NEUROLOGICAL SURGERY
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83 NEUROLOGICAL SURGERY. THE LANCET. LONDON : SATURDAY, JAMVUARY 8, 1927. THE formation and inauguration of a Society of !!ritish Neurological Surgeons is a sign of the tinier. Relatively limited in numbers as the exponents of fhis particular branch of surgery must be, if only because in comparison with other surgical conditions their clinical material is somewhat restricted they constitute nevertheless a professional coterie of some significance and importance, and are animated, we may feel sure, with a spirit of scientific hopefulness. Sir CHARLES BALLANCE has been elected the first President of the Society, which has honoured itself by securing as honorary members Sir DAVID FERRIER, Sir EDWARD SHARPEY - SCHAFER, Sir CHARLES SHERRINGTON, Sir ARTHUR KEITH, and Prof. G. ELLIOT SMITH. America has already forestalled this interesting development by the founding of a Society of Neuro-Surgeons (it is matter for minor congratula- tion that our British colleagues have avoided the adoption of this needlessly contracted neologism for their own description), and, as is known, there have been in various countries and at various times promi- nent exponents of the surgery of the nervous system ; pioneers, indeed, in what has now come to take a recognised place among the specialties. These, however, as is also known, were not infrequently compelled hy circumstances to " play a lone hand," hut their names and memories, which in some instances that come readily to the mind are all that remain, are still potent to inspire their successors, now usefully associated in a company of experts whose future transactions will be followed with interest and iiistrue- tion by not a few in the more general ranks of surgery. So recent, comparatively speaking, has been the organisation of attack on conditions of the nervous 8ystem amenable to surgical intervention, that the lifetime of some still fortuilatel-v with us covers practically the whole period within which such efforts have come to be regarded as definitely comprisable in the scope of surgical procedure. It is true, no doubt, that the more obvious pathological states of depressed cranial fracture, rupture of meningeal vessels, and so forth, were handled by ‘ surgeons " as early as medical history begins, and that for less certainly diagnosed conditions resort was made to trepanning by members of races both with and without any pretence to civilisa- tion, in times long past, as well as in the darker corners of the earth to-day ; but there can equally be no doubt that the era. of promise in respect of scientific neuro- logical surgery was entered on only when the experi- mentalist showed the way by his investigations into the neurophysiology of the lower animals, and when the researches of the neuro-anatomist finally elucidated the intimate structure of the neuraxis and its append- ages. Thus it is natural and just that the honorary members of the new Society should consist of very distinguished anatomists and physiologists, not only because of the cardinal role they have played in render- ing possible the appearance of the Society in the fullness of time, but also because their nominal associa,- tion with it will prove a constant reminder to its active members of the fundamental basis of all successful surgery—viz., knowledge of the anatomy and physiology of the mechanisms with which they deal. Some may suppose the day will pass when the neurological surgeon will be content to have his clinical diagnoses made for him by neurological physicians ; with one or two notable exceptions, such has been tlie relationship more or less tacitly acquiesced in by those who have regarded themselves as competent to operate in nervous cases. Yet under a considerable variety of circumstances collaboration of physidan and surgeon still remains desirable if not always essential, and in respect of the nervous system accuracy in topographical diagnosis is an indispensable preliminary to surgical success. Hence the surgeon either ought himself to have had a training in neuro- logy or should be prepared to utilise the aid which the neurologist can give him. Be this as it may, it is unquestionably for the ultimate benefit of mankind that surgery should persistently insinuate itself into a region which has been explored in little more than its confines. The spectre of ’ inaccessibility " has often handicapped well-intentioned if less well- directed efforts, but with slow and steady steps the range of feasible interference is being extended. Of no less importance is operative security for the patient, and if for some cerebral operations mortality percentages are still high, surgery is but experiencing in this field the hard schooling it has had in others ere increase of knowledge has widened the margins of safety. A further equally important aspect of neurological surgery concerns the attainment of adequate degrees of functional recovery after opera- tion. Hereiu, we believe, would lie one of the major advantages to be expected at the surgeon’s hands, if only the possibility could be relied on with some little confidence ; but too often have technical surgical successes been unaccompanied by functional restitu- tion. largely owing to the peculiar compactness of the structures forming the nervous system, whose physiological value is out of all proportion to their mass. Delicacy of touch and nicety of manipulation are here as requisite and will repay the surgeon’s skill as greatly as in the case of the eye or the ear. To conserve function is an aim no less worthy of his concentrated effort than to remove the results of disease. A wide field lies open before this new Society for theoretical and practical study. ’Yo felicitate its members on their realisatioii of the advantages of corporate existence, and believe its installation will usher in a period of enhanced knowledge of the functions of the nervous system and of ever more successful treatment of the serious diseased states with which it is the province of the surgeon to deal. THE ALLEGED INCREASE OF CANCER. Ix all European countries except one the recorded mortality from cancer has shown a rapid increase during the last 40 years. The one exception is Switzerland, which by 1880 had the highest death- rate from cancer of all European countries, and has maintained this high rate during the present century without showing any marked increase. In the mean- time the increase in some of the other European countries has been so great that England and Wales, for instance, which in 1881 had only half the crude death-rate from cancer of Switzerland, now equals it. The same holds good for Sweden and Holland, while the death-rate for the urban population in Denmark, which by the end of last century equalled that of Switzerland, now exceeds it. It is generally
Transcript of NEUROLOGICAL SURGERY
83
NEUROLOGICAL SURGERY.
THE LANCET.
LONDON : SATURDAY, JAMVUARY 8, 1927.
