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Wilder G. Penfield (1891-1976), Neurosurgeon and Scientist

Jacques G. Ruelland

Summary Founder and first director of the Neurological Institute, W i l d e r G. Penfield established the "Montreal Procedure" for the surgical treatment of , a disorder characterized by sudden and recurrent . His revolutionary w o r k is the very foundation of neurological studies. He was celebrated as 'the greatest living Canadian!

Resume Fondateur et premier directeur de I'lnstitut neurologique de Montreal, W i l d e r G. Penfield inventa une methode d'intervention connue sous le nom de « Protocole de Montreal » applique au traitement chirurgical de I'epilepsie, cette maladie du cerveau caracterisee par des crises recurrentes. Son travail revolutionnaire est consideree comme le fondement des etudes neurologiques et lui a valu les plus grand honneurs.

W i l d e r Graves Penfield was b o r n in Spokane At Oxford, he was influenced by Sir William Osier and Sir (Washington) on January 26 th , 1891. He died in Montreal Charles Sherrington. Sherrington was noted for his th () on A p r i l 5 , 1976. World-famous brain experiments establishing modern understanding of surgeon, he reflected t o w a r d the end of his productive integrated nervous functions 9. He made Penfield realize life that "the only certain virtue" that came into the w o r l d that "the nervous system was the great unexplored field - the with him at his birth was "tenacity of purpose'!' undiscovered country in which the mystery of the mind of man might someday be explained' 0!' In 1899, his father's medical practice failed and he was 2 unable to support the family . His parents separated. His In January 1915, he enrolled in courses (histology, mother t o o k his elder brother and sister and eight-year- pharmacology, bacteriology, and chemistry) that would old W i l d e r to live w i t h her parents in Hudson assist in his completion of a medical degree at Johns (Wisconsin) 3 .There, he graduated from Galahad School 4. Hopkins University (Baltimore, Maryland) which he Following his graduation, he entered Princeton, where planned to enter on his return to the United States. He he was determined to make himself an all-round scholar, was assisted in arranging this by Sir William Osier, athlete, and leader so that he might qualify for a Cecil Canadian-born Regius Professor of Medicine. Osier invited .The best he could do in football in W i l d e r to accompany him on medical consultations from his first year, was to qualify as a substitute on the one English hospital to another. freshman team. On the advice of Heff Herring, Princeton football player, wrestler and Rhodes Scholar, he went out In late 1915, during the Christmas break from his studies for wrestling 5 , and thereby developed large neck at Oxford, Penfield worked briefly as a volunteer in a Red muscles, w o n the interclass f r e s h m a n - s o p h o m o r e Cross hospital in France. W h e n he returned to the Red wrestling match, and eventually found a place on the Cross w o r k in late March 1916, after the winter term at varsity football team as a first-string tackle 6. O x f o r d , the ship on which he was travelling was

At the end of his sophomore year, an enthusiasm torpedoed in the English Channel. Although he was engendered by Professor Conklin's biology lectures led erroneously reported dead and his obituary was published him to decide on a career in medicine 7. He obtained a in an American newspaper, he survived the torpedo attack bachelor degree in literature f rom Princeton in 1913. but spent three weeks in a hospital in Dover, and several weeks recuperating at Sir William Osier's residence in Penfield looked f o r w a r d to beginning his medical O x f o r d " . education at Oxford (England), but he lost out for the Rhodes Scholarship f r o m N e w Jersey to an "excellent On his return to America, after t w o years in England, fellow" f r o m Rutgers. Instead, he devoted the year after Penfield was given academic credit for his science studies graduation to earning money for his medical education at O x f o r d and embarked upon his final years of medical by coaching the Princeton freshman football team and study at Johns Hopkins Medical School 12 . teaching at the Galahad School. In the middle of the year, he received w o r d that a Rhodes Scholarship for the In April 1917, the U.S. began to enter fully into the First following year had been awarded him and he was W o r l d War. The following June, Penfield married Helen accepted for admission to Merton College at Oxford 8 , Kermott. Several weeks later, he and his wife took a ship where he completed a bachelor degree in sciences and, to France where they both worked in an American Red in 1920, a master's degree. Cross hospital in Paris 13 .

