Tag Archives: surgery

Biosciences, Literature

Wound Man

wound-man-wellcome-library-ms-49

No, the image is not a still from a forthcoming episode of Law & Order or Criminal Minds. Nor is it a nightmarish Hieronymus Bosch artwork.

Rather, “Wound Man”, as he was known, is a visual table of contents to a medieval manuscript of medical cures, treatments and surgeries. Wound Man first appeared in German surgical texts in the early 15th century. Arranged around each of his various wounds and ailments are references to further details on appropriate treatments. For instance, reference number 38 alongside an arrow penetrating Wound Man’s thigh, “An arrow whose shaft is still in place”, leads to details on how to address the wound — presumably a relatively common occurrence in the Middle Ages.

From Public Domain Review:

Staring impassively out of the page, he bears a multitude of graphic wounds. His skin is covered in bleeding cuts and lesions, stabbed and sliced by knives, spears and swords of varying sizes, many of which remain in the skin, protruding porcupine-like from his body. Another dagger pierces his side, and through his strangely transparent chest we see its tip puncture his heart. His thighs are pierced with arrows, some intact, some snapped down to just their heads or shafts. A club slams into his shoulder, another into the side of his face.

His neck, armpits and groin sport rounded blue buboes, swollen glands suggesting that the figure has contracted plague. His shins and feet are pockmarked with clustered lacerations and thorn scratches, and he is beset by rabid animals. A dog, snake and scorpion bite at his ankles, a bee stings his elbow, and even inside the cavity of his stomach a toad aggravates his innards.

Despite this horrendous cumulative barrage of injuries, however, the Wound Man is very much alive. For the purpose of this image was not to threaten or inspire fear, but to herald potential cures for all of the depicted maladies. He contrarily represented something altogether more hopeful than his battered body: an arresting reminder of the powerful knowledge that could be channelled and dispensed in the practice of late medieval medicine.

The earliest known versions of the Wound Man appeared at the turn of the fifteenth century in books on the surgical craft, particularly works from southern Germany associated with the renowned Würzburg surgeon Ortolf von Baierland (died before 1339). Accompanying a text known as the “Wundarznei” (The Surgery), these first Wound Men effectively functioned as a human table of contents for the cures contained within the relevant treatise. Look closely at the remarkable Wound Man shown above from the Wellcome Library’s MS. 49 – a miscellany including medical material produced in Germany in about 1420 – and you see that the figure is penetrated not only by weapons but also by text.

Read the entire article here.

Image: The Wound Man. Courtesy: Wellcome Library’s MS. 49 — Source (CC BY 4.0). Public Domain Review.

Idea Soup, Technica

Time For a New Body, Literally

Brainthatwouldntdie_film_poster

Let me be clear. I’m not referring to a hair transplant, but a head transplant.

A disturbing story has been making the media rounds recently. Dr. Sergio Canavero from the Turin Advanced Neuromodulation Group in Italy, suggests that the time is right to attempt the transplantation of a human head onto a different body. Canavero believes that advances in surgical techniques and immunotherapy are such that a transplantation could be attempted by 2017. Interestingly enough, he has already had several people volunteer for a new body.

Ethics aside, it certainly doesn’t stretch the imagination to believe Hollywood’s elite would clamor for this treatment. Now, I wonder if some people, liking their own body, would want a new head?

From New Scientist:

It’s heady stuff. The world’s first attempt to transplant a human head will be launched this year at a surgical conference in the US. The move is a call to arms to get interested parties together to work towards the surgery.

The idea was first proposed in 2013 by Sergio Canavero of the Turin Advanced Neuromodulation Group in Italy. He wants to use the surgery to extend the lives of people whose muscles and nerves have degenerated or whose organs are riddled with cancer. Now he claims the major hurdles, such as fusing the spinal cord and preventing the body’s immune system from rejecting the head, are surmountable, and the surgery could be ready as early as 2017.

Canavero plans to announce the project at the annual conference of the American Academy of Neurological and Orthopaedic Surgeons (AANOS) in Annapolis, Maryland, in June. Is society ready for such momentous surgery? And does the science even stand up?

