The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. X. Of Prognostickes to be made, in fractures of the scull.

VVEE must not neglect any wounds in the head, no not these which cut or bruise but onely the hairy scalpe; but certainely much lesse, these * 1.1 which are accompanied by a fracture in the scull; for oft times all horride symptomes follow upon them, and consequently death it selfe, especially in bodies full of ill humors, or of an ill habite, such as are these which are affected with the Lues venerea, leprosie, dropsie, Pthisicke and con∣sumption; for in these, simple wounds are hardly or never cured; for union in the cure of wounds, but this is not performed, unlesse by strength of nature, and suffici∣ent store of laudible blood: but those which are sicke of hecticke feavers and con∣sumptions, want store of blood and those bodies which are repleate with ill humors, and of an ill habite have no affluxe or plenty of laudible blood: but all of them want the strength of nature; the reason is almost the same in those also which are lately recovered of some disease.

Those wounds which are brused are more difficult to cure, than those which are cut, When the scul is broken, than the continuity of the flesh lying over it must necessarily be hurt & broken, unlesse it be in a Reso••itus. The bones of children are more soft, thin * 1.2 and replenished with a sanguine humidity, than those of old men, and therefore more subject to putrefaction; Wherefore the wounds which happen to the bones of chil∣dren, though of themselves, and their owne nature they may be more easily healed, (because they are more soft, whereby it comes to passe, that they may bee more ea∣sily agglutinated, neither is there fit matter wanting for their agglutination by rea∣son of the plenty of blood laudible both in consistence and quality) than in old men, whose bones are dryer and harder, and so resist union, which comes by mixture, and their bloud is serous, and consequently a more unfit bond of unitie and agglu••ination; yet oft times through occasion of the symptomes which follow upon them, that is putrefaction and corruption, which sooner arise in a hot and moyst body, and are more speedily encreased in a soft and tender, they usually are more suspected and difficult to heale.

The Patient lives longer of a deadly fracture in the scull, in Winter than in Sum∣mer, for that the native heat is more vigorous in that time than in this; besides, also the humors putrifie sooner in Summer, because unnaturall heat is then easily enfla∣med and more predominant, as many have observed out of Hippocrates.

The Wounds of the braine and of the Meninges or membranes thereof are most * 1.3 commonly deadly, because the action of the muscles of the chest, and others serving for respiration, is divers times disturbed & intercepted, whence death insues. If a swel∣ling happening upon a wound of the head presently vanish away, it is an ill signe, unlesse there be some good reason therefore, as blood-letting, purging, or the use of resolving locall medicines, as may be gathered by Hippocrates in his Aphorismes. If a feaver ensue presently after the beginning of a wound of the head, that is, upon the * 1.4 fourth or seaventh day, which usually happens, you must judge it to bee occasioned by the generating of Pus or Matter, as it is recited by Hippocrates. Neither is such a feaver so much to be feared, as that which happens after the seaventh day, in which * 1.5 time it ought to be determinated; but if it happen upon the tenth or foureteenth day with cold or shaking, it is dangerous, because it makes us conjecture that there is pu∣trefaction in the braine, the Meninges, or scull, through which occasion it may arise, chiefely if other signes shall also concurre, which may shew any putrifaction, as if the wound shall be pallide and of a faint yellowish colour, as flesh lookes after it is wa∣shed.

For, as it is in Hippocrates Aphoris. 2. sect. 7. It is an ill signe if the flesh looke livide, * 1.6 when the bone is affected; for that colour portends the extinction of the heate, through which occasion, the lively, or indifferently red colour of the part, faints and dyes, and the flesh there abouts is dissolved into a viscide Pus or filth.

