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MONTREAL NEUROLOGICAL INSTITUTE

ANNUAL REPORTS

TIUENTY-SIXTH TO THIRTY-SECOND

1960-61 - 1966-67

Twenty-Sixth Annual Report

of the

MONTREAL NEUROLOGICAL INSTITUTE

and the

DEPARTMENT OF NEUROLOGY

AND NEUROSURGERY

McGILL UNIVERSITY 1960-61

CONTENTS

Report of the Director 5

Clinical Staff 9

Consulting and Adjunct Clinical Staff 10

Teaching Staff 10

Executive Staff 11

Resident Staff 12

Laboratory Departments 12

Nursing Staff 15

Social Service Staff 16

Appointments in other Teaching Hospitals 16

Report on Graduate Studies and Research 17

Report of the Neurologist 20

Report of the Neurosurgeon 21

Report on Hospitalization 24

Report of the Director of Nursing 28

Department of Social Service 29

Department of Anaesthesia 31

Department of Radiology 32

Department of Neurochemistry 34

Donner Laboratory of Experimental Neurochemistry 34

Department of Electroencephalography 36

Department of Neurophysiology 38

Department of Neuropathology 39

Multiple Sclerosis Research Laboratory 40

Department of Neuroanatomy 41

Tumour Registry 41

Photography ^2

The Fellows' Library 43

The Montreal Neurological Society 45

The Fellows' Society 46

Clinical Appointments and Fellowships 47

Courses of Instruction 48

Publications 50

Donations 54 STATISTICS — Diseases, Operations, and Causes of Death 56

R E P O R T OF T H E D I R E C T O R

D R . THEODORE RASMUSSEN

We are once again making our official yeaily report to the Principal, and through him to the Board of Governors oi McGill University. As in the past, this is also an unofficial report to the public, to the City of Montreal, the Province of Quebec, the Canadian Government and the many private benefactors ^vho have supported the work of the Institute this past year and in earlier years. Th i s report will not come with the eloquence of previous years, I 'm afraid, but this will be compensated for by the oppor­tunity Ave have this evening of hearing Dr. Penfield deliver the 27th Annual Hughlings Jackson Memorial Lecture. It is a great pleasure for all of us to have him here at this occasion. I have never before seen him so relaxed at an M.N.I. Annual Meeting!

T h e coming retirement this summer of Miss Eileen Flanagan provides stimulus to comment on the matchless work of the nursing staff of the Insti tute throughout the 27 years of its existence. T h e international scope of the postgraduate training program in neurological and neurosurgical nursing is tangible evidence of this excellence, but the recognition that warms the heart comes daily to the members of the medical staff in the comments of patients and their relatives. 1 suppose many factors contribute to the esprit-de-corps and the devotion to nursing ideals that are the essential basis upon which highly skilled and compassionate nursing care rests. Important , certainly, are the high standards of medical care established from the beginning by Dr. Penfield and Dr. Cone. T h e research orientation that stems from interchange between clinic and laboratory and keeps constantly in the forefront the search for better and safer procedures and techniques is doubtless an addit ional factor of importance. Most important of all, how­ever, has been the leadership and contributions of Miss Flanagan and her senior associates, to which I pay special tribute today on behalf of the entire staff.

Miss Bertha Cameron, who will take over the post of Director of Nursing, on Miss Flanagan's retirement, has played a major role in building this nursing tradition of which we are all so proud and is Avell-qualified to provide the leadership for the future.

We report with pride Dr. Jasper's appointment as the first Executive Secretary of the Internat ional Brain Research Organization, incorporated in Ottawa but established as an arm of UNESCO to support international collaboration in the many scientific disciplines concerned with modern brain research. We wish him well in the organizational trials and tribulations that doubtless lie ahead. We hope after this sabbatical year with its added attraction of living in Paris, that he will still be happy to return to the familiar turmoil, problems and excitement of the Institute's 7th and 8th floors, and will not be tempted to leave us again.

Our two new additions to the staff, Dr. Romeo Ethier in Radiology, and Dr. Leonhard Wolfe in the Donner Laboratory of Exper imental Neuro­chemistry, have settled quickly into productive work, shedding their status as newcomers, and are making the valuable contr ibut ions to the work of the Insti tute expected of them.

Spring always brings a touch of sadness as Fellows who have completed their work here make preparat ions to go on to increased responsibilities elsewhere. Th i s year, as always, the contr ibutions of the Fellows to the clinical and scientific work of the Inst i tute have been an essential and impor tant factor in the record whose outlines have been briefly sketched today. We take great pride in the new posts that lie ahead for them.

T h e renovations of the sixth floor laboratories are now essentially completed, for the time being, at least. T h e unified Neuropathology Laboratory under Dr. Mathieson's able direction is functioning with increased efficiency and now space and facilities are provided for expansion of research activities in this field. T h e alterations have also provided room for the new Cone Laboratory for Neurosurgical Research where work is now getting underway under Dr. Feindel's supervision. T h e Wil l iam Cone Memorial Research Fund, the income of which provides the basic financial support for this work has received addit ional contributions dur ing the year, bringing the permanent capital to $440,000.

Th i s current year will go down in the unofficial annals of the business office as the year of "the batt le of the budgets". Dr. Robb, Mr. Hogan and the business office staff, faced with the necessity on short notice of changing from the University's fiscal year to a calendar fiscal year, by prodigious efforts have completed the budget for 1961 for McGill, redrafted the budget in completely different form for the Quebec Hospital Insurance Plan, and without losing momentum are making plans for the preparation of the budget for 1962 whose fall deadline is already bearing down upon us.

Th i s is an impor tan t and perhaps critical year for the hospital side of the Insti tute, as it is for most other hospitals of the Province, since there is now visible a beacon of hope for future financial stability. Vision, foresight and cooperation will be needed from political authorities, the public, doctors, nurses, hospital administrators and other hospital personnel, to insure that this financial stability is not achieved at the cost of lowering the standards of pat ient care.

T h e new Provincial Hospital Insurance Plan provides a powerful tool for the elevation of standards of patient care throughout the province to that currently present in our most progressive, best equipped and best staffed insti tutions. It is vital to our citizens that hospital standards not be reduced to the lowest denominator , and that future progress in improving hospital procedures not be impeded by pressures toward uniformity and bureaucratic convenience. As the Quebec Hospital Insurance Plan authorities struggle with the awesome financial problems ahead, the medical profession and hospital administrators will be watching with concern as the budget negotia­tions give concrete evidence as to the standards of patient care that will be available to the citizens of Quebec in the year ahead.

The need for more adequate and more permanent financial support for the scientific half of the Institute has provided one of the major topics of Dr. Penfield's annual reports in the 20 years that have elapsed since the first Institute annual meeting of this type was held in 1941. Such financial support has come, but the costs of research, and more important, the scope of research have increased still more rapidly. For example in 1950 the total scientific and departmental budget totalled $100,000. At present the total cost of running the scientific and teaching half of the Institute has nearly quad­rupled. In 1950, when % of this $100,000 came from endowment funds, and % from the newly established Federal Consolidated Grant, the fact that the remaining % was dependent upon precarious yearly project research grants was viewed with some concern. Today these temporary grants, exclusive of the yearly Consolidated Grant, have increased to constitute over % of the total scientific and departmental budget.

Thus despite the addition of the Donner Endowment for Experimental Neurochemistry in 1952, and the magnificent gift that established the Lily Griffith McConnell Endowment in 1953, and despite the progressive increase in the Federal Government's annual Consolidated Grant from $40,000 to $60,000, the problem of permanency of financial support for the research work of the Institute is increasing rather than decreasing.

It will never be possible to measure or even to estimate the magnitude of the benefits that have come to mankind as a direct and indirect result of the endowments conferred by philanthropic foundations and generous, far-sighted, private benefactors upon the universities, medical schools and hospitals of North America. By virtue of the permanence these endowments provide, these benefits will continue to multiply as long as such institu­tions exist.

The political realities of democratic governments seem to rule out, for the present at least, the possibility of governmental funds as a source of the endowments of the future which apparently must come, as in the past, from philanthropic foundations and from private philanthropy. The need and the importance of such endowments can hardly be over-estimated in the light of the opportunities at hand for lifting from the human race the crushing burden of mental disease, cancer, cardiovascular disease and a host of other ailments. Endowments provide much of the life blood of the university departments and laboratories that are the main source of the trained man power needed to utilize efficiently the funds becoming in­creasingly available for specific 1-, 3-, or 5-year project grants. If the latter expand too far out of proportion to the former, the quality and importance of Canadian medical research must inevitably decline.

The explosively expanding research needs of modern civilization, however, have far outstripped the means of private philanthropy. Consider, for example, the bill for the development of atomic power and the cost of the satellite programs in the United States and in Russia. It thus seems inevitable that our universities must increasingly rely on governmental sources for much of the support of their research programs.

These considerations are of special importance for the Canadian citizen at this time when the newly created Medical Research Council of Canada is taking its first steps away from its parent, the National Research Council. This new independence provides the opportunity to tailor plans and policies for the special needs of medical as opposed to other forms of research. The nature of these plans and policies now being established will play an important role in determining the caliber of future research in the medical schools across Canada. Wisdom and foresight will be needed to strike the proper balance between long-range and short-range support and to define the forms of financial support for medical research, so there will be provided maximum stimulus for strength and longevity of research programs in all of the many aspects of modern medicine, where new vistas of knowledge and understanding are opening up just as rapidly, although not as spectacularly perhaps, as in the explorations of outer space.

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CLINICAL STAFF

Director THEODORE RASMUSSEN, B.S., M.B., M.D., M.S., F.R.C.S. (C)

Honorary Neurosurgeon and Guggenheim Fellow W ii.nr.R PKNFII LD, O.M., C.M.G., ^r.D., D.Sc, F.R.C.S. (C) , Hon. F.R.C.S. (Eng.)

F.R.S.C, F.R.S. (Lond.) , Hon. F.R.C.P. (Eng.)

Ne u rologist-in - Cli ief FRANCIS MCNAU(;HTON, B.A., M.Sc, M.D., CM. , F.R.C.P. (C)

Neurologist I'RESTON RoBB, B.Sc, M.Sc, M.D., C M .

Associate Neurologist DONALD LLOVD-SMITH, B . S C , M.D., CM. , F.R.C.P. (C)

Assistant Neurologisls J. B. R. CosGROVE, M.D., M.SC. (Cantab.) BERNARD GRAHAM, B.A., B.Sc, M.D., C M .

IRVING HELLER, B.Sc, M.D., CM. , M.Sc. DAVID HOWELL, M.B., B.S. (Lond.) , M.R.C.P. (Lond.)

REUBEN RABINOVITCH, B.A., M.D., M.Sc. WILLIAM TATLOW, M . D . (Lond.) , M.R.C.P. (Lond.) , F.R.C.P. (C)

Neurosurgeon-in-Chief ARTHUR R . ELVIDGE, M.D., C^L, NLSc, Ph.D., D.CL. (Bishop's), F.R.C.S. (C)

Neurosurgeons GiLLLs BERTRAND, B.A., M.D., M.Sc, F.R.C.S. (C)

WILLIAM H . FEINDEL, M.Sc, M.D., CM. , F.R.C.S. (C) THEODORE RASMUS.SI N

Assistant Neurosurgeons JOHN BLUNDELL, M.\., M.D. (Cantab.) , M.R.C.P. (Lond.) , F.R.C.S. (Eng.)

CHARLES BRANCH, B.A., ^^.D., M.Sc RICHARD ROVIT, NED., >ESc.

Radiologist DONALD M C R A E , M.D.

Associate Radiologist R O M E O ETHIER, B.A., M.D.

Neurophysiologist and Consultant i)i Electroencephalography HERBERT JASPER, Ph.D., D.es Sci. (Paris) , NED., C.\E

Electroencephalographer

PIERRE GLOOR, M.D. (Basle), Ph.D.

Assistant Electroencephalographer DONALD LLOYD-SMITH

Anaesthetist RICHARD G . B . GILBERT, M.B., B.S. (Lond.) , M.R.C.S., L.R.CP., DA. ,

F.R.C.P. (C) , F.F.A.R.CS., F.A.CA.

Associate Anaesthetists G. FREDERICK BRINDLE, B.A., M.D., C M . (McGill) , F.R.C.P. (C)

RONALD MILLAR, AED. , Ch.B. (Edin.) , F.F.A.R.CS., M.Sc.

Neurochemist and Donner Fellow K. A. C ELLIOTT, AESC, Ph.D., ScD.

Associate Neurochemist HANNA PAPPIUS, B . S C , Ph.D.

Associate Neurochemist and Kenny Foundation Scholar LEONHARD S. WOLFE, B . S C , M . S C , (N .Z . ) , Ph.D. (Cantab.) , M.D.

Neuropathologist GORDON MATHIESON, M.B., Ch.B. (Aberdeen)

Clinical Research Psychologist BRENDA MILNER, B.A., M.A. (Cantab.) , Ph.D.

CONSULTING AND ADJUNCT CLINICAL STAFF

Consulting Pathologist GARDNER C MCMILLAN, M.D., CM,, M.Sc, Ph.D.

Consulting Psychiatrists D. EWEN CAMERON, M.D., F.R.C.P. (C) MIGUEL PRADOS, M.D.

Consulting Neurologists ROMA A M Y O T , B , A . , M.D., (Montreal and Paris) SvLvio CARON, M.D., F.R.C.P. (C) GUY COURTOIS, M.D. JEAN-LEON DESROCHERS, M.D.

JEAN SAUCIER, B.A., M.D., (Paris and Montreal) NORMAN VINER, B.A., M.D., C M . ARTHUR YOUNG, M.D., CM., F.R.C.P. (C)

Adjunct Neurosurgeons CLAUDE BERTRAND, B.A., M.D., F.R.C.S. (C) HAROLD ELLIOTT, B . S C , M.D., C M . JEAN SIROIS, B.A., M.D.

Consulting Anaesthetist HAROLD R . GRIFFITH, M.M., B.A., M.D., CM. , F.A.C.A., F.I.C.A., F.F.A.R.CS. (Eng.), F.R.C.P. (C)

Consulting Research Anaesthetist J. G. ROBSON, M.B., B.Ch. (Glasgow), F.F.A.R.CS. (Eng.) .

Consulting Bacteriologist R. W. REED, M.A., M.D., C M . Consulting Radiologist CARLETON PEIRCE, A.B., M.Sc, M.D., F.A.C.P. Adjunct Radiologists NORMAN M . BROWN, B.A., M.D., C M

ROBERT ERASER, M.D., F.R.C.P. (C) JEAN L . LEGER, M.D.

