The Founding of Pediatric Neurology in America

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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 available 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 historical 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

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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 medicine 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-

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dent of the New York Academy of Medicine. He was the prime mover behind 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 topics. His bibliography17 attests to his special interests in neurological disorders 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 neuropathy, 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 diphtheritic 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 became 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 medical 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.

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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 acquired 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 neurologist 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 progressive? 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

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Fig. 2 Bronson Crothers (1884-1959). Reproduced by the permission from Byers, R.K.: Bronson Crothers (1884-1959). J. Ped. 58: 438-44, 1961. discusses such disorders of function as speech problems, tics and habits, and learning problems. These latter problems, common in the pediatric

Vol. 57, No. 9, November 1981 810 D. A. STUMPF setting, were given only cursory treatment in prior, more traditionally neurological texts. Crothers, first in a White House conference30 and later in A Pediatri- cian in Search of Mental Hygiene,31 explored the complex "mental hygiene movement." This movement was prominent during the first halfof the century and sought, among many other things, to prevent mental ill- ness. This naturally encompassed the pediatric age range and utilized many paramedical skills. Crothers encouraged pediatrics, while maintaining the primacy of caring for physical diseases, to include behavioral and other rel- evant subjects within its training programs. Such preventive psychiatry is now widely taught in pediatrics. Crothers is best remembered now for his works on cerebral palsy. He followed a carefully selected population of patients over many years. The Natural History of Cerebral Palsy" is a summary ofthis extensive work and is particularly notable for longitudinal data difficult to find elsewhere. His books point out his compassionate nature, concern for personality development, and the importance he at- tached to the art of medicine. Crothers sought professional affiliations in both parent disciplines as a member ofthe American Neurological Association and the American Pedi- atric Society. He was president of the Society in 1951. His major contributions to pediatrics led to the Society's coveted John Howland Award in 1960. He knew of his honor but died of motor neuron disease before receiving it. The Bronson Crothers chair of Neurology at Harvard was the first en- dowed pediatric neurology professorship. Occupied briefly by Lahut Uzman (1923 to 1962)" before his untimely death, and since then by Charles F. Barlow, this endowment assures a prominent role for Harvard in the future of child neurology34. FRANK R. FORD (1892-1970) Frank Ford (Figure 3) was born and spent nearly his entire life in Balti- more, where he established a strong pediatric neurology service. He gradu- ated from Johns Hopkins University in 1915 and its medical school in 1920. He spent a year in psychiatry at the Phipps Psychiatric Clinic under Adolf Meyer, but found Meyer's laboratory more objective and satisfying. He left for New York and Bellevue Hospital for a year of neurology training under Foster Kennedy. Here he would also have encountered Sachs, who was a member of the staff.

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Fig. 3 Frank R. Ford (1892-1970). Reproduced by permission from Chambers, J.W., Nelson, B.A., Martin, L., et al.: Frank Rodolph Ford (1892-1970)Johns Hopkins Med. J. 128: 96-109, 1971.

He returned to the Johns Hopkins Hospital in 1923 and was chiefofneu- rology from 1932 to 1958. He had a major interest in pediatric neurology. Cerebral Birth Injuries and Their Results (1927) was his first book in this area. His text, Diseases of the Nervous System in Infancy, Childhood and Adolescence,36 was first published in 1937. This book grew from 950 to over 1,500 pages by its posthumous six edition. Ford must have worked on this continuously, considering the amount of material he included and

Vol. 57, No. 9, November 1981 812 D. A. STUMPF that he did all the work including the typing! This work, which became the Bible ofpediatric neurology, remains his major legacy. To those who worked with him, his greatest strength was his authoritative bedside finesse, which led to his designation as "the judge." Ford's work was confined to Baltimore. He did not join national societies and declined invitations to speak elsewhere. His withdrawn personality also made it difficult for him to teach classes. 35.37.38

