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An Early Partial History of Neurology at UAB and the Alabama Area
By James H. Halsey, M.D.,
Founding Chair of the UAB Department of Neurology

Prior to about 1933 neurology was done by general practitioners and by superintendents of Bryce Psychiatric Hospital. In those days, one of the most common diagnoses was syphilitic general paresis, treatable with malaria therapy. Another was intractable epilepsy for which bromide and Phenobarbital were inadequate to enable them to function in open society.

In approximately1933, Dr. Wilmot Littlejohn settled here as the first physician in Alabama that was actually trained as a neurologist, though with credentials in psychiatry. The main neurologic journal at that time was the AMA Archives of Psychiatry and Neurology.  The second neurologist in Alabama was Dr. Samuel C. Little, settling here in 1946 following World War 2. In the meantime, with the beginning of the war, the Medical College of Alabama (then a two-year preclinical program), was moved from Tuscaloosa and expanded in Birmingham as a 4-year program as part of the war effort.

Dr. Little was the first user of EEG in the Southeast, and one of the founders of the Southern EEG Society. At some point, he moved full time into an office in the New Hillman Building with his EEG laboratory. He suffered a myocardial infarct about 1960, which greatly reduced his energy for general neurology, but he maintained an international reputation in EEG.

He was joined subsequently by Dr. Jolyn Tucker who later relocated to Hartford, Connecticut (prior to my arrival). Neurologist number 4 in the State was Dr. Harry Fang, a neurologist trained in Boston by Denny-Brown and also in neuropathology by Raymond Adams. He developed a substantial reputation in cerebrovascular disease, applying benzidine staining to brain tissue (the stain was of hemoglobin) to view the microcirculation post-mortem.

In 1964, Dr. Robert Ford, trained at the Mayo Clinic, and Dr. Irwin Lewis, from the Montreal Neurologic Institute, came to UAB. Lewis became the first in-house Chief of Neurology at the Birmingham VA Hospital. Ford remained in full-time private practice of general neurology, subsequently specializing in headache, in part because he, himself, suffered severe migraine. He retired about 2005, bequeathing much of his practice to Dr. Robert Slaughter and myself. Lewis left for private practice at Brookwood Hospital about 1968, but during his time here, he initiated one of the first clinical trials of levodopa in Parkinson’s disease. He died thereafter in 1999. Dr. Littlejohn was continuing to practice but was getting older, eventually retiring after suffering a stroke, and dying about 1970. Dr. Fang left for USC, where he had many family ties in LA, a month after I arrived at UAB.

 There were then several “neuropsychiatrists” who shouldered some of the general neurology load and performed many cases of electroshock therapy. Dr. Garber Galbraith, the first chief of neurosurgery, had also come to Birmingham following the war but remained in private practice, yet practicing a fair amount of general neurology. Interestingly, he practiced frontal lobotomy at Bryce Hospital, with a total experience of about 200 cases before the procedure died out as first reserpine and then thorazine became available in the late 50s, and general paresis had become treatable with penicillin. He taught us what came to be called “Galbraith’s Law”: “Don’t mess with a patient who is getting better.”

In those days, The Medical College of Alabama was the leader of institutions graduating the most doctors specializing in neurology.  The reason was thought to be from its strengths in teaching of neuroanatomy.  There were at least five full-time faculty members committed to that discipline, under the intellectual leadership of Dr. Elizabeth Crosby. Each of her colleagues specialized in a different evolutionary order of vertebrates: fish, amphibians, reptiles, and lower mammals, while she reserved primates and man for herself. She co-authored Correlative Neuroanatomy in 1962, while commuting between Birmingham, the University of Michigan, and Aberdeen Scotland, and continuing to do so until her death around 1985 at 90+ years of age.  I still have my copy of that book.

It is important to realize that in those days most of the private doctors had admitting privileges to University Hospital, then called “Hillman Hospitals and Clinics.” They moved around 1970 coincident with the opening of Montclair Baptist Hospital, now Trinity Medical Center.

