ON the 24th of February, 1708/9. I was called in much Hast, to a Child about the Age of Six Years, who was just then brought out of Moor-Fields, wounded by a Catstick, as he was sitting at some Distance from a Cock, set to be thrown at; where a young Fellow, missing his [...]m, unfortunately struck the Child over the Head, and knock'd him down. He was taken up for dead, and continued speechless for some [...]ime.

Upon examining the Head, I per­ceiv'd a small Wound on the right Side, which had bled freely, and lay­ing my Fingers hard upon the Part, under a Sort of Quagmire of gru­mous Blood, I found there must be a considerable Depression of that Part of the Scull.

Whilst I was delivering my Prog­nostic of the Child's great Danger, and telling them of the Necessity there was to make Way to the Fra­cture, by removing some Part of the Scalp, the Boy began to cry and fell a vomiting. Having no Assistant then by, nor Dressings suitable to the Ope­ration: I contented my self for the present with the common Restrin­gents for staying the Flux: sending for a Barber to shave that Side of the Head, whilst I open'd a Vein in the Arm, and took about Six Oun­ces of Blood; then applying a De­fensative over that Part of the Head, I rolled up the same, intending to proceed farther, (if Necessity so re­quired) the same Evening; at what Time I found my little Patient per­fectly [Page 3]sensible, but complaining of his Head-ach, still throwing up all he [...]ook. I order'd the following Julep [...]o be taken two or three Spoonfuls betwixt whiles, and left him for that Night.

℞ Aq. Ceras. nigr. ℥iiij.

Cinam hordeat. ℥j.

Aq. Paeon. C. ℥ss.

Syr. Caryoph. ʒvj.

Misce pro Julapio.

The next Day I call'd in Mr. Blun­del, and together visiting, we found the Child had been hot and restless all Night. His retching to vomit having left him: When we had taken him out of Bed, and placed him in a good Light, I took off the Bandage and Dressings, and passing a Probe into the Wound, plainly felt the Cra­nium for a great Compass, denudated of its Covering.

I began to draw a semicircular Line on the Outside of the Depression, as a Direction for my Knife; and ano­ther perpendicular from the one Point to the other; that we might feel the [Page 4]Extent of the Fracture, before we removed any more of the Scalp. The [...] whilst Mr. B— kept the Head stea­dy, I cut thro' my half Circle to the Cranium, and found I was just beyond the Edge of the fractur'd Bone; but drawing my Knife upon the streight Line, it slipt in a considerable Di­stance from the Superfice unawares; which Mr. B — perceiving, I with­drew the same to make Way for his Finger, by which he discover'd so great a Vacuity, that we conclud­ed the Bones were beat thro' both Meninges into the Substance of the Brain.

Upon this, he approv'd of my making another Semicircle, and ta­king off the Scalp on the opposite Side, by which we might have the whole Fracture in full View, accor­dingly I dispatch' the Work, and took from the Scalp a Circle, in all as large, or somewhat larger than a five Shil­ling Piece: when immediately we dis­cover'd this vast Fracture and Depres­sion (exactly enough delineated in the following Table) of four Angles, sunk [Page 5]so low beneath the Surface of the other Part of the Cranium, as to make a Cavity sufficient to contain near two Ounces of Liquor.

The outward Table was broke all round, whilst the inward was only bow'd: upon which Account there was no room for an Elevator, or in­deed any other Instrument, by which we could hope to raise up the deprest Bones, without the Help of the Tre­pan. The Terebra was propos'd, but concluded insufficient as well as ha­zardous; insufficient to lift up the Bones, unless we could go quite thro', and hazardous by going thro', of wounding the Dura Mater; which if not lacerated by the prodigious Stretch, must needs bear tight against the In­fide of the fractur'd Bone. The Tre­pan in so young a Child was thought likewise to have its Danger: the Mem­brane in young Children lying high, and in a Manner continuous to the Inside of the Scull.

However, here was no room for long Delay, the foresaid Part subja­cent, being so wonderfully oppress'd [Page 6]by the Points of the Bones, thro' the Clefts of which we might perceive a manifest Oscillation. Yet for the pre­sent we could do nothing more, be­ing disturbed in our Work, by a Flux of Blood from an incised Artery, to the Mouth of which I clapt a small Button of Lint, dipt in equal Parts of Bole and Vitriol, fill'd up the Ca­vity and Edges with dry Lint, and a Compress wrung out of Oxycrate and Albumen Ovi, strow'd with Fa­rina Tritici, to be lay'd over all, and rolled the Head up again for this Second Dressing.

I visited in the Evening, and found a quick Pulse, Thirst and Head-ach; especially toward the Forehead, but no Vomiting. He was very sensible, and indeed bore up beyond Expecta­tion, yet in Consideration to the Di­sturbance we had given to the whole animal Oeconomy, by that Morning's Work, I prescrib'd for him as follows;

℞ Aq. Ceras. nigr. ℥j.

Paeon. C. ʒij.

Syr. de Meconio ℥ss.

Misce, & exhibeatur hac nocte Hora Somni.

As a Preparative to this Draught, a Clyster was administer'd the same Evening. Notwithstanding all this, the Child slept little and unquietly.

Next Day, which was the 26th, I called upon my Brother B — who was himself now laid up with the Gout. It was agreed for that Day, to defer taking off the Dres­sings, in Consideration of the Flux, unless some more threatning Symp­tom shou'd appear, to obviate which, I directed thus;

℞ Pul. e chelis Canc. C.

de Gutteta aa gr. X.

Misce sumat quamprimum, repetatur mane & vesperi, vel sepius pro re na­ta, superbib. Cochl. ij. Julapij sequentis.

℞ Aq Ceras. nigr. llss.

Paeon C. ℥j.

Spt. Lavendul. ʒss.

Syr. Paeon. C. ℥j.

