from the Bone, or Skull lying under it, that none thereof remain upon the Bone; for if it should be rent or torn with the Trepan, it would cause vehement pain with inflammations. You must be∣gin to pull it back at the corners of the lines crossing each other with right angles, with this Chis∣sel whose figure you see here expressed.
Then you must fill all the wound with boulsters of fine soft lint, that so the lips may be kept fur∣ther a-sunder. But you shall apply upon it medicines fit to stanch bloud. But if it come so to pass that the bloud flows forth so violently, that it can be stayed by no means, the vessel it self must be bound, after this manner.
First thrust through the musculous skin on the outside with a needle and thred, then thrust the Needle back again; then tye the thred on a knot on the outside, but first put some lint rolled up to the bigness of a Goose-quill between the thred and the hairy scalp on both sides thereof, lest the strait twitching of the thred which may serve to stay the bleeding, may cut and tear the skin, or cause pain: then must you raise his head somewhat higher.
I have lately tryed, and performed this upon a certain Coach-man, who thrown from the Coach upon his Head on a pavement of free-stone, exceedingly bruised the hind-part of the Bregma, for which cause it was fit to open the musculous skin, with a cross Incision, both that the congealed bloud might be pressed out, as also that the fracture (if there were any) might be observed. But an Artery being cut in performance hereof, when as the Chirurgeon, who was there present, could not stay the bloud leaping out with violence; and the Coachman already had lost so great a quantity thereof, that his strength was so much decayed, that he could not stir himself in his Bed, or scarse speak: I being called, shewed them by experience, that whereas astringent medicines were used before to no purpose, it was better to stay the bleeding by binding the vessel, than to let the Patient dye for a childish fear of pricking him.
But that we may return to our former matter, the Chirurgeon shall the next day consider, with what kind of fracture the Bone is hurt; and if no signs of hurt appear to the eyes, nor be perceived with your fingers and probe, yet some of the rational signs may cause one to have a con∣jecture that there is a fracture: Then you must anoint, as we told you before, the bared Bone with writing Ink, and a little Oyle of Roses; that the cleft or crack may be dyed or coloure therewith, if that there be any there. Then the next dressing you must dry the Bone with a linnen cloth, and scrape off the Ink, and Oyl, with scraping Instruments made for the purpose, if any part thereof shall be sunk into the Bone; for if there be any crack, it will be black; Wherefore you must continue scraping until no sign of the fissure remain, or else until you come even to the Dura Ma∣ter. But that he may be more certain whether the Fissure pierce through both the Tables of the Skull, he must bid the Patient, that stopping his Nose and Mouth, he strive to breathe with a great indeavour. For then bloudy matter, or sanies, will sweat through the Fissure: For the breath driven forth of the Chest, and prohibited passage forth, swells and lifts up the substance of the Brain, and the Meninges, whereupon that frothy humidity and Sanies sweats forth. Therefore then the Bone must be cut, even to the Dura Mater, with a Radula, and other scraping Instruments, fit for that purpose, yet so as you hurt not the Membrane; but if the Fissure shall be some∣what long, it will not be convenient to follow it all the extent thereof: for Nature will repair and restore the remnant of the Fissure by generating a Callus: besides also, the Chirurgeon accor∣ding to Celsus opinion must take away as little of the Bone as he can, because there is nothing so fit to cover the Brain as the Skull. Therefore it shall suffice to make a passage; whereby the bloud and Sanies may pass and be drawn forth, lest that matter being suppressed may corrupt the Bone, and cause an inflammation in the Brain. But the broken Bone must be taken forth within three days, if it be possible, especially in Summer, for fear of inflammation. Yet I have often taken forth with a Trepan, and with Scrapers the Bones of the Skull, after the seventeenth day, both in Winter and Summer; and that with happy success. Which I have the rather noted, lest any should, at any time, suffer the wounded to be left destitute of remedy: for it is better to try a doubtful remedy than none: Yet the By-standers shall be admonished and told of the danger, for many more dye who have not the broken bones of the Skull taken out, than those that have.
But the Instruments, with which the wounded or cleft Bones may be cut out, are called Scal∣pri or Radulae, of which I have caused divers sorts to be here decyphered, that every one might take his choyce, according to his mind, and as shall be best for his purpose. But all of them may be scrued into one handle, the figure whereof I have exhibited.