ON ULCERS
by Hippocrates
translated by Francis
Adams
ON ULCERS
We must avoid wetting all sorts of ulcers except
with wine, unless
the
ulcer be situated in a joint. For, the dry is nearer to the sound,
and
the wet to the unsound, since an ulcer is wet, but a sound part is
dry.
And it is better to leave the part without a bandage unless a
unless
a cataplasm be applied. Neither do certain ulcers admit of
cataplasms,
and this is the case with the recent rather than the
old,
and with those situated in joints. A spare diet and water agree
with
all ulcers, and with the more recent rather than the older; and
with
an ulcer which either is inflamed or is about to be so; and where
there
is danger of gangrene; and with the ulcers an inflammation in
joints;
and where there is danger of convulsion; and in wounds of
the
belly; but most especially in fractures of the head and thigh,
or
any other member in which a fracture may have occurred. In the case
of
an ulcer, it is not expedient to stand; more especially if the
ulcer
be situated in the leg; but neither, also, is it proper to sit
or
walk. But quiet and rest are particularly expedient. Recent ulcers,
both
the ulcers themselves and the surrounding parts, will be least
exposed
to inflammation, if one shall bring them to a suppuration as
expeditiously
as possible, and if the matter is not prevented from
escaping
by the mouth of the sore; or, if one should restrain the
suppuration,
so that only a small and necessary quantity of pus may be
formed,
and the sore may be kept dry by a medicine which does not
create
irritation. For the part becomes inflamed when rigor and
throbbing
supervene; for ulcers then get inflamed when suppuration
is
about to form. A sore suppurates when the blood is changed and
becomes
heated; so that becoming putrid, it constitutes the pus of
such
ulcers. When you seem to require a cataplasm, it is not the ulcer
itself
to which you must apply the cataplasm, but to the surrounding
parts,
so that the pus may escape and the hardened parts may become
soft.
Ulcers formed either from the parts having been cut through by a
sharp
instrument, or excised, admit of medicaments for bloody wounds
('enaima),
and which will prevent suppuration by being desiccant to
a
certain degree. But, when the flesh has been contused and roughly
cut
by the weapon, it is to be so treated that it may suppurate as
quickly
as possible; for thus the inflammation is less, and it is
necessary
that the pieces of flesh which are bruised and cut should
melt
away by becoming putrid, being converted into pus, and that new
flesh
should then grow up. In every recent ulcer, except in the belly,
it
is expedient to cause blood to flow from it abundantly, and as
may
seem seasonable; for thus will the wound and the adjacent parts be
less
attacked with inflammation. And, in like manner, from old ulcers,
especially
if situated in the leg, in a toe or finger, more than in
any
other part of the body. For when the blood flows they become drier
and
less in size, as being thus dried up. It is this (the blood?)
especially
which prevents such ulcers from healing, by getting into
a
state of putrefaction and corruption. But, it is expedient, after
the
flow of the blood, to bind over the ulcer a thick and soft piece
of
sponge, rather dry than wet, and to place above the sponge some
slender
leaves. Oil, and all things of an emollient and oily nature,
disagree
with such ulcers, unless they are getting nearly well.
Neither
does oil agree with wounds which have been recently inflicted,
nor
yet do medicines formed with oil or suet, more especially if the
ulcer
stands in need of more cleansing. And, in a word, it is in
summer
and in winter that we are to smear with oil these sores that
require
such medicines.
