Prof. Jim Lance was a pioneer in the field of headache, and a teacher who drew many students to neurology

By Tissa Wijeratne, Alessandro Zagami, and William Carroll

This In Memoriam is reprinted COURTESY of InSight+.

The neurological world, and Australian neurology in particular, lost an outstanding leader Feb. 20, 2019, with the death of Prof. James (Jim) Waldo Lance in Sydney, at the age of 92.

His contribution to neurology, neurological training, and headache medicine, in particular, together represent an outstanding legacy of a life experienced to the full.

James Lance was born in Wollongong, NSW, in 1926. On his mother’s side, his forbears were veterinarians who came to Australia from Edinburgh in about 1840. His maternal grandfather studied veterinary science and founded the School of Veterinary Science at the University of Sydney in roughly 1909. (The J.D. Stewart building at University of Sydney is named after him.)

Growing up in Wollongong, Jim had asthma as a young child. His parents felt it was better to send him to a boarding school near Moss Vale, NSW, at the age of 7, which settled his asthma. Tudor House, the boarding school, had a famous headmaster, John Medley, who was later Sir John Medley, the vice chancellor of the University of Melbourne and chair of the Australian Broadcasting Corporation.

Dr. Cotter Harvey, a respected respiratory physician from Sydney, visited the school to give a talk on breathing problems.

“Why do people yawn?” Jim asked afterward.

Dr. Harvey replied: “Well, I don’t know that I can give you an answer to that question.” This was a revelation to Jim; grown-up specialists could not answer all questions.

At the beginning of World War II in 1939, Jim went to Geelong Grammar School in Victoria. In 1944, he had to change to the King’s school in Parramatta, NSW, due to difficulties in interstate travel at that time. He was enthused by chemistry there and entered the University of Sydney Medical School in 1944, completing his degree in 1950.

Research

There was no formal research component to the undergraduate curriculum at that time. The professor of bacteriology, the late Dr. Hugh Ward, introduced Henry Harris and Jim Lance to Howard Florey, of penicillin fame, who advised them on a potential research career. They both flew to Melbourne to embark on research experience. Harris adopted the advice so well to the extent that he replaced Florey when he retired and became the Regius professor of medicine with a distinguished scientific career.

Jim chose to return to Sydney and met with Peter Bishop, an experimental neurophysiologist, and then embarked on research into the pyramidal tract. He also began clinical work as a resident medical officer at the Royal Prince Alfred Hospital (1950–1951). Cutting his residency short, Prof. Lance took up a National Health and Medical Research Council fellowship at the University of Sydney (1952–1953) to work toward his Doctor of Medicine degree, which he was awarded in 1955. He became firmly engrossed in neurology and with research. He produced five articles from this period, including an article on an attempt to regenerate the pyramidal tract.

The articles were:

• Origin of the Pyramidal Tract in the Cat
• Properties of Pyramidal Tract
• Pyramidal and Extrapyramidal Control of Tonic Mechanisms in the Cat
• Pyramidal Tract in Spinal Cord of Cat
• Supraspinal Control of Tonic Vibration Reflex

In 1954, he traveled to London to train as a neurologist. At that time, the fastest way was a three-day journey in a propeller-driven aircraft. This was prohibitively expensive for Jim so he signed up as a ship’s surgeon on a shilling a month for a return trip to England.

After a month-long voyage, he arrived in London and accepted a position as assistant house physician at the National Hospital in Queen Square. He became houseman to Sir Francis Walshe, an outstanding neurologist, and learned to master the art of neurology, realizing that physiology was the basis of clinical neurology. While at Queen Square, he developed a keen interest in headache.

He returned to Sydney and met his wife-to-be, Judith, for the second time at a dance at St. Paul’s College. He had first met her when she took a post in physiology as a medical student. Following their second meeting, the relationship blossomed, and the marriage produced five children.

Headache Medicine

At work, Jim combined teaching and clinical practice with appointments as tutor at St. Paul’s College (1956-1960), visiting lecturer at the University of Sydney (1956-1962), superintendent at the Northcott Neurological Center (1956-1957) and honorary assistant physician at Sydney Hospital (1956-1961) and St. Luke’s Hospital (1957-1961).

