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III. An Incision is made by a cutting Instrument; wherein either a part of the Scull is raised up, but is yet fast to the other part: or, a mark of the Cut only remains in the Scull, according to the figure of the Instrument, which they call Sedes, or, the Seat; being the Seat of the Weapon: or, a part of the Scull is cut slopingly thro', and quite taken away.
IV. As to the Sedes, where the Print of the Weapon is only left behind in the Scull; the
Wound is to be dilated or opened, and the Skin and Flesh with the Pericranium is to be raised, and the Sedes or Seat of the Weapon is to be imme∣diately pared away with a Knife or Chizel; or it must be scraped with a Scraping-Instrument, and that 'till the whole Sedes or Incision is gone.
V. After the Sedes or Print of the Weapon is pared or scraped away, you must dress it with con∣venient Medicaments, such as we use in the Cure of a Fissure, or after the rasping of the Scull.
VI. If it passes thro' both Ta∣bles, and splints of Bone prick the Meninges; and way enough is made by the Weapon, for the evacuating of the Pus or Matter; no farther apertion is to be made, but the Wound is to be dressed, as after the application of the Trepan.
VII. But if either splinters of Bones do offend the Dura Mater, or the way out is too narrow for the coming forth of the Sanies or Pus; a farther opening of the Scull is to be made, with such Instru∣ments as you shall think most fit for the Operation.
VIII. But if the Sedes passes no farther than the first Table, then the Cranium is only to be smoothed with Raspatories; that the Pus or Matter may not settle in the Sedes, and so cause a deeper ca∣riosity; and the Wound is to be drest with Linimentum Arcaei, melted in a Spoon: in these Cases many times, if the Patient is of a good habit of Body, the Cranium casts off no Scales.
IX. If a part of the Scull is raised up by the Cutting, out yet is fast on the other parts; having dilated the Wound, see whether the Weapon has passed the first Table only, or the first and second, if the first only, the Bone may be rasped away; but if both, there will be a necessity of applying the Trepan, to make way for the Matter.
X. The lips of the Wound may be kept asunder with Pledgets, or Dossels of fine Tow dipt in whites of Eggs, which will also stop the flux of Blood: the Parts which are ad∣jacent are to be anointed with astringent Oils made hot, to prevent Inflammation, and con∣venient Ligature is to be ap∣plied, which is the Band-Cancer, with a thrice doubled linnen Cloth; that the wounded Parts may not be more hurt by the ambient Air, (which is an Enemy to the Wounds of the Head;) and that the Medicaments laid on, may be kept close, and not fall off.
XI. The following Figure repre∣sents the Band-Cancer, which for Wounds of the Head, is the best of all to contain them, and also the most useful and commodious: it is broad in the middle A, and both ways it has four ends; of which two begin from the Temples, and end on the hin∣der part of the Head; where they must be sewed, as E, E: two arise from the hinder part of the Head, and are bound together on the forepart of the Head, as B, B: two are turned behind the Ears, and fastned under the Chin, as C, C: and
two of them come before the Ears, and are fastned as the other also, under the Chin; as D, D.
XII. The second day, let the Wound be drest; being cleansed of its Sanies, let some Astringent Pouder or dry Lint be laid upon the Bone, and let the lips of the Wound be drest with some Dige∣stive, which apply upon Lint; and and over that Emplastr. Album, or Diapalma, with a Hole cut in in it for the Pus to issue forth; over which Hole lay Linimentum Arcaei, with a Pledget of Cloth three times doubled: anoint the Parts adjacent with some Astrin∣gent Oil before-named, then bind it up with the Band-Cancer, and a good Rowler; and con∣tinue this course of Dressing, 'till a good and white sort of Pus, and not stinking, is pro∣duced.
XIII. If the Artist is careful, he will find, where the Bone is only rasped or scraped, that if the Ce∣phalick drying Pouders be strewed upon it, and dressed with dry Lent, it will be covered with Flesh the next day: they that will not endure Scraping or Rasping the Bone, (when it is altered) leave it to Nature for the Scaling of it: but such Men prolong the Cure.
XIV. The Wound being digested, you must daily apply Detersives, mixed with Digestves, until it is throughly cleansed; continuing the use of the Pledget of Cloth thrice doubled, with the Un∣ctions and Bandage.
XV. The Wound being cleansed, you must with Sarcotick Ointments, as Linimentum Arcaei, &c. laid upon Lint, to the lips; fill it up with Flesh, (and not use Oil of Roses, as some Ignorants do;) and over that Diapalma, or Em∣plastr. Album, malaxed with a little Oil; and then a Cloth thrice doubled, wet in Red-wine, or some Astringent Decoction, and prest out again.
XVI. The Wound being filled with Flesh, it must at last be covered with a Cicatrice; which is done either with dry Lint only, or else by applying Cera∣tum Diviaum, or such other like; renewing the Dressing 'till the Skin is produced.
XVII. When a part of the Scull is separated, so that the first Table is divided from the second, and sticks close to the Skin, you must first take away the Bone, and then cure the Wound.
XVIII. If a part of the whole Scull is divided, so that the Dura Mater is seen, you must reduce
the Incision, being first cleansed with Canary or S.V. or with them mixed equally together; and so keep it, either by stitch∣ing the Lips of the Wound, or rather by fit Bandage.
XIX. But a smooth Chopping away, or Cutting off a piece of the Skull, requires no Manual Operation; but it ought to be co∣vered with Flesh, by strewing on it some Cephalick astringent Pouder, &c. as a Skull newly scraped, or rasped with Rasps.