Skull fracture

It often happens that the skull breaks, but the skin does not tear, but swells. If a doctor treats a tumor without paying attention to the fracture, the bone under the skin often deteriorates and before or after the tumor is cured, severe illnesses of fever, shaking, loss of reason, and the like arise, and the skin has to be opened. The location of the fracture is often recognized by the behavior of the patient, who grabs it and touches it every minute; then it is inevitably necessary to leave the wound as it is and treat the fracture.

The skin should be cut so that the ichor does not linger under it - this is necessary with such a fracture and with any other, whatever it may be, for nothing should retain the ichor, however, unless you are afraid that the tumor will increase, or if it begins shrink, it's not necessary. If the incision in the skin is small and lies opposite only one of several fractures, or if the tumor has opened and only one fracture becomes visible, then many mistakes arise from this, because the doctor thinks that there are no other fractures besides this one. Therefore, it behooves you to thoroughly investigate the state of the fracture, and one of the means leading from assumption to truth is to investigate the cause of the fracture and the quality of what caused the fracture - in relation to the severity and size of the tool or the force of the blow - you will learn from this what is degree of fracture. This is also indicated by such phenomena as sakta, sadar, loss of voice and the like.

Sometimes skin breaks, due to their multiplicity, diversity, or the fact that they are on one side, also indicate the quality of the fracture, although this is by no means indisputable evidence, because internal fractures are often numerous or large, but there is no break or a small break on the skin. Therefore, one inevitably has to, if possible, determine the state of affairs according to the instructions arising from examining the fracture using vision. In this case, you need to cut the skin crosswise and scrape the bone until the entire crushed part becomes visible. If bleeding starts, you fill the scraped area with dry rags, apply compresses soaked in wine, and leave them until the morning.

As for fractures to the degree of visibility, they are treated as mentioned in the paragraphs on ulcers and in the previous ones, and we will still talk about crushing, displacement and similar fractures here.

The least damage to the bones of the head consists of a rupture of the periosteum, which does not reach the opposite side, but stops at some depression. Such damage is, as it were, hidden from view and looks like a hair. This kind of crack is also best scraped until there is nothing left of it. If you manage to make the crack noticeable by pouring some black liquid on it so that the visibility of the crack increases, do this and scrape until the trace of it will not disappear. And let you have scrapers of various sizes with you, first use the widest one and then the next narrower one. And when you have scraped it out, use some medicine for the head, and that will be enough for you. The head medicines are, for example, orris root, vetch flour, frankincense powder, aristolochia, opopanax root bark, myrrh, anzarut, dragon's blood and all medicines that dry without burning, and these lesions are treated as they are treated for ulcers.

If you assume that the crack reaches the other side, then it cannot be destroyed by scraping without breaking through the bone. Be careful not to go too far when scraping, but on the contrary, stop at the place where you reach and recognize the state of the lining of the brain - whether it has retained its position relative to the bone. If so, then the damage is less, safety is more obvious, tumors form less frequently and they are smaller and not so scary, and mature pus appears faster and is more abundant. If the blow separated the shell from the bone, then this is one of the cases when the danger is greater and pain, fever and what follows them are more common, the ability of the bone to change color manifests itself more quickly, the flow of liquid, ichorous pus is more frequent, the occurrence of pain, fevers, tamadduda, fainting and loss of reason due to neglect of treatment also occur more often. In this case, and in all cases, one must be careful to protect oneself from the cold, even in summer, because there is great danger in being cold.

As for a splitting blow, in which there is nothing but a crack, but it is large and the periosteum is visible, then for treatment it is often enough to tie and bandage, as well as apply cooling medicinal bandages, but it is best to pour warmed rose oil over the tear, then connect the edges wounds and stitch them, if necessary, and sprinkle with head powder, and on top put a linen rag dipped in egg white. Compresses soaked in astringent wine, diluted with olive oil, and other dressings are placed on top of the rag. And let the patient be kept in peace, groomed and euthanized, and, if necessary, let him bleed. Do not try to remove the entire bone for every crack or fracture - this cannot be done in every place, and remember what we advised in the paragraphs about the general principles of the doctrine of fracture and fusion. However, many people have had a bone removed from their heads by cutting or otherwise, and flesh and skin grew from the gap, and they survived.

As for crushing fractures and those that follow them, know that the bones of the head are not similar in case of fracture to other bones. The fact is that when they break, nature covers them not with a strong callus, which it imposes and strengthens on other bones, but with something weak. Therefore, to prevent ichor from pouring in, they must be removed entirely if the dissection is complete, or partially cut out if the dissection is incomplete, and they should not be fused. Extractions should not be delayed for more than seven days in the summer, and more than ten days in the winter, and the sooner you do this, the better it will be and the further away from the possibility of severe damage.

