SECT. XL.—ON HOLLOW ULCERS.
The hollow ulcer requires the filling up of the deficient flesh, the materiel of which is a moderate quantity of good blood. Wherefore we procure a moderate supply of it by a sufficiency of food, and produce a proper temperament of the sore by food of wholesome juices, and a suitable temperament of the part in which the sore is seated. With regard to the discharge, that which is thin renders the sore more humid, and that which is thicker makes the sordes adhere to it; on that account it requires applications that are moderately desiccant and detergent; such as frankincense, the flour of barley, that of beans and tares, iris, birthwort, calamine, panax, and pompholyx. When one incarnative remedy does not answer another must be tried. But if the sordes of the ulcer appear greater, and the ulcer more humid, it is to be understood that the medicine has not dried properly, and its powers are to be increased by a mixture of honey. If it is clean, but with less moisture than natural, the medicine has dried more than was proper, and we must apply a cerate mixed with more oil. It sometimes happens when the application is too strong, that the flesh is melted down, so that the ulcer appears foul and moist, like those which have been imperfectly dried; but that from the melting of the flesh becomes more hollow, its lips are callous, and it is red and inflamed; and sometimes the patient has very acute pain. But the other, which arises from the applications being less desiccant than proper, is attended with none of these characters. Wherefore the caries of wood, more especially of such as is possessed of a moderate degree of astringent and detergent qualities, as that of the elm, purges and incarnates clean ulcers; or anemone may be applied for the same purpose. Having shaven down the bark of the pine and pounded it with cerate, and rubbed it upon pledgets, apply it to hollow ulcers, more especially to such as are recent, for it will fill them. The compound medicines for ulcers which are clean, are, that from snails, that ascribed to Manetho from the lees of wine, that from aloes, the dry powder called meletera, that containing equal parts of starch, of manna, of halica, and of tares; and in like manner, the composition from frankincense and that called aphroditarium. But when the ulcers are fouler the powders called cephalic are to be applied, and of those applications that are made upon pledgets, that called trophos, the isis and the athena, and that from distaff-thistle (atractylis,) and moreover that called Italicum, and any others of tried efficacy.
Commentary. The resemblance here pointed out between an ulcer too strongly stimulated and one too little is highly deserving of attention. Our author appears to have borrowed his description from Oribasius, who however abridges it from Galen. Galen and Aëtius give a somewhat fuller account than our author, but their principles of treatment are the same. They remark that frankincense in humid intemperaments engenders flesh, but in dry ones only pus. Pompholyx burnt and washed; calamine and the shells of oysters are said to be incarnant and dissiccant without pungency. Galen inculcates that the greatest difficulty in treating these ulcers, is to find out the nature of the intemperament of the part, and correct it.
Celsus gives the following list of incarnants: Carnem alit et ulcus implet resina pinea, ochra attice, vel asterace, cera, butyrum. He recommends the use of hot water; an application consisting of butter, roses, and a small portion of honey; or the tetrapharmacum with roses. He approves of giving wholesome and nutritious food, such as fowls, venison, pork, and even wine. The list of the Pseudo-Dioscorides contains nearly the same articles as that of Celsus. (Euporist. i, 186.)
Octavius Horatianus recommends a composition of equal parts of honey, turpentine, rosin, and wax, melted in a vessel; or a mixture of powdered rosin, wax, and fat.
Scribonius Largus recommends basilicon, and a composition consisting of calf’s marrow, the fat of geese, butter, stag’s marrow, wax, turpentine, honey, and roses.
Avicenna remarks, that in treating hollow ulcers we must not use very desiccative applications, as they dry up the fluids which are necessary for forming flesh; nor for the same reason, very astringent applications, nor abstergents of any greater strength than to remove the sordes. Rhases recommends a mixture of equal parts of olibanum, aloes, sarcocolla, and dragon’s blood. Camphor is an ingredient in one of his incarnative applications. Alsaharavius makes mention of an application from olibanum, like that of Rhases.
All the ancient authors say that round ulcers are more difficult to heal than those of any other shape; and Cassius Medicus and Alexander Aphrodisiensis assign various reasons for this, the most probable of which seems to be, that in this case the sound parts are further removed than in any other.
Apollonius Dyscolus states that ulcers are prevented from healing by pregnancy, by disease of the spleen, and by varicose veins. (Histor. Mirab. 42.)