Fracturealsoforthemostpartiscombinedwiththeindentationwhenitoccursinthesutures;andthisfractureismoredifficulttodiscernwhentheboneisbroken，onthisaccount，thatiftherebeafracture，itissituatedforthemostpartinthesuture。Fortheboneisliabletobebrokenandslackenedthere，owingtothenaturalweaknessofthebonethere，andtoitsporosity，andfromthesuturebeingreadilyrupturedandslackened:buttheotherboneswhichsurroundthesutureremainunbroken，becausetheyarestrongerthanthesuture。Forthefracturewhichoccursatthesutureisalsoaslackeningofthesuture，anditisnoteasytodetectwhetherthebonebebrokenandslackenedbytheindentationofaweaponoccurringinthesuture，orfromacontusionoftheboneatthesutures;butitisstillmoredifficulttodetectafractureconnectedwithcontusion。Forthesutures，havingtheappearanceoffissures，eludethediscernmentandsightofthephysician，asbeingrougherthantherestofthebone，unlessthebonebestronglycutandslackened（foracutandahedraarethesamething）。Butitisnecessary，ifthewoundhasoccurredatthesutures，andtheweaponhasimpingedontheboneorthepartsaboutit，topayattentionandfindoutwhatinjurythebonehassustained。Forapersonwoundedtothesame，oramuchsmaller，extent，andbyweaponsofthesamesizeandquality，andevenmuchless，willsustainamuchgreaterinjury，providedhehasreceivedtheblowatthesutures，thanifitwaselsewhere。Andmanyoftheserequiretrepanning，butyoumustnotapplythetrepantothesuturesthemselves，butontheadjoiningbone。
13。Andwithregardtothecureofwoundsinthehead，andthemodeofdetectinginjuriesinthebonewhicharenotapparent，thefollowingismyopinion:—Inawoundofthehead，youmustnotapplyanythingliquid，notevenwine，butaslittleaspossible，noracataplasm，norconductthetreatmentwithtents，norapplyabandagetoanulceronthehead，unlessitbesituatedontheforehead，inthepartwhichisbareofhairs，orabouttheeyebrowandeye，forwoundsoccurringthererequirecataplasmsandbandagesmorethanuponanyotherpartofthehead。Fortherestoftheheadsurroundsthewholeforehead，andthewoundswhereversituatedbecomeinflamedandswelled，owingtoaninfluxofbloodfromsurroundingparts。Andneithermustyouapplycataplasmsandbandagestotheforeheadatalltimes;butwhentheinflammationisstoppedandtheswellinghassubsided，youmustgiveupthecataplasmsandbandages。Awoundinanyotherpartoftheheadmustnotbetreatedwithtents，bandages，orcataplasms，unlessitalsorequiresincision。Youmustperformincisiononwoundssituatedontheheadandforehead，whenevertheboneisdenudedofflesh，andappearstohavesustainedsomeinjuryfromtheblow，butthewoundhasnotsufficientlengthandbreadthfortheinspectionofthebone，sothatitmaybeseenwhetherithasreceivedanymischieffromtheblow，andofwhatnaturetheinjuryis，andtowhatextentthefleshhasbeencontused，andwhetherthebonehassustainedanyinjury，orwhetheritbeuninjuredbytheblow，andhassufferednomischief;andwithregardtothetreatment，whatthewound，andtheflesh，andtheinjuryofthebonestandinneedof。
Ulcersofthisdescriptionstandinneedofincision;and，ifthebonebedenudedoftheflesh，andifitbehollow，andextendfarobliquely，wecutupthecavitywhereverthemedicinecannotpenetratereadily，whatevermedicineitmaybe;andwoundswhicharemoreinclinedtobecircularandhollow，andforthemostpartothersofthelikeshape，arecutupbymakingdoubleincisioninthecirclelengthways，，accordingtothefigureoftheman，soastomakethewoundofalongform。Incisionsmaybepracticedwithimpunityonotherpartsofthehead，withtheexceptionofthetempleandthepartsaboveit，wherethereisaveinthatrunsacrossthetemple，inwhichregionanincisionisnottobemade。Forconvulsionsseizeonapersonwhohasbeenthustreated;andiftheincisionbeonthelefttemple，theconvulsionsseizeontherightside;andiftheincisionbeontherightside，theconvulsionstakeplaceontheleftside。
