April 23, 2016

I'd like to hear Ben Carson talk about Harriet Tubman's brain surgery.

I see that the brain surgeon was asked about whether Harriet Tubman belongs on the $20 bill and he said something that got him criticized about how Andrew Jackson was "a tremendous present" so maybe Tubman — whom he loves — could go on the $2 bill. (Thomas Jefferson would have to be ousted for that, but whatever.)

I'd like to hear him talk about Harriet Tubman's brain surgery:
Early in life, she suffered a traumatic head wound when an irate slave owner threw a heavy metal weight intending to hit another slave and hit her instead. [She later explained her belief that her hair – which "had never been combed and ... stood out like a bushel basket" – might have saved her life.] The injury caused dizziness, pain, and spells of hypersomnia, which occurred throughout her life. She was a devout Christian and experienced strange visions and vivid dreams, which she ascribed to premonitions from God....

As Tubman aged, the seizures, headaches, and suffering from her childhood head trauma continued to plague her. At some point in the late 1890s, she underwent brain surgery at Boston's Massachusetts General Hospital. Unable to sleep because of pains and "buzzing" in her head, she asked a doctor if he could operate. He agreed and, in her words, "sawed open my skull, and raised it up, and now it feels more comfortable." She had received no anesthesia for the procedure and reportedly chose instead to bite down on a bullet, as she had seen Civil War soldiers do when their limbs were amputated.
What could brain surgery have been like at that time? I see that Harvey Williams Cushing (April 8, 1869 – October 7, 1939), the "father of modern neurosurgery," did his internship at Massachusetts General Hospital after graduating from Harvard Medical School in 1895.



I wonder how sophisticated the surgery could have been in the late 1890s. Here we have this wonderful brain surgeon, Ben Carson, on a show to talk about Harriet Tubman, and there was a fascinating subject squarely within his expertise. I would have loved to hear what he might have said about the history of brain surgery!

50 comments:

David Begley said...

Reports that there was ether as anesthesia in use in Boston before the Civil War.

Ignorance is Bliss said...

She was a devout Christian and experienced strange visions and vivid dreams, which she ascribed to premonitions from God....

And this is relevant to a paragraph about a brain injury how?

bagoh20 said...

When it comes to stuff at this level, you need to consult someone who knows "a very good brain" when they see one. I'm sure Carson would ask his friend before offering an opinion, and I'm sure the answer would describe an amazing brain, a really incredible brain - a little buzzy, but a really classy brain.

David Begley said...

Bliss

Because the Wikipedia crowd considers Christians to be a little "off," not very smart and uneducated. Some are brain damaged. Flyover people. Deniers of the CAGW hoax. People who don't agree with Tony Kennedy on SSM.

FullMoon said...

"Ignorance is Bliss said... [hush]​[hide comment]

She was a devout Christian and experienced strange visions and vivid dreams, which she ascribed to premonitions from God....

And this is relevant to a paragraph about a brain injury how?"

Would be relevant if visions stopped after surgery.

traditionalguy said...

FTR: Jackson had no industrial King Cotton slavery involvement. Scots-Irish southerners could not afford that way of farming, and Jackson was a poor lawyer, Later in life his wife inherited some house servants.

The Removal of Indian Warrior tribes by the Indian Fighter Jackson was to be expected. He had to fight three wars against savage raiders who were armed and supported by The British Empire and the Spanish Empire. (See, Ft Mims Massacre.) Along the way Jackson lead Militia was able to keep the Mississippi River From the British and take Florida from the Spanish.

His real sin was killing the Bank of the United States, and the pro British New England Merchant aristocracy has never forgiven him for that.

ColleenQ said...

Considering medicine at that time, even anecdotal info - esp from the patient, may eventually be tied in with more data from other patients.
Following possible cause & effect - logically - can & often does add to our store of knowledge.
And sometimes it doesn't. Ya gotta play the odds.

Quaestor said...

Never mind Harriet Tubman, who elected to"bite the bullet". What about all those thousands of Pre-Columbian Indians who underwent trepanation apparently without anesthesia (or medically indicated justification) and survived? And that was in a culture that knew little of sanitation. At least Tubman's surgeon kept a clean operating room.

And what exactly does Ben Carson, a pediatric neurosurgeon whose experience in the treatment of traumatic brain injury is limited compared to a specialist in that field, have to do with Harriet Tubman's brain? Or do you adhere to the theory that skin color conveys a special insight into the experiences and motivations of other person with the same skin color?

