A Return From Oblivion: Portland's First Neurosurgeon, A.J. McLean

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Arthur John McLean a student of Harvey Cushing, the father of American neurosurgery and Otfried Foerster, the celebrated German neurosurgeon was Portland’s first trained neurosurgeon. His life was cut short by a tragic accident and so it is uncertain what his future might have held. What emerges from the record is his recognized brilliance contrasted against the intense drama of his life.

When Dr. McLean died on December 7, 1938, he was just 44 years old and had not yet reached the apex of his career. When his body was found, the wheels of his car hung over the edge of the canyon where it had crashed through a guardrail on N.W. Cornell Road. The car was still running; his body was some 10 feet from the car, a handkerchief tied around a deep wound on his head.

Some alleged that McLean had committed suicide while others asserted that McLean would not have taken his life. One Portland physician is quoted as saying, “McLean simply wasn’t the kind to kill himself. He was the sort who would want to stick around, just to prove that all he had said was right.” (Oregonian, 2/5/1939) McLean had made enemies and had denounced his opponents fervently. He demanded perfection of himself and of others. Another physician remembers, “…a charge of laxity was perhaps the bitterest accusation that he hurled at his fellow physicians” (Oregonian, 2/5/ 1939). Some say he had grown bitter and had developed deep prejudices.

McLean had been born in Seattle on October 29, 1894. A two-year stint in the military interrupted his education at Reed College, from which he graduated in 1921. The Griffin, Reed’s yearbook, described McLean as, “The busiest man on campus… carrying six subjects was his business…” He was ever the personification of that term “intellectual enthusiasm.” He went on to receive his M.D. from Johns Hopkins Medical School in 1925. He studied neurosurgery with Harvey Cushing, as a neurosurgical resident at Peter Bent Brigham Hospital (1925-1929). He was Surgical House Officer (1925-1926), the Arthur Tracy Cabot Fellow, in charge of laboratory research at Harvard Medical School (1926-1927), Associate in Surgery, Peter Bent Brigham Hospital (1928-1929), and Acting Resident in Surgery at Peter Bent Brigham Hospital (June –September 1929). He then moved to Breslau, Germany with his wife, Gladys Merle Bragg, where he studied from 1929-1930, as a George Gorham Peters Traveling Fellow, with Dr. Otfried Foerster. He returned once again to Boston in 1930-1931, to serve as a Resident in Surgery before moving to Portland.

In 1931, McLean entered private practice in Portland, opening an office in the Medical Arts Building. He was clinical instructor in Surgery and Neuropsychiatry (1931-1934), assistant professor of pathology (1936-1938) and clinical associate in Surgery and Neuropsychiatry (1934-1937). In 1937, he resigned his position. At the behest of his colleagues he returned, continuing as assistant professor of pathology until 1938, when he once again resigned. He went on to teach, independently, a course for clinicians in Neurological Diagnosis and Neurological Surgery at Good Samaritan Hospital.

From the collection, we know that he gave the impression of being brash, disrespectful and hot-headed. But the record also portrays a man of reason, who could not stand dishonesty and hated stupidity. His fellow faculty members pronounced him a “brilliant” physician, said that his teaching work was “beautifully” organized, and that he was a “magnetic” person in the eyes of the medical students.

Furthermore, McLean was invited to be one of the charter members of the Harvey Cushing Society. In the Founding book, there is a letter to McLean from William P. Van Wagenen, dated October 24, 1931, inviting McLean to join as a founder. McLean accepted and Van Wagenen acknowledges. However, there is no record to explain why he was never listed as a member. In addition, in the volume, A History of Neurosurgery, there is no reference to him. Further, it seems that he did not belong to the Society of Neurological Surgeons because he is not listed with their historical figures.

He was accused by some of his detractors of writing nothing new, yet others claimed that his findings were not mere mimicry but based on indisputable and dedicated research. Cushing appeared to be always supportive of his work: In 1936 Cushing writes to “Mac” and pronounces McLean’s paper on, cerebral neuroepithelioma “…a perfectly bang-up piece of work. we are delighted with it… it is certainly the best worked-up case in the literature. Cushing encouraged him not to apologize for his youth. Foerster was equally confident and affectionate. He invited him to contribute to his Handbuch der Neurologie in 1936. McLean authored a chapter titled “Intracranial Tumors.” The prevalence of requests for reprints of his papers came from around the world. McLean’s operative record speaks well of his competence as a neurosurgeon. His mortality rate in 55 operations over 6 years was 21.8% and compared well with other leaders in his field. Cushing’s mortality rate in 11 years was 30.9% though in the final years dropped to 8.7%.

