EXPLORERS OF THE BRAIN

Star (Christchurch), Issue 8832, 19 January 1907, Page 1

EXPLORERS OF THE BRAIN

Rcj_ar_a-1© Progress madefy Key Sra&oh of Surgery. It has been somewhat aptly rem ark-' ed that the present time is, in the do-' main of the healing art j the reign ; of the knife. Surgery has made - far ' greater actual progress and still mora apparent progress than has ite sister . branch. . -While general surgery has made yery rapid advance, especially in regard to. .abdominal operations, tfie strides, made in brain surgery have been phenomenal. . The forward movement has been by leaps and bounds. Brain surgery may be termed * THE YOTOGEST BEANCH OV BCBOSRT, for, although operations on the skull . were practised by .the ancients, as ha, i been shown by the evidenc.es of tn*-., phining. exhibited by the skulls of mun_. mies who lived thousands of years ago, 'it became a lost art. It is only withia that time that enough has been known of the' anatomy of tie skull an-d brain and the localisation of brain functions to warnant interference with the knife. Up to twenty years ago the brain Was regarded by surgeons as more or. less a . terra incognita " and looked upon with some awe as the seat of the men-. • tai and nerve functions, and crude • ideas prevailed as to the result of disturbing by force any interior part '«#,. '■ the brain. The consequence was that. '-. if a person suffered from a tumor or. • abscess of the brain it was left to tako its course and no surgical < attempts, were made to relieve the patient. -- t However, some bold spirits; among ' the surgeons in the early part of tbo . -sighties determined to diwjard tradi-. tion and to try to save life by ppeUat- ■ ing foi* certain brain affections, and at. 1 the same time to learn as accurately aa 1 possible the exact position of brain functions. | . - ;■" ' 'In Great Britain, MacEwan, ; ofGlas- , gow, and Victor Horsley, of London, were the pioneers in this line of opera--tive research. In America, Weir, -of New York; Keen, of Philadelphia, andRoswell Park, of Buffalo, were almost at the same time doing- sinHlar work, ■ while, later, Yon' Bergman, of Berlin ; »' ChampoahieTe, of. Paris ; M'Burney , and Starr, of New York, and other* have taken up the subjeot with great 1 success; . . . Undoubtedly, the first brain affection ■ for which an. operation was attempted -" was epilepsy. It fe believed that the ; i ancient Egyptians occasionally opened . ' the skulls of individuals suffering "from this disease. The. form of epilepsy' known as- Jacksoniaft, which -takes its name from ■ that great British nerve specialist Jackson, who .-was the firet to point out its distinctive, features, is the . form of the disease .or which operations' are employed, and/ it may be said, in numerous instances, with excellent re» v 6ults. - '■'* sin -victor hobskby's work. Sir Victor Horsley, -surgeon to th«T National Hospital for the Paralysed, and Epileptic, Queen's Square, liondon, chose as the subject' for the- address .in. -. surgery, read at the meeting- of " the 7 British MedjLc-ai Association recently held in Toronto "The Technique of Operations on the Central Nervous System." _ The. address was a resume of. Horsley's. experience of . brain' '^jwira-*"' 'tions which have •takeav.place.' at the Queen's Square Hospital during the last twenty years, and as he was tie first to make incursions. T^ith the knife into regions of the, braf_ : hitherto severely left alone by the -surgeon, and. as "he has developed his methods of operation and kept abreast with the times, his remarks practically cover. tie. entire subject. - It is interesting to know that Horn-: ley gained the knowledge of the brain, which enabled him first to attempt successfully operations on that part of the body by experiments on animals, chief- ' ly on monkeys. ' , Since then the operating theatre it-' ; self has taught surgeons, a great deal of the true nature' of brain' disease and of the! probable situation of the affeo- . tion, so that now brain tumours and - abscesses of a size and position which' would • have daunted the most dating operators of but a few years ago, can be and have been operated upon with success. BRAIN NOT SENSITIVE TO BAIN. Points of much interest referred to in the address were those concerning tlie grades of pain, during an operation on the brain and the amount of, shock caused thereby. The general pubhb still believes, as surgeons believed up to twenty years ago, that meddling with the brain itself must inevitably have grave consequences and caiiSe great shock. This is another illusion to be dispelled, as the chief shock' in a brain operation is brought about by opening ; the skull. The interference' with the brain itself oauses.no great amount of shock, and injury, to the brain during an operation would seem "to leave no permanent bad after effects. Indeed, a well-known -American surgeon, Pro- ' feasor Frazier, has proposed to cut out entirely one of the lobes, an important portion of the brain known as the cerebellum, or little brain, in preference to pushing it aside for the purpose of reaching deep seated tumours. This, radical procedure has been successful. The most frequent brain operation . is for the removal of tumours'. Tumours are common in children, especially those of tubercular origin. The methods of opening the skull are various. The German surgeons still use the hammer and chisel. In America, the electric saw is used by many operators on the brain, and some use the so-called dental engine, armed with r a trephina -and a drill. Horsley, after . a long experience with saws and trephines driven by electro-motors, now cuts away the bone with large bone forceps, believing that such, is the best mode of dividing the bone with as little force as possible and with the least . possible pressure on the brain. However much surgeons may differ as to the best method of making an opening through the skull, all . agree that whatever opening is made should be at least one and a-half inch in diameter, and many prefer the opening to be at least two inches in diameter. One of the greatest dangers attending a brain operation is that of infection. Blood poisoning will result with / the most careful operators and for the most simple operations affecting the brain and opine. Thus the precautions taken to prevent blood poisoning during and after an operation on the brain -j-aust be of a most thorough and search- ' ing character. In many brain operations it is necessary to displace parts of the brain in order, to reach tumours at the base. This can be.done by compressing the cerebral hemisphere upward by inserting a flat spatula cau- '■; tiouely beneath it and the veins by which it *i_ affixed to the membrane underneath the skull. When this has been properly performed much of the interior of the brain can be seen and correctly examined. Operating on the brain to remove malignant tumours or TI7MOTJHS OP A OANCEROXTS NATCBE is attended, as in operating for such in. many other parts of the body, with unsatisfactory results. Simple tumours