Consulting Radiation Therapist JEAN BOUCHARD, M.D., D.M.R.E. (Cantab.) Consulting Executive Director J. GILBERT TURNER, M.D., CM. , M.Sc,

F.A.CH.A. Consulting Psychologist M . S A M RABINOVITCH, Ph.D. (Purdue)

TEACHING STAFF

A. Department of Neurology and Neurosurgery, McGill University Faculty of Medicine.

Chairman of Department and Professor of Neurology and Neurosurgery THEODORE RASMUSSEN

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Professor of Neurology FRANCIS MCNAUGHTON Associate Professor PRESTON ROBB Assistant Professors of Neurology J. B. R. COSGROVE

DONALD LLOYD-SMITH REUBEN RABINOVITCH WILLIAM TATLOW

Lecturers in Neurology BERNARD GRAHAM

IRVING HELLER DAVID HOWELL

Demonstrators in Neurology ISRAEL LIBMAN PRAKASH I A N D O N

SUSAN WOODCOCK Professor of Neurosurgery W ILLIAM FEINDEL Associate Professor of Neurosurgery ARTHUR ELVIDGE Assistant Professors of Neurosurgery GILLES BERTRAND

HAROLD ELLIOTT Lecturers in Neurosurgery J<^"^ BLUNDELL

CHARLES BRANCH RICHARD ROVIT

Demonstrators in Neurosurgery JESSE BARBER PHANOR PEROT HUGH SAMSON

Professor of Experimental Neurology HERBERT JASPER Professor of Biochemistry K. .\. C ELLIOTT Assistant Professors of Experimental Neurology Pii RRE GLOOR

LEONHARD S. WOLFE Lecturer in Experimental Neurology HANNA PAPPIUS Associate Professor of Neurological Radiology DONALD M C R A E Associate Professor of Anaesthesiology RICHARD GILBERT Assistant Professor of Neuropathology GORDON MATHIESON Assistant Professor in Clinical Psychology BRENDA MILNER Demonstrator in Neuropathology BARTOLO BARONE Demonstrator in Electroencephalography LEWIS HENDERSON

B. Department of Neurology and Neurosurgery, McGill University Faculty of Graduate Studies and Research

Professors HERBERT JASPIR (Chairman) K. , \ . C ELLIOTT \ViLLiAM F E I N D E L

FRANCIS MCNAU(;HTON THEODORE RASMUSSEN

Associate Professors .\RTHUR ELVIDGE DONALD M C R A E PRESTON ROBB

Assistant Professors J- ^ R- COSGROVE PIERRE GLOOR GORDON MATHIESON BRENDA MILNER

EXECUTIVE STAFF OF T H E MONTREAL NEUROLOGICAL INSTITUTE

Director THEODORE RASMUSSEN Assistant Director "(Hospitalization) PRESTON ROBB

Assistant Director (Scientific) FRANCIS MCNAUGHTON

Registrar BERNARD GRAHAM Business Manager f.^V' ^ ^ ' ' ' ' Executive Secretary MISS ANNE DAWSON

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RESIDENT STAFF —JULY 1960-1961

Senior Resident PHANOR PEROT, M.D. (New Orleans) U.S.P.H.S. Felloe

Neurological Services Teaching Fellows PRAKASH TANDON, M.D. (New Delhi) *

SUSAN WOODCOCK, M.D. (London, Eng.) * Residents J. JACOB, M.D. (Vellore, India) *

ISRAEL LIBMAN, M.D. (McGill) SUSAN WOODCOCK, M.D. (London, Eng.) *

Assistant Residents D. BHATHAL, M.D. (Madrid) J. C JACOB, M.D. (Vellore, India) * R. GiGUERE, M.D. (Laval) G. KARPATI, M.D. (Dalhousie) R . GROSSMAN, M.D. (Colombia) F. MAROUN, M.D. (Beirut)

R. MUSELLA, M.D. (Naples, Italy) * RVH Rotators

R. BALTZAN, M.D. I. J. LIGHT, M.D.

D. EiDiNGER, M.D. R. MACDONALD, M.D. M. J. FERRARI, M.D. S. SALISBURY, M.D.

E. GABOR, M.D. H. J. SMITH, M.D.

R. KEOGH, M.D. W. B. VAN ALSTYNE

MGH Rotators D . DoNNENFELD, M . D . M. R . G R Y M A L O S K I , M . D .

R. D. ELLIS, M.D. A. VOST, M.D.

F. G. GOMES, M.D.

Neurosurgical Services Residents

J. Barber, M.D. (Washington) PHANOR PEROT, M.D. (New Orleans) U.S.P.H.S. Fellow U.S.P.H.S. Fellow

HUGH SAMSON, M.D. (Ontario)

Assistant Residents F. COOPER, M.D. (Atlanta, Georgia) D. GONZALES, M.D. (Mexico) V. DAVE, M.D. (Jodhpur, India) J. GYBELS, M.D. (Belgium) H. GARRETSON, M.D. (Arizona) R. MUSELLA, M.D. (Naples) *

J. OSTERHOLM, M.D. (St. Louis)

LABORATORIES AND DEPARTMENTS

ANAESTHESIA

Anaesthetist RICHARD G. B. GILBERT, M.B., B.S. (Lond.), M.R.C.S., L.R.CP., DA., F.R.C.P. (C), F.F.A.R.CS., F.A.CA.

Associate Anaesthetist and Research Associate RONALD A. MILLAR, M.D., Ch.B. (Edin.),

F.F.A.R.CS., M.Sc Associate Anaesthetist G. FREDERICK BRINDLE, B.A., M.D.,

C M . (McGill) F.R.C.P. (C) Assistant Anaesthetist N. \V. B. CRAVTHORNE, M.B., B.Ch.

Research Fellow MARY MORRIS, M.D. (Ontario) Beatty Memorial Scholarship

Resident Staff A. K. CHAKRABARTI, M.D. (Calcutta) * J. J. MCGRATH, M.D. (Belfast) ** W. J. CiPRiCK, M.D. (McGill) * I. T. J. O 'NEILL, M.D. (Western Ontario) ^ SHOU-HSIN HSU. M.D. (Shanghai) * V. T . RICARDO, M.D.(Dominican Republic) J. L. LAJGIE , M.D. (Laval) * N. J. SOLTICE, M.D. (Alberta) *

Nurse in Charge of Anaesthetic Rooms HELEN CALLANDER, R.N.

*Six months on this service. **Three months on this service.

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13

ELECTROENCEPHALOGRAPHY AND ELECTROMYOGRAPHY

Electroencephalographer PIERRE GLOOR, M.D., Ph.D. Consultant in Electroencephalography HERBERT JASPER, Ph.D., D.^s Sci., M.D., C M . Assistant Electroencephalographer DONALD LLOYD-SMITH, B.Sc, M.D.,

CM. , F.R.C.P. (C) Electroencephalograjyhic Fellows

FREDERICK ANDI RMANN, M.D. (Montreal) ROSARIO MUSELLA, M.D. (Naples, Italy) • RA^ NioND GIGUERE, M.D. (Laval) * YAVUZ RAZ RENDA, M.D. (Ankara, DES R A ) GULAII , M.D. (Punjab, India) * Turkey) * Rockefeller Fellow

Colombo Plan Fellow PRAKASH TANDON, M.D. HuNiiNGioN MAYOR, M.D. (New Delhi, India) *

(Burlington, Vt.) U.S.P.H.S. Fellow CRISTIAN VERA, M.D. (Santiago, Chile) * Electromyographic Fellow COSTAS STEFANIS, M.D. (Greece, Athens) *

Muscular Dystrophy Assn. Fellow Chief Technician and Demonstrator LEWIS HENDERSON, JR.

N E U R O C H E M I S T R Y

(DONNER LABORATORY AND CLINICAL LABORATORY)

Neurochemist and Donner Felloiu K. A. C ELLIOTT, M . S C , Ph.D. ScD. Associate Neurochemist HANNA M . PAPPIUS, M . S C , Ph.D. (McGill) Associate Neurochemist and Kenny

Foundation Scholar LEONHARD S. WOLFE, B .SC , M . S C (N.Z.) Ph.D. (Cantab.). M.D.

Assistant Neurochemist, Clinical IRVING HELLER, B . S C , M.D., CM., M.Sc. Felloii's

FERNAND BILODEAU, (Montreal) , J. A. LOWDEN, M.D. (Toronto), N.R.C. (Can.) Studentship Queen Elizabeth II Fellow

R. .\ . LovELL, (Montreal) Muscular Dystrophy .Assn. Fellow

N E U R O P A T H O L O G Y

Neuropathologist GORDON MATHIESON, M.B., Ch.B. Assistant Neuropathologist GILLES BERTRAND, B.A., M.D., M.Sc.

Fellou's BARTOLO BARONI, M.D. (Chicago) MANOUCHFR GUERAMY, M.D.

RIC;HARD BROWN, M.D. (Iran-Aberdeen, Scot.) • (London, Eng.) * DES R A J GULATI, M.D. (Punjab,

STIRI.IN(, CARI 'ENH R, M.D. (Burlington, India) * Colombo Plan Fellow Vt.) Vt. Exchange Fellow KENNETH KAPPHAHN, M.D. (St. Louis) *

GARTH EMBREE, M.D. (Halifax) YAVUZ RENDA, M.D. (Ankara, Turkey) * Rockefeller Fellow

Chief Technicians JOHN GILBERT BARBARA NUTTAI.L, B .A.

NEUROANATOMY Neuroanatomist FRANCIS L . MCNAUGHTON, B.A., M.SC,

M.D., C M . Fellow \iLAN MORTON, M.D., CM., M.Sc (McGill)

N E U R O P H Y S I O L O G Y

Neurophysiologist , HERBERT JASPER, Ph.D., D.cs Sci., M.D., CM. Assistant Neurof)hysiologist PIERRE GLOOR, M.D., Ph.D.

*Six months on this service.

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T'isiting Scientist

Fellows BARUCH BLUM. M.D. (Rehovoth,

Israel) , N.R.C. (Can.) Fellow JERZY MAJKOWSKI, M.D. (Warsaw,

Poland) * Rockefeller Fellow MoRio MATSUNAGO, M.D.

(Kvoto, Japan) ELM AN POOLE. M.D. (London. Eng.) **

Rockefeller Fellow

W. C STEWART, B.A., M.A., M.D. (Alberta) Defence Research Board, Chemical Warfare

FOSTER REDDING, M.D. (Phila.) RICHARD ROVIT, M.D. (Boston) *

U.S.P.H.S. Fellow JEAN SIEGFRIED, M.D. (Geneva,

Switzerland) * Fellow of Swiss Acad. of Medical Sciences

COSTAS STEFANIS, M.D. (Greece, Athens) * Muscular Dystrophy Assoc. Fellow

Nurse in Charge of Neurophysiology Rooms . .^ MARY ROACH, A . R . R . C , R.N.

PHOTOGRAPHY Supervisor GILLES BERTRAND, B.A., M.D.. M.Sc. Photographer CHARLES HODGE, F . B . P . . \ . Assistant Photographer JEAN GARNEAU

RADIOLOGY Radiologist DONALD M C R A E . M.D. Associate Radiologist ROMEO ETHIER, M.D. James Picker Foundation Fellow GUIDO CASTORINA, M.D. Residents

PIERRE FAUTEUX, M.D. (Montreal) * I. K. MILLAR. M.D. GiSELE LUSSIER, M.D. (Montreal) * RUDOLPHE BEAULIEU, M.D. (Laval) *

Chief Technician JOAN BROADLEY. R . T .

(Rome)

(Ireland) *

RESEARCH IN MULTIPLE SCLEROSIS Chief J. B. R. COSGROVE, M.D.. M.Sc Immunochemist and Research Associate CATHERINE MACPHERSON, Ph.D.

(Columbia) B.Sc. M.Sc Technician MRS. EVA MEHLHOSE

NURSING STAFF Director of Nursing Miss Assistant Director of Nursing Miss Administrative Assistant MRS. Supervisor Dressing Rooms Miss Educational Director MRS. Clinical Instructor Miss Night Supervisor Miss Assistant Night Supervisors Miss

Miss Operating Room Supennsor Miss Assistant Operating Room Supennsor Miss

EILEEN C FLANAGAN, B.A., R.N. BERTHA CAMERON, R.N. ELEANOR CARMEN, R.N. ANNIE JOHNSON. R.N. R. A. BLAKE S. O ' H E I R ELIZABETH BARROWMAN, R.N, LILLIAN MCAULEY, R.N. MARILYN MANCHEN, R.N. PHOEBE STANLEY. R.N. PATRICIA MURRAN , R.N.

HEAD NURSES

Miss EVELYN ADAM, R.N. MISS M . ACNEW, R.N. Miss ALICE CAMERON, R.N. MISS MARY CAVANAUGH, R.N.

MISS BARBARA FIELDS, R.N. MISS AUDREY KIMBERLEY, R.N. MISS CAROLINE ROBERTSON, R.N.

•Six months on this service. • * T h r e e months on this service.

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SOCIAL SERVICE STAFF Director ^jiss C Y M I I I A G R I F F I N , B.A., M.S.

Social Workers:

Miss PATRICIA L I N C K , B.A., M.S.W. M R S . B E T T E SCHON, B.A., M.S.W.

Miss K A T M M 1 N M A C D O N A L D , B.A., B.S.W. Miss N O E L L A VAILLANCOURT, B.A., M.S.S.

M R S . M A R ( . U I U I I I PUVREZ, D i p l o m a in

Social W o r k (U. of M.)

APPOINTMENTS HELD IN

TEACHING HOSPITALS OF MONTREAL R O Y A L V I C T O R I A H O S P I T A L

Xeurologist and Neurosurgeon-in-Chief ARTHUR R . ELVIDGE Xeurologist FRANCIS L . MCNAUGHTON

Assoc talc Neurologists DONALD LLOYD-SMITH PRESTON R O B B

ARTHUR W . YOUNG

Assisi/nit Neurologists J. B. R. COSGROVE REUBEN RABINOVITCH

Clinical Ass^siauts in Neurology BERNARD F . GRAHAM IRVING H . HELLER

Nrurosurgrons W I L L I A M H . FEINUFL THEODORE RASMUSSEN

•l.sso(iatr Xrtirosurgeon , GILLES BERTRAND Clinical Assisttnits in Xcuiosiirgery J O H N BLUNDELL

CHARLES BRANCH

Ph\si(ian-in-Chargr of Electroencephalography and l:lt<homyoi:^raf>hy HERBERT H . JASPER

Issociatr Radiolooisl DONALD L . M C R A E Houoran' Consulting Staff ^ Anaesthesia R- G. B. GILBERT

M O M R E A L C.ENER. \L H O S P I T A L

\runnu,<'eon-in-Chief and Director H . E L L I O T T , , , , .\V. F. T . TATLOW

hsoddte \('ntologist , , , , D . HOWELL

•iwisldiit \(inoloilist ^ ^ , . , ; , , FRANCIS L. MCNAUGHTON

(Oiisultanls in Ar/zro/oi^v PRESTON ROBB ARTHUR ELVIDGE

(onsultanl in Nrun>sit> ij^rtx • I i / HERBERT IASPER

Cnnsultant in lln tuumephalography J

MON I R E A l , CHILDREN'S HOSPITAL

GILLES BERTRAND

(onsultnnts ARTHUR ELVIDGE

HERBERT JASPER

FRANCIS MCNAUGHTON

DONALD M C R A E

THEODORE RASMUSSEN

M. SAM. RABINOVITCH

Ilononnx Consulting Staff , ; : ; , , ^ , ^ ; ^ ; : ; ; ^ , „ PRESTON ROBB

!)iii(l<>> ^ Z : Z Z : i o r . . . r . . O..io,.

GRADUATE STUDIES AND RESEARCH

DR. HERBERT H . JASPER

Traditionally at this time it has been my task to review briefly the main trends of research during the past year. This year I would like to speak instead, about the broader reaches of our Institute in Canada, and on the international scene.

