A career in cerebrovascular disease: a personal account.

Abstract

The Editor, when inviting this piece, thought that an account of my entry into the stroke field and the unfolding of the subsequent studies in cerebrovascular disease would be instructive for the younger readers of Stroke . Be that as it may, knowledge of how a specialty has evolved can be useful in placing present endeavor in perspective. The story is one of clinical and neuropathological studies carried out by one person, an approach now largely superseded. In 1949, after my completing a fellowship in Neurology at the Montreal Neurological Institute, Dr Wilder Penfield recommended a year of postgraduate work abroad. Dr Roy Swank, a colleague, insisted that a period of study on the Neurology Service of the Boston City Hospital (BCH) under the direction of Dr Derek Denny-Brown and Dr Raymond D Adams would be unparalleled. Dr Swank placed a telephone call and in a minute or two it was arranged that I spend a year in Neuropathology at BCH under the guidance of Dr Adams. The subject to be investigated was acute hypertensive encephalopathy. A grant-in-aid was received from the Multiple Sclerosis Society. It was for $100. In 1949 BCH was one of the world’s premier medical centers: 2000 beds and 3 academic medical services, Harvard Medical School, Boston University, and Tufts Medical School. Enthusiasm was the order of the day. The Department of Pathology, including the Section of Neuropathology, comprised the Mallory Institute of Pathology. It was a busy service, with 900 autopsies performed each year. In addition, the Coroner’s Office was housed in the Institute. In Neuropathology 700 to 800 brains were examined yearly. The abundance of pathological material would be an important factor. Two residents in Neuropathology were responsible for the day-to-day work: Dr David McDougall, the senior, and myself. Dr McDougall developed formalin dermatitis …