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

CHAP. VI. Of an Effracture, depression of the bone, being the third kinde of Fracture.

BEfore I come to speake of an Effracture, I thinke it not amisse to crave pardon of the courteous and understanding Reader, for this reason es∣pecially, that as in the former Chapter, when I had determined and ap∣pointed to speake of a Contusion. I inserted many things of a Depres∣sion; so also in this chapter of an Effracture, I intend to intermixe something of a Contusion; wee doe not this through any ignorance of the thing it selfe; for wee * 1.1 know that it is called a contusion, when the bone is deprest and crusht, but falles not downe. But an Effracture is when the bone falls downe and is broken by a most vio∣lent blow. But it can scarse come so to passe, but that the things themselves must be * 1.2 confounded and mixt, both as they are done; and also when they are spoken of: so that you shall scarse see a Contusion without an Effracture, or this without that. Therefore the bones are often broken off and driven downe with great and forcible blowes, with clubbes whether round or square, or by falling from a high place di∣rectly * 1.3 downe, more or lesse according to the force of the blow, kinde of weapon, and condition of the part receiving the same: Wherefore you must bee provided with diversity of remedies and Instruments to encounter therewith. Wherefore admit the bone is pressed downe, and shivered into many peeces, now for that these splin∣ters neede not be taken out with a Trepan: you may do the businesse with Levato∣ries * 1.4 made and neatly fashioned for that purpose; such as these, which are here ex∣prest.

[illustration]

A Levatorie.

But we must have speciall care, least that in pulling and taking out of these scales and splinters, we hurt the membranes. These scales are somtimes very rough & prick∣ly, so that they cannot touch the Meninges without offence; but somewhiles the busi∣nesse is so intricate, that they cannot be taken out unlesse by enlarging the fracture. Wherefore in this case, if there be a space so large, as that the ends of these mullets may enter you may easily sheare off so much of the bone, as shall be necessary •…•…e∣quisite for the taking away of these scales, without any assistance of the Trepan, which I have done very often and with good successe; for the operation performed by these mullets is far more speedy and safe, than that with the Trepan; and in the per∣formance of every operation, the chiefe commendation is given to safenesse and ce∣leritie.

[illustration]

Cutting Mullets, commonly called, Rostra Psittaci, or Parrots-beakes.

Moreover I have thought good here to give you the figures of chissells, scrapers, and Pincers, together with a leaden mallet, because such Instruments are not onely very necessary to take forth the scales of bones which are broken, but also to plaine, and smooth those which remaine whole.

[illustration]

The Figures of Scrapers, Pincers, a Leaden Mallet, &c.

But here you must note, that a Trepan nor Leva∣torie must never bee applyed to a bone quite bro∣ken, lest the membranes lying under it bee hurt by the compression thereof. Therefore you must ap∣ply them to a sound bone, but as neare as you can to the fracture, so that you take away as little of the scull as is possible, least the braine despoiled of its bonie cover, take some harme thereby. Neither Effractures, nor yet fissures if they bee of some length, must be followed to their ends, but thinke your selfe well, if you have made a passage for the issuing forth of the Sanies or filth, and have drawne forth that bone, which pricked the mem∣branes. For nature is accustomed by generating a Callus to souder, or unite the bones of the scull, as it also doth these of the other parts; as wee have read it written by Hippocrates and Galen; for which purpose it hath by singular pro∣vidence * 1.5 replenished both the Tables of the scull, with a certaine alimentarie and bloody matter, that with this, as with marrow it might repaire the losse and defect of the bone.

The truth hereof was lately manifested in the servant of Master Grol••, who had an * 1.6 Effracture on the coronall bone, by a greevous blow, given him with the foote of a Mule; which when I understood, I devided the musculous skinne with a three corne∣red section in that place, with an intent to apply a Trepan there; wherefore the day following, the bone being bored, and when I thought to draw it forth, yea verily endevoured to plucke it forth, being already divided with the Trepan; I perceived a fearefull production of an Effracture; by the moveablenesse of the bone shaking un∣der my hand; for it reached from the midst of the forehead, to the lesser corner of the

eye. Wherefore omitting both my determination and endeavour to pull it forth, I thought I should doe sufficiently for the patient•…•… if I should only raise up the bone which was deprest; for so it did not trouble the Crass••meninx by pressing it, and the matter, and filth, were let forth by a passage made with a saw. So that in conclusi∣on, he recovered perfectly, but that he lost one of his eyes which was adjoyning to the fracture.

Notes

• * 1.1

  What a contu∣sion is.
• * 1.2

  What an Ef∣fracture is.
• * 1.3

  The causes of Effractures.
• * 1.4

  The cure.
• * 1.5

  Hip. lib. do ••ul••. cap. Gal. sib. 6. meth. cap. 〈◊〉〈◊〉.
• * 1.6

  A History.