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First accurate illistration of the brain from "De humani corporis fabrica"

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Hydrocephalus's foundation can be found in Andreas Vesalius's book of human anatomy "De Humani Corporis Fabrica". The Fabrica was one of the most influential books that progressed the understanding of human anatomy, and it offered the first accurate representation and illustrations of the human body based on numerous dissections². This artifact¹, is an excerpt from the book, showcasing the very first accurate illustration of the brain. Throughout this book, Versalius made history by being the first to understand the cerebrospinal fluid and describe these fluids in the brain, with his accurate works of the ventricular system³. This understanding and description by Vesalius progressed the foundations of hydrocephalus. Before this understanding, was only the foundation built throughout history dating back to the Paleolithic period⁶, but the most prominent were Hippocrates and Galen. Hippocrates stated that this fluid was water in the brain, while Galen called it "excremental liquid"⁴.

"De Humani Corporis Fabrica" was written in 1543 in Basel, Switzerland⁵

Sources:

(1) Vesalius' De humani corporis fabrica, figure on plate 609

(2) Toledo-Pereyra LH. De Humani Corporis Fabrica surgical revolution. J Invest Surg. 2008 Sep-Oct;21(5):232-6. doi: 10.1080/08941930802330830. PMID: 19160130.

(3) Paolo Missouri, Sergio Paolini, Antonio Currà, From congenital to idiopathic adult hydrocephalus: a historical research, Brain, Volume 133, Issue 6, June 2010, Pages 1836–1849, https://doi.org/10.1093/brain/awq014

(4) http://www.annclinlabsci.org/content/33/3/334.full#ref-2

(5) https://www.britannica.com/topic/De-humani-corporis-fabrica-libri-septem#:~:text=The%20drawings%20of%20his%20dissections,Fabrica%2C%20was%20printed%20in%201543.

(6) https://link.springer.com/referenceworkentry/10.1007/978-3-319-31889-9_34-1

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The artifact above showcases puncturing tools made by Al-Zahrawi or Albucasis, who was deemed the "Pioneer of Modern Surgery"¹

Throughout history, hundreds of tools were created for puncturing and draining the fluid in people who had hydrocephalus. This artifact showcases these tools that were primarily used around the 10th century when Al-Zahrawi was creating them. They were a part of the puncturing process that could also be noted as "stab and drain". These tools consisted of hooks and scalpels that would decompress the child's head and remove the excess fluids. His tools were used throughout the Islamic world in the Middle East and North Africa¹

Sources:

(1) https://link.springer.com/referenceworkentry/10.1007/978-3-319-31889-9_34-1

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Throughout history, a lot of harmful "treatments" exist for Hydrocephalus. However, the first external drainage done through ventricular puncturing was in 1744, by Claude-Nicolas Le Cat. The artifact above showcases the trocar system, which shows the tools that Le Chat used. In the first ventricular puncture, Le Chat inserted a wick-like tool to allow drainage for the next 5 days on a young boy. However, this procedure was damaging and the boy on whom it was performed did not survive. This procedure was most likely performed in France.

Due to these damaging results, this procedure resulted in the change of external ventricular puncturing and altering the drainage¹

Source:

(1) https://pubmed.ncbi.nlm.nih.gov/31424901/

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The artifact above is an image of a hydrocephalus child featured in British Surgeon Robert Listons book, "Elements of Surgery". This book provided various methods and strategies involved with effective surgery and was published in 1831.

As treatments got worse, a British surgeon, Robert Liston, recognized these effects on the brain because of puncturing and his studies resulted in the indication that these treatments were detrimental. As a result of these findings, more effective ways and strategies of treatment were made in the 18th century. These puncturing methods involved severe drainage that wasn't efficient and Liston recognized that¹.

