Mensch

A farewell to Gerald Stern, a mensch

I had the wonderful opportunity of working as the last Senior Registrar at UCLH under Professor Andrew Lees in 1997–1998 when I met Gerald Stern. This was shortly after his retirement.

Gerald used to call me into his office and give me sage advice about life and being a neurologist. He was particularly supportive of the younger generation. Our chats were memorable and I had the sense of being in the presence of a very wise man. He was a regular attendee at Gower’s round and would sit in the second row. Whenever I chaired the round I would make a point of asking either Gerald or one of the other senior consultants their opinion about the case. Gerald always gave a very sound and grounded opinion; the kind of opinion that comes with decades of clinical experience. After the round, he would always seek me out to discuss things further. Gerald Stern was a deep thinker and it is the deep thinkers who have an indelible impact on the world.

When I moved to ‘The London’ one of the first things I did was to invite Gerald to give a talk at one of our grand rounds. It was an autobiographical tour de force about the hardships of living and growing up in the East end of London and succeeding against all the odds. I recall Gerald shedding a tear as he reminisced about his childhood and particularly his memories of his parents and grandparents.

Sadly, Gerald passed away last week.

Gerald was a remarkable man. He sent me the following script of an interview he did with Professor Niall Quinn shortly before his 80th birthday in 2010. The interview briefly chronicles his life in East London and touches on his contributions to the study of Parkinson’s disease. The interview can be watched on YouTube and I would urge you all to take the time out of your busy lives to reflect on a life that was quite remarkable.

Gerald, we will miss you.

I had the privilege of being invited to and attending his 80th Birthday party in a beautiful villa just outside Taormina in Sicily. The evening was a celebration of a life well lived surrounded by family and friends. That evening Gerald taught us the meaning of L’Chaim.

The interview:

Professor Quinn: I’m Niall Quinn interviewing Gerald Stern, in Buenos Aires, on the occasion of the 14th Movement Disorder Congress. Gerald is approaching — you’re approaching the age of 80, 18 years older than me. You were 1 of the 2 original honorary members of the Society,

Professor Stern: Correct.

Professor Quinn: …and you’re delivering the Stanley Fahn Lecture this year.

Professor Stern: Yes, indeed.

Professor Quinn: And I’ve been asked to probe a little bit about your early life about things that are important to you and, perhaps starting at the beginning, how did you to come into medicine, neurology, movement disorders, and what was your early educational experience?

Professor Stern: Entering medicine was really fortuitous. I had no desire to be a doctor. My father really wanted me to take over his cigarette shop. My parents worked very hard and the hours were long. My father was very intelligent, although uneducated and he quickly perceived that I was innumerate. When you’re selling cigarettes in Bethnal Green and obliged to give the correct change (before the era of cash registers there were no second chances). He could effortlessly add up 20 items in his head. There was no prospect that I could manage the shop. This led to a family pow-wow, “What are we going to do with this stupid boy?” One thing that a Jewish family in the East End of London really wanted was to have a doctor son. I acquiesced because I knew there wasn’t much of a chance of acceptance into a medical school. During the post-war years, there were twelve independent schools in London, and there were many mature ex-servicemen, returning from the war, wanting to have a career. My educational achievements at the time were very poor. I was reasonably sure that I wouldn’t get or deserve a university place but wanting to keep my parents content I wrote, at my father’s insistence, to the 12 medical schools. Unsurprisingly, 11 declined to give me an interview. I had nothing to offer. Then unexpectedly, I was granted an interview at the London Hospital. I suspect that this was because my grandfather’s delicatessen was 100 yards from the London Hospital. (it is now a mosque and although he was a devout monotheist and a tolerant man, I think he would have thought that it was going a bit too far. My father’s cigarette shop was about 400 yards away. I can only guess that I gained an interview because I was a local boy. It was a strange experience. I had not yet seen Leonardo da Vinci’s Ultima Cena but it resembled the picture. There was a long table. A man sat in the middle with others on either side and there was a small chair for me to sit on. They looked through my flimsy papers, I had no educational achievements at that time and frankly, I felt embarrassed for them. There were no evident questions for them to ask. There was complete silence until a chap at the end said, “I’ve seen you before.”

