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G. Robert DeLong, MD

Profile written by Robert S. Rust, MD

G. Robert DeLong, MD

Bob De Long was born and grew up in Lafayette, Indiana. He attended Indiana’s DePauw University, where his exceptional academic accomplishments led to election to Phi Beta Kappa, and the completion of a BA degree with high honors in 1957. He attended Harvard Medical School, receiving his MD degree cum laude. His distinguished performance merited membership in Harvard Medical’s Boylston Society. During medical school, Dr. DeLong became keenly interested in neuroanatomy and developmental neurobiology under the influence of Richard Sidman, in whose laboratory he completed work concerning lesional effects on superior collicular histogenesis that was published as his first paper in 1962. Internship and Assistant Residency in Medicine at the MGH was followed by two years of research at the NIH and then Residency in Neurology, completed at Harvard’s Boston City Hospital in 1966. The then characteristic year of training in Neuropathology of the MGH program was completed in 1967. Chief Residency in Neurology completed Dr. DeLong’s formal neurological training in 1968. His clinical development during his training had particularly been influenced by Phil Dodge and Ray Adams. Dr. DeLong’s first faculty appointment also occurred in 1968, as Instructor in Neurology at the MGH. In the following year, Dr. DeLong was chosen to succeed departing Phil Dodge as Chief of the Pediatric Neurology Unit of the Massachusetts General Hospital.

Dr. DeLong’s career as a neuroscientist continued with a series of additional developmental studies in the Sidman Laboratory of the induction of retinotectal projections, as well as histogenetic developmental studies of alignment and connectivity of neural elements in developing brain cultures. Two of these papers were to achieve more than 100 citations in the medical literature. In 1975, Dr. DeLong published imaging studies demonstrating temporal lobe anomalies in an infant with autistic manifestations, a paper that achieved 127 citations.

His interest in autism had arisen because he regarded this strange disorder as the most mysterious challenge in clinical medicine. Despite many other interests, activities, and responsibilities this subject was to retain his attention for more than the thirty years. In 1981 he published meticulous neuropathologic studies of the brains of four apparently congenitally mentally retarded individuals who developed, in addition, autistic manifestations. These important studies have garnered more than 200 citations to date. Dr. DeLong has been greatly interested in the manner in which a given set of neurological manifestations may arise in association with different potential inciting circumstances. Thus, in 1981 he reported the circumstances and manifestations of transient autistic features in an individual who had experienced an acute encephalopathic illness, a study that has been cited more than 120 times.

Dr. DeLong’s interest in other psychobehavioral aspects of children was attracted at almost the same time as his interest in autism. Four papers (in 1978, 1983, 1986, and in a particularly highly cited paper in 1987) reported the efficacy of lithium treatment in improving function and behavior of children thought to manifest manic-depressive disturbance. Dr. DeLong had performed these studies because the condition had “forced itself” on his attention: he had encountered numerous young individuals with the considerable disability and troublesome behaviors this condition produced in them, disturbing their development and the lives of their families. Throughout his career, Dr. DeLong has emphasized that although he hadn’t adequate time to complete detailed histogeneic developmental studies, his very busy clinics had become a laboratory wherein he could catalogue the clinical features of illness and their response to thoughtful interventions. In 1988 Dr. DeLong published what he recognized as features of overlap between certain subgroups of autistic subjects and some with manic-depressive illness. A contemporary paper in which Psychiatrist- Research Fellow, Judith Dwyer also collaborated helped to recognize and refine the distinction between mania and attention deficit disorder. The combination of subjects would continue to engage Dr. DeLong’s scientific attentions through ensuing decades as his trainees were taught to consider the distinction between illnesses labelled as psychiatric or neurological to be an artificial one – just as did his colleague C. Miller Fisher.

Dr. DeLong participated in the important and highly cited pioneering studies that KS Krishnamoorthy organized and performed between 1976 and 1984 identifying the clinical and CT imaging findings of neonatal intraventricular hemorrhage. Dr. DeLong was interested as well in metabolic disturbances, publishing papers concerning OTC deficiency, Reye syndrome, and mitochondropathies. A highly cited example of such a study, of which Rose- Mary Boustany was first author in 1983, proved to be a durable contribution to exciting interest in the recognition of such conditions. In 1985, Dr. DeLong published an important paper on the clinical aspects and environmental
aspects of congenital iodine deficiency. Professor John B. Stanbury, of the Thyroid Clinic at MGH, was a pioneer in such studies; he enlisted Dr. DeLong’s assistance in characterizing the neurological manifestations of endemic iodine deficiency – the first of a number of quite valuable papers that resulted from study of individuals living in iodine-deficient regions of China. Dr. DeLong, who published during his career 33 thoughtful chapters, achieved a particularly high citation rate (155) for the chapter he published in 1994, together with Chinese colleagues, identifying a particularly critical time during which brain vulnerability to iodine deficiency is noteworthy.

Had his clinical demands not been more pressing, and given the skillfulness with which he had studied histological variations in early brain development, Dr. DeLong might have demonstrated the subsequently discovered effects that iodine deficiency produced in early development of dendritic arboring. But, of greater value for the physician have been the three influential papers that Dr. DeLong published concerning the clinical effects as well as the approach to intelligent management of the neurological effects on infants of endemic iodine deficiency. In 1989, Dr. DeLong published an excellent book entitled Iodine and the Brain. His subsequent 1994 paper, written with his Chinese collaborators, disclosed the critical timing of vulnerability to the development of endemic cretinism due to iodine deficiency and, as a result, characterized the time at which intervention to replete iodine in infants and small children should most effectively be undertaken. Among the 33 book chapters that Dr. DeLong published are to be found other thoughtful and detailed considerations of the clinical conditions that had attracted his attention because of their puzzling mysteriousness and clinical importance. Four of Dr. DeLong’s chapters concerned autism, three manic-depressive illness. His findings and recommendations concerning congenital iodine deficiency resulted in eight invited lectures that were delivered to international audiences. A similar number of invitations of international audiences were honored with the delivery of his mature thoughts on autism and on the neurological aspects of affective disorders.

The pattern of his intentions and ensuing achievements were in keeping with a principle that has figured greatly in his instruction of those he has trained. He concluded early in his professional life that accurate description of a clinical condition must be sought in order to generate a reasonable hypothesis as to some comprehensible mechanism that accounts for the condition. Only then could proper experimentation be undertaken to define mechanisms in order to select interventions to be tried to remedy the problem. He has felt that a considerable portion of the purview of child neurology has remained at the descriptive phase of defining the condition properly. He has emphasized that so long as some of our descriptions of “mysterious varieties” of nature’s mistakes remain inadequate, further progression will not be achieved. He once noted that like Lewis and Clark, child neurologists with imagination and independent thinking will be at the vanguard of new scientific discovery.

Dr. DeLong left Harvard in 1988 to assume the position of Chief of the Division of Pediatric Neurology at Duke University, remaining in that post until 1994. He remained on the attending staff until 2006. During the course of his career he received a number of professional awards, in particular the Shriver Prize for Mental Retardation Research (1995), the E. H. Christopherson Award and Lectureship of the American Academy of Pediatrics in 2002 for his contributions to international child health and, in 2003, a Doctor of Science Degree (honoris causa) was conferred on him by DePauw University. He has been married for 56 years to his “indispensable partner,” his wife, Nancy. The couple have raised four children with international interests and successful careers.