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

  The trial lasted about eight hours total, over two days. This included two hours for jury selection, during which time all twelve jurors admitted they’d pretty much made up their minds already. Czolgosz, citing his anarchist creed, denied the legitimacy of his court-appointed defenders and refused to speak to them. They’d hoped to plead insanity, but all the alienists who’d chatted with Czolgosz had already declared him free of paranoia and delusions. (Rather than dig into his background or motives, the psychiatrists had mostly inquired into his reading habits, or tried to catch him in lies about the shooting. Two psychiatrists couldn’t get Czolgosz to speak one word in two hours. They declared him fit for trial anyway.) Without the insanity defense, Czolgosz’s lawyers basically gave up and focused on defending themselves, for having to take this “repugnant” assignment. They called zero witnesses, and when the case closed, the jury returned after half an hour—most of which time they’d spent debating how long they had to wait, for appearances’ sake, before condemning Czolgosz. Two days later, in keeping with the major theme of the expo—the marvels of electricity—a Buffalo judge sentenced Czolgosz to die in the electric chair at Auburn State Prison.

  The nation’s first-ever execution by electricity, in 1890, had also taken place in Auburn—and had been overseen by Edward Charles Spitzka, the alienist who’d insisted that Charles Guiteau was crazy. Things had not gone well. The prisoner fried but refused to die, and his burning hair and flesh stunk up the tiny execution room. Spitzka screamed to flip the switch again, but the electricians had to wait two whole minutes for the generator to recharge. (In their defense, earlier tests that involved electrocuting a horse had gone much smoother.)

  By 1901 Auburn had worked out the kinks. Guards awoke Czolgosz around 5 a.m. on October 29 and gave him dark trousers slit up the side. Inside the death chamber, an electrician wired up a string of twenty-two lightbulbs to test the current; when they began beaming, he pronounced the chair ready. Czolgosz entered at 7:06 a.m. and took a seat on “Old Sparky,” a rough-hewn wooden throne sitting on a rubber mat. He promptly condemned the government again. Meantime, guards plopped a sponge soaked with conductive salt water onto his head. Next came the metal helmet, then another electrode clamped onto his calf beneath the slit in his pants. Last came the leather mask, which kept his face in place. It also muffled his final words: “I am awfully sorry because I did not see my father [again].” The electrician waited until Czolgosz exhaled—gases expand when heated, and the less air in the lungs, the less unsightly moaning during the death throes—and snapped the switch. Czolgosz jerked, cracking his restraints. After a few pulses at 1,700 volts, a doctor could find no pulse in Czolgosz. Time of death, 7:15 a.m.

  *

  His hair still wet, his lips still curled from the shock of the shock, Czolgosz was laid out on a nearby table for the autopsy. One doctor dissected the body, while the all-important brain autopsy, including the determination of sanity, fell to a second doctor—or rather, a wannabe doctor, a twenty-five-year-old medical student at Columbia University.

  Why entrust this job to someone with no medical license? Well, he’d already published scores of articles about the brain, including work on whether high doses of electricity damaged brain tissue or altered its appearance, an important consideration here. (Peripheral nerves usually fried, he’d found, but beyond a few small hemorrhages, the brain itself suffered little.) He also claimed phrenological expertise, including the ability to link mental deficiencies with unusual anatomical features. What clinched the selection was his pedigree—for this was Edward Anthony Spitzka, son of the Edward Charles Spitzka who’d defended Guiteau. No other father and son doctors can boast of involvement in two such historic cases. And whereas Spitzka père had failed to convince the world of Guiteau’s insanity, Spitzka fils could still perhaps grant Czolgosz a posthumous scientific pardon.

