Cerebral Story

In its day, the Montreal Neurological Institute was the institute for the diagnosis, treatment, and study of the brain, and today, ninety-one years after it was founded, it remains among the leading neurological institutes on the planet. The success of the Neuro, as it is known on the McGill University campus, is usually attributed to one man: Wilder Penfield. The charismatic neurosurgeon had every attribute required to head a world-class medical centre: he was a brilliant researcher, groundbreaking doctor, and formidable fundraiser. His iconic status was confirmed fifteen years after his death, in a 1991 “Heritage Minute” with a catchphrase now enshrined in popular culture. He was depicted in an operating theatre, performing brain surgery on a woman who suddenly gasps, “I can smell burnt toast.”

In The Mind Mappers, Eric Andrew-Gee tells a compelling story about how the Neuro came into being and why Penfield is so revered. But this is no hagiography, because Andrew-Gee, a reporter with the Globe and Mail, has not made Penfield the hero of his book. Instead he focuses on William Cone, the stocky, shy, and brilliant pioneer of neurosurgery whose skills and devotion to Penfield made the latter’s success possible.

Both Penfield and Cone were Americans from families with strong medical traditions. Born in rural Iowa in 1897, Cone exhibited an obsession with the brain while still a medical student at the University of Iowa. He went on to the prestigious Presbyterian Hospital in New York City to train in general surgery. There he met another Midwesterner with an interest in the brain and big ambitions. Six years older than Cone, Penfield was already a more accomplished and polished figure; a Princeton graduate from Wisconsin, he had developed an interest in neurology while a Rhodes Scholar at Oxford, where he had met such medical titans as Sir William Osler and Charles Sherrington. Now he was the first neurosurgeon ever on staff at the Presbyterian Hospital.

At this stage, little was known about the three-pound organ in our heads; the brain was uncharted territory, and crude attempts to remove tumours were terrifying for both physicians and patients. The first two patients on whom Penfield attempted surgery died on the operating table. But together, Penfield and Cone painstakingly advanced neuropathological knowledge. Penfield was the intellectual, synthesizing breakthroughs that were often made elsewhere. Cone was the technician, substantiating in the laboratory the physiology of Penfield’s concepts. He was also a better surgeon than his boss, working methodically, insisting on rigorous standards of hygiene, and eschewing risk.

Over the next four years, the two men developed a partnership that made them the rising stars of neurosurgery. In 1927, Penfield was offered the job of chief brain surgeon at Montreal’s prestigious Royal Victoria Hospital. He recognized his chance to be more than a great surgeon, but he stipulated two conditions. The first was that the hospital would provide him with research as well as surgical facilities. The second was that Cone, his “undivorceable colleague,” as he called him, would come too. When news of Penfield’s impending appointment got out, both the Presbyterian Hospital and the University of Chicago rushed to make generous job offers to Cone. To Penfield’s relief, Cone turned his back on the chance to be a star in his own right and agreed (at considerable financial cost) to join Penfield in Canada. As Andrew-Gee puts it, “The master had his apprentice.” Cone’s starting salary would be $4,000; Penfield’s would be $10,000.

The bond between the two men went way beyond professional camaraderie. During their early years in Montreal, their mutual dependence bred a close friendship — too close, perhaps, for the comfort of Penfield’s wife, Helen. “Will you want Bill here when you are planning to take your vacation in August,” she once asked her husband. “He cannot keep far from you, can he?” The Penfields enjoyed a rich home life, and Cone was always available to them. On one dramatic occasion, when the family was staying in a remote winter cabin and Helen developed a mysterious fever, Cone arrived by ski-plane and floundered through hip-deep snow to take blood cultures that he could study back in the city. Meanwhile, Cone’s childless marriage to Avis Wood was strained by his workaholic devotion to his patients, the pathology laboratory, and Penfield.

The Penfield-Cone partnership was immensely fruitful. Cone’s reputation as a gifted and compassionate surgeon for any kind of injury to the head, and later to the spine, attracted patients from across the continent, while Penfield’s inquiries into the structures of the brain, particularly the frontal lobe functions, yielded powerful insights into what Andrew-Gee terms “the cartography of our grey matter.” One of Penfield’s most significant surgical interventions, conducted with Cone at his side, was on his sister, Ruth Inglis, who had suffered seizures since childhood. Back then, in 1928, the surgery could not be considered a success, though Inglis lived on for more than two years. But in time, Penfield refined the knowledge he had gained from that operation into a technique known as the Montreal procedure for treating intractable epilepsy, which became the global gold standard. By 2010, 5,000 patients had undergone this treatment at the Neuro, and three out of four were cured without intellectual impairment.

