Calling Dr. Cooper

In a work that is still regarded as a classic of clarity of writing and astuteness of observation, James Parkinson (1775-1824) was the first to describe “an evil from the domination of which the victim had no prospect of escape.” This was paralysis agitans, the shaking palsy that Charcot renamed “Parkinson’s disease.” It is marked by a wide variety of motor disorders of which the most conspicuous is uncontrollable tremor, sometimes accompanied by local muscular rigidity and by a characteristic rigidity of the muscles of facial expression leading to the set expression known as the “parkinsonian mask.” For well over a hundred years the disease remained a complete mystery so far as concerned interpretation and treatment.

I.S. Cooper’s very substantial claim to fame is founded on his having devised a neurosurgical treatment for parkinsonism which could relieve the tremors and the rigidities without causing damage on its own account. This is indeed a gift of life because parkinsonism can be very long lasting. Macdonald Critchley, one of the world’s leading neurologists, has described a pensioner whose mild symptoms of parkinsonism had lasted from the age of 65 until his death at 105.

Cooper devised his operation by ordinary scientific procedures extraordinarily well worked out; that is, he built upon his own hunches or on clues already available (Russell Meyers had already made a significant contribution which Cooper acknowledges) and he seized astutely and perceptively upon any informative conjunction of events thrown up by chance (through that which Bacon described as “the casual felicity of particular events”); in due course by a characteristically scientific flash of imaginative insight he hit upon a hypothesis about the control of parkinsonism of which a surgical operation would be the empirical test.

Apart from the surgical strategy, Cooper raised stereotactic surgery to a specially high degree of proficiency. Stereotactic surgery is a system of surgery in which the surgeon’s hands and the various instruments (scalpels, probes, forceps, etc.) that represent functional extensions of the hands are guided with geometrical precision to the part of the brain that is to be the subject of a surgical procedure. Stereotaxy is specially valuable in the surgery of the brain. If a surgeon has to conduct a surgical operation on the contents of the perivisceral coelom (known to laymen as the “insides”) he can rummage around inside until he finds the part he is seeking, pushing tubes and pipes aside now this way and now that; they can be even partially externalized provided they are kept moist. There is no record in the history of medicine of any surgeon’s forgetting to spoon them back in again. If any such procedure were applied to the brain the patient would end as a human vegetable, for functions and faculties are to so high a degree localized in the brain that every brain surgeon operates in the anxiety that his operative procedures cause functional damage as great as or even worse than that which he is seeking to relieve.

In addition to needing technical proficiency, then, the brain surgeon must be a man with strong nerve, resolution, and strength of character, and must have in specially full measure that sanguine temperament which is a precondition of success in all forms of surgery from chiropody upward. In addition to these specialized endowments a surgeon intent upon using new operations must have an inventive brain and must also be a good man in a moral sense. When the time comes to decide upon whether or not to undertake an operation, Cooper writes

…though approval may come from a committee of professors or professional peers in the hospital, and appeals to do so may come from the patient and family, it is impossible not to ask, “Do I have the right? Can I bear responsibility if I am wrong?” One may have the technical skill of Harvey Cushing, but the motivation and morals of a whore. Motivation and morals may play the principal role in deciding what one should do.

A second technique that Cooper developed and improved upon was that of cryosurgery, the destruction or functional inactivation of tissues by the use of extreme cold (around 196 degrees below zero Celsius). This was a stroke of genius in brain surgery because of the extreme importance of avoiding any procedures likely to give rise to hemorrhage or the inflammation that follows tissue damage.

Parkinsonian tremors consequent upon encephalitic infections are not the only motor disabilities Cooper has alleviated by neurosurgery. He has relieved the symptoms of about 150 cases of dystonia musculorum deformans (DMD)—a quite dreadful disease that may afflict the young of both sexes. It is marked by uncontrollable muscular tremors combined with sometimes grotesque postural fixations resulting from the simultaneous contraction of antagonistic muscles. Cooper himself has given a moving nontechnical account of this disability in his The Victim Is Always the Same (1973).¹ Not the least of the disabilities suffered by many of the victims of DMD is the incompetent misdiagnosis of psychoanalysts, many of whom contrive to weave around the victim of DMD the kind of tailored myth that ostensibly explains their symptoms and at the same time, unhappily, demonstrates the uselessness of attempting their surgical alleviation.

