SECT. LIX.—ON TRICKLING OF BLOOD AND HEMORRHAGE FROM THE NOSE.
Since a trickling of blood indicates a fulness in the whole body, or in the head, being occasioned either by expression or contraction, and as a free evacuation would relax them, and diminish the quantity, it may be proper to evacuate where nature points. With this view, I have ventured, in cases of quartan epistaxis, to open the vessels in the nostrils with the reed called typha. We must not be contented with a small evacuation, but must take away blood in proportion to the strength. Spontaneous hemorrhages from the nose in fevers, when critical, are not to be interfered with; but yet, if the flow of blood be immoderate, it ought to be restrained. In the first place, tight ligatures ought to be applied to the patient’s extremities, and his head elevated. It would appear that a ligature to the privy parts, is particularly adapted for restraining bleeding from the nose. The nostrils ought not to be wiped, nor the part irritated, so that a clot of blood may be allowed to form. Let the nose be cooled by a sponge soaked in oxycrate, and the nostril plugged up with a pledget dipped in some of the astringent applications. The composition of them, and the rest of the treatment, we will deliver more fully in the [following Book], “on topical affections.”
Commentary. Hippocrates declares that profuse bleeding at the nose indicates a disposition to convulsions, which venesection is calculated to remove. (Prædict. i, 21.) Galen, in his Commentary, remarks that the convulsions are brought on by the unseasonable use of cold applications to stop the hemorrhage. He strongly recommends bleeding from the arm of the side from which the blood flows. In another place, he states that epistaxis in acute fevers is an unfavorable symptom. (In iii, Epidem. Comment.)
Aëtius mentions that Hippocrates had declared a bleeding from the nose on the fourth day of a fever to be a very bad symptom. He recommends encouraging the bleeding by irritating the nostrils with a stalk of grass. Our author, it will be observed, directs this operation to be performed until the typha, a species of grain several times mentioned by Theophrastus (Hist. Plant.); by Galen (de Aliment. i, 13); and by Alexander Trallian (vii, 5.) Sprengel makes it to be a species of secale or rye; but Stackhouse, the English editor of Theophrastus, is of opinion that it was the triticum spelta, or spelt.
When it is judged proper to restrain the hemorrhage, Avicenna recommends ligatures to the extremities and cold and styptic applications to the nose and adjoining parts, (iv, i, 2, 14, and iii, v, 1.) Serapion agrees with most of the ancient authorities in commending a mixture of frankincense and aloes, when applied on the down of a hare. He also directs us to apply a sponge soaked in cold water to the temples and forehead. (ii, 13.) When bleeding at the nose occurs in a fever, Rhases forbids us to stop it, unless it prove excessive; in which case, he directs us to apply a cupping instrument, without scarification, to the hypochondrium; to tie ligatures about the testicles; to pour cold water on the head; and to drink cold water. (Divis. 40.)
Considering how full and accurate our author and the others are in treating of the complications of fever, it is singular that they should all have passed by a profuse discharge of blood per anum, although it had been noticed by Hippocrates. In one of his Aphorisms he says: “When, in cases of fever, there is a quantity of blood discharged, the bowels get into a loose state.” His commentators Theophilus and Damascius say, in explanation, that the natural heat of the intestines being wasted by the discharge of blood, they lose their power of retention. (Ed. Dietz, ii, 401.)
SECT. LX.—ON DELIQUIUM ANIMI OR SWOONING.
When the fainting is occasioned by cholera, diarrhœa, or other repeated and copious evacuations, we must sprinkle water upon the patient, twist his nose, rub over the orifice of the stomach, and encourage vomiting; and we should also irritate the throat with our fingers or the introduction of a feather. Several strong ligatures are likewise to be applied; when the evacuations are downwards, to the arms; and, when upwards, to the legs. The patients are also to be placed in an easy, erect posture, and a cupping-instrument applied, so as to produce revulsion to the opposite part of the body. Wine and water relieves prostration of strength occasioned by frequent evacuations, provided there be no inflammation of any visceral part, nor violent headach, nor delirium, nor ardent fever unconcocted, to contra-indicate it; for in such cases wine will do much mischief. And if it be summer, and the patient of a hot temperament, and addicted to drink cold things, we may give cold drink; but if the contrary, warm. When the deliquium is occasioned by profuse sweats, we are to constrict the skin, as formerly said, and allow a free current of cool air. In defluxions on the stomach, none of these things is fitting, unless the application of strengthening things to the belly and stomach, and bathing them; for baths are most beneficial in cases of stomach defluxions, but greatly aggravate hemorrhages and sweatings. Those who have fainting fits from plethora, must abstain from wine, and food, and from baths too, if there be fever. And we must give them honied water having thyme, marjoram, pennyroyal, or hyssop boiled in it. Oxymel also is beneficial to them. But if the faintings proceed from depraved humours contained in the stomach, we must prescribe a vomit with water and oil—at the same time tickling the throat with the finger or a feather. But if vomiting cannot be thereby procured, we must give pure oil, which will often evacuate downwards. And wormwood is applicable in such cases. But if the faintings are occasioned by weakness of the stomach, we must use tonic medicines, as formerly stated in the Section which treats of this affection, and rub the extremities. When they proceed from exposure to immoderate heat, we are to prescribe the bath; or, when from excessive cold, we must use the medicine containing the three peppers, and pepper itself. Those who fall into fainting fits owing to great heat, or insolation, or from remaining long in the bath, may be cured by being sprinkled with cold water, and exposed to the wind; by having their stomach rubbed, and getting wine and food. But if the swooning be occasioned by the greatness of the inflammation, or bad nature of the fever in the attacks, and if the patient is cold, we ought to rub his limbs strongly, chafe him, apply ligatures, force him to keep awake, and abstain from food. And these things are to be done previous to the paroxysm. But those who have faintings from dryness, should get for food two or three hours before the paroxysm either the juice of chondrus, or bread out of water, along with the kernels of the pomegranate, or apples, or pears. But if great danger be anticipated, we must also give wine. Those who have sudden attacks of fainting are to be thus treated. And in all cases we are to find out the cause of the deliquium, and direct our attention to it. And sometimes the greatest care must be bestowed upon this symptom, which threatens danger, or death itself.