Leonard Rowntree, Louis Wilson, Fielding Garrison, and the origins of teaching medical history at the Mayo Clinic.

A visiting surgeon described his disappointment with an aspect of the Mayo Clinic in 1914, stating that there was "the almost lack of anything that could be dignified by the term 'lecture.'" One year later, the Mayo Foundation for Medical Education and Research was founded. By 1917, the foundation declared history of medicine a graduate-level subject, and history of medicine questions were included in final oral examinations. In 1920 and 1921, lectures were given on historical topics; however, these lectures petered out, and there were no historical lectures in the official curriculum of 1923 or 1924. Enter Leonard Rowntree, who in 1926 proposed a lecture series on the history of medicine. Rowntree wrote to Fielding Garrison in early 1927 to ask for assistance selecting speakers. The two men corresponded and developed a list of eminent medical historians to invite, including Sir Charles Ballance, William Welch, and Garrison himself. These lectures served to enrich the greater Midwestern medical community as well thanks to Louis Wilson. Then head of the Mayo Foundation, Wilson wrote to nearby institutions to create a lecture circuit for speakers who traveled to the Mayo Clinic. Ultimately, the lectures were published as a book in 1933.

The Auxiliary to the American Academy of Neurology.

The American Academy of Neurology (AAN) was founded in 1948, and the Women's Auxiliary to the AAN was founded shortly thereafter. We reviewed historical archives of the AAN and Women's Auxiliary and interviewed past Auxiliary leaders to understand the perception and roles of neurologists' spouses. The Women's Auxiliary to the AAN was originally formed for the wives of neurologist Academy members with the intention of facilitating social and intragroup relationships. The first leaders and members of the organization included some of the spouses of the original Academy founders. With the original scope to provide socialization while the men were at meetings, the male neurologists initially planned much of the Auxiliary's activities. Over time, the Auxiliary's activities shifted and became women-led; engagement in community outreach grew, subcommittees expanded, and the group engaged in supporting the AAN in achieving its goals of improving neurology education and research. The change paralleled the women's movement with educational topics during the Auxiliary's meetings evolving from topics on homemaking to business and understanding neurologic diseases. The Auxiliary was intertwined with the Academy and initiated the S. Weir Mitchell Award and the Founders Award of the AAN in 1955 and 1994 to encourage basic and clinical research in neurology, respectively. In 1982, the Auxiliary requested increased involvement in the scientific programs at the annual meetings. Reflecting societal change, the name was changed to the "Auxiliary to the AAN" in the 1970s, and in the mid-1990s to the "Alliance to the AAN" to accommodate the increasing number of male partners of neurologists. Based on interviews, the Auxiliary provided engagement, empowerment, and connection between women. The Auxiliary's activities tapered in the late 1990s, in part due to changes in women's occupations, and to the rise of women's membership and leadership within the Academy.

History of migraine.

Migraine symptoms were described in ancient Babylonia, and supernatural forces were felt to play a role in etiology and treatment. This changed in the Greco-Roman period, when the (dis)balance of humors was considered in (patho)physiology and treatment based on this. Aretaeus distinguished between cephalalgia, cephalea, and heterocrania. The latter term was changed to hemicrania by Galen. Physicians in the 17th century attributed headache to the meninges, extracranial periost, and cranial blood vessels. As for the pathophysiology, Willis suggested intracranial vasoconstriction with subsequent dilatation. Tissot and Fothergill gave comprehensive descriptions of migraine, including visual symptoms. Symptomatic and idiopathic hemicrania were distinguished in the early 19th century. Vasomotor pathophysiology was scientifically studied in the 1860s, leading to sympathicotonic and angioparalytic theories. Latham combined them, stating the latter follows the first. Ergot was introduced in 1868; ergotamine was isolated in 1918. This led to the vasodilatation theory of migraine (Wolff), the discovery of 5-HT, and later the specific agonists. Aura and cortical spreading depression were studied in the early 1940s and related to spreading oligemia in the 1980s. Subsequently, hyperemia followed by oligemia after CSD was found. After the discovery of CGRP, a new a class of drugs became the subject of clinical studies.