Cooper is probably the world’s greatest authority on the treatment of disorders of movement, of which in his principal professional work² he remarks,

…disorders of movement are not clearcut entities but rather constitute a spectrum of abnormal postures, states of muscle tone and movements varying from hypotonic flaccidity to bone-breaking muscular contractions, from akinesia to relentless, violent movements capable of producing exhaustion and death.

Psychoanalytic dogmas and other such obfuscations were not the only ones Cooper had to put up with, for when he began his work in the early Fifties conventional opinion had it that cerebral surgery could cure tremor only by substituting paralysis for it and that tremor could only be abolished by a procedure that inactivated the source or interrupted the conduction of the motor nerve impulses that arise in the “precentral gyrus” and are conducted down the great corticospinal (pyramidal) tract. Cooper’s work confuted many of these dogmas and I can easily imagine that he was not as grovelingly tactful as a man of about thirty ought to be when, in a very authoritarian profession, he challenges the opinion of his seniors.

Cooper began his great work on parkinsonism at Bellevue Hospital and University Hospital. In the first twelve cases in which he tried to relieve the shaking palsy by surgical intervention, seven were markedly improved, four were not, and one died. Nevertheless there were grounds for encouragement and Cooper was invited to tell a meeting of the American Neurological Association in June 1953 what these were.

Cooper woke at 2 AM on the day of the meeting and delivered his address from memory to the bathroom mirror in order to be able to speak without notes—in my opinion a form of showing off that does not produce anything like such a good impression as the lecturer believes it will. He had high hopes of the meeting and of the effect he thought his contribution to it would produce, but in the outcome he was bitterly disappointed: having said his piece and shown a film to an interested minority of the audience he returned to the lecture hall and found himself the subject of unfavorable comment. He learned he had not followed up his cases long enough—and that even hypnotism could allay the tremors of parkinsonism. How then could Cooper attribute his cures to his own surgical skill? Worse still, Cooper’s claims became front-page news in an article in The New York Times by its famous science editor, David Lawrence. The reporting in newspapers of disputed or not yet published scientific or medical findings was then an unforgivable medical and scientific solecism—Cooper was accused of being responsible, though he had never before met Mr. Lawrence or spoken to him. Cooper was thereupon labeled “controversial” and the label, being pejorative, stuck.

During the golden age of surgery—the days of W.S. Halsted of Johns Hopkins and Berkeley George Moynihan, Lord Moynihan of Leeds, when the vast improvements of anaesthesia and asepsis had made possible abdominal surgery of until then unimaginable audacity and therapeutic effectiveness, the surgeons were mostly successful in a medical sense, but physicians in the days before antibiotics and, effectively, before vitamins, hormones, and electrolyte balances, etc., were not. This was an inequality of accomplishment which surgeons (remembering all those sneers about surgery having been an accomplishment of barbers) did not allow their physician colleagues to forget.

So began the tension that still exists between physicians—the patricians of medicine, as they imagine themselves to be—and surgeons, dismissed as high-grade manual workers; and in no branch of medicine was this antipathy more strongly marked than in neurology—for clearly cognate reasons. In the main neurologists are very skilled at interpretation and diagnosis—so much so that sometimes one gets the impression that neurology is more an intellectual than a practical pursuit. Where medical neurology fails is in treatment and cure, for so many neurological injuries have irreversible consequences, as the victims of strokes and of peripheral nerve injuries learn to their dismay.

Neurosurgeons, however, were sometimes able to do good and gave reason enough, therefore, for jealousy. Even the great British surgeon Victor Horsley, whom Cooper (and, more significantly, Gilbert Horrax, Harvey Cushing’s assistant for twenty years) describes as the father of modern neurosurgery, was looked down upon by his physician colleagues. Horsley, soured by his failure to relieve his teenage son of epilepsy, became aggressively more sharp and critical with his colleagues, with the effect that, according to Cooper’s account of the matter, he was never allocated beds of his own at the National Hospital for Nervous Diseases in Queen Square in London; and in the First World War, while Harvey Cushing was commissioned as a brain surgeon, Horsley was relegated to Mesopotamia (now Iraq), where he died of a tropical fever.

