The Frenche chirurgerye, or all the manualle operations of chirurgerye , vvith divers, & sundrye figures, and amongst the rest, certayne nuefovvnde instrumentes, verye necessarye to all the operationes of chirurgerye. Through Iaques Guillemeau, of Orleans ordinarye chirurgiane to the Kinge, and sworen in the citye of Paris. And novv truelye translated out of Dutch into Englishe by A.M.

THE SECONDE TREATISE OF THE OPE∣ratione of Chyrurgerye, wherin is discoursed, of the meanes, hovve to Trepane the Cranium, of the Heade, Contayninge sixe Chapiters. (Book 2)

• Of the signes & tokens by the vvhich vve may knovve vvhen ther is a Fracture in the Heade. Chap. 1.
• Of the counterfracture, of the sculle. Chap, 2.
• VVhich Fractures vve ought to trepane. Chap. 3.
• Hovv longe, vve ought to tarrye, before vvee proceede vvith the trepane. Chap. 4.
• Hovv greate a quantitye of bone, vve ought to take therout. Chap. 5.
• The manner, and methode of trepaninge. Chap. 6.

❧Of the tokens, throughe the which, we shal kno∣we the fractures, of the sculle. Cap. 1.

* 1.1THe operations of Chyrurge∣rye, vvhich vvith greate pru∣dence, & consideratione, vvil∣be effected, vve must not all to rashlye or overbouldlye be∣ginne them seinge, therfore that it is daungerous, to open the Cranium of the heade, before vve may attayne vnto the operatione, vve must dilligentlye and truelye consider, vvhether it be verye necessarye, or not, vvhich is revealed vnto vs, by those sig∣nes and tokens vvhich the auncient Chyrur∣gianes have beqveathed vnto vs: For the sig∣ne or token, is the demonstratione vnto vs, vvhich discovereth, that vvhich before laye occulte, & hidden: The vvhich fore sayed to∣kens, of the vvounded parte, muste be taken, and observed, ether of the accidents vvhich chaunce vnto the vvounde, after the blovve, or fall, or allsoe of the instrumēt, vvhervvith the vvounde vvas made.

VVe must therfore first of all note,* 1.2 vvhich parte of the heade, hath receaved the strok & namelye, vvhether the Cranium, one this place be thin, or tender, thicke or stronge, because the bones of the heade, are not in all places of aequalle crassitude, or of aequall tenuitye: 〈◊〉〈◊〉 ther vve must marke, vvhether the vveapōs, vvhervvith the blovve vvas given, have all∣soe cut of the hayre, & that it shevveth it selfe right in the vvounde for if it be soe, it is to be∣feared, that the bone is bared or vncovered, out of the vvhich vve may easylye iudge, the Cranium to be hurte, because that it is all most impossible, the hayre to be cut throughe, the

vvhich for the most parte slippeth asyde, vvith out hurtinge of the Cranium or breakinge ther of. Havinge thus considered and noted all this vve must interrogate the patient, vvhether he have parbraked & vomited anye Cholera, vvhe¦ther he loste not his sight, and his eyes darcke∣ned, vvhether he lost not his speeche, or hath voyded anye bloode through his nose, throu∣ghe his eares, or throughe his mouthe, vvhe∣ther after the blovve he fell not dovvne to the earth, and ther lay still, vvithout anye reason, as if he hadd bīne one sleepe: For it is impossi∣ble that all these fore sayed signes chaunce vn∣lesse the scull vvere dilaniate, or brokē. In like sorte if the patient, lye vvithout his memorye or reason, if he rage, if he be vexed vvith Parali∣sis,* 1.3 or vvith Spasmo, or vvith them both toge∣ther, it is then credulous, that the Membrana called Dura Mater, is hurte, and suffereth grea∣te payne. And althoughe that none of these accidentes have happened vnto the patient, yet notvvithstandinge all vvayes theris som∣thinge doubtfull, vvhether the Cranium be hurte & broken, or not: and to be therof cer∣tifyed vve are to note, vvith vvhat instrument the vvound vvas made, as ether vvith a stone, vvith a sticke, vvith an iron, or vvith anye o∣ther vveapons: also vvhether it vvear greate, or reasonable greate, light or heavye, smooth or rugged, vvhether the blovve vvas smitten violentlye, or easylye, vvith greath ire, & fu∣rye, vpvvardes or dovvnevvardes: of all the vvhich vve may be certifyed of by the patiēte, vvhen as vve aske him on vvhat manner he vvas stroken, or from vvhence he is fallen, & vvherone, to vvit on the earthe, or on the pa∣vement, vvhether he have great payne, and in vvhat place, for hovv easyer the blovve hath bin stroken the lesse feare ther is of a broken scull: yet notvvithstandinge, there is nothinge surer,* 1.4 as Celsus sayeth, thē that vve search the vvounde, & give iudgement throughe a more surer signe, vvherfore, if soe be, the vvounde be greate enoughe, vve must as then search it vvith the finger, scrapīge the bone vvith your nayle, one that manner to perceave the rēte, and dilaceratione, and if soe be vve can not ef∣fect that vvith the finger, vve must as thē trye it vvith the searchinge iron, vvhich must not be to grosse and thicke, nether to sharpe and thinne, because, if that per adventure vve per∣ceaved anye naturall hollovvnes of the scul∣le,* 1.5 vve should not thincke & esteeme it to be a dilaceratione, or fracture: nether must the privet or searchinge iron be to thicke, or gros∣se, because it should not praetermit & overru∣ne a little or smalle dilaceratione, vvithout perceavinge it, and stayinge ther at. VVhen as therfore vve leade and perfricate the privet or searchinge iron over the sculle, & perceave noe vnsmothnes, then all even, and smothe, then vve saye & esteeme the sculle to be vvith out daunger, & not dilacerated or torne. But if so be vve perceave anye thinge, vvhich is rugged and vneven, and that the searchinge iron stādeth therat faste, if soe be, it be not on the sutures or commissures, and ioyninge of the sculle, or anye naturall cōcavitye hollovv¦nes of the Cranium, it is then a signe, that the heade is broken, or lacerated, and rent vvher∣fore the Chyrurgiane must dilligentlye mar∣ke, that he doe not in steede of the fracture, ta∣ke the suture, because that those cōmissures,* 1.6 often times doe deceave the sight of the Chy∣rurgiane in his iudgemente, and that as tou∣chinge the similitude, vvhich the commissu∣res, are participatīge vvith the fractures: And vve are to note, that in some persons, the fu∣tures have no naturall situatione, or place,* 1.7 but to the contrarye vve must also note, vvhe∣ther that ther be any dilaceratione one the fracture, or not: for it might chaunce, that the naturall similitude of a suture, might vvel be a rent or dilaceratione, vvhich is not soe easy∣lye to be perceaved, & knovvne, because that a suture consideringe her nature is vnsmothe and rugged, even as a dilaceratione is vvonte to be. VVherfore Hippocrates,* 1.8 acknovvledgeth to have binne deceaved, in the person of An∣tonomus, of Omilos, vvhoe beinge throvvne vvith a stone in the middest of his foreheade, and a boute the sutures, died vvithin the space of fifteene dayes therafter, because that he vvas not trepayned, and because alsoe the fo∣resayed Hippocrates, thought and iudged the skull not to be dilaniated or torne. VVherfo∣re, it is the surest, and certaynest vvay, & prin∣cipallye, vvhen by, or in the vvounde ther are these foresayed accidentes, vvith agues, that as then vve denudate, and vncover the sculle, be∣cause the sutures sometimes have no certay∣ne place, for sometimes vve espye thē, in the middest of anye bone, vvhich a man vvoulde thincke to be a fracture or dilaceratione: it might alsoe chaūce that the foresayed sutures, or the next partes, vnto the same,* 1.9 might be dilacerated and torne, the vvhich vve can not certaynlye espye, vvithout makinge denuda∣tione of the Cranium, and to our sight vncover it: vvhen as therfore vve doubt, vvhether ther be a fracture or fissure, and can not certaynlye espye it, because of the smallenes of the vvoū∣de, as then ther is lesse daunger, and the cure therof happeneth so much the sooner, & the surer, vvhen as therin vve make a resonable vvyde apertione, rather then beinge therof vncertayne, vve as yet proceede vvith such a small apertione, in curinge of the same vvoū∣de, because that it is vvholye impossible, other¦vvyse to knovve anye certayntye, of that

