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. XXI. Of the discommodities which happen to the Crassa Meninx by fractures of the Skull.

MAny discommodities chiefly happen to the Crassa Meninx by a fracture of the skull and rash trepaning thereof; for it sometimes chances to be cut and torn. Agglutination is a remedy for this disease, which Hippocrates wishes to be procured with the juyce of Nepeta, [that is, of that Calamint, which smells like Penny-royal] mixed with Barly-flour. In stead whereof this following powder having the like faculty may take place.

* 1.1℞ Colophon ʒ iij, Myrrhae, Aloes, Mastiches, sanguinis Dracon. an. ʒ j, croci, sarcocollae, an. ʒ ss. misce & fiat pulvis subtilis. But to purge the bloud and matter which is gathered and lyes between the Crassa Meninx and Skull, you shall put in a Tent made of a rag twined up some four or five double, and steeped in syrup of Roses or Wormwood, and a little Aqua vitae; for thus you shall press down both the Crassa Meninx, lest lifted up by the accustomed and native pulsation of the Brain, it should be hurt by the edges of the Skull, yet rough by reason of the sharp splinters of the bone lately trepaned, and give freer passage forth for the matter there contained. But as oft as you shall dress the Patient, you shall renew the forementioned Tent, until all the matter be purged forth. And so often also you shall press down with this following Instrument the Dura Mater,

and bid the Patient to strive to put forth his breath, stopping his mouth and nose, that so the matter may more easily be evacuated. This Instrument wherewith you shall hold down the Dura Mater, must have the end round, polisht, and smooth, as it is here exprest.

[illustration]

A fit Instrument to press and hold down the Dura Mater, so to make way for the passage forth of the Sa∣nies or Matter.

And let there be laid upon the Du∣ra Mater strewed over with the formerly forementioned powder, a spunge moistened and wrung forth of a drying decoction made of aromatick and cephalick things, such as this which follows. ℞ Fol. salviae, majoran. betonicae, rosar. rub. absinth. Myrtil.* 1.2 florum cha∣maem. melil. stoechad. utriusque an. M. iij. ss. rad. cyperi, calam. aromat. ireos, caryophyllatae, angelicae, an. ℥ ss. bulliant omnia secundum artem cum aqua fabrorum & vinoru••ro, fiat decoctio ad usum dictum. And instead hereof you may use claret with a little aqua vitae, that so the contained matter may be evacuated and dryed up. A spunge is fitter for this purpose to draw than a linnen rag or any other thing, both because it is good of it self to draw forth the humidity,* 1.3 as also for that by its softness it yeelds to the pulsation of the Brain. Then apply to the wound and all the adjoining parts, an emplaister of Diacalcitheos dissolved with vinegar, or wine, or oyl of Roses, that so the plaister may be the more cold and soft. For, in Hippocrates opinion, nothing which is any thing heavy or hard must be applyed to wounds of the head, neither must it be bound with too strait, or hard a ligature, for fear of pain and inflammation.* 1.4

For Galen tells (as he had it from Mantias) that a certain man had lost his eyes by inflammation and impostumation, arising for that an Apothecary had used too strait a ligature to his head and face; for, this strait ligature so pressed the sutures, that the fuliginous vapours,* 1.5 which used to pass through them and the pores of the skull, were stopped from passing that way; besides, the beating of the Arteries was intercepted and hindered; by which means the pain and inflammati∣on so encreased, that his eyes were rent and broke in sunder and fell forth of their orb.* 1.6 Where∣fore Hippocrates rightly commends an indifferent ligature: also he fitly wisheth us to let the em∣plaisters be soft which are applyed to the head, as also the cloaths wherewith it is bound up to be of soft and thin linnen, or of Cotton, or wool. When the patient is in dressing,* 1.7 if there come much matter out of the wound, you shall wish him if he can, to lye upon the wound, and now and then by fits to strive to breathe, stopping his mouth and nose, that so the brain lifted and swoln up∣wards, the matter may be the more readily cast forth; otherwise suffer him to lye so in his bed, as he shall best like of, and shall be least troublesome to him. You may with good success put upon the Crassa Meninx oyl of Turpentine with a small quantity of aqua vitae and a little Aloes and Saf∣fron finely powdred, to clense or draw forth the Sanies, or matter. Or else, ℞ Mellis rosar. ℥ij. farinae hord. pulver. aloes, mastich. & Ireos florent. an. ʒ ss. aqua vitae, parum; let them be incorporated together and make a detersive medicine for the foresaid use.

Sometimes also the Crassa Meninx is inflamed after Trepaning, and swoln by a Phlegmon, that,* 1.8 impatient of its place, it rises out of the hole made by the Trepan, and lifts it self much higher then the skull, whence grievous symptoms follow. Wherefore to prevent death, of which then we ought to be afraid, we must inlarge the former hole with our cutting mullets, that the mat∣ter contained under the skull, by reason of whose quantity the membrane swells, may the more freely breathe and pass forth; and then we must go about by the prescript of the Physitian to let him bleed again, to purge and diet him. The inflammation shall be resisted by the application of contrary remedies, as this following fomentation. ℞. Sem. lini, althae, fon. psillii, ros. rub. an. ℥ j. solani, plantag. an. M. j. bulliant in aqua tepida communi, ex qua fiat fotus. Anodyne and repelling me∣dicines shall be dropped into his ears, when it is exceedingly swoln, that the tumor may subside,* 1.9 you shall cast upon it the meal or floure of lentils, or vine leaves beaten with Goose grease. With all which remedies if the tumor do not vanish, and withall you conjecture that there is Pus or mat∣ter contained therein, then you must open the Dura Mater with your incision-knife, holding the point upwards and outwards, for so the matter will be poured forth and the substance of the brain not hurt nor touched. Many other Chirurgeons, and I my self,* 1.10 have done this in many patients with various success. For it is better in desperate cases to try a doubtful remedy then none at all; also it oft-times happens, whether by the violence of the contusion and blow, or concretion or clotting of the blood which is shed, or the appulse of the cold ayre, or the rash application of me∣dicines agreeing neither in temper nor complexion with the Crassa Meninx, or also by the putre∣faction of the proper substance, that the Dura Mater it self becomes black.* 1.11 Of which symptome the Chirurgion must have a great and special care.

