Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)

TANULMÁNYOK - Bakay, Louis: Félelem a koponya varratain át végzett trepanációtól (angol nyelven)

TANULMÁNYOK THE ANCIENT FEAR OF TREPHINING THROUGH THE CRANIAL SUTURES LOUIS BAKAY The fear of opening the skull over the cran ial sutures is steeped in antiquity. Hippocrates was the first to warn of the danger of this procedure: "you must not apply the trepan to the sutures themselves, but on the adjoining bone".

1 He as well as Galen

2 were fascinated by the anatomy and possible function of the cranial sutures, although Hippocrates believed that not every person has sutures. He also freely admitted that on one occasion he mistook a suture for a fracture. Early authors were not very articulate in describing the danger, their warnings were hardly more than vague fears that something dire could happen and the patient might die. To the sutures they attributed great physiological, almost mythical, properties. Galen thought that the sutures permitted transpiration from the brain; the escape of the pneuma or vital spirit, from the cerebral ventricles.

3 The early Arabs believed that the cranial sutures represented man's destiny as written by the hand of Allah, surely not to be tampered with! The eminently practical Roman surgeons did not dwell much on the problem. Celsus

4 devotes a long chapter to the treatment of skull fractures and the instruments used for their correction in his De Medicina written around 40 AD. He, incidentally, used the crowned trephine of the same design used in our time, including the serrated edge and centerpin, but did not warn against its use over the sutures although he mentions that the dura should not be injured. He considered it deadly. A hundred years later, Galen does not mention the subject either. The great Arabic physicians of the early middle ages paid close attention to the clinical symptoms caused by head injuries. They performed burr holes to evacuate blood or elevate depressed bone fragments but did not seem to use the trepan. This may explain the absence in their literature of any mention of the danger of opening the skull through the sutures. They were otherwise very careful not to injure the dura. Albucasis, in 1000 AD, stated this very clearly: "you will have to observe the utmost caution that neither drill nor chisel touch any part of the membrane'' (dura).

5 He used drills of various lengths to conform with the thickness of the skull in different locations. He removed bone very 1 The genuine works of Hippocrates. Translated from the Greek by Francis Adams. London, Sydenham Society 1849, p. 456. 2 C. L. Galeni pergameni sept ima classis. Basel, Froben 1561. 3 Siegel, R. E. : Galen's system of physiology and medicine. Basel, S. Karger 1968, p. 125. 4 Aulus Cornelius Celsus: Über die Arzneiwissenschaft. Translated by Eduard Scheller.

' Braun schweig, F. Vieweg 1906. 5 Albucasis: On surgery and instruments. Translated by M. S. Spink and G. L. Lewis. Berkeley and Los Angeles, University of California Press, 1973, pp. 704—708.