Sachs portraits are available.1O Reproduced by permission from Kennedy, F.: Bernard Sachs. Bull. N. Y. Acad. Med. 20: 309-11, 1944. Vol. 57, No. 9, November 1981 806 D. A. STUMPF time of his death in 1944.12-14 He was born in Baltimore two years before Lincoln's election. His brother Julius became a prominent teacher and prepared him for Harvard College, where he received the Bowdoin Prize and delivered the commencement address in 1878. He studied medi- cine in Strasbourg, Alsace, and Berlin, graduating from the University of Strasbourg in 1882. For the next two years he studied psychiatry under Meynert in Vienna and neurology with Jackson in London and Charcot in Paris. Sachs returned to New York as an instructor (1884) and then pro- fessor (1888) at the Polyclinic Hospital. Sachs' own words best describe the status of neurology: In the late seventies and early eighties ofthe last century, neurology had already made a distinct impression on medical science here and abroad ... but general medicine as it does to this day [1942], tried to hold its child in check and to deny its rights. No private (voluntary) hospital had established wards for nervous diseases. The general medical attending was supposed to know it all. Discussing this question with Abraham Jacobi as far back as 1885, I asked him whether he realized that a knowledge of neurology has to be acquired and does not come by intuition. He pardoned my boldness and in spite of this frontal attack, we were good friends many years thereafter. I5 His persistence as an early spokesman for neurology led to his commission to open one of the first neurological services at Mount Sinai Hospital in 1900. Sachs became one of the New York City "triumvirate" with Charles Dana and Moses Starr. Sachs was deeply interested in science and advancing the frontiers ofour knowledge: We were proud of those who had preceded us, eager to follow in their foot- steps and to help American neurology in the forefront ofthe scientific battle... To those who may be inclined to have a slight sneer for the clinician and think him inferior to the laboratory worker, let me say as I have said elsewhere, all truescientific research in medicine stemsfrom the bedside. The patient presents the problem, it is for the physician to study and solve it; and he can do much toward formulating these problems if he will wear his thinking cap at the bedside. 16 Sachs became director of the Friedsam Foundation, an early supporter of pediatric neurology research. Sachs was an organization man. He joined the American Neurological Association in 1886 and served as its president in 1894 and again in 1932. He was also twice president ofthe New York Neurological Society and presi- Bull. N.Y. Acad. Med. PEDIATRIC NEUROLOGY 807 dent of the New York Academy of Medicine. He was the prime mover be- hind and president of the First International Neurological Congress in Berne in 1931. He edited the Journal ofNervous and Mental Disease from 1886 to 1891. Sachs published extensively on a wide variety ofgeneral neurological top- ics. His bibliography17 attests to his special interests in neurological dis- orders in children. This interest is attributed to his family's prominent role in education. 18 His description at the age of 29 of the cerebral clinical and pathological abnormalities in amaurotic familial idiocy in 188719 was followed by a series of seven articles over the next 42 years further defining the Tay-Sachs phenotype. He also wrote on myotonia congenita (1886), intracerebral hemorrhage (1887), muscular dystrophies (1888 and later), and congenital syphilis (1896). He wrote a number of papers on poliomyeli- tis and cerebral palsy. Nervous Diseases of Children (1895) was the first pediatric neurology text20 and was translated into German in 1897. This monumental work ofmore than 600 pages demonstrates his wealth ofinfor- mation and broad experience in pediatric neurology, and remains a classic source for data on now uncommon conditions (tetanus, diphtheritic neuro- pathy, etc.) and ofthe natural history of now more treatable diseases (men- ingitis, hydrocephalus). Also discussed are some interesting therapies, including cannabis indicis for epilepsy and migraine, head wrapping for hydrocephalus, phrenic nerve stimulation for respiratory failure in diph- theritic neuropathy, and strychnine as an indispensable nervous system tonic. The second edition was published in 1905, and more extensive revi- sions were incorporated with Hausman21 in Nervous and Mental Dis- ordersfrom Birth Through Adolescence (1926). Sachs established, with funds from the Friedsam Foundation, and be- came the director of the first Division of Child Neurology at the New York Neurological Institute in 1934. Sachs was a pioneer of great importance in neurology's growth from adolescence to maturity and in the birth of child neurology. In this sense, he is the father of pediatric neurology. Sachs maintained an interest in other areas of medicine including medi- cal history16 and psychiatry. He translated Meynert's Psychiatrie into English in 1885 and had several quarrels with the evolving psychoana- lysts.22 He helped to found the Charaka Club devoted to exploring history and the humanities in relation to medicine. He was a trusted friend of Ben- jamin Altman in securing porcelains and paintings, now in the Metropoli- tan Museum of Art. Mountain climbing and walking were his chief sports. Vol. 57, No. 9, November 1981 808 D. A. STUMPF Sachs died February 8, 1944. The Division of Pediatric Neurology he established at the Neurological Institute continued its prominent role under Louis Casamajor (1881-1962),23 Sidney Carter, and now Darryl DeVivo. BRONSON CROTHERS (1884-1959) Bronson Crothers (Figure 2) was a distinguished pediatrician who ac- quired training and broad experience in neurology. He was born in upstate New York, the son of Samuel Crothers, a Unitarian minister, lecturer, essay- ist, and adventurer, and Louise Bronson. He spent most of his boyhood in St. Paul, Minn., before moving to Cambridge, Mass., where he entered Harvard College in 1900. He received his medical education at Harvard, graduating in 1909. He was a house pupil at the Massachusetts General Hospital and then an intern at Children's Hospital in Boston. His briefperi- od in private practice in St. Paul was interrupted by the assassination of Archduke Ferdinand. He served in the British Medical Corps (1915 to 1917), where he acquired an appreciation for neurology from watching Sir Almoth Wright, Sir Henry Head, and Dr. George Riddock. After serving in the United States Army Medical Corps (1917-1919), he returned to pursue his neurological interests. He studied one year in the laboratory of Dr. Walter Cannon under the guidance of Stanley Cobb and at the Neurological Insti- tute in New York with Frederick Tilney. In 1920 he was appointed neurolo- gist to the Children's Hospital in Boston. His clinical experience and ac- complishments over his ensuing 38 years in this position establish him as a pioneer pediatric neurologist.24"26 His early manuscripts on birth trauma27'28 favorably influenced obstetric practices. His 242-page text, Disorders of the Nervous System in Child- hood,29 appeared in 1926. This book reflects Crothers' pediatric orienta- tion, which insisted on distilling the issues down to practical applications: The results of any pathological process are important only as they affect function... I am making no attempt to describe all the various systems. Nor will I attempt to provide the intellectual tools for making elaborate neurological diagnoses. I feel that the important thing is to present a point ofview. I believe that, in cases where damage to the central nervous system is suspected, only a few important questions arise. 1. Can it be arrested? 2. Is it inevitably pro- gressive? 3. If the process is no longer active, does the physiological residue justify efforts at education? The book contains many chapters on defined organic processes, but also Bull.
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