  He never got the chance. Spitzka removed the brain at 9:45 a.m., noting its warmth—the body can reach 130°F during electric execution. He sketched it while it cooled, then began to investigate every fold and fissure. As with Guiteau, the brain looked normal, unnervingly normal, on a gross scale. But before Spitzka could examine it microscopically, the prison warden stepped in. The warden had already received offers of $5,000 for Czolgosz’s skull, and rather than risk making Czolgosz a martyr, he was determined to destroy every last scrap of him. Cruelly, spitefully, he refused Spitzka’s plea for even a tiny slice of brain to examine later. Instead, the warden ordered the body sewn up at noon. He salted Czolgosz’s corpse with barrels of quicklime, then poured in gallons of sulfuric acid. Based on experiments he’d been conducting with shanks of meat, he figured Czolgosz would liquefy in twelve hours. By midnight, Leon Czolgosz’s troubled brain was no more.

  *

  Assassin Leon Czolgosz.

  The gun and handkerchief Czolgosz used in the murder of McKinley.

  Like his father, then, the young Spitzka couldn’t salvage the assassin’s reputation. But neuroscience hadn’t yet had its final say. As a good, sober scientist, the younger Spitzka admitted in the official autopsy that he’d found no sign of insanity. But in summing up, he added a qualifier: “some forms of psychoses,” he wrote, “have no ascertainable anatomical basis… These psychoses depend rather upon circulatory and chemical disturbances.”

  Chemical disturbances. Even if the brain’s anatomy appears normal, in other words, the brain still might not function properly, because of chemical imbalances. Spitzka’s intuition here proved remarkable. To understand Guiteau’s mental troubles, neuroscientists had to examine his cells. To understand Czolgosz’s, they would have to drill down even deeper.

  Smack in between the trials of these two American assassins, Santiago Ramón y Cajal had revealed that neurons were discrete cells. As a corollary, they must have a teeny gap, now called a synapse, separating them. But how exactly neurons sent signals across the gap—with pulses of chemicals or pings of electricity—remained unknown. Adherents of each idea called themselves “soups” and “sparks,” respectively, and their mutual acrimony would shape the next half century of neuroscience.

  The sparks had the upper hand at first. Electrical transmission seemed fresh and modern, chemical transmission passé, like those hoary old Greek theories about the four “humors.” There was experimental evidence for electricity as well. Recently invented probes, fine enough to slip inside individual cells, revealed that neurons always discharged electricity whenever they fired. This was only an internal discharge, but it stood to reason that neurons would use electricity externally as well, to communicate with each other.

  A set of macabre experiments with frog hearts seemed to buttress this theory further. By 1900 biologists knew that a frog heart, if removed from the frog and plopped into salt water, will beat on its own inside the solution. It just hovers there, throbbing, wholly disembodied yet somehow madly alive. Scientists discovered that they could even slow the heart rate down, or speed it up, by sparking different strands of the severed nerves that led into the heart. True, other scientists discovered that a splash of certain chemicals could accelerate or decelerate the heart in a similar way. But because the chemicals were man-made, the chemical action seemed a strange coincidence, little more.

  A young scientist visiting England in 1903, Otto Loewi, found the frog-heart tricks fascinating, and upon returning to Austria he decided to investigate the link between nerves, electricity, and chemicals. Loewi, however, had an absentminded, daydreaming personality: when young he’d often blown off biology class to catch the opera or a philosophy lecture. So even though he became a noted pharmacologist, he neglected to follow up on the frog hearts. All the while the spark doctrine gained momentum.

  Loewi finally got back into frog hearts in 1920, albeit under odd circumstances. The night before Easter that year, he nodded off while reading a novel. A Nobel-worthy experiment flashed before him in a dream, and he awoke, groggy, and jotted it down. The next morning he couldn’t read his handwriting. Annoyed, th
en desperate, he pored over every jot and tittle. All he could remember was the moment of euphoria, the moment when everything made sense. He retired to bed crushed.