Since the founding of this Institute we have trained 350 carefully selected men from 37 different countries scattered over the globe. This includes only those spending at least one year with us, most spending more. Others have come for shorter periods of observation or short specialized training.

Most of these men are now engaged in productive work as neuro­surgeons, neurologists or in some branch of the neurological sciences. Many have distinguished careers, some surpassing their teachers in their accomplish­ments. In fact the tide is beginning to turn, as we find ourselves going to them for instruction in newly developed surgical or laboratory techniques. When enough of them get together in groups, such as at the National Institutes of Health in Bethesda, one can almost speak of another branch of our Institute, with the fellows carrying on with similar work, just where they left off when working with us here.

Miss Dawson has kindly provided me with some figures of interest in this connection. Since the founding 27 years ago, 23 percent of our fellows have come from Canada as compared to 34 percent from the United States. Together we North Americans accounted for only 57 percent of our fellows, a bare majority. The rest came from 35 other countries. In other words, about 1 out of 3 were Americans and about 1 out of 4 Canadians. Only 1 out of 5 (or 18 percent) are still working in Canada, if one includes the 7 still at the Institute. Thirty percent are still working below the border. This includes a few Canadians, but we have kept a few Americans in exchange. I suppose this qualifies us as an International Institute with a strong North American bias and a distinctly Canadian flavor.

Preoccupation with a newly formed International Organization for Brain Research has given me a renewed perspective and appreciation for our own opportunities and responsibilities in the neurological sciences, with much encouragement for the interest our government has shown in this work. Since such a large proportion of our national productivity in this field is being exported abroad, the strengthening of the neurological sciences throughout this country becomes one of the most effective ways to contribute to others.

The problem of furthering the development of the neurological sciences in our country, (and here I include the basic sciences of Psychiatry as well) cannot be divorced from the medical sciences generally, nor even from the

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natura l sciences upon which we depend to an increasingly large extent. Computers and automatic control systems are beginning to have important applications, both theoretical and practical, to studies of the nervous system as they cont inue to replace and even to surpass the human brain in the performance of complex tasks and in the solution of most difficult problems. Secrets of biological memory, unravalled by molecular biophysicists and chemists are becoming of importance to an understanding of how the brain records experience. Radiat ion, electronic, and mathematical physicists are becoming essential members of medical research teams. (In this connection we are pleased to w^elcome Mr. Nicholas Rumin to our staff from the McGill Depar tment of Physics, to be joined in the fall by another physicist, experienced with electronic computers, Mr. Kenneth Reid, also from McGill via Saskatoon, following Dr. Feindel's footsteps).

In 1957 the Association of Canadian Medical Colleges represented by the Deans of our 12 Medical Schools, presented to the Prime Minister a resolution expressing grave concern about the "alarming inadequacy" of Federal support for medical research in Canada. Our government acted promptly to set up a Committee, headed by Dr. Ray Farquharson to study this problem. In November of 1959 there appeared the report of this Committee in which Federal support in Canada was found to be considerably below that of all other countries studied, figured in proport ion to gross national productivity. Events have been moving so rapidly dur ing the last tAvo years, especially in the United States, that this report is already some­what out of date.

Many specific recommendations were made for greatly increased Federal support for medical research throughout this country, with particular mention of the neiuological sciences. Acting on these recommendations there has been established an independent Medical Research Council, with Dr. Farquharson as its President, and with prospects of great consequence \vhen their programme becomes established. This is a most encouraging development, and one which deserves our full support .

I h e r e is indeed much more we can do with our resources, limited as they may be as compared to those in the United States. American support for medical research has inevitable effects upon Canadian science, and creates competition for our scientists.

We should appreciate also the very generous support being provided by the American Government for medical research in Canada. During the first quarter of this year alone the National Institutes of Heal th has granted over 4 /4 million dollars in support of work outside their country. Canada was the largest benefactor with 48 grants totalling nearly $800,000. At this rate the N I H alone may soon be support ing more medical research in Canada than our own Medical Research Council with their present limited budget, and this does not include large contributions being made by the United States National Science Foundat ion and from many other sources south of the border. We feel sure that this challenge will be met by greatly increased government support of the right kind for medical research in Canada.

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While financial support does not guarantee good work it is seldom considered a serious handicap, unless it restricts our freedom or adds to our insecurity by the limitations and restrictions of short term projects. Working on a solid and broad base of permanent endowment we need fluid funds to pursue shorter or long term programmes which seem most promising.

Our most urgent problem now is to recruit and to keep good men, and to develop more of our resources, with our own resources, but not in isolation from other departments of McGill, nor independent from the needs of other Universities in Canada.

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R E P O R T OF T H E NEUROLOGIST

D R . FRANCIS L . MCNAUGHTON

In ponder ing over the work of the Department of Neurology for the past year, I find it difficult to highlight any special events apart from the Inst i tu te as a whole. T h e number of in-patients was slightly less than in 1959, and as usual our admissions constituted approximately half the total admissions to the Inst i tute. Our Neurosurgical colleagues, as ever, have given us wonderful cooperation, and we continue to live in that pleasant state of neurological-neurosurgical symbiosis for which this Institute has always been noted!

Among the achievements by members of the Staff during the past year, I would ment ion Dr. Rabinovitch's monograph on "Diseases of the Inter­vertebral Disc", the fruit of years of experience and collaboration with Dr. Cone, to whom it is so fittingly dedicated.

Of the younger men in training last year. Dr. Kenneth Kapphahn has now joined the neurological staff of the Henry Ford Hospital, Detroit, and Dr. Hun t ing ton Mavor has gone to the University of Utah. We wish these two promising young men every success in their future careers. Special ment ion should also be made of Dr. Andre Barbeau, who has left us to become Assistant Professor of Experimental Neurology at the University of Montreal . We congratulate him on his recent Markle Scholarship award, and are happy to see him following in the footsteps of his distinguished father. Fortunately we have not entirely lost Andre, for he is continuing his special interest in extra pyramidal disorders here through an appointment to the Out-Patient Staff.

I must thank all the young men and women, our own residents, and those who rotate to the M.N.I, from the Royal Victoria Hospital and the Montreal General Hospital for their contr ibution to the life and work of the Institute, and only hope that we are giving them full measure in return. Of the Residents, I will mention particularly the outstanding work of Dr. Israel Libman and Dr. J. C. Jacob during the past year. T h e Graduate Teaching Program continues to benefit from the financial help we receive from the United States Public Heal th Tra in ing Grant.

T h e Out-Patient Services in the Royal Victoria Hospital showed a moderate drop in attendance in 1960, though the difference was not great. T h e Epilepsy Clinic continues as our largest Out-Patient service, and we are grateful for the continued support of this work by the Federal-Provincial Rehabil i tat ion Grant. Madame Puvrez continues to make a splendid con­tr ibution through her special group work with some of our seizure patients and with a Parent-Group, and constantly reminds us that there is far more to the treatment of epilepsy than prescribing pills I Our best wishes eo to Mrs. Bette Schon, our Senior Social Worker, who is leaving the Clinic Staff after 5 years of valuable service.

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Dr. Cosgrove's work with Multiple Sclerosis has been mentioned in past reports, and I would again draw attention to his admirable supervision and treatment of a group of patients which now approaches five hundred. The Social Service Department also carries a heavy load of responsibility for this group. Dr. Cosgrove's research work will be mentioned in other Institute reports.

Professor Rasmussen has asked me to say a word about the Under­graduate Teaching Program. We are now beginning to feel the full effect of the changes in the curriculum of the Medical School, and our medical students are slowly becoming integrated into the team work of the Institute. The integration is still imperfect, but is improving steadily. As part of the Second Year course on the Nervous System, the student is introduced to Clinical Neurology, but he sees it at a distance. In the Third Year, each student spends 36 hours working closely with patients, and the bedside teaching involves our nurses. Residents, and Teaching Fellows, as well as Senior Teachers, both Neurological and Neurosurgical. This is where we have our closest personal relationship with the students and it is the teaching that counts the most. We hope that this teaching will not only give the students a grounding in the practical management of disorders of the nervous system, but will challenge some of them to devote their lives to this most exciting of all the branches of medicine. I want to mention the two teaching fellows who during the past year have contributed so much to the students and the Staff, Dr. Prakash Tandon, and Dr. Susan Woodcock.

I wish to say a final word about the reorganization of the Neurological Services. After July 1st, the two services will be reconstituted into three, each with its Resident and two Assistants, and with a separate Out-Patient service. This change will allow for more thorough care and study of patients, and will re-distribute the heavy load carried by the Residents, allowing we hope more time for reading and clinical research. The fact that we can now expand into three services is a tribute to the ever-growing experience and good judgment of my fellow Neurologists, and I close this report by giving them my hearty thanks.

REPORT OF T H E NEUROSURGEON

DR. ARTHUR R . ELvmcE

During the year the Neurosurgical Department has been very active. There were 1,262 direct admissions and 113 patients transferred from the Neurological Department making a total of 1,375 patients cared for on the three neurosurgical services. In the Outdoor Clinics which are held Tuesday, Wednesday and Thursday afternoons there were 210 new patients and a total of 913 visits.

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T h e total number of operative procedures was 1,082, an increase of 127. T h e total n u m b e r of major craniotomies was 245. Of these 99 were performed for cerebral t umour and 63 more specifically for epilepsy. Surgery for inter­vertebral dis( disease has shown a slight decrease over the last three years. However, 120 patients have been treated surgically. Arteriograms show a sharp increase. Nineteen stereotaxic operations were undertaken. The overall operative infection rate was 0.4 percent. T h e operating room supervisor Miss P. Stanley, the operat ing room staff, and the ward staff are to be congratulated upon this excellent record. T h e Institute is fortunate to have one of the finest Depar tments of Anaesthesia under the direction of Dr. R. G. B. Gilbert , so that procedures can be undertaken which otherwise might not succeed.

T h e accident service has been busy, and 97 cranial operations were resorted to in these cases. Th i s represents only a very small percentage of the total number of head injuries treated, and much additional operadng is accomplished in our dressing rooms which can be used for minor surgery. In addi t ion 25 operations were performed for fracture of the spine.

W e congratulate the Royal Victoria Hospital and the Department of Surgery on the establishment of a Traumat ic Service under Dr. H. t . Moseley, and hope that this will lead to better treatment and create greater possibilities for post-graduate training at all levels, and opportunities tor research. We look forward to our continued association with the new T r a u m a t i c Service. In the Neurological Insti tute the care of accident patients is rotated weekly through one of' the three Neurosurgical Services which seems to be a very satisfactory arrangement.

We must thank our resident staff and the nursing staff for the very efficient way in which they have cared for patients especially those severely injured and acutely ill. Many of these owe their lives to expert bedside care. In the p lanning of their rehabil i tat ion we have been greatly helped by our Social Service Depar tment under Miss C. Griffin. It is a great pleasure to thank our radiologist. Dr. D. McRae, and associates for their expert assistance at all times.

We at the Insti tute view with pride this year the record of the Neuro­surgical Fellows who go to assume greater responsibilities in different parts of the World: Dr. Cristian Vera has returned to his home University in Santiago, Chile, with a long stopover in Boston. Dr. Prakash Tandon is en route to India via Norway, to finish some work with Dr. K. Kristiansen, another old friend and former Fellow of the Institute. Dr. Jesse Barber leaves to re turn to his post in Howard University, Washington, D.C., as Assistant Professor of Surgery in charge of the Division of Neurosurgery. Dr. Richard Rovit departs in August for Jefferson Medical College in Philadelphia, to be Associate Professor of Surgery and head of the Division of Neurosurgery. Dr. D. R. Gulati returns this summer as Associate Professor to develop a Department of Neurosurgery in the City of Amritsar in the Punjab, India. Dr. John Blundell is remaining in the vicinity and goes to the Montreal Children's Hospital to extend the work of Neurosurgery there,

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and we are fortunate to retain close ties with him. It might be of interest to add that Dr. John Hunter A\ ho previously spent some years at the Institute is organizing a Neurosurgical Service in Hong Kong.

I am sure that 1 can speak for all in \ ishing these FelloAvs of the Institute much success in their chosen fields. We know that these men are excellent surgeons, but they are our friends and we shall miss them.

The Neurosurgical Services take some part in the vast amount of clinical and basic research ^vhich continues at the Montreal Neurological Institute. Large areas having to do ^vith aspects of research in epilepsy and related problems initiated and developed over thirty years by Dr. Wilder Penfield and staff have always attracted world wide attention. These researches are being directed and constantly expanded on the surgical side by Dr. T. Rasmussen and associates, and are correlated with basic research in the laboratories of physiology and chemistry, which are under the direction of Dr. H. H. Jasper and Dr. K. A. C. Elliott. In addition highly important psychological findings continue to emerge under the expert guidance of Dr. Brenda Milner. Stereotaxic surgery has been developed at the Institute by Dr. Gilles Bertrand and associates. Dr. J. Blundell and Dr. Jan Gybels.

Much investigation is carried out by the surgical staff and associates in the general field of neoplastic growth both on the clinical side and in the laboratories of neuropathology and neurophysiology and through the Tumour Registry. Altogether the names of 376 patients including those with verified and non-verified tumours have ])cen listed in the Tumour Registry during the year. I thank the Secretary, Miss Suzanne Cripps for her conscientious work.

Further progress has been made during the year by Dr. C. Branch and associates with the use of cytotoxic agents and antimetabolites administered by a closed cerebral perfusion technique, which is a means of bringing higher concentrations of the treating agent to the areas involved by the growth. A new tool for the study of tumour localization and which is useful in the study of the cerebral circulation was introduced here by Dr. W. Feindel. It depends upon the employment and their detection of radioactive tracers by an automatic scanner. This particular apparatus was developed in Saskatoon and a late model has been installed here. This research, which is expanding rapidly, is under the direction of Dr. W. Feindel, and he is assisted in this by Dr. R. Rovit.

It is my pleasure to thank all those who have contributed so much to the activities of the Neurosurgical Department.

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R E P O R T OF T H E DIRECTOR OF HOSPITALIZATION

DR. PRESTON ROBB

This report is a presentation of the statistics for 1960, as well a brief look at some of the problems that confront the hospital side of the Institute.

Hospital Statistics

In 1960 there were 2,514 patients admitted as compared to 2,577 in 1959. The total number of patient days was 45,280 a decrease of 1,650 over the previous year. The average daily occupancy was 91.5% as compared to 95% in 1960. Officially we have 135 beds, however, by dint of putting up extra cots and folding beds, there were 146 patients in at one time. The lowest occupancy during the year was 94. As January 1st 1961 approached there was a distinct fall off in patients, as it was known that after this time there would be no direct charge for hospital care. This accounts for the decrease in patient days in 1960 as compared to 1959.

The average length of stay was 18.2 days. This had remained fairly constant over the years. There were 1,082 operations performed, an increase of 129 over the previous year. The infection rate was 0.04%. There were 96 deaths (death rate 3.81%) and an increase in the autopsy rate from 80% to 81.25%. What does all this mean? We have reached a plateau Without increasing our size we cannot accommodate more patients than at present.

