Heritage: The Story of St. Mary's Hospital, 1880-1980
By Leo G. Bryne and Sister Alberta Cammack, C.S.J
Chapter III Contemporary St. Mary's
The study of the brain's electrical activity has been made possible by the Electroencephalograph (EEG). It is a diagnostic key which helps confirm a variety of brain disorders. In 1952, when St. Mary's opened its brain wave laboratory, EEG was the latest in diagnostic techniques. It is used primarily in the study of infectious diseases of the nervous system, head injuries, cerebral vascular accidents (strokes), epilepsy and brain tumors. It can also contribute as an indicator of brain function in metabolic disorders and in the evaluation of organic causes of psychiatric problems and behavioral and adjustment problems in children. In the case of epilepsy, it is the test that determines the diagnosis, and, with other brain problems, it provides valuable information to the physician. More recently, EEG has come to play an important role in the evaluation of carotid endarterectomies in surgery and all-night sleep recordings for patients who stop breathing for short periods during sleep.
By far the most critical application of the EEG data relates to the determination of brain death and the decisions made relating to the removal of life support systems. There are woeful misunderstandings of the criteria justifying this definitive determination. The electrocerebral inactivity examination requires absolute precision, and it must be done according to strict procedures There must be at least two recordings 24-hours apart. Brain death determination requires more than just a flat EEG. The patient must be incapable of maintaining heartbeat or breathing on his own, unassisted by a respirator; and there can be no cerebral reflexes of any kind such as reaction to pain, light or sound.
The procedure is concerned with total brain death in contrast with a view of some who claim that human death should be related to the cessation of functions distinctly human. At present it is not possible to define these distinctly human functions unrelated to the brain's total activity, and if such criteria were accepted, the way would be open for the elimination of those in a deep coma, and in certain conditions, those who are retarded, senile, infirm and debilitated, as is advocated by the Euthanasia Educational Council of America. It is the same reasoning that concludes that a fetus is not a person even though the capabilities of higher functioning are present.
The brain is considered alive and the organism distinctly human as long as the person is able to maintain breathing and heartbeat unassisted, even though not evidencing higher functions, such as response to outside stimulus. A flat EEG is but one of the criteria in determining total brain death, and the technologist who takes the EEG recordings is keenly aware of the responsibilities inherent in such testing procedures.
Two other diagnostic procedures related to brain tumors and circulatory insufficiency are done by this department: Echoencephalography and the Ocular Pulse Study. Echoencephalography, using pulsed ultrasound, detects space-occupying lesions which cause a shift to the left or right of the brain structure. The Ocular Pulse Procedure, since developed by Mark Kartchner, M.D., and Lorin McRae, Ph.D., of Tucson, is proving to be a unique method for detecting stroke potential in patients with carotid stenosis or blockage of specific neck arteries. The test, given by means of contact lenses placed on the eyes and electrodes connected to the ear lobes, takes about fifteen minutes. Comparison of eye and ear pulse has significantly indicated stroke potential in 90 percent of the cases examined.
Continue with Chapter III: Contemporary St. Mary's Pharmacy