On Ulcers — First Draft Translation

ON ULCERS. Ulcers in general should not be moistened with anything except wine—unless the ulcer is in a joint. For what is dry is nearer to the healthy state, and what is wet is nearer to the unhealthy; the ulcer is wet, and what is healthy is dry. 1 It is better to leave an ulcer unbandaged, provided no poultice is being applied. And indeed it is not possible to apply a poultice to some ulcers—more so with fresh wounds than with older ones, and with those in the joints. Eating sparingly benefits all ulcers, and water likewise benefits all ulcers—more so fresh wounds than older ones; and whatever ulcer is inflamed or is about to become so; and where there is danger of mortification—both the ulcers and the inflammations in the joints; and where there is danger of convulsions supervening; and in wounds of the belly; and most of all in wounds of the head and in fractures of the thigh, and in any other fracture that may occur. Standing is least beneficial for ulcers, and especially if the ulcer is in the leg—and neither sitting nor walking; but rest and stillness are most beneficial. All fresh-wound ulcers, both themselves and the surrounding parts, would be least inflamed if one were to bring them to suppuration as quickly as possible, and the pus were not retained and blocked off from the mouth of the ulcer—or if one were to turn the course aside so that it would not even be on the point of suppurating beyond the minimum of necessary pus, but would be as dry as possible with a remedy that is not harsh. For the part becomes feverish when shivering and throbbing arise; the ulcers are then inflamed whenever they are about to suppurate; and suppuration occurs when the blood is altered and heated until, rotting, it becomes pus. In such ulcers, whenever it seems that a poultice is needed, one must not apply the poultice to the ulcer itself, but to the surrounding parts, so that the pus may be discharged and what has hardened may be softened. Of ulcers, whichever has been cut through or chopped through by a weapon admits of a blood-staunching remedy and of something that prevents suppuration by drying. But flesh that has been bruised and crushed by the weapon—treat this so that it suppurates as quickly as possible; for it is less inflamed this way. And it is necessary that the flesh that has been bruised and crushed should rot and become pus and then melt away, and afterward new flesh should sprout. For every fresh-wound ulcer, except in the belly, it is beneficial that blood flow out from the wound at once, more or less; for the ulcer itself and the surrounding parts are less inflamed. 2 And from old ulcers it is beneficial to make blood flow off frequently, whenever the moment seems right, both from the ulcers themselves and from the parts surrounding the ulcer—especially if the ulcer is in the shin or in a toe or finger, more so than anywhere else on the body. For when blood flows off, the ulcers become drier and smaller as they shrink; for what hinders the healing of such ulcers most—and also all the others—is the putrefaction of blood and whatever has arisen from the shifting of blood. After the flowing-off of blood in such ulcers it is beneficial to bind on a sponge that is dense and soft, cut, whether drier or more moist, and on top of the sponge to place many leaves. Oil and all remedies that are soft or oily are not beneficial for such ulcers, unless the ulcer is already advancing very much toward health. Nor is oil beneficial for fresh-wound ulcers, nor soft nor fatty remedies, especially if the ulcer needs more thorough cleansing. To speak generally: one should employ oil as a vehicle both in summer and in winter for the remedies required. Gentle purging of the lower belly is beneficial for most ulcers—both in wounds in the head and in the belly and in the joints; and for those where there is danger of mortification; and for those that need suturing; and for eating and creeping ulcers; and for otherwise long-standing ulcers; and wherever one is about to apply a bandage. 4 One should not apply plasters either, before making the ulcer thoroughly dry; then one must apply them, sponging the ulcer repeatedly with a sponge, and again applying a dry clean linen cloth repeatedly; then, having applied the remedy judged beneficial, to bandage or not to bandage. For most ulcers, the warmer season is more beneficial than winter, except for those of the head and belly—and more especially the season of the equinox. 6 Ulcers that have not been properly cleansed to the required degree and begin to granulate before they should—these are most prone to overgranulation. Those that have been properly and appropriately cleansed and are always treated toward a drier state—except if they have been bruised—these do not overgranulate for the most part. If a bone is separating from anywhere, whether by burning or by sawing or by any other means, the scars of such ulcers become more hollow. 