14。When，then，youlayopenawoundintheheadonaccountoftheboneshavingbeendenudedoftheflesh，aswishingtoascertainwhetherornotthebonehasreceivedaninjuryfromtheblow，youmustmakeanincisionproportionatetothesizeofthewound，andasmuchasshallbejudgednecessary。Andinmakingtheincisionyoumustseparatethefleshfromthebonewhereitisunitedtothemembrane（pericranium？）andtothebone，andthenfillthewholewoundwithatent，whichwillexpandthewoundverywidenextdaywithaslittlepainaspossible;andalongwiththetentsapplyacataplasm，consistingofamass（maza）offineflourpoundedinvinegar，orboiledsoastorenderitasglutinousaspossible。Onthenextday，whenyouremovethetent，havingexaminedthebonetoseewhatinjuryithassustained，ifthewoundinthebonebenotrightseenbyyou，norcanyoudiscoverwhatmischieftheboneitselfhassustained，buttheinstrumentseemstohavepenetratedtothebonesoastohaveinjuredit，youmustscrapethebonewitharaspatorytoadepthandlengthproportionatetothesutureofthepatient，andagaininatransversedirection，forthesakeofthefractureswhicharenotseen，andofthecontusionswhicharenotdiscovered，asnotbeingaccompaniedwithdepressionofthebonefromitsnaturalposition。Forthescrapingdiscoversthemischief，iftheinjuriesinthebonebenototherwisemanifest。Andifyouperceiveanindentation（hedra）
leftinthebonebytheblow，youmustscrapethedintitselfandthesurroundingbones，lest，asoftenhappens，thereshouldbeafractureandcontusion，oracontusionalone，combinedwiththedint，andescapeobservation。Andwhenyouscrapethebonewiththeraspatory，anditappearsthatthewoundinthebonerequirestheoperation，youmustnotpostponeitforthreedays，butdoitduringthisperiod，moreespeciallyiftheweatherbehot，andyouhavehadthemanagementofthetreatmentfromcommencement。Ifyoususpectthattheboneisbrokenorcontused，orhassustainedboththeseinjuries，havingformedyourjudgementfromtheseverityofthewound，andfromtheinformationofthepatient，asthatthepersonwhoinflictedthewound，provideditwasdonebyanotherperson，wasremarkablystrong，andthattheweaponbywhichhewaswoundedwasofadangerousdescription，andthenthatthemanhadbeenseizedwithvertigo，dimnessofvision，andstupor，andfelltotheground，—underthesecircumstances，ifyoucannotdiscoverwhetherthebonebebroken，contused，orboththeoneandtheother，norcanseethetruthofthematter，youmustdissolvethejet—blackointment，andfillthewoundwithitwhenthisdissolved，andapplyalinenragsmearedwithoil，andthenacataplasmofthemazawithabandage;andonthenextday，havingcleanedoutthewound，scrapethebonewiththeraspatory。Andiftheboneisnotsound，butfracturedandcontused，therestofitwhichisscrapedwillbewhite;butthefractureandcontusion，havingimbibedthepreparation，willappearblack，whiletherestoftheboneiswhite。Andyoumustagainscrapemoredeeplythefracturewhereitappearsblack;and，ifyouthusremovethefissure，andcauseittodisappear，youmayconcludethattherehasbeenacontusionofthebonetoagreaterorlessextent，whichhasoccasionedthefracturethathasdisappearedundertheraspatory;
butitislessdangerous，andamatteroflessconsequence，whenthefissurehasbeeneffaced。Butifthefractureextenddeep，anddonotseemlikelytodisappearwhenscraped，suchanaccidentrequirestrepanning。Buthavingperformedthisoperation，youmustapplytheothertreatmenttothewound。
15。Youmustbeuponyourguardlestthebonesustainanyinjuryfromthefleshypartsifnotproperlytreated。Whenthebonehasbeensawedandotherwisedenuded，whetheritbeactuallysound，oronlyappearstobeso，buthassustainedsomeinjuryfromtheblow，theremaybedangerofitssuppurating（althoughitwouldnototherwisehavedoneso），ifthefleshwhichsurroundsthebonebeillcured，andbecomeinflamedandstrangled;foritgetsintoafebrilestate，andbecomesmuchinflamed。Fortheboneacquiresheatandinflammationfromthesurroundingflesh，alongwithirritationandthrobbing，andtheothermischiefswhichareinthefleshitself，andfromtheseitgetsintoastateofsuppuration。Itisabadthingfortheflesh（granulations？）inanulcertobemoistandmouldy，andtorequirealongtimetobecomeclean。