vvhich thervnder lyeth hidden, as vve easylye see in the greate apertions, vvhich therafter, may verye easilye be cured. It sometimes alsoe chaunceth, that the Cranium beinge sufficiētlye denudated rovvnde about the fissure, yet for all that vvith the tacture, or vvith the searchin∣ge iron, or vvith the eyes, vve can not by anye meanes possible espye the fissure or rente, be∣cause it is as subtile and fine,* 1.10 as a hayre, vvher∣fore it is allsoe called the hayrye fissure, or rēt: to the vvhich purpose vve must above on the sculle or bone, vvype a little incke, or anye o∣ther blacke medicamente, because that the ni∣greditye or blacknes, may imprint in the fissu∣re some signe of his blackenes, if soe be that ther be anye, vvhich bare bone, vve muste ther after scrape vvith an exfoliative trepane: For that vvhich is burst or rent, notvvithstandinge retayneth his blackenes, by the vvhich mea∣nes, vve shallbe certifyed of the largenes ther of and profunditye of the same.

❧ Of the counter fissure, in the bones of the heade. Chap. 2.

THe auncient Doctours, and all soe certayne professors of our time, make mentione, that vve somtimes finde a counter tea∣re or fissure in the sculle, as if vve had receaved a blovve in the occipitialle parte of the heade and had the teare or fissure in the antereore parte of the sa∣me and ther revealed it selfe, or in anye other parte of the heade also, vvheras the blovve did not alight.* 1.11 The coniecture vvhich vve ought to have of a counter fissure, is, that vve surelye knovve vvhether the patient vveare roughlye stroken, and vvhether after the blovve, anye bad accidētes have follovved, as if through the blovve he fell to the grovvnde, hath ther lien impotente, hath vomited Cholera, is full of a∣gues, although it soe be that vve can finde noe fissure in the Cranium in the place of the vvoun∣de, and ther vvher the scull is denudated. VVe must alsoe farther note, and observe, vvether the patient often times lay his hande, on anye other place of his heade, then vvher the vvoun¦de is, complayninge of anye payne or heavines of his heade: vve must one that place vvhich vve suspecte applye some Cephalicke plaster, vvhich vvhen vve remove, the same, vve must then note, vvhether anye one certayne place of the applicatiane, be moyster then in ano∣ther place, or els any vvher vnder the payster, the skinne be softened and a little more svvol∣lene, then the other, vvhich findinge it to be soe, it is thē a signe, that in the sculle ther must needes be a fissure, & that it is necessarye, there and in that place to denudate the Cranium: for somtimes vve finde the bone ther to be brokē: The aunciente Chirurgians have beyonde all this vvritten,* 1.12 that although vve have inscided the skinne, vvithout anye reason or occasio∣ne, it easylye and lightlye vvilbe agayne cured∣and if soe be that the sculle be dilaniated & tor∣ne, and vve havinge forgot to detecte & denu∣date the same ther immediatlye follovveth a great imflammatione, vvhich verye difficuttlye can be cured. But I as yet coulde never attayne to the knovvledge of such a fracture, nether can I perfectlye adhibite any credite thervnto that ther can by anye meanes chaunce to be such fissures shutt vp, and closed or ioyned on vvith the other and soe grovvne together, or beinge missinge of the broken bone vnto that, vvhich findeth it selfe in the fracture of the other syde, right over agaynst it. I have seene, that vvith the shott of a gunne, that the first table vvas vnhur¦te, and yet not vvithstandinge the seconde vvas crushed and broken, & vvhen I perceaved that the patient, had gotten manye bad accidentes, namelye, that throughe the blovve he fell to the grovvnde, had vomited, forth at his nose voy∣ded bloode, vvas vvholye abashed feelinge pay∣ne about the vvounde, havinge alsoe an ague: and fearinge least the patient might have dyed, I trepaned him, vvheras vvhen I had pearced the firste table I founde, that the seconde vvas burst, yea and that reasonable vvyde: vvherfore ther∣after I vvas vrged to beleeve that the counter teare or fissure, in the other syde of the sculle, vvhich by the aunciente professors vvas discri∣bed, must be vnderstoode in the same bone, for the first table, is right agaynst the seconde situa∣ted. It might alsoe chaunce that nether the first table nor the seconde shoulde be hurte, or bro∣ken, yet notvvithstanding the Diploe, that is the porositye vvhich is betvveene them bothe,* 1.13 vvas soe plettered & crushed, that the little vaynes, vvhervvith it vvas, replenished, vveare broke & burst and avoyded bloode from them vvhich in time corrupteth and rotteth and alsoe corrup∣teth the bone internallye, the vvhich in some ti∣me thereafter vve perceave, for the bone vvax∣eth leadishe coloured, on the vvhich the Chi∣rurgiane must vvell note.

