Montreal, Canada (Winter 2015)
|The Montreal Neurological Institute|
The time was 1928 and the patient was a forty-three year old mother of six. After nearly thirty years of headaches and seizures, she had started to have problems with her right eye. A young neurosurgeon examined her and found evidence of a right frontal-lobe tumor, which had to be removed right away. The operation he went on to perform not only spared her vision, but added a few years to her life.
That young neurosurgeon was Dr. Wilder Penfield (1891–1976), and the patient was his older sister, Ruth. Despite having all the best care available at the time, she died three years later, in 1931. Penfield was devastated. There was, however, a fortuitous outcome from his personal loss and sense of professional failure. As he relates in his autobiography, No Man Alone, he found inspiration in the depths of his grief. “The resentment I felt because of my inability to save my sister spurred me on to make my first bid for an endowed neurological institute.”1 It was as if he wanted assurance that his sister’s tragic death would not be in vain.
Penfield quickly gathered funds from various donors; the Rockefeller Foundation put up approximately half the amount needed. The Montreal Neurological Institute and Hospital was built in 1934, fulfilling Penfield’s dream of bringing research into close association with patient care. The Montreal Neurological Hospital, part of the Neurological Institute, aka The Neuro, perches on a flank of the city’s iconic Mount Royal, and looks over the downtown campus of McGill University. Across the street lies the venerable Royal Victoria Hospital (RVH), with which The Neuro was intimately affiliated in its early years. Until 1963, when The Neuro became an independent institution, the two hospitals worked together to provide care for thousands of patients and accommodate many students from McGill’s Faculty of Medicine.
On the side of the original building, facing the mountain, there was a plaque: “Dedicated to the relief of sickness and pain and to the study of neurology.” During his nearly 30-year service at The Neuro, Penfield put Montreal on the map for several pioneering surgical techniques. The most famous was the Montreal Procedure for the treatment of epilepsy. Along with Herbert Jasper (1906-1999), who pioneered the EEG before coming to The Neuro in 1938,2 Penfield was able to locate a patient’s seizure site with precision and perform his delicate surgery.
The study of neuroanatomy took another leap forward with Penfield’s exploration of the frontal lobe around the central sulcus. He worked on patients who remained awake and able to speak while their exposed brains were lightly stimulated by electrodes. Penfield and his colleagues were able to report which functions correlated with each touch, thereby creating a map of motor and sensory functions (along pre- and post-central gyruses, respectively).3 The results were sketched as a distorted human figure (disproportionately large hands and thumbs, for example, reflecting their importance relative to the whole body) dubbed the “homunculus.”
Until he stepped down in 1960 and took up full-time book writing, Penfield became a valuable mentor to a new generation of fine scientists, a list of whom could belong in any Neuroscience Hall of Fame. Under subsequent directors, The Neuro has upheld the culture of cooperation and dedication he instilled. It accrues accolades for its high standards of care. From all over the globe, the best and brightest flock there to study and train. Many stay on as part of the staff. Thanks to this concentration of talent, the hospital has become one of the world’s preeminent places to treat brain cancers, head injuries, chronic pain, genetic diseases of the central nervous system, strokes, neuromuscular disorders, psychiatric disorders, and neurological consequences of aging, such as Alzheimer’s. Accommodating these specific concerns are the hospital’s many specialized clinics, among them: Migraine, Speech Pathology, Cognitive Neuroscience, Imaging, MS, and, of course, Neurosurgery. The Neuro-oncology clinic is now the province of Quebec’s only adult center for cancers of the nervous system to attain the highest accreditation, Level-4. The Multiple Sclerosis Clinic is the oldest in all of Canada.4
The Neuro celebrated its 80th anniversary in 2014. Recent expansion has allowed better housing of research units and more machinery for peering into the brain. The McConnell Brain Imaging Centre, for example, now figures as one of the top three such centers in the world. Over the course of the next few years, The Neuro’s current Director, Dr. Guy Rouleau, plans to ease the transition to an entirely new, much larger and integrated, facility—the McGill University Health Complex (MUHC)—across town. (The RVH moves there in April, 2015.)
What the next 20, let alone 80, years will bring for The Neuro, no one can say with absolute certainty—but undoubtedly they will continue to honor the goals proclaimed on the founder’s original plaque.
- Penfield, W., No Man Alone, Little, Brown & Co., 1977, p. 221
- Loring, David W., “History of Neuropsychology Through Epilepsy Eyes” in Archives of Clinical Neuropsychology, June 2010; 25(4): 259–273.
- Mitchell, G.A.G., Major, D. The Essentials of Neuroanatomy, 3rd Ed., Churchill Livingstone 1978, pp. 58–61
LOUISE FABIANI, B.Sc. Biology (McGill) and M.E.S. (York), is a Montreal science writer. From 2010 to 2012 she produced a series of podcasts based on interviews with Neuro staff, including the late director (2002–2011), Dr. David Colman. In addition to work that reflects her lifelong fascination with the human brain, she has published articles and essays about public health, ecology, and literature. She is also the author of The Green Alembic (Signal Editions, Montreal), a book of mostly science-oriented poetry.
Dr. William Feindel, who trained under Wilder Penfield, also contributed to the development of the Montreal Neurological Institute. He was the founder and first director of the McConnell Brain Imaging Center. During his tenure as director of the Neuro, Feindel initiated use of CAT, MRI and PET as diagnostic tools and was the first to do so in Canada and one of the first in North America. He was also extremely involved in the team that developed of the “Montreal procedure” for epilepsy. His book, written with Richard Leblanc, The Wounded Brain Healed The Golden Age of the Montreal Neurological Institute, 1934-1984 will be released January 2016 by McGill-Queen’s University Press.