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Wilder Penfield—Contributor to the Surgical Treatment of Epilepsy

      Born on Jan. 26, 1891, in Spokane, Washington, Wilder Penfield attended school in Hudson, Wisconsin, where his mother was a teacher. His father and grandfather were physicians in Spokane. Penfield attended Princeton University and had a goal of winning a Rhodes Scholarship to Oxford University in England. He was a football player and subsequently a coach; he was also an excellent wresder. He received a Rhodes Scholarship in 1914, but because of the war, he attended the College of Physicians and Surgeons in New York City. In 1915, he enrolled in the school of physiology at Merton College, Oxford University. While at Oxford, he was influenced by Sir Charles Sherrington (1857–1952), a famous physiologist, and Sir William Osier (1849–1919), a well-known physician. As a student of Sherrington, Penfield wrote years later, “I looked through his eyes and came to realize that here in the nervous system was a great unexplored field—the undiscovered country in which the mystery of the mind of man might some day be explained.”
      During vacation at the end of the fall term in 1915, Penfield served at the French Red Cross Hospital at Ris-Orangis, where he assumed intern-level responsibilities in a ward. After the winter term in March 1916, Penfield boarded the panel steamer Sussex to return to France. The ship was struck by a torpedo, and Penfield sustained a severe injury to his leg. He returned to Oxford University and convalesced at Osier's home for 3 weeks. Ten years later, he received, from the German government, a war indemnity for his leg injury and purchased a farm on Lake Memphremagog, 90 miles east of Montreal.
      Penfield obtained a B.A. degree in physiology from Oxford University in 1916 and an M.D. degree from Johns Hopkins Medical School in 1918. He then participated in a surgical internship at the Peter Bent Brigham Hospital in Boston, where Harvey Cushing (1869–1939), a well-known neurosurgeon, was a member of the staff; however, Penfield did not work with Cushing. Penfield returned to Oxford University because he was awarded a Beit Fellowship, after which he received further neurologic training at the National Hospital at Queen Square in London. In 1921, he returned to New York City, where he worked in the surgical department at Presbyterian Hospital and College of Physicians and Surgeons of Columbia University. He studied the healing of experimental wounds in the brain, but because his histologic techniques were inadequate, he worked with Pio del Rio-Hortega (a pupil of a Spanish histologist Ramon y Cajal, 1852–1934) in Madrid, Spain. While there, he became an expert in the methods of metallic impregnation for displaying neuroglia.
      In 1928, Penfield became head of neurosurgery at the Royal Victoria Hospital at McGill University. Before this appointment, he spent 6 months in Breslau, Germany, where he learned the method of operating with use of local anesthesia and electrical stimulation to identify the sensory motor cortex to guide surgical excision in patients with posttraumatic epilepsy. In 1934, Penfield founded the Montreal Neurological Institute, where he worked with other experts in electroencephalography and neurochemistry; thus, he contributed substantially to the fields of neurology and neurosurgery.
      Epilepsy became Penfield's main interest. With use of gentle electrical stimulation of the cortex and local anesthesia in patients with epilepsy, he was able to excise the epileptogenic scar tissue. He also recognized epilepsy of the temporal lobe and performed surgical excision in patients who had medically intractable seizures. Penfield also noted that stimulation of the amygdala produced automatism, which is often associated with seizures of the temporal lobe. Additionally, he recognized the role of the hippocampus in memory. Postoperative infections were minimal in his patients because he had an elaborate scrubbing technique and wore a double-layer mask and a hood.
      Penfield made the following observations:
      What we learn in this field of neurology is more important to man and more vast than outer space. The secrets of the brain and mind are hidden still. The interrelationship of brain and mind is perhaps something toward which scientists and doctors will always struggle.
      During World War II, Penfield was chairman of the Committee on Surgery of the Canadian National Research Council. He wrote a manual on neurosurgical procedures for the army and subsequently performed research on seasickness in naval personnel. He served as president of the Royal College of Physicians and Surgeons of Canada and was primarily responsible for ensuring the use of the French language for French-speaking physicians and surgeons. Penfield had become a Canadian citizen in 1934.
      Penfield was almost 70 years old when he retired from neurosurgical practice. He then wrote two historical novels—one based on Abraham and Sarah of the Old Testament and the other on Hippocrates. His most substantial scientific work was the book Epilepsy and the Functional Anatomy of the Human Brain, which was published in 1954. He also wrote a well-received biography of Alan Gregg, who was responsible for obtaining financial support from the Rockefellers for the Montreal Neurological Institute.
      Penfield died of a sarcoma in the abdominal wall on Apr. 5, 1976. He was honored on a stamp issued by Canada in 1991.