WOUNDS OF THE BRAIN Proved CURABLE Not only by the Opinion and Experience of many the best Authors but the remarkable History of a Child four Years old cured of two very large Depressions with the loss of a great part of the Skull a Portion of the BRAIN also issuing thorough a penetrating Wound of the Dura and Pia Mater Published for the Encouragement of Young Chirurgeons and Vindication of the Author JAMES YONGE Haec dixi ut contradicerem Opiniosis qui non credunt cerebrum posse sanari juia ego cognosco Cerebrum sanari alias medullas Jac. de Carpio Tract de Fr. Cranii LONDON Printed by J. M. for Henry Faithorn and John Kersey at the Rose in St Pauls Church-yard 1682. Non audita loquor narranti credite vidi His Oculis tetigi non dubitante manu Accr erat Juvenis medio cui Vulnus adactum Est Capiti Cerebri pars quoque caesa fuit Ille tamen vivit Si credas Arte Melampi Id factum peccas hic Medicina silet Monstra sed in Morbis Arabum Flos ille Sophorum Quod fieri dixit re patet apse palám G. F. Hildan obs m. Chir. 13. To the HONOURABLE Sir HUGH PIPER Kt Lieutenant Governor of His Majesty's Royal Cittadel at Plimouth SIR BEfore I enter the Lists with my Adversary and engage in a publick Vindication of my self and Fraternity I presume to put my self under Your Patronage and Protection For the World will have good reason to conclude my Complaint true and my Cause just when I dare take sanctuary under Your Name who besides Your impartial knowledge of us both are in such other circumstances as render the right or wrong of our pretences easily discernible to You and who have long since been well assured of the truths here related and by an unquestionable hand the falshood of those reflections my Antagonist hath made thereon These considerations encouraged my presumption and is all the Apology I can make for it I know there needeth none for the smartness wherewith I have treated my Opponent to a Person that understands so well as You the justice of such resentments and hath with more bravery vindicated his honour by his Sword than ever any Writer did an Hypothesis by that sharper Weapon his Pen. Nor shall I according to custom in applications of this nature seem to bribe and biass Your Favour by soothing Flourishes and complementing Harangues though Your constant and unblemish'd Loyalty Your great Age and Courage with the wonderful Briskness and Vivacity that accompany them be Subjects so manifestly large and rare for Encomium and Celebration that I might without flattery praise and admire Yet because severe Men and Censurers will say It looks more like the mercenary Addresses of Plays and Poems than Seriousness and that Integrity with which I profess to appeal and defend my self and my Cause and is an Entertainment which few good men receive with delight I shall decline it But thus much I dare affirm That how short soever I may come of obtaining satisfaction by this method of vindicating my self and confuting my malicious Opposer I am sure of gaining one Point of my design for which I thank Him that is to let the whole World know that I am SIR Your Obliged Humble Servant JAMES YONGE Plim April 26th 1682. THE PREFACE I HAD not ushered this small Tract into the World with the formality of a Preface had it not been extremely necessary to give my Reader an account of the occasion inducing me to publish this Case and the provocations I had to handle my Opponent so roughly About two years since I had the good fortune to be a successful Chirurgeon to the Child whose Case is contained in the following Narrative But I had scarce wiped my Instruments and put up my Plaister-Box before a Physician of this Town sneakingly and maliciously endeavoured to stifle the reputation Dr. Spenser and my self got by that Cure insinuating that it was impossible to be performed because Wounds of the Brain were absolutely mortal We endeavoured to rescue and secure our credits from so spightful a calumny by producing the Parent the Apothecary and others who handled and saw what came out thorough the Wound of the Meninges But that not satisfying we sought Compurgators in our Books where we found more than we expected and produced their suffrages to the number of no less than fifty This was so unanswerable a Proof and clear eviction that my Enemy retreated and became silent Had he so continued this Story had remained a Secret to the World But he impatient and dissatisfied