Misce fiat Julap.

The 27th, I visited again by my­self, found the Child somewhat fe­verish, but without other ill Symptom.

Having his Head supported betwixt the Hands of an Attendant upon the Nurse's Knee, I began to malax the Bandage and Dressings, (very stiff by reason of the effused Blood) with a little Ol. Rosarum, and after some Time clear'd all away: taking Care to secure the Application upon the wounded Artery, which from the first Dressing bled no more.

I now could plainly perceive the Extent of the Fracture, which lay all in View, and finding it would be fruitless to attempt the Reduction of the deprest Bones to their pro­per Places (which were so fast lock'd in) by any other Means, resolv'd to make Way for setting on the Trepan.

Whilst I was making ready, I or­der'd a Stuph to be express'd out of the following Decoction, and apply'd over the Wound.

℞ Summit. Centauri

Hypericon. aa Mj.

Flor. Chamomel. Mss.

Betonic.

Rorismar.

Lavendul. aa P. ij.

Bulliantur in A. F. ad Consumptionem dimidij, addendo sub finem, Vini alb. lbss. reservetur Colatura per fotu.

Having apply'd two or three warm Flannels, and filled up the Cavity with dry Lint, I concluded the best Part for Trepaning, as likewise for the Elevator, would be above the Fracture: which being seated on the right Bregma was bounded forwards by the Coronal, backwards by the Lamdoide, upwards by the Sagittal, and downwards by the Squammous Suture. And indeed so near to this latter (as may be seen in the Figure hereto annex'd) that there was not room for the Trepan below. When I had therefore drawn a Circle above, within a quarter of an Inch, or less of the broken Edge, I took out a proportionate Piece of the Scalp, al­most the Compass of a mill'd Shil­ling, which my Patient never winch'd [Page 10]at: altho' he told his Nurse the Day before, he thought at his first cut­ting, we would not leave him 'till we had taken off all the Flesh from that Side of his Head. I had now no Occasion for any Restringent, so that dressing up the Bones all dry, I apply'd a large Pledgit of Liniment upon soft Tow over the Lips, and rolled up his Head for that Day.

His Drink, which was indeed his whole Diet, was Milk and Water boil'd together, Barley-Water, Water­gruel, and betwixt whiles a small Sack Whey. A Clyster was repeated also at this Time, and his Anodyne at Night.

This Preparation being made for the Work, I went to Mr. Warden Herenden, stated the Case, and ap­pointed a Consultation at Three next Day, after Dinner; desiring he would not fail me; that I might be justify'd in the Operation. Accor­dingly, on the 28th, being provided of a good Instrument, with a Bore of the smallest Sise, and a suitable Apparatus for the Work: At the Hour [Page 11]appointed he called on me, and [...]tring my Patient's Chamber, when [...]e found him on his Feet, walking [...]bout the Room, he seem'd amas'd, [...]s ready to surmize the Case had [...]een mis-stated, and that probably we might spare the Operation. I was not in the least concern'd hereat, well knowing he would alter his Sen­timents, upon a Sight of the Wound; and taking off the Dressings, he seem'd astonish'd that a Child, under such a violent Pressure of that most noble Part, (the Source of all the other Membranes, if we may trust a late new System) from the forcibly intruded Bones, should labour under no worse Symptom than a Head-ach, and be in a Condition to walk about the Chamber.

Pleas'd with the Child's Courage, he plac'd him against the Nurse's Bo­som, and took upon himself to keep his Head steady, whilst I began to work with the Trepan; observing that admirable Axiom, Festina lente, I gently turn'd the Instrument, now and then taking it up to clean, 'till I had got to the Diploe: when lift­ing [Page 12]it out again, brushing off the Saw­dust, and laying the Pin aside, I pro­ceeded to work farther; examining with my Probe betwixt whiles, where I was got thro', and bearing down upon those Parts where I found I was not.

In few Minutes the Work was dis­patch'd, and being willing to have it out as clear as I could, without ha­ving Occasion to shiver off any Part that might remain undivided by the Saw, I thought to pass gently a Turn more upon the adhering Side, and so remove my Instrument; when at first somewhat surpriz'd, we mis'd the perforated Bone, and were ready to surmise, the Membrane being some­where lacerated underneath, had let it in, and return'd by its own pro­per Elasticity again to its Convexity; but looking into the Instrument we found it in the Bore. I hint this as a Memoir for the young Artist: for 'twas not truly my Intention to have taken it so out: Nor did I suspect, that one gentle Turn, would have cut asunder that Part which just before [Page 13] [...]d seem to stick to fast, to hazard [...]e breaking off.

The Warden was pleas'd however [...]ith the Operation, the Edges of the [...]one were so exactly smooth and [...]ven, that we needed no Lenticular to [...]ome after, for to polish the Work. The Dura Mater appear'd fair, tho' somewhat storid from its Inflamati­on: And now we immediately set about the lifting up the deprest Bones; in order to which passing carefully my Elevator thro' the Perforation, and heedfully observing that the Mem­brane might not slip between my In­strument, and the fractur'd Bone I was about to raise; I began to lift, having placed the End of the said In­strument under the Center of the lar­gest and most likely of them; when bearing up with considerable Force, I found it would not stir: on which Account I drew back my Elevator, and arming its Shank with a soft Rag, placed also a linnen Bolster upon that Part of the Edge of the sound Cra­nium, which was to be its Fulcrum.

Being thus provided, I convey'd it in once more, and with redoubled Force perceived it began to give; con­tinuing the same Force, it immedi­ately flew up, and shiver'd off the inner Table.

This Bone extracted, our Work was much facilitated, nor had we farther Occasion to pass our Instrument thro' the Bore; for by shifting our Ful­crum, or resting upon another Part we could command the other Peices at our Pleasure.

