Eye Signs, Syndromes, and Reviews and Opinions

This chapter discusses Fisher’s contributions in regard to abnormalities of visual perception, eye appearance, and eye movements (“eye signs”) and also new syndromes, especially the Miller Fisher variant of Guillain–Barré syndrome. Much of human brain activity relates to visual perception and exploration of the visual environment—looking and seeing. Many of Fisher’s observations during his lifetime were related to the appearance of eye structures, loss of vision, abnormal visual phenomena, and movements of the eyes, qualifying him as one of the first neuro-ophthalmologists. Fisher also described a number of new syndromes and condition. In addition, he urged neurologists to engage in self-observation.

Carotid Artery and Cerebral Atherosclerosis, Transient Ischemic Attacks, Symptoms and Signs Correlated with Lesions at Various Brain Locations, Cervical and Cranial Arterial Dissections, and Hydrocephalus and Gait Abnormalities

This chapter describes Fisher’s contributions in regard to the presence, nature, and severity of carotid artery and cerebral atherosclerosis and the symptoms and signs in patients with brain ischemia and infarction; transient ischemic attacks; the nature and symptoms related to dissection of brain-supplying arteries; and hydrocephalus and gait abnormalities in older adults. Fisher made many contributions to medicine. Arguably his major contribution to the care of patients with cerebrovascular disease and brain ischemia and strokes was his lengthy descriptions and diagrams of the symptoms and signs in patients with occlusive cerebrovascular disease that appeared in textbooks of internal medicine and neurology.

Toronto University and Medical School and Internship in Detroit

Fisher’s medical school experience and training are described in this chapter. Medical education and medicine in general at the time of Fisher’s matriculation seem quite primitive and undisciplined by today’s standards. A very brief review of the history of medicine and medical education up to that time places the situation during the 1930s when Fisher matriculated into perspective. William Osler’s career, which predated but influenced Fisher, is described. Fisher’s medical internship at Henry Ford Hospital in Detroit, Michigan, is also briefly discussed. During his entire medical career, Fisher maintained a strong commitment to accurate measurement and quantification of physical signs and observations, a discipline he first learned in Toronto as a student.

Retirement and Beyond

Fisher’s retirement and his life, activities, and accomplishments during retirement are discussed in this chapter. He received many awards, including entrance into the Canadian Medical Hall of Fame. During his last years, his wife developed a dementing illness and died, and he had a myocardial infarction and became nearly blind due to glaucoma. His 90s were spent in assisted living and nursing home facilities in Albany, New York, near his youngest son. He died at age 98 years. He witnessed remarkable changes during his near century of life. Much of the change in the care of patients with stroke and cerebrovascular disease could be directly attributable to his research, writings, and teachings and to the physicians he had mentored lovingly during his long and fruitful career.

Prisoner of War, 1941–1944

This chapter deals entirely with Fisher’s experience as a medical officer in a prisoner-of-war camp during World War II. Medical facilities and care, recreation, learning experiences, and German behavior in the prisoner-of-war camp are discussed, as is his liberation. Undoubtedly, Fisher’s wartime experiences had a profound effect on his later life and career. He did not pay much attention to material goods, money, or finances. He believed so much time in his life had been wasted as a prisoner that he was determined to make each subsequent day meaningful. With regard to his career, he was determined to contribute to knowledge and to dedicate himself to the optimum care of patients. He also developed a wide interest in people and human nature, probably at least kindled by the variety of individuals he came in contact with during the war years.

Fisher’s Early Years

This chapter describes Fisher’s early life; his family; his upbringing in a rural town in Ontario, Canada; and his characteristics as a child and young boy. Fisher was born on December 5, 1913, in Waterloo, Ontario, Canada. He was one of nine siblings. He attended the public school system in Waterloo through high school. Although he spent little serious time as a student and did little homework until age 15 or 16 years, he was awarded a scholarship to the University of Toronto in recognition of his academic performance during high school. Only a small minority of students from his high school went on to college.

Atrial Fibrillation, Memory, Timing and Quantity of Behavior, Randomized Therapeutic Trials and Anticoagulation of Brain Ischemia Patients, and Headache and Migraine

This chapter describes Fisher’s contributions in regard to atrial fibrillation as a common cause of brain embolism; the brain anatomy of memory and persistent and temporary amnesia; the brain anatomy related to the timing and quantity of behavior; randomized therapeutic trials and anticoagulation treatment of patients with brain ischemia; and headache and migraine. Fisher and colleagues made important contributions to knowledge concerning the acquisition and retention of memories. Fisher recognized that strokes offered an opportunity to learn how various areas in the brain functioned. He became avidly interested in all aspects of cognition and behavior. In addition, Fisher had a career-long interest in headache, and he cared for many patients in whom headache was the predominant symptom and health problem.

Neurological Examination of the Stuporous Patient, Lacunar Infarction, Intracerebral Hemorrhage, and Aneurysmal Subarachnoid Hemorrhage

This chapter describes some of Fisher’s major contributions in neurology, stroke, and cerebrovascular disease. The main areas are the neurological examination, especially in patients with decreased consciousness; the pathology of penetrating artery disease and lacunar infarction and the associated clinical findings; the pathology and clinical features of intracerebral hemorrhage and description of the findings in cerebellar hemorrhage; and the presence and clinical features of delayed cerebral infarction and arterial vasoconstriction in patients with aneurysmal subarachnoid hemorrhage. His contributions were often made over time. He often worked on different areas of interest concurrently. When he prepared a list in 1998 of his own contributions for a Canadian Medical Hall of Fame biographer, he listed 101 separate contributions.

Montreal, 1950–1954

This chapter describes Fisher’s career in Montreal (1950–1954) and his ultimate transfer to Boston. His family life, studies, accomplishments, and writings during this period are also described. Highlighted are his discoveries about carotid artery disease, transient loss of vision, transient episodes of brain ischemia, lacunar brain infarction and its mechanisms, brain embolism, and the distribution of atherosclerosis within the arteries that supply the brain. While in Montreal, Fisher became a productive researcher. His work on carotid artery disease and temporary episodes of eye and brain ischemia gained him widespread recognition. However, he eventually decided that the future of his stroke work was far brighter in Boston than if he stayed in Montreal, and so he eventually decided to return to Boston.

Fisher’s Collegiality, Personality Traits and Idiosyncrasies, and “Rules”

The main attributes of Fisher—being a learner and teacher, his Socratic teaching method, his mentoring, his role as a physician, and his role as a colleague—are analyzed in this chapter. In addition, the “rules” that guided his behavior are enumerated. Fisher was unconcerned about time. He spent as much time as he needed to thoroughly analyze neuropathology specimens, to review literature in the library, and at the bedside until he satisfied himself that he had obtained all the salient details of a case. Fisher was clearly focused entirely on medical activities. His disregard and unconcern about practical and financial matters were legendary. He was a very compulsive note taker and collector. In addition, he was forward looking and flexible. He also enjoyed acting and was very patriotic.