第1章

MEN’Sheadsarebynomeansallliketooneanother,norarethesuturesoftheheadofallmenconstructedinthesameform。Thus,whoeverhasaprominenceintheanteriorpartofthehead(byprominenceismeanttheroundprotuberantpartofthebonewhichprojectsbeyondtherestofit),inhimthesuturesoftheheadtaketheformoftheGreeklettertau,T;fortheheadhastheshorterlinerunningtransversebeforetheprominence,whiletheotherlinerunsthroughthemiddleofthehead,allthewaytotheneck。Butwhoeverhastheprominenceinthebackpartofthehead,inhimthesuturesareconstructedinquitetheoppositeformtotheformer;forinthiscasetheshorterlinerunsinfrontoftheprominence,whilethelongerrunsthroughthemiddleallalongtotheforehead。Butwhoeverhasaprominenceoftheheadbothbeforeandbehind,inhimthesuturesresembletheGreekletteretaE;forthelonglinesoftheletterruntransversebeforeeachprominencewhiletheshortonerunsthroughthemiddleandterminatesinthelonglines。ButwhoeverhasnoprominenceoneitherparthehasthesuturesoftheheadresemblingtheGreekletterchi;fortheonelinecomestransversetothetemplewhiletheotherpassesalongthemiddleofthehead。Theboneatthemiddleoftheheadisdouble,thehardestandmostcompactpartbeingtheupperportion,whereitisconnectedwiththeskin,andthelowest,whereitisconnectedwiththemeninx(duramater);andfromtheuppermostandlowermostpartsthebonegraduallybecomessofterandlesscompact,tillyoucometothediploe。Thediploeisthemostporous,thesoftest,andmostcavernouspart。Butthewholeboneofthehead,withtheexceptionofasmallportionoftheuppermostandlowermostportionsofit,islikeasponge;andthebonehasinitmanyjuicysubstances,likecaruncles;andifonewillrubthemwiththefingers,somebloodwillissuefromthem。Therearealsointhebonecertainveryslenderandhollowvesselsfullofblood。Soitiswithregardtohardness,softness,andporosity。

2。Inrespecttothicknessandthinness;thethinnestandweakestpartofthewholeheadisthepartaboutthebregma;andthebonetherehasthesmallestandthinnestcoveringoffleshuponit,andthelargestproportionofbrainissituatedinthatregionofthehead。

Andhenceithappensthatfromsimilarorevensmallerwoundsandinstruments,whenapersoniswoundedtothesameoralessdegree,theboneoftheheadthereismorecontused,fractured,anddepressed;

andthatinjuriestherearemoredeadlyandmoredifficulttocure;

anditismoredifficulttosaveone’slifeininjuriestherethaninanyotherpartofthehead;thatfromhavingsustainedasimilarorevenalesswoundamanwilldie,andthat,too,inashorterspaceoftimethanfromawoundinanyotherpartofthehead。Forthebrainaboutthebregmafeelsmorequicklyandstronglyanymischiefthatmayoccurtothefleshorthebone;forthebrainaboutthebregmaisinlargestquantity,andiscoveredbythethinnestboneandtheleastflesh。Oftheotherportions,theweakestisthataboutthetemples;

foritistheconjunctionofthelowerjawwiththecranium,andthereismotionthereupanddownasatajoint;andtheorganofhearingisnearit;andfurther,ahollowandimportantveinrunsalongthetemple。Butthewholeboneoftheheadbehindthevertexandtheearisstrongerthanthewholeanteriorpart,andtheboneitselfhasalargeranddeepercoveringoffleshuponit。Andhenceitfollows,thatwhenexposedtothesameorevengreaterinjuriesfrominstrumentsofthesameorgreatersize,theboneislessliabletobefracturedanddepressedthanelsewhere;andthatinafatalaccidentthepatientwilllivelongerwhenthewoundisintheposteriorpartoftheheadthanwhenelsewhere;andthatpustakeslongertimetoformandpenetratethroughthebonetothebrain,owingtothethicknessofthebone;andmoreover,asthereislessbraininthatpartofthehead,morepersonswhoarewoundedinthebackpartoftheheadescapethanofthosewhowoundedintheanteriorpart。Andinfatalcases,amanwillsurvivelongerinwinterthaninsummer,whateverbethepartoftheheadinwhichthewoundissituated。

