Our author having alluded to the pulsatory motion of the brain, we will state briefly the opinions of the principal ancient and modern authorities on this matter. Besides our author, Hippocrates, Galen, Oribasius, and Aëtius, among the ancients, mention a certain movement of the brain, namely, a swelling up during expiration, and a falling down during inspiration. Fallopius, Vesalius, Voltherus, Coiter, and Boerhaave maintained that this opinion is unfounded. But Columbo, Piccolomini, Dulaurens, Riolan, Littré, and more recently, Schliting, Lamure, Haller, Lorri, Vic d’Azyr, and Dumas, have reproduced this ancient truth. We once had an opportunity of observing the pulsatory motion of the brain in the case of a poor boy who had lost a considerable piece of the skull by exfoliation.
This would appear to be the most suitable occasion which we shall have to introduce an account of the osseous tumour, nearly all the information regarding which is derived from a fragment of Heliodorus. He describes it as a hard resistent tumour, immoveable, without pain, or change of colour. He says it occurs on all parts of the body, but more especially on the head, about the temples, when if one is formed on each side they are called horns. He directs that the tumour should be cut out from the very base, and the bone scraped with a raspatory. The wound is to be healed by glueing (the first intention?), if possible, but otherwise by suppurative applications. (Ch. Vet. 124.)
SECT. XCI.—ON FRACTURE AND CONTUSION OF THE NOSE.
The under part of the nose being cartilaginous does not admit of fracture, but it is liable to be crushed, flattened, and distorted; but the upper part being of a bony substance is sometimes fractured. In such cases Hippocrates prohibits bandaging, which only increases the flatness and distortion, unless when from a blow the parts about the middle of the nose protrude. For in these cases he applies a suitable bandage with medicines, in order to give the nose its proper shape. When, therefore, the nose is fractured in its under parts, having introduced the index or little finger into the nostril, push the parts outwards to their proper position. When the fracture is of the inner parts this is to be done with the head of a probe immediately, during the course of the first day, or not long afterwards, because the bones of the nose get consolidated about the tenth day. But they are to be put into the proper position with the index-finger and thumb externally. In order to prevent the bones from changing their position, two wedge-like tents, formed of a twisted linen rag, are to be applied, one to each nostril, even if but one part of the nose be deranged, and these are to be allowed to remain until the bone or cartilage gets consolidated. And some sew the quills of the feathers of a goose into the rags, and thus introduce them into the nose, in order that they may preserve the parts in position without obstructing the respiration; but this is unnecessary, as respiration is carried on by the mouth. If the nose become inflamed we may use some anti-inflammatory application to it, such as that from juices (diachylon), the one from vinegar and oil, and such like; or a cataplasm of fine wheaten flour boiled with manna or gum may be applied, both for the sake of the inflammation and in order to keep the nose in position. When the nose is distorted to either side, Hippocrates directs us, after it has been restored to its proper position, to take a piece of leather of a finger’s breadth, and having spread one of its ends with taurocolla or gum, to fasten one extremity of it on that side of the nose to which it inclines, and after it dries to bring the thong by the opposite ear to the occiput and forehead, and to fix the other end of the thong firmly there, so that the nose being drawn sideways may take the proper position in the middle. This practice, however, is not much approved of by the moderns. If the bones of the nose are broken into small pieces we must make an incision or enlarge the wound, and having removed the small bones with a hair forceps, unite the divided parts with sutures, and use the applications for recent wounds and those of an agglutinative nature. If there be a sore within the nose it is to be cured with the pledgets called lemnisci, spread with suitable ointments. Some also use leaden tubes until it cicatrize, lest a fleshy excrescence should arise from the ulcer.
Commentary. Some account of Hippocrates’s practice is given by our author. As here mentioned, he strongly disapproves of bandages which, he says, never fail to disappoint the expectations of both surgeon and patient. He directs us to replace the broken parts, either with the fore-finger or a specillum. He also describes the application of the piece of thong; a distinct account of which is given by our author. (De Articulis, 30.)
Galen, in his ‘Commentary,’ explains the obscurities in the text, but supplies no additional facts or views of practice. He greatly disapproved of agglutinative applications and bandages. (Fragmentum ap. Nicetæ Collect.)
Celsus gives a full account of fractures of the nose, but as he follows the plan of treatment recommended by Hippocrates, it will be unnecessary to dwell long upon it. When the cartilages are fractured, the pieces are to be replaced with a specillum, or with two fingers pressing on both sides; then oblong tents sewed round with a thin soft skin are to be introduced into the nostrils; or a large quill smeared with gum, or artificers’ glue may be applied in like manner. He speaks of the leathern thong, but uses it under somewhat different circumstances than those for which our author recommends it. He directs us to fasten the middle of it to the nose, and the extremities to the temples on either side. When any fragment of a bone does not coalesce properly with the rest, he recommends us to extract it with a forceps. The case, he properly states, is more dangerous when there is an external wound; but in this case he recommends us to apply one of the plasters adapted for recent wounds; like the others he disapproves of bandages.
Rhases, Avicenna, Haly Abbas, and Albucasis lay down exactly the same rules of practice as Hippocrates and our author.