[When no doctor is on call. Medical works for lay persons in late antiquity]

The article offers a survey of the chief medical texts for lay persons in Latin, followed by a more detailed discussion of two examples, hare's brain for teething troubles and remedies for nosebleed.

[History of epistaxis since the ancient times to the first half of the XXth century]

Epistaxis is one of the more frequent entities in the otolaryngological practice. The term is attributed to CULLEN (1785). Since them, multiple theories concerning etiology, clinical manifestacions, diagnosis and management have been reported in the medical literature. Nevertheless, an impressive improvement of awareness about these questions have emerged in the last half of past century. The objective of this work is to revise the history of epistaxis since the ancient times to the first half of the 20th century.

Nothing new under the sun: the management of epistaxis

The management of epistaxis is reviewed from ancient times onwards. Many curious methods have been employed and indeed epistaxis has been encouraged at times. Although current management is based on sound principles folklore remedies still predominate amongst some of our patients. The basis of contemporary treatments was known and practised by our ancient forbears.

[Nosebleed in the history of rhinology. Images of the history of otorhinolaryngology presented by instruments from the collection of the Ingolstadt Medical History Museum]

ETIOLOGY AND ANATOMY: Up to the Middle Ages, nosebleeds were considered a natural means of purification in internal diseases. In addition injuries, extreme physical exertion, and influences from the sexual sphere were recognized causes. In the 19th century, low atmospheric pressure on mountains and in balloons was also assumed to be an etiological factor. It was only at the end of the 19th century that the importance of high blood pressure and defective coagulation were diagnosed in context with nosebleeds. In ancient times, it was known that compressing the nasal alae can often stop the bleeding, but that blood may as well run down the throat and mimick a hemorrhage coming from the trachea. Between 1874 and 1884, several authors, among them J. L. Little in USA and W. Kiesselbach in Germany, recognized the anterior part of the nasal septum as a frequent location of bleeding. GENERAL THERAPY AND ANTERIOR NASAL PLUGGING: General measures of hemostasis recommended already in ancient times were the application of cold and diverting the blood to other regions of the body by applying tourniquets to legs and arms, or by cupping. Anterior nasal plugging was already known to the ancient Assyrians and Hippocrates. Scribonus Largus (1st century) was the first to describe a nasal plugging around a tube, thus preserving a patient respiratory passage. During the Middle Ages local application of assumedly hemostatic substances of the apothecary of that time played an important part, among them "cranial moss", the lichen that grew on the skulls of hanged corpses exposed to the weather for a long time, and "mumia", a black unctuous substance made of Egyptian mummies. Plugging the nares with an inflated balloon, fabricated from animal intestines, was described first by J. P. Frank in 1807. During the second half of the 19th century, numerous varieties of rubber balloons, rubber caps, and condoms came in use for this technique. The first nasal balloon combined with a respiratory tube was presented by Dionisio in 1890. POSTERIOR NASAL PLUGGING: Plugging of the posterior nares was anticipated by Hippocrates technique of removing a pendulous polyp by pulling a sponge tied to four strings backwards through the nasal cavity. Le Dran, surgeon in Paris in 1731, was the first to adopt this technique for stopping a nasal hemorrhage. The instrument named after Belloc (or Belloq) for placing a posterior nasal plug consists of a metal tube in which a curved spring can be pushed forwards and backwards. The first description of this instrument remains a mystery. There were at least two French surgeons named Belloc and Belloq, and this has been the source of some confusion. A paper of a certain Belloq of 1757, which is generally regarded as the source, deals with means of stopping certain hemorrhages. It exists in two different printed versions with identical wording and describes the application of candle wax for stopping severe hemorrhages after tooth extraction and abdominal puncture; however, it makes no mention of nosebleeds. Bellocq's tube was made known by Deschamps' book on diseases of the nose in 1804. For about 150 years, it was one of the instruments most frequently illustrated in textbooks and most rarely used in practice because surgeons generally preferred a simple catheter for placing a posterior nasal plug. The article concludes with a short survey of the history of chemical and thermal cauterisation and ligation of blood vessels for stopping nosebleeds.

2,500 years of nosebleeding in art

In 132 objects of art (mainly paintings and drawings, a few sculptures, and one mosaic) dating from the pre-classical period in ancient Greece to our days, nosebleeding due to different reasons could be detected in museums, churches, galleries and art-books. Children and adults were bleeding from their noses because of mechanical injury, infectious diseases, haemorrhagic diathesis, and drugs. Some artists depicted nosebleeding in a very realistic manner, others represented this symptom in an exaggerated or caricaturistic way. From a total of 132 examples of nosebleeding 53 are presented, including 18 with figures.

Nosebleed of children in painting

In 13 paintings and drawings, dating from the preclassic period in ancient Greece to the present day, representations of children with nosebleed could be detected in museums, churches, galleries and art-books. Children and adolescents were bleeding from their noses because of mechanical injury, infectious diseases, or hemorrhagic diathesis. Some artists depicted nosebleeding in a very realistic manner, others represented this symptom in a more abstract or caricaturistic way. Nosebleed stood as a symbol for human failure, as a sign of the loser, the suffering and tortured child, and as a sign of death.