I had no idea who he was. At that time I was keen on athletics and was a member (barely county standard level) of the local club, the Victoria Park Harriers. The whole interview was about athletics. When I went home I felt it had all been a terrible mistake. I can’t remember the subsequent event clearly. It was a Friday night, there were Sabbath candles on the table — by the way, Yiddish was the domestic language — my parents knew little English. After the meal, my father said, “Noo?” which in Yiddish means, “Well, how did you get on? I said, “This was a disaster. Here they are looking for potential doctors and all we discussed was athletics.” My parents were bitterly disappointed and my Mother burst into tears. I was surprised to be given a place.

At medical school, I could understand very little of the preclinical curriculum because I had no basic scientific knowledge. During the war, like most East End children, I was evacuated to the countryside. I found that I had a good unconsummated memory, which I attributed to the unexpected advantage of not going to school from the age of 8 to 12 years. It was not too difficult to retain details of the anatomy including the origins of insertions of muscles and ossification dates, but I could not see the point. I stuck it out, mainly not to disappoint my parents. I think I was the only student who walked daily from his home to medical school. The considerable advantage was the food was much better. I just scraped through second MB. It was only when we started clinical work did I become truly interested. From the start, I found clinical neurology fascinating.

The neurological tradition at ‘The London’ was very strong. Distinguished contributors included Henry Head and so forth to my Guru, Russell Brain. Dorothy Russell was professor of neuropathology. Her scholarly lineage –from Virchow, through Recklinghausen to Turnbull, was an inspiring introduction to neurology. It is chastening to recall, that most of my distinguished clinical teachers had made their reputation — some of them deservedly international — without salary or pension. They had to earn their bread, butter and jam from private practice. Yet they were conscientious consultants and cared admirably for their public (later NHS) patients. A wonderful esprit was present during the post-war years. Everyone was glad to be alive.

My intake of 65 students included many ex-servicemen, very bright mature people, about a third, were children of doctors, mostly public school boys, very nice people and about a third were odd ‘bods’, missionaries and a few black people from overseas. I was the only local boy. As I had become very interested in neurology, I really I had to get some sort of academic background to improve my chances of progressing in the very competitive “Queen of the Specialties”. The only subjects that came relatively easily to me — or so I thought — were European languages.

There were 5 undergraduate prizes. I thought if I could get a few of those, it might improve my chances. I decided to play hooky from much of the clinical course. I went to the Hammersmith Post-graduate Hospital and attended lectures there and gained the prize in surgery. Thus encouraged, I went to the Hospital for Sick Children at Great Ormond Street and gained the Pediatric Prize and so on. No one seemed to be concerned about my absences from the course. After qualifying, I was delighted to be House Physician to Sir Russell Brain. He was a wonderful man. I once heard him introduced before he gave a scholarly lecture as “A man without a single redeeming vice”. I’d like to spend the rest of your interview extolling his many virtues. He was highly intelligent, a poet, philosopher and writer and a lucid and sensitive speaker, You may read of his numerous academic and professional achievements, his scholarship, his omniscience and his political abilities. I would add his sense of tolerance and fairness. He appointed Noshir Wadia from Bombay, as his registrar from a field of excellent UK applicants– to probably the most prestigious post in the United Kingdom — because he was clearly the most talented applicant. Noshir was the first Indian registrar at that time, to hold such a position at the London Hospital. Another example was that Brain put up with me.

Professor Quinn: Yes.

