Manuscripts and Archives of the Historical Medical Library of The College of Physicians of Philadelphia

Francis C. Grant papers Edit


MSS 2/184


  • 1920 – 1957 (Creation)


  • 63 Linear Feet (Whole)
    52 boxes

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  • Biographical / Historical

    Francis Clark Grant, eminent neurosurgeon who trained under pioneers Charles Harrison Frazier and Harvey Cushing, was born in Philadelphia on 9 November 1891, and spent all but one year of his professional life there. He married Anne Lewis in 1917; they had five children, of whom three survived him: sons Francis, Jr., and Joseph (a physician), and daughter Nancy (now Thayer.) Another son, William, was killed in a 1953 accident which also fractured Dr. Grant's hip and right thumb, forcing his early retirement. Grant remained active until his death, of coronary thrombosis, at the Hospital of the University of Pennsylvania, on 20 November 1967.

    "Chubby" Grant, as he was known to his friends, graduated from Harvard College in 1914, and near the top of his class at the University of Pennsylvania School of Medicine, in 1919. After a two year surgical internship, he became an "apprentice" (resident) to pioneer neurosurgeon Charles Frazier at the University Hospital. He continued on the Neurosurgical Service in both the School of Medicine and the Graduate School of Medicine until 1953, except for the year 1925, which he spent on the service of Harvey Cushing at Peter Bent Brigham Hospital, Boston. In 1936 Grant succeeded Dr. Frazier as Professor and Chairman of Neurosurgery in the School of Medicine, and was appointed Chief at both Graduate and University Hospitals. During World War II he trained military surgeons at the University of Pennsylvania in treatment of injuries to the nervous system.

    Grant's early interests followed Frazier's in developing the subtemporal operation for tic doloureux, and in cordotomy, expanding with the developing field to cover all areas of neurosurgery and neurosurgical technique. He developed an improved ventriculoscope, a laminectomy retractor, a more precise method for spinal fluid pressure determination, and a one stage procedure for cerebellar abscess excision. With Naffziger, in 1938 he defined the scalenus anticus syndrome. Of some 226 published papers, one major contribution, " A Study of the Results of Surgery in 2,326 Consecutive Patients with Brain Tumors," Journal of Neurosurgery 13 (Sept. 1956): 479-488, evaluates the years 1924 to 1954, nearly Grant's entire career.

    Dr. Grant was active in many professional organizations, including the American Surgical Association, Association for Research in Nervous and Mental Diseases, Society of Neurological Surgeons, American Neurological Association, and the Philadelphia Neurological Society, which he chaired in 1935. He was elected to the College of Physicians of Philadelphia in 1926. Grant was a founding member of the American Board of Surgery, and an early member (1937) and Chairman (1952) of the American Board of Neurological Surgery.

    Apart from his career, Grant was an avid sailor and yachtsman. He and his family maintained a life long association with Mount Desert Island, Me., and the Northeast Harbor Fleet Club (his father was an original contender.) Following his Harvard graduation, Francis sailed for a year on a mission boat for Dr. Grenfell along the Labrador coast, beginning a life long interest in the Grenfell Association.

    Grant retained an active interest in the alumni affairs of Groton, Harvard, and the University of Pennsylvania. In addition, he participated in such social and cultural organizations as the Racquet Club, Saturday Night Club, Philadelphia Cricket Club, Fly Club, Penn Athletic Club, Philadelphia Barge Club, Print Club of Philadelphia, Pennsylvania Academy of the Fine Arts, and the American Academy of Political and Social Science.

  • Scope and Contents

    This collection contains professional, personal, and subject correspondence; financial and property papers; course material; discussions, book and article reviews, and miscellaneous writings; and extensive case records with indexes, documenting the life, interests, and neurosurgical career of Francis Clark Grant. Although the correspondence is incomplete (primarily 1923 to 1933), the discussions and reviews extend to 1949, and the case records span Grant's entire career, 1921-1957.