8 Ulcers that have not been cleansed are unwilling to close when drawn together, nor do they come together of themselves. Those whose surrounding parts are inflamed, so long as the inflammation has not ceased, are unwilling to close. Nor will those ulcers whose surrounding parts have become blackened by putrefaction of blood, or where a varix is providing the inflow of blood, be willing to close—unless you restore the surrounding parts to a healthy state. Circular ulcers, if they are hollow beneath, must be incised around the circumference on all sides where there is separation, either all around or on half the circle, along the length of the person's body. Whenever erysipelas supervenes on any ulcer, a purging of the body must be carried out, in whichever direction is beneficial for the ulcer, whether upward or downward. 10 In whichever case a swelling arises beside an ulcer while the ulcer is free from inflammation, in time the swelling holds an underlying deposit of pus. And whatever has swollen with the inflammation and does not subside—while the others that began to be inflamed and to swell at the same time do subside—there is also danger that this one will not close along with the rest. Those wounds that are cut through and bruised by falls or by some other means, and the parts surrounding the ulcer swell up, and after suppurating, pus withdraws from the swellings along the ulcer: of such cases, whenever a poultice seems to be needed, one must not apply the poultice to the ulcer itself but to the surrounding parts, so that the pus may withdraw and what has hardened may be dispersed. When it has been dispersed and the inflammation has ceased, apply binding sponges against the separated parts, starting from the healthy tissue and proceeding a little at a time. On top of the sponge, let many leaves be placed. If anything cannot adhere, the flesh being moist is the cause; remove it. If the ulcer is beneath deep flesh, it becomes varicose in both respects—from the bandaging and from the compression. If one cuts such a case, one should incise the ulcer with a probe, if possible, from the mouth, making it free-flowing, wherever the moment seems right, and then apply whatever treatment seems needed. As a general rule with every ulcer that has a cavity toward the direct view, it can be seen clearly, without swelling being present. [If it has a cavity not toward the direct view, or if swelling is present,] if there is putrefaction in it, or if the flesh is seeping away, soft and rotten, this ulcer and the parts surrounding the ulcer will appear dark and livid to look at. And of eating ulcers, wherever phagedaina is present and spreads and eats most vigorously, the part surrounding the ulcer in that direction will have a dark, livid color. Poultices for swellings and inflammation in the surrounding parts: boiled mullein; the raw leaves of trefoil; the boiled leaves of rockfoil; and poley. If the ulcer also needs cleansing, all of these cleanse as well; and also the leaves of the fig tree and of the olive, and marrubium. 11 All these are to be boiled; and above all, of these, boil chaste-tree (agnus castus), and the fig, and the olive, and the leaves of the pomegranate likewise boil. The following are to be used raw: the leaves of mallow, rubbed with wine; and the leaves of rue and of fresh marjoram. To all of these one must mix linseed that has been roasted and pounded as fine as possible. Where there is danger of erysipelas supervening on ulcers, rub the raw leaves of woad and apply as a poultice with the linseed, or moisten the linseed with the juice of nightshade or of woad and apply as a poultice. When the ulcer is clean but the ulcer and the surrounding parts of the ulcer are inflamed, boil lentil in wine and pound it smooth, mix in a little oil, apply as a poultice, and bind. Also, boil the leaves of dog-rose in water, pound smooth, and apply as a poultice, having first laid beneath a thin clean linen cloth moistened with wine and oil. And when you wish to close the ulcer, prepare the dog-rose leaves as the lentil. Lizard-herb: wine and linseed are mixed in, finely ground; and also this: linseed, and raw chaste-tree, and Melian alum, these moistened with vinegar. Press white unripe grapes through a strainer into a red copper vessel; set it in the sun during the days, and bring it in at night so it is not wetted by dew; stir it ceaselessly during the day so that it dries evenly and takes up as much as possible from the copper vessel; set it in the sun for as long a time as it takes to become thick like honey. Then pour it into a bronze pot, and add the finest honey