Raymond Delacy Adams

BMJ 2010; 340 doi: (Published 03 February 2010) Cite this as: BMJ 2010;340:c724
  1. Robert Laureno,
  2. Joseph B Martin

    Pioneering neurologist, innovative teacher, and textbook author

    Raymond Adams, one of the great neurologists of the 20th century, died of congestive heart failure on 18 October 2008, in Boston, Massachusetts. He was the Bullard professor of neuropathology emeritus at Harvard Medical School.

    Adams was born to a family of uneducated farmers in Oregon on 13 February 1911. At his parents’ insistence he attended the University of Oregon, where he studied psychology. In 1937 he obtained his medical degree at Duke University.

    After residency in internal medicine at Duke, he obtained a three year Rockefeller fellowship, of which he spent two years at Massachusetts General Hospital, one as a neurology resident and one as a psychiatry fellow. The third year he spent as a psychiatry fellow at Yale-New Haven Hospital.

    He came to prominence as a neuropathologist and neurologist during his 10 year career at Boston City Hospital. From this position he was recruited to the Massachusetts General Hospital, where he directed the neurology programme for more than 25 years. He remained active as a clinician-teacher and author for more than a decade after his retirement as chairman.

    Adams was a spectacularly successful builder of institutions related to the spheres of neurology, experimental neuropathology, and child neurology. When he took over the department at Massachusetts General Hospital the entire neurology staff amounted to a handful. He enlarged the resident staff and faculty, and he arranged for the development of extensive research laboratories. He built the first large programme in paediatric neurology, with specialised faculty, residency training, and extensive Kennedy research laboratories. As a part of this effort he founded the Eunice K Shriver Center for mental retardation research and patient care. His combined staff numbered in the hundreds by his retirement.

    Adams’s important original contributions are too many to list. He described previously unknown diseases, including oculopharyngeal muscular dystrophy, central pontine myelinolysis, pituitary apoplexy, and Lance-Adams syndrome. He wrote definitive works on disorders that had been well known or barely noted but needed rigorous description and clarification: Wernicke-Korsakoff syndrome, “alcoholic” cerebellar degeneration, transient global amnesia, chronic hepatocerebral disease, acute hepatic encephalopathy, delirium tremens, and diphtheritic polyneuropathy.

    With his former fellow C Miller Fisher he wrote most of the original National Institutes of Health classification of cerebrovascular diseases, the terms of which have become the lingua franca among stroke professionals. With Charles Kubik he wrote the defining article on basilar artery occlusion. With Fisher he propounded the concept that distal migratory embolism explains the phenomenon of haemorrhagic brain infarction.

    In neuroimmunology he advanced knowledge of experimental allergic encephalomyelitis. In the light of this experimental disease he wrote a description of the pathology of the human demyelinative diseases, which led the profession to accept these diseases as autoimmune. He and Byron Waksman were the first to produce experimental allergic neuritis. In the light of these experiments he wrote a seminal article about Guillain-Barré syndrome, in which he argued for an allergic mechanism.

    As a clinical neurologist and bedside teacher, Adams was magisterial. As a residency director he was innovative, requiring that one year of the three year programme be spent in neuroscience, usually neuropathology. As a teacher of neuropathology he was original. At Boston City Hospital he developed a brain cutting conference. After a detailed patient summary was presented, the clinicians in attendance would be challenged to analyse the case. Adams would then cut the brain and show the actual pathology. When Adams moved to Massachusetts General Hospital, he arranged that this method of teaching be instituted there as well. At Massachusetts General Hospital he added another weekly conference, this one designed to challenge the pathologist. An array of microscopic slides of a case would be presented. From study of these sections, discussants would be asked to make a diagnosis and predict the history. Only after Adams discussed the case, always unknown to him, would the clinical facts be presented.

    Adams’s books included the first volume on muscle pathology in half a century. As an editor and author of the leading US textbook of medicine, Principles of Internal Medicine (later Harrison’s Principles of Internal Medicine) he helped to educate generations of students and internists. He was often teased by his fellow editors of the best known textbook of medicine that its title ought to be changed to “Principles of internal medicine and the details of neurology.” Frustrations of limitation of space encouraged Adams to coauthor with Maurice Victor, a brilliant textbook, Principles of Neurology, now in its eighth edition. Underappreciated is his classic Introduction to Neuropathology.

    Adams’s legacy is not limited to his array of original works, his nine major books, and the thriving neurology department at Massachusetts General Hospital. His fellows and residents became professors all over the United States and the developed world. For examples, those whom he helped educate include Sir John Walton, who became professor of neurology and dean of medicine at Newcastle upon Tyne; Martin Raff, who became professor of biology at University College, London; and James Lance, who founded a neurology department at the University of Sydney, Australia.

    Renowned trainees from the Adams programme at the Massachusetts General Hospital went on to lead key departments of neurology in the United States—Richard Johnson, Hopkins; Art Asbury, University of Pennsylvania; Barry Arnason, University of Chicago; Richard Barringer, University of Utah; and Guy McKhann, also of Hopkins, to name a few. Furthermore, Adams played a key role in helping academic neurology to develop in both Lausanne and Beirut. The breadth of his contributions is indicated by a few of his honours—presidency, American Neuropathology Society; presidency, American Neurological Association; and recipient, Hower award (Child Neurology Society).

    Raymond Adams is one of those few people, appearing every generation or so, who leave such a profound and lasting mark on neurological medicine that the profession is indelibly changed.

    His first wife, Margaret Elinor, and his second wife, Dr Maria Salam, died before him. He leaves four children.


    Cite this as: BMJ 2010;340:c724


    • Raymond Delacy Adams, (b 1911; q 1937, Duke University) died 18 October 2008 from heart failure.

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