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  A HOLE IN THE HEAD

  A HOLE IN THE HEAD

  MORE TALES IN THE HISTORY OF NEUROSCIENCE

  CHARLES G. GROSS

  THE MIT PRESS

  CAMBRIDGE, MASSACHUSETTS

  LONDON, ENGLAND

  © 2009 Massachusetts Institute of Technology

  All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher.

  MIT Press books may be purchased at special quantity discounts for business or sales promotional use. For information, please e-mail [email protected] or write to Special Sales Department, The MIT Press, 55 Hayward Street, Cambridge, MA 02142.

  This book was set in Bembo on 3B2 by Asco Typesetters, Hong Kong. Printed and bound in the United States of America.

  Library of Congress Cataloging-in-Publication Data

  Gross, Charles G.

  A hole in the head : more tales in the history of neuroscience / Charles G. Gross.

  p. cm.

  Includes bibliographical references and index.

  ISBN 978-0-262-01338-3 (hardcover : alk. paper) 1. Neurosciences—History.

  2. Neurosciences and the arts. 3. Neuroscientists. I. Title.

  RC338.G76 2009

  616.80092’2—dc22 2009009928

  10 9 8 7 6 5 4 3 2 1

  To Joyce Carol Oates

  CONTENTS

  PREFACE ix

  I EARLY NEUROSCIENCE AND ITS REVERBERATIONS TODAY 1

  1 A HOLE IN THE HEAD: A HISTORY OF TREPANATION 3

  2 HEART VERSUS BRAIN: GALEN AND THE SQUEALING PIG 25

  3 THE FIRE THAT COMES FROM THE EYE 53

  4 THE DISCOVERY OF MOTOR CORTEX 77

  II NEUROSCIENCE AND ART 117

  5 “PSYCHOSURGERY” IN RENAISSANCE ART 119

  6 LEFT AND RIGHT IN SCIENCE AND ART WITH MARC H. BORNSTEIN 131

  7 REMBRANDT’S THE ANATOMY LESSON OF DR. JOAN DEIJMAN 161

  III SCIENTISTS WHO WERE “BEFORE THEIR TIME” 179

  8 CLAUDE BERNARD AND THE CONSTANCY OF THE INTERNAL ENVIRONMENT 183

  9 BARTOLOMEO PANIZZA AND THE VISUAL BRAIN WITH MICHAEL COLOMBO AND ARNALDO COLOMBO 201

  10 JOSEPH ALTMAN AND ADULT NEUROGENESIS : THE DOGMA OF “NO NEW NEURONS ” IN THE ADULT MAMMALIAN BRAIN 229

  11 DONALD R. GRIFFIN: ECHOLOCATION AND ANIMAL CONSCIOUSNESS 247

  12 THE GENEALOGY OF THE “GRANDMOTHER CELL” 263

  REFERENCES 285

  INDEX 331

  PREFACE

  My interest in the history of neuroscience began when I was an undergraduate and extended for more than 50 years throughout my career as an experimental neuroscientist specializing in vision and the functions of the cerebral cortex. This is my second collection of history of neuroscience papers; the first, published in 1998, was entitled Brain, Vision, Memory: Tales in the History of Neuroscience.

  This collection differs from the previous one in including postscripts that endeavor to bring the papers up date, even those that deal with events over a thousand years ago. For example both the study of trephining, cutting holes in the skull, and of the Greek physician and scientist Galen of Pergamon remain active and often controversial fields of research with continuing interesting new developments.

  Part I deals with early developments in neuroscience that are still relevant today. The articles in part II deal with the interactions of art and science. Part III tells the stories of neuroscientists whose ideas were so advanced as to be ignored or even inconceivable to their contemporaries.

  In general, for the chapters previously published I have made only a few minor corrections and changes other than to eliminate the abstracts, add cross-references, make the citations consistent, and provide a consolidated reference list.

  Chapter 6 was coauthored with Marc Bornstein and Chapter 9 with Michael Colombo and his father Arnaldo Colombo. Chapter 4 arose, in part, from a collaborative effort with Charlotte Taylor.