There had been a Debate the Day before, betwixt Mr. B — and my self, whether after extracting one or two of the Bones, we should not leave the Remainder, having raised them up to their Places, in expectation that they might agglutinate, or unite by Inter­vention of a Callus; by which the Dura Mater would be defended from lying bare so large a Compass, and our Work shorten'd, in respect to the Cure, if such a thing might be accom­plish'd. However finding them all break upon their Elevation, and fear­ing some loose Angles might irritate [Page 15] [...]e Membrane, creating to us more [...]nd greater Disturbance; it was now [...]oncluded they should be all taken [...]way, and very happily they were so, [...]s appears by the Sequel.

Having remov'd these four Peices of Bones, of the exact Shape and Di­mension with those express'd in the annex'd Scheme, the Dura Mater be­gan to vibrate strongly, and raised it self at the same Instant, to fill up the surprising Chasm; which wiping gently with a Piece of a soft Sponge wrung out of a little warm Claret, I presently co­ver'd that and the bored Part, with suitable Syndons of white Sarsnet, dipt only in Mel Rosarum, continu­ing my dry Lint upon the Lips, and having laid the Digestive over all, I rolled up his Head.

After the Work was over, he was carry'd to Bed, being refresh'd with two or three Spoonfulls of his Cepha­lic Julep.

From this Day our Work seeming­ly went on with a prosperous Aspect; the Cephalalgye much abated, the Pulse grew calm and the Child lively; so [Page 16]continuing for Four or Five Days. The Dura Mater, both in the Place of the Perforation, as well as that where the Bones had been extracted, began to be besprinked with little Grains of Flesh, only in the midst of this lat­ter, there appear'd a kind of Slough, occasion'd by the Points of the de­prest Bones, which by grating hard had ras'd the outward Membrane; to digest and hasten Separation of which, I dress'd those Parts with a little of the Balsam. Terebinth. added to the Mel Rosarum.

No sooner was this Part mundify'd, and a Sort of granulated Flesh had cloathed the bare Membrane: but our Head-ach return'd afresh with greater Extremity than ever, the Symptoma­tic Fever and Restlesness also accom­pany'd; so that on the 5th of March, about Five Days after the Operation, upon taking off the Bandage, I per­ceiv'd there had been a much greater Discharge than could be reasonably expected from the outside Wounds; and removing the Dressings, to ap­ply a Stuph wrung out of the Fomen­tation, [Page 17]took notice of an offensive Smell, when looking carefully upon the Membrane, thoro' a small Pa­pilla, or Grain of the new incarned Flesh, where the Slough had thrown off, there ouzed out a faetid Matter from underneath.

Believing the Case to be desperate, I armed a small Pledgit with Linim. Arcaei. dipping the same in the 'fore­said Mixture of Mel. Ros. and Bals. Tereb. to apply on the Part, whence the Matter issued forth. The other Parts of the Membrane I cover'd with the Syndons of Sarsnet, moisten'd only with the Mel. Ros. and clapping the Edges of the Silk under the shiver'd Edge of the Cranium, that the subja­cent noble Part might not be offended thereby, I drest as before and rolled up the Head.

The next Day intending to make Apertion thro' the Meninx, and re­lieve the Brain of the fluctuating Mat­ter, I acquainted Mr. H—, told him what I had discover'd, and the Neces­sity of our farther proceeding.

March 6. we met in Consultation, [Page 18]where we found the Matter somewhat lessen'd in its Discharge, tho' still abundantly too much. The Lips which, the Day before were fallen, looking white and flabby, and the in­carn'd Granules of Flesh, upon the Membrane which were then sinking and of the same Colour, had now as it were reviv'd, and put on a fresh Complexion; nor could we perceive the least Drop of Matter, bursting thro' in any Part of the Membrane, or any room for a Probe, where I had remark'd it ouzing forth.

Upon these Considerations, tho' the Symptoms still kept up, without Re­mission, I mean the Fever, Watching, and Headach, yet Mr. H— sur­mising I might be mistaken in my ye­sterdays Remark, or hoping the Mat­ter (lodging only betwixt the Dupli­cature) had made its Exit: perswaded me to dress up, and endeavour to re­lieve the Child some other way; to which Purpose, upon further Consul­tation, it was agreed, that I should presently open the Jugular on the same side, out of which running briskly, and in a full Stream, we drew Six Ounces [Page 19]of Blood. A Vesicatory was also ap­ply'd to the Neck, and an Emollient Clyster thrown up in the Evening. The Anti-epileptic Powders were repea­ted, with the Addition of two Grains of Sal Vol. C. C. to each Paper: The Cephalic Julep ut antea. and if the Head­ach did not remit by the next Day, Leaches were concluded to be set be­hind the Ears, as also to each Temple.

The 7th, I call'd again, and under­stood by the Nurse the Child had a bad Night; was then hot and restless, and cry'd out of his Head.

This Afternoon I took off the Dres­sings, perceiv'd the Bandage and Com­press were fouled with the Matter, likewise the Pillow he had lain on, which confirm'd my beleif that it was highly rational to make an Aperti­on thro' the Dura Mater, and that without so doing, all other Endea­vours would prove useless.

The Dressings taken off, I plainly observ'd from whence the Matter had come forth, but could not find a Pas­sage for my Probe, altho there was a small Drop of Matter in the Mouth of [Page 20]the Papillary Excrescens, the supposed Place of its Vent. There being no Artist by to justify my Proceeding, I drest up again as before, the Warden having promis'd to meet me on the 8th, du­ring which Interval, so great a Quan­tity of the purulent Matter bad workt out, as to afford some Relief to the Brain, so that the Symptoms grew milder: He try'd at this Dressing with his Probe, but could find no Entrance: The Wound lookt fresh, and the In­carning ruddy, tho' not much en­creas'd for 3 or 4 Days past. However, (much contrary to my own Sentiments) I was again prevail'd upon to dress up, continuing my wonted Applica­tions, and to wait a little longer, to see what farther Time might produce, unless fresh Symptoms call'd for a Penetration, of which I was to give notice.

