Alfred Reginald Allen: The mythic career of a gifted neuroscientist

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229

Historical Vignette

Alfred Reginald Allen : The Mythic Career of a Gifted Neuroscientist Edward B . Schlesinger, M .D. Neurological Surgery, College of Physicians and Surgeons, Columbia University, and Neurological Surgery, Presbyterian Hospital, New York, New York

The titanic battle fought in 1918 over the terrain between the west bank of the Meuse and the Argonne forest led ineluctably to final victory for the Allied forces . It marked the first major commitment of American troops in an independent combat role, as well as unequivocal evidence of their battle readiness . Its portent was not lost upon the German high command . The casualties sustained by units of the American 79th Division (tasked with clearing the enemy from the heights of Montfaucon) included Major A . R. Allen, a line officer of the 314th Infantry Battalion, whose role invites our scrutiny (Figure 1) . From this distance in time it seems worthwhile to review the facts concerning the entry of American troops into combat at that critical juncture and their impact upon the course of a long and increasingly desperate war . In the previous year, General Petain had replaced Nivelle as Commander in Chief of an utterly demoralized and attenuated French army . Years of inept leadership and an excessive price for paltry success had left the French soldier weary, disillusioned, and bitter . The Germans had proven better prepared and disciplined, and superbly led by veteran noncommissioned officers and supported by modern weaponry and state-of-theart artillery tactics . The French troops were ripe for rebellion at the prospect of further aggressive action, driven to such extremity by rumor of a renewed offensive. Rejection of orders and defection from the ranks gathered momentum as the new commander assumed control . Mutinous conduct spread, fanned to incandescence by propagandists and by the vicious barbs directed at the military hierarchy by the Parisian press . The common soldier, aware of high-level ineptitude and moral decay, was prey to a sense of utter helplessness and hysteria, compounded by chronic fatigue and inadequate Address reprint requests to : Edward B . Schlesinger, M .D ., Box 76, 710 West 168th Street, New York, NY 10032 . Received February 4, 1991 ; accepted February 25, 1991 .

C 1991 by Elsevier Science Publishing Co ., Inc .

rations . Among other defects, the French command sadly lacked a tradition of concern for the psychological and physical sustenance of its citizen army . In such a grim setting, Petain was not the man later remembered as the pliant tool of German policy in World War II . In 1917 he was one of the few commanders to articulate the defects in the French military system, with its decadent, narcissistic, and romantic ethic . He laid out disciplinary plans for the dissident troops but showed respect and concern for the roots of their treasonous conduct . Miraculously, Petain restored order by suasion based on the troops' respect for his peasant honesty, although it was coupled with harsh punishment when deemed essential . He considered the Army unprepared physically, emotionally, or in training for any aggressive action . His strategy perforce would be to rely solely upon defensive tactics until the Americans arrived to tip the balance . During the interregnum, he hoped to rest his troops, boost morale, and train them for what he felt would be the conclusive battles of the war . Throughout the war, there were profound differences in strategic thinking on the part of British and French leaders . Marshal Haig saw the problem in a sharply divergent light and, undaunted by a record of previous disasters, called for a major offensive while Petain counseled a defensive stance . Haig, plagued by miserable rapport with his Prime Minister, Lloyd George, was certain that his renewed offensive would win the war without support from the disdained and untried Americans . For his part, Lloyd George deeply mistrusted Haig and would have dismissed him, but hesitated because of Haig's close friendship with the British monarch . One of his byzantine political maneuvers was to divert urgently needed troop replacements from the European front and send them instead to safer but strategically remote missions in the Middle East . Petain was soon replaced, due to dreary military infighting, as well as the mercurial and impatient tempera0090-3019/91/$3 .50



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Figure

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1 . Major Alfred Reginald Allen, U .S .A ., 1876-7918 .