with peoples believing so many men and Books against his single and groundless opinion very lately took occasion unprovoked by any man in company of divers Gentlemen in a publick place to renew his reflections on us repeating with the utmost advantage his great malice and little wit could afford those objections we had so long ago baffled and confuted and not content to bound his scurrility there he proceeded to vilifie all the Chirurgeons in this place calling us A Company of Ignoramus's fit for nothing but to cut Corns Judge if these repeated provocations and affronts were not enough to raise resentments in any man that had but common sence or regard of his credit and tenderness for his good name I accordingly took a speedy opportunity to confront him offered to produce Authorities against his Objections and to vindicate our own affirmation He himself nominated time and place for the deciding the Question but as ungenerously absenting declined the Test as he rudely gave the occasion I resolved therefore since he would not abide a private tryal to refer my Cause to the World and by a publick Vindication stop his mouth for ever Having thus signified the occasion and provocation to this Effort I hope the sharpness wherewith I have treated him will not be thought rude nor those little heats and excursions in the Epilogue causless Had he stuck to his first reflection though that wanted not its Dirt and acted like a Disputant only I had behaved my self accordingly and continued to oppose him with as soft words and hard arguments as I could But when he forsook the Scholar and took up the part of a Railer when he became reproachful and contumelious I resolved to deal with him according to his demerit I am not insensible how little esteem this contentious way of Writing hath in the World and that a superfoetation of Controversies hath surfeited even a wrangling Age But certainly for a man to be call'd Fool and Knave unjustly to be disparaged in his reputation and way of living belied and reproached in his Practice on which the life and happiness of himself and Family depends and this by a series of words and actions some years long is such an intolerable indignity and barbarous affront as will excuse and justifie the sharpest resentment To suffer such abuses tamely is to betray and expose a
and Cephalick were good for the design I then had viz. to comfort and relieve the Brain and Head so egregiously hurted and to prevent coagulation or other mischievous effect of the Contusion The Clyster â„ž Decoct com pro Clyst â„¥ x. Mel. Anthosat Ol. Hyperrici c. ana â„¥ ij Succini Chym. Gut 8. Sal GemmaeÊ’sx M. fiat Clyst The Sudorifick Mixture â„ž Pulv. ad CasumÊ’s Sperm Ceti gr 12. Balsam Peruv gut iij. Syr. Betonicae â„¥ ss misce The Cephalick Julep â„ž aq Cerasor nigr Flor. Tiliae Jugland s. Betonicae ana â„¥ iij. Syr. paralyseos Aq. poeoniae comp ana â„¥ ij Pulv. guttetae Tinct succini anaÊ’i M. The Child sweated very well and slept quiet most part of the Night had no more vomitings or convulsions c. but was as if he ailed no other than a common slight wound of the head The sharp Point was deprest so as the surface of it was contiguous with the inside of the Skull from whence it was separated so that it was fallen just the thickness of the Child's cranium this made us fear it might hurt the Dura Mater and therefore we resolved though no symptom argued any such thing to at tempt the raising of it I was so close that we could not enter an Elevatory and therefore at that time left it as it was and drest it up as the day before all this while the whole head was guarded with woollen stuphes wrung out of the following fomentation made hot The Fomentation â„ž Fol. Betonicae m. iij. Verbenae Centaurii Hyperici Paralyseos ana m. ij Herb. Salviae Rorismarini Lavendulae ana m. j. Praep. coq aquaf q. s f. colatura Opening the other wound and taking out the Dossils that I had laid in the day before several small portions of the Brain shewed themselves among the grumous Blood and on the dress but we were not more astonisht at that than when we saw a prodigious piece of the skull beaten in and wholly separate from the rest and which was a very ill circumstance the outward table being broken narrower than the innermost made the deepest piece larger than the hole it had made so that at that time we could not get it out and indeed we were not sollicitous of it