[797] On the terms which occur parenthetically, the philological reader may consult the note of Stephanus, contained in the edition of Erotian by Franzius, under ἑδράιως. I may here remark, that it is difficult to account for the frequent repetition of these words in parentheses.
[798] It will be remarked that, as a general rule, Hippocrates forbids us to apply the trepan at the sutures, but, notwithstanding this prohibition, it would appear to have been departed from in two cases related in the Sixth Book of the Epidemics. (See § 27 and 28.) The rule, however, to avoid the application of the trepan at the sutures, was generally observed by nearly all the modern authorities down to Pott, and even he admits that the sutures should be avoided when the trephine may with equal utility be set on any other part. Louis, in a paper lately reprinted from the Memoirs of the Royal Academy of Surgery, by the Sydenham Society, gives an interesting examination of the doctrine of the ancient and modern authors on this rule of practice. Most of the authorities quoted by him are averse to the application of the trepan over sutures, except when very urgently required. C. Porralius, in his marginal notes on Arantius’s Commentary on this work of Hippocrates, assigns three reasons for avoiding the sutures in this operation: 1st, because the bone is weak at that place; 2dly, because the membrane there being in close connection with the bone, is in danger of being injured; 3dly, because, by the contraction of the callus, the transpiration there will be stopped. The last of these reasons is based on the physiological doctrine of the ancient authorities respecting the uses of the sutures, one of which was, to permit transpiration from the brain. See Galen, de Usu Partium, ix., 1, 2.
[799] Our author, it will be remarked, forbids liquid applications, tents, cataplasms, and bandages, in wounds of the head. He seems to have approved most of things of a drying nature. The other authorities would appear to differ considerably in their views regarding the proper principles upon which wounds on the head are to be treated. Celsus directs us, after laying bare the dura mater by trepanning, to apply strong vinegar to it, and when the membrane is inflamed, he approves of tepid rose-water. (viii., 4.) Paulus Ægineta, after the operation of trepanning, directs a piece of cloth, or small ball of wool dipped in oil, to be applied to the part. I believe they all agreed in rejecting sutures. See Galen, de Med. sec. Genera III.
[800] Hippocrates would seem to hold the fanciful idea, that the forehead is environed by the rest of the head, and that afflux of blood takes place from the parts around to it. Scaliger rejects this passage as containing a doctrine wholly unworthy of our author.
[801] The danger of incisions, in the temporal region, is adverted to in several parts of the Hippocratic Collection, as in the work On the Articulations, in the Prorrhetics, and the Coan Prænotions. Even at the present day, when the treatment of hemorrhage is better understood than in the days of the great Fathers of Grecian medicine, a large incision in that quarter is regarded with considerable apprehension. Convulsion, that is to say, tetanus, was supposed to be the frequent, if not the invariable, result of a wound in the temporal muscle. Pott, indeed, contends that lock-jaw is not necessarily produced by a wound there; he admits, however, that the application of the trepan to the temple is not often successful, but the reason of this he contends is, that in these fractures the breach generally extends to the base of the skull (§ 5). Quesnay, however, inclines to support the views of Hippocrates. (On the Use of the Trepan, p. 15, Syd. Soc. edit.) Scultet, in like manner, pronounces decidedly that a wound in the temple is a very dangerous affair. (Armam. Chirurg. Tabl. xxxi.)
[802] The maza was evidently a poultice prepared with barley-meal and vinegar, or water. See the Annotations on the treatise On Ancient Medicine.
[803] Celsus translates this passage as follows: “At si ne tum quidem rima manifesta est, inducendum supra os atramentum scriptorium est, deinde scalpro id deradendum; nigritiem enim continet, si quid fissum est.” (viii., 4.) Arantius properly remarks, that the ancient ink must not be confounded with the modern, which is composed principally of copperas and galls. It was, no doubt, the milder kind prepared from the soot of pines with gum which was used in this case. On the writing-ink of the ancients, see Dioscorides (M. M., v., 182) and Pliny (H. N., xxxv., 6).
[804] The text in the beginning of this paragraph is in a very unsatisfactory state. It seems pretty clear, however, that in this place our author describes caries of the bone brought on by an unhealthy state of the integuments. The description—allowance being made for the corruption of the text—is sufficiently distinct, and most probably has reference to that condition of the parts which is so graphically described by Pott as forming “a puffy, circumscribed, indolent tumour of the scalp, and a spontaneous separation of the pericranium from the skull under such tumour.”
[805] Our author in this place would appear to treat of incipient hernia cerebri, as immediately before he treats of fungous ulcers on the pericranium. Galen in like manner, praises powerfully dessicant medicines upon the authority of Meges the Sidonian, who, he says, had great experience in these cases. He speaks of the plaster called Isis as being a most efficacious application to the dura mater, when laid bare. Its principal ingredients are of an escharotic and detergent nature, such as squama æris, burnt copper, ammoniac salts, myrrh, aloes, and the like. See Paulus Ægineta, Vol. III., p. 564. Galen concludes his remarks on this subject with stating that, before getting into an inflamed state, the dura mater, as being of a dry nature, endures the most powerful medicines. (Meth. Med., vi., at the end.)
[806] This description of a piece of bone which is going to exfoliate, is remarkably correct. Compare it with the following narrative: “A girl of ten or twelve years of age was struck on the head by an iron rod falling on her; the blow caused no wound, and the young woman was soon well, with the exception of a fixed pain of no great extent, which remained over one of the parietal bones. The pain continued for several years. M. Mareschal, who was at last consulted, considered it necessary to trepan. He exposed the bone at the painful part, and applied one crown of a trepan; he observed, that the bone, when sawed, appeared dry, like a skull that had been buried.” (Quesnay, on the Use of the Trepan.) This agrees excellently with the description given by Hippocrates. It is to be regretted, however, that the text here; as far as regards one word ἀποστρακὸς, is in a very unsatisfactory state. The conjectural emendation of Schneider (ἀπεσκληκὸς) seems to be a plausible emendation, but it is not adopted by Littré.