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. XXII. Of the cure of the Brain being shaken, or moved.

* 1.1WE have formerly declared the causes, signs and symptoms of the concussion, or shaking, of the Brain, without any wound of the musculous skin, or fracture of the bone; wherefore for the present I will treat of the cure. Therefore in this case, for that there is fear that some ves∣sel is broken under the skull, it is fit presently to open the cephalick vein. And let blood be plen∣tifully taken according to the strength of the Patient, as also respectively to the disease both which is present, and like to ensue, taking the advice of a Physitian. Then when you have shaven away the hair, you shall apply to the whole head and often renue the forementioned cataplasm, Ex f••rinis, oleo rosaceo, oxymelite, and other like cold and moist repelling medicines. But you must es∣chew dry; and too astringent medicins must be shunned, such as are Unguentum de bolo and the like; for they obstruct too vehemently, and hinder the passage forth of the vapours both by the sutures and the hidden pores of the skull. Wherefore they do not only not hinder the inflammation, but fetch it when it is absent, or encrease it, when present. The belly shall be loosed with a clyster, and the acrid vapours drawn from the head; for which purpose also it will be good, to make frictions from above downwards, to make straight ligatures on the extream parts, to fasten large cupping-glasses with much flame to the shoulders and the original of the spinal marrow, that so the revulsion of the blood running vio••ently upwards to the brain, and ready to cause a phlegmon, may be the greater,* 1.2 The following day it will be convenient to open the Vena Puppis, which is sea∣ted upon the Lambdall suture, by reason of the community it hath with the veins of the brain, and shutting the mouth and nose to strive powerfully to breathe. For thus the membranes swell up, and the blood gathered between them and the skull, is thrust forth; but not that which is shut up in the brain and membranes, of which if there be any great quantity, the case is almost desperate, un∣less nature assisted with stronger force, cast it forth turned into Pus. But also after a few dayes the vena frontis or forehead-vein may be opened, as also the Temporal Arteries, and Veins under the tongue, that the conjunct matter may be drawn forth by so many open passages. In the mean space the Patient must keep a spare diet, and abstain from wine, especially until the 14^th day, for that un∣til that time the fearful symptoms commonly reign. But repelling medicins must be used untill the 14^th day be past,* 1.3 then we must come to discussing medicins, beginning with the more milde, such as is this following decoction. ℞ rad. Alth. ℥vj. ireos, cypari, calam. arom. an. ℥ij. fol. salviae, majoran. betonic. flor. chamaem. melil. ros. rub. stoechad. an. M. ss. salis com. ℥iij. bulliant omnia simul secundum artem cum vin•• rub. & aqua fabrorum, fiat decoctio. Let the head be washt therewith twice a day with a spunge. But yet when you do this, see that the head be not too much heated by such a fomentation, or any such like

thing, for fear of pain and inflammation.* 1.4 Then you shall apply the cerate of Vigo which hath power to discuss indifferently, to dry, and draw forth the humors which are under the skull, and by its Aromatick force and power to confirm and strengthen the Brain; it thus described. ℞ Furfuris bene triturati ℥ iij. farin. lentium ℥ ij. ros. myrtillor. foliorum & granorum ejus, an. ℥ j. calam.* 1.5 aro∣mat. ℥ i ss. chamaemel. melil. M. ss. nuces cupressi num. vj. olei rosacei, & chamaem. an. ʒ iij. cerae albae ℥ ij ss. thuris, mastichis, an. ʒ iij. myrrhae ʒ ij. In pulverem quae redigi d••bent redactis, & liquefactis oleis cum cera, omnia misceantur simul & fiat mixtura, quae erit inter formam emplastri & ceroti.