OTHER CONTRIBUTORS These pioneers set the stage for the development of pediatric neurology as a subspecialty. The decade after Crothers and Ford initiated their endeav- ors saw others begin their academic careers with significant contributions to child neurology. Douglas N. Buchanan was drawn to the University ofChi- cago in 1931 by Percival Bailey and held weekly clinics at Children's Memo- rial Hospital with encouragement from the influential pediatrician Joseph Brennemann. His work with Bailey and Bucy resulted in the still authoritative Intracranial Tumors ofInfancy and Childhood39 in 1939. Bernard J. Alpers in Philadelphia,40 while maintaining a broad base in neurology and neuropathology, cultivated his interest in pediatric patients. His descrip- tion41 of the cortical degenerative disease that now bears his name is particularly memorable. Randolph K. Byers began his work at Children's Hospital in Boston shortly after Crothers. He produced many exceptionally incisive and well written papers that demonstrate his special ability to clarify a wide variety of perplexing problems. H. Douglas Eaton (1886-1952)42 arrived in Los Angeles in 1921 and became the Chief of Neu- rology at Los Angeles Children's Hospital. Wilbur Smith taught neuroana- tomy at the University of Rochester from 1930, subsequently went to Queen's Square for neurology training and on his return directed pediatric neurology until his retirement in 1968. Other physicians, devoting major attention to other areas of medicine, made important contributions to pediatric neurology. Sarah J. McNutt (1839-1930)43 was primarily interested in the perinatal period, and had been trained in obstetrics and pathology. She was a member of the American Neurological Association (1885 to 1902), wrote on the neuropathology of birth injuries, and founded Babies Hospital in New York City. Other notable early neuropathologists with pediatric interests were Myrtelle M. Cana- van (1879-1953), Cyril B. Courville (1900-1968),4 and Paul I. Yakovlev.

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Edouard 0. Seguin (1812-1880) did pioneer work with the mentally retarded at the Bicetre and Hospice des Incurables before departing for America during the 1848 revolution. He continued his exemplary work, settling by 1861 in New York City, where he and his sons remained influential.8 Harvey Cushing's work on brain tumors included many pediatric patients. Cushing was greatly influenced by William Osler, who wrote classic monographs on chorea and cerebral palsy during his earlier years. Pediatric neurology in other countries influenced our earlier subspecial- ists. Jean Baumes (1756-1828), in his 500-page Traite des Convulsions dans L'enfance, reviewed many neurological disorders producing convulsions.45 This remarkable book, first published in 1787 and in an expand- ed text in 1805,46 discusses genetic factors, febrile seizures, neonatal convulsions, parasites, toxins including maternal alcoholism, hydrocephalus, and other anomalies. Desire Bourneville (1840-1909)47 was neurologist to and chiefofthe pediatric service ofthe Bicetre and the continental expert in child neurology. Frederick Batten (1865-1918) took a special interest in pediatric disorders at the National Hospital for Paralyzed and Epileptic in Queen's Square and at the Hospital for Sick Children at Great Ormond Street.4849 William G. Wyllie (1889-1969)5° followed Batten as Lon- don's early pediatric neurologist. Ivar Wickman (1872-1914) was a pediatric neurologist and neuropathologist who published several articles on polio- myelitis before his premature death.51 Knud Krabbe (1885-1961)52 5 made important contributions in many areas, including neuroembryology, and published a text in Danish on pediatric neurology in 1947. Sigmund Freud (1856-1939) wrote these significant books on pediatric paralysis, culminat- ing with Die infantile Cerebralldhmung (1897), which was translated into English.54 In 1906, to the encyclopedic pediatric work, Handbuch der Kinderkrankheiten, was added a supplementary volume on neurology which was published in English two years later. 55 EVOLUTION OF THE SUBSPECIALTY During the early 1950s there were pediatricians and neurologists and a few who mixed these specialties in their own special manner. Their training back- grounds were varied. Our present concept of pediatric neurology training grew out of the vision, perseverence, and resources available to Dr. Pearce Bailey, Jr. (1902-1976). Bailey was the director of the National Institute of Neurological Diseases and Blindness which began funding pediatric neurology training in 1957. In 1958 Bailey organized a committee of prominent