2. Gentle purging of the bowels agrees with
most ulcers, and in
wounds
of the head, belly, or joints, where there is danger of
gangrene,
in such as require sutures, in phagedaenic, spreading and in
otherwise
inveterate ulcers. And when you want to apply a bandage,
no
plasters are to be used until you have rendered the sore dry, and
then
indeed you may apply them. The ulcer is to be frequently
cleaned
with a sponge, and then a dry and clean piece of cloth is to
be
frequently applied to it, and in this way the medicine which it
is
supposed will agree with it is to be applied, either with or
without
a bandage. The hot season agrees better than winter with
most
ulcers, except those situated in the head and belly; but the
equinoctial
season agrees still better with them. Ulcers which have
been
properly cleansed and dried as they should be, do not usually get
into
a the state. When a bone has exfoliated, or has been burned, or
sawed,
or removed in any other way, the cicatrices of such ulcers
become
deeper than usual. Ulcers which are not cleansed, are not
disposed
to unite if brought together, nor do the lips thereof
approximate
of their own accord. When the points adjoining to an ulcer
are
inflamed, the ulcer is not disposed to heal until the inflammation
subside,
nor when the surrounding parts are blackened by
mortification,
nor when a varix occasions an overflow of blood in
the
part, is the ulcer disposed to heal, unless you bring the
surrounding
parts into a healthy condition.
3. Circular ulcers, if somewhat hollow, you
must scarify all along
their
edges, or to the extent of half the circle, according to the
natural
stature of the man. When erysipelas supervenes upon any
sore,
you must purge the body, in the way most suitable to the
ulcer,
either upward or downward. When swelling arises around an.
ulcer,
and if the ulcer remain free from inflammation, there will be a
deposit
of matter in process of time. And whatever ulcer gets
swelled
along with inflammation and does not subside as the other
parts
subside which became inflamed and swelled at the same time,
there
is a danger that such an ulcer may not unite. When from a
fall,
or in any other way, a part has been torn or bruised, and the
parts
surrounding the ulcer have become swelled, and, having
suppurated,
matter flows from the swelling by the ulcer, if in such
cases
a cataplasm be required, it should not be applied to the sore
itself,
but to the surrounding parts, so that the pus may have free
exit,
and the indurated parts may be softened. But when the parts
are
softened as the inflammation ceases, then the parts which are
separated
are to be brought toward one another, binding on sponges and
applying
them, beginning from the sound parts and advancing to the
ulcer
by degrees. But plenty of leaves are to be bound above the
sponge.
When the parts are prevented from coming together by a piece
of
flesh full of humors, it is to be removed. When the ulcer is deep
seated
in the flesh, it is swelled up, both from the bandaging and the
compression.
Such an ulcer should be cut up upon a director
(specillum)
if possible, at the proper time, so as to admit a free
discharge
of the matter, and then the proper treatment is to be
applied
as may be needed. For the most part, in every hollow ulcer
which
can be seen into which can be seen into direct without being any
swelling
present, if there be putrefaction in it, or if the flesh be
flabby
and putrid, such an ulcer, and the parts which surround it,
will
be seen to be black and somewhat livid. And of corroding
ulcers,
those which are phagedaenic, spread and corrode most
powerfully,
and, in this case, the parts surrounding the sore will
have
a black and sub-livid appearance.
4. Cataplasms for swellings and inflammation
in the surrounding
parts.
Boiled mullein, the raw leaves of the trefoil, and the boiled
leaves
of the epipetrum, and the poley, and if the ulcer stand in need
of
cleansing, all these things also cleanse; and likewise the leaves
of
the fig-tree, and of the olive, and the horehound, all these are to
be
boiled; and more especially the chaste-tree, and the fig, and the
olive,
and the leaves of the pomegranate are to be boiled in like
manner.
These are to be used raw: and the leaves of the mallow pounded
with
wine, and the leaves of rue, and those of the green origany. With
all
these, linseed is to be boiled up and mixed by pounding it as a
very
fine powder. When there is danger of erysipelas seizing the
ulcers,
the leaves of woad are to be pounded and applied raw in a
cataplasm
along with linseed, or the linseed is to be moistened with
the
juice of strychnos or of woad, and applied as a cataplasm. When
the
ulcer is clean, but both it and the surrounding parts are
inflamed,
lentil is to be boiled in wine and finely triturated, and,
being
mixed with a little oil, it is to be applied as a cataplasm; and
the
leaves of the hip-tree are to be boiled in water and pounded in
a
fine powder and made into a cataplasm; and apply below a thin, clean
piece
of cloth wetted in wine and oil; and when you wish to produce
contraction,
prepare the leaves of the hip-tree like the lentil, and
the
cress; wine and finely-powdered linseed are to be mixed
together.
