PRIMARY H.:EMORRHAGE. — A slight haemorrhage of any kind is usually re covered from promptly unless the pa tient's general health is impaired. The almost universal practice of bleeding as a therapeutic measure during the early part of this century showed how even copious bleeding could be benign in im mediate results. After severe bleeding the patient's color is lost, the surface be coming pale and the lips white, the ex tremities are cold, the heart's action is weak, the pulse feeble and rapid, the respiration frequent and at times sigh ing. A feeling of faintness is enced, together with loss of voice and buzzing in the ears. Often the body be comes covered with a profuse cold per spiration, while there may be delirium, collapse, and even death.
Following the hemorrhage the patient is very weak, the muscles are flabby and soft, the pulse is rapid and easily dis turbed, and there is often a slight rise of temperature.
Conclusions regarding post-operative hemorrhage are: 1. In diagnosticating post-operative limmorrhage the oper ative history will aid much. 2. The symptoms of shock and those of hmmor rhage are very similar. 3. In suspected cases the cutting of a single stitch in the incision will tell. 4. The surgery must be quick and decisive in these cases. 5. In cases in which bleeding is expected the tube should be used. G. Large quantities of decinormal saline solution will save many patients. This should be used both per rectum and by injection into the veins. 7. Strychnine, belladonna, etc.. will not control bleed ing from a uterine or ovarian artery any better than from any other artery. S. The surgeon should do what his surgical conscience tells him is right. Late researches in hematology make it appear that an internal concealed hemorrhage may be demonstrated by a careful blood-eount. This, it is stated. will show a decrease in the red cells and an increase in the white. Very similar symptoms accompany shock from vari ous causes, such as internal hernia, etc., none of which produce a change in the red cells. If an operation was per formed for the relief of an inflammatory this test you'd lose its value .
in part, as there would exist at the time of operating a leucoeytois. Sa line infusions apparently increase the white cells at first. A. II. Cordier (Jour. Amer. Sled. Assoc., July 6, 1901).
—The treatment of limn orrhage may be both constitutional and local. It is important to keep the tient in the recumbent position with the head on a level with or lower than the body, unless the bleeding be from the nose or cars, when the upright posi tion will often cause it to cease. All clothes are to be loosened and the normal temperature is to be sustained by means of warm blankets and hot-water bottles, care being taken in the use of the latter that they are not hot enough to burn the patient. When the bleeding vessel has not or cannot be secured, lants should be very carefully given if they are given at all. If, however, the vessel has been secured, strychnine, nitroglycerin, digitalis, ammonium car bonate, or hypodermic injections of ether or brandy are of great value. Rectal,
subcutaneous, or intravenous injections of a warm normal saline solution (1 spoonful of sodium chloride to the pint of water) are often of advantage in fill ing the empty blood-vessels, and thus giving the heart something to work upon. Transfusion of blood may also be used.
Analysis of the literature and per sonal experience with gelatin: I. Gela tin increases the coagulability of the blood, whether applied locally, taken in ternally by the mouth, or injected sub cutaneously or intravenously. 2. Ap plied locally, it is usually harmless, and may, as Carnot suggested, aid in heal ing by improving the nutrition of the cells, although this is personally re garded as doubtful. It may be injuri ous by promoting bacterial growth, and should probably always have some anti septic added to it. 3. Injected subcu taneously or intravenously, it is en tirely harmless, and, when the technique is perfect, practically painless. The solution should be thoroughly sterile; the dose employed should vary from 1 to 3 grammes of pure gelatin. 4. When administered by the mouth from 1 to 300 grammes, or perhaps more, should be employed daily. 5. It is of advantage in any form of local hiemor rhage, such as epistaxis, Imnorrhoids, or injuries. 6. It checks certain forms of internal haemorrhage, such as ha2mop tysis, hiematemesis, metrorrhagia, and melna neonatorum. T. It appears to be the best remedy at our command in the treatment of hoemophilia, and to be of great advantage for purpura haemorrhagica, and in ha morrhagie forms of infectious disease. S. At pres ent it appears to be contra-indicated in only one condition, viz.: acute nephri tis. Joseph Sailer (Therap. Gaz., Aug. 15, 1901).
Injuries and Wounds of Arteries.
—An artery may be con tused and not give rise to any special symptom, but if badly injured its walls are apt to slough and cause Aneurism or obliteration of the artery may also result from this injury, and when the latter occurs in some large or important vessel gangrene of the parts supplied by it may follow. (See ANEU RISM, volume i.) —This may be either incom plete or complete. When incomplete the external coat is preserved, the middle and internal being torn. The latter, by curl ing up, may form the starting-point of a thrombus, thus causing the lumen of the artery to become occluded. In other cases the accident may be followed by an aneurism, or by hemorrhage the re sult of an erosion of the outer wall of the vessel.
In complete rupture or laceration, if there is an external wound, haemorrhage is often severe, but it may be scarcely noticeable, provided the inner coats have been able to act as a barrier. If there is no external wound the tissues become infiltrated with blood or a traumatic aneurism results.
— A punctured wound is caused by some thin sharp or blunt instrument: a needle, the blade of a knife, etc. It may give no trouble if the wound is small; but, when large, hannorrhage may be considerable. This kind of a wound is very apt to be fol lowed by a traumatic aneurism. (See ANEURISM, volume i.)