A systeme of anatomy, treating of the body of man, beasts, birds, fish, insects, and plants illustrated with many schemes, consisting of variety of elegant figures, drawn from the life, and engraven in seventy four folio copper-plates. And after every part of man's body hath been anatomically described, its diseases, cases, and cures are concisely exhibited. The first volume containing the parts of the lowest apartiments of the body of man and other animals, etc. / by Samuel Collins ...

CHAP. XXX. Of the Diseases of the Skull, and their Cures.

THe Skull (being the Head-piece of the Brain to secure its choice Com∣page) is made up of many Bones mutually locked in and set toge∣ther by various Sutures, as so many fine and strong Articulations peculiar to the Skull, which is obnoxious to many wounds, of which every one admit∣teth variety of kinds.

The most General Wounds are Five in number, called by the Latines, * 1.1 Fissura, Contusio, Ossis depressio, Sedes, and Contrafissura.

The First is described by Hipocrates, de Capitis Vulneribus, after this manner, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: Os sub vulnere finditur, ossi{que} rimam habenti siquid fissum fuerit, Collisionem acce∣dere necesse est.

A Fissure of the Skull is produced by some heavy blunt Weapon, * 1.2 or by a fall against some hard Body, or by a Stone, a piece of Timber, or the like, by which the natural unity of the Skull is violated, as parted by a fra∣cture into two or more Bones, which keep their natural situation in reference to depression.

This Fracture hath many kinds, some broad, or narrow, * 1.3 others long or short; some crooked or straight, others superficial or deep; some Fractures penetrate only one Table, and others the Meditullium and both Laminae of the Skull.

In order to discover whether both Tables are broken, * 1.4 the Patient may stop his Nostrils, and shut his Mouth, and make a strong expiration, where∣upon the detained Breath will have recourse to the Brain and swell up its substance and Membranes, whereupon will ensue an Exudation of a frothy Moisture, and sometimes of Blood, or sanious Matter; so that the manner of the Fracture may be discerned when the Skull is laid bare, which is necessary in wounds of the Skull.

After the Scalpe is removed from the Skull by the incision of the Muscular Skin and Pericranium, which must be divided from the Skull, * 1.5 else pro∣per Medicines cannot be applied, and presently after this Chirurgical Ope∣ration hath been celebrated, Medicines must be administred to stop the im∣moderate flux, which often happens in this case, and requireth the assistance of a Skilful Chyrurgeon; and if the Skull be broken into small pieces, they must be taken away with proper Instruments, as not apt to be healed.

If the Skull be broken, so that it is necessary either to be Trepaned, * 1.6 or lifted up, being depressed, or to be scraped in some case, the Pericranium must be removed from the Skull, which (as being fixed by numerous Mem∣branes) is hardly effected, and accompanied with great pain, as being a Nervous part, endued with most acute sensation; whereupon to prevent an Inflammation and other severe accidents, Anodynes are to be applied, and a digestive immitted into the wound, made of the Yolke of an Egg, and Oyl of Roses, with this Caution, That no moist Medicine do affect the sound part of the Bone, but rather drying Medicines which do Conserve it,

in absuming all superfluous and extraneous moisture, which rendereth the Skull obnoxious to be corrupted and carious.

And the Trepan being applied in a Fracture of both Tables, * 1.7 a great care must be had, that the Dura Mater be not wounded; And it is also worth our consideration, how to demean our selves, when a great flux of Blood (ariseth from a broken Vessel, adhering to the inward La∣mina) which must not be immediately stopped, but be permitted to flow some time, as far it is consistent with the strength of the Patient, to prevent a Fever, Inflammation, pains, and other ill symptoms.

The application of the Trepan being very troublesome, it may be de∣manded upon what account it is celebrated; to which I take the freedom to make this reply; First, That the depressed Bones in great Fractures of the Skull may be reduced to their former situation; Secondly, To discharge the extravasated Blood falling upon the Dura Mater. in great wounds of the Skull, when the inward or both Tables are broken, and the Blood-vessels lacerated; and that the Sanious Matter may be evacuated, which often happens in Contusion of the Coats of the Brain.

Thirdly, the Trepan is used to lay open the wounded inward parts, the Dura and Pia Menynx, to see how they are affected, and that they may have Medicines immediately administred to them.

