A BRIEF HISTORY OF NEUROLOGY AND NEUROSURGERY AT MCGILL|
The current stature of McGill's Department of Neurology and Neurosurgery is the result of a remarkable cooperative effort by neurologists, neurosurgeons and neuroscientists over several generations. Since the 1930's, over 2000 neurologists, neurosurgeons and neuroscientists have received their specialty training at McGill. The following is a brief history of how one of the most dynamic centers of neurology came to be.
McGill University began with a royal charter from George IV of England in 1821. The first four professors, all Edinburgh-trained physicians, also comprised Canada's first Faculty of Medicine.
McGill graduates include William Osler, who taught at the medical school (1874-1884) and practiced at the Montreal General Hospital (MGH), where he developed a keen interest in the pathology of the nervous system. At a meeting of the British Medical Association in 1907, after Victor Horsley and William Macewen had reviewed what had been accomplished in brain surgery, Osler was reported as commenting that "a great deal of scepticism in regard to the value of operation in cases of cerebral tumor was the result of the bicipital condition of neurology." He deprecated operations in these cases at the hands of general surgeons and said he "would prefer to see neurology a special department, so that there would not be neurological physicians and surgeons, but medical chirurgical neurologists, properly trained in the anatomical, physiological, clinical and surgical aspects of the subject."
Edward Archibald, another McGill graduate, became one of the earliest thoracic surgeons in America, and, beginning in 1906, he pioneered neurosurgery in Canada. In an address to the Nova Scotian Medical Association in 1907 on cerebral compression, he said, "If only the internist, especially the neurologist and also the general practitioner, will learn to give up their traditional pessimism with regard to cerebral cases, and will work hand in hand with the surgeon, I am convinced that great results are possible of attainment." In 1908, he published a 385-page monograph on "Surgical Affections and Wounds of the Head" in Bryant and Buck's American Practice of Surgery. In the same year, the review by Harvey Cushing on surgery of the head was published in William Keen's Surgery: Its Principles and Practice. They were the two most useful works in English dealing with the advances in cranial surgery at that time. Archibald's survey, although less well known today, stands out as a substantial landmark in neurosurgical literature because of its well-ordered, scholarly consideration of intracranial pathophysiology, illustrated by clinical cases from the McGill hospitals and from the pathological museum that had been started by Osler.
At Archibald's invitation, Wilder Penfield moved in 1928 to Montreal from the Columbia-Presbyterian Hospital of New York. Joined by his partner, William Cone, Penfield focused on neurosurgery and neurocytological research at the Royal Victoria Hospital.
For years, Penfield was driven by a dream to establish an institute for the scientific study and treatment of neurological disorders. He began to realize this goal in 1928 when he arrived in Montreal. The Principal of McGill University General Sir Arthur Currie, and the Dean of Medicine, Charles Martin, had developed an excellent relationship with the Rockefeller Foundation since 1921, with the goal of modernizing the medical school. This offered Penfield a favorable matrix in which he could fulfill his plan to "provide a center for neurological thought that would serve the whole continent" and to "work effectively upon the unsolved problems in neurology unhampered by the artificial division in medicine and surgery."
After 3 years of applications and negotiations, with strong backing by McGill colleagues, Penfield realized his goal. In April 1932, the trustees of the Rockefeller Foundation granted $1,232,000 to McGill University for a neurological institute. One million dollars was specified as an endowment to support brain research. The remainder was applied to the construction of laboratories; this was matched by private and government funds to build and operate the hospital.
The MNI of McGill University opened in 1934 as a 50-bed hospital for brain disorders combined with a brain research center that was "dedicated to relief of pain and suffering and to the study of neurology' (57) (Fig. 5). The founding of the institute stands as Penfield's main legacy to world neurology; the intellectual life of its staff is enhanced by the institute's fortunate setting that is within a great university and medical school and next to a famous teaching hospital, by the continual comings and goings of young physician-scientists, and, most of all, by scientific projects that are continually brought into focus by the compelling demands of patients with neurological problems.
The Department of Neurology and Neurosurgery was created in the Faculty of Medicine of McGill University in 1930. Dr. Penfield was the first Chair and held this position until 1962. During this period the bulk of the academic activities of the department was concentrated at the Montreal Neurological institute.
