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AS to Wounds in the Head with a Fracture of the Cranium, the Question is, when the Separation is to be made, says Albucasis, If the Pa∣tient come to the three first days after the Wound, then the Bone must be taken away before the fourteenth day: if it be in the Summer, then make hast to remove the Bone before the seventh, before what lyes under the Bone of the Pannicle be corrupt∣ed,
and terrible accidents ensue. Says Avicen, Separation must not be de∣lay'd in Summer beyond seven days, in Winter not beyond ten, but the sooner the better. Hippocrates allows but three days before Separation of the Bone, which is to be cut, and admits no longer delay if the weather be hot. To which Hippocrates ought to have added, if the Chyrurgeon be sent for soon enough: for if he be sent for late; or that the Patient and his friends will not consent, then the Skull is to be perforated at any time, so there be any hopes of Life. For in a certain danger a doubtful Remedy is better then none. For it matters not, says Celsus, Whe∣ther the Remedy be altogether safe, when there is no other. Horstius opened the Cranium of a certain Person upon the Eleventh day, and of another upon the Fifteenth. Hildan tells a remarka∣ble Story of a Cranium perforated with success, two Months after the Wound received; upon which the Matter gushed out with a full stream, the Patient was cured. Thus in our Patients Case at first came forth mattry and watry Blood, and upon the Seventeenth day meer white Matter. Hildan also produces ano∣ther Example of a Skull perforated upon the eleventh day. And Aegineta writes, that he knew one whose Cranium was per∣forated a Year after the Wound re∣ceiv'd, by which means, the Patient re∣covered. However he advises Separation of the Bone in the Winter before the fourteenth day, and in the Summer be∣fore the Seventh. In short these Ope∣rations prove best at the beginning, and as Avicen says the sooner the bet∣ter. But if the beginning be over-slip∣ed, it would be inhuman to give men over so long as there is hopes. Other∣wise as Celsus says, It is part of a pru∣dent Man not to meddle, where there is no hopes at all. Had those deadly Symp∣toms there appeared in our Patient be∣fore the Operation, which appeared af∣terwards, we had never adventured it; nevertheless he was cured contrary to our Expectation.
Some Physitians advise ye to take great care, least in the laying bare of the Cranium, which proceeds perfora∣tion, you make any Incision in the Sutures, for fear the Fibres of the hard Meninx, passing by the Sutures, and uni∣ted with the Pericranium, should be hurt: as if there were any such great danger in that. For I have been present at such Operations many times, and have ordered Incisions to be made upon the Sutures, if I found it a proper place, and that the little Fibres should be scraped off with a Pen-knife; and yet no harm ensued; and I have found by Experi∣ence, that such cautions as these are on∣ly fit for contemplating Physitians, who never were present at such Operations. Only take care of hurting the Tem∣poral Muscle, and that the Trepan be not set upon the Sutures, and the Per∣foration made there.