Operations on Human Brain mark a big advance in Modern Surgery (May, 1933)
Operations on Human Brain mark a big advance in Modern Surgery
By Frederic Damrau,M.D.
IF YOU were in an operating room watching surgeons working on the brain, you would see things that would make you gasp. For example, at the Cleveland, O., Clinic, August 31, 1931, Dr. W. James Gardner removed the entire right half of the brain. And the patient recovered!
A woman, thirty-one, mother of two small children, had suffered from epileptic fits for ten years. She was becoming blind and had terrific headaches. The pressure of a growing tumor inside her skull was killing her.
From the right side of her shaved head, Dr. Gardner removed a section of skull four and a half inches in diameter. Then he cut through the dura, the tough protecting membrane covering the gray matter. Under it, he saw a cauliflower-like growth covering the surface of the brain. It had eaten its way like a cancer throughout the entire right hemisphere. The left half of the brain, far more important than the right because it contains the centers for speech and writing and governs the right side of the body, was perfectly healthy. Four times before, Dr. Gardner knew, distinguished surgeons had removed the right hemisphere of a patient’s brain and every time the results had been fatal. Yet, it was the woman’s only chance. With deft hands, he slipped loops of catgut around the arteries and veins and pulled them taut. This stopped hemorrhage. Then he scooped the entire right half of the brain, containing the huge tumor, out of the skull!
The cavity was filled with warm salt solution, the plate of bone replaced and anchored with silk, the flap of scalp sewed back in place, and the operation was over.
A few hours later, the woman recognized and talked with her friends. She improved rapidly, reading and writing during her convalescence. Her headaches and epileptic fits were gone. Although her left arm and leg were stiff, due to the loss of the right hemisphere of the brain, she was able to walk and three and a half months after the operation, she was helping care for her children.
One of the most amazing things about the human brain is its ability to recover from seemingly-fatal injuries.
I recall one case during the World War. A soldier was brought back from the lines, the front part of his brain riddled with shrapnel. We removed one piece, lodged deep between the two frontal lobes, which was two inches in diameter. The rest we did not dare touch because the fragments were too widely scattered. Nevertheless, the patient made an excellent recovery. He was not paralyzed in the least and his senses were unimpaired. The only troubles that remained with him were slowness of speech and a tendency to forget appointments.
On the Fourth of July, three years ago, an eighteen year old boy in Fargo, N. D., placed two lighted firecrackers in the barrel of a tire pump. They exploded with such force that they blew the handle off the pump and drove the piston shaft, a steel rod five-sixteenths of an inch in diameter and eighteen inches long, through the boy’s skull and brain. It entered near the right eye and projected from the back of the skull.
Dr. Joel C. Swanson treated the boy for shock, gave him antitoxin against lockjaw and sterilized the protruding ends of the shaft with iodine. Then he pulled the shaft out. The boy recovered and successfully completed another year of high school. Apparently, his mind did not suffer from the accident.
On record in one European hospital is the astonishing case of a shoemaker who, during a temporary fit of insanity, tried to commit suicide by driving nails into his head. When he was brought to the hospital, five two-inch nails penetrated through the bone of the skull into the brain. Yet, after a surgeon removed the nails, the man recovered and he was later discharged completely cured.
Most incredible of all, is the story of the New England laborer who lived for twenty years after an iron bar, an inch thick, had been driven by an explosion through his skull and brain. The bar entered just below the left cheekbone, destroying the left eye, and a large part of the brain, and coming out at the top of the skull. Not only did the victim of this accident make a miraculous recovery, but he continued to perform his duties as a farm-hand and coachman to the entire satisfaction of his employers. Such accidents to the brain have played a part in enlarging the surgeon’s knowledge of this vital organ. Step by step, medical men have built up a mass of information about it by observation of the sick, study of the brain after death in hopeless cases, and by stimulating the brains of dogs and monkeys with an electric current.
During the Franco-Prussian War, two German physicians, Gustav Fritsch and Eduard Hitzig, stimulated the brains of wounded soldiers and for the first time produced definite movements in unconscious humans by means of an electric current. Applying the electrodes to one spot, they made the legs move; to an-
other, the face; and to another, the fingers. Thanks to experiments on dogs and chimpanzees, the surgeon now knows exactly which part of the brain controls each function of the body. According to the symptoms, he knows just what part of the brain is diseased and where to operate. In the field of brain surgery, there can be no guessing.