    Professional, personal, subject, and business correspondence issued and received (Series "K","M","E", and "I 1" in Grant's original filing scheme) is contained in Series 1. Although the professional correspondence (Series 1.1) spans only the years 1923-1932, the principal correspondents constitute a virtual who's who in the development of neurosurgery: Bernard Alpers, Percival Bailey, Harvey Cushing, Walter Dandy, Temple Fay, Charles H. Frazier, Walter Freeman, Gilbert Horrax, Kenneth G. McKenzie, William Mixter, Wilder Penfield, I.S. Ravdin, Ernest Sachs, George Schaltenbrand, and Byron Stookey. Folders for individuals are interfiled with an alphabet of miscellaneous folders, some of which also include significant names, e.g., William Spiller and Max Peet. The letters provide a great deal of insight into the activities, personalities, medical developments, and thinking in the early years of the new specialty of Neurosurgery. Three folders of Charles H. Frazier correspondence extend until 1932, four years before Frazier's death, and include also a file of departmental financial accounts.

    Personal correspondence (Series 1.2), arranged in an alphabet of miscellaneous folders followed by a few specific names, includes Grant's colleagues, friends, students, relatives, and legal and financial advisors, and contains considerable information on his social activities and hobbies, especially his Maine home and boating interests. The folder of T. H. Weisenberg includes typescripts of Grant's summary/reviews of articles for the Archives of Neurology and Psychiatry, 1924-1931, for which Weisenberg was editor in chief.

    Series 1.3-1.5 contains a small amount of subject material relating to Grant's personal interests. Included are correspondence on schools, which contains useful family information; on the International Grenfell Association; a file on the 1928 Associated Harvard Clubs meeting in Philadelphia, for which Grant chaired the Schools of Medicine and Public Health Committee; and some material on "Prohibition and Narcotics" which provides a glimpse of the physician's role in prescribing and obtaining alcohol during prohibition.

    Series 2, a small collection of financial and property papers, relates to family members (for example, E. W. Clark and Co.) and family estates; to medical consultations; to the Frances Clark Scholarship Fund; to plans for a suite of offices to be shared by Drs. Frazier, Spiller, and Grant.

    Also included are some representative records of Grant's properties, assets and accounts, and a colorful letter describing a sailing trip (n.d., possibly from Grant's son William, whose wife could be the "Betty" in the letter.) Some correspondence re: Philip B. Fisher includes Grant's interesting personal response to a conflict within the Philadelphia office of Scudder, Stevens and Clark. A file on miscellaneous dealers reflects Grant's interests in antiques, art, books, and history, especially relating to sailing ships and navigation of the North Atlantic coast.

    Grant's experiences during World War II in training Army and Navy medical officers in medicine, general surgery, and neurosurgery, are recorded in Series 3. Included, for example, are course schedules, planning and follow up correspondence, source material, the neurosurgical course curriculum and Grant's analysis of it, student critiques of the course, and Grant's evaluations of individual students.j Sidney R. Govons, M.D., (1912- ) was a Charles Harrison Frazier fellow at the Hospital of the University of Pennsylvania, 1940-1943; his name appears as a staff physician in some of Grant's case records during that period. Articles and related correspondence, especially concerning Govons' work on experimental head injury, are retained in Series 4. Some correspondence (Folder 5) describes Govons' Army experience as a neurosurgeon without assignment, which he attributes partly to the Army's use of general surgeons trained in Grant's two month course.

    Grant was a prolific writer and valued contributor to neurosurgical meetings and publications. Series 5 contains a varied representation of his discussions, book reviews, and miscellaneous neurosurgical writings, 1932-1949. The (forty) discussions are incomplete; Grant was actively involved, for example, in almost every meeting of the Philadelphia Neurological Society, both presenting and discussing, through the 1920s, 30s, and 40s. Much of the material is published (as these are) in the Society Transactions sections of the Archives of Neurology and Psychiatry.

