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400 BC
ON ULCERS
by Hippocrates
translated by Francis Adams
We must avoid wetting all sorts of ulcers except with wine； unless
the ulcer be situated in a joint。 For； the dry is nearer to the sound；
and the wet to the unsound； since an ulcer is wet； but a sound part is
dry。 And it is better to leave the part without a bandage unless a
unless a cataplasm be applied。 Neither do certain ulcers admit of
cataplasms； and this is the case with the recent rather than the
old； and with those situated in joints。 A spare diet and water agree
with all ulcers； and with the more recent rather than the older； and
with an ulcer which either is inflamed or is about to be so； and where
there is danger of gangrene； and with the ulcers an inflammation in
joints； and where there is danger of convulsion； and in wounds of
the belly； but most especially in fractures of the head and thigh；
or any other member in which a fracture may have occurred。 In the case
of an ulcer； it is not expedient to stand； more especially if the
ulcer be situated in the leg； but neither； also； is it proper to sit
or walk。 But quiet and rest are particularly expedient。 Recent ulcers；
both the ulcers themselves and the surrounding parts； will be least
exposed to inflammation； if one shall bring them to a suppuration as
expeditiously as possible； and if the matter is not prevented from
escaping by the mouth of the sore； or； if one should restrain the
suppuration； so that only a small and necessary quantity of pus may be
formed； and the sore may be kept dry by a medicine which does not
create irritation。 For the part becomes inflamed when rigor and
throbbing supervene； for ulcers then get inflamed when suppuration
is about to form。 A sore suppurates when the blood is changed and
becomes heated； so that becoming putrid； it constitutes the pus of
such ulcers。 When you seem to require a cataplasm； it is not the ulcer
itself to which you must apply the cataplasm； but to the surrounding
parts； so that the pus may escape and the hardened parts may become
soft。 Ulcers formed either from the parts having been cut through by a
sharp instrument； or excised； admit of medicaments for bloody wounds
（'enaima）； and which will prevent suppuration by being desiccant to
a certain degree。 But； when the flesh has been contused and roughly
cut by the weapon； it is to be so treated that it may suppurate as
quickly as possible； for thus the inflammation is less； and it is
necessary that the pieces of flesh which are bruised and cut should
melt away by becoming putrid； being converted into pus； and that new
flesh should then grow up。 In every recent ulcer； except in the belly；
it is expedient to cause blood to flow from it abundantly； and as
may seem seasonable； for thus will the wound and the adjacent parts be
less attacked with inflammation。 And； in like manner； from old ulcers；
especially if situated in the leg； in a toe or finger； more than in
any other part of the body。 For when the blood flows they become drier
and less in size； as being thus dried up。 It is this （the blood？）
especially which prevents such ulcers from healing； by getting into
a state of putrefaction and corruption。 But； it is expedient； after
the flow of the blood； to bind over the ulcer a thick and soft piece
of sponge； rather dry than wet； and to place above the sponge some
slender leaves。 Oil； and all things of an emollient and oily nature；
disagree with such ulcers； unless they are getting nearly well。
Neither does oil agree with wounds which have been recently inflicted；
nor yet do medicines formed with oil or suet； more especially if the
ulcer stands in need of more cleansing。 And； in a word； it is in
summer and in winter that we are to smear with oil these sores that
require such medicines。
2。 Gentle purging of the bowels agrees with most ulcers； and in
wounds of the head； belly； or joints； where there is danger of
gangrene； in such as require sutures； in phagedaenic； spreading and in
otherwise inveterate ulcers。 And when you want to apply a bandage；
no plasters are to be used until you have rendered the sore dry； and
then indeed you may apply them。 The ulcer is to be frequently
cleaned with a sponge； and then a dry and clean piece of cloth is to
be frequently applied to it； and in this way the medicine which it
is supposed will agree with it is to be applied； either with or
without a bandage。 The hot season agrees better than winter with
most ulcers； except those situated in the head and belly； but the
