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 ...

II. Of a PƲNCTƲRE of the SKƲLL.

XX. If the Puncture pierces not both Tables, (as it seldom does) it must be taken off with Pier∣cers, or the Trafine, which must be put just upon the middle.

XXI. But if it penetrates thro' both Tables, the Skull must be opened with the Trepan, setting the Pin of the Male-Trepan upon the Point or Puncture, and so turning it round till it make a print, upon which the Female may stand fast.

XXII. Now that these Opera∣tions may be performed quickly, safely, and pleasantly, the Cutis Musculosa and Pericranium must be separated from the Bone: And when the Trepan has done its work, the rest of the Cure must be compleated, as we have al∣ready taught in Chap. 12. Sect. 83. ad 104.

XXIII. In all Fractures, if they be so large, or well-condition∣ed, that you can thereby free the Brain, or Place, from Coagulated or Corrupted Blood, or from the prickings of the Splinters; these Operations will be needless.

XXIV. But if otherwise, there is a necessity, you must use great Care in applying the Instru∣ments; which ought to be done before the Patient is grown too weak, or the Cure of the Dis∣ease is become past hope.

XXV. It is also to be noted, that if the bare Bone lies open to the ambient Air but for two Hours, the Bone will be altered; but if it lies open longer, it will grow black: In these Cases, if the Weapon (whether sharp-edged, or poin∣ted) pierces not both Tables, or pierces only one, or the Su∣perficies of the first Table, you must then scrape or rasp off all round about, till the Colour is changed, or the Sedes or Pun∣cture is taken totally away; or till Blood comes forth of it, &c.

XXVI. If there is a Concame∣ratio, or vaulting out of the Skull, made by the plucking out of a poin∣ted Weapon forcibly, whereby an empty space or vacuity is left be∣neath, and the upper Table is se∣parated from the lower; you have no more to do, but (dilating the Wound by Incision) to rasp or smooth the Skull, and then to heal up the Wound ac∣cording to the Method before laid down.

XXVII. But if it passes thro' the second Table, you must open the Skull in the most depending Part with the Trepan, to make way for the issuing forth of the Sanies or Pus, which of necessity must be lodged in the void space, if the hole the Weapon has made is

large enough to give a passage for the same.

XXVIII. And if any ruggedness or pointed Splinters prick the Dura Mater, the whole Fracture is to be removed, compassing it with a large head of a Trepan; after which the Wound is to be Cured, as we have formerly taught.