Arpan K. Banerjee
Stroke, in spite of its serious and widespread impact, had long received little interest from physicians. C. Miller Fisher, one of the twentieth century’s outstanding neurologists and researchers, revolutionized the management of stroke. In this well-researched and readable biography, Louis Caplan, a distinguished Harvard neurologist and former trainee of Miller Fisher, chronicles the extraordinary life of this father of modern stroke medicine.
Miller Fisher was born in Canada and attended the Toronto Medical School. During the Second World War he served time in a German prisoner-of-war camp and there honed his literary skills by reading literature, including the works of Shakespeare and Dickens, and was particularly fond of his dictionary. On returning to civilian medical life, this experience enabled him to write elegant prose and make careful observations, which were trademarks of his many publications.
Wilder Penfield, the famous Canadian neurosurgeon, suggested he study neurology in Boston, where the two giants of Boston neurology, Denny Brown and Raymond Adams, worked. In 1949 Miller Fisher went to Boston to study neuropathology before returning to Montreal as a neurologist. In 1954 he moved to the Massachusetts General Hospital where he remained for almost fifty years. He wrote many papers, was a meticulous collector of cases, and took time to study the pathology of his patients’ diseases. In 1956 he published a paper in the New England Journal of Medicine that described a syndrome of ataxia, areflexia, and ophthalmoplegia that is now eponymously attributed to him.
At the Massachusetts General Hospital he set up a neuropathology laboratory and started to research cerebrovascular disease and stroke. He meticulously studied pathological sections of the brain of such patients and developed training in stroke medicine by appointing fellows. There was little brain imaging available in those days and the stroke fellows or neurosurgeons were responsible for performing cerebral angiograms using the direct puncture technique. As radiology techniques such as CT and MRI scanning developed in the 1970s and ‘80s, he embraced and studied them, although he was officially retired by the late seventies. He attended the hospital for twenty years after his retirement, continued his research, and was always ready to advise fellows on difficult cases.
Miller Fisher was totally dedicated to neurology, often staying in hospital until late in the evenings. His knowledge was always up-to-date through his voracious reading of the literature, to which he himself made prolific contributions. He even wrote a memoir.
In this scholarly biography, Caplan has not only chronicled Miller Fisher’s life, but has also described his extraordinary contributions to neurology, especially to cerebrovascular disease. The extensive references and images all serve to illustrate the history of stroke medicine in the second half of the twentieth century, making it an interesting and inspiring read.
C. Miller Fisher: Stroke in the 20th Century
Louis R Caplan
OUP 2020, 264 pages
ARPAN K. BANERJEE, MBBS (LOND), FRCP, FRCR, FBIR, qualified in medicine at St. Thomas’s Hospital Medical School, London. He was a consultant radiologist in Birmingham from 1995-2019. He served on the scientific committee of the Royal College of Radiologists 2012-2016. He was Chairman of the British Society for the History of Radiology from 2012-2017. He is Treasurer of ISHRAD and adviser to radiopaedia. He is the author/co author of numerous papers and articles on a variety of clinical medical, radiological, and medical historical topics and seven books including Classic Papers in Modern Diagnostic Radiology 2005 and “The History of Radiology” OUP 2013.