CHAP. II. Of the causes and signs of a broken Skull.
THe causes of a broken Skull are external, as a fall, a blow or stroak with any kind of weapon, sharp, obtuse, heavy, hard, the bitings of Beasts, and many other things of the like kind. But the signs by which we come to know that the Skull is broken, are of two kinds; for some of them are found out by the reasoning and discourse of the mind, other by the sense, as those which lay open the wound to the eye and hand.
The Rational signs shew by these things which have happened upon the thing it self, whether it be, and of what sort it is. For you may know the Skull is broken, if the Patient shall fall down with the stroak, or if he shall fall headlong from a high place upon some hard thing. If for sometime after the stroak, he shall lie without speaking, sight and hearing; if he shall have felt and feel much pain, so that he is often forced to put his hand to the wound. But also the weapon is to be considered, that is, whether if it be heavy, obtuse, pricking or sharp. Also we must consider with what and how great strength the stroak was given, and with how great anger, and from what distance the weapon fell. Also we must consider whether the Patient received the blow with his head unarmed and naked; whether he fell into a swoon presently after the blow; whether, when he came to himself, he was in his right senses; whether his eyes were blinded; whether he were troubled with a giddiness or diziness, and whether he bled at the nose, mouth, ears, or eyes; and lastly, whether he vomitted. For Hippocrates writes, that those who have their Brain cut must necessarily have a Feaver and Vomitting of choler to ensue thereupon, which Galen confirming in his Com∣mentary, saith, that the same happens also when the Wound comes to the Membranes of the Brain.
Also a dull sound as from a broken vessel coming from the skull, (the hairy scalp and Pericra∣nium being taken off) and it being lightly smitten upon with an Iron probe, is said to be a sign of a fracture thereof, as it is recorded by Paulus Aegineta. Truly, all these signs make a great con∣jecture, or rather assuredness that the skull is wounded, and the Brain hurt, as which cannot happen unless the bone be broken, as Celsus hath written. Yet many have had their skulls broken, who had no such sign immediately after the blow, but this is very seldom. But I do not think fit amongst so many signs, here to omit that which is set down by Guido. If any (saith he) will know in what place the skull is broke, let the Patient hold fast between his fore-teeth, one end of a Lute-string or thread, and the Chirurgeon hold the other in his hand, then let him lightly touch or play upon the string with his fingers; for in the very instant of the sound or stroke, the Pati∣ent will be certainly admonished, or perfectly perceive the part of the skull that is broken, and as orecome and forc'd by this sense of pain, will by lifting up of his hand make demonstration thereof. As yet I have not been able to find the truth hereof by experience, although I have made tryal of it in many. Wherefore I cannot say any thing certainly of this sign, as neither of that which is mentioned by Hippocrates in Coais Praes. In such as you doubt, whether the Bones of