ration with the
finger, it should be enlarged by crucial incisions, the flaps loosened
from the cranium by a suitable scraper (_rugine_) and folded back
out of the way, and any fragments of bone removed by the forceps
(_pinceolis_). If, however, haemorrhage prevents the immediate removal
of the fragments, this interference may be deferred for a day or
two, until the bleeding has stopped or has been checked by suitable
remedies. Then, after their removal, the piece of linen described
above is to be inserted between the cranium and dura mater. Upon the
cranium and over the flaps of the scalp, as well as in their angles,
the ordinary dressing of albumen is to be applied, covered by a
pledget of lint and a suitable bandage. No ointment, nor anything
greasy, should be applied until after the healing of the wound, lest
some of it may accidentally run down into the fracture and irritate
the dura matter. Some surgeons, Gilbert tells us, insert in the place
of the fragments of the cranium removed a piece of a cup (_ciphi_) or
bowl (_mazer_), or a plate of gold, but this plan, he says, has been
generally abandoned (_dimittitur_.)

Sometimes the cranium is simply cracked without any depression of the
bone, and such fractures are not easily detected. Gilbert tells us,
however, that if the patient will close firmly his mouth and nose and
blow hard, the escape of air through the fissured bone will reveal the
presence of the fracture (f. 88a). In the treatment of such fissures
he directs that the scalp wound be enlarged, the cranium perforated
very cautiously with a trepan (_trepano_) at each extremity of the
fissure and the two openings then connected by a chisel (_spata_?),
in order to enable the surgeon to remove the discharges by a delicate
bit of silk or linen introduced with a feather. If a portion of the
cranium is depressed so that it cannot be easily raised into position,
suitable openings are to be made through the depressed bone in order
to facilitate the free escape of the discharges.

Gunshot wounds were, of course, unknown in Gilbert's day. In a chapter
entitled "_De craneo perforato_" he gives us, however, the treatment
of wounds of the head produced by the transfixion of that member by an
arrow. If the arrow passes entirely through the head, and the results
are not immediately fatal, he directs the surgeon to enlarge the wound
of exit with a trephine, remove the arrowhead through this opening,
and withdraw the shaft