Ann Althouse said...

Throughout human history, brain malfunctions have been attributed to supernatural sources (including possession by the devil). I don't see any disrespect of religion in talking about Tubman's interpretation of her own malady and I wouldn't expect religious people today to be troubled by trying to make distinctions that people from earlier times could not have figured out.

Ann Althouse said...

"And what exactly does Ben Carson, a pediatric neurosurgeon whose experience in the treatment of traumatic brain injury is limited compared to a specialist in that field, have to do with Harriet Tubman's brain? Or do you adhere to the theory that skin color conveys a special insight into the experiences and motivations of other person with the same skin color?"

He's a brain surgeon. I'd like to hear him -- or some other brain surgeon -- as long as were talking about Tubman -- get into the part of the story that touches on his area of expertise. She's a heroine and part of her heroism was having to deal with a serious disability, doing her work despite that and, as an elderly woman, submitting to surgery of what seems to be a very frightening sort.

bagoh20 said...

The surgery was a success, but she choked to death on the bullet.

I mean use something sensible. A steak maybe, definitely not eggplant or even an extra firm tofu, but whatever it is, it should have a handle.

mikee said...

Ben Carson is expected, nay, encouraged, to speak only to his field of expertise, wherein he is among the most expert in the entire world. And when he is asked about something non-brain related, he gets guided by the low expectations of a soft bigotry back toward his expertise.

Hillary, expert in amassing fortunes and fighting scandals, yet little else of public record, gets asked about things she not only does not care about - security of her emails, quid pro quo payments from folks with business before our government, the failure of Libya after her intervention there - but about which she knows absolutely nothing, based on her answers.

Which one is speaking to subjects that are further outside their realm of knowledge?

Fernandinande said...

Ignorance is Bliss said...
She was a devout Christian and experienced strange visions and vivid dreams, which she ascribed to premonitions from God....

And this is relevant to a paragraph about a brain injury how?


"Visions" is a polite word for hallucinations. Damaged or diseased brains, perhaps by definition, are more likely to produce hallucinations and religious delusions, er, experiences.

Quaestor said...

Throughout human history, brain malfunctions have been attributed to supernatural sources (including possession by the devil).

And the intervention of sentient apes from the 25th century.

Big Mike said...

I don't understand why Tubman didn't choose anesthesia. Ether was available and used by Union surgeons during the Civil War. By the 1880's -- well before her procedure -- chloroform was in wide use as an anesthetic. Morphine was also available -- it's addictive properties may or may not have been recognized by 1896.

As to the procedure itself, trepanning (relieving pressure on the brain by removing a small section of skull) was in wide use during Medieval times and fossil skulls from the Pleistocene have been found which don't just have the trepanning hole in the skull, but which show subsequent bone growth (i.e., the patient lived for a while thereafter).

Ignorance is Bliss said...

Ann Althouse said...

Throughout human history, brain malfunctions have been attributed to supernatural sources (including possession by the devil). I don't see any disrespect of religion in talking about Tubman's interpretation of her own malady...

I'm just amused by the casual assumption that her gift was a malady or malfunction.

Of course, I'm an atheist, so I assume the same thing.

dustbunny said...

Beside the point trivia: Dr Cushing was the father of Babe Cushing Paley one of Truman Capote's "swans".

gadfly said...

Sorry, but biting down on a bullet would not work even if the time required was only long enough to cut open her skull and then reclose the wound. Excruciating debilative pain, even for those used to severe punishment, is beyond tolerance, so Harriet Tubman fails to pass the first Tubman "old wives' tale" test.

EDH said...

Today, aren't many brain surgeries, by necessity, performed with the patient conscious?

https://www.youtube.com/watch?v=OQ3_IXuhZxQ

Anthony said...

Yeah, one wold guess trepanning was what was done, although why it might work escapes me. It's usually done to relieve brain swelling soon after the traumatic injury that had occurred, not many years later. I wonder if perhaps the original injury resulted in scarring that perhaps caused additional swelling later on due to some other factor? One would guess they didn't leave an open hole but just adjusted the bone outward some and fixed it back in place.

Fascinating though.

mockturtle said...

Brain surgery was performed in ancient Egypt.

bagoh20 said...

Anesthesia must be one of the top three greatest medical advancements. At least on surgery day. My life has been saved by serious surgeries a number of times, and I don't know if I would have agreed to it without anesthesia.

Yancey Ward said...

What would surgery in that age look like? The Knick on Cinemax gave a pretty gruesome view of it.

