Translated by Francis Adams
PART 1
Men'S heads are by no means all like to one another, nor are the sutures
of the head of all men constructed in the same form. Thus, whoever has
a prominence in the anterior part of the head (by prominence is meant the
round protuberant part of the bone which projects beyond the rest of it),
in him the sutures of the head take the form of the Greek letter tau, T;
for the head has the shorter line running transverse before the prominence,
while the other line runs through the middle of the head, all the way to
the neck. But whoever has the prominence in the back part of the head,
in him the sutures are constructed in quite the opposite form to the former;
for in this case the shorter line runs in front of the prominence, while
the longer runs through the middle all along to the forehead. But whoever
has a prominence of the head both before and behind, in him the sutures
resemble the Greek letter eta E; for the long lines of the letter run transverse
before each prominence while the short one runs through the middle and
terminates in the long lines. But whoever has no prominence on either part
he has the sutures of the head resembling the Greek letter chi; for the
one line comes transverse to the temple while the other passes along the
middle of the head. The bone at the middle of the head is double, the hardest
and most compact part being the upper portion, where it is connected with
the skin, and the lowest, where it is connected with the meninx (dura mater);
and from the uppermost and lowermost parts the bone gradually becomes softer
and less compact, till you come to the diploe. The diploe is the most porous,
the softest, and most cavernous part. But the whole bone of the head, with
the exception of a small portion of the uppermost and lowermost portions
of it, is like a sponge; and the bone has in it many juicy substances,
like caruncles; and if one will rub them with the fingers, some blood will
issue from them. There are also in the bone certain very slender and hollow
vessels full of blood. So it is with regard to hardness, softness, and
porosity.
PART 2
In respect to thickness and thinness; the thinnest and weakest part
of the whole head is the part about the bregma; and the bone there has
the smallest and thinnest covering of flesh upon it, and the largest proportion
of brain is situated in that region of the head. And hence it happens that
from similar or even smaller wounds and instruments, when a person is wounded
to the same or a less degree, the bone of the head there is more contused,
fractured, and depressed; and that injuries there are more deadly and more
difficult to cure; and it is more difficult to save one's life in injuries
there than in any other part of the head; that from having sustained a
similar or even a less wound a man will die, and that, too, in a shorter
space of time than from a wound in any other part of the head. For the
brain about the bregma feels more quickly and strongly any mischief that
may occur to the flesh or the bone; for the brain about the bregma is in
largest quantity, and is covered by the thinnest bone and the least flesh.
Of the other portions, the weakest is that about the temples; for it is
the conjunction of the lower jaw with the cranium, and there is motion
there up and down as at a joint; and the organ of hearing is near it; and
further, a hollow and important vein runs along the temple. But the whole
bone of the head behind the vertex and the ear is stronger than the whole
anterior part, and the bone itself has a larger and deeper covering of
flesh upon it. And hence it follows, that when exposed to the same or even
greater injuries from instruments of the same or greater size, the bone
is less liable to be fractured and depressed than elsewhere; and that in
a fatal accident the patient will live longer when the wound is in the
posterior part of the head than when elsewhere; and that pus takes longer
time to form and penetrate through the bone to the brain, owing to the
thickness of the bone; and moreover, as there is less brain in that part
of the head, more persons who are wounded in the back part of the head
escape than of those who wounded in the anterior part. And in fatal cases,
a man will survive longer in winter than in summer, whatever be the part
of the head in which the wound is situated.
PART 3
As to the haedrae (dints or marks?) of sharp and light weapons, when
they take place in the bone without fissure, contusion, or depression inwards
(and these take place equally in the anterior and posterior part of the
head), death, when it does occur, does not properly result from them. A
suture appearing in a wound, when the bone is laid bare, on whatever part
of the head the wound may have been inflicted, is the weakest point of
the head to resist a blow or a weapon, when the weapon happens to be impinged
into the suture itself; but more especially when this occurs in the bregma
at the weakest part of the head, and the sutures happen to be situated
near the wound, and the weapon has hit the sutures themselves.
