De Medicina

11 When blood is spat up there is more cause for alarm, although that presents at one time less, at another more of danger. Blood sometimes comes from the gums, sometimes from the mouth, and that at times copiously, yet without cough, without ulceration, without any disease of the gums, so that there is no expectoration. But just as there is on occasion bleeding from the nostrils, so also does it

burst out from the mouth. And sometimes it is blood which flows, sometimes something resembling water in which fresh meat has been washed. On the other hand, blood may come from the uppermost part of the throat, at one time when there is ulceration in that part, at another without ulceration, but either the mouth of some blood-vessel has opened, or the blood breaks out of certain tubercles which have originated there. When this happens, neither food nor drink does harm, nor is there any expectoration as from an ulcer. When, however, the throat and air tubes are ulcerated, the frequent cough also forces out blood; at times it is even brought up out of the lung or out of the chest or out of the sides or out of the liver. Often women, in whom the blood is not being given out through the menses, expectorate blood.

According to medical authorities blood gains exit either from some part eroded, or ruptured, or from the opened mouth of some blood-vessel; the first they call diabrosis, the second rhexis, the third anastomosis. The last is the least harmful, the first, the worst. And often indeed it happens that pus follows the blood. Now at times to stop the bleeding suffices to promote recovery; but if there follow ulcerations, or pus, or a cough, according to the situation there arise various and dangerous classes of diseases. But if only blood flows out, both the remedy and the ending are the quicker. Nor ought we to ignore that in those who are in the habit of bleeding or in whom the back or hips ache whether after hard running or walking, a limited flow of blood is not disadvantageous as long as fever is absent, and when blood is passed by the

urine it even relieves this very lassitude; nor indeed, in the case of a fall from a height, is there anything alarming if blood comes with the urine, so long as there is nothing else unusual in the urine; nor does vomiting of blood bring about danger, even when repeated, if before it recurs the body is allowed to regain strength and fill up; and it does no harm at all in a robust man, if not excessive, and when it excites neither cough nor fever.

The foregoing are general remarks: now I come to the particular points mentioned above. If blood escapes from the gums, it suffices to chew purslane; if from the mouth, undiluted wine should be held in it; if this does no good, then vinegar. If in spite of these remedies there is a severe outburst, since this may be the death of the patient, its attack is best diverted by applying a cup to the occipital region, after first incising the skin; when this happens in a woman whose menses are not forthcoming, a cup is applied to each groin, likewise after making incisions. But if the bleeding comes from the throat, or from more internal parts, there is more to fear, and a more active treatment is to be adopted. Blood should be let, and if the flow from the mouth is not lessened, the venesection should be repeated a second or a third time, and every day a little. From the first also the patient should sip either vinegar or plantain or leek juice with frankincense, and outside over the seat of pain there is to be applied unscoured wool soaked in vinegar, cooled at intervals by means of a sponge. Erasistratus used also to bind up the legs and thighs and the forearms of such patients in several places. This constricting Asclepiades declared far from being beneficial, to be even harmful. But that it often

answers well experience bears witness. Yet there is no necessity to bind the patient in many places; it is enough to do it below the groins and above the ankles and at the upper part of the arms, also the forearms. Further, if fever is troublesome, gruel must be given, and for drink water in which has been boiled any one of the intestinal astringents. But if fever is absent, there may be given: either washed spelt or bread soaked in cold water and also soft eggs, and for drink either that mentioned above, or sweet wine or cold water; but drink must be given with the knowledge that in this disease thirst is an advantage. Besides these, there are needed rest, freedom from care, and silence. The head also of the patient whilst in bed should be kept raised, and well shaved; the face is often to be bathed with cold water. On the other hand, there is danger in wine, the bath, coition, oil in the food, all acrid food; the same applies to hot foments, a hot close room, much bedclothes piled on the patient. Rubbings also are useful after the bleeding has quite stopped. Then indeed a beginning can be made on the arms and legs, avoiding the chest. A patient in this case should live through the winter by the sea, during the summer inland.

12 Below the throat is placed the stomach, in which there tend to occur many chronic complaints. For sometimes great heat affects it, sometimes flatulence, sometimes inflammation, sometimes ulceration; at times phlegm collects, at times bile; but the most frequent malady is that in which it undergoes paralysis, nor does anything else so affect it, or,

through it, the whole body. As diverse as are its complaints, so are the remedies.

When heated, it should be bathed externally at intervals with vinegar and rose oil, and road dust applied with oil, and those plasters which simultaneously repress and soothe. For drink, unless there is anything against it, lukewarm water is the best.

