A compleat discourse of wounds, both in general and particular whereunto are added the severall fractures of the skull, with their variety of figures : as also a treatise of gunshot-wounds in general / collected and reduced into a new method by John Brown ...

CHAP. XXI.

Of the Head it self, and of its Sutures.

WE come next to the Cranium it self; where we may find with what Art it is made and contrived. It is made of severall Bones, as you shall see expressed in the next Chapter. The Greek word for Bone is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quasi 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ab adjuncto proprio; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ab officio. I shall pretermit the generall discourse of other Bones, my present Task confining me to the Head. And here may * 1.1we consider of their Temper. For in Children we shall daily find in their primo Intuitu, these are more cartilagi∣nous then boney, and it is onely time and age that gives and bequeaths them their solidness and driness: and al∣though they may come under the name of Simple Parts, having no proper Figure allowed them, as have the Or∣ganicks; yet consider the rare Use appointed them, their particular Shapes and Forms; and in these also, were not a certain Articulation and Commissure granted them, all Animall motion must necessarily perish. Some of these we meet with accompanied with Protuberancies; others are like Valleys, giving way and shrowded under them: and hence do they assume their variety of names. And here also may we see how Nature, the rare Mistress of Curiosity and Art, endeavoureth to keep this Fabrick

entire and trim, who, by her kind Invention and curious Cunning, hath to these hard Substances added a middle matter, both for their better motion, and action. And since also this Queen of Order and Form hath granted Man the Divine sparks of Reason and Action, and allow∣ed him the Majesty of Government, she hath not nar∣rowly confined his Animall faculties to a strict Room, but hath allotted him a large Compass to exercise the same; and to guard these hath appointed this Cranium, as their best defence and security: and this brings me to the Dis∣course it self. And because Infants and young Babes, who have not arrived at a good age, cannot be granted to have in them a true and just Symmetry and Proportion of Bones, these I at present pretermit, and shall onely treat of such who have gained these.

* 1.2 And here we do grant, and generally allow, and ac∣count that the Head, which is set and fixed upon the Vertebrae of the Neck, does divide it self into a Cranium and a Face; the Head being that Part which containeth the Brain, as we have already shewn. It is called Cra∣nium or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Galea. As touching its Fi∣gure and Use, more afterwards. In young people it is seen to consist of fourteen Bones, some of which are par∣ticularly proper to it, others common. The proper are the Frontall bone, two of the Sinciput, one of the Occi∣put, two Temple-bones, in each Ear planted, three Bones named Incus, Stapes, Malleus. The common are, Os Cu∣neiforme, and Spongiosum, and two of the Mandibles, be∣sides the Teeth. But to pass these at present, we shall particularly treat of those of the Skull, which are proper∣ly thereto belonging, and its Sutures. And here, as the Brain is the most noble Vessell of all others in the Body, Nature hath placed this on the Top, being as the Prince of the rest, and covered it with a Skull, for keeping in its own dominion the Seat of Reason, the Treasure of Judgment, the Register of Memory, the Shop of Sense

and Motion, and the Royall Order of Contrivance and Ex∣ecution. This being planted as the Angelicall part of the World, having allowed it Reason to invent, Memory to retain, Judgment to execute, and Counsell to advise. Neither hath she framed these alone with Curiosity; but viewing its Front and exteriour Vesture, we must grant that she hath so wonderfully lockt up this Treasury un∣der the particular Keys of her Connexions, that it is past the proudest Judgments of men to frame any one thing to compare with it. And considering its Sphaericall Figure, and the Connexion of parts, it might well make poor Man fall into an humble adoration of his Maker, who hath thus guarded this Treasury, which contains in it the whole Life, Sense, and Reason of mankind. It is not made of one Bone, but framed of many; which may be accounted an admirable piece of Contrivance: and so strangely fashioned, that no other Part of the Body dares compare with it.

