The Tale of the Dueling Neurosurgeons: The History of the Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery

by Sam Kean

  Scientists at the time already knew that the nervous system contained two main types of cells, neurons and glia. (Neurons process thoughts and sensations in the brain, and also make up the bodies of nerves. Glia, meaning “glue,” hold neurons in place and provide nutrients, among other jobs.) Golgi, however, became the first person to see these cells in anything like full detail. The rounded glia with their wispy tentacles astounded him, like black jellyfish frozen in amber. The neurons looked equally exotic, being composed of three distinct parts. Each neuron had a circular central body; an intricate bush of “dendrite” branches sprouting from the body; and a glorious “axon,” an arm that spooled out incredibly far from the body, twisting and turning for microscopic miles before erupting into its own tiny branches at the far tip. Golgi deduced that neurons must communicate via their axons, since the branches at the far tip were often entangled with other neurons. In fact, the axons were so closely entangled that Golgi could see no space between neurons, and he came out as a strong supporter of reticulum theory.

  Other neuroscientists, including Santiago Ramón y Cajal, found la reazione nera every bit as enchanting as Golgi did. “[It] renders anatomical analysis both a joy and a pleasure,” Cajal gushed, and he compared the stains to “fine India ink drawings on transparent Japanese vellum.” That’s awfully specific, but Cajal would know: he’d aspired to be an artist while growing up in Spain. That dream ended at age ten, however, when a local landscape painter declared Cajal talentless, prompting the boy’s father to seize his brushes and easels and enroll him in a Jesuit school. Bored and angry, Cajal began lashing out, and at age eleven was jailed for building a cannon from an oil drum and blowing down a neighbor’s gate. Cajal’s father tolerated this, but when the boy’s grades started slipping, he yanked him from school and apprenticed him to a barber. Suddenly appreciative of his education, Cajal reenrolled in school and began studying various topics in medicine, including hypnosis. He settled on neuroscience, and Golgi’s reaction opened his eyes to the beauty of the field, allowing him to fuse neuroscience with art.

  However much he adored Golgi’s artistry, though, Cajal disagreed with Golgi’s conclusions, especially about the brain’s gray matter. Anatomically, the brain contains two distinct substances, gray matter and white matter. Gray matter has a high percentage of neurons, and most gray matter resides on the brain’s surface, in a wrinkly rind called the cortex. (Or at least most gray matter resides near the surface: two-thirds of the cortex is actually invisible from the outside, being corrugated and folded up just beneath the surface. If unfolded and smoothed out, the cortex would be the rough size of a pillowcase, but would be only one-tenth of an inch thick.) After inspecting hundreds of stains with his microscope, Cajal saw that the gray matter didn’t look at all like what Golgi claimed, with all the neurons fused together. Cajal saw discrete neurons. Moreover, when Cajal strangled a few neurons as an experiment and let them wither, the decay always stopped at the border of the next neuron instead of killing it, too, as you’d expect if both were really fused together.

  Cajal also rejected Golgi’s metaphor for the macro organization of brain cells: rather than a horizontally spread neural hairnet, Cajal saw neurons arranged into tiny vertical “columns” of around one hundred neurons each—little stacks that covered the surface of the brain like stubble. Axons from one column did sometimes reach horizontally into neighboring columns, Cajal admitted, but vertical organization

  * was the general rule.

  Finally, while Golgi believed that neurons communicated exclusively via their axons, Cajal ruled otherwise. Near the eyes, for instance, Cajal saw dendrites turned toward the retina, poised to absorb information. And within long chains, neurons usually lined themselves up axon to dendrite, one after the other. Indeed, the axons of one neuron “fit” into the dendrites of the next neuron like a hundred-fingered hand sliding into a hundred-fingered glove. All this could mean only one thing: neurons might speak with axons, but they listened with dendrites. Both were essential for communication.

  Gorgeously intricate neurons drawn by Santiago Ramón y Cajal, a neuroscientist and sometime artist.

  Cajal himself.

  These findings led Cajal to propose the “neuron doctrine,” one of the most important discoveries ever in neuroscience. In brief, Cajal’s neurons were not continuous, but had tiny gaps between them. And they transmitted information in one direction only: from dendrite to cell body to axon. That is, no matter the signal (food! tiger! hubba-hubba!), it always entered a neuron through its dendrites; passed through the cell body for processing; and only then shunted down the axon. (I think of this progression, reverse-alphabetically, as d → cb → a.) When the signal reached the axon tip, the neuron then tickled the dendrites of the next neuron in line, and the process started over. Golgi might have seen the true shape of neurons first, but Cajal first determined how those silhouettes worked.