The first attempt at a head transplant was carried out on a dog by Soviet surgeon Vladimir Demikhov in 1954. A puppy’s head and forelegs were transplanted onto the back of a larger dog. Demikhov conducted several further attempts but the dogs only survived between two and six days.

The first successful head transplant, in which one head was replaced by another, was carried out in 1970. A team led by Robert White at Case Western Reserve University School of Medicine in Cleveland, Ohio, transplanted the head of one monkey onto the body of another. They didn’t attempt to join the spinal cords, though, so the monkey couldn’t move its body, but it was able to breathe with artificial assistance. The monkey lived for nine days until its immune system rejected the head. Although few head transplants have been carried out since, many of the surgical procedures involved have progressed. “I think we are now at a point when the technical aspects are all feasible,” says Canavero.

This month, he published a summary of the technique he believes will allow doctors to transplant a head onto a new body (Surgical Neurology International, doi.org/2c7). It involves cooling the recipient’s head and the donor body to extend the time their cells can survive without oxygen. The tissue around the neck is dissected and the major blood vessels are linked using tiny tubes, before the spinal cords of each person are cut. Cleanly severing the cords is key, says Canavero.

The recipient’s head is then moved onto the donor body and the two ends of the spinal cord – which resemble two densely packed bundles of spaghetti – are fused together. To achieve this, Canavero intends to flush the area with a chemical called polyethylene glycol, and follow up with several hours of injections of the same stuff. Just like hot water makes dry spaghetti stick together, polyethylene glycol encourages the fat in cell membranes to mesh.

Next, the muscles and blood supply would be sutured and the recipient kept in a coma for three or four weeks to prevent movement. Implanted electrodes would provide regular electrical stimulation to the spinal cord, because research suggests this can strengthen new nerve connections.

When the recipient wakes up, Canavero predicts they would be able to move and feel their face and would speak with the same voice. He says that physiotherapy would enable the person to walk within a year. Several people have already volunteered to get a new body, he says.

The trickiest part will be getting the spinal cords to fuse. Polyethylene glycol has been shown to prompt the growth of spinal cord nerves in animals, and Canavero intends to use brain-dead organ donors to test the technique. However, others are sceptical that this would be enough. “There is no evidence that the connectivity of cord and brain would lead to useful sentient or motor function following head transplantation,” says Richard Borgens, director of the Center for Paralysis Research at Purdue University in West Lafayette, Indiana.

Read the entire article here.

Image: Theatrical poster for the movie The Brain That Wouldn’t Die (1962). Courtesy of Wikipedia.

Idea Soup

Doctor Lobotomy

walter-freeman

Read the following article once and you could be forgiven for assuming that it’s a fictional screenplay for Hollywood’s next R-rated Halloween flick or perhaps the depraved tale of an associate of Nazi SS officer and physician Josef Mengele.

Read the following article twice and you’ll see that the story of neurologist Dr. Walter Freeman is true: the victims — patients — were military veterans numbering in the thousands, and it took place in the United States following WWII.

This awful story is all the more incomprehensible by virtue of the cadre of assistants, surgeons, psychiatrists, do-gooders and government bureaucrats who actively aided Freeman or did nothing to stop his foolish, amateurish experiments. Unbelievable!

From WSJ:

As World War II raged, two Veterans Administration doctors reported witnessing something extraordinary: An eminent neurologist, Walter J. Freeman, and his partner treating a mentally ill patient by cutting open the skull and slicing through neural fibers in the brain.

It was an operation Dr. Freeman called a lobotomy.

Their report landed on the desk of VA chief Frank Hines on July 26, 1943, in the form of a memo recommending lobotomies for veterans with intractable mental illnesses. The operation “may be done, in suitable cases, under local anesthesia,” the memo said. It “does not demand a high degree of surgical skill.”

The next day Mr. Hines stamped the memo in purple ink: APPROVED.

Over the next dozen or so years, the U.S. government would lobotomize roughly 2,000 American veterans, according to a cache of forgotten VA documents unearthed by The Wall Street Journal, including the memo approved by Mr. Hines. It was a decision made “in accord with our desire to keep abreast of all advances in treatment,” the memo said.