equinoctial season agrees still better with them。 Ulcers which have
been properly cleansed and dried as they should be； do not usually get
into a the state。 When a bone has exfoliated； or has been burned； or
sawed； or removed in any other way； the cicatrices of such ulcers
become deeper than usual。 Ulcers which are not cleansed； are not
disposed to unite if brought together； nor do the lips thereof
approximate of their own accord。 When the points adjoining to an ulcer
are inflamed； the ulcer is not disposed to heal until the inflammation
subside； nor when the surrounding parts are blackened by
mortification； nor when a varix occasions an overflow of blood in
the part； is the ulcer disposed to heal； unless you bring the
surrounding parts into a healthy condition。
3。 Circular ulcers； if somewhat hollow； you must scarify all along
their edges； or to the extent of half the circle； according to the
natural stature of the man。 When erysipelas supervenes upon any
sore； you must purge the body； in the way most suitable to the
ulcer； either upward or downward。 When swelling arises around an。
ulcer； and if the ulcer remain free from inflammation； there will be a
deposit of matter in process of time。 And whatever ulcer gets
swelled along with inflammation and does not subside as the other
parts subside which became inflamed and swelled at the same time；
there is a danger that such an ulcer may not unite。 When from a
fall； or in any other way； a part has been torn or bruised； and the
parts surrounding the ulcer have become swelled； and； having
suppurated； matter flows from the swelling by the ulcer； if in such
cases a cataplasm be required； it should not be applied to the sore
itself； but to the surrounding parts； so that the pus may have free
exit； and the indurated parts may be softened。 But when the parts
are softened as the inflammation ceases； then the parts which are
separated are to be brought toward one another； binding on sponges and
applying them； beginning from the sound parts and advancing to the
ulcer by degrees。 But plenty of leaves are to be bound above the
sponge。 When the parts are prevented from coming together by a piece
of flesh full of humors； it is to be removed。 When the ulcer is deep
seated in the flesh； it is swelled up； both from the bandaging and the
compression。 Such an ulcer should be cut up upon a director
（specillum） if possible； at the proper time； so as to admit a free
discharge of the matter； and then the proper treatment is to be
applied as may be needed。 For the most part； in every hollow ulcer
which can be seen into which can be seen into direct without being any
swelling present； if there be putrefaction in it； or if the flesh be
flabby and putrid； such an ulcer； and the parts which surround it；
will be seen to be black and somewhat livid。 And of corroding
ulcers； those which are phagedaenic； spread and corrode most
powerfully； and； in this case； the parts surrounding the sore will
have a black and sub…livid appearance。
4。 Cataplasms for swellings and inflammation in the surrounding
parts。 Boiled mullein； the raw leaves of the trefoil； and the boiled
leaves of the epipetrum； and the poley； and if the ulcer stand in need
of cleansing； all these things also cleanse； and likewise the leaves
of the fig…tree； and of the olive； and the horehound； all these are to
be boiled； and more especially the chaste…tree； and the fig； and the
olive； and the leaves of the pomegranate are to be boiled in like
manner。 These are to be used raw： and the leaves of the mallow pounded
with wine； and the leaves of rue； and those of the green origany。 With
all these； linseed is to be boiled up and mixed by pounding it as a
very fine powder。 When there is danger of erysipelas seizing the
ulcers； the leaves of woad are to be pounded and applied raw in a
cataplasm along with linseed； or the linseed is to be moistened with
the juice of strychnos or of woad； and applied as a cataplasm。 When
the ulcer is clean； but both it and the surrounding parts are
inflamed； lentil is to be boiled in wine and finely triturated； and；
being mixed with a little oil； it is to be applied as a cataplasm； and
the leaves of the hip…tree are to be boiled in water and pounded in
a fine powder and made into a cataplasm； and apply below a thin； clean
piece of cloth wetted in wine and oil； and when you wish to produce
contraction； prepare the leaves of the hip…tree like the lentil； and
the cress； wine and finely…powdered linseed are