Penfield's pioneering craniotomies in 1928 has grown to include over 2200 operations in nearly 2000 patients, and continues to provide new knowledge about the way the human brain functions in health and disease. References I. PEN FIELD WG: Meningocerebral adhesions. A histological study of the results of cerebral incision and cranioplasty. Surg Gynecol Obseet 39: 803, 1924 2. Idem: Microglie et son rapport avec la d6g6n6ration microgliale dans un gliome. Tray Lab Recherches Biol Univ Ma rid 22: 277, 1924 3. Idem: Oligodendroglia and its relation to classical neuroglia. Brain 47: 430, 1924 4. Idem: Phagocytic activity of microglia in the central nervous system. Proc NY Pathol Soc 25: 71, 1925 5. RfO-HORTEGA P
DEL,
PENFIELD
W:
Cerebral
cicatrix: the reaction of neuroglia and microglia to brain wounds. Bull Johns Hopkins Hosp 41: 278, 1927 6. PENFIELD W, CONE W: Acute swelling of oligodendroglia: a specific type of neuroglia change. Arch Neurol Psychiatry 16: 131, 1926 7. PENFIELD WG: The acute regressive changes of neuroglia (ameboid glia and acute swelling of oligodendroglia). J Psychol Neurol 34: 204, 1926 8. Idem: The mechanism of cicatrical contraction in the brain. Brain 50: 499, 1927
9. FOERSTER 0, PENFIELD W: The structural basis of traumatic epilepsy and results of radical operation. Brain 53: 99, 1930 10. PENFIELD W: The radical treatment of traumatic epilepsy and its rationale. Can Med Assoc J 23: 189, 1930 11. PENFIELD W, GAGE L: Cerebral localization of epileptic manifestations. Arch Neurol Psychiatry 30: 709, 1933 12. PENFIELD W: The evidence for a cerebral vascular mechanism in epilepsy. Ann Intern Med 7: 303, 1933 13. Idem: Las effets des spasmes vasculaires dans l'6pilepsie. Union Med Can 63: 1275, 1934 14. Idem: The circulation of the epileptic brain.
Rex Pubi Assoc Rex Nerv Ment Dis 18: 605,
1938 15. PENFIELD W, BOLDREY E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60: 389, 1937 16. PENFIELD W, RASMUSSEN T: Further studies of the sensory and motor cortex of man. Fed Proc 6: 452, 1947
17. Idem: The Cerebral Cortex of Man, New
York, Macmillan, 1951 18. PENFIELD W, ERIcKsON
Cerebral Localization,
TC:
Epilepsy and
Springfield,
IL, CC
Thomas, 1941 19. JASPER H, PENFIELD W: Electroencephalograms in post-traumatic epilepsy: preoperative and postoperative studies. Am J Psychiatry 11: 365, 1943 20. PENFIELD W, JASPER H: Highest level sei-
zures. Proc Assoc Rex Nerv Ment Dix 26: 252, 1947
21. FEINDEL W, PENFIELD W:
Localization of
discharge in temporal lobe automatism. Arch Neurol Psychiatry 72: 605, 1954
22. PENFIaLD W, JASPER H: Epilepsy and the
Functional Anatomy of the Human Brain, Boston, Little, 1954
23. PENFIELD W: Epilepsy and surgical therapy.
Arch Neurol Psychiatry 36: 449, 1936 24. PENFIELD W, STEELMAN H: The treatment of focal epilepsy by cortical excision. Ann Surg 126: 740, 1947 25. PaNFIELD W, FLANIGAN H: Surgical therapy of temporal lobe seizures. Arch Neurol Psychiatry 64: 491, 1950 26. PENFIELD W, PAINE K: Results of surgical therapy for focal epileptic seizures. Can Med Assoc J 73: 515, 1955 27. PENFIELD W: Pitfalls and success in surgical treatment of epilepsy. Br Med J 1: 669, 1958
28. Idem: Psychical seizures. Br Med 1 2: 639, 1946 29. PENFIELD W, BALDWIN M: Temporal lobe
seizures and the technique of subtotal temporal lobectomy. Ann Surg 136: 625, 1952 30. PENFIELD W: Temporal lobe epilepsy (Hunterian lecture). Br I Surg 41: 337, 1954 31. Idem: The role of the temporal cortex in
certain psychical phenomena. Br Ment Sci 101: 451, 1955
32. EARLE KM, BALDWIN M, PENFIELD W: In-
cisural sclerosis and temporal lobe seizures produced by hippocanipal herniation at birth. Arch Neurol Psychiatry 69: 27, 1953
33. PENFIELD W: Epilepsy, the great teacher: the progress of one pupil. Acta Neurol Scand
43: 1, 1967
Impact on medical neurology FRANCIS L. MCNAUGHTON,* M SC, MD, CM, FRCP[C]
It is difficult in a short space to do justice to Wilder Penfield's many contributions to medical neurology because so many things he achieved have been of significance to neurology and to neurologists everywhere. Throughout his career he was widely regarded as a skilled neurosurgeon, but I would claim him rather as the complete neurologist. True, he had the bold, direct approach to problems and the manual skills that we usually associate with a surgeon, but for him neurosurgery was merely one technical aspect of his work. As Cushing would say, he was a neurologist who did his own operating. Among Penfield's early papers that helped to establish his reputation are those on the cytology of the nervous system, on brain tumour classification and on experimental brain scars. He later published studies on intracranial pain, on the nerve supply of intracranial structures and on surgical methods for the relief of intractable headache. He also became greatly interested in the nervous control of the cerebral circulation and the possible role of *Emeritus professor of neurology, McGill University
