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

CHAP. IIII. Of a Fissure, being the first kinde of a broken scull.

IF the Chirurgion by the forementioned signes shall know that the scull is * 1.1 broken, or crackt, and if the Wound made in the musculous skin shall not be thought sufficient for ordering the fissure, then must he shave off the haire, and cut with a razour, or incision knife, the musculous skinne with the Pericranium lying under it, in a triangular or quadrangular figure to a propor∣tionable bignesse, alwayes shunning, as much as in him lies, the futures and tem∣ples; neither must the feare any harme to ensue hereof; for it is farre better to bare * 1.2 the bone by cutting the skinne, then to suffer the kinde and nature of the fracture to remaine unknowne, by a too religious preservation of the skinne; for the skinne is cured without any great adoe, though pluckt off to no purpose.

For it is much more expedient (in Hippocrates opinion) to cure diseases safely and * 1.3 securely though not speedily; than to doe it in a shorter time with feare of relapse and greater inconveniencies. Let this dissection bee made with a razour, or sharpe knife, and if there be any Wound made in the skinne by the weapon, let one of your incisions be made agreeable thereto.

[illustration]

A Razour, or Incision knife.

Now therefore the Musculous skinne together with the Pericranium must be di∣vided and cut with a sharpe razour pressed and guided with a strong and steddy hand; * 1.4 then must it be so pluckt from the bone, or scull lying under it, that none thereof re∣maine upon the bone; for if it should be rent or torne with the Trepane, it would cause vehement feavers with inflammation. You must beginne to pull it backe at the corners of the lines crossing each other with right angles, with this Chissell whose figure you see here expressed.

[illustration]

A Chissell or Instrument to pull backe or separate the Pericranium from the Scull.

Then you must fill all the wound with boulsters of fine soft linte, that so the lippes may be kept further a sunder. But you shall apply upon it medicines fit to stanch blood. But if it come so to passe that the blood flowes forth so violently, that it can be stayed by no meanes, the vessell it selfe must be bound, after this manner

First thrust thorough the musculous skinne on the outside with a needle and * 1.5 thred, then thrust the needle backe againe; then tye the thred on a knot on the out-side, but first put some lint rolled up to the bignesse of a Goose quill betweene the thred and the hairy scalpe on both sides thereof, least the strait twitching of the

thred which may serve to stay the bleeding, may cut and teare the skinne, or cause paine: then must you raise his head somewhat higher.

I have lately tried, and performed this upon a certaine Coach-man, who throwne * 1.6 from the Coach upon his head on a pavement of freestone, exceedingly bruised the hind part of the Bregma, for which cause it was fit to open the Musculous skinne, with a crosse incision, both that the congealed blood might bee pressed out, as also that the fracture (if there were any) might be observed. But an Artery being cut in per∣formance hereof, when as the Chirurgion who was there present could not stay the blood leaping out with violence; and the Coachman already had lost so great a quantity thereof, that his strength was so much decayed, that hee could not stirre himselfe in his bed, or scarce speake: I being called, shewed them by experience, that whereas a stringent medicines were used before to no purpose, it was better to stay the bleeding by binding the vessell, than to let the patient die for a childish feare of pricking him.

But that we may returne to our former matter, the Chirurgion shall the next day consider with what kinde of fracture the bone is hurt; and if no signes of hurt ap∣peare to the eyes, nor be perceived with your fingers and probe, yet some of the ra∣tionall signes may cause one to have a conjecture that there is a fracture: Then you * 1.7 must annoint as we told you before, the bared bone with writing Inke, and a little oyle of Roses; that the cleft or cracke may be dyed or coloured therewith, if that therebe any there. Then the next dressing you must drie the bone with a linnen cloth, and scrape off the Inke, and oyle, with scraping Instruments made for the purpose: if any part thereof, shall be suncke into the bone; for if there be any cracke, it will bee black; Wherfore you must continue scraping untill no signe of the fissure remaine, or else untill you come even to the Dura Mater. But that he may be more certaine whe∣ther the fissure pierce thorough both the Tables of the scull, he must bid the Patient, that stopping his nose & mouth, he strive to breathe with a great endevour. For then bloody matter or sanies will sweat thorough the fissure: For the breath driven forth * 1.8 of the chest, and prohibited passage forth, swells and lifts up the substance of the braine, and the Meninges, wherereupon that frothy humidity and Sanies sweats forth. Therefore then the bone must be cut even to the Dura Mater, with Radule and other scraping Instruments, fit for that purpose, yet so as you hurt not the membrane; but if the fissure shall be somewhat long, it will not bee convenient to follow it all the extent thereof: for nature will repaire and restore the remnant of the fissure by generating a Callus, besides also the Chirurgion according to Celsus opinion must take away as little of the bone as he can, because there is nothing so fit to cover the braine, as the scull. Therefore it shall suffice to make a passage, whereby the blood and Sanies may passe and be drawne forth, least that matter being suppressed may corrupt the bone, and cause an inflammation in the braine. But the broken bone must bee taken forth within three dayes if it be possible, especially in Sommer for feare of inflamma∣tion. Yet I have oftentimes taken forth with a Trepan and with Scrapers the bones * 1.9 of the scul, after the seaventeenth day, both in Winter & Sommer; and that with hap∣py successe. Which I have the rather noted, least any should, at any time, suffer the wounded to be left destitute of remedie: for it is better to trie a doubtfull remedie than none: Yet the By-standers shall be admonished and told of the danger, for ma∣ny more die who have not the broken bones of the scull taken out, than those that have.

But the Instruments, with which the wounded or cleft bones may be cut out are called Scalpri or Radulae, of which I have caused diverse sorts to be here decyphered, that every one might take his choice, according to his minde, and as shall bee best for his purpose. But all of them may be scrued into one handle, the figure whereof I have here exhibited.

[illustration]

Radulae or Scalpri (i) Shavers or Scrapers.

[illustration]

Radulae of another forme, for the better cutting of the greater bones.

To conclude, when the scull shall be wounded or broken with a simpleifissure, the * 1.10 Chirurgion must thinke he hath done sufficient to the patient; and in his Art, if hee shall divide the bone and dilate the fissure or cleft with the described Instruments, though he have used no Trepan, although the fissure pierce thorough both the Ta∣bles. But if it doth not exceed the first Table, you must stay your scrapers as soone as you come to the second, according to the opinion of Paulus: but if the bone shall be broken, and shivered into many peeces, they shall be taken forth with fit Instruments, using also a Trepan if neede shall require, after the same manner as we shall shew you hereafter.

Notes

• * 1.1

  Vpon what occasion the hairy sealpe must be cut.
• * 1.2

  Celsus.
• * 1.3

  Hippocrater.
• * 1.4

  The manner how to pull the hairiesealp from the bro∣ken scull.
• * 1.5

  The manner to binde a ves∣sell in case of too much bleeding.
• * 1.6

  A History.
• * 1.7

  A way to finde a fra∣cture in the scull, when it presents not it selfe to the view at the first.
• * 1.8

  A signe that both the Ta∣bles are bro∣ken.
• * 1.9

  You may use the Trepan after the tenth day.
• * 1.10

  It it sufficient in a simple fis∣sure to dilate it with your Scalpri onely and not to Trepan it.