of these, one, to which I would direct attention, consists of the impure sulphate of copper, alum, and elaterium. (See the Annotations.) It is said to be very efficacious in removing warts from the genital member.

The eighth contains some prescriptions for medicines which are represented as being sarcotic, or incarnative, that is to say, calculated to promote the filling up of hollow sores. They are mostly of a detergent and desiccative nature, such as linseed, the fatty part of a fig, horehound, and the like. The principle upon which they are applied, is not stated by our author.

In the ninth paragraph is described the composition of a medicinal preparation called caricum, consisting of strong escharotic and septic articles, such as hellebore, the flakes of copper, arsenic, and cantharides. It is evidently meant to be used for the purpose of removing the morbid parts of indolent and malignant ulcers, and with this view, it would be difficult, even at the present day, to find ingredients more likely to be efficacious.

In the tenth paragraph, likewise, there are given various prescriptions, consisting of articles mostly of a corrosive nature, such as misy and chalcitis, which, as explained in the Annotations, there is every reason to regard as having been mere varieties of the chalcanthos, or impure native sulphate of copper. In the text these applications are designated as being adapted to fresh wounds, but, as stated in the Annotations, there is reason to suppose that there is some mistake about this title.

In the eleventh is described an application for old ulcers and sections of tendons, consisting of melilot, myrtle, and a herb which probably was some species of the Tormentilla or Potentilla.

In the twelfth there are various prescriptions for preparations designated as emollient, and the term, although questioned by some of the earlier commentators in modern times, seems not so very inappropriate, as they all consist, in a great measure, of axunge, oil, ceruse, wax, the grease of a goose, and so forth.

The thirteenth treats of burns; for these are recommended things of a cooling and digestive nature without pungency. The roots of the ilex boiled in wine or water until of the consistence of a liniment, are particularly mentioned. The squill is an ingredient in the composition of several of these prescriptions.

In the fourteenth paragraph is laid down the treatment of œdemata, or swellings in the feet, the particular nature of which, however, is not sufficiently defined. Scarifications are much recommended in the treatment of them.

The treatment of varix by puncture is briefly noticed in the fifteenth paragraph.

The operation of venesection, and the various circumstances relating to it, are briefly noticed in the sixteenth.

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The last paragraph is devoted to the description of the operation of cupping. As the contents of the last two paragraphs are foreign to the subject on hand, there is some reason for suspecting them to be an appendix to the treatise.

From this brief outline of its contents, it will be readily admitted that the work is one of considerable importance, and it appears to me that, when fairly regarded, there is nothing in it at all derogatory to the high reputation of our author. That it is in some respects defective, and contains matters foreign to the professed object of the treatise, must, perhaps, be admitted, but the same objections apply to certain other treatises which are generally recognized as being genuine. That it contains much valuable matter will scarcely be questioned by any practical surgeon; indeed, one cannot fail to remark with astonishment, how many of the general principles upon which ulcers of all descriptions are now treated, may be traced out in the present work. In particular, it will be remarked that the mode of treating ulcers by the formation of a scab, which was much approved of by Hunter and his friend, Sir Everard Home, and also that the method of curing indolent ulcers by applications which produce sloughing of their callous edges are recommended in this treatise.

Rest, and a spare diet, it will further be remarked, are held by our author to be the best remedial means for promoting the cure of an ulcer, and he particularizes gangrenous sores as being more especially benefited by this plan of treatment. This is a rule of practice about which there is great difference of opinion among our surgical authorities at the present time, some of them, in gangrene of the toes, contending for the stimulant, and others for the opposite plan of treatment. It will be seen, then, that the latter have Hippocrates on their side, and along with him a whole host of ancient authorities. While upon this subject I may take the opportunity of mentioning that the stimulant plan of treatment is not at all of long standing, for, as far as I am aware, all the earlier modern authorities in surgery are advocates for the mild plan of cure. I shall onlytake time to refer to one of the best authorities of the sixteenth century-Tagault."

The views of our author in directing the choice of incarnants, or sarcotic medicines, are not very clear, and yet such as they are, they guided the practice of the profession for full two thousand years. For example, Galen expounds the principle fully, professing to have adopted it from Hippocrates, in the fourth book of his work, "On Therapeutics," and gives his most decided adherence to it. The same principles are expounded and advocated by Avicenna,' and Haly Abbas. In like manner,

1 See in particular, Avicenna, I., iv., 28. I., iv., 28.

2 Inst. Chirurg. i., 7.

4

Pract. iv., 18.