Irving Cooper, it may be observed, is both a physician and a surgeon, for he is a diplomate of the American boards of neurology and psychiatry as well as of neurological surgery. His qualifications were not high enough, unfortunately, to protect him from the campaign of depreciation amounting sometimes to vilification of which he became the victim. It is as true in the world of medicine and science as it is in the world of letters that any very notable accomplishment by a young man—particularly if there is a suspicion that it is due to a real superiority of skill of hand or mind—arouses an extreme envy or resentment. Professor Adrian Upton, MD, who introduces this volume in a wise and temperate foreword, writes:

…a young physician can expect nothing but trouble from an important and original discovery made early in his career. Such an individual would be wise to attribute his discovery to luck rather than ability. An even more cynical thought is that a pioneer should develop some physical handicap (a limp, a stutter, or an eyepatch)….

Upton adds that Cooper compounded his sins by “developing a stream of original ideas. His youth and enthusiasm have continued to jar the academic community.” His position is by no means unique: Jonas Salk is in the same boat—a man whose accomplishment was far too great to avoid envy and the severest censure. Among the first of the missiles to be thrown by the little men—for such they are—who feel themselves diminished by another’s success is the imputation that the work which is so much admired is not really original but was thought of by someone else—in desperate cases, it will be alleged, by the Chinese. Penicillin?—why, did not the Chinese long ago use moldy soya bean curds as wound dressings? So much for Alexander Fleming and Howard Florey.

The best way to cut Salk down to the size of his detractors, it was found, was to declare that the really important scientific innovation that was embodied in Salk vaccine was the discovery by John Enders, Thomas Weller, and Frederick Robbins of how to grow human polio virus in tissue culture outside the body. This was certainly a splendid achievement and very eminently worthy of the Nobel Prize that it received, but the electors seem to have forgotten that although the growth of polio virus in vitro was a necessary condition for the preparation of a vaccine, it was not a sufficient condition.

The preparation of the vaccine had to await Jonas Salk’s skillful biological engineering. This too was carried out in defiance of conventional wisdom embodied in the belief that only living virus could provide an antigenic stimulus sufficiently powerful and sufficiently prolonged to give protection against virus infections. This view was quite mistaken, having been based on the use of inadequate dosages of inactivated virus—and in ignorance, moreover, of the best way of rendering a virus noninfective without impairing its power to act as an antigen. It does seem very unfair that Salk’s great practical skill and theoretical understanding of the problem he set himself to solve, combined with the unforgivably high esteem in which he was held by the parents of potential victims of poliomyelitis, should have so far closed the door upon many forms of scientific recognition.

Of Cooper’s neurosurgical procedures it can be said that the credit for providing the first evidence that tremors could be controlled by neurosurgery should properly go to Dr. Russell Meyers of the University of Iowa. Cooper greatly admired Meyers’s work and regarded his own as a natural extension of it—but there is all the difference in the world between raising a possibility and devising a documented and reproducible procedure for bringing about the desired effect. It is nevertheless very relevant that in correspondence with Cooper Meyers should indirectly uphold him and criticize Cooper’s critics.

In the attempt to discredit Cooper’s work another charge brought against him was that the crucial tactic in the treatment of parkinsonism, the occlusion of the anterior choroidal artery—crucial because it inactivated the target area of the brain by vascular deprivation—was discovered by chance and not by systematic clinical inferences which could in theory have been drawn but were not in fact drawn by a neurological physician.

The clinical validation of this procedure is the subject of the most interesting chapter in Cooper’s book. He there describes three men who had become victims of severe parkinsonism as a late sequel of an encephalitic virus infection; of these, two were well aware of the hazards of the operation that they agreed to submit to. All three were treated by occlusion of the anterior choroidal artery with satisfactory results, but with one of them there was a long and agonizing period of uncertainty and the patient, though he showed some motor improvement, remained comatose for a while and needed strenuous drug treatment to reinstate awareness. Indeed, the results of these operations were in general better than Cooper himself had reckoned on.

I turn now to the question of luck and serendipity in Cooper’s research. I do not think there is any received philosophy of luck but because of its importance in scientific research I shall do my best to clarify the notion.

Consider first “serendipity.” The word was coined by Horace Walpole on the basis of a fairy tale set in Serendip—an old name for Ceylon—about the three princes of Serendip who repeatedly made discoveries by accident of things they were not in search of. It is not a word that can very often be used to describe discoveries in science which are most often discoveries of that which is being sought, or anyhow discoveries that gratify an expectation. It certainly cannot be applied to penicillin, for example, because although there is a plausible-sounding myth about a spore’s floating in through the window, we know from Fleming’s past life that he had been looking for years if not for penicillin then for something as much as possible like it—for an antibacterial agent that damaged bacteria more than tissues.

