Albucasis enumerates the same varieties of fracture as our author, and his description of the operation is little different. The drawings which he gives of the surgical instruments used by the ancients in operations on the head are interesting, as they tend to illustrate the descriptions of Paulus and the other authorities. We may remark, by the way, that his abaptista, which he calls terebra non profundantia, are a sort of spear-shaped instruments, having a globular ball a short way above their extremity. They, therefore, had no resemblance to a modern trephine with a conical crown.
Avicenna gives a very full account of injuries of the head, but it is taken almost word for word from Galen and our author. Nearly the same may be said of Haly Abbas.
Avenzoar states that trepanning the skull will be proper when there is fracture with depression; but laments that in his time it would be difficult to find a surgeon capable of performing the operation. Averrhoes likewise intimates that he did not know a surgeon who could trepan the skull. This is an additional proof to what we have mentioned in the section on amputation that the Arabians in general were very timid operators.
Rhases strongly inculcates the propriety of having recourse promptly to the operation, when the bone is fractured and depressed, before dangerous symptoms have come on. Unless there be pressure on the brain, however, he does not approve of having immediate recourse to the operation.
It will be remarked that Celsus affirms, and our author denies, the occurrence of fracture by repercussion. It is the same as la fracture par contre-coup of the French medical authors, or the counter-fissure, namely, the fractura per resonitum of the earlier authorities. Soranus, who, like Celsus, believes in its occurrence, defines it to be a fissure which takes place in the part of the cranium opposite to that which received the blow. (Nicetæ Collectio.) Hippocrates himself makes mention of the counter-fissure, and pronounces it to be incurable, as the surgeon has no certain data to discover its existence. (Vul. Cap. viii.) Tulpius, Paré, and Van Sweiten have related cases of the counter-fissure. (See Comment. in Boerhaav. Aph. 254.) Heister also believed in its occurrence. (Chirurg. i, 1, 14.) For cases of it he refers to D. Wagnerus, (Dissert. de contra-fissura,) and Le Maire (De resonitu.) He is mistaken, however, when he quotes Ægineta as an authority for it. Sabatier relates a case of fracture par contre-coup in the sternum occasioned by a fall on the back. (Mémoires de l’Institut Natural, ii, 120.) See also Sprengel (Hist. de la Méd. 17.) Garengoit further relates various cases of the contre fissure. Bertaphalia defines it in much the same terms as Soranus. (v, 5.) Mr. Guthrie treats learnedly of this subject; but although he quotes many instances from the earlier authorities of fracture on one side of the head from a blow on the other, he states that in later years there is little proof of such an occurrence taking place. He admits, however, as indisputable the occurrence of fracture at the base of the skull from a blow on the vertex or back of the head. (Injuries of the Head, 65.) He also states that the term ἀπήχημα of our author, and that of ‘resonitus,’ as used by Latin authors, was applied to that species of fracture when the inner plate of the skull is knocked in or fractured, without the outer one being injured. (Ibid.) It does not appear, however, that the ancients applied the term in this sense. Thus Soranus, as stated above, defined it to be a fissure produced in the parts of the skull opposite to those which have received the blow. See the learned note of Cocchi. (Ap. Chirurg. Vet. 47.) Galen’s definition is to the same effect. (Ibid. 107.)
The treatment here recommended for inflammation of the membranes of the brain is so judicious, that even at the present day scarcely any improvement could be made on it. Our late authorities have shown the utility of cholagogue purgatives in such cases, and it will be remarked that they are recommended by our author and Hippocrates. (De Cap. Vuln. 27.)
Celsus directs us, when the dura mater gets inflamed and swelled, to pour tepid rose-oil upon it; and if it rise above the bone to apply lentil or vine leaves pounded with fresh butter or the grease of geese. He enjoins us to avoid all kinds of food requiring mastication, also smoke and sternutatories. When the brain projects beyond the bone (a case called hernia cerebri by modern surgeons), he advises us to sprinkle it with squama æris, and to use cicatrizing applications. A person who has sustained a fracture of the skull is advised to avoid the sun, wind, frequent baths, and the free use of wine until the wound is healed.
Aëtius recommends bleeding and laxative clysters. (vi, 47.)
Heliodorus recommends abstinence at first, and afterwards spare diet, water for drink, bleeding, when the inflammation is violent and the patient full, light dressings, cataplasms of melilot, linseed, and oil, and fomentations with decoctions of fenugreek or mallows. Archigenes directs us when there is a fungous tumour projecting above the bone, to remove it with septics or the scalpel, and then to apply pledgets. (Nicetæ Collect.)
Avicenna and Albucasis repeat our author’s directions. Haly Abbas follows in the same strain, recommending us to remove any cause of irritation, to pour refrigerant oils on the place, and to have recourse to venesection. (Pract. ix, 85.)