    Dr. Grant's detailed case records, with card index, 19211957 (Series 6), constitute the bulk of this collection. Spanning his entire career, the files contain histories, operative notes, correspondence, autopsies, charts, test results, some X rays and photographs, and follow up, often for years or until the patient's death. Physicians everywhere consulted Grant and referred patients, and Grant saw patients in many area hospitals regularly, although the majority of his cases were seen at the Hospital of the University of Pennsylvania and its graduate affiliates: Postgraduate, Medico Chirurgical, and Polyclinic Hospitals. The files are arranged by year, then according to a comprehensive alpha numeric classification scheme, then by the patient's name. The scheme is very different from the one used by Frazier, thorough and accommodating to both basic and changing interests of Grant's practice: areas of the body or nervous system, procedures, diagnoses, and combinations thereof. Letters represent broad categories, each with a numerical breakdown. Unfortunately the complete code has not been found. V

    An attempt has been made to reconstruct much of the code (Appendix 1) by isolating the common element(s), in sometimes complex histories, that would constitute a logical, definitive arrangement. In most categories a pattern emerges clearly; however, some uncertainties remain, especially in category "C", where the breakdown of pituitary tumor cases seems unrelated to operative technique, tumor type, location, symptom pattern, or therapy, and in "G" and all code letters beyond "H", where there are very few records. Occasional odd cases in otherwise clear categories seem to be errors by the coder.

    Grant divides his cases roughly into the following broad categories: cerebrum, cerebellum, pituitary sellar area, facial nerves, neck and shoulder area, peripheral nerves, gastrointestinal tract, spine and spinal cord, trauma, plastic repair (?), autopsy, and miscellaneous/problems. Special areas of interest include tumors of all areas of the brain and spinal cord; brain and spinal abscess; head injury; herniated disc; operative technique for the pituitary; major trigeminal neuralgia; cordotomy, sympathectomy, alcohol injection, and other techniques for relief of pain; lobotomy; nerve surgery and repair; ventriculography and encephalography.

    A few of the specific code categories are further subdivided, notably A 9 [disorders with mental and/or behavioral complications]. These include the classes from which, beginning in 1938, candidates for lobotomy were chosen, chiefly, A 9-C [cortical atrophy/agenesis mental deficiency with depressive/agitative psychoneurosis] and

    A 9-l [manic depressive psychosis]. Accordingly, from 1938 on, all A 9 categories were lumped together except the lobotomies. These were classed as A 9-c (1938-1940) and A 9-l (1941-1957), in later years including primarily newer related techniques, such as frontal lobe injection, thalamotomy, and chemopallidectomy.

    Each letter category seems to have one division (number) for consultations only (largely correspondence, not case records.) It is worth noting that each of these divisions might contain any or all of the other subjects within the category, and might be searched in addition to the subject. For example, lobotomy cases may be found in category A 12 (consultations) as well as A 9; herniated disc cases in

    H 10 as well as H 1. ^

    A time study of the codes might provide interesting clues to Grant's career as well as the development of neurosurgery. For example, categories E 1 to E 7 appear primarily in the early years, rarely after 1928. These relate largely to the thyroid and neck glands, possibly reflecting a major interest of Dr. Frazier in his early years as John Rhea Barton Professor of Surgery at the University of Pennsylvania. The subject of lobotomy first appears in 1938, three years after its advent in Spain. In 1942 herniated disc operations appear, along with spinal tumors, in category H 1, by 1943 exploding the category from one (small) to six folders.

    The card indexes to the case files (Series 6.2) seem complete, covering the years 1921 to 1955, and separately, 1956 and 1957. Arranged alphabetically by patient's name, each card contains a synopsis of the case, including the classification number, for quick review or to locate a patient's file. One filing inconsistency was noted: nuns

    were filed variously, some by family surname, others under "Sister", then by first name.

    An incomplete (N Z only) card index to Grant's photograph collections (Series 6.3.1), described by Robert Groff as "outstanding", provides a name and possible subject approach to the photographs contained in the patient files. An index to slides (6.3.2) is more complete (A Z), and has been retained in case the slides should some day be found.

    Grant's photograph and slide collections were apparently incorporated into a single numbered listing, in subject series (unrelated to the case classification scheme.) Notations on alphabet guide cards, as well as subject cards interfiled in the indexes, provide clues to the scheme.

