[777] Perhaps the meaning here is, that when the forehead is much elevated, and the occiput much depressed, if one looks down upon the skull from above, the sagittal and coronal sutures will present the appearance of the letter Τ.
[778] The meaning, I suppose, may be, that when the forehead is very low, and when the occiput is protuberant, if one looks down upon the skull from above, the sagittal and lambdoidal sutures will present the appearance of the letter Τ reversed.
[779] The meaning would appear to be, that in a square-built head, that is to say, when it is prominent both before and behind, the coronal and sagittal sutures run nearly parallel to one another, and the sagittal connects them together in the middle. In this case they would present the appearance of the letter Η reversed.
[780] Perhaps this alludes to the form of the head in which the sagittal suture passes through the middle of the os frontis down to the nose, in which case we may imagine that the coronal suture intersects the lambdoidal in such a manner as to have some resemblance to the letter χ. It is to be borne in mind, that the character of this letter was very variable in ancient writing. Ruffus Ephesius describes the sagittal suture as sometimes passing down the middle of the frontal bone.
[781] This passage was considered by Scaliger as a gloss, but as interpreted by M. Littré, whom I have followed, the meaning is quite suitable. See his note, h. 1.
[782] It is difficult to say what can be meant by caruncles in this place, but still I agree with M. Littré that Scaliger was not warranted in proposing to eject the passage from the text as an interpolation. Unless the glandulæ Pacchioni are meant (and the description must be admitted not to be quite applicable to them), I cannot pretend to explain or account for the description.
[783] I need scarcely remark, that if by this is strictly meant that wounds in the posterior part of the head are less dangerous than those in the anterior, the statement is at variance with the experience of certain modern authorities. See, in particular, Pott and Liston, p. 46. At the same time, it is, no doubt, anatomically correct, that the occipital bone can bear more violence, without being seriously fractured, than the frontal or parietal bones, and it is worthy of remark, that the views and experience of Mr. Guthrie are very consonant with those of Hippocrates. He says: “The result of my experience on this point is, that brain is more rarely lost from the fore part of the head with impunity, than from the middle part; and that a fracture of the skull, with even a lodgment of a foreign body, and a portion of the bone in the brain, may be sometimes borne without any great inconvenience in the back part.... I have never seen a person live with a foreign body lodged in the anterior lobe of the brain, although I have seen several recover with the loss of a portion of the brain at this part. My experience, then, leads me to believe, that an injury of apparently equal extent is more dangerous on the forehead than on the side or middle of the head, and much less so on the back part than on the side. A fracture of the vertex is of infinitely less importance than one of the base of the cranium, which, although not necessarily fatal, is always attended with the utmost danger.” (On Injuries of the Head, p. 3.) I feel difficulty in reconciling these discordant results of modern experience. Perhaps the fact of the matter is, that injuries on the upper part of the occipital region are the least dangerous of any, whereas those in the lower part of it, are particularly fatal.
[784] Vidus Vidius thus explains the hedra or sedes: “Inciditur os ita ut teli vestigium remaneat, quod genus fracturæ appellatur a Hippocrate ἒδρα, id est sedes, quum (ut ipse inquit) appareat in osse qua telum insederit; fit autem ab acuto telo, quod et ipse in sequentibus, et Galenus, in Commentario, in librum memoriæ prodidit, quum sub telo acuto incidi os dixit. Requirit autem sedes ut incisum os nullo modo ad cerebri membranam inclinatur.” (Chirurg. Græc., p. 71.) Andreas à Cruce defines it thus: “Potissimum vero sedes vocatur ubi osse in suo statu remanente qua parte telum insederit apparet.” (De Vulneribus, 1. 2.) By hedra would appear to have been understood a dint, or impression, left in a bone by a blow which has not produced fracture or depression. It was also applied to a cut or slash affecting only the outer plate of the skull. Hippocrates, it will be remarked, pronounces this sort of injury not to be dangerous of itself, but M. Littré relates a case taken from the “Journal de Médecine,” in which a sabre-cut, which only penetrated through the external plate of the cranium, and did not touch the internal, proved fatal. (Op. Hippocrat. iii., p. 170.) Our author, in the latter part of this paragraph, mentions cursorily injury of the skull at a suture, and more circumstantially in the twelfth paragraph. This accident is very correctly described by the later writers, under the name of diastasis. See Heliodorus (ap. Chirurg. Veteres, p. 100), and Archigenes (ibid., p. 117). Pott declares that he did not remember having ever seen a single instance of recovery when there was separation of the bones at a suture. Morgagni, in like manner, represents the case as being of a particularly serious character. (De Caus. et Sed. Morb.) I once saw a strongly marked case in which there was a considerable separation of the bones at the upper part of the temporal suture, along with an extensive wound, unguardedly inflicted by the scalpel of a juvenile surgeon, in order to explore the nature of the accident. As might have been expected, under these circumstances, the case had a fatal issue. Mr. Guthrie writes thus of diastasis: “It is well known, that when a violent shock has been received on the head, particularly by a fall on the vertex, the sutures are often separated to a considerable extent; these cases usually terminate fatally.” (p. 135.)
[785] The meaning here is somewhat obscure, but as Arantius states in his commentary on this tract, our author probably means that a fissure is necessarily complicated with a contusion, or, in other words, that there can be no fissure without contusion.
[786] Arantius and Porralius, in their conjoined commentary on this treatise, mention that in contusion sometimes only the outer plate of the skull is contused, but the inner is depressed upon the dura mater. This is a case of which we have examples in modern surgery; but it does not appear clearly to be alluded to in this place by our author. Mr. Guthrie, indeed, understands the ἀπήχημα of the Greek authors, and resonitus of the Latin, to apply to this variety of fracture; but he appears to me to be mistaken, for these terms unquestionable refer to the contre-coup, of which we will treat presently. Quesnay, indeed, uses the term contre-coup in this double sense, but, as I think, very injudiciously, as it tends to introduce confusion of ideas; for assuredly the case of a fracture on a different part of the head from that which received the blow, and a fracture on the inner plate of the skull from an injury on the outer, are quite different cases. See Quesnay, etc., p. 20, Syd. Soc. edit.