  Still, Cajal found the neuron doctrine a tough sell. He actually had to launch his own journal to propagate his ideas, and even this didn’t help, since few medical scientists bothered reading Spanish journals. So in 1889 he staked his career on traveling to a conference in Germany, the world’s greatest scientific center, even paying his own way when his university refused. Luckily for him, his gorgeous freehand drawings of neurons won him some converts. And over the next decade the neuron doctrine gained a foothold in scientific circles—albeit grudgingly. Many scientists still refused to believe Cajal, and by 1900, two armies of neuroscientists had drawn up lines, with Golgi’s “reticulists” and Cajal’s “neuronists” despising each other more and more each year.

  History loves a good gag, though, so it was inevitable that Golgi and Cajal would share a Nobel Prize in 1906. Cajal groaned about this, lamenting the “cruel irony of fate, to pair, like Siamese twins united at the shoulders, scientific adversaries of such contrasting character.” In their acceptance speeches both men, especially Golgi, kept bashing each other’s “odious errors” and “deliberate omissions.” The Peace Prize this wasn’t.

  Ultimately, the neuron doctrine triumphed because it explained so much more. Even the unraveling of Charles Guiteau’s mind began to make sense. Guiteau’s autopsy found extensive damage to his glia, which support and nourish neurons. Minus that support, neurons languished and died—especially in his gray matter, which was reduced to a combover in spots. And even where neurons had survived, they often had fewer axon and dendrite branches than normal, further reducing their ability to communicate and process thoughts. In retrospect, Guiteau’s brain offered ugly but definitive proof of how neurons work, or fail to.

  Like all great discoveries, though, Cajal’s neuron doctrine opened up as many new questions as it answered. Most important: if neurons were separate, how exactly did a signal cross the gap between them? There seemed just two possibilities, electric currents or chemical pulses. Once again, each side in this battle had its partisans and stalwarts, with the “sparks” championing electricity and the “soups” championing a mélange of biochemicals. And once again, the dispute between them would bleed beyond the realm of neuroscience and color the debate over the sanity of an enigmatic assassin.

  Smile pump nudge. Smile pump nudge. Smile pump wink laugh smile pump nudge—on September 6, 1901, William McKinley was on. Throughout his five years as president, McKinley had adored mingling with crowds: flirting with housewives, tipping his hat to bankers, pinching the cheeks of beribboned girls. But to keep the lines of well-wishers from clotting, he’d developed the “McKinley handshake.” He’d smile broadly and intercept the person’s fingers above his palm, so he could disengage at will. He’d then cradle their elbows with his left hand and gently nudge them off balance, moving them aside and clearing room for the next mark. Smile pump nudge—fifty handshakes per minute. But while visiting Buffalo on September 6, a mustachioed foreigner outmaneuvered McKinley. He clasped the presidential palm and, even as one of McKinley’s guards lurched forward, held the shake suspiciously long. />
  The Pan-American Exposition in Buffalo had been wowing crowds for months, with bullfighting and mock Japanese villages and fountains fit for Versailles. The Trip to the Moon exhibit featured midgets dressed like aliens and serving green cheese, and the 389-foot Electric Tower—a spire illuminated with thousands of “electric candles” (i.e., lightbulbs)—shone so beautifully at night that people wept. McKinley’s four-day visit crowned the expo as the national event of the year, and McKinley responded by giving, on the afternoon of September 5, the finest speech of his presidency, about the boundless prosperity of the United States.

  Amid the cheering crowd of fifty thousand, though, one man—a laborer with a slight build, a thin mustache, and little hope of sharing in that prosperity—seethed. Leon Czolgosz had started working full-time at age ten, in 1883, and by 1893 was making four dollars a day spinning wire near Cleveland. But his mill cut wages during the 1893 financial panic and fired him when he joined a strike. A committed Republican before this, Czolgosz (chol-gawsh—think z = h) declared himself a socialist. The burgeoning socialist movement had clashed repeatedly with factory owners that decade, and the conflict had split the country ideologically. The brutal conditions in factories appalled most people, but Americans felt equally scared of the unruly mobs marching in the streets, rioting and spouting off about revolution.