and sweet wine, having first boiled turpentine resin in the wine; boil the resin in the wine until it becomes as hard as cooked honey; then take out the resin and pour in the wine. Let the juice of the unripe grape be greatest in amount, second the wine, third the honey. Rub the choicest stacte myrrh, otherwise as fine as possible, pound it smooth, strain it, pouring in the same wine a little at a time; then boil the myrrh separately on its own with the wine, stirring; when the consistency seems already good, pour it into the juice of the unripe grape; then roast the finest available natron and mix it gently into the remedy, and flower of copper less than the natron. When you have mixed these in, boil for no fewer than three days, heating gently with fig-wood or charcoal, so that it does not scorch; and let everything mixed in be anhydrous; and let the ulcers not be moistened wherever this remedy is being applied. Use this remedy for long-standing ulcers and for fresh wounds, and for the prepuce, and for ulcers of the head and ear. 12 Another remedy for the same ulcers: dried ox bile, finest honey, white wine; boil shavings of lotus wood in it; frankincense, equal myrrh, equal saffron, flower of copper. Similarly of liquids: wine most, honey second, bile least. — Another: wine, cedar resin, little; of the dry ingredients, flower of copper, myrrh, dried pomegranate rind. — Another: half-part of roasted flower of copper, two half-parts of myrrh, three parts of saffron, a little honey, roasted together with wine. — Another: one part frankincense, one part myrrh, one part oak-gall, three parts saffron; grind each of these dry as fine as possible, then mix, and grind in the hottest possible sun, pouring in juice of unripe grape until it becomes sticky, for three days; then pour in a little at a time of astringent dark fragrant wine and strain. — Another: boil roots of holm-oak in sweet white wine; when it seems to be in good condition, pour off; make two parts of this wine and one part of olive oil-lees as free from water as possible, then boil, stirring so it does not scorch, over a gentle fire, until the consistency seems good. — Another: the other ingredients the same; but instead of wine, let the vinegar be as sharp as possible and white; dip into it wool as lanolin-rich as possible; then, having moistened it with the oil-lees, boil; and mix in fig juice, and Melian alum, and natron and flower of copper, both roasted. This cleanses the ulcers more than the previous one, but the previous one dries no less. — Another: dip the wool in as little water as possible, then pour in one-third part wine, and boil until the consistency is good. From these, fresh wounds will be able to suppurate most quickly. — Another: sprinkle on dry arum and dress. — Rub the green bark of a fig shoot in its own juice in wine and dress; also without wine on its own and with honey. — Another: vinegar, boiling shavings of lotus wood in it; let the vinegar be white; then mix in lees of olive oil and raw pine-pitch serum; apply by spreading, by dripping, and by binding. 13 Dry remedies turn fresh wounds away from suppurating—either washing off with vinegar or sponging off with wine. Sprinkle smooth lead ground with Cyprian ash; and sprinkle the lotus wood-dust, and scale of copper, and alum, and chalcitis together with copper, and chalcitis alone, and with the lotus wood-dust. And otherwise, when needed, use such dry remedies: also the Illyrian ash finely ground with the wood-dust, and wood-dust alone, and flower of silver alone as finely ground as possible. And scrape and grind aristolochia smooth and sprinkle it on. Another blood-staunching remedy: myrrh, frankincense, oak-gall, copper rust, roasted flower of copper, roasted Egyptian alum, oenanthe, oesypum (lanolin), molybdaena; of each of these an equal amount; the preparation with wine as before, and the rest of the working in the same way. 14 Vinegar as sharp as possible and white; honey; Egyptian alum; the finest natron gently roasted; a little bile; boil these together. This clears away and hollows out overgrown flesh, and does not bite. — Another: the small-leafed herb called small-leafed parthenion, which removes the wart-like growths from the prepuce; and chalcitis alum; and raw Melian alum; apply a thin dry elaterium compressed, and likewise thin dry pomegranate rind. The herb named hare's-wheat fills hollow clean ulcers best; when dried it resembles bran, with a small leaf like that of the olive but longer; also the leaf of marrubium, with oil. 15 Another: the inside of a dried fig—the fat, honey-like flesh—of as dry a fig as possible; two parts water; one part of linseed, not greatly roasted, as finely ground as possible. — Another: the dried fig, a little fine flower of copper, and fig juice. — This one using the dried fig: black chameleon thistle, dried ox bile; the other ingredients the same. The dry remedies: — Fine watercress, raw; hedge-mustard; equal parts of each; two parts dried fig; two parts linseed; fig juice. When you use any of these remedies, having placed spleens [of uncertain character—see note] on top, place a sponge above the spleens, bind, and press somewhat more firmly; if the surrounding parts are inflamed, apply around them whatever seems beneficial. If you wish to use a liquid preparation, also apply the Carian remedy by spreading, and bind as described previously, by the same method. 