Elliott Mancall, MD, a neurologist who was internationally known for his work on two formative papers identifying progressive multifocal leukoencephalopathy (PML) and central pontine myelinolysis, a brain cell dysfunction caused by the destruction of the myelin sheath in the middle of the brainstem, died of end-stage renal disease on Jan. 2. He was 85 years old and a professor emeritus at Thomas Jefferson University Medical College in Philadelphia at the time.
“His work in identifying PML was especially important because it presaged the AIDS epidemic where PML came to the forefront,” said H. Royden Jones, MD, Jaime Ortiz-Patino chair in neurology at Lahey Clinic in Burlington, MA, and clinical professor of neurology at Harvard Medical School. Dr. Jones worked with Dr. Mancall at the American Board of Psychiatry and Neurology (ABPN), and described his former colleague as “a tremendous role model and a teacher who endeared himself to his students.”
“When I worked with him at ABPN, at times we would examine candidates together. He always went out of his way to find out how much the candidate knew, instead of finding out how little the candidate knew,” he added. “I know that everyone who had a chance to work with Elliott was impressed by his sense of complete fairness.”
Dr. Jones was also an assistant editor of Continuum: Lifelong Learning in Neurology (r), the AAN's self-study continuing medical education publication, when Dr. Mancall was editor-in-chief. [Dr. Mancall was the founding editor of Continuum, and held that role from 1993 to 2002.] In that role, “I saw his commitment to education. Elliott was dedicated to providing a series of monographs that astutely and practically addressed the needs of the practicing neurologist, making certain that these did not become too esoteric,” noted Dr. Jones.
Paul T. Gross, MD, clinical professor of neurology at Tufts University School of Medicine and chair of the neurology department at Lahey Clinic, who received his medical degree at Hahnemann Medical College, credits Dr. Mancall with motivating his interest in neurology. “When [Dr. Mancall] gave lectures at the medical school, he would have patients from his practice come to the classroom as examples of the diseases that he was trying to teach us about,” Dr. Gross recalled.
Sometimes, Dr. Mancall would go down to the Philadelphia Naval Hospital and bring some accompanying residents and students, Dr. Gross added. “I was lucky enough to go with him....We were in a large auditorium, seated in a row, and the naval medical officers would bring in patients with various neurologic disorders and present them to Dr. Mancall.” After hearing the patient's story and performing examinations, Dr. Mancall would pronounce the patient's diagnosis. “Then they would bring on the next person. It was quite remarkable to watch,” Dr. Gross said.
An inspiration to many, Dr. Mancall was also the reason Karen L. Roos, MD, John and Nancy Nelson professor of neurology at Indiana University in Indianapolis, chose to study neurology. She was on his service as a medical student, and he was “such a wonderful physician, not only in his fund of knowledge, but also in the respect he showed to patients and to us... I carried my notebook with me with the notes I had taken from Dr. Mancall's lectures.”
He “would get a twinkle in his eye and tell us how proud he was of us,” she remembered. The desire to please Dr. Mancall was “not because we cared about our grade, but because we had such respect and admiration for him. We wanted to be the physician that he was.”
Joyce Liporace, MD, director of the Women's Health and Epilepsy Program, Center for Neuroscience at Riddle Hospital in Media, PA, came to know Dr. Mancall when she was the residency director at Thomas Jefferson and he was chairman. “He was the traditional gentleman neurologist — they just don't make them like that anymore,” she said of Dr. Mancall.
His sense of humor was wonderful, she said. The first year she worked with Dr. Mancall, “we had a case of an alcoholic who was admitted into the emergency room with low sodium, and we were talking to the residents. He and I were doing a teaching case, and he asked a resident, ‘What concerns might there be with correcting the sodium?’
“The resident really had no idea of the answer. So, Dr. Mancall was teaching him about central pontine myelinolysis, and telling him in great detail everything about the condition. And the resident finally said to him, ‘My gosh, how do you know so much about this rare condition that I'm probably really never going to see?’”
In response, Dr. Mancall simply said, “I read a thing or two about it,” and then walked away. “It wasn't until after he left that I told the resident, you better go do a little research and discover what you just did,” Dr. Liporace told Neurology Today.
Dr. Roos also credits Dr. Mancall for her marriage to Robert Pascuzzi, MD, professor of neurology and chairman of the department of neurology at Indiana University. She told Neurology Today that she had been ready to do her neurology residency with Dr. Mancall, but she was engaged to a man in her medical class — and she knew she could not marry him. “I told Dr. Mancall. He said: ‘If you need to leave, I want you to train with my dear friend, T.R. Johns.’”
