Part 14
When, then, you lay open a wound in the head on account of the bones
having been denuded of the flesh, as wishing to ascertain whether
or not the bone has received an injury from the blow, you must make
an incision proportionate to the size of the wound, and as much as
shall be judged necessary. And
[p. 154]in making the incision you must separate
the flesh from the bone where it is united to the membrane (
pericranium?)
and to the bone, and then fill the whole wound with a tent, which
will expand the wound very wide next day with as little pain as possible;
and along with the tents apply a cataplasm, consisting of a mass (
maza)
of fine flour pounded in vinegar, or boiled so as to render it as
glutinous as possible. On the next day, when you remove the tent,
having examined the bone to see what injury it has sustained, if the
wound in the bone be not right seen by you, nor can you discover what
mischief the bone itself has sustained, but the instrument seems to
have penetrated to the bone so as to have injured it, you must scrape
the bone with a raspatory to a depth and length proportionate to the
suture of the patient, and again in a transverse direction, for the
sake of the fractures which are not seen, and of the contusions which
are not discovered, as not being accompanied with depression of the
bone from its natural position. For the scraping discovers the mischief,
if the injuries in the bone be not otherwise manifest. And if you
perceive an indentation (
hedra) left in the bone by the blow, you
must scrape the dint itself and the surrounding bones, lest, as often
happens, there should be a fracture and contusion, or a contusion
alone, combined with the dint, and escape observation. And when you
scrape the bone with the raspatory, and it appears that the wound
in the bone requires the operation, you must not postpone it for three
days, but do it during this period, more especially if the weather
be hot, and you have had the management of the treatment from commencement.
If you suspect that the bone is broken or contused, or has sustained
both these injuries, having formed your judgement from the severity
of the wound, and from the information of the patient, as that the
person who inflicted the wound, provided it was done by another person,
was remarkably strong, and that the weapon by which he was wounded
was of a dangerous description, and then that the man had been seized
with vertigo, dimness of vision, and stupor, and fell to the ground,-
under these circumstances, if you cannot discover whether the bone
be broken, contused, or both the one and the other, nor can see
[p. 155] the
truth of the matter, you must dissolve the jet-black ointment, and
fill the wound with it when this dissolved, and apply a linen rag
smeared with oil, and then a cataplasm of the maza with a bandage;
and on the next day, having cleaned out the wound, scrape the bone
with the raspatory. And if the bone is not sound, but fractured and
contused, the rest of it which is scraped will be white; but the fracture
and contusion, having imbibed the preparation, will appear black,
while the rest of the bone is white. And you must again scrape more
deeply the fracture where it appears black; and, if you thus remove
the fissure, and cause it to disappear, you may conclude that there
has been a contusion of the bone to a greater or less extent, which
has occasioned the fracture that has disappeared under the raspatory;
but it is less dangerous, and a matter of less consequence, when the
fissure has been effaced. But if the fracture extend deep, and do
not seem likely to disappear when scraped, such an accident requires
trepanning. But having performed this operation, you must apply the
other treatment to the wound.