64 Wilder G. Penfield (1891-1976), Neurosurgeon and Scientist, Vesalius, X I , 11, 64-69, 2005

In late 1917, they returned to the U.S.A. Penfield himself 2I , he began to of organizing an institute completed his medical studies at Johns Hopkins and where neurologists, neurosurgeons, and received his medical degree in 1918.The following year, neuropathologists would work together in a team, as he he was surgical intern at the Peter Bent Brigham had learned as football player and coach 22 . He thought Hospital in Boston, serving as both apprentice and later he might be better able to realize this dream in assistant to , one of the most gifted Montreal. He joined the medical faculty of McGill 4 brain surgeons in the United States' . University in 1928 and became, at the same time, neurosurgeon at the Royal Victoria and Montreal But the memory of the "undiscovered country" he had 23 General Hospitals , convinced by the great Canadian glimpsed through Sherrington's lectures continued to neurosurgeon, Edward Archibald, that his skills were intrigue him. He accordingly returned to Oxford for the needed there 24 . He moved to Montreal with his best third and final year of his Rhodes Scholarship as a friend William Vernon Cone. At the Royal Vic, he graduate student in neurophysiology under Sherrington developed a good relationship with Dr. Colin K. Russel, and following that with a year as a research fellow in clinical neurology and at the National a well-established neurologist who supported him in his Hospital at Queen Square in London 15 . surgical treatment of epilepsy. They soon became associates. While in England, he developed a special interest in epilepsy.When this period of his advanced research was Penfield's fascination with the brain led to research into finished successfully, Penfield and his family, which by tumours, brain scars and the various forms of epilepsy this time included two children, returned to the U.S. and he was much in demand as a surgeon. His successes were many but one operation remained in his mind for In 1921, he rejected a lucrative position as a surgeon at the rest of his life. A few months after his arrival in the Henry Ford Hospital in Detroit - because it would Montreal, he was called upon to remove a tumour from have afforded him no opportunity for research - and the brain of his sister Ruth. After finding that the accepted instead a post as associate surgeon at tumour was malignant and far advanced, he performed Columbia University and Presbyterian Hospital, a more radical operation most neurosurgeons would affiliated with Columbia, and to the New York never have dared attempt, but could not safely remove 16 Neurological Institute . Through his work there, his all of the malignant cells. Although the operation made interest in epilepsy was deepened. In his effort to it possible for his sister to enjoy a normal life again, the advance his knowledge and ability in his areas of symptoms eventually returned and she died three years specialization, Penfield studied first hand the methods later 25 . used by specialists in Spain 17 , Germany and elsewhere. There, he developed his surgical techniques under Allen The difficulties of his sister's case spurred him to make O.Whipple, and organized and pursued research in a laboratory of neurocytology 18 . his first effort to realize his dream of an endowed neurological institute for investigation of the brain and His research in 1924 with the Madrid neuro-histologist mind as a way to human betterment. Pio del Rio-Hortega provided him with metallic staining techniques that yielded new information on the ". In After a first rejected application, in 1934 the Rockefeller 1928, he learned from the German surgeon Otfrid Foundation joined with the Province of Quebec, the Foerster, the method of excising brain scars to relieve City of Montreal, and private donors to help implement focal epilepsy 20 . Penfield and Cone's Montreal Neurological Institute. That application resulted in a grant of $l,232,000 26 . During his postgraduate years in Oxford and in London, Penfield had turned from experimental neurophysiology The Institute gradually emerged as a centre of toward neurosurgery because he believed that, since outstanding research, teaching and treatment. Like the neurosurgeon could lay bare the living human brain, Osier, Penfield worked with great skill as he constantly he should be able to study and influence the brain's sought to find new means to cure epilepsy and related physiological activity. As he came to realize that he dysfunctions. Penfield led the commitment, dedication, could not carry out an effective approach to knowledge and hard work of the institute. He was its director of the brain and make use of that knowledge all by during 25 years, until I960 27 .