Commonly another worse affect followes hereon, wherein the wound becomming withered and dry, lookes like salted flesh, sends forth no matter, is livide and blacke, whence you may conjecture, that the bone is corrupted, especially if it become rough, whereas it was formerly smooth and plaine; for it is made rough when Caries or cor∣ruption invades it; but as the Caries encreases, it becomes livide and blacke, sanious matter withall sweating out of the Diploe, as I have observed in many: all which are signes that the native heat is decayed, and therefore death at hand; but if such a fea∣ver be occasioned from an Erysipelos which is either present or at hand, it is usually lesse terrible. But you shall know by these signes, that the feaver is caused by an Erysipelas * 1.7 & confluxe of cholericke matter; if it keepe the forme of a Tertian, if the fit take them with coldnes and end in a sweat; if it be not terminated before the cholerike matter is either converted into Pus or else resolved; if the lips of the wound be somwhat swollne, as also all the face; if the eyes be red and fiery; if the necke and chappes bee so stiffe, that he can scarse bend the one, or open the other; if there be great excesse of biting and pricking paine, and heate, and that farre greater than in a Phlegmon. For such an Erysipelous disposition generated of thinne and hot blood, chiefely assailes the face, and that for two causes.

The first is, by reason of the naturall levity of the cholericke humor; the other be∣cause * 1.8 of the rarity of the skinne of these parts.

The cure of such an affect must be performed by two meanes, that is, evacuation, and cooling with humectation. If choler alone cause this tumor, we must easily bee induced to let blood, but we must purge him with medicines evacuating choler. If it be an Erisipelas phlegmonodes, you must draw blood from the Cephalicke veine of that side, which is most affected, alwayes using advise of a phisition. Having used these generall meanes, you must apply refrigerating and humecting things, such as are the juice of Night-shade, Housleeke, Purslaine, Lettuce, Navell wort, Water Lentill, or Ducks-meate, Gourdes; a liniment made of two handfulls of Sorrel boiled in faire water, then beaten and drawne through a searse, with ointment of Roses, or some vnguent. Populeon added thereto, will bee very commodious. Such and the like remedies must be often and so long renued untill the unnaturall heat be extingui∣shed. But we must be carefull to abstaine from all unctuous and oyly thing, because * 1.9 they may easily be enflamed, and so increase the disease. Next we must come to re∣solving medicines; but it is good when anything comes from within, to without; but on the contrary it is ill, when it returnes from without inwards, as experience and the Authority of Hippocrates testifie: If when the bone shall become purulent, pustles * 1.10 shall breake out on the tongue, by the dropping downe of the acride filth or matter by the holes of the pallate upon the tongue, which lyes under. Now when this symp∣tome appeares, few escape. Also it is deadly when one becomes dumbe and stupid, that is, Apolecticke by a stroake or wound on the head; for it is a signe that not onely the bone, but also the braine it selfe is hurt. But oft times the hurt of the Braine pro∣ceedes * 1.11 so farre, that from corruption it turnes to a Sphacell, in which case, they all have not onely pustles on their tongues, but some of them dye stupide and mute, o∣thersome with a convulsion of the opposite part; neither as yet have I observed any which have dyed with either of these symptomes, by reason of a wound in the head, who have not had the substance of their braine tainted with a Sphacell, as it hath appeared when their sculls haue beene opened after their death.

Notes

• * 1.1

  Hippoc. de vul. cap.
• * 1.2

  Whether the wounds of children, or old people are bet∣ter to heale.
• * 1.3

  Aph. 15. sect. 1.
• * 1.4

  Aphor. 65, sect. 5
• * 1.5

  Aph. 47, sect. 2.
• * 1.6

  Wounds which are dry, rough, livide and black are evill.
• * 1.7

  The signes of a feaver caused by an Erysipe∣las.
• * 1.8

  Why an Ery∣sipelas chiefely assailes the face. The cure of an Erysipelas on the face.
• * 1.9

  Why oyly things must not be used in an Erysipelas of the face.
• * 1.10

  Aph. 25. sect. 6
• * 1.11

  Deadly signes in wounds of the head.