Big Mike said...

Harriet Tubman fails to pass the first Tubman "old wives' tale" test.

@gadfly, your skepticism does not an alternative narrative make. Are you aware of any references that suggest she did anything other than have the surgery performed sans anesthesia?

jimbino said...

He needs to do some surgery to remove the "god" that is still polluting all our bills.

Michael K said...

"those thousands of Pre-Columbian Indians who underwent trepanation apparently without anesthesia (or medically indicated justification) and survived?"

Cocaine was used by chewing cocoa leaves and we assume dripping the saliva into the wound. Why they did;t get infected is another question.

From the sound of it there was probably a depressed skull fracture from the original injury and it may have been elevated. I cry much doubt she had it done without anesthesia. Some conscious surgery has been done with local for certain procedures requiring the patient to respond.

Carson was chief of neurosurgery in the place where Cushing was a neurosurgeon after he retired from Peter Bent Brigham. I'm sure he has huge experience in trauma.

Michael K said...

"I very much doubt..."

Michael K said...

"I wonder how sophisticated the surgery could have been in the late 1890s."

Most of our modern GI surgery was developed then. Cushing did his surgery training at Johns Hopkins and retired there after years at the Peter Bent Brigham. Heart surgery came late. Appendicitis and a few others came about 1905.

Zach said...

"sawed open my skull, and raised it up, and now it feels more comfortable."

It sounds like a depressed skull fracture.

Cushing is a fascinating person. For all of his innovations, he was an extremely conservative surgeon -- he would only operate when the odds were heavily in his favor and he knew he could help. He spent a long time doing simple trapanations to relieve excess pressure.

It would be fascinating to hear Carson talk about something in his realm of expertise. For all his virtues, he seems to be winging it when it comes to politics.

Zach said...

For all you hear about the virtues of disruption, a lot of historical innovators have followed the Cushing mold. When you're doing something that can go wrong in a million different ways, there's great virtue in taking an approach which minimizes the number of unknowns.

Fred Drinkwater said...

Re:anesthesia - There's a book "Eyewitness to History" which contains a first-person account by a woman of her mastectomy without anesthesia. Truly gut wrenching. Most of the book is gut wrenching.

Michael K said...

" For all his virtues, he seems to be winging it when it comes to politics."

Thank God!

"a lot of historical innovators have followed the Cushing mold."

Cushing also invented the anesthesia record. As a medical student he was giving ether anesthesia and was distressed that some patients died. He and a friend, Amory Codman, devised a chart to record pulse, respiration and later blood pressure every 15 minutes. Cushing found the blood pressure device in Italy and brought it back to the US and introduced it. He also introduced the use of electric cautery to neurosurgery in the 1920s after seeing a demonstration by Professor Bovie. His studies of intracranial pressure in Italy explained why blood pressure goes up when intracranial pressure went up.

His brain tumor patients were asked to send him a postcard on the anniversary of their operation each year. That became the Brain Tumor Registry at Johns Hopkins and continues to this day. It was how we learned to follow cancer and cancer registries are universal now.

Mary Beth said...

Why would CNN want to ask Carson a question that would let him show his expertise? Viewers might think he's intelligent and would then have a harder time thinking of him as just a stupid shill for Trump.

Saint Croix said...

Here we have this wonderful brain surgeon, Ben Carson, on a show to talk about Harriet Tubman, and there was a fascinating subject squarely within his expertise. I would have loved to hear what he might have said about the history of brain surgery!

Yes, it's embarrassing. We're a race-obsessed society. She's black, he's black, they don't get beyond the black.

Carson was once asked by a NPR reporter why he doesn't talk about race more often. His response is priceless.

“I said it’s because I’m a neurosurgeon. And she thought that was a strange response. And I said, you see, when I take someone into the operating room, I’m actually operating on the thing that makes them who they are. The skin doesn’t make them who they are.”

Ann Althouse said...

"Re:anesthesia - There's a book "Eyewitness to History" which contains a first-person account by a woman of her mastectomy without anesthesia. Truly gut wrenching. Most of the book is gut wrenching."