65 Wilder G. Penfield (1891-1976), Neurosurgeon and Scientist, Vesalius, X I , 11, 64-69, 2005

In drawing together the disciplines of neurosurgery, While he was developing a surgical approach to the neuropathology, neurology and related basic sciences, treatment of epilepsy, Penfield began to map the brain and Penfield transformed the study of the brain. determine which functions of the body were controlled by which brain segment. He located the accumulated store of O n e of his associates was psychologist Donald Olding memory of past events and the emotions, sensations, and Hebb f r o m Halifax. In the I930's, the brain was regarded thoughts to which the events had given rise. as a relay station to process incoming and outgoing

impulses; behaviour was just stimulus and response. Penfield developed a new surgical approach that became Hebb w o r k e d w i t h W i l d e r Penfield f ro m 1937 to 1939 known as the "Montreal Procedure". He developed his and noted that loss of large parts of the brain did not method while his patients were awake and able to interact necessarily diminish intelligence. He was convinced that with him. Using local anaesthetics, he removed the skull neural circuits linking incoming and outgoing neurons cap to expose the brain tissue of the conscious patient. were the loci for thought and emotions 28 . In 1949, Hebb W h e n he probed certain areas of the brain, the patients published The Organization of Behavior, w h i c h would be able to provide him feedback on what they were revolutionized psychology by putting "mind" back into 32 the brain. experiencing at that very moment . Then, he was able to map the functions of tissues in different parts of the brain — a dream already made, but in vain, by Gall and Spurzheim Penfield believed that the problem of neurology is to understand man himself. He made important gains in the in their treatise on the Anatomy and Physiology of the 3 3 study and treatment of the brain. In particular, he Nervous System (I8I0) . In most cases, he identified the investigated the surgical treatment of epilepsy - precise location of the source of the activity. He especially focal epilepsy -, then considered to be an could then remove or destroy that bit of tissue to end the incurable disease. patient's seizures.

His surgical studies yielded reports on brain tumours, Furthermore, Penfield completed his mapping of the brain. the pial circulation, the mechanisms of headache, the He discovered the sources of memory and . Some localization of motor, sensory and speech functions, and of the modern theories of the separate functions of the the role of the hippocampus in memory. t w o cerebral hemispheres were built upon his findings. His concept of centrencephalic seizures 34 arising from deep Penfield's primary concern was that his patients avoid midline portions of the brain had an important impact on unpleasant secondary effects such as m e m o r y loss or the understanding of the relationship between the brain's language disorders w h i c h frequently f o l l o w e d the structures and consciousness 35 - Fritsch and Hitzig (1870) removal of the brain tissues causing the epileptic being "the first to demonstrate that supraliminal electrical seizures 29 . He stimulated the c o r t e x by a mild electric stimulation of the with galvanic currents results in shock in o r d e r to locate the different brain functions, the development of a convulsive seizure which continues far like language and memory, and determined which part of longer than the duration of the stimulus 36 !' that organ should be removed w i t h o u t any danger of neurological deficit. A m o n g his many discoveries was Perhaps what made this gentleman even more amazing that he could summon a patient's past experiences by was the humanity with which he approached his patients mildly shocking the temporal lobes and stimulating memory.As he carefully probed the brain, he found that and their families:"77?e patient must understand the gravity of administration of a mild electric shock to one of the his condition, and must be informed accurately of the chances 37 temporal lobes could cause the patient to recall precise of success !' He made a point of getting to know them as personal experiences that had long been forgotten. He individuals, building a high degree of confidence in his also discovered that stimulating parts of the cortex knowledge and skills: "Fools, alas, and charlatans, too, have could evoke vivid and specific memories 3 0 including traded on the credulity of the epileptic in his great need. (...) sounds and smells. Epilepsy arising in the The physician who unwittingly administers anticonvulsant of the brain assumed special importance because of the remedies to a patient with benign tumor of the brain is open to re-excitation of past experiences that occurred when equal criticism with the surgeon who carries out a craniotomy the c o r t e x was stimulated during surgery. It was an area on a patient without a reasoned therapeutic plan. Adequate that Penfield was passionate about, discovering and investigation of his case is the right of every epileptic who 31 unlocking the hidden treasures in the human mind . seeks help 3"'!'

