Rome-Celsus (ca 25BC to ca. 50AD).

Celsus gave an adequate description of the bones and sutures of the calvarium. His classification of injuries was simple including fissures and depressions. He is the first to relate specific symptoms to specific tissue injury. In addition, he was aware that fractures could be present in the absence of typical findings. He was also the first to note the meningeal vessels could rupture producing severe localized pain. His treatment was more conservative than that of Hippocrates. Plasters were to be used and if there was no deterioration trepanation was avoided. He described the use of the crown trepan (modiolus) and the instrument with a smaller tip which expands rapidly to prevent penetration. He also described the technique of rotating the trepan between the palms. His description of operations for depressed fractures were unusually clear and relevant even by modern standards. His wound care is strikingly different from that of Hippocrates as he advocates various dressings soaked in vinegar and as time passes plasters should be softened with rose oil. Regrettably, Celsus influence would not be felt until the time of the Renaissance, because his texts were lost. However, his "De Medicina" was rediscovered and became the first medical text to be published using the new moveable type printing press, in the year 1478. Thus, his influence was minimal in the Arabic world and the early Renaissance. Thereafter it was profound.