Vigo saith, that one of the Duke of Urbins Gentlemen found the Urine hereof to his great good.* 1.6 He fell from his Horse with his head downwards upon hard Marble, he lay as if he had been dead, the bloud gusht out of his nose, mouth and ears, and all his face was swollen, and of a livid colour; he remained dumb twenty days, taking no meat but dissolved Gellies, and Chicken and Capon broths with Sugar; yet he recovered, but lost his memory, and faultered in his speech all his life af∣ter. To which purpose is that Aphorism in Hippocrates;* 1.7 Those that have their Brain shaken by what cause soever, mus of necessity become dumb; yea also, as Galen observes in his Commentary, lose both their sense and motion. That Cerot is not of small efficacy, but of marvellous and admirable force, which could hinder the generating of an abscess, which was incident to the Brain by reason of the fall. Yet there be many men so far from yielding to reason, that they stifly deny,* 1.8 that any impostumation can be in the Brain; and augmenting this errour with another, they deny that any who have a portion of the Brain cut off can recover, or rise again; but the authority of ancient Writers, and Experience, do abundantly refel the vanity of the reasons whereon they rely. Now for the first, in the opinion of Hippocrates; If those which have great pain in their heads have ei∣ther pus, water or bloud flowing from their Nose, Mouth or Ears, it helps their disease.

But Galen, Rhasis, and Avicen,* 1.9 affirm that Sanies generated in the Brain disburdens it self by the Nose, Mouth, or Ears; and I my self have observed many who had the like happen to them.

I was told by Prothais Coulen, Chirurgeon to Monsieur de Langey, that he saw a certain young man in the Town of Mans, who often used to ring a great Bell; he once hanging in sport upon the rope; was snatcht up therewith and fell with his head full upon the pavement: he lay m••te, was deprived of his senses and understanding, and was besides hard bound in his Belly. Wherefore presently a Feaver and Delirium with other horrid symptoms assayled him, for he was not trepanned because there appeared no sign of fracture in the skull: on the seventh day, he fell into a great sweat with often sneesing, by violence whereof a great quantity of matter and Pus flowed of forth his ears, mouth and nose; then he was eased of all his symptoms, and recovered his health.

Now for the second,* 1.10 Galen affirms that he saw a Boy in Smyrna of Ionia that recovered of a great wound of the brain, but such an one as did not penetrate to any of the ventricles. But Guido of Cauliac saith, he saw one which livad and recovered after a great portion of the brain fell out by reason of a wound received on the hind part of his head. In the year of our Lord 1538. while I was Chirurgeon to the Marshal of Montejan at Turin, I had one of his Pages in cure, who playing at quoits received a wound with a stone upon the right Bregma with a fracture, and so great an Ef∣fracture of the bone: that the quantity of half a hasel Nut of the brain came forth thereat. Which I observing, presently pronounced the wound to be deadly; a Physitian which was present contra∣dicted my opinion, affirming that substance was no portion of the brain, but a certain fatty body. But I with reason and experience in presence of a great company of Gentlemen,* 1.11 convinced the pertinacy of the Man, with reason; for that fat cannot be generated under the skull, for although the parts there contained be cold, yet because they are heated by the abundance of the most hot and subtle animal spirits, and the heat of vapours rising thither from all the body,* 1.12 they do not suf∣fer fat to concreat about them. But with experience, for that in dissecting of dead bodies, there was never any fat observed there; besides also fat will swim on the top of water; but this sub∣stance as marrowy, cast into the water presently sunk to the bottom.

Lastly, fat put to the fire becomes liquid and melts; but this substance being laid upon a hot iron, became dry, shrunk up and contracted it self like a piece of leather; but dissolved not at all. Wherefore all those which were present, cryed out, that my judgment was right of that substance that came forth of the skull. Yet though it was cut away, the Page recovered perfectly, but that he continued deaf all his life after.

Notes

• * 1.1

  What the concussion of the brain is.
• * 1.2

  The opening of the Vena Puppis.
• * 1.3

  A discussing fomentation. A caution in fomenting the head.
• * 1.4

  A caution in fomenting the head.
• * 1.5

  A description of Vigo's Ce∣rate.
• * 1.6

  A History.
• * 1.7

  Aph. 58. sect. 7.
• * 1.8

  That there may be an ab∣cess in the brain. Aph. 10. sect. 6.
• * 1.9

  Gal. lib. de inae∣qual intemp. Rhas. cap. 4. contine••t. Avi∣cen. cap. de exit. sen. 3. lib. 4. cap. 20. A History.
• * 1.10

  Lib. 8. de usu part. & com. ad Aph. 18. sect. 6.
• * 1.11

  Why fat can∣not be genera∣ted under the skull.
• * 1.12

  Signs of a fatty sub∣stance.