Neurology: Past and Future

Abstract

Half a century ago a neurologist reached the apex of his proficiency near the end of a life of busy practice during which he had exhaustively examined many patients, among them those who were later to reach the postmortem table. Thus, in time, he became an accurate judge of localization and of the kind of lesion. Owing to the character of his preceptorship, that neurologist relied upon practical points for diagnosis—a state of affairs which today we call clinical acumen. A promising student might impress the master by the rapidity with which he learned sensory and motor distributions, cord reflex levels, and the multitudinous signs which the master's colleagues were forever discovering. For tools such a neurologist depended largely upon his ophthalmoscope, reflex hammer, and pin. He used them with a skill we envy. Eventually he, too, became a consultant and a professor. In the former role his knowledge of