|Figure 1: Image in the public domain. Credit: The National Library of Medicine. Source|
Amongst the titans of medicine, it is not easy to pick out those whose footprints will not fade with passing time. Derek Denny-Brown (Fig 1) was one. He was born in Christchurch, New Zealand. After his graduation in medicine from Otago University in 1924, he won a Beit fellowship to study in the Oxford laboratory of Sir Charles Sherrington. Within a remarkably short period of intensive research at Oxford, Denny-Brown obtained his D Phil Oxon (1928), MRCP (1931), MD (1946), and published fourteen papers. He was awarded the FRCP (1936) and the OBE in 1942.
He wrote classical physiological papers with Cooper and Sherrington on the flexor reflex. Equally important was his work with Liddell on the stretch reflex, and on red and white muscle physiology.1 His definition of the distinctive properties of red and white muscles fit with Sherrington’s concept of the motor unit. He also developed the technique of antidromic stimulation for the analysis of motor neuron responses. When a damaged nerve was stimulated, it failed to pass the impulse to the connected muscle. This led to a new concept; that it was demyelination that was responsible for this conduction block, still an important feature in distinguishing different peripheral nerve diseases.
With the Sherrington team, he studied both brain and cord physiology by stimulation-ablation techniques.2 He also described the “Nature of Posture,” and published a monograph on spinal reflex function.
On completing his fellowship, Denny-Brown in 1928 became resident medical officer at the National Hospital, Queen Square. This was a golden era of Queen Square, where his contemporaries included Gordon Holmes and Kinnier Wilson, Walshe, Adie, Riddoch, and Symonds. The registrar was MacDonald Critchley, and the pathologist was Godwin Greenfield. In 1935 he was appointed assistant physician to the National Hospital and neurologist at St. Bartholomew’s Hospital. In 1936, he gave the Goulstonian Lectures at the Royal College of Physicians and in the same year received a Rockefeller Travelling Fellowship to work with Fulton at Yale.
In what must have been a difficult decision for him, in 1941 whilst serving in the British Army, he was released at the request of James Bryant Conant, a politically influential President of Harvard University, in order to take up his appointment as director of Harvard’s Neurological Unit at Boston City Hospital. In 1946 he was appointed Putnam Professor of Neurology at Harvard. Many years later, in 1960 he declined the invitation of former colleagues to become the first professor of neurology at Queen Square.
Although articulate, his thoughts were at times punctuated by hesitation; but then would be revealed the most compelling syllogisms providing insights into the physiology of humans or monkeys, which enlightened both students and international visitors. A hard taskmaster with an austere, distant manner, at home he was warm, humorous, and would occasionally uncover his wider intellectual interests and courtesy.3 Clinical diagnosis4 was neither his major interest nor his forte. However, his Saturdays at the Boston City Hospital began at 10 a.m. with the grand rounds filled with hospital staff and many visitors from the US and abroad. After the clinical presentation, he discussed the problem exhaustively, showing clinical knowledge and experience. A more sociable lunch was succeeded by afternoons experimenting on primates by testing the effects of lesions of the central nervous system on the motor and reflex behavior. During his life these studies involved about 450 monkeys.
Denny-Brown’s prolific work yielded important insights into diseases of muscle, peripheral nerve, the basal ganglia, higher cerebral function, and the cerebral circulation.5 In his early days he also published clinical studies on myoclonus, seizures, multiple sclerosis, porphyria, myokymia, electromyography, head injury, poliomyelitis, hereditary sensory radicular neuropathy, meningitis, as well as apraxia, thiamine deficiency, Parkinsonism, and pain. He was one of the first to recognize non-metastatic carcinomatous sensory neuropathy.6 A dedicated quest for the mechanisms of nervous disease, particularly the physiology of the motor system, inspired his tirelessly energetic work in the Sherringtonian mold. In his later years he primarily investigated motor control and its breakdown in disease, and the mechanisms of compensation for its deficits.7
Besides many papers were two classic books, The Basal Ganglia and Their Relation to Disorders of Movement (1962) and The Cerebral Control of Movement (1966).
Not only is Denny-Brown remembered for his research, but in Boston, alongside Raymond Adams, EP Richardson, and C Miller Fisher, he also cultivated the growth of American neurology. His training program linked neurology with internal medicine rather than conventionally with psychiatry, a theme elaborated in his 1952 paper, “The changing pattern of neurological medicine.” His program grew rapidly, so that by the early 1960s, of forty-one departments of neurology in the United States, he had trained nineteen chairmen. He and Raymond Adams, who could make comparable claims for successful acolytes, dominated American neurology. Many aspiring British neurologists visited and studied under them.
He gave the Goulstonian Lecture in 1937, the Croonian Lecture in 1960, won the Sherrington Medal from the Royal Society of Medicine, 1962, and the Jacoby Award from the American Neurological Association in 1968.
He was married to Sylvia Summerhayes and they had four sons. In 1967 he retired from Harvard Medical School and from clinical work8 to begin a productive period as Chief of Neurophysiology and Associate Director of the New England Regional Primate Center until 1972. He continued to write until his death from multiple myeloma in 1981.9 The Denny-Brown Collection includes surgical records, photographs, and films of patients and monkeys and is used by many scientists.10
RW Gilliat’s appreciation in 1981 provides a suitable epitaph:
There can be few people whose influence on the neurology of this century has been greater, or whose pupils can have derived more strongly the feeling of having been changed by their experience.11
- Creed RS, Denny-Brown D, Eccles JC, Liddell EGT, Sherrington CS. Reflex activity of the spinal cord. Oxford, The Clarendon Press, 1932.
- Denny-Brown D. The Sherrington school of Physiology. J. Neurophysiol 1957;20:543-7.
- MacDonald WI. Munk’s Roll. Lives of the Fellows of the Royal College of Physicians of London, Vol VII (1826-1925). Ed Gordon Wolstenhome. London: Published by the College. 1984. Pp.146-8.
- Denny-Brown D. Handbook of neurological examination and case recording. Harvard University Press; Oxford University Press. 1946.
- Foley JM. Derek Denny-Brown, 1901-1981. Ann Neurol. 1982;11(4):413-9. http://doi.org/10.1002/ana.410110416
- Denny-Brown D. Primary sensory neuropathy with muscular changes associated with carcinoma. Journal Neurology, Neurosurgery & Psychiatry 1948;11:73-87.
- Martinez ARM , Faber, I, Martins Jr, CR, Casseb, R F , Nucci, A, França Jr, M C, Teive, Hélio AG. Derek Denny-Brown: the man behind the ganglia. Arquivos de Neuro-Psiquiatria 2017;75(2), 127-129. https://doi.org/10.1590/0004-282×20160190
- Modern Neurology. Papers in Tribute to Derek Denny-Brown. Edited by Simeon Locke, M.D. London: J. & A.Churchill. 1969.
- Cobb S. D. Denny-Brown Obituary. Transactions of the American Neurological Association 1968, 93: 306-308.
- Vilensky J.A., Gilman S. and Dec E.M. The Denny-Brown Collection: A research and teaching resource. Annals of Neurology 36:247-251, 1994). Collection at: ([email protected])
- Gilliat RW. Dr. Derek Denny-Brown OBE, MD, DPHIL, FRCP, 1901-1981, An Appreciation. Le Journal Canadien Des Sciences Neurologiques 1981;8:271-3
JMS PEARCE, MD, FRCP, is a retired neurologist and author with a particular interest in the history of science and medicine and emeritus consultant neurologist in the Department of Neurology, Hull Royal Infirmary.