Two anecdotes surface from the collection, which illustrate McLean’s qualities that raised the ire and respect of adversaries, associates and friends alike:

To commemorate Cushing’s 60th birthday in April 1928, a festschrift was to be published as a special volume of the Archives of Surgery. McLean was invited to contribute a paper. He submitted a manuscript titled, A New Type of Apparatus: Its Physics and Results, in which he gives a technical description of the Bovie Electro-surgical Unit (surgical current generator). In 1920 William T. Bovie had developed this innovative electrosurgical unit that Cushing had introduced to clinical practice.

McLean submitted his manuscript for editing to G. H. Liebel (of the Liebel-Flarsheim Company, manufacturers of the first Bovie), as well as to Cushing, Bovie, and others.

Liebel’s response to the paper was that it would be “way, way over the head of any physician or surgeon and would be way, way over the head of any engineers…” Further, Dr. Liebel informed McLean that Bovie was about to deliver an address describing the electro-surgical unit.

Bovie’s reaction to McLean’s article was scathing. Bovie wrote discrediting McLean’s attempt to write about the biophysical aspects of electro-surgery as “confusing froth… leading to no definite conclusion.” “…You are writing, Bovie charges, “in a field for which you have not been adequately trained. Many of [your] ideas are erroneous… and might give you a reputation of being superficial”. Bovie went on to say that, McLean’s description of their invention before they (Bovie and Liebel) published about their own work was equal to stealing. He also accused him of not giving credit to others involved in the research. He threatened that if McLean did not assure him that he and Liebel would have priority to publish, he would take it up with Cushing.

McLean’s rejoinder is equally acerbic: “Your extraordinarily harsh letter,” he begins, “…arrived this afternoon. I think my letter of yesterday morning is sufficient personal answer to your gratuitous slurs concerning publications in medical fields. The paper is recalled, and I shall take care that I publish nothing whatever concerning the machine or its use so long as you remain alive; I think that may be a reasonable guarantee against even the possibility of inadvertent trespass upon the field you have vigorously marked out.” Since he had been forewarned of Bovie’s upcoming presentation, McLean immediately withdrew the manuscript.

Cushing wanted something from McLean to appear in the literature, but the histological part of the paper hinged on the apparatus. So rather than have nothing appear from McLean, Cushing offered to furnish a general description of the machine for anonymous inclusion in the paper, but McLean declined saying it was overly general and vague therefore worthless. He returned it to Cushing to be used in the Scott lecture where Bovie was to give his address.

Liebel, in correspondence with McLean, writes, “I believe the one who is going to suffer most from this [falling out] is Dr. Cushing.” McLean offered the photographs that were to be included in his article to the Liebel Company but then adamantly refused to be acknowledged for them.

Cushing once again requested that McLean submit the paper for publishing and at this, McLean acquiesced. In spite of the dissention, the paper was published in the festschrift. In the end, McLean apologized profusely to Bovie and the two men eventually spent a great deal of time discussing the paper. Bovie simply did not feel that McLean should address the technical description of the machine in surgical literature. [1]

McLean was not easily discouraged. In 1929, while still at Peter Bent Brigham Hospital with Cushing, he had received a grant to research the electrosurgical operating unit and to investigate and perfect a simpler and more flexible unit. And even after the disagreement with Bovie, McLean continued to write about electricity and surgery. He published, “Characteristics of Adequate Electrosurgical Currents” in the American Journal of Surgery, December 1932. And physicians and scientists continued to request reprints of his articles in the field of electro-surgery and solicit his recommendations for electrosurgical apparatus for cutting and coagulation.

A second anecdote of great local interest concerns his relationship with his colleagues in Portland. As noted earlier, McLean repeatedly resigned from the faculty. All that can be discerned from our records is that they had intense disagreements over policies. However, the disagreements appear to have been extensive. McLean was never one to mince words.