Thus we continu'd to the 15th, the Pain 'twixt whiles remitting and returning, a stinking Gleet with much Matter upon our Dressings: One Day we seemed to get Ground, but the next lost it. The Lips again grew [Page 21]flaccid, and the Flesh upon the Mem­brane loose and pallid; so that, re­solving to wait no longer, I went again to Mr. H— and told him I should lose my little Patient, if he would not comply with my dividing the Membrane: He readily offer'd me his Assistance, and came according to his Appointment.

When we came into the Chamber, the Child was crying very dolefully of his Head: There was a fae­tid Smell by the Bedside, from the putrid Effluvia, arising from the pent up Matter: And tho' we were sensi­ble there was far too great a Quan­tity to proceed from the Wound, yet could we not, even at this Dres­sing, discover the Orifice that had let it out. The Systole and Diastole of the Membrane likewise hindring us, from apprehending any Fluctuation under our Fingers: So that I cannot any ways blame, nor would I reflect by any Means upon that Gentleman's Judgment and great Caution in this Affair; he having never seen the Mat­ter arising out of the incarned Flesh, [Page 22]as I had done, and might think, per­haps, I was therein deceiv'd.

I was at this Time extreamly un­willing to dress again, 'till I had gi­ven a freer Vent: and attempted the Search once more with my Probe, yet still without Success: At last pres­sing hard down upon one Side of the strongly resiliating Dura Mater, a small Drop of Matter blubber'd out of the aforesaid Papilla, which Mr. Warden perceiving, immediately took out a fine Probe from his Box, and pressing gently down, got in; very readi­ly giving Way to make an Apertion: whilst his Probe which he bore up un­derneath, was to guide my Lancet: with which Direction I passed the same in, and made a Wound about a Quar­ter of an Inch in Length; when exa­mining more narrowly with the Probe, we found (having not the Discharge we expected) that it was got betwixt the Duplicature of the Membrane; so that without Delay, examining again, he soon got under to the Pia Mater, when raising up the Part as before with his Probe, I cut close to the [Page 23]Side thereof, 'till I had made a Wound of half an Inch, by which we dis­charg'd a vast Quantity of stinking Pus, interspers'd with two or three small Globules of the Cortex of the Brain.

By this last Incision, we were put to a Dilemma: a small Capillary Artery being divided in the inmost Coat of this Membrane. Here was no Place for biting Stiptics, nor indeed for the common Restringents; some Part of which, with the utmost Care, must in­evitably fall in upon the Brain, and there produce very bad Effects, if not the most direful Symptoms: Nor was there, by any resisting Body under­neath, any hope that by Compression, we could stay the Flux.

The Moment of its spurting up, Mr. H— with an armed Probe prest close upon the Mouth thereof, which did me double Service, by restraining its Bleeding and dilating the Wound, whilst I conveyed a Dossil ty'd round with Thread, whose End hung out for the secure Extraction, dipt in the above-mentioned Mel Rosarum, into [Page 24]a small Quantity of which, for cor­recting the Stench and Putrifaction, I had before-hand instilled a few Drops of a Tinct: Myrh: drawn in White­wine. Clapping this down softly upon the tender Meninx, or rather upon the Brain it self, the Pia Mater being here eroded, and having made up a second Dossil somewhat tighter, and fitted to the Dimensions of the Wound, ty'd likewise with a Thread as the other: whilst he took away his armed Probe, I clap'd it close upon the wounded Vessel, which being but Capillary, we were in Hopes would be soon choak'd by this kind of Com­pression.

Being dress'd up, he was carry'd to his Bed, Mr. H— acquainting the Parents, that his Case was truly doubt­ful, if not desperate absolutely: and I my self indeed believing, I should not often dress him after. How­ever considering with the great Hip­pocrates, that there is a [...] in Morbis aliquibus, and having found that there often occurs an aliquid Mi­raculi, in the wonderful Escapes of [Page 25]these little Innocents: I resolv'd to leave nothing unattempted, justifyable by Art, for this little Champion's Re­covery.

Having no more to do at present, we took our Leaves, when I had first (for his Refreshment) prescrib'd the following Julep.

℞ Aq. Ceras. nigr. ℥v.

Paeon. C.

Angelic. C. aa ℥ss.

Sal. vol. oleos. gut. XXX.

Margarit. p. p. ʒss.

Sacch. albis. q. s.

Misce fiat Julapium perlat. cujus sumat Coch. ij. in languoribus, tempore usus agitetur Phiala.

The next Day after opening the Membrane, the Fever and Head-ach did again remit, our Patient was mani­festly reliev'd: And what is a remar­kable Instance of the Truth of that grand Physical Axiom, Natura est sui Conservatrix: we could perceive the Dura Mater plainly to do the Office of a Pump, throwing off at every Systole [Page 26]a large Quantity of the offensive Mat­ter, together with several considerable Thrombi of the grumous Blood, which had been effus'd from the bleeding Artery, and fallen inwardly upon the Brain.

At this Dressing likewise I appre­hended some small Particles of the Brain, mixed with the Matter and Blood aforesaid.

Thus we continued on the mend­ing Hand: So that in few Days more our little Patient began to call for his Play-Fellows, and walk'd sturdily a­bout the Chamber. The Matter dai­ly lessen'd, grew perfectly sweet and well concocted: altho' still some Quan­tity thereof (upon Removal of the Dressings) we could discern to be lifted out by the Vibration of the Membrane, whose proper Elater (as I just now hint­ed) well supply'd the Place of the Antlia or Sucker in the Pump or Syringe, cast­ing off the offending Matter, so far as lay within the Spheer of its Activity.

