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

CHAP. XIIII. Of the generall cure of a broken scull, and of the Symptomes usually happening thereupon.

THe first cure must bee, to keepe the patient in a temperate aire; and if so bee, that it bee not such of it selfe and its owne proper * 1.1 nature, it must be corrected by Art. As in winter he must have a cleare fire made in his chamber, lest the smoake cause sneesing and other acci∣dents; and the windowes and doores must be kept shut to hinder the approach of the cold ayre and winde. All the time the wound is kept open to bee drest, some body standing by shall hold a chafendish full of coales or a heated Iron barre over the wound, at such a distance, that a moderate heate may passe thence to the wound; and the frigidity of the encompassing ayre may be corrected by the breathing of the diffused heate. For cold according to the opinion of Hip∣pocrates, * 1.2 is an enemie to the Braine, Bones, Nerves, and spinall marrow; it is also hurtfull to ulcers, by suppressing their excrements, which supprest

doe not onely hinder suppuration, but also by corrosion makes them sinuous. There∣fore Galen rightly admonisheth us, to keep cold from the braine, not only in the time * 1.3 of Trepaning, but also afterwards. For there can no greater, nor more certaine harme befall the fractured scull, than by admitting the aire, by such as are unskilfull. For if the ayre should be hotter than the braine, then it could not thence be refrigerated; * 1.4 but if the braine should be layd open to the ayre, in the midst of Summer, when it is at the hottest, yet would it be refrigerated, and unlesse it were releeved with hot things, take harme: this is the opinion of Galen, whereby you may understand that many who have their sculls broken, dye more through default of skill in the curing, than by the greatnesse of the fracture.

But (when the wound is bound up with the pledgets, clothes, and rowlers as is fit) if the ayre chance to be more hot, than the patient can well endure, let it be amended by sprinkling, and strawing the chamber with cold water, oxycrate, the branches of Willowes and Vine. Neither is it sufficient to shunne the too cold ayre, unlesse al∣so you take heed of the over light, chiefely untill such time as the most feared and maligne symptomes are past.

For a too great light dissipates the spirits, encreases paine, strengthens the feaver and * 1.5 symptomes. Hippocrates wholy forbids wine, therefore the patient in steed thereof must drinke, Barly water, faire water boyled and tempered with Iulep of Roses, * 1.6 syrupe of Violets, vinegar and the like: water wherein bread crummes have beene steeped, water and sugar, with a little juyce of Lemons, or pomecitron added thereto, and such like as the abilitye and taste of the patient shall require. Let him continue such drinkes, until he be free from maligne symptomes, which usually happen within foureteene dayes.

His meat shall be pappe, ptisan, shunning Almond milkes; (for Almonds are sayd * 1.7 to fill the head with vapours and cause paine) stued damaske Prunes, Raisons and Currance, seasoned with sugar, and a little cinamon (which hath a wonderful power to comfort the stomack, and revive and exhilarate the spirits) Chickens, Pidgeons, Veale, Kid, Leverets, birds of the fields, Pheasons, blacke-birds, Turtles, Partridges, Thrushes, Larkes and such like meates of good digestion, boiled with lettuce, pur∣slaine, sorrell, borage, buglosse, succory, endive and the like, are thought very conve∣nient in this case. If he desire at any time to feed on these meates roasted, he may, only dipping them in verjuice, in the acide juices of Oranges, Citrons, Lemons, or Pome∣granets, sometimes in one, and sometimes in another, according to his taste and abi∣lity. If any have a desire to eate fish, he must make choyce of Troutes, Gudgions, * 1.8 Pikes and the like, which live in running and cleare waters, and not in muddy; hee shall eschew all cold sallets and pulse, because they flye up and trouble the head: it will be convenient after meate to use common drige powder; or Aniseed, Fennell-seed or Coriander comfits, also conserve of Roses, or Marmilate of Quinces to shut up the orifice of the Ventricle, lest the head should bee offended with vapoures arising from thence.

Children must eate often, but sparingly; for children cannot fast so long as those * 1.9 which are elder, because their naturall heate is more strong, wherefore they stand in neede of more nourishment; so also in winter all sorts of people require more plenti∣full nourishment, for that then their stomackes are more hot than in Summer.

When the foureteenth day is past, if neither a feaver, nor any thing else forbid, hee * 1.10 may drinke wine moderately, and by little and little, encrease his dyet, but that re∣spectively to each ones nature, strength and custome. He shall shunne, as much as in him lyes, sleepe on the day time, unlesse it happen that a Phlegmon seaze upon the braine or Meninges. For in this case it will bee expedient to sleepe on the day time, * 1.11 especially from morning till noone, for in this season of the day, as also in the spring blood is predominant in the body, according to the opinion of Hippocrates. For it is so vulgarly knowne, that it need not be spoken, that the blood when wee are awake is carryed into the habite and surface of the body; but on the contrary by sleepe it is called into the noble parts, the Heart and Liver. Wherefore if that the blood by the force of the Sunne casting his beames upon the earth, at his rising is carryed into the habite of the body, should againe bee more and more diffused by the

strength and motion of watching, the inflammation in the braine and Meninges would be much encreased. Wherefore it will bee better, especially then to stay by sleepe the violence of the blood running into the habite of the body, when it shall seeme to rage and more violently to affect that way. Watching must in like manner * 1.12 be moderate; for too much depraves the temper of the braine and of the habit of the whole body; it causes crudities, paines and heavinesse of the head, and makes the wounds dry and maligne.