PART 4
The bone in the head is liable to in the following modes, and there
are many varieties in each of these modes of fracture: When a wounded bone
breaks, in the bone comprehending the fissure, contusion necessarily takes
place where the bone is broken; for an instrument that breaks the bone
occasions a contusion thereof more or less, both at the fracture and in
the parts of the bone surrounding the fracture. This is the first mode.
But there are all possible varieties of fissures; for some of them are
fine, and so very fine that they cannot be discovered, either immediately
after the injury, or during the period in which it would be of use to the
patient if this could be ascertained. And some of these fissures are thicker
and wider, certain of them being very wide. And some of them extend to
a greater, and some to a smaller, distance. And some are more straight,
nay, completely straight; and some are more curved, and that in a remarkable
degree. And some are deep, so as to extend downwards and through the whole
bone; and some are less so, and do not penetrate through the whole bone.
PART 5
But a bone may be contused, and yet remain in its natural condition
without any fracture in it; this is the second mode. And there are many
varieties of contusion; for they occur to a greater or less degree, and
to a greater depth, so as sometimes to extend through the whole bone; or
to a less depth, so as not to extend through the whole bone; and to a greater
and smaller length and breadth. But it is not possible to recognize any
of these varieties by the sight, so as to determine their form and extent;
neither, indeed, is it visible to the eyes when any mischief of this kind
takes place, and immediately after the injury, whether or not the bone
has been actually bruised, as is likewise the case with certain fractures
at a distance from the seat of injury.
PART 6
And the bone being fractured, is sometimes depressed inwards from its
natural level along with the fractures, otherwise there would be no depression;
for the depressed portion being fractured and broken off, is pushed inwards,
while the rest of the bone remains in its natural position; and in this
manner a fracture is combined with the depression. This is the third mode.
There are many varieties of depression, for it may comprehend a greater
and a small extent of bone, and may either be to a greater depth, or less
so, and more superficial.
PART 7
When a hedra, or dint of a weapon, takes place in a bone, there may
be a fracture combined with it; and provided there be a fracture, contusion
must necessarily be joined, to a greater or less extent, in the seat of
the dint and fracture, and in the bone which comprehends them. This is
the fourth mode. And there may be a hedra, or indentation of the bone,
along with contusion of the surrounding bone, but without any fracture
either in the hedra or in the contusion inflicted by the weapon. But the
indentation of a weapon takes place in a bone, and is called hedra, when
the bone remaining in its natural state, the weapon which struck against
the bone leaves its impression on the part which it struck. In each of
these modes there are many varieties, with regard to the contusion and
fracture, if both these be combined with the hedra, or if contusion alone,
as it has been already stated that there are many varieties of contusion
and fracture. And the hedra, or dint, of itself may be longer and shorter,
crooked, straight, and circular; and there are many varieties of this mode,
according to the shape of the weapon; and they may be more or less deep,
and narrower or broader, and extremely broad. When a part is cleft, the
cleft or notch which occurs in the bone, to whatever length or breadth,
is a hedra, if the other bones comprehending the cleft remain in their
natural position, and be not driven inwards; for in this case it would
be a depression, and no longer a hedra.
PART 8
A bone may be injured in a different part of the head from that on which
the person has received the wound, and the bone has been laid bare. This
is the fifth mode. And for this misfortune, when it occurs, there is no
remedy; for when this mischief takes place, there is no means of ascertaining
by any examination whether or not it has occurred, or on what part of the
head.
