Wilder Penfield and the Architecture of Collaboration
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
When the pioneering neurosurgeon Wilder Penfield moved from New York to Montreal in 1928, he arrived with a passion to “find a way of understanding what the brain did and how it did it” (2, p. 133). To this end, Penfield envisioned a multidisciplinary team that would work in a neurological institute where patient care and research had equal priority.
In 1929, Penfield outlined his plan in a letter to Edward William Archibald, Department of Surgery Chair at RVH, enclosing a sketch on hotel stationery (Figure 1). This paradigmatic, “back of the envelope” drawing captured what Penfield had in mind. Penfield’s future institute would connect with RVH—an embodiment of facilitated collaboration between clinicians and basic science researchers.
FIGURE 1. Sketch of a proposed version of the Montreal Neurological Institute, drawn by Wilder Penfield in 1929a
aThis is a sketch of a proposed version of the Montreal Neurological Institute [MNI]. It was drawn by Wilder Penfield in 1929 on letterhead from the Biltmore Hotel in New York. The sketch shows a seven-story building with floors for an X-ray department, patients, laboratories, and the housing of laboratory animals. The proposed institute is shown as being directly next to the Royal Victoria Hospital (RVH), rather than at its eventual location, across University Avenue from the RVH (1). Adapted with permission from the Osler Library of the History of Medicine, McGill University, Montreal.
Many factors influenced Penfield’s vision. After beginning to write a book on the fundamental principles of neuropathology, he had realized that “far too often…someone else, somewhere in the world…could write a better chapter” (2, p. 129). Seeing the value of a selected team, he shifted his role from sole author to editor.
Penfield also valued research with clinical applications, having observed that breakthroughs in basic science research were unpredictable, while the needs of patients were ever-present. Indeed, Penfield’s letter to Archibald (3) was written only 6 weeks after Penfield had operated on his own sister’s brain tumor: “The resentment I felt because of my inability to save my sister spurred me on to make my first bid for an endowed neurological institute” (2, p. 221).
Although psychiatry was not a core discipline at the inaugural institute, Penfield always envisioned a role for psychiatry. In original discussions with Rockefeller Foundation physician-philanthropist Alan Gregg, Penfield noted, “[N]eurology, neurosurgery, and psychiatry eventually should be joined together somehow in thought and plan, in the laboratory for scientific study, and in teaching” (2, p. 296).
Penfield’s vision came to fruition in 1934 as the MNI, funded by the Rockefeller Foundation and private donors. Penfield was involved in planning virtually every detail of the building, including innovations to facilitate the mission; for example, buzzers in operating rooms could call fellows from their laboratories once a patient’s brain had been exposed (4, p. 149). The MNI’s first annual report cited 939 patients cared for and an output of 39 scientific publications (5).
As fundamental as the architecture was, Penfield asserted that the enterprise of scientific discovery was the crucial factor in binding a team together: “It is not the building…It is something beyond all that, something that may be compared to the spirit of a group of explorers” (6, p. 6). Penfield led his expeditionary team to investigate what he called “the most promising unexplored body of knowledge in the whole field of medicine” (2, p. 296).
Since Penfield’s time, “architecture” that supports collaboration has expanded with the development of the Internet. Multidisciplinary teams now frequently number in the hundreds, span the globe, and include not only specialists from medicine, surgery, and psychology but also neuroscientists, data scientists, physicists, biomedical engineers, and geneticists.
References
1.
McGill University: First proposed diagram of the Montreal Neurological Institute, diagram. Montreal, Osler Library of the History of Medicine, McGill University. http://digital.library.mcgill.ca/penfieldfonds/fullrecord.php?ID=10397
2.
Penfield W: No Man Alone: A Neurosurgeon’s Life. New York, Little, Brown and Company, 1977
3.
McGill University: Letter from Wilder Penfield to Edward Archibald: Jan 18, 1929. Montreal, Osler Library of the History of Medicine, McGill University. http://digital.library.mcgill.ca/penfieldfonds/fullrecord.php?ID=9955
4.
Jefferson L: Something Hidden: A Biography of Wilder Penfield. Halifax, Nova Scotia, Doubleday Canada Unlimited, 1981
5.
Montreal Neurological Institute: 1st Annual Report, 1934–1935. Montreal, Osler Library of the History of Medicine, McGill University. http://digital.library.mcgill.ca/penfieldfonds/fullrecord.php?ID=10462
6.
Montreal Neurological Institute: 24th Annual Report, 1958–1959. Montreal, Osler Library of the History of Medicine, McGill University. http://digital.library.mcgill.ca/penfieldfonds/fullrecord.php?ID=10485
Information & Authors
Information
Published In
History
Accepted: 27 February 2019
Published in print: Fall 2019
Published online: 15 October 2019
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Author Contributions
Drs. Schildkrout and MacGillivray share first authorship.
Funding Information
National Institute of Health: P01 AG019724, P50 AG023501
National Institute of Aging: T32 grant AG 23481-13, T32 grant AG AG031189
Michael J. Homer Family Fund: 000000000
This Icons in Neuropsychiatry was a project of the Neuropsychiatry Committee of the Group for Advancement of Psychiatry.The authors report no financial relationships with commercial interests.Metrics & Citations
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