When the flux of Blood hath been sufficiently permitted upon the appli∣cation of a Trepan; * 1.8 to hinder an Apoplex, Fever, and other accidents, Medicines may be advised to stop the flux of Blood made of the Powder of Aloes, Frankincense, Mastick beaten up with the Whites of Eggs, and the Hairs of a Hare cut into most minute Particles.

After the flux of Blood is stopped, the Searcloth of Vigo may be used, as good in Fractures of the Skull, by reason it is attractive and made up of resolving and drying Ingredients; which being of a fragrant smell, do refresh the Brain, and also are endued with other qualities, which do corro∣borate it and its Membranes.

Powders of a drying nature, * 1.9 or a corrosive nature may be used to the Skull, as Aloes, Frankincense, Dragons Blood, Mastick, Myrrhe, &c.

The second wound of the Skull is called by the Latines, Contusio, by Hi∣pocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and is described by him after this manner in his Tractat. de Ca∣pitis Vulneribus.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Contundi autem Os potest, Osse naturaliter se habente, ut & rima nulla ad ossis contusionem accedat, atque hic alter modus est: At Contusionis plures sunt formae. Nam plus aut minus, & al∣tius per totum Os contusio pervadit, aut minus alte, ne{que} per totum Os & am∣pliorem aut minorem, tum longitudinem, tum latitudinem occupat. Sed nulla earum qualinam specie, aut quanta magnitudine existat, Oculis dijudi∣cari potest. Namque enim ubi quid Contusum est, & malum accessit

statim sub ipso vulnere Contusio oculis est Conspicua, ut neque rimae quaedam, quae procul a Fisso Osse longius excurrunt.

A Contusion of the Skull is made by a Collision of one hard Body (vi∣olently encountring another) wherein the outward Surface remaineth en∣tire according to Sense, and the inward position of Parts, * 1.10 receiveth an alte∣ration, whence the Bone is forced more inward, and its parts are lodged more close and contracted; * 1.11 so that there seemeth to be Two kinds of Con∣tusion in the Skull; The one is when the more outward parts have a recourse inward, not admitting a change in the Figure of their Surface; The other is when the outward Table is depressed, and loseth its former Situation and Form, by obtaining a Cavity or Trench, which is the Third kind of wound relating to the Skull, of which I intend to Treat hereafter.

The First kind of Contusion is found in the soft part of Skulls, and chief∣ly in those of Children, who are endued with a more moist and loose Com∣page of Bones, and the more solid frames of Skulls of Men have a spungy substance lodged between the two Tables, which is receptive of compressi∣on, and may have its parts more closely brought together, and affected with a Contusion, which being acted with violent ill accidents, is sometimes ac∣companied with the laceration of Vessels; whereupon extravasated Blood is lodged in the inward Recesses of the Skull, and rendreth it carious.

The Third kind of wound belonging to the Skull, * 1.12 is called by the La∣tines Depressio, and by Hipocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 As he hath it in his Book De Ca∣pitis Vulneribus. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

Os medium desidit, ubi a Natura sua intro recedit, una cum rimis, alioqui medium non desideret; quod enim medium desidit, ab alio Osse naturaliter se habente abruptum fractumque introcedit, itaque sane huic casui rimam accedere necesse est. Atque hic tertius est modus. Multis autem modis os medi∣um desidit. Namque hoc majorem & minorem ossis partem occupat, aut magis & altius ad imum penetrat, aut minus, & in superficie extat.

This kind of fracture of the Skull, named Depression, is different from that of a Rima, by reason it changeth its place, as the Bones of the Skull are bea∣ten inward, and receive a Cavity or Furrow, which is not visible in Rima simplici, wherein the surface of the Skull retaineth the same equality of sur∣face, with which it was invested before the Fissure.

And this wound of the Skull doth not suppose only an Introcession of it, but is attended with a Fracture, wherein the natural union of the Bones is vio∣lated, and is sometimes accompanied Cum Fissura, and other times Cum Sede.

The depressed Particles of the Skull being protruded inward, have some∣times one or more fragments, or shivers, gauling the tender Compage of the Dura Mater, which now and then happens, but is not a requisite condition to constitute a depression of the Skull, which may be produced by a violent fall or stroke against some hard body or weapon, dashing the broken Skull inward, without any violence offered to the neighbouring Membranes of the Brain.