PART 9
Of these modes of fracture, the following require trepanning: the contusion,
whether the bone be laid bare or not; and the fissure, whether apparent
or not. And if, when an indentation (hedra) by a weapon takes place in
a bone it be attended with fracture and contusion, and even if contusion
alone, without fracture, be combined with the indentation, it requires
trepanning. A bone depressed from position rarely requires trepanning;
and those which are most pressed and broken require trepanning the least;
neither does an indentation (hedra) without fracture and contusion require
trepanning; nor does a notch, provided it is large and wide; for a notch
and a hedra are the same.
PART 10
In the first place, one must examine the wounded person, in what part
of the head the wound is situated, whether in the stronger or weaker parts;
and ascertain respecting the hairs about the wound, whether they have been
cut off by the instrument, and have gone into the wound; and if so, one
should declare that the bone runs the risk of being denuded of flesh, and
of having sustained some injury from the weapon. These things one should
say from a distant inspection, and before laying a hand on the man; but
on a close examination one should endeavor to ascertain clearly whether
the bone be denuded of flesh or not; and if the denuded bone be visible
to the eyes, this will be enough; but otherwise an otherwise an examination
must be made with the sound. And if you find the bone denuded of the flesh,
and not safe from the wound, you must first ascertain the state of the
bone, and the extent of the mischief, and of what assistance it stands
in need. One should also inquire of the wounded person how and in what
way he sustained the injury; and if it be not apparent whether the bone
has sustained an injury or not, it will be still more necessary, provided
the bone be denuded, to make inquiry how the wound occurred, and in what
manner; for when contusions and fractures exist in the bone, but are not
apparent, we must ascertain, in the first place from the patient's answers,
whether or not the bone has sustained any such injuries, and then find
out the nature of the case by word and deed, with the exception of sounding.
For sounding does not discover to us whether the bone has sustained any
of these injuries or not; but sounding discovers to us an indentation inflicted
by a weapon, and whether a bone be depressed from its natural position,
and whether the bone be strongly fractured; all which may also be ascertained
visibly with the eyes.
PART 11
And a bone sustains fractures, either so fine as to escape the sight,
or such as are apparent, and contusions which are not apparent, and depression
from its natural position, especially when one person is intentionally
wounded by another, or when, whether intentionally or not, a blow or stroke
is received from an elevated place, and if the instrument in the hand,
whether used in throwing or striking, be of a powerful nature, and if a
stronger person wound a weaker. Of those who are wounded in the parts about
the bone, or in the bone itself, by a fall, he who falls from a very high
place upon a very hard and blunt object is in most danger of sustaining
a fracture and contusion of the bone, and of having it depressed from its
natural position; whereas he that falls upon more level ground, and upon
a softer object, is likely to suffer less injury in the bone, or it may
not be injured at all. Of those instruments which, falling upon the head,
wound the parts about the bone, or the bone itself, that which falls from
a very high place, and the least on a level with the person struck, and
which is at the same time very hard, very blunt, and very heavy, and which
is the least light, sharp, and soft, such an instrument would occasion
a fracture and contusion of the bone. And there is most danger that the
bone may sustain these injuries, under such circumstances, when the wound
is direct and perpendicular to the bone, whether struck from the hand or
from a throw, or when any object falls upon the person, or when he is wounded
by falling, or in whatever way the bone sustains a direct wound from this
instrument. Those weapons which graze the bone obliquely are less apt to
fracture, contuse, or depress the bone, even when the bone is denuded of
flesh; for in some of those wounds thus inflicted the bone is not laid
bare of the flesh. Those instruments more especially produce fractures
in the bone, whether apparent or not, and contusions, and inward depression
of the bone, which are rounded, globular, smooth on all sides, blunt, heavy,
and hard; and such weapons bruise, compress, and pound the flesh; and the
wounds inflicted by such instruments, whether obliquely or circularly,
are round, and are more disposed to suppurate, and to have a discharge,
and take longer time to become clean; for the flesh which has been bruised
and pounded must necessarily suppurate and slough away. But weapons of
an oblong form, being, for the most part, slender, sharp, and light, penetrate
the flesh rather than bruise it, and the bone in like manner; and such
an instrument may occasion a hedra and a cut (for a hedra and a cut are
same thing); but weapons of this description do not produce contusions,
nor fractures, nor depressions inwardly. And in addition the appearances
in the bone, which you call detect by the sight, you should make inquiry
as to all these particulars (for they are symptoms of a greater or less
injury), whether the wounded person was stunned, and whether darkness was
diffused over his eyes, and whether he had vertigo, and fell to the ground.
