But if the diaphragm is wounded, the præcordia are drawn upward; there is a pain in the spine, an oppression of the breath, and a discharge of frothy blood.
Of the bladder.
When the bladder is wounded, the groin is pained, there is a tension of the parts immediately above the pubes; instead of urine comes blood; and the urine is discharged at the wound; the stomach is affected, so that the patients either vomit bile, or have a hiccough; a coldness seizes them, and after that death.
Of the discharge from wounds and ulcers.
Blood, sanies, and pus.
These things being known, there still remain some other particulars to be observed relating to the wounds and ulcers, which we are to treat of. From wounds then and ulcers are discharged blood, sanies, and pus. Blood is known to every one. Sanies is thinner than blood, unequally thick, glutinous, and coloured. Pus is very thick and white, also more glutinous than either blood or sanies. Now blood is discharged from a recent wound, or one that is just healing: sanies appears betwixt these times: pus in an ulcer beginning to heal. Further, both sanies and pus are distinguished into several species by Greek names; for there is one kind of sanies, which is called ichor[ EO ], another melicera[ EP ]. There is also a species of pus called elæodes[ EQ ]. Ichor.Ichor is thin, of a whitish colour, and proceeds from a bad ulcer, and especially where a nerve has been hurt, and an inflammation has followed. Melicera is thicker, more glutinous, whitish,Melicera. and somewhat resembling white honey: this also is discharged from malignant ulcers, where the nerves about the joints are hurt; and amongst the joints principally from the knees. Elæodes is thin, whitish, somewhatElæodes. unctuous, in colour and fatness not unlike to white oil; and appears in large ulcers, that are healing. Now blood is bad that is either too thin or too thick, in colour either livid or black; or mixed with phlegm, or of various colours: the best is warm, red, moderately thick, and not glutinous. Therefore from the first the cure of a wound, which has yielded good blood, is more easy and quick: and afterwards there is more hope of those, from which the several discharges have been of the best kind. Sanies then is bad, where it is in great quantity, over thin, livid, or pale, or black, or glutinous, or fetid, or such as corrodes the ulcer itself and the adjacent skin. It is better, when the quantity is small, indifferently thick, of a reddish colour, or inclining to white. Ichor again is the worst, that is plentiful, thick, inclining to a livid or pale colour, glutinous, black, hot, fetid. It is more tolerable, if inclining to white, and when in all other respects it is the reverse of the former. But melicera is bad, when it is in great quantity, and very thick; better, when thinner, and less in quantity. Pus is the best amongst these. But even that too is bad, when it is copious, thin, diluted; and the more so, if it be such from the beginning; also if in colour it resemble serum, if it be pale, or livid, or feculent; moreover if it be fetid; unless the smell arises from the nature of the particular part, where the ulcer is. The less there is of it, and the thicker, and whiter, so much the better; and also if it be smooth, if it have no smell, if it be homogeneous. In quantity, however, it ought to correspond both with the size and age of the wound: for a greater quantity is discharged naturally from a larger one; and more before the inflammation is removed, than afterwards. Elæodes also when plentiful, and containing but little fat, is bad: but the less there is of it, and the more oily so much the better.
Cure of a hæmorrhage from a wound.
These things being considered, when any person is wounded, that can be cured, two things are immediately to be regarded: that he do not perish either by a hæmorrhage, or an inflammation. If we are afraid of a hæmorrhage (which may be known from the situation of the wound and its largeness, and from the force of the stream of blood) the wound is to be filled with dry lint, and over it a sponge squeezed out of cold water must be applied, and pressed down with the hand. If this does not stop the blood, the lint is to be frequently changed: and if it have not strength enough dry, it must be moistened with vinegar. This is very powerful in stopping blood: and therefore some people pour it into the wound. But here again it is to be feared, that the matter being too forcibly retained there, may afterwards raise a great inflammation. Which is the reason why neither corroding medicines, nor such as are caustic, and therefore forming a slough, are to be used, although most of these stop blood: but if recourse is ever had to them, such ought rather to be employed, as are the mildest in their operation. But if even these do not prevail against the hæmorrhage, the vessels, which discharge the blood are to be taken hold of, and tied in two places about the wounded part, and cut through, that they may both unite together, and nevertheless have their orifices closed. When the circumstances do not even allow of this measure, they may be cauterized with a hot iron. And in this case too, when there is a considerable hæmorrhage from a part, where there is neither nerve, nor muscle, in the forehead for instance, or upper part of the head, it is very proper to apply a cupping vessel to the opposite part, that the current of blood may be diverted thither.
Cure of the inflammation in wounds.
These then are the remedies against a haemorrhage: but for an inflammation the flux of blood itself is the cure. This may be apprehended, when either a bone has been hurt, or a nerve, or a cartilage, or a muscle, or when the haemorrhage has been too small in proportion to the size of the wound. Therefore when any thing of this kind happens, it will not be proper to stop the blood quickly, but to suffer it to flow as long as it is safe; insomuch that if the discharge has appeared small, it ought also to be taken from the arm; especially if the patient be young and robust, and used to exercise; much more, if he was intoxicated before he received the wound. And if a muscle shall appear to be wounded, it must be cut through: for when it is only divided in part, it is mortal; cut quite through it admits of a cure.