Post-operative Hemorrhage. — Occa sionally after the best operations for piles the dressings will be saturated with blood. This, as a rule, need not cause uneasiness, for when due to bloody water left in the rectum after irrigation or from a superficial cut in making the muco cutaneous incision it will not amount to anything. On the other hand, when in ternal bleeding is suspected, the patient should be requested to empty the rectum. If bleeding has occurred, clots of blood will be discharged with the faeces. When there is reason to believe that the bleed ing is due to a small vessel or to oozing, it can frequently be arrested by simply tightening the bandage. If this fail, the rectum should be irrigated for several minutes with cold or quite hot water, or with some one of the various astringent solutions, as alum-water, the infusion of black-oak bark, etc. Astringent pow ders dusted over the bleeding parts, tan nic acid, gallic acid, zinc, Monsell's powder, and other powders known to have a contracting effect on the tissues have all been recommended. Monsell's powder has been used more frequently than the others, but it has proved very undesirable, not because it did not arrest the bleeding, but on account of the filthy condition in which it leaves the wound.
When the haemorrhage is profuse, time should not be wasted on injections and powders. The rectum should be exposed by means of a speculum and the bleed ing vessel searched for until it is found and ligated or seared over with the Paquelin cautery. If the operator be not so fortunate as to have one of these instruments, a poker or a curling-iron may be heated to a red heat and used as a substitute. In case the vessel is situ ated so high that a ligature cannot be applied, it should be seized with a pair of artery-forceps and thoroughly twisted, and the forceps left on if necessary; for in cases of profuse haemorrhage of the rectum the patient's life not infrequently depends upon the thoroughness of the work.
In case the bleeding-point cannot be located packing of the rectum should be resorted to. This must be done carefully, however. Gauze or other packing loosely inserted into the rectum does not arrest the bleeding.
The majority of operations for hwm orrhoids are performed on the lower inch and a half of it. When bleeding occurs in this locality it can be speedily arrested by inserting into the rectum a firm piece of rubber tubing, three inches long and three-fourths of an inch in diameter, around which has been wrapped.'several
layers of gauze. It can be kept in place by placing a safety-pin through the outer end and into a T-bandage. This makes a desirable compress and at the same time allows the escape of wind and dis charges, and warns the attendant in case the bleeding has not been arrested (Fig. 6). Vulcanite tubes (Fig. 7), which are kept at most any instrument-dealer's store, act in the same way. The main factor in arresting hmnorrhage after any operation about the rectum, where the cautery or ligature cannot be used, is to make firm and constant pressure over the bleeding-points, so that not a single point of the rectum will be exempt from the pressure; when this has been accom plished, we can retire with the assurance that our patient is perfectly safe and that all bleeding has been arrested.
HAMAMELIS.—Hamamelis, or witch hazel, consists of the leaves of Hama melis Virginiana, a North American shrub growing east of the Mississippi River. The leaves, collected in the au tumn when the twigs are flowering, have an odor resembling that of tea and an astringent, bitter taste. It contains about 10 per cent. of tannin, bitter and odorous extractives, and a trace of oil.
Preparations and Doses.—The fresh leaves (hamamelis, U. S. P.) are used to prepare the fluid extract, which, al though chiefly used as an external appli cation, may be given internally in doses of V, to 1 drachm.
Therapeutics.—Hamamelis is limmo static, astringent, and tonic in its action. Containing considerable tannin, it coag ulates the albuminous elements of the tissues, when applied locally, and dimin ishes the blood-supply and secretions.
IN ILEMORRHAGE.—The fluid extract has been given internally for the relief of pulmonary, renal, and uterine halmor rhage; purpura, halmatemesis, varicose veins, and haemorrhoids. The local ap plication of hamamelis has been used for recent wounds, sprains, bruises, superfi cial hxmorrliage, halmorrhoids, epistaxis, and for bleeding or discharges from the natural cavities or openings of the body.
As AN ASTRINGENT. — Hamamelis is used, in diluted form, as a mouth-wash, as a gargle in chronic pharyngitis, and in spray after attacks of acute coryza (1 part to S, or 1 part to 24). In relaxed conditions of the mucous membranes generally it is beneficial. Peristalsis and the secretions of enteritis are checked. It is of value in diarrhoea and dysentery.