There is one way the turnover could be increased; by providing more beds for the chronically ill in Montreal. We have many patients who, although they no longer need our services, continue to need nursing care and cannot be looked after at home. It must be pointed out that if the turnover was increased, we would require more facilities for the ancillary services. The X-ray, EEC, Neurochemistry, and Accounting Departments to mention a few have reached a peak, and to enable them to increase their work load, more space would be necessary.

Clinics

The Neurology and Neurosurgery Clinics continue to be operated by and in the Royal Victoria Hospital. The total number of patients seen was 4,950 as compared to 5,415 the previous year. As well as the regular clinics, special ones are held for Multiple Sclerosis, Parkinsonism, Muscle Diseases, and Epilepsy.

The Clinics are an essential part of the hospital. Diagnostic facilities and treatment are provided either free or far below cost to those who cannot afford to pay for private service. The teaching hospitals recognize that these Out-patient Clinics are necessary, but they are faced with the dilemma that they can no longer afford to maintain them. Until such time as government is prepared to pay the hospital for each visit, generous grants should be provided to help maintain these services. Further, regardless of the social

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status, facilities should be such that patients are treated with kindness, and dignity.

Records

T h e problems of changing staff and limited space have made it in­creasingly difficult to mainta in the steady {\o\v of records through the Registrar's office to the Record Room. We are deeply grateful to those loyal members of the staff who have continued to help us over our difficulties and mainta in the high standards ^vhich have characterized the MNI records. We hope that in the very near future the typing pool will be rebuilt and working conditions \ astly improved.

Finance

I have been known in the past as a prophet of gloom. T h e fiscal year of 1960 was unusual in that it had only 7 months. T h e end of the financial year, coinciding with that of the University, has always been May 31st. This year, with the starting of the Quebec Hospital Insurance Plan the books were closed on December 31st. These 7 months were bad ones for the Institute. There was a deficit of $124,077.00. T h e fall-off in admission at the end of the year caused a drop in income of S34,0()0 less than had been budgeted, losses from Q.P.C.A. were 827,000 more than expected. Items that normally have been purchased over a 12-month period ^vere included in the 7-month period. These items account for $81,000 of the deficit. T h e rest could be accounted for by increased costs. You can appreciate why 1 have the feeling of Job, who said "when I looked for good, then evil came unto me: and when I ^vaited for light, there came darkness . . . my harp is also turned to mourning and my pipe into the voice of them that weep".

Building Maintenance

Old friends visiting the Institute notice a strange quiet they can't explain. T h e Ticker System has gone and has l^een replaced by the Pagemaster Call System. By means of a radio beamed signal, individuals carrying receivers are notified to contact the locating operator who relays messages. Al though there have been minor difficulties, the system has been a great success and we hope will soon be expanded.

Painting, p lumbing repairs, new screens and other minor works have continued to keep the Depar tment of Buildings and Grounds busy. We are all deeply grateful for the continued cooperation of Mr. Cunningham and his staff.

Women's Auxiliary

Working quietly and busily in the coffee shop the Women's vVuxiliary have provided a very useful service to our patients, their relatives and our staff. As well, they have been most generous to the Institute. They were able to give 82,000 to the Harvey Gushing Clinical Relief Fund; $1,000 to refurnish the Social Service Department ; $200 to the Social Service Trus t Fund; 8500 to the Nursing Education Fund; $200 to the Christmas

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Cheer Fund; and $300 to die Building and Equipment Fund, making a grand total ot $4,200. We are most gratelul to them and widi to sa? a loud thank you. ^

The Hospital Insurance Service

O n January 1st, 1961 the Quebec Hospital Insurance Plan came into being and we became Hospital Number 19. This service provides standard ward care without charge to all people who have been residents of Quebec for 3 months. Semi-private and private ward care may be had on payment of a modest differential charge.

First let me say that physicians and the patients welcomed this service. 1 he publ ic has demanded, and we in turn, have done all we can to provide the best in hospital care. However the public was no longer able to pay for it. T h e cost per pat ient per day in this hospital in 1960 was $35.87, and we predict a substantial increase in costs for this year. Wages have increased and the shift to a 40-hour week, in line with industry, has required an increase in staff. A long hospital stay would have meant increasing financial disaster to the family, and most certainly increasing hospital deficits. For these reasons — and others we all welcome the change.

Hospitals are created for the care of the sick. Let us not lose sight of this. Regardless of the difficulties confronting the administrator and his staff created by this scheme, regardless of the uncertainties of dealing with those who operate the scheme, and the changing directives, or lack of directives, the patient will be better off. Our major concern should be to maintain the high standards of medical and nursing care that have characterized this Inst i tute. It will be a constant and continuing battle for which we all must steel ourselves.

W h a t are some of the problems ^ve have had to contend with? We have been operat ing to capacity. Patients now wait to get in. For the first five months of the year there was a 98.3^f occupancy. There does not seem to be any sign of a let up. There is a constant struggle to get patients out so that those waiting may be admitted.

T h e first problem to confront us was the admission procedures. It is like ancient history now but at the time it seemed as if we were in one continuous meeting trying to straighten out the difficulties. T he n the definition of semi-private accommodation varied. In a brief presented to the Q.H.I.S. a statement of how our wards operated as intensive care units was made. In the past patients have been moved around according to their medical needs. A ward patient would be in a single side room, if necessary, or a private or semi-private patient could be on an eight-bed ward such as one of the nor th wards for observation of seizures. Although the merits of such a system was recognized, the Minister of Health did not feel that he could make an exception for this Institute. As a result, we may no longer put semi-private patients in any room with more than four beds. Th i s has left us with a great shortage of semi-private beds. Many patients who are willing and able to pay have to be admitted as standard, simply because semi-private accommodation is not available. ^

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On the Neurology services in the past, one physician was in charge of all s tandard ward patients. Th i s provided the bulk of material for teaching, both graduate and undergraduate . As potential semi-private patients are being admit ted of necessity to standard ^vard care, it has been necessary to change this. Each neurologist looks after all patients he refers regardless of their status. T h e man-on-service looks after patients admitted from tlie Clinic, and the odd patient that turns up ^vithout a doctor. This has its advantages and disadvantages. My only concern is that resident teaching \vi\\ not be neglected.

Another big problem has been the preparation of the budget. This has fallen on Mr. Hogan's shoulders. It has been a tremendous task. It meant changing our fiscal year from May 31st to December 31st, and integrating a completeh new bookkeeping system. As ^vell as preparing the budget we have had to operate in a sort of a vacuum, not knowing how much we have to spend, or where to spend it. T o o many salary increases are due, but we can do nothing unt i l the budget is approved.

T h e tentative daily allowance per patient per day was set for us at 825.00. Th i s is the amount paid for patients from Quebec and the amount to be collected from patients from outside the province. As I have said before it cost us 335.87 per patient per day in 1960. Quebec was informed of this; but to no avail. T h e estimated cost per patient per day for 1961 is $38.00. This means that patients from outside the province are presently getting a lot of their hospitalization free, and will continue to do so unti l a firm and final rate is set for 1961.

In some ways accounting procedures have been simplified, but this has been offset bv the number of reports that have to be made. At present rather than a decrease, there has been an increase in the amount of work — particularly at the executive level.

As of May 31st the accounts receivable have decreased 477r since December 31st. Th i s is understandable. It should be pointed out that we are having a great deal of difficulty collecting accounts incurred late in 1960. The patient 's a t t i tude is "why should 1 pay?" 1 feel very pessimistic about

our ability to collect all the remaining 537r of the accounts receivable at the end of 1960.

Th i s leads one to the accumulated deficits of the Institute.

T h r o u g h the generosity of the Board of Governors of McGill University the large debt of the Inst i tute that had accumulated, was wiped out some years ago, and we started with a clean slate. Annual losses continued to occur, and at present the accumulated deficit stands at $483,216.27. As a large part of this is due to the inadequate remunerat ion over the years for the indigent of this Province, we feel, as has forcefully been expressed by others, that Mr. Lesage must take steps to help l iquidate these debts.

In the first five months of this year there has been a change in percentage of private and semi-private to s tandard ward patients. In 1960 it was 62%

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private and semi-private and 389r standard. This has changed to 40^o private and semi-private and 6 0 % standard.

W e must pay t r ibute to the nurses on the wards and in the admitdng office for their patience and understanding. T h e changing admission and discharge procedures and handl ing of prescriptions has created many problems which have been solved by a trial and error method. As well as doing their regular work under great pressure, they have cheerfully worked along with us. I must say to them now, that regardless of the administrative problems we run into, there must not, and will not be any interference with the care of the pat ient .

We are soon to come to a changing of the guard. This Institute has developed a reputa t ion a round the ^vorld for the excellence of its nursing care. Th i s has come about under the direction of our Director of Nursing, Miss Eileen Flanagan. As well. Miss Flanagan has done outstanding service to the nursing profession as a whole. She has provided leadership in nursing administrat ion, nursing standards, labour relations and other committees in provincial and Canadian nursing associations. Miss Flanagan is soon to retire. She has given much to this Insti tute and we all are deeply grateful. We shall miss her. She has kept her plans a secret. Whatever they are, we wish her the very best. We are p roud to announce that Miss Bertha Cameron is to become director of Nursing. We are counting on Miss Cameron to carry on the traditions of the Inst i tute. I am sure I speak for all of us when I say she shall have our complete support in the difficult job that lies ahead.

R E P O R T OF T H E D I R E C T O R OF NURSING

MISS EILEEN C . FLANAGAN

T h e responsibilities of the Nursing Depar tment continue to increase, as the pace of patient care accelerates with the growing demands resuldng from more complicated medical care, and the pressures resulting from the new Hospital Insurance plan.

We also realize that many other Institutions and nurses are depending on us for teaching and experience in this field.

It is most essential, therefore, that our own staff should be well qualified and be sufficient in numbers to undertake all these duties. Every member of our staff must consider herself as part of the teaching department .

We continue to supply the nursing needs of the greater number of our patients. In 1960 we nursed 96% of our patients with our regular staff or 98% of patient days. Our graduate nursing students numbered 40, our undergraduate, 120 from the Royal Victoria School of Nursing and 4 from the McGill Basic Course in Nursing.

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We endeavour to maintain an average of 4.5 hours of nursing care per patient in 24 hours.

In am glad to be able to say that Ave will have another House for residence this year, which Avill greatly ease the problem of finding suitable accommodation for post graduates and a certain number of operating room and general staff.

W e have to thank Mrs. Samuel Reitman, and The Ladies Committee of the Dalse Welfare Club, for nursing bursaries in memory of Dr. William V. Cone; and also the Women's Auxiliary and St. Georges' Lodge # 1 0 for tw o further bursaries for post-graduate training.

This last year bursaries were awarded to Miss Irene MacMillan, Mrs. Eleanor Carman and Miss Mary Agnew.

Miss Ingrid Kaarsberg was awarded the prize given by the M.N.I, to the R.V.H. student for outstanding work in this department.

Miss Bertha Cameron has just completed a month of visits to leading Neurological and Neurosurgical centres in the U.S.A. and Canada in order to insure that Ave can benefit from the ideas and accomplishments of our confreres.

The past twenty-seven years have in many ways been pioneering ones and I believe that our nursing staff has made a valuable contribution to the care of patients suffering from neurological diseases all over the world.

The Medical Staff as always has helped in many ways during the year with teaching and encouragement.

SOCIAL SERVICE DEPARTMENT

MISS CYNTHIA GRIFFIN

In the past year we bade regretful farewells to several of our Social Service staff, but we have been very fortunate in our new members. We have continued true to the M.N.I, tradition of internationalism, as our staff and students have represented four continents and a variety of cultural backgrounds.

As I noted a year ago, we consider that our primary function is to "help patients and families make maximum use of all the tangible and intangible resources within themselves and in the community, in trying to solve a variety of problems related to illness, or accident, and to hospitalization". In short, our goal has been to help patients maintain, regain, or sometimes gain for the first time the highest degree of social functioning of which they are capable within the limitations set by their disabilities.

This year it seems appropriate to consider our goals in terms of four effects of the Quebec Hospitalization Plan. The first was unexpected — a

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torrent of requests from patients overwhelmed by revised O.P.D. policies requi r ing payment for all medication. There was a distressing period of contusion and anxiety for all, bu t social workers have now been relieved of the pressure by the generally satisfactory arrangement worked out between the Out-Pat ient Adminis t ra t ion and the City Social Welfare Department.

Secondly, a l though the Admit t ing Office naturally shoulders the major responsibility, social workers have been called upon increasingly to interpret the reason for delay in recommended l)iit non-emergency admissions.

T h e third effect concerns assistance with post-hospital care. Although we have only recently noticed a substantial increase in the number of referrals, the problem of finding adequate facilities for the chronically ill, convalescent and custodial care patient , which has existed for years, has been intensified. For the future, we anticipate a still greater need for social service assistance to hospitalized patients.

T h e fourth effect is a pleasant one — a sharp decrease in requests for help with payment for hospital care, with the resultant release of precious funds for other needs — a wheelchair, a brace or special training to help rehabil i tate a paraplegic or MS patient , or temporary homemaker service to assist a disabled mother to keep her family together.

This year, as last, about one-third of all referrals to social service were from in-patient and two-thirds from out-patient services, but if we exclude certain categories such as the seizure out-patients, we find that not one-third, but slightly more than one-half were in-patients at the time of referral or sometime dur ing the year. Th i s year, too, social workers made a greater number of home visits (or visits to patients in nursing homes), frequenUy an aid in earlier and sounder assessment for immediate and long range plans.

T h e French Speaking Young Adults Discussion Group of seizure patients has continued to meet regularly every Wednesday evening. The nucleus remains the same in number (about 15) but has become stronger, more cohesive, and with more awareness among the members of ways in which they may help themselves and others.

Our close collaboration with doctors, nurses and other hospital staff is an essential requisite of service to patients. In addit ion, effective service often requires reaching beyond the hospital, beyond the patient 's family, into the community: for a retarded child, to the Association for Retarded Children; for the physically handicapped, to different rehabil i tat ion and recreational agencies, whether the patient is remaining in Montreal or returning to New Brunswick or New York State; for patients who can be cared for at home, to the V.O.N.; for others, to the more than 20 nursing homes and chronic care hospitals in the area. Some of the many agencies with which we collaborate help directly through the dispensing of funds or counselling, others through group activities, and still others through community planning. For example, the Montreal Council of Social Agencies with M.N.I, medical and social service staff on its committees, has undertaken projects of vital

30

interest to us, including studies of nursing homes, and of ways and means of establishing an epilepsy information service.

Our staff has also been fortunate in having had the stimulating experience of sharing Avith and learning from those beyond the community. One social worker at tended the Canadian Conference of Social Work in Halifax, another the U.S. Conference of Social Welfare in Atlantic City, and several Avere among the 800 at tending the Amei ican Annual Conference of Social Work Education held for the first time in Canada. We have also played an active part in social Avork education on the local level, as two students from the McGill School of Social Work had their field trainine at the M.N.I.

Again referring to the local scene our work would be greatly handi­capped Avithout the inspiring and consistent help in time and funds of the many individuals and groups in our own hospital organization and in the community: T h e Cancer Aid League, mult iple sclerosis associations and the Jun io r Red Cross among the latter; and among the former, the ever-faithful volunteers, the busy nurses and busy M.N.I. Avives and the M.N.I. Committee of the R.V.H. Women's Auxiliary. T o all, I wish to express the patients ' and our grateful thanks.

