The hardest cut: Penfield and the fight for his sister

In 1935, world renowned neurosurgeon Wilder Penfield published three remarkable case studies describing the psychological effects of frontal lobe surgery.

They remain a fascinating insight into the link between brain and behaviour, but one case was unlike anything Penfield had tackled before.

It described the fight to save the life of his only sister.

 

Penfield’s sister, Ruth, had been experiencing splitting headaches since the age of fourteen. Suddenly, at the age of twenty, she experienced a Jacksonian seizure – a fleeting but distinctive type of neurological disturbance that can cause an almost eerie succession of involuntary movements.

Ruth’s cortex was mercifully quiet for the next eight years, until she unexpectedly suffered a succession of seizures, in a pattern which would become increasingly common as she reached her early 40s.

By that time it became clear that she was suffering from a type of glioma, a particularly dangerous form of brain tumour caused by a cancer of the glial cells, the essential building blocks that support the very structure of the brain itself.

Penfield undoubtedly knew that her life was in grave danger. He had spent his adult life travelling the world training as a brain surgeon and had worked with some of the finest neuroscientists of his time.

He stepped in to undertake the operation himself and opted to remove almost the entire right frontal lobe, a radical form of brain surgery that had barely been tried before.

Then, as now, the majority of these operations are done while the patient is awake, so the surgeon can check that they’re not unnecessarily removing any areas needed for speech, memory or other essential functions.

We can only imagine what was running through the mind of brother and sister as one began the attempt to save the other’s life by moving surgically through the brain.

Throughout his professional life, Penfield often considered what the brain could tell us about the possible existence of the soul, and it would be hard not to speculate on whether this profound experience had any bearing on his quest.

If he was troubled by these existential issues at the time, he remained outwardly cool. The operation was a success.

Penfield’s sister did worry during the operation, but not, seemingly, about her life. Penfield’s colleague, Colin Russel had sat by Ruth throughout the operation, and afterwards noted that her main anxiety was a sisterly concern about embarrassing her younger brother at work.

Russel, neuroscientist to the last, noted “She said that she had felt so afraid of causing you distress by making an exhibition of herself… When I remarked that the only exhibition I had seen was one of the best exhibitions of courage that it had been my fortune to witness, she expressed her gratitude so nicely that one could not help wondering how much of the frontal lobe had to do with higher association processes”.

Ruth recovered and returned to work as a valued wife and mother of six children. She found planning and organisation difficult, something that we would now call dysexecutive syndrome, but lost none of her eloquence and good humour.

Quite suddenly, after two years, her symptoms returned. The tumour had regrown and was successfully removed, this time by Penfield’s mentor, Harvey Cushing, but this last-ditch attempt only bought her a few final months and, sadly, she died shortly after.

Nevertheless, her brother’s operation had gained her two more valuable years with her family, but it was not enough to save her.

The experience had a profound impact on Penfield, who was inspired to found the Montreal Institute of Neurology, then, as now, one of the world’s leading centres for brain treatment and research.

Penfield obviously struggled with the decision to publish a clinical case study on his sister’s treatment, but eventually included it with two other cases in a 1935 article for the journal Brain, writing that “if she were alive, I am sure she would approve of such an analysis in the hope it would help others”.

As an academic case study, it is almost unique, as it weaves the medical language of neurology with fragments of memories and heart-felt tributes.

As a historical document, we learn as much about Ruth Wilder as neurosurgery itself. As a piece of science, it remains a skilful description of a rarely performed operation and an insightful commentary on the link between the frontal lobes and psychological function.

Penfield became one of the most important neurosurgeons of his generation, advancing a type of medicine only just finding its feet while making some of the most significant advances in neuropsychology – the science of linking mind to brain.

Throughout his career, family was never far from his mind, and after his retirement, and shortly before his own death, Penfield wrote Man and His Family, stressing the need to nurture and encourage positive family life.

It’s fitting that his legacy is not only a contribution to scientific knowledge, but also a hospital and institute that allows neuroscience to be applied where it is most needed – helping individuals affected by brain disorder. Truly, Penfield’s speciality.

Link to more about Wilder Penfield.
Link to Penfield’s Brain paper, sadly not open-access.