Healing chronic wounds is a challenging endeavor, even in modern times where wound care professionals can harmonize key factors to achieve an optimal wound environment for recovery. These key factors include:

• Moisture control
• Infection management
• Tissue management via debridement
• Primary wound dressing use

In earlier centuries, physicians and surgeons alike grappled with the same issues. They struggled to balance interventions with the body’s own wound healing abilities. One such physician, Cesare Magati (1577-1647) would adopt a novel approach to wound dressing application that still permeates contemporary practices. Magati was born into a wealthy Italian family from Scandiano, obtained a degree in Medicine from the University of Bologna in 1597.¹ In 1616, He wrote the De rara medication vulnerum which can be translated as “About the rare dressing of wounds,” which challenged the widely accepted principles of wound care at that time.¹ His departure from the established norm reflected his non-traditional lifestyle and unique views on the nature of healing.

Dressing Application Frequency

The practice of medicine in the 17th century was still rooted in Galen’s humoral principles, where bloodletting and aggressive invasive treatment to restore health regardless of the underlying condition’s pathogenesis reined supreme.² The standard of care involved the use of harsh substances and several dressing changes a day.² Magati believed that nature played a strong role in the process of healing. He learned from clinical experience that a “less is more” approach to dressing change frequency was advantageous.¹ While working in a Roman hospital, he cared for a 9-year-old girl with a non-healing leg wound, performing dressing changes twice a day with no improvement for 6 months.¹ Eventually, he altered the treatment schedule to include dressing changes with medication application every 4 days, and her wound healed soon after.¹

Dr. Magati also advocated for the use of herbal remedies as opposed to more caustic ones, along with flushing the area with wine, and speculated that disease was spread through air. Many of these sentiments were documented in his De rara medication vulnerum.¹ The medical establishment criticized his assertions, and disdained his condemnation of the class separation between medicine and surgery.¹ One of his most adamant opponents was the German physician and naturalist, Dr. Daniel Sennert (1572-1637), who accused Magati of setting back the medical profession with his new theory of treatment.¹ The backlash from his colleagues did not phase Cesare Magati, and at the age of 41 he became of monk of the Capuchin Order, providing medical care to his religious brethren and many famous people of the era.¹

Conclusion

His respect for the body’s healing ability and use of natural remedies set Cesare Magati apart from his colleagues, but centuries later those notions were proven clinically relevant. Allowing and supporting the natural immune response facilitates the healing cascade, a practice used in wound clinics throughout the world. His belief in the importance of both surgery and medicine regardless of socio-economic stratification was as also quite radical for the 17th century.¹ Magati’s treatise stated that it made no sense to separate the surgeon and doctor. This notion of a more amalgamated approach to wound healing is still used today.¹ Dr. Cesare Magati, physician, reformer, and monk was a true patient-centered innovator.

References

1. Fughelli P. Cesare Magati. Spanning over centuries. Medicina Historica. 2017;1: 7–12.
2. Nicoli Aldini N, Fini M, Giardino R. From Hippocrates to tissue engineering: Surgical Strategies in Wound treatment. World Journal of Surgery. 2008; 32(9): 2114–2121. https://doi.org/10.1007/s00268-008-9662-1

About the Author
Christine Miller, DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.