PART 12
When the bone happens to be denuded of flesh by the weapon, and when
the wound occurs upon the sutures, it is difficult to distinguish the indentation
(hedra) of a weapon which is clearly recognized in other parts of the bone,
whether it exist or not, and especially if the hedra be seated in the sutures
themselves. For the suture being rougher than the rest of the bone occasions
confusion, and it is not clear which is the suture, and which the mark
inflicted by the instrument, unless the latter (hedra) be large. Fracture
also for the most part is combined with the indentation when it occurs
in the sutures; and this fracture is more difficult to discern when the
bone is broken, on this account, that if there be a fracture, it is situated
for the most part in the suture. For the bone is liable to be broken and
slackened there, owing to the natural weakness of the bone there, and to
its porosity, and from the suture being readily ruptured and slackened:
but the other bones which surround the suture remain unbroken, because
they are stronger than the suture. For the fracture which occurs at the
suture is also a slackening of the suture, and it is not easy to detect
whether the bone be broken and slackened by the indentation of a weapon
occurring in the suture, or from a contusion of the bone at the sutures;
but it is still more difficult to detect a fracture connected with contusion.
For the sutures, having the appearance of fissures, elude the discernment
and sight of the physician, as being rougher than the rest of the bone,
unless the bone be strongly cut and slackened (for a cut and a hedra are
the same thing). But it is necessary, if the wound has occurred at the
sutures, and the weapon has impinged on the bone or the parts about it,
to pay attention and find out what injury the bone has sustained. For a
person wounded to the same, or a much smaller, extent, and by weapons of
the same size and quality, and even much less, will sustain a much greater
injury, provided he has received the blow at the sutures, than if it was
elsewhere. And many of these require trepanning, but you must not apply
the trepan to the sutures themselves, but on the adjoining bone.
PART 13
And with regard to the cure of wounds in the head, and the mode of detecting
injuries in the bone which are not apparent, the following is my opinion:—In
a wound of the head, you must not apply anything liquid, not even wine,
but as little as possible, nor a cataplasm, nor conduct the treatment with
tents, nor apply a bandage to an ulcer on the head, unless it be situated
on the forehead, in the part which is bare of hairs, or about the eyebrow
and eye, for wounds occurring there require cataplasms and bandages more
than upon any other part of the head. For the rest of the head surrounds
the whole forehead, and the wounds wherever situated become inflamed and
swelled, owing to an influx of blood from surrounding parts. And neither
must you apply cataplasms and bandages to the forehead at all times; but
when the inflammation is stopped and the swelling has subsided, you must
give up the cataplasms and bandages. A wound in any other part of the head
must not be treated with tents, bandages, or cataplasms, unless it also
requires incision. You must perform incision on wounds situated on the
head and forehead, whenever the bone is denuded of flesh, and appears to
have sustained some injury from the blow, but the wound has not sufficient
length and breadth for the inspection of the bone, so that it may be seen
whether it has received any mischief from the blow, and of what nature
the injury is, and to what extent the flesh has been contused, and whether
the bone has sustained any injury, or whether it be uninjured by the blow,
and has suffered no mischief; and with regard to the treatment, what the
wound, and the flesh, and the injury of the bone stand in need of. Ulcers
of this description stand in need of incision; and, if the bone be denuded
of the flesh, and if it be hollow, and extend far obliquely, we cut up
the cavity wherever the medicine cannot penetrate readily, whatever medicine
it may be; and wounds which are more inclined to be circular and hollow,
and for the most part others of the like shape, are cut up by making double
incision in the circle lengthways,, according to the figure of the man,
so as to make the wound of a long form. Incisions may be practiced with
impunity on other parts of the head, with the exception of the temple and
the parts above it, where there is a vein that runs across the temple,
in which region an incision is not to be made. For convulsions seize on
a person who has been thus treated; and if the incision be on the left
temple, the convulsions seize on the right side; and if the incision be
on the right side, the convulsions take place on the left side.