It may allsoe chaunce, that the sculle, be safe and sounde, yet throughe the violence of the blovve, anye vaynes vvhich contayne that mem¦brane vvhich is called Dura mater,* 1.14 as vvell of tho∣se vvhich passe throughe the sutures as througe anye of the other smalle holes internallye are situated vvith in the braynes, might come to bre¦ake, out of the vvhich ther vvill issue bloode, vvhich therafter cōgealeth and vvith great pay∣ne changeth in to matter, vvith manye other fe∣arfull accidents. In this dissease theris all vvayes payne about that vayne vvhich is burst, and if

soe be vve chaunce to open in this place the skinne, the bone there vnder hath a pale and deade Coloure: but it is a difficult matter to iudge, and knovve it, vvherfore consideringe often times of the impossibilitye, to doe anye remedye or cure therine & by vvant of knovv¦ledge, death suddaynlye ensueth theron. The vvhich Hippocrates reciteth of the daughter of Nerius,* 1.15 vvhich vvas but 20. yeares oulde vvho in playinge beinge smitten on the bone Breg∣ma, vvith an outstreched arme, of one of her playfellovves, strayghtvvayes vvithout anye respiringe is, fallen into a Vertiginem vvho as soone as she vvas brought into the house is fallen into a violent ague, vvith payne in the heade, and rednes of face: & one the seaventh day she voyded a goblet fulle of reddishe mat∣ter filthylye stinckinge out of her right eare, by the vvhich she seemed to be somevvhat lighted and easyed but vvhen the ague agay∣ne returned vnto her, she vvas then vvholye abashed, and allmost lay vvithout anye rea∣son or vnderstandinge, vvith Spasmo, in her right cheeke, or syde of the face, vvithout be∣inge able to speake vvherone the foresayed Spasmus hath possessed the vvhole bodye, vvith shakinge, & qviveringe, vvith the tonge tiede, and vvith irremoveable eyes, and dyed on the ninthe daye.

❧ What Fractures of the heade we ought to trepane and wherfore we must tre∣pane them. Chap. 3.

* 1.16ALthoughe that in all fractures and fissures of the sculle, the yōghe Chyrurgians take ther light or refuge strayght vnto trepaninge: it is notvvithstā∣dinge better, that in the firste vve trye, vvith playsters, and vvith manye o∣ther remedyes, and inventions therto consti∣tuted, and ordayned: consideringe one the consequence and importāce, of the foresayed Fracture, vvhether, it be needfull or necessa∣rye, to take avvay anye parcell or peece of bo∣ne, consideringe the excellentie, and vvorthi∣nes of the braynes, vvhich are such vvorthye partes: vvherfore vve must vviselye and dilli∣gentlye consider and marke, vvhether the vvounde give a goode digestione forth of her, and purifieth her selfe, and vvhether there be∣ginne in the vvounde to grovve, anye redde pomgronate Kernell vvise fleshe, or vvhether the ague vvhich consideringe the suppuratio¦ne in the vvounde, be abated or asvvaged, or hath left him vvhich soe in tollerablye vexed and tormented him, vvhether his apetite be agayne restorede, and vvhether the patient reasonablye taketh rest or sleepe, vvithout havinge anye troublesome accidente chaun∣ce vnto him, vvherbye vve might suspecte, that the membrane called Dura mater, or the braynes, are molested, affected, or suffer any payne, ether throughe a splinter, or throughe anye bloode, or throughe anye matter, vvhich might be come and situated it selfe therone: And the matter luckylye & ominouslye pro∣cedinge,* 1.17 vve may continue the fore sayed re∣medyes, and the vse therofe, because that so∣metimes by this meanes the fissures, are reple¦nished & filled vp vvith some obdurate sub∣stance and callositye, vvhich agreeth and may be likened vnto the callositye or cicatrice of other bones.

Sometimes onlye the first table of the scul∣le breaketh and renteth vvithout pearcinge or penetratīge the Diploe:* 1.18 Some times allsoe is the fore sayed diploe crushed plettered, and broken & yet the seconde tablē safe and illaese or vnburte, vvherfore as then it is not neces∣sarye to detecte and make bare or to trepane the membrane Dura Mater, yea and as then vve may perceave the manner as it vveare of a splinter, of the sculle therin lyinge erected. The fracture at sometimes alsoe is soe greate, vvith such a huge quantitye of massacred, and crushed bones, vvhich lye halfe, and halfe se∣parated, or els for the most parte cleane bea∣ten theroute, that vve may playnlye vvith our eyes behoulde the membrane Dura mater, soe that the bloode vvhich driveth therone, may verye easylye flovve out of the vvounde, in like forte allsoe may the remedies therin easy¦ly be applyed: To the vvhich fractures, the tre¦pane is nothīge behoovinge or nedefull: And if so be in anye sorte you perceave anye skil∣fers or splinters, by the vvhich that membra∣ne might be pricked, or crushed, you must ta∣ke them verye easylye therout.

It happeneth alsoe some times, not onlye in the little children but in aged poeple,* 1.19 alsoe in vvho me the bones are soe thinne and ten∣der, that vvith anye rude blovve they are in∣vvardlye bente, (as vve see a tinne or a copper potte to be brused) vvithout the externall skinne beinge anye vvhere externally hurte: To the vvhich disease of the bones, vve must onlye take our refuge & flight vnto our ex∣tractive, & dravvinge plasters, vvherbye that the depressede bone, might by anye meanes be elevated, and heaved agayne into his right place.

Hippocrates, comprehendethe in verye Shorte vvordes in his blooke De Locis in home∣ne,* 1.20 the vvhole cure of the fractures of the scul∣le demonstratinge those vnto vs vvhich vve