ment of the civilian leadership . In retrospect, Petain deserves credit for restoring the French to some semblance of preparedness for the final campaigns of the war . It was a sad quirk of fare that he did not pass from the scene before World War II . Historians might then have recalled him at his zenith rather than during the awful years of his dotage after the fall of France . The Germans, meanwhile, had leisure to reinforce their western front with troops fortuitously released by Russia's defection from the Allied cause . General Ludendorff and his staff assiduously drew plans to deliver a conclusive coup de grace to the wavering Allies . In the event, his huge offensive proved a death blow to the Prussian cause for a variety of reasons, not the least of which was his personality disintegration under stress . The dramatic appearance and effectiveness of the fresh albeit unbloodied American troops in the battle line made it clear to him that they would have a powerful effect upon the agonizing seesaw of military dominance . What haunted Ludendorff was his nightmarelike awareness that a million more well fed, eager Americans could shortly pour into the enfeebled lines . On September 30, 1918, at the height of the Meuse/ Argonne offensive, as noted earlier, Major Alfred Reginald Allen, U .S-A, a battalion commander of the 314th

Schlesinger

Infantry Regiment, 79th Division, died, victim of a shrapnel wound to the brain . His fatal injury was incurred late in the previous afternoon as he directed his battalion in the village of Nantillois, a few meters from Mt . Montfaucon . He was buried with the usual military honors ; a deeply lamented casualty of a fine division . Although by the 26th of September the Americans had driven the obstinate German forces from the strategic heights of the mountain, the battlefield was not completely stabilized until October 4th . The death of a line officer in battle is certainly not unique, but the dreadful rate of attrition of field grade officers was one of the most appalling aspects of that cruel and blundering war . What was distinctly unusual was that Major Allen was a distinguished academic neurologist . The inevitable question arises : "Why was a neurologist leading an infantry battalion?" The answer is only partially revealed in extant military records-the bare facts of his military career . Lehigh, Allen's college, is, like the Army, only dimly aware of him-the record of his physical presence during 1893-1894 . An extensive obituary delivered by Charles K. Mills, a distinguished academic neurologist, merely records that Allen chose to join the combat forces rather than the medical corps . In spite of a diligent search for greater dimension than this single flat sentence, no further cogent information has been found . Mills pointed out, incidentally, that Allen was the only member of the American Neurological Association killed in military service in the history of the American Neurological Association . It is disappointing to be unable to learn more about Allen's decision . His medical skills were acknowledged to be of a high order, and he obviously enjoyed his professional work . One might have presumed that with his medical training and exceptional accomplishments he would have chosen the role of medical officer . Until the recrudescence of interest in spinal cord trauma during and after World War II, Allen's name and research achievements lay fallow or were barely recalled . The order of magnitude of his achievements and talents have never been fully recognized . He deserves reappraisal as a seminal figure in American neuroscience . Allen was a descendant of English Quakers who reached America in 1681 . His father, George Pomeroy Allen D .D ., was a respected theologian, and his mother, the daughter of Mark DeWolf Howe, the first bishop of the central diocese of Pennsylvania . Allen was one of a long line of distinguished offspring of intermarriages with the Waln and Pomeroy families . From that fecund admixture, he inherited a rich endowment of musical and mathematical talent, language proficiency, and the intellectual breadth that motivated his research and clinical pursuits . It is not unusual for medical graduates to opt to join



