John W. Griffin, M.D.
June 2000

The comments which follow are a historical sketch using, when possible, the words of participants in events, and outlining these first 80 years.


The relationship of the first two figures in Hopkins Neurology might be summarized as that of a gifted, charismatic, and powerful generalist with a special interest in Neurology, teamed with a skilled and personally modest specialist. Both worked within the Department of Medicine.


William Osler was Baltimore’s first great figure in Neurology. Osler was a truly a medical polymath, and Neurology is not the only field in which he played a catalytic but little-recognized developmental role. His fascination with diseases of the nervous system arguably sprung from his facility in clinical, anatomical, and pathological correlation. Clinicopathologic conceptualization was the "secret ingredient" in Osler’s teaching and arguably the springboard for his feelings for expression of disease.

Thomas was born in 1861 in Baltimore, the son of Dr. James Carey Thomas, a medical practitioner and future Trustee of the University. Parenthetically, Thomas’ sister, Martha Carey Thomas, led the Women’s Fund Committee that raised the critical support for opening of the Medical School in 1890, and mandated admission of women on an equal basis with men. She went on to Presidency of Bryn Mawr College. From this solidly Quaker family Henry Thomas was educated in private schools in Baltimore and at Haverford College. He received his undergraduate degree from Johns Hopkins University in 1882, and his MD at the University of Maryland in 1885.  He then spent three years in Heidelburg, studying under Wilhelm Erb, as well as in Vienna and probably in London with William Gowers.  Thomas returned to Baltimore and spent time working at the Pathological Institute of William Welch, with Welch, Francis Mall, Councilman, and Halstead.  He was appointed as "Attending Physician to the Insane" at Bayview Hospital.  At the age of 27, in 1888, he contracted pulmonary tuberculosis and sent off for rest and rehabilitation at Lake Saranac. 

The next year, 1889, William Osler arrived in Philadelphia as Physician-in-Chief, and Thomas immediately became a committed member of the circle of young physicians surrounding "the Chief". Throughout his career, Thomas was a dedicated admirer of Osler, as reflected in their correspondence continuing long after Osler went to Oxford.

Thomas produced some 30 publications, and a review of these publications gives a striking picture of neurologic disease at Johns Hopkins before the turn of the century.  Much of his writing revolves around syphilis, with 110 cases of tales in his clinic in its first 10 years.  Thomas also had a special interest in neuromuscular diseases, including what he termed "multiple neuritis (non-diphtheritic)".  Most of these in retrospect had the Guillain Barre syndrome, which at that time still awaited its description (in 1916). He provided clear criteria for distinguishing these "neuritis" cases from poliomyelitis, and pointed out that the prognosis was almost always good.  He authored one of the first and most detailed reports of the recurrent form of what we would now term as chronic inflammatory demyelinating polyneuropathy (CIDP).  He also identified 58 cases of lead neuropathy at Johns Hopkins.  Finally, he was interested in electrical stimulation of nerve and muscle and provided descriptions for a battery of his own design to allow testing of patients at the bedside.

Because of the great national need for a university department of Neurology, the Faculty of the Johns Hopkins Medical School has given careful consideration to the plans for the proposed institute.  Initially the clinic should provide about 40 beds in the free wards, 10 beds of a cubicle type for persons of moderate means, and 10 private rooms; but provision should be made for the expansion of the service to a maximum of 80 beds, of which at least 50 are free.  Likewise ample, well-equipped laboratories for the study of problems presented by patients and for research in neurological anatomy, in the pathology and bacteriology of diseases of the nervous system, etc., should be included, in addition to well furnished operating rooms, examining rooms and the other necessary accommodations for the study of patients.

With this plan search began for the first head of a new Department of Neurology, a search which was to recur fitfully for 45 years. Francis M.R. Walshe of Queens Square was approached, as was Sir Gordon Holmes, from Queens Square and Bernardus Brouwer from Amsterdam. The most serious candidate, and the only one who formally accepted the position, was George Schaltenbrand, then at Freiburg and subsequently at Wurzburg. It seems likely that one of the attractions of Schaltenbrand to the search committee was that he had participated in the early years of the Peking Union Medical College in Beijing, a Rockefeller Foundation project. There was hope that the foundation might support a Neurologic institute at Hopkins.