Teaming beyond the clinical environment - building collective commitment across graduate medical education.

This commentary provides evidence and expert opinion on effective relationships and communication strategies for trainee and graduate medical education leaders. The authors also argue that consistent communication and alignment of goals between trainee leadership and graduate medical education leadership are essential components of a successful collaboration that promotes trainee well-being.

Women in the Mayo Clinic Department of Neurology in its early years.

The stories of early women physicians in the field of neurology are seldom discussed. Understanding the history behind women in neurology can inform our current practice and uncover the possible origins of gender disparities in academic neurology. Utilizing annual section/department reports and other primary sources, we describe the first women trainees and staff who broke gender barriers to train and work in the Mayo Clinic Department of Neurology. The department was founded in 1913 when Walter Shelden became its first consultant. It was not until the 1950s that a woman completed her neurology training and went on to practice neurology. Throughout the early years of the training program, there were no women on staff, as it was not until the 1970s when the first women were hired as consultants.

Paroxysmal Panting: On Respiratory Crisis and Other Respiratory Curiosities in the Aftermath of Encephalitis Lethargica.

Pandemics in the early 20th century (and now with SARS-CoV-2) have been dominated by respiratory viruses damaging the lungs. Less is known about abnormal respiratory patterns from brain inflammation. One of the first descriptions of respiratory rhythm abnormalities was seen with an acute attack of epidemic encephalitis (encephalitis lethargica), and reports appeared soon after the original description in 1921. We reviewed these ill-remembered disorders of respiration rate, respiratory patterns, and respiratory tics. Most commonly, dysregulations occurred during the phase when ocular signs appeared. The early symptoms were an unrelenting tachypnea (panting) without air hunger and an inspiratory hold (fixés en inspiration forcée). Initially regarded as hysterical in nature, the later bizarre disorders of respiration were considered equally serious with attacks of gasping, panting, puffing, inspiratory breath holding, coughs, giggles, sighing, grunting, and moaning. These respiratory disorders were seen exclusively as part of a parkinsonian syndrome. Most remarkably, these attacks could be provoked by oxygen administration. These respiratory abnormalities with encephalitis lethargica are not well remembered. One purpose of recalling these episodes is to call attention to central causes of respiratory illness even in pandemics with respiratory viruses.

Dr. Betty Clements: Breaking Gender Barriers in the Air Force and Neurology.

Women currently make up 45.9% of neurology residents and fellows, although little is known about the individual women who broke gender barriers to train as neurologists. Grace Elizabeth Betty Clements (1918-1965) was the first woman trainee at the Mayo Clinic to practice neurology and later became a founder of the Barrow Neurological Institute. Before paving the way for future women trainees in neurology, she served as a Women Airforce Service Pilot including flying atomic bomb planning missions during World War II. Following the war, her path to medicine included volunteering in the American Red Cross in the Philippines where she treated patients with Hansen disease (leprosy). Clements returned to her home state to complete medical school at the University of Nebraska before seeking neurologic training at the Mayo Clinic in 1954. Following additional training at Queen Square, she became a founder of the Barrow Neurological Institute in Phoenix, Arizona. Many early women in neurology have remarkable backgrounds that have equipped them for their career in medicine which Clements exemplifies.

Primer on the In-home Teleneurologic Examination: A COVID-19 Pandemic Imperative.

It is imperative in the coronavirus disease 2019 (COVID-19) pandemic that we serve our patients by implementing teleneurology visits for those who require neurologic advice but do not need to be seen face to face. The authors propose a thorough, practical, in-home, teleneurologic examination that can be completed without the assistance of an on-the-scene medical professional and can be tailored to the clinical question. We hope to assist trainees and practicing neurologists doing patient video visits for the first time during the COVID-19 pandemic, focusing on what can, rather than what cannot, be easily examined.

