374 HEMORRHAGE the vessels of the living body, called active or passive according as it is arterial or venous in character. Haemorrhage may be natural, as in the menstrual discharge; symptomatic of disease, as in scurvy, typhoid fever, epistaxis, and haemorrhoids ; essential, inasmuch as the bleeding appears to constitute the principal disease, arising from and keeping up a degen- eration of the vital fluid ; and traumatic, when the blood vessels are wounded. Active haem- orrhage, when not traumatic, consists in an escape of blood from the capillaries, distended and ruptured by inflammation and excitement, as in bleeding from the mucous membrane of the lungs, nose, rectum, urethra, and from granulating wounds; this is accompanied by local heat, pain, tension, and general febrile condition. In passive haemorrhage the blood is venous, as in chronic diseases of the liver, uterus, and rectum. There are certain persons called " bleeders," in whom a haemorrhagic diathesis exists, a peculiar and often hereditary constitutional defect in which the blood seems to have no power of coagulation and the ves- sels none of contractility ; in such the most trifling wounds are followed by profuse and sometimes uncontrollable and fatal bleeding. The symptoms of haemorrhage vary according to its seat, whether external or internal, active or passive ; the amount of blood lost is almost always greatly overestimated by terrified pa- tients and bystanders. In most acute attacks there are premonitory symptoms, constituting the so-called molimen hcemorrkagicum, such as chills followed by heat and fulness of the vessels of the part. A small loss of blood may produce great relief* in congestions and inflam- mations, but haemorrhage carried beyond this point causes paleness, chilliness, cold sweats, nausea and vomiting, hurried respiration, weak and rapid pulse, dizziness, fainting, and finally convulsions and death. In severe wounds these symptoms may in a few moments end fatally; at other times the train may be pro- longed for years, with a gradual sinking of the vital forces. In acute inflammations an amount of blood may be taken which would be seriously felt in a state of health. Bouillaud and his disciples of the French school applied the lancet, cups, and leeches in a way that de- servedly excited the opposition of other prac- titioners ; Lisfranc, in a case of tetanus, bled a patient from the arm 19 days in succession, and applied nearly 800 leeches along the spine. The loss to the system from profuse bleeding is very soon made up, and the sooner in pro- portion to the rapidity of the abstraction, in a healthy person ; while the feebleness arising from frequent but inconsiderable haemorrhages may require years for its removal. Modern practitioners generally avoid venesection ex- cept in inflammatory and congestive diseases of threatening character, as where the brain, heart, and lungs are in momentary danger; arterial sedatives (like digitalis and veratrum viride), and revulsives to the skin and mucous HAEMORRHOIDS membranes, have nearly taken the place of the lancet and the leech. Bleeding from the nose is most frequent in the young, from the lungs between the time of puberty and adult age, and from the rectum, bladder, and uterus later in life. The prognosis of haemorrhage varies according to its origin and amount, and the constitution of the individual. While an effusion of blood into the brain or the peri- cardium would be very dangerous, a bleeding from the nose or from piles would be generally of little importance; blood coming from the stomach and urinary organs is a graver symp- tom than that from the air passages ; a rapid is more dangerous than a slow loss to the same amount, and a passive than an active haemor- rhage. The treatment of haemorrhage, ex- clusive of strictly surgical means, consists, in the active forms, of general and local de- pletion, cold and astringent applications ; the administration of digitalis andveratrummride to quiet the circulation ; of common salt, es- pecially in bleeding from the lungs; of the mineral acids, chloride and sulphate of iron, vegetable astringents, as tannin, and sometimes ergot of rye ; and rest and elevated position of the bleeding part when practicable. Arterial haemorrhage maybe known by the florid color, profuse quantity, and pulsating jet of the blood. Nature's processes for arresting such a flow are the contraction of the divided orifice, the re- traction of the vessel into its sheath, the coag- ulation of the blood in and about the sheath, and the retardation of the circulation by faint- ness ; and these will generally suffice for the wound of an artery of the size of the temporal. When art interferes, it is by pressure, torsion, the ligature, cold, styptics, and caustics ; a par- tial is more dangerous than a complete division of an artery, as contraction and retraction are prevented, and for this reason a small vessel should be completely divided. A lacerated artery contracts almost immediately, and rarely bleeds; hence the umbilical cord of animals bitten or torn by the mother gives forth no blood, and hence the efficacy of torsion. Haem- orrhage from a vein is continuous and darker colored, and rarely dangerous, unless from a large, deep-seated, or varicose vessel ; pressure, elevated position, and styptics will generally arrest it, and as a last resort the ligature. Bleeding from the nose may be either arterial or venous, and requires nothing special beyond snuffing up astringents and plugging the nos- trils. In each case the treatment must depend upon the seat of the lesion, and other circum- stances, which require either topical or gen em 1 remedies. Whenever topical applications are admissible, they are the most efficient. For haemorrhage of the lungs and rectum, see IL- MOPTYSIS, and HEMORRHOIDS. Bleeding from the stomach is hcematemesis, and that from the uterus metrorrhagia, or menorrhagia when, connected with the menstrual discharge. II 1:11011111101 US (Gr. atfza, blood, and ptetv, to flow), or Piles, tumors situated near the
