Harley Smyth (M.A., M.D., D.Phil. Oxon.) is a Canadian neurosurgeon whose career was deeply influenced by a series of encounters with Wilder Penfield (1891-1976), a pioneering American-Canadian neurologist, neurosurgeon, and founder of the Montreal Neurological Institute. In the spring of 1924, Penfield travelled to Spain with the express purpose of studying with Santiago Ramón y Cajal and his fellow neuroscientist Pío del Río Hortega at the Residencia des Estudiantes, Laboratorio de Histopatología, in Madrid. Cajal,who won the Nobel Prize jointly with the Italian Camillo Golgi in 1906, is best known for the neuron doctrine, or the idea that the brain is composed of individual cells, and for his thousands of extraordinary drawings of the microanatomy of the brain, still unequalled in accuracy and beauty. Río Hortega discovered microglia, the cells that protect the brain from infection. Penfield, who together with Río Hortega discovered oligodendroglia — the cells which support and protect the axons of the central nervous system — is best known for his work on the cortical basis of higher function and for his innovations in epilepsy surgery.
The Residencia des Estudiantes, where Penfield went to learn from Cajal, was conceived as a center for artistic and scientific innovation and exchange. It flourished during Spain’s Silver Age, a period of tremendous creativity and experimentation in the decades leading up to the Spanish Civil War. Albert Einstein visited the Residencia in 1923, just a year before Wilder Penfield. Poet Federico Garcia Lorca was there during the same time as Penfield, as were filmmaker Luis Buñuel and artist Salvador Dalí.
Just as Penfield was profoundly influenced by the burgeoning interdisciplinary atmosphere of the Residencia de Estudiantes, Harley Smyth was influenced by Penfield, the person who connected him to Cajal in the lineage of modern neuroscience.
You are just one degree of separation from Santiago Ramon y Cajal, the father of modern neuroscience. Tell me how you came to meet Wilder Penfield, the man who is the connector between you and Cajal.
At the age of fourteen I had decided to become a neurosurgeon. I recall having read a Maclean’s magazine article about Wilder Penfield. It featured the famous Karsh photograph of Penfield at his microscope, and I think the caption was “A musing genius.” This gave me an introduction to Wilder Penfield and his vision. My uncle, a military physician, was interested in fostering any medical interest that I had, and he somehow arranged that I could meet with Dr. Penfield if I went to Montreal. I travelled by train from Ottawa to Montreal at the age of fifteen. I found my way to the Montreal Neurological Institute and entered its picturesque lobby. A copy of the sculpture entitled La Nature se dévoilant à la Science stood centrally. On a nearby wall hung a splendid autographed portrait of Pío del Río Hortega. It was a revealing introduction to the spirit of the Institute. I met with Dr. Penfield and was fascinated by my first viewing of a neurosurgical operation.
The next chapter was my entry into medical school at Queen’s University just two years later, in 1957, at the age of seventeen. It was because of Dr. Penfield that the first book I bought as a first-year pre-medical student was a graphic biography of Cajal. In the penultimate year of medical school I spent a long summer in Uganda and worked there with Dr. Denis Burkitt, who was making the first causal connection between a virus and a human cancer, Burkitt’s lymphoma. I was fascinated by Burkitt’s elegant blending of climate, rainfall, and epidemiology as an example of interdisciplinary original research. Later that year I was a successful applicant for a Rhodes Scholarship, and now that I knew I was headed for Oxford and an attempt at research experience, I wrote once again to Dr. Penfield. I wrote that, “I’ve tried to follow in your footsteps, and somehow or other I’ve won a Rhodes Scholarship. I’ve written to Oxford to attempt to plan my studies, but I never received any reply.” Penfield said, “Well, Smyth, nobody ever returns letters from Oxford. Why don’t you come see me, and we’ll talk about what you can do.” I went to Montreal and met with him again. That evening he attended our Rhodes Scholars’ Sailing Dinner where he addressed the departing scholars.
In the course of that evening, Penfield said, “Here’s what worked for me at Oxford.” Penfield had been going back and forth from England to France to help at military hospitals; he was a wound-dresser at World War One hospital stations in France between terms at Oxford. On the return journey of one of these trips, his ship was torpedoed by an early German U-boat and his leg was shattered into several pieces. He ended up, amazingly, being taken back to Oxford to 13 Norham Gardens, the residence of the Regius Professor of Medicine, Sir William Osler, the great Canadian physician. Penfield was nursed by Lady Osler, and thus became acquainted with Sir William Osler. Wilder Penfield was an American-born Rhodes Scholar, from Wisconsin, and Lady Osler was American — she was a Revere, descended from Paul Revere — their son was named Revere, and he was fighting in France.