Robert Wartenberg and the American Academy of Neurology.

Robert Wartenberg (1887-1956) was born in Grodno (in present-day Belarus) and received his medical degree in Germany in 1919. He enjoyed a productive career at the University of Freiburg until 1935, when he fled Nazi Germany for the United States. Bernard Sachs, with whom he had worked during a Rockefeller fellowship in 1926, helped him secure a position at the University of California Medical Center in San Francisco in 1936. He was popular with students there as his sizeable personality translated into an engaging classroom style, but that same personality could create friction with colleagues. Following World War II, neurology as a specialty was growing and establishing its place in the medical landscape. With this goal in mind, A.B. Baker and other young neurologic leaders formed the American Academy of Neurology (AAN) in 1948 as an inclusive professional society. Baker recruited Wartenberg to join, he agreed, and immediately provided his own critiques on the organization. Wartenberg's standing in the academic community combined with his strong personality would serve Baker well as Wartenberg shielded the young AAN leadership from potential retribution. He was especially invested in ensuring the Academy had a journal as a means of development, and the journal Neurology® was born. Wartenberg died on November 16, 1956, and was honored for his service to the Academy with the Robert Wartenberg Memorial Lecture, which stands today as one of the principal events at the Annual Meeting.

"Filler-ins" to Physicians: History of the Otolaryngology Training Program at Mayo Clinic.

The first officially recognized otolaryngology resident at Mayo Clinic started training in 1908. In the following years, the residency program evolved through emerging national standards and regulations for medical education, declining and resurgent interest in the specialty, and radical changes in otolaryngology as a practice. This article details the growth of the Mayo Clinic otolaryngology residency program, often in the words of the pioneering physicians involved in the process, from "filler-ins" for the staff to today's nationally recognized program.

A Journey Through 100 Years of Vestibular Schwannoma Surgery at Mayo Clinic: A Historical Illustrative Case Series.

: The present state of vestibular schwannoma (VS) management is the product of over a century of technical progress by revolutionary surgeons who transformed a once perilous operation. At the beginning of the 1900s, patients who did not succumb to their disease were treated exclusively with surgery, which itself was almost assuredly devastating. Through the pioneering work of surgeons such as Harvey Cushing, Walter Dandy, William House, and others, safer surgical approaches were established with concurrent advances in neuromonitoring, neuroanesthesia, radiology, and adoption of the operating microscope. Owing to refinements in radiosurgical treatment and a greater understanding of the natural history of disease, there has been a dramatic shift toward more conservative management in recent years. For more than 100 years, the Mayo Clinic in Rochester, MN, has maintained an active and uninterrupted VS practice with activities that are well documented and preserved through the Mayo Clinic historical archives. We herein report representative early cases to illustrate the fascinating evolution in VS surgery over the past century at a single-tertiary referral center. Original clinical, imaging, pathology, and operative reports are presented from each era of management. To accurately portray the medical context of each era, antiquated terminology is intentionally preserved as originally transcribed.

The Mary Walker effect: Mary Broadfoot Walker.

Mary Broadfoot Walker (1888-1974) was the first to demonstrate the 'Mary Walker effect' describing the weakness of other muscle groups following release of the arteriovenous occlusion of an unrelated exercising muscle group in patients with myasthenia gravis, which led to the search for a circulating causative agent for myasthenia gravis. She was the first to clearly demonstrate that strength temporarily improved in patients with myasthenia gravis with physostigmine or Prostigmin (neostigmine). This dramatic treatment response has been erroneously termed the 'Mary Walker effect'. Further, she noted hypokalaemia during attacks of weakness in familial periodic paralysis, pioneering treatment with potassium chloride. Although Mary Walker practiced in a nonacademic setting and trained at a time when women were not allowed to train alongside men, she was the first to convincingly demonstrate three life-changing treatments in the field of neuromuscular medicine, a feat that few physicians of any era can claim.