PART 14
When, then, you lay open a wound in the head on account of the bones
having been denuded of the flesh, as wishing to ascertain whether or not
the bone has received an injury from the blow, you must make an incision
proportionate to the size of the wound, and as much as shall be judged
necessary. And in making the incision you must separate the flesh from
the bone where it is united to the membrane (pericranium?) and to the bone,
and then fill the whole wound with a tent, which will expand the wound
very wide next day with as little pain as possible; and along with the
tents apply a cataplasm, consisting of a mass (maza) of fine flour pounded
in vinegar, or boiled so as to render it as glutinous as possible. On the
next day, when you remove the tent, having examined the bone to see what
injury it has sustained, if the wound in the bone be not right seen by
you, nor can you discover what mischief the bone itself has sustained,
but the instrument seems to have penetrated to the bone so as to have injured
it, you must scrape the bone with a raspatory to a depth and length proportionate
to the suture of the patient, and again in a transverse direction, for
the sake of the fractures which are not seen, and of the contusions which
are not discovered, as not being accompanied with depression of the bone
from its natural position. For the scraping discovers the mischief, if
the injuries in the bone be not otherwise manifest. And if you perceive
an indentation (hedra) left in the bone by the blow, you must scrape the
dint itself and the surrounding bones, lest, as often happens, there should
be a fracture and contusion, or a contusion alone, combined with the dint,
and escape observation. And when you scrape the bone with the raspatory,
and it appears that the wound in the bone requires the operation, you must
not postpone it for three days, but do it during this period, more especially
if the weather be hot, and you have had the management of the treatment
from commencement. If you suspect that the bone is broken or contused,
or has sustained both these injuries, having formed your judgement from
the severity of the wound, and from the information of the patient, as
that the person who inflicted the wound, provided it was done by another
person, was remarkably strong, and that the weapon by which he was wounded
was of a dangerous description, and then that the man had been seized with
vertigo, dimness of vision, and stupor, and fell to the ground,— under
these circumstances, if you cannot discover whether the bone be broken,
contused, or both the one and the other, nor can see the truth of the matter,
you must dissolve the jet-black ointment, and fill the wound with it when
this dissolved, and apply a linen rag smeared with oil, and then a cataplasm
of the maza with a bandage; and on the next day, having cleaned out the
wound, scrape the bone with the raspatory. And if the bone is not sound,
but fractured and contused, the rest of it which is scraped will be white;
but the fracture and contusion, having imbibed the preparation, will appear
black, while the rest of the bone is white. And you must again scrape more
deeply the fracture where it appears black; and, if you thus remove the
fissure, and cause it to disappear, you may conclude that there has been
a contusion of the bone to a greater or less extent, which has occasioned
the fracture that has disappeared under the raspatory; but it is less dangerous,
and a matter of less consequence, when the fissure has been effaced. But
if the fracture extend deep, and do not seem likely to disappear when scraped,
such an accident requires trepanning. But having performed this operation,
you must apply the other treatment to the wound.