  Many friends and colleagues made suggestions or helped with the original articles or postscripts including T. Albright, S. Alisharan, M. Bentivoglio, G. Berman, B. Campbell, D. Cooke, J. Cooper, J. E. Cottrell, R. Desimone, R. Galambos, S. Gandhi, A. Ghanzanafer, E. Gould, M. Graziano, A. Grinnell, D. A. Gross, M. Hauser, F. L. Holmes, X. T. Hu, E. Isaac, G. Krauthammer, S. Landes, M. Mugan, J. C. Oates, R. Payne, G. E. Peierls, R. E. Peierls, A. Repp, H. R. Rodman, L. Seacord, T. Sejnowski, J. Simmons, M. Sommer, H. Terrace, S. Waxman, G. Winer, and R. M. Young.

  Linda Chamberlin of the Princeton University library was tireless in getting books and articles. Shalani Alisharan copyedited magnificently. Tyler Clark played a major role in every aspect of the preparation of this book. Production of the original articles was helped by my grants from the National Institutes of Health EY 11347-1-34.

  I

  EARLY NEUROSCIENCE AND ITS REVERBERATIONS TODAY

  Modern neuroscience is often said to have begun with the work of the great neuroanatomist Ramón y Cajal (1852–1934) and that of the founder of modern neurophysiology E. D. (Lord) Adrian (1889–1977). Yet the study of brain function has much deeper historical roots. For example, the author of the Edwin Smith Surgical Papyrus, written about 1000 BCE (but derived from an older treatise from about 3000 BCE), knew that different types of head injury produce different symptoms. At the very beginning of formal science in the sixth century BCE, several of the pre-Socratic natural philosophers (particularly the ones who were also physicians) were aware of the hegemony of the brain in sensation, movement, and mentation.

  The four chapters in this part of the book span this long history. The first deals with trepanation, or cutting holes in the skull. It was practiced among the Neolithic Peruvian Indians and, through subsequent centuries, all over the world; it is advocated even today on the Internet for “enhancing” consciousness.

  The second chapter deals with an experimental demonstration in classical times that was aimed at proving the role of the brain as opposed to the heart in cognition and emotion. The controversy between head and heart as the seat of mind stretches from the time of preliterate cultures well into the Renaissance.

  The third discusses another question that dates to ancient Greece, namely whether vision involves something going into the eye or coming from it—a question that seems still unresolved among contemporary undergraduates. This question bears on both the “evil eye” and the feeling of being stared at.

  The final chapter in this part concerns a more modern problem, one that has extended from the nineteenth century until today: the role of the cerebral cortex in producing movement of the body.

  1

  A HOLE IN THE HEAD: A HISTORY OF TREPANATION

  The oldest known surgical procedure is trepanation or trephination, the removal of a piece of bone from the skull. It was practiced from the late Paleolithic period and in virtually every part of the world. It is still used in both Western and non-Western medicine. We consider the methods and motives of trephining in different times and cultures.

  A PERUVIAN SKULL

  In 1865, in the ancient Inca city of Cuzco, Ephraim George Squier, explorer, archeologist, ethnologist and U.S. charge d’affaires in Central America, received an unusual gift from his hostess, Señora Zentino, a woman known as the finest collector of art and antiquities in Peru. The gift was a skull from a vast nearby Inca burial ground. What was unusual about the skull was that a hole slightly larger than a half-inch square had been cut out of it (see figure 1.1). Squier’s judgment was that the skull hole was not an injury but was the result of a deliberate surgical operation known as trepanning and furthermore, that the individual had survived the surger
y.1

  When the skull was presented to a meeting of the New York Academy of Medicine, the audience refused to believe that anyone could have survived a trephining operation carried out by a Peruvian Indian.2 Aside from the racism characteristic of the time, the skepticism was fueled by the fact that in the very best hospitals of the day, the survival rate from trephining (and many other operations) rarely reached 10%, and thus the operation was viewed as one of the most perilous surgical procedures.3 The main reason for the low survival rate was the deadly infections then rampant in hospitals. Another was that the operation was only attempted in very severe cases of head injury.

