HISTORICAL NEUROLOGY AND NEUROSURGERY Neurosurgery at the Toronto General Hospital, 1924 -1990: Part 2 J. Max Findlay Can. J. Neurol. Sci. 1994; 21: 278-284 Part 1 of this two part series outlined the beginning of Professor of Surgery Robert Janes' office in the Banting Canadian neurosurgery and neurosurgical training at the Institute. As Morley recalls it, Prof. Janes began: "Well Morley, Toronto General Hospital under Kenneth G. McKenzie, and thank you for coming, it was a joy having you here, and we described the efforts of E. Harry Botterell, McKenzie's neuro­ would like to offer you a probationary one-year appointment." surgical trainee and successor, in establishing the Toronto Morley responded that that seemed fair, and if either he was not school of neurosurgery.1 This second part reviews the course of satisfactory or happy in Toronto then he could be released from neurosurgery at the Toronto General until the creation of The further obligation. "No," answered Prof. Janes, "if you are satis­ Toronto Hospital. factory to us, and if you say you are unhappy here for whatever reason, you will still stay." Not wanting the opportunity to slip Thomas Paterson Morley and Neurosurgery at the Toronto through his fingers, Morley quickly thanked Prof. Janes for General Hospital, 1962-1979 making clear the very reasonable conditions of the offer he was Neurosurgical training under Sir Geoffrey Jefferson happy to accept. Thomas P. Morley was born in Manchester, England, on June 13, 1920. His father, a general surgeon, was Professor of Thomas P. Morley at the Toronto General Hospital Surgery at the University of Manchester. Morley attended Dr. Morley moved to Canada in 1952 and after spending a University College at Oxford, obtaining a B.A. degree in 1940 year as fellow on the neurosurgical service at Toronto General and B.M. and B.Ch. degrees in 1943. Following graduation, and Hospital obtained both his Canadian Royal College Fellowship a brief appointment as a resident medical officer at a large pri­ in Neurosurgery and a junior staff appointment. He quickly vate lunatic asylum outside Manchester (where included among established himself as an astute clinician and skilled surgeon. his duties was administration of insulin shock therapy, remem­ Morley also opened Toronto's first neurosurgical research labo­ bered as a distressing practice for everyone involved), Morley ratory in 1953, growing brain tumor cell cultures in a small bor­ spent six months as house Surgeon (the British equivalent of an rowed room at the Banting Institute. The laboratory expanded, intern) to Professor Geoffrey Jefferson. The original attraction and 16 years later, in 1969, was eventually taken over by one of to this job was a practical one: it was the only housesurgeon Morley's Ph.D. graduates, Dr. Charles Tator. position vacant and available. Starting out, young Morley had In 1962, when Harry Botterell accepted the position of Dean not wanted to become a neurosurgeon, but even this short expo­ of Medicine at Queen's University, Morley succeeded him as sure to the keenly intelligent and fascinating mind of Geoffrey Head of the division of Neurosurgery at the Toronto General Jefferson convinced him that he could be nothing else. Hospital, and in 1964 he was named Chairman of Neurosurgery In the midst of World War II Morley entered the Royal Air at the University of Toronto (Figure 1). Although possessed of a Force, serving as a squadron medical officer first in England calmer, more aristocratic demeanour than Dr. Botterell, Morley and then India for two years. Following demobilization in 1946 became no less the "Professor". One now senior neurosurgeon he worked briefly as a family doctor, followed by training in recalls spending several months on the neurosurgical service at orthopedic and general surgery. Obtaining his Royal College of Toronto General Hospital as a keen young intern anxious to be Surgeons (England) Fellowship in 1948, he was then able to accepted to neurosurgical training. He worked hard and late return to Jefferson for neurosurgical training. every day and weekend, and hoping to make an impression, The articulate, intellectual, and philosophical Sir Geoffrey paid particular attention to Dr. Morley's admissions. On the last Jefferson had a profound influence on Morley, and in turn, day of this exhausting rotation the chief resident suggested that influenced neurosurgery at the Toronto General Hospital. Dr. the time was right for the intern to pay a visit to Dr. Morley for Morley spent three and one-half years training with Jefferson, an interview. The intern was ushered quietly into Morley's and many years later paid a fond tribute to his neurosurgical 2 office. Dr. Morley sat at his desk, pen in hand, and peering up mentor. over his reading glasses at the applicant, began the interview. At completion of Morley's residency the outlook for a staff "Name?", he inquired. appointment in neurosurgery in England looked bleak. When Dr. Botterell succeeded McKenzie as Chief of Neurosurgery