But if the patient cannot sleepe by reason of the vehemencie of the inflammation of the braine and Meninges, Galen wishes, to wash, besmeare and annoint the head, nose, * 1.13 temples and eares with refrigerating and humecting things, for these stupifie, and make drowsie the Braine and membranes thereof, being more hot than they ought to be. Wherefore for this purpose let the temples bee anointed with Vnguentum po∣puleon, or Vnguentum Rosatum with a little rose vinegar, or oxycrate; Let a spunge * 1.14 moistened in the decoction of white or blacke poppie seed, of the rinds of the rootes of Mandrages, of the seedes of Henbane, lettuce, purslaine, plantaine, night-shade and the like. He may also have a broath or barly creame, into which you may put an emulsion made of the seedes of white poppye, or let him have a potion made with ℥j. or ℥iss. of the syrupe of poppie, with ℥ij. of lettuce water; Let the patient use these things 4 houres after meate, to procure sleepe. For sleepe doth much helpe con∣coction, it repaires the effluxe of the triple substance caused by watching, aswageth * 1.15 paine, refresheth the weary, mitigates anger and sorrow, restores the depraved rea∣son, so that for these respects it is absolutely necessary that the patient take his natu∣rall rest.

If the patient shall bee plethoricke, let the plenitude be lessened by blood-letting, purging and a slender diet, according to the discretion of the Phisition who shall oversee the cure.

But we must take heed of strong purgations, in these kindes of wounds, especially at the beginning, lest the feaver, inflammation, paine, and other such like symptomes be increased by stirring up the humors.

Phlebotomie according to Galens opinion, must not onely be made respectively to * 1.16 the plenty of blood, but also agreeable to the greatnesse of the present disease, or that which is to come, to divert, and draw backe that humor which flowes downe, by a way contrary to that which is impact in the part; and which must be there eva∣cuated, or drawne to the next. Wherefore for example, if the right side of the head be wounded, the Cephalicke veine of the right arme shall be opened, unlesse a great Plethora or plenitude cause us to open the Basilica, or Median, yet if neither of them can be fitly opened, the Basilica may bee opened, although the body is not ple∣thoricke.

The like course must be observed in wounds of the left side of the head; for that is farre better by reason of the straightnesse of the fibers, than to draw blood on the opposite side; in performance whereof you must have diligent care of the strength of the patient, still feeling his pulse, unlesse a Physition be present, to whose judge∣ment you must then commit all that businesse. For the pulse is, in Galens opinion, the certainest shewer of the strength. Wherefore we must consider the changes and inequalities thereof, for as soone as we finde it to become lesser and more slow, when * 1.17 the fore-head beginnes to sweate a little, when he feeles a paine at his heart, when he is taken with a desire to vomit, or goe to stoole, or with yawning, and when hee shall change his colour and his lips looke pale, then you must stop the blood as spee∣dily as you can; otherwise there will be danger lest hee poure forth his life together with his blood. Then he must bee refreshed with bread steeped in wine, and put into his mouth, and by rubbing his temples and nosethrilles with strong vinegar, and by lying upon his backe.

But the part shall bee eased and freed from some portion of the impact and con∣junct humor by gently scarifying the lippes of the wound, or applying of Leaches. But it shall bee diverted, by opening these veines which are nighest to the wounded part, as the Vena Puppis, or that in the middest of the forehead, or of the temples, or these which are under the tongue; besides also cupping-glasses shal be

applied to the shoulders sometimes, with scarification, sometimes without; neither * 1.18 must strong, and long frictions with course clothes, of all the whole body, the head excepted, be omitted during the whole time of the cure, for these will be available, though but for this, that is; to draw backe and dissipate by insensible transpiration the vapours which otherwise would ascend into the head, which matters certainly in a body that lyes still and wants both the use and benefit of accustomed exercise, are much increased.