ought to trepane,* 1.21 or not. As farre forthe ther¦fore (sayeth he) as if the bone be broken, or massacred, ther is as thē noe perrille, or daun∣ger at all, & vvith moysteninge medicamen∣tes must it be cured and helped, vvhich quiet, and take a vvay the inflammatione, & soften and mollyfye the bone, because that vvithout payne vve might take the brokē peeces of bo∣ne therout: but insomuch as the bone onlye chaūcede to be burst, it is then verye daunge∣rous, & must of necessitye be trepaned, becau∣se that the matter vvhich distilleth throughe the rente, or fissure one the membrane, doe not in anye sorte corrupte and rott, the fore¦sayed subiacent, or subiectede membrane: for as vvithout havīnge anye issue agayne, shee come to sincke throughe this angustnes, and narrovvnes, as then she causeth an ague, and somtimes allsoe distemperatenes of minde: vvherfore vve must needes trepane, and make a large apertione because that the sanious matter may not onlye have an entrance, but an issue alsoe: & vvhen as vve doe not in anye sorte suspecte that the membrane Dura mater, sufferethe any thinghe, or is in any sorte crus∣hed, or pricked vvith anye peeces of the brokē bones, & that ther is noe matter runne ther∣one, by the vvhich she might be troubled, it is not thē necessarye that vve trepane, or open the sculle.* 1.22 The Chyrurgiane is constrayned to vse the trepane for divers occasions, and take therout the broken bones: First of all to give an issue and passage to the congealed or not congealed bloode, vvhich was suncke on the membrane Dura mater, throughe the effluxio∣ne of those vaynes, vvhich are as vvell situated in the fleshe of the heade as betvvixt both the tables, & vnder the sculle, vvhich as there doe restrayne that membrane fast vnto the sculle. Secundaryly, because the matter, vvhich con∣tinuallye soacketh throughe the fissure on the membrane doe not chaunce to spoyle, or in∣flame the same, because that throughe such an anguste passage she can have noe issue, the vvhich in the end might be the cause of the pa¦tient his death. Thirdlye, to dravve forthe the brokē bones & splinters, through the vvhich the foresayed membrane might in anye sorte be pricked or lye crushed:

Fourthlye, accordinge as the vvorke reqvi∣reth, to applye convenient and necessarye re∣medyes into the vvounde: Fifthlye, because it might serve in steede of a repercussive, & de∣fensive ligature of inflammations, vvhich o∣thervvyse may be vsed in all other brokē par∣tes and ioynctes,* 1.23 exceptinge onlye the heade, because that this, consideringe the rotunditye & rovvndnes ther of can not by anye meanes possible therone be effected: for a ligature, vvhich must be stifflye & fast vvoūde, rovvn∣de aboute the fracture, to praeserve and keepe the broken bones one by the other, might in the heade be the cause of paye, and inflamma∣tione, it vvoulde alsoe hinder the agilitye of the arteryes, and the ascendinghe of the fuli∣ginous excrementes, vvhich throughe the fu∣tures of the sculle, doe evaporate: it vvoulde alsoe repelle the externall bloode of the vvoū¦de, & sende it tovvarde the braynes, & mem∣branes therof, out of the vvhich might ensue verye bad accidentes.

How longe we ought to tarrye, before we beginne to trepane, and of the places which in trepanin∣ge we must chuse, or eschewe. Chap. 4.

HIppocrates chargeth the Chyrur¦giane,* 1.24 in his booke concernin¦ge the vvoundes of the heade, vvhen as in the first he hath binne therūto fetched or sent-for, havinge together noted, the fracture of the bone, vvith the molestinge and troublesome accidentes therof, that vvith¦out anye longer delaye, he shall vvithin the space of thre dayes beginne to trepane, and especiallye the vvether beinge hotte, therby to prevent the inflammatione: but not to the membrane, least she lye bare, and soe the ex∣ternall ayre chaūce to distemper her, and cau∣se therine some corruptione and rottinge, le∣ast also that in so doinge vve might chaunce to teare the membrane, in boaringe through the sculle vvhich cleaveth vnto the same, or anye of the other fasteninges of the membra∣ne: or in placinge of the instrument theron, she might therby be hurt or vvoūded. VVher¦fore, (as he sayeth) it is farre better, vvhen as ther is but a little more bone to pearce or bo∣are throughe, & the barede bone beginneth to stirre it selfe, that as then vve desiste, vntill such time as it of him selfe falleth out.* 1.25 But if soe be that the Chyrurgian hath not in the first binne therat present, & the patient hath of some idiote or ignorāt fellovv binne dres∣sed, vvhich hath not knovve the fracture, and because ther vvas noe apertione made in the bone, to give ayre or light, vnto the matter, ther are chaunced thervnto (as is a fore reci∣ted) greate inflammations, and manye other fearfull accidentes: vve must then (if it be in the summer, and the putrifactione one the suddayne reveale it selfe) vvithin the seaventh day treparte the patiēt, before the braynes are vvholye infected, and chaunce to mortifye:

But in the vvinter vvhen as the corruptione procedeth and goeth somvvhat tarder ofsloer forvvarde, vve must then effect it vvith in 14 dayes: because these dayes beinge passed, as vvel consideringe the imbicillitye of his for∣ces, as the greatnes of the dissease is incurable, although as then vve trepane the scull, it is then to late, vvherfore in noe vvyse must vve effect or doe it.

* 1.26Avicenna vvil have that vve strayght vva∣yes beginne to trepane, and if so be vve must needes deferre it, that vve shoulde defer∣re it noe longer then tvvo or three dayes at the most, and that especiallye vvhen as the Du∣ra mater is pricked or lyeth crushed, of anye broken bones.

Celsus sayeth, that he vvhich tarrieth anye longer from trepaninge then three dayes, are not to be excused, because that such delay cau∣seth a concursione of humors, on the Dura mater vvhich findinge noe apertione, or is∣sue, disordereth the foresayed membrane, and spoyleth it, out of the vvhich necessarylye must follovv greate inflammationes.

But our vse and practise in these dayes, is that as soone as vve are sent for, vvhether it be in time or out of time, earlye or late, and vve espye, ether through searching vvith our, fin∣gers, through the searchinge iron, or by our sight, that the scull is broken, rente, or torne, and that the Dura mater suffereth anye thinge, vve out of hande proceede vvith the operati∣one, and that soe much the sooner, vvhen as vve note, that ther accidentes demonstrate themselves, vvithout anye longer delay and especiallye, in debile aegritudinous, or corpu∣lent bodyes, because in them ther are revea∣led farre vvorse accidentes then in others, vvherfore to tarrye or deferre the trepaninge anye longer it vvould be smalle commoditye vnto vs, but better that altogether vve defer∣red it.

And althoughe the Chyrurgiane vveare not in the first sent for, and that the seaventh day of the sommer, and the 14 of the vvin∣ter vveare praetermitted, and let passe, he shall not therfore refuse to doe his vtter most ende¦voure, vvith trepaninge, for it is yet better somvvhat to late them never, consideringe the goode hope vvhich vve must have of doin¦ge the patient anye good, helpe, and comfor∣te, vvhich othervvyse vvithout trepaninge of the broken bone, or the elevatione of the sa∣me, can by noe meanes be done, vvhich vve onlye vnderstande of those, vvhich are not cleane vvithout hope.