Ironically, Rockefeller support for just such a venture went about this time to Montreal to found the Montreal Neurologic Institute, directed by the same Wilder Penfield who was excited in 1922 by Meyer's vision of an integrated institute..

He was responsible for planning for neurology. The Dean’s Report from 1948-49 concludes:

"Dr. Harvey, after studying the problem during the past year, submitted a memorandum to the Advisory Board of the Medical Faculty in which he recommended that the development of clinical neurology in the Hopkins environment should not take the form of establishing a new and independent department but should be devoted to close relation to general medicine with other departments, notably Pediatrics, participating in that development."

Given this Institutional decision not to form a department of Neurology, it is striking how successful the products of its training program were throughout the 1950's. The credit lies in the men who led Neurology during this period. They inherited the mantle of Henry Thomas, and shared with him a willingness to develop, but to high quality, small programs and a freedom from ambition for influence or building.

The first of these leaders was Frank Ford. From the time of Thomas' death in 1925 until his retirement in 1958, Frank Ford acted as Hopkins' "Neurologist without portfolio". Ford graduated from medical school in 1919, studied Neuropsychiatry under Adolf Meyer, spent time working in Virology, and worked in Neurophysiology looking for circulating neurotoxins in the plasma of patients with myasthenia gravis. He then did formal training in Neurology at Belluvue with Foster Kennedy and returned to Hopkins as a Neurology resident in 1922.

Ford produced one of the first and most widely read pediatric Neurology texts, drawn largely from his patient files. He was the neurologist to Walter Dandy, and  formed a legendary relationship with Frank Walsh in Ophthalmology. He participated in Walsh’s Saturday morning Neuro-ophthalmology conference, sitting in his designated seat in the front row. He was notoriously formal, so that the leaders of this conference referred to each other as "Dr. Walsh" and "Dr. Ford". Howard Moses recalls "he smoked two Optimo cigars during each 2 hour rounds."  David Clarke portrays "the Judge" as follows:

"He was a man of strong personal quirks and prejudices.He hated to travel; beyond an annual trip to Virginia to visit a sister - a voyage to which, as he said, he looked forward with loathing and backward with despair - he went for years without leaving Baltimore. As a young man he drove a motor car, but a near accident - not his fault - in which he feared he might have struck a child, led to instant refusal to continue. After that, his wife Loel and a very few friends, plus the street cars of Baltimore while they endured, were his means of transportation."

"Ford was a Virginian by extraction and conviction, a Hopkins graduate by education, and a neurologist and raconteur by profession. He was also, by personality trait, one of the more outstanding members of a hospital staff well known for characters...."

David Clarke assesses Frank Ford's goals as Chief of Neurology as follows:

"He told me once that when, after his years of waiting in the wings whilst foreign dignitaries vented, he was finally made Chief of Neurology, he considered his situation carefully. He decided he was neither a scientist nor a great leader. He could not give The Hopkins great neurology, but he could give it a great neurologist. He set out to do exactly that, and his career is outstanding evidence of his success. He was, I think, one of the three of four finest neurological diagnosticians I have ever seen."

"With this enormous ability, he combined little or no desire to develop Neurology and made few demands on the Hospital. He was exactly what was wanted after the decade of search for an Institute director. He filled the role to perfection. It was his tragedy that the needs to The Hopkins grew beyond what he alone could provide."

Magladery served in the African campaign under Montgomery in the British Army and on his way back to Canada in 1946, was recruited by Harvey and Joseph Lillienthal to be head of the new division of Neurology in the Department of Medicine at Johns Hopkins.

In spite of the divisiveness Hopkins was visible in the clinical as well as the basic Neurosciences.  The division of Neurology recruited Robert Teasdall who, with Magladery, was responsible for the first descriptions of some of the spinal reflexes including the H-wave. Magladery’s faculty included Charles Luttrell, Thomas Preziosi, and David Clarke, the distinguished Pediatric Neurologist.  A number of residents who trained in the early years of Magladery's program went on to distinguished academic and teaching careers.  David Hubel went on to become a vision physiologist and the Nobel prize winner.  Other notable examples include Howard Moses at Johns Hopkins, David Clarke, who became the first Chairman of Neurology at the University of Kentucky, Charles Luttrell, the Professor of Neurology at the University of Washington, Thomas Preziosi, who remained at Johns Hopkins throughout his career, Robert Teasdall, who went on to be Chairman at Henry Ford Hospital, Eijiro Satayoshi, distinguished Neuromuscular researcher from Japan and head of the Japanese equivalent of NINDS, Flaviu Romanul, Professor of Neurology in the Harvard Program at Boston City Hospital, John Menkes, Floyd Gilles, a distinguished Pediatric Neurologist at Children's Hospital in Boston, Philip Swanson and Mark Sumi, both of whom went on to be Professors of Neurology at the University of Washington, Ronald Meyers, who spent his career at the National Institutes of Health and developed the primate facility in Puerto Rico, and two distinguished Neurovirologists, Leslie Weiner, currently Professor and Chair of Neurology at the University of Southern California and Howard Lipton, Professor of Neurology at Northwestern University.

