Dr. William Cone met Wilder Penfield at a New York hospital in 1924 and struck a friendship that, a decade later, would lead them to create a neuroscience institute in Montreal.Osler Library of the History of Medicine, McGill University
Shortly after midnight on the morning of May 4, 1959, Dr. William Cone lay his head on a pillow he had placed on the floor of his office in the Montreal Neurological Institute. Things were quiet at the hospital. No one would guess what had happened until dawn.
The Neuro, housed in a Gothic-looking stone fortress on the lower slopes of Mount Royal, was arguably the worlds most prestigious centre for the study and treatment of the brain. Cone was its co-founder and top surgeon.
Twenty-five years earlier, when he opened the institute with his mentor and closest friend Wilder Penfield, the brain was the deepest kind of mystery. Now, a quarter-century later, they and their colleagues had finally begun to let light in on some of the dark chambers of the mind: how memories were stored; where pleasure came from; even some of them believed the location of the soul.
One puzzle this team of brilliant scientists had not begun to solve, however, was William Cone. He was their unquestioned leader, The Boss. But there was also something remote, unfathomable, and sad about the 61-year-old. Especially in later years, he seemed barely to sleep and preferred to work at night, performing elaborate nocturnal surgeries that he called symphonies.
Even as his moods darkened, Cones skill never wavered. Some fellow physicians thought he was the best surgeon they had ever seen.
Patients adored him. His round-the-clock care and warm baritone voice seemed to be full of compassion for their seizures and broken spines. That God, one of them later wrote. That wonderful man.
The truth was, he understood their suffering better than they knew.
On that lightless morning in May, with his desk in order and his patients safe in their beds, he put a dose of cyanide to his lips and swallowed.
I learned about William Cone just over a year ago, while I was preparing to move to Montreal. The MNI is still an important local institution and I wanted to know more about it. Wilder Penfield remains its icon with a street named after him and a Heritage Minute in his honour but as I read about the pair, it became clear that Dr. Cone was every bit as important to their world-changing institute, although he has been largely forgotten outside its walls.
Soon I was trying to learn everything I could about this overlooked medical hero, to better understand how an intense, kindly man, who came as close as anyone in his lifetime to sounding the depths of the human brain, had so been overcome by his own.
Today, many may remember Wilder Penfield from this 1991 Heritage Minute. It dramatized his treatment of a seizure patient in 1934, the debut year of the Montreal Neurological Institute that he co-founded with Dr. Cone.
William Vernon Cone witnessed the glory and the sorrow of practicing medicine at an early age. He was born in 1897 and raised in tiny Conesville, Iowa, where he grew up idolizing his grandfather, a country doctor who made house calls by horse and buggy, or sleigh in winter, to treat fevers or deliver babies. When William was a small child, however, his father contracted a fatal case of typhoid after drinking from the tin cup of a public water pump. There was nothing the Old Doc could do.
William Cone emerged from a turbulent upbringing as an apparently well-adjusted young man. He was thought to have a beautiful singing voice and was in demand as a performer at weddings, said his nephew, J. Richard Cone, before going off to the University of Iowa, where he wrestled and boxed while studying medicine.
His life took a decisive turn in 1924, when he arrived as a research fellow at New Yorks Presbyterian Hospital and met Wilder Penfield. The two men were a study in contrasts: Wilder Penfield tall and handsome, a former Rhodes Scholar and Princeton football standout, with a charming twinkle in his eye; William Cone stocky and short, with a toothy smile and a way of folding in on himself when being photographed every inch the sidekick.
For all their apparent differences, the two men bonded quickly and intensely. Dr. Cone joined the hospitals department of surgery that year, working essentially as Dr. Penfields apprentice, and began operating on the tumours, cases of water on the brain, and New York City car crash victims that came their way.
Neurosurgery in the 1920s was a brutal business that involved gruesome guesswork and often killed patients, as Dr. Penfield later admitted in his memoir. Despite these obstacles, or because of them, Dr. Cones approach to the work was tireless as though he were trying to outhustle death. At first, his boss was delighted. His young assistant seemed to double my potential, Dr. Penfield said.
Their friendship blossomed, too. While housesitting for his colleague, Dr. Cone wrote him a letter: I am enjoying every minute of it but miss you a great deal. Soon their wives were friends too, and Dr. Cone was Uncle Bill to Wilder Penfields children.