  Figure 1.1

  The trephined Inca skull given to Squier, showed to Broca, and now residing in the American Museum of Natural History (Squier, 1877).

  Squier then brought his Peruvian skull to Europe’s leading authority on the human skull, Paul Broca, professor of external pathology and of clinical surgery at the University of Paris and founder of the first anthropological society. Today, of course, Broca is best known for his localization of speech in the third frontal convolution, “Broca’s area,” the first example of cerebral localization of a psychological function, but at this time his fame seems to have been primarily for his craniometric and anthropological studies.4

  BROCA AND MORE SKULLS

  After examining the skull and consulting some of his surgical colleagues, Broca was certain that the hole in the skull was due to trephination and the patient had survived for a while. But when, in 1876, Broca reported these conclusions to the Anthropological Society of Paris, the audience, as in the United States, was dubious that Indians could have carried out this difficult surgery successfully.5

  Seven years later a discovery was made in central France that confirmed Broca’s interpretation of Squier’s skull, or at least, demonstrated that “primitives,” indeed Neolithic ones, could trephine successfully. A number of skulls in a Neolithic gravesite were found with roundish holes 2 or 3 inches wide. The skulls had scalloped edges as if they had been scraped with a sharp stone. Even more remarkable, discs of skull of the same size as the holes were found in these sites. Some of the discs had small holes bored in them, perhaps for stringing as amulets. Although a few of the discs had been chiseled out after death, in most cases it was clear from the scar formation at the wound’s edge that the interval between surgery and death must have been years. Trephined skulls were found of both genders and of all ages. Virtually none of the skull holes in this sample were accidental, pathological, or traumatic. Furthermore very few of the skulls showed any sign of depressed fractures, a common indication for trephining in modern times.6

  These findings finally established that Neolithic man could carry out survival trephination but left unresolved the motivation for this operation. At first, Broca thought that the practice must have been some kind of religious ritual, but later he concluded that, at least in some cases, it must have had therapeutic significance. Broca actually wrote more papers on prehistoric trephination and its possible motivation than he did on the cortical localization of language.7 Since Broca’s time thousands of trephined skulls have been found and almost as many papers written about them. They have been discovered in widespread locations in every part of the world in sites dating from the late Paleolithic to this century. The usual estimates for survival of different samples of trephined skulls ranges from 50% to 90% with most estimates on the higher side.8

  METHODS OF TREPHINING

  Across time and space five main methods of trephination were used.9 The first was rectangular intersecting cuts as in Squier’s skull (figures 1.1 and 1.2). These were first made with obsidian, flint, or other hard stone knives and later with metal ones. Peruvian burial sites often contain a curved metal knife called a tumi, which would seem to be well suited for the job. (The tumi has been adopted by the Peruvian Academy of Surgery as its emblem.) In addition to Peru, skulls trephined with this procedure have been found in France, Israel, and Africa.

  The second method was scraping with a flint as in skulls found in France and studied by Broca. Broca demonstrated that he could reproduce these openings by scraping with a piece of glass, although a very thick adult skull took him 50 minutes “counting the periods of rest due to fatigue of the hand.”10 This was a particularly common method and persisted into the Renaissance in Italy.

  Figure 1.2

  Different methods of trephining: (1) scraping; (2) grooving; (3) boring and cutting; (4) rectangular intersecting cuts (Lisowski, 1967).

  The third method was cutting a circular groove and then lifting off the disc of bone. This is another common and widespread method and was still in use, at least until recently, in Kenya.

  The fourth method, the use of a circular trephine or crown saw, may have developed out of the third. The trephine is a hollow cylinder with a toothed lower edge. Its use was described in detail by Hippocrates.11 By the time of Celsus, a first-century Roman medical writer, it had a retractable central pin and a transverse handle. It looked almost identical to modern trephines including the one I used as a graduate student on monkeys.12 (See figure 1.3.)