During the 1950's and early 1960's, neuroscience flourished with the work of Vernon Mountcastle and David Bodian. A. Earl Walker in Neurosurgery, David Grob and Richard Johns, who investigated myasthenia in the Department of Medicine, Samuel Livingston, the pediatrician epileptologist and first enthusiast for the ketogenic diet, and others.

By 1960, however, the fortunes of the Neurology program had begun to fade. Frank Ford retired in 1958, although he remained active until his death in 1970. David Clarke, Charles Luttrell, and Philip Swanson left over a short period of time. The trainees stopped taking academic positions While the situation at Hopkins remained stagnant, departments of Neurology were being established in Universities around the country. And the National Institutes of Health had signaled its willingness to support research in Neurology. One suspects that the availability of support gave due impetus to a plan for a department of Neurology, much as the hope for support had in the 1920's and 1930's.

Several motives undoubtedly led to the decision in 1967 to place Neurology on a departmental status and to make the required investment.  Some were practical; Magladery had been ill, and much of the clinical and teaching load was borne by one individual, Tom Preziosi.  Some motives were probably competitive; many of the major medical schools had already established department of Neurology, and recruiting outstanding individuals into a division would likely prove difficult.  Some may have reflected opportunity.  The NIH had formed a separate Institute for neurologic disease, and thus opened an attractive means of support for strong programs.  And it may be hoped that some of the motivation sprang from the desire to translate into the clinic the fundamental observations from the physiology and pharmacology of Vernon Mountcastle and Solomon Snyder respectively, as well as other basic neuroscientists 

What has come from that decision has fulfilled and surpassed the vision of Adolph Meyer and his 1921 committee, but effecting the vision was based on several deviations from the proposed blueprint.  In 1921 the intention was to garner resources and build and Institute before recruiting a leader.  In 1967 the search was for a leader, on the assumption that space would follow.  A modest financial package was developed; the hope of massive resources to start up and maintain an institute gave way to a plan of incremental building, relying on competition for federal resources rather than a foundation or philanthropic windfalls.  In the 1920's the institution decided that Neurology would develop separately from Neurosurgery. By 1971 Hopkins had leaders in these departments who achieved unparalleled cooperation and integration.

Arguably, the personal traits of modesty, aloofness, and self-reliance that characterized the leaders of Neurology for its first 80 years were those that the structure required.  But the job of building to which the new Department of Neurology was committed required leadership of expansive vision, energy, and the ability to excite others into shared goals.  This anniversary celebrates the insight of the search committee in deciding on a young clinician-investigator, Guy McKhann, with personal characteristics not previously seen in Hopkins Neurology.  Hopkins' new leaders in Neurology in turn contributed to inspired recruitments of Directors of Neurosurgery, Psychiatry, the Kennedy Center, and Neuropathology.  The research output soared, the residency became one of the most sought after in the country, and within 10 years Neurology, Neurosurgery and Psychiatry were centralized in a new building much like that foreseen by the man whose name it still bears, Adolph Meyer.  By energy rather than endowment, by people rather than prefabricated blueprints, the Clinical Neurosciences fulfilled the vision of 1921. True to the prediction of the 1921 blueprint,

"Under these conditions, the instruction of the undergraduate medical student, in the necessarily elementary course in Neurology, would be markedly improved, and the training of neurologists, by the system of internship and postgraduate fellowship, would be such that well qualified young men, capable of extending the traditions of good treatment and advance of knowledge, would go out to all parts of the country..."

The greatest legacies of the last three decades are the leaders and their impacts on clinical care, teaching and research.