Professor Stern: As you know, you learn so much from your registrar, Noshir helped me greatly. After the preregistration year, I enjoyed a series of training jobs at the London, which puzzled people. Why? I have a theory. While working for Sir Horace Evans, he became Lord Evans, Sir Russell Brain became Lord Brain and Dr. John Ellis became Sir John Ellis. You can image the gossip in the consultant’s dining room. “This strange unimpressive fellow Stern, apparently without influence, yet honors keep falling off the back of the lorry! Let’s keep him around”. I worked for Dorothy Russell in neuropathology and for my general medicine, obligatory at that time, as registrar to Lord Evans. I managed to get my membership fairly quickly. It was then time to enlist. I was the last National Serviceman to enter the Navy as RNVR, and enjoyed a marvellous two years. I was at sea most of the time and saw much of the Mediterranean littoral, North Atlantic, Caribbean and Suez. I will show you my solitary service medal if you have time but my contribution was minor. On Day 2, an unfortunate French paratrooper bent down and received a small fragment of shrapnel into his buttock. I had the honor of removing the ‘foreign body’. That was my total war contribution but it did give me an opportunity to learn some Italian. I was on a frigate and we were tied up outside the entrance to the Grand Canal in Venice. I used to sit in the Piazza, after ostensibly visiting the sick in the Ospedale Generale, with my textbook. Later, this stood me in good stead because it probably helped me to become neurologist to a most interesting patient. When I came out of the Navy, prospects for clinical neurology were still difficult. Some declared, “To get on the House (appointed registrar) at the National Hospital Queen Square, it was desirable to have a double-barreled name, preferably with a hyphen”. I had a fairly good track record for training post and decided to apply at The National. In those days, this was a House Resident appointment and you were obliged to visit all the consultants individually…

Professor Quinn: Trial-by-sherry, in those days, quite right.

Professor Stern: Of the consultants, there was one who was very elusive. At last, I caught him leaving the front porch of the Hospital. He glanced through my CV and remarked “Well you worked for some good people, but,” he said, “your problem is you’re from the 2nd XI,” [laughter].

Professor Quinn: So what do you think he meant by that?

Professor Stern: Well it aptly described the prevailing animosity between Maida Vale Hospital where I had worked for Russell Brain and the National.

Professor Quinn: Yes.

Professor Stern: At one time, feelings were bitter. When Russell Brain was the most famous and distinguished member of the UK neurological community, he remained faithful to Maida Vale Hospital. It was there, as a registrar, he wrote the first edition of his famous textbook. He was eventually invited to join the QS consultant staff. He responded that he couldn’t fit it in. He didn’t have the time. As you know, he was a great diplomat and an able politician, He was an advisor to the Department of Health, Chairman of Royal Commissions and later facilitated the fusion of the National with Maida Vale. This was eventually closed. From there, I went to Columbia University in New York City where Houston Merritt, was the great American neurologist of his generation. I was engaged in research on the subthalamic nucleus, so fashionable now, and other disorders of the basal ganglia. My mentor was a highly intelligent, somewhat eccentric gentleman called Fred Mettler, a distinguished neuroanatomist. He gave an unconvincing carapace of toughness but in fact, he was kind and gentle and very generous to me. I could tell you many stories about him but I will tell you just one. When I was ushered into his presence for the first time, having crossed the Atlantic, we gazed at one another in mutual sartorial astonishment. I was formally dressed like a conventional English Senior Registrar with a waistcoat and a collar and tie.

Professor Quinn: No bowtie though.

Professor Stern: No, just a tie and he was dressed in a bright yellow shirt with red braces, vivid corduroy trousers and skiing boots. He later admitted that he dressed in this inconspicuous manner so he could move around the Institute and hear what people were saying about him. His first remarks to me were memorable. “See hear Stern, there are one or two things you got to know about this department.” I said, “Yes sir, yes sir.” “It doesn’t matter who does the work, my name is on the paper.” “Oh yes, of course, sir.” “Next,” he said, “it doesn’t matter who does the work, all the authors are in alphabetical sequence. Don’t calculate,” he said, ‘my nom de plume’, is Aaron Aarons, what’s yours?”

[Laughter] So Fred promptly put me in my place but he taught me a great deal He wanted me to concentrate on the somatotopic organization of the subthalamic nucleus, equine encephalitis and one or two other matters. I was curious to know the effects of acute lesions within the substantia nigra., There was considerable uncertainty at the time. Fred simply said, “Well go ahead and do it,” and gave me free access to the monkey house. This became the substance of my MD thesis. When I returned to the London Hospital, after the excitement and stimulation of the United States, English neurology seemed rather dull. The neurological atmosphere in America had been invigorating, with jobs galore and generous research money. At a meeting, people might come up and suggest that you might like to come and work in their department.

