J Neurol (2003) 250 : 120121 DOI 10.

1007/s00415-003-0862-1

PIONEERS IN NEUROLOGY

H. Petit

Paul Nayrac (18991973)

Paul Nayrac (18991973)

Received: 16 April 2002 Accepted: 3 May 2002

Prof. H. Petit () Department of Neurology University Hospital Salengro 59037 Lille, France E-Mail: henri.petit@nordnet.fr

Paul Nayrac was one of the leading French neurologists after World War II. In French Flanders, the Nord-Pas de Calais district area (4 million inhabitants) located close to Belgium and England, he created the neurological department of the University-Hospital of Lille, the capital city of the region. Paul Nayrac was born in Algiers where his father was a civil servant in the French government. After graduation at the University of Algiers, he was to spend 3 months in Lille in 1922, in the neuropathology laboratory, under the leadership of Professor F. Curtis (18581937), a friend of Virchow. However, he never left. His interests included neurology and psychiatry, as was usual in the twenties. His medical thesis (1923, on paranoid dementia), was followed by his first neurological publication, on the first French case of Wilsons disease [1]. In 1924, he had the foresight to express the following notion of senile dementia: With a doctrinal mind, we have to dissociate argyrophilic dementia characterised by Alzheimer cells (neurofibrillary tangles) and argyrophilic plaques, which is Alzheimers disease, from arteriosclerotic dementia; senile dementia is a particular aspect of Alzheimers disease, but dementia with argyrophylia and arteriosclerosis also exists and is usually called senile dementia [2].

In 1931, he created an outpatient clinic devoted to neurology and was also in charge of teaching neurology to medical students; his lessons were published as part of a book in 1935 [3]. He was appointed associate Professor in 1929, then full Professor of Neurology in 1941. At the end of World War II he founded the Department of Neurology, which was to undergo a huge development under his authority between 1944 and 1969. He actively participated in the debate about the rise of basic neuroscience after his retirement, until his death in 1973. In 1958 he was elected chairman of the Congrs de Psychiatrie et Neurologie de Langue Franaise; the title of his presidential address was Langoisse de Saint-Exupry. In 1969 he was the first member of the Socit Franaise de Neurologie outside Paris to become chairman of this Society, a society born, like him, in July 1899! That same year, he became Vice-President of the IXth World Congress of Neurology, held in New-York. A good sailor, he reached New York by a liner, the new France. Paul Nayrac deserves his place under the Pioneers in Neurology not so much because of his academic career but because he was a freethinker in advance of his time. He perceived the need for clinical neurology to be open to all aspects of neuroscience. He regarded as cru-

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cial the application of mathematical methods to biology: As early as in 1926, he applied statistical methods to cell counts. Also he studied memory with biological methods. In 1956, he created an electronic model of the conditioned reflex [4]. A few years later he wrote: There is little to be gained by comparing the activity of the brain and that of a computer unless they are compared schematically, abstractly and mathematically. About complex behaviour such as logical thought, he stated: Is the brain probabilistic? We have to recognise its superiority over all the deterministic machines but perhaps also over probabilistic machines [5]. He stimulated the development of neurosurgery in the 1940s, with a young surgeon, Emile Laine (19121997), as well as that of neuroradiology, clinical neurophysiology, clinical chemistry and nuclear medicine. Important contributions on arterial aneurysms and arteriovenous malformations were published during this period. Paul Nayrac had always been interested in medical psychology, as a counterpoint to his interest in mathematical applications. He contributed to the introduction of medical psychology in the French medical curriculum, and wrote a

book on psychology [6]. He also favoured the application of neuropsychology to patients with neurodegenerative disorders; the term extra-pyramidal dementia preceded the concept of subcortical dementias. In patients with functional disorders mimicking or associated with a neurological disease he always requested the help of a psychiatrist with a good knowledge of general medicine and psychoanalysis. The most original aspect of Paul Nayrac was how he predicted the future evolution of neurology. In the fifties, a large part of his activity was dedicated to neurological emergencies, fits, strokes, meningitis and meningo-encephalitis (which were still often tuberculous) but he considered multiple sclerosis, neurodegenerative disorders, Parkinsons disease and dementias as the future challenges. His retirement coincided with the levodopa era. Nayrac was gifted with an attractive personality and he was soon recognized as a natural leader in many fields. However, he was not an authoritative man and left his coworkers and assistants free to develop unexplored fields. In 1947, in a talk at the University Assembly entitled Hamlets message, he said: Action and reflection are irreconcil-

able . . . many Humans follow a road between impulsive action and pure thought. They are able to think without regarding thought as the only aim. Living their life, they play a game, at the same time pleasant and terrific, and accept the rules of this game where reflection, deduction, prediction are needed, but where the rules are determined by a judgement of value which surpasses reason. For a life to be worthy, it is necessary to be consecrated, even sacrificed, to some special mission . . ..

References
1. Nayrac P (1923) Sur ltiologie de la dgnrescence hpato-lenticulaire. Rev Neurol (Paris)29:504508 2. Leys D, Petit H (1988) La Maladie dAlzheimer. Rapport du congrs de Psychiatrie et Neurologie de Langue Franaise. Chambry. Masson, Paris 3. Nayrac P (1935) Maladies du Systme Nerveux. In Manuel de Clinique Mdicale ed. Minet J Doin, Paris. pp 1246 4. Nayrac P, Masse L, Dujardin J (1956) Modle lectronique de rflexe conditionnel. Rev Neurol (Paris) 95:5657 5. Nayrac P (1970) La relation Cerveau Machine et la mathmatique moderne. Confrontations Psychiatriques 6: 217241 6. Nayrac P (1962) Elments de Psychologie. Flammarion, Paris