Source:

(1) https://link.springer.com/article/10.1007/s00381-015-2652-3

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Discovery of the Choroid Plexus sourcing cerebrospinal fluid

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Discovery of the Choroid Plexus sourcing cerebrospinal fluid

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The artifact above is an image displaying the diagram of the movement of cerebellum fluid produced by the Choroid Plexus. This image provides an understanding of how excess fluids get built up and allows us to look further into the discovery that the choroid plexus secretes this fluid. This diagram was made in present times after the understanding of the flow was developed this would be helpful in contexts of studies, research, etc...¹

After treatments began developing, so did the theories of how the excess fluids in the brain were being caused. Many early theories falsely interpreted Hydrocephalus, for example, bad nutrition and diets were made as a theory in the 18th century by Isbrand de Diemerbroeck, to explain the fluids producing. Others had no theories and only suggested the detrimental practices that were done to individuals with Hydrocephalus including, wrapping of the head and puncturing². However, in 1914 Harvey Crushing discovered that the Choroid Plexus was the reason for this excess fluid and secreted it. He was also able to show the flow of this diagram of the choroid plexus and the workings of the fluid through the ventricular system³.

Sources:

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818536/#:~:text=Almost%20100%20years%20ago%20to,as%20a%20possible%20postmortem%20precipitate.

(2) https://link.springer.com/article/10.1007/s00381-015-2652-3

(3) https://www.americanscientist.org/article/the-early-years-of-brain-imaging

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For this modern-day artifact, I chose a video made by the Boston Children's Hospital. This video describes the process through which modern-day treatment is made. The instructor shows a guide to the current treatment called Hydrocephalus Shunting⁴.

Shunting is the process where in the ventricle they place a tube that can go all the way down to the stomach or another area of the body that can absorb/redirect the cerebrospinal fluid out. This tube is permanent and throughout time if any damage occurs it can be fixed just not taken out¹. Throughout history, it is a treatment that has evolved to its full efficiency, as the first making of a shunt was in 1961 by Rudi Schulte², and through time it is now modern-day treatment with an average of 125,000 people yearly who live with one³.

Source:

(1) https://www.hopkinsmedicine.org/neurology-neurosurgery/specialty-areas/cerebral-fluid/shunts

https://www.youtube.com/watch?v=bHD8zYImKqA

(2) https://clinicalconnection.hopkinsmedicine.org/news/shunning-the-shunt-in-hydrocephalus#:~:text=The%20current%20treatment%20involves%20surgically,drain%20fluid%20from%20the%20brain.

(3) https://www.uclahealth.org/medical-services/pediatric-neurosurgery/conditions-treatment/pediatric-hydrocephalus-program/hydrocephalus-faqs#:~:text=Hydrocephalus%20occurs%20in%20two%20out,annually%20in%20the%20United%20States.

(4) https://www.youtube.com/watch?v=bHD8zYImKqA

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Hydrocephalus and its treatment | Boston Children’s Hospital

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Andrew Vesalius would be the best to walk you through this exhibit. Vesalius was born in 1514, in Brussels, Belgium, and was a well-known influential Physician. He is most known for his makings of the first accurate illustrations of the human body and the understanding of the brain structure, which led to the foundation of Hydrocephalus. Known as the founder of modern anatomy, Vesalius produced books with accurate illustrations and firsthand experiences of human dissections that completely changed the world of medicine and neuroscience¹. His illustrations of the brain allowed Hydrocephalus to be understood more, as he was the first to describe the ventricles and the fluid of the brain².

Without Vesalius's illustrations and findings of the human brain and anatomy, the foundations of Hydrocephalus and other medical findings would not have been present. He helped construct the medical world as we know it and allowed for further improvements in the human body and understanding.

Source:

(1) https://www.cam.ac.uk/research/features/andreas-vesalius-1514-1564-and-the-books-that-made-the-father-of-anatomy#:~:text=Vesalius's%20books%20were%20complex%20statements,acquired%20through%20carrying%20out%20dissections.

(2) https://academic.oup.com/brain/article/133/6/1836/350881