16 The remedy is prepared from the following: black hellebore, sandarac, scale of metal, lead burned with much sulfur, orpiment (arsenikon), cantharis. Use whichever combination of these seems appropriate; the preparation medium is cedar oil. When there has been sufficient application, remove the remedy, sprinkling on boiled arum finely ground, or grinding it dry and moistening with honey. And if you use this Carian remedy in the dry form, you must remove the remedy by sprinkling. The dry form acts from the hellebore alone and the sandarac. 17 Another liquid remedy: an herb whose leaf is similar in nature to arum, but white and downy, about the size of an ivy leaf; this herb is applied as a poultice with wine. — Or rub the bark around the trunk of the holm-oak in wine and apply as a poultice. — Another: juice of unripe grape, vinegar as sharp as possible, flower of copper, natron, juice of wild fig. — Throw alum ground as fine as possible into juice of unripe grape, set it in a red copper vessel in the sun, stir, and take it up when the consistency seems good. — Another: black hellebore as finely ground as possible is sprinkled on, as long as there is something of the oozing and spreading; the bandaging is the same as for plasters. — Another: throw lumps of salt as dry as possible into a small bronze or new earthenware pot, making them as equal in size as possible, not coarse; and pour over the salt roughly double the amount of the finest honey; then set the pot on coals and leave it until everything is burned; then sponge and clean the ulcer, bind as before, and press somewhat more firmly. The next day, wherever the remedy has not taken hold, sprinkle on more and press and bind; when you wish to remove the remedy, pour warm vinegar over it until it comes away, and again do the same things if needed, having sponged it. — Another dry biting remedy: burn the most lanolin-rich wool possible on a potsherd, holding a torch against it until you have burned all of it; grind this smooth, sprinkle on, and apply the same bandage. — Another dry remedy, similarly biting: sprinkle as finely ground misy as possible onto the moist and rotten parts, and fine scale not entirely smooth. — For the same ulcers: black chameleon thistle, alum soaked in fig juice—soak it when roasted—and mix in alkanna. — Pimpernel and roasted Egyptian alum: sprinkle on an Orchomenian application. For spreading ulcers: alum—both roasted Egyptian alum and Melian alum—but first clean with roasted natron and sponge. 18 And chalcitis alum roasted: roast until it becomes flame-colored. For old ulcers arising on the shins—these tend to become blood-tinged and dark: grind the flower of melilot, mix with honey, and use as a spread-on plaster. 20 For severed sinews, bind on: pound the roots of wild myrtle and sift through a strainer, mix with oil. Also the five-leafed herb—it is white and downy and grows taller from the ground than the dark cinquefoil—pound this in oil and bind on; remove it on the third day. Soft remedies: one should use such remedies in winter rather than in summer. Soft remedies, which also produce fine scars: grind the inner mucilaginous part of squill; or pine resin with fresh pig fat, a little oil, a little resin, and white lead. 21 Also goose fat and fresh pig fat and squill and a little oil. — Wax as white as possible, fresh clean fat. — Or squill, white oil, a little resin. — Wax, old and fresh pig fat, and oil, and copper rust, and squill, and resin; let there be two parts of the old fat to the fresh; of the other ingredients as much as seems appropriate. — Melt fresh fat, pour it into another small pot, and grind molybdaena as fine as possible, sift through a strainer, mix in, boil, and stir from the start; boil until when a drop falls on the ground it congeals; then take it off, pour off the rest except for the stone residue at the bottom, and throw in resin and stir, mixing in a little cedar oil and what has been removed. For all soft preparations, wherever you mix in resin, when you take the remedy off the fire, while it is still warm, put the resin in and stir. — Another: old pig fat and wax and oil; of the dry ingredients, lotus wood-dust, frankincense, molybdaena—let there be one part of each—and two parts of old fat, one part wax, one part oil. — Or old pig fat alone, with this: fresh goat fat as free as possible from membrane—purified, cut into small pieces or finely chopped—pour in oil, and sprinkle in the lead with the ash, and half of the lotus wood-dust. — Another: goat fat, ash, blue chalcitis, oil. On burns: one must boil the soft young roots of holm-oak, where the bark is thickest and most green, having cut them small, pour white wine over them, and boil slowly over a gentle fire until the consistency seems good enough to be applied as an ointment; and likewise in water. 