The program at the University of Virginia had only trained two women before, but, to Dr. Roos' surprise, Dr. Johns chose her. “I have always thought that Dr. Mancall must have spoken to his dear friend, and that is why Dr. Johns chose me. Bob [Pascuzzi] was in his second year of neurology residency when I met him on the 11th day of my internship.”
Dr. Mancall played a role in cultivating at least one other marriage, Jonathan Hosey, MD, director of the neurology residency program at Geisinger Medical Center in Danville, PA, said. He met his wife of 30 years, Linda M. Famiglio, MD (now the chief academic officer at Geisinger), when they were both Dr. Mancall's students. “I am a neurologist today and proud of being a neurologist because of Elliott Mancall,” he said. ”As I took on more administrative roles, he used to tell me, ‘Never give up your day job — never leave the practice of clinical neurology,’ because to him it was magical. He exemplified that we could measure ourselves by our clinical interactions with our patients and their families.”
The chair of neurology at Thomas Jefferson University, A.M. Rostami, MD, PhD, said Dr. Mancall not only motivated several generations of students, residents, and young neurology faculty, but he also inspired his own children. “He was interested in American history and that inspired his son Peter to become a historian, now a professor of history at University of Southern California.” Another son, Andrew, followed his love of neurology and became a neuroradiologist, he added.
Apart from neurology, Dr. Mancall loved bad science fiction movies, Dr. Liporace said. “He used to take all the residents out to see movies at least once a year,” she told Neurology Today.
Dr. Mancall was also an avid bibliophile and a collector of miniature WWI toy soldiers, Dr. Hosey recalled. “He was really a renaissance person. And not only did he have these amazing interests, but he continuously shared them with us and also reached out to all of us to share our life experiences with him.”
Born in 1927, Dr. Mancall graduated from Trinity College in Hartford, CT, in 1948 with a bachelor's degree in biological sciences, and received his medical degree at the University of Pennsylvania in 1952. He completed a one-year internship and then served as assistant resident in surgery for one year at Hartford Hospital in CT. Subsequently, Dr. Mancall was awarded a Fulbright scholarship to spend a year at the National Hospital for Nervous Diseases in London, UK.
Dr. Mancall did his residency in neurology at the Neurological Institute of New York, Columbia Presbyterian Medical Center (1955-56), and then a neuropathology residency at Massachusetts General Hospital (1956-57), where he also spent the following year as a clinical and research fellow.
In 1958, Bernard J. Alpers, MD — who was then the chair of neurology at Jefferson Medical College — recruited Dr. Mancall as assistant and then associate professor of neurology. The distinguished neurologist then became a professor at Hahnemann Medical College — now Drexel University College of Medicine (1965-1976) — where he founded the neurology department in 1976, and continued on as chairman of neurology until 1994.
Dr. Mancall returned to Jefferson in 1995, and served as interim chair of the department (1997-2003). He became emeritus professor of neurology at Jefferson in 2005, but still continued to teach and mentor students. His research included the effects of chronic alcoholism, malnutrition, and systemic cancer on the nervous system.
He served as president of the American Association of University Professors of Neurology (1988-90), and the Philadelphia Neurological Society (1966-77). He was also a fellow of the AAN, as well as a member of the American Neurological Association and the American Association of Neuropathologists. Dr. Mancall was director of the American Board of Psychiatry and Neurology (1983-1991), and chair of the Accreditation Council for Continuing Medical Education from 2003 until the time of his death.
Along with colleague David G. Brock, MD, Dr. Mancall co-wrote the widely used Gray's Clinical Neuroanatomy, The Anatomic Basis for Clinical Neuroscience. He received numerous accolades, including the Christian R. and Mary F. Lindback Award for distinguished teaching in 1969; the A. B. Baker Award in Neurological Education from the AAN in 1997; the Presidential Award for Distinguished Service from the AAN in 2004; and the Dean's Citation for Faculty Mentoring from Jefferson Medical College of Thomas Jefferson University in 2004.
Dr. Mancall is survived by his wife of 59 years, Jacqueline; his two sons, Andrew and Peter; and four grandchildren. Contributions may be made in Dr. Mancall's memory to the Miquon School, 2025 Harts Lane, Conshohocken, PA 19428.