since it no where hurt the Dura Mater and for ought we knew might succour the torn Meninges and keep the Brain from spewing out extravagantly So that having cleared the part of matter c. I then only made yesterdays incision into a cruciat by which that whole fracture lay open we dress'd him as before and rowled up his head upon a Stuphe dry wrung from the fomentation A little before and during this dress he took of his Cordial Cephalick Julep though the Child's courage seemed not to need it He had no heats upon him nor made any complaint but a little of the incision although he was as perfectly sensible and apprehensive as ever The same Julep was kept by him that was first ordered excepting that instead of Syr. Florum Paralyseos was mixed Syr. Poeoniae simpl and the addition of Aqua Hirundinis Rond â„¥ i. The Clyster was repeated every day for some considerable time as being extremely necessary to divert humors from a too great recourse to the head His Diet was Water-Grewel with Corinths c. thin Broth of a Chicken wherewith was boiled Pearl Barley Harts-horn Raspt Ivory Flowers of single Poeony Sage and Rosemary he sometimes drank small beer not bitter with a Tost rub'd with Nutmeg but more commonly the following Julep â„ž Flor. Poeoniae Rorismarini ana P.j. Hordei perlat Ras C. Cervi Eboris ana â„¥ ss â„ž Poeoniae M. Ê’iij Visc Quercin Ê’iss Tamarindar â„¥ i. coq aq Font. lib. iij. ad lib. ij â„ž Colaturae lib. ij Syr. Poeoniae â„¥ ij Aq. Poeoniae comp â„¥ j. Misce The second Night the Child slept indifferently well and continued in good temper and courage we again opened the left side and attempted to fasten a Terebra into the depress'd Skull and thereby to raise it But it seemed so to shake and yield to the pressure of that Instrument that we desisted doubting it might force it wholly in to which considering how small the sound part was we feared it would be very incident I endeavoured therefore by a Head Saw and a Rasp to enlarge one of the Seams that we might enter an Elevatory but when we had done so we could not raise it without hazard of forcing down the sound part of the Skull or breaking in pieces the depress'd the one was so thin and weak and the other so tyed down to its depression Considering therefore that we had made breathing enough that there was no ill symptome and that when any occurred we should have time enough to use force we resolved to let it remain and strewing Cephalick Powder on it with dry Plegents of Lint dress'd it up as besore and betook our selves to the other more dangerous part of our work Upon opening of which we saw again some little owzings of the Brain among the matter but not so very distinct as before we now resolved to extract the piece of Skull After some little time I did it by turning it so that the narrowest part of it might come to the broadest of the Gap when holding it fast with a Crow's Bill it easily came forth It was dreadful to behold what a breach it left as may be imagined by the following Figure which is exactly its shape and bigness A is the part that was undermost next towards the ear B is a rima or fracture of the outward Table only the inward remaining whole but on the depression bent and yielded so that the Angle of that part marked A the edge whereof was very keen by the oblique transient division thereof ran throught the Meninges into the Brain This we concluded from the place where the wound was made and the length of it both corresponding with the situation of that part of the deprest Skull and the length of that end of it which bent at that crack like a half broken Stick C is the end towards the Lambdoidal suture D that towards the Coronal E the upper part towards the Sagittal The wound on the Membranes we saw plainly with some effusion of the Brain but it happened though in the inferior and consequently most disadvantageous place because more apt to shed Brain that it was below the edge of the sound Skull so that it became succoured thereby and the Child being young the Membranes more soft and apt to consoliclate coalesced the sooner for after four days we saw no Brain We made our dress this time after this manner We had a good Guard of hot Stuphes to defend from the Air and having cleansed out the part and smoothed the uneven edge of the Skull we dipt a Synclon that is a piece of fine Cloath bigger than the extracted Skull having a thred fastned to the middle to