22 Another, non-biting: smear with old pig fat alone, having melted it; then divide the root of squill, apply it on top, and bind; the next day foment. — Another: melt old pig fat and mix in wax, oil, frankincense, and lotus wood-dust, and red ochre; having spread this on, boil leaves of arum in wine and oil, apply them, and bind. — Another: after smearing with the old pig fat, spread over it roots of asphodel ground and pounded smooth in wine. — Another: melt old pig fat, mix with resin and asphalt, spread it on linen cloth, warm it by the fire, apply, and bind. When an ulcer arises on the back from blows or otherwise, grind well-boiled squill and spread it on linen cloth and bind; afterward spread on goat fat and fresh pig fat and ash and oil and frankincense. 24 [5] Swellings arising in the feet, whether spontaneous or not, that are not at all settled by poultices — both the swellings and the inflammation — and if one binds on sponges or wool or anything else over a healthy part and it then swells up spontaneously and becomes inflamed, the cause is a flow of blood through the vessels, in cases where bruising is not the cause; and if something of this kind occurs anywhere else in the body, the reasoning is the same. One must then release blood, preferably through the very vessels that are flowing into the part, if these are visible; if not, one must make the scarifications into the swellings deeper and closer together. Everything else that you scarify should be done in the same way — using the sharpest and finest instruments possible. When drawing off the blood, do not press hard with the probe, so that bruising does not come about in addition. Wash down with vinegar, and do not allow a clot of blood to be left behind in the scarifications. After coating with a haemostatic remedy, bind on soft carded wool still bearing its grease, sprinkled with wine and oil; and keep the scarified part positioned so that the blood flows upward rather than downward. Let it not be wetted at all, and let the patient eat little and drink water. If on loosening you find the scarifications inflamed, apply a poultice made from the fruit of the chaste tree and linseed. If the scarifications ulcerate and break open, look to the position, then bring whatever is needed and treat the rest accordingly. Where a varix is present on the shin — whether prominent on the surface or lying within the flesh — and the shin is dark, and it seems that blood must drain away from it, one must not scarify such parts in any way. For in most cases large ulcers arise from scarifications on account of the blood flowing in through the varix. Rather, one must puncture the varix itself from time to time, wherever it seems timely. 26 [5] Whenever you cut a vessel, after you have released the blood and loosened the band and it does not stop, let the limb be held in the position opposite to the direction of the blood's flow — whether it be arm or leg — as if the blood were going back; and after remaining in this way for a longer or shorter time lying down, then bind it in this position, with no clot present in the incision. Place a double compress, soaked in wine, and above it clean wool dressed with oil. For even if there is a forcible inflow of blood, a stoppage of the flowing occurs. And if a clot forms over the incision and inflammation then supervenes, suppuration will result. One must perform phlebotomy on a person who has eaten and drunk — more or less — and is somewhat warmed, on a day that is warmer rather than colder. When applying a cupping vessel, if blood flows on when the cup is removed, even if much flows or serum flows, one must quickly, before the cup is full, apply it again straightaway and draw out what remains. If not, clots become lodged in the scarifications, and then ulcers arise from them through inflammation. 27 One must wash all such things down with vinegar; afterward, do not wet them, and do not lie upon the scarifications. Coat the scarifications with one of the haemostatic remedies. Whenever it is necessary to apply cupping below the knee or at the knee, do so with the patient standing upright, if he is able to stand.