* 1.27Seinge therfore that vve have the time & day limited vnto vs, in the vvhich vve ougt to trepane, vve must cōsider vvhat places, or par∣tes of the sculle are able to abide the trepanin∣ge, and vvhich not. VVe must first of all ther fore consider, that the bones vvhich vvholye are in peeces, or beinge crushed, or at the least a great parte of the same beinge separated, can not easylye be trepaned, because he might chaunce to crushe the trepane one the mem∣branes, hovve easylye soever he leane theron. VVe must alsoe note, that vve doe not chaun∣ce to sett the trepane one any suture, because in soe doinge, vve should vvith great payne, and vvith great bloode sheddinge, cut of the vaynes, arteryes, and synnuish filamentes, vvhich have a vnitye and fasteninge, vvith the Pericranium, and the membrane Dura mater,* 1.28 vvhich have the free passage throughe the fo∣resayed sutures, to retayne the Dura Mater, and administer life, and nurture vnto her. But if it soe chaunced that the fracture chaunced to be one the suture, vve must then applye the trepane, on both the sydes of the suture, vvith out in the least touchinge of her: for if soe be vve trepane but on the one syde onlye and not at the other syde of the suture it vveare then impossible that the bloode or matter, should have at that hole anye issue or passage, the membrane beinge betvvixt them both: nether may vve trepane on the fontanelle, or openinge of the heade in yonge Children, be∣cause that ther tendere imbicillitye as yet is notable to suffer and abyde the trepane. The inferior, or descending partes of the sculle, are not convenient or fitt to be trepaned, becau∣se the braynes throughe ther ponderousnes, might chaūce to sincke therout, or the mem∣branes throughe the apertione might chaun∣ce to be extruded: But if soe be vve vveare vrged ther vnto, vve must make but a verye smalle apertione.

VVe ought in noe vvyse to trepane the temples of the heade,* 1.29 because vve shoulde not hurte the temporalle muscle, considerin∣ge divers synnues, arteryes and vaynes, vvhich are therin divided and entermingled throu∣ghe the vvhich there might be caused to grea∣te payne, fluxione of bloode, agues, Spasmus, and the patient might chaunce to dye: Be∣cause that ther vnder the bone called Os petro∣sum is situated, and that consideringe, the mo∣vinge and stirringe in the temporall muscle, vvhich happeneth in speakinge or eatinge, the vvoūde might be farre more daungerous, and Hippocrates alsoe sayeth, that the inscisione of the same muscle, might be cause of a grea∣te, and villanouse distortione out of the vvhich one the same syde, a Paralisis on the other a cōvulsione of synnues might chaun∣ce to ensue. Nether ought vve to trepa∣ne that parte of the sculle, a little above the eye brouvves, because in this place ther is a greate concavitye, fylle of ayre, and vvhite sli∣mye,

mye, humiditye, of nature, in that place cōsti∣tuted & ordayned, to paepare the ayre, vvhich ascēdeth vp to the braynes, the vvhich indeed is vvorthye to be knovvne & observed, becau¦se that the Chyrurgiane, might not in anye sort be deceaved, takinge the foresayed conca∣vitye to be, a depressione of the bone, vvhich needes must be trepaned: & if it so chaunced, that anye of these foresayed partes vveare bro¦kē, as are the temples of the heade, vve ought then to applye the trepane, a little above the tēporall muscle:* 1.30 if soe be that the part or por∣tione of the sculle, be broke a little above the eyebrovves, vve must as then make choyse of that parte of bone, vvhich boundeth on the fracture, as above in the fooreheade: it is right true, that if so be the foresayed bones, vveare depressed, and crushed, that as thē vve ought to elevate them, and if they be cleane separa∣ted vve as then must plucke them out in like sorte as vve must doe in the sutures.

* 1.31Yet consideringe all this, vve are oftētimes compelled & constrayned, to trepane in all places of the scull: The vvhich a renoumned, & experte Chyrurgiane called Andreas a cru∣ce, confesseth often times to have done, vvith∣out anye daunger. And I dare my selfe bould∣lye affirme, that I in the yeares, of 1591 & 1592 have my selfe trepaned, and have seene others trepane, in the foresayed prohibited places, as one the sutures, and one the temples of the heade. Notvvitstandinge I vvould councell the yonge Chyrurgiane, that in as much as is possible he avoyde & eschevve, the trepanin∣ge of these places, but rather make choyse of anye other parte, vvhich parte, may be a little descendinge, because havinge made the aper∣tione, the bloode, the matter, & all impuritye might therout have ther free passage. Con∣sideringe in the dayes vvhich goe before and vvhich conseqventlye follovve after the tre∣paninge, on the singularitye, and vvorthines of tvose partes, vve must commaunde the aff∣licted and vvounded persone, that in all thin∣ges he vvilbe sober, and observe a good diet, both in etinge and drinckinge, abstayninge especiallye from vvine, and phlebotomye, as much as is needfull, because that the humors, shoulde not concurre vnto the vvoūded par∣te, and that alsoe vve keepe his heade vvarme, vvith light coveringes of the heade, because coulde is a greate enymye vnto the braynes & all synuis he partes.

❧ What qvantitye, or vvhat bignes of the bo∣ne in trepaninge vve must take out Chap. 5.

WE must in the firste, accordin∣ge vnto the quantitye,* 1.32 and bi∣gnes of the bone vve purpose to take out make an apertio∣in the skinne & denudate the foresayed sculle: Therfore if so be ther be noe vvounde nor anye aper∣tione, and the skinne externallye as yet vn∣hurte, this shall as thē be the convenientest apertione, vvhich vvith handes may be made, vvhich vve shall make vvith tvvo crossevvyse overthvvarte inscisiones, in such a forme as this in the margine, demonstrateth vnto you, or els in forme of a borghondiane crosse, vvhich in his middle praesenteth four cor∣ners. In somuch therfore, as if the hurte, have made a vvounde, and inscisione, in the skinne, vve must suffise our selves thervvith, vvith such as it is, if soe be she be thervnto fit and apt, making an other transversall inscisi∣one, namelye overthvvarte the vvounde, be∣cause these tvvo as then may present one. But if soe be, the vvounde be verye ample, & lar∣ge, vve must as then onlye cutt the skinne one the one syde, begīninge the same in the midd∣le of the vvounde, because soe the vvounde may present this letter T, in the vvhich vvilbe but tvvo corners.

These foresayed inscisions, are cenvenien∣test done for the inflammations.* 1.33 But if soe be vve perceave the vvounde to be large e∣noughe to give place vnto the trepane, or a∣nye other instrumente, vvhatsoever, vvher∣vvith vve might endevoure and seeke to ele∣vate, and restore agayn the broken, or depres∣sed bones, in so much as if ther be anye, vve must thervvith content our selves, exsten∣dinge the foresayed vvounde at the first vvith linte, & vvith little plumaceoles, therof being made and therin crushed, on allsydes, & cor∣ners of the vvounde.

