ON ULCERS. THE ARGUMENT. I HAVE stated in the Second Section of the Preliminary Discourse, the reasons which determined me to allow this treatise a place among the genuine works of Hippocrates, and I need only add further here, that a careful reconsideration of the subject has confirmed me in the judgment on it which I then announced. When we take into account the positive manner in which Galen, on very many occasions, dwells upon its contents with the fullest confidence that they are the opinions of our author, and reflect that all the subsequent authorities, including those of the Arabian and Roman periods, and the learned restorers of ancient surgery in the fifteenth and sixteenth centuries, agreed in recognizing it as authentic, I cannot see how, consistently with the principles upon which it is now generally admitted that questions regarding the genuineness of ancient works should be settled we could be at all warranted in rejecting it without disputing the claims of the greater number of treatises contained in the small list of the Hippocratic works which are still acknowledged as genuine. Certain it is, at all events, that the evidence in support of this treatise is far greater than that upon which the treatises "On Ancient Medicine," and "The Law," have been sustained as being the productions of Hippocrates. We shall be better able, however, to judge whether the external evidence in this case be confirmed or neutralized by the internal, when we have taken a careful inspection of its contents. In the beginning of it there is given an exposition of the principles upon which ulcers are to be treated. Agreeably to the great rule of medical practice, so often inculcated in the Hippocratic treatises, namely, that "diseases are to be cured by their contraries," he argues that as a sound part of the body is dry, and an ulcerated, moist, drying or desiccant things are indicated in the cure of wounds and sores, and consequently we must avoid using all liquid things, with the exception of wine, for which he claims an especial indulgence, owing, no doubt, to its being possessed of desiccant powers. A low diet is particularly enjoined when a sore shows any tendency to gangrene, and especially in ulcers of the joints and thigh, when there is danger of spasm (tetanus?), and in injuries of the head, when complicated with fracture. Rest is particularly enjoined, and all severe exercise proscribed. Two opposite modes of practice VOL. II.-19. 290 GENUINE WORKS OF HIPPOCRATES. are mentioned in the treatment of recent wounds, either to promote a healthy suppuration or to use means for preventing the formation of pus. The discharge of blood from a fresh wound is to be encouraged, and in old ulcers the callous edges are to be scarified in order to evacuate the unhealthy blood. After the discharge of the blood, the part is to be covered with a piece of sponge, and some slender leaves placed over it. As a general rule, oil, and all greasy things, are to be avoided in the treatment of ulcers. But, if used at all, they answer best in cold and hot weather. (See § 1.) Gentle purging is recommended for most ulcers, and in wounds of the head, belly, and joints, in gangrenous and other intractable sores, and in those requiring sutures. The sore is to be frequently wiped with a sponge, and a dry piece of clean cloth is to be applied. Mild weather is favorable to the healing of wounds, and heat is preferable to cold. Ulcers which are foul, will not heal until they are cleansed. When the parts adjoining to a sore are inflamed or gangrenous, or when there is a varix in a part, the sore will not heal. (§ 2.) Circular sores are to be treated by having their edges scarified. When erysipelas supervenes, emetics or purgatives are to be administered. When the parts around the sore are swollen, a cataplasm is to be applied to the adjoining parts, but not to the sore itself, in order to allow a free discharge of the pus. After the swelling has subsided, a bandage is to be applied, so as to bring the separated parts close to one another. Any piece of flesh which prevents the lips from coming close together, is to be removed. Sponges, with leaves above them, as formerly directed, are to be placed on the sore. (§ 3.) In the next paragraph our author gives minute directions for preparing cataplasms, consisting of various ingredients of a desiccative and emollient nature, such as mullein, linseed, and the like. These are either to be laid on the sore, or with a clean piece of cloth wetted in wine and oil, applied next to the sore. (§ 4.) In the next paragraph are described several preparations, mostly of a desiccative and caustic nature, for the treatment of ulcers. The object is sometimes not very accurately defined, but it is impossible not to see, in certain cases, that they are prescribed for the purpose of producing a superficial slough or scab, in order to imitate one of nature's modes of effecting a cure. Of the articles entering into the composition of these medicinal preparations, the flowers of copper, myrrh, pomegranate rind, and galls are some of the most important. (§ 5.) In the sixth paragraph there are two prescriptions for the purpose of preventing inflammation, and for cleansing foul ulcers. They are strongly discutient and detergent. In the seventh there are also some very important prescriptions, evidently meant to act upon the principle of producing a scab upon the sore: |