Book 5
26
Now, when bleeding has been suppressed if excessive, or encouraged when not enough has escaped of itself, then by far the best thing is for the wound to become agglutinated. But this is possible for a wound in the skin, or even in the flesh, if nothing else has occurred to do it harm. Agglutination is possible if the flesh is hanging free at one part, whilst attached at another, provided, however, that the flesh is still sound, and has a connexion with the body to feed it. But with wounds which are being agglutinated, there are two treatments. For if the wound is in a soft part, it will be stitched up, and particularly when the cut is in the tip of the ear or the point of the nose or forehead or cheek or eyelid or lip or the skin over the throat or abdomen. But if the wound is in the flesh, and gapes, and its margins are not easily drawn together, then stitching in unsuitable; fibulae (the Greeks call them ancteres) are then to be inserted, which draw together the margins to some extent and so render the subsequent scar less broad. Now from the above it can be gathered also whether flesh which is hanging free at one part and attached at another, if it is still capable of juncture, demands suture or fibula. But neither of these should be inserted until the interior of the wound has been cleansed, lest some blood-clot be left in it. For blood clot turns into pus, and excites inflammation, and prevents agglutination of the wound. Not even lint which has been inserted to arrest bleeding should be left in, for this also inflames the wound. The suture or fibula should take up, not only skin but also some of the underlying flesh, where there is any, that it may hold more firmly, and not tear through the skin. And both are best used with a strand of a soft wool not too closely twisted that it may cause less irritation to the body, and both should be inserted at intervals not too distant or too close. For if the intervals are too distant, the wound is not held together; if too close, it is very hurtful, for the more often the needle this fixes the tissues, and the more places are wounded by the inserted stitches, the worse is the inflammation set up, especially in summer. Neither procedure needs any force, but is useful just so far as the skin follows that which draws it as if of its own accord. Generally, however, fibulae leave the wound wider open, a suture joins the margins together, but these should not be brought actually into contact throughout the whole length of the wound, in order that there may be an outlet for any humour collecting within. If any wound admits of neither of these, it should none the less be cleaned. Hence, upon every wound there is to be applied, first a sponge squeezed out of vinegar; or out of wine if the patient cannot bear the strength of vinegar. A slight wound is even benefited if a sponge is applied wrung out of cold water. But in whatever way it is put on, it is only of service while moist; and so it must not be allowed to become dry. And a wound can be treated without foreign and far-fetched and complicated medicaments. But if any one has not confidence in this treatment, a medicament should be put on, which has no suet in its composition, chosen from those which I have stated to be suitable for bleeding wounds: and especially, if it is a flesh wound, the composition called barbarum; if a wound of sinews or of cartilage or of some projecting part, such as the ears or lips, the seal of Polyides: the green composition called Alexandrian is also suitable for sinews; and that which the Greeks call rhaptousa for parts which project. When the body is bruised it is usual also for the skin to be broken to a small extent. When this occurs, it is not improper to lay it open more widely with a scalpel, unless there are muscles and sinews near, as it is inexpedient to cut into these. When it has been sufficiently opened, a medicament is seem to be put on. But if the skin over the contusion, although broken too little, yet must not be laid open more widely on account of sinews or muscles, then such applications should be made as gently extract humour, especially that which I have said is called rhypodes. It is also not inappropriate, when the wound is severe, after putting on what is beneficial, to lay on over this, wool saturated with vinegar and oil; or a poultice, gently repressant if to a soft part; or emollient to a part where there are sinews or muscles.