The same Applications were still continu'd leaving out the Tinct. Myrh. and putting in daily a soft [Page 27]Dossil thro' the Wound, dipt only in the Mel Rosarum, upon the Pia Mater; the Syndons being also moisten'd in the same, which were laid upon the upper Membrane: 'till such Time as it was firmly incarn'd, and the Flesh even with the Superfice of the Crani­um; about which Time I left off the the Mel. Ros. unless a small Pledgit upon the wounded Part of it: using nothing but dry Lint, which however despicable, is surely the best of Dres­sings at these Times, by which and a slight Touch of the Vitriol Stone, I kept off the luxuriant Flesh (at some­times troublesome, when improperly treated) and disposed the Edges of the Bones for Desquamation, which in Seven Weeks Time was accomplish'd: A small Part only, and that upon one Side, exfoliating visibly.

By the 10th of May, our incarned Flesh grew callous, the Pulsation un­derneath but little perceptible, and a sound Cicatrix brought over to the very Edge of the Apertion, which had been made upon the Dura Mater; and thro' which we had [Page 28]still a Discharge of laudable Pus, tho' inconsiderable to what it had been.

We kept him all this while to his first Allowance of Water-gruel, Pana­do, Barley-gruel, Milk, Pottage; his Drink chiefly Milk boil'd with Wa­ter; but growing brisk, and playing about as cheerfully as ever, when he had been purged two or three times with Manna, he had the Liberty of a more free and airy Chamber, and in­deed trespass'd so far as to get down Stairs, to eat (tho' sparingly) fresh Meat every other Day; and could not be restrained from all his usual Exercises and Diversions.

Our Business now was to contrive the keeping open the Wound I had made in the Dura Mater, which was ready to close upon us, tho' of the utmost Consequence to be kept there­from, whilst there was any Matter to be dreined off.

Mr. B — being got abroad, was easily prevail'd upon to give us a Vi­sit, and having inspected the Work, passed in his Probe down to the Pia Mater. but finding no slanting Sinus, [Page 29]on1y a direct one to the Brain, concluded there was no dilating; for indeed, where could we cut, unless upon this lower Meninx, or into the Brain it self. Our Work was all in the dark: Nor could we know the Source of the Matter, daily discharging in small Quantity; so that all we could do, was to prevent the Coalition of the Wound, hoping that in Time the said Matter might be cleansed off, or in­sinuate it self up higher into the ad­ventitious Body that was there formed from the Vessels and Membranes cir­cumjacent, when we might with more Safety enlarge, and give a freer Vent.

For keeping the Wound open, which was the more difficult in Con­sideration of the Part, I proposed a little Cannula, but he rather preferr'd a Bit of Sponge Tent, which he thought would not only lye much ea­sier, but imbibing the Matter, dis­charge it at the same Time.

With this I comply'd, and put in a small Peice, fasten'd about with a String on the upper Part.

Next Day, when I came to open the Wound, I found the Matter (as I fear'd) was entirely pent in; nor had one Drop of it passed either by the Sides, or thro' the Pores of the Sponge; but drawing the same forth by the Thread, a considerable Quantity (col­lected in the Twenty Four Hours past) gusht forth, and continued to be thrown off by the Systole of the Dura Mater, 'till it had empty'd the Cavi­ty of all it could lift up.

The Orifice being now enlarged by the Tent: I apply'd a small Pledgit of Liniment on the outside; having before-hand dropped in with a Fea­ther, a Drop or two of Mel Ros. and observed this Way of Dressing, still breaking asunder the uniting Fibres, with my Probe, where they were rea­dy to coalesce; and dipping its End in Oyl, besmear'd the Lips of the Wound, by which Means the Matter which became now again inconsidera­ble, made its Way without Obstacle.

And thus we continu'd to the mid­dle of May; our young Gentleman growing fleshy, and enjoying a bet­ter [Page 31]State of Health than he had done some Years before.

About this Time, meeting my Neigh­bour Dr. Morton, and my Brother Blundel, in Consultation at another Place; and passing by my Patient's House, I invited them to walk in, where they saw him dress'd, and took a View of the extracted Bones. Mr. B— had the Curiosity again to ex­amine the Wound, and having the Probe streight down for about half an Inch, discovered a slanting Sinus, not before observ'd, as very likely but lately made: when drawing it forth, to bend the End, he passed the same in again, and lifting up the Ex­tremity, we could perceive it near an Inch distant from the Place it enter'd.

Having made this Discovery, I re­solved, if the Discharge continued much longer, or any Symptom re­turn'd, to cut into this Cavity: For I had taken Notice that several of our late Dressings had been disturbed from the Child's Scratching: Insomuch that altho' the same Bandage was all along continued, yet by the Distur­bance [Page 32]from breeding of Lice, from Dandrif, or Humour under the Cuti­cle some one or all these Causes, there grew so troublesome an Irching, that in the Night he had got all off: The Wound was upon closing, and a dry crusty Scurf, or caked Matter had choaked up the Orifice.

The same Day the By-standers had observ'd a Sort of Rigour had seiz'd him, which went off in a Moment. Whilst I was dressing him next Day, I perceiv'd somewhat of that Kind, and asked him what he ailed, he reply'd briskly enough, he could not tell, nor could he help it.

The Wound was again open'd by the Digestive I had apply'd the Day before; and the scabby Crust cast off, with a small Quantity of Matter as usual. To prevent the like Inconve­nience of rubbing off his Dressings, I laid over my Pledgit a more adhe­sive Emplaster, clipt the Hair close, and rolling up his Head, carefully cau­tion'd him to keep his Hands off.

