Book Review: Robert Laureno, Raymond Adams: A Life of Mind and Muscle (2009)

Raymond Adams (1911-2008) was one of the most important American neurologists of the twentieth century. He possessed an almost complete knowledge of the neuropathology and neurophysiology of his day and used it to make original clinical contributions to many fields, including neurology, psychiatry, and psychology. His research touched on a variety of clinical research topics, most significantly diseases of muscle, nerves, and liver. The textbook Adams completed in 1977 with Maurice Victor, Principles of Neurology, remains a classic. Terminology he introduced such as asterixis, stratonigral degeneration, and pituitary apoplexy remain common medical parlance. He was one of the first neurologists to consider developmental disability from a neurological and biochemical perspective. He also sought to reclaim stroke as a neurological condition, insisted that clinicians view mental illness from that perspective as well, and drafted the first, legal definition of “brain death.” To his students, colleagues, and even his rivals, Adams elaborated through his work and teaching a complex monist worldview that claimed that neurology encompassed, “all diseases of the nervous system from the simplest disorder of muscle function to the most elaborate psychological derangement such as impaired memory, alertness and attention” (p. 151).


In this thorough and comprehensive oral history, Robert Laureno reveals much about this important and complicated figure. Born in 1911 in Portland Oregon, and the son of a farmer and oil distributor, Raymond Adams grew-up in modest middleclass circumstances. Following completion of his undergraduate degree in psychology from the University of Oregon in 1937, Adams matriculated at Duke University Medical School, where he was subsequently an Intern and Assistant Resident in Medicine. After receiving a Fellowship from the Rockefeller Foundation in 1938, Adams became a Resident in Neurology at the Massachusetts General Hospital, where he met Stanley Cobb who introduced Adams to psychoanalysis, a subject with which he quickly lost patience. In 1940, Adams continued his Rockefeller Fellowship in Psychiatry at Yale University, where he worked under Eugen Kahn and met such notable physiologists as John Fulton and Warren McCulloch. From 1941 until 1951, Adams was Neurologist at Boston City Hospital, Neuropathologist at the Mallory Institute of Pathology, and Assistant Professor of Neurology at Harvard Medical School. He eventually became Chief of the Neurological Service at Massachusetts General, and in 1954 the Bullard Professor of Neuropathology at Harvard Medical School, a position from which he retired in 1978 (picture on Left).

Given Adam’s illustrious career, I confess to a feeling of disappointment upon a cursory perusal of Robert Laureno’s book. Fortunately, I was greatly mistaken in my summary judgment. At first glance, this book appears little more than an unfinished work of oral history. Laureno has organized it mainly around transcripts of interviews he conducted with Adams in 2002 and 2003. He enhances those interviews with some short essays and interview summaries, and illustrates them further with numerous photographs, bibliographies, and primary sources from Adam’s career and private life. Reading through the transcripts of these almost fifty interviews with Adams, the richness and vitality of Adams’ perspective about his life and work become manifest. It would have been a tragedy not to publish these interviews in this form, for as a primary source to twentieth century neurology, neuroscience, and medicine they are invaluable. Robert Laureno has done a great service to neurology and historians of the neurosciences by persevering through the work entailed in producing this volume. I suspect that it will also be of use to medical historians interested in topics beyond the clinical and cognitive neurosciences.

Yet this volume is lacking in its discussion of historical context and is perhaps overly celebratory in its descriptions of Adams. This is a pity but nonetheless fair criticism. Still, the volume remains important, and historians of medicine and science should not dismiss it on those grounds. To understand why the historical context is so germane to Adams’ story, it is necessary to recognize that he did not single-handily transform neurology. Rather than a “phenomenon”, Adams should be understood to have been a distinguished representative of a new movement within the neurosciences and neurology in the twentieth-century. This becomes clear in Laureno’s interviews, but Laureno never pauses to explain to the reader fully why this matters. Instead, he mistakenly assumes that these are evident details to his readers. It seems, then, that a brief discussion of this point may help to further frame the value of Laureno’s volume.