One of the reasons that urgently requires and calls for this is that matter is sometimes diverted from other bones, not from the bones of the head, by a bandage, and on the head such a bandage is impossible, therefore, for the ichor to come out as needed, it is impossible on the head to do without removing the bone in case of any significant fracture. And if pus appears inside the fused bone, tied with a bandage that squeezes out and expels the matter, and this pus originated in that very place and penetrated to the bone marrow, then you have to expose and clean the bone, especially on an organ such as the head. It is therefore necessary to select or cut off the bone in this way, as well as to expose the damaged area and not allow it to heal until it is safe to do so. If it were not for the fear that pus would flow inside, we would not cut off the bones.

The cutting must be done from the most suitable place, and the most suitable place is the one that is opposite the fracture, allowing one to assume that the ichor will flow out of it best, and is easily cut off and there is no need to strongly shake and irritate the brain. At the same time, this place should be the most distant from the nerves, and this is, for example, the crown, because its middle does not come into contact with the places from which the nerves emerge. Try to prevent the cold from affecting the lining of the brain, because this is not good and dangerous, lighten the regime and constantly pour warm oil over the wound. If blackness appears on the shell, then know that sometimes it is only on the surface and does not harm, and it is often caused by medications. In this case, they treat with honey, mixed with triple the amount of rose oil as compared to honey, until the blackness disappears, and sprinkle the area with the head medicine. If the blackness is firmly established, then run away

If there really is a need to rip off, cut off or extract something, then you should hurry up with this, without waiting until the formation of pus in a given place is completed; delay is permissible only in the case when the shell, called the mother, is not pressed or pricked by anything, because the tingling immediately causes swelling and spasms. Often this leads to sakta, and then the bone must be immediately removed, after which the feelings, if there was sakta, immediately return to the patient. When there is a hole, then the matter requires even greater haste.

If the skull is broken and the membrane and tumor are visible - this is called a hole - then you should show the same haste as we said, and if you need to wait, then wait until the second or third day; in most cases, you should treat on the second day.

The cutting is sometimes done with the small saw mentioned above, and sometimes adjacent small holes are drilled in the place from which the bone is to be removed. However, there is a danger in this, since the drill sometimes penetrates to the shell at once, unless, of course, they used the trick we mentioned - then it is safer.

As for the method of treatment itself, let us recall what the ancients say about this. They say you should first shave the wounded person's head and make two cuts intersecting at right angles, so that they cross each other in a cross shape; one of the cuts should be the original cut made by the blow. Then the skin at the four corners should be torn off so that all the bone that is going to be scraped out is exposed, and if this causes bleeding, the cut should be filled with rags soaked in water and vinegar, or filled with dry rags, and then apply a compress moistened with wine with olive oil, and make an appropriate bandage. When the next morning comes, then if no unpleasant phenomena have occurred, you should start scraping out the broken bone. To do this, the patient must sit down, or you tell him to lie down, taking a position suitable for this fracture, and plug his ears with wool or cotton so that he is not irritated by the noise from the blows, then you untie the bandage on the wound, remove all the rags from it and wipe it, and then you order two assistants to hold the cut skin at the four corners with thin rags and pull it up - I mean the skin that lies on the broken bone.

If this bone is weak by nature or due to a fracture that has occurred to it, then it should be removed with incisors located one opposite the other, starting with the widest one, which are then replaced with thinner ones, moving on to the hairline ones. When hitting and chiseling a bone, be careful not to cause pain and anxiety to the head. If the bone is strong, then first you should chisel with chisels, which are called non-penetrating chisels, and these are chisels that have small protrusions on the inside of the sharp places, and these protrusions do not allow them to go deeper and reach the shell, so the split bone is chiselled and it is not taken out at once, but little by little, if the doctor can take it out with his fingers, let him do so, and if not, let him take it out with tweezers, forceps, or something like that. Between the holes, you should leave gaps the width of a needle to sharpen the eyes and bring the chisel closer to the inner surface of the bone. You need to be careful not to hit the shell somewhere with a chisel, and to avoid this, the length of the chisel should be the same as the thickness of the bone, and you should use many chisels of different lengths. If the fracture occurred only at the bend of the bone, then you should pay attention only to this bend.