I was very much concerned at these Rigours, and fearfull lest the Matter [Page 33]should have got into the Blood, or tainted the Nerves, by insinuating it self thro' the Cortical Part of the Brain: but did not expect the Sur­prize so sudden; for early the next Morning I was alarmed with the News, that the Child was seized with a violent Convulsion. I hasten'd, and found him senseless, very strongly twitcht on the contrary Side: The Tendons of that Arm and Leg especi­ally, perpetually relaxing and again contracting: Upon which, 'till they thought fit to send for a Physician, I prescribed thus to their Apothecary.

℞ Aq. Ceras. nigr.

Rutae aa ℥iij.

Paeon. C. ℥j.

Tinct. Castor. ʒss.

Syr Paeon. C. ℥j.

Misce, & detur Cochl. ij. quam primum: repetatur tertia vel quarta quaque ho­ra.

℞ Pul. de Gutteta ℈j

Salis vol. C. C. gr. ij.

Fiat Pulvis, exhibiatur mane & ves­peri.

℞ Spt. Lavend. C. ij.ʒ

Sumat. gut. x. in omni haustulo Liquo­ris appropriati.

℞ Decoct. com. p. Clyster. Ilss.

Ol. Chamomel.

Rutae aa ℥j.

Misce, injiciatur statim. Applicentur vesicatoria Brachiis internis, & pone utramque aurem

Having made this Provision, the best I could surmise, for his Relief; whilst the Medicines were preparing, I had him taken out of Bed, and strongly supported upon the Knees of an Attendant. I took off the Dres­sings, which were in a Manner dry, and passing a Probe, (there being no Room either for Scissars or Directour) into the Sinus discover'd two Days before, and turning in the same, I felt the End as formerly: taking out my Knife, I carefully cut thro' upon my Probe, and let out the same: In do­ing [Page 35]this we lost no Blood; nor can I say indeed any Matter was let out; so that filling up the Wound I had now made, with a Dossil arm'd with Liniment, and moisten'd with the warm Bals. Terebinth. with a Pledgit of the same over it, and the usual Plaister, Compress and Bandage, he was laid again in his Bed, where presently after I perceiv'd the Spasms grew milder.

Returning to him in the After­noon, I heard they had held him in the Manner I left him, for near an Hour; that he had been seized with two or three Fits since, but from the first Paroxysm they observ'd a Palsey on the Arm of the Side affected, which was thereby become incapable of Mo­tion; for the Relief of which I thus directed;

℞ Ol. Lumbricorum ℥j.

Spt. Lavend. C.

Aq. Regin. Hungaric. aa ℥ss.

Ol. Succin.

Petrol. aa. ʒij.

Misce, & inungatur Spina Dorsi, te­pide, mane & vesperi, a Nucha ad Coxygem usque.

In the Evening I return'd again, found the Child sensible: his Fits had been off and on, at two or three Hours Distance: He then complain'd of being sick, and retcht to vomit; his Head-ach also was very trouble­some.

May the 18th, which was the Day after these Convulsions, I undrest his Head, and found all things had an ill Aspect: The Wound was indigested, the Lips puffed up, and risen to a con­siderable Heighth above the rest of the Parts, discharging only a bloody Se­rum.

I fomented again as I had done thro' the whole Course of my Atten­dance, ordering each Time the Fotus was taken from the Fire, two Spoonfulls of the Aq. Hungaric. to be put there­in, apply'd several warm Stuphs, and with my Digestive made up as before. At this Time I observ'd a Lypothumia, on which Account, I hasten'd them to [Page 37]lay him down in his Bed, administring some Drops of the Sp. Lavend. in a little of the Julep.

He continu'd sensible all that Day, still crying out of his Head, but at Night was delirous at some Times.

The next Day I perceiv'd the Wound was crude still, and no Sign of Mat­ter: The turgid Lips turning livid, and a very languid Oscillation underneath. The whole Membrane, so far as had been bare, to the very Edges of the fractur'd Cranium, was stangely huft up or elevated.

I passed my Probe down cautiously upon the Pia Mater, and could feel all round, a pappy Excrescens, which had incarn'd upon the lower Mem­brane, or was formed together with the upper and the adjacent Vessels, from whence arose (upon drawing back my Instrument) a small Quantity of Matter.

I now ventur'd to drop in a little of my Bals. Terebinth. to the Bottom of the Wound, and as to the rest made up as the Day before

May the 20th, he grew comatose, crying faintly now and then, his Head, and dropt asleep. That Night his Spasms return'd, with which the Paralytic Arm was chiefly and severe­ly handled, The Wound tending to gangreen: which I scarrify'd, snipping off some Part of the Lips at the same Time, but had little or no Blood fol­lowing either my Scissars or Lancet.

Seeing now no Advantage to be gained, but only Disturbance to the Child, I drest him for that Time, with a somewhat warmer Application, on Account of the Gangreen; conclu­ding to give neither my self, nor him, any more Trouble.

That Day and next the Convulsions were seldom off; and when they were, he was perfectly stupid: Some­times indeed he would attempt to speak, but could not.

However, on the 22d, finding him still alive, I thought it would be deem­ed an Omission, if I did not inspect his Wound: And as he lay along, I took off the Dressings, found the Lips flabby and subsiding, so far from ap­pearing [Page 39]to digest, that every thing tended to a suddenly approaching Death. Having cover'd up his Head again, I took my Leave.

The next Day, which was the 23d of May, I had Notice given me, he was dead.