In order to help the depression of the Skull, * 1.13 when it is broken into di∣vers Particles, sometimes the Trepan may be applied, to let out the putrid or sanious Matter lodged near the Brain, and other times the shivers of the Skull may be removed by Vectes, or Forcipes, lest they should offend the tender Coats of the Brain; with this caution, that as little of the Skull as

may, be taken away, by reason it is instituted by Nature, to guard the Brain from cold, and ill outward accidents.

Learned Paraeus giveth a History of a Servant, * 1.14 whose Skull was broken by the kick of a Mule, and being depressed, was lifted up by the applica∣tion of the Trepan, and the Matter lodged under the Skull discharged; and some part of the broken Skull being removed, the Patient was restored to his former Health. As this Learned Author hath it De partium vulneribus, lib. 9. Pag. 274. Ejus rei nuper patuit veritas in servo, D. Groto gravi Mulini Pedis Calcitratu effracturam in Coronali Osse passo: Id ipse cùm intelligerem, tri∣gona sectione cutem Musculosam eo consilio parte illa divisi ut terebram licerer ad∣movere, sequente die ergo terebrato osse, cùm de illo extrahendo cogitarem, imò ipsum jam terebra divisum avellere Conarer, enormem effracturae productionem, ex Ossis sub manu vacillantis mobilitate cognovi: a medio enim fronte us{que} ad mi∣norem oculi Canthum protendebatur. Ita{que} extrahendi & consilio & conatu misso aegro satisfactum putavi, si Os ipsum depressum erigerem altius: sic enim non jam crassae meningi comprimendo molestum erat, & conclusis materiebus per divisionem serra factum exitus patebat; quo factum est, ut tandem convaluerit, nisi quod inde altero lumine, quod ad fracturam orbatus est.

The Fourth kind of a wound of the Skull is styled by the Latines, * 1.15 Sedes, by Hipocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which he deciphers in his Book De Capitis vulneribus. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Ac ubi telum in Osse vestigium reliquit, utique rima adjici poterit, & ad rimam collisum aut magis aut minus accidere necesse est, cum qua etiam parte rima acces∣sit eadem teli vestigium appareat & rima sit in Osse qua teli vestigium in Osse re∣manet. Teli autem Sedes dicitur, cum Os suo statu permanens manifestum fece∣rit qua telum insederit.

This wound of the Skull is made, when the weapon, or any other hard, sharp Body, leaveth a plain impression in the cut Skull, which always is con∣joyned with the Incision of the Scalpe and Pericranium.

In this case the Skull is many ways offended, * 1.16 First, when a simple wound is inflicted by a Sword, Knife, or the point of any sharp weapon, where∣by the Skull is wounded, and a Puncture produced, not only penetrating the First Table, * 1.17 but the Second too; and if the Skull be cut with a sharp weapon (which is the Second kind of Sedes) according to the length of it; so that the wounded Skull is not disordered according to its situation, it may be called Incision, as the print of the weapon remaineth in the cut Bone, sometimes affecting the First Table, and other times the Second.

The Third kind of a Sedes, * 1.18 discomposing the Skull in the unity of parts, when some part of the Bone is cut off and lost, which the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latines Dedolatio sive excisio, wherein the Skull is shaved in some part, after the manner as a Trencher or Borde hath its Compage made more thin by a Plane.

The Fourth kind of Sedes is a kind of compound wound, * 1.19 wherein not on∣ly part of the Skull is cut off, but is attended also with a Fissure too, as the wound is made by a weapon somewhat blunt in its edge.