But in vvhat sorte or fashone soever, vve make our inscisione in the skinne, vve must allvvayes note that vve doe not suffer anye portione of the Pericranium to remayne one the sculle: vvhich vnder the skinne, decketh and covereth the vvhole sculle: because if so be the foresayed membrane Pericranium, vvea∣re per happes, torne vvith the teeth of the tre∣pane, might be the cause of greate inflamma∣tione, payne, and agues, vvher fore it is better that vve cleane, and vvholye separate it from the sculle, vvhich beinge done, vve must then damme & stoppe vp the vvounde vvith vvhi∣te linte, by the vvhich the next day ensuinge vve shall finde the vvounde vvide open, & if as yet ther vveare anye parcell of the skinne, or lippe of the vvound, vvhich might be a hin¦derance vnto the trepane, the vvhich in the turninge about might chaūce to touche, vve

shall vvith the scissors clippe it of, vvithout deferringe it vntill the next day.

Vvhen as vve havinge considered, one the place vvher to set the trepane, vve must then note, hovv much, & hovve broade, vve ought to boare the sculle.* 1.34 First of all therfore, vve must vvholye take avvaye all the broken and crushed bones, vvhich vvholye are separated from the sovvnde parte, and alsoe from the Pericranium, consideringe that they can never thervvith be vnited & ioyned agayn. But vvhē as the broken bone is depressed, & anye parte therof as yet theron vveare fastened, vvith the sovvnde partes therof, vvhich crushed the membranes of the braynes, or any acuitye of the same, as yet sticke therī, vve must not ther∣for for all that cut it of, and vvholye take it a∣vvaye. But must by all meanes endevoure, ea∣syly to lift & elevate the same, & situate it next vnto the borderinge bones, exemptinge only out of the same the small peeces, vvhich might hurte the membrane, & pricke it, because by this curinge & remedye, the bones agayne re∣nevve, vnite, and ioyne themselves together vvith the circumiacent bones. In soe much as if ther be anye more rentes or fissures before hādes, vvhich frō the one syde, disperse them∣selves this vvay or that vvay, vve shall not nee¦de to pursue thē vnto theire end, but vve shall onlye take some parte therof avvay, because most commonlye they ioyne, & saulder as it vveare together agayne, the vvhich is a farre more better opercle for the braynes, thē that nevve incarnated fleshe, vvhich after the tre∣paninge grovveth therin, vvhere vve have ta∣ken the vvhole broken bone therout, vvher∣fore vve must take noe bones therout, then vvith greate discretione, & then as fevve as is possible,* 1.35 soe that they doe not pricke, & trou∣ble the membrane, vvith ther acuitye & edge, & that ther remayne distance enoughe, to gi∣ve passage vnto the bloode, and the matter vvhich is therone gatherede, to departe, for as vvel the membrane as the braynes, shalbe better defended, through the bone vvhich as yet they Keepe, vvhich is ther naturall defēce, as if vve qvite & cleane toke it avvay, through vvhich discoveringe, the foresayed braynes might be hurte or hindered.

* 1.36It chaunceth often times that the first table commeth to be broken, & rente vnto the Di∣ploe, yet for all that the secōde table remaynin∣ge vntouched, vvherfore it is not thē needfull to applye the vvhol trepane therone, to boare the bone qvite out, but in this case vve must ōlye vse the exfoliative trepane,* 1.37 therby to ad∣minister anye passage or apertione vnto the bloode, vvhich, beinge suncke betvvē the fo∣resayed Diploe, through continuance of time beginninge to corrupte, might in the same ti∣me chaunge & aulter the seconde table alsoe, and cause anye accidentes therof to ensue. If so be in the vvounde vve perceave any splin∣ter, vvhich exalteth it selfe vvith some highe eminence, vve must not be soe curious, to ta∣ke the same immediatlye a vvaye, or cut it out seīge that it is anye vvher fastened, but rather commit it vnto the vvorke of nature, vvhich vvil deminishe & separate noe more therofe, then shalbe necessarye & neede full, because she is vvise and prudent in all her vvorkes. It might alsoe chaunce that the bone, not bein∣ge broken or rente hath onlye binne above contunded, hurte, or externallye denudatede, vvhich beīge soe, vve must onlye above scra∣pe it even, and grate it.

❧ Of the māner & methode hovve to trepane vvell, and artificiallye. Chap. 6.

SOe manye and divers species & formes of fractures, as there are even soe are ther divers meanes vvher by vve may suc¦coure the vvounded patient. Vvhen as therfore the fractu∣re, is nothinge els, then a right runninge fis∣sure, vve must then consider vvhether it pear∣ce or penetrate throughe both the tables: the vvhich me may knovve throughe the Raspato∣riū, or throughe the exfoliative trepane, vvher vvith vve must grate the first table, vnto the Diploe, & if that the foresayed fissure,* 1.38 as there doth not departe or vanishe out of sight, ne∣ther the accidentes desist, findinge allsoe the fore sayed Diploe plettered crushed, or brokē, & anye matter vvhich throughe the seconde table commeth to distille into this place, it is as then a signe that the foresayed fracture pe∣arceth, vnto the seconde table, & stretcheth it selfe one the Dura mater alsoe:* 1.39 vve are as then counceled to applye the vvhole trepane ther∣one: & ordinarylye to effecte this, as it is nee∣defull to be done, vve must cause the patiēt to sitt, one such a manner as the parte vvhich is broken reqvireth: vve must stoppe his eares vvith cotten, & decline and lay his head one a companye of pillovvebeares, vvhich must be indifferent harde, & cause his head of one or tvvo men to be helde fast, because he stirre it nether this vvay nor that vvay: then vve must cover the lippes of the vvounde, vvith anye plasters spreade vppen fine linnen cloth, least that of the ayre, of the turninge rounde of the trepane they might be hurte or vvoūded, Al-this beinge in such sorte fineshed, vve must si∣tuate and settle, the perforative trepane verye fast or stedfastly, on the brokē bone, on such a place vvher as vve desire to have the acuitye or poynt of the trepane situated, ther to make