But what of “luck” in the everyday sense? Clearly a distinction must be drawn between on the one hand a man who having bought a ticket in a lottery draws a winning number and on the other hand a man who finds on a park bench a ticket that bears the winning number. The difference is that the man who bought a ticket did at the same time buy his candidature for a prize and thus made himself eligible for winning. The rest is merely a matter of probabilities. It is boring and pointless to attribute degrees of luck to the ticket holder’s fortunes because everyone’s good luck must be counterbalanced by someone else’s bad luck or negative luck.

The man who found the ticket on the park bench was really lucky because he wasn’t a candidate, merely a beneficiary of a casual intersection of world lines. Contrary to popular belief I do not believe that this is an important part of science. Luck is most usually, I believe, the ratification of some covert expectation—the filling of a vacant slot in the mind. A scientist is a man who by his observations and experiments, by his reading, and even by the company he keeps has made himself a candidate for good fortune—has purchased his candidature for a prize. In biochemical terms his brain is bristling with “luck receptors.” Unlike Walpole’s princes he wants to make the discoveries he does make.

Certainly Cooper did. It is perfectly clear, and Cooper admits it, that when he interrupted the anterior choroidal artery the first time—that was in 1951—it was a mistake; but the mistake was made in the course of attempting a surgical procedure for relieving severe parkinsonian tremor. Something would achieve this purpose, he felt sure. His mind was therefore prepared.

A disadvantage of the operation to interrupt the anterior choroidal artery, early recognized by Cooper himself, was that the area served by the artery varies so greatly from one person to another that there could be no relying upon the operation’s having precisely the same effect in different subjects. For this reason Cooper’s thoughts turned toward direct inactivation of the target area—the “globus pallidus”—by means of a drug introduced into the brain through a tube passed through a dime-sized aperture in the skull.

The principle of the operation, which Cooper first performed in December 1953, was as follows: a tube guided by a stereotactic mechanism was inserted through the hole and to make sure that the right region of the brain had been reached the first fluid to be introduced was a local anaesthetic that would cause a temporary block. If this worked, i.e., reduced rigidity and tremor, it could be followed by an agent such as alcohol—which had long been used in neurosurgery for injection into ganglia to reduce pain. As to the final location of the tube that had been progressively inserted, this could be ascertained by X-radiography following the injection of a small quantity of a radio-opaque substance.

In the few weeks following Cooper successfully carried out the operation five more times. The entire procedure took about twenty minutes. In view of these successes Cooper began to think—as scientists and medical men do—of prompt publication of his findings, the purpose of which was to make his valuable new discovery public, to secure credit for his prowess and to establish a claim to priority in the matter. It is pure humbug to pretend to be above such considerations. Newton wasn’t—nor were Galileo and Darwin.

At all events Cooper resolved to try for publication in Science, the famous scientific newspaper which in 1953 had published his first paper.³ But Science rejected his new paper—a deeply wounding rebuff. It is a lucky scientist who never in his lifetime is so rebuffed—lucky or very unimaginative. The more strictly he confines himself to performing the scientific equivalent of engraving the Lord’s Prayer upon the head of a pin the less likely he is to have his paper turned down. Scientific inadequacy is not the most frequent reason for the rejection of a paper, which in each case is submitted to a group of referees. Quite common grounds, I suspect, are inadequate attention paid to the referees’ own work, jealousy, spite, and a referee’s inclination to take the author down a peg. It had happened to Cooper before and this time he was not going to put up with it. He appealed to the editor, who agreed to hear him in his office in Baltimore provided Cooper would accept as final the verdict of the professor of neurology at Johns Hopkins, Earl Walker. Cooper was able to give Walker satisfactory answers to his objections and the paper was passed for publication.

According to Cooper’s account there was however an anatomical error in his paper: he had assumed too readily that the procedure of instilling drugs directly into the brain through a tube reproduced the lesion brought about by a severance of the anterior choroidal artery: that the part of the brain affected was the globus pallidus. More probably, Cooper says, it was in the posterior portion of the ventrolateral nucleus of the thalamus. He had misinterpreted the X-radiograph—a “stupid mistake,” he remarks, but one which led him to the adoption of a clinically effective procedure.

Cooper continued to use the chemical procedure for inactivation before he developed the techniques of cryosurgery I explained earlier.