mans self to the lash of every injurious Calumniator and encourage ill-minded men to trample on and abuse us Wherefore let Controversie and recrimination be ever so immodish I shall not be thereby deterred from acting once more out of fashion If my Adversary perform his threatning promise and answer me publickly I will rejoin and that with so little favour to him that in comparison with it the smartest I have here said will appear very inferiour But I know my Cause to be impregnable against the strongest attacks he can make and how otherwise inconvenient to say no worse it 's for him to attempt what he hath menaced An Alphabetical Catalogue of the Authors quoted to prove Wounds of the BRAIN not absolutely mortal ACademia Curiosa Germ. Alexander Benedictus Alexander Read Amatus Lusitanus Ambros Pareus Andreas Laurentius Bartapalea Bernardus Gordonus Cabriolus Caspar Bauhinus Cornelius Celsus Cornelius Gemma Christopherus à Vega Danielus Senertus Desiderius Jacotius Felix Wurtz Franciscus Arceus Franciscus Sanchez Franciscus Valeriolus Gabrielus Fallopius Galenus Georgius Horstius Glandorp Guido Cauliacus G. Fabricius Hildanus Henricus Petreus H. Fab. ab Aquapendente Hilkiah Crook Horatus Augenius Jacobus de Carpio Jann Van Beverwik James Cook Jaques Guilleameu Joannes And à Cruce John Banister John Brown Joannes Bilgerus Joannes Fernelius John Goulart Joannes Heurnius Joannes Langius Joannes Rhodius Joannes Scultetus Joannes Skenckius Joannes Tagaultius Joannes Veslingius Leonardus Fuchsius Marcellus Donatus Musa Brasavolus Nicolas Nicolaus Flor Paul Barbet Peter Borellas P. J. Fabrus Petter Forestus Phil. Jacobus Sanchz P. J. Lotichius Peter de Marchetis Peter Pigreus Serjeant Wiseman Symon Aloysius Symphor Campegius Theodoricus Thomas Bartholine Volcher Coitarus Zacutus Lusitanus ERRATA PAge 11. line 20. read ℥ viii p. 19. l. 19. r. Rad. Poeoniae p. 27. l. 12. r. Cephalick Julep p. 46. l. 12. r. all else p. 49. l. 18. r. Objection THE HISTORY OF A Wound in a Childs Brain cured although some part thereof issued forth together with a large piece of the Skull with Remarks thereon ON Saturday the 28. of February 1679. I was called to Swilly a House above a Mile distant from Plimouth where Mr. John Stone was retired with his Family to secure them from the small Pox at that time raging in Town He had a Daughter almost six Years old and a Son that was then four Years and two Months a sanguine fair Child but somewhat sickly These two endeavouring to get into a Field where they espied a Maid milking of Kine pull'd at the Gate thereof which she had shut they unhappily tug'd at a part of it which was heaviest and loose and by their little strength made the defective hinges give way so that the Gate fell upon them the Girl escaped without hurt but the Boy unluckily falling had his head crushed between the heavy end of the Gate so heavy that a man could scarce lift it and a small stone that stood above the level of the ground this stone bore against the left Bregma somewhat above the Ear opposite to which on the other side about the same distance from that Ear a pin of Wood an inch square that stood out half an inch from the Gate and served to fasten an oblique piece to the bars being forced by the weight of the Gate made a small wound but a very great depression it bled much the Child cryed a little did not faint nor convulse only vomited two or three times This Accident hapned some hours before I came to the House in all which time nothing had been applyed to or removed from the Head I presently laid it bare and upon examination by my fingers found where this little wound was and that the Skull under it was largely deprest I cut and shaved away the hair from about it in doing which I used warm Sack diluted with water and glowing coals not charcoal it being hurtful to the head and suffocating to prevent ill impressions from the air at this time cold and raw That being done I entred my Probe at the wound and found the scalp separate from the skull a great way and that there was a very large depression of the latter I therefore resolved without delay to dilate it and free the Dura Mater from any shivers or splinters of the bone that might prick or offend it Mr. Knotsford the Apothecary was just then unknown to me come into the chamber and stood behind me when withdrawing my Probe some of the Brain came out upon it I rub'd it on my hand and bruised