The Vital Probe: My Life as a Brain Surgeon
In a work that is still regarded as a classic of clarity of writing and astuteness of observation, James Parkinson (1775-1824) was the first to describe “an evil from the domination of which the victim had no prospect of escape.” This was paralysis agitans, the shaking palsy that Charcot renamed “Parkinson’s disease.” It is marked by a wide variety of motor disorders of which the most conspicuous is uncontrollable tremor, sometimes accompanied by local muscular rigidity and by a characteristic rigidity of the muscles of facial expression leading to the set expression known as the “parkinsonian mask.” For well over a hundred years the disease remained a complete mystery so far as concerned interpretation and treatment.
I.S. Cooper’s very substantial claim to fame is founded on his having devised a neurosurgical treatment for parkinsonism which could relieve the tremors and the rigidities without causing damage on its own account. This is indeed a gift of life because parkinsonism can be very long lasting. Macdonald Critchley, one of the world’s leading neurologists, has described a pensioner whose mild symptoms of parkinsonism had lasted from the age of 65 until his death at 105.
Cooper devised his operation by ordinary scientific procedures extraordinarily well worked out; that is, he built upon his own hunches or on clues already available (Russell Meyers had already made a significant contribution which Cooper acknowledges) and he seized astutely and perceptively upon any informative conjunction of events thrown up by chance (through that which Bacon described as “the casual felicity of particular events”); in due course by a characteristically scientific flash of imaginative insight he hit upon a hypothesis about the control of parkinsonism of which a surgical operation would be the empirical test.
Apart from the surgical strategy, Cooper raised stereotactic surgery to a specially high degree of proficiency. Stereotactic surgery is a system of surgery in which the surgeon’s hands and the various instruments (scalpels, probes, forceps, etc.) that represent functional extensions of the hands are guided with geometrical precision to the part of the brain that is to be the subject of a surgical procedure. Stereotaxy is specially valuable in the surgery of the brain. If a surgeon has to conduct a surgical operation on the contents of the perivisceral coelom (known to laymen as the “insides”) he can rummage around inside until he finds the part he is seeking, pushing tubes and pipes aside now this way and now that; they can be even partially externalized provided they are kept moist. There is no record in the history of medicine of any surgeon’s forgetting to spoon them back in again. If any such procedure were applied to the brain the patient would end as a human vegetable, for functions and faculties are to so high a degree localized in the brain that every brain surgeon operates in the anxiety that his operative procedures cause functional damage as great as or even worse than that which he is seeking to relieve.
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