at Toronto General Hospital in 1952 it was decided that a third neurosurgeon was needed on the service. Having established close ties with Manchester and Sir Geoffrey Jefferson during From the Division of Neurosurgery, University of Alberta, Edmonton. the war, Botterell canvassed Jefferson's senior registrars. As a RECEIVED APRIL 15, 1993. ACCEPTED IN FINAL FORM OCTOBER 29, 1993. Reprint requests to: J. Max Findlay, MD, University of Alberta, Department of Surgery, result, Morley flew to Canada, and his introductory several days 2D 1.02 Mackenzie Health Sciences Centre, 8440 - 112 Street, Edmonton, Alberta, in Toronto concluded with a somber interview in the then Canada T6G 2B7 Downloaded278 from https://www.cambridge.org/core. IP address: 170.106.40.40, on 25 Sep 2021 at 21:55:06, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0317167100041299 LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES another of Dr. Botterell's strategies, and that was subspecialization within his own division. Dr. Morley's own research endeavours were in the study of brain tumors, and on the clinical side he achieved particular distinction as a tumor surgeon. His residents remember his Henry Birk's silver teaspoons, with holes drilled through the bowls to both render them unattractive to thieves and to allow their gathering on a large bobby-pin for autoclav- ing. He found these spoons useful for scooping out gliomas and occasionally as retractors. His residents also remember his care­ ful and wise judgment in managing meningiomas, and his flu­ ent, rapid and assured operating technique. Dr. Morley also maintained a constant interest in tic douloureux. While he enjoyed the accuracy, selectivity and reli­ ability of the Frazier operation (which he also thought was good training for cavernous sinus surgery of any sort), he really pre­ ferred more "minimal" operations for tic (either percutaneous or open peripheral rhizotomy).3 In later years he watched, with some concern, the growing popularity of posterior fossa microvascular decompression.4 Morley also made valuable con­ tributions in vascular neurosurgery, including the first definition and characterization of "giant" intracranial aneurysms,5 and along with Hugenholtz a detailed analysis of the results of a once popular and still occasionally justifiable treatment for anterior communicating artery aneurysms: proximal anterior cerebral artery occlusion.6 Another important report pointed out the possibility of post-traumatic dural fistulae and cerebrospinal fluid leakage from lateral extensions of the sphenoid sinus.7 Perhaps Morley's most outstanding contribution to the neuro­ surgical literature was his book Current Controversies in Neurosurgery, published 1976.8 In this book concise chapters Figure 1. Dr. Thomas P. Morley, Toronto (Summer of 1992). on a large number of evolving neurosurgical subjects, written by experts in their respective fields, are woven together and enhanced by brief, articulate and penetrating commentaries by One of Morley's achievements as Chairman of Neurosurgery the editor. Morley has also written on professional and historical in Toronto was expanding the training program, beginning with aspects of Canadian neurosurgery.910 Dr. Morley's colleagues at the acceptance of additional residents so that two would complete the Toronto General Hospital became preeminent in other areas training the same year. One of his priorities was maintaining the of neurosurgery. high quality of the training program established by his prede­ cessors, and he paid particular attention to the resident selection William M. Lougheed and cerebrovascular surgery at process. Morley avoided a paternalistic attitude towards his Toronto General Hospital trainees and younger colleagues at the University of Toronto. Dr. Bill Lougheed joined the Toronto General Hospital He expected them, as mature individuals, to learn and perform surgical staff in 1956 and opened a cerebrovascular research excellent neurosurgery, pursue a research interest and become laboratory at the Banting Institute." Recognizing the advan­ productive with his assistance and encouragement, but without tages of the microscope in surgery, in the early 1960's he began structured interference or enforcement. His guiding principle, in a series of experiments in microvascular reconstruction.12"14 The his own words, was that if you "picked a man, the right man, development of a maneuverable, double-headed surgical diplo- you should leave him alone, not breathe down his neck, and let scope enable Lougheed to become one of the world's first, and him get on with his job and develop in the way he himself felt Canada's first, microneurosurgeon. fruitful." In 1969 Lougheed and neuroanesthetist Brian Marshall Like Drs. McKenzie and Botterell before him, Morley sup­ reported a series of 40 patients with ruptured aneurysms ported the creation and strengthening of neurosurgical divisions repaired with the operating diploscope and Lougheed-Kerr at other major Toronto hospitals.