Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. XVII.

Of the rest of the points common to most Wounds. of the Head.

THe Second general point con∣cerning Wounds of the Head, shall be dispatched by setting down the general Prognosticks of them, which are these that here ensue.

1. Nulla capitis vulnera quan∣tumvis exigua: No Wounds of the Head although they seem small are to be slighted and neglected; for oftentimes it falls out, that when a Wound is received with∣out a fracture in the Head, a man may die, if fearful symptomes or accidents appear: as a Convulsion, a Palsie of one Arm or Leg, a Fe∣ver, Raving, Vomiting, faltring of the Tongue, Valeriol. lib. 3, obseiv. 1. ••ungius tom. 1. ep. 10.

2. Wounds of the Head often become 〈…〉〈…〉 easie or hard to be cured, bit reason of the Coun∣tries 〈◊〉〈◊〉 Ch••••••tes.

This happens either because the Air is hurtful by its elementary quality only, as when it is cold and moist, as in Florence and Bononia, according to Amat. Lusitan. Cent. 6. Curat. 100. Quercet. de Vul∣nerib. Sclopet. cap. 3. and in Paris, according to Parey, lib. 10. cap. 8. Or this happens when the Air uffends by a malign quality, as is observed in Gallia Narbonensis, and those parts of Italy, which lie near to the Mediterranean Sea, by rea∣son of malign Vapours raised out of the Sea, and dispersed through the Air.

3. Wounds of the Head recei∣ved by persons who have the Pox, Leprosie, Dropsie, a Cough of the Lungs, a Hectick Fever, a Con∣sumption, or ill habit of Body, are hardest to be cured; partly be∣cause the Blood is not sit for uniti∣on, being corrupt, as in the Pox and Leprosie; partly because there is not a sufficient store of it, as in a Hectick, and Extenuation of the Body.

4. Wounds of the Head in Chil∣dren prove sometimes rebellious; partly because they are of a hot and moist constitution, which is most apt to admit putrefaction; partly because the habit of their Body is thin, and so ministreth occasion to the breathing out of the Spirits.

5. In deadly Wounds of the Head, the parties live longer in the Winter, than in the Summer: for in it unnatural heat is not so easi∣ly raised as in the Summer.

6. If in Wounds of the Head a

Swelling suddenly doth vanish away, it is an ill sign, unless some e••aeuation hath gone before, or discussive Medicaments have been applied.

7. A Fever which invades while Suppuration is procured, that is, before the Seventh day, is less dan∣gerous than that which invades af∣ter the Seventh day: for about that time all accidents use to cease.

8. If a Fever in these Wounds do appear the Eleventh or Four∣teenth day, with a cold and groo∣••ing, it is dangerous, because it is to be feared lest some putrefaction bath possessed the Brain, the Me∣rurges, or the Scull; which a pale 〈◊〉〈◊〉 yellowish colour of the Wound, or like to Water, wherein raw flesh hath been washen, will dis∣cover.

9. Wounds contused are more flowly cured, than those which are ixised, because they require great∣er Suppuration.

10. Symptoms do sooner appear in the Summer, than in the Win∣ter; for in the Summer we look for them the Seventh or Four∣teenth day; and the reason is, be∣cause in the Summer the Humors admit sooner putrefaction, the un∣natural Heat being more readily stirred up. Vide Hippocrat. 1. Aphor. 15.

11. It is an ill sign, if the flesh of the brims look livid, for that is a sign of the decay of natural heat: See Hippoc. Sect. 7. Aphor. 2.

12. If in Wounds of the Head Reason fail, if Speech cease, if Sight be lost, if the party labour to tumble out of the Bed, when he is not able to move the parts of his Body, if he have a continual Fever, if his Tongue be black and dry, if the brims of the Wound be blackish or dry, if he have an Apoplexy, Palsie, with an involun∣tary excretion of his Excrements, or an absolute suppression of Excre∣ments and Urine, a Phrensie, or Convulsion, then you may pro∣nounce death to attend at the Door.

