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Updated: May 25, 2025
Pare, the inventor of trephining, was, perhaps, the only man in Europe who could have dealt with the fracture in the back of the head, and he likewise extracted the remaining splinters of the jaw, though at the cost of much severe handling and almost intolerable pain: but by Easter, Berenger found the good surgeon's encouragement verified, and himself on the way to a far more effectual cure than he had hitherto thought possible.
Every strange and outre case of which he had ever heard or read came back into his mind, and long before he reached the Towers he had worked himself into a positive conviction that he would be instantly required to do a trephining at the least. The Towers was a very large house, standing back amid trees, at the head of a winding drive.
In some of his surgical operations, such as trephining for fracture of the skull, his technique has been little improved upon even in modern times. In one of these operations he successfully removed a portion of a man's brain. Surgery was undoubtedly stimulated greatly at this period by the constant wars.
While success will depend always to a certain extent upon the personal equation, yet it seems now that for a large majority if not all of the cases we are justified in abandoning all other operations than trephining, notwithstanding the verdict of Elschnig and others that fistula forming operations eventually will be discarded in favor of iridectomy and cyclodialysis.
The application of pine tar to the nostrils of sheep is the most practical method of preventing "grub in the head." This should be practised every few days during the summer months. A very good preventive measure is plenty of shade for the flock. Valuable animals may be treated by trephining into the head sinus and removing the "grub."
He instances the medicine-man's excellent management, in most cases, of childbirth, or of wounds and fractures, or his primeval skill in trepanning or trephining all of which operations, he admits, may be accompanied with grotesque and superstitious ceremonies, yet show real perception and ability.
To this comprehensive material is added an appendix on the topic of psychic and neurotic disturbances as indications for trephining. This outline of the contents of the book, which contains in addition many subheadings, gives a sufficiently clear idea of its scope and of the pains which the author has taken to subdivide his subject matter to the last possible degree.
I have seen results of trephining by American surgeons which could not be bettered anywhere. Fourth: I am sure that everybody will recognize the difficulties of operating during such a tour as I am now making. I have so far in the last month performed over seventy trephinings in ten cities, and in twice as many clinics.
I have as yet seen no cases of remote infection, but the report of Axenfeld and some others would indicate that this occurred following the Lagrange as well as the trephining operation, the then bulging conjunctiva having become eroded and infection having taken place through the eroded conjunctiva as shown when stained with flourescin.
First: The operation of trephining is suitable, not merely for chronic cases, but for sub-acute and acute cases of glaucoma as well. I would urge on your attention that, of all the operations dealing with glaucoma, this one involves the minimum of surgical violence, and should, therefore, in acute cases be the operation of choice.
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