Penfield was known as the Chief, while Cone was the Boss; few failed to notice that the former handed off most of the surgery to the latter. Yet Cone did not complain about the heavy workload and (to Penfield’s immense relief) refused to consider other well-paying job offers from top American hospitals. “What Penfield seems not to have realized,” suggests Andrew-Gee, “was that his friendship, rather than his professional assistance, was the most important reason for Cone to stay.” In fact, Penfield was preoccupied with another ambition for which Cone’s collaboration was essential.

In 1932, the Rockefeller Foundation agreed to give McGill University $1.2 million to finance an independent institute for Penfield that would bring together the three subdisciplines of neurology, neurosurgery, and neuropathology. But Cone’s loyalty to Penfield meant that independence, for him, couldn’t happen: “A tall, suave shadow would always loom over his own accomplishments.”

The grandiose Gothic Revival building that housed the new Montreal Neurological Institute officially opened its doors in 1934 with great ceremony. For the next quarter century, the two men would “build something together in Montreal that would make people crane their necks and watch,” Andrew-Gee writes. Cone, who preferred the silence of a laboratory to the limelight, was happy to watch Penfield be the Neuro’s public face. Within the Neuro, it was Cone who cultivated team spirit among the staff.

But cracks appeared in the partnership, especially after Cone temporarily left Montreal in 1940 to head a front-line neurological hospital in Britain. His success changed the balance of power between the two men. When he returned to the Neuro as second-in-command, he found it in chaos, short of supplies and overwhelmed by patients. He finally (and successfully) confronted Penfield about the inequity in their earnings; by the 1950s, Cone was handling an annual average of 650 patients while Penfield’s surgical caseload was 100. While the Neuro continued to go from strength to strength — Penfield’s exploration of the brain’s temporal lobes led to extraordinary breakthroughs — the two men drifted apart, causing divided loyalties among surgical residents and depression in Cone, who was clearly overworked.

The break came in the late ’50s, when Penfield contemplated retirement and, without consulting Cone, looked around for a successor. Cone was devastated that his friend had not told him of his plans — and had not recommended him as his successor. He exploded with rage and hurt in a way, Andrew-Gee suggests, that is hard to account for “unless, perhaps, we accept that Cone felt something more than friendship for Penfield.” It seems unlikely that Penfield understood his friend’s emotions and probable that, if Cone was a closeted gay man, he suppressed his sexuality, given the homophobia of that era. Andrew-Gee never found any conclusive proof that Cone’s feelings for the Chief went beyond comradeship. But William Cone’s story ended abruptly. He swallowed poison in his office in May 1959.

Canada has produced several notable historians of medical science and practitioners, the greatest of whom is undoubtedly Michael Bliss, the late University of Toronto professor who wrote about Frederick Banting, William Osler, and Harvey Cushing. These books unravelled the complexities of medical and surgical advances through the biographies of individual pioneers. Like Bliss, Andrew-Gee tells a great story and makes complex physiological concepts both accessible and exciting. However, The Mind Mappers is a twenty-first-century biography, focused on a relationship rather than a heroic individual. Although the Wilder Penfield papers in McGill University’s archives are extensive and no authoritative biography has yet been written of him, Andrew-Gee chose not to focus on the founding director of the Montreal Neurological Institute. Instead, he explored the role of Cone, who left little on paper. I suspect that only in recent years would Andrew-Gee’s guesswork on the complexity of the Penfield-Cone bond even have made it into print.

I can imagine that it was a challenge for the author to keep his narrative balanced between the two men and the institution they built together. Speculation about the Cone-Penfield relationship ripples below the larger story of the Neuro’s birth, and although Andrew-Gee admires Penfield, an inspirational leader, his sympathy for the underdog often overshadows the achievements of the senior partner. Could Penfield have built the Montreal Neurological Institute without Cone? Perhaps. Could Cone have created a world-class institution in a strange city by himself? Almost certainly not.

The Mind Mappers is Eric Andrew-Gee’s first book, and it is impressive. He has produced a well researched and lively account of Canada’s premier neurological institute and its founders, while reminding us that the successes of inspirational leaders such as Penfield — and, in their time, Banting, Osler, and Cushing — often depend on their colleagues in the wings. And the feelings of über-loyal colleagues are always intense.