As to the cure of this Disease it may be observed, * 1.20 that if some part of the Skull be cut off, and hang only to a little of it, or to the Pericranium, and Muscular Cutis, it is not to be parted from them, but to be reduced to its pro∣per

situation; whereupon it will be agglutinated to the Skull, by the appo∣sition of a clammy, or callous Matter, uniting them to each other; as Learn∣ed Celsus an antient Chyrurgeon hath well observed, which Paraeus hath con∣firmed by his experience, Cap. 9. De partium vulneribus, Pag. 274. Hujus rei veritatem certa experientia in capitaneo Hydron non ita pridem comprobavi. Illi Ossis Coronalis portio media tres digitos longa, lata{que} ense valido sic excisa erat, ut jam viciniae osseae non cohaereret, sed vix pericranio & cuti musculosae ad∣haerens in faciem inversa procumberet, ac crassam meningem oculis subjiceret, ita∣que ipsam a sua cute revulsam parabam adjicere, in Hipocratici illius praecepti in mentem venisset, quo cautum est cerebrum operculo suo exarmare, & nudum relinquere. Quare sanguinem qui in crassam meningem, cujus motum oculis erat percipere, exciderat primo quoque tempore abstersi, ossis provolutam portionem suo loco reddidi, & ex superna parte Sutura, tribus punctibus adacta acu, stabilivi: at{que} quò reliqua saniei pateret effluxus, interjectas vulneris rimas, linamentis com∣plevi: Hac arte factum est, ut etsi eodem illo tempore multis aliis & ingentibus vulneribus Corpus confossum haberet, per Dei tamen misericordiam convaluerit: exemplo certissimo nihil ne{que} Cranii, ne{que} Pericranii, ac ne Musculosae quidem Cu∣tis quidquam nisi poscente necessitate abjiciendum, multo vero minus ut cerebrum suis operculis nudum maneat committendum.

The Fifth kind of the wound of the Skull is called by the Latines, * 1.21 Contra∣fissura, when it is made in some opposite place to the stroke, or fall, and is described by Hipocrates in his Book De Capitis Vulneribus, after this manner, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Os sub vulnere frangitur alia capitis parte quam quae ulcus est & Os nudatum est. Quin∣tus hic modus est. Huic{que} calamitati nullis remediis subvenias. Neque enim ubi istud contingit quanam ratione istud homo patiatur aut quanam Capitis par∣te ex ejus percunctatione deprehendas.

The Great Master of our Art calleth it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Infortunium, and denoteth those surprised with this Disease to be unfortunate, as being ignorant of the seat of their malady; whereupon the Physician is left in the dark, till the Disease having got too great a head, becomes incurable.

Learned Sennertus giveth this account of it, Accidit autem contrafissura ex resultu ictus in partem a plaga distantem, & ad resistendum minus aptum. Dum enim aer in diploe vocata, hoc est in Meditullio Cranii, seu inter utramque lami∣nam, conclusus vehementer ex ictu alterius loci agitatur & impellitur undique, fit, ut loco alter Calvae solidae allisus ipsam perfringat.

This Disease admitteth diverse kinds, * 1.22 The First may be when the Bone struck and wounded, being seated in different places in a Contrafissure, hap∣pens to be both in the same Bone.

The Second kind is, when the outward Table being struck, * 1.23 remaineth sound, and the inward is wounded.

The Third is, * 1.24 when the struck Bone is parted from the wounded by some Suture.

The Fourth kind of a Contrafissure may be, * 1.25 when a blow being inflict∣ed upon some part of the Head, and the Blood-vessels of the Dura or Pia Mater, are wounded in a place distant from the blow, which being given against the hinder part of the Skull, hath broken the vessels seated in the an∣terior part of the Dura or Pia Menynx, causing a Flux of Blood to be dis∣charged through the Nostrils.

Having given a description of several kinds of Diseases relating to the Skull, * 1.26 it may seem not improper to shew their Prognosticks, which may be of great use to arm our selves, with a true Prognostick, when we cannot make a Cure, which speaketh our Skill, and giveth satisfaction, that we are not mistaken in the knowledge of the Disease.

The wounds of the Skull, as being an Integument of the most noble part of the whole Body, do threaten great danger, as often affecting the Mem∣branes and substance of the Brain.

The danger is less when one Table is wounded, * 1.27 and greater when both are divided, and when the Fissure is small it hath most of danger, and less in a Sedes when the wound is broad and not deep, without any Contusion or Fissure; * 1.28 which when made through both the Laminae, is attended with a Flux of Blood (coming from the lacerated vessels) falling down upon the Dura Mater, often productive of an Apoplexy, from compressing the Ori∣gens of the Nerves, and intercepting the Influx of animal Liquor.