The late Dr. George Selby reignited Jim’s interests in headache medicine in Australia with the large number of patients with headache attending his clinic. The two studied 500 patients with headache in great detail, resulting in a landmark article that identified many features of migraine that had not been previously appreciated, such as the frequent onset of migraine in childhood, the presence of allodynia in many patients with migraine, reflecting the presence of central sensitisation, and the major impact of emotional factors on the migraineur.

In 1960, Jim Lance again left Australia to follow his passion for research work at the Massachusetts General Hospital in Boston, where he became interested in myoclonic epilepsy and described the Lance–Adams syndrome in “The Syndrome of Intention or Action Myoclonus as a Sequel to Hypoxic Encephalopathy” and “The Falling Attacks of Myoclonus.” He returned to Australia as the founder of the first academic Department of Neurology in Australia in the newly established medical school at UNSW. He remained at UNSW from then, starting as a senior lecturer (1961-1963), then associate professor (1964-1974), professor of neurology—personal chair (1975-1992) and, most recently, as emeritus professor.

Along with his active research program, Prof. Lance continued his busy clinical practice at the Prince Henry and Prince of Wales Hospitals where he was chair of the department of neurology (1961-1992) and foundation director of the Institute of Neurological Sciences from 1990 until his retirement. He was a former president of the Australian and New Zealand Association of Neurologists, a founding director of the Australian Brain Foundation, inaugural president of the Australian and New Zealand Headache Society and president of the International Headache Society (1987-1989).

In Practice

Jim was a mentor to many neurology trainees in Australia and many other parts of the world. Together with Prof. Jim McLeod, they provided a beacon for Australian neurologists and clinician scientists. Through the 1970s and 1980s, they were regarded as the most influential neurologists in Australia. Almost all neurology trainees in those times would have had the good fortune to have been exposed to their skill and expertise, and a good number of them have gone on to carve their own places in Australian neurology.

Jim had a remarkable power of observation, which enabled him to collect unusual symptoms and signs, collate them, and describe them in detail as new entities, ranging from benign coital headache to the Harlequin syndrome.

He was a prolific publisher, contributing 33 articles to the Medical Journal of Australia alone from 1959 to 2003, with the last being an invited autobiography. He was the undoubted leader of headache medicine in Australia and greatly influential in headache medicine worldwide. This was recognized when he was honored with numerous awards from the American Association for the Study of Headache, the British Migraine Association and, in 2015, the International Headache Society Special Recognition Award, presented to him by Peter Goadsby.

Jim was actively involved in the World Federation of Neurology (WFN) and served as a vice president from 1989-1997. He was delighted to hear that the WFN would be dedicating the year 2019 to migraine and headache medicine through its World Brain Day initiative July 22.

Jim Lance was a gentleman, in the true sense of the word, always courteous, and kind. Despite his numerous achievements, he was always humble and was the first to acknowledge the contributions of others. He was passionate about teaching and drew more than the occasional medical student listening to his lectures to a career in neurology. He was the embodiment of the clinician scientist. He had boundless enthusiasm, which was infectious, and was a great mentor to many neurological trainees.

We will all miss him.

Jim Lance is survived by his wife Judy, his five children, 19 grandchildren, one great grandchild and another on the way. •

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

Prof. Wijeratne is chair of advocacy and public awareness for the World Federation of Neurology, chair of the SIG-Migraine for the World Federation of Neurology, chair of the Annual Lance-Goadsby Migraine Symposium and Oration, director of the department of neurology at Sunshine Hospital, and research scholar at the School of Psychology and Public Health, and the College of Science, Health, and Engineering at La Trobe University.

Zagami is associate professor at the Institute of Neurological Sciences  at the Prince of Wales Hospital and the Prince of Wales Clinical School, UNSW.

Prof. Carroll is president of the World Federation of Neurology, professor in the department of neurology at Sir Charles Gairdner Hospital and the Centre for Neuromuscular and Neurological Disorders, Perron Institute, University of Western Australia.

By David Burke

This In Memoriam is reprinted COURTESY of The Australia & New Zealand Association of Neurologists Newsletter.

Australia and the world have lost a true giant of neurology with the passing of James Waldo Lance, CBE, AO, MD, FRCP, FRACP, FAA.

Following is the eulogy that was delivered at Jim’s funeral service by Prof. David Burke, past presidentof ANZAN.

We are here today to pay our respects to the doyen of Australian neurology. Jim Lance was the complete physician, a man who covered all fields and was an exemplar clinician-scientist. He was the academic father and intellectual inspiration for many of us. We will not see his like again.