After describing his life as a neurosurgeon Cooper turns to autobiography of a more ordinary sort. At George Washington University he majored, unusually, in both chemistry and English literature. He is a skillful writer, as his earlier books made clear (one thinks especially of The Victim Is Always the Same and It’s Hard to Leave While the Music’s Playing). He has a gift for writing vividly of the teachers to whom he feels specially indebted. Of his inspiring professor of English, Fred Tupper, he writes, “He wore dark gray or black rumpled suits and could have been type-cast by a film producer as the unnoticeable, but evidently brilliant secret-service agent in the British Foreign Service.”

But considered as a work of literature this new book would not appease those who have resolved to think ill of Cooper. He is like Voltaire’s wicked animal that defends itself upon being attacked. He naturally takes his own part and is a skillful advocate in defending himself against misrepresentation. His prose style is heated, moreover, and this is as it should be: a surgical operation is an intrinsically dramatic event and the flat narrative style of police court re-portage such as Daniel Defoe was accused of writing does not suit it or him. Cooper describes convincingly the ups and downs of a creative life in science and scientific medicine—from that which Freud described as “the oceanic feeling” which is a reward for having any notable accession of understanding to the mood of bewildered despair and black depression when things don’t go right and when the understanding we thought we had seems in large part illusory.

Reading a book such as this, one wonders how it could ever have got about that a scientist is a cool, dispassionate observer of natural phenomena, objective and uninvolved, eliciting as far as possible nature’s lessons from her own lips without the interposition of expectations of any kind. This is all bunk, of course. It is a passionate life and Cooper is a passionate man. He has faults, of course, some of which he admits to: he was ambitious, surely, and he worked for his own advancement; moreover, he very much liked to work for the advancement of medical science, and in the especially difficult and exacting domain in which he worked he wanted to be recognized and justly rewarded (how low can one sink?). But one is left in no doubt that the fault for which his critics find it most difficult to forgive him is his success—both in a worldly sense and as a medical scientist and clinician.

It was during the early 1950s at St. Barnabas Hospital in the Bronx that Cooper felt he would finally be able to demonstrate the validity of the thesis that the shaking palsy could be abrogated by a surgical procedure which would not substitute paralysis or any functionally important degree of incapacitation for the tremors. This was also an intellectually active and fruitful period for Cooper. In the pages of his book in which he describes it, exciting hypotheses and research leads—his own and others—weave in and out. Among them is the notion of a viral origin of parkinsonian tremors, and Cooper’s interest in this idea established a connection between his work and that of a very gifted virologist, Carleton Gajdusek, who had been working in New Guinea on “the laughing sickness,” Kuru. Apropos of the viral etiology of involuntary movement, Cooper remarks that virus invaders that swept through the world in 1918 were still “reaping a harvest of brain-diseased cripples two decades later.”

One feels that this period in the Bronx would have been the best time of Cooper’s life were his work not still in the shadow of the dogma that the shaking tremors could not be abrogated except by surgical procedures that entailed some degree of paralysis. In desperation and genuinely bewildered to know the kind of evidence he would have to produce to confute this dogma he turned to Dr. Francis Grant, professor of neurosurgery at the University of Pennsylvania; he asked Grant if he would accompany him on rounds to appraise his patients and to examine also patients of longer standing who would be summoned back to the hospital for the purpose.

Grant agreed and a date was fixed somewhat before Christmas 1954. He came accompanied by Robert Schwab, professor of neurology at Harvard and the head of a parkinsonism clinic at Massachusetts General Hospital, and by James White, a Harvard professor of neurosurgery: a pretty formidable team—one that would make anyone quake who was not sure of his ground. But the outcome of the visit could not have been more satisfactory. “Once again,” Cooper wrote, “fate was inordinately kind to me.”

Cooper demonstrated for the triumvirate his chemical incapacitation of regions of the thalamus. “It’s the best damn thing I’ve ever seen,” said Professor Grant, and later he wrote Cooper a treasured letter in which the sentence occurs: “You do a patient more good in twenty minutes than many four hour intracranial procedures accomplish.” It would be very superficial judgment to describe Cooper’s quoting this sentence as boastful. On the contrary, misunderstood and rebuffed as he had been, such an opinion was balm to him and it is as such that Cooper calls attention to it.

