Under such circumstances the following combination may be employed with advantage: 13, . Calcii Chloridi 3iiss.
Heroin. Hydrochlor. gr. 1.
Tinct. Aconiti Acid. Hydrocyanici Dil. iitxvj. Aqua Chloroformi 3viij. Misce.
Ft. mist. Signa.—"A tablespoonful to be given every 15 minutes whilst the hcemorrhage is severe." In former times blood-letting was practised to lower the arterial pressure. This effect can be more safely achieved by causing the patient to inhale Nitrite of Amyl, and it should have a trial in every case where the systemic pressure is above normal; Nitroglycerin may be given by the mouth.
A smart saline purgative will produce the same result, the only objection to its use being that it will compel the patient to alter his position as soon as it begins to purge, but this is usually a trivial contra-indication. Temporary ligatures may be applied to the limbs in order to prevent the return of their venous blood to the heart. Revulsant measures as a brisk counter-irritation of some part of the skin or the use of a hot mustard-bath to the lower extremities often prove useful, and many practitioners resort to dry cupping of the chest.
'The results of the loss of blood must be combated, as the acute anemia may result in a fatal syncope. A large enema of normal Saline with which Chloride of Calcium may he combined should be slowly injected, and failing its retention, or even when it is retained, the saline may be injected in several places hypodermically. Gelatin solution 5 to to per cent. may he safely combined with it, and in desperate cases the injection may be made into a vein. These agents afford all the benefits obtainable from blood transfusion.
Threatening asphyxia from regurgitation of blood into the main bronchus of the sound lung should be treated promptly by artificial respiration; little is to be expected from Oxygen inhalation when the cyanosis is clue to such blocking.
The secondary anemia is afterwards to be treated by Iron, prolonged rest and judicious feeding.