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What Lies Beneath

What Lies Beneath

Humble Beginnings and the Magic of an Island

Johnston, Michelle MBBS

Emergency Medicine News: June 2019 - Volume 41 - Issue 6 - p 8
doi: 10.1097/01.EEM.0000559973.31910.c4
    experiments, innovation:
    experiments, innovation

    Part 1 of 2

    Palm tree-fringed islands have long been destinations for escapist travel. The hero of today's column was born on one such idyllic atoll, and he returned there several times during his capricious existence, usually when the challenges of life became too overwhelming.

    Charles Edouard Brown-Séquard was born in 1817 on Mauritius, an island secreted away in the Indian Ocean (photo), a place that attracts more than its fair share of desert islandy superlatives (sparkling sapphire waters, powdery sand, etc.). Even Mark Twain claimed that heaven had copied its decor.

    Brown-Séquard's beginnings, however, were rather more inauspicious. His father was a naval captain and his mother a landed slave owner. These titles are remnants of the niceties of yesteryear. Brown-Séquard's father drowned in a merchant boat before his son's birth, and his mother, who is often described as having a vivacious personality, was a penniless seamstress. Such is the retrospective housekeeping of history.

    That notwithstanding, Brown-Séquard was a unique breed of genius. Among his litany of discoveries (which has necessitated a column in two parts), he was the first to come to grips with the switch-tracks of the spinal cord. Like many people of genius, one of his most important attributes was attention. Precise, careful attention.

    It was watching sugar cane farmers slash recklessly into their own necks that he observed a peculiar constellation of peripheral neurology. He then went on to study medicine in France, and he dissected a menagerie of animals, many of which doubled as pets, after which he wrote the original dissertation on the sensory pathways up the cord, shining illumination on which fibers cross sides immediately and decussate in the brainstem. (Let us, for a moment, recap: Spinal cord hemisection, known as Brown-Séquard syndrome, results in ipsilateral motor paralysis and proprioception loss, with contralateral pain and temperature loss below the level of the lesion. Apart from hacking into one's own neck and other penetrating spinal catastrophes, one can hemisect one's spinal cord with bubbles [the bends] or with insidious inflammation, such as in tuberculosis or multiple sclerosis.)

    History is dotted with creative pursuits inspired on islands. Among the sweep:

    • The restless painter who swerved through artistic movements like a drunkard, Paul Gauguin grew unhappy with the misery of Paris and its salons and sailed for Tahiti. It was there that his most accomplished works were produced, while living in a bamboo hut by the sea. His personal life was volcanic, and he died destitute and angry, but it is undeniable that the influence of Polynesia produced some of the great artistic works of the late 19th century.
    • Anton Chekhov was one of our finest doctor-writers. His island escape was a little less salubrious. He lied and cajoled his way over to Sakhalin Island, the “gulag archipelago,” and out of this tortured journey he produced a most extraordinary work of attention and humanity: “It is remarkable that a man will write and carve various abominations on a bench while at the same time he is feeling lost, abandoned and profoundly unhappy.”
    • A swathe of other writers have gazed out at crimson sunsets in sea-wrapped solitude, sitting quietly in the silence of transformative geography: Colleen McCulloch (Norfolk Island, Australia), George Orwell (1984 was written on the Scottish island of Jura), Hannah Kent, and Ernest Hemingway.

    Each of these islands brings something unique to the creative table, and it is fair to say that the one thing in common they permit is the heightened gaze that enables one to summon forth new ideas. Quietude, time, new perspectives, unfamiliarity.

    Back to attention. If I had to come up with a singular essential tool for good writing, it would be attention. We are a world of tiny exquisite details, which, when amassed, forge our human magnificence. Sense everything anew, afresh, and you're ready to start. As Mary Oliver, the divine human's poet, said of writing: “Pay attention. Be astonished. Tell about it.”

    But we must return to Brown-Séquard before this column gives out. Not only did he pay elegant attention in the first place, he never stopped questioning his observations. His initial experiments, predominantly on frogs, then rabbits, then sheep, led him to believe that localized cord lesions resulted in distal hyperesthesia. In 1892, a young British neurologist, Frederick Mott, challenged some of Brown-Séquard's findings, and Brown-Séquard responded almost immediately with his ongoing findings of 15 years of additional work, a huge suite of understanding, including the effects of partial lesions and how sensory deficits produced by a cord injury could be altered, reversed, and modified by additional lesions.

    Charles Edouard Brown-Séquard, however, has given us more than just a finely crafted eponymous syndrome. In addition to the hope that even those of us with the most modest of heritage can produce great works and the idea that the seclusion of an island life can stimulate extraordinary acts of creativity, he was a poster boy for self-experimentation. But that, dear reader, will need to wait until the next column.

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    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, She also contributes regularly to the blog, Life in the Fast Lane, Follow her on Twitter@Eleytherius.

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