D E P A R T M E N T OF ANAESTHESIA

DR. R . G . B . GILBERT

During the year 1960 more anaesthetics were given than any other year dur ing the past 14 years. All the anaesthetics Avere administered or super­vised by a staff anaesthetist.

A much greater use is now being made of the Ventilator technique than in any previous year. T h e vast majority of the "prone" and sitting cases are now so handled as well as the haemorrhagic types of brain tumour and cases of hypothermia.

Th i r ty (30) craniotomy cases have received lyophilized urea dur ing this period. Modified use of this dehydrating agent has also been made dur ing certain hypothermia procedures; it is our feeling, however, that this may be a hazardous procedure.

Methoxyflurane has been used in 28 cases to date, 10 dur ing the last months of 1960. It is our opinion that, al though this agent has some advantage, such as noninHammability, it will not prove of sufficient value to replace our other drugs. T h e induction and recovery times are usually too long, its half life being about 48 hours.

Teach ing in the Depar tment has continued. Dr. Gilbert gave the sessional lectures to the 3rd year students and arranged the clinical pro­gramme for those in the 4th year. Dr. Millar gave lectures and seminars in

31

the Depar tment of Pharmacology as well as teaching Applied Pharmacology to the Diploma Course students. Dr. Brindle has been givinP lectures in Applied Anatomy. A two-week Refresher Course was organized by the Depar tment of Anaesthesia at McGill University - all of our Staff doctors part icipated.

Members of the Department of Anaesthesia have been able to contribute something towards the care and monitoring of patients on Respirators and those under hypothermia. I h o u g h we spend much time and effort in endeavouring to run such a service, the situation is far from satisfactory. 1 can not too strongly plead once again, for the welfare of the patients, that these (ases are looked after in a single special treatment zone, intensive care unit, or whatever it may be called — with specially trained permanent nursing staff and a resident doctor; at the same time rotating other perma­nent staff through this area Avhen demanded by pressure of work. There is no place for a "Special" nurse.

Use is now being made in some patients of Epidural Cortisone. This seems of real value in some postoperative cases and in those showing sAinptoms but not signs of disc protrusion.

Dr. Afary Morris as Fellow, assisting Dr. Millar, has made great use of the facilities already available to them. They have studied acid/base changes and plasma catecholamine levels during the past year. They have shown that respiratory acidosis is associated with noradrenaline liberation from areas outside the adrenal medulla, that sympatho-adrenal responses and acid/base changes differ in many details during anaesthesia with different agents. Various methods for measurement of arterial pH, pCO^ and bicarbonate levels have been used both experimentally and clinically.

We are indebted to the same sources as last year for our grants towards ihe laboratory maintenance, while Dr. Mary Morris was granted a Beatty Memorial Scholarship.

D E P A R T M E N T OF RADIOLOGY

DR. DONALD M C R A E

During 1960 8,922 examinations were carried out, slightly less than last year. Included in this total, were 139 ventriculograms, 700 other pneumo-graphic procedures, 431 cerebral angiograms and aortograms, 350 myelo­grams and 16 stereotaxic procedures. T h e number of angiograms almost doubled on comparison with the previous year. Angiograms are the most time consuming and complex procedures that we carry out and when they are done by means of a catheter passed through the femoral artery into the aorta or into the arteries of the head, they are especially lengthy. Since we have no special equipment for controlling the passage of such a catheter up

32

the aorta, we h a \ e to move the patient from the fluoroscopic room to the angiographic room and sometimes h a \ e to move him back and forth several times with the catheter in place, if we do much retrograde aortography and cerebral arteriography in future, Ave Avill have to install an image amplifier in the angiogram room.

A modified Reid-Johns Dual Channel Isotope Counter Avas installed for the external localization of intracranial lesions. T h e electronic balancing of the tAvo channels proved unexpectedly difficult so that the unit was not yet in regular operation at the end of the year.

T h e ncAv biplane film changer and electronic program selector for rapid biplane cerebral angiography has proAcn very satisfactory as has the high pressure injector.

Automat ic film processing becomes more and more necessary as the number of films made each day increases. We noAv process approximately 160 films each Avorking day. An automatic processing device should be seriously considered Avhen the rate of films reaches 100 per day.

A laminograph and an x-ray uni t for operating room No. 4 are still needed, as ment ioned in last year's report.

Six post-graduate students in Neuroradiology spent periods of six months in the depar tment . They Avere Drs. Francois Hebert, J. K. F. Millar and Frank Linsdell from AfcGill University and Drs. Denise Ouimet, Giselle Lussier and Romeo Ethier from the University of Montreal. Dr. Guido Castorina, neuroradiologist at the l^niversity of Rome, began a one year Picker Foundat ion FelloAvship in Radiology in September of 1960. Dr. Vincent Hinck, Neuroradiologist at the University of Oregon, spent one month as an observer in the department . When the department was planned, it Avas not p lanned to include such large numbers of trainees, research Avorkers and obser\ers and, as a result, Ave are badly over-crowded. T h e Research FelloAvs in Radiology use my office while the Residents have no space for their films or their books.

Dr. Douglas Sproul, Assistant Radiologist, left in April, 1960 to take u p a position in VancouA er. He has been missed by all of us. His place has been ably filled by Dr. Romeo Ethier.

T h e Post-graduate Seminar in Neuroradiology was given in September, October, November and December as in past years. T h e Monday morning Colloquia in Neuroradiology Avere continued as in past years. T h e Intro­ductory Course in general Radiology for the second year medical students Avas again given by this depar tment .

T h e increase in number and complexity of the radiological examinations carried out on in-patients forced us to curtail out-patient examinations. In September Ave had to write to the outside doctors who had been sending us out-patients and explain that we could no longer accept their patients. At present we are barely able to handle the out-patients referred to us by our oAvn staff members.

33

nf fK^l^ I I I x P'' ^ ^^' ^^^"^ ^ ' ^ ^ ^ ^«^d of thanks to the rest f n w r ^^Neurological Institute. It may seem as if this is done for ^ I / Au'^ll' ^^^ '""^^ ^' ^ ^ ^ ^ ^ ^ - T^^ cooperation, the encourage­ment and the friendly rivalry with the other departments continually makes our work a pleasure and a challenge.

DEPARTMENT OF NEUROCHEMISTRY

DR. K. A. C. ELLIOTT

CLIN1C.\L NEUROCHEMISTRY AND WARD LABORATORIES

The work in the 7th floor clinical neurochemistry laboratory was some­what less than in previous years while the 3rd floor ward laboratory reported a slight increase.

Around 8,200 separate procedures were performed in the 7th floor lalK)ralory on blood and spinal fluid samples obtained from parients. In addition 5,600 liters of irrigation soludons were prepared for the operat­ing rooms and over 200 liters of nupercaine soludon for the clinical services. Ulood pyruvate determinadons are now available for the study of selected palienis with thiamine deficiency neuropathies.

The ward laboratory performed 13,700 separate determinations on blcKKl samples and another 2.400 specimens were drawn for analysis in other Imspiial departments. In addition some 4,800 urinalyses were done.

The Neurochemistry and Ward Laboratories are / f ^^^^ Dr. I. H. Heller and technical supervision is provided by Dr. Hanna

M. Pappius.

noNNFRIARORATORVOFEXPERIMENTAL NEUROCHEMISTRY

... C>c.o.K-.- .9r.O Dr. ^ • / • S l S ^ r ^ S ^ ' ^ ' ^ ^ ^

,v ...... a...l educated in N<=«'/ ='''p"A deeree from Cambridge and an he ' iversity of New Zeala.id, a PLDJegre ^ ^ ^ ^ . ^ ^ ^ ^ h^

\ I) Imcv tnm ihe University " WestOT u ^^ ^^^ institute of

Ro?al S . . i a HospiUj. he g n t 5 .nonths . ^^ ^ , ^ ^„„^ F,„„, ,

l's>. Iiiairy work...g w.th Protesso

Dr. Wolfe has prepared basic proteins from brain cell-nuclei and from myelin and is folloAving up previously developed indications that these proteins are concerned in the regulation of brain responses to electrical stimulation and may also be the active proteins involved in the production of experimental allergic encephalomyelitis. He has also prepared the acidic neuraminic acid-containing Avater-soluble lipids, gangliosides, from brain and is studying their chemical structure, synthesis and biological properties. These lipids, localized in the cellular membrane component of gray matter, seem to be involved in the regulation of transport of electrolytes across the neuronal membrane.

In cooperation Avith Dr. Webb Haymaker of the Armed Forces Institute, Washington, and his team of physicists at the University of California, Berkeley, and Dr. Igor Klatzo of the National Institutes of Health, Washington, Dr. W^olfe has studied the brains of rats that have been irradiated Avith a-particles in the 60-inch cyclotron. Striking changes appear in the glycogen content of the cortex of irradiated rats that correspond with the appearance of periodic acid-Schiff-stained a-amylase-soluble granules in sections of irradiated cortex.

Dr. AV olfe is also helping direct other aspects of the work of the Department.

Dr. Irving Heller has completed two studies on the metabolism of peripheral nerve. Rat sciatic nerve contains a substance which diffuses into the surrounding medium and causes a fresh normal nerve to respire at an increased rate. Both the utilization of glucose and the increase in oxygen uptake Avith electrical stimulation of nerves in the presence or absence of glucose appear dependent upon the presence of this substance. In other experiments oxygen uptake rates were increased by 60% during the application of electrical pulses to normal nerves, nerves from animals in hypoglycemic coma, and nerves undergoing Wallerian degeneration. Substrate utilization patterns were significantly altered during electrical stimulation of nerves from all three groups of animals. Dr. Heller's results suggest that the respiratory activity of Schwann cells may be quantitatively altered during electrical stimulation, while the metabolism of the active axis cylinder undergoes both qualitative and quantitative changes. Further work is in progress to determine the nature of the active substance found in peripheral nerve. Mr. Sigurd Hesse continues to provide reliable tech­nical help.

Dr. Hanna Pappius continues to extend her studies on fluid spaces in the brain and the nature of cerebral edema. She has shown that rat serum proteins, labeled with the fluorescent dye Lissamine Rhodamine sulphonyl chloride, is taken up during brain tissue swelling in just the same way as is inulin. This will allow histological examination of the swelling spaces. Both inulin and the labeled protein can be readily washed out of swollen brain which indicates that these substances enter by diffusion and not by pinocytosis and that there is no obvious barrier to the diffusion into the tissue of sAvelling water and its contents. This is difficidt to reconcile with the

35

conclusions of electronmicroscopists that swelling fluid is intracellular. Dr. Pappius is also studying the nature of cerebral edema in the brains of cats in which lesions have been produced by freezing and otherwise. This is a cooperative project with Dr. Rasmussen and Dr. Gulati in which effects of cortisone are being studied.

Mr. Fernand Bilodeau has continued his studies on the effects of potassium on the metabolism of potassium-depleted brain cortex slices. Marked stimulation is caused even by concentrations as low as in CSF. Aerobic glycolysis is inhibited by low and accelerated by high concentrations. The reverse is true for anaerobic glycolysis. The study of the effect of K-|-on the amino acid content of brain slices and on the activity of some enzymes concerned with the amino acids metabolism — has given some indications concerning the mechanism of action of potassium on the general metabolism of brain cortex tissues. Our previous finding that Factor I exists largely in an occult form in brain and only a fraction is free and immediately active has been confirmed by paper chromatographic determinations of GABA (gamma-aminobutyric acid) in centrifuged extracts and residue of brain suspensions. It is now being shown that the division into occluded and immediately extractable fractions applies also to other acids present in brain.

Mr. Richard Lovell completed a study with Dr. Levin which showed that all Factor I—containing extracts of rat, cat and beef brain contain GABA and that the GABA can account for all the Factor I activity. GABA was determined chromatographically; various factors which affect its chromatographic behaviour in brain extracts were investigated. This led to an explanation of the failure of some previous workers to identify GABA chromatographically in their brain extracts. Glutamate was shown to exert Factor I activity under certain conditions. Other substances known to have Factor I activity could not be found in significant amounts in the brain extracts. Mr. Lovell is now determining whether GABA, determined by two chromatographic methods and an enzymatic method, can account for the Factor I activity in extracts of specific regions of the beef brain. The amount of GABA probably present /?/ vivo, before the occurrence of the post-mortem increases which we have previously observed, is also being determined by quick freezing of the various beef brain regions in liquid air and sub­sequent analysis.

Dr. Pappius and Dr. Wolfe have been appointed Honorary Lecturers in the Department of Biochemistry, McGill.

DEPARTAfENT OF ELECTROENCEPHALOGRAPHY

DR. PIERRE GLOOR

DR. HERBERT JASPER

DR. DONALD LLOYD-SMITH

Work in this department has continued at about the same level as during the previous year, with a total of 3,202 examinations on, 2,631

36

patients, Avith about . of these patients from outside the Neurological Institute, % in-patients. This represents an increase of 667 in-patient examinations Avith a proportionate decrease in out-patients. This cannot be accounted for by an increase in the number of re-examinations, since actually they Avere decreased as compared to the previous year. It represents a genuine increase in the demand for in-patient examinations, with some decrease in out-patient demands.

Teaching of felloAvs and technicians continues to be an important part of the Avork of these laboratories, under the general direction of Mr. Lewis Henderson for the technical training, and Dr. Gloor and Dr. Lloyd-Smith for training in interpretation of records. There Avere eight fellows in training during the past year: Drs. Andermann, BroAvn, Giguere, Gulati, Renda, Stefanis (electromyography), Tandon and Vera.

The regidar conferences led each Tuesday afternoon by Dr. Rasmussen on epileptic patients continues to provide a good forum for discussion. In addition, monthly departmental meetings have been organized during Avhich certain subjects from the field of clinical EEC were discussed in seminar form for the benefit of felloAvs in training and technicians. Every second month this meeting Avas conducted in the form of an EEC Pathology Conference.

Work in the operating room has fallen off considerably during the past year, with only 70 cortical electrograms, as compared to 101 the previous year.

In electromyography there have been 169 examinations, many for determining conduction velocities in peripheral nerves. Investigative work in electroencephalography has included continued studies of the use of intra-carotid sodium amytal for the analysis of bilateral EEC abnormalities, and follow-up studies on epileptic patients.

37

DEPARTMENT OF NEUROPHYSIOLOGY

DR. HERBERT JASPER

DR. PIERRE GLOOR

Work in this Department has not been quite as active during the past year as during the previous year due to the departure of some of our most active and experienced fellows.

The long-term program of study on the neurophysiological basis of learning has been pursued very intensively by Dr. Majkowski, a visiting scientist from Warsaw, Poland, working on a grant from the Rockefeller Foundation. Dr. Redding, and more recently Dr. Siegfried, have been continuing this research following Dr. Majkowski's return to Warsaw and perfecting some new microelectrode techniques for analysis of both cortical and sub-cortical activity in the alert monkey during conditioning procedures. It will be possible now to continue more actively this entire project with the generous assistance of a five-year grant from the National Science Foundation of the United States which makes it possible for us to bring Mr. Kenneth Reid back to work with us on the physical and mathematical aspects of this large program.

