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Atrament, młotek, pilnik i wino – jak średniowieczny chirurg leczył złamania czaszki?

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Pod opiekę średniowiecznych chirurgów często trafiali pacjenci z urazami głowy. Uderzenie miecza, maczugi czy kamiennego pocisku mogło skutkować złamaniem podstawy czaszki. W takim wypadku medycy używali m.in. dłuta i drewnianego młotka, by oddzielić odłamki kości od zdrowych tkanek.

W średniowieczu lekarze dysponowali ograniczoną wiedzą o ludzkiej anatomii. Byli jednak świadomi, że poszczególne obszary mózgu odpowiadają za różne funkcje. Wiedzieli również, że obrażenia zadane po jednej stronie głowy spowodują reakcje po przeciwnej stronie ciała. W przypadku urazów głowy zdawali sobie sprawę, że niektóre z nich są nieuleczalne. Za śmiertelne uznawano te, podczas których doszło do złamań podstawy czaszki i wycieku płynu mózgowo-rdzeniowego. Szanse przeżycia pacjenta w takim wypadku były niewielkie, jednak zdarzało się, że chirurg podejmował próbę leczenia.

W jaki sposób oceniano obrażenia głowy?

Pierwszym elementem postępowania w przypadku ran głowy było sprawdzenie, czy chory w ogóle kwalifikuje się do leczenia. O śmiertelnym charakterze rany świadczyły takie objawy jak drgawki, utrata świadomości, wymioty, ropny wysięk i afazja. Jeśli u pacjenta nie wystąpił żaden z powyższych symptomów, oceniano, czy doszło do złamania czaszki i urazu mózgu.

W tym celu najpierw czyszczono ranę i metodą palpacyjną badano głowę. Na skalpie szukano wgnieceń i wystających elementów kości. Inną techniką diagnostyczną było umieszczenie w zębach pacjenta jednej końcówki sznurka. Lekarz naprężał sznurek i zaczynał nim szarpać. Następnie wsłuchiwał się w dźwięki, które powstawały wskutek szarpania sznurka. W opinii ówczesnych chirurgów pewne konkretne tony mogły świadczyć o uszkodzeniu czaszki.

Średniowieczni medycy stosowali także metodę, którą obecnie znana jest jako próba Valsalvy. Poszkodowany przy zamkniętych ustach i uciśniętych skrzydełkach nosa wydmuchiwał powietrze. Dochodziło wtedy do zamknięcia głośni i zwiększenia ciśnienia w klatce piersiowej. Jeżeli u pacjenta doszło do złamania podstawy czaszki, powietrze mogło wydostawać się przez szczeliny. Pozwalało to medykowi zlokalizować miejsce złamania.

W niektórych przypadkach chirurg stosował bardziej inwazyjne techniki. Najpierw nacinał skalp, a następnie polewał ranę atramentem. Płyn zabarwiał linie złamań, dzięki czemu medyk mógł dokładniej ocenić rodzaj i rozległość uszkodzeń.

Jak leczono złamania czaszki?

Jeżeli chirurg uznał, że jest szansa na uratowanie życia pacjenta, podejmował próbę leczenia. Zaczynał od nacięcia skalpu. Następnie wykonywał nacięcie w kształcie krzyża, co umożliwiało mu lepszy wgląd w ranę. Przy użyciu dłuta i drewnianego młotka oddzielał od zdrowej tkanki ułamane bądź wgniecione elementy kości. Potem usuwał je palcami albo szczypcami. Niektórzy medycy stosowali w tym celu wiertła chirurgiczne. Na narzędziu tym znajdowała się specjalna otoczka, która minimalizowała ryzyko, że ostrze wbije się w mózg.

Po usunięciu wszystkich odłamków kości chirurg sięgał po pilnik, by wygładzić ostre elementy zdrowej tkanki. Potem nakładano skalp z powrotem. Na ranę następnie kładziono bandaże, które nasączano winem lub olejkiem różanym.

Jakie konsekwencje groziły chirurgowi w przypadku zgonu pacjenta?

Wiele średniowiecznych tekstów medycznych wzywało chirurgów do zachowania szczególnej ostrożności podczas opatrywania obrażeń głowy. Za popełnienie błędu, który doprowadził do uszkodzenia mózgu czy zgonu chorego, lekarza mogły spotkać surowe konsekwencje.

W XIII wieku w Królestwie Jerozolimskim chirurg musiał zapłacić odszkodowanie, jeśli w wyniku jego błędu doszło do śmierci niewolnika. Jeżeli jednak wskutek niekompetencji medyka zmarł wolny człowiek, groziła mu kara śmierci przez powieszenie. Podobny wyrok mógł otrzymać także, jeśli zaniedbał opiekę nad pacjentem. Do obowiązków chirurga należało przynajmniej raz dziennie sprawdzać stan chorego. W przeciwnym wypadku, jeśli doszło do powikłań lub zgonu, mógł zostać oskarżony o zaniedbanie.

Źródło: P.D. Mitchell, „Medycyna podczas krucjat. Wojna, rany i średniowieczna chirurgia”, Kraków 2021.

 

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