of large ed_e, which penetrate the brain," oan au be excised with good, permanent results. . U*_fortun_tely, a large proportion of cases of brain tumour are cancerous and cannot be dealt with so as to clear away their roots*, entirely. Out of a series of twenty-three cases of malignant tumour operated on at Queen's Square Hospital twenty-two recurred. Perhaps, however, the most remarkable feature connected with certain malignant tumours of the brain is the fact that frequently the mere opening of the skull over the seat of the disease .-will cause recovery. Many such instances are' upon record. In 1890 Hors•ley attempted to operate for the removal of a brain tumour known as •pjlioma, but after it had been exposed it waa found to be so large that it was deoided not to attempt . to remove it, the wound was closed and the patient made a good recovery. Two and a half years later he died suddenly from some other disease, and at the necroscopy it was found that the tumour had wholly disappeared. With the improved methods now in •vogue a skilful brain surgeon can expose the* brain .within ten minutes of the time of the beginning of the operatic-, whereas using other methods from fifteen to twenty-five minutes were often expended in this part of the operation . So great' is the reputation of Sir Victor Horsley as a brain surgeon, tha* a few years ago a Chicago- journal contained a startling r acoount of an operation performed by him on a sister of Mrs John Mackay. She suffered ftom «ome very painful nervous affection of the head. Horsley, according to the Chicago journal, operated upon •her, took out the entire brain, and with great difficulty disentangled the offend,;S_ nerve, replaced the brain, closed the wound and * . THB PATEEHT MADE A SATISFACTORY RE- I '. .. . COVERT. It has been suggested recently that | --for certain forms of insanity it would j Ye advisable to perform a brain opera- i 'tion. Dr Qaye-Shaw, a well-known | London brain specialist, wrote to the j "Lancet" on September 15 that he is ] of opinion that operative cranial surgery is" not only justifiable but in well obosen oases of dementia is the only means of scientific treatment, and there ' is every reason to believe that the early adoption of it would have cured many, persons who for- the want of it proceeded to incurable insanity. Enough, has been said to prove the wonderful progress made within twenty years by. brain surgery, and to show that a brain operation undertaken, by skilful hands is not much more d&iir gerous and no more painful than an operation on any other part of the body. The unfortunate thing is that there are . so few really skilful brain tHirgeo-ns.