CHAPTER II. CURE OF THE BRINGING UP OF BLOOD.
ALL the forms of the bringing up of blood are of an unmild
character, not only as to mode, whether the flow proceed from
rupture, erosion, or even rarefaction; and whether it come
from the chest, the lungs, the stomach, or the liver, which are
the most dangerous cases; but also from the head, although it
occasions less mischief. For the flow is of blood; and blood
is the food of all parts, the heat of all parts, and the colour of
all parts. It is dreadful to see it flowing from the mouth in
any way; but bad indeed if it proceed from an important
viscus, and still worse if it proceed from rupture and erosion.
It is necessary, therefore, that the physician should make
the more haste in bringing assistance to this affection; and, in
the first place, the patient must get coldish air to breathe, a
chamber on the ground, and a couch firmly fixed, so that he
may not be shaken (for all shaking is stimulant); the bed
should be solid, not very yielding, nor deep, nor heated; his
position erect; rest from speaking and hearing; tranquillity of
mind, cheerfulness, since depression of spirits especially accompanies
these cases; for who is there that does not dread death
when vomiting blood?
If, therefore, the patient be full of blood, and have large
veins, in every form of rejection we must open a vein; whether
it proceed from rupture, or erosion, venesection is very
suitable; and even, if from rarefaction, there is danger, lest
the fulness of blood burst forth.
1 And we are to open the
hollow vein at the elbow (for the blood flows readily from it,
and it is easily opened, and the orifice can be safely kept open
for several days). In a word, then, in all the diseases of all
the vital organs, this is the outlet of the blood. For the one
higher up and this are both branches of the humeral, so that
the one above can have no more remedial power than the
mesal. They are ignorant of these divisions who have connected
the upper vein with the stomach and liver. But if the
flow proceed from the spleen, they direct us to open the vein
of the left hand, which runs between the little finger and the
one next the middle; for certain physicians held it to terminate
in the spleen; but it is a branch of the vein below those at
the elbow. Why, then, should we rather open the vein at the
fingers than the one at the elbow? for there it is larger, and
the blood flows readily from it. Altogether, then, we are to
stop before coming to
deliquium animi. Yet neither, also, is
much blood to be abstracted; for the hemorrhage itself is calculated
to enfeeble the patient; but, after abstracting a small
quantity, repeat the bleeding the same day, the next, and the
day following. But if the patient be thin, and scantily supplied
with blood, we must not open a vein. So much respecting
the abstraction of blood.
We are also to assist by means of ligatures to the extremities.
Above the feet to the ankles and knees, and above the hands
to the wrists and arms, a broad band is to be used, so that the
constriction may be strong, and yet not produce pain. To the
regions, also, from which the blood flows, we are to apply unwashed
wool from the sheep; but moisten it with a liquid,
such as austere wine, and the oils of roses and of myrtles.
But if the hemorrhage be of an urgent nature, instead of the
wool we are to use sponges, and vinegar instead of the wine,
and let the part be anointed with myrtle oil; and we are to
dust upon the sponges some of the dry inspissated juices, such
as that of acacia, or of hypocistis, or else of aloes. The juice
of the unripe grape, dissolved in vinegar, is also a very excellent
thing. But if the liquid application be troublesome or
disagreeable, we are to use plasters; for these stretch the skin
around, and press it, as it were, with the hand, and they are
possessed of very strong powers as astringents and desiccants.
In addition to these, there are very many others of tried
efficacy; but the best are those which contain vinegar, and the
expressed juice of ivy leaves, and asphaltos, and verdigris,
alum, frankincense, myrrh, calcined copper, the squama æris,
and such of the plasters as resemble these; or unscoured wool,
or sponges damped in a small quantity of vinegar. But if the
patients cannot bear the distension of the plasters, we are to
make these things into an epitheme: fat dates, damped in dark
austere wine, are pounded into a cake; then we are to sprinkle
on it acacia in a soft state, and the rinds of pomegranate;
these things having been all rubbed upon a rag, are applied to
the chest. Barley-meal, moistened in wine or vinegar, or the
fine flour of the dried lentil, sifted in a sieve, and made up
with cerate or rose ointment, is to be applied; we are also to
mix some of the root of the comfrey sifted. Another: Boil
the roots of the wild prunes in vinegar, and having pounded
into a cake, mix a little of sumach, and of gum, and of myrtle.