3。Astothehaedrae(dintsormarks?)ofsharpandlightweapons,whentheytakeplaceinthebonewithoutfissure,contusion,ordepressioninwards(andthesetakeplaceequallyintheanteriorandposteriorpartofthehead),death,whenitdoesoccur,doesnotproperlyresultfromthem。Asutureappearinginawound,whentheboneislaidbare,onwhateverpartoftheheadthewoundmayhavebeeninflicted,istheweakestpointoftheheadtoresistabloworaweapon,whentheweaponhappenstobeimpingedintothesutureitself;

butmoreespeciallywhenthisoccursinthebregmaattheweakestpartofthehead,andthesutureshappentobesituatednearthewound,andtheweaponhashitthesuturesthemselves。

4。Theboneintheheadisliabletointhefollowingmodes,andtherearemanyvarietiesineachofthesemodesoffracture:Whenawoundedbonebreaks,inthebonecomprehendingthefissure,contusionnecessarilytakesplacewheretheboneisbroken;foraninstrumentthatbreakstheboneoccasionsacontusionthereofmoreorless,bothatthefractureandinthepartsofthebonesurroundingthefracture。Thisisthefirstmode。Butthereareallpossiblevarietiesoffissures;forsomeofthemarefine,andsoveryfinethattheycannotbediscovered,eitherimmediatelyaftertheinjury,orduringtheperiodinwhichitwouldbeofusetothepatientifthiscouldbeascertained。Andsomeofthesefissuresarethickerandwider,certainofthembeingverywide。Andsomeofthemextendtoagreater,andsometoasmaller,distance。Andsomearemorestraight,nay,completelystraight;andsomearemorecurved,andthatinaremarkabledegree。Andsomearedeep,soastoextenddownwardsandthroughthewholebone;andsomearelessso,anddonotpenetratethroughthewholebone。

5。Butabonemaybecontused,andyetremaininitsnaturalconditionwithoutanyfractureinit;thisisthesecondmode。Andtherearemanyvarietiesofcontusion;fortheyoccurtoagreaterorlessdegree,andtoagreaterdepth,soassometimestoextendthroughthewholebone;ortoalessdepth,soasnottoextendthroughthewholebone;andtoagreaterandsmallerlengthandbreadth。Butitisnotpossibletorecognizeanyofthesevarietiesbythesight,soastodeterminetheirformandextent;neither,indeed,isitvisibletotheeyeswhenanymischiefofthiskindtakesplace,andimmediatelyaftertheinjury,whetherornotthebonehasbeenactuallybruised,asislikewisethecasewithcertainfracturesatadistancefromtheseatofinjury。

6。Andthebonebeingfractured,issometimesdepressedinwardsfromitsnaturallevelalongwiththefractures,otherwisetherewouldbenodepression;forthedepressedportionbeingfracturedandbrokenoff,ispushedinwards,whiletherestoftheboneremainsinitsnaturalposition;andinthismannerafractureiscombinedwiththedepression。Thisisthethirdmode。Therearemanyvarietiesofdepression,foritmaycomprehendagreaterandasmallextentofbone,andmayeitherbetoagreaterdepth,orlessso,andmoresuperficial。

