Hæmorrhage

“ In certain cases the inheritance is transmitted by the female alone. This is the case in the hæmophilia, the unfortunate subjects of which are known as bleeders. There is in this a marked tendency to hæmorrhage which depends upon an alteration in the character of the blood which prevents clotting. This, the natural means of stopping bleeding from small wounds, being in abeyance, fatal hæmorrhage may result from pulling a tooth or from an insignificant wound. ”

“ Wounds of the brain present very great difficulties, and vary greatly in their effect, very slight wounds producing severe symptoms, and vice versâ. A person may receive an injury to the head, recover from the first effects, and then die with all the symptoms of compression from internal hæmorrhage. This is due to the fact that the primary syncope arrests the hæmorrhage, which returns during the subsequent reaction, or on the occurrence of any excitement. ”

“ The prognosis depends partly on the extent of the injury and the parts involved, but there is also risk from secondary hæmorrhage, and from such complications as pleurisy, pericarditis, and peritonitis. Death may result from shock, hæmorrhage, injury to brain or important nervous structures. ”

“ The same thing also occasionally occurs with great rapidity in performing amputations and removing tumours in the human subject.... Moreover it appears ... that the more frequently or forcibly the arteries pulsate, the more [211] speedily will the body be exhausted of its blood during hæmorrhage. Hence also it happens that in fainting fits and in states of alarm when the heart beats more languidly and less forcibly, hæmorrhages are diminished and arrested. ”

“ Of the Lungs.—These usually cause hæmorrhage, and are frequently followed by pleurisy, either dry or with effusion, and by pneumonia.
8. Of the Heart.—Penetrating wounds are fatal from hæmorrhage, of the base more speedily than of the apex; but life may be prolonged for some time even after a severe wound to the heart. Injury to the right ventricle is the most fatal injury and the most frequent. Rupture from disease usually occurs in the left ventricle; rupture from a crush is usually towards the base and on the right side. ”

“ Bleeding may be divided into active, passive, and accidental.—Active hæmorrhage is that arising from a full state of the vessels, or plethora.—Passive hæmorrhage, from general debility of the system, and of the blood-vessels in particular.—Accidental hæmorrhage, from external violence, as blows, wounds, &c. ”

“ It is probably true that patients very seldom die as the result of a single rapid hæmorrhage, even if severe. There can, however, be no doubt that death due actually to acute anæmia may follow repeated or prolonged hæmorrhage. ”

“ Extra-medullary Hæmorrhage—Hæmatorrachis.—The symptoms associated with extra-medullary hæmorrhage are at first of an irritative kind—muscular cramps and jerkings, radiating pains along the course of the nerves pressed upon, and hyperæsthesia. It is only when the blood accumulates in sufficient quantity to exert definite pressure on the cord that symptoms of paralysis ensue, and it is characteristic of extra-medullary hæmorrhage that the paralysis comes on gradually. ”

“ At the time I had a case of hæmorrhage per rectum that had baffled me for several months. No remedy had aided the case in the least, so far as I could see, unless it was Pond's Extract used locally in the form of injection; and I finally came to the conclusion that the relief apparently due to the Hamamelis was merely a coincidence. I had given all the hæmorrhagic remedies I knew of or could hear of. Still the bleeding came just as often, with increasing severity. Each time the patient was sure she would "bleed to death," and I was not positive she would be disappointed. ”

“ The characteristic appearance in a necropsy of plague is that of engorgement and hæmorrhage, nearly every organ of the body participating more or less. There is also parenchymatous degeneration in most of the organs. ”

“ The former of these cases is known by the heat of the part, and the general fever or inflammation that accompanies the hæmorrhage. An hæmorrhage from the nose or from the lungs is sometimes a crisis of inflammatory diseases, as of the hepatitis and gout, and generally ceases spontaneously, when the vessels are considerably emptied. Sometimes the hæmorrhage recurs by daily periods accompanying the hot fits of fever, and ceasing in the cold fits, or in the intermissions ”

