Wilder Penfield and the Rise of Modern Neurosurgery

Published April 28, 2011 · Estimated reading time: 18 minutes · Share your thoughts
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“Neurologists should push their investigation into the neurologic mechanism associated with consciousness and should inquire closely into the localization of that mechanism without apology… To make such an inquiry is to ask a very old question, as is shown by the following quotation from the Book of Job:

Surely there is a vein for the silver
And a place for the gold where they find it

But where shall the wisdom be found?
And where is place of understanding?”

– Wilder Penfield (1938)[1]

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A Framework for Brain Surgery
Wilder Penfield and the Rise of Modern Neurosurgery

By Marzieh Ghiasi (Apr 2010)

O

n July 29th, 1935, 667 neurologists and neurosurgeons from forty-two countries gathered in University College in London, England for the second International Neurological Congress. The conference, which lasted for five days, featured some 300 manuscripts[2]. One of these papers, entitled Epilepsy and Surgical Therapy, was printed by the neurosurgeon Wilder Penfield from Canada. Penfield was keenly interested in developing a functional map of the human brain in order to better understand and provide treatment options for various brain disorders. Throughout his career, he built a reputation for developing new investigative and curative neurosurgical procedures.

Penfield’s thirty-five page manuscript, hereafter known as the 1936 paper as it was published several months after the conference, can be divided in two parts. In the first seven pages of the work, Penfield lays out a map of the brain, setting the ground and criteria by which epileptic foci, aberrations in the brain leading to seizures, can be localized and studied. In the second twenty-eight pages of the paper, he describes different categories of epilepsies based on their phenomenology and etiology, and proposes neurosurgical treatment where possible.

I contend that Penfield’s purpose in this paper is to (1) build on and synthesizing the traditional body of the field, (2) use the scientific method to collect and interpret data, (3) introduce a curative innovation to the field and (4) establish a cultural and practical framework within which neurosurgeons of the future can operate. He organizes arguments in the paper based on hypothesizing, scientific observation, experimentation, and deductive reasoning. These aspects of the paper would have made it particularly compelling to the audience in the International Neurological Congress and particularly important in context of the history of neurosurgery.

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