In 1962, Dr. Theodore Rasmussen succeeded Dr. Penfield and served in this capacity through 1972. This was a period in which academic activities of the department in the Montreal general hospital and the Montreal Children's Hospital increased appreciably.
It was also during this period that the Jewish General Hospital joined the other teaching hospitals in contributing to the undergraduate teaching program and the training program in neurology. Dr. William Feindel served as Chair from 1972 to 1977. The physical facilities of the MNI were appreciably expanded during this time and there was a continued increase in the academic activities of the department based in the Montreal General Hospital.
In 1977, Dr. Joseph Martin became departmental chair - a break with tradition that the Director of the MNI was also departmental chair. In 1978, Dr. Martin was succeeded by Dr. Preston Robb who served as Acting Chair during 1978-79. Dr. Donald W. Baxter served as Chair from 1979 to1989. Dr. Jack Antel was appointed as Chairman of the Department of Neurology and Neurosurgery in 1989. In 1991, Dr. André Olivier was appointed as Director of the Division of Neurosurgery within the department. In 1992, Dr. Richard Murphy was appointed as Director of the MNI, in line with the policy of separation of the operations of the MNI and the department.
When the Montreal Neurological Institute opened, Colin Russel was appointed the senior neurologist. He was already the neurologist to the Royal Victoria and had established a reputation not only for his work in the laboratory but also as an astute clinician. Russel was elected president of the American Neurological Association. On his return from distinguished service overseas in 1942, he again took up the reins as neurologists to the institute and carried on until 1945 when he turned them over to Donald McEachern.
McEachern came to McGill at the invitation of Penfeild and was appointed associate neurologist in 1934 and later founded and directed the laboratory of neurochemistry. In taking over Russel's duties McEachern became the MNI's neurologist in chief, neurologist to the RVH and associate professor of neurology. With him at that time were associate neurologists John Kershman, Francis McNaughton, Preston Robb and Arthur Young.
Following the death of McEachern in 1951, Francis McNaughton took over as neurologist in chief and neurologist to the Royal Victoria. A native Montrealer, McNaughton did much for neurology at McGill.. He vastly improved the undergraduate teaching of basic sciences, and saw to it that the residents and fellows were exposed to neuroanatomy and the other neurosciences. As Preston Robb wrote of McNaughton, "In his kindly and forceful way, he was able to get things done where others had failed. Perhaps most importantly, he ran a happy ship and was beloved by all. It was little wonder that he was referred to as 'St. Francic'." During McNaughton's early years as a professor, he enlarged the staff to include Donald Lloyd-Smith, Roy Swank, Miller Fisher, Bernard Smith Donald Tower and Reuben Rabinivitch.
McNaughton continued on as neurologist in chief until 1969 when the post was turned over to Preston Robb. Robb set out with several priorities, including: to provide leadership in patient care; to improve undergraduate teaching; to promote the McGill Neurology Training Program, a three year traing program giving residents a chance at positions at the MNI, the General, the Children's and the Jewish; and in Robb's words, "to protect staff members from administrative jobs so that they could get on with their research." Robb's efforts nurtured the excellent work of such researchers as George Karpati, Stirling Carpenter, Andrew Eisen, Allan Sherwin, Ivan Woods and Fred Andermann, among many others.
Into the future
The Institute and Department of Neorology and Neurosurgery has served for the past 60 years as a rigorous training ground in the clinical and scientific aspects of brain disorders and is recognized worldwide for the surgical treatment of epilepsy, brain tumors, and neuromuscular, neurogenetic, cerebrovascular, and spinal problems. The MNI is known for its leadership in the fields of human neurophysiology, neurochemistry, neuropsychology, and brain imaging. The McGill residency program in neurosurgery, based at the institute, also involves a wide range of adult and pediatric clinical instruction at three other major teaching hospitals. The program offers a variety of experience in basic neurosciences as applied to neurosurgery, with strengths in brain imaging, neural regeneration, molecular neurobiology, neuro-oncology, and cerebral vascular research. The range of the McGill program is structured to provide a sound clinical, scientific, and technological preparation for neurologists and neurosurgeons of the next millennium.