MELENA.
The first step is to find out the cause of the bleeding and to remove this when possible. Under Himatemesis the agents indicated in bleeding from the stomach are enumerated.
The melxna of duodenal ulcer is a clear indication for surgical proce dures, and very copious and repeated gastric haemorrhages should be also met by gastro-enterostomy.
The drenching of the patient with tannin, vegetable and mineral astringents, turpentine, ergot, &c., is useless, and should never be resorted to in intestinal hxmorrhage. The only resource is to rapidly saturate the patient's blood with Chloride of Calcium by the mouth or rectum, and this is also the best procedure in purpuric conditions.
In gastric or duodenal haemorrhage Adrenalin solution often proves useful by its local action, but for bleeding low down in the bowel it is worse than useless, since increase of blood-pressure favours the escape of the blood from the opened vessel. Gelatin by the mouth is always admissible in internal bleeding, and the hypodermic administration of Normal Saline solution to make up for the bulk of the blood lost. A
small quantity of Calcium Chloride can he added to the serum injected.
The black motions clue to iron, bismuth and manganese and those sometimes occurring in a raw-meat dietary and after eating spinach should be distinguished from true melmna.
neonatorum is a serious and often fatal form of intestinal haemorrhage which usually occurs within 2 or 3 days after birth, and is due either to microbic causes or to the result of ligature of the cord inducing hepatic or intestinal hyperxmia. Chloride or Lactate of Calcium should he administered in small quantities (2 to 5 grs.) in milk, and external warmth employed to counteract shock. Hypodermic injection of Normal Horse and Rabbit Serum and direct blood transfusion have all been successfully employed. A less formidable and equally reliable method of treatment in this serious emergency is the hypodermic injection of carefully sterilised Gelatin solution, by which Engelmann saved 4o out of 43 cases of this affection.