Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)
TANULMÁNYOK - Bakay, Louis: Félelem a koponya varratain át végzett trepanációtól (angol nyelven)
was arrested with a little dry lint" without much difficulty. 25 It is interesting that Cheselden, in his comments on Le Dran's English edition a few years later, takes a completely different view. The trephine should never be applied over the sagittal sinus ("except by ignorant surgeons")26 The English school of surgeons, flourishing in the second part of the 18th and early 19th centuries, showed controversial views of trephination. It was generally believed that blood accumulating under a fractured skull is likely to separate the dura from the internal table but interference with the sutures was still considered a possible danger. A few years later Sharp looked with less alarm at the chance of bleeding from the longitudinal sinus. The trepan "cannot be used with so much safety at some places as on others, one place being the whole length of the sagittal sinus". "The superior longitudinal sinus under this part, which is supposed would be necessarily wounded by the saw, and in consequence destroy the patient by the hemorrhage; but though a perforation may, contrary to the general opinion be made over the sinus without offending it, and even ifit was wounded, the effusion of blood would not in all probability be mortal." "Yet at best it would be very troublesome, and since we are not straitned in that part of the cranium for room, I think it is adviseable to forbear operating in that place." 21 Abernethy, a bold and innovative surgeon who advocated the removal of epidural and subdural hematomas aggressively and without delay "to preserve the life of the patient" does not even comment on the danger of trephining over the sutures in his book on head injuries written in 1811. 28 We must assume that a dashing surgeon who's exploration of the brain through frontal craniotomy carried him beyond the sphenoid ridge on more than one occasion could not be bothered with the sutures. It must be mentioned at this point that even those surgeons who did not refrain from trephining over the sutures, warned against the application of the trephine over the fontanelles of infants, "because the bone is there not sufficiently solid". As far as the English school of surgeons is concerned, the early eighteen hundreds were still quite controversial. Samuel Cooper in 1807 writes: "The moderns have discovered, however, that the mere presence of a suture ought not to deter the surgeon from making the perforation in any place which seems advantageous. I believe trephining may be performed in any practicable situation, without being deterred by the fear of wounding the longitudinal sinus. The longitudinal sinus has often been purposely punctured, and the bleeding never proved troublesome." 2 ® Two decades later Sir Astley Cooper warns against this view: "You should never trephine in the course of the longitudinal sinus" and warns particularly against opening the skull over the transverse sinus that, incidentally Samuel Cooper also declared out of bounds. 30 German surgery, emerging somewhat timidly at the beginning of the 19th century took a generally cautious view. Both Chelius 31 and Grossheim, 32 celebrated surgeons of the 25 Le Dran, H. F.: Traité des operations de chirurgie. Paris, C. Osmont 1741, p. 256. 26 Le Dran: The operations in surgery. Translated by T. Gattaker, with remarks by William Cheselden. London, C. Hitch & R. Dodsley 1749, pp. 445—446. 27 Sharp, S.: A treatise on the operations of surgery. London, F. Brotherton 1743, pp. 141—142. 28 Abernethy, J.: Surgical observations on injuries of the head. Philadelphia, T. Dobson 1811. 29 Cooper, Samuel: The first lines of the practice of surgery. Hanover, Justin Hinds_1815 (from the third London edition. The first edition was in 1807), pp. 187—188. 30 Cooper, Sir Astley: Manual of Surgery. London, E. Cox 1831, p. 76. 31 Chelius, M. J.: Handbuch der Chirurgie. Heidelberg, Karl Groos 1826, p. 248. 32 Grossheim, E. L. : Lehrbuch der operativen Chirurgie. Berlin, T. C. F. Enslin 1830, p. 272.
