ASBURY, ARTHUR K. MD
Robert Laureno, MD, a noted neurologist and neurological educator in his own right, has produced an excellent biography of Raymond D. Adams, MD, whom many regard as the father of modern neurology. Much of the book is the product of over fifty interviews of Dr. Adams by Dr. Laureno, face-to-face or by telephone, beginning in 2002 and lasting into 2005. It is noteworthy that Dr. Adams was in his nineties when these interviews were undertaken. In addition, Dr. Laureno interviewed scores of Dr. Adams' professional colleagues, friends, former trainees, and family members.
Dr. Adams played a huge role in shaping the field of neurology as we know it now, and Dr. Laureno thoroughly documents each step of the way through eight chapters, 50 pages of appendices, and an index.
We get to see a more personal side of the man through 66 photographs covering every period of Dr. Adams' life, including a number of group photos from his professional years. Other photographs depict family members and home life, title pages of important papers and monographs, correspondence by and about Dr. Adams, clinical notes, gross pathological specimens, and photomicrographs of pathology slides.
The opening chapter, “The Phenomenon of Raymond D. Adams,” captures the essence of the man, his towering intellect, his calm, supportive but all-business demeanor, his incredible work habits (roughly 18 to 20 hours a day and seemingly most days for the first 80 years of his life), his disdain for administrative matters and committee meetings, and his remarkable skills both as a clinician and as a pathologist.
We learn about the breadth and depth of his knowledge of all fields related to the nervous system. Dr. Adams had a visionary ability to recognize incipient new sub-fields of neurology, and to guide able young people into leadership roles. And he had an uncanny capacity to draw information from his vast store of knowledge with which to fashion logical, and often novel, overarching concepts.
Dr. Adams also had his blind spots. One example was his frequent inability to remember the names of his residents and other trainees. Another example, not mentioned by Dr. Laureno, but well known to his residents, was his difficulty in recognizing psychiatric problems in young women who were well educated or were from well-to-do families. It reminded us that he was human, because in so many other ways he was super-human. These traits included his work habits, his teaching skills, his capacity to think broadly and imaginatively, and to gather ideas from disparate sources that together illuminated otherwise impenetrable problems.
An important addendum for chapter 1 is Appendix A (pages 201–207), which chronicles a key interview of Dr. Maurice Victor about Dr. Adams. This took place in 2000, less than a year before Dr. Victor died. Dr. Victor was both Dr. Laureno's mentor and also a close colleague and friend of Dr. Adams for many decades.
The second chapter reviews the life history of Dr. Adams, from his background and birth to old age, mainly through a question-answer format (brief questions and long answers). It chronicles Dr. Adams's early years — growing up poor in rural Oregon, and developing his titanic work ethic, at first relating only to physical labor. This reflected a similar work habit of his father, an uneducated laborer. He made a rapid but undistinguished educational journey through high school, but later blossomed as a scholar at the University of Oregon when he discovered the field of psychology, the science of the mind.
He went to medical school at Duke University where he was drawn to psychiatry. All of this educating had to be done on the cheap, with dependence on scholarships and many menial part-time jobs, often concurrent, in order to secure a living.
The preponderance of his career was based at the Massachusetts General Hospital (MGH), but a key junior faculty experience lasting a decade was done elsewhere in Boston. These ten years were devoted primarily to neuropathology and general pathology at the Mallory Institute, and attending duties in clinical neurology, the latter both at the Boston City Hospital and at the Tufts-New England Medical Center. Dr. Adams was subsequently the chief of the neurology service at MGH for 27 years (1951–1978), and for 24 years was concurrently the Bullard Professor of Neuropathology at the Harvard Medical School. I should disclose here that I got to know Dr. Adams through my years (from 1958–1969) as an intern, resident, fellow, and junior faculty member at Harvard Medical School and MGH.
Figure. DR. ARTHUR A...Image Tools
In subsequent chapters, we learn more about Dr. Adams's ideas and the investigations he devised to explore them. His knowledge and experience were widespread, ranging from pediatric conditions to muscle, peripheral nerve, spinal, and virtually all types of brain pathologies. For example, he wrote more than 200 original papers and publications on the neurology of liver failure, striatonigral degeneration, autoimmune neuropathy, paraneoplastic neuropathy (with myeloma), oculomotor apraxia, pan-dysautonomia, and histiocytosis. He was the first to describe and refer to transient ischemic attacks, transient global amnesia, and normal pressure hydrocephalus. He was also renowned for his work on basilar artery stroke and hypoxic-ischemic encephalopathy after cardiac arrest.
A short chapter deals with his family life, retirement and old age, and a brief epilogue added in press tells us of Dr. Adams' demise in October of 2008, a few months short of both his 98th birthday and the publication of this biography.
Dr. Laureno has done a masterful job of summarizing the life and times of Raymond D. Adams and the profound impact he had on the shape of modern neurology.