13. Wounds of the fore-part of the Head, are more dangerous than those of the hinder-part. First, because greater store of Brain is contained in the part. Secondly, because the containing parts are thinner there. Thirdly, because the Meninges have Sinuosities or Cels in the fore-part, but not in the back-part: wherefore this in∣equality cannot but endanger the Membranes, which cover the Brain, to be offended, if the Wound pass thorow the Scull, or if the Tre∣pan be to be applied. Fourthly, because if Wounds of these parts be deadly, he who hath a deadly wound in the fore-part of the Head, dieth sooner than he that hath a deadly Wound in the hin∣der-part. Fifthly, because more noxious Matter may be gathered in the fore-part, which may offend the Brain, than in the hinder-part, by reason of the multiplicity of the Cells. Sixthly, because the fore-part hath more Sutures than the hinder-part. See Fallop. in Hippocrat. de vulner. capitis, cap. 7, & 8.

14. Wounds of the Temples are very dangerous, First, because the motion of the joint of the low∣er Jaw, while we speak, eat, or drink, doth hinder unition. Se∣condly, because the passage of

Hearing is in the Temples: now the instruments of the Senses are very sensible. Thirdly, because vessels of Moment, as the branches of the jugular veins, and soporal Arteries are distributed there: Fourthly, because the temporal Muscle is placed in the Temple, whose offence is not to be neglect∣ed. See Fallop. in Hippoc. de cap. vulnerib. c. 9.

15. A Wound in a Suture is dan∣gerous: First, because the Scull is there parted, and so more apt to opening than one solid Bone. Secondly, because in the Suture there is a Ligament, by which the Memnges are tied to the Pericra∣ni••m: Wherefore a Wound being inflicted there, an Inflammation may easily be communicated to the Meninges. Vide Fallop. in Hipp. de c. vuln. cap. 12.

16. Blackness in the parts near to the Wound, a Convulsion, Palsie, loss of Appetite, much watching, and colduess of the ex∣tremities of the Body, portend an evil event.

17. In these Wounds, if the brims tumesie not a little, it is an ill sign, according to Hipp••c. 5. Ap••••r. 66. If the tumefaction be soft, it shews concoction; but if it be hard, crudity. Secundum eun∣dem 5. Aphor. 67.

18. Flesh is easily regenerate in all wounds of the Head, if you ex∣cept those wherein there is a fea∣cture of the Scull a little above the Eye-brows: Three reasons may be yielded for this: First, because in those places there is a Cavity be∣tween the two tables of the Scull, which passes to the Sieve-like bones of the Nose, full of Air, by which the generation of flesh is hindred; for if you cause him, who hath a Wound with a fracture, there to breath strongly, his Mouth and Nostrils being shut, the breath which comes out at the Wound will blow out a reasonable Candle held to it. Secondly, because the thickness of the Bone will not suffer so much bloudy juice to breath out, as is sufficient for the generation of flesh. Thirdly, be∣cause there is a great affluxion of Excrements to the part, which otherwise would be discharged by the Eies and Nose, which hinder the desiccation of the Wound, and so cicatrization. Vid. Par. lib. 10. cap. 12.

19. In wounds of the Head you may hope well, if the Patient hath no Fever, if he be in his right mind, if he finds himself well when he takes any thing, if he sleep well, and have his Body soluble, if the Wound look with a fresh and live∣ly colour, if it yield laudable Quittour, and if in fractures the Dura Mater hath its motion free, and be not discoloured.

20. In wounds of the Head with a fracture, we must not think that danger is past before an hundred daies be expired.

21. The Callus, whereby the parts of the Scull are united, thô it be sooner induced in young, than in old persons; yet most com∣monly it is procured in the space of 40 or 50 daies.

The Third common point to be observed in Wounds of the Head, I affirmed to be the appointing of Topicks fit for the asswaging of pain, and the removing and hin∣dring of an Inflanmmation. Sundry

Authors have set down sundry de∣scriptions of such Medicaments, which if one should gather toge∣ther and set down, a reasonable Book might be compiled.

To avoid tediousness, and not to leave you altogether unfurnished without the description of any such effectual Medicament, I will set down the Receipts of such Medi∣caments which will answer your expectation, and ease the Patient.

