But there are some peculiarities to be attended to in the joints. If the nerves, which secure them, are cut through, a weakness of that part follows. If that is uncertain, and the wound is from a sharp weapon, and that in a transverse direction, it is more easy to cure: and if it be from a blunt and heavy one, the figure of it makes no difference: but it must be observed whether the pus comes from above or below the joint. If it come from under it, and continue a long time white and thick, it is probable that a nerve is cut through, and the more so, the greater the pains and inflammations are, and the sooner they began. But although the nerve be not cut through, yet if a hard tumour continue round it long, the ulcer of necessity must be tedious, and even when that is healed, the tumour will remain; and it will be a considerable time before that limb recover its power either of extension or contraction. And it is longer before it can be extended, when the cure has been conducted with the joint bent, than it is before one can be bent, which we have kept straight. The limb, that is wounded, ought to be placed also in a certain position: if it is to be agglutinated, it must be laid high; if it is inflamed, so as to incline to neither side; if the pus has begun to flow, it must be kept in a depending posture.
Rest too is an excellent remedy. Motion and walking are prejudicial, except to people in health: however, less dangerous to such as are wounded in the head or arms, than those, that are wounded in the lower parts. And walking is least of all proper, when the hurt is in the thigh, or the leg, or the foot. The place, where the patient lies, ought to be warm. Bathing also, while the wound is not clean, is extremely bad: for that renders it both tumid and foul; from whence the transition to a gangrene is common. Gentle friction is good; but in those parts, that are at a great distance from the wound.
Deterging of wounds.
After the inflammation is gone, the wound must be deterged. That end is best obtained by lint dipt in honey; and over that must be applied either the tetrapharmacum plaister, or the enneapharmacum. Now that ulcer is clean, which appears red, and is neither too dry nor too moist. But any ulcer that is deprived of its sensibility, or whose feeling is unnaturally exquisite, or that is either too dry or too moist, or that is either whitish or livid, or black, that ulcer is not clean.
Incarning of wounds.
After a wound is deterged, it must next be incarned; and for that purpose warm water is so far necessary, as to remove the sanies. The use of sordid wool is improper; it is better to cover it with such as has been washed. And there are also some medicines, which conduce to the filling up of the wound; therefore it is not amiss to make use of them: such as butter with oil of roses, and a small proportion of honey; or the plaister tetrapharmacum with the same proportion of honey, or with the oil of roses; or lint dipped in oil of roses. But the bath used sparingly is more efficacious; and food of a good juice, avoiding every thing acrid. When they are almost filled up, birds and venison and boiled pork may be given. Wine is always hurtful, while there is a fever or inflammation; and indeed, till it be cicatrized, if either nerves or muscles are wounded; or even the flesh, if it be deep. But if the wound is of the safer kind, and only superficial, wine not very old, given in moderate quantities however, may promote the incarnation. If any thing is to be softened, which is necessary in nervous and muscular parts, cerate must also be laid upon the wound. But if fungous flesh has grown upon it, dry lint restrains it gently; copper scales more powerfully. If the quantity to be taken away be more considerable, things still stronger must be applied to eat down the flesh. After these a cicatrix is very well formed by lycium diluted in passum or milk; or dry lint laid on alone is still more efficacious.
Bad consequences from unsuccessful cures.
This then is the process of a successful cure. But at times things will happen to take a dangerous turn. For sometimes the ulcer grows ancient, a callosity comes over it, and its lips are thick, and of a livid colour: after which, whatever medicine is applied, does little good; and this generally happens to an ulcer negligently treated.
Sometimes from an excessive inflammation, or violent heats, or excessive cold, or too tight bandages, or the old age or bad habit of the patient, a gangrene seizes upon it. This kind of disorder by the Greeks is divided into several species, for which we have no terms in our language. Now every gangrene not only corrupts that, which it has seized upon, but also spreads. But then the distinction is to be made between the species by different symptoms. For sometimes beyond the inflammation a redness surrounds the ulcer, and spreads with pain; the Greeks call it erysipelas[ ET ].; sometimes the ulcer is black, because the flesh of it is corrupted, and the blackness is greatly increased as the putrefaction goes on, when the wound is moist, and from the black ulcer is discharged a pale fetid liquor, and the flesh within is corrupted[(67)]: sometimes also the nerves and membranes are dissolved, and a probe put in descends either laterally or downwards; sometimes the bone is affected with that disorder: and sometimes there follows what the Greeks call gangræna[ EU ].
The former kinds happen in any part of the body: the last mentioned about the extremities, that is, the nails, the armpits, or groin; and generally in old people, or in such as are in a bad habit of body. The flesh of such an ulcer is either black or livid, but dry and withered, and the contiguous skin is for the most part covered with pustules of a dark brown colour; then the next to that is either pale or livid, and commonly of an æruginous colour, and void of sensation; the skin a little farther off[(68)] is inflamed. And all these spread at once; the ulcer into the pustulous part; the pustules to the part that is pale or livid; the paleness or livor to that which is inflamed; and the inflammation proceeds to that which is sound. In the mean time an acute fever comes on, and a vehement thirst; some are also delirious; others, though they be sensible, stammer, and with great difficulty can make their meaning understood; the stomach begins to be affected; the breath itself acquires a fetid smell. Now this disorder in the beginning admits of a cure; but when it is thoroughly rooted, it is incurable; and most of them die with a cold sweat.