Freezing for Parkinson's

The movies that Manhattan's Dr. Irving S. Cooper showed to the American Medical Association last week were heartrending even to medical men familiar with the ravages of disease. There were pictures of adult victims of Parkinson's disease, or "shaking palsy"--men who could not stay the agitated tremor of their rigid, half-clenched hands, or could not walk except in jerky petits pas. There were children suffering from nerve disorders similar to Parkinsonism. During an attack, a pretty girl of eleven was doubled up, her whole body distorted and shaking. A boy the same age was bent backwards; eventually, said Dr. Cooper, his back and legs might arch until his head touched his heels.

All those pictures were of people who had not yet been operated on by Dr. Cooper. Next, the inventive neurologist paraded the same grateful postoperative patients before the professional audience.

Ex-Coal Miner Arnold Smith, 46, has been so completely freed of the palsy that he has taken up a new career as a physiotherapy aide at the Whitesburg Memorial Hospital in Kentucky. Remarkably erect Joan Harris, now 15, of Larchmont, N.Y., is doing well in school. The boy, 13, is as straight as a spruce, and supple as a birch.

But there were still more surprises to come. These patients, like famed LIFE Photographer Margaret Bourke-White, were operated on by techniques that Dr. Cooper, 39, now considers outmoded. The patients he really wanted to show off were the next to be presented: a housewife and a schoolgirl on whom he operated by freezing a pea-sized portion of the brain.

Crossed Connections. Parkinsonism (the cause of which is unknown in most cases) is a disorder of nerve cells near the thalamus deep in the brain. The affected nerve cells keep on firing impulses for muscle contraction when the contractions are not necessary. Effective treatment consists of somehow interrupting these misfiring nerves.

Dr. Cooper's first approach, back in 1952, was to sever an artery supplying the nerve-cell complex. Though many patients got relief, several died, and an equal number were left worse off than before their operation. Next he tried injecting absolute alcohol into part of the brain near the thalamus. Then Dr. Cooper put the alcohol into the thalamus, as in Photographer Bourke-White's case.

Three in One. But the neatest, cleanest way to kill a specific segment of tissue in a living body is by rapid deep-freezing. Dr. Cooper's newest technique, used in almost 200 cases in the past year, is to put the patient on the operating table under a battery of X-ray machines. Using a local anesthetic, he saws out a dime-sized piece of the skull, then inserts a three-in-one tube, only 2 mm. (less than 1 1/2 in.) in diameter. The tube slips painlessly through the insensitive brain to the deep-lying thalamus. The tube's outer layer is a vacuum insulator; the innermost bore carries liquid nitrogen supplied at --196DEG C.; the middle layer is for warmed and gaseous nitrogen to escape.

When the X rays show that the tip of the tube is in the thalamus, Dr. Cooper lets in enough liquid nitrogen to drop the tip temperature to zero or --10DEG C. This knocks out the nerves, but does not destroy them. He asks the patient to raise an arm, or leg, or both: if the patient has full control of his limbs, with no tremor remaining, the tip is in the right place.

Then Dr. Cooper admits more liquid nitrogen, to drop the tip temperature to --40DEG or --50DEG. In less than five minutes, this rapid freezing kills the offending, misfiring nerve cells. If the freezing extends a bit too far and the patient becomes unable to move his arm satisfactorily, Dr. Cooper has 30 seconds in which to correct the error and rewarm the thalamus. Most patients can be out of bed the same day and out of the hospital within a week.

Now that nitrogen injection kits are being manufactured, other neurosurgeons, still skeptical, will try to duplicate Dr. Cooper's results. Awaiting the benefits of his bold pioneering are at least 300,000 U.S. victims of Parkinsonism, a lifelong affliction, of which doctors say: "Patients don't die of this disease--they die with it."

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