66 Wilder G. Penfield (1891-1976), Neurosurgeon and Scientist, Vesalius, X I , 11, 64-69, 2005

In treating 1,132 patients during Penfield's directorship, He then published TheTorch, a biographical novel about the Institute improved the techniques of brain surgery Hippocrates. Three years later, he brought o u t The and added materially to neurological knowledge. Second Career, a collection of essays and addresses Research at the Montreal Neurological Institute has led encouraging o t h e r s to use r e t i r e m e n t f o r the to improved surgical and nursing techniques for the development of a new career. management of spinal lesions, to the development of He became first president of the Vanier Institute of the electroencephalography (EEG) to treat conditions such Family. In 1967, his participation in the Josiah W o o d as epilepsy, and to a deeper understanding of cognitive Lectures resulted in the publication of Man and His and other behavioural changes associated with brain Family, a collection of personal reflections on the family. lesions. Non-invasive imaging techniques, such as That same year, he produced The Difficult Art of Giving, a computerized axial tomography (CAT) and positron biography of Alan Gregg, director of the medical emission tomography (PET), in conjunction w i t h a new sciences division of the , w h o had understanding of neurotransmitters, help researchers engineered the grant that had made the Montreal understand the way the various parts of the brain and Neurological Institute possible. nervous system grow, develop, take on specific tasks, and repair and replenish themselves. Penfield was widely known for promoting early second- language training 40 . In 1959, Penfield observed that Penfield's w o r k brought him many high honours. He was complete recovery of language ability after brain damage the first recipient, in 1967, of the $50,000 Royal Bank was possible in children but not in adults. For Penfield, Centennial Award for Canadian Achievement. President there is a limited age — 10 years — beyond which of the Royal College of Physicians and Surgeons of acquiring a second language becomes very difficult. After Canada and of the American Neurological Association, 10, the brain gradually hardens. He advocated that "the Penfield was a fellow of the Royal Society of London and child who hears a second language very early has a great twenty-five other scientific and professional advantage in many aspects of education and life'"." organizations and a recipient of honorary degrees from Penfield's writings on the relationship between science as many universities: Princeton, Oxford, McGill, and religion reflected his insight as a renowned scientist Montreal... Twice decorated by Canada, he was also and dedicated humanism. Emulating Osier in The Second awarded the United States Medal of Freedom, crosses of Career and Second Thoughts, he reflects on the need for the French Legion of H o n o u r and the Greek Legion of "eternal vigilance and resolute action" in a changing George I, and the British O r d e r of Merit. world 4 2 .

Penfield received the Lannelongue Medal of France in In 1974, he completed The Mystery of the Mind, an 1958, and the Lister Medal of the Royal College of account for laymen on brain research.There, he set o ut Surgeons in 1961. His many scientific writings — among his views on the relationship between the human brain them The Cerebral Cortex of Man, co-authored w i t h and the human mind. Theodore Rasmussen, w e r e accepted as definitive statements in their field. Three weeks before his death, Penfield completed the draft of his autobiography, No Man Alone, a phrase He retired from the McGill medical faculty in l954.That repeated frequently in the b o o k to underline his same year, he co-authored w i t h H e r b e r t Jasper Epilepsy emphasis on the team approach to neurological research and the Functional Anatomy of the Brain. He visited and treatment. Published posthumously in 1977, this final w o r k covers the period from 1891 to 1934. In 1981, Princeton in 1956 to deliver theVanuxem Lectures, later Jefferson Lewis w r o t e Something Hidden. A Biography of published and co-authored by W i l d e r Penfield and Lamar Wilder Penfield. Roberts, as Speech and Brain-Mechanisms. He also completely rewrote his late mother's novel, Story of Penfield depicted himself as follows:"/ am an explorer, but Sarah (based on a Biblical tale), which was published unlike my predecessors who used compasses and canoes to under the title No Other Gods. discover unknown lands, I used a scalpel and a small electrode to explore and map the human brain. Throughout In I960, he intensified w o r k on his second career in line my career, I was driven by the central question that has with his belief that "rest, with nothing else, results in rust 39 !' obsessed both scientists and philosophers for hundreds of