It was very exciting. I almost returned to America but then out of the blue, I had an invitation from Newcastle University, to apply for a position, which had just fallen vacant. Newcastle was a bright and stimulating place. Professor Henry Miller was the director and John Walton was the second consultant. Visitors would come from America, change planes at Heathrow and fly up to Newcastle. It was a most exciting place.

There is much anecdotage about Henry Miller. He was witty, amusing and charismatic. He complained that “Every morning, I get out of bed and look at my shoes and see if John Walton’s there yet, and one day he was.”

Professor Quinn: I remember his great aphorism about the correct implement for eliciting the Babinski response, was the ignition key of a Bentley.

Professor Stern: Absolutely.

Professor Quinn: Fantastic.

Professor Stern: He was a wonderful man. He could disarm you with his uncomplimentary, corrosive wit and humour, but was totally loyal and exceedingly generous to you behind your back. He told me that he “wanted someone to look after the shop while he was away in Australia and that I really could not be as bad as others had informed him”. When he returned from a very successful lecture tour, he said, “Now, look here, Gerald, while you haven’t killed too many of my patients, you’ve let me down very much. You have failed to antagonize certain of my consultant colleagues. Your punishment,” he announced, “I’m sending you to Paris to learn some neurology. It’s about time you knew some”.

So I went to the Salpêtrière. I have very few distinctions as a neurologist but I don’t think there are many who could compete with the fact, that I wrote my MD thesis sitting on a bidet. We had a very small room in a former bordello. There was a diaphanous partition and behind a bidet with an overhead light bulb. It was perfect. At the Salpêtrière, as you well know, having studied there yourself, all the 18th and 19th Century classic French texts and theses were available proving most helpful for my thesis. My French slowly improved and I learned some of the esoteric traditional neurology, which stemmed back to the Charcot era. Professor Raymond Garcin, the inheritor of Charcot’s Chair, was a superb clinician.

At that time, the French academic system was authoritarian and very competitive. Under Garcin, there were three ‘Professeurs agrégés. Each had successfully achieved professorial status after rigorous examination but could not obtain a professorial chair in a university without Garcin’s powerful support. The agrégés, tended to become obsequious supplicants, attending to Garcin’s whims.

A strange event occurred.. I was an ‘externe’, as you know well, a nobody, whose place was at the back of the crowd attending Garcin’s demonstrations. A meeting between senior members of the section of Neurology of Neurology of the Royal Society of Medicine and the grandees of the French Neurological Society was announced. I put in a paper. To my surprise it was accepted. You cannot imagine the effect on the Salpetriere community. They could not understand how it was possible for an unknown junior and inexperienced trainee, to appear before this august audience? I suspect it was my title, “Parkinson’s Equine” (Parkinson’s disease in Horses”) which may have taken their fancy. Their magnificent social activities in addition to a banquet at a 5-star restaurant (I was not invited), included a trip to Longchamps Race Course!

Professor Quinn: And the meeting was in Paris or London?

Professor Stern: In Paris.

Professor Quinn: And you gave this in French or in English?

Professor Stern: In French. I was fairly competent in neurological jargon at the time. Instead of being in the back I was differentially ushered to the front. Garcin actually asked me a question. After the session, one of the agrégés, came up to me. He looked long and hard and was clearly very puzzled. At last he couldn’t contain himself and asked “Msr. Stern, ”Qui est votre piston (who is pushing you?”) I erroneously replied, “Oh, Lord Brain.” [Laughter]. There was another unexpected event. I was due to return to Newcastle when I heard through the grapevine, that a consultant at UCH and at The National Hospital, was resigning.

Four half-day sessions had fallen vacant. As a Londoner I was keen to return. I wrote to Professor Henry Miller one of those long tortuous indecisive letters that only a stupid, immature young man can compose. I wanted to know whether I should apply. I voluminously assembled all the points in favor and those against. I assured him that I was very happy at Newcastle, I could see a possible career etc. By return of post, I received a postcard from Henry. On one side was the Tyne Bridge and on the other, written in his beautiful handwriting, was, “Dear Gerald, If you don’t, I will. Yours, Henry.”

He was very generous to me. I could spend the rest of the interview telling you what an attractive, intelligent, gifted man he was. Anyhow that is how I obtained four sessions at St. Pancras Hospital, a former workhouse attached to UCH.