Tagault contends that an incarnant medicine should consist of articles which are moderately desiccative and detergent.' Very similar views are also advocated by Holler, another surgical authority of about the same age. Like Tagault he holds that the best sarcotics consist of articles which are moderately detergent and desiccative. Much the same principles are laid down by Marianus Sanctus.3

ON ULCERS.

4

1. 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 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

'De Vulner. i.

De Med. Chirurg., vi., 8.

3 De Ulcer., iii.

* Dr. Hosack mentions the use of wine as a dressing to wounds among the improvements in surgical practice, which the profession might derive from a study of Hippocrates. It is, in fact, often used in this way by the French surgeons. Galen, adhering to the principle here laid down, extends in so far the application of it: he says, the most proper thing to be used is wine, or oxycrate, or the decoction of an austere herb; that is to say, things possessed of a desiccant power. (Meth. Med., iv.) Upon the whole, however, he prefers wine. (iii., 4.)

'It will be remarked that our author in this work, as in the preceding one, On the Articulations, is a decided advocate for a low diet and very mild treatment in the management of recent ulcers.

"Galen comments upon this rule of practice in his work, On Trembling. 'Celsus renders this sentence as follows: “Optimum etiam medicamentum quies est; moveri et ambulare nisi sanis alienum." (v.)

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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 (evalua), and which will prevent suppuration by being desiccant to a certain degree.' But, when the flesh has been contused

1 Vidus Vidius understands the last clause of this sentence (papuáky μì) tepiokéλei) in a different sense; he reads and explains these words as follows: "vinculum non postulant, jure autem ita Latinum fecimus. Nam Tεрioкελog Græcè subligaculum significat, nec quidquam verisimilus nobis visum est, quam Hippocratem loqui de medicamento quod non alligetur." He understands it, then, to mean an application which does not require to be kept on the place by a tight bandage. The reader will remark that, in this place, our author mentions two opposite modes of treating fresh ulcers, namely, either by promoting moderate suppuration, or by using means to check it. The text, indeed, is in an equivocal state, but I can make no more of it. In the work, On Female Complaints, the author lays down the principles for managing the treatment of ulcers as follows: "In order to cure ulcers they are to be kept free of inflammation, and cleansed, and filled up, and brought to cicatrization; water is to be given for drink, but not wine; little food, and by no means a full diet." (Lib. i.) These rules, in the main, it will be remarked, agree with those here laid down, only no mention is made of any means being used to promote suppuration; but every person acquainted with practice is aware that a healthy suppuration is one of the best means of preventing inflammation.

2 Our author here, as elsewhere, assumes that pus is nothing else but vitiated blood. Vidus Vidius holds that this is a fact so evident as not to require any proof. It certainly must be admitted to be highly probable, and yet the chemical authorities of the day are not agreed on this point. See Simon's Chemistry, vol. ii., p. 86; and Berard, Dict. de Méd., tom xxvi. The French physiologists seem to deny that pus is a direct transformation of the blood.

The class of applications here referred to are described more fully by Celsus than by any other ancient author. The object of them all would appear to be to effect a cure by the formation of a scab upon the sore. The words of Celsus are: "Ex emplastris autem nulla majorem usum præstant, quam quæ cruentis protinus vulneribus injiciuntur; Evaua Græci vocant. Hæc enim reprimunt inflammationem, nisi magna vis eam cogit, atque illius quoque impetum minuunt; tum glutinant vulnera, quæ id patiuntur, cicatricem iisdem inducunt; constant autem ex medicamentis non pinguibus, ideoque àλñáin nominantur." He gives prescriptions for no fewer than twenty-eight ointments of this class. Of these, the first consists of verdigris, litharge, alum, dried pitch, dried pine-rosin, with a portion of oil and vinegar. (v., 19.)

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 neces sary 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 phagedænic, 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

Vidus Vidius remarks on this passage, that the rule of practice here stated by Hippocrates, namely, that a discharge of blood from a recent ulcer is highly beneficial, had been injudiciously departed from by surgeons in his time, who usually made haste to stop the flow of blood as quickly as possible. The same remark may apply to the surgical practice of the present age.

What our author here remarks on oil as an application to sores, deserves to be seriously considered. I cannot but think that at the present time it is often very injudiciously applied to fresh wounds.

* Galen approves highly of this practice, the merits of which he discusses fully. (Meth. Med., iv., 6.)

The text here is in a very unsatisfactory state. What I have given appears to be the most natural sense of the passage.