a perforatione, vvhich beinge effected, vve must therone situate the vvhole trepane vvherof the poyncte, muste be set in the hole or perforatione, the vvhich before vvas made vvith the perforative trepane, and soe easilye turninge it, the bone first of all shall raceave the poyncte, & by and by the crovvne, or the teeth of the trepane, vvithout ether glidinge this vvay or that vvay, or remove out of there circkle, because of the acuitye or poyncte of the trepane vvhich must restraygne the trepa∣ne, vvith out slippinge out of his place. There is a certayne industrye in the depressione of the trepane, soe that it both turneth rounde, & pearceth or cutteth alsoe: for if so be vve le∣ane to lightlye therone, it then pearceth and cutteth litle, or nothīge at all: & if it soe chaū∣ced that as then vve depressed is somvvhat to harde, it vvill not then turne rounde, vvher∣fore heerine vve muste vse a medium betvven them both, or mediocritye, & lifte it some ti∣mes out, to purifye, & brushe it, and then an∣noynte it vvith oyle of roses, because that it might the betre pearce and enter in. The tre∣pane having novv made a reasonablve dee∣ped circle, as then vve must take avvay the poynte out of the middle therof, for if it pear∣ced deeper thē the crovvne or teeth of the tre∣pane, he shoulde be sooner passed by or throu¦ghe the bone then the trepane vvith his teeth, by the vvhich the membrane called Dura Ma∣ter might chaunce to be hurte, the foresayed poyncte therfore beinge taken therout, vve must agayne sett the trepane in his hole, or circkle, and markinge that the trepane hath pearced the Diploe,* 1.40 and passed therbye, the vvhich me may perceave by the blood vvhich vvil issue therout, throughe those little vay∣nes vvhich there are openede, vve must then finnishe the trepaninge vvith more discretio∣ne and heede takinge ther vnto, vnto the con∣cavitye of the sculle, turninge the foresayed trepane verye easylye & vvyselye, layinge the left hand verye lightlye therone, that therbye vve may the better espye, vvhen that the scul∣le shalbe pearced qvite throughe, that vve doe not in anye sorte hurt the membrane: be∣cause therof might ensue, inflammatione, and the daūger of death.* 1.41 Novv to marke this, vve must often times lift vp the trepane, to try the thicknes of the bone, through the vvhich the trepane hath passed, vvhich vve must vvith a little privette or searcher try, or vvith a pro∣pre instrument vvhich heere to fore is onlye for this intent discribed. By vvhich meanes, vve must alsoe note, vvhether it be in noe pla¦ce cleane perced, for althoughe vve rightlye & aeqvallye turne the trepane, it may never the lesse happen, that the foresayed bone be one the one syde cleane througe, vnto the Dura Mater, and one other syde not soe deepe: vvhē vve therfore perceave this, vve muste procee∣de vvith turninge, & depresse the trepane one the other syde vvhere the bone as yet is not throughe somevvhat more, because the bone may aeqvallye be pearced, or if it vvil not soe be, vve may then vvith the same turne of the trepane, pearce the bone one the one syde, & denudate the Dura Mater one the other syde, vvhich somtimes I have knovvne to be done. Such an in aeqvallitye, cōmeth partlye as vvel consideringe the heade, vvhich is rounde, as concerninge anye concavityes or furrovves vvhich are situated in the secōde table, vvhich toucheth the Dura mater, vvherfore the bone is in one place thicker then in an other.

In like sorte vve must alsoe plante the little groundedravver in the perforatione, the vvhich in the first vvas made vvith the poync∣te of the trepane: Or vve must, stick that Eleva∣torium vvhich is at the poyncte of the little fo∣resayed grovvndedravver in that circkle, vvhich by the trepane is made, thervvith to lift out the little peece of bone, or make it loo¦se, by the vvhich vve shall easylye espye, vvhe¦ther it yet hould verye fast, & vvhether it nee∣de anye more to be boared, & if vve see that it hath pearced vnto the Dura mater, vve shall then vvith the foresayed Elevatorium,* 1.42 or vvith the groundedravvere, vvholye lift it out, vvith out breakinge of it or doinge anye violen∣ce therone, because ther throughe vve doe not chaunce to hurte the membranes but gi∣ve it rather one turne or tvvo, because that soe much the easyer vve might lift it out, at one ti-time. This beinge done and the rounde bone beinge taken therout, vve must then smoothe and make playne, the edges of the perforatio∣ne, and grate them, and take avvay all his acui∣tye and ruggednes, from him, for if soe be the∣re remayne anye small splinter therone or a∣nye other vnevennes, the vvhich not beinge clenlye taken therof, it might be agreat hinde∣rance unto the membrane: and if soe be that through trepaninge ther chaunced anye of the poulder of the bone to fall one the membra∣ne, vve must endevour by all meanes to get it out: If so be it is sufficient to remove the first table, vvithout touchinge of the seconde, vve shall not then playne and scrape the edges on∣lye of the pearced hole, but allsoe the vvhole bone, because that therafter vvithout any trou¦ble to the patient the skinne may grovve ther∣over: for if soe be that it come to grovve over the rugged and vnsmooth bone it vvil be a gre¦at hinderance to the patiente, and cause a nue payne, because that the fleshe vvill not be soe goode, vvhervvhithe the rugged bone shal be covered.

And this is our practise,* 1.43 and manner of tre∣paninge

vnto the membrane Dura mater, and the manner allsoe hovv immediatlye to lifte the bone out of the perforatione, althoughe that Hippocrates, in his booke of the vvoundes of the heade, strictlye prohibiteth to boare the hole vnto the membrane, and presentlye to take it therout, because the external ayre, sud∣daynlye alightinge one the same, might chaū∣ce to hurte the same, by the vvhich occasione she might therafter chaūce to rotte: and more alsoe if that vve take the bone out of the same the vvhich as yet might be fastened vvith the foresayed membrane, vve might chaunce to teare the same, or anye smalle vaynes therone fastened: or if that vve stucke the trepane vnto the membrane, vve might hurte the same: it is therfore the surest vvaye, sayeth he, that vvhē as the bone is all moste cleane throughe, and beginneth to stirre, that vve then desiste, and tarrye vntill such time as it of it selfe falleth out: But our trepane vvith the crovvne, or teeth is such, that vnlesse the Chyrurgiane be verye ignorant, might in anye sorte ther∣vvith, hurte or crushe dovvne the membra∣ne.