  At three o’clock that night the dream returned. Loewi awoke and, rather than risk another loss in translation, scampered to his lab. There, he etherized two frogs, and slipped their cherry-sized hearts into two separate beakers of saline, where they beat and beat and made little waves against the glass. One heart had its nerves still attached, and when Loewi sparked certain nerve fibers, the beat slowed down, as expected. It was the next step that made him tingle. He sucked up saline from inside the first heart and squirted it into the other beaker. The second heart slowed down immediately. He then sparked some different nerve fibers on the first heart and sped it up. Another saline transplant made the second heart speed up, too—exactly as he’d dreamed. Loewi concluded that the nerve, whenever it was sparked, was spurting out some chemical. The chemical then got transferred to the second heart when he transferred the saline.

  Loewi’s experiment provided an enormous boost for the soups—proof that the nervous system, at least in some animals, did use chemicals to transmit messages. Other scientists quickly discovered heart-racing chemicals in mammals, then in human beings. After that the soup doctrine got so popular so quickly that Loewi collected a Nobel Prize for his dream work in 1936. (Typically blithe, though, he had to abandon the medal in 1938, leaving it behind in a bank vault: although he was Jewish, he’d paid no attention to the darkening thundercloud of Nazism, and when Hitler annexed Austria, he had to flee.

  * )

  Still, Loewi and the soups had won only half the battle. The sparks conceded that the body might use chemical messengers in the peripheral nervous system, which controls mere limbs and viscera. But within the brain and spinal cord—the hallowed central nervous system—the sparks didn’t budge. There, they insisted, the brain used electricity alone. And again, they did have good evidence for this, since neurons discharged electricity every time they fired. The sparks moreover argued that chemicals—the stuff of “spit, sweat, snot, and urine”—were too sluggish for brain duty. Only electricity seemed nimble enough, lightning enough, to underlie thought. Like Golgi’s reticulists, sparks declared that the brain worked differently from the rest of the body.

  But those who declare the brain somehow different, somehow biologically special, virtually always eat their words. Over the next few decades, the soups in fact detected plenty of chemicals that transmit signals only within the brain—so-called neurotransmitters. These discoveries undermined the hegemony of the sparks, and by the 1960s most scientists had integrated neurotransmitters into their understanding of how neurons work.

  To wit: Whenever a neuron “fires,” an electrical signal goes rippling down its axon to the axon tip—that’s the electricity that the sparks had detected long ago. But electricity cannot jump between cells, not even across the 0.000001-inch-wide synapse separating one neuron from another. So the axon must translate the electrical message into chemicals, which can cross the chasm. Like a chemical supply depot, the axon tip stores and manufactures all sorts of different neurotransmitters. And depending on the message it needs to convey, the tip will package certain ones into tiny bubbles. These bubbles then dump their contents into the synapse, allowing the neurotransmitters to stream across the gap and connect with the dendrites of nearby neurons. This docking triggers those neurons to send an electrical signal down their own axons. At this point, with the message delivered, cleanup begins. Nearby glial cells start to remove excess neurotransmitter molecules from the synapse, either by vacuuming them up or releasing predator enzymes to shred them. This effectively resets the synapse so the neuron can fire again. All this happens within milliseconds.

  Overall, you can think about the brain as both soup and spark, depending on what you measure and where—much the same way that photons of light are both waves and particles.

  That said, the soup aspect has proved far more complex. The brain contains hundreds of types of neurons, all of which fire the same basic way electricity-wise. As a result, electrical signals can’t convey much nuance. But neurons use over one hundred different neurotransmitters

  * to convey various subtleties of thought. Certain neurotransmitters (e.g., glutamate) excite other neurons, rile them up; other neurotransmitters (e.g., GABA) inhibit and anesthetize. Some brain processes even release both excitatory and inhibitory chemicals simultaneously. (When the brainstem sends us into dream sleep, for instance, it stirs up dreams by exciting certain neurons, but paralyzes our muscles by inhibiting others.) The neuron on the receiving end of a message must therefore sample the soup in a nearby synapse carefully, weighing every ingredient, before firing or not. The soup must taste just right to provoke the proper reaction.

  The soup in Charles Guiteau’s brain never tasted right. In retrospect, he almost certainly had schizophrenia, which disrupts neurotransmitters and skews their balance inside the brain—forcing neurons to fire when they shouldn’t and preventing them from firing when they should. Syphilis also inflicted heavy damage. With his schizophrenia Guiteau was already on the brink, and when neurosyphilis started killing brain cells, his mind dribbled away into insanity.

