Penfield - A Great Explorer of Psyche-Soma-neuroscience.

“I am an explorer, but unlike my predecessors who used compasses and canoes to discover unknown lands, I used a scalpel and a small electrode to explore and map the human brain. Throughout my career, I was driven by the central question that has obsessed both scientists and philosophers for hundreds of years. Are mind and body one? Can the mind - thinking, reasoning, imagination — be explained by the functions of the brain? As a doctor, my first concern was always for my patients — to relieve the terrible suffering caused by diseases such as epilepsy. I found that by stimulating the exposed brain of a conscious patient with a small electrical current, the patient could tell me what they were feeling or seeing, and through this we could isolate the damaged part of the brain. I developed treatments for epilepsy based on this knowledge. But the procedure also opened a window to the mind, giving us for the first time a glimpse of how dreaming occurs, how memory works, and where speech and speech comprehension reside.” WILDER GRAVES PENFIELD Wilder Graves Penfield was born in Spokane (Washington) on January 26th, 1891. He reflected toward the end of his productive life that “the only certain virtue” that came into the world with him at his birth was “tenacity of purpose‘!’ Having grown up in an unstable family, both financially and emotionally, his childhood was eventful. At the end of his sophomore year, an enthusiasm engendered by Professor Conklin's biology lectures led him to decide on a career in medicine. He was accepted for admission to Merton College at Oxford, where he completed a bachelor's degree in sciences and, in 1920, a master's degree. At Oxford, he was influenced by Sir William Osler and Sir Charles Sherrington.[1] Sherrington was noted for his experiments establishing modern understanding of integrated nervous functions. He made Penfield realize that “the nervous system was the great unexplored field – the undiscovered country in which the mystery of the mind of man might someday be explained‘!’ Still, many expressed doubts about this simplistic way of trying to understand the human mind! In January 1915, he enrolled in courses that would assist in his completion of a medical degree at Johns Hopkins University. He was assisted in arranging this by Sir William Osler, Canadian-born Regius Professor of Medicine. In late 1917, he returned to the United States. Penfield completed his medical studies at Johns Hopkins and received his medical degree in 1918.The following year, he was surgical intern at the Peter Bent Brigham Hospital in Boston, serving as both apprentice and later assistant to Harvey Cushing, one of the most gifted brain surgeons in the United States.[1] The memory of the “undiscovered country” he had glimpsed through Sherrington's lectures continued to intrigue him. He accordingly returned to Oxford for the third and final year of his Rhodes Scholarship as a graduate student in neurophysiology under Sherrington and following that with a year as a research fellow in clinical neurology and neurosurgery at the National Hospital at Queen Square in London. While in England, he developed a special interest in Epilepsy. Penfield returned to the United States. In 1921, he rejected a lucrative position as a surgeon at the Henry Ford Hospital in Detroit – because it would have afforded him no opportunity for research – and accepted instead a post as associate surgeon at Columbia University and Presbyterian Hospital, affiliated with Columbia, and to the New York Neurological Institute. Through his work there, his interest in epilepsy was deepened. In his effort to advance his knowledge and ability in his areas of specialization, Penfield studied first hand the methods used by specialists in Spain, Germany and elsewhere. There, he developed his surgical techniques under Allen O. Whipple, and organized and pursued research in a laboratory of neurocytology. His research in 1924 with the Madrid neuro-histologist Pio del Rio-Hortega provided him with metallic staining techniques that yielded new information on the glia”.[2] In 1928, he learned from the German surgeon Otfrid Foerster, the method of excising brain scars to relieve focal epilepsy. During his postgraduate years in Oxford and in London, Penfield had turned from experimental neurophysiology toward neurosurgery because he believed that, since the neurosurgeon could lay bare the living human brain, he should be able to study and influence the brain's physiological activity. As he came to realize that he could not carry out an effective approach to knowledge of the brain and make use of that knowledge all by himself , he began to dream of organizing an institute where neurologists, neurosurgeons, and neuropathologists would work together in a team. He thought he might be better able to realize this dream in Montreal. He joined the medical faculty of McGill University in 1928 and became, at the same time, neurosurgeon at the Royal Victoria and Montreal General Hospitals. Penfield's fascination with the brain led to research into tumours, brain scars and the various forms of epilepsy and he was much in demand as a surgeon. After a first rejected application, in 1934, the Rockefeller Foundation joined with the Province of Quebec, the City of Montreal, and private donors to help implement Penfield and Cone's Montreal Neurological Institute. The Institute gradually emerged as a centre of outstanding research, teaching and treatment. Like Osler, Penfield worked with great skill as he constantly sought to find new means to cure epilepsy and related dysfunctions. Penfield led the commitment, dedication, and hard work of the institute. He was its director during 25 years, until 1927. In