67 Wilder G. Penfield (1891-1976), Neurosurgeon and Scie ntist, Vesalius, XI, 11, 64-69, 2005

years. Are mind and body one? Can the mind - thinking, W i l d e r Penfield: The Difficult Art of Giving. The Epic of Alan reasoning, imagination — be explained by the functions of the Gregg: Boston, Little Brown and Co; 1967. brain? As a doctor, my first concern was always for my W i l d e r Penfield: Second Thoughts. Science, the Arts and the patients — to relieve the terrible suffering caused by diseases Spirit: Toronto, McClelland and Stewart; 1970. such as epilepsy. I found that by stimulating the exposed brain of a conscious patient with a small electrical current, W i l d e r Penfield: The Mystery of the Mind. A Critical Study of the patient could tell me what they were feeling or seeing, Consciousness and the Human Brain: Princeton, Princeton and through this we could isolate the damaged part of the University Press; 1975. brain. I developed treatments for epilepsy based on this Wilder Penfield: No Man Alone. A Neurosurgeon's Life: knowledge. But the procedure also opened a window to the Boston, Little Brown and Co; 1977. mind, giving us for the first time a glimpse of how dreaming occurs, how memory works, and where speech and speech R e f e r e n c e s 3 comprehension reside* ." ' Jefferson Lewis, Something Hidden, p. 2. 2 W i l d e r Penfield, No Man Alone, p. 9. We will remember W i l d e r G. Penfield for his humanity J Jefferson Lewis, op. cit, p. 16. and his vigorous scientific approach to unveiling the 4 Ibid., p. 24. mysteries of the human mind. 5 W i l d e r Penfield, op. cit, p. 7. Bibliography Jefferson Lewis, op. cit, p. 35. 7 W i l d e r Penfield, op. cit, p. 18. Charles Hampden-Turner: Maps of the Mind. Charts and ° Jefferson Lewis, op. cit, p. 45. Concepts of the Mind and Its Labyrinths: N e w York, 9 Ibid., p. 54. Macmillan; 1981. 10 Wilder Penfield, op. cit, p. 36. ' Ibid. Donald O. Hebb:"lntelligence in Man after Large Removals 12 Jefferson Lewis, op. cit, p. 64. of Cerebral Tissue". Journal of General Psychology. 21:73-87 13 Ibid., p. 69 (1939). 14 Ibid., p. 77. Donald O. Hebb and W i l d e r Penfield: "Human Behavior 15 Ibid., p. 80. after Extensive Bilateral Removal from the Frontal Lobes". 16 Ibid., p. 86. Archives of Neurology and . 44:421-438 (1940). 17 Ibid., p. 93 sq. 18 Wilder Penfield, op. cit, p. 67, I 15. Donald O. Hebb: The Organization of Behavior. A 19 Neuropsychological Theory: N e w York, Wiley; 1949. Jefferson Lewis, op. cit, p. 97. 20 Ibid., p. 109. Jefferson Lewis: Something Hidden. A Biography of Wilder 2 ' W i l d e r Penfield, op. cit, p. 121 -122. Penfield: N e w York, Doubleday and C o ; 1981. 22 Ibid., p. 174. Wilder Penfield: No Other Gods.A Story of Abraham: Boston, Jefferson Lewis, op. cit, p. 115. 24 Little Brown and Co; 1954. W i l d e r Penfield, op. cit, p. 133. 2 5 Ibid., p. 209-221. W i l d e r Penfield and : Epilepsy and the 26 Ibid., p. 3 I I. 27 Jefferson Lewis, op. cit, p. 258. Functional Anatomy of the Human Brain: Boston, Little Brown 2° Donald O. Hebb, "Intelligence in Man after Large and C o ; 1957. Removals of Cerebral Tissue!' p. 86. See also: Donald O. W i l d e r Penfield and Theodore Rasmussen: The Cerebral Hebb and W i l d e r Penfield, "Human Behaviour after Cortex ofMan.A Clinical Study of Localization of Function: N e w Extensive Bilateral Removal from the Frontal Lobes," p. 425. York, Macmillan; 1957. Z7 W i l d e r Penfield and H e r b e r t Jasper, Epilepsy and the Functional Anatomy of the Human Brain, p. 776. Wilder Penfield and Lamar Roberts: Speech and Brain- W i l d e r Penfield and T h e o d o r e Rasmussen, The Mechanisms: Princeton, Press; 1959. Cerebral Cortex of Man, p. 170. W i l d e r Penfield: The Torch. Love, Treachery, and a Battle for Jefferson Lewis, op. cit, p. 2 0 1 . Truth in Ancient Greece: Montreal, McClelland and Stewart; 32 W i l d e r Penfield, The Mystery of the Mind, p. 2 1 . I960. " Wilder Penfield and Theodore Rasmussen, op. cit, p. I. Wilder Penfield: The Second Career with Other Essays and 34 W i l d e r Penfield and H e r b e r t Jasper, op. cit, p. 27-28. Addresses: Boston, Little Brown and Co; 1963. See also: W i l d e r Penfield, The Mystery of the Mind, p. 16. W i l d e r Penfield: Man and His Family: Toronto, McClelland & •" "Consciousness" must be understood in terms of an Stewart; 1967. electrical activity of the brain, instead of psychological or