“ The patient was a young man, strong and well-nourished, who was attacked repeatedly by hæmorrhage from the surface of the lower limbs. This generally occurred during the night, so that he first became aware that the bleeding had taken place by finding the sheets stained with spots of blood when he awoke. I once, however, saw blood flow from the uninjured back of the hand of this patient while he was sitting near me at table. The blood formed a jet, which would about correspond in size to the duct of a sweat-gland. ”

“ Hæmothorax, even of considerable severity, will undergo spontaneous cure. An early rise of temperature may be disregarded.
(ii) Tapping the chest is indicated when pressure signs on the lung are sufficiently severe to cause serious symptoms, and the removal of the blood undoubtedly shortens the period of recovery, as well as relieves symptoms.
In such cases the collection of blood has usually been rapid and continuous; hence a fresh hæmorrhage is always probable when the local pressure has been removed. ”

“ As secondary hæmorrhage is apt to be met with the patient should be advised to leave his nose alone, neither blowing nor clearing it, nor using any cleansing measures for 48 hours. After that time he can employ the usual warm alkaline nose lotion. He should be warned against the habit of hawking backwards, as this would tend to a recurrence of the hypertrophy.
Prognosis. Great relief can generally be promised within a few days. There is no danger in the operation. The hæmorrhage may be troublesome, especially in men. ”

“ In all Hæmorrhages, all Fluxes of Blood, great Tranquillity, Ligatures, and the Use of the Drinks No. 2 or 4, are very useful.
§ 515. People who are very liable to frequent Hæmorrhages, ought to manage themselves conformably to the Directions contained in the next Chapter, § 544. They should take very little Supper; avoid all sharp and spirituous Liquors; Apartments that are over hot, and cover their Heads but very lightly.
When a Patient has for a long time been subject to Hæmorrhages, if they cease, he should retrench from his usual Quantity of Food ”

“ D---- turning a hair. As fairly often happens, a haemorrhage followed, but I told the dentist that I would try suggestion without his using a haemostatic, without knowing beforehand what would happen. I then asked Mlle. D---- to look at me fixedly, and I suggested to her that in two minutes the haemorrhage would cease of its own accord, and we waited. The patient spat blood again once or twice, and then ceased. ”

“ When, however, blood is found effused on the surface of the brain, especially between the dura mater and the skull, either beneath or opposite to an external wound, we may reasonably infer that the hæmorrhage is due to a direct blow. Hæmorrhage so severe as to produce dangerous pressure on the brain, as a rule, comes from a rupture of the middle meningeal artery. ”

“ The hæmorrhage which occasionally comes on several days after an operation, from sloughing, ulceration, or the non-formation of a coagulum in an artery, is probably as liable to occur now as formerly; but I believe that hæmorrhage, a few hours after an operation, is much less frequent since the practice of narcotism by inhalation. Before this practice, it was extremely common for the patient to faint during an operation, when the bleeding of the smaller arteries stopped, and they escaped the ligature, to break out in hæmorrhage occasionally afterwards ”

“ Death occurs primarily through paralysis of the respiratory centre.
Local effects. In many cases considerable help to diagnosis may be obtained by external examination—bruising and ecchymosis, or definite hæmatomata, in the temporal or parietal regions. In some cases the hæmatoma may pulsate, and in others the application of pressure to the hæmatoma will lead to the development of fits involving the face and extremities on the contra-lateral side. Copious [141] hæmorrhage from the ear should always arouse suspicion as to the probability of an extra-dural hæmorrhage (see p. 97) . ”

“ Occasionally the disease proves fatal by sudden haemorrhage, but a fatal result is more frequently due to perforation and the escape of the contents of the stomach into the peritoneal cavity, in which case death usually occurs in from twelve to forty-eight hours, either from shock or from peritonitis. ”