PART 15
You must be upon your guard lest the bone sustain any injury from the
fleshy parts if not properly treated. When the bone has been sawed and
otherwise denuded, whether it be actually sound, or only appears to be
so, but has sustained some injury from the blow, there may be danger of
its suppurating (although it would not otherwise have done so), if the
flesh which surrounds the bone be ill cured, and become inflamed and strangled;
for it gets into a febrile state, and becomes much inflamed. For the bone
acquires heat and inflammation from the surrounding flesh, along with irritation
and throbbing, and the other mischiefs which are in the flesh itself, and
from these it gets into a state of suppuration. It is a bad thing for the
flesh (granulations?) in an ulcer to be moist and mouldy, and to require
a long time to become clean. But the wound should be made to suppurate
as quickly as possible; for, thus the parts surrounding the wound would
be the least disposed to inflammation, and would become the soonest clean;
for the flesh which has been chopped and bruised by the blow, must necessarily
suppurate and slough away. But when cleaned the wound must be dried, for
thus the wound will most speedily become whole, when flesh devoid of humors
grows up, and thus there will be no fungous flesh in the sore. The same
thing applies to the membrane which surrounds the brain: for when, by sawing
the bone, and removing it from the meninx, you lay the latter bare, you
must make it clean and dry as quickly as possible, lest being in a moist
state for a considerable time, it become soaked therewith and swelled;
for when these things occur, there is danger of its mortifying.
PART 16
A piece of bone that must separate from the rest of the bone, in consequence
of a wound in the head, either from the indentation (hedra) of a blow in
the bone, or from the bone being otherwise denuded for a long time, separates
mostly by becoming exsanguous. For the bone becomes dried up and loses
its blood by time and a multiplicity of medicines which are used; and the
separation will take place most quickly, if one having cleaned the wound
as quickly as possible will next dry it, and the piece of bone, whether
larger or smaller. For a piece of bone which is quickly dried and converted,
as it were, into a shell, is most readily separated from the rest of the
bone which retains its blood and vitality; for, the part having become
exsanguous and dry, more readily drops off from that which retains its
blood and is alive.
PART 17
Such pieces of bone as are depressed from their natural position, either
being broken off or chopped off to a considerable extent, are attended
with less danger, provided the membrane he safe; and bones which are broken
by numerous and broader fractures are still less dangerous and more easily
extracted. And you must not trepan any of them, nor run any risks in attempting
to extract the pieces of bone, until they rise up of their own accord,
upon the subsidence of the swelling. They rise up when the flesh (granulations)
grows below, and it grows from the diploe of the bone, and from the sound
portion, provided the upper table alone be in a state of necrosis. And
the flesh will shoot up and grow below the more quickly, and the pieces
of bone ascend, if one will get the wound to suppurate and make it clean
as quickly as possible. And when both the tables of the bone are driven
in upon the membrane, I mean the upper and lower, the wound, if treated
in the same way, will very soon get well, and the depressed bones will
quickly rise up.
PART 18
The bones of children are thinner and softer, for this reason, that
they contain more blood [than those of adults]; and they are porous and
spongy, and neither dense nor hard. And when wounded to a similar or inferior
degree by weapons of the same or even of an inferior power, the bone of
a young person more readily and quickly suppurates, and that in less time
than the bone of an older person; and in accidents, which are to prove
fatal, the younger person will die sooner than the elder. But if the bone
is laid bare of flesh, one must attend and try to find out, what even is
not obvious to the sight, and discover whether the bone be broken and contused,
or only contused; and if, when there is an indentation in the bone, whether
contusion, or fracture, or both be joined to it; and if the bone has sustained
any of these injuries, we must give issue to the blood by perforating the
bone with a small trepan, observing the greatest precautions, for the bone
of young persons is thinner and more superficial than that of elder persons.
