Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)
TANULMÁNYOK - Bakay, Louis: Félelem a koponya varratain át végzett trepanációtól (angol nyelven)
confusion can easily be explained. The first edition of Berengario's book in 1518 was quickly followed by a second in 1522 and a third (1535, Venice). All these publications occured in the author's lifetime; they contain slight variations in words and sentences. Later versions added to or deleted from the text at random. Authors of modern medical textbooks with a useful "lifetime" of only a few years should remember the good old days when the same books on sugery were used for centuries. No mention was made on the danger of trephination over the sutures by the celebrated barber surgeons of the 15th and 16th centuries with the notable exception of Ambroise Paré. This is understandeable in the case of Hieronymus Brunschwig 15 who published his book in 1497. His text closely follows the tenets of earlier Arabic surgeons down to the highly schematic drawings of instruments. It seems that he performed only occasional burr holes for the elevation of depressed skull fractures or removal of bone chips. Hans von Gerssdorff, a much bolder surgeon, included in his book a picture on the elevation of an extensive depressed fracture of the midline over the midportion of the superior longitudinal sinus without mentioning anything about the possible danger involved in such procedure. 16 However, this otherwise dramatic illustration only served to illustrate the application of his instrument, the "torcular"; it might have not been a faithful rendition of an actual case. Ambroise Paré, on the other hand, was much more explicit in 1562. "If the fracture happens upon the suture, set two trepans upon the sides, on each side one" because of the danger of injuring "sinewy membranes, veins and arteries by which the meninx is tyed up to the skull." 17 He did not hesitate to trephine to evacuate the "blood and ichorous matter which upon breaking of a vessel floweth upon the meninx" . Fabricius Hildanus (Fabry von Hilden), in his Observations, mentions a patient of his, a blacksmith, who received a blow which caused a considerable fracture at the junction of the coronal and sagittal sutures in 1593. He removed the bone fragments without much difficulty but warned against the application of the trephine in this area and over the sutures in general for various reasons, one being the laceration of arteries and veins which traverse the sutures: "When a considerable contusion of the sutures obliges us to trepan, it is better to apply the instrument on each side than to cut the bone over the suture itself". 18 Surgeons of academic erudition were of the same opinion. One of the great teachers of surgery, Fabricius ab Aquapendente warns against trephination over the sutures in his monumental "Opera Chirurgica", first published in 1617. He mentions the danger of hemorrhage, "quae est periculosissima". He also points out that some blood vessels run close to the internal table, some even within the bone ("in ossa canaliculus"); these can be easily injured leading to fierce bleeding "cum periculo mortis". 19 Clearly he refers to the observation that not only injury to the venous sinuses can put the patient in mortal peril but also bleeding from other blood vessels between bone and dura, including those that run in bony canals. Aquapendente was fully aware of injuries to the dura during drilling or trephining 15 Hieronymus Brunschwig: Buch der Cirurgia. Strasbourg, Grüninger 1497. 10 Hans von Gersstorff: Das Feldibuch der Wundartzney. Strasbourg, J. Scott 1517, p. 23. 17 Ambroise Paré: Three and fifty instruments of chirurgey. London, M. Sparke 1631, pp. 23—26. 18 Fabricius G. Hildanus : Observationum et curationum chirurgicum centuria. Frankfurt 1610, p. 85. 19 Hieronymi Fabriciiab Aquapendente Opera chirurgica. Leyden, Boutestian 1723, pp. 390—391.
