[807] Our author delivers the same doctrine in the work On the Articulations, and states that extensive fractures of the bones are often less dangerous than others which appear not so formidable. I need scarcely remark that modern experience has confirmed the truth of this position. How often has it been seen that one patient died from a slight injury to the skull, while another recovered from an extensive fracture of it? Mr. Guthrie appears in so far to agree in opinion with our author, that extensive fractures are less dangerous than they appear; he says, “Mr. Keate, who has had great opportunities for observation in St. George’s Hospital, has invariably remarked that the symptoms dependent on extravasation have been less severe in the first instance, in proportion as the separation of the edges of the fracture have been greater one from the other, or when the sutures have yielded to the shock and have been separated. It has been stated from the earliest antiquity, that the greater the fracture, the less the concussion of the brain.” (p. 56.) See the Argument.
[808] It will be remarked as a striking feature in our author’s views of practice in injuries of the head, not to interfere with fractures attended with depression. See the Argument, where the rationale of this practice is fully discussed.
[809] Although these directions of our author regarding the treatment of children be most important, I am not aware that any other of the ancient authorities has shown his sense of their value of them by repeating them. It is well known that in children there is but one table, and that it is very thin. Our author, as remarked above, does not entirely omit the operation in the case of children, but uses a small trepan.
[810] The reader will again remark an instance of our author’s fondness for prognosis, and his observance of the rule at all times to prevent the surgeon from committing himself by attempting hopeless cases. Celsus, writing in the same spirit, says, “Ante omnia scire medicum oportere, quæ vulnera insanabilia sint, quæ difficilem curationem habeant; ... non attingere, nec subire speciem ejus, ut occisi, quem sors ipsius intermit.” (v., 26.)
[811] This is an opinion held by all the ancient authorities. Some interesting cases in point are related in the First Book of the Continens of Rhazes. It was explained on the principle that the cerebral nerves decussate. (See Aretæus, on the Causes of Disease, i., 7.) Modern experience, in the main, is in accordance with the ancient on this point. Paralysis has generally been found on the opposite side to that which has received the injury. See Thomson’s Observations, etc., p. 52; Larrey’s Mem. de Chirurg., iv., p. 180; Hennen’s Principles, p. 301.
[812] This passage is thus translated by Celsus: “Si sub prima curatione febris intenditur, brevesque somni, et iidem per summa tumultuosi sunt, ulcus madet, neque alitur, et in cervicibus glandulæ oriuntur, magni dolores sunt, cibique super hoc fastidium increscit, tum demum ad manum scalprumque veniendum est.” (vii., 4.)
[813] The practice advocated in this paragraph is alluded to by Paulus Ægineta, in his chapter on Fractures of the Skull. (vi., 90.)
[814] The operation here described by our author is the more deserving of attention, as it appears to have been peculiar to him. It is not described by Celsus, Paulus Ægineta, Albucasis, nor any one of the ancient authorities, as far as I can find; neither am I aware of its having been attempted in modern times. The object of it, however, seems to be very rational, namely, to avoid doing serious injury to the dura mater by tearing the bone forcibly from it at once.
[815] The instrument here used is named πρίων χαρακτὸς; and, as far as I can see, was the same as the modiolus of Celsus, and the χοινικὶς of the later authorities. It would certainly appear to have been a circular saw, and consequently not unlike our modern trephine. See the figures and the Argument.
[816] The following sentence, taken from Sir Charles Bell’s description of the operation, looks like a translation of this passage of Hippocrates; but it is well known that our English surgeon was not guilty of reading Greek! “Withdraw your trephine from time to time, brush it, and run the flat probe round the circular cut.” The specillum of the ancient surgeons was, in most respects, not unlike our modern probe.