Gerard van Swieten and his World 1700–1722

general sound in principle, some of it curiously unaltered since the days of Theodoric and Johannes de Mirfeld. Evidently a seventeenth-century neurosurgeon kept his fingernails long in readiness for the removal of an exposed pericranium. The selected case histories of Scultetus (23 out of the 100 concern the skull and brain) make interesting reading showing a conservative approach to treatmentwhich is commendable. Dr. Bakay, whose scholarly treatment of a serious subject is occasionally, and delightfully, betrayed by a spontaneous wit, has tried with success to view surgical problems of that time in the light of reasonably fair knowledge of anatomy but dismal ignorance of brain function. Experience counted for much: Scultetus probably did not believe the astrologer-surgeons who held that it was dangerous to trephine at full moon when the brain was thought to be swollen and 'near to the skull', but he may well have been aware of the phenomenon of a post-traumatic cerebral oedema even if not of its underlying mechanism. Trephination for a comminuted fracture of the skull, he stated, should be undertaken when the patient had recovered from the immediate shock but not after the third day: the operation would then be fraught with danger. W. H. MCMENEMEY