The Tale of the Dueling Neurosurgeons, also known by its full title The Tale of the Dueling Neurosurgeons: The History of The Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery is a science book regarding the brain and its functions by Sam Kean. The Daily Telegraph described it as "A dramatic account of the gruesome accidents that shaped modern neuroscience."
Publication The book was published in hardback on May 6, 2014 by Little, Brown and Company.
Contents/Synopsis In The Tale of the Dueling Neurosurgeons, Sam Kean travels through time with stories of startling peculiarity and incredible fascination, stories of neurological curiosities: phantom limbs, cannibalism, Siamese brains and a plethora of other strange, though equally fascinating things. Kean effortlessly ties historical accounts, stories of madness and insanity, with the scientific breakthroughs that often followed. His writing shows that every breakthrough was borne of malady, injury, necessity.
Part I: Gross Anatomy
Introduction Each chapter begins with a rebus, a word puzzle, pertaining to the subject of the chapter. In this introductory section, Kean essentially provides some background information and summarizes how the book will continue.
Chapter 1: The Dueling Neurosurgeons The first chapter begins with Kean setting the stage of a historic jousting match between King Henri II of France and Gabriel Montgomery. After jousting with Montgomery once, Henri demanded that he go a second time (which broke the laws of chivalry and good sport). It is during this second joust that Henri was whacked square in the face by his opponent's jousting pole.
This is when Kean introduces the "dueling neurosurgeons": Ambroise Paré and Andreas Vesalius, both esteemed neurosurgeons at the time. Paré was the royal surgeon at the time and was a pioneer in terms of medicine, as he refused to heed medical norms at the time due to the fact that they were often painful and useless for the patient. Vesalius was a royal surgeon in a different court, best known for writing and illustrating the book De Humani Corporis Fabrica Libri Septem, which represented a significant advancement in anatomical knowledge and artwork using contemporary renaissance techniques.
They both teamed together when the king fell to try to see if they could revive him. Upon examination, the king had no fractures to his head and so it would have been assumed that nothing was wrong. The surgeons knew better, and were going to encounter the first concussion of that time. After the king's death, they found that his brain was in awful shape, "yellowed and putrefied" and found "pools of blackened fluid beneath the meninges". This is the medical discovery/advancement that would set the stage for generations to come: the fact that brain damage could be present despite no obvious fractures or surface wounds.
Part II: Cells, Senses, Circuits
Chapter 2: The Assassin's Soup This chapter begins with a troubled man: Charles Guiteau. He had apparently heard God speak to him, saying that he should assassinate the president at the time: James Garfield. The man, arguably insane before his attempt to kill the president, had endured a lot in his life such as divorce and being relentlessly made fun of by many groups of people for his unsightly appearance. After much planning, he shot Garfield in the lower back, not killing him right away, but being the ultimate cause of his death (Guiteau claimed that doctors killed Garfield, he had just shot him).
Guiteau's lawyer (who was, subsequently, his brother) George Scoville, pled insanity. Though, after many tests with various court-appointed psychologists/psychiatrists, he was declared sane because he could differentiate between right and wrong.
During the trial, a neurosurgeon Edward Charles Spitzka pointed out that there was more than likely underlying trouble in Guiteau's mind. After the trial concluded and Guiteau passed, an autopsy of his brain was conducted. By this time, autopsy had evolved into a microscopic art, and so Spitzka took to the microscope with samples of Guiteau's brain. Of course, Spitzka found holes in his gray matter and extensive damage to the tissue that "nourished neurons". Later, it was declared that Guiteau was more than likely a schizophrenic.
During this time, another scientist, Camillo Golgi, was brewing up reticulum theory. He had spilled silver solution on brain samples and then looked at them under a microscope. What he saw stunned him: neurons. He noticed they had three parts: the cell body, axon, and dendrites, and he was the first to see them in such detail. He could determine no space between the neurons and emerged a supporter of reticulum theory.
Another scientist, Santiago Ramón y Cajal, was enamored by the pictures of neurons that Golgi produced. Despite his fascination with the drawings, though, he disagreed with reticulum theory. He noticed that, under a microscope, gray matter neurons were not fused together.
The story of another assassin follows: Leon Czolgosz. The man had a similar past to that of Guiteau, and planned to murder president William McKinley as to secure his own party's political candidate in the White House. He proceeded to shoot McKinley in the stomach and pancreas and was then sentenced to the electric chair. McKinley died of infection after eating when his stomach had not fully healed. Much to the anger of various neuroscientists and neurosurgeons alike, Czolgosz's brain was confiscated from study and destroyed.
