Skull Sarcoma Removed Under Local Anesthesia, East Prussia, Circa 1921

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The text and photographs on this page are excerpted from a four-volume series of books titled Oncology Tumors & Treatment: A Photographic History, by Stanley B. Burns, MD, FACS. The photos below are from the volume titled “The Radium Era: 1916–1945.” To view additional photos from this series of books, visit


In this case, Heinrich Braun, MD, removes a large sarcoma of the skull. The development of a local anesthetic solution with adrenalin was a major step forward in expanding the possibilities of major surgery using regional block anesthesia.

The first photograph (A) shows the lesion with a central depressed area. A line has been drawn on the photograph showing a portion of the area to be injected; 75 cc of 1% “novacaine-suprarenin” is necessary to attain the proper depth of anesthesia and blood control. The second photograph (B) shows the entire defect after excision of the tumor. The third photograph (C) shows the skin flap that has been prepared from the adjacent area. This skin flap will be swung over to cover the defect. The final photograph (D) shows the end result, a remarkable postoperative view of a “cured patient.” There is hair growing in most of the area of the excision, though the adjacent skull from which the flap was taken is devoid of hair.

Dr. Braun emphasizes that his procedure allows bloodless and painless surgery, even in the scalp, which is notoriously prone to bleeding. Most operations involving the scalp required head tourniquets. During the first decades of the 20th century, local anesthesia was used by numerous surgeons to expand their capabilities in dealing with a variety of diseases. It became especially important in operating on elderly patients and those with significant cardiovascular decompensation.

Excerpted from Oncology Tumors & Treatment, A Photographic History, The Radium Era: 1916-1945 by Stanley B. Burns, MD, FACS. Photographs courtesy of Stanley B. Burns, MD, and The Burns Archive. ■




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