But it shall bee made manifest by this following and notable example, how po∣werfull * 1.19 blood-letting is, to lessen and mitigate the inflammation of the Braine, or the membranes thereof in wounds of the head. I was lately called into the suburbs of Saint German, there to visite a young man twenty eight yeeres old, who lodged there in the house of Iohn Martiall, at the signe of Saint Michaell. This young man, was one of the houshold servants of Master Doucador, the steward of the Lady Admirall of Brion. He fell downe headlong upon the left Bregma, upon a marble pave∣ment, whence he received a contused wound, without any fracture of the scull, and being he was of a sanguine temperature, by occasion of this wound, a feaver tooke him on the seaventh day with a continuall delirium and inflammation of phleg∣monous tumor of the wounded Pericranium. This same tumor possessing his whole head and necke by continuation and sympathy of the parts, was growne to such a bignesse, that his visage was so much altred, that his friends knew him not; neither could he speake, heare, or swallow any thing but what was very liquide. Which I observing, although I knew, that the day past, which was the eight day of his disease, he had foure saucers of blood taken from him by Germaine Agace Barber-surgion of the same suburbs; yet considering the integrity and constancie of the strength of the patient, I thought good to bleed him againe; wherefore I drew from him foureteene saucers at that one time; when I came to him the day after, and saw that neither the feaver, nor any of the fore mentioned symptomes were any whit remitted, or aswa∣ged, I forthwith tooke from him foure saucers more, which in all made two & twen∣ty; the day following when I had observed, that the symptomes were no whit lesse∣ned, I durst not presume by my owne onely advice, to let him the fourth time blood as I desired. Wherefore I brought unto him, that most famous Physition Doctor Violene, who as soone as he felt his pulse, knowing by the vehemencie thereof, the strength of the Patient, and moreover considering the greatnesse of the inflamma∣tion and tumor which offered its selfe to his sight, hee bid mee presently take out my Lancet and open a veine. But I lingred on set purpose, and told him, that hee had already twenty two saucers of blood taken from him: Then sayd he, Grant it be so, and though more have beene drawne, yet must we not therefore desist from our enterprise, especially seeing the two chiefe Indications of blood-letting yet re∣maine, * 1.20 that is, the greatnesse of the disease, and the constant strength of the Patient. I being glad of this, tooke three saucers more of blood, hee standing by, and was ready to take more but that he wished mee to differ it untill the after noone; wherefore returning after dinner I filled two saucers more, so that in all, this young man to his great benefit, lost twenty seaven saucers of blood at five times, within the space of foure dayes. Now the ensuing night was very pleasing to him, the feaver left him about noone, the tumor grew much lesse, the heat of the inflammation was aswaged in all parts, except in his eyelids, and the lappes of his eares, which being ulcerated cast forth a great quantitie of Pus or matter. I have recited this history pur∣posely, to take away the childish feare which many have to draw blood in the con∣stant strength of the patient, and that it might appeare how speedy and certaine a remedy it is in inflammations of the head and braine.

Now to returne from whence we digressed, you must note that nothing is so hurt∣full * 1.21 in factures and wounds of the head, as venery; not onely at that time the disease is present, but also long after the cure thereof. For great plenty of spirits are con∣teined in a small quantity of seed, & the greatest part thereof flowes from the braine; hence therefore all the faculties, but chiefly the Animall, are resolved, whence I have divers times observed death to ensue in small wounds of the head, yea when they have beene agglutinated and united.

All passions of the minde must in like sort be avoided, because they by contraction and dissipation of the spirits cause great trouble in the body and minde. Let a place be chosen for the Patient as farre from noise as can be, as from the ringing of bells, beatings and knockings of Smithes, Coopers, and Carpenters, and from high-wayes * 1.22 through which they use to drive Coaches; for noyse encreases paine, causes a fea∣ver, and brings many other symptomes.

I remember when I was at Hisdin at the time that it was beseiged by the forces of Charles the fifth, that when the wall beaten with the Cannon, the noise of the Ordi∣nance * 1.23 caused grievous torment to all those which were sicke, but especially those that were wounded on their heads, so that they would say, that they thought at the discharging of every Cannon that they were cruelly strucken with staves on that part which was wounded; and verily their wounds were so angred herewith, that they bledde much, and by their paine and feavers encreased, were forced with much sigh∣ing to breathe their last.

Thus much may serve to be spoken of the cure in generall, now we will out of the monuments of the ancients, treate of the particular.

Notes

• * 1.1

  How the ayre ought to be.
• * 1.2

  Aphor. 18. sect. 〈◊〉〈◊〉.
• * 1.3

  Lib. 2, de us•• part. ca. 2.
• * 1.4

  The Aire though in sum∣mer is colder than the braine.
• * 1.5

  The discom∣modities of too much light.
• * 1.6

  What his drink must be.
• * 1.7

  Almonds en∣crease the paine of the head.
• * 1.8

  What fish he may eate.
• * 1.9

  Aphor 13. & 14 sect. 1.
• * 1.10

  Aphor. 15, sect. 2
• * 1.11

  Why sleepe up∣on the day-time is good for the braine being enflamed. Lib. 2. Epidem.
• * 1.12

  The discom∣modities ensu∣ing immode∣rate Watching.
• * 1.13

  Gal. Meth. 13.
• * 1.14

  Medicin••s pro∣curing sleepe.
• * 1.15

  The commo∣dities of sleepe.
• * 1.16

  Lib. 4. Meth.
• * 1.17

  Lib. de cur. per sangu•…•… Miss.
• * 1.18

  The use of Fractures.
• * 1.19

  A History.
• * 1.20

  The two chiefe Indica∣tions in blood letting.
• * 1.21

  The discom∣moditis of ve∣nery in vvounds of the head.
• * 1.22

  Hovv hurtfull noyse is to the fractures of the scull.
• * 1.23

  A History.