Isabelle Rapin is the perfect Luminary to discuss today, because she was born December 4🎂and was a founding member of the @ChildNeuroSoc in 1973 in #Nashville (where everyone is going for #AES2022).
Peds neurologists know why she has a pinwheel on her card - do you? 2/🪑
Born in Lausanne, Switzerland - where Augusta Déjerine-Klumpke studied - Rapin went to medical school locally. Like ADK, she worked at the Salpétrière - and like ADK, she wrote a brief autobiography (please write one, send to @JChildNeurol) journals.sagepub.com/doi/10.1177/08… 3/🪑
Rapin wrote her M.D. thesis on reducing mortality from juxtadural hematomas.
(The librarians at the University of Lausanne are so nice, btw.) 4/🪑
Rapin needed a residency, and Bellevue Hospital offered her pediatrics.
Once there, she applied to @Columbia for neuro residency - with Sidney Carter, new chair and director of the 1st training program for peds neuro in the U.S. (he also has a @JChildNeurol autobio) 5/🪑
(H. H. Merritt was chair @Columbia, and the Big Deal. Rapin writes that Robert Fishman "carried Merritt's bag," meaning that he saw the patients and presented to Merritt, who said the diagnosis, and everyone clapped. Fishman probably answered his MyChart messages too #goals) 6/🪑
In 1959 she married Harold Oaklander, of whom she says: "without his unselfish and sustained encouragement and help, his willingness to share in all household and child-rearing jobs...I could never have flourished in child neurology as I did." 7/🪑
In her autobio, Rapin also gives credit to her babysitter, Evelyn Barnes. Rapin and Oaklander had 4 children - one of whom, Anne Oaklander, would go on to become a successful neurologist herself. massgeneral.org/doctors/17253/… 8/🪑
In the meantime, Rapin became interested in hearing impairment and language development in children. She joined the faculty at @EinsteinMed and received an NIH grant. As she studied language and communication, she became interested in the disorder of autism. 9/🪑
She also published extensively on leukodystrophies and glycogen storage disorders - like Canavan Disease, named for another important woman in the history of neurology, Myrtelle Canavan (1879-1953). 10/🪑
With Doris A. Allen, PhD, Rapin published many papers in the 1980s that changed the way we think of autistic spectrum disorder, and how we treat and educate children with ASD. 11/🪑
Rapin wrote about her own work for a lay audience here.
"No one disagrees with or doubts the diagnosis [of autism] if the measure is very far from average, but there is a wide gray area at the edges of both normality and disease." spectrumnews.org/opinion/viewpo… 12/🪑
She was also friends with Oliver Sacks (!), who wrote "Isabelle would never permit me, any more than she permitted herself, any loose, exaggerated, uncorroborated statements. 'Give me the evidence,' she always says."
This blurb is from An Anthropologist on Mars. 13/🪑
All the best child neurologists like history, I hear. Rapin wrote a history of the neurology department @EinsteinMed, here (thank you for making my job easier, Dr. Rapin): einsteinmed.edu/departments/ne…
(She is in the middle, with a stylish patterned shirt.) 14/🪑
Rapin also wrote a history of the International Child Neurology Association, of which she was a founder - now led by another Luminary, Pratibha Singhi 15/🪑 tcender.org/wp-content/upl…
And of course she was a founding member of @ChildNeuroSoc, served on the board, and won one of the first Hower Awards in 1987.
The child neurology department at @EinsteinMed is now named for her: montefiore.org/rapin 16/🪑
In her @nytimes obituary she was called the "doyenne of autism." Described by patients as "gentle, warm and empathetic," she used her skills to change the way we care for one of the most vulnerable populations.
Happy birthday (November 29) to the Father of Neurology, Jean-Martin Charcot (1825-1893)!
I wouldn't say we're best friends exactly, but yeah, we used to hang out in Paris together. 1/4
Charcot was a neurologist in Paris in the late 1800s, when neurology was developing as a field. He was the 1st chair of neurology, and was a celebrity doctor at the time (this is a poem written and published in the newspaper after his death in 1893). 2/8
He was so famous that charlatans used his name after his death to sell "Kola Nervine Tablets" made from the "wonder-working Kola nut." 3/8
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Luminary #4: Dorothy Russell (1895-1983)
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Hands up if you used this textbook! The 7th edition of "R&R" was published in 2007.
You may have known that this was written by eminent neuropathologist Dorothy Russell, but did you know she had epilepsy? 2/🪑
Russell was born in Australia, but after both her parents died (her mother from measles), Dorothy and her sister Petronella went to live in England with an aunt. 3/🪑
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Luminary #1: Sarah McNutt (1839-1930)
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In 2002, Horn and Goetz published this excellent paper on McNutt - the 1st woman elected to the American Neurological Association (@TheNewANA1) - and her work with other early female physicians, including the Blackwells. n.neurology.org/content/59/1/1… 2/🪑
McNutt came from a long line of female midwives and healers, including Sarah Weir, who worked on Nantucket, and Rachel Hussey, who delivered 2992 children (both called physicians here, but neither MDs) 3/🪑
Edwin Smith, born in Connecticut, lived in Egypt in the late 1800s. An antiquities dealer, he bought a papyrus in 1862 that he was unable to translate.
Smith died in 1906, and his daughter donated the scroll to the New York Historical Society.
In 1920, Egyptologist Caroline Ransom Williams found it and recognized its worth. She wrote to her mentor James Henry Breasted and asked him to translate it. brewminate.com/the-contributi…
Ransom Williams felt she was too occupied with family to take it on.
“The papyrus is probably the most valuable one owned by the Society and I am ready to waive my interest in it, in the hope that it may be published sooner and better than I could do it.” [November 22, 1920]
Bradford-Hill's trial of streptomycin for TB (see my thread from earlier today) was the first randomized controlled trial - but not blinded, and not placebo controlled. There was another trial, around the same time, for a medication called patulin. 1/6
You've never heard of patulin? It's a mycotoxin (it grows on apples), once used as an antibiotic (but not any more, due to toxicity).
In the 1940s, it was billed as the cure for the common cold. 2/6
A study showed that if you spray patulin in someone's nose when they have a cold, they feel much better - within 48 hours - than people who didn't receive any treatment.
This was huge! Everyone wanted patulin to treat colds.
So what happened? 3/6
Here’s a good story about the placebo effect – on physicians:
If you had a stroke in 1810, it would have been diagnosed clinically, without MRI. Your doctors knew that if you died, your brain held either fluid (edema, ischemic stroke) or blood (hemorrhagic stroke). 1/
So obviously the problem was that there was too much fluid in your body.
Solution? Reduce fluid, by blood-letting. This was the solution to a lot of things (one of these days I'll do a #histmed#tweetorial on Benjamin Rush).
And many people got better. 2/
People got better because when you have a small stroke, inflammation and edema make symptoms worse initially, and then, over time, symptoms improve.
If they didn't get better? Easy - you didn't bleed them enough. 3/