    (A partial approximation, derived from the card notations, is attached as Appendix 2.) A number of photos illustrating techniques appear in the index under "Technique" as well as subject; some give the patient's name, and others might possibly be found by locating the case file folder (by subject code and date), and searching for the numbered photograph.

    To date (August 1991) the only photographs in the Grant collection are those included with the case records; neither slides, photo files, negatives, nor the numerical subject listing have been located. ^ Processing note

    Although the Grant papers had been boxed hurriedly and out of order, the papers fall into natural series. Grant's original alpha numeric filing arrangement for his professional and personal material was identifiable, and was retained as appropriate within the series. (Original code numbers are indicated following headings in the finding aid.) Folders of miscellaneous correspondence have been rearranged from chronological to alphabetical order, so that all of an individual's correspondence falls together.

    Duplicates and a small file of personal correspondence ("L"), relating to minor medical problems, have been removed, along with routine correspondence and files re: such personal interests as travels, cars, charities, sports, books, fraternities, theatre, and numerous clubs and organizations in which Grant participated. Also removed were extensive files (4.5 linear feet) relating to Grant's banking and investment interests; maintenance, repair, and rental of his properties in Philadelphia (2026 Spruce Street, 9012 Crefeld Street, 2031 Locust Street) and on Mount Desert Island, Me., as well as his various boats; and insurance and leases.

    Off prints of eighteen of Grant's articles and five book chapters (1935-1940) have been removed and placed with the uncataloged reprints of Fellows of the College of Physicians of Philadelphia. An additional cataloged collection of nineteen reprints, 1922-1929, is housed in the Library of the College, and several other bibliographic references may be found in the card catalog.

  • Custodial History

    The collection of papers and clinical records of Francis C. Grant (63 linear feet) was donated, along with those of Charles H. Frazier, to the Historical Collections of the Library of the College of Physicians of Philadelphia by the

    Department of Neurosurgery, Hospital of the University of Pennsylvania, on 21 February 1989.

    The collection was processed and cataloged by Barbara Williams in 1991.

  • Reconstructed Case Classification Code (Partial)

    A. Cerebrum, cerebral disorders, cranium

    A 1. Cerebral tumor

    A 2. Cerebral tumor, suspected

    A 3. Cerebral abscess

    A 4. Hydrocephalus

    A 5. Decompression (edema, hemorrhage)

    A 6. Concussion, contusion, hematoma

    A 7. Meningitis

    A 8. Epilepsy, convulsions, dysrhythmia

    A 9. Diseases/disorders with cerebral complications (largely mental or behavioral)

    9-a. Birth injury

    9-b. Lues (cerebrovascular)

    9-c. Cortical atrophy/agenesis depressive/agitative psychoneuroses, mental deficiency

    9-d. Headache (alcoholic, migraine, anxiety)

    9-e. Hysteria psychoneuroses, psychoses

    9-f. ? (No cases)

    9-g. Encephalitis (post encephalitic parkinsonism)

    9-h. Sclerosis (incl. multiple sclerosis, arteriosclerotic dementia)

    9-i. Developmental anomaly, microcephaly; mental arrest

    9-j. Encephalopathy toxic, Schilder's, encephalo malacia

    9-k. Paresis (lues)

    9-l. Manic depressive psychosis

    9-q. Correspondence re: potential lobotomy candidates following a 1940 newspaper article on "Brain Operation"

    A 10. Cranial fracture

    A 11. Cranial cyst/tumor/disease, osteoma, osteomyelitis

    A 12. Consultations re: cerebral/cranial problems

    A 13. Cranioplasty

    A 14. Cerebral cortical atrophy, arachnoiditis

    A 15. Cerebral complications, other diseases metastatic cancer, cerebro/cardiovascular disease, diabetes, degenerative diseases, etc.

    A 16. Foreign body injury 16-a. Bullet/gunshot wound

    A 17. Cerebral aneurysm/hemorrhage, vascular lesion h

    A 18. Porencephaly, Jacksonian epilepsy

    A 19. Cranio/cerebral infection/inflammation (cellulitis, papilledema, toxic encephalomyelitis, sinus thrombosis, etc.)