And that it may not glory or boast of its fair and strong * 1.3Structure, embracing onely the name of a Helmet of de∣fence, you may find that it is allowed a proper Office granted it by the Divine Artificer. For you may see it ordained as a strong foundation for the maintaining, keeping and propagating the interest and priviledges of other Bodies, planted both in it, and under it. Thus the Brain, by the benefit of its Sutures, tying its Membranes to this Skull, is kept in a fair Aequilibrium: and had it not been thus fashioned, those frequent Concussions or violent Motions occasioned by jumpings or leapings would herein soon create a great disturbance.

* 1.4 The Sutures also are of much benefit to the Brain: for as it is placed in the upper house, many Fumes and Va∣pours do ascend hither from the Kitchin of the Body, which are not speedily to be dispatched by these. What an ill condition are those poor people in, what storms of troubles and tempests of distempers are such people assaul∣ted

with, who have these wanting in them? Hence is it, that those that want these are so frequently accompanied with Pains of the Head, and other Perplexities; which trouble not such as have these expulsive Passages. Ano∣ther benefit hereof is, that one of these being obstructed, the other do supply its place: and though in this case it is not capable to give so quick a dispatch, yet by degrees it performeth its office very promptly.

* 1.5 The Substance of the Skull does vary much in respect of age, being in an infant Membranous, and in one of riper years of a more Boney substance. It hath not a like * 1.6Figure in all men, containing in it both the Cerebrum and Cerebellum. And this variety or dissimilitude is not so much inconsistent with the Eyes, Nose, Ears, and the lineaments of the Face, as in the Bones and Sutures. And the cause hereof is generally referred to the strength or weakness of the Formative faculty, plenty or scarcity of Matter, or its goodness or illness, as Galen declares.

* 1.7 Hippocrates does set down four Figures of the Head; two of which he saith are preternaturall. For in one hereof there is found no Prominency in the Occiput, and then there remain two Sutures, the Coronall, and Right; the Lambdoidall vanishing. In the other there is no Projecture about the Front, and then onely these appear, viz. the Lambdoides, and Recta; and the Coronall is ex∣tinct. And these two Figures in their Sutures do form the Letter T. The third is naturall, and is of a Sphaeri∣call Roundness, carrying with it the naturall Idea and Resemblance of the Head: but this being depressed, it expresseth an anteriour and posteriour prominent part; and being on either side depressed, these three Sutures do remain in the form and constitution of the Head, (viz.) Coronalis, Recta, Lambdoides, and being placed together exactly do make H. The fourth Figure is, when either Prominency is lost, which is contrary to the naturall fi∣gure

of the Head; then the Sutures do thus appear, X, and the Head is very round and sphaericall.

* 1.8 The Cranium is light both outwards and inwards, that it may neither seem troublesome to the Pericrane, nor Dura Mater. It hath and must have allowed it its Ine∣qualities, framed according to the bodies of the two Brains. It is framed of two Bones, thin, but hard, the one in∣ward, the other outward, not much unresembling a Pu∣mice-stone: and these by Anatomists are called Laminae Calvariae, or the two Tables of the Skull; the outward hereof being more thick and hard, the inward more thin and soft: and hence is it, that the outward, by stout and hard blows being given it, suffers not much; whilst the inward may be rent and divided. And because also man's Head is very various, as touching both the number and position of its Bones, in their thickness and thinness, hardness and softness, density and rarity, equality and in∣equality; and because of the Veins and Arteries allowed them, for conveying their nutriment and sustenance, pas∣sing between these; I shall afterwards enlarge on these for our better knowledge, and at present shut up this Chapter with a brief discourse of the Sutures.