The 1943 decision gave birth to an alliance between the VA and lobotomy’s most dogged salesman, Dr. Freeman, a man famous in his day and notorious in retrospect. His prolific—some critics say reckless—use of brain surgery to treat mental illness places him today among the most controversial figures in American medical history.

At the VA, Dr. Freeman pushed the frontiers of ethically acceptable medicine. He said VA psychiatrists, untrained in surgery, should be allowed to perform lobotomies by hammering ice-pick-like tools through patients’ eye sockets. And he argued that, while their patients’ skulls were open anyway, VA surgeons should be permitted to remove samples of living brain for research purposes.

The documents reveal the degree to which the VA was swayed by his pitch. The Journal this week is reporting the first detailed account of the VA’s psychosurgery program based on records in the National Archives, Dr. Freeman’s own papers at George Washington University, military documents and medical records, as well as interviews with doctors from the era, families of lobotomized vets and one surviving patient, 90-year-old Roman Tritz.

The agency’s use of lobotomy tailed off when the first major antipsychotic drug, Thorazine, came on the market in the mid-1950s, and public opinion of Dr. Freeman and his signature surgery pivoted from admiration to horror.

During and immediately after World War II, lobotomies weren’t greeted with the dismay they prompt today. Still, Dr. Freeman’s views sparked a heated debate inside the agency about the wisdom and ethics of an operation Dr. Freeman himself described as “a surgically induced childhood.”

In 1948, one senior VA psychiatrist wrote a memo mocking Dr. Freeman for using lobotomies to treat “practically everything from delinquency to a pain in the neck.” Other doctors urged more research before forging ahead with such a dramatic medical intervention. A number objected in particular to the Freeman ice-pick technique.

Yet Dr. Freeman’s influence proved decisive. The agency brought Dr. Freeman and his junior partner, neurosurgeon James Watts, aboard as consultants, speakers and inspirations, and its doctors performed lobotomies on veterans at some 50 hospitals from Massachusetts to Oregon.

Born in 1895 to a family of Philadelphia doctors, Yale-educated Dr. Freeman was drawn to psychosurgery by his work in the wards of St. Elizabeth’s Hospital, where Washington’s mentally ill, including World War I veterans, were housed but rarely cured. The treatments of the day—psychotherapy, electroshock, high-pressure water sprays and insulin injections to induce temporary comas—wouldn’t successfully cure serious mental illnesses that resulted from physical defects in the brain, Dr. Freeman believed. His suggestion was to sever faulty neural pathways between the prefrontal area and the rest of the brain, channels believed by lobotomy practitioners to promote excessive emotions.

It was an approach pioneered by Egas Moniz, a Portuguese physician who in 1935 performed the first lobotomy (then called a leucotomy). Fourteen years later, he was rewarded with the Nobel Prize in medicine.

In 1936, Drs. Freeman and Watts performed their first lobotomy, on a 63-year-old woman suffering from depression, anxiety and insomnia. “I knew as soon as I operated on a mental patient and cut into a physically normal brain, I’d be considered radical by some people,” Dr. Watts said in a 1979 interview transcribed in the George Washington University archives.

By his own count, Dr. Freeman would eventually participate in 3,500 lobotomies, some, according to records in the university archives, on children as young as four years old.

“In my father’s hands, the operation worked,” says his son, Walter Freeman III, a retired professor of neurobiology. “This was an explanation for his zeal.”

Drs. Freeman and Watts considered about one-third of their operations successes in which the patient was able to lead a “productive life,” Dr. Freeman’s son says. Another third were able to return home but not support themselves. The final third were “failures,” according to Dr. Watts.

Later in life, Dr. Watts, who died in 1994, offered a blunt assessment of lobotomy’s heyday. “It’s a brain-damaging operation. It changes the personality,” he said in the 1979 interview. “We could predict relief, and we could fairly accurately predict relief of certain symptoms like suicidal ideas, attempts to kill oneself. We could predict there would be relief of anxiety and emotional tension. But we could not nearly as accurately predict what kind of person this was going to be.”

Other possible side-effects included seizures, incontinence, emotional outbursts and, on occasion, death.

Read the entire article here.