Vol. 57, No. 9, November 1981 814 D. A. STUMPF pediatricians and neurologists to evaluate training. This committee established guidelines that are, in general, followed to this day; modifications reflecting changes in adult neurology training were introduced in a follow-up conference in 1967 led by Sidney Carter.56 With these established guidelines, the American Board of Psychiatry and Neurology in 1968 began certification in neurology with special competence in child neurology. By December 1979 361 were certified. Pediatric neurologists have now spread to all parts of our country. The presence ofpediatric neurologists in most medical school faculties attests to their valuable role in teaching. Most ofthose who established pediatric neurology services in medical schools found themselves amply busy with teaching, administrative, and clinical activities. A major challenge presently of academic pediatric neurology is to expand its research productivity. The Child Neurology Society was established in 1972 and has grown to 448 active and 82 junior members awaiting Board certification. Training program directors organized the Professors of Child Neurology in 1978 to consider such pressing current questions as manpower needs and quality control in training; currently more than 70 institutions are represented in this organization. The organization ofchild neurologists has greatly enhanced communica- tion and solidified common bonds. The subspecialty is currently in its adolescence - much as pediatrics and neurology were early in the century and the next several decades promise to be an exciting era of growth into maturity. This process will continue to involve close contact with the parent disciplines. They too will share in and contribute to the advances within pediatric neurology. ACKNOWLEDGEMENTS: I am grateful to those who reviewed the manuscript for accuracy, and provided helpful comments. These include Drs. Bernard J. Alpers, Charles F. Barlow, Douglas Buchanan, Randolph K. Byers, Thomas E. Cone, Jr., Darryl C. DeVivo, Paul R. Dyken, Sidney Carter, and H. Richard Tyler. A special appreciation is felt for Dr. Tyler, who, as my mentor in neurologic history, spawned my interest in our pediatric neurology heritage. REFERENCES 1. Brandt, S.: The Parentage of Child bourne, M., editors. New York, Spec- Neurology. In: Topics in Child Neu- trum, 1977, pp. 3-7. rology, Blaw, M., Rapin, I., and Kins- 2. Salam, M.Z.: Pediatric neurology. An

