Of all authors, ancient or modern, Galen has laid down the principles upon which ulcers ought to be treated with the greatest precision. He defines an ulcer to be, “a solution of continuity,” a definition evidently very comprehensive, and including wounds as well as cases of spontaneous ulceration. His directions for the treatment of a simple ulcer or fresh wound are similar to those of our author; that is to say, he directs us to bring the lips of it together, and secure them with a bandage, or, if that is not sufficient, by sutures or clasps. Wine he pronounces to be the best of all applications to ulcers, in as far as they are ulcers.
Our author copies very closely from Oribasius.
In applying the bandage, Aëtius directs us to begin above the sore if only one simple bandage is to be used, but if two are necessary, as in fractures, he recommends us to begin at the ulcer and proceed upwards, and in like manner to begin again at the ulcer and roll downwards. He forbids us to loose the bandages oftener than every alternate day; and directs us not to apply water to the ulcer, but to remove the sanies with a soft, dry linen cloth.
Celsus describes very accurately the treatment of a recent wound or simple ulcer. He approves, according to circumstances, of bandages, clasps, or sutures, and his directions respecting the application of them are highly important, but too long for our limits. After the sore is dressed he directs us to apply over it a sponge soaked in vinegar, or, if that cannot be borne, in wine or cold water. This practice is deserving of imitation. He says afterwards: “Optimum etiam medicamentum quies est: moveri et ambulare nisi sanis alienum.”
Octavius Horatianus directs us to avoid the bath, the fire, the sun, cold air, loud cries, intoxication, venery, and passion, lest these should occasion a rupture of the parts which had adhered.
Avicenna with his usual good sense gives judicious directions for the treatment of simple ulcers, but his principles are nearly the same as those laid down by Galen. He defines an ulcer to be “a solution of continuity, attended with a discharge of sanies or pus.” This seems to be an unexceptionable definition. He forbids all oily and watery applications, and recommends us to observe that no body intervene between the lips of the wound when the bandage is applied. Rhases gives similar directions. He condemns the practice of those who put oil into a wound, and who allow the patient to take wine and heating food. Averrhoes lays down similar rules with considerable precision. Haly Abbas and Alsaharavius follow the practice of Galen without the slightest alteration.
Considerable difference of opinion has prevailed respecting the nature of the clasps (Fibulæ ἄγκτηρες) recommended by Celsus and other ancient authorities. Rhodius and Le Clerc maintain that no more was meant than a simple interrupted suture, but to this opinion we cannot subscribe. (See Le Clerc, Hist. de la Méd. iv, 2, 5, and Fabricius of Aquapendente Œuvres Chirurg. ii, 108.) They would appear to have been metallic clasps of a peculiar construction.
SECT. XXXVII.—ON AGGLUTINANTS.
Oak leaves applied, and those of the willow and cabbage; the fruit, leaves, and bark of the mezereon, and the juice of the more austere plantain, papyrus soaked in oxycrate or wine, and wrapped round in a circular manner. The following are agglutinants of fresh wounds: the leaves of the pine and spruce fir, and their fresh bark wrapped round like a bandage, with water, oxycrate, or wine; and new cheese pounded. But we must apply externally the leaves of dock, or of vine, or of beet, or of lettuce. But cheese made of acid milk cures even the larger sores; and the wild pears repress the discharge. The horse-tail (Hippuris) may be applied with advantage, even if the tendons are divided asunder; and the matured woad may be used to indurated bodies even when they occur in the heads of muscles. The leaves and shoots of cypress, and its recent and soft balls (pilulæ) may be applied to indurated parts, but we must mix with it some of the fine dust taken from a wall near a mill. Myrrh rubbed with water, or frankincense and earth worms, agglutinate even the divisions of tendons; also, cinquefoil leaves with honey, and garlic burnt and applied. Old ulcers again are remedied by barley burnt with cerate, and by ceruse with a quadruple quantity of myrtle cerate. For ulcers on the head sprinkle dried myrrh, and do not moisten it, for it will speedily produce adhesion. Or, having triturated dried aloes or birthwort, and having boiled it with honey in wine until it is of a proper consistence, spread upon a pledget and apply it. Of the compound agglutinants are those called the Barbarous, the Golden, that ascribed to Nicolaus, that from willows and dittany, and others of a similar nature, which can produce the adhesion even of very large sores.
Commentary. Celsus gives the following list: glutinant vulnus, myrrha, thus, gummi, præcipueque acanthinum, psyllium, tragacantha, cardamomum, bulbi, lini semen, nasturtium, ovi album, gluten, ichthyocolla, vitis alba, contusæ cum testis suis cochleæ, mel coctum, spongia, vel ex aquâ frigidâ, vel ex vino, vel ex aceto expressa, ex iisdem lana succida: si levis plaga est etiam aranea.