Alfred Reginald Allen

the military . Few have served in combat roles ; their careers ordinarily remain within the confines of medical department responsibilities . Allen's military career grew from a prescient conviction about the need for American military preparedness for World War I . He was among the first to attend the training camp at Plattsburgh in 1915, returning in 1916 . Commissioned a 1st Lieutenant in the Reserve, and Major upon the declaration of war, he was ordered to Fort Niagara, then Meade, and eventually the training school at Fort Sill, Oklahoma . For his exceptional performance, upon return to Meade he was made director and briefly Commandant of the School of Automatic Arms in the Infantry School of Arms of the 79th Division . Overseas as a field officer, he, from all accounts, soon gained the respect of his troops and fellow officers for proficiency and diligence in leadership . Upon graduating from the University of Pennsylvania Medical School in 1903, Allen was for several years the assistant of S . Weir Mitchell, the distinguished neurologist, author, and experimentalist, whose Civil War treatise on peripheral nerve injuries remains a classic . By 1905, Allen was active in research in neuropathology at his alma mater. In 1908, he published an informative and technically well-illustrated monograph, "Injuries of the Spinal Cord ." It was widely considered to be a significant contribution to an understanding of the sequence of pathological events after trauma . In the following year he joined the clinical neurological staff at the medical school . His publications, clinical and experimental, were chiefly concerned with the nervous system and its pathology . A special skill at microscopy and medical photography illuminated his publications, as did his meticulous approach to laboratory experimentation . His major achievement was a study of the effects of spinal trauma, begun in 1908 and continuing through 1914 . He maintained a rigorous attitude in reporting his results . His work involved techniques for reducing cord damage in dogs subjected to measured trauma to the spinal cord . Early in the paper he states his position : "I would accentuate the fact that this is a preliminary report and that I am fully aware of the amount of control experimentation necessary before an ex cathedra statement can be made as to the applicability of this work in the human subject." A related chapter, "Normal and Pathological Physiology of the Spinal Cord," in Frazier's The Surgery of the Spine and Spinal Cord, is even now exciting and cogent reading. It describes the sequential pathological events that follow trauma to the cord, as seen under the microscope . Allen's surmise that secondarily elaborated toxic chemical substances create secondary damage to the injured cord was a prophetic insight . His model for evaluating the reversibility of cord damage, utilizing graded weights dropped onto the exposed cord, became

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the standard tool for much subsequent research (Figure 2) . He concluded that early decompression, with deliberate incision of the pia arachnoid and cord to allow debris of necrotic cord and blood products to extravasate, was useful in preserving functional cord substance after severe focal trauma to the spinal cord . In reviewing the literature on the clinical management of spinal cord trauma, one finds the same basic arguments debated over many generations, with little variation . It is pleasant to read Allen's measured discussions and discern how reasonable and logical he was in his analyses . Earlier in the century, debates were generally more philosophical than scientific, largely because the clinician had little objective information compared with the armamentarium now at one's disposal . Allen was unusual in his lack of bias and his insistence upon laboratory proof of any positions taken . In the context of the times, his approach and techniques of evaluation are impressive . The conventional comprehension of the aftermath of serious cord injury



232

Schlesinger

Surg Neurol 1991 ;36 : 2 2 9 -33

A NEW DIAGNOSTIC SIGN IN RECURRENT LARYNGEAL PARALYSIS'

Dorsal Region with Conservation of the Spinal Reflexes Below the Level of the Region ." Attention was not yet

From the Department of Neurology of the University of Pennsylvania

focused upon the chain of pathological events that take place within the spinal cord after injury, nor upon its potential for recovery under a variety of clinical circumstances . Allen's stature as a gifted investigator was recognized early, and he was active in local and national societies . At the University, Charles Frazier and his neurosurgical group found him a valued confrere with many shared research interests Concurrently, his deep devotion to musical endeavors made him prominent in amateur theatrical affairs. He founded the Savoy Opera Company of Philadelphia and produced and directed memorable Gilbert and Sullivan operettas . The organization remained for many years a cherished Philadelphia musical tradition . Allen enjoyed writing carols and became the acting musical editor of the "Hymnal," an official publication of the Presbyterian Church . He was particularly skilled at revising the harmonies of established hymns and chants . His musical interest ranged from theory to performance on piano and violin-incidentally, selftaught . His ability to blend musical interest into his medical approach is evident in a paper he read at the 33rd Annual Meeting of the American Neurological Association in May of 1907, entitled "A New Diagnostic Sign in Recurrent Laryngeal Paralysis" (Figure 3) . The paper illustrates his modest estimation of his efforts, a characteristic evi-

By ALFRED REGINAID ALLEN, M .D . INSTEUCrot IN NEUROLOGY AND IN NLURDPATHOLOGY IN "It UNIYYZITY OV PENNSYLVANIA, ASSISTANT NLURELOGIST To IRE PHILADELPHIA GENERAL HOSPITAL I make the report of this sign, not with the expectation and hope of its becoming one of the great diagnostic methods, but rather because it seems to me of interest in that it permits a quantitative estimation of the contractile ability remaining in a vocal cord in cases of recurrent laryngeal paralysis . I have noticed in these cases where the lesion is monolateral that there is a very material difference in the upward excursion of pitch when the vocal apparatus is stimulated electrically during the singing of a tone . To demonstrate this it is necessary to bare the neck completely and by careful palpation determine the angle on each side of the larynx formed by the cricoid and the thyroid cartilages . A small button electrode with a thumb circuit breaker is placed in this angle over the cricothyroid membrane, pressing back slightly the sterno-hyoid muscle, and then the patient is instructed to sing the note C . For a man this should be _6* -~ and for a woman

.