When the bone is hollowed out, it is necessary to smooth out, using a scraper or some kind of cutter similar to a blade, the roughness on the bone of the head that has arisen as a result of cutting and chiseling, having previously placed a device underneath that covers and protects the shell. If small bones or fragments remain in the wound, they should be carefully removed and then proceed to treatment with tampons and patches - this is the easiest and least harmful of all existing methods of treatment.

Says Galen When you expose part of the bone of the head, then bring a cutter under it, the part of which, similar to a lentil and protruding at the rear end, is as if smooth, and the blade goes along, and the lentil-shaped extension rests on the shell. We should hit the top of the incisor with a small hatchet and cut off the head bone little by little, and when we do this, that will be all that is needed. The fact is that the shell will then not be wounded, even if the doctor falls asleep during the operation, or it is facing the wide side of the lenticular instrument, and if this instrument is near the bone of the head, he will remove it without suffering, since its rounded, lenticular parts They will guide the incisor from behind and it will cut out the bone of the head. It is impossible to find a better and faster way to cut this bone than this method. As for the method of treatment with files and instruments called juskandas, modern doctors condemn it because of its depravity.

Here is our word about the treatment of the head bone when a crack forms in it; the same treatment is suitable for other types of fractures that occur in the head bone, and if we only mentioned the treatment of a crack, then we took it as a model for everything else.

Paul says that Galen also teaches us how much should be cut off from a bone, and these are his words. As for how much should be cut off from a diseased bone, that part of it that is very crumbled should be cut off entirely. If cracks in it stretch over a long distance - and this sometimes happens - then you do not need to follow the cracks to the end, if you also know that nothing harmful will happen for this reason, since all the actions that had to be performed, done properly.

Then, after treatment with iron, you need to take an unrolled linen rag corresponding to the size of the wound, moisten it in rose oil and cover the mouth of the wound with it. Then you take a rag folded in two or three layers, immerse it in wine with rose oil, smear the whole wound with rose oil, and then put the rag on it as lightly as possible so that it does not burden the membrane, and make a wide bandage over it, pulling it just enough so that it holds the rag. After this, you apply a regime that calms the heat and eliminates the fever, and every now and then you moisturize the membrane, topped with rose oil. You remove the bandage on the third day, wipe the wound and treat it in a way that builds up the meat and calms the heat, and sprinkle the shell, where the meat grows, with a powder of dry medicines called head medicines, and sometimes you sprinkle the bone itself if This is also necessary if the bone is one of those that grow meat, or so that the meat grows faster. We treat such patients with all the medicines that we mention in the treatment of wounds.

Says Pavel After treatment with iron, a hot swelling often appears in the shell of the head, which even protrudes above the thickness of the bone and the thickness of the skin; this is accompanied by hardening, which impedes the movement of nature. Such people often experience tension and other bad phenomena, and death follows. A hot swelling is caused either by a protruding bone which pricks the membrane, or by the weight of the tampons, or by cold, by eating or drinking heavily, or by some other hidden cause. If a hot tumor arises from a visible cause, then this cause must be quickly eliminated, and if it is formed from a hidden cause, then try to eliminate it and use bloodletting from the vessel, if there are no obstacles to this, and otherwise, prescribe a reduction in nutrition and appropriate treatment for hot tumors, for example, pouring hot rose oil or water in which marshmallow, fenugreek, flaxseed and chamomile have been boiled. Also use medicinal dressings prepared with barley flour, hot water, oil, flaxseed, and use chicken fat on a woolen rag, moisturizing the head, neck and vertebrae with it, drip some oil into the ears that calms the heat, put the patient in hot water in room and rub in the same oil. If a hot tumor exists for a long time and nothing prevents you from taking a laxative medicine, then tell the patient to do so, because Hippocrates prescribes this.

Says Pavel: If the shell has turned black and the blackness is on the surface and the blackening is due to the medicine that was used to treat the patient - and black medicine sometimes works like this - then you should take honey - one part and rose oil - three parts, mix them, spread it on a rag and apply to the shell. If the shell has turned black on its own and the blackness has reached the depths, especially in the presence of other bad phenomena, then one should despair of the recovery of such a patient, for this indicates the death of the innate warmth and its disappearance.

I saw a man who suffered a fracture of the bone of his head, and after a year the bone was scraped out, he recovered. The fact is that the fracture was on the crown of the head and occurred from a fired arrow; there was an outlet for the flow of pus, and therefore nothing happened to the shell, but on the contrary, it was saved from rotting.

Galen says I was shown a man who had a longitudinal fracture of the crown, as well as the temple. I left the fracture as it was, except for a part of the parietal bone, which I cut out for a well-known purpose, and this was enough, and the man recovered.