* 1.9 A Suture therefore is the perfect draught and resem∣blance of things sown together. This I call a Composition, which may thus be understood. For that it is not 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 an Union, but a certain Articulation made 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, is thus best explained, in that it taketh its proper name from the resemblance of Cloath which is sown together. * 1.10And of these Sutures there are two kinds; the one pro∣per to the Head, the other common to it with the up∣per * 1.11Jaw and Os Cuneiforme. These proper are either true, or false; the true being in number three, the false * 1.12five; the first being single, the other double. The first are the Coronall, Sagittall, and Lambdoidall Sutures; the latter having Companions annexed to them, as one on the right side, another on the left. The First of these

is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Coronalis, from the Ancients, whose custome was to wear Garlands in that place. Our per∣sons of Honour at this day here do place their hairy Towers. And this does distinguish the Frontall bone from that of the Sinciput. The Second is called Lambdo∣ides, * 1.13from the resemblance it hath with the Greek A. It is also called the Occipitall Suture, from its site, it being placed in the back-part of the Head, separating the Oc∣cipitall bone from the Sincipitall bone. This Suture is seen sometimes double, containing in its middle a Bone with three corners, from whence it is called Triangularis. The Coronalis does resemble a Semicircle, crossing the Front as far as the Scaly Agglutinations, and does there separate the Frontall bones from those of the Sinciput. Sagittalis, the Third Suture, is placed between these, and * 1.14is a direct Suture, and divideth the Bones of the Sinciput, sometimes descending even to the Nose. There are be∣sides these four Bastard Sutures, but not so conspicuous as * 1.15the former. The first two are planted above the Ears, one on either side, above the Petrosa; these rather de∣serve to be nominated Scaly Agglutinations: the other two belonging to the Os Sphenoides, on its anteriour and posteriour part. Besdies these there are five Commissures * 1.16belonging to the Cranium, and to the upper Mandible, by some called Harmoniall Sutures. The first is made in the right Orbit of the Eye, proceeding outwardly from the end of the fifth Suture, and is common to the first Bone of the Front, and upper Mandible. The second appears in the lower and laterall seat of the Eye. The third ascends outwards to the uppermost part of the Nose obliquely from the inward side of the Eye. The fourth proceeds ob∣liquely through the middle of the Jugal bone, and joyns to the Temporall bone. The fifth is in the breadth of the Nose, and in the amplitude of the Nostrills, and the bridge of the Nose. All these are ordained by Nature * 1.17to be as Vents and Discharges to send forth and dispatch

both Fumes, Vapours, and Excrements: framed also for the ingress and engress of the Vessells, which are procured for the nourishing of the Brain. And hence may we well admire the true Judgment of Hippocrates, who writes, that such people who have most Sutures in their Head are * 1.18most healthfull. We are advised by him also, in Sutures not to make any Incision, for these three Reasons. 1. Be∣cause they are weak and easily perforated by the Saw, and thus the Brain and its Membranes hurt. 2. Because through these Sutures both the Veins and Arteries do pass, and these being touched with any iron Instrument, it may perhaps or by chance reach the Membranes. 3. Be∣cause Callosities being here contracted they do much hin∣der Transpiration.

Notes

• * 1.1

  The Temper of Bones.
• * 1.2

  As touching the Head.
• * 1.3

  Its Use.
• * 1.4

  Of the Su∣tures, and their Uses.
• * 1.5

  As touching its Sub∣stance.
• * 1.6

  Its Figure.
• * 1.7

  Four Figures of the Head set down by Hippocrates.
• * 1.8

  Its Superfi∣cies.
• * 1.9

  The true de∣finition of Sutures, and why so cal∣led.
• * 1.10

  Of their Dif∣ferences.
• * 1.11

  Three pro∣per Sutures.
• * 1.12

  1. Coronalis.
• * 1.13

  2. Lambdoi∣des.
• * 1.14

  3. Sagittalis.
• * 1.15

  Four Bastard▪ Sutures.
• * 1.16

  Five Com∣missures.
• * 1.17

  Their Uses.
• * 1.18

  Three Rea∣sons not to make any Incision into the Sutures, given by Hippocrates.