These are to be mixed with one another differently, according
as the strength of the medicines, mildness, or smell thereof is
wanted. For we must also gratify the sick. These are the
external remedies.
But a more important part of the treatment lies in things
drunk and swallowed, since these remedies come nearest the
injured parts. Of these there are three distinct kinds: either
they are calculated by the contraction or compression of the
vessels to bind the passages of the flux; or to incrassate and
coagulate the fluid, so that it may not flow, even if the passages
were in a state to convey it; or to dry up the outlets, by
retaining the blood in its pristine state, so that the parts may
not thus remain emptied by the flux, but may regurgitate
where the effusion is. For rarefaction of the veins, astringency
is sufficient, for it runs through the pores like a fluid when
poured into a water-cask newly wetted. And also in the
division of vessels stypticity is the remedy, by producing contraction
of the lips; but for this purpose we must use the
greater and more powerful medicines. But if the form of
hemorrhage be that from erosion, and if the lips of the ulcer
do not coalesce by the action of the astringents, but the wound
gapes, and cannot be brought together by compression, we must
produce congelation of the blood, and also of the heat; for the
flow is stopped by the immobility and coagulation of these.
To the rare parts, then, oxycrate is sufficient for producing
astriction; for the fluid is not pure blood, but the sanies thereof
from small orifices; and even of this medicine, there is no
necessity of much being given, or frequently; and in certain
cases, the external treatment is sufficient. So, likewise, the
decoction of dates and of edible carobs, when drunk, has by
itself proved sufficient. Let the vinegar be from wines of an
astringent nature, and if not by pharmaceutical preparation,
at all events let it be such as by time has become acrid and
astringent. But in dilatations of the wounds, in addition to
the oxycrate, let there be given the simple medicines at first,
such as the juice of plantain, of knot-grass, or of endive; of
each an equal part with the oxycrate. But if the flow increase,
sprinkle on it one dram of the dried hypocistis, or of acacia,
on three cupfuls of the oxycrate. The juice, also, of the wild
grape is very excellent. But if the ailment prevail over this,
sprinkle on it triturated gall, and the dried root of the bramble,
and the sea stone, the coral, triturated and dried. But the
root of rhubarb is more powerful than these to cool, to dry,
to astringe; in short, for every purpose. But it is used with
the oxycrate alone; or, if more powerful things are required,
as a remedy. To the juices of endive with plantain we add
some of the root, namely, three oboli of it to three or four
cyathi of the fluid. But in crosions, we must produce astringency
even in it, so as to induce coagulation of the blood that
flows, and also for the sake of the containing vessels, so that
the veins which have sustained a large wound may shut their
mouths. But the medicines which are drunk should be strong,
and capable of inducing coagulation. Wherefore, give the
juice of coriander with vinegar, and the rennet of a hare, or
of a hind, or of a kid, but not in great quantity (for certain of
these have proved fatal in a large dose); but of the juice of
the coriander give not less than half a cyathus to three of the
oxycrate, and of the rennet three oboli, or at most four. For
such modes of the flow, the Samian earth is very excellent, and
the very white Aster, and the Eretrian, and the Sinopic, and the
Lemnian seal: of these, at least, one dram weight, and at most
three, with some of the decoctions, as of dates, or of edible
carobs, or of the roots of brambles. But if there be roughness
of the windpipe, and cough along with it, we must sprinkle
these things on Cretic rob. Starch, dissolved in these, is a
most excellent thing for lubricating the windpipe; for along
with its power of lubricating, it also possesses that of agglutinating.