vascular spasm in provoking epileptic seizures. This work led to pioneering studies of cerebral circulation, which has become a vast and exciting area of research since those early days. There is no doubt that Penfield's greatest contribution to neurology grew from his years of concentrated research on epilepsy, which began immediately after his arrival in Montreal in 1928 and continued, with scarcely any interruption, for over 40 years. His interest was stimulated from the beginning by the writings of Hughlings Jackson on epilepsy and the functional anatomy of the brain, as well as by Otfried Foerster's surgical experience in treating post-traumatic epilepsy. Penfield's work established a firm basis for the modern diagnosis and neurosurgical treatment of focal types of epilepsy, particularly those involving the temporal lobe, and brought new hope for the patient with seizures. In studying and treating such patients he not only increased our understanding of epilepsy but also added greatly to our knowledge of the normally functioning brain through his fresh observations on memory, speech and consciousness. Some of his writings have already
1370 CMA JOURNAL/JUNE 18, 1977/VOL. 116
become neurologic classics. Two such are "The Cerebral Cortex of Man",1 with coauthor Theodore Rasmussen, and "The Excitable Cortex in Conscious Man",2 his Sherrington lecture of 1958. His "magnum opus.., "Epilepsy and the Functional Anatomy of the Human Brain",3 written with Herbert Jasper, records the observations and thinking of an unusual team of investigators, consisting of Wilder Penfield, the surgeon-neurologist, and Herbert Jasper, the pioneering neurophysiologist, as well as their many devoted coworkers. These are some of the significant ways in which Wilder Penfield has influenced the course of neurology in the 20th century. But perhaps his most creative contribution, his legacy for the future, lies in what he called "this continuing fabulous enterprise". He was referring, of course, to the institute that he founded. References 1. PENFIELD W,
RASMUSSEN
T:
The Cerebral
Cortex of Man, New York, Macmillan, 1951 2. PENFIELD W: The Excitable Cortex in Conscious Man, Liverpool, Liverpool U Pr, 1958 3. PENFIELD W, JASPER H:
Epilepsy and the
Functional Anatomy of the Human Drain, Boston, Little, 1954
DEL,
PENFIELD
W:
Cerebral
cicatrix: the reaction of neuroglia and microglia to brain wounds. Bull Johns Hopkins Hosp 41: 278, 1927 6. PENFIELD W, CONE W: Acute swelling of oligodendroglia: a specific type of neuroglia change. Arch Neurol Psychiatry 16: 131, 1926 7. PENFIELD WG: The acute regressive changes of neuroglia (ameboid glia and acute swelling of oligodendroglia). J Psychol Neurol 34: 204, 1926 8. Idem: The mechanism of cicatrical contraction in the brain. Brain 50: 499, 1927
9. FOERSTER 0, PENFIELD W: The structural basis of traumatic epilepsy and results of radical operation. Brain 53: 99, 1930 10. PENFIELD W: The radical treatment of traumatic epilepsy and its rationale. Can Med Assoc J 23: 189, 1930 11. PENFIELD W, GAGE L: Cerebral localization of epileptic manifestations. Arch Neurol Psychiatry 30: 709, 1933 12. PENFIELD W: The evidence for a cerebral vascular mechanism in epilepsy. Ann Intern Med 7: 303, 1933 13. Idem: Las effets des spasmes vasculaires dans l'6pilepsie. Union Med Can 63: 1275, 1934 14. Idem: The circulation of the epileptic brain.
Rex Pubi Assoc Rex Nerv Ment Dis 18: 605,
1938 15. PENFIELD W, BOLDREY E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60: 389, 1937 16. PENFIELD W, RASMUSSEN T: Further studies of the sensory and motor cortex of man. Fed Proc 6: 452, 1947
17. Idem: The Cerebral Cortex of Man, New
York, Macmillan, 1951 18. PENFIELD W, ERIcKsON
Cerebral Localization,
TC:
Epilepsy and
Springfield,
IL, CC
Thomas, 1941 19. JASPER H, PENFIELD W: Electroencephalograms in post-traumatic epilepsy: preoperative and postoperative studies. Am J Psychiatry 11: 365, 1943 20. PENFIELD W, JASPER H: Highest level sei-