During that time there was no UAB, only the Medical College of Alabama, and the University of Alabama extension center. The rapid growth of clinical departments fostered development and growth of basic science departments as necessary infrastructure for research. This culminated in the designation of the University of Alabama at Birmingham in 1969 as a separate component of a University of Alabama with ultimately 3 campuses at Tuscaloosa, Huntsville, and Birmingham. Each campus had then and now has its own president, reporting to a common chancellor and board of trustees.

I came to Birmingham in 1965, in part attracted by the presence of Dr. Fang as well as the EEG reputation of Dr. Little, and the pioneer program in carotid endarterectomy, a collaborative effort of Dr. Galbraith and then chairman of surgery Dr. Champ Lyons. Dr. Fang left a month after I arrived and Dr. Lyons died about 6 months later.  Thus, by my count, we have as the list of early Alabama neurologists: 1) Littlejohn, 2) Little, 3) Tucker, 4) Fang, 5) Ford, 6) Lewis, and 7) Halsey.  And 8), the first outside neurologist (not a native of Birmingham) was Dr. Dwight Plott, settling in Huntsville in 1966. Dr. Shin Oh in 1967 would be number 9 for Alabama.  So 8 for Birmingham and 7 for Medical College of Alabama which became UAB in the early 1968.  I have lost count since then.

 Sometime around 1968, Dr. Little asked me to relieve him of the duties of Director of the Division of Neurology, and around 1974 we became an independent department.

Neurology Grand Rounds, was for a long time spelled with a small “g”, comprising Dr. Little, Dr. Oh, and me, with neurology residents. These were always case-based discussions, usually comprising the two most interesting cases between our VA and UH services. This gradually attracted attendees from other departments including pediatrics, rehabilitation medicine, and psychiatry, by then justifying a capital G. As long as I remained Chairman, I resisted the national trend toward topical lectures, believing that case analysis was of more enduring importance in teaching than lecture topics which were likely to become outdated at the same rate as textbooks. Moreover, this format more suited my own preference.  In those days we regarded the “inservice exam” for residents as primarily for their own self-assessment, and also as a live preparation for the Neurology Board exam.

Two additional conferences filled out our teaching program: a case-based weekly neurology/neurosurgery conference, which attracted neuroradiologists, a neuro-otolaryngolist, and neuro-opthalmologists, as well as Dr. Crosby and sometimes some of her neuranatomy colleagues. Usually one case was presented by neurology and one by neurosurgery.

Autopsy conference was also weekly, attended by neurology, neurosurgery, neurology, neuroradiology, and neuroanesthesiology.  Cases were selected by the neuropathologist, and a neurology resident would prepare a case abstract, read it, incorporating his own discussion, followed by general discussion, and subsequently the pathology and final clinical pathology correlation. These were not really classical CPC in the sense of an unknown mystery case discussed by a senior clinician, followed by the pathological answer and interpretation.

Both of these conferences were made possible by the support of Dr. Galbraith, arising out of his unusual abilities as a neurological clinician, a fine technician, a great teacher, and our shared interest in cerebrovascular disease which made up a big part of the Neurology Service business. Drs. Faught and Harrell will remember them in their early years here. These conferences died out after Dr. Galbraith’s retirement and Neurosurgery’s priorities changed.

By 1984 it was clear that the problems and opportunities we were confronting were outgrowing my own administrative capacity and I asked the Dean to find a new chairman. Rumors of my death at that time proved to be greatly exaggerated. Dr. John Whitaker, Chairman at the University of Tennessee/Memphis was recruited and took over the position in 1985, initiating a period of growth that is continuing to accelerate now under Dr. Ray Watts. I was glad to have more time for my patients, my research, and collaboration with other colleagues.

I was saddened to see the degeneration of Grand Rounds into a lecture.

The rest is contemporary history.