    A 20. "Encephalograms other services"

    A 21. Clinic (Graduate Hospital?)

    B. Cerebellum

    B 1. Cerebellar tumor

    B 2. Cerebellar tumor, suspect

    B 3. Cerebellar agenesis, atrophy, ataxia

    B 4. Cerebello pontine angle tumor

    B 5. Cerebello pontine angle tumor, suspect

    B 6. Consultations cerebellar problems

    B 7. ? (No cases)

    B 8. Cerebellar abscess

    B 9. Cerebellar cyst?

    B 10. Cerebellar malformation (Arnold Chiari, platybasia)

    10-a. Friedreich's ataxia

    B 11. Arteriovenous aneurysm occipital, cerebellar

    B 12. 4th ventricle tumor (sub occipital)

    B 13. Cerebellar atrophy, sub occipital arachnoiditis

    C. Pituitary, sellar area

    C 1. Pituitary tumor

    C 2. Pituitary tumor (adenoma, cystadenoma, cranio pharyngioma?)

    C 3. Pituitary tumor, suspect

    C 4. Pituitary tumor, suspect

    C 5. Pituitary tumor, suspect

    C 6. Consultation pituitary

    C 7. Pituitary dysfunction

    C 8. Suprasellar/parasellar cyst/tumor (Rathke's pouch)

    C 9. Pineal gland tumor C 10. 3rd ventricle tumor

    D. Facial nerves, neuralgia

    D 1. Major trigeminal neuralgia

    D 2. Major trigeminal neuralgia alcohol injection

    D 3. Trigeminal neuralgia, atypical

    D 4. Gasserian ganglion tumor

    D 5. Carcinoma of face, neck, tongue (pain)

    D 6. Facial pain other? (trifacial, 5th cranial nerve)

    D 7. Supra orbital neuralgia D 8. Atypical neuralgia

    D 9. Facial nerve damage, paralysis (Bell's palsy); repair

    D 10. Labyrinthitis, tinnitus, Meniere's disease

    D 11. Pneumogastric neuralgia

    D 12. Glossopharyngeal neuralgia

    D 13. Optic neuritis, optic nerve lesions

    D 14. Parotid tumor

    D 15. Consultations facial neuralgia

    D 16. 6th cranial (abducens) nerve paresis, neuritis

    D 17. 3rd nerve (oculomotor) palsy, neuritisj E. Neck and shoulder area

    E 1. Exophthalmic goiter (toxic)

    E 2. Lingual thyroid goiter (tumor)

    E 3. Colloid goiter

    E 4. Thyroid adenoma toxic, non toxic, cystic

    E 5. Neck swelling? (cyst, adenoma)

    E 6. Endocrine imbalance? (thyroid disease, carotid sinus syndrome, hyperplastic toxic goiter, etc.)

    E 7. Neck tumor/cyst (tubercular adenitis, thyroid carcinoma, sarcoma, thyroglossal cyst, etc.)

    E 8. Neck contusion, pain

    E 9. Torticollis

    E 10. Consultations neck/shoulder

    E 11. Cervical/thoracic sympathectomy, ramisectomy

    E 12. ? (No cases)

    E 13. Cervical rib

    E 14. Scalenus anticus syndrome, bursitis, scalenotomy

    F. Peripheral nerve injury/neuropathy; repair

    F 1. Neurorraphy

    F 2. Neurolysis, exploration

    F 3. Peripheral nerve pain (neuropathy, injury, neuritis post herpes neuralgia, post operative complications, compression, cause undetermined, etc.)

    F 4. Sciatica

    F 5. Brachial plexus palsy, neuritis

    F 6. Consultation nerve injury, neuritis

    F 7. Peripheral nerve injury, repair, transplantation

    F 8. Neuroma excision F 9. Injection (nerve block)

    F 10. Occipital neuralgia injection, neurectomy

    F 11. Contracture (hand) (one case)

    F 12. Peripheral nerve section/avulsion (multiple?) (and/or injection?)