  Czolgosz eventually got his job back under a false name. But his working career ended when he had a mysterious mental breakdown in 1898. He retreated to the family farm, where he loafed away most afternoons, occasionally doing mechanic jobs but mostly hunting rabbits and leafing through socialist tracts. He also became withdrawn, taking meals of raw milk and crackers alone in his room in the attic—possibly because he feared his stepmom, Catrina, wanted to poison him. (Shades of paranoia.) His one happy memory from these years came in July 1900, when he read in the newspaper that an Italian American silk weaver, Gaetano Bresci, had assassinated King Umberto I of Italy. Bresci’s bravery riveted Czolgosz, who clipped and kept the story.

  In May 1901, Czolgosz heard the anarchist leader Emma Goldman speak in Cleveland. Goldman sometimes glorified assassinations, and as Czolgosz later told his jailers, when he heard Goldman, “My head nearly split… She set me on fire.” He converted from socialism to anarchism on the spot. He then tailed Goldman to Chicago, where he badgered local anarchist leaders, calling them “comrade” and asking in conspiratorial tones to attend their “secret meetings.” Overall, most anarchists found Czolgosz pathetic. Others considered him either ignorant (he didn’t seem to grasp the contradictions between socialism and anarchism, for one thing) or outright dangerous: the editor of an anarchist newspaper denounced him, in print, as a police narc.

  To prove himself, and “to do something heroic for the cause,” as he said, Czolgosz took a room above a saloon in Buffalo on August 31, telling people he planned to sell souvenirs at the expo. The proprietor remembered liking Czolgosz, since he paid his two dollars rent up front and drank good whiskey, not the nickel-per-shot turpentine that most patrons did. Sometime that week Czolgosz bought the same make of revolver that Bresci had used to kill King Umberto, a $4.50 silver-plated “Saturday Night Special.” A good hunter, Czolgosz needed no target practice, but he did spend hours alone at night (shades of Travis Bickle) yanking the gun from his pocket and quick-wrapping it in a white handkerchief to conceal its glint.

  Czolgosz met McKinley’s train when it arrived in Buffalo on September 3. Before he could shoot, though, a fusillade of cannons—there to welcome the president—fired instead. The concussion shattered windows on the train and put McKinley’s security detail on edge, so Czolgosz slunk off. For the next three days he stalked “the ruler” (his words) around the expo, shadowing him near the Pylon of Liberty and Streets of Mexico bullfighting ring and other exhibits. But Czolgosz never could get a clean shot.

  On September 6, the president’s last day in Buffalo, McKinley toured Niagara Falls, which powered the electric dynamos that lit the expo. Reporters recorded a hairy moment that morning, when McKinley’s coach drew near a chalk line marking the international boundary with Canada. No sitting president had ever left the country before, and McKinley warned his coachman to give the line a wide berth. That crisis averted, McKinley enjoyed a buffet lunch at a hotel. He then said goodbye for the day to his wife, who was tired and flushed with heat. With only the menfolk left, they broke out the cigars and shot the bull. One local bigwig remarked that McKinley sure seemed to enjoy Buffalo. McKinley teased, “I don’t know if I’ll ever get away.”

  By midafternoon McKinley had one event left, a ten-minute meet-and-greet at the rococo Temple of Music, a 22,000-square-foot terra-cotta dome with garish pastel trim. People had started lining up hours before, dabbing their faces with handkerchiefs in the eighty-two-degree heat. Near the front of the queue, to pass the time, a six-foot-four-inch black waiter named James Parker tried to chat up a freshly shaven young man. Leon Czolgosz snubbed him.

  At 4 p.m. McKinley’s guards wrenched open the temple’s immense doors and channeled the crowd into an aisle of chairs draped with bunting. Off to one side an organist played Bach on one of the largest pipe organs in the country. Czolgosz could just make out McKinley at the head of the line: “the ruler” stood amid a jungle of potted trees, beneath two gigantic U.S. flags. Smile pump nudge, smile pump nudge. McKinley paused only once, to give away the lucky red carnation in his buttonhole to a young lass.

  Around 4:07, one of McKinley’s guards noticed a swarthy, mustachioed Italian man who seemed a little too eager to meet the president. The guard considered intercepting him, but hesitated. At that moment the Italian grabbed McKinley’s palm and pulled the president close. The guard’s gut clenched, and he jumped forward. He broke up the tête-à-tête, then swiveled to watch the suspect depart.

