The field and limitation of the operative surgery of the human brain / by John B. Roberts.

  • Roberts, John B. (John Bingham), 1852-1924.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The field and limitation of the operative surgery of the human brain / by John B. Roberts. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    A good example of strictly cortical lesion, involving only gray mat- ter, and having only a very thin layer of softened tissue on its inner side. Microscopic examination of the optic nerves showed the ap- pearance of choked disk, with probable ascending neuritis. I have thus considered most of the topics which may be in- cluded under the head of cerebral surgery. In fractures, hem- orrhage, and abscess, perforation of the skull will soon become quite common. In epilepsy, insanity, and tumor the profession will be more tardy in opening the skull. While I am sure that these conditions, in certain instances, can only be treated suc- cessfully by operative procedures, I believe also that other cere- bral conditions, less well defined in pathology, such, for example, as incurable and intolerable headaches after injury, may in time be justifiably subjected to similar operations. For such operations upon the skull and brain proper instru- ments should be at hand. For uncovering the centres of motion in searching for suspected lesions localized by symptoms, a tre- phine removing a disk three centimetres in diameter is none too large, for then both ascending convolutions and the inter- vening fissure of Rolando can be inspected with ease. A tic- phine with a cutting edge along only a half or two-thirds of its circumference, would, I think, be convenient at times for deepening a groove on one side of the disk, when the remaining portion of the circular groove has already completely cut through the bone in a thinner spot; and also for enlarging a trephine hole previously made. Dr. W. R. Hopkins has suggested a modifi- cation of the trephine which may be of value in this connec- tion.1 A probe with a large olive-shaped head and a light aluminium shaft, as recommended by Fluhrer, is ceitainly the proper exploring instrument in gunshot wounds of the biain. The head should, as he suggests, be placed so that the probe will be vertical and drop into the wound by its own weight. Aspirating needles should probably be made with a round end and a lateral opening like a catheter. Annals of Surgery, July, 1SS5.