Therefore that thou mayst take away the blackness, caused by the vehemency of the contusion, you shall put upon it oyle of eggs with a little Aquae vitae, and a small quantity of Saffron and Or∣ris roots in fine powder, you shall also make a fomentation of discussing and aromatick things boy∣led in water and wine; and Vigoes Cerat formerly described shall be applyed. But if the harm come from congealed blood, you shall withstand it with this following remedie. ℞ Aqua vitae ℥ij. granor. tinctorum in tenuem pulverem tritorum ʒijss. croci, ℈1. Mellis rosat. ℥ijss. sarcocol. ʒiij. Leviter & simul ••••lliant omnia, & de colatura infundatur, quousque nigrites fuerit obliterata.* 1.12 If this affect come by the touch of the ayre, it shall be helped with this following remedy. ℞ Tereb. ven. ℥iij,

Mellis. ros.* 1.13 ℥ij. Vitellum ov. unum, farin. hordei ʒiij. croci ℈j. sarcocol. ʒij. aq. vitae ʒij. Incorporentur simul, & ••ulliant paululum. This remedy shall be used untill the blackness be taken away, and the membrane recover its pristine colour.

* 1.14But if this affect proceed from the rash use of medicines, it must be helped by application of things contrary. For thus the offence caused by the too long use of moist and oyly medicines, may be amended by using catagmatick and cephalick powders; but the heat and biting of acrid medi∣cines, shall be mitigated by the contrary use of gentle things: for both humid and acrid things somewhat long used make the part look black; that truly, by generating and heaping up filth; but this,* 1.15 by the burning and hardening heat. But when such blackness proceeds from putrefaction, Iohn de Vigo commends the following remedy. ℞ aqua vitae ℥ij. mellis rosat. ℥ ss. But if the affect be grown so contumacious that it will not yeeld to this gentle remedy, then this following will be convenient. ℞ Aq. vitae ℥iij. mellis ros. ℥j. pulver. Mercur. ʒij. unica e••ullitione bulliant simul ad usum dictum. Or ℞ aqua vit. ℥jss. syrup. absinth. & mellis rosat. an. ʒij. unguenti Aegyptiaci ʒjss. sarcocol. myrrhae, aloes, an. ʒj. vini albi boni & odoriferi, ℥j. Bulliant leviter omnia simul, colentur ad usum dictum. But if the force of the putrefaction be so stubborn, that it will not yeeld to these remedies, it will be helped with Aegyptiacum (made with plantain water instead of Vinegar) used alone by it self, or with the powder of Mercury alone by it self, or mixt with the powder of Alome. Neither must we be afraid to use such remedies especially in this extream disease of the Dura Mater; for in Galens opinion the Crassa Meninx after the skull is trepaned delights in medicines that are acrid,* 1.16 that is, strong and very drying, especially if it have no Phlegmon: and this for two reasons; the first is, for that hard and dry bodies, such as membranous bodies are, be not easily affected unless by strong medicines; the other is, which must be the chief and prime care of the Physitian, to pre∣serve and restore the native temper of the part by things of like temper to it. But if the auditory passage not only reaching to the hard membranes of the Brain, but also touching the Nerve which descends into it from the brain, suffer most vehement medicines, though it be placed so neer; cer∣tainly the Crassa Meninx will endure them far more easily and without harm. But if by these means the putrefaction be not restrained, and the tumor be encreased so much, that the Dura Mater ri∣sing far above the skull, remains unmoveable, black and dry, and the patients eyes look fiery, stand forth of his head and rowl up and down with unquietness and a phrensie,* 1.17 and these so many ill ac∣cidents be not fugitive, but constant; then know that death is at hand, both by reason of the cor∣ruption of the gangraen of a noble part, as also by extinction of the native heat.

Notes

• * 1.1

  Remedies for the lacerated Meninx.
• * 1.2

  A spunge fit to foment withal.
• * 1.3

  Lib. de vuln. cap.
• * 1.4

  Lib. de fasciis.
• * 1.5

  The discom∣modities of too strait binding of the head.
• * 1.6

  What cloaths we must use.
• * 1.7

  How the pati∣ent must lye in his bed.
• * 1.8

  Paulus lib. 6. cap. 90.
• * 1.9

  Remedies for the inflamma∣tion of the Crassa Meninx.
• * 1.10

  How we must open the Cras∣sa Meninx when it is im∣postumate.
• * 1.11

  The causes and remedies of the blackness of the Dura Mater. Remedies for contusion.
• * 1.12

  For congealed blood.
• * 1.13

  For the hurt received by the Ayre.
• * 1.14

  What medicins make the Cras∣sa M••ninx black.
• * 1.15

  Medicins a∣gainst the pu∣trefaction of the Meninx.
• * 1.16

  Why the Cras∣sa Meninx easi∣ly endures a∣c••id medicins.
• * 1.17

  Signs of death at hand.