The Tale of the Dueling Neurosurgeons

by Sam Kean

  On a deeper level, Henri’s death helped inaugurate a new approach to neuroscience. You can’t call Vesalius and Paré modern: each revered Galen along with Hippocrates and the rest of the Greek medical chorus. But each of them also evolved past the ancients, by emphasizing experiments and observation. Vesalius bequeathed a new map of the brain, Paré new diagnoses and surgical techniques; and while Henri’s was not the first autopsy, in terms of prestige—prestige of both the patient and the practitioners—it was the summa of early medical science. The treatment of royals often defined what became standard care for everyone else, and after Henri’s death, autopsies started to spread throughout Europe. This expansion made it easier to correlate specific brain damage with altered behavior, and with every new autopsy, neuroscientists learned to pinpoint people’s symptoms more precisely.

  Soon scientists even moved beyond the brain’s gross anatomy, into a realm that Paré and Vesalius never dreamed of, the microscopic. Like physicists drilling down into the fundamental particles of the universe, neuroscientists began to drill down, down, down into the fundamental matter of the brain, parsing it into tissues and cells and axons and synapses before finally arriving at the brain’s basic currency, its neurotransmitters.

  PART II

  CELLS, SENSES, CIRCUITS

  CHAPTER TWO

  The Assassin’s Soup

  Now that we’ve gotten an overview of the brain, we’ll investigate it piece by piece in upcoming chapters, starting with its smallest bits—the neurotransmitters that relay signals between cells.

  God’s ways are not man’s ways, God’s reasons not man’s reasons, so when God told Charles Guiteau to shoot the president, Charles Guiteau agreed. And if doing so simultaneously saved his beloved Republican Party, so much the better.

  God and Guiteau (pronounced Git-OH) went way back. During Guiteau’s childhood, his mother used to shave her head and lock herself into her bedroom to chant Bible passages. His father obsessed over the millenarian sermons of one John Noyes, and after failing a college entrance exam, Charles himself joined Noyes’s sex-crazed utopian cult in Oneida, New York. Guiteau whiled away the Civil War there, but even the polyamorous, free-lovin’ ladies at Oneida froze him out, repelled by his bulging eyes, lopsided smile, and monomania. They mocked him as “Charles Get-out.”

  After he got out, in 1865, he began evangelizing—first founding a newspaper, The Daily Theocrat, which flopped, then trying his hand at preaching, charming crowds with talks like “Why Two-Thirds of the Human Race Are Going Down to Perdition.” He also self-published a book, The Truth, about Christ’s second coming. Much of the book was mad—he called Stanley and Livingstone signs of the apocalypse—and what wasn’t mad he plagiarized from Noyes. Along the way Guiteau passed the bar exam (depending on the year, it contained three or four questions; he needed to get only two right), but lost his first case after frightening the jury with a fist-shaking, spit-flecked rant. He started a debt-collection service but mostly pocketed his clients’ cash, and after running out of boardinghouses to get blacklisted at, he moved to Chicago to mooch off his sister, Frances, and her husband, a lawyer named George Scoville. That cozy arrangement ended when he swung an axe at Frances. He drifted back to New York, where he married a YMCA librarian whom he punched and kicked and locked into closets for sassing back. She divorced him, but only after nursing him back to health after he caught syphilis from a hooker. The disease eventually infected his brain.

  Naturally, Guiteau thought himself fit for politics. A stalwart Republican, he wrote a clichéd stump speech in 1880 supporting Ulysses S. Grant’s bid for a third term as president. When James Garfield got the Republican nomination instead, Guiteau simply swapped in Garfield’s name. He then begged Garfield’s campaign crew in New York—including Chester Arthur, nominee for vice president—for chances to deliver it. The party finally sent him to a rally for black laborers. Struck with stage fright, Guiteau muttered a few paragraphs and quit. He nonetheless convinced himself that he’d delivered New York for Garfield. So after Garfield won the election, Guiteau spent some of his last dollars on a train to Washington, D.C., to claim a job in the new administration.