7。Whenahedra,ordintofaweapon,takesplaceinabone,theremaybeafracturecombinedwithit;andprovidedtherebeafracture,contusionmustnecessarilybejoined,toagreaterorlessextent,intheseatofthedintandfracture,andinthebonewhichcomprehendsthem。Thisisthefourthmode。Andtheremaybeahedra,orindentationofthebone,alongwithcontusionofthesurroundingbone,butwithoutanyfractureeitherinthehedraorinthecontusioninflictedbytheweapon。Buttheindentationofaweapontakesplaceinabone,andiscalledhedra,whentheboneremaininginitsnaturalstate,theweaponwhichstruckagainsttheboneleavesitsimpressiononthepartwhichitstruck。Ineachofthesemodestherearemanyvarieties,withregardtothecontusionandfracture,ifboththesebecombinedwiththehedra,orifcontusionalone,asithasbeenalreadystatedthattherearemanyvarietiesofcontusionandfracture。Andthehedra,ordint,ofitselfmaybelongerandshorter,crooked,straight,andcircular;andtherearemanyvarietiesofthismode,accordingtotheshapeoftheweapon;andtheymaybemoreorlessdeep,andnarrowerorbroader,andextremelybroad。

Whenapartiscleft,thecleftornotchwhichoccursinthebone,towhateverlengthorbreadth,isahedra,iftheotherbonescomprehendingthecleftremainintheirnaturalposition,andbenotdriveninwards;forinthiscaseitwouldbeadepression,andnolongerahedra。

8。Abonemaybeinjuredinadifferentpartoftheheadfromthatonwhichthepersonhasreceivedthewound,andthebonehasbeenlaidbare。Thisisthefifthmode。Andforthismisfortune,whenitoccurs,thereisnoremedy;forwhenthismischieftakesplace,thereisnomeansofascertainingbyanyexaminationwhetherornotithasoccurred,oronwhatpartofthehead。

9。Ofthesemodesoffracture,thefollowingrequiretrepanning:thecontusion,whetherthebonebelaidbareornot;andthefissure,whetherapparentornot。Andif,whenanindentation(hedra)byaweapontakesplaceinaboneitbeattendedwithfractureandcontusion,andevenifcontusionalone,withoutfracture,becombinedwiththeindentation,itrequirestrepanning。Abonedepressedfrompositionrarelyrequirestrepanning;andthosewhicharemostpressedandbrokenrequiretrepanningtheleast;neitherdoesanindentation(hedra)withoutfractureandcontusionrequiretrepanning;nordoesanotch,provideditislargeandwide;foranotchandahedraarethesame。

10。Inthefirstplace,onemustexaminethewoundedperson,inwhatpartoftheheadthewoundissituated,whetherinthestrongerorweakerparts;andascertainrespectingthehairsaboutthewound,whethertheyhavebeencutoffbytheinstrument,andhavegoneintothewound;andifso,oneshoulddeclarethatthebonerunstheriskofbeingdenudedofflesh,andofhavingsustainedsomeinjuryfromtheweapon。Thesethingsoneshouldsayfromadistantinspection,andbeforelayingahandontheman;butonacloseexaminationoneshouldendeavortoascertainclearlywhetherthebonebedenudedoffleshornot;andifthedenudedbonebevisibletotheeyes,thiswillbeenough;butotherwiseanotherwiseanexaminationmustbemadewiththesound。Andifyoufindthebonedenudedoftheflesh,andnotsafefromthewound,youmustfirstascertainthestateofthebone,andtheextentofthemischief,andofwhatassistanceitstandsinneed。Oneshouldalsoinquireofthewoundedpersonhowandinwhatwayhesustainedtheinjury;andifitbenotapparentwhetherthebonehassustainedaninjuryornot,itwillbestillmorenecessary,providedthebonebedenuded,tomakeinquiryhowthewoundoccurred,andinwhatmanner;forwhencontusionsandfracturesexistinthebone,butarenotapparent,wemustascertain,inthefirstplacefromthepatient’sanswers,whetherornotthebonehassustainedanysuchinjuries,andthenfindoutthenatureofthecasebywordanddeed,withtheexceptionofsounding。Forsoundingdoesnotdiscovertouswhetherthebonehassustainedanyoftheseinjuriesornot;butsoundingdiscoverstousanindentationinflictedbyaweapon,andwhetherabonebedepressedfromitsnaturalposition,andwhetherthebonebestronglyfractured;allwhichmayalsobeascertainedvisiblywiththeeyes。