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emerging subspecialty in the U.S.A. development of neurology in America with a brief commentary on its poten- and its relation to medical science. J. tial development in the Middle East. Mt. Sinai Hosp. 10: 678-83; 10: Leb. Med. J. 18: 495-510, 1965. 765-72, 1944. 3. Clarke, E. and O'Malley, C.D.: The 17. Sachs, B.: Bibliography. J. Mt. Sinai Human Brain and Spinal Cord. A Hosp. 9: 262-70, 1942. Historical Study, illustrated by writ- 18. Meyer, A.: Historical fragments on the ings from antiquity to the twentieth neurological and psychiatric special- century. Los Angeles and Berkeley, ties. Factors and results in an eminent University of California Press, 1968. medical and specifically neurological 4. McHenry, L.C.: Garrison's History of career. J. Mt. Sinai Hosp. 9: 213-48, Neurology. Springfield, Ill., Thomas, 1942. 1969. 19. Sachs, B.: On arrested cerebral devel- 5. Levinson, A.: Notes on the History of opment, with special reference to its Pediatric Neurology. In: Essays on cortical pathology. J. Nerv. Ment. History of Medicine, Kagan, S.R., Dis. 14: 541-53, 1887. editor. Frosben, N.Y., Victor Robin- 20. Sachs, B.: A Treatise on the Nervous son Memorial volume, 1948, pp. 225- Diseases of Children for Physicians 40. and Students. New York, Wood, 6. Peterman, M.G.: Pediatric contribu- 1895. tions to neurology. J.A.M.A. 165: 21. Plum, F. and Jonas, S.: Louis Haus- 2161-62, 1957. man (1891-1972). Trans. Am. Neurol. 7. Rubinstein, E.A.: Childhood mental Assoc. 98: 328-29, 1973. disease in America. A review of the 22. Sachs, B.: The false claims of psycho- literature before 1900. Am. J. Ortho- analysts. Am. J. Psychiat. 12: 725-49, psychiat. 18: 314-21, 1948. 1933. 8. Kanner, L.: A History ofthe Care and 23. Yahr, M.D.: Louis Casamajor Study of the Mentally Retarded. (1881-1962). Trans. Am. Neurol. Springfield, Ill., Thomas, 1964. Assoc. 88: 299, 1963. 9. Wilkins, R.H. and Brody, I.A.: Neu- 24. Byers, R.K.: Bronson Crothers (1884- rological Classics. New York, Johnson 1959). J. Pediatr. 58: 438-44, 1961. Reprint Corp., 1973. 25. Denny-Brown, D.: Bronson Crothers 10. Portrait Catalog of the Library of the (1884-1959). Trans. Am. Neurol. New York Academy ofMedicine, Bos- Assoc. 85: 251-52, 1960. ton, Hall, 1960, vol. 5, p. 3604. 26. Crothers, L.B.: A Family Chronicle. 11. Kennedy, F.: Bernard Sachs. Bull. Concord, N.H., Rumford, 1966. N. Y. Acad. Med. 20: 309-11, 1944. 27. Crothers, B.: Changes of pressure in- 12. Hausman, L.: Dr. Bernard (Barney) side the fetal craniovertebral cavity. Sachs - Biographical milestones. J. Surg. Gynecol. Obstet. 37: 790-801, Mt. SinaiHosp. 9:258-60,1942. 1923. 13. Haymaker, W.: Bernard Sachs. In: 28. Crothers, B. and Putnam, M.: Obste- Founders ofNeurology, 2nd ed., Hay- trical injuries of the spinal cord. Med- maker, W. and Schiller, F., editors. icine 6: 41-126, 1927. Springfield, Ill., Thomas, 1970, pp. 29. Crothers, B.: Disorders of the Ner- 513-17. vous System in Childhood. New York, 14. Hausman, L.: Bernard Sachs (1858- Appleton, 1926. 1944). Proc. Charaka Club 11: 231- 30. Crothers, B.: Psychology and Psychi- 38, 1947. atry in Pediatrics: The Problem. New 15. Sachs, B.: The first neurological divi- York, Century, 1932. sion in New York City - at the Mount 31. Crothers, B.: A Pediatrician in Search Sinai Hospital. J. Mt. Sinai Hosp. 9: of Mental Hygiene. New York, Com- 292-95, 1942. monwealth Fund, 1937. 16. Sachs, B.: The early years and rapid 32. Crothers, B. and Paine, R.S.: The

