The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. XX. Of the corruption and Caries, or rottenness of the Bones of the Head.

THere sometimes follows a corruption and Sphacel of the fractured bones of the skull up∣on wounds of the head; which happens either because they are touched by the air,* 1.1 which they are not sensible of; or for that the Sanies putrefying and detained under them, hath infected them with like putrefaction; or by the cure unskilfully handled, they by the rash appli∣cation of suppurating and oyly medicines becoming more moist, and so undergoing an unnatural change of their proper complexion and native temper, as we shall shew more at large, when we shall treat of the reason of the Caries in the Lues venerea.* 1.2 We shal know this unnatural change and corruption, partly by sight, that is, when from white they become to be yellowish, livid, and black; partly also by putting down a Probe, when as it meets with nothing smooth and slippery, but feels rough in many places, and besides also when it enters and easily penetrates with a small thrusting down into their substance, as if it were fungous. Yet this last sign may often deceive you,* 1.3 for I have divers times observed rotten bones, which being bare had long suffered the injury of the air, to become so hard, that a Trepan would scarse pierce them; for it is putrid humidity which makes the bones soft and fungous; but the air by drying them exhausts this humidity, and lastly dryes it, whence follows such contumacious hardness. This sign will be far more certain, if the flesh which is grown upon the bone be more soft than is fit, loose, and have little or no sense of feeling. You may correct and amend this corruption of the bone with cauteries as well actual, as potential; or with the powders of Aloes, Gentian, Aristolochia, Centaury, Cortex pini: as ℞ radic. Ireos, Flor. Aristolochiae an. ʒ. j. centaur. ʒ ij, corticis pini ʒ ss, Misce & fiat pulvis subtilissimus ossi in∣spergendus. But if it be much corrupted, it must be scraped forth with your Scalpra. And you must expect the falling or scaling of the corrupt bone from the sound, and not forcibly procure it; for otherwise the sound Bone, which lies under it, being as yet covered with no flesh growing over it, would be corrupted by the appulse, or touch of the air. Yet you shall by little and little gently move and shake rotten Bones with your Probe, that so they may more easily scale, and with less trouble to Nature. But note by the way, that the scaling of the Bone which hath invironed the Trepan, is commonly performed in the space of forty or fifty days. So long also will that caused by the unusual appulse or touch of the air, or application of a cautery, or the aspersion of the Cepha∣lick powders; besides also, in the same number of dayes broken bones may be united and joyned together by a Callus, which is to them as a scar, yet sometimes sooner, somewhiles later, according to the variety of the ages, tempers, & habits of divers men. But if the Caries or rottenness can neither by these fore-mentioned remedies be orecome & amended, neither the loosed continuity aggluti∣nated nor united, you must give the Patient a vulnerary potion; for hence I have found happy suc∣cess in many. But sometimes not only a certain portion of the Bone, is taken with a Caries,* 1.4 but also the whole is often seised upon with a sphacel, and all falls out. For, in Hippocrates opinion, Lib. de vulneribus capitis, the Bone of the skull being broken falls from the sound more or less, according

to the violence of the blow;* 1.5 which also is confirmed by experience. For which purpose, I think good in this place to recite a History, whereof I was an eye-witness, whilst I served as a Chirurge∣on in Piemont under the Marshal de Montejan (who was the King's Lieutenant there.) It happened that a Lackey of Monsieur de Coulains came to me to be cured; he had the Bregma-bone of the left side broken with a Sword, neither yet did the fracture come to the second Table; a few days af∣ter his recovery, the bone being agglutinated and united, it came to pass that a company of Gas∣coine Souldiers his Countrymen came to Turin, with whom one morning he eat plentifully Tripe fryed with Onions and Spices, and drunk a great quantity of strong Wine. Whereupon he present∣ly fell into a continual Feaver, and lost his speech and understanding; his head swelled, his eyes looked red and fiery, and as though they would have started out of his head. Which things being considered, I let him bloud, having first (by the Physitian's advice) given him a Glyster, and applyed to his head such things as were fit; and also I laboured with Frictions and Ligatures of the extream parts to draw the humors downwards; yet for all this, the part of the head which was formerly affected begun to apostumate; which being opened, there came forth a great quantity of matter, and at the length the musculous skin and P••ricranium sinking down, both the Tables of the Skull became putrefied and rotten, as you might know by their blackness and stench. Now to take away this corruption, I applyed at certain times actual cauteries, both to amend the corruption and separate that which was altered: but mark, after some months space, a great number of worms came forth by the holes of the rotten bones from underneath the putrified skull; which moved me to hasten the separation and falling away of the putrid bones. Which being done, upon the very Crassa Meninx,* 1.6 which is more strange, in that place which nature had covered with flesh, I observed 3. cavities of the largeness of one's thumb filled with worms about the bigness of a points tag, with black heads, diversly wrapped among themselves. The bone which Nature separated was of the bigness of the palm of ones hand, so that it was strange that so large a portion of the skull should be cast off by Nature, and yet the Patient not dye thereof; for he recovered yet beyond all mens expectation, but after the agglutination of the wound the scar remained very hollow according to the decree of Hippocrates.* 1.7 For flesh doth not easily grow upon a Callus, because it is a thing strange and supposit••tious by Nature: besides, as a scar is a thing more dense than the skin, so is a Callus than the bone, so that through the more compact substance thereof, the bloud can neither freely nor plentifully sweat through for matter to regenerate flesh. Hence it is, that wheresoever any portion of the skull is wanting, you may there by putting to of your hand perceive and feel the beating of the brain, wherefore the skull must needs be much weaker in that place. Now to help this infirmity, I wished this Lacky to wear a Cap made of thick Leather, so more easily to withstand external injuries:* 1.8 and verily thereby he grew much better. Now I think good in this place to lay open the deceit and craft of some Impostors falsly styling themselves Chirur∣geons, who when they are called to cure wounds of the head, wherein any part of the skull is lost, perswade the Patient and his fr••ends, that they must put a plate of gold in the place of the skull which is wanting. Wherefore they hammer it, in the presence of the Patient, and turn it divers wayes and apply it to the part, the better to fit it; but presently after they slily convey it into their purses, and so leave the patient thus couzened. Others brag, that they are able to put the dryed rind of a gourd in the place of a lost bone, and fasten it on to defend the part; and thus they grossely abuse those which are ignorant in the Art. For this is so far from being done, that Nature will not suffer nor endure so much as an hair, or any other small body to be shut up in a wound when it is cicatrized; neither is the reason alike of a leaden bullet, which shot into the body lies there for many years without any harm to the Patient; for although lead have a certain fa∣miliarity with mans body, yet is it at length (unless the density of the opposed flesh, ligament, tendon, or some other such like substance hinder) thrust forth by nature impatient of all strange bod••es. And thus much of the rottenness and corruption of fractured bones; now must we speak of the discommodities which befal the Meninges by wounds whereby the Skull is broken.

Notes

• * 1.1

  Why when the skull is broken the bones sometimes be∣come foul or rotten.
• * 1.2

  The signs of foulness of the bone.
• * 1.3

  Corrupt bones are sometimes hard.
• * 1.4

  The benefit of a vulnerary potion.
• * 1.5

  〈1 paragraph〉〈1 paragraph〉.
• * 1.6

  A great fal∣ling away of a corrupt bone.
• * 1.7

  Aph. 45. sect. ••.
• * 1.8

  The covetous craft of impo∣stors.