The fracture of the inward Table is sometimes accompanied with shivers of the Skull, which do prick the Coats of the Brain, and produce dreadful symptomes, which prove very fatal, especially if the fragments of the bro∣ken Skull do penetrate the substance of the Brain.

In hidden Fractures and Contusions, the Meditullium is often wounded, and its vessels broken; whereupon it is filled with extravasated Blood, which putrifies and corrupts the Skull.

Wounds are dangerous in the Sutures, in reference to the weakness of the Skull, and by reason some part of the Dura Mater is fastned by Fibrils to the Interstices of the Sutures.

Depressions of the Skull are not safe, * 1.29 because there is but a little space be∣tween the Skull and the Brain; whereupon it being compressed, is often en∣gaged in ill accidents, which are of Two kinds, which follow the affections of the substance of the Brain, and its neighbouring parts, as a Convulsion, Palsy, Sopor, Stupor, Delirium, and a Fever.

A Second kind of Symptomes is less terrible, and follows the commotion of the animal Liquor and Spirits, whence Patients are deprived of their Speech, Hearing, and Sight, which often return without any great preju∣dice. * 1.30

Accidents coming in the beginning of wounds of the Head, as pain of the Head, and bleeding of the Nose, or the disturbance of the animal Spirits are not deadly; and ill symptomes arising about the state of the Disease are worse, by reason they denote a collection of Pus or sanious Matter, &c. And if a Fever doth appear about the Fourth or Seventh day, it proceedeth from the generation of Pus, and if the Fever happens after that time, it may have a more sad consequence, as denoting the corruption of the coats or substance of the Brain.

If the lips of the wound be hard and dry, somewhat resembling salted flesh, as also depressed without any Tumor, or sanious Matter, or Pus coming out of the wound, it portends great danger.

If the Bone groweth Black in the beginning it is deadly; and very dange∣rous in wounds of the Skull to have Pustles in the Tongue and Mouth, which are symptomes of ill and malignant Fevers, attended with a Delirium, a lost Memory, Stupor, loss of Sight, Hearing, and sometimes with a Palsey, or Convulsive motions, which often speak a period to Life.

Notes

• * 1.1

  The five wounds of the Skull.
• * 1.2

  The cause of a Fissure.
• * 1.3

  The various kinds of Fra∣ctures.
• * 1.4

  The manner how to dis∣cover a Fra∣cture.
• * 1.5

  The Skull is to be laid bare in wounds.
• * 1.6

  The Trepan is to be ap∣plied in wounds of the Skull.
• * 1.7

  A care must be had in the application of the Trepan lest the neigh∣bouring prrts be wounded.
• * 1.8

  The Blood is not immedi∣ately to be stopped upon the applica∣tion of the Trepan.
• * 1.9

  Drying Pow∣ders are pro∣per in the Fracture of the Skull. The second wound of the Skull called Contusio, is described by Hypocrates.
• * 1.10

  The cause of a Coutusion of the Skull.
• * 1.11

  The kinds of a Contusion.
• * 1.12

  The Third kind of a wound, called a Depression of a Skull.
• * 1.13

  A Trepan may be admini∣stred in the Depression of a Skull.
• * 1.14

  An instance of the Cure of the Depressi∣on.
• * 1.15

  The Fisth wound, cal∣led Sedes.
• * 1.16

  The First kind of Sedes.
• * 1.17

  The Second kind of Sedes.
• * 1.18

  The Third kind of Sedes.
• * 1.19

  The Fourth kind of Sedes.
• * 1.20

  The Cure of a Sedes.
• * 1.21

  The Fifth kind of a Se∣des, called Contrafissura.
• * 1.22

  The diverse kinds of a Contrafissure. The First,
• * 1.23

  The Second,
• * 1.24

  The Third kind.
• * 1.25

  The Fourth kind of a Contrafissure.
• * 1.26

  The Progno∣sticks relating to the wounds of the Skull.
• * 1.27

  A small Fis∣sure of the Skull is very dangerous.
• * 1.28

  The wound of both Tables is often fatal.
• * 1.29

  Divers dan∣gerous Diseas∣es follow the depression of the Skull.
• * 1.30

  The ill symp∣toms of the wounds of the Skull.