The satire 247

Pl asti c Techniques in Neurosurgery

Ed. by J. T. Goodri ch, K. D. Post, R. V. Ar-
gamaso
For ewor d by M. L. Lewin, New York
1991. Cloth. DM 188, -
XVI I I , 150 pages, 137 figures in 232 ill. (128
in color), 8 tables
I SBN 3-13-758801-4 (TMP)
G. Thi eme Verlag, St u t t g a r t - Ne w York
This vol ume describes the use of plastic surgery
techniques in neurosurgery. Aft er i nt r oduct or y
chapt ers on the fundament al s of wound healing
and the principles of the coverage of large
wounds, there are five furt her chapters which
cover special aspects: the repai r of calvarial
bone defects, plastic repai r of congenital de-
fects, craniofacial reconst ruct i on for pr emat ur e
craniosynostosis, and congenital facial disor-
ders as well as short chapt er on the surgery of
the skull base which most l y considers plastic
met hods for resection of t umors.
This is not a compl et e list of met hods, but one
based on the experience of the author. The
techniques described are illustrated with bot h
black and white sketches and color illustra-
tions, and sometimes suppl ement ed with pho-
t ographs of operations. Al t hough some of the
descriptions do not go beyond the already
known, (e. g., the t reat ment of myeloceles),
some are rat her well organized. The chapt er on
the t reat ment of vari ous forms of pr emat ur e
craniosynostosis, for example, offers usable
plastic surgery met hods for each of the vari ous
mal f or mat i ons of the skull. These seem to be
based on the aut hor ' s own experience.
The value of this vol ume is t hat the aut hor
emphasizes the met hods which he has f ound
most useful. The met hods of craniofacial re-
const ruct i on for crani osynost osi s are mai nl y
those most l y used and pr oven in Germany.
Mor e i nf or mat i on could have been given on
techniques for the operat i on of dysrhaphi c mal -
f or mat i ons which can deter retethering of the
cord. On the ot her hand, our knowl edge of
such techniques is, at present, not so firm t hat
such descriptions would have fit into the scope
of such a book.
This book shoul d be of interest to neurosur-
geons, and, in part s, to ot orhi nol aryngol ogi st s,
since, especially for operat i ons in the area of
the face, the cosmetic aspects should not be
neglected.
The quality of the pri nt i ng and binding and of
the illustrations are, as to be expected f r om this
publisher, very good. Considering this, the
book is inexpensive.
The satire
A letter from Ni col 6 di Bernado dei
Machiavelli sent t o the designated Medi cal
Director of the Ho l y Ghost Hospi t al in
Bol ogne.
The question put in Your letter, for which I
t hank you, how it is possible to achieve a
reput at i on as the first among your equals,
shows me two things: first, t hat you are am-
bitious, and, second, t hat you are lack confi-
dence. Otherwise You would have strived to be
the first - the first in cleverness, benevolence,
virtue, knowledge, and skill.
You will thus be forced to follow a less good,
but for your and your kind, the only open and
easy pat h, for which I will, if it pleases You,
present a short description.
When you enter the circle of your colleagues,
so - meed as a dove and clever as a snake -
find at the beginning t hat man among t hem
who is equal to, or even superior to you. It is
he whom you must first at t empt to bring to
fall. Since you may say everything and must
not prove anything, accuse hi m of i ncompet -
ence or lack of cooperat i on or of a secret vice,
which you openl y express - in nine of ten
cases they will believe you, or at least pret end
belief.
Divide the gr oup of ot her physicians by giving
or wi t hdrawi ng favour: since many humans are
opportunistic, timid, and cowardly, you will
easily achieve your ends. Promi ses and com-
mi t ment s should never be kept; rat her you most
Neurosurg. Rev. 16 (1993)
248 The satire
continually use their revolking as punishment
- an occasion for this can always be conjured!
Never express Your intentions Yourselfl Breed
a pair of colleagues, whom You may call "the
fat and the thin cousin". One of them should
speak your mind, the other feign opposition,
only to later join joyously in agreement. The
others will follow him, and you will thus win
them to your side: it provides the servile soul
sweet peace to be in harmony with power.
For all intriges, conspiracies, and plots use a
person with the resistence of a jellyfish, the
upright posture of a wurm, and the conscience
of one who would murder his mother. Let him,
controlled and guided by you, do his illdeeds
and then denounce him loudly, immediately,
and fiercely, when his connivances, which can-
not be seen as Yours, are admonished. Reward
this man with the most vulgar that this world
has to offer - with money. But never let him
rise in prestige; one makes use of villians, but
does not love and honour them.
If You will insure the loyalty of Your subor-
dinate physicians, then make an assertion
which you claim to be unquestinable, to be
Your Truth - be it ever so fallacious! Refer to
this assertion as a Vision of the Future - thus
all who are so clever as to see the fallacy and
refute You can be denounced as enemies of
advancement.
If you admit a new Physician to your circle,
then win him over with flattery and the promise
of auspicious prospects. When, however, You
have brought him to Your side, then break and
renew Your promises quickly and often: this
will rob him of his confidence and render him
servile. Use murky accusations of other phy-
sicians to take him into Your confidance; he
will consider your lies as revelation.
Perhaps you wunder why I have yet to address
the patients whose care is Your calling. But you
will perceive that, for you, they can only be the
base upon which You stand and standout, only
the ground from which Your fruits grow. You
should strive to amass a fortune: this should
be the prime among Your endevours. Fortune
renders You free and independant. But guard
Yourself against a reputation for being miserly
by occasional rewards to Your subordinates,
which, however, are so measured that they do
not burden you. You may be miserly, but no
man should be able to accuse You of this.
If You take this advice to heart and follow this
path, then Your desire to be considered the
first among Your equals will be fulfilled among
people of Your kind. But I cannot conceal from
You that this path also bears disadvantages:
Inevitably such a system will engender more
and more physicians whose characters must be
worse than Yours. But this will not torment
you, since it is not your aim to serve the Gen-
eral Good, but rather to serve Yourself.
And now, live well!
Set down in San Cascanio on this 23rd day of
April in the year 1521.
Postscriptum
What I have not revealed in my writings is this:
I have set down the principles and maximes of
ruling and being ruled without judging or at-
taching values to them. This does not at all
mean that I do not have my own judgement of
such men who follow these rules: I believe then
to be ... [end of the text fragment]
Published by D. V., translated by B. Wall-
brecher.
Neurosurg. Rev. 16 (1993)