  Him and about a million others. This was the peak of the spoils system, which transformed the first months of any presidency into a job fair. Despite not speaking a foreign language or ever having traveled abroad, Guiteau decided to seek a post in Europe. After waiting in line for hours, he finally met Garfield and handed him the speech that “clinched” New York, with “Paris consulship” scrawled across the top. By this point Guiteau was down to his last shirt; he wore rubber rain covers for shoes and owned no socks. But he smiled his best zigzag smile at Garfield and withdrew, letting the president puzzle over what the hell had just happened.

  In those days common citizens could visit the White House unannounced, and in late March, Guiteau began nagging Garfield’s secretaries and even Cabinet members for news about his Paris post. The secretary of state finally screamed at Guiteau to shut up already, and when Guiteau got caught nicking White House stationery, he was banned. Guiteau nevertheless—the man was a true, true optimist—kept scanning the newspapers for word of his appointment.

  It never came. And other notices in the papers disturbed him even more. Garfield—despite previous success as a college president, Civil War officer, and congressman from Ohio—soon found his administration floundering. A few broken promises had caused a rift among Republicans, and both Republican senators from New York resigned in a snit. With every damning headline, Guiteau’s buggy eyes bulged even more: the GOP was disintegrating. Someone had to save it.

  Kill Garfield. God first whispered this to Guiteau in May of 1881. Although stunned that, as he put it, “Jesus Christ & Co.” had selected him for the deed, the more Guiteau pondered it, the more logical it seemed. Kill Garfield. Yes, with Garfield gone, his New York chum Chester Arthur would assume power and calm the Republican waters. Arthur would then of course pardon Guiteau once Guiteau explained about God’s instructions. Heck, he might see Paris yet.

  Guiteau borrowed ten dollars and bought a “British Bulldog” revolver at a gun shop one block from the White House—paying extra for an ivory handle, since it would look handsomer in a museum someday. Guiteau had never fired a handgun, so he marched to the Potomac Tidal Basin for practice. The gun’s recoil almost somersaulted him into the mud, and he hit his target just once—blowing a hole in a sapling. Ever confident, though, he began stalking the president that very week. He also began revising The Truth, sure to become a bestseller soon.

  Guiteau decided to assassinate Garfield in church, and tailed him there one Sunday to do some recon. Despite the need to be inconspicuous, a revved-up Guiteau stood up at one point and shouted at the preacher, “What think ye of Christ?” (In his diary, Garfield recalled “a dull young man, with a loud voice.”) Guiteau changed his mind later that week, and decided to shoot Garfield at the train station instead. But he backed down, all mushy, when he saw Mrs. Garfield walking arm in arm with her man.

  Weeks later Guiteau called off a third assassination attempt because the weather got too hot, then a fourth because he didn’t want to interrupt an important-looking conversation between Garfield and the secretary of state. At last the newspapers announced that Garfield would leave D.C. for the summer on July 2, and Guiteau steeled himself to act. On the big day he arose at 4 a.m., took some practice shots by the Potomac, got his boots polished, and rode a cab to the train depot, where he unwrapped his gun in the bathroom and waited.

  Garfield woke up buoyant that morning, eager to abandon the stinking swamp of Washington and all its partisan spats and grubby job-seekers. He burst into the bedroom of his young boys, Abram and Irvin, and clowned around like a teenager—doing handstands, singing Gilbert and Sullivan, vaulting over the bed to prove the old man still had it. He arrived at the depot around 9:20 a.m., and walked with an advisor toward his train.

  Kill Garfield. Slinking out, Guiteau closed to within tw
o yards. The first shot grazed Garfield’s arm, stunning him. Guiteau fired again and plugged Garfield in the lower back. This second shot brought pandemonium on the platform—screams, hollers, chaos. Guiteau speed-walked away, but a policeman nabbed him at the depot exit.

  Meanwhile Garfield’s legs crumpled and he sank down, a circle of red blooming on his back. Two doctors arrived moments later—as did Garfield’s advisors, including Robert Todd Lincoln, who sixteen years before had seen his father borne out of Ford’s Theatre. “Mr. President, are you badly hurt?” one doctor asked. According to one account, Garfield breathed, “I’m a dead man.”