it with my finger and found it to be Brain Before I would proceed to incision I entred my Probe again with the eye forward and endeavoured to get out what I could at once the instrument being both times without the skull only it brought forth as much as two Pea's Mr. knotsford presently apprehended it and whispered to me that it was Brain I then put it from my Instrument on his hand and proceeded to dilate the wound by an incision knife after doing it several parcels of Brain appeared among the blood I cleaned it off and finding the depression to be but of one piece and that none of it or ought else offended the Dura Mater I drest it up with Dossils dipt in Mel Rosatum and Spirit of Wine made warm and covered all with a plegent of linimentum Arcei This great mischief I found was done by the Pin of the Gate a Figure of which I have here inserted that every Reader may be able to understand this part of the Story The place where the Pin was is marked + This Wound thus drest up I examined the rest of the Head and found on the other Bregma an Ecchymosis and under it another depression I shaved off the Hair from thence also and with the same Razor excised a piece of the Scalp as big as a Shilling which laid bare the depression and fracture which was such as I could not then elevate I fill'd this wound with Dossils of dry Lint covered with a plegent of Arceus liniment over all laid a Plaister rowled up the head and laid the Child who endured all with incredible courage to Bed his head bolster'd as high as he could well lye Having dispatcht a Messenger to Plimouth for necessaries I examined that part of the Brain which I had taken out the Father Mr. Knotsford and others saw it and were assured that it was such no man of brains can imagine what else it could be I then gave the Father a dreadful Prognostick though not of positive death as I secretly thought but the utmost hazard thereof and desired the assistance of Doctor Spenser That Evening I gave the Child a Clyster which having wrought two or three times I got him to take the following mixture to sweat and a little draught of a Cephalick Julep upon it these kept him in a small Diaphoresis all Night the Julep in little quantities being sometimes repeated to him they being Diaphoretical
Rhoonbuyse Observ Med. Chir. part 2. Obs 1. and Monsieur de Foy urge against the use of a Trepan viz. That the Dura Mater adheres firmly to the inside of the Cranium and that it cannot be separated therefrom without laceration nay it sticks saith Monsieur de Foy so fast as Paper pasted to a Board And hence they take occasion to render not only Trepanning and all Perforations impertinent and useless but make an absurdity of what 's a most common Observation viz. which I just now noted that large breathing or discharge prevents the severe symptoms of Convulsions Vomiting Sopor c. by venting off the matter For if the Dura Mater so closely and firmly adhere to the Skull and therefore trepanning be dangerous and useless upon the same reason and principle must all discharges be of no benefit yea they are impossible so that they deny not only what is commonly inferred That the discharge prevents the deadly symptoms but tacitely disown the possibility of any such efflux since it the Dura Mater and the Skull be so united there can be no room for matter there to lodge But forasmuch it 's frequently seen that large quantities of bloud and matter ure to gleet out of cracks and perforations of the Skull we may conclude them mistaken till they tell us from whence that should come and where it lay except there be a space between the Dura Mater and Cranium I have upon opening the Skull of one dead by a fall or blow seen almost all the Dura Mater covered with coagulate bloud and in some places near half an inch thick but more remarkably doth the History of this Child confute the pretended observation of these two men although they say Sylvius de Boe and Blasius were Eye-witnesses for here was many days a sensible evacuation from under the Skull of much matter at first serous and sanguinary but afterward concocted and laudable If it be alledged that this was matter descending from the wound of the Calvaria it doth not answer me for come it whence it will it supposeth that there was room to contain it under the Skull and consequently that there was no such adhesion as they pretend If it be further urged That upon such