  The fifth method was to drill a circle of closely spaced holes and then cut or chisel the bone between the holes. A bow may have been used for drilling or the drill simply rotated by hand. This method was recommended by Celsus, was adopted by the Arabs, and became a standard method in the Middle Ages. It is also reported to have been used in Peru and, until recently, in North Africa. It is essentially the same as the modern method for turning a large osteoplastic flap in which a Gigli saw (a sharp-edged wire) is used to saw between a set of small trephined or drilled holes.13 (I used this method as a graduate student, too.)

  “TREPAN” VERSUS “TREPHINE”

  The relationship between the terms trepan and trephine is a curious one. The terms are now synonyms but have different origins and once had different meanings. In Hippocrates’ time the terms terebra and trepanon (from the Greek trupanon, a borer) were used for the instrument that is very similar to the modern trephine. In the sixteenth century Fabricius ab Aquapendente invented a triangular instrument for boring holes in the skull. (He was Harvey’s teacher and the discoverer of venous valves.) It had three arms with different-shaped points. Each of the ends could be applied to the skull using the other two as handles. He called it a “tre fines” from the Latin for three ends, which became trafine and then trephine, and by 1656 it was used as a synonym for trepan, as a term for the older instrument. In another version of the etymology, a quite different triangular instrument for boring a hole in the skull was invented in 1639 by John Woodall, a London surgeon, who also called his instrument a tres fines, which became trefina and then trephine and, eventually, a synonym for trepan. More generally, in Renaissance times and later, trephination was a popular operation and a great variety of instruments for carrying it out were invented.14

  Figure 1.3

  A seventeenth-century naval surgeon’s trephination kit (Woodall, 1639). The trephines are very similar to both ancient Roman and modern ones (Wilkins, 1997).

  WHY TREPHINE?

  Why did so many cultures in different periods cut or drill holes in the skull? Since most trephined skulls come from vanished nonliterate cultures, the problem of reconstructing the motivations for trephining in these cultures is a difficult one. However, there is information about trephining in Western medicine from the fifth century bce onward as well as about trephining in recent and contemporary non-Western medical systems. Both of these sources may throw light on the reasons for the practice in earlier times. In the following sections we consider trephination in Hippocratic medicine, in ancient Chinese medicine, in European medicine from the Renaissance onward, in contemporary non-Western medicine, and on the Internet today.

  GREEK MEDICINE

  The earliest detailed account of trephining is in the Hippocratic corpus, the first large body of Western scientific or medical writing that has survived. Although there is no question that there was a
famous physician called Hippocrates in the fifth century BCE, it is not clear which of the Hippocratic works were written by him. The most extensive discussion of head injuries and the use of trephining in their treatment is in the Hippocratic work On Wounds in the Head. 15

  This treatise describes five types of head wounds. Interestingly, however, the only type for which trephination is not advocated is in cases of depressed fractures. Even when there is not much sign of bruising, drilling a hole in the head is recommended. The trephining instrument was very similar to the modern trephine, except that it was turned between the hands or by a bow and string rather than by using a crosspiece. The Hippocratic writer stressed the importance of proceeding slowly and carefully in order to avoid injuring the [dural] membrane. Additional advice was to “plunge [the trephine] into cold water to avoid heating the bone . . . often examine the circular track of the saw with the probe. . . . [and] aim at to and fro movements.”16 Trephining over a suture was to be studiously avoided.

  Apparently the Hippocratic doctors expected bleeding from a head wound and the reason for drilling the hole in the skull was to allow the blood to escape (“let blood by perforating with a small trepan, keeping a look out [for the dura] at short intervals”). Since they presumably had no notion of intracerebral pressure, why did they want the blood to run out? Although the reasons for trephining are not discussed in On Wounds in the Head, they seem clear from other Hippocratic treatises such as On Wounds and On Diseases. The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled. In cases of depressed fractures, there was no need to trephine since there were already passages in the fractured skull for the blood to escape.17