drawing together the disciplines of neurosurgery, neuropathology, neurology and related basic sciences, Penfield transformed the study of the brain. He believed that the problem of neurology is to understand man himself. He made important gains in the study and treatment of the brain. In particular, he investigated the surgical treatment of epilepsy-especially focal epilepsy-then considered to be an incurable disease. While he was developing a surgical approach to the treatment of epilepsy, Penfield began to map the brain and determine which functions of the body were controlled by which brain segment. He located the accumulated store of memory of past events and the emotions, sensations, and thoughts to which the events had given rise. Penfield developed a new surgical approach that became known as the “Montreal Procedure”. He developed his method while his patients were awake and able to interact with him. Using local anesthetics, he removed the skull cap to expose the brain tissue of the conscious patient. When he probed certain areas of the brain, the patients would be able to provide him feedback on what they were experiencing at that very moment.[34] 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 in their treatise on the Anatomy and Physiology of the Nervous System. In most cases, he identified the precise location of the source of the seizure activity. He could then remove or destroy that bit of tissue to end the patient's seizures. His surgical studies yielded reports on brain tumours, the pial circulation, the mechanisms of headache, the localization of motor, sensory and speech functions, and the role of the hippocampus in memory. Penfield's primary concern was that his patients avoid unpleasant secondary effects such as memory loss or language disorders which frequently followed the removal of the brain tissues causing the epileptic seizures. Among his many discoveries was that he could summon a patient's past experiences by mildly shocking the temporal lobes and stimulating memory.[4] As he carefully probed the brain, he found that administration of a mild electric shock to one of the temporal lobes could cause the patient to recall precise personal experiences that had long been forgotten. He also discovered that stimulating parts of the cortex could evoke vivid and specific memories including sounds and smells. Epilepsy arising in the temporal lobe of the brain assumed special importance because of the re-excitation of past experiences that occurred when the cortex was stimulated during surgery. It was an area that Penfield was passionate about, discovering and unlocking the hidden treasures in the human mind. Furthermore, Penfield completed his mapping of the brain. He discovered the sources of memory and dreams. Some of the modern theories of the separate functions of the two cerebral hemispheres were built upon his findings. His concept of centrencephalic seizures arising from deep midline portions of the brain had an important impact on the understanding of the relationship between the brain's structures and consciousness. In treating 1,132 patients during Penfield's directorship, the Institute improved the techniques of brain surgery and added materially to neurological knowledge. Research at the Montreal Neurological Institute has led to improved surgical and nursing techniques for the management of spinal lesions, to the development of electroencephalography to treat conditions such as epilepsy, and to a deeper understanding of cognitive and other behavioral changes associated with brain lesions.[56] Non-invasive imaging techniques, such as computerized axial tomography and positron emission tomography, in conjunct ion with a new understanding of neurotransmitters, help researchers understand the way the various parts of the brain and nervous system grow, develop, take on specific tasks, and repair and replenish themselves. Penfield was widely known for promoting early second-language training. In 1959, Penfield observed that complete recovery of language ability after brain damage was possible in children but not in adults. For Penfield, there is a limited age — 10 years — beyond which acquiring a second language becomes very difficult. After 10, the brain gradually hardens. He advocated that “the child who hears a second language very early has a great advantage in many aspects of education and life’”.” Penfield's writings on the relationship between science and religion reflected his insight as a renowned scientist and dedicated humanist. Emulating Osler in The Second Career and Second Thoughts, he reflects on the need for “eternal vigilance and resolute action” in a changing world. His many scientific writings — among them The Cerebral Cortex of Man, co-authored with Theodore Rasmussen, were accepted as definitive statements in their field. He retired from the McGill medical faculty in l954.That same year, he co-authored with Herbert Jasper Epilepsy and the Functional Anatomy of the Brain. He visited Princeton in 1956 to deliver the Vanuxem Lectures, later published and co-authored by Wilder Penfield and Lamar Roberts, as Speech and Brain-Mechanisms. In 1974, he completed The Mystery of the Mind, an account for laymen on brain research.[7] There, he set out his views on the relationship between the human brain and the human mind. Three weeks before his death, Penfield completed the draft of his autobiography, No Man Alone, a phrase repeated frequently in the book to underline his emphasis on the team approach to neurological research and treatment.[8] Published posthumously in 1977, this final work covers the period from 1891 to 1934. In 1981, Jefferson Lewis wrote Something Hidden. A Biography of Wilder Penfield. He died in Montreal (Quebec) on April 5th, 1976.