Yes, that description is also repeated in Bill Bryson's "At Home":

"In her diary she wrote: “I walked backwards and forwards till I quieted all emotions, and became, by degrees, nearly stupid—torpid, without sentiment or consciousness—and thus I remained till the clock struck three.” At that point she heard four carriages arrive in quick succession. Moments later, seven grave men in black came into the room. Burney was given a drink to calm her nerves—she didn’t record what, but wine mixed with laudanum was the usual offering. A bed was moved into the middle of the room; old bedding was placed on it so as not to spoil a good mattress or linens. “I now began to tremble violently,” Burney wrote, “more with distaste and horror of the preparations even than of the pain.… I mounted, therefore, unbidden, the bedstead, and M. Dubois placed me upon the mattress, and spread a cambric handkerchief upon my face. It was transparent, however, and I saw through it that the bedstead was instantly surrounded by the seven men and my nurse. I refused to be held; but when, bright through the cambric, I saw the glitter of polished steel—I closed my eyes.” Learning that they intended to remove the whole breast, she surrendered herself to “a terror that surpasses all description.” As the knife cut into her, she emitted “a scream that lasted intermittingly during the whole time of the incision—and I almost marvel that it rings not in my ears still, so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished … but when again I felt the instrument—describing a curve—cutting against the grain, if I may say so, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired. I attempted no more to open my eyes.” But still the operation went on. As the surgeons dug away diseased tissue, she could feel and hear the scrape of the blade on her breastbone. The entire procedure lasted seventeen and a half minutes, and it took her months to recover. But the operation saved her life. She lived another twenty-nine years and the cancer never came back."

Bryson, Bill (2010-10-05). At Home: A Short History of Private Life (p. 334). Random House, Inc.. Kindle Edition.

Michael K said...

Fanny Burney's story is in my book as well. The cancer "never came back" but this was before microscopic anatomy and we have no idea if it was a cancer. Baron Larrey did her surgery. He was the great chief surgeon for Napoleon and invented the military ambulance but we will never know if that was a cancer he removed.

Big Mike said...

Back when he was still a candidate I had an opportunity to ask a close friend -- a retired ob/gyn -- if she knew anything about Carson's reputation as a surgeon. My friend positively gushed, and she never gushes! A lifelong Democrat, she did eventually allow that he was reputed to be hard to work with -- as hard on his staff as he was on himself. Not sure that's a bad thing, but she surely respected his skill and his willingness to take on the very hardest cases.

Phil 3:14 said...

"She was a devout Christian and experienced strange visions and vivid dreams, which she ascribed to premonitions from God...."

Or like an aura before a seizure.

ken in tx said...

"..irate slave owner.." Slave owners almost never punished their own slaves. If they didn't have a Yankee overseer to do that, they took them to a "Whipping Man". There's a play by that name that touches on that subject. Most slave owners were mostly softhearted Episcopalians and Jews--surprise! you didn't know that, did you? Judah Benjamin was the Confederate Secretary of State, and the highest ranking Jew in North America at the time.

~ Gordon Pasha said...

Cushing also wrote the definitive biography of the father of modern internal medicine, Sir William Osler, and even more cool, an eponymous disease, an ACTH producing adenoma of the pituitary gland causing adrenal cortical over activity.

Michael K said...

Cushing wrote that book, which won a Pulitzer Prize of biography, while working full time as the busiest neurosurgeon in the world.

He was a giant.

Quaestor said...

Slave owners almost never punished their own slaves.

I've often heard this story and yet I'm not convinced of its truth. (In case one thinks I voice doubts as part of some kind of regional animus, let me stipulate that I'm a Southern and a descendant of slave owners, for which I feel no guilt, though that detail of my heritage is something I'm not proud of.)

The usual explanation offered for the "slave owners almost never punished their own slaves" — I'm not saying this a myth or a lie — is the quite reasonable observation that slaves were immensely valuable, the average cost of a slave of any age, sex, or condition in 1850 was $400 ($11,500 in current dollars), and no reasonable person would damage his won valuable property simply out of anger. However, there are too many examples of angry men doing just that to allow me to fully credit the just-so tale of the kindly master unwilling to punish his slaves. Permit to cite an example. Coming up within a few weeks is the second leg of the Triple Crown, the Preakness Stakes, which is named in honor of an outstanding American-bred colt sold to the Duke of Hamilton in 1870. Due to some quirk of character in both horse and owner the duke shot Preakness dead, drawing international condemnation and the expulsion of Hamilton from the Jockey Club. But that's a horse, you say, not a human being, to which I reply Surely there must have been many master who thought more highly of a horse of exhausted lineage than of a Negro slave.

Laslo Spatula said...

A Letter from Miss Harriet Tubman, Kansas, 1954:

No, I am not THAT Harriet Tubman. Nor did my parents name me after that negro that helped other negroes escape from their owners.

