Wounds can arise either accidentally or because of conflict, and can range from grazes and severe bruising to life-threatening, but there has always been a need for protection and care to aid healing. Wound care dates from prehistory, as demonstrated by several species of apes who make efforts to both stop bleeding and protect wounds with grass or leaves.
Early wound care
The earliest evidence of medical attention for wounds is found in the ancient Egyptian Edwin Smith papyrus (circa 1600 BC), which describes closing wounds with sutures, bandaging, splints and poultices. Stopping bleeding with raw meat and dressing with honey are also recommended. The Ebers papyrus (circa 1500 BC) details the use of lint as an absorbent, animal grease as a sealant and honey as a topical dressing. While their remedies are remarkably (for the time) non-magical there are also suggestions of lizard’s blood, dead mice and mouldy bread as dressings! In the limited number of Egyptian medical and veterinary papyri available, it is seen that the medical culture and procedures for humans and animals were based on identical precepts. The known papyri are copies of originals written some 3,000 years earlier; Egyptian medicine dates back to between 4000 and 5000 BC.
In the limited number of Egyptian medical and veterinary papyri available, it is seen that the medical culture and procedures for humans and animals were based on identical precepts
Early wound dressing in Mesopotamia featured the use of both honey and alcohol. A Sumerian clay tablet (circa 2200 BC) describes wound washing, dressing and bandaging. They used special beers and sesame infusions for wound cleansing, and to aid healing applied a herbal, milk and beer dressing with bandaging.
In ancient Greece, wound treatment was well recognised. Homer documented the treatment of battle wounds in the Iliad (circa 800 BC), and Diocles of Carystus (circa fourth century BC) invented the Dioclean cyanthiscus (the spoon of Diocles), an invaluable “instrument” providing a safe way to extract arrowheads and foreign bodies from wounds. The importance of wound closure was emphasised, and wounds were differentiated between acute and chronic, termed “fresh” and “non-healing”. Hippocrates (circa 460-370 BC) stressed the cleansing of wounds with milk or boiled water with wine and vinegar. Dressing with honey and herbs and bandaging was recommended, as were “plasters” of mud or clay with herbs and oils to shield from infection and absorb exudates. Galen (120-201 AD), a Greek practising in Rome treating gladiator wounds, made a major contribution by always keeping the wound site moist to enable successful healing.
Dressing with honey and herbs and bandaging was recommended, as were “plasters” of mud or clay with herbs and oils to shield from infection and absorb exudates
Chinese medicine in its early days also had a strong reliance on selected herbs to achieve successful healing, both in cleansing lotions and topical application, in particular a tea leaf tincture.
Roman medicine was based on Greek knowledge but with little significant progress. Columella (circa 70 AD), writing on animal care, recommended the use of a knife rather than medication to get rid of suppuration, and then cleansing by washing the wound with warm ox urine followed by binding with bandages soaked in liquid pitch and oil. There were only limited advances made in wound care.
The Middle Ages: wounds from conflict
The Livre de Chasse, a text written by Gaston Phoebus in the 14th century on hunting dogs, did not advocate sutures but recommended covering the wound with raw wool soaked in olive oil to be changed every day for three days. The lanolin in the wool would have provided an emollient and mild antiseptic effect and the oil a protective seal.
Ambroise Paré (1516-1590), a renowned French barber-surgeon, made advances in wound care through treating conflict and gunshot injuries. He rejected the use of cautery on wounds and introduced a healing ointment of egg yolk, oil of roses and turpentine, both soothing and antiseptic.
In the Middle Ages when horses were the most important animals, “veterinary care” was provided by farriers; there were many saddle and harness sores as well as wounds from accidents or war. Family recipes (usually of unknown ingredients) were in widespread use. Leonard Mascell (1605) suggested washing the wound with warm wine to cleanse it and then to dress the wound with a mixture of “cherpi, tarre and oyle olive”. Thomas Blundeville (1609) also recommended washing with warm wine and made a distinction between bruises made by blunt and by sharp weapons, while in 1631 Conrad Heresbach proposed for treatment of a large wound, “best stitch it up with a needle and redde silk, then taynte it with turpentine, ware and clarified hogs-grease…”. Gervase Markham (1635) also proposed “turpentine, wax and hogges grease” but for “old petrified and most rancorous ulcers” he advocated “loame and vinegar”.
There were innumerable recipes and mixtures with an ever-growing list of ingredients: birthwort, hard rosin, frankincense, sheep suet, Venice turpentine, unslaked lime, dust of oaken barke, mastik, cloves, green copperas, myrrh and even “old shoe-soles burned to a cole”, but with little advancement.
The “rules for curing wounds”
In 1711, Jacques de Sollysol laid down “rules for curing wounds”. He listed: first probe the wound with a silver probe, arrest the bleeding, trim the proud flesh, wash with warm wine or urine, prevent the horse from licking the wound, shave the hair and apply an ointment of herbs. Gradually sutures were becoming generally used, of waxed thread, thin leather or silk. Poultices also gained in popularity for use on more deep-seated problems like poll-evil, fistula, sitfast and puncture wounds caused by thorns. These were based on a clay mud boiled in vinegar, or a bread or meal and milk poultice.
While in earlier years there was a great use of and belief in herbal medicine, much of this was misleading. However, many plants were recognised with a specific value – two had a good veterinary indication for wound care. The first was the use of the dried rhizome and root of comfrey (Symphytum officinale). In particular, it was known as a treatment for equine fistulous withers, and chemical analysis has shown it is a good source of urea, which stimulates cell granulation. The second is the puffball (Lycoperdon pyriforme), which when mature is a bag of fine powder (spores). In 1754, E G La Fosse, farrier to the King of France, described how he controlled haemorrhage from arteries by inserting cone-shaped plugs of spores which controlled bleeding within minutes and remained in place during healing. In Britain and other countries, the folklore pharmacy for farmers had recognised this property for controlling bleeding and aiding healing.
Advancement in wound care: microbiology and pathology
It was not until the 19th century that real progress was made with the development of microbiology and cellular pathology
Advances in wound care were slow as there was no practical knowledge of infection and hygiene. It was not until the 19th century that real progress was made with the development of microbiology and cellular pathology. In 1847, I Semmelweis recognised the importance of handwashing between examining patients: hygiene had begun. Then in 1865, Joseph Lister introduced surgical gauze and carbolic acid (phenol) as a potent antibacterial of particular value in surgery, to be followed in 1890 when Robert Johnson introduced sterilised dressings. These were the first real advances since the writings of the ancient Egyptians.
In the First World War, the army suffered significant losses from traumatic wounds in both soldiers and horses. Henry Dakin, a chemist, produced a sodium hypochlorite and boric acid solution, known as Dakin’s Solution, which became invaluable for washing and cleansing wounds. In 1938, it was recognised that urea was a great aid in wound healing, not as an antiseptic, but due to its action in stimulating granulation and the growth of new tissue regeneration with a good blood supply, as seen with the old herbal country medications.
In the 1940s and 1950s, there was the introduction of antibiotics and new antibacterials as well as fibrous synthetic dressings: wound treatment was transformed from its experimental past. A long story, probably the longest history of any medical procedure.