* 1.44We have invēted other formes of trepanes, vvhich vve have in this booke also set dovv∣ne ther forme vvhich vve cal Terrebellum alatū, the vvinged trepane, vvhich taketh noe pee∣ces of bone vvith it but diminisheth, and con¦sumeth them, vvhervvith by noe meanes vve may hurte the membrane: there are some vvhich havinge vsed them, finde them farre surer, and expediter in ther operationes, then those vvith the hoode. But if soe be there be anye greate massacringe of bones, or depres∣singe of the same, thē the membrane is there throughe depressed and crushed, and is alsoe sometimes pricked vvith the splinters, of the broken bone. In these tvvo daungerous mat∣ters, vve must helpe, and succoure the patient or vvounded persone one some other sorte, & that as soone as it may be possible, in the ex¦tractinge of the same, if so be they be vvholye seperated:* 1.45 To vvhich purpose, it is oftentimes necessarye to trepane, & cut avvay some parte of the sovvnde bone, vvhich bordereth and is situated next vnto the plettered bones, becau∣se that our Elevatorium, might in the elevating of that vvhich is depressed dovvnvvardes have sufficient place, & rest it selfe one the sovvn∣de bone, vvith out in the elevatione to depres¦se the brokene bones any more dovvnevvar∣des: for as Hippocrates sayeth, the bones vvhich are broken, and depressede, can not vvithout greate daunger be boared or perfotated, be∣cause that the depressinge of the trepane, or Elevatorij, by anye meanes of them can not be suffered. It often times happeneth that the seconde table is more depressed thē the first, vvherfore to that intent vve must let the Ele∣vatorium passe throughe the perforatione of the trepane, betvveene the seconde table,* 1.46 and the membrane Dura mater, because in that sort vve might lift vp the broken bones and splin∣ters agayne, and take them out if they lay loo∣se or separated. And if so be there vveare noe hole, & above all this, the place of the fractu∣re, could by noe meanes suffer, to have therin made a hole, it is as then my manner to take my grovvndedravvere vvith three feete or poynctes and set therone,* 1.47 & then make choy∣se, of the greatest, & vvhich is most fittest for me, consideringe the fracture vvhich is in the bone, to intrude the same therin, and easylye vvinde the same therin, houldinge your han∣de alvvayes hanginge, and not depresse the sa∣me to harde, because he vvil easylye enough enter therin, & vvhen he hath a little pearced vve must as then vvith a certayntye, & the ea∣syest vvay possible endevoure, to lift vp the broken and crushed peeces of bones. But if soe be, there be anye peece of bone soe farre shoved vnder the sculle, that it laye above the membrane, and the same consideringe his greatnes, and the angustnes of the apertione, coulde not by anye meanes be taken therout, ether by Elevatories, or Pincets, vve must thē take our refuge, (if so be vve vvil not through the trepane make the apertione anye bigger) to the cuttinge pincers, & to the Parrates bil∣le, vvith the vvhich vve may cutt of as much bone as vve please, vvith out anye paynes, or daunger, makinge one this sorte the apertio∣ne somvvhat vvijder, to take out of the same the foresayed peece of bone, vvhich driveth one the Dura mater. Touchinge the inflecti∣one or bendinge invvardes, vvithout fractu∣re, vvhich commonlye chaunceth in yonge children, or in these vvhich have a vveake & tender sculle, vvhen this is crushed, or bendt invvardes, as is a copper or time potte, those ar better to be cured vvith extractīge plasters, then vvith the trepane or vvith the grovvn∣dedravvere.

Notes

• * 1.1

  Chyrur∣gerye must not rashelye be effec∣ted.
• * 1.2

  Discrip∣tione of the signes
• * 1.3

  Divers accidētes of the vvoundes of the heade.
• * 1.4

  Celsus.
• * 1.5

  What for∣me the searchin∣ge iron must be of.
• * 1.6

  The Chy¦rurgiane may easy∣lye be de∣ceaved.
• * 1.7

  A suture, or com∣missure, is the ioy∣ninge to∣gether of the bones of the he∣ad.
• * 1.8

  Hippocra¦tes hath binne de¦ceaved.
• * 1.9

  The futu∣res of the heade are variable.
• * 1.10

  Hovv vve shall e∣spye the hayrye fissure.
• * 1.11

  Signes of a counter fissure.
• * 1.12

  Opinio∣ne of the aunciēte professors touchin∣ge inscisi∣one.
• * 1.13

  An obser∣vatione of the au∣ctor.
• * 1.14

  Vaynes vvhich burst vvit¦hin the braynes.
• * 1.15

  A historye must of the daug∣hter of Nerius, described through Hippocra¦tes.
• * 1.16

  We ought not at all times to trepane.
• * 1.17

  The fissu∣res recol∣lecte then selves sō∣times.
• * 1.18

  Diploe is the porosi¦tye be∣tvveene the bo¦tables.
• * 1.19

  The bo∣nes of the yonge Childre∣ne are bēt invvard∣lye.
• * 1.20

  The opi∣nione of Hippocra¦tes tou-
• * 1.21

  The opi∣nione of Hippocra∣tes tou∣chinge the cu∣ringe of fractures.
• * 1.22

  For vvhat occasione vve ought to trepa∣ne.
• * 1.23

  The hea∣de may not to strictlye be bovvn¦de, & the reason vvhy.
• * 1.24

  Opinione of Hippo∣crates.
• * 1.25

  The Chy∣rurgiane is someti∣mes to late sent for.
• * 1.26

  Opinio∣ne of A∣vicenna.
• * 1.27

  What pla¦ces may beare the trepanin∣ge.
• * 1.28

  We may right vvell tre∣pane one the sydes of the fu∣ture.
• * 1.29

  We may not trepa∣ne the temples of the he∣ade.
• * 1.30

  Vve may not trepa∣ne that bone abo¦ve the ey∣ebrovves.
• * 1.31

  The sutu∣res and temples of the heade may so∣metimes be trepa∣ned.
• * 1.32

  Hovv gre¦ate the apertione must be for to tre∣pane.
• * 1.33

  The insci¦sione must be done be∣fore the inflam∣matione.
• * 1.34

  Vvhat qvā¦titye of bone vve ought to trepane.
• * 1.35

  The scull is the na∣turall o∣percle, or cover to the bray∣nes.
• * 1.36

  The Di∣ploe is the distance betvvene the tvvo tables.
• * 1.37

  Vvhē vve ought on¦lye to vse the exfo∣liative tre¦pane.
• * 1.38

  Diploe is the space betvveen the tvvo tables.
• * 1.39

  Methode hovve to trepane.
• * 1.40

  Signes to knovve vvhē the trepane is entred in¦to the Di∣ploe.
• * 1.41

  Note the forme or figure of your trepane in the sculle.
• * 1.42

  After vvhat sor¦te vve ought to lifte out the perfo¦rated bo∣ne.
• * 1.43

  Manner vve to tre¦pane vnto the mem¦brane.
• * 1.44

  Nue invēted trepa∣nes.
• * 1.45

  What vve ought to doe vvhē as the Du¦ra mater is crushed throughe the brokē bones or splinters.
• * 1.46

  Elevato∣rium is an instrumēt vvher∣vvith vve vse to lift vp anye thinge out of a vvound.
• * 1.47

  Practise & inven∣tione of the au∣cthor.