No Man Alone
Author: Wilder Penfield

Background

This book is less an autobiography, and more what the author depicted as the ‘biography of an idea‘ – a tale of a relentless mission to ‘find a way of understanding what the brain was doing and how it did it’. Narrated with a humility that is reflected by the book’s title, the author downplays his extraordinary achievements as he documented a chronological account of his obsession to solve the scientific and medical mystery of the brain. Acquiring and deploying a breathtaking range of neuroscience knowledge and skills, and without compromising his social and family commitments, the author’s life story is both inspiring and instructive. Apart from reflecting the time-honoured values of determination, commitment, and hard work, the book also highlights the priceless qualities of co-operation and collaboration in the pursuit of scientific progress (page 133).

 

Synopsis

The author’s interest in the brain was kindled very early in his medical career when he realised that ‘there was work for me to do in the world’. This was a calling that crystallised as a plan ‘to become a brain surgeon, and to apply basic science to the needs and problems of patients in the neurological field of medicine’. In pursuing this goal, he understood that ‘no man could master all the current knowledge of the nervous system by himself’, and that ‘no one can make the best use of that knowledge working alone in the vast field of neurology‘. At a time when ‘no one had made a balanced academic approach to the mind…through studies of the brain of man’, the author was clear in his mind that ‘I would try to do what I knew no man alone could do‘. And he illustrated the imperative of teamwork and loyalty in the attainment of scientific success when he made an apt comparison with football in which ‘the captain should not carry the ball himself in any play if others on his team could do it as well, or better’. As he gradually achieved his vision, he said ‘many had been drawn into the project, and teamwork was making possible for each of us to do what no man could do alone‘ (page (pages 304, 63, 130-132, 201, 185, 251 and 275).

 

One of the paramount objectives that drove the author’s academic pursuits was to understand the cause of epilepsy, a problem he portrayed as a mystery which is ‘as old as the history of man‘, and as a disease which ‘had fascinated me from the time I had seen, and first studied, the brain’. His singular mission was inspired by the writings of Hughlings Jackson, the neurologist who he said believed that ‘each seizure was the result of irritation at some particular focus in the brain’. And he was encouraged to follow this path by William Clarke, a he surgical pathologist who he said was ‘in appearance and in turn of mind, a modern version of the Greek philosopher Socrates‘. His ambition to unravel the riddle of epilepsy led him to work with the German neurologist Otfrid Foerster, who the author likened to the great Charles Sherrington because they both had ‘the same mental type as far as simplicity, accuracy and logic are concerned’. Indeed it was whilst working with Foerster that he appreciated the structural basis of seizures, referring to what he observed as ‘valid clues‘ pointing to ‘where dawn might break‘ in his search. These were the clues that enabled him to formulate valid hypotheses, remarking that ‘the door had opened and I was in a room that no one had entered before me…as if I were moving on through a labyrinth like the mythical one that Daedalus built in ancient Crete’ (pages 279, 159-174 and 63-64).

Alongside his ambition to understand the brain, the author also nurtured a career-long passion to bring the different branches of neuroscience together as ‘parts of a functional whole’, working in unison rather than in competition. Believing that ‘there is a world of neurology in which there are no subdivisions and to which ‘man is the common problem’, he set out to dismantle the artificial boundaries that had hitherto separated the specialities, limited their ability to solve the riddles of the brain, and hindered their attempts at improving patient care. His vision was to establish an institute ‘where neurologists could work with neurosurgeons and where basic scientists would join the common cause’, and an establishment which would be built ‘in close and constant contact with general medicine and surgery and all the facilities of a great modern hospital‘. By a very collegiate approach, effective networking, and persistent fund-raising efforts, the author eventually achieved his dreams with the launching of the Montreal Neurological Institute (pages 43, 267-272, 277-283, 294-301, 313, 333, 219,395, 297 and 174).

Whilst the author did not intend the book to be just an autobiography, it nevertheless provided valuable insights into his personality. And a worthy trait that shone through was his compassion, a quality he portrayed as ‘this streak of kindness, this desire to help others’ that ‘is born in all men and women’, and which he said enables physicians to discover ‘the fears, the loves, the sorrows, the anguish and joy and the hopes the patient harbors deep down inside’. Indeed, it is from his empathy that he cautioned physicians against closing the ‘door to hope’ in patients’ faces, or using phrases such as ‘hopeless prognosis’. He also wrote of his respect for the courage of his patients who underwent his operations, saying ‘I never witness this heroism without fresh admiration for the stuff that makes a human being’. He added that ‘any doctor who is deeply involved in his patients is inevitably pushed and pulled through life by their hopes and their despairs‘. Amongst his other qualities are confidence and determination, traits which he attributed to the extremely close and loving relationship he had with his mother, a connection that also instilled in him the optimism with which he faced every challenge, and responded to setbacks. (pages 3-4, 68, 83, 120, 238-239 and 276).

A prominent feature of the author’s life are the diverse people who contributed to his career development. Asserting that ‘as neurosurgeon I could claim to be the pupil of many‘, he referred to the roles played in fashioning his career by such prominent teachers as Walter Dandy, Harvey Cushing, Percy Sargent, Charles Frazier, and Thierry de Martel. He also developed defining relationships with many physicians and scientists, the most influential being that with Charles Sherrington – ‘a quiet man of many talents‘ who made the author realise that ‘here in the nervous system was the great unexplored field’. Another major  personal and professional relationship was with Gordon Holmes -‘the most outstanding of the new generation of neurologists in London’ – who he said ‘came close to me and influenced me profoundly‘. It was however his staining methods tutelage under Santiago Ramon y Cajal and Pio del Rio Hortega in Spain that most defined his work as a neuroscientist because it enabled him to observe the non-nervous cells in brain tissue specimens. He asserted that ‘the methods learned in Madrid were to point the way for me, and later for my own pupils, to make a worthwhile contribution to neuropathology and to neuroanatomy and to clinical neurology‘ (pages 35-45, 84-86, and 103-112).

Opinion

This is more than just the autobiography of one of the major creative forces of neuroscience. It is an inspiring lesson in the higher motives for pursuing dreams, and an exemplar of living a life in the pursuit of knowledge for the greater good. Demonstrating such high qualities as humble leadership and effective teamwork, the book is also an educational excursion in the intricacies of business plans – from proposing to costing, from funding-raising to implementation. The author’s emphasis on strong collaboration between physicians and their patients, and between different medical specialties, is one that is valid today. In portraying a life that crisscrossed the world in the ever-present pursuit of skill and technology, the author has laid the foundations for progress, not just for neuroscience, but for all of medicine.

Overall assessment

With an admirable blend of outstanding achievement and deep humility, this autobiography of one of the giants of neuroscience is indeed inspiring. Compelled by the single-minded determination to understand the brain, the author narrates his zealous pursuit of knowledge, unbounded by the artificial boundaries that new separate neuroscience into splintering fields. As much a neurologist and neuropathologist as he is a neurosurgeon, the author’s life is an example of the achievements possible when a goal is pursued diligently and confidently. The book explains why the author’s almost mythical status is justified, and I highly recommend it to all doctors.

Book details

Publisher, Place, Year:  Little, Brown and Company, Boston, 1977
Number of chapters: 19
Number of pages: 398
ISBN: 978-0-316-69839-3
Star rating: 5
Price: £21.96