THE formation and inauguration of a Society of!!ritish Neurological Surgeons is a sign of the tinier.Relatively limited in numbers as the exponents offhis particular branch of surgery must be, if onlybecause in comparison with other surgical conditionstheir clinical material is somewhat restricted theyconstitute nevertheless a professional coterie of somesignificance and importance, and are animated, wemay feel sure, with a spirit of scientific hopefulness.Sir CHARLES BALLANCE has been elected the firstPresident of the Society, which has honoured itselfby securing as honorary members Sir DAVID FERRIER,Sir EDWARD SHARPEY - SCHAFER, Sir CHARLESSHERRINGTON, Sir ARTHUR KEITH, and Prof. G.ELLIOT SMITH. America has already forestalled thisinteresting development by the founding of a Societyof Neuro-Surgeons (it is matter for minor congratula-tion that our British colleagues have avoided theadoption of this needlessly contracted neologism fortheir own description), and, as is known, there havebeen in various countries and at various times promi-nent exponents of the surgery of the nervous system ;pioneers, indeed, in what has now come to take a
recognised place among the specialties. These,however, as is also known, were not infrequentlycompelled hy circumstances to
"
play a lone hand,"hut their names and memories, which in some instancesthat come readily to the mind are all that remain,are still potent to inspire their successors, now usefullyassociated in a company of experts whose futuretransactions will be followed with interest and iiistrue-tion by not a few in the more general ranks of surgery.So recent, comparatively speaking, has been the
organisation of attack on conditions of the nervous8ystem amenable to surgical intervention, that the lifetime of some still fortuilatel-v with us covers
practically the whole period within which such effortshave come to be regarded as definitely comprisablein the scope of surgical procedure. It is true, no doubt,that the more obvious pathological states of depressedcranial fracture, rupture of meningeal vessels, and soforth, were handled by
‘
surgeons "
as early as medicalhistory begins, and that for less certainly diagnosedconditions resort was made to trepanning by membersof races both with and without any pretence to civilisa-tion, in times long past, as well as in the darker cornersof the earth to-day ; but there can equally be no doubtthat the era. of promise in respect of scientific neuro-logical surgery was entered on only when the experi-mentalist showed the way by his investigations intothe neurophysiology of the lower animals, and whenthe researches of the neuro-anatomist finally elucidatedthe intimate structure of the neuraxis and its append-ages. Thus it is natural and just that the honorarymembers of the new Society should consist of verydistinguished anatomists and physiologists, not onlybecause of the cardinal role they have played in render-ing possible the appearance of the Society in thefullness of time, but also because their nominal associa,-tion with it will prove a constant reminder to itsactive members of the fundamental basis of all
successful surgery—viz., knowledge of the anatomyand physiology of the mechanisms with which theydeal. Some may suppose the day will pass when theneurological surgeon will be content to have hisclinical diagnoses made for him by neurologicalphysicians ; with one or two notable exceptions,such has been tlie relationship more or less tacitlyacquiesced in by those who have regarded themselvesas competent to operate in nervous cases. Yet undera considerable variety of circumstances collaborationof physidan and surgeon still remains desirable if notalways essential, and in respect of the nervous systemaccuracy in topographical diagnosis is an indispensablepreliminary to surgical success. Hence the surgeoneither ought himself to have had a training in neuro-logy or should be prepared to utilise the aid which theneurologist can give him. Be this as it may, it is
unquestionably for the ultimate benefit of mankindthat surgery should persistently insinuate itself intoa region which has been explored in little more thanits confines. The spectre of ’ inaccessibility
" hasoften handicapped well-intentioned if less well-directed efforts, but with slow and steady steps therange of feasible interference is being extended.Of no less importance is operative security for thepatient, and if for some cerebral operations mortalitypercentages are still high, surgery is but experiencingin this field the hard schooling it has had in othersere increase of knowledge has widened the marginsof safety. A further equally important aspect of
neurological surgery concerns the attainment ofadequate degrees of functional recovery after opera-tion. Hereiu, we believe, would lie one of the majoradvantages to be expected at the surgeon’s hands,if only the possibility could be relied on with somelittle confidence ; but too often have technical surgicalsuccesses been unaccompanied by functional restitu-tion. largely owing to the peculiar compactness ofthe structures forming the nervous system, whosephysiological value is out of all proportion to theirmass. Delicacy of touch and nicety of manipulationare here as requisite and will repay the surgeon’s skillas greatly as in the case of the eye or the ear. Toconserve function is an aim no less worthy of hisconcentrated effort than to remove the results ofdisease.A wide field lies open before this new Society for
theoretical and practical study. ’Yo felicitate itsmembers on their realisatioii of the advantages of
corporate existence, and believe its installation willusher in a period of enhanced knowledge of thefunctions of the nervous system and of ever moresuccessful treatment of the serious diseased stateswith which it is the province of the surgeon to deal.
THE ALLEGED INCREASE OF CANCER.Ix all European countries except one the recorded
mortality from cancer has shown a rapid increaseduring the last 40 years. The one exception isSwitzerland, which by 1880 had the highest death-rate from cancer of all European countries, and hasmaintained this high rate during the present centurywithout showing any marked increase. In the mean-time the increase in some of the other Europeancountries has been so great that England and Wales,for instance, which in 1881 had only half the crudedeath-rate from cancer of Switzerland, now equalsit. The same holds good for Sweden and Holland,while the death-rate for the urban population inDenmark, which by the end of last century equalledthat of Switzerland, now exceeds it. It is generally