The study of nervous diseases in the nineteenth century was a mainly clinical and descriptive pursuit. While nineteenth-century clinical medicine generally benefited from Rudolf Virchow’s cellular theory of pathology and Louis Pasteur and Robert Koch’s theories of disease transmission, the value of those discoveries for the study of the diseases of the nervous system was not immediately evident, except in a very few cases. To be sure, certain anatomical and physiological investigations throughout the century – e.g. those of Charles Bell, Robert Bentley Todd, Marshall Hall, Paul Broca, and David Ferrier – provided deeper insight into the multiple functions of the nervous system, but these rarely enhanced diagnosis or therapeutics.

Some of the most important scientific achievements came late in the nineteenth century. Santiago Ramóne y Cahal’s development of histological techniques that revealed that the nervous system was comprised of single cells were complemented further by Charles Sherrington’s contemporaneous formulation of synapse theory. Those studies, along with Paul Erlich’s later work on cellular membrane biochemistry, permitted novel approaches to the understanding of nervous diseases in the mid-twentieth century. One of the defining intellectual features of interwar and post-war neurology became the tendency for investigators – e.g. Walter Spielmeyer, Fritz Nissl, and Oskar and Cecil Vogt – to examine the histological architecture of the nervous system. This resulted in many atlases of the brain, and a more complete description of the anatomical organization of brain tissue.

Raymond Adams, more than most of his American contemporaries, combined pathological and physiological investigations with these developments in synapse theory, immunology, and histology-driven anatomy. He insisted, moreover, that his residents attend weekly conferences on neuropathology and microscopy (pp. 71-81). This new approach to neurological diseases reformulated many clinical problems in terms such as problems of synaptic transmission, disease at the level of the cellular membrane, and demyelination. All implied novel potential chemical interventions in the treatment of neurological diseases. In many respects, modern neurology originated through this conception of disease that emerged in the 1950s.

It would not be a stretch to argue that the study of nervous conditions prior this period was almost wholly different. There are, of course, exceptions to this claim, but the defining feature of clinical neurology prior to the 1950s was that it offered insight into the larger physiological functions of the nervous system. In other words, clinical neurology was valuable mainly because of its ability to reveal physiological function. The work of Adams and his contemporaries reversed this circumstance. By turning away from the holistic and clinical features of neurological lesions, and reformulating them in microscopic and biochemical terms, Adams and his contemporaries created the possibility for therapeutic intervention in nervous diseases in ways that had never existed. To use an old phrase from the history of science, their integration of multiple fields of knowledge at this most reductive level led to a paradigm shift in clinical practice – a shift that had profound implications in the organization and treatment of neurological and psychiatric patients.

Adams was not the only individual involved in this transformation, which really had been ongoing since the 1920s. But he was certainly important, and because of this, his own perspective on these events make worthwhile reading. I have no doubt that Raymond Adams will appear in many future works on American medicine and science, as well as neurology, psychiatry, and neurosurgery. Robert Laureno’s collection of interviews in this volume, as well as his short essays, will prove invaluable for many of those projects. I think it not an exaggeration to claim it as one of the most useful published sources on post-Second World War neurology.

Featured Neurologist: Edwin Bramwell

Edwin Bramwell was born in North Shields, the son of Byrom Bramwell, a physician interested in the diseases of the nervous system. Educated at Edinburgh University, Edwin qualified in 1896. After studying in J. J. Dejerine’s laboratory at La Salpêtrière (1899), Bramwell held a House appointment at the National Hospital for Paralysis and Epilepsy, where he worked with John Hughlings Jackson. In 1907, he was appointed Assistant Physician at the Royal Infirmary Edinburgh, then Full Physician (1919), and finally Moncrieff-Arnott Professor of Clinical Medicine at the University (1922). A fly-fishing enthusiast and President of the Royal College of Physicians, Edinburgh, Bramwell was remembered as an exceptional teacher. He retired early on account of rheumatoid arthritis. Chiefly a clinician, he regularly speculated on the nature of the nervous system in his private diary, an invaluable primary source. His casenotes may still be viewed at the University and the Royal College of Physicians Edinburgh. Bramwell married Elizabeth Cunningham; they had four children.