It is clear that Francis Grant went out of his way to get his colleagues to realize the magnitude of Cooper’s accomplishment, for having arranged for him to present his material the following year to the Harvey Cushing Society he went up to the podium after Cooper had spoken and said, “I’ve seen these cases and I’ve watched Cooper operate. Everything he has said today is true.” Cooper’s relief to hear that he was no longer controversial was understandable, for he had a very bad time.

One Argentinian surgeon, humiliated by having failed with Cooper’s operation for parkinsonism while a colleague of his had succeeded and had derived considerable credit for doing so resolved to denounce the Cooper operation by maintaining that it theoretically could not be, and in practice was not, successful.

The Argentinian surgeon had his revenge by denouncing Cooper to President Perón who because of his wife Evita’s illness acquired a lively interest in medical science. Perón was urged to prohibit the operation in all Perón clinics. The surgeon, “Rudolf Valentino-like and slick haired,” resolved to look into the matter himself, visiting New York and the clinic at which he was able to inspect the patients and see films embodying past case records. These seemed to convince him for he quit the scene of the demonstration without comment.

Much less understandable was the resolute opposition of a very distinguished American neurologist who had been chairman of the conference in Atlantic City at which Cooper presented his first findings on the surgical treatment of parkinsonism—and had come under the unjust suspicion of having briefed David Lawrence of The New York Times for his front-page article. This professor was to be the discussant at a meeting of the New York Academy of Medicine at which Cooper was to lecture on the current status of his surgical procedures.

The eminent professor was not present but sent a deputy to present his apologies to the audience and tell them that he felt convinced that the results of Cooper’s operation were only temporary and were to be attributed in large measure to his strong personality and sanguine appraisal of the likelihood of success. It is as if he were saying that the cures were psychogenic in origin and could be palliated therefore by psychotherapy. Would he, one wonders, have thought more highly of Cooper if he had told his patients that the operation he was proposing to undertake had been thought by some of his colleagues to be unsound and to be likely to end in failure? The author of these views reiterated them formally in a paper delivered at the American Academy of Neurology. In particular he implied that relief (which could only be temporary) by surgery of parkinsonism was merely secondary to nonspecific neurological damage.

Readers may find these stories difficult to believe, but I am ashamed to say that I know enough of the inside of medicine and the characters of those who pursue it that I found them all entirely too easy to believe. I have myself not mentioned the proper names of Cooper’s principal depreciators, but I hope people will buy or refer to Cooper’s book so that their names become more widely known. Of many of them it may come to be said that the highest distinction they achieved was to be mentioned by name in the pages of this book.

Dr. Schwab of Harvard, with whom Cooper was now collaborating, again intervened in Cooper’s life. Schwab managed to persuade the eminent neurologist who was to denounce Cooper’s operation at the Academy to inspect some of Cooper’s cases for himself. A demonstration was prepared for him and he duly came. Cooper remarks that he was a rather small man and that he was accompanied by an entourage of persons smaller than himself. The great man professed himself interested by what he had seen, adding. “Our boys in the surgical department haven’t had that kind of luck.” When the Academy met he spoke in terms as close to a retraction as a man of his character would be likely to use. To press his point home Cooper had introduced into the auditorium an ex-patient who had been cured by him of severe parkinsonism. The audience was impressed. In private conversation with the patient later many of them tried to coax him into admitting that he had a history of mental illness, presumably in the hope of demonstrating that his tremors had been hysterical in origin.

Very few advances into science or medicine are definitive—very few are such that they could not have been or will not be improved. The treatment of parkinsonism is no exception.

Cooper was not only the man who introduced an effective surgical treatment of parkinsonism, he was also the man who fulfilled his enemies’ deepest ambition by directing that the surgical procedure could stop—anyhow for a year—and make possible the appraisal of a promising new treatment introduced by a man who became and remained one of Cooper’s closest friends. This was George Cotzias, who introduced the administration of high doses of 1-3, 4-dihydroxyphenylalanine, known everywhere by the acronym L-DOPA. The great importance of this discovery was to have introduced an alternative and powerful weapon into the armory of the would-be healer of Parkinson’s disease. This has relieved brain surgeons of some of the pressures that are otherwise chronically upon them. For a man of sensibility the moral and physical stress of operating on the brain is enormous and now, after a brilliant career, Cooper wants to be free. He is luckier than most, though: he can write and he has indeed written a splendid book. It is both stirring and informative. We learn from it much about the surgeon and the brain and much about people, and most rewardingly about Cooper himself, a man very well worth getting to know.