the swelling subsides, and the patient gets well. In giving the medicine
you must pay attention to the strength of the patient.

PART 21

With regard to trepanning, when there is a necessity for it, the following
particulars should be known. If you have had the management of the
case from the first, you must not at once saw the bone down to the
meninx; for it is not proper that the membrane should be laid bare
and exposed to injuries for a length of time,as in the end it may
become it may become fungous. And and there is another danger if you
saw the bone down to the meninx and remove it at once, lest in the
act of sawing you should wound the meninx. But in trepanning, when
only a very little of the bone remains to be sawed through, and the
bone can be moved, you must desist from sawing, and leave the bone
to fall out of itself. 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, and
see that it is fixed on the thickest part of the bone, and endeavor
to remove the bone by moving it about. But if you use a perforator
(trepan?), you must not penetrate to the membrane, if you operate
on a case which you have had the charge of from the first, but must
leave a thin scale of bone, as described in the process of sawing.

THE END