Note 798 — ON INJURIES OF THE HEAD.

It will be remarked that, as a general rule, Hippocrates forbids us to apply the trepan at the sutures, but, notwithstanding this prohibition, it would appear to have been departed from in two cases related in the Sixth Book of the Epidemics. (See § 27 and 28.) The rule, however, to avoid the application of the trepan at the sutures, was generally observed by nearly all the modern authorities down to Pott, and even he admits that the sutures should be avoided when the trephine may with equal utility be set on any other part. Louis, in a paper lately reprinted from the Memoirs of the Royal Academy of Surgery, by the Sydenham Society, gives an interesting examination of the doctrine of the ancient and modern authors on this rule of practice. Most of the authorities quoted by him are averse to the application of the trepan over sutures, except when very urgently required. C. Porralius, in his marginal notes on Arantius’s Commentary on this work of Hippocrates, assigns three reasons for avoiding the sutures in this operation: 1st, because the bone is weak at that place; 2dly, because the membrane there being in close connection with the bone, is in danger of being injured; 3dly, because, by the contraction of the callus, the transpiration there will be stopped. The last of these reasons is based on the physiological doctrine of the ancient authorities respecting the uses of the sutures, one of which was, to permit transpiration from the brain. See Galen, de Usu Partium, ix., 1, 2.