11。Andabonesustainsfractures,eithersofineastoescapethesight,orsuchasareapparent,andcontusionswhicharenotapparent,anddepressionfromitsnaturalposition,especiallywhenonepersonisintentionallywoundedbyanother,orwhen,whetherintentionallyornot,abloworstrokeisreceivedfromanelevatedplace,andiftheinstrumentinthehand,whetherusedinthrowingorstriking,beofapowerfulnature,andifastrongerpersonwoundaweaker。Ofthosewhoarewoundedinthepartsaboutthebone,orintheboneitself,byafall,hewhofallsfromaveryhighplaceuponaveryhardandbluntobjectisinmostdangerofsustainingafractureandcontusionofthebone,andofhavingitdepressedfromitsnaturalposition;whereashethatfallsuponmorelevelground,anduponasofterobject,islikelytosufferlessinjuryinthebone,oritmaynotbeinjuredatall。Ofthoseinstrumentswhich,fallinguponthehead,woundthepartsaboutthebone,ortheboneitself,thatwhichfallsfromaveryhighplace,andtheleastonalevelwiththepersonstruck,andwhichisatthesametimeveryhard,veryblunt,andveryheavy,andwhichistheleastlight,sharp,andsoft,suchaninstrumentwouldoccasionafractureandcontusionofthebone。Andthereismostdangerthatthebonemaysustaintheseinjuries,undersuchcircumstances,whenthewoundisdirectandperpendiculartothebone,whetherstruckfromthehandorfromathrow,orwhenanyobjectfallsupontheperson,orwhenheiswoundedbyfalling,orinwhateverwaythebonesustainsadirectwoundfromthisinstrument。Thoseweaponswhichgrazetheboneobliquelyarelessapttofracture,contuse,ordepressthebone,evenwhentheboneisdenudedofflesh;forinsomeofthosewoundsthusinflictedtheboneisnotlaidbareoftheflesh。Thoseinstrumentsmoreespeciallyproducefracturesinthebone,whetherapparentornot,andcontusions,andinwarddepressionofthebone,whicharerounded,globular,smoothonallsides,blunt,heavy,andhard;andsuchweaponsbruise,compress,andpoundtheflesh;andthewoundsinflictedbysuchinstruments,whetherobliquelyorcircularly,areround,andaremoredisposedtosuppurate,andtohaveadischarge,andtakelongertimetobecomeclean;forthefleshwhichhasbeenbruisedandpoundedmustnecessarilysuppurateandsloughaway。Butweaponsofanoblongform,being,forthemostpart,slender,sharp,andlight,penetratethefleshratherthanbruiseit,andtheboneinlikemanner;andsuchaninstrumentmayoccasionahedraandacut(forahedraandacutaresamething);butweaponsofthisdescriptiondonotproducecontusions,norfractures,nordepressionsinwardly。Andinadditiontheappearancesinthebone,whichyoucalldetectbythesight,youshouldmakeinquiryastoalltheseparticulars(fortheyaresymptomsofagreaterorlessinjury),whetherthewoundedpersonwasstunned,andwhetherdarknesswasdiffusedoverhiseyes,andwhetherhehadvertigo,andfelltotheground。

12。Whenthebonehappenstobedenudedoffleshbytheweapon,andwhenthewoundoccursuponthesutures,itisdifficulttodistinguishtheindentation(hedra)ofaweaponwhichisclearlyrecognizedinotherpartsofthebone,whetheritexistornot,andespeciallyifthehedrabeseatedinthesuturesthemselves。Forthesuturebeingrougherthantherestoftheboneoccasionsconfusion,anditisnotclearwhichisthesuture,andwhichthemarkinflictedbytheinstrument,unlessthelatter(hedra)belarge。