Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XIV. Of a CONTƲSION or DEPRESSION of the SKƲLL.

I. IT is first culled in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cranii depressio, a depressi∣on of the Skull: And 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Cra∣nium depressum, a Skull depressed.

II. It is also called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cranii Contusio, a Contusion of the Skull: and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Cranium Con∣tusum, a Contused Skull.

III. A Depression or Contusion of the Skull, is made by a hard and blunt Instrument or Weapon, where∣in the Skull is so hurt, that tho' it appears whole on the outside, yet it is depressed down, or bruised, and is for the most part severed from the whole within.

IV. Others define a depression of the Skull to be a Solution of Conti∣nuity in the Cranium, made by the violence of some external In∣strument or Weapon, whereby se∣veral parts of it are brought nearer together, than naturally they should be.

V. It is indeed when the Skull is beaten down, or inwards: And it is either of the outward Ta∣ble only, or of both Tables to∣gether; in which latter kind, shivers of the Skull are many times separated from the whole Skull; and sometimes they cleave to the whole in one part, and are separate from it in ano∣ther.

VI. The Signs. It is known partly by sight, partly by feeling, and partly by relation of the action, or force which was used, and kind of the Weapon giving the blow.

VII. In its beginning, it is known by the alteration of the Colour of the Skull; for while the Bone is living and sound, it is of a whi∣tish Colour, mixed with a lively ruddiness; but if it is mortified, or dead, it will be white or whi∣tish, without any kind of red∣ness: And if it is carious or rot∣ten, it will be of a livid or blackish Colour.

VIII. If therefore you meet with such a kind of Fracture, the plea∣sant or desirable ruddiness of the Bone will be gone, and white spots or patches will appear in it, such as are sometimes seen upon the Nails of ones Fingers: If it is left untouched, so that the Disease makes a progress, it will be cari∣ous, and of a livid or blackish Colour: In this kind of Fracture you are to take away so much of the Cranium, as is mortified by the Contusion with Raspatories, and then to heal up the Wound with Sarcoticks.

IX. The Prognosticks. If recent, and without evil Sym∣ptoms, there is hope: But if evil Symptoms follow, not gradually,

but on a heap, and as it were up∣on the spot, the danger of Death is not small.

X. If evil Symptoms come on with violence, and go off again, and then come on again, it shews that Nature has had a great contest with the Disease: and tho' she seems Victrix for a while, yet she is so spent, that at length she is overcome; and that last return of the Symptoms proves fatal, for they never go off any more, but with the Life of the Patient.

XI. The Cure. A Depression or Contusion is made in Children some∣times without a Fracture, (by reason of the toughness of their Bones:) but there is for the most part the suspicion of a Fracture.

XII. It is cured, as Scultetus says, with admirable success, with the Skins of Beasts newly killea; especially of a Dog, Cat, Wea∣zle, Rat, Mouse, Lamb, or Sheep; if applied while they are yet hot, and left on for 24 Hours.

XIII. If the Contusion is not wholly discussed with one Skin, you must apply another; and the Skin of a Lamb, or Sheep, is as powerful as any other.

XIV. By this one excellent Re∣medy, Scultetus affirms that he has cured many; as also, that it never failed him: I have also used it three or four times with the like happy success: and with Sculte∣tus, I advise all young Chirur∣geons, that they never open Contusions, or other Tumors, unless they sind them to resist the help of Topicks.

XV. If with the said Contusion there is a Fracture, as in a simple Depression of the Scull, the Skin being whole above; if the fractu∣red part cleave to the whole on one side, you are to elevate the other with a Levatory: but if with that it cannot be done, you are then to apply the Tre∣pan, as near to the fractured part as you can, that as little of the Cranium, may be taken away, as may be.

XVI. Afterwards, you are either to reduce the depressed part to its own place, or wholly remove it, as you shall think most fitting: but in doing these things, you must take great care that the Meninges be not hurt by the sharp splinters of the fractured Bones.

XVII. But in Children this Con∣tusion many times happens without a Fracture, (tho' scarcely ever in those of ripe age:) and therefore in those little ones the Depres∣sion may be raised, as Paraeus, lib. 9. cap. 3. has taught; and that excellently, with a Cupping-Glass, and reduced to its proper place.