PART 19
When a person has sustained a mortal wound on the head, which cannot
be cured, nor his life preserved, you may form an opinion of his approaching
dissolution, and foretell what is to happen from the following symptoms
which such a person experiences. When a bone is broken, or cleft, or contused,
or otherwise injured, and when by mistake it has not been discovered, and
neither the raspatory nor trepan has been applied as required, but the
case has been neglected as if the bone were sound, fever will generally
come on if in winter, and in summer the fever usually seizes after seven
days. And when this happens, the wound loses its color, and the inflammation
dies in it; and it becomes glutinous, and appears like a pickle, being
of a tawny and somewhat livid color; and the bone then begins to sphacelate,
and turns black where it was white before, and at last becomes pale and
blanched. But when suppuration is fairly established in it, small blisters
form on the tongue and he dies delirious. And, for the most part, convulsions
seize the other side of the body; for, if the wound be situated on the
left side, the convulsions will seize the right side of the body; or if
the wound be on the right side of the head, the convulsion attacks the
left side of the body. And some become apoplectic. And thus they die before
the end of seven days, if in summer; and before fourteen, if in winter.
And these symptoms indicate, in the same manner, whether the wound be older
or more recent. But if you perceive that fever is coming on, and that any
of these symptoms accompany it, you must not put off, but having sawed
the bone to the membrane (meninx), or scraped it with a raspatory (and
it is then easily sawed or scraped), you must apply the other treatment
as may seem proper, attention being paid to circumstances.
PART 20
When in any wound of the head, whether the man has been trepanned or
not, but the bone has been laid bare, a red and erysipelatous swelling
supervenes in the face, and in both eyes, or in either of them, and if
the swelling be painful to the touch, and if fever and rigor come on, and
if the wound look well, whether as regards the flesh or the bone, and if
the parts surrounding the wound be well, except the swelling in the face,
and if the swelling be not connected with any error in the regimen, you
must purge the bowels in such a case with a medicine which will evacuate
bile; and when thus purged the fever goes off, the swelling subsides, and
the patient gets well. In giving the medicine you must pay attention to
the strength of the patient.
PART 21
With regard to trepanning, when there is a necessity for it, the following particulars should be known. If you have had the management of the case from the first, you must not at once saw the bone down to the meninx; for it is not proper that the membrane should be laid bare and exposed to injuries for a length of time,as in the end it may become it may become fungous. And and there is another danger if you saw the bone down to the meninx and remove it at once, lest in the act of sawing you should wound the meninx. But in trepanning, when only a very little of the bone remains to be sawed through, and the bone can be moved, you must desist from sawing, and leave the bone to fall out of itself. For to a bone not sawed through, and where a portion is left of the sawing, no mischief can happen; for the portion now left is sufficiently thin. In other respects you must conduct the treatment as may appear suitable to the wound. And in trepanning you must frequently remove the trepan, on account of the heat in the bone, and plunge it in cold water. For the trepan being heated by running round, and heating and drying the bone, burns it and makes a larger piece of bone around the sawing to drop off, than would otherwise do. And if you wish to saw at once down to the membrane, and then remove the bone, you must also, in like manner, frequently take out the trepan and dip it in cold water. But if you have not charge of the treatment from the first, but undertake it from another after a time, you must saw the bone at once down to the meninx with a serrated trepan, and in doing so must frequently take out the trepan and examine with a sound (specillum), and otherwise along the tract of the instrument. For the bone is much sooner sawn through, provided there be matter below it and in it, and it often happens that the bone is more superficial, especially if the wound is situated in that part of the head where the bone is rather thinner than in other parts. But you must take care where you apply the trepan, and see that you do so only where it appears to be particularly thick, and having fixed the instrument there, that you frequently make examinations and endeavor by moving the bone to bring it up. Having removed it, you must apply the other suitable remedies to the wound. And if, when you have the management of the treatment from the first, you wish to saw through the bone at once, and remove it from the membrane, you must, in like manner, examine the tract of the instrument frequently with the sound, and see that it is fixed on the thickest part of the bone, and endeavor to remove the bone by moving it about. But if you use a perforator (trepan?), you must not penetrate to the membrane, if you operate on a case which you have had the charge of from the first, but must leave a thin scale of bone, as described in the process of sawing.
End of Etext On Injuries of the Head by Hippocrates
Return to www.BrainFly.Net