Wilder Penfield and Dr. Cone.OSLER LIBRARY OF THE HISTORY OF MEDICINE, MCGILL UNIVERSITY
The pair co-founded The Neuro in 1934. It would encompass every aspect of the study of the brain: a working hospital where the sick could be diagnosed, treated, and operated on; a school for the training of the worlds best neuroscientists; and a massive laboratory, where patients could be healed but also studied.
It was a place whose ambitions were captured in a quotation from Dr. Penfield himself, inscribed next to the ambulance driveway: The problem of neurology is to understand man himself. Nothing like it existed in the world.
The building, with its small windows and extreme proportions, looked more like Count Draculas castle than a modern place of healing. But the Neuro was also a state-of-the-art temple to modern science. Dr. Cone would accept nothing less: the younger doctor was forever writing to Dr. Penfield from Chicago or Berlin about new equipment he wanted to buy. The institute came to reflect these high-end tastes and lofty goals.
The Neuro was also a global institution, and Drs. Cone and Penfield sought out medical skill wherever they could find it, among the female neurosurgeons of the Soviet Union, refugees from the Spanish Civil War, or the French-Canadian doctors in their own backyard. They took you no matter if you were polka-dotted or landed from Mars, said Mark Preul, a neurosurgeon in Arizona who trained at The Neuro. They looked for one thing and that was talent.
For decades, Dr. Cones own university explicitly discriminated against Jews, enforcing a 10-per-cent cap on the share of Jewish students in the faculties of medicine and law. But he was absolutely free of prejudice, said Daniel Slatkin, a young Jewish man whom Dr. Cone successfully recommended for McGill medical school.
Because many U.S. schools refused to accept Black medical students, meanwhile, some came to study at The Neuro instead. Dr. Cone trained two of the first three African-American neurosurgeons and proudly called himself the grandfather of neurosurgery at Howard University, the historically Black college in Washington, D.C., according to William Feindel and Richard Leblanc in The Wounded Brain Healed: The Golden Age of the Montreal Neurological Institute, 1934-1984.
A London hospital lies in ruins after an air raid during the Second World War.The Associated Press
In the spring of 1940, Dr. Cone sailed across the Atlantic to serve as head wartime surgeon at the new Number 1 Canadian Neurological Hospital in England. The Battle of Britain had begun by summer and casualties were mounting. Dr. Penfield sent him a tersely protective note shortly after he left: Good luck to you and dodge anything you see coming. Their letters for the next two years were often signed, Love.
As the bombs of the Blitz began crashing down on London, patients came streaming in to Dr. Cones hospital in rural Basingstoke, often with little hope of recovery. For a time we just got the hard ones almost hopeless things, he wrote to Dr. Penfield. At one point he saw 550 neurological cases in the course of three months.
Virtually every medical person who came across Dr. Cone was amazed by the crew-cut Iowan with the shy gaze and inexhaustible hunger for work. One professor at the University of Manchester reported back to Dr. Penfield, I cant make out whether Bill Cone is the greatest surgeon I have ever met or whether I am just a damn fool.
Dr. Penfield should have radiated pride, but instead he was distinctly uneasy about his former pupils sudden renown, writes Jefferson Lewis, Wilder Penfields grandson, in his biography of the great doctor, Something Hidden. He was desperate to take over for Dr. Cone in England, but kept stumbling in his efforts, thanks to a failed military exam and a worrying chest X-ray. In early 1941, he drafted an abject note to Dr. Cone sorry am helpless before striking it out and writing a braver, more formal message. Dr. Cone consoled his friend, in turn, reversing the dynamic of master and apprentice that had governed their relationship for fifteen years. Please please take care of yourself, he wrote. There is still a lot we have to do together.
Dr. Cone, second from right, spent a year and a half in England during the Second World War.Osler Library of the History of Medicine, McGill University
When Dr. Cone finally returned to The Neuro after 18 months overseas, he seemed more determined than ever to throw himself into endless labour.
In England he had faced the awful toll of war with only the roughest surgical tools at his disposal. Hes seeing all of these terrible head and spinal cord injuries, and what can you do? said Richard Leblanc, a neurosurgeon at the institute who has written extensively about its history. The instruments that you have at the time are basically 19th-century instruments.