The experiments of Otto Loewi are also mentioned. His experiment was one in which he placed two frog hearts in separate cups of saline. He sped one heart up by triggering nerves, then transferred the saline of the fast heart into the saline of the normal beating heart, resulting in the normal heart being as fast as the other heart that he had triggered. This proved that neurons did not just use electricity, but also used chemicals. But since he realized that electricity could not jump the (tiny) distance between dendrites, he concluded that the electricity transformed into transferable chemicals.
Chapter 3: Wiring and Rewiring Here, Kean introduces the eccentric James Holman. He was a blind explorer, a man who climbed mountains and visited all corners of the globe without sight. He was appointed the Naval Knight of Windsor, which was more illustrious than it sounded. Holman hated being home and often sank into deep bouts of depression when cooped up for too long a time.
To get around during his journeys, he carried a cane. He did not use the cane like other blind people did, feeling around with it. He used his cane to strike the ground, causing a click that he could hear. This click, in turn, echoed in his ears, creating what was essentially human echolocation.
Kean ties in Holman's use of his cane, to teach his brain to "see", with gray matter and white matter. He also talks extensively about circuits. Circuits essentially make up the brain, every human function being controlled by one. The circuits for breathing and yawning do not have much variation and are extremely simple. In contrast to that, the circuit that connects pictures to words, sounds to pictures (i.e. small children learning to read and associating the word dog with the actual animal) are more complicated. Negative experiences also wire circuits. A bad fright in a dark alley may cause you to flinch next time you enter one.
Another thing that concerns wiring and rewiring is the neurological phenomenon of synesthesia. There are over 60 known types of synesthesia. An example would be a synesthesiat hearing a sound and colors flooding their vision or someone reading a passage of words and each letter evokes a different color or a different smell or a different taste. Certain sounds cause the person to feel certain things in turn, or see spots of color dance across their vision. Neurologists agree that this occurs of faulty wiring in the brain, that "neuron circuits that process a sense accidentally strum circuits of another sense, causing both to go off simultaneously". It is debated how this happens. As a child, one possesses more neurons than necessary and the unnecessary ones are pruned away and die when not used. Some believe that synesthesia is a result of poor pruning.
Albert Hoffman helped scientists further understand synesthesia by creating a certain psychedelic drug known as LSD. Created in his lab, he tried it, and was startled by the results. It ultimately showed that we all carry the latent ability of synesthesia if we knew how to tap it as LSD does.
Cajal (from the previous chapter) pointed out that adult neurons and neuron circuits could not renew themselves, and once they were dead, they were dead for good. He said that only children could renew their brain tissue. This is true to some extent, though for adults, while they cannot regrow neurons, they can rewire circuits in their brains with hard work.
Chapter 4: Facing Brain Damage This chapter starts with the introduction of mutilés, French soldiers whose faces had been disfigured in World War I. This was the cause of much sadness and insecurity for these men, and many committed suicide. Anna Coleman Ladd, an American sculptor, traveled to France and created facial masks of painted tin for such men, which helped them assimilate back into society to an extent.
Related, a Japanese scientist Tatsuji Inouye examines soldiers who had been shot through their visual cortex during battle and lost random spots of vision. Inouye figured that the spots of missing vision were connected with the spots that their brain had been shot through, and set out to map the visual cortex through talking to these soldiers.
Kean introduces other scientists such as the duo Hubel and Wiesel, who tried various experiments with cats to get their neurons to fire. Through many botched experiment attempts, one fateful accident led to the breakthrough that certain neurons fire at certain things. Specifically, they discovered that neurons like to track motion and can derive the shapes of objects through columns of orientation-preferring neurons.
Kean also, in depth, explains the role of the parietal lobe and the occipital lobe through all these accounts. He writes that the brain can stumble after injury, and the results can be serious. For example, if the visual cortex suffers damage, the person afflicted will lose many things, one of which being basic perceptual skills. Damage to the parietal lobe causes the loss of the ability to locate objects in space. Infections and viruses like herpes may make their way up to the brain and affect it.
He also covers the interesting topic of object-blindness. Someone may not recognize an object, a color, or other seemingly mundane things. Face-blind people cannot recognize faces, and can hardly discern age or gender between portrait pictures.
Part III: Body and Brain
Chapter 5: The Brain's Motor Kean begins the chapter with the sad (fictional) tale of George Dedlow, protagonist of a short story by Silas Weir Mitchell. George Dedlow had fought in the Civil War and in turn had both his arms and both his legs amputated for various reasons. These amputations brought on another neurological phenomenon: phantom limbs. George Dedlow, amongst millions of other war amputees, felt pain in limbs that he did not have.
A neuroscientist, Mitchell specialized in examining amputees and was fascinated with them. He examined patients who complained of pain or discomfort in their phantom arms, legs, and genitals. Here, Kean ties the motor and sensory cortexes in. When something is amputated, the respective part of the brain for controlling that part goes black (figuratively). The now obsolete part of the brain is quickly taken over by neighboring brain areas, such as the face or arms.