This article is part of an on-going series of biographies published in this blog.

Academic Distinction and British Neurologists

British neurologists (n=100) active during the Interwar Period performed highly during the course of their education: 12 received gold medals for academic achievement, 13 special academic prizes, 23 scholarships, and 23 received research fellowships following the completion of their degrees.

Edgar Adrian (1889-1977), at the time of his death, still held the honourable position of having received the highest marks ever given at Cambridge. Listed separately here are fellowships that may be a particular interest. Notable is that both F. M. R. Walshe and W. R. Brain were awarded the Theodore Williams Scholarship to work with Nobelist Charles Sherrington. Derek Denny-Brown also worked with Charles Sherrington before coming to the Boston City Hospital.

Though numerous figures in British neurophysiology, neuropsychiatry, and neurology received travelling fellowships from the Rockefeller Foundation, only listed here are those who received awards to continue training. Others, such as Edgar Adrian, who eventually became a Trustee of the Foundation, received occasional travel subsidy from the Foundation throughout their careers. It is noteworthy that Dorothy Russell and Honor Smith (2 of 4 women in British neurology before 1960) received Rockefeller Fellowships. Russell spent her time with Wilder Penfield at the Montreal Neurological Institute and with Adolf Meyer in Baltimore. Honor Smith spent a year at the Boston Hospital for Sick Children before returning to Oxford where she worked in one of the MRC’s Peripheral Nerve Injury Centres.

(Citation: Stephen T Casper (2007) The Idioms of Practice: British Neurology, 1880-1960, University College London, Dissertation, p.420)

Charleston 2009

This is the second time I have attended the “International Society for the History of Neurosciences.” Like my first visit, I have had a wonderful experience. Charleston is a beautiful city done-up in gorgeous pastels and Georgian facades, many of them actually from the period. While the humidity and heat have kept me from the streets in the mid-Afternoon, my moments of leisure in this city will leave lasting memories. I will come back here again.

The meeting itself has been a delightful and thought-provoking event for me. Like all such academic meetings, it has been a time for greeting old friends and making new acquaintances. There have been the usual habits of the bottle and feasting and other forms of self-medication, and those moments have led to many a good laugh and conversation.

As I was at the Los Angeles meeting, I am struck by the obvious generational divides here. I must be one of the youngest people here. And perhaps because of the difference in age, I sense acutely all of those unresolved tensions in twentieth-century historiography that one might expect: there are the internalist and externalist camps, the commonplace controversy between the Whig and Social interpretations, and the occasionally voiced scepticism of cultural approaches. In a way, of course, these different traditions reflect both the international diversity of the group and its demography.

Nevertheless, I appreciate being surrounded by people with my passion for this topic. We may all bring different viewpoints and approaches to the table, but the singular advantage of being with people genuinely fascinated in the history of the neurosciences, is that no further justification is required. Nobody asks here, “why does neuroscience history matter”? We simply know it does.

David Ferrier and the Cortical Localization of Cerebral Function

Among the many discoveries of late-nineteenth century physiology, one that certainly ranks very high is David Ferrier’s research on the cerebral localisation of function, the principle that specific areas of the brain are associated with specific behaviours. Celebrated for its demonstration of the scientific basis of phrenology, condoned for its practical implications, no doubt instrumental in ushering in the animal rights movement, and part of a gripping human story of priority disputes, Ferrier’s research possesses all of the ingredients of a fantastic tale.

David Ferrier (1843-1928) was the sixth child of Hannah and David Ferrier. He attended Aberdeen Grammar School and then studied classics and philosophy under Alexander Bain at Aberdeen University. Bain, an enormous intellectual influence on Ferrier, suggested that he pursue a year abroad studying physiological psychology. Germany was then, as sociologist Joseph Ben-David has observed, the pre-eminent location for this field of inquiry, and Ferrier accordingly took up residence there for a time at the University of Heidelberg. Following his wanderjahr, Ferrier returned to Scotland where he completed his medical degree in 1868. Following a brief residency under Thomas Laycock, Ferrier completed his MD – an advanced medical degree in Britain – and was appointed lecturer in physiology at the Middlesex Hospital in London. The following year he was appointed to King’s College, where he remained the remainder of his career.