Professor Quinn: So what year was that that you came back to London, finally?

Professor Stern: 1965.

Professor Quinn: Right.

Professor Stern: I knew that I had been very lucky. I was 35. I’d spent 2 years in the Navy and had obtained a consultant post at a relatively young age. In those days you usually had to wait your turn in the queue.

Professor Quinn: Still at that time you were — you had done your research on aspects of movement disorders but everybody was a general physician in those days and you still were relatively undifferentiated consultant. How did you evolve into a movement disorders person because — ?

Professor Stern: Well, my research interests included the substantia nigra and having recently been in America I had a notion of recent advances as the levodopa story was breaking…

Professor Quinn: But you, oh, sorry…

Professor Stern: I heard that there was going to be a small meeting of the cognoscenti, including those directly concerned in the exciting developments in catecholamine research. Barbeau, Hornykiewicz and several other distinguished contributors were to be present. It was to be held in Val David a skiing resort near Montreal. I made my uninvited way from London. I hadn’t calculated for the winter weather and I arrived looking like a cold, miserable, wet snowman. The door was opened by a big man. He was holding a large glass of brandy. It was André Barbeau, the convener(I didn’t know what he looked like). He reasonably asked, ”Who are you?’ I said, “I’m a nobody, I’d heard about this meeting and I thought I might be able to get in”. I guessed that he was going to throw me out. He said, “You need this brandy more than I do. Come in.” [Laughter]. Miraculously, I was able to listen to the leading world authorities. It was such a remarkable experience that I published the story in our MDS journal, “Why Catechol?” Returning to London, I was able to find a supply of levodopa. There was a world shortage at the time. We were the first group in the UK to publish a controlled trial of levodopa’s efficacy, but that is another story.

Please forgive me, I’m in my anecdotage, but I am sure that you will appreciate that I had the most extraordinary good fortune. There I was at St. Pancras Hospital with four beds. I had several research ideas, but where was the money coming from? When you take over a consultant’s post, as you know, you take over his old patients. There was one lady with mild tremulous Parkinson’s disease. She was exceptionally pleasant. She was a Health Services patient, not a private patient.

I have always admired people who are blessed with good qualities that I lack. She was most appreciative, polite and considerate and I got to know her quite well. She came from a large family. It was traditional that the youngest daughter did not marry because she was destined to look after her widowed father. She always came to the clinic wearing the same institutional faded floral apron. I enjoyed her company and her good humour and her courage, although life had not been kind to her. I admired her so much that I used to bring her follow-up appointments earlier so that we could chat. At that time, synthetic Belladonna alkaloids were the only available treatments. After about two years, she failed to keep her appointment. The family doctor rang me up and he said, “I know you liked her and got on with her well. You will be sorry to hear that she died in her sleep.”

I was indeed sorry. Some months later I had a letter from a solicitor telling me I’d been mentioned in the will of the late Miss X. I thought, “Well, how very charming and generous.” As far as I was aware she was impoverished. Later, I was asked to see a lawyer in the Middle Temple. His office resembled a Charles Dickens novel. Surrounded by dusty volumes, he delved into scattered papers until he found the will. “Yes,” he said, “you have indeed been mentioned in the will. You are not at the top of the stated benefactions. First, there’s the home for aged ladies and then, there’s the home for stray dogs and cats. You’re about third or fourth.”

I said, ‘Well it’s exceptionally nice for her to remember me. We had known one another for only a short time. Thank you very much.” As I left, I added, “I suppose that she left me a modest amount, (thinking perhaps 5 or 10 pounds). He replied, “Well, we haven’t quite worked it out the details but it’s about 600.” Astonished, I said, “Six hundred pounds? “No, no,” he said, “ £600,000.”

I protested. You’ve got the wrong fellow.” “No,” he says, “she was quite specific. It’s to you, personally.” I went home and told Jenny, “I’m retiring at the end of the week”. She being much more sensible commented, “If you accept this money, you’ll regret it and you’ll be ashamed of yourself.” So, I invested the benefaction and ran my research on that basis.