There is a simple rule by which you can map out, on the outside of your skull, the location of the motor area that controls all the movements on the opposite side of your body. Draw an imaginary line from the root of your nose over the top of your skull to the bump on the back of your head. From a point half an inch behind the middle of this line, draw another line, three and three-quarters inches long, extending downward and forward at an angle of seventy degrees. In front of this line is the control-room governing bodily movements, the motor area of the brain in control of all your movements.
BEHIND the line is the portion of the brain that governs all the sensations to which the body is exposed. The only nerves connected directly with the hemispheres of the human brain are those controlling the sense of smell. Originally, our brains were smelling organs.
Just behind your forehead, are the frontal lobes with which you do your thinking. Savages and idiots have low, receding foreheads because this part of their brains has not developed. Strange to say, when one of these frontal lobes is destroyed by an abscess or a tumor, some other part of the brain tries to take over its functions and do the thinking.
Many geniuses have willed their brains to medical science for careful study under the microscope. Examination of the brain of Anatole France, the famous French writer, revealed that the convolutions and gray matter cells were both of exceptional development. When Nikolai Lenin, founder of the Russian Soviet Republic, died, his brain was sliced into 31,000 specimens and studied carefully by many scientists. Turgueneff, the Russian novelist, had one of the largest brains on record. It weighed more than four pounds. However, the size of the head is not an accurate measure of intelligence, for one of the two brains that exceeded his in weight was that of an imbecile. Large brains have no more units than small ones but the units are larger.
In the back part of the brain is located the center of sight. A tumor or injury here causes blindness. The lobe of the brain near the ear governs hearing. Just in front of the lower part of the motor area is the voice center. On the flat surfaces where the two hemispheres almost come together are the centers of smell and taste. We hear words with one part of the brain; see words with another part, and speak words with a third.
STRANGE things occur when any of these centers are disturbed. In one instance, a professor who used Latin and Greek fluently was struck on the head in an accident. When he recovered, he had forgotten every word of these languages. The cells of the brain in which they were stored had been permanently injured by the blow while the rest of the gray matter remained normal.
In another case, a little artery that supplies blood to a small area in the visual region of a patient’s brain became plugged. Overnight she became as illiterate as an Australian Bushman. She could see perfectly but she could not read a word. She had been struck by word-blindness, a rare brain affliction which prevents the recognition of words when seen in type. Similarly, when another center of the brain is injured word-deafness results. Hearing is acute, but spoken words mean nothing. In one small patch of gray matter, hardly larger than a nickel, is stored every word we know!
A few weeks ago, medical authorities were amazed by a report coming from Los Angeles, Calif. A twenty-year-old Mexican girl, day after day ran a temperature of 110 degrees. One hundred and seven degrees had been considered fatal. The Medical Director of the Los Angeles General Hospital reported that for more than a month the girl lived with a temperature higher than that of any other known sufferer. Specialists who examined the patient concluded that a tubercular tumor in the heat control center of the brain had upset its normal operation in regulating the temperature of the body. Because a surgeon can lay out a map on the skull of a patient and know that under each section lie the cells controlling a special function of the body, he can know the exact position of any trouble. New methods of diagnosis, such as injecting air into the brain cavity, have also increased the accuracy with which the surgeon can trace the effect back to its cause.
I REMEMBER one man who was cured of epilepsy by the removal of a brain tumor that we found in this manner before an operation. Since convulsions invariably started in his face, we knew that the trouble was in the motor area, near the lower third of the previously-described imaginary line, running from the nose to the back of the head. To determine its size and position, we drilled two small holes through the skull near the bump at the back. Hollow needles, pushed through the brain substance into its central cavity, drained off some of the fluid. Finally, air was injected into the cavity and X-ray pictures taken. They showed that the cavity inside the brain was entirely out of shape on one side, due to the pressure of an extensive brain tumor. With this knowledge at our command, we were able to remove the growth successfully in a single operation.