On the normal side there will be a rise

in pitch equal to from seven to fourteen half-tones, or in other words the excursion will be an interval of from a perfect fifth to a major ninth or over . On the paralyzed side, however, the tone will only be raised from two to three half-tones -a major second or a minor third. As the amplitude of this excursion varies in the normal individual according to the pitch of the note from which the test is 'Read at the thirty-third annual meeting of the American Neurological Association, May 7, S and 9, 1907 . rat

Figure 4 . The obituary of Alfred Reginald Allen II . Copyright 7988 by

Figure 3. An example both ofAlien'r modest self appraisaland hirapplica-

Alfred Reginald Allen, 83, Dies ; Former Official of the Met Opera

tion

of an avocation to his medical approach .

Tbr New York Times Company . Reprinted with permirrion .

By BERNARD HOLLAND

and transection was, until the publication of Riddoch's magisterial monograph, in 1917, bogged down in the rigid dogma of Bastian, and in Gordon Holmes' conclusions in "Spinal Injuries in Warfare" (1915), based upon an appraisal of acute spinal injuries in the military hospitals in France . Riddoch's "The Reflex Functions of the Completely Divided Spinal Cord in Man" traced the clinical changes after transection and the transition from the early phase of areflexia and flaccidity to the chronic one of spasticity . He, of course, had the great advantage of studying patients who had somehow survived the acute syndrome following cord trauma, and lie graciously acknowledged that fact in his papers . As late as 1916, our national societies still listened to papers such as "The Effects of Laminectotny and Simple Exposure of the Cord Upon the Crucial Reflexes," or "A Complete Division of the Spinal Cord in the Lower

Alfred Reginald Allen, who had a long career as an assistant general manager at the Metropolitan Opera sod es the executive director of operations for Lincoln Center, died of natural causes last Sunday in WashlngtomL He was83yearsold. Mr. Allen, who was also known as an expert on Gilbert and Sullivan operas, was bo In in Philadelphia and educated at Phillips Exeter Academy and Harvard College . His first venture into the performing arts business came in 1918 when he did promotion for the Victor Talking Machine Company . After a period in Africa as part of a scientific expedition there, he returned to the United States and became a copywriter for advertising agencies in Philadelphia and New York . This led to an association with Leopold Stokowski . the conductor, to Mr. Allen's election to the board of the Philadelphia Orchestra and a subsequent job as the orchestra's manager beginning in 1935 . In the latter post he succeeded Arthur Judson, the powerful musical-artists manager . In 1939, Mr . Allen became head of the

scenario department at Universal Pictures in Hollywood . That career was Interrupted by World War 11, when Mr. Allen Served as a lieutenant commander in Air Combat Intelligence . After working for the J . Arthur Rank organization In postwar Hollywood. Mr. Allen returned to work at the Metropolitan Opera. He helped preside over the transition between Edward Johnson's regime at the house and that of Rudolf Ding Mr. Allen worked at the Metropolitan until his retirement m 1969, except for a five-year Interlude

Linccoln Center project and supervised

the Metropolitan's transition to its new headquarters there. His subsequent activities Included executive positions at the American Academy in Rome and with D'Oyle Carte Inc. ; from 1971, he was curator of the Gilbert and Sullivan Collection of the Plerpont Morgan Library . Mr. Allen published two hooks on Gabon and Sulllvants opera . Mr . Allen's wife, the former Helen Howe of Boston, died m 1975. He is survived by two nieces and a nephew.



