Neurology in the Dark Ages
Neurology in the Dark Ages - by Michael Nelson MD house call neurologist and CEO of Memento Care Homes
Okay, by the Dark Ages, I really mean before CT and MRI scans. Actual neurological care in the Dark Ages was based on the belief that there were four humours in the body and they needed to be in balance. The four humours were black bile, yellow bile, phlegm, and blood. All diseases and disabilities resulted from an excess or deficit of one of these four humours. Bloodletting by leeches or venesection was a common treatment.
The very earliest neurological treatments were prehistoric and involved a procedure called trepanation. Trepanation is the process of drilling holes into the skull with a tool known as a trephine. At the time, it is postulated that healers thought that neurological disorders like epilepsy or mental illness may have been attributed to evil spirits that could only be released through the drilling of holes into the skull. Patients would have been fortunate to merely survive these ancient treatments. If you didn’t survive, then I suppose death does provide a 100% cure rate of any disease.
Moving forward several hundred years brings us to x-ray technology. The advent of this technology was at the end of the 19th century. With x-ray, we could see inside the body without cutting it open for the first time. As with any new technology in the health field, x-rays were used to image all parts of the human body. It is best at seeing the difference between densities, such as a broken arm or detection and location of foreign bodies. Because the brain has relatively the same amount of density, taking an x-ray of the head only provides details of the bony structure of the skull itself.
In order to see the brain better, Dr. Walter Dandy developed the technique of diagnostic encephalography by being the first to inject air into the head in 1918. The thought was that the air would provide a clearer image of the brain itself by creating a greater contrast in densities. How do you get air inside the head? Excellent question. Dr. Dandy, as a neurosurgeon, would drill a small hole into your skull. The technique was later changed to using a lumbar puncture, also called a spinal tap. Spinal fluid was drained and then air, oxygen, or helium was injected through the spinal needle. The air would then travel up to the brain and a head x-ray was performed. This procedure is called a pneumoencephalogram.
Now those of you who have had a lumbar puncture are probably shocked that you would have to go through the pain of a lumbar puncture in order to take an x-ray of your head. Trust me, the lumbar puncture would have been nothing compared to the pain of having air injected into a space never meant to hold air. The fact that this procedure was featured in the film, The Exorcist, should be a clue to the level of pain. Severe headaches and vomiting were common side effects. The pain and other side effects would continue for weeks as the air was slowly absorbed.
Fortunately, CT scans were developed in the 1970’s and were in common use by the early 1980’s. These scans made pneumoencephalograms obsolete. The first CT scans took nine days to complete and took 21 hours of computer processing time. Now, you can have a CT scan in a few minutes. CT scans allow much greater detail than x-rays and are still extremely valuable to today’s physician. You can thank Godfrey Hounsfield and Dr. Allen Cormack who won the Nobel Prize in 1979 for developing the CT scan. After the development of the CT scan, modern neuroimaging techniques have had a rapid rate of development and now include MRI, MRA, functional MRI, nuclear medicine, CT-angiograms, CT-perfusion studies, PET, and SPECT scans. I hope this historical perspective can help you the next time your physician sends you for a CT scan or MRI.