My first research fellow was Donald Calne, who didn’t do too badly and the second was a young fellow called Andrew Lees, who didn’t do too badly either. I was free to hire and fire. The secret of any research success that I may have had in neurology is quite clear. To all my students and fellows I give two pieces of advice. “One, surround yourself with young people who are cleverer, more able, more hard-working and more gifted than yourself and help them in any way you can; two, be nice to old ladies.” [Laughter). Perhaps you won’t believe this, but it happened again.

Another Health Service patient! It wasn’t quite so much money but it was a totally unexpected, substantial amount. She was a failed actress and a very charming woman. She had a whole series of wretched neurological illnesses. Each time she pulled through, she teasingly commented, “You’ll regret this Doc”, which I attributed to her keen sense of humor. Amazingly, she too left me a considerable personal benefaction. These two wonderful people gave me research independence. Hence my advice!

Professor Quinn: I’ll tell you a story of mine —

Professor Stern: Please!

Professor Quinn: Just to compete with that, As an academic as you know, one was only allowed to half a day private clinic a week. All the proceeds went to the research funds. My private waiting list was longer than my NHS one and because of that, I started getting a message from somebody saying, “Would you see this man urgently? He’s got Parkinson’s.” And I said, “Well my waiting list is six weeks” and he came back and he said, “I have to tell you he’s one of the richest men in Europe and he’s already donated £10 million to neurological research.” So I thought, “Okay, I’ll make an exception.” So I saw this chap. He’d never started L-dopa and had no autonomic problems.

He only had premature ejaculations and on the basis of a scan had been told that he had MSA. He was terrified. He came to see me and I reassured him. I said, “There’s no evidence that you’ve got MSA”. I was thinking, “What if I ask him about a donation for possible research.” I said to myself, “You can’t possibly, not the first time you meet a patient.” So I said, “Next time, six months when he comes for follow-up.”

6 months went by, 9 months, a year and another 18 months later he came back to see me and I said, “Oh, how are you, how have you been keeping?” He said, “Oh, it’s been a catastrophe. The accountants are all crooked, the whole company’s gone completely bust, I have no money” and I said, “Well, you know, when I first saw you I was thinking about asking you about a donation for your research but I thought you can’t tell somebody on the first occasion” and he said, “If only you had! If only had!” he said.

Professor Stern: [Laughter] It didn’t come off that time!

Professor Quinn: No, and it’s never arisen since but it’s a lesson to remember …

Professor Stern: Very wealthy people don’t often spontaneously give you money. It’s the impecunious strangely enough.

Professor Quinn: In terms of movement disorders, how are you seeing the whole speciality develop? Because it wasn’t a sub-specialty originally and you were in the World Federation, Extrapyramidal Group long before MDS was founded. What’s been your perspective over the years with the way movement disorders has evolved as a speciality?

Professor Stern: Well, I think that the MDS is a wondrous achievement. You will be relieved to know that I will not relate the story now, but I was present at the birth of the MDS. To see it grow from a little infant into this very influential muscular giant and the good work that it does is a spectacular result. It has been a very great success. This you know yourself, having greatly contributed to its achievements.

Professor Quinn: Finally, you have chosen, for your title, for your talk, “The Fox, the Hedgehog, the MDS and the World’s Best Known Neurologist.” I don’t know whether you can give a preview?

Professor Stern: I decline.

Professor Quinn: A sneak-preview of what you’re going to talk about?

Professor Stern: Of course not. I do not want to spoil the fun. All I can tell you is this is when MDS kindly extended the invitation, I thought that resurrection occurred only in the New Testament. I’d been out of action for so long. I was asked for a title, months ahead. I thought that if I gave a title, so opaque and so incomprehensible that no one, including me, knew what I had in mind, I hoped it might develop in my mind. Here, I must here give full credit to Christopher Goetz. He read the title and the submitted incomprehensible abstract. Wonderfully, he had made a succinct summary. When he politely asked for approval, “Is this suitable for publication?” I said, “Not only is it suitable, it’s brilliant. You are the only person including me, who knows what I’m going to say”.

Professor Quinn: I’ll look forward to that.

Professor Stern: [Laughter]

Professor Quinn: Gerald, thank you very much.

Professor Stern: Great pleasure!

Professor Quinn: Nice talking with you again.