Thus did this little Hero, of truly Manly Courage, who had struggled under, and got thro' so many Difficul­ties, and seemed now in vulgar Esti­mation, to have been well and out of danger for a long Time past, at last de­cease, after Fourscore and Four Days. And indeed had there been nothing more than the Fracture and Depression (how desperate soever they might seem) yet his Cure had been com­pleated in a much shorter Time. But considering the large Abscess upon the Pia Mater, its Rupture or Erosion, from whence there issued (as Mr. H— can testifie) some of the outward Substance of the Brain, 'twas little Wonder Nature should succumb and baffle Art: But very surprising, that for three Months Time, whilst Mat­ter lay upon this noble Part, nei­ther [Page 40] Palsie, Spasm, Sopor, nor so much as a Vertigo should invade; but on the contrary, that the Child should eat, drink and sleep, as actively tum­bling about with his Companions, and as ready (if he had not been pre­vented) to stand upon his Head, as any of 'em all.

I am very confident, I should not have magnify'd my own Judgment, had I succeeded in this Cure, which the Gentleman aforesaid was pleas'd to allow would have been one of the greatest had been perform'd in England; and if so, I think I may say, Elsewhere. As it was, I thought there would intervene somewhat worthy of Remark; and accordingly (as I ge­nerally do of rare Cases) I made this Ephemeris; which if it should not furnish Matter of Instruction, as I hope it may, to my younger Bro­ther; yet will it let him see, how near he may come to the Accomplish­ment of his Work, and at last meet with Disappointment.

The Day after his Death, I took with me a small Capital Saw, and a [Page 41]dissecting Knife, and placing the Head to my Advantage, I divided the Scalp from the Base of the Occiput, close by the Sagittal Suture, to the Top of the Forehead; then turning it down, together with the Temporal Muscle, which I raised at the same Time, over the Ear of the wounded Side of the Head: With the back of my Knife I clear'd off the Pericranium: And with my Saw, (guided by a Line of Ink I had drawn before-hand, on the Top as well as on that Side,) I got thro' the Skull; which being remov'd with the End of my Spathula, the right Hemisphere of the Brain, I found would come into View, by only clip­ping off the Dura Mater. But before I began to meddle with this latter, having rais'd up the Side of the Skull, I took special Notice of that Part of the Membrane which I had formerly divided or cut into, and of the sub­jacent Pia Mater and Cerebrum.

I perceiv'd there had been ingen­dred a fibrous Substance, but whether springing from the tender Meninx, or complicated together of both Mem­branes [Page 42]and Vessels, was not so easie to determine. Two or three Days before, it seem'd to be an Inch thick, but after Death, growing flabby, it parted upon the least Touch, and was fallen off from the upper Membrane, tho' here and there continuous with the under one.

When I had remov'd this interpo­sing Body, I expected to find some la­tent Abscess upon the Substance of the Brain, at least upon the Pia Mater: Where all that was conspicuous (an Indication there had been such) were the larger Ramifications of the San­guiferous Vessels, upon the Surface of the Membrane, whose Cavities, instead of their naturally contained Cruor, were implete with a transparent Pus: More especially those upon the ante­rior Lobe, under the Os Frontis, where the Head-ach was at first, as well as at the last, continually pointed to.

Cutting into the Cortical Part of the Brain, I found all free and clear, as in a sound State: The Ventricles like­wise, the Oblong Marrow, also the [Page 43] Cerebell were firm, and to the Eye un­tainted.

Being now minded to take a View of the other Side, I divided the Falx, and (without sawing off that Part of the Cranium) with my Hand, brought out the left Hemispheer: The Vessels on whose Surface, in like Manner with the right, were conspicuously turgid with the same Matter, a little of which, here and there, was shed upon the Cortex of the Brain: At the first Sight, I thought it might lie on the Outside of the Pia Mater; but going over gently with the Back of my Knife, and wiping also with a soft Sponge, I found it not removed: So that in several Places, opening the Membrane with the Point of my Lancet, I per­ceiv'd it lay immediately upon the Substance of the Brain, and issued out thro' each Apertion.

Having thus far satisfy'd my own Curiosity, I placed the Brain where I found it, and fitting to, the divided Skull, drew over the Scalp: which stitching up, and with the Point of my Needle raisingthe short Hair, to cover [Page 44]the said Stiches: 'Twas no easie Matter for the nicest Surveyor, to perceive that the Brain had been taken out and inspected, or the Cranium med­dled with: But this only by the bye.

It may be now expected, I should descend to the AEtiologye, and ratio­nally solve, or mechanically explain the foregoing Phaenomena: But as to this, I think I may as well in gene­ral confess my Ignorance, as pretend to unfold that, for another Person's, which I never could elucidate to my own Satisfaction.

'Till the Business of Sensation is bet­ter unravell'd, than hitherto it hath been, or I fear will be; die Disor­ders of the Nervous System may be con­jectur'd, but not clearly demonstrated.

Whither there be any such Bodies as the Animal Spirits, is not yet univer­sally agreed on: That the Source of these Disorders lies somewhere in the [...], and that the Nervous Bodies, thence arising, are some how or other the Causae sine qua, of Motion and Per­ception, seems incontestable. Thus far we may go, and trace out many Appea­rances: [Page 45]Thus also from the bare Mo­tion of the Particles of Matter, as they happen to be this or that Way modi­fy'd, may we by Mechanic Laws ac­count for sundry Observables in the Animal Structure: But how meer Mat­ter, which Way soever figur'd, can at first give, guide, and govern the Impetus is unaccountable. 'Tis here that the poor. Twilight of Humane Understanding is truly nonplust. And what we argue must be still a posterio­ri: We may judge, having afore­hand discovered the Effect produc'd, that the like under similar Circumstan­ces, will be brought forth again: Thus, the Quod sit, is apparent, but the Quo­modo, out of Sight.

'Tis manifest the Blow upon our little Patient's Head, was the remote Cause of his Death, by occasioning a Rupture of some of the Vessels upon the Brain, which shedding forth their Blood upon this noble Part, did there (being not discharg'd) produce an Aposteme: And when the purulent Matter, was, afterwards, imbibed or absorbed by some of the said [Page 46]Vessels; it might in the Way of Cir­culation, raise a Febrile Effervescence: And 'tis very rational to believe, that the same Matter also did impress a Taint upon the Nerves, exciting to­gether an Orgasmus, to the Subversi­on of the whole Oeconomy.