In November 1937, he delivered an 80-minute report before the Multnomah County Medical Society in which he lashed out at certain members. He later had this address, titled Brain Tumors Always Die: A Satiric Parade, privately printed at his own expense. In this diatribe he denounced, first of all, those who still believed that brain tumors represented only a death sentence: “Among the enlightened places where one would expect not to find doddering adages still extant are hospitals. Yet the title of my paper, “Brain Tumors always die” is the factual recording of a remark made pre-operatively on three widely-separated occasions to different patients of mine by the sisters in a Portland hospital. The first time it occurred I believed it was but a repetition of the 1890 adage; the second time I wondered if that was the sole reason and after the third, I took my patients elsewhere, believing it useless to attempt cooperation for the patient’s benefit in such atmosphere…”

He did not stop with the hospitals. “Neurosurgical work requires some 3 ½ -5 hours of examination for preliminary diagnosis; neurosurgical operations demand for the patient’s safety a fastidiousness of technique often completely lacking at the hands of general abdominal surgeons not specially trained in neurosurgical methods…. As a member of the neurosurgical tribe, one has a right and a duty to demand of those who profess to be its practitioners, a modicum of knowledge, of technique, and of nicety which, by my observation of results, is quite absent in this surgical slattern of whom I speak…” “The long list of resignations from the surgical and clinical sides of the medical school since his headship[2] that constitutes a role of honor; most of the men who are acknowledged leaders in the specialties are locally found recently outside the medical school rather than in it transmitting their knowledge to the younger men, and as long as he remains in authority, with his tight ring of sycophants and his interknit downtown clinical organization, so long will the clinical teaching of surgery and surgical specialties at out local school remain the chagrinned and amusing laughing-stock that it at present is for students. As regards my own specialty, I have come to regard myself as derelict unless I speak out in condemnation of such results as representative of what modern neurosurgery can and does accomplish whatever may have been the extenuation of the last decades, a continuation in present circumstances has no warrant in fact or accomplishment….”

In an article in the Western Journal of Surgery, Obstetrics and Gynecology, after McLean’s death, Dr. Goodrich C. Schauffler paid tribute to McLean, saying that “No one, anywhere, ever exemplified a finer loyalty, a more loving nature, the kindliness of his contacts with his students and those who wanted to learn from him was at times emotional in its quality. No one will know, except those who were truly his apostles, how much of himself he gave to teaching. In it he was consumed not by an ideal of self-aggrandizement but by an unquenchable thirst for the truth behind all the didacticism… Could McLean have achieved a serenity of spirit to match the true greatness of so much of his character, his intellectual and spiritual stature might have been limitless. But he had very strong prejudices and feelings and had developed a deep prejudice… Dr. Arthur McLean leaves accomplishments which will dwarf the best of his detractors. In the proper setting, with more wisdom and understanding on the part of his associates, he could, had he conquered his small bitternesses, have become a world figure.”

According to his attorney, his affairs were in order down to the smallest detail. His undated will was given national publicity: “…To 95 percent of Portland’s medical practitioners and their ethics, and the whole local organized medical profession, a lusty, rousing belch. To Portland’s thieving patients, the haphazard care they will receive for their chiseling tawdriness.  I desire that there be no funeral service of any sort; that the eleventh stanza of Swinburn’s ‘Garden of Proserpine’and the entire ‘Thanatopsis’ of Bryant be read aloud over my body by a lay person; that my cremated body’s ashes be strewn by a paid employee on the waters of the straits of San Juan de Fuca”.

 And “To my name, oblivion” McLean declared in his last will and testament. The unexamined records of A. J. McLean have lain silent for nearly 70 years. There is little evidence to warrant censure or to condemn his name to oblivion, yet up until this point in time it appears to have been accomplished.

[1] McLean’s comments from the text appearing in the Archives of Surgery, April 1929, vol. 18 no. 4: “The original manuscript was submitted for criticism to a number of persons; among these was Dr. Bovie, who took exception to the interpretation of some of the physical principles involved. He had taken the trouble to write a description of the mode of action of the currents employed, and, with his permission, his text, which designedly avoids leaning on either resonance or quantum theories of matter, is here substituted for the original.”

[2] Referring only to our records, it is unclear to whom “his headship” or “this surgical slattern” refers. McLean notes in the address that another neurosurgeon had joined the surgical staff: (It can be assumed that he was referring to John Raaf.) “I have previously referred to the fact that, with the entry of a second trained neurosurgeon into the local field, I no longer feel that I can ethically be accused of thumping my own tub when I speak of the state of neurosurgery as it actually exists in Portland, and this is the sole purpose of my talk this evening.”