Butthewoundshouldbemadetosuppurateasquicklyaspossible;for，thusthepartssurroundingthewoundwouldbetheleastdisposedtoinflammation，andwouldbecomethesoonestclean;forthefleshwhichhasbeenchoppedandbruisedbytheblow，mustnecessarilysuppurateandsloughaway。Butwhencleanedthewoundmustbedried，forthusthewoundwillmostspeedilybecomewhole，whenfleshdevoidofhumorsgrowsup，andthustherewillbenofungousfleshinthesore。Thesamethingappliestothemembranewhichsurroundsthebrain:forwhen，bysawingthebone，andremovingitfromthemeninx，youlaythelatterbare，youmustmakeitcleananddryasquicklyaspossible，lestbeinginamoiststateforaconsiderabletime，itbecomesoakedtherewithandswelled;forwhenthesethingsoccur，thereisdangerofitsmortifying。
16。Apieceofbonethatmustseparatefromtherestofthebone，inconsequenceofawoundinthehead，eitherfromtheindentation（hedra）ofablowinthebone，orfromthebonebeingotherwisedenudedforalongtime，separatesmostlybybecomingexsanguous。
Forthebonebecomesdriedupandlosesitsbloodbytimeandamultiplicityofmedicineswhichareused;andtheseparationwilltakeplacemostquickly，ifonehavingcleanedthewoundasquicklyaspossiblewillnextdryit，andthepieceofbone，whetherlargerorsmaller。Forapieceofbonewhichisquicklydriedandconverted，asitwere，intoashell，ismostreadilyseparatedfromtherestofthebonewhichretainsitsbloodandvitality;for，theparthavingbecomeexsanguousanddry，morereadilydropsofffromthatwhichretainsitsbloodandisalive。
17。Suchpiecesofboneasaredepressedfromtheirnaturalposition，eitherbeingbrokenofforchoppedofftoaconsiderableextent，areattendedwithlessdanger，providedthemembranehesafe;andboneswhicharebrokenbynumerousandbroaderfracturesarestilllessdangerousandmoreeasilyextracted。Andyoumustnottrepananyofthem，norrunanyrisksinattemptingtoextractthepiecesofbone，untiltheyriseupoftheirownaccord，uponthesubsidenceoftheswelling。Theyriseupwhentheflesh（granulations）
growsbelow，anditgrowsfromthediploeofthebone，andfromthesoundportion，providedtheuppertablealonebeinastateofnecrosis。Andthefleshwillshootupandgrowbelowthemorequickly，andthepiecesofboneascend，ifonewillgetthewoundtosuppurateandmakeitcleanasquicklyaspossible。Andwhenboththetablesofthebonearedriveninuponthemembrane，Imeantheupperandlower，thewound，iftreatedinthesameway，willverysoongetwell，andthedepressedboneswillquicklyriseup。
18。Thebonesofchildrenarethinnerandsofter，forthisreason，thattheycontainmoreblood[thanthoseofadults];andtheyareporousandspongy，andneitherdensenorhard。Andwhenwoundedtoasimilarorinferiordegreebyweaponsofthesameorevenofaninferiorpower，theboneofayoungpersonmorereadilyandquicklysuppurates，andthatinlesstimethantheboneofanolderperson;
andinaccidents，whicharetoprovefatal，theyoungerpersonwilldiesoonerthantheelder。Butiftheboneislaidbareofflesh，onemustattendandtrytofindout，whatevenisnotobvioustothesight，anddiscoverwhetherthebonebebrokenandcontused，oronlycontused;andif，whenthereisanindentationinthebone，whethercontusion，orfracture，orbothbejoinedtoit;andifthebonehassustainedanyoftheseinjuries，wemustgiveissuetothebloodbyperforatingthebonewithasmalltrepan，observingthegreatestprecautions，fortheboneofyoungpersonsisthinnerandmoresuperficialthanthatofelderpersons。
19。Whenapersonhassustainedamortalwoundonthehead，whichcannotbecured，norhislifepreserved，youmayformanopinionofhisapproachingdissolution，andforetellwhatistohappenfromthefollowingsymptomswhichsuchapersonexperiences。Whenaboneisbroken，orcleft，orcontused，orotherwiseinjured，andwhenbymistakeithasnotbeendiscovered，andneithertheraspatorynortrepanhasbeenappliedasrequired，butthecasehasbeenneglectedasiftheboneweresound，feverwillgenerallycomeonifinwinter，andinsummerthefeverusuallyseizesaftersevendays。Andwhenthishappens，thewoundlosesitscolor，andtheinflammationdiesinit;anditbecomesglutinous，andappearslikeapickle，beingofatawnyandsomewhatlividcolor;andthebonethenbeginstosphacelate，andturnsblackwhereitwaswhitebefore，andatlastbecomespaleandblanched。