Early Experiences with Local and Generalized Refrigeration of the Human Brain

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The clinical benefits from the use of local cold applications to the cutaneous surfaces of the body and head have been known to the profession for many centuries.

As far as I am aware, capsules housing refrigerated solutions were first introduced into the tissues of the human skull and brain in 1938 at Temple University Hospital in Philadelphia, on the author's Neurosurgical Service.

The original apparatus devised for local refrigeration of an area was crude (Fig. 1). Ice water was circulated by the method of gravity. An old water cooler, some rubber tubing and a discarded

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    Closed irrigation unit with constant thermal control used with metal capsules for clinical observations of the effect of local refrigeration. (Reproduced from Surgery, Gynecology and Obstetrics.16)

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    Instruments devised for application of local refrigeration. (Reproduced from Surgery, Gynecology and Obstetrics.16)

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    Pneumoencephalogram (G.M., April 22, 1940) showing large postoperative decompressive craniotomy with refrigeration capsule in place. Note depth of capsule. The tumor involved the temporal lobe below the thalamic structures. The capsule was implanted at the periphery of the tumor in order to determine the direct effect of hypothermia upon the normal brain tissue and adjacent malignant cells (see Fig. 7).

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    Final modern equipment used for general refrigeration. Note addition of hood to the blanket, for full application of cold to the head (donated by Therm-O-Rite Products Co.).

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    With this mobile refrigeration apparatus, G.M. (April 9, 1940) was able to enjoy a fair degree of activity in the ward during the weeks of local refrigeration of the brain through an implanted capsule (Fig. 3) in the cavity of an evacuated glioma.

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    Patient with brain abscess and diffuse cerebritis. Sterile refrigerated boric acid and Dakin's solution were used alternately to flush the intracranial area. Fluid flowed by gravity from burette above the bed. The sterile solution was passed through a metal cylinder, around which a cold solution of brine was circulated, without disturbing the integrity or sterility of the irrigating solution. The two-way circulation of the refrigerated solution was maintained through the large tubes at the upper corner of the bed. Drainage was accomplished by a small model Babcock sump pump located beneath the bed. This technique was extremely well tolerated and clinical results were very satisfactory.

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    Early method of total refrigeration with recording thermocouple (89.5°F. rectal). Patient was under Amytal Sodium, chloral hydrate and paraldehyde anesthesia. This patient (a physician) insisted upon keeping socks on.

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    Showing detail of apparatus and equipment in use on Dec. 27, 1939. Special insulated mattress is between bed and “zipper” blanket containing rubber tubing, so that continuous circulation of brinechilled solution could be directed toward either half of the blanket. Refrigeration apparatus, designed by the author and Mr. Brenner of the Therm-O-Rite Company of Buffalo, was quiet, with automatic temperature control. Rectal electrothermocouple designed by Dr. George Henny, and constantly registering dial thermometer, supplied by Leeds and Northrup Co., showed this patient's temperature to be 89.5°F. rectal. This large-face type of dial thermometer was calibrated from 70°F. to 110°F. and could be constantly observed by the nurse at the ward station 40 feet away.

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