Tuesday, January 12, 2010

Neurosurgery in the First World War

Our intermittent poaching from the circulating collections of the main library has brought another tender volume to a happy home in the History of Medicine Room: War surgery of the nervous system; a digest of the important medical journals and books published during the European war, compiled by the Division of Brain Surgery, Section of Surgery of the Head, Office of the Surgeon General (Washington, GPO, 1917).

The "digest" portions of the book are each prefaced by a synopsis of the current literature, in an effort to put the "foreign war literature" into context. The abstracts cover articles published in English, German, and French medical journals from August 1914 to August 1917, "and those foreign treatises dealing with war surgery as practiced and observed during the present conflict." The context is provided by the "chapters from Keen's Surgery written by Dr. Harvey Cushing, and chapters from Dr. Isaac H. Jones's forthcoming book on Equilibrium and Vertigo", as well as selections from "C.A. Elsberg's book on Diseases of the Spinal Cord and its Membranes, and Dr. Charles H. Frazier's volume (in press) on Surgery of the Spine," and Gordon Holmes's chapter on peripheral nerves from Osler's Modern medicine.

More than a mere historical accounting of the actions of military surgeons during the conflict, the volume was meant to shed light on developments in neurosurgery that could be, and now were being, applied in operating rooms everywhere. The preface states:
The use of the phrase "war surgery" must be taken with a good deal of qualification, lest one fall into the error of thinking of this type of work as separate and distinct from the surgery of civil life. As a matter of fact the surgical principles governing both are in large part exactly the same. The laws of ballistics, trench life, the terrain of the battle field, the problems of transport, and numerous other incidentals serve to modify established principles of surgery, but not more than that. [emphasis added]
Indeed, the modifications made to address some of war's "incidentals" have been adopted by for use in peacetime with great success, belying the old adage that you can't make a silk purse out of a sow's ear (Arthur D. Little, Inc. notwithstanding).

Table of contents:
Preface -- ch. 1. Head. pt. 1. Fractures of the skull ; pt. 2. Meninges, ependyma, and brain ; pt. 3. The vestibular apparatus in the diagnosis of intracranial diseases ; pt. 4. Abstracts from foreign war literature -- ch. 2. Spine. pt. 1. Surgical anatomy of vertebral column and spinal cord ; pt. 2. Normal and pathological physiology of the spinal cord ; pt. 3. Localization of motor, sensory, and reflex functions in the different segments of the spinal cord ; pt. 4. The symptomatology of spinal disease ; pt. 5. The symptoms of spinal disease at different levels and in different regions of the cord ; pt. 6. The operation of laminectomy ; pt. 7. Abstracts from foreign war literature -- ch. 3. Peripheral nerves. pt. 1. Diseases of the peripheral nerves ; pt. 2. Abstracts from foreign war literature.

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