Carotid Cavernous Fistula Mimicking Hemicrania Continua: A Case Report.

BACKGROUND: Hemicrania continua is a primary headache disorder characterized by a continuous, unilateral headache associated with ipsilateral cranial autonomic features that responds to indomethacin. By definition, the symptoms are not referable to an underlying structural pathology. However, several cases of secondary hemicrania continua related to underlying structural lesions have been reported. CASE: We present a case of a 53-year-old male with a prolonged, right-sided headache associated with intermittent right-sided ptosis, conjunctival injection, tearing, and nasal congestion, suggestive of hemicrania continua, who was found to have an indirect carotid-cavernous fistula, and who, after endovascular treatment of the fistula, had resolution of his symptoms. CONCLUSION: Alternative, and perhaps less common, causes of headache should be considered when the clinical presentation is atypical or does not clearly fulfill diagnostic criteria for primary headache disorders. Carotid cavernous fistulas should be included within this differential, and represent a potentially treatable and reversible cause of otherwise refractory headache.

Occipital neuralgia associates with high cervical spinal cord lesions in idiopathic inflammatory demyelinating disease.

BACKGROUND: The association of trigeminal neuralgia with pontine lesions has been well documented in multiple sclerosis, and we tested the hypothesis that occipital neuralgia in multiple sclerosis is associated with high cervical spinal cord lesions. METHODS: We retrospectively reviewed the records of 29 patients diagnosed with both occipital neuralgia and demyelinating disease by a neurologist from January 2001 to December 2014. We collected data on demographics, clinical findings, presence of C2-3 demyelinating lesions, and treatment responses. RESULTS: The patients with both occipital neuralgia and multiple sclerosis were typically female (76%) and had a later onset (age > 40) of occipital neuralgia (72%). Eighteen patients (64%) had the presence of C2-3 lesions and the majority had unilateral symptoms (83%) or episodic pain (78%). All patients with documented sensory loss (3/3) had C2-3 lesions. Most patients with progressive multiple sclerosis (6/8) had C2-3 lesions. Of the eight patients with C2-3 lesions and imaging at onset of occipital neuralgia, five (62.5%) had evidence of active demyelination. None of the patients with progressive multiple sclerosis (3/3) responded to occipital nerve blocks or high dose intravenous steroids, whereas all of the other phenotypes with long term follow-up (eight patients) had good responses. CONCLUSIONS: A cervical spine MRI should be considered in all patients presenting with occipital neuralgia. In patients with multiple sclerosis, clinical features in occipital neuralgia that were predictive of the presence of a C2-3 lesion were unilateral episodic symptoms, sensory loss, later onset of occipital neuralgia, and progressive multiple sclerosis phenotype. Clinical phenotype predicted response to treatment.

Timing of milestone competency acquisition in neurology residency: What by when?

OBJECTIVE: To determine the stage of training at which neurology residents should achieve individual elements of the Accreditation Council for Graduate Medical Education neurology Milestones and to examine the relationship between perceived importance of Milestones and the stage by which they should be achieved. METHODS: A modified Delphi technique was used to establish consensus postgraduate year (PGY) expectations for neurology Milestone competencies across 3 geographically and administratively distinct Mayo Clinic neurology residency programs. Timing expectations were examined for relationships to perceived importance of the individual Milestones and effects of participant characteristics. RESULTS: PGY expectations for neurology Milestone elements ranged from PGY 1.3 to PGY 4.1. Extent of rater educational seniority had no effect on PGY competency expectations. There was a moderate inverse relationship between perceived importance of the Milestone element and the PGY by which it should be achieved (r s = -0.74, p < 0.0001). CONCLUSIONS AND RELEVANCE: Expectations for neurology Milestone competency acquisition can be measured and may help inform individual program design, educational expectations, and future Milestone design.