zures. Proc Assoc Rex Nerv Ment Dix 26: 252, 1947
21. FEINDEL W, PENFIELD W:
Localization of
discharge in temporal lobe automatism. Arch Neurol Psychiatry 72: 605, 1954
22. PENFIaLD W, JASPER H: Epilepsy and the
Functional Anatomy of the Human Brain, Boston, Little, 1954
23. PENFIELD W: Epilepsy and surgical therapy.
Arch Neurol Psychiatry 36: 449, 1936 24. PENFIELD W, STEELMAN H: The treatment of focal epilepsy by cortical excision. Ann Surg 126: 740, 1947 25. PaNFIELD W, FLANIGAN H: Surgical therapy of temporal lobe seizures. Arch Neurol Psychiatry 64: 491, 1950 26. PENFIELD W, PAINE K: Results of surgical therapy for focal epileptic seizures. Can Med Assoc J 73: 515, 1955 27. PENFIELD W: Pitfalls and success in surgical treatment of epilepsy. Br Med J 1: 669, 1958
28. Idem: Psychical seizures. Br Med 1 2: 639, 1946 29. PENFIELD W, BALDWIN M: Temporal lobe
seizures and the technique of subtotal temporal lobectomy. Ann Surg 136: 625, 1952 30. PENFIELD W: Temporal lobe epilepsy (Hunterian lecture). Br I Surg 41: 337, 1954 31. Idem: The role of the temporal cortex in
certain psychical phenomena. Br Ment Sci 101: 451, 1955
32. EARLE KM, BALDWIN M, PENFIELD W: In-
cisural sclerosis and temporal lobe seizures produced by hippocanipal herniation at birth. Arch Neurol Psychiatry 69: 27, 1953
33. PENFIELD W: Epilepsy, the great teacher: the progress of one pupil. Acta Neurol Scand
43: 1, 1967
Impact on medical neurology FRANCIS L. MCNAUGHTON,* M SC, MD, CM, FRCP[C]
It is difficult in a short space to do justice to Wilder Penfield's many contributions to medical neurology because so many things he achieved have been of significance to neurology and to neurologists everywhere. Throughout his career he was widely regarded as a skilled neurosurgeon, but I would claim him rather as the complete neurologist. True, he had the bold, direct approach to problems and the manual skills that we usually associate with a surgeon, but for him neurosurgery was merely one technical aspect of his work. As Cushing would say, he was a neurologist who did his own operating. Among Penfield's early papers that helped to establish his reputation are those on the cytology of the nervous system, on brain tumour classification and on experimental brain scars. He later published studies on intracranial pain, on the nerve supply of intracranial structures and on surgical methods for the relief of intractable headache. He also became greatly interested in the nervous control of the cerebral circulation and the possible role of *Emeritus professor of neurology, McGill University
vascular spasm in provoking epileptic seizures. This work led to pioneering studies of cerebral circulation, which has become a vast and exciting area of research since those early days. There is no doubt that Penfield's greatest contribution to neurology grew from his years of concentrated research on epilepsy, which began immediately after his arrival in Montreal in 1928 and continued, with scarcely any interruption, for over 40 years. His interest was stimulated from the beginning by the writings of Hughlings Jackson on epilepsy and the functional anatomy of the brain, as well as by Otfried Foerster's surgical experience in treating post-traumatic epilepsy. Penfield's work established a firm basis for the modern diagnosis and neurosurgical treatment of focal types of epilepsy, particularly those involving the temporal lobe, and brought new hope for the patient with seizures. In studying and treating such patients he not only increased our understanding of epilepsy but also added greatly to our knowledge of the normally functioning brain through his fresh observations on memory, speech and consciousness. Some of his writings have already
1370 CMA JOURNAL/JUNE 18, 1977/VOL. 116
become neurologic classics. Two such are "The Cerebral Cortex of Man",1 with coauthor Theodore Rasmussen, and "The Excitable Cortex in Conscious Man",2 his Sherrington lecture of 1958. His "magnum opus.., "Epilepsy and the Functional Anatomy of the Human Brain",3 written with Herbert Jasper, records the observations and thinking of an unusual team of investigators, consisting of Wilder Penfield, the surgeon-neurologist, and Herbert Jasper, the pioneering neurophysiologist, as well as their many devoted coworkers. These are some of the significant ways in which Wilder Penfield has influenced the course of neurology in the 20th century. But perhaps his most creative contribution, his legacy for the future, lies in what he called "this continuing fabulous enterprise". He was referring, of course, to the institute that he founded. References 1. PENFIELD W,
RASMUSSEN
T:
The Cerebral
Cortex of Man, New York, Macmillan, 1951 2. PENFIELD W: The Excitable Cortex in Conscious Man, Liverpool, Liverpool U Pr, 1958 3. PENFIELD W, JASPER H:
Epilepsy and the
Functional Anatomy of the Human Drain, Boston, Little, 1954
