BLEEDING, the escape of blood from the arteries or veins. Bleeding may be external, and thus readily seen and prevented by proper sur gical measures, or it may take place internally, into one of the large body cavities, and is then a serious matter. The amount of blood that is in.the human body varies from one-tenth to one twelfth of the weight of the individual, and of this from 40 to 60 per cent may be lost without resulting in death from the direct effects of bleeding. Death may result in some individuals from the loss of much smaller quantities, but most persons can lose two-fifths of their blood and not die. Bleeding varies widely in its rapidity. Some wounds ooze, others well-up, and again bleeding may be very rapid when a large vessel has been cut.
Bleeding from a vein or an artery may be recognized by the dark color and regular flow from the former, and the brighter red and spurting or throbbing flow from the latter. If bleeding is taking place while pressure is being applied to a cut, these differences may not be so pronounced. In emergencies bleeding from an artery may be stopped by direct and hard pres sure of the carefully cleaned finger immediately over the source of the issuing jet of blood. This pressure must be hard and continued. This will permit time to find the chief artery that is supplying the bleeding vessel, and as soon as this is found pressure upon it will further aid in suppressing the flow. Thus the brachial artery can be found on the inside of the arm by feeling on the patient's well side, and firm pres sure on it will stop all bleeding in the parts below, as in a cut wrist or cut hand. Pressure on the femoral artery in the groin will control all bleeding below the point of pressure. As pressure by means of the finger is difficult to maintain, an improvised apparatus may be made of a knotted napkin or large handkerchief. This may be placed about the arm or leg, the knot brought to press on the artery and then by means of a short stick the whole may be made to tightly compress the entire limb. (See TOURNIQUET). Pressure of this kind should not be too prolonged, or serious damage to the parts may result. Venous bleeding is usually controlled by direct pressure of the limb on the side away from the heart and by direct pressure of antiseptic gauze. In oozing, direct pressure
of antiseptic gauze or direct application of hot water, 118-120° F., is most effective. Powders, cobwebs, iron alum, etc., are not advisedly used.
Internal hemorrhage is extremely import ant, since the blood cannot be seen, and one has to rely on the symptoms solely. These are usually a beginning sense of faintness or weak ness, and perhaps some nausea. The extremities commence to get cold and white, the face be comes pale and anxious, and the patient may commence to have air-hunger. He desires the windows to be opened wide, thinking thereby to get more air. Thus the beginning symptoms are very similar to those of a severe fainting spell. But as the bleeding continues there is increasing restlessness with increased air hunger ; there may be cold, clammy sweat over the patient's body; there is sighing to gasping respiration, and the heart-beat is hard to hear and it may be impossible to feel the pulse beat. The patient may die in convulsions, the face becoming deeply cyanosed, and the respirations spasmodic or convulsive in type. If the patient does not die he will have a long, tedious con valescence. Prompt medical or surgical aid is imperative in all such cases. The best tempo rary stimulant is an enema of hot (118-120° F.) salt solution, one teaspoonful to the pint, which is allowed to run in and out of the rectum, a quart or two at a time.
This procedure was one much in vogue in former years, and while still a most desirable operation to perform for cer tain types of disease, the conditions brought about by its use are now largely induced by other means. In conditions of poisoning, some cases of pneumonia, and in some apoplexies, bleeding is still performed by competent medical practitioners, and is advocated in most manuals of practice. It is its indiscriminate use for all ills that has fallen out of favor.
Certain individuals have a ten dency to bleed inordinately from even the slightest wound. They are called "bleeders,") and are frequently found in families, most of the members of which have like traits. The pulling of a tooth is often followed by con tinuous hemorrhage. The causes for this idiosyncrasy are not all known. In some an in sufficient quantity of calcium salts in the blood has been thought to be the most important cause.