  So began the national James Garfield deathwatch. With the recent expansion of telegraph lines across the world, Garfield’s suffering became practically a live event, and Garfield’s physician, one Dr. Doctor Bliss (sic the first name, and last), took full advantage of the new medium. Newspapers coast to coast reprinted his daily bulletins, and many cities plastered updates onto huge billboards in their public squares.

  Unfortunately, Dr. Doctor provided more bliss with his public relations than with his medical care. Garfield suffered from three main problems over the next few months: isolation, hunger, and pain. Isolation, because Bliss confined him to a bed and forbade even family members from seeing him at first. Hunger, because Bliss, fearing an intestinal infection, began feeding the president rectally, with a slurry of beef broth, egg yolks, milk, whiskey, and opium. (The empty-bellied president spent many an hour that summer fantasizing about hearty recipes from his frontier boyhood such as squirrel soup.) Pain, because Guiteau’s second shot had lodged itself inside Garfield’s torso: he described the discomfort as a “tiger claw” raking his legs and genitals. Bliss tried excavating the bullet, but no matter how many times he worked his fingers into the wound and rooted around in Garfield’s groin, the slug eluded him. Other doctors tried their hands, too, and Bliss even recruited Alexander Graham Bell to rig up a crude metal detector of batteries and wire. No trace. A few doctors begged Bliss to check near Garfield’s spinal cord instead, since the collapse of the president’s legs at the depot and the subsequent shooting pain both sounded like neurological trouble. Bliss blew them off and kept digging. Meanwhile, he kept releasing what one historian called “fraudulently optimistic” bulletins about Garfield’s progress and sure recovery. Other doctors leaked more negative assessments, causing a rift within the president’s medical team.

  Bliss eventually granted Garfield’s wish to escape D.C., and they relocated to the president’s cabin in coastal New Jersey. Ironworkers laid 3,200 extra feet of track right to the cabin door, then pushed Garfield’s railroad car the last quarter mile when it got stuck on a hill. The change of scenery and seaside air buoyed the president at first, but he soon faded, as he still couldn’t eat. Overall, Garfield lost eighty pounds in eighty wretched days, and when Bliss’s fingers finally infected Garfield’s wound, turning it into a slimy pocket of pus, Garfield had no fight left. He died on September 19, 1881. The autopsy found the bullet nestled near his spine.

  The public, both North and South, howled in anguish. Garfield had been the American ideal, a genuine rag-to-riches president, and the mourning for him—not to mention the loathing for Guiteau—united the country for probably the first time since before the Civil War. In fact, Guiteau almost didn’t make it to trial later that year, as two Jack Ruby wannabes tried to exact revenge. One (Guiteau’s jailer) missed from five feet, and one put a bullet through his coat but missed everything vital.

  Guiteau finally stood trial in November, with George Scoville, his poor brother-in-law, handling the defense. Overwhelmed—he normally handled land deeds—Scoville submitted an insanity plea. Guiteau scoffed, thinking himself perfectly sane—would God have chosen him otherwise? But he unwittingly made Scoville’s case for him by repeatedly interrupting the trial: at various points, in his whiny, scratchy voice, he chanted epic verse, sang “John Brown’s Body,” called the jurors jackasses, and announced his own candidacy for president in 1884. He ranted, too, that the murder charge was unfair: he’d merely shot Garfield; doctors had killed him. (Here, he was probably right.) Nor were Guiteau’s antics limited to courtroom hours. Newspapers caught him selling autographed glamour shots from his cell—nine dollars per dozen.

  Amazingly, the insanity defense went nowhere, even after Guiteau compared himself to Napoleon, St. Paul, Martin Luther, and Cicero. The public’s appetite for revenge had grown too keen, and the prosecution whetted it further by passing around Garfield’s shattered vertebrae. Besides, psychiatrist after psychiatrist testified that Guiteau understood right and wrong, and was therefore sane. Of 140 witnesses, in fact, only one man maintained, unshakably, without qualification, that Guiteau had lost his mind.