    G. Gastrointestinal tract? (Hernia, stomach carcinoma)

    H. Spine/spinal cord

    H 1. Spinal cord tumor; herniated disc (from 1942)

    H 2. Spinal cord tumor, suspect; herniated disc, suspect

    2-a. "Myelograms for other services" (1949-1950)

    H 3. Cordotomy

    H 4. Meningocele

    H 5. Spinal pain (lesions, damage) multiple causes? (carcinoma, sclerosis, osteoarthritis, multiple myeloma, sprain, injury, meningitis, surgery, etc.)

    H 6. Spine/cord fracture, contusion, dislocation, compression

    H 7. Spinal abscess

    H 8. Sympathectomy abdominal, lumbar?

    H 9. Laminectomy, rhizotomy, cordotomy, ganglionectomy, thoracic/lumbar sympathectomy

    H 10. Consultation spinal problems

    H 11. Infectious/inflammatory conditions? (Postoperative myelitis, sterile lumbar abscess, poliomyelitis, radiculitis, diffuse neuromyelopathy, Pott's Disease, etc.)

    H 12. Paravertebral injection (alcohol, novocaine)

    H 13. Degenerative diseases/changes? (amyotrophic lateral sclerosis, lues, tuberculosis, spinal metastases, osteoarthropathy, neurofibromatosis, muscular dystrophy, lumbosacral strain, congenital malformation, foreign body, osteitis, spinal caries, dystonia, Pott's Disease, Guillain Barre syndrome, polyneuropathy, etc.)

    I. Trauma, accident cases?

    I 1. Head injury/fracture? (orbit fracture, nasal bone, eye, maxilla, mandible)

    I 2. Other injury? (facial injury, rib fracture)

    I 3. ? (No cases)

    I 4. ? (No cases)

    I 5. ? (No cases)

    I 6. Multiple injury? (shoulder, rib)

    I 7. Head injury with other fractures?

    J. Plastic repair?

    J 1. Facial injury plastic repair?

    K. Autopsy?

    K 1. Autopsy?

    K 2. Autopsy notes?

    L. Lung?

    L 1. ? (No cases)

    L 2. ? (No cases)

    L 3. ? (No cases)

    L 4. ? (No cases)

    L 5. ? (No cases)

    L 6. Fluid tap?j

    M. Vascular diseases, thrombosis

    M 1. Peripheral vascular diseases? (endarteritis, varicose veins of scalp, embolus, leukemia metastatic to brain)

    M 2. Diabetic neuropathy?

    M 3. Extremities vascular disease (Buerger's, Raynaud's, etc.)

    M 4. Embolism/thrombosis (jugular vein, sinus thrombosis, endarteritis, arteriosclerosis)

    M 5. Hypertension, stroke M 6. Consultation vascular problems

    X. Problems and miscellaneous? (legal, bill collection, free patients, insurance, etc.)

  • Reconstructed Photograph Numbering Scheme (Partial)

    1 Tumors, brain

    1000 Skull fractures (1264-1278) Hematoma, subdural

    1500 Tumors, cerebellum

    2500 Tumors, cerebellopontine angle

    3000 Tumors, pituitary (endothelioma, etc.)

    3500 Pituitarism 4000 Tumors, spine

    4500 Spine, lesions

    5000 Trigeminal nerve

    (5538-5543) Tractotomy

    6000 Neck, thyroid

    6250 Neck sympathectomy

    7500 Anesthesia, pain relief

    8000 Technic photographs

    (8000?) Brain/spine anatomical technique

    8250 Craniotomy, brain abscess, brain surgery

    8750 Ventriculography, encephalography

    9000 Pituitary operative technique

    9250 Trigeminal nerve, alcohol injection, tractotomy, major trigeminal neuralgia

    9500 Carcinoma face, head, neck

    10000 Spinal cord cordotomy, laminectomy, rhizotomy, lumbar puncture, disc, spinal tumors, sympathectomy

    10250 Cranial trauma, hemorrhage, cranioplasty

    10500 Brain tumors, metastasis, (astrocytoma)

    11000 Sympathetic nervous system, sympathectomy (hypertension)

    12000 Tractotomy

    13000 Lobotomy technique

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