  Leon Czolgosz presents a tougher case. For one thing, it’s nearly impossible to separate the judgments about his sanity from his era’s dread of anarchy: some psychiatrists even defined anarchism itself as ipso facto mental illness. And while all five alienists who examined Czolgosz before his trial pronounced him sane, that sounds a little hollow when whole choruses of psychiatrists had sung the same line about Guiteau. Czolgosz’s pretrial behavior doesn’t clear up much, either. Czolgosz succumbed to a screaming fit one day in his cell, but some observers thought he’d shammed it. He once admitted that, after deciding to take McKinley down, “there was no escape” from the idea, not even “had my life been at stake”—but does that rise to the level of insane compulsion? And what about his habit of repeatedly wrapping a handkerchief around his hand in his cell? A guilty conscience? A mad tic? Depends on whom you ask.

  Right after Czolgosz died, a few independent psychiatrists tracked down and interviewed family members and acquaintances, and they came away believing that Czolgosz had become unhinged not long before visiting Buffalo. One clue was that shooting the president seemed out of character. Czolgosz had no prior history of violence; in fact, patrons in bars often laughed at him for taking flies outdoors instead of swatting them. The psychiatrists noted, too, that Czolgosz barely understood anarchism and had converted to it only in May 1901—an awfully short time to become so fixated that you’d throw your life away, with no thought of escaping. And even fellow anarchists were baffled by Czolgosz’s obsession with McKinley. The president had generally sided with management over labor during disputes, but he was no Rockefeller, no Carnegie, beating down the workingman, and McKinley himself never accumulated much lucre. (In one way, then, even Guiteau’s ends seem more rational. Guiteau simply sought to install Chester Arthur in the White House. Czolgosz wanted to topple capitalism and the Republic in one swoop.)

  Above all, the psychiatrists who studied the arc of Czolgosz’s life emphasized how he’d changed after his mental breakdown and retreat to the family farm in 1898—becoming edgier, mistrustful, more isolated and paranoid. And it’s here that Spitzka’s comments about “chemical disturbances” seem most prescient. Czolgosz broke down in his midtwenties, a common time (as some historians have noted) for schizophrenia to emerge. I don’t think that diagnosis holds up: Czolgosz was no Guiteau, untethered from reality. But given the primitive state of psychiatry in 1901, and the general rush to punish Czolgosz, the alienists might well have missed subtler symptoms, of subtler disorders, willfully or not. And regardless of the specific diagnosis, Czolgosz emerged from his breakdown a changed man: a desperately lonely man, someone longing for friends and meaningful work—but someone even anarchists, the most marginalized group in America, shunned. (In this he resembled less the hobn
obbing, high-spirited Guiteau and more the loners Lee Harvey Oswald

  * and John Hinckley Jr.)

  Sorting out cause and effect is tricky with brain chemistry: does depression cause changes in brain chemicals, or do changes in brain chemicals cause depression? The street probably runs both ways. But the balance of evidence does suggest that loneliness, isolation, and a sense of helplessness can all deplete neurotransmitters—can poison the soup and sap vital ingredients. That’s surely part of what the younger Spitzka—after sluicing through a still-steaming brain on that cool October morning in 1901, hunting for signs of insanity and coming up empty—was getting at when he wrote about hidden chemical disturbances.

  “I never had much luck at anything,” Czolgosz once sighed, “and this preyed upon me.” Indeed, it preyed upon him more than he knew: chronic stress can shrivel axons and dendrites, and skew the brain’s thinking in unpredictable ways. That Spitzka intuited all this in 1901 is remarkable. And we can do even better today, since we know so much more about how neurons can affect global thinking patterns. We simply need to expand our scope and explore how individual neurons wire themselves together into circuits, which provide the raw material for our thoughts.

  CHAPTER THREE