• He was the first person appointed as a neurologist in Australia.
• He set up the first academic department of neurology in Australia and founded the Institute of Neurological Sciences of the Prince Henry and Prince of Wales Hospitals.
• He was the first professor of neurology in Australia.
• He was the first practicing clinician elected as a Fellow of the Australian Academy of Science.
• He was president of the Australian Association of Neurologists, and one of the founding fathers and a lifelong supporter of the Brain Foundation.
• He was the foundation president of the Australian Headache Society and president of the International Headache Society.

His service to the community has been recognized by the Governor General.

• He was appointed commander of the order of the British Empire in 1977.
• He was appointed officer in the order of Australia in 1991.
• He was awarded the Centenary Medal of Federation in 2001.
• He was recognized nationally and internationally.
• He won the Lilly Foreign Education Fellowship at Massachusetts General Hospital in Boston in 1960.

The British Migraine Association awarded him the Gold Medal in 1975.

The American Association for the Study of Headache recognized him four times: the Harold G. Wolff Memorial Award in 1967 and again in 1983, the Arnold Friedman Distinguished Clinician/Researcher Award in 1989, and the John Graham Senior Clinician Award in 1991.

Under the presidency of Geoff Donnan, the Australian Association of Neurologists created an annual award: The James Lance Young Investigator Award, in recognition of his lifelong role in training the next generation.

When Michael Halmagyi was president, the Brain Foundation created the James Lance Award for research into migraine and other headaches. These achievements and this recognition do not tell you much about Jim Lance as we knew him. He has contributed so much to our lives that it is difficult to know where to begin.

James Waldo Lance was born in Wollongong in 1926 and graduated in medicine in 1950 from the University of Sydney. Influenced by Nobel Laureate Howard Florey, he cut short a residency at Royal Prince Alfred Hospital to undertake full-time research for the degree MD with Peter Bishop at the newly established Brain Research Institute at the University of Sydney. A fellow student was Jim McLeod, undertaking research for the BSc (medicine), and the two became lifelong friends, spending time in the U.K. and later in Boston at much the same time. The two Jims became known as the “Gentleman Jims,” a legendary twosome in Australian neurology, running complementary departments at our two premier institutionssetting a high bar for others to emulate elsewhere in the country.

He spent a couple of years in London, first at the Royal Postgraduate Medical School at Hammersmith Hospital, and then at Queen Square, where he was influenced by eminent clinicians and great teachers. After he returned to Australia, an opportunity to develop a neurological career arose when the University of New South Wales set up a new medical school at The Prince Henry Hospital under Ralph Blacket, the foundation professor of medicine. After a year in Boston honing his academic skills, Jim took up the appointment as chair of the department of neurology, an appointment that he held for 30 years.

During that time, he worked tirelessly to develop the specialty, at Prince Henry and throughout the country. And now, we can see the fruits of his labor: Neurology is arguably the most exciting field in which to work as a physician.

Our unit was blessed by its leadership, with Jim running neurology, Alec Gonski running neurosurgery, and Jo Loder running Ward 4. Prince Henry became a beacon in neuroscience in Australia, culminating in the formation of the Institute of Neurological Science, with Jim as the first director, and then the Prince of Wales Medical Research Institute. Now renamed NeuRA, this was the first medical research institute devoted exclusively to neuroscience in Australia.

He formally retired from the hospital service at the obligatory age of 65, but he continued a neurological practice until his late 80s. He maintained a weekly presence at our Grand Rounds, where he shared clinical insights and taught our trainees the art of neurology.

Throughout his life, Jim championed the scientific basis of medicine, always inquiring, always interested in evidence, but always humble and ready to change his mind when the evidence dictated that. He was a man of enthusiasms and unquenchable work ethic, that stimulated his colleagues and staff to work harder to emulate the standards he had set. If one questioned a task, Jim’s response was typical of the man: That’s OK: I’ll do it myself.

He believed in people whether colleagues or patients, and his support was unwavering. He actively nurtured the careers of junior colleagues, and took pride in their achievements. He treated his patients as people—intelligent and capable of understanding if the right language was used. He was unfailingly honest in his appraisals, but did not have a bad word for people: If a reference consisted of two paragraphs the thumb was down; if it consisted of two pages, the thumb was up. And his influence extended beyond those who worked directly with him, and beyond Australia.

