[p. 159]you must desist from sawing, and leave the bone
to fall out of itself.| 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 AEgineta, 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. |
For to a bone not sawed through, and where
a portion is left of the sawing, no mischief can happen; for the portion
now left is sufficiently thin. In other respects you must conduct
the treatment as may appear suitable to the wound. And in trepanning
you must frequently remove the trepan, on account of the heat in the
bone, and plunge it in cold water. For the trepan being heated by
running round, and heating and drying the bone, burns it and makes
a larger piece of bone around the sawing to drop off, than would otherwise
do. And if you wish to saw at once down to the membrane, and then
remove the bone, you must also, in like manner, frequently take out
the trepan and dip it in cold water. But if you have not charge of
the treatment from the first, but undertake it from another after
a time, you must saw the bone at once down to the meninx with a serrated
trepan, and in doing so must frequently take out the trepan and examine
with a sound (specillum), and otherwise along the tract of the instrument.
For the bone is much sooner sawn through, provided there be matter
below it and in it, and it often happens that the bone is more superficial,
especially if the wound is situated in that part of the head where
the bone is rather thinner than in other parts. But you must take
care where you apply the trepan, and see that you do so only where
it appears to be particularly thick, and having fixed the instrument
there, that you frequently make examinations and endeavor by moving
the bone to bring it up. Having removed it, you must apply the other
suitable remedies to the wound. And if, when you have the management
of the treatment from the first, you wish to saw through the bone
at once, and remove it from the membrane, you must, in like manner,
examine the tract of the instrument frequently with the sound,
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