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Natural History of Cerebral Palsy. Bull. L.A. Neurol. Soc. 33: 160-84, Cambridge, Mass., Harvard Univer- 1968. sity Press, 1959. 45. Harms E.: A nonpsychiatric pioneer 33. Denny-Brown, D.: Luftu Lahut Uz- of childhood neuropsychiatry, Am. J. man (1923-1962). Trans. Am. Neurol. Psychiatry 122: 222-23, 1965. Assoc. 88: 302-04, 1963. 46. Baumes, J.B.T.: Traite des Convul- 34. Anonymous: Bronson Crothers pro- sions dans VEnfance, de leurs causes, fessorship of neurology: "Not the dis- et de leur traitement, 2nd ed. Paris, ease only, but also the man." Harvard Societe de Medecine, 1805. Med. Alumni Bull. 36 (2): 5,8, 1961. 47. Benda, C.E.: Desire Magloire Bourn- 35. Chambers, J.W., Nelson, R.A., Mar- ville (1840-1909). In: The Founders of tin, L., et al.: Frank Rodolph Ford Neurology, 2nd ed., Haymaker, W. (1892-1970). Johns Hopkins Med. J. and Schiller, F., editors. Springfield, 128: 96-109, 1971. Ill., Thomas, 1970. 36. Ford, F.R.: Diseases of the Nervous 48. Chaves-Carballo, E.: Eponym: Fred- System in Infancy, Childhood and erick E. Batten: Father of pediatric Adolescence. Springfield, Ill., Thom- neurology. South. Med. J. 71: 1428- as, 1937. 29, 1978. 37. Langworthy, O.R.: The Johns Hop- 49. Anonymous: Frederick Eustace Bat- kins Hospital and Medical School. In: ten, M.D. Cantab., F.R.C.P. Br. Centennial Anniversary Volume of Med. J. 2: 148, 1918. the American Neurological Associa- 50. P.R.E.: W.G. Wyllie, M.D., F.R.C.P.: tion, 1875-1975, Denny-Brown, D., Br. Med. J. 4: 372, 1969. Rose, A.S., and Sahs, A.L., editors. 51. Klotz, M.: Nachruf auf Ivar Wick- New York, Springer, 1975, pp. 429- man. Z. Neurol. Psych. (Berlin) 26: 33. 1-5, 1914. 38. McKusick, V.A. and Tumulty, P.A.: 52. Pakkenberg, H.: Knud H. Krabbe Dedication to Frank R. Ford, M.D. (1885-1961). Trans. Am. Neurol. Birth Defects 7 (1): 1, 1971. Assoc. 87: 264-66, 1962. 39. Bailey, P., Buchanan, D.N., and 53. Schlesch, T. and Fog, T.: Bibliog- Bucy, P.C.: Intracranial Tumors of raphy ofthe works ofKnud H. Krabbe. Infancy and Childhood. Chicago, Acta Psych. Neurol. Scand. 30: VII- University of Chicago Press, 1939. XIX, 1955. 40. Berry, R.G.: Bernard Jacob Alpers. 54. Freud, S.: Infantile Cerebral Paraly- In: Centennial Anniversary Volume of sis, Russin, L.A., translator. Coral the American Neurological Associa- Gables, Fla., University of Miami tion, 1875-1975, Denny-Brown, D., Press, 1968. Rose, A.S., and Sahs, A.L., editors. 55. Pfister, H.: The Peculiarities of the New York, Springer, 1975, pp. 297- Child's Nervous System, pp. 111-22; 301. Zappert, J.: Organic Diseases of the 41. Alpers, B.J.: Diffuse progressive Nervous System, pp. 123-284; Thie- degeneration of the gray matter of the mich, M.: Functional Diseases of the cerebrum. Arch. Neurol. Psychiat. Nervous System, pp. 285-375; Thie- 25: 469-505, 1931. mich, M.: Diseases of the Meninges, 42. Anonymous: H. Douglas Eaton (obi- pp. 376-417. In: The Diseases ofChil- tuary). J.A.M.A. 149: 1662, 1952. dren, vol. 4, Pfaundler, M. and 43. Anonymous: Dr. Sarah J. McNutt. Schlossmann, A., editors. Philadel- In: Semi-centennial Anniversary Vol- phia, Lippincott, 1908. ume of the American Neurological 56. Severinghaus, A.E.: Neurology: A Association (1875-1924), Tilney, F. Medical Discipline takes Stock. and Jelliffe, S.E. editors. Albany, DHEW Publication No. (NIH) 72- N.Y., Boyd, 1924, pp. 214-16. 175, pp. 74-80. Washington, D.C., 44. Anonymous: Cyril B. Courville, M.D. Govt. Print. Off., 1971.

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