Abstracts

Rationale: The neurologist and neurosurgeon Tracy J. Putnam MD was a pivotal figure in epilepsy and neurosurgery. It is widely known that in 1937 he was co-developer, with H. Houston Merritt, of phenytoin, and director of the New York Neurological Institute, 1939-19471. He was also a technical advisor concerning the neurological and neurosurgical aspects of the 1950 film Crisis2 starring Jose Ferrer and Cary Grant. The neurological and neurosurgical aspects of this film have never been explored in medical or cinema literature. Methods: Successive versions of original scripts and other primary documents show Putnam's input to the script3. He and a surgical nurse from his neurosurgical team at Cedars of Lebanon Hospital in Los Angeles were on the set to coach Grant in surgical techniques and were present on the set during surgical scenes. Grant and Richard Brooks attended several surgeries performed by Putnam. Results: This film depicts the kidnapping of American neurosurgeon Eugene Norland(Grant) while on his honeymoon in South America. He is brought to the mansion of the dictator Raoul Ferrago ( Ferrer) who is shown having a complex partial seizure with secondary generalization. He has a visual aura ( a cheering throng) in his right visual field while having simultaneously a right hemianopsia. He has papilledema and right arm drift. He is diagnosed with a left temporal meningioma and surgery is performed in the mansion because the dictator has too many enemies to risk going to a hospital. The surgeon is caught between caring for a patient he does not respect while resisting the pleas of revolutionaries who would like the surgeon to let his patient die. The film depicts several contemporary surgical techniques including the use of drawings in which landmarks of the left temporal lobe and sylvian fissure is clearly visible. Conclusions: New developments in antibiotics, neurosurgical technique, anesthesia delivery, and antiepileptic medications in the previous 10 years made it possible to use seizures as a device to explore the dramatic situation of a neurosurgeon holding in his hands the possibility of letting his dictator patient die for the good of the country or to save the dictator in order to also save his wife's life. This mirrored situations during the regime of Joseph Stalin, who called several surgeons, including Herbert Olivecrona to care for him or a member of his political cabinet. Actually, in the original story for the film written by George Tabori3, Olivecrona is mentioned specifically several times as an example of a physician who did his best for every patient despite his life choices. Tracy Putnam s expert and unrecognized contribution of neurological accuracy contributes to the realism and intensity of the situation in the film and permits the dramatic irony of the story of a murder with no murderer. 1. Rowland, LP. The Legacy of Tracy J. Putnam and H. Houston Merritt. Oxford: Oxford University Press, 2009. 2. Crisis MGM 1950. Directed by Richard Brooks; from a story by George Tabori. 3. Original papers Crisis, Margaret Herrick Library, Academy of Motion Picture Arts and Sciences, Los Angeles.