Sir William said to him, “Now, Penfield, I think you should meet Sir Charles Sherrington. He is a neurophysiologist, and his research is in neurology.” That was the very first inkling that Wilder Penfield had that he would be involved in neuroscience. Sherrington was a poet, a philosopher, and a scientist. Penfield worked with Sherrington in his laboratory for several months learning about reflexes and nerve conduction and neurology. Then Penfield conceived the idea that he would like to be involved in research in curing epilepsy. Why? Because his sister had epilepsy. He determined that the clue to working in neurology in a way that would actually be practically applied to the welfare of patients was to find out what caused epilepsy. He suspected that it was scarring on the cortex, and that to understand what caused the scarring, he needed to understand every set of cells present in the cortex. As he sought this basic knowledge, he learned that Cajal was working in Madrid, and that he had produced these marvelous microdemonstrations of the infrastructure of the cortex.
Cajal was not multilingual; most of his work was published in Spanish. Penfield decided to go to Madrid to learn more of this original work. What Penfield understood, and this is the amazing thing to me, is the absolute importance of learning about the histocytology of the central nervous system, and learning what its actual structure was. Penfield and his wife and child went to Madrid. He found Cajal in a profound depression for part of the time of his visit, perhaps because most of his original work had not been published in the wider world.
To return to Penfield’s advice to you, though, what did you do about it when you arrived in Oxford?
In Montreal, Penfield had advised that as soon as I arrived in Oxford, I should make an appointment to meet the current Regius Professor of Medicine, Sir George Pickering. I did, and I found myself in the former residence of Sir William Osler. Pickering was resting in his bedroom after an international tour of lectures. I told him that Penfield had sent me, and that I was looking for advice about how best to spend the year or two of my Rhodes Scholarship. He said, “Smyth, you should study Schools. It’s our very best scientific degree, The Honours School of Animal Physiology.” I went to discuss it with the tutors at Balliol College, and they agreed to help me along. My tutor was none other than Denis Noble, who was in his first year of teaching at Oxford. I was his first student. He had just completed famous work in Imperial College London, where he had rewritten the Hodgkin-Huxley equations for nerve conduction, and applied them to the nervous system of the heart, the Purkinje fibers. He was a brilliant young biophysicist and physiologist.
I set to work learning the history of physiology, how it was formed, and what kind of critical thinking was involved in designing experiments. The graduates of this course were meant to emerge as independent researchers with an ability to design an experiment. Sir George Pickering was a leader in the field of human clinical experimental medicine and a leading world authority on high blood pressure. His team designed experiments to study actual human physiology, rather than primarily operating on animals. Schools was a three-year course, but I began to think I might write the exams in one year — I was so short of time and money. I took the exams at the end of that year and got a First.
I then went to see Sir George Pickering again, and he asked me come to work with him. I said to him, “What I really want to do is to find out how the brain lowers the blood pressure during sleep.” In the summer term of 1965, I returned to the Montreal Neurological Institute where I learned how to study human sleep. During the course of my research back in Oxford, which would take three more years, Dr. Penfield came for a Rhodes Scholars Dinner one November. It brought full circle that first meeting I had with him when I was fifteen. I took him and Mrs. Penfield in my Morris Mini-Minor in the pouring rain to see the Canadian maple tree they had given to Sir George Pickering to plant in his garden in memory of Sir William Osler. This was eleven years after we first met. Our last contact was when I invited Dr. Penfield to come and give his final lecture, on cortical stimulation, at the Toronto Academy of Medicine. I think he was seventy-six at the time.
You and I met many years ago singing sacred polyphonic music of the renaissance, sixteenth century English polyphony, and Gregorian chant. The halls of the Residencia de Estudiantes, where Wilder Penfield went to study with Santiago Ramón y Cajal in 1924, were filled with music, and it is likely that Penfield crossed paths with Lorca, Buñuel, and Dalí when he was there. As a neurosurgeon, what does art mean to you?
Art and the humanities in general are inseparable from science in the world of learning. Your exhibit ties beautifully together the abilities of Cajal as both an artist and a scientist. Perhaps very early on I was aware that medical studies and neurosurgery threatened to be too narrowing, too focused, too exclusive. I feared I would not have a broad education and I did my best to study Latin and Greek, Philosophy and English during my pre-medical years at Queen’s. I would attempt this grounding before I got lost in science. Again, Penfield was my exemplar, writing in other genres, championing the learning of second languages in youth, and lending his influence to the Vanier Institute for the Family.
I loved your reflection on our shared experience of singing. I thought about the Residencia in Madrid. You mentioned Lorca, Buñuel, and Dalí. Penfield himself reflected that many influential people there were involved in deeply humanitarian concerns and were leaders in a movement that would culminate in the Spanish Civil War. I like to think that there might have been a chapel or church near enough to the Residencia to enable the students to hear the music of a Mass by Tomás Luis de Victoria, the great Spanish renaissance composer. Perhaps not many of those radicals went to Mass, but Penfield himself said that even the scientists in that place and time were as much involved in humanistic reforms as they were in science.