At about the time that Ferrier was completing his medical degree, Gustav Fritsch (1838-1927) and Eduard Hitzig (1838-1907) demonstrated that muscle movements in the body of a dog could be stimulated by the direct application of electricity to its brain. This was an important discovery. Few had hitherto believed in the electro-excitability of brain tissue. Hitzig and Fritsch’s research suggested that the popular view was wrong. Ferrier, perhaps excited by these findings, began shortly thereafter analysing whether stimulation of specific areas of the brain might lead to repeatable motor behaviours in the living animal body.

Invited for a time to the West Riding Asylum in Wakefield by his friend James Crichton-Browne – himself an arch monist – Ferrier began conducting his research there. His findings, according to historian Samuel Greenblatt, quickly suggested that electrical stimulation of different portions of the brain could evoke movements in the limbs of animals. This work suggested that there were centers in the brain that might be devoted specifically to certain motor functions, an idea then also promulgated by Paul Broca, a French anthropologist, who had noted that lesions in the same area of the brain seemed constantly associated with the impairment of speech.

The early context of this research is important to note. Although he continued his early research at King’s, Ferrier had been one of a youngish cohort at the West Riding Lunatic Asylum. They were paradigm-makers. Crichton-Browne, John Hughlings Jackson, and others undoubtedly had much influence on Ferrier’s perspectives – and he, in turn, on theirs. Indeed, Ferrier dedicated his monograph on his research The Functions of the Brain to John Hughlings Jackson, who Ferrier acknowledged “from a clinical standpoint” had “anticipated many of the more important results of recent experimental investigation into the functions of the cerebral hemispheres.” He cited Jackson’s research many times throughout his work and always with the aim of complementing his own conclusions that motor centers existed in the brain.

Ironically, Ferrier’s research did not initially sit well with his peers in Britain and elsewhere. As historian David Millet describes, 1874 – the year in which physiologist John Burdon Sanderson read Ferrier’s lecture before the Royal Society – was filled with critical appraisals. But Ferrier appears not have thought their eviscerations particularly significant. His unwillingness in fact to take his critics seriously, left the status of his first manuscript reporting the results of his labor, then under-review with the Transactions of the Royal Society by Michael Foster, George Rolleston, and Thomas Huxley, much in doubt. It ultimately did not appear in print, although the Society did allow publication of a short abstract. Ferrier followed that editorial with many substantial works, most of which are now classics of physiology.

Ultimately, his peers in Britain, as well as continental physiologists and philosophers, came around to Ferrier’s views. By the International Medical Congress of 1881, which was held in London, Ferrier’s research had become widely accepted among European and American men and women of science and medicine. The same was not true for the public, who throughout the period of his research decried his experiments on living animals. As he had been to his peers in science, so Ferrier was to public antipathy. In an early letter expressing his gratitude to the Sheffield Medical-Chirurgical Society for their support in the face of charges brought against him by the police, he stated flatly, “even if I have no case, I should regard the result with comparative indifference, knowing that as to my object I have the sympathy and moral support of my professional brethren”.

To this day, many of the controversies surrounding Ferrier’s research remain unresolved, not least the question of whether the centers actually exist in the brain. While Ferrier had verified that certain motor behaviors could be produced through stimulation of the same areas, the question that haunted his Victorian contemporaries was whether those centers existed and had equivalents for the mind. Were, in other words, mind and brain the same substance? On this question, unlike so many others, Ferrier was not ambivalent. His one comment in The Functions of the Brain voices succinctly his opinion: “We may succeed in determining the exact nature of the molecular changes that occur in the brain cells when a sensation is experienced, but this will not bring us one whit nearer the explanation of the ultimate nature of that which constitutes the sensation.”