Guest blog-post by Matthew Weldon, final year Neuroscience student who undertook a public engagement project, looking at the revolutionary work of Sir William Macewen with regard to the brain and how it relates to neuroscientific practices today.
Sir William Macewen
William Macewen enrolled at the University of Glasgow in 1865 to study medicine. During his time at the university, he was taught by Joseph Lister, even becoming his dresser. He graduated in 1869, though his results were unremarkable. The same could not be said of the life that was to follow.
In the decade after his graduation, Macewen occupied a variety of positions. He worked in several hospitals across Glasgow, including the Western Infirmary and the Royal Infirmary. His time with Lister evidently left an indelible impression, as Macewen was extremely fond of employing antiseptic methods of surgery. To this end, he commissioned the production of steel surgical instruments, made from a single piece of metal, to allow for sterilisation and avoid infection. This was of particular importance in the Macewen’s pioneering brain surgery.
To learn more about Macewen on the University Story website, click here.
Removing a Brain Tumour
In 1879 while working in the Royal Infirmary Macewen became the first person to remove a brain tumour. The individual he removed the tumour from was a 14-year old girl called Barbara Watson. She had been seen by Macewen a year before, as she had been suffering from a tumour growing above her eye. He removed the tumour, but within a few months it began to grow back.
When the tumour had grown to around the size of a kidney bean, Watson once again found herself being examined by Macewen. Macewen was simply going to remove the tumour again, but before he could Watson started showing signs that there was something more substantial amiss. She started convulsing, and nurses attending to her assured Macewen that epilepsy was not the cause.
Macewen put in to practice a technique called “cerebral localisation”. This technique has the practitioner observe and note a patient’s symptoms and, based on this information, determine the site of damage within the brain. Macewen concluded that without surgery Watson would die. Guided by his observations, Macewen determined where the problem was and cut into the skull. He found a tumour adhering to the removed skull bone and spread out across the dura mater, one of the brain’s protective coverings. In some areas, it was more than an inch thick. Macewen removed as much as he could.
Barbara Watson lived relatively healthily for the next 10 years, before dying of a disease of the kidneys. Post-mortem examination of Watson revealed that there had been no recurrence of the tumour. Macewen’s operation was a remarkable success.
Click here to learn more about Macewen’s contributions to surgery on the website of the Royal College of Physicians and Surgeons of Glasgow.
Macewen’s use of cerebral localisation in Barbara Watson’s brain surgery would not have been possible without the work of his contemporaries. The decade before the surgery was a time of intense research into the brain in an attempt to elucidate as much about brain function as possible.
John Hughlings Jackson was a medical practitioner who carefully watched his patients and noted down observations as to their behavioural symptoms. He then drew correlations between these symptoms and the damage to the brain he observed post-mortem. He determined that different areas of the brain had different functions. The work of Gustav Theodore Fritsch and Edvard Hitzig in 1870 supported this. They applied electrical stimulation to a dog’s cerebrum. They were able to induce movements in limbs on the opposite side of the body (i.e. stimulating a certain region on the right hand side of the brain would result in movement of a limb on the left hand side of the body). Furthermore, damage to these areas weakened the limb.
Another Scottish physician, David Ferrier, built upon this research while working in (what was then known as) West Riding Lunatic Asylum. He showed that, in the human brain, applying electrical current could again induce movement of the limbs, as well as fits. He went on to produce a map of sorts of localised brain function in several species, and through his clinical work related his findings to his patients. Ferrier began advocating for surgical intervention in cases of suspected brain lesions, using cerebral localisation as a guide.
Research into the brain is of course very different today. Our knowledge of the brain now is much greater than it was in the time of Macewen. We understand the brain at the cellular level much better, thanks to many innovations developed over the course of the last 140 years. Not only that, we have a much better understanding of the localisation of brain function too.
Complicated techniques like functional magnetic resonance imaging (fMRI) allow us to see changes in blood flow within the brain in real time. If the flow of blood to a particular area increases while someone is carrying out a certain task, then we can assume that area of the brain is working harder than normal, and therefore infer that this specific area is involved in this specific task.
Another such technique is called Transcranial Magnetic Stimulation (TMS). TMS allows us to choose an area of the brain and stimulate it- and then we can observe the effects by asking the patient what they feel. For example, some people report that when the visual area of the brain is stimulated then they see a bright flash of light. This is a bit like the studies by Fritsch and Hitzig mentioned earlier, except this time electrical current isn’t being applied to the brain of a dog, the human brain is being harmlessly magnetically stimulated.
Diagnosis of cases like Barbara Watson’s also occurs differently now. There may be an element of cerebral localisation employed, but we have powerful imaging tools available to us now. MRI allows us to look in to the body of a living person and identify tumours. One can imagine how much easier such inventions would have made William Macewen’s life. To find out more about neuroscience research at the University of Glasgow, click here.
Matthew would really appreciate some feedback on this blog-post for his course work and if you would like to help him gather some statistics, please answer the questions in these polls- your answers are anonymous and greatly appreciated. Thank you!
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