Dr. Baruch Blum, a visiting scientist from Israel has been working with another senior visiting scientist, Dr. William Stewart, on studies of focal epileptogenic lesions in animals in view of a collaborative program which we plan to undertake on the neurochemical mechanisms of epilepsy with Dr. Leonhard Wolfe of the Donner Laboratories of Experimental Neuro­chemistry. Dr. Poole also participated in this work for a brief time during the year.

Dr. Matsunaga, an experienced microelectrophysiologist from Japan, has been working intensively on the unitary analysis of the motor cortex in the cat, with special interest in mechanisms of inhibition. He has been joined by Dr. Stefanis from Greece in this project.

Dr. Gulati, under the direction of Dr. Rasmussen, has been pushing forward in their long-term studies of cerebral oedema, working in collabora­tion with Dr. Pappius of the Department of Neurochemistry.

Dr. Gloor has been very busy working up the extraordinarily rich and large amount of data which were collected during the past year Avith Dr. Sperti and Dr. Vera, who have both left us unfortunately, during the year. This is providing sufficient material for several publications on the intimate mechanisms of the activity of the hippocampus, Avith special reference to its susceptibility to epileptic discharge, and the cellular and dendritic contributions to epileptic processes. This was a detailed, multi-microelectrode study, including the analysis of long-lasting states of sus­tained polarization between cells and dendrites which is of considerable

general interest as AVCU as being of particular importance to our under­standing of the extreme susceptibility of the hippocampus to epileptic seizures.

Dr. Millar, Avith Dr. Morris have been continuing their studies of the effect of anaesthetic agents upon blood catecholamines in relation to changes in blood oxygen and hydrogen ion concentrations.

Dr. Branch, Avith Dr. Barone have been continuing their study of cytotoxic agents and metabolic inhibitors in their long-term program on this problem, designed to discover methods for the treatment of brain tumours.

Dr. Perot, in spite of his being resident in neurosurgery, has been able to continue at odd times some of his studies on the relationships between brain stem and the cerebral cortex, Avith particular reference to the mechanism of petit mal epilepsy.

We have been aided greatly in the Avork of these laboratories by the continued contributions to the Bronfman Neurophysiology Research Fund Avhich w e hope may be continued in the future. The long-term grant from the United States National Science Foundation has also been of the greatest importance to the support of this laboratory.

We welcome the addition of Mr. Nicholas Rumin to the research staff of the Institute as a physicist and electronic engineer. He will be of great value to the neurophysiology laboratories, as well as to the Department of Neuroelectronics.

Dr. Gloor will be in charge of the neurophysiology laboratory during the coming year while Dr. Jasper is on leave of absence, although Dr. Jasper hopes to be able to return from time to time to keep in touch with the work going on.

DEPARTMENT OF NEUROPATHOLOGY

DR. GORDON MATHIESON

DR. GILLES BERTRAND

During the calendar year 1960, detailed autopsy studies were carried out on 78 patients dying in the Institute. There were 96 deaths in all, giving an autopsy rate of 81.25%. A further 78 cases of neurological interest from other hospitals were investigated. The brains from 311 autopsies in the Department of Pathology were examined in this department and reported. Surgical specimens for the year totalled 474; Dr. John Jane looked after this material during the first six months, being succeeded by Dr. Richard Brown. A long list of Fellows joined in the autopsy service: Drs. Barbeau, Brown, Marin, Giguere, Withrow, Kapphahn, Renda, Carpenter and Embree.

39

Dr. Jan Mossakowski completed his study of succinic dehydrogenase activity in glial tumours and this work Avill appear in the Journal of Neuropathology. Another step in the application of newer techniques to material from the operating room is being taken by Dr. Barone in using acridine orange staining and ultra-violet light illumination. Other investiga­tive work of the department now in the press includes histochemical and biochemical studies of the lipidoses carried out in collaboration with Dr. J. N. Cumings of the National Hospital, Queen Square.

Weekly clinico-pathological conferences are now held on Thursdays Avith surgical and medical neurological emphasis on alternate weeks. Latterly these meetings have been largely the work of Drs. Barone and Carpenter who have set a high standard of preparation of their material.

The department has noAV been topographically consolidated on the 6th floor with, we hope, increased working efficiency as well as saving of valuable space. This reorganization, which was part of more widespread alterations, has allowed a small suite to be set aside for the development of some experimental work. Unfortunately time and energy cannot be provided by a similar administrative act! The long term needs of the department are still for stability and continuity to allow a AvortliAvhile investment in experimental work.

MULTIPLE SCLEROSIS LABORATORY

DR. J. B. R. COSGROVE

DR. CATHERINE MACPHERSON

Investigations in this laboratory have continued to be centred on the cerebrospinal fluid proteins. Paper electrophoretic protein patterns of cere­brospinal fluid have proven to be useful as an aid in the diagnosis of Multiple Sclerosis. Follow-up studies of cerebrospinal fluid proteins by paper electrophoresis in suspected cases of Multiple Sclerosis and further studies of the proteins in hydrocephalus are being continued. Data has been accumulated for a correlative study of the electrophoretic protein patterns of cerebrospinal fluid and the pathological findings at post mortem.

The separation of cerebrospinal fluid proteins by means of starch electrophoresis has been accomplished and has demonstrated many more protein fractions than obtained by paper separation. Application of this technique to cerebrospinal fluid of control and Multiple Sclerosis patients is underway.

Dr. MacPherson has been carrying out immunochemical studies on cerebrospinal fluid proteins of patients and has found that it contains at least two gamma globulins, one of Avhich is not found in human serum. The existence of this latter protein demonstrates that central nervous tissue

40

can synthesize the kind of protein Avhich is most often associated with immunity. Work is in progress to characterize this component of cerebro­spinal fluid more fully.

Immunochemical experiments have also shown that in Multiple Sclerosis the gamma globulin of the serum undergoes significant changes at some stage in its passage through to the cerebrospinal fluid. The exact nature and extent of these changes are being investigated.

Clinical investigations have included the effect of Medrol by mouth, ACTH by injection, and Depo-Medrol intrathecally on the electrophoretic protein pattern of cerebrospinal fluid. The clinical follow-up study of Multiple Sclerosis patients to form a control group for Dr. Swank's low animal fat diet group continues in the Multiple Sclerosis Clinic of the Royal \'ictoria Hospital. The total number of patients now being followed in this clinic and in the private office numbers 502.

DEPARTMENT OF NEUROANATOMY

DR. F . L . MCNAUGHTON

The major activity in the past year was participation in the Second Year Undergraduate course on the Nervous System. This followed the Dis­section Course on the Head and Neck, conducted by Professor Langman during the Fall Term. Dr. John Blundell gave the lectures in Neuro­anatomy, and directed the laboratory course, assisted by Dr. Allan Morton, and several Fellows who served as instructors. A seminar in Neuroanatomy for the Instructors was held weekly during the Winter Term.

Members of the Staff also took part in the weekly seminars held on Mondays during the Winter and Spring.

Dr. Morton received his M.Sc. degree for his thesis "THE HYPO­THALAMIC MAGNOCELLULAR NUCLEI IN MAN: Studies of the normal and of the reactions to stalk section and hypophysectomy".

T U M O U R REGISTRY

DR. ARTHUR R . ELVIDGE

During the current year the records of 376 patients have been pro­cessed in the Tumour Registry, and of these 239 were of proven tumour. The number verified in 1960 alone was 122. Operations performed in the course of treatment numbered 140 and Roentgen Therapy was employed in 46 cases.

41

record t L f o l l l ^ p ' ' J ij^^e^n^s^T t ^^^^^S^^^^Y - o catalogue and lor tumour involviL th^ ^ ^ ^^^' ^ '"^ ''^^'^^ ^t the Institute through the O u t Z r ^L^"'"'^' '^''''^- ^^l^^^'^P data is obtained OeparLent oV 1 ^ ^ " ^ ; ^ ^ ^ ^ ^ ^ '^T' ^^^^^™g ^ - ^ - ^ - ^ ^ e are reminded to m Z ? ^ tn ^""^ ^^^'^ necessary. Clinic padents social p o b l e m b r b A ' / ^ ^ ^ ^ "^^ ^^^^^^^ " ^^^ ^^^ helped in u-itie u ^ T n T l . ^ the Social Service Department. This is an aid to both n u en n • ^V""'^' ''''' ^ ^ '^^'^^ ^^ material for research

•n tumour prognosis under various types of treatment. The Tumour Registry is under the immediate and efficient care of

tne secretary Miss Suzanne Cripps. The routine follow-up of tumour (_iscs in the neurological and neurosurgical clinics is carried out by the Wllow of the Registry, Dr. D. Gonzales, who succeeded Dr. A. Tarazi during the latter half of the year.

During the year Dr. E. Berger has conunued his statisdcal investigation of the result of biopsy and radiation therapy as compared to radical removal plus irradiation in the treatment of the medulloblastomas. Dr. D. Cfonzales has been making a study of epilepsy as it occurs in astrocytoma of the temporal lobe. Dr. S. AVoodcock with Dr. B. Cosgrove, has inidated a studv of the etiology of epilepsy in patients over age 50, to which the Tumour Registry Avill contribute information. The extensive analysis of

llu' glioblastoma multiforme Avith Dr. J. Roth has been published in part during the vcar.

Other projects in continuation and contemplation incliide a study of acoustic neuromas, studv of long term survival in malignant gliomas, and the treatment of gliomas of the dominant hemisphere. A pathological study of oligodendroglioma has been initiated by Dr. G. Mathieson to which the I umour R(oistr) Avill contribute follow-up data. The detailed analysis o

the .(suits of radiaticm therapy administered in the Department o Raciioiogv in the RoAal \'ictoria Hospital of ^^^ . ^^ . ^Vl L nve a WrNous SNstem treated at the Montreal Neurological Institute over a p,,-iod of '>() Nc-ars. has been published by Dr. J. Bouchard and Dr. C. ^. Vciuv to which the Imnour Registry has contributed.

DEPARTMENT OF NEUROPHOTOGRAPHY

DR. GILLES BERTRAND

The year lOfiO-lPfil has been a very busy one for this department and one (hat has scon a number o( changes.

fjhistration. AO

There has also been a tremendous increase in the number of charts and graphs made by this department since this new service was introduced a year and a half ago. The making of these charts is now a full time job and, prior to meetings many extra hours are spent on this type of work. The improvement in our gra})hic illustrations, hoAvever, is well worth the extra time spent.

Recent work in ultra-violet photondcrography carried out by Drs. Bertrand and Barone has necessitated the development of new techniques in color photography, liv (hanging the characteristics of the color film and developing it as a negative rather than a positive, photographic exposures Avhich, as a rule for this type of Avork, ranged from 40 seconds to 5 minutes, has been cut doAvn to 2 seconds Avhich is quite important since fluorescence diminishes quickly Avith time.

The addition of sound recording equipment now makes possible the production of full lip-synchronized sound movies and it is hoped that use Avill be made of these ncAv facilities lor almost any type of audio-visual illustration.

During the course of the year, Mr. Hodge presented a paper to the Biological Photographic Association in Salt Lake City, Utah on "A Visual Control Over the Activity of Photographic Developers." Mr. Hodge also attended the first International Congress on Medical Photography held in Dusseldorf, Germany, on Avhich occasion he visited many hospital photo­graphic departments in Great Britain and on the Continent.

T H E FELLOWS' LIBRARY

DR. BERNARD F . GRAHAM

The modern doctor's need for greater knowledge to serve wisely and effectively a bewildered and suffering humanity is a continuation of a long and variegated tradition. For many centuries libraries have been his refuge, his repository of knowledge, his teacher, his companion. Here the Avisdom and folly of his predecessors have been received as an inheritance, and here his own insights and errors can be made a legacy to inform, inspire, and amuse generations of successors (provided always that we do not share the fate of the library at Alexandria).

To serve the practitioner-student, and to facilitate his serving, the library must be well stocked with the old, yet ever acquiring the new; it must have space where its resources can be stored and facilities where they may be consulted; it must be equipped for the efficient locating of the needed information. While other ancillary departments in our hospital have been increasing rapidly in size and complexity, the library has con­tinued its more sedate but steady expansion until the need for expert technical services to enhance its value has become widely evident and has

43

been voiced frequently during the past year. In response to this need Dr. Rasmussen has dipped his hand into some magic hat and brought forth a part-time professional librarian. All who use the library are grateful at the prospect of more adequate services, and as we welcome Mrs. Melzak to our institute we are already impressed by the technical advances she is introducing.

The prospect of a more professional type of service confronts us again with other old "friends": how to select additions to our library from the endless supply of new material; how to increase the funds available for such selection; how to store the new additions within the present limited space; and how to find new space? Now that our governments are accepting responsibility for hospitalization we must hope that they will appreciate the need for an expanding library.

In recent months Miss Eraser has placed an appropriate book plate in each volume we have received from Doctor Cone's library; these books are now ready for our shelves.

As so often before, our library has been enriched by gifts of books and periodicals, particularly from Doctor Jasper and the "Journal of Electroencephalography and Clinical Neurophysiology", and from Dr. Penfield. To all donors we express our gratitude. From Miss Flanagan we have received the "Official History of the Canadian Medical Services 1939— 1945" by Doctor W. R. Freasby. We are especially grateful for Sir Charles Symonds' inscribed copy of A. W. Dawson's monograph "Dis­seminated Sclerosis".

During the past year, while busily engaged in other activities, Mrs. Casselman has continued with the daily chores necessary to the operadon of our library; she has brought our transgressions to our attention that the library might serve us more adequately, and we all are grateful for the interest and care she has given us.

44

T H E MONTREAL NEUROLOGICAL SOCIETY

President DR. D . LLOYD-SMITH

Vice-President DR. A. PARENTEAU

Secretary-Treasurer DR. I. HELLER

Twenty-tAvo meetings of the Section of Neurology of the Montreal Medico-Chirurgical Society were held from September 14th, 1960 to May 3rd, 1961.

Clinical meetings Avere held at Notre Dame Hospital, Hotel Dieu, the Montreal Children's Hospital, the Montreal General Hospital, and Ste. Justine Hospital.

Papers read before the Society by distinguished visitors and local col­leagues were as follows:

PROFESSOR SYDNEY SUNDERLAND, Neuroanatomist, University of Melbourne,

Australia: "Effect of Stretch and Compression of Peripheral Nerves".

DR. GIOVANNI RUGGIERO, Consultant Neuroradiologist, University Neuro­surgical Clinic, Paris: "Encephalography & Ventriculography in Tumours of the Posterior Fossa".

DR. LUCIEN RUBINSTEIN, Department of Neuropathology, London Hospital: "Growth and Spread of Intracranial Gliomas".

DR. PAUL BRAND, American Leprosy Missions, Inc., New York City: "Neuro­logical Lesions and Rehabilitation in Leprosy".

DR. JOHN R . LINDSAY, Otolaryngologist, University of Chicago: "Experi­ments in Vestibular Physiology".

DR. IGOR KLATZO, Neuropathologist, National Institute of Neurological Diseases & Blindness: "Labelled Serum Proteins in Studies of Cerebro­vascular Permeability".

DR. GRANT L . RASMUSSEN, Chief, Section of Functional Neuroanatomy, National Institute of Health, Bethesda, Maryland: "Normal and Ex­perimental Morphological Studies of the Synapse".

