on ulcers-第1章

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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