The Tale of the Dueling Neurosurgeons by Sam Kean

Source of book: Borrowed from the library

Like a kid waiting eagerly for the next comic book to come out, I find myself checking to see when the next Sam Kean book will arrive. And then, I have to wait until the initial rush dies down so I can get it from the library. I went ahead and bought his first book, but I have, alas, limited shelf space, so I have been trying to pace myself.

For those who are interested, here are my reviews of his other books:

The Disappearing Spoon

The Violinist’s Thumb

Sam Kean’s books are best described as pop science. These are not textbooks by any means, but they do explore a particular area in enough detail to be informative. The best thing about the books, though, is the way that Kean uses stories to make the concepts real and memorable.

The Case of the Dueling Neurosurgeons is all about the brain and its function. It opens with the story of King Henri II of France, who had a lance shoved through his eye and into his brain, and ends with the famous, yet often mis-reported, case of Phineas Gage, who had an iron rod blown through his head in a freak blasting accident. In between are a myriad of interesting persons who inadvertently furthered the science of the brain by suffering damage to one part or another. Along the way, Kean introduces the many doctors and scientists who gradually pieced together the function and layout of the brain. Both patients and doctors were often fascinating characters, with unique stories of their own.

The book takes its title from the two celebrity physicians called in to attempt to save Henri’s life. They failed, unfortunately, but in the process of trying, they discovered firm evidence that the brain can be harmed even if the skull is intact. The first doctor was Ambroise Paré, famous for pioneering a scientific approach to evaluating the effectiveness of a treatment - but even more so for his line, “I treated him. God healed him.” The other was Andreas Vesalius, whose illustrated anatomy book, On The Fabric of the Human Body, was the first to really show body structures in scientific detail. The drawings are beautiful, but the methods he had to use to obtain corpses were a bit morbid.

There are a few other characters that I found particularly interesting. Several presidential assassins are featured, because their brains were studied after they were executed. In the one case (president Garfield’s killer), there was clear evidence of brain damage, while in the other (McKinley’s), there was no obvious sign of a physical problem. (There was other evidence of mental illness, just not physical signs of damage.)

Of particular interest to a lawyer was the case of Supreme Court Justice William Douglas, who suffered a stroke, but remained in denial of the damage done. In fact, the very area damaged was one that affected his ability to realize his disability. (Apparently, this is a common issue with strokes that occur in the Parietal Lobe.) In an interesting coincidence, the same problems had disabled president Woodrow Wilson a generation earlier. He likewise could not comprehend that he wasn’t the same as before, and it fell to his wife (who should get credit as the first female president) to keep him out of sight and run the country in his stead.

The most crazy story, in my opinion, and the one that still bends my brain every time I think about it, is that of conjoined twins Tatiana and Krista, who share significant brain structures, and cannot be separated. They experience a weird sharing of consciousness, in which they are two separate persons, but not quite. Tastes and sensations are often shared, which gets interesting when a taste is something one twin likes but the other hates. It’s messy and forces one to grapple with the complex interplay between the “self” and one’s sense of it and the physical biological brain which gives rise to that very consciousness.

In fact, that is probably the part of the book that is most philosophical. Since we discovered the function of the brain, there has been a search for how the brain as a biological structure gives rise to consciousness. Traditionally, there has been a belief in a mind/body duality - religion would describe this as a soul/body dichotomy. To some scientists, this is all an illusion. Consciousness - and the essence of ourselves - is merely a function of biology, the brain doing its work. This question then leads into the concept of free will and whether it actually exists. One can go down the rabbit hole really fast here. At some level, we at least experience something that resembles a “mind,” and we have built our government and our own lives on the idea that we do have the ability to exercise free will, and thus moral agency. And yet, the way this works with our brains is hardly clear. We do know that the experience of consciousness can be affected by damage to the brain, so the two are intertwined - or are the same thing - take your pick. It’s not just philosophers and theologians who debate this either. Scientists are hardly in agreement about this too.

Another topic which I found interesting was that of Synesthesia, which causes the brain to associate things that we don’t generally associate. For example, numbers will have colors or smells, or words might have taste. (One wonders if the author of The Phantom Tollbooth either had this condition, or knew someone who did.) I have a friend with this, and it is quite interesting to talk to her about the personalities of numbers and letters. Kean tells of a man, though, with a particularly severe form, which enabled him to have a photographic memory, but caused him great distress and inability to function due to the overwhelming and uncontrollable associations.

Kean has a bit of wit of his own, and one particularly memorable example was his invention of a term to describe the result of damage to a particular language processing center. People with damage to this area can string together sentences of words, often with great rhythm - but the words are not connected and make no sense. The official term is “word salad,” but Kean coined the term “Finnegan’s Wake Syndrome.”

One final bit of fun that I should mention is the fact that Kean’s earlier book, The Violinist’s Thumb, which was about genetics, has an illustration of DNA on the cover. The problem is, the spiral is backwards. Which nobody caught before the book was published. Kean mentions this in connection with Mad Cow Disease, where a misshapen protein causes damage by influencing other proteins to deform. Shape - and direction of twist - are important to life, and a backwards molecule can kill.

Obviously, I have barely scratched the surface of this book. There is so much more. I highly recommend this book, and Kean’s other books, as great introductions to fascinating scientific topics. The concepts stick in the mind because of the memorable stories and Kean’s engaging way of telling them.