My parents were poorly educated, and might have even been what we now call retards. Daddy had one dull eye. Still, they were upstanding folk, and I am proud of my name.

I am sorry about the sad state of white gentlemen today, however.

No, I don't want to help the slave escape from your trousers.

No, I do not know Aunt Jemima.

No, your train cannot ride my Underground Railroad.

No, my name will not make me have black babies.

No, I do not care if there is an 'Uprising' by your Ferry.

No, I never met a slave owner named Master Bayter.

I have no opinion on that other Harriet Tubman: I mean, slavery was probably bad and all, but then it couldn't have kept going with such honorable men leading it.

I am just a white woman in Kansas that doesn't personally know any negroes, and I am fine with keeping it this way, God Willing.

Sincerely.

Harriet.

I am Laslo.

Quaestor said...

"Surely there must have been many master who thought more highly of a horse of exhausted lineage than of a Negro slave."

Should read "Surely there must have been many master who thought more highly of a horse of exalted lineage than of a Negro slave."

The unsteady hand betrays.

David said...

"Are you aware of any references that suggest she did anything other than have the surgery performed sans anesthesia?"

The least credible aspect of the story is Tubman's own statement. She said that she refused anesthetic because she wanted to "bite the bullet" like the patients in the hospital she served at in the Civil War. Problem is, the notion that many Civil War surgeries were performed without anesthetic is a myth, as least as far as Union soldiers were concerned.

Anesthetic was widely available and used. It would have been even more likely to be available in the hospitals in Beaufort-Hilton Head, where Tubman was during the Civil War. This was unthreatened Yankee territory with regular shipping from New York and the rest of the east coast. It was a well supplied base famous for being soft duty. The senior officers had strong political ties in Washington. I've never seen anything to suggest that there were shortages of medical supplies in this area, and it would have been highly unusual to have a surgery without anesthetic.

It's not even clear that Tubman worked in the hospitals in the area. She might have, but there is little mention of her during her lengthly tenure in South Carolina, apart from the Combahee raid. There were thousands of black women working in agriculture, as cooks, nannies, maids, and some doing menial work in hospitals. But despite Tubman's celebrity, she's not mentioned as doing much of anything. This tends to suggest that she was treated pretty much like nearly all the other black women in the area, as a source of faceless labor for the Union military, the suttlers and the missionaries. The blacks were in the main treated quite badly by the Yankees. Their greatest heroism was that they endured until this too passed.

She may well have been burnishing her own legend by stating that she worked in the hospitals and if she did, she knew that biting bullets was not the usual response to surgical pain.

mikeyes said...

The surgery described in the article was not brain surgery, it was a long used method of relieving pressure from a depressed fracture of the skull - her brain remained intact and was not the cause of the suffering as the brain has no pain receptors. Apparently she suffered chronic and acute pain from the fracture which was improved by the procedure. Anesthesia had been available for 50 years and well known to surgeons at the time (there were over 80,000 documented uses of anesthesia in the Union army records during the Civil war) so her refusing anesthesia, if true, is an anomaly. More likely is that she had anesthesia but did not remember having it.
As for whitewashing Andrew Jackson and the trail of tears, he may have fought hostile Indians, but the Cherokee tribe members he moved were integrated into society in the East, many had the same Scots-Irish genes he had and a significant number owned valuable property that somehow managed to get into the hands of Jackson supporters after the move to the West. I doubt that the trail of tears was motivated by a subconscious desire to keep Indians from raiding his property in middle Tennessee, a property that was magnificent (and still is) in those days and reflected his status and wealth.

Gahrie said...

The surgery described in the article was not brain surgery, it was a long used method of relieving pressure from a depressed fracture of the skull

Trepanning goes back 10,000 years.

Sammy Finkelman said...

If you want to prevent brain damage, you really can't use anesthesia during brain surgery. Maybe they were already at the stage where they test out the effect by freezing. She went to the state of the art hospital.

Sammy Finkelman said...

"The Removal of Indian Warrior tribes by the Indian Fighter Jackson"

That was actually done by his sucessor, Martin Van Buren, or the worst part of it was. That's when tghe "Trail of Tears" finlally happened. Andrew Jacksaon signed a bill that made the whle thing possible back in 1829.

Also, although he created a great depression, he did that only at the end of his term.

Sammy Finkelman said...

If this surgery did not affect the brain at all, it could be that she just didn't want to be unconscious. She might have been offered this option because of her prominence in Massachusetts.