But what these putrid Bodies are, which did the Mischief, or in what their Essence does consist, how, or after what Manner, and why they came chiefly to affect the Arm on the contrary Side, how after a few Mi­nutes they brought on a Paralysis, or how the Nervous Fibres with the Tendons of the Muscles, in that Arm and Leg, came so regularly and al­ternately to be haled by the direful Spasms, is what I know little or no­thing of.

'Tis true, I might make some Noise, and talk of venomous Exhalations, or malign and poisonous Miasmata, which insinuating into the Fibres, like so many Stimuli, must needs twitch and convell those exquisitely sensible, the Nervous Bodies. With some I might denominate them Acids: [Page 47]With others, Atkelyes: Or with our curious Mathematical Gentlemen, I might essay to investigate the Confi­guration of their Parts, whether Cubes, Cones, Prisms, &c. and so let you into the Way of their Operation up­on the Animal Spirits, or the Nervous Filaments: And when I had gone thus far, a judiciously learned Man would see I had harrangu'd to very little Purpose: And that I might as well have own'd, it was some how or other the Effect was brought about, but which Way I could not tell.

Let the Adept in Atheism, here strut and pride himself in his Recourse to a Mundane Soul, or his Omnipotent Nature: Let him take up with those unintelligible Terms of his Archaeus, or his Plastic Powers, whilst I, who never yet shook off the Sacred Ties of Religion, and am self conscious how great a Debtor I am to His Munificence, look up to the prime Architect, the great [...], and cor­dially, as well as orally, acknowledge, that it was HE that made me, and not I my self, that Man is fearfully [Page 48]and wonderfully formed, being perfe­ctly ignorant of the How, and when he was so.

In this Confession, I have the Suf­frage of the greatest Men of the Fa­culty: Such, I mean as the renowned Harvey, and the famous Lower: The latter ingeniously acknowledging that it was the Prerogative of God only, who searcheth the Secrets of the Heart, to know the Reason of its Motion also.

To these, I may well add, that in­comparable Benefactor to Medicine, and therein, to Mankind, the judici­ous Sydenham: who on this Topic, thus expresseth himself;

‘Neque hoc mirum est, cum longè (imò supra omnem humanum captum longè) credibilius sit nos Misellos ho­munciones, ab illustri vitae lucisque Regione exulantes, Methodum qua in fabricanda Machina usus est sa­pientissimus Artifex, capere millate­nus posse; quam fabrem ferrarium rudem prorsus & imperitum, nescire quo pacto concinnetur Automaton ho­rarum [Page 49]rarum index, cujus Structura & Mo­tus exquisitissimam Artis Eleganti­am prae se ferunt. Sicuti de facto constat Cerebrum omnis tam Sensûs quam Motûs fontem esse, tum etiam & cogitationum & Memoriae Offici­nam, & tamen non est possibile a di­ligentissimâ ejus inspectione contem­plationeve mentem usque adeò illu­mitrari, ut intelligere possit quo pacto Substantia ita crassa & quasi Pulpa quaedam neque operis, ut videtur, us­que adeo affabrè elaborati, usui ita nobili & facultatibus tam praecellen­tibus queat sufficere, neque exinde assignare quis potis est, quâ ratione ex Naturae ejus vi & Structurâ par­tium, sive haec sive altera ista Facul­tas necessariò fuerit exerenda. Epist. ad Gulielm. Cole.’

I hope this Excursion will be deem'd pardonable, in which I was willing to take Notice of the vain Arrogance of such as fancy nothing to be insol­vable by their (supposedly) unboun­ded Comprehension.

I must confess, I would not willingly by any Means, discourage that most no­ble and useful Study of the Mathema­tics, whose Improvements are so ad­vantageous, so great and profitable to the Public, as well as satisfactory and pleasant to each Proficient. But yet I cannot see, that Medicine, strictly speaking, will be much advanc'd there­by: Nor how the Fluids or Humours of the Body, (from a Thousand im­perceptible Accidents diversifying their Texture) are at all compatible with the strict and plain Rule of Lines or Figures.

I am not unacquainted how many pretty Hints are given, how many probable Truths unveil'd, for this and future Ages to build some farther Dis­coveries upon, in that most excellent Baglivian Tract, De Motrice Fibra. Yet surely those who have been entire­ly ignorant of Baglivi's System, have done excellent Service to their Country in the Faculty of Physick: And truly for my own Part, I ne'er expect to find more real Advantage accruing to Man­kind in general, this Way, by the [Page 51]whole Clan of Phylosophic and Mathe­matical Physitians, (notwithstanding some Modern Flourishings) than has already, by that most diligently ob­serving and heedfully reflecting, the last of the 'foremention'd Authors. Whatever others may opine, I neither know, nor am solicitous, being my self well satisfy'd, that nothing short of Omniscience, will ever be able to bring Medicine to bear strictly with Mathematics.

How improvable the Humane In­tellect may be in its new Cloathing, Futurity must determine: It is at pre­sent manifestly bounded, and that (in Spight of all our proud Pretences) to a narrow Compass: So that the most knowing amongst us, knows truly on­ly this, that the all powerfull and immense Being, who hath geometri­cally fabricated these Bodies of ours; and observed a just Number, Weight and Measure in his Works: or in other Words, the supreme [...], who gave Life to Man, the undoubted Masterpiece of the Sublunary Creation, fitted the great Spring of Motion, and [Page 52]set all the lesser Wheels a going in the most, wonderful Automaton: That 'tis He, I say, and He alone who can, and does foresee the Result of all the several Particles of Matter, tra­versing the Machine, under the Va­riety of each or all their several Com­binations.