In New York, the famous brain specialist, Dr. K. Winfield Ney, with whom I worked during the World War, has recently developed a spectacular new technique for curing epilepsy, which he has demonstrated to be caused by the sagging of the brain after it has become attached in places to the top of the skull. The fits, in such cases, are caused by pulling upon the attached portion of the brain. Dr. Ney’s original operation consists in removing the top of the skull and replacing the bone with a heavy plate of special celluloid. This somewhat changes the shape of the skull and eliminates the pull at the attached points. The scalp grows over the plate and fibers of the dura, growing through tiny holes in the thick celluloid, anchor it firmly in place. To date, Dr. Ney has performed this operation upon seventy-four epileptic patients, with remarkable results.
AT ONE point on the brain, a speck the size of a pinhead produces alarming symptoms; at another point, a tumor becomes as big as a fist before it gives serious trouble.
A few years ago, a young tennis player of my acquaintance began having trouble with his serve. He couldn’t seem to throw the ball into the air twice alike. That was the only thing he noticed wrong with himself, he told me when he came for an examination. Yet study of his case revealed that the cause of his trouble was a tumor on the brain about the size of a hazelnut and almost as hard.
When it was removed, the player’s difficulty disappeared. If the tumor had not been discovered in this unusual manner, it might have grown to a size that would have made its removal most difficult, or even impossible. Surgeons today are more than ever on the alert to discover and remove such tumors as early as possible.
Not many years ago, an abscess of the brain was considered hopeless. Even when an operation was performed, at least eighty-five per cent of the patients died. Today, improved methods and earlier diagnosis save the lives of an increasing number of such sufferers. There have been cases in which an abscess of the brain has been cured simply by tapping through the skull.
An instance of this kind occurred in Cleveland, Ohio, three years ago. A six-year-old boy was running down the street when he fell and the point of an umbrella punctured his skull. Infection, carried into the brain, developed into an abscess.
By drilling a small hole through the skull over the infected spot, Dr. Albert T. Steeg-mann, the surgeon in charge, inserted a hollow needle attached to a syringe and drew off an ounce of pus. Immediately the boy began to improve. On alternate days, this tapping was repeated until no more pus could be drawn off. As a result the child made a complete and permanent recovery.
Approximately ten per cent of all cases of insanity grow out of injuries to the head. It has been proved, in a number of instances, that normal persons have been turned into criminals as a result of a blow that injured the brain. Curiously enough, the most serious symptoms of brain injuries often fail to appear until weeks after an accident.
FOR instance, take the queer case of a a wandering bullet found in the brain of a negro bricklayer. A few days before he was rushed to a hospital, after being shot through the back of the skull, a fire had destroyed all the X-ray equipment. It was impossible to find the lead and the surgeons dared not operate without knowing exactly where they would find the bullet.
In spite of the fact that the missile was left within his skull, the negro apparently recovered and left the hospital. Seven weeks later, however, he began to go blind. An X-ray picture showed that the bullet had wandered from the course it had taken on entering the skull and had been carried to the center of vision at the back of the head.
It was removed and the patient regained his sight.
At the last meeting of the American College of Surgeons, Sir William I. de Courcy Wheeler, famous Irish surgeon, told of removing a bullet that had been in a patient’s brain for four years. The lead had lodged in the association area impairing the victim’s memory, vision, and hearing, all of which were restored by the operation.
In another case, seventeen years passed before the serious results of an accident became apparent. A falling brick fractured the skull of an eleven-month-old baby boy. Convulsions followed for a time, then passed away. At the age of seventeen, the boy began to have epileptic fits.
THROUGH an amazing piece of surgery in which part of the boy’s thigh was transplanted to act as a cushion for his brain, Dr. Charles H. Harris, of Fort Worth, Texas, restored him to health.
He found the fits were caused by pressure of the fractured skull-bone on the brain. Making a horseshoe-shaped incision, nine inches long, which extended from just behind the left ear around the back of the head, he lifted the section of the skull which was causing the trouble. Under it, to act as a cushion and eliminate the pressure, he placed a strip of fatty membrane cut from the patient’s thigh.
The operation was a complete success. The convulsions disappeared and the boy returned to school. Another dramatic feat had been added to the long list recorded in the annals of brain surgery.