Vomiting blood is an acute medical problem that is a standard and common emergency in all A&E units. The doctors work on the principle that the patient is in danger until the cause of the bleeding has been determined, and the bleeding point or area has either spontaneously stopped bleeding, or steps have been taken to arrest it with surgery. The most frequent reason for a stomach haemorrhage is that the patient has gastritis. In any heavily built Russian the immediate thought before last week’s alarms about poisons would be that he could be suffering from alcoholic gastritis (inflammation of the stomach) or oesophagitris (inflammation of the gullet) brought on by heavy vodka drinking. This is a common problem in Russia and although in this case the haemorrhage followed breakfast it could have been triggered by a party the night before. It is believed that Mr Gaidar is diabetic.

Another common cause of abdominal bleeding is peptic ulceration, either gastric or duodenal ulcers. These are less frequently seen after the introduction of efficient antacid medication. However, gastrointestinal bleeding from the stomach or small intestine following the use of anti-inflammatory drugs to treat arthritic or other pain is common and accounts for nearly 2,000 deaths a year in Britain. As well as the non-steroidal anti-inflammatory drugs, aspirin or steroids may also cause gastric bleeding.

Gastrointestinal bleeding after excessive irradiation could be caused by destruction of the gastrointestinal wall, by damage to the bone marrow and changes to the blood count and clotting mechanism, and I have once seen it after destruction of the kidneys from irradiation when the patient developed secondary ulcers from this in the stomach.