accidents as fractures of the Skull Concussions of the Brain c. the extravasate bloud separates the Dura Mater as Serum doth the Cuticula in application of Cantharides or scalding then their inference against Trepanning is out of doors and it remains as safe and needful as if their exploration had never been made I must profess that I never found any truth in their discovery by divers dissections trepannings c. nor in this Child but that the large piece of Skull I extracted had not the least adhesion to the Dura Mater certainly had it been so common or as they say constant an Observation it 's probable in one so young where parts are usually less distinct and separation imperfect it must have been found The Summary of all that hath been said in the Remarks on this Case are reducible to these five Consectaries First That improbable and discouraging accidents have been cured and that therefore we never ought to despair or esteem any thing absolutely mortal Secondly That we may be deceived by relying on the Axioms Aphorisms and Prognosticks of the Ancients though of the most constant and universal reception Thirdly That wounds of the Brain in particular are curable Fourthly That ample vent thorough the Skull in fractures thereof prevents the direful symptoms and the want of it occasions them and lastly That the Dura Mater doth not always adhere to the Skull but trepanning is safe and necessary and Monsieur de Foy and Rhoonhuyse in an errour My next Work is to produce my Vouchers the Authours that affirm wounds of the Brain curable Some from their opinion confirmed by History but most of them from their experience the number of the Evidencesare sixty four that of the Experiments a hundred I hope it will not seem superfluous and redundant to produce so many since in matters of great dispute and where an Adversary is very cofident it 's not only usual but a great credit to the Cause to have a multitude of Witnesses It 's no less necessary to produce all those and more if I had them to shew the wonderful ignorance of my Adversary in not knowing any of them or his wickedness in dissembling that knowledge so common and familiar to men of reading in his Profession and that only because he might have the better pretence and colour to abuse A COLLECTION OF THE Opinions of sundry good Authors concerning Wounds of the Brain wherein no less than sixty affirm them curable and confirm it by above an hundred Observations GAlen in Comment ad Aphor. 18. lib. 6. Hippocratis Cerebrum vulneratum saepius sanatum vidimus semel bis in Smyrna Ioniae vivente adhuc Praeeeptore Pelope erat Vulnus satis effatu dignum Idem de usu partium cap. 10. lib. 8. Admirabile spectaculum atque incredibile quod Smyrnae in Ionia accidit aliquando sumus conspicati Adolescentulum Vulnere in alterum anteriorum Ventriculorum accepto superstitem fuisse Dei ut plerisque videbatur voluntate Nicolas Nicolaus Flor. Serm. 7. Tract 4. cap. 91. writing of one wounded in the head by a Sword saith Profundato vulnere usque ad substantiam Cerebri super verticem in anteriore parte Frontis usque ad medium Capitis qui sequenti die post vulnerationem incurrit paralysim universalem rectus evasit Jacobus Carpus Tract de fract Cranii Vidi ad hunc usque diem sex homines à quibus notabilis quantitas medullae cerebri exivit sanati sunt habui fideles peritos physicos in societate à quibus in prima vet secunda visitatione aegro extraxi à labiis vulnerum magnam cerebri partem quae ex se exierat cranium he proceeds to give very particular accounts of each and brings Persons of great Name one of them being Nephew of the Cardinal of Histrigon Et ad istum habui multos Nobilissimos Testes M. Brasavolus Comment ad Aphor. 18. lib. 6. Hippoc. Nos in Cerebro vulner at is mira vidimus in uno qui Magnificis Valengis inserviebat tanta substantiae cerebri quantitas exivit quantum est parvum galliae ovum tamen evasit Alium vidimus ex Corsica miliâ—em cui sere dimidium Capitis cum sua cerebri portione ablatum est qui convaluit N. Massa Tom. 2. Lib. 1. Epist 11. Ego testor Deum quamplurimi homines qui adhuc vivunt testes sunt me plurimos vulneratos in capite cum incisione ossis panniculorum insignis cerebri substantiae sanasse arte remediis medicinalibus laceratio in substantia cerebri cum deperditione non modicae cerebri quantitatis Inter quos vivit adhuc Clar. P. Raymundus Vir Nobilis Venetus who he saith was wounded in