And this is proper: linseed, and raw chaste-tree, and Melian
alum,
all these things being macerated in vinegar.
5. Having pounded the white unripe grape in
a mortar of red
bronze,
and passed it through the strainer, expose it to the sun
during
the day, but remove it during the night, that it may not suffer
from
the dew; rub it constantly during the day, so that it may dry
equally,
and may contract as much virtue as possible from the
bronze:
let it be exposed to the sun for as great a length of time
as
till it acquire the thickness of honey; then put it into a bronze
pot
with the fresh honey and sweet wine, in which turpentine resin has
been
previously boiled, boil the resin in the wine until it become
hard
like boiled honey; then take out the resin and pour off the wine:
there
should be the greatest proportion of the juice of unripe
grape,
next of the wine, and third of the honey and myrrh, either
the
liquid (stacte) or otherwise. The finest kind is to be levigated
and
moistened by having a small quantity of the same wine poured on
it;
and then the myrrh is to be boiled by itself, stirring it in the
wine;
and when it appears to have attained the proper degree of
thickness,
it is to be poured into the juice of the unripe grape;
and
the finest natron is to be toasted, and gently added to the
medicine,
along with a smaller quantity of the flowers of copper (flos
aeris)
than of the natron. When you have mixed these things, boil
for
not less than three days, on a gentle fire made with fuel of the
fig-tree
or with coals, lest it catch fire. The applications should
all
be free from moisture, and the sores should not be wetted when
this
medicine is applied in the form of liniment. This medicine is
to
be used for old ulcers, and also for recent wounds of the glans
penis,
and ulcers on the head and ears. Another medicine for the
same
ulcers:-The dried gall of an ox, the finest honey, white wine, in
which
the shavings of the lotus have been boiled, frankincense, of
myrrh
an equal part, of saffron an equal part, the flowers of
copper,
in like manner of liquids, the greatest proportion of wine,
next
of honey, and least of the gall. Another:-Wine, a little cedar
honey,
of dried things, the flowers of copper, myrrh, dried
pomegranate
rind. Another:-Of the roasted flower of copper half a
drachm,
of myrrh two half-drachms, of saffron three drachms, of
honey
a small quantity, to be boiled with wine. Another:-Of
frankincense
a drachm, of gall a drachm, of saffron three drachms; let
each
of these be dried and finely levigated, then, having mixed,
triturate
in a very strong sun, pouring in the juice of an unripe
grape,
until it become of a gelatinous consistence, for three days;
then
let them be allowed to macerate in an austere, dark-colored,
fragrant
wine, which is gradually poured upon them. Another:-Boil
the
roots of the holmoak in sweet white wine; and when it appears to
be
properly done, having poured off two parts of the wine, and of
the
lees of wine as free of water as possible one part; then boil,
stirring
it, so that it may not be burnt, at a gentle fire, until it
appear
to have attained the proper consistence. Another:-The other
things
are to be the same; but, not withstanding, instead of the wine,
use
the strongest white vinegar, and dip into it wool as greasy as can
be
procured, and then, moistening it with the lees of oil, boil, and
pour
in the juice of the wild fig-tree, and add Melian alum, and
natron,
and the flowers of copper, both toasted. This cleanses the
ulcers
better than the former, but the other is no less desiccant.
Another:-Dip
the wool in a very little water; and then, having added a
third
part of wine, boil until it attain the proper consistence. By
these,
recent ulcers are most speedily prevented from getting into a
state
of suppuration.
6. Another:-Sprinkle on it dried wakerobin,
and add the green bark
of
the fig-tree, pounding it in the juice: do this with or without
wine,
and along with honey. Another:-Boiling the shavings of lotus
with
vinegar (the vinegar should be white); then mix the lees of oil
and
raw tar-water, and use it as a liniment or wash, and bandage
above.