If, therefore, the flow of blood be not urgent, it must
be given once a day, before the administration of food; but if
it be urgent, also a second and third time in the evening. And
from the medicines are to be made draughts of the dried substances
with honey, boiled to the proper consistence; galls pulverised:
and a very good thing is sumach for the condiments,
also grape-stones, and the fruit of the sharp dock, either each
by itself, or all together. These things, moreover, are good
to be kept below the tongue during the whole time of melting;
but likewise common gum with the plant, (?) and the gum
tragacanth. The compound medicines of tried efficacy are
infinite; and various are the usages of trochisks--of that from
Egyptian thorn, of another from amber, and another named
from saffron, of which the composition has been described
separately.
In the absence of fevers, everything is to be attempted in
regard to medicines, giving them copiously and frequently.
But if fever come on--and most frequently fever takes place,
along with inflammations of the wounds--we must not stop
the flow suddenly, nor give medicines during the paroxysms,
for many die sooner of the fevers than of the flow of blood.
The articles of food are various in kind like the medicines,
but also "the medicines are in the food;" for neither would it be
easy to find all the good properties of food in any one article,
nor even if a solitary thing were sufficient for the cure, should
one only be used, as one would thus readily produce satiety;
but we must grant variety if the disease should prove prolonged.
Let the food, then, be astringent and refrigerant in
properties, as also to the touch, for heat encourages bleeding.
Washed alica; rice added to oxycrate; but if the vinegar
excite coughing, the decoction of dates; baked bread which
has been dried and pounded down to meal, and sifted. Of
all these things a draught is to be made with oil; savory
seasoned with salts, and sumach to be sprinkled upon it. And
if you wish to gratify the patient's palate, let coriander be
added, for this purpose, whenever it is agreeable, or any of the
diuretic and diffusible seeds. Lentil, then, with the juice of
plantain, if the hemorrhage be urgent, but if not, we should
spare the juice, for neither is it of easy digestion, nor pleasant
to the taste; for in these cases we must not give indigestible
things. But if you apprehend death from the hemorrhage,
you must also give what is unpalatable and indigestible; nay,
let even harsh things be given if they will preserve life;
wherefore, let galls, dried and pulverised, be sprinkled when
dry, and cold lentil: eggs thick from boiling, with the seeds
of pomegranate or galls, for the food necessarily consists in
the medicines. The drink altogether should be scanty, since
liquids are incompatible with a dry diet. These are the proper
things, provided you wish to astringe and cool. But if
you wish also to thicken the blood and spirit (
pneuma), milk
along with starch and granulated spelt (
chondrus), the milk
being sometimes given with the starch, and sometimes with
the
chondrus; they should be boiled to such a consistence as
that the draught may not be liquid. But if you wish to
incrassate and astringe still more, let the
chondrus be boiled
with dates, and for the sake of giving consistence, let there be
starch and milk; and the Tuscan
far is a very excellent thing,
being thick, viscid, and glutinous when given along with the
milk; the rennet of the kid is to be added to the liquid
decoctions for the sake of coagulation, so that with the milk,
it attains the consistency of new cheese: still thicker than these
is millet boiled with milk like the
far, having gall and pomegranate
rind sprinkled on it as a powder. But we must look to
the proportions of the desiccants and incrassants, for all these
things provoke coughing, and in certain cases, from excess of
desiccant powers, they have burst the veins. But if things
turn out well, and the blood is stopped, we must gradually
change to the opposite plan of treatment, "and nothing in
excess," for these cases are apt to relapse, and are of a bad
character. We must also strive to put flesh and fat on the
patient by means of gestation, gentle frictions, exercise on
foot, recreation, varied and suitable food.
These are the means to be used if, after the flow of blood,
the wound adhere and the part heal properly. But if the
ulcer remain and become purulent, another plan of treatment
is needed, for a discharge of different matters succeeds. This, however, will be treated of among the chronic diseases.