A quote from a senior colleague from Melbourne typifies responses received from all over the country, and from overseas:

“Jim was an inspiration to me while training in the early 1980s. He always had encouraging and kind words for me as a trainee and junior neurologist, and I feel a great debt both to his leadership in our profession and in shaping my own development as a clinician-scientist.”

He loved nothing more than teaching, and his Grand Rounds and lectures on Mondays in Ward 4 at The Prince Henry Hospital attracted young aspiring clinicians from all over the city. His clinical consultations were incisive, instructive, and an opportunity to teach. The referring physician inevitably learned not only what to do, but why to do it.

We have benefitted from his leadership, his wisdom, his generosity, and his support. Jim may have gone, but his legacy will continue to grow not just through his direct family, but through those clinicians and scientists who count themselves as part of his extended family.

We thank Jim for a life well spent. More particularly we thank Judy, Fiona, Sarah, Jenny, Robert, and Sophie and their families for allowing us to share his life. •

(1935-2019)

By Prof. Inder M.S. Sawhney, MD, DM, FRCP, MNAMS, FIAN; Prof. Vijay K. Kak, MS, FRCS, FRCSE, FAMS, FIAMS, FIHE and Prof. Sudesh PrabhakarMD, DM, FIAN

The World Federation of Neurology (WFN) honored Prof. Jagjit Singh Chopra (JSC) with the Lifetime Achievement Award in September 2017 at Kyoto, Japan. His achievements were applauded on the world stage in his absence, as he could not attend the meeting due to a disabling stroke.

Prof. Chopra displaying the latest edition of the book, “Neurology in Tropics,” edited by him.

He was selected as Secretary General of the World Congress of Neurology (WCN), which was organized successfully in 1989 at New Delhi. He has the distinction of being associated with the WFN since 1985 in various capacities, including co-chair of the Finance Committee, vice chair of the research group on organization and delivery of neurological services and editor-in-chief of World Neurology from 1999-2009.

Prof. Chopra was the first Indian neurologist to be nominated for the post of WFN president in 2005. He breathed his last Jan. 18, 2019, in Chandigarh, India, plunging the neurology community worldwide, his friends, and colleagues into gloom with the loss of a distinguished neurologist.

JSC was born June 15, 1935, in Lahore (now Pakistan). He received his early school education in Fazilka and completed his medical degree at the Government Medical College, Patiala (Punjab University) in 1959. He proceeded to the U.K. after one year’s house job at Rajindra Hospital in Patiala, and worked at the Royal Belfast Hospital for Sick Children, Belfast, and later in the departments of medicine and neurology at the Royal Victoria Hospital in Belfast.

He was trained under neurology stalwarts such as Drs. R.S. Allison, JHD Miller, L.J. Hurwitz and M.W. Swallow. He passed the examination for diploma in child health from Royal College of Physicians in 1962 in London, and obtained MRCP (Edinburgh) with specialization in neurology in 1963. He was the youngest Indian to be awarded FRCP (Edinburgh) in 1969. He was awarded a PhD by the Queen’s University in 1967 in Belfast for extensive research on diabetic neuropathy.

Toward the end of his U.K. sojourn, JSC met his former teacher, Dr. P.N. Chuttani, in an elevator in London. In the brief encounter, JSC expressed his desire to return to India.

“Boy, go and pack your bags. I have given you the job,” said Dr. Chuttani to his bright student. That is how Dr. Chopra joined the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, in 1968, as assistant professor of neurology, and gradually rose to professor of neurology until his superannuation in June 1995.

Neurology Department

JSC was instrumental in setting up a world-class department of neurology and research laboratory at PGIMER and dedicated his life to establishing model clinical, teaching, and research facilities in the department. He started the DM (neurology) training program at PGIMER and trained several super-specialists in neurology, most of whom are heading departments at various establishments in India and abroad. He also trained many specialists in neurology for the Armed Forces of India.

Neurology training during his tenure was rigorous. None of his trainees can forget the teaching at Saturday grand rounds, where the emphasis used to be on clinical neurology. He was a man who appeared tough in his professional and academic dealings, but was endowed with a kind heart and always went the extra mile to help everyone, especially his students. He had the reputation of being a hard taskmaster, a strict disciplinarian, and an immaculate clinician.

