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

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

the skull and for that reason invented the first self-arresting drill to prevent it from plunging into the brain once the skull was perforated.

20 Scultetus, a contemporary of Hildanus, does not mention the relationship between the sutures and trephination in his Armamentarium Chirurgicum (1653)

21 that saw many subsequent editions. This is somewhat surprising because he was an educated surgeon, a mile apart from the ignorant "barbitonsores", as he called barber surgeons derisively, who quoted various authorities extensively in his book. He was a disciple of Aquapendente in Padua; he admired his teacher. In his case histories Scultetus mentions several patients in whom he elevated depressed fractures involving the sutures, one of them at the junction of the coronal and sagittal sutures, without making much of it. Although he was far from hesitant to apply the trephine for the evacuation of blood or pus, he refrained from applying the instrument directly over the fracture. He considered that a foolhardy venture resulting in "damnation to the patient and a shipwreck to the reputation of the doctor" ("cum summo aegrotantis damno & famae Medici naufragio"). In 1739, the celebrated surgeon Lorenz Heister still forbids the application of the trepan on the sutures, especially the sagittal suture, because of the danger that this might injure the sagittal sinus, "quern perrumpere pestiferum est"?

2 However, toward the middle of the 18th century some doubts were expressed about the dogma of non-violation of the sutures, timidly enough at first. Garengeot in his book of 1738 describes in details his technique "pour bien faire Toperation du trepan", "avec prudence & circonspection"

. He states that "in general we do not trepan over the sutures, because in so doing we may destroy the attachments of the dura mater, which generally adhers strongly at those parts; we are also liable to tear the vessels which pass from that membrane to the pericranium." The middle of the coronal suture should be avoided on account of the superior longitudinal sinus, which lies in a channel hollowed in the internal surface of the frontal bone; the crown of the trepan should not be applied there. It may lead to hemorrhage, "qui serait très difficile à réprimer".

23 One must remember that in operations of yore sinus bleeding, even from the anterior portion of the longitudinal sinus, was much more formidable than in present operations where the patient is under general anesthesia, his head placed in an adjustable headrest where elevation of the head can reduce venous pressure to zero. In the hands of early surgeons the patient struggled, he was forcibly restrained and often struggled against the hands which were keeping him as immobile as possible. All this resulted in markedly increased venous pressure and ferocious bleeding. A. Louis, the doyen of Fench surgeons in the mideightecnth century mentioned that "contrary to the general opinion, we may trepan over the sinus without wounding it, and even should we wound it, the hemorrhage would not be mortal." Still he found the bleeding "very troublesome".

24 Le Dran mentioned as early as 1741, that when the longitudinal sinus was sounded by the trephine in course of an operation in the center of the frontal bone, "this hemorrhage 20 Bakay, L. : The treatment of head injuries in the Thirty Year's War (1618—1648). Joannis Scultetus and his age. Springfield, Charles C. Thomas 1971, pp. 49—51. 21 Joannis Scultetus: Armamentarium chirurgicum. Ulm, B. Kühnen 1653, p. 47. 22 Lorenz Heister: Institutiones chirurgicae. Amsterdam, J. Waesberg 1739, p. 526. 23 S. no. 13 24 S. no. 14 •