  Meanwhile, a man with his right hand bandaged in a handkerchief stepped forward. Czolgosz was so close that his first shot left powder burns on McKinley’s vest. The puny bullet struck a button, however, and caromed off McKinley’s sternum; doctors later found the bullet wrapped inside his clothes. The second shot struck home, tearing a hole in McKinley’s stomach and pancreas. The handkerchief, still wrapped around the gun, caught fire.

  Czolgosz had wanted, like Bresci, to squeeze off five rounds, but big James Parker, the waiter behind him in line, clobbered Czolgosz’s fist, then smashed him in the face. Another guard swooped in, then ten more, and Czolgosz fell to the floor in a blur of boots and rifle butts.

  * A few feet away guards led McKinley to a chair, blood overflowing his waistband. After a few breaths McKinley noticed the scrum around Czolgosz and called out, “Go easy on him, boys.” (This probably saved Czolgosz’s life.) Moments later McKinley’s entourage of advisors converged on him—including Robert Todd Lincoln, that Hope Diamond of nineteenth-century Republican presidents.

  The expo ambulance—an electric “horseless carriage,” one of the first electric cars—spirited McKinley off to a glorified first-aid station nearby. Buffalo’s best surgeon was elbow deep in another patient just then, so officials grabbed the most senior medical man they could find, a gynecologist. His hair half cut—he’d been yanked from the barbershop—the gynecologist prepped for surgery while McKinley huffed ether. Frustratingly, despite the electric lighting elsewhere at the expo, the clinic wasn’t wired. Even when assistants used mirrors to reflect the fading sunlight into the wound, the doctor couldn’t see much. He managed to patch the stomach but couldn’t find the second bullet, and he sewed McKinley up without draining the wound.

  Meanwhile, thousands of people swarmed the Temple of Music, howling to lynch the assassin; some brandished ropes they’d torn off nearby exhibits. Buffalo’s finest barely got Czolgosz to jail alive. A search of his person revealed, among other effects, $1.54, a pencil, a rubber nipple from a baby’s bottle, and, legend has it, the newspaper clipping of the Bresci assassination.

  In the week after his surgery, McKinley convalesced at the expo president’s
mansion. Teddy Roosevelt, McKinley’s rambunctious vice president, rushed to his bedside. So did McKinley’s wife, Ida; she’d suffered from epilepsy for years, and now reciprocated for all the hours that he’d nursed her. As with Garfield, his doctors fed McKinley rectally, and briefed the press daily about his temperature (approximately 102 degrees) and pulse (approximately 120). Although high, those numbers remained steady. And because McKinley remained coherent, even asking after Czolgosz once, people were confident that he’d recover. Roosevelt, in fact, soon skipped town for a hunting trip. McKinley’s doctors also declined an offer to use one expo exhibit, a Thomas Edison–designed X-ray machine, to locate the second bullet. A New York Times headline on September 11 proclaimed, “President Will Get Well Soon.”

  McKinley nibbled his first solid food on the twelfth, toast and soft-boiled eggs. It was also his last solid food. His stomach and pancreas hadn’t quite healed, and an infection roared to life inside him. By that night he was drifting in and out of consciousness. Aides tried frantically to locate Roosevelt, but he’d gone off the grid, deep in the Adirondacks. A park ranger finally spotted T.R. on September 13, and they tramped down a mountain in a midnight drizzle to catch a train to Buffalo. They were too late. McKinley had slid quickly, and died at 2:15 a.m. on September 14.

  McKinley’s death inflamed an already healthy public hatred of anarchists and immigrants. (Czolgosz was a U.S. citizen, Detroit born, but most decent folk sided with the Journal of the American Medical Association, which took one look at those diphthongs and spat, “thank God [he] bears a name that cannot be mistaken for that of an American.”) Despite the national uproar, Czolgosz himself seemed indifferent to his fate: guards remembered a bicycle thief in the cell next to him going to pieces over being caught, while Czolgosz sat there phlegmatically day after day. He also grew his beard out, making him look far more like a stereotypical anarchist than before. To complete the picture of dishevelment, his jailers made him wear the same bloody clothes and underwear every day until the trial. Not that Czolgosz had long to wait: his trial opened September 23, just nine days after McKinley died. What followed was a low moment in American jurisprudence.