If there is flatulence, it is beneficial to apply cups, but there is no need to incise the skin; dry and hot foments do good, but not the strongest kind. At intervals there should be enjoyed abstinence from food; a draught of wormwood or hyssop or of rue on an empty stomach is useful. Exercise at first should be light, then more is to be taken, especially such as moves the upper limbs; the kind most appropriate in all complaints of the stomach. After exercise there is need of anointing, rubbing, occasionally also the bath, yet less often than usual; now and then a clyster; later, food which is hot but not flatulent, and similarly hot drinks, first water and after the flatulence has subsided, dry wine. In all complaints of the stomach this also is to be prescribed, that each should adopt in health that regimen which has cured him; for his weakness will recur unless his health is protected by the same measures as those by which it was restored.

But if there is inflammation of any kind, which is generally followed by swelling and pain, the primary remedies are rest, abstinence, a belt of sulphurated wool, and the wormwood draught upon an empty stomach. If a burning heat troubles the stomach, it should be fomented at intervals with vinegar and

rose oil; next food should be given in moderation, external applications are also to be made which simultaneously both repress and soothe; next after that, when these are taken off, hot meal plasters are put on to disperse the remnants of the disease: now and again a clyster must be given, exercise must be taken, and a fuller diet.

But if ulcers attack the stomach, generally the same treatment should be applied as has been prescribed in the case of an ulcerated throat (IV.9). Exercise, also rubbing of the lower extremities, is to be practised; bland and glutinous foods taken short of satiety; and all pungent and sharp food withdrawn. Sweet wine is to be used if there is no fever, or if that causes flatulence at any rate light wine, but neither very cold nor too hot.

If the stomach becomes filled with phlegm an emetic is needed, sometimes on an empty stomach, sometimes after food: there is benefit in exercise, rocking, a sea-voyage, rubbing. Nothing should be eaten or drunk unless hot, whilst such things must be avoided as have tended to collect phlegm.

There is worse trouble when the stomach is vitiated by bile. Patients who are troubled with this, vomit up bile at intervals of some days, and worst of all, vomit black bile. For such a clyster is appropriate, and draughts of wormwood should be given; rocking and a sea-voyage are necessary; vomiting when possible is induced by sea-sickness; indigestion must be avoided, the food should be such as is readily swallowed, and not repugnant to the stomach, the wine must be dry.

But the commonest and worst complaint of the stomach is paralysis, when it does not retain food,

and the nutrition of the body is wont to cease, and so it is consumed by wasting. In this sort of disease the bath is most harmful; reading aloud and exercise of the upper limbs are needed, as also anointing and rubbings; it is good for the patient to have cold water poured over him, and to swim in cold water, also to submit his stomach to jets of it, especially at the back of the stomach from the shoulder-blades downwards, to bathe in cold medicinal springs, such as those at Cutilia and Simbruvium. Food should be also taken cold, rather that which is digested with difficulty than that which readily decomposes. Hence many who can digest nothing else, digest beef, and therefore it may be inferred that neither poultry no venison, nor fish except the harder kinds, should be given. The most suitable drink is wine cold, or else undiluted and well heated, particularly Rhaetic or Allobrogic wine, or any other which is both dry and seasoned with resin; if there is none of the above at hand, then the harshest possible, especially Signine wine. If food is not retained, water must be given and a more copious vomit elicited, after which food is to be given again, and then cups are to be applied two fingers' breadth below the stomach, and they are to be kept on two or three hours. If simultaneously there is both vomiting and pain, there should be placed over the stomach unscoured wool or sponge soaked in vinegar, or a refrigerant plaster. The arms and legs too are to be rubbed sharply, but not for long, and to be kept warm. If pain is more severe, a cup is to be put on four fingers' breadth below the praecordia, and following that bread in cold vinegar and water is to be given; should this not be retained, after the vomiting, anything light or not unsuitable for the stomach can be given; if even that is not retained, give a cupful of wine every hour until the stomach settles down. Radish juice also is an active remedy; more active still is a mixture of the juice of sour and sweet pomegranates in equal parts, with the addition of endive and mint juice, the least quantity of the last; the whole of the above may be mixed thoroughly well with an equal quantity of cold water, which is better than wine for tightening up the stomach. Now, vomiting when spontaneous should be arrested; but if there is nausea, or if food turns acid inside, or decomposes, both of which are manifested by eructations, the food should be evacuated, and the stomach forthwith replenished by the taking of food of the kind just noted (§ 9). When immediate apprehension has been removed a return should be made to the prescriptions given above (§ 7).