68 Wilder G. Penfield (1891-1976), Neurosurgeon and Scientist, Vesalius, X I , 11, 64-69, 2005

Freudian terms - even Freud's contribution to the Author understanding of mind began w i t h his "limited energy Prof. Jacques G. Ruelland, B.A. (philosophie), M.A. model". Charles Hampden-Turner, Maps of the Mind, p. (philosophie), M.A. (histoire), M.A. (museologie), Ph.D. 40. See also: W i l d e r Penfield and H e r b e r t Jasper, op. at, (histoire des sciences), currently teaches philosophy at p. 196. College Edouard-Montpetit in Longueuil (Quebec), and • ^ W i l d e r Penfield and H e r b e r t Jasper, op. at., p. 183. also the history of sciences, the history of medicine and 37 Ibid., p. 748. museology as an Associate Professor in the De pa rt me nt Ibid., p. 747. See also: Jefferson Lewis, op. at, p. 246. of History at the University of Montreal. He has ^ W i l d e r Penfield, The Second Career, p. 14. authored or co-authored 27 books in different fields: 40 Ibid., p. 128. history of science, history of ideas, philosophy, ethics, 41 W i l d e r Penfield and Lamar Roberts, Speech and Brain- literature, etc. Mechanisms, p. 275. 4^ W i l d e r Penfield, The Second Career, p. 17. A d d r e s s 4 3 Q u o t e d f ro m Canada Science and Technology Jacques G. Ruelland, Ph.D360, rue de Venise, Brossard, Museum's W e b site: Q C J 4 W I W 7 Canada www.sciencetech.technomuses.ca/english/about/hallfam Phone: 450-671 -7427 Fax: 450-671 -1604 e/u i I I e.cfm E-mail: [email protected] www.hist.umontreal.ca/u/ruelland/ ROYAL SOCIETY OF MEDICINE PRESS Do you want to know more about Medical History? Look no further, RSM Press the right publication for you... • Purchase securely online at www.rsmpress.co.uk, or • Contact Marston Book Services tel+44 (0)1235 465 500, or • Email® [email protected] Journal of Medical Biography An essential subscription for 2006, the Journal of Medical Biography is a compelling and captivating read, and an intriguing and unique source of medical biographies. This fascinating journal is an international quarterly publication focusing on the lives of people in or associated with medicine, including those considered legendary as well as the less well-known. The journal includes much original research, both about medical figures and well known characters from history, and their afflictions, providing an interesting, fresh and new perspective which can lead to a greater understanding of each subject. Find out more about the origins of modern medicine and the characters and personalities that made it what it is today. For more info or to view a free sample article visit www.rsmpress.co.uk/jmb.htm Subscribe quoting 'Vesalius' and receive a 1 5% DISCOUNT on an annual individual subscription: Europe: £55/€ 83, USA: $102, Rest of World: £59 To subscribe Contact Portland Customer Services quoting 'Vesalius' at: Tel: +44 (0)1206 796351 Fax: +44 (0)1206 799331 E-mail: [email protected]

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