Prof. Chopra retired in 1995 but continued as professor emeritus at PGIMER. He was also selected as national lecturer by University Grants Commission, and lectured at various medical institutions across the country. The National Academy of Medical Sciences (India), New Delhi, also honored him with emeritus professorship. He was awarded the Dr. B.C. Roy National Award as an eminent medical teacher.

Research

JSC has contributed immensely in the field of neurosciences research and education. He has conducted research in muscle diseases, peripheral nerves, young strokes, and infections of the nervous system, and has guided over a dozen PhD theses. He has published nearly 250 scientific research papers in journals of national and international repute.

He was editor-in-chief for “Text Book of Neurology,” and “Neurology India,” a publication of the Neurological Society of India, for six years. He has written about 50 chapters in various books and monographs, published in India and abroad. He served on the editorial board of several journals. Age did not dampen his enthusiasm for neurology. He had a firm belief that there was no limit to gaining knowledge and giving it back to the world. He co-edited “Neurology in Tropics” in his 80s and was a force behind meeting the deadlines for its publication.

JSC was the founder president of Indian Academy of Neurology (1993-1994), his brainchild, and past president of the Neurological Society of India (2003). He had been a member of the executive committee of the International Federation of Clinical Neurophysiology, selected as an honorary member of the American Academy of Neurology and the American Neurological Association, member of the London Medical Society, Association of British Neurologists, and Ulster Medical Society. He was elected fellow of the Medical Society of London and the National Academy of Medical Sciences (India), New Delhi.

JSC has been a member of the advisory groups/panels of medical education and training of National Board of Examinations; Indian Council of Medical Research; NIHMANS, Bangalore; Indian Council of Child Welfare, Chandigarh; and the department of biotechnology for the government of India. He had been a member of several international scientific program advisory committees. He was nominated as a senator to the Baba Farid University of Health Sciences, Faridkot, Punjab, by the governor of Punjab.

Awards

JSC had been the recipient of several awards and orations, including the Ninth Amrut Modi Research Award, Pelipu Perindevi Suriya Award of Pharmacological Society of India, MN Sen Oration Award of ICMR, Life Time Achievement Award in Neurosciences, Madras Neuro Trust, Dr. M.S. Sanjeev Rao Oration, Dr. R.S. Allison Oration, Belfast, U.K., Baldev Singh Orations, NSI and National Academy of Medical Sciences, New Delhi, Vishist Chikitsha Gold Medal by Association of Chest Physicians of India, award by Pan Arab Union of Neurological Societies, Emirates Medical Association and Emirates Neurological Society and Emirates League Against Epilepsy, and awards from Pakistan Neurological Society and Epilepsy Association of Pakistan. He was awarded the Parman Patra by S. Prakash Singh Badal, chief minister, Punjab in 2007, and Padma Bhushan (the third highest national award) by the president of India in 2008.

JSC was happily married to Amarjit Chopra, who passed away over a year ago. They have a daughter and a son. Dr. Brinder Chopra received her MD in clinical biochemistry from Punjab University, and is currently working as associate professor of biochemistry at Gian Sagar Institute of Medical Sciences, Patiala. She is married to Dr. Sukhpreet Singh, MS (general surgery), and they have two children.

Their son, Dr. Harvin Chopra, is trained in radiodiagnosis with an MD from Medical University of Innsbruck, Austria, and an MD from MMU, Mullana. He is married to Natasha.

JSC was a brilliant organizer, an excellent clinician, and mentor to a large number of neurologists all over the world. Prof. Chopra will be immensely missed in the world of neurology and will live forever in the hearts of his students and colleagues. We owe him a debt of gratitude for his contribution to neurosciences and for his never-ending faith in the potential of his students. •

Prof. Sawhney is the honorary professor of neurology at Swansea University, and consultant neurologist and clinical director neurosciences at the ABM University Health Board, Morriston Hospital Swansea, U.K. Prof. Kak is emeritus professor of neurosurgery at PGIMER in Chandigarh, former director-principal of Government Medical College in Chandigarh, and secretary medical education and research at the Chandigarh Administration, India. Prof. Prabhakar is the former professor and head of the department of neurology, Postgraduate Institute of Medical Education & Research in Chandigarh, India.

References
Kak VK, Sawhney IMS. In Memorium – Prof. JS Chopra. Neurology India 2019; 67(1): 346-349.
Sawhney IMS, Kak VK. In Memorium – Prof JS Chopra. Annals of Indian Academy of Neurology 2019; 22 (2): 259-260.