DR. DAVID HSIA, Director, Genetic Clinic, Children's Memorial Hospital, Chicago: "Inborn Errors of Metabolism Related to Hereditary Neuro­logical Defects".

DR. JULIUS METRAKOS, Department of Genetics, McGill University: "Genetic and EEG Studies in Centrencephalic Epilepsy".

DR. JOHN MARSHALL, National Hospital, Queen Square, London, England, "Cerebro-Vascular Disease".

45

PROFESSOR FRANCIS O . SCHMITT, Dept. of Biology, Massachusetts Institute of Technology, Boston: " T h e Molecular Biology of the Neuron".

PROFESSOR C . P. LEBLOND, Chairman, Department of Anatomy, McGill University: "Evidence of Division and Transformation of Neuroglia".

D R . BYRON WAKSMAN, Neurological Unit , Massachusetts General Hospital, Boston: " Immunologic Reactions and the Nervous System".

D R . BRENDA MILNER, Psychologist, Montreal Neurological Institute: "Some Effects of T e m p o r a l Lobectomy on Auditory Discrimination in Man".

D R . ARTHUR HESS, Depar tment of Anatomy, Washington University, St. Louis, Missouri: "Structural Differences between Fast and Slow Muscle Fibres and their Nerve Endings".

M R . W A L P O L E L E W I N , Radcliffe Infirmary, Oxford, England: "Clinical Pathological Problems in Closed Head Injuries".

T H E FELLOWS' SOCIETY

FREDERICK ANDERMANN, M.D., President 1961

KENNETH H . KAPPHAHN, M.D., President 1960

DES R A J GULATI , M.D., Vice-President

GARTH H . EMBREE, M.D., Secretary

T h e academic year 1960-1961 has been a fruitful one for the FCIIOAA S'

Society. We have 51 Fellows from 18 countries, of which 35 were in neuro­logy and neurosurgery, 5 in neuroradiology, 3 in neurochemistry and 8 in anaesthesia.

T h e social functions of the Society included a party at the Fellows' Residence, and a hockey game, organized jointly with the Wives UuD and the Graduate Nurses' Society. In February Dr. Preston Robb was host to a Fellows' party at his home, Avhere Dr. Norman Viner reminisced on more than half a century in neuropsychiatry. A picnic is planned tor the m o n t h of June .

T h e Fifth Annua l Fellows' Lecture was delivered on June 7th by Dr. Guy L. Odom, Professor of Neurosurgery at Duke University who spoke on "Vascular Lesions of the Spinal Cord". T h e ^^^^'^ ^^^'^^^^ by short presentations on current research by Drs. Perot SherwinOs^erh^^^^^ and Stefanis. T h i s was followed by cocktails at the Fellows Residence our annua l d inner at Mart in 's to say farewell to departing Fellows.

46

During the year AVC had the opportunity of meeting several dis­tinguished workers in the field of neurology. Speakers at the Fellows' Society meetings included Drs. Paul Brand, Grant Rasmussen, Igor Klatzo, John R. Lindsay, L. J. Rubinstein, Francis O. Schmitt, John Marshall, David Hsia, Byron Waksman, Murray Bornstein, Arthur Hess, Walpole LeAvin, and Jean Schneider.

We have aimed in the last year to maintain the high standards Avhich our predecessors amongst the FelloAvs of the Montreal Neurological Institute have set for us, both in social and scientific activities.

CLINICAL APPOINTMENTS AND FELLOWSHIPS*

Appointments to the Resident Staff in Neurology or Neurosurgery are made for January 1st or July 1st. All candidates are expected to have pre­vious interneships in Medicine or Surgery.

The posts of Senior Resident in Neurosurgery, Resident in Neuro­surgery and Resident in Neurology are available only to men who have had previous clinical service in the Institute. Assistant Resident in Neurosurgery — one year's duration — available

January 1st and July 1st.

Assistant Resident in Neurology — six to tAvelve months' duration — avail­able January 1st and July 1st.

Appointments for periods of research and training in one of the labora­tories are made by Professor Rasmussen for the Chief of the laboratory in question. Research stipends are available for the following Fellowships: Senior Fellowship in Neuropathology — six to twelve months' duration —

available January 1st and July 1st.

Junior Fellowship in Neuropathology — six to tAvelve months' duration — available January 1st and July 1st.

Senior Fellowship in Clinical Electroencephalography — six to twelve months' duration — available January 1st and July 1st.

FelloAvship in Neuroanatomy — six to twelve months' duration — available January 1st and July 1st.

The Diploma in Neurosurgery, M( Gill University, requires at least four years study, including periods of investigative work and neurology.

The Diploma in Neurology, McGill University, requires at least four years of study, including periods of investigate work, neurosurgery and psychiatry.

*Graduate physicians or surgeons who Avish to be enrolled in clinical or scientific work as something more than an observer must fill out application forms obtainable from the Director's office and provide names of reference.

47

Applicants for clinical services are nreferred whr KO,, i • knowledge of the French language. ^ ^"^ ^^' ' ' ^ 'P'^^^"§

COURSES OF INSTRUCTION

UNDERGRADUATE

The Department of Neurology and Neurosurgery cooperates intimately with the Departments of Medicine, Surgery, Pathology, and Radiology in their undergraduate teaching. Thus the teaching of neurology, neurosurgery, neuropathology, and neurological radiology is carried out as part of the regular course planned by the Chairman of each of the above departments.

GRADUATE

In the Faculty of Graduate Studies and Research, courses are offered leading to the degree of Master of Science and Doctor of Philosophy. Throughout the year, the following elective courses are given for graduate students. Fellows and members of the house staff, and are open to under­graduates by arrangements.

A. SEMINAR IN NEUROANATOMY, M.N.I.

1. This course is given in combination with course Med. 2A 'The Central Nervous System".

2. Additional graduate seminars will be held co-ordinated with Course B.

3. Graduate students are expected to pass the same examination which is given in undergraduate course Med. 2A, but with higher standing, and to act as demonstrators.

Professor McNaughton

4. Advanced Neuroanatomy for selected group; times to be arranged. Professor McNaughton

B. SEMINAR IN NEUROPHYSIOLOGY.

1. Lectures and examination together with undergraduate course Med. 2A "The Central Nervous System".

2. Weekly seminars and demonstrations co-ordinated with Course A-2 (4 months, beginning in December). Mondays, 4:30 to 6:00 p.m.

3 Under exceptional circumstances, a paper on a neurophysiological subject may be written by special arrangements as a substitute r xy 1

Professors Jasper, Elliott, and Gloor

48

C. COLLOQUIUM IN CLINICAL NEUROLOGY.

1 hour Aveekly. clinics and lectures, Wednesdays, 5:00 p.m. M.N.I. (9 mon ths ) .

Staff and Visiting Lecturers

D. SEIZI RE MECHANISMS AND CEREBRAL LOCALIZATION: Clinical Electroence-phalographic, and Roentgenographic Conference. M.N.I. IVo hours Aveekly (9 months) . Tuesdays, 4:00 to 5:30 p.m.

Professors Rasmussen, Jasper, McNaughton, and McRae

E. O I T L I N E OF NEUROCHEMISTRY.

Instruct ion in neurochemistry in addition to that provided in course B-2 may be obtained by spec ial arrangement.

Professor Elliott

F. NFUROPATHOLOGY.

1. Six months laboratory in neuropathology. Professors Mathieson and Bertrand

2. Conference in neuropathology, Thursdays, 4:00 to 5:00 p.m. Professors Mathieson and Bertrand

3. In t roduct ion to histopathology of the Nervous System. A short basic course for a limited number . By special arrangement with Professor Mathieson. For graduate credit, courses Nos. 1 and 2 are required. Under special circumstances written a n d / o r oral examinations may be substi tuted for Nos. 1 and 2.

G. NEUROLOGICAL RADIOLOGY.

1. Lecture demonstrat ions (3 months beginning in September) . Mondays, 4:30 to 6:00 p.m.

2. Col loquium, 1 hour Aveekly (9 months) Mondays, 9:00 a.m. Professor McRae

49

PUBLICATIONS

1960-61

^GUiLAR, J. A. and ELVIDGE, A, R.

Intervertebral Disk Disease Caused by the Brucella Organism. Journal of Neuro­surgery, v. 18, p . 27-33, 1961.

VGUILAR, J. A., MARTIN, H . L . and MCNAUGHTON, F . L .

Aminoglutethimide in the Treatment of Epilepsy. Canadian Medical Association Journal , v. 84, p . 374-376, 1961.

\GUILAR, M . J. and RASMUSSEN, T .

Role of Encephalitis in Pathogenesis of Epilepsy. American Medical Association Archives of Neurology, v. 2, p . 663-676, 1960,

\ \DF.RMANN, F. , COSGROVE, J. B. R., LLOYD-SMITH, D . , GLOOR, P. and MCNAUGHTON, F . L.

Facial Myokymia in Multiple Sclerosis. Brain, v. 84, p . 31-44, 1961.

BLOOM, D . , JASPER, H . H . and RASMUSSEN, T .

Surgical Therapy in Patients with Temporal Lobe Seizures and Bilateral EEG Abnormality. Epilepsia, v. 1, p . 351-365, 1960.

CoRDEAU, J. P., GYBELS, J., JASPER, H . H . and POIRIER, L . J.

Microelectrode Studies of Unit Discharge in the Sensorimotor Cortex. Neurology. V. 10, p . 591-600, 1960.

COSGROVE, J. B. R.

Multiple Sclerosis, Current Therapy, ed. H. F. Conn., Philadelphia and London, 1961, p . 538-542.

ELLIOTT, K, A. C.

Concluding Statement, Inhibition in the Nervous System and y-Aminobutyric Acid, ed. E. Roberts et al. London, 1960, p. 260-266.

ELLIOTT, K . A. C. and VAN GELDER, N .

The State of Factor I in Rat Brain. Journal of Physiology, v. 153, p . 423-432, I960

ELVIDGE, A, R.

Obituary—William Vernon Cone. Journal of Neurosurgery, v. 17, p. 357-359, I960.

FEINDEL, W . H .

Neurosurgery, T h e Choice of a Medical Career, ed. J. Garland. Philadelphia, I960, p. 125-140.

FEINDEL, W . H . and FEDORUK, S.

Measurement of Brain Circulation Time by Radio-Active lodinated Albumin. Cana­dian Journal of Surgery, v. 3, p . 312-318, 1960.

FEINDEL, W . H . , PENFIELD, W . and MCNAUGHTON, F .

The Tentorial Nerves and Localization of Intracranial Pain in Man. Neurology. V. 10, p . 555-563, 1960.

FEINDEL, W . H . , POSNIKOFF, J. and STRATFORD, J. G.

The Effect of Hypothermia and Other Factors on Cerebrosfnnal Fluid Pressure. Canadian Anaesthetists Society Journal , v. 7, p. 429-442, I960.

50

FEINDFL, W . H . and SCHNEIDER, R .

Closed-Circuit Television in Electrocorticography. Journal of Electroencephalo­graphy and Clinical Xeurophysiologv, v. 12, p. 925-927, 1960.

GEIGER, L .

Fusion of Vertebrae folloiving Resection of Intervertebral Disc. Journal of Neuro­surgery, v. IS. p . 79-85, 1961.

GLOOR, P.

Etudes electrographiques de certaines connexions rhinencephaliques. Les grandes activitcs du rinnencephale. ed. I h . Alajouanine. Paris, 1961, p. 1-27.

HELLER. L and HESSE, S.

Action of Insulin on the Respiration of Rat Sciatic Nerve. Lancet, Aug, 20, p 406-407, 1960, ^

JASPER, H . H .

Current Concepts of Xen>ous Inhibition, Inhibition in the Nervous System and y-Aminobutyric Acid, ed. E. Roberts et al. London, 1960, p. 12-28.

Evolution of Conceptions of Cerebral Localization since Hughlings lackson. World Neurology, v, 1, p . 97-112, 1960,

Interpretation of the Effect of Gamma Aminobutyric Acid on Cortical Electrical Activity, Ex'oked Potentials and Effects of Strychnine and Picrotoxin, Inhibition in the Nervous Systems and y-Aminobutyric Acid, ed, E, Roberts et al, London, 1960, p, 544-553,

The Physiological Significance of Gamma-Aminobutyric Acid in the Central Nervous System. Actualites neurophysiologiques, ed. A. M. Monier. Paris, 1960, p. 33-47,

JASPFR. H . H . , LENDI , R. and RASMUSSEN, T .

Evoked Potentials from the Exposed Somato-Sensory Cortex in Man. Journal of Nervous and Mental Diseases, v. 130, p. 526-537, 1960.

JASPFR, H , H „ RICCI, G . and DOANE, B .

Microelectrode Analysis of Cortical Cell Discharge during Ax>oidance Conditioning in the Monkey. Journal of Electroencephalography and Clinical Neurophysio­logy, Supplement 13, p, 137-155, 1960,

KEENER, E , B . and PEROT, P.

Antibacterial Drugs Topically Applied to the Central Nervous System. American Medical Association Archives ol Neurology, v. 3, p, 665-676, 1960.

KLINGLER, J, and GLOOR, P ,

The Connections of the Amygdala and of the Anterior Temporal Cortex in the Human Brain. T h e Journal of Comparal i \e Neurology, v, 115, p, 333-369, 1960,

LENDF, R , A.

Local Spasm in Cerebral Arteries. Journal of Neurosurgery, v. 17, p . 90-103, 1960.

M C R A E , D . L .

Anatomical and Pathological Factors of Radiological Importance in Disorders of the Spine. Proceedings of the IXth International Congress of Radiology, Munich, 1960, p . 424-432,

Die Bandscheibendegeneration — radiologische und klinische Probleme. Klinische Neuroradiologie, ed. K. Decker. Stuttgart, 1960, p, 440-465.

Diagnostic X-Ray Exposures: The Middle Road. Canadian Medical Association ' j o u r n a l , v, 83, p , 929-933, 1960,

Die Krampferkrankungen. Klinische Neuroradiologie, ed. K. Decker, Stuttgart, I960, p, 181-205.

Semeiologie Radiographique des Epilejmes, Rayons X, Radioisotopes et EEG dans I'Epilepsie, ed,' H, Fischgold and H. Gastaut. Paris, 1960, p. 9-39.

51

The Significance of Abnormalities of the Cervical Spine. American Journal of Roentgenology, Radium Therapy and Nuclear Medicine, v. H4, p. 3-25, 1960 (Caldwell Lecture)

MILLAR, R , A,, BRINDLE, G , F . and GILBERT, R , G , B .

Studies with an Organic Buffer (T.H.A.M.) during Apnoeic Oxygenation in Dogs. British Journal of Anaesthesia, v. 32, p . 248-255, 1960.

MILLAR, R . A, and CONN, A, W.

Post-Occlusion Hypertension and Plasma Catecholamine Levels. Canadian Anaes­thetists Society Journal , v, 7, p , 443 446, 1960,

MILLAR, R , A, and MORRIS, M , E .

Induced Sympathetic Stimulation during Halothane Anaesthesia. Canadian Anaes­thetists Society Journal , v, 7, p, 423-428, 1960,

Norepinephrine Release during Respiratory Acidosis in Adrennlectomized Dogs. Anaesthesiology, v, 22, p , 62-66, 1961,

MORTON, A.