  Though just twenty-nine, Edward Charles Spitzka had already earned renown in certain circles as a brain pathologist. Guiteau’s case made Spitzka famous, period, in part because he testified despite receiving death threats from citizens angry that he might get Guiteau off. Besides all the psychological signs of insanity, like the god delusion, Spitzka pointed out signs of neurological trouble in Guiteau as well. In particular, Guiteau’s lopsided smile, lazy left eye, and lolling tongue implied that he couldn’t control both sides of his face equally well. In all, Spitzka would later call Guiteau the most “consistent record of insane manner, insane behavior, and insane language… in the history of forensic psychology.”

  The jury disagreed and found Guiteau guilty in January 1882. Remanded to his cell, Guiteau waited months for a pardon from Arthur. When it didn’t come, he shrugged, eager to taste the fruits of paradise. On the scaffold, near the Anacostia River, he even recited a poem he’d written for the occasion: “I’m Going to the Lordy.” (The city denied his request for orchestral accompaniment.) As the hangman hooded him, blotting out his crooked smile for the last time, Guiteau let the verses waft from his hands. A moment later he fell earthward himself.

  Assassin Charles Guiteau (left) and his brain (right). The caption on the jar reads: “What is left of the brain if [sic] Guiteau.” (National Library of Medicine)

  The autopsy took place ninety minutes later, at 2:30 p.m. Overall Guiteau’s body looked sound, aside from the rope burns on his neck; Guiteau had even (like most hanging victims) gotten an erection and ejaculated before dying. The bigger question was whether Guiteau’s brain looked sound. Most scientists at the time believed that insanity, true insanity, always betrayed itself by clear brain damage—lesions, hemorrhages, putrid tissue, something. Inside Guiteau’s skull, though, nothing seemed amiss at first. His brain weighed fifty ounces on a grocer’s scale, a tad more than average, and beyond some small anomalies (extra creases here and there, a slightly flattened right hemisphere) his brain looked normal, chillingly normal.

  Since the days of Vesalius and Paré, though, autopsies had become much more of a microscopic art. And under a microscope, Guiteau’s brain looked awful. The outer rind on the surface, the “gray matter” that controls higher thinking, had thinned to almost nothing in spots. Neurons had perished in droves, leaving tiny holes, as if someone had carbonated the tissue. Yellow-brown gunk, a remnant of dying blood vessels, was smeared everywhere as well. Overall the pathologists found “decided chronic disease… pervad[ing] all portions of the brain.” As Spitzka had testified, Guiteau was surely insane.

  Still, because the stigmata of insanity—the physical signs of brain damage—appeared only on the microscopic level, most neuroscientists continued to dispute the evidence, because most neuroscientists at the time didn’t appreciate the importance of microanatomy. Only over the next two decades, in fact, would neuroscientists take the first real steps toward explaining how brain cells work. This understanding would emerge just in time for the next assassination of a U.S. president and the next national dispute over criminal insanity.

  By the later 1800s most biologists believed in “cell theory”—the idea that living creatures are composed entirely of tiny, squishy bricks called cells. Neurosc
ientists weren’t so sure. Discrete cells might exist in the rest of the body, yes. But under the microscope, neurons seemed to have no breaks or gaps between them; instead, they seemed fused together into one large, lacy net. Moreover, neuroscientists believed that—unlike other, more autonomous cells—neurons acted in unison as well, pulsing and thinking as one. They called this big net of neurons the neural reticulum.

  The undoing of the neural reticulum theory started with an accident one night in 1873. According to legend, Camillo Golgi was working by candlelight in the kitchen of an old Italian insane asylum when he elbowed over a beaker of silver solution onto some slices of owl brain. Merda. The silver solution was used to stain tissues, and Golgi assumed that his clumsiness had ruined his samples. Still, he examined them under his microscope a few weeks later—and found, to his delight, that the silver had stained the brain cells in a peculiar, and most useful, way. Few cells absorbed the silver overall; but those that had absorbed it stood out dramatically—black silhouettes on a sherbet-yellow background, with their finest fibers and tendrils suddenly visible. Fascinated, Golgi set about refining this staining technique, which he called la reazione nera, the black reaction.*

  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.