“ On the Field.—Hæmorrhage is arrested in the limbs by an improvised tourniquet; in the head by a pad and bandage; in the thorax or abdomen by packing if necessary, but this should be avoided if possible, as it favours septic infection. If a limb is all but detached it should be completely severed. A full dose of morphin is given hypodermically. The ampoule of iodine carried by the wounded man is broken, and its contents are poured over and around the wound, after which the field dressing is applied. ”

“ It is chiefly by means of their activity that other sorts of substances are removed. They often contain dead cells or cell fragments, and when hæmorrhage takes place in a tissue they enclose and remove the granules of blood pigment which result. They often join together, forming connected masses, and surround such a foreign body as a hair, or a thread which the surgeon places in a wound to close it. They may destroy living cells, and do this seemingly when certain cells are in too great numbers and superfluous in a part, their action tending to restore the cell equilibrium. ”

“ The more rapidly and completely the operation is executed, the less will be the bleeding. It not infrequently originates from semi-detached fragments of growth. Even when the hæmorrhage is profuse it is better to push on and complete the removal of growth before attempting to check it. ”

“ Exploring with the probe and curetting away of granulations should be avoided as far as possible for fear of injuring the sinus. If its wall be already inflamed, it may be torn through, and the resulting hæmorrhage may render the further steps of the operation a matter of extreme difficulty. ”

“ The floor of the ulcer is smooth and glazed, or occupied by necrosed tissue, and the discharge is watery and blood-stained, and as a result of putrefactive changes may become offensive. Hæmorrhage is rarely a prominent feature, but discharge of blood may constitute a symptom of considerable diagnostic importance in cancer of internal organs such as the rectum, the bladder, or the uterus. ”

“ Evidence of mediastinal hæmorrhage existed in the presence of subcutaneous discoloration of the abdominal wall, below the ensiform cartilage and extending slightly over the costal margin of the thorax. In the absence of an aneurismal swelling, or of the development of any further symptoms, the patient was sent home to Netley in January. ”

“ The hæmorrhage is ascribed by Schlesinger and Weichselbaum directly to lesions of the mucous membrane caused by the larvæ; in the case reported by these writers there were found shreds of tissue as well as pus in the stool. The pains occurring spontaneously in the abdomen are at times influenced by position and attitude of the body, often they were more violent after rest and after evacuation of the bowels; often they were continuous, but in that case less intense; pressure on the abdomen is generally little felt. ”

“ The hæmorrhagic state of fever, in which are included discharges of blood from the nose, lungs, stomach, liver, bowels, kidneys and bladder, hæmorrhoidal vessels, uterus, and skin. Hæmorrhages have been divided into active and passive. It would be more proper to divide them, like other states of general fever, into hæmorrhages of strong and feeble morbid action. There is seldom an issue of blood from a vessel in which there does not exist preternatural or accumulated excitement. ”

“ Is not that hereditary consumption, which occurs chiefly in dark-eyed people about the age of twenty, and commences with slight pulmonary hæmorrhages without fever, a disease of this kind?—These hæmorrhages frequently begin during sleep, when the irritability of the lungs is not sufficient in these patients to carry on the circulation without the assistance of volition; for in our waking hours, the motions of the lungs are in part voluntary, especially if any difficulty of breathing renders the efforts of volition necessary. ”

“ When serum is effused, a pituitous or purulent expectoration alone takes place; when blood is discharged, a disease is produced which has been called hæmoptysis. An effusion of blood in the brain, brought on by the operation of general debility, has been called by Dr. Hoffman, with equal propriety, a hæmorrhage of the brain. The effusion of blood in the lungs, in consequence of the rupture of a blood-vessel, is less fatal than the same accident when it occurs in the brain, only because the blood in the former case is more easily discharged from the system. ”

“ But no local applications will be sufficient to produce this effect, unless the powers of the constitution are supported at the same time.
A heavy man received a wound in the back of his head from an iron spike; he was kept very low, complaining occasionally of want of food. Repeated hæmorrhage took place at intervals of a day or two, which no local applications could suppress, and he ultimately died from loss of blood. The wound was found to extend through the bone into the lateral sinus, which contained only some fluid blood. ”