Hypothalamic Magnocellular Nuclei in Man. Anatomical Record, v, 139. p, 331, 1961

ORBACH, J., MILNER, B , and RASMUSSEN, T ,

Learning and Retention in Monkeys after Amygdala-hippocampus Resection. American Medical Association Archives of Neurology, v. 3, p. 230-251, 1960.

PENFIELD, W .

Neurophysiological Basis of the Higher Functions of the Nervous System — Introduction. Handbook of Physiology — Neurophysiology 111, ed. J, Field et al, Washington, I960, p, 1441-1445,

A Surgeon's Chance Encounters with Mechanisms Related to Consciousness. Journal of the Royal College of Surgeons of Edinburgh, v, 5, p, 173-190, 1960,

PEROT, P , and PENFIELD, W .

Hallucinations of Past Experience and Experiential Responses to Stimulation oj Temporal Cortex. Transactions of the American Neurological Association, p. 80-84, 1960,

T H E QUARTER CENTURY CELEBRATION OF THE MONTREAL NEUROLOGICAL INSTITUTE OF MCGILL

UNIVERSITY, World Neurology, v, I, p, 113-126, 1960,

RABINOVITCH, R .

Diseases of the Intervertebral Disc and Its Surrounding Tissues. Springfield, Charles C, Thomas, 139 p„ 1961,

RASMUSSEN, T , and BLUNDELL, J,

Epilepsy and Brain Tumor. Clinical Neurosurgery, v, 7, Baltimore, 1961, p. 138-158.

ROBB, J. P

An Introduction to the Diagnosis of Cerebral Palsy and the Vse of a Punch Card Record. Journal of the 'Canadian Medical Association, v. 84. p, 651-657, 1961.

ROTH, J. G. and ELVIDGE, A. R,

Glioblastoma Multiforme: A Clinical Survey. Journal of Neurosurgery, v, 17, p 736-750, 1960,

ROVIT, R , and EAGER, C , A .

Solitary Plasmacytoma of Petrous Bone. Journal of Neurosurgery, v. 17, p. 929-933, 1960. ^ B 7 r

52

ROVIT, R , and GLOOR, P ,

Temporal Lobe Epilepsy — A Study Using Multiple Basal Electrodes. II. Clinical EEG Findings. Neurochirurgie, v. 3, p. 19-34, 1960.

ROVIT, R , , GLOOR, P , and HENDERSON, L .

Temporal Lobe Epilepsy — A Study Using Multiple Basal Electrodes. I. Description of Method. Neurochirurgie, v. 3, p , 6-19, 1960,

ROVIT, R , , GLOOR, P , and RASMUSSEN, T .

Effect of Intracarotid Injection of Solium Amytal on Efyileptiform EEG Discharges. Transactions of the American Neurological Association, p. 161-165, 1960.

ROVIT, R . , HARDY, J. and GLOOR, P .

Electroencephalographic Effects of Intracarotid Amobarbital on Epileptic Activity. .American Medical Association Archives of Neurology, v, 3, p, 642-655, 1960,

STEPIEN, L , S, and CORDEAU, J. P.

Memory in Monkeys for Compound Stimuli. American Journal of Psychology, v. 73, p. 388-395, 1960.

STEPIEN. L . S., CORDEAU, J. P. RASMUSSEN, T .

The Effect of Temporal Lobe and Hippocampal Lesions on Auditory and Visual Recent Memory in Monkeys. Brain, v. 83, p . 470-489, 1960.

53

ENDOWMENTS

\ll^^ ~~ ^^^^^f^ll^r Foundation Endowment dll ~~ PM" ' ' ^ ' " Canadian Foundation Grant Q^ "~ i T l ^ '^^^^ McConnell Endowment 957 - Hobart Anderson Springle Memorial Endowment 958 —Rupert Bruce Memorial Endowment nrn ~ f ."; ^ ' ^^^^^'^ Memorial Endowment

lybU — William Cone Memorial Endowment

FELLOWSHIP FUNDS

1948 — Duggan Fellowship 1950 — Lewis L. Retord Fellowship 195(i — Dr. and Mrs. Charles F. Martin Fellowship

RECURRING ANNUAL GRANTS

1917 — Federal Government Consolidated Grant 1951 — Bronfman Grant for Neurophysiology

(.RANTS FOR SPECIAL PROJECTS

Doniinion-PioNincial Health Grant — Dr. McNaughton — Dr. Rasmussen

Eli/abeth Kenny Foundation Grant — Dr. Rasmussen Eli/abelh Kenny Foundation Fellowship Grant — Dr. L. Wolfe r .S . Publi( Health NcuK^logical Training Grant — Dr. McNaughton r .S. National Science Foundation Grant — Dr. Jasper

DONAllONS TO SPECIAL FUNDS—1960-61

S 10,000.

100.1

\ \ \ l sMI l M \ R i S I A K t II l i \ i ) :

Paike l)(n'L\ s> Co ( I ARl N« I H l R N M I IN M i M O R I A I . R l N l \K(II 1 LM)!

\ \ k \ i \ I I \ H ) i K R I M ARC II 1 i M ) : .Mr. Benny Bc>o(i in menu)ry of Mr. Milton Berger

HORDI s i l l l O U M I I I ' i IM>:

( S N ( I R ( IINK AP R l I l M I I M ' : I5OO

((uutr lid l((iii,nc

( ,,s«.K()M R I M \R(U Fi \ i ' : 60

itionymoiis - p i 4,nhler ^^ Mn. Jean lioxc, in memoiy of M>y R. J- Ambtci

l)i( K I I'll I I'sN I I ' N D : 1000

\uou\moits ••;•, (.,.K..(.N l.iHKVRV AM) i N r o R M M i o N H ' N P : 4^834

{nonymons , , , K M N ( , > M . M . ( : . . N M A . . R . U H F ^ ' M ^ : 25

Mrv. J. D. Stnrarl MK /. Clnre Wilcox •••••••••• Mrs. Andrew Slott ••"•• .Mrvs Suzanne Cohen

54

100.1 10.1 30.1

R.V.H. Women's Auxiliary 2 000 00 HOSPITAL EQUIPMI NT FUND:

R.V.H. Women's Auxiliary 300.00

MASSABKE FOUNDATION RESEARCH FUND: 165 58

M.X.I, NEUROSURGICAL RESEARCH FUND:

M.N.I. STAFF LOAN FUND:

MISCELLANEOUS SPECIAL FUNDS:

R.V.H. Women's Auxiliary Fund for Christmas Cheer 200.00 for Social Service Fund 200.00

Miss Mary Claydon 5 00 In Memory of the late Professor H. R. Scott 109,00

Mr. C. Sydney Lyman 325.00 " Mr. Horace L. En man 1,343.15

" " " Mr. Madison Walter 6,580.15 MULTIPLE SCLFROSIS RESEARCH FUNDS:

MULTIPLE SCLEROSIS RESEARCH FUND:

Multiple Sclerosis Society of Canada . 14,400,00 MULTIPLE SCLEROSIS CLINICAL RELIEF FUND:

Multiple Sclerosis Golf League 275.00 Montreal Association for Multiple Sclerosis 500,00 Mr. Gerard Martin 10.00

McDouGALL N U R S I N G S C H O L A R S H I P :

MCNAUGHTON NEUROANATOMY RESEARCH FUND:

Mrs. Robert Reford 500.00 NEUROLOGICAL RESEARCH FUND:

The late Miss Isabella McLennan in memory of Mr. Bartlett McLennan 5,000.00 The late Mrs. Caroline Celestial McLean 4,553.26

NEUROPHYSIOLOGY RESEARCH FUND: (JASPER)

NEURORADIOLOGY RESEARCH AND TEACHING FUND:

NURSING EDUCATION FUND:

R.V.H. Women's Auxiliary 500,00 OAKLAWN FOUNDATION FELLOWSHIP FUND 2,000,00

PENFIELD RP:SEARCH FUND:

LEWIS REFORD FELLOWS FUND:

WOMEN'S AUXILIARY FUND 1,000.00 T o ENDOWMENTS OF THE MONTREAL NEUROLOGICAL INSIITUTE:

Estate of the late Mr. fosepJi Levinson 3,000.00

Donations to the Montreal Neurological Institute may be made to any of the above funds or for other purposes as specified by the donor. Receipts for such contributions are valid for income tax purposes in Canada. Donations from the United States will also qualify for income tax allowance if cheques are made out to the Friends of McGill University, Inc., and sent to the Secretary, Mrs. Ernest Rossiter, Jr., Box 533, Hempsted, N.Y., with the notation that they are for the Montreal Neurological Institute.

Bequests and donations should be made out to the Montreal Neuro­logical Institute, McGill University, and sent to the Director.

55

STATISTICS

CLASSIFICATION OF DISEASES

Nervous System Generally:

Multiple Sclerosis 116 Motor Neurone Disease 33 Neurosyphilis 1

Meninges:

Meningocele & Myelomeningocele 21 Acute Purulent Meningitis 13 Tuberculous Meningitis 6 Headache 67 Subdural Haematoma 26 Subdural Hygroma 5 Epidural Haematoma 8 Subarachnoid Haemorrhage 41 CSF Rhinorrhoea 2 Miscellaneous 8

Brain:

Congenital Anomalies 8 Hydrocephalus 20 Brain Abscess 2 Cerebral Concussion 145 Acromegaly 2 Cerebral Contusion, Laceration, Traumatic Encephalopathy 177 Syncope 13 Ischemia 11 Epilepsy 499 Migraine 41 Parkinsonism 29 Vertigo 2 Cerebral Thrombosis, Encephalopathy due to Arteriosclerosis 173 Cerebral Haemorrhage 9 Cerebral Embolism 2 Intracranial Aneurysm 19 Encephalitis 17 Miscellaneous 5

Tumours:

Gliomas 22 Perineurial Fibroblastoma 12 Meningeal Fibroblastoma 18 Craniopharyngioma 4 Angioma 2 Glioblastoma Multiforme 28 Metastatic Carcinoma — General Body 38 Meningioma 5 Astrocytoma 20 Medulloblastoma 7 Tumour Brain 22 Ependymoma 2 Oligodendroblastoma 3

56

Haemangioblastoma 4 Secondary Fumours, Brain. Spinal Cord 13 Melanoma 2 Sarcoma 1 Neurofibroma 4 Dermoid Cyst 3 Stenosis Aqueduct of S^lvius 3 Chromophobe Adenoma Pituitary 9 Recklinghausen's Disease 1 Granuloma. Eosinophilic 3 Sacral Radiculopathy due Metastases 1 Miscellaneous Tumours , Body Generally 2 Miscellaneous CNS and Skull 2

Spinal Cord: Compression of the Spinal Cord 8 Transverse Acute Myelitis 4 Guillain-Barre Syndrome 4 Myelopathy II Syringomyelia 4 Radiculitis 5 Poliomyelitis 1 Miscellaneous 9

Cranial and Peripheral Nerves:

Optic Neurit is 12 Trigeminal Neuralgia 55 Bell's Palsy .- 3 Meniere's Syndrome 17 Traumat ic Peripheral Nerve Lesions 6 Compression Ulnar Nerve 15 Other Neuralgias H Peripheral Neuropathy 14 Diabetic Neuropathy 3 Ocular Myopathy 4 Miscellaneous 9

Muscles: Myasthenia Gravis 5 Muscular Atrophy 1^ Polymyositis • •• 4 Miscellaneous ^^

Mental Diseases:

Mental Retardat ion J^ Depression - ^^ Drug Addiction J Psychoneurosis *^ Alzheimer's Disease ^ Dementia, due chronic alcoholism 4 Behaviour Disorder, Post-traumatic 6 Miscellaneous • • "

Other Systems:

Protrusion Disc — Lumbar 207 — Cervical • ^^ — Thoracic • 3

57

Fracture a n d / o r Dislocation of Vertebral Column 26 Fracture Skull go Back Pain 18 Neck Pain 4 Face Pain 9 Traumat ic Lesions and Infections — Misc 25 No CNS Disease 23 Miscellaneous 35

58

OPERATIONS

Craniotomy (Osteoplastic, miscellaneous, etc.)

Hemispherectomy i and Biopsy o and Decompression Q and Drainage of Abscess ] and Drainage of Subdural Haematoma 20 and Drainage of Intracerebral Haematoma 12 and Drainage of Extradural Haematoma 7 and Excision of Epileptogenic Focus 62 and Reinforcement of AneurNsm 3 and Exploration 5 and Hypophysectomy 10 and Clipping of Aneurvsm 9 and Obliteration of Cyst 2 and Plastic Repair of Dura 3 and Removal of T u m o u r 95 and Rhizotomy 5 and Excision of Arteriovenous Malformation 3

and Arteriectomy 1

Trepanations & Craniocentesis

and Biopsy 6 and Drainage of Subdural Space 7 and Drainage of .\bscess 1 and \ 'entr icular Puncture 4 and \ 'entr iculography 4 and Exploration 6 and Pallidotomy 19

Ele\ation of Depressed Skull Fracture 47 Plastic Repair of Skull Defect, Tan ta lum 3 Plastic Repair of Skull Defect, Bone 2 Suture of Lacerated Wound of Scalp 4 Ventriculocisternostomy (Torkildsen's) 9 Ventriculovenostomy or Ventriculo-Atrial 16 Morcellation of Skull 1 .Artificial Cranial Suture 2 Laminectomy or Hemilaminectomy

and Anterolateral Cordotomy 5 and Biopsy 5 and Decompression of Spinal Cord 6 and Exploration 8 and Incision & Drainage of Abscess 2 and Removal of Haematoma 1 and Removal of T u m o u r 16 and Rhizotomy 3 and Spinal Fusion, Stainless Steel Plate 2 and Spinal Fusion with Bone Graft 31 and Discoidettomy m and Cervical Discoidectomy 9 and Cut t ing of Dentate Ligament 1

Sympathectomy:

Plastic Repair of Cranium Bifidum 5 Plastic Repair of Spina Bifida 12

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Ligation of Artery 4 Exploration of Nerve 4 Ligation of Artery with Selverstone Clamp 10 Avulsion of Nerve 13 Exploration of Nerve 17 Removal of Neuroma 1 Nerve Suture 2 Nerve Anastomosis 3 Reopening of Wound with Evacuation 5 Reopening of Wound with Exploration 5 Reopening of Wound with Removal of Bone Flap 1 Reopening of Wound with Repacking 7 Reopening of Wound with Drainage of Infection 1 Miscellaneous 49 Plaster Cast 14 Ventriculo-Peritoneal Shunt 4 Lumbar Peritoneal Shunt 2 Cerebral Arteriography — Percutaneous 299 Pneumogram 40 Tracheotomy 8 T O T A L 1082

CAUSES OF D E A T H

Head Injury 23 Tumour 18 Aneurysm 8 Cerebral Haemorrhage 8 Subarachnoid Haemorrhage 5 Subdural Haematoma 4 Meningitis 1 Encephalitis 1 Thrombosis 10 Fracture Cervical Spine 1 Leukemia 1 Carcinoma (General) 7 Glioblastoma Multiforme 8 Other Systems 1 TOTAL ....Z......... Z. [^Z 96

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