Two Hundred and Fifty Years of Wound Medicine

© 2026 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Wounds or HMP Global, their employees, and affiliates.

Dear Readers:

The ongoing experiment that is the United States of America continues into its 251st year this summer. In a country where access to care is very unequal, where states are identified by color (red or blue), which to some degree differentiates who has access to care, in a country where insurance coverage for many is a for-profit business, we first and foremost must all continue to provide the best care to all, regardless of race, creed, or gender identity. No matter your personal politics, I commend all health care providers out there (our readers) for living up to ideals of this Nation while navigating the pitfalls and potholes that the experiment provides. Interestingly, Benjamin Rush, the surgeon who signed the Declaration of Independence, advocated for the abolition of slavery, women’s education, public schools, and humane mental health treatments, exhibiting that those of us called to medicine are often driven by humanistic ideals.

Despite lingering inequity, look how far we have come. In 1776, there was no knowledge of germ theory. Dry lint dressings were considered the standard of care before amputation. The thoughts of Herman Boerhaave; including that disease was not caused by an imbalance of Galen’s 4 humors but by chemical and physical qualities; instructed William Cullen, who purported that symptoms such as fever were to be treated by bleeding, a restricted diet, purging, and rest and sedation. Benjamin Rush (who was the Surgeon General of the Continental Army) thought most maladies could be cured by “a low diet, vigorous purges with calomel and jalap, and bleeding until the patient fainted.”¹

However, even at that time some of the primary treatments we use today were implemented. John Jones (who published America’s first surgical textbook in 1775), wrote about debridement: “cutting away jagged, dead flesh to turn a lacerated injury into a clean one.”² Given the lack of antibiotics, these wounds were appropriately left open to drain. Advances did come with the war of independence. Chemical cautery was more commonly used to stop minor bleeding, while pressure sponges, alcohol, and turpentine were used to treat minor wounds. The invention of locking forceps saw the use of thermal cautery diminish. While the screw tourniquet made thigh amputations possible, surgeons preparing limbs for prosthesis as flap amputations became more common.

At the time of our independence venous leg ulcers were often left open to supposedly drain the acrid humors. Agents such as vinegar, alum, tannins, charcoal or mercury were often applied. Elevation and rest were prescribed but so was bloodletting. Of course, people with “sweet disease” or “melancholy disease” (diabetes) did not usually live long enough to develop neuropathy in the 18th century. If these patients presented with a foot complication, it was almost always with gangrene, which then too was treated with amputation.

Just imagine if we advance to the same degree in the next 250 years. Certainly, advances in knowledge and practice will come in fits and starts, much like the experiment that is the United States of America. However, unlike politics and policy there are certain biologic truths that remain true, which allows the scientific clinician to move doggedly forward. The patient and practitioner were confined by the quality of scientific knowledge 250 years ago, as we are today. We have done an amazing job of expanding and implementing that knowledge. Congratulations and keep up the fight!

Enjoy the semiquincentennial!