When the bone happens to be denuded of flesh by the weapon, and when
the wound occurs upon the sutures, it is difficult to distinguish
the indentation (hedra) of a weapon which is clearly recognized in
other parts of the bone, whether it exist or not, and especially if
the hedra be seated in the sutures themselves. For the suture being
rougher than the rest of the bone occasions confusion, and it is not
clear which is the suture, and which the mark inflicted by the instrument,
unless the latter (hedra) be large. Fracture also for the most part
is combined with the indentation when it occurs in the sutures; and
this fracture is more difficult to discern when the bone is broken,
on this account, that if there be a fracture, it is situated for the
most part in the suture. For the bone is liable to be broken and slackened
there, owing to the natural weakness of the bone there, and to its
porosity, and from the suture being readily ruptured and slackened:
but the other bones which surround the suture remain unbroken, because
they are stronger than the suture. For the fracture which occurs at
the suture is also a slackening of the suture, and it is not easy
to detect whether the bone be broken and slackened by the indentation
of a weapon occurring in the suture, or from a contusion of the bone
at the sutures; but it is still more difficult to detect a fracture
connected with contusion. For the sutures, having the appearance of
fissures, elude the discernment and sight of the physician, as being
rougher than the rest of the bone, unless the bone be strongly cut
and slackened (for a cut and a hedra are the same thing). But it is
necessary, if the wound has occurred at the sutures, and the weapon
has impinged on the bone or the parts about it, to pay attention and
find out what injury the bone has sustained. For a person wounded
to the same, or a much smaller, extent, and by weapons of the same
size and quality, and even much less, will sustain a much greater
injury, provided he has received the blow at the sutures, than if
it was elsewhere. And many of these require trepanning, but you must
not apply the trepan to the sutures themselves, but on the adjoining
bone.

PART 13

And with regard to the cure of wounds in the head, and the mode of
detecting injuries in the bone which are not apparent, the following
is my opinion:- In a wound of the head, you must not apply anything
liquid, not even wine, but as little as possible, nor a cataplasm,
nor conduct the treatment with tents, nor apply a bandage to an ulcer
on the head, unless it be situated on the forehead, in the part which
is bare of hairs, or about the eyebrow and eye, for wounds occurring
there require cataplasms and bandages more than upon any other part
of the head. For the rest of the head surrounds the whole forehead,
and the wounds wherever situated become inflamed and swelled, owing
to an influx of blood from surrounding parts. And neither must you
apply cataplasms and bandages to the forehead at all times; but when
the inflammation is stopped and the swelling has subsided, you must
give up the cataplasms and bandages. A wound in any other part of
the head must not be treated with tents, bandages, or cataplasms,
unless it also requires incision. You must perform incision on wounds
situated on the head and forehead, whenever the bone is denuded of
flesh, and appears to have sustained some injury from the blow, but
the wound has not sufficient length and breadth for the inspection
of the bone, so that it may be seen whether it has received any mischief
from the blow, and of what nature the injury is, and to what extent
the flesh has been contused, and whether the bone has sustained any
injury, or whether it be uninjured by the blow, and has suffered no
mischief; and with regard to the treatment, what the wound, and the
flesh, and the injury of the bone stand in need of. Ulcers of this
description stand in need of incision; and, if the bone be denuded
of the flesh, and if it be hollow, and extend far obliquely, we cut
up the cavity wherever the medicine cannot penetrate readily, whatever