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Hemorrhage and Its

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HEMORRHAGE AND ITS CONTROL.—II umorrhage is the general term for bleeding, or for a loss of blood, from the blood-vessels. Distinction must be made between internal and external limnorrhages. The loss of blood may he slight, as in the cases of nose-bleeding and insignificant cuts ; or it may be extensive, as in the bleeding that may occur from ulcer of the stomach. Hemorrhage may be a normal physiological process (as, for in stance, the recurring bleeding of menstrua tion), but in the great majority of instances it is a pathological process. Many persons bleed very freely on slight provocation, and are always in danger of fatal hxmorrhage. See II.EmoPHILIA.

The causes of hmmorrhage are very numerous, hut for the layman the most important types of bleeding are those due to accidental cuts. Here it is essential to recognise the character of the blood-vessels injured, whether veins or arteries. The so-called " blue venous blood " is largely a fiction. The difference in colour in venous blood and arterial blood is in reality very slight, and, as oxygenation rapidly takes place in the air, venous blood (which is only a shade darker than arterial blood) is rendered lighter. If the injured blood-vessel be a superficial one, the difference between the steady oozing from a vein (see Fig. 219) and the pulsating outflow from an artery (Fig. 22o) is readily perceived ; but if the wound be deep and partly blocked by clots and cut flesh, the pul sations from a bleeding artery may not be readily noticed. In attempting to stop a flow of blood it is of importance to remember that in veins the current of blood is in a direc tion opposite to that in the arteries. In the latter vessels the blood is propelled inter mittently away from the heart toward the extremities ; in the veins it flows uninterruptedly from the extremities toward the heart. Therefore, when it has been definitely deter mined whether an artery or a vein has been cut, compression must be made accordingly. If an artery has been injured, compression must be made on that side of the wound which is nearest the heart ; if a vein, on that side of the wound which is furthest away from the heart. When both types of vessels have been severed by the same cut, compression on both sides of the wound may be necessary.

In the case of every bleeding injury great care must be taken not to infect the wound. Whatever comes in contact with the \ vou n d (whether it be the hands, the dressing-material, or the bandages) must be thoroughly cleansed and, if possible, sterilised.. A moderate bleeding may be stopped

by applying a compress of surgical cotton or gauze to the wound, holding it in place with the fingers or with a snug bandage. It neither cotton nor gauze is at hand, a piece of clean linen or a handkerchief folded several times may be used. The application of various remedies, such as pumice, plaisters, cobwebs, etc., is dangerous rather than helpful, and should be avoided.

If the bleeding cannot be controlled by the means just noted, it mar be possible to do so by applying a suspender, a handkerchief, or a bandage made from any material immediately at hand around the injured limb (see Fig. 221). If greater pressure is desired, a lever may be inserted under the knot of the bandage, and a still greater constriction secured by twisting this (see Fig. 222) . If the injured vessel be an artery, the pressure should be applied above the site of the wound. Where the haemorrhage takes place from a vein, the bandage must be applied from the hand or foot upwards to a point above the wound, which is covered with a pad of gauze or cotton.

In localities where no bandage can be applied, the control of hzemorrhage is a more difficult matter. In such cases it is advis able to press the bleeding artery against a neigh bouring bone Nvi t h the finger. When the bleeding occurs on the forehead, the temporal artery may be compressed just in front of the car (see Plate VI I.) ; when it takes place from the neck, the carotid artery may be compressed in the groove between the larynx and the vertebral column (see Fig 223); and if the haemorrhage occurs on the shoulder or in the axilla, it may be con trolled by compressing the subclavian artery, and at the same time drawing the arm downward against the first rib (see Figs. 224 and 225). In haemorrhage from the thigh, the femoral artery can be pressed against the pelvic bone in the middle of the groin, when the leg is half bent. The best place on which to apply pressure on the upper arm is along the inner side, just below the biceps (see Fig. 226). A similar effect may he secured by compressing the upper arm between two sticks applied as shown in Fig. 227. Pressure for this purpose must not be kept up for a longer period than three or four hours ; otherwise gangrene is apt to set in.

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