NEUROLOGY IN THE 1930's
1930-1939

Richard Satran, MD

Insignia of the American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology was founded in 1934 as primarily a vehicle to accredit specialists in the two fields. The founding resulted from a long series of heated negotiations.

         In 1932 the United States Public Health Service began what became known as the Tuskegee Experiment to observe the natural history of untreated latent syphilis in Macon County, Alabama and periodic reports were published. A cohort of 408 black men with syphilis and 196 black male controls were enrolled. The then current therapies of fever, mercury and bismuth were supervised by general practitioners or syphilologists and usually not by neurologists or psychiatrists. Forty years elapsed before the study was brought to public attention by a critical national press and addressed by Congress. The natural history of syphilis and its treatment, racism, informed consent, and failure to treat despite the availability of penicillin were reveiwed. Ultimately follow-up care was provided for the survivors and their families.

         Although there had been some successful reports using sulfonamide drugs in the treatment of infectious disease, the number of patients and long-term post therapy observations were few. In 1937 an untested sulfanilamide preparation containing diethylene glycol caused more than 73 deaths in this country. An immediate review by the Federal Government led to legislation to correct deficiencies in the preparation, safety testing, labeling, distribution, and marketing of certain drugs.

Elixir Sulfanilamide Label Sulfanilamide became one of the most important therapeutic advances of the 1930's, although contaminated drug batches were associated with death and high morbidity.

         Merritt and Putnam in their search for a non-toxic anticonvulsant drug tested more than 700 substances by studying the elevation of seizure threshold upon electrical stimulation of the brain in animals. Some hydanation and dione compounds were found to have antiepileptic potential. In 1938 they described their remarkable results using phenytoin to treat major, absence, and psychic equivalent seizures. Their discovery ranked as the first major successful medical treatment for epilepsy in the 20th century.

The Development of Phenytoin H Houston Merritt and Tracy J Putnam developed phenytoin in 1938 and established a new era of anticonvulsant neurotherapeutics.

         In 1935 Moniz of Portugal was impressed by the report of behavioral changes in chimpanzees after frontal lobe ablations. No psychotropic drugs were then available to control the behavior of severely disturbed patients. Moniz and Lima, first with alcohol injections and later a leucotome, interrupted the frontothalamic pathways of twenty mentally ill patients and described their results. In 1937 Freeman and Watts introduced the operation in this country. Thousands of surgeries were done although there was some physician resistance to the procedure. The years, which followed, clarified the merits and deficiencies of this operation for which Moniz received a Nobel Prize.

Early Lobectomies Egas Moniz studied the effects of frontal lobe ablations during the 1930's and introduced lobectomy surgery to the United States of America via his American colleagues, Walter Freeman (shown here receiving an emblem from the Lisbon Academy of Sciences) and James Watts.

         Although the 1930's were bleak, stressful and uncertain, important changes in neurology took place. In addition to providing financial assistance the government became more involved with medical care. These discoveries and laboratory investigations during this period not only strengthened the specialty but brought neurology in the United States to a position of international stature.