Horrified by the lot of his patients, he began a second life in the workshop and never really emerged. He devised an apparatus of elastic bands and fish hooks with the barbs filed down for pulling back scalp and muscle during operations, and developed surgical instruments powered by dry nitrogen based on experiments with discarded aircraft parts during the war, according to an homage written by a group of fellow neurosurgeons, including Drs. Preul and Feindel, in the early 1990s. The simultaneous delicacy and brutality of the field is evoked by some of his designs, like the Cone-Barton Ice-Tongs.
The easiest way to lose a patient in those days was through infection Cone knew this all too well so his endless tinkering was matched by an obsessive quest for hygiene. Requiring his residents to rinse their mouths with a foul-tasting antibiotic called chloramphenicol was only one step in a fanatical regime to stamp out killer microbes.
No aspect of Dr. Cones profession was beneath him; he embraced the kind of basic nursing that other doctors shunned. He took bedpans and gave enemas and developed new procedures for handling catheters. He preferred to reposition patients in their beds himself and even helped with tube feeding, during which he insisted on a nutritious (if not necessarily delicious) slurry of corn flakes, cheese, eggs, baby food meat, vegetables, cocoa and sugar.
Patients were often surprised to find such a lofty figure getting down into the muck with them. When a woman named Rae Hershenkopf came to The Neuro in 1945 with a broken back, Dr. Cone tickled her feet with his keys to test the feeling in her extremities, then laughed his gorgeous laugh when she shrieked in surprise. Her surgery happened in the middle of a hot summer night, in a room with a tiny ceiling fan they barely felt, and she watched as he scrubbed down his chrome operating table all by himself with a big hard brush. Sweat poured down his face as he worked around her in a kind of careful dance. I felt horrible for him, she wrote. I was crying and not for myself.
His work habits, always intense, grew more and more compulsive. After eating dinner with his wife on weeknights, he would return to the Institute to make the rounds, often staying until morning. Cone would operate all day he had energy like a diesel engine and he expected everyone to keep up with him, said Joseph Hanaway, a neurologist who trained at the Neuro in the 1950s.
He and his wife Avis an effervescent, blonde-haired woman from Iowa had no children, and tended to treat The Neuro as their family. Cone saw certain young doctors as the sons he never had, but Avis was often left to entertain Willys Boys after her husband had returned to the hospital for the night. She struck some people around The Neuro as a lonely figure.
Dr. Penfield, right, at a Canadian Club luncheon in Toronto.John Boyd/The Globe and Mail
Although he was manically driven, Dr. Cone wasnt ambitious in a conventional sense. It was Dr. Penfield who continued to receive most of the credit for The Neuros success, which included leaps forward in the treatment of epilepsy, the study of memory, and mapping the brain. There had always been a sharp asymmetry in their relationship and it only grew over time, until there were effectively two schools within the institute: a Penfield school and a Cone school, each with its own disciples, priorities, and strengths. Dr. Penfield was a pious man with an almost mystical sense of purpose, desperate to find the seat of the soul and interested in illnesses, like epilepsy, that promised rich experimental and even spiritual insights. Dr. Cone had an earthier approach to his work: he wanted to make people better, above all, and took on far more of the day-to-day patient care. Dr. Penfield was the captain of the ship, said Mark Preul, while Dr. Cone was its engine room.
The final rupture in their friendship arrived in the fall of 1953, when Dr. Cone learned that Dr. Penfield had struck a nominating committee to replace him as director of The Neuro. This was not how the passing of the sceptre was supposed to go. Everyone at the institute had always assumed the Boss would succeed the Chief one day; Dr. Cone himself believed the top job would be his when Dr. Penfield retired.
More painful still, Dr. Penfield announced his retirement at a meeting in The Neuros amphitheatre without telling Dr. Cone first. As the head nurse Eileen Flanagan later wrote, Dr. Cone felt he had been betrayed. After appealing to the university administration to block his colleagues departure, Dr. Cone threatened to quit. Stunned by his partners reaction, Dr. Penfield finally relented and agreed to remain as director part-time. The institute simply couldnt run without its Boss; even in the lowest moment of his career, he had at least proven that.