XVIII. Hildanus, Cent. 2. Obs. 5. invented two Helps, viz. a Horn-Cup, and an Emplaster; which if they prevail not, he then advises to the raising of the Bone by a Pierce, upon a Triploides: but this is in many things both needless and unprofitable, yea sometimes very dangerous.

XIX. For that such Depres∣sions in Children, which press upon the Brain, hindering the generating and distributing of the Animal Spirits, are mortal: and in others, not only make work for the Chirurgeon, but oftentimes

prove very dangerous; because the Levitor being fastned upon the center of the Depression, the Pit in the Scull is easily made greater.

XX. 'Tis true, that Manual Operation being neglected, the Cure, with danger to the Fatient, is often prolonged: yet the prudent. Ar∣tist ought rather to omit it, than to lay an Infamy upon the Art.

XXI. The only thing to be ap∣plied, is the aforesaid hot Lamb∣skin, for a day or two; with convenient Ligature of the Band-Cancer.

XXII. When the Tumor is dis∣cussed, and no great Symptoms ap∣pear, apply under the Lambskin Ceratum Diapalma, or Emplastr. Album, brought to the softness of a Cerat with Oil of Ben; which spread upon a broad Lin∣nen Cloth, to corroborate the Part.

XXIII. If there is a Contusion of the Cutis Musculosa, a Depres∣sion of the Scull, with a Fracture of the inner Table, without any Wound in the Flesh or Skin, or any Crack in the outward Table; you must presently cut the Skin with the Incision-Knife, either crosswise, like the Letter X; or triangu∣larly, like the Greek Letter A, or the Greek Letter T.

XXIV. Then the Skin, Flesh, and Pericranium together, must be parted, or raised from the Scull, and the gaping Wound must be kept open with Pellets; to see whether there is a Chink, Cleft, or Crack with the Depression in the outward Table.

XXV. But if no such thing is found in that Table, but it appears whole; yet by the ill Symptoms accompanying the Depression, it is feared that the inward Table is broken: the Cranium must then be opened with the Trepan, by the side of the Depression, that the Matter which is fallen down by the secret Fissure of the inward Table, upon the Membranes of the Brain, may have a place to come forth; and the Scull which is depressed or fallen inwards, may be raised up, by the help of the Levitor.

XXVI. But if the Contusion is without a Depression, or Pitting-down, no Manual Operation must be attempted, but only the Lamb∣skins aforementioned, are to be laid upon the place as afore∣said; unless Symptoms shewing the Scull to be broken, follow.

XXVII. But if there is with the Depression, a broad Rife in the middle of the inward Table, or in one side of the Depression, it re∣quires the taking off the Peri∣cranium.

XXVIII. The Crack in the mid∣dle of the Depression, is either broad or narrow: if it is broad, and the Depression not great, the Scull must be raised with the Levitor, in Tab. VI. Lett. N, M. But if the Depression is greater than ordinary, you must raise it with a stronger Levitor, as that in Tab. V. Lett. L, L.

XXIX. If with a broad Crack the Scull is gone far in, the said Levitors are then of little use; but you must come presently to the use of the Terebra and Tri∣ploides.

XXX. If the Depression has a narrow Crack in the middle, then

at the bounds of the Depression, the Scull must be cut away with the Trepan: and the distance be∣tween the Holes is to be taken a∣way with a Turning-Saw; (which, if rightly made, with a double Socket, and a firm Screw) is done without the least danger.

XXXI. This done, you may raise the Depression with the Levitors, and take away any small fragments of Bones, (which are sometimes parted from the inward Table of the Scull, and prick the Mem∣branes like Thorns) with all the ease imaginable.

XXXII. If with the Depression there is a Crack, whether broad or narrow, at the side of the De∣pression, you must (if broad) pre a Levitor under the Scull, to raise it. Or, (if narrow) the Scull must be evenly terebrated on that side which is sound and bare, with the Modiolus or Tre∣pan; and then it must be raised by the help of Levitors.

XXXIII. If the Levitor let down at one hole, cannot raise the Scull; you must make another hole, and then cut forth the di∣stance between these holes, with the round Saw; that in what part soever of the Fissure it is need∣ful, the Levitor may be put down, and the Scull raised by it.