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Professor James Lance was interviewed in 2010 for the Interviews with Australian scientists series. By viewing the interviews in this series, or reading the transcripts and extracts, your students can begin to appreciate Australia's contribution to the growth of scientific knowledge.
The following summary of Lance’s career sets the context for the extract chosen for these teachers notes. The extract highlights the way in which Lance collected interesting cases from his clinical work and determined how these conditions arose. Use the focus questions that accompany the extract to promote discussion among your students.
James Waldo (Jim) Lance was born in Wollongong in 1926. Lance completed his medical degree at the University of Sydney in 1950. He began his clinical work as a resident medical officer at the Royal Prince Alfred Hospital (1950-51). Cutting his residency short, Lance took up a National Health and Medical Research Council (NHMRC) fellowship at the University of Sydney (1952-53) to work towards his Doctor of Medicine (MD, awarded 1955). During this time Lance determined the origin of the pyramidal tract in cats and traced these fibres down the spinal cord.
In 1954 Lance travelled to London, England to train as a neurologist and accepted a position as assistant house physician at the National Hospital in Queen Square. Upon his return to Australia Lance combined teaching and clinical practice with appointments as tutor at St Paul’s College (1956-60), visiting lecturer at the University of Sydney (1956-62), superintendent of the Northcott Neurological Centre (1956-57) and honorary assistant physician at Sydney Hospital (1956-61) and St Luke’s Hospital (1957-61).
In 1960 Lance once again left Australia to follow his passion for research work. While at the Massachusetts General Hospital in Boston he investigated the cause of myoclonic epilepsy and established the relationship between tremors and the cogwheel effect in Parkinson patients. Lance returned to Australia as the founder of the department of neurology in the newly established medical school at the University of New South Wales (UNSW). He remained at UNSW throughout his professional career starting as senior lecturer (1961-63), then associate professor (1964-74), professor of neurology – personal chair (1975-92) and currently, as emeritus professor. Concurrent with his research, Lance continued his clinical practice at the Prince Henry and Prince of Wales Hospitals where he was chairman of the Department of Neurology (1961-92) and foundation director of the Institute of Neurological Sciences (INS, 1990-91). It was on these patients that much of his research work was based; including investigations into visual hallucinations and the Harlequin syndrome. Lance continues to see patients as a consultant neurologist at the INS.
Professor Lance has received many awards and honours throughout his career including several awards from the American Association for the Study of Headache (1967, 1983, 1989 and 1991), the Gold Medal from the British Migraine Association (1975), commander of the Order of the British Empire (1978), officer of the Order of Australia (1991), an honorary doctorate in science from UNSW (1992) and the Centenary Medal (2001). Lance was elected a Fellow of the Australian Academy of Science in 1980.
“Three is a paper”
One thing that has marked your career, Jim, is that you have taken the opportunity presented by patients of studying the mechanisms underlying their conditions. Can you tell us about some of the conditions that you’ve studied?
Look, there’s an old saying that ‘one patient with a new symptom is interesting, two is a coincidence and three is a paper’. I have always been a sort of collector of unusual things and have put them on the back-burner. They include all sorts of odd things, like neck-tongue syndrome and funny postures assumed in dystonia. Visual hallucinations is another interesting one and Harlequin syndrome, where people flush and sweat on one side of the face and not on the other.
The Harlequin syndrome: can you tell us a little bit about it?
This started off with my daughter, Fiona, actually, when she was working I think in general practice shortly after she left hospital work. She said, ‘Oh, this will puzzle you’—and this was a woman who, whenever she played squash, flushed brilliantly and sweated on one side of the face and didn’t on the other side. This resembled very much the traditional painting of Harlequin in Commedia dell’arte, so we thought we would call it Harlequin syndrome. Eventually we accumulated a number of others with this.
Peter Drummond, who is a very talented research worker—now Professor of Psychology at Murdoch University in Western Australia—worked with me in elucidating this syndrome. Essentially, it appears to be part of an autonomic neuropathy. At first we thought it was compression of the fibres that left the upper part of the spinal cord to supply the face with the sympathetic supply. It hadn’t been realised, before we did a whole series of investigations, that the sympathetic nerves, which were thought to constrict blood vessels and make people pale, also had fibres in them that made people flush. So this was quite a useful scientific endeavour—explaining this so-called Harlequin syndrome.
How about visual hallucinations?
This was fascinating. A level headed farmer reported wild animals of all sorts creeping into his left visual field. Every time he would look to the left, the animals would retreat; and, when he would look forward, they would come out again. This, we found, was caused by a blackout in his field of vision in that area caused by, in his case, a stroke affecting a limited part of the primary visual cortex. I eventually collected about 12 such patients; they all had these hallucinations from a lesion in an area affecting the primary visual cortex. If the normal input into the visual cortex is not there—if it’s taken away—the association cortex which surrounds it, manufactures fantasies or memories to fill the gap. The most striking one I remember was Her Majesty the Queen, who emerged from the left side of the ward, went across the middle and just disappeared. The person who had these hallucinations described her exactly, with her handbag and hat and so on.
This led to a landmark paper in Brain, didn’t it?
On a form of visual hallucinations and their causations, yes.
An edited transcript of the full interview can be found at http://www.science.org.au/node/327162.
Focus questions
Select activities that are most appropriate for your lesson plan or add your own. You can also encourage students to identify key issues in the preceding extract and devise their own questions or topics for discussion.
brain
hallucinations
Harlequin
nerve fibres
para-sympathetic
spinal cord
sympathetic
visual cortex
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