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

CHAP. XIX. Of the places of the scull whereto you may not apply a Trepan.

FIrst of all, you shal not apply a Trepan, to a bone that is so broken that it is * 1.1 wholy, or in the greater part thereof divided from the scull by the vio∣lence of the stroake, least by your weight and pressing of the Trepan, you force it downe upon Membrane.

Secondly, you must not apply one to the fractured Sutures, for the reasons men∣tioned in the former chapter.

Thirdly, nor to that part of the forehead which is a little above the eye-browes, * 1.2 for these reasons we gave you before in the twelfth chapter. For there is in that place under the first table of the scull it selfe, a large cavitie replenished with a certaine white and tough humor, as also with a certaine spirituous and ayrie substance, placed there by nature, to prepare the aire which ascends to the braine by the Nose-thrills: unlesse the Chirurgion observe and be mindfull hereof, he may bee deceived, sup∣posing this cavity to be an Effracture of the bone and a depression thereof.

Fourthly, neither in the lowest parts of the scull, lest the marrowy substance of the Braine, by reason of its weight, should slide through the hole made by the Tre∣pan.

Fifthly, neither to the Bregma bones of Children, as those which as yet have not acquired just soliditie, to endure the impression of a Trepan.

Sixtly, nor to the temples by reason of the Temporall muscle, the cutting whereof in the opinion of Hippocrates causes convulsson of the opposite part. For being cut * 1.3 athwart it looses its proper action, that is, to move and lift up the lower Iaw; but then the opposite Temporall muscle being whole and perfect, using its strength, (his Antagoniste suffering it, and not resisting or labouring any thing at all to the contrary) it drawes the same Iaw to it, whereupon the mouth and all the parts of the face are drawne awry, and suffer a Convulsion towards the sound part, the other be∣ing resolved according to Hippocrates his rule.

For as often as the muscles of one kinde are equall in number, magnitude and * 1.4 strength on each side, the resolution of the one part, causes the Convulsion of the other. * 1.5

Neither doth this danger alone arise from the cutting of the Temporall muscle, but also another, which is, that this muscle when we eate and speake, is in perpetuall motion, whereby it comes to passe, that being once cut, it is scarse ever united againe, besides also the commissure or joyning together of the stonie bones lye under it.

But by the second caution we are forbid to Trepan upon the sutures; moreover

also many Veines, Arteries and Nerves are spred over the substance thereof, so that by cutting of them, there is danger of many and maligne symptomes, as paine, in∣flammation, a feaver, a convulsion not onely of the part it selfe, but also of the whole body, whence lastly death ensues.

Wherefore let no Chirurgion be so foole hardy, as to attempt the cutting of this muscle, so to Trepan the bone which lyes under it; rather let him apply his Trepan above it, or on the side thereof, or as neere to the affected part as he can, as I did in a Gentleman caled Monsieur de la Bretesche.

He in the triumphant entrance of King Henry the second, into the Citty of Paris; was so hurt with a stone, that the Os Petrosum or scaly bone, was broken with the * 1.6 violence of the blow, and the temporall muscle was vehemently contused, yet with∣out any wound. I being called the next day (viewing the manner of the hurt, and the condition of the wounded part) thought good to bring some Physitions, and Chi∣rurgions with me to consult hereof, of whom when some thought it expedient pre∣sently to divide the Temporall muscle, that baring the bone we might apply a Tre∣pan, and so take forth the broken bones: I on the contrary begun earnestly to with∣stand that opinion, citing that saying of Hippocrates, ex libr•• de vulneribus Capitis, wherein Chirurgions are forbidden to cut such muscles, for feare of the foremen∣tioned symptomes; also I cited experience, how that I had often observed all those which had this muscle cut, dyed with a convulsion; but that it should be farre better, that neere above the fracture the bone should be Trepaned, not touching the Tem∣porall muscle at all if he could. When all of them at the last had inclined to my o∣pinion, I presently divided the musculous skinne which was over the upper part of the fracture with a three cornered section: the day following which was the third of his disease I Trepaned him, and after I had done, some few dayes after, I tooke out some foure splinters of the broken bone; and I put in a plaine leaden pipe, by which (I wishing the patient ever when I drest him to hold downe his head, to stoppe his mouth and his nose, and then strive as much as in him lay to put forth his breath) much sanious matter came forth, which was gathered betweene the scull and Crassa Meniux. Other filth which stucke more fast, I washed out with a detergent decocti∣on, injected with such a syring as is heere exprest; And I did so much, God blessing my endeavours, that at length he recovered.

[illustration]

A Plane leaden pipe for to carry forth the Sanies gathered under the scull.

[illustration]

A little syring fit to make injections withall.

The like chance and fortune befell Monsieur de Pi••nne at the seige of Mets. For he as hee fought at the breach of the wall, had the bone of his Temples broken with a stone strucke out of the adjacent wall, by a peece of Ordinance shot from the * 1.7 Emperours campe; he presently fell downe with the blow, and cast blood out of his mouth, nose and eares, with much vomiting, and remained dumbe & as it were sense∣lesse almost foureteene dayes, so that he knew none of the by-standers. He had often palpitations, and convulsiue twitchings, and his face was swollne. His forehead bone was Trepaned at the side of the Temporall muscle by the hand of Peter Aubert the Kings Chirurgion: and although on the 25. day, soft flesh, endued with exqui∣site sense grew out of the hole made with the Trepan, whose growth could not bee hindred by Cathaereticke pouders, yet at the length he recovered.

The Ancients called this kinde of growing flesh a Fungus [i. a Mushrome] for that it is soft, and growes with a small roote and broad top like a mushrome: but it encrea∣ses and decreases, according to the plenty of the flowing matter, and industry of the Chirurgion hindring by art the growth thereof.

This flesh stinkes exceedingly, they commonly call it ••icus sancti ••icarij [i. the

Figge of S. Fiacrye.] This disease commonly hath its originall after this manner. Even as in the bodies of Trees from the excrements of nourishment, a certaine halfe putrid * 1.8 grosse and viscous humor sweats through the barke, and gathered together by lit∣tle and little growes into a Mushrom, so blood melancholly both in temper and consi∣stence, springs from the broken vessells of the scull and Crassa Meninx, which also is sent sometimes by nature for the necessary repairing of the flesh in these parts, whereupon a certaine fungus breedes, which in Galens opinion, savors or partakes of the nature and condition of the parts to which it growes; though in generall it bee of the nature of maligne warts, or excrescences. But for to take away such Fungi, you must apply medicines which have a specifick faculty to waste superfluous flesh; such are these which strongly dry, and gently waste and eate, such as this which fol∣lowes.

℞ Sabinae ʒij. ocrae ʒj. pulverisentur simul, aspergatur caro excrescens. or else. ℞ Hermods∣ctylorum combustorum ℥ss. make a pouder for the same use. But if so be that this fungous flesh come to such growth, (as it often happens,) as to equall the bignesse of an egge, it must be tyed and straite twitched, close to the roote with a silken thred; and when it shall fall away by reason of this binding, the place must be strewed with the fore-mentioned powders, for so it will be more certainely cured, than with more acride cathaeretickes.

Notes

• * 1.1

  A bone almost severed from the scull must not be Tre∣paned.
• * 1.2

  A notable ca∣vitie in the forehead bone.
• * 1.3

  Lib. de ••ul. c••.
• * 1.4

  A rule out of Hippocrates.
• * 1.5

  What discom∣modities arise from cutting the temporall muscle.
• * 1.6

  A history.
• * 1.7

  A history.
• * 1.8

  The generati∣on of a Fungus.