Alfred Reginald Allen

dent in all his writings . Perhaps it was a trait reaching back far into his family tree, the moderation in all things of the "plain people"-his Quaker ancestors . He had an equally avid interest in mathematics and took great pleasure in mastering a variety of languages . One seldom finds an individual with so many matured talents . His perception of the need to prepare our country for inevitable involvement in World War I was a driving one, and his prompt participation an exemplary act of citizenship . Unfortunately, both he and the nation paid the ultimate price for such insistent patriotism . As a. footnote, it is of interest to recall an obituary notice published in 1989 (Figure 4) . At random glance, this reader was taken aback to recognize the familiar name, particularly when identified in the text with deep musical interest . Allen's son and namesake, whose obituary it proved to be, had a distinguished career in a number of musical enterprises and served creditably in Army Intelligence during World War If . He died, fulfilled, at 83 . The career of his father, with a far richer panoply of talents, ended abruptly upon the battlefield, his life a paradigm for the fate of the mythological hero . One can only speculate upon his achievements had he been allotted the biblical three score and ten . Note : Alfred Reginald Allen, Sr ., seems not to have merited mention in his son's extensive obituary .

Bibliography Allen AR . Combined pseudosystemic disease, with special reference to annular degeneration . University of Pennsylvania Medical Bulletin 1905 ;17 :382-5 . Allen AR. The connective tissue character of the septa of the spinal cord as studied by a new stain . J Nerv Ment Dis 1906 ;33 :771-2 . Allen AR . Two cases of the polyneuritic psychosis with necropsies and microscopical findings . Contributions from the Department of Neurology and Laboratory of Neuropathology, University of Pennsylvania, 1907 . Spiller WG, Allen AR. Internal hydrocephalus, with the report of two

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cases, one resulting from occlusion of the aqueduct of Sylvius . University of Pennsylvania Medical Bulletin 1907 ;20 :11-3, and JAMA 1907 ;48 :1225-6 . Allen AR . Distribution of the motor root in the anterior horn . University of Pennsylvania Medical Bulletin 1907 ;20 :202-4 . Allen AR. Injuries of the spinal cord . University of Pennsylvania Medical Bulletin 1908 ;21 :34-7 . Allen AR . The symptom-complex of transverse lesions of the spinal cord and its relation to structural changes therein . Am J Med Sci 1908;135 :735-9. Allen AR. Delayed apoplexy (spatoplexie), with the report of a case . Contributions from the Department of Neurology and Laboratory of Neuropathology, University of Pennsylvania, 1908 . Allen AR . Hemorrhage into the ventricles, its relations to convulsions and rigidity in apoplectiform hemiplegia . JAMA 1908 ;51 :216-20 . Allen AR. A new diagnostic sign in recurrent laryngeal paralysis . J New Ment Dis 1908 ;35 :141-3 . Allen AR . Special features concerning multiple neuritis. University of Pennsylvania Medical Bulletin 1909 ;22 :262-78 . Allen AR . Concussion of the brain . JAMA 1910 ;55 :945 . Allen AR . The hisropathology of the preparalytic stage of acute anterior poliomyelitis . Pennsylvania Medical journal 1911 ;15 :169-72 . Allen AR . Surgery of experimental lesions of spinal column (preliminary report) . JAMA 1911 ;51 :878-80 . Allen AR, Sweet JE . The effect of the removal of the hypophysis in the dog . Ann Surg 1913 ;57 :485-91 . Allen AR . Remarks on the histopathological changes in the spinal cord due to impact . J Nerv Ment Dis 1914 ;41 :141-7 . Riddoch G . The reflex functions of the completely divided spinal cord in man. Compared with those associated with less severe lesions . Brain 1917 ;40 :26-402 . Holmes G. "Spinal injuries of Warfare' Goulstonian lectures . Br Med 1 1915 ;2 :815-21 . Bastian CH . Paralyses. Cerebral bulbar and spinal . A manual of diagnosis for students and practitioners . Spinal paralyses of abrupt onset. New York : D. Appleton & Co ., 1886 :565-6 . Frazier CW . The surgery of the spine and spinal cord (with collaboration of Alfred Reginald Allen) and Normal and pathological physiology of the spinal cord . Trauma: experimental observations on contusions. New York : D . Appleton & Co., 1918 :391, 398-406 . Mills CK. Major Alfred Reginald Allen, U .S .A . 1876-1918 . Arch Neurol Psychiatry 1919 :1 :115-23 .