Dr. Cone chats with head nurse Eileen Flanagan, left, and Ruth Reitman, left. His compassionate, round-the-clock care endeared him to patients throughout his career. But he also picked up a reputation for moodiness.Osler Library of the History of Medicine, McGill University
As the 1950s wore on, Dr. Cone suffered increasingly from what we would now probably call clinical depression.
He had a longstanding reputation for moodiness, but after his falling-out with Dr. Penfield, William Cones symptoms seemed to get worse. He would lock himself in his office for hours and come out to do his rounds at 2 a.m. His deep, pained sighs grew more frequent.
Colleagues at The Neuro didnt know how to respond. These brilliant explorers of the human brain were often adrift in the face of other minds, not least each others. The resident Mark Rayport later recalled how in Dr. Cones prolonged, frequent depressive spells, when he stalked the halls of the Institute with his head and prominent nose facing down, the apparent animal resemblance gave rise to a system for rating his moods on a scale of Moose 1 to 5.
In his upswings, his eyes still sparkled and his smile took on a mischievous cast. He loved nurses and they loved him back. When he was preparing a reluctant vacation to Sea Island, Ga., to recover his health during the war, Eileen Flanagan sent him flowers. He wrote back, giddily unpunctuated, that she was to be both scolded and thanked for sending me the lovely roses I did enjoy them.
Still, depression was a dark, uncharted ocean then, still not widely diagnosed as an illness and with no effective therapy. The first tricyclic antidepressant drugs were only just being developed. When he was at his lowest, there was no way to reach him. Those were terrible times to be depressed, said Richard Leblanc. Suicide was not unusual for lack of treatment.
Four days shy of his 62nd birthday, Dr. Cone entered The Neuro for the last time.
He had planned his death carefully, like everything he did. The cyanide he would ingest came from the institutes pathology department, said Dr. Preul. Dr. Cone also made sure to finish his portion of The Neuros annual report, which showed how hard and how well he had worked. In the previous year, Neuro staff had performed 971 operations, with only two infections.
Dr. Penfield was shattered by the loss of his friend. In the following months, he tried desperately to understand what had happened, filling a diary with thoughts about Dr. Cones death. The truth always eluded him.
Eileen Flanagan, who knew both men well, later wrote down her assessment of the tragedy on a stray piece of paper filed away in the institutes archives. Dr. Penfield, she said, never understood that it was his alienation from Dr. Cone which made him so unhappy.
The details of Dr. Cone's death would be shrouded in secrecy for decades afterward.OSLER LIBRARY OF THE HISTORY OF MEDICINE, MCGILL UNIVERSITY
From the morning Dr. Cones body was discovered, The Neuro treated his suicide essentially as a family secret. They purposely suppressed that idea, said Dr. Hanaway. They didnt want anyone to think there were any problems. This approach was not uncommon, but it added a layer of posthumous confusion to the misunderstanding that plagued William Cone during his life.
Even within the Institute, the secrecy surrounding his death led to rumours, some more credible than others. Many residents believed Dr. Cone had shot himself. Others spoke about his ghost creeping around the halls at night. The real circumstances of the suicide werent revealed until 1981, when Jefferson Lewis published his biography of Wilder Penfield.
Still, in death, Dr.Cone had a lasting impact on the study of the brain, made all the more poignant by his personal struggles. Many of his surgical innovations were still in use decades later and his bedside manner what the resident Harold Rosen called his tender loving care for the patient as a whole individual remained an inspiration for doctors across North America.
With money from the Bill Cone Memorial Fund endowed by gifts from grateful patients one of his successors, William Feindel, set about improving The Neuros brain imaging technology and developing new ways to use it. With PET scanners, researchers at the institute were eventually able to study the neural distribution of serotonin, a neurotransmitter that is key to regulating mood allowing them to better understand the brains of people who suffer in the way Dr. Cone suffered.
Today, even if he is mostly forgotten by the world at large, his memory is alive at The Neuro. A wall-sized mural in the institute shows its co-founders surrounded by famous neurologists of the past and captures the contrast between the friends. Dr. Penfield, wearing a pin-striped suit, looks upward in classical profile, gazing toward the future or the heavens. Dr. Cone is dressed in blue, his sad eyes looking down at a patient.
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