The First shall be this: ℞ farin. herd. ℥ iiij. poscae ℥ vj. coq. ad ca∣taplasmat is consistentiam: tune ad∣d••ntur ol. ros. ℥ ij. fiat Cataplasma s. a. Si desit posca, substituendi in ••••ius locum acetum & vinum Ru∣beum, sumantur partes duae vini & 〈◊〉〈◊〉 aceti: Acotum rosaceum aut simbucinum praest antius est vulgari. This Medicament of Hippocrates Fallopius extolls above all others, 〈◊〉〈◊〉 lectionib. in Hippoc. de capitis ••••lnerib, c. 39. Let this Medica∣ment be used until the Seventh, or Fourteenth day, as you shall per∣ceive cause; Then apply other Medicaments, whereof I will speak when I come to discourse of the Cure of particular wounds of the Head.

The Second shall be this: ℞ Fa∣rin. bord. & Fabar. an. ℥ ij aceti res. ℥ vj. ceq. ista ad Cataplasma∣us. consistentiam: tum addantur ••. ros. ℥ ij. This Cataplasm cools, repells, dries, asswages pain, mi∣tigates Inflammation, and hinders the affluxion of Blood or hot Hu∣mors.

The Third shall be this: ℞ Me∣dullae panis albi ℥ iiij. lactis recen∣tis ℥vj. coq. ista. ad cataplasmatis consistentiam, tandem adae un∣guenti popul. ℥ ij. croci pulv. ℈ ij. This Cataplasm is effectual, if the Inflammation and Pain be great, if the party be of a dry and hot Complexion, or be any way Fe∣verish. These Cataplasms are to be applied above the Medicaments wherewith the Wound is drest, the hairy Scalp having been shaven for a reasonable compass about the Sore or Wound.

The last general point concern∣ing all wounds of the Head, set down by me, was of dressing up of the Head after the application of the Medicaments. In the dres∣sing two things are to be observed; the covering of the Head, and the rolling: As for the covering, A Cap must be made of a soft Lin∣nen-cloth, basted with fine Chi∣rurgeons Tow, but not quilted; and it must be of that bigness, that it may compass the whole Head: it must not be too thick, too heavy, or too hard; because the Head requires light, soft, and easie applications; yea, Topicks which are applied to Wounds of the Head must not be stubborn, as firm Emplasters; nor too viscous: because the First will cause pain, and the Second will not easily be taken off.

As for the rolling, it differs from the rolling of other parts because the Head is somewhat spherical or round.

Of the Rollers these doubts may be proposed; First, of what Mat∣ter they ought to be made? Se∣condly, of what breadth and length they ought to be? Thirdly, of what Figure they ought to be? And lastly, what mediocrity of con∣striction is to be used in the appli∣cation of them?

As for the First, to wi••, the matter whereof the Rollers are to be made; it ought to be of Flax and not of Wooll, because it would be too hot, and cause itching, which inconveniences would trou∣ble the Patient. The Linnen∣cloth whereof the Rollers are to be made, must not be too new, for then it would be somewhat too rough; nor too old, for then it would be subject to tearing: nei∣ther ought it to be too thick, for then it would be heavy and boisterous, nor too thin, for then it would be too weak.

As for the Second doubt, the Rollers ought to be three Inches in breadth, and of a Fathom and an half in length, or of such a length as is sufficient to compass the whole Scalp after manifold Circumvolutions and Rollings; for the Roller must keep on the local Medicaments, and make some constriction of the Head.

As for the figure of the Rol∣lers, they must have two ends, that when they meet they may by natural linking be strength∣ened and kept from slipping.

As for the mean of Constricti∣on to be used in applying the Rol∣lers (which was the last doubt:) The Roller ought not to be too loose; for then it could neither keep to the Medicaments, nor any way bind the Head: Neither ought it to be too strait, for then these inconveniences might follow: First, the pulsation of the Arteries would be intercepted. Secondly, fuligi∣nous Exhalations could not breath thorow the Sutures. Thirdly, the Blood would be driven from the wounded part to the Meninges and Brain, from the outward to the inward parts: from whence would ensue Pain, Inflammation, a Fever, Apostemation, a Con∣vulsion, Palsie, Apoplexy, and last of all Death. Neither wonder at this; for Galen. lib. de Fasciis, re∣lates, that one by too strait deli∣gation of the Head, lost both his Eies; howsoever, great skill and circumspection is required to dress the Wounds of the Head artificially.