These things in powder prevent recent wounds from
suppurating,
or they may be used for cleansing the sore along with
vinegar,
or for sponging with wine.
7. Another:-Sprinkle (on the sore?) lead finely
triturated with
the
recrement of copper; and sprinkle on it, also, the shavings of
lotus,
and the scales of copper, and alum, and chalcitis, with copper,
both
alone, and with the shavings of lotus. And otherwise, when it
is
wanted to use these in a dry state, do it with the Illyrian
spodos
triturated with the shavings, and with the shavings alone.
And
the flowers of silver alone, in the finest powder; and
birthwort,
when scraped and finely pounded, may be sprinkled on the
part.
Another, for bloody sores myrrh, frankincense, galls,
verdigris
the roasted flower of copper, Egyptian alum roasted, vine
flowers,
grease of wool, plumbago, each of these things is to be
diluted,
in equal proportions, with wine like the former. And there is
another
preparation of the same:-The strongest vinegar of a white
color,
honey, Egyptian alum, the finest natron; having toasted these
things
gently, pour in a little gall; this cleanses fungous ulcers,
renders
them hollow, and is not pungent. Another:-The herb with the
small
leaves, which gets the name of Parthenium parviflorum, and is
used
for removing thymia (warts?) from the glans penis, alum,
chalcitis,
a little crude Melian alum (?); sprinkle a little dried
elaterium,
and a little dried pomegranate rind in like manner.
8. The herb which has got the name of lagopyrus,
fills up hollow and
clean
ulcers; (when dried it resembles wheat; it has a small leaf like
that
of the olive, and more long;) and the leaf of horehound, with
oil.
Another:-The internal fatty part, resembling honey, of a fig much
dried,
of water two parts, of linseed not much toasted and finely
levigated,
one part. Another:-Of the dried fig, of the flower of
copper
levigated a little, and the juice of the fig. The preparation
from
dried fig:-The black chamaeleon, the dried gall of an ox, the
other
things the same. Of the powders:-Of the slender cress in a raw
state,
of horehound, of each equal parts; of the dried fig, two parts;
of
linseed, two parts; the juice of the fig. When you use any of these
medicines,
apply above it compresses wetted in vinegar, apply a sponge
about
the compresses and make a If the surrounding parts be in an
inflamed
state, apply to them any medicine which may appear suitable.
9. If you wish to use a liquid application,
the medicine called
caricum
may be rubbed in, and the bandages may be applied as
formerly
described upon the same principle. The medicine is prepared
of
the following ingredients:-Of black hellebore, of sandarach, of the
flakes
of copper, of lead washed, with much sulphur, arsenic, and
cantharides.
This may be compounded so as may be judged most proper,
and
it is to be diluted with oil of juniper. When enough has been
rubbed
in, lay aside the medicine, and apply boiled wakerobin in a
soft
state, either rubbing it in dry, or moistening it with honey. But
if
you use the caricum in a dry state, you must abstain from these
things,
and sprinkle the medicine on the sore. The powder from
hellebore
and sandarach alone answers. Another liquid medicine:-The
herb,
the leaf of which resembles the arum (wakerobin) in nature,
but
is white, downy, of the size of the ivy-leaf: this herb is applied
with
wine, or the substance which forms upon the branches of the ilex,
when
pounded with wine, is to be applied. Another:-The juice of the
grape,
the strongest vinegar, the flower of copper, natron, the
juice
of the wild fig-tree. Alum, the most finely levigated, is to
be
put into the juice of the wild grape, and it is to be put into a
red
bronze mortar and stirred in the sun, and removed when it
appears
to have attained proper consistence.