Butwhensuppurationisfairlyestablishedinit，smallblistersformonthetongueandhediesdelirious。And，forthemostpart，convulsionsseizetheothersideofthebody;for，ifthewoundbesituatedontheleftside，theconvulsionswillseizetherightsideofthebody;orifthewoundbeontherightsideofthehead，theconvulsionattackstheleftsideofthebody。Andsomebecomeapoplectic。Andthustheydiebeforetheendofsevendays，ifinsummer;andbeforefourteen，ifinwinter。Andthesesymptomsindicate，inthesamemanner，whetherthewoundbeolderormorerecent。Butifyouperceivethatfeveriscomingon，andthatanyofthesesymptomsaccompanyit，youmustnotputoff，buthavingsawedthebonetothemembrane（meninx），orscrapeditwitharaspatory（anditistheneasilysawedorscraped），youmustapplytheothertreatmentasmayseemproper，attentionbeingpaidtocircumstances。
20。Wheninanywoundofthehead，whetherthemanhasbeentrepannedornot，butthebonehasbeenlaidbare，aredanderysipelatousswellingsupervenesintheface，andinbotheyes，orineitherofthem，andiftheswellingbepainfultothetouch，andiffeverandrigorcomeon，andifthewoundlookwell，whetherasregardsthefleshorthebone，andifthepartssurroundingthewoundbewell，excepttheswellingintheface，andiftheswellingbenotconnectedwithanyerrorintheregimen，youmustpurgethebowelsinsuchacasewithamedicinewhichwillevacuatebile;andwhenthuspurgedthefevergoesoff，theswellingsubsides，andthepatientgetswell。Ingivingthemedicineyoumustpayattentiontothestrengthofthepatient。
21。Withregardtotrepanning，whenthereisanecessityforit，thefollowingparticularsshouldbeknown。Ifyouhavehadthemanagementofthecasefromthefirst，youmustnotatoncesawthebonedowntothemeninx;foritisnotproperthatthemembraneshouldbelaidbareandexposedtoinjuriesforalengthoftime，asintheenditmaybecomeitmaybecomefungous。Andandthereisanotherdangerifyousawthebonedowntothemeninxandremoveitatonce，lestintheactofsawingyoushouldwoundthemeninx。Butintrepanning，whenonlyaverylittleoftheboneremainstobesawedthrough，andthebonecanbemoved，youmustdesistfromsawing，andleavethebonetofalloutofitself。Fortoabonenotsawedthrough，andwhereaportionisleftofthesawing，nomischiefcanhappen;fortheportionnowleftissufficientlythin。Inotherrespectsyoumustconductthetreatmentasmayappearsuitabletothewound。Andintrepanningyoumustfrequentlyremovethetrepan，onaccountoftheheatinthebone，andplungeitincoldwater。Forthetrepanbeingheatedbyrunninground，andheatinganddryingthebone，burnsitandmakesalargerpieceofbonearoundthesawingtodropoff，thanwouldotherwisedo。Andifyouwishtosawatoncedowntothemembrane，andthenremovethebone，youmustalso，inlikemanner，frequentlytakeoutthetrepananddipitincoldwater。Butifyouhavenotchargeofthetreatmentfromthefirst，butundertakeitfromanotherafteratime，youmustsawtheboneatoncedowntothemeninxwithaserratedtrepan，andindoingsomustfrequentlytakeoutthetrepanandexaminewithasound（specillum），andotherwisealongthetractoftheinstrument。Fortheboneismuchsoonersawnthrough，providedtherebematterbelowitandinit，anditoftenhappensthattheboneismoresuperficial，especiallyifthewoundissituatedinthatpartoftheheadwheretheboneisratherthinnerthaninotherparts。
Butyoumusttakecarewhereyouapplythetrepan，andseethatyoudosoonlywhereitappearstobeparticularlythick，andhavingfixedtheinstrumentthere，thatyoufrequentlymakeexaminationsandendeavorbymovingthebonetobringitup。Havingremovedit，youmustapplytheothersuitableremediestothewound。Andif，whenyouhavethemanagementofthetreatmentfromthefirst，youwishtosawthroughtheboneatonce，andremoveitfromthemembrane，youmust，inlikemanner，examinethetractoftheinstrumentfrequentlywiththesound，andseethatitisfixedonthethickestpartofthebone，andendeavortoremovethebonebymovingitabout。Butifyouuseaperforator（trepan？），youmustnotpenetratetothemembrane，ifyouoperateonacasewhichyouhavehadthechargeoffromthefirst，butmustleaveathinscaleofbone，asdescribedintheprocessofsawing。