ressure of
blood that might be affecting it.

There are many warnings, however, of the danger of opening the skull and
of the necessity for definitely deciding beforehand that there is good
reason for so doing. How carefully their observations had been made and
how well they had taken advantage of their opportunities, which were, of
course, very frequent in those warlike times when firearms were unknown,
hand-to-hand conflict common, and blunt weapons were often used, can be
appreciated very well from some of the directions. For instance, they
knew of the possibility of fracture by _contrecoup_. They say that
"quite frequently though the percussion comes in the anterior part of
the cranium, the cranium is fractured on the opposite part."[18] They
even seem to have known of accidents such as we now discuss in
connection with the laceration of the middle meningeal artery. They warn
surgeons of the possibilities of these cases. They tell the story of "a
youth who had a very small wound made by a thrown stone and there seemed
no serious results or bad signs. He died the next day, however. His
cranium was opened and a large amount of black blood was found
coagulated about his dura mater."

There are many interesting things said with regard to depressed
fractures and the necessity for elevating the bone. If the depressed
portion is wedged then an opening should be made with the trephine and
an elevating instrument called a spatumen used to relieve the pressure.
Great care should be taken, however, in carrying out this procedure lest
the bone of the cranium itself, in being lifted, should injure the soft
structures within. The dura mater should be carefully protected from
injury as well as the pin. Care should especially be exercised at the
brow and the rear of the head and at the commissures (_proram et pupim
et commissuras_), since at these points the dura mater is likely to be
adherent. Perhaps the most striking expression, the word _infect_ being
italicized by Gurlt, is: "In elevating the cranium be solicitous lest
you should infect or injure the dura mater."

For wounds of the scalp sutures of silk are recommended because this
resists putrefaction and holds the wound edges together. Interrupted
sutures about a finger-breadth apart are recommended. "The lower part of
the wound should be left open so that the cure may proceed properly."
Red powder was strewed over the wound and the leaf of a plant set above
it. In the lo