10. These are other powders:-Black hellebore,
as finely levigated as
possible,
is to be sprinkled on the sore while any humidity remains
about
it, and while it continues to spread. The bandaging is the
same
as when plasters are used. Another, in like manner:-The driest
lumps
of salt are to be put into a copper, or earthen pot, of equal
size,
as much as possible, and not large, and the finest honey, of
double
the size of the salt, as far as can be guessed, is to be poured
upon
the lumps of salt, then the vessel is to be put upon coals and
allowed
to sit there until the whole is consumed. Then, having sponged
the
ulcer and cleansed it, bandage it as before, and compress it a
little
more. Next day, wherever the medicine has not been taken in,
sprinkle
it on, press it down, and bandage. But when you wish to
remove
the medicine, pour in hot vinegar until it separate, and
again
do the same things, sponging it away, if necessary. Another
corrosive
powder:-Of the most finely-levigated misy, sprinkle upon the
moist
and gangrenous parts, and a little of the flower of copper,
not
altogether levigated. Another powder equally corrosive:-Having
sponged
the ulcer, burn the most greasy wool upon a shell placed on
the
fire until the whole be consumed; having reduced this to a fine
powder,
and sprinkled it on the sore, apply the bandage in the same
manner.
Another powder for the same ulcers:-The black chamaeleon, when
prepared
with the juice of the fig. It is to be prepared roasted,
and
alkanet mixed with it. Or, pimpernel, and Egyptian alum roasted,
and
sprinkle on them the Orchomenian powder. For spreading
ulcers:-Alum,
both the Egyptian roasted, and the Melian; but the
part
is to be first cleansed with roasted natron and sponged; and
the
species of alum called chalcitis roasted. It is to be roasted
until
it catch fire.
11. For old ulcers which occur on the fore
part of the legs; they
become
bloody and black:-Having pounded the flower of the melilot
and
mixed it with honey, use as a plaster. For nerves (tendons?) which
have
been cut asunder:-Having pounded, sifted, and mixed with oil
the
roots of the wild myrtle, bind on the part; and the herb
cinquefoil
(it is white and downy, and more raised above the ground
than
the black cinquefoil), having pounded this herb in oil bind it on
the
part, and then remove it on the third day.
12. Emollients (?):-These medicines are to
be used in winter
rather
than in summer. Emollient medicines which make the cicatrices
fair:-Pound
the inner mucous part of the squill and pitch, with
fresh
swine's seam, and a little oil, and a little resin, and
ceruse.
And the grease of a goose, fresh swine's seam, and squill, and
a
little oil. The whitest wax, fresh clean grease, or squill and white
oil,
and a little resin. Wax, swine's seam (old and fresh), and oil,
and
verdigris, and squill and resin. Let there be two parts of the old
grease
to the fresh, and of the other things, q. s. Having melted
the
grease that is fresh, pour it into another pot; having levigated
plumbago
finely and sifted it, and mixed them together, boil and
stir
at first; boil until when poured upon the ground it concretes;
then
taking it off the fire, pour it all into another vessel, with the
exception
of the stony sediment, and add resin and stir, and mix a
little
oil of juniper, and what has been taken off. In all the
emollient
medicines to which you add the resin, when you remove the
medicine
from the fire, pour in and mix the resin while it is still
warm.
Another:-Old swine's seam, wax, and oil, the dried shavings of
the
lotus, frankincense, plumbago,-namely, of the frankincense one
part,
and of the other one part, and of the shavings of the lotus
one
part; but let there be two parts of the old grease, one of wax,
and
of fresh swine's seam one part. Another:-Or old swine's seam along
with
the fresh grease of a goat; when cleaned, let it retain as little
as
possible of its membrane: having triturated or pounded it smooth,
pour
in oil, and sprinkle the lead with the spodium and half the
shavings
of the lotus. Another:-Swine's seam, spodium, blue chalcitis,
oil.
13. For Burns:-You must boil the tender roots
of the ilex, and if
their
bark be very thick and green, it must be cut into small parts,
and
having poured in white wine, boil upon a gentle fire, until it
appear
to you to be of the proper consistence, so as to be used for
a
liniment. And it may be prepared in water after the same manner.
