Brain Surgery

McGill University has always aspired to foster healthcare complexes second to none in North America. It was not surprising in the late 1920s that McGill should reach south to hire Wilder Penfield, a very promising young American brain surgeon, in the hope that he would make McGill and Montreal a leader in one of medicine’s most remarkable new subspecialties.

The plan worked spectacularly. In the early 1930s, Penfield was able to secure major support from the Rockefeller Foundation to establish the Montreal Neurological Institute, a stand-alone facility aimed at becoming a global centre of neurological research and neurosurgical excellence. The MNI opened in 1934, almost instantly fulfilled its promise (Rockefeller administrators considered it one of the best projects they ever funded) and continues to flourish today in our vastly more populated and fast-moving medical world.

Penfield, who became legendary in his lifetime, retired as director of the MNI in 1959. Its third director, William Feindel, who served from 1972 to 1984, decided as a retirement project to write the history of the institute from its beginnings through to his tenure. He made slow progress on the project, but after his death in 2014, the work was taken up and speedily completed by another “Neuro” veteran, Richard Leblanc. Thus we now have a hefty new history of the first half-century of the MNI, The Wounded Brain Healed: The Golden Age of the Montreal Neurological Institute, 1934–1984, by Feindel and (mostly) Leblanc. The book is long, detailed, lavishly illustrated and documented, and will no doubt find its way to the desks of all MNI staff and alumni and perhaps many others in the global neuroscience community.

I wish I could write that the book will also appeal to the general or lay reader, but that will not -happen. The Wounded Brain Healed is an insider’s history, conceived and written by and for professional insiders. The authors have little sense of how to present an institutional history, how to explain technical work or how to reach out to a wider readership. Their chapters are mostly dreary and uncritical summaries of the qualifications, research achievements and later careers of all the scientists who worked at the MNI during its first half-century. Everyone is given credit, including each year’s distinguished visiting lecturers. We learn quite a bit about the nursing support staff, the original building’s architecture, the fate of its squash court and Dr. Feindel’s contributions to neurosurgery in Saskatchewan. We do not come away from the book with any real understanding of the place of this institution’s early years in the history of Canadian, North American or global medicine. Pity.

Or perhaps promising, at least in the sense that with the publication of this official history, the records of the MNI and its builders are now fully available for study by historians of medicine and science, biographers and other medical writers. Scholars are already at work on the mass of Penfield material in McGill’s Osler Library, and we can be very confident that they will have rich and fascinating and important stories to tell in future books and articles.

From existing books—Penfield wrote a revealing autobiography, No Man Alone: A Neurosurgeon’s Life, and one of his grandchildren, Jefferson Lewis, in 1981 published an excellent, even more revealing biography of the patriarch, Something Hidden—we already have a fairly good understanding of some of the depths of Wilder Penfield’s very complex personality, some of the conflicts and issues in the MNI’s early years (Penfield’s subordinate partner, neurosurgeon William Cone, resolved the difficult question of his future at the institute by committing suicide in 1959), and hints at questions future writers will address.

Before Penfield’s era, pioneering neurosurgeons, led by Harvey Cushing in Baltimore and Boston, had concentrated on developing techniques to go into the brain primarily to search for and, if possible, remove tumours. Relations between ambitious surgeons and cautious neurologists were often strained or ruptured. Penfield’s single greatest achievement was to conceive of the MNI as a home for all the neurosciences and all the varieties of neurosurgery, a centre for research that would move from bench to bedside and back again, a place that would offer first-class training to everyone who wanted to specialize in brain work. Despite its limitations, The Wounded Brain Healed does convey a sense of the MNI as a vital way station for generations of talented fellows who went on to staff hospitals and other institutes around the world.

Did they actually heal the wounded brain? The evidence is not yet in, not least because neuro-surgeons, like surgeons generally, used to skimp on doing serious studies of their results. Sometimes brain surgery worked; many times it did not. We do not know how effective tumour surgery was at the MNI. One early study found that Penfield’s success at surgically treating epilepsy was not much better than 50 percent, with some of the successes stemming from a bizarre placebo effect of exploratory procedures alone.

Still, the suffering of afflicted patients interacted with surgeons’ ambitions to cause them to become ever more forward in attempting to treat brain illness. The epilepsy work was Penfield’s most publicized forte. It started with attacks on scar tissue on the surface of the brain and developed into attempts to remove entire portions of brain tissue that seemed to generate seizures.

We do not know whether prefrontal lobotomies, the popular but terribly mutilating procedure to treat mental illness, were ever done at the MNI. Perhaps Penfield never went that far. But we do know that some of Penfield’s epilepsy patients had their memories badly damaged through surgery, so much so that in the early 1950s he brought in a young neuro-psychologist, Brenda Milner, to study these patients’ conditions. Ironically, Milner’s work on the implications of surgically caused memory impairment became arguably the MNI’s single greatest contribution to the development of neuroscience, much more significant, for example, than Penfield’s own over-hyped search for the creative centre of human consciousness. As I write this review in 2016, 98-year-old Brenda Milner is still teaching at McGill, one of Canada’s half-dozen greatest living scientists.

Those who come along to tell her story, and the stories of Penfield, Cone, Feindel and the other builders of the MNI, will find Healing the Wounded Brain helpful as a reference work, a useful building block in the making of better books.

Postscript: I should disclose that after I published my 2005 biography of Harvey Cushing, I had hoped to tell some of the Penfield-related stories myself, but was frustrated for many years by Dr. Feindel’s insistence that the full Wilder Penfield collection, which he controlled as Penfield’s literary executor, would only be opened for research when he published his book. He outlasted my intellectual stamina, a cautionary tale. Now there are no more barriers to the advance of good and serious writing by younger historians.