The agglutination of wounds.
The blood then being either stopped, when the haemorrhage is excessive, or more taken away by phlebotomy when too small, it is far the best method to agglutinate the wound. Now this may be done, either when it is in the skin, or even in the flesh, if nothing else is hurt. It may be done, where the flesh is hanging down in one part, and adhering in another; provided however it be still sound, and nourished by its continuity with the body.
In wounds to be agglutinated there is a double method of cure. For if the wound be in a soft place, it ought to be sewed: and especially, if the extremity of the ear, or the lower part of the nose be cut, or the forehead, or the cheek, or the eye-brow, or the lip, or the skin about the throat, or the belly. But if the wound is in the flesh, and gapes, and its lips cannot be easily brought together, a suture is improper: and in this case fibulæ[(64)] are to be put on (the Greeks call them ancteres[ ER ]) to draw the lips a little closer; that the cicatrix may be the less broad after the cure.
Hence now it may be collected, whether a wound, in which the flesh is in one part depending, and in another adhering, if it is not yet corrupted, requires a suture, or a fibula. But neither of them ought to be applied before the wound be cleansed within, lest any concreted blood be left there. For that turns to pus, raises an inflammation, and prevents the wound from being agglutinated. Even the lint, that is put into it to stop the bleeding, must not be left there; for that also inflames.
It will be necessary to take up with the needle, or the fibula, not only the skin, but also some of the flesh below it, that it may adhere the more strongly, and not break away the skin. Both of them are best done with soft thread[(65)], not too much twisted, that it may be the less uneasy to the part. Neither of them are to be applied at too great distances, nor too frequently: if at too great distances they will not hold; if too frequently they are very hurtful; because the oftener the needle has passed, and the more places are gauled by the fibula, so much the greater will the inflammation be; and especially in the summer-time. Neither of them requires any force; but the operation is only so far useful, as the skin follows the hand as it were of its own accord. Now the fibula commonly allows a wound to be broader: a suture joins its lips, but these should not touch one another in every part; that if any humour be collected within, there may be a passage for it to escape. But if a wound admits of neither of these, it ought nevertheless to be cleansed.
In the next place, upon every wound should be applied first a sponge squeezed out of vinegar: if any patient is not able to bear the strength of vinegar, wine must be made use of: a slight wound is helped by laying on a sponge squeezed even out of cold water. But in whatever way it is put on, it does good no longer than it is moist: therefore it must not be suffered to dry. A wound may be cured without foreign, scarce, and compound medicines. But if one has not confidence in that method, he ought to apply a medicine, that is composed, without suet, of those things, which I mentioned to be proper for bloody wounds; and particularly if it be in the flesh, the barbarum: if it be a nerve, or cartilage, or any of the prominent parts, as the ears, or lips, the sphragis of Polybus. The green Alexandrian also is fit for the nerves; and for the prominent parts that, which the Greeks call rhuptousa[ ES ].
It is common also, where there is a contusion, for the skin to be a little broken. When this happens, it is not improper to make a larger opening with a knife; unless there be muscles and nerves near to it, which it is not fit to cut. When it is sufficiently opened, a medicine must be applied. But if the bruised part cannot admit the opening, though too small, to be enlarged, upon account of nerves or muscles, such applications are to be used, as may draw out the humour gently; and of that kind the fittest for the present purpose is the composition, which I said was called rhypodes. It is not improper also, wherever there is a severe wound, after applying[(66)] what is agreeable to it; to cover the whole with sordid wool moistened with vinegar and oil; or if the part be soft, a mild restringent cataplasm; if nervous, or muscular, an emollient.
The proper bandages for wounds.
For binding up a wound a linen roller is most convenient: and this ought to be bandages for so broad, that a single application of it may not only cover the wound, but take in a little on each side of it. If the flesh has shrunk away more on one side, it is better to begin the rolling from thence; if equally on both sides, it ought to lay hold of the lips transversely; or if the nature of the wound does not admit of that, the middle of it is first put on, that it may be drawn afterwards both ways. Now it is to be bound on in such a manner, that it may both hold, and not be over tight. When it does not hold, it slides off; and that, which is over tight, hazards a gangrene. In the winter-time the roller ought to be carried round oftener; in the summer, no more than necessity requires. Then the extremity of it is to be sewed to the lower part of the bandage. For a knot hurts a wound, unless it be at a distance from it.