Another,
not corrosive:-Old swine's seam is to be rubbed in by itself,
and
it is to be melted along with squill, the root of which is to be
divided
and applied with a bandage. Next day it is to be fomented; and
having
melted old swine's seam and wax, and mixed with them oil,
frankincense,
and the shavings of lotus and vermilion, this is to be
used
as a liniment. Having boiled the leaves of the wakerobin in
wine
and oil, apply a bandage. Another:-When you have smeared the
parts
with old swine's seam let the roots of asphodel be pounded in
wine
and triturated, and rubbed in. Another:-Having melted old swine's
seam,
and mixed with resin and bitumen, and having spread it on a
piece
of cloth and warmed it at the fire, apply a bandage. When an
ulcer
has formed on the back from stripes or otherwise, let squill,
twice
boiled, be pounded and spread upon a linen cloth and bound on
the
place. Afterward the grease of a goat, and fresh swine's seam,
spodium,
oil, and frankincense are to be rubbed in.
14. Swellings which arise on the feet, either
spontaneously or
otherwise,
when neither the swellings nor the inflammation subside
under
the use of cataplasms, and although sponges or wool, or anything
else
be bound upon the sound part; but the swelling and inflammation
return
of themselves again, an influx of blood into the veins is the
cause,
when not occasioned by a bruise. And the same story applies
if
this happen in any other part of the body. But blood is to be
abstracted,
especially the from the veins, which are the seat of the
influx,
if they be conspicuous; but if not, deeper and more numerous
scarifications
are to be made in the swellings; and whatever part
you
scarify, this is to be done with the sharpest and most slender
instruments
of iron. When you have removed the blood, you must not
press
hard upon the part with the specillum, lest you produce
contusion.
Bathe with vinegar, and do not allow a clot of blood to
remain
between the lips of the wounds, and having spread greasy wool
with
a medicine for bloody wounds, and having carded the woof and made
it
soft, bind it on, having wetted it with wine and oil. And let the
scarified
part be so placed that the determination of the blood may be
upward
and not downward; and do not wet the part at all, and let the
patient
be put upon a restricted diet and drink water. If upon loosing
the
bandages you find the scarifications inflamed, apply a cataplasm
of
the fruit of the chaste-tree and linseed. But if the scarifications
become
ulcerated and break into one another, we must be regulated by
circumstances,
and otherwise apply whatever else appears to be proper.
15. When a varix is on the fore part of the
leg, and is very
superficial,
or below the flesh, and the leg is black, and seems to
stand
in need of having the blood evacuated from it, such swellings
are
not, by any means, to be cut open; for, generally, large ulcers
are
the consequence of the incisions, owing to the influx from the
varix.
But the varix itself is to be punctured in many places, as
circumstances
may indicate.
16. When you have opened a vein and abstracted
blood, and although
the
fillet be loosed the bleeding does not stop, the member, whether
the
arm or leg, is to be put into the reverse position to that from
which
the blood flows; so that the blood may flow backward, and it
is
to be allowed to remain in this position for a greater or less
space
of time. Then bind up the part while matters are so, no clots of
blood
being allowed to remain in the opening. Then having applied a
double
compress, and wetted it with wine, apply above it clean wool
which
has been smeared with oil. For, although the flow of blood be
violent,
it will be stopped in this way. If a thrombus be formed in
the
opening, it will inflame and suppurate. Venesection is to be
practiced
when the person has dined more or less freely and drunk, and
when
somewhat heated, and rather in hot weather than in cold.
17. When in cupping, the blood continues to
flow after the
cupping-instrument
has been removed, and if the flow of blood, or
serum
be copious, the instrument is to be applied again before the
part
is healed up, so as to abstract what is left behind. Otherwise
coagula
of blood will be retained in the incisions and inflammatory
ulcers
will arise from them. In all such cases the parts are to be
bathed
with vinegar, after which they are not to be wetted; neither
must
the person lie upon the scarifications, but they are to be
anointed
with some of the medicines for bloody wounds. When the
cupping
instrument is to be applied below the knee, or at the knee, it
should
be done, if possible, while the man stands erect.
THE END
