The application of iced or cold water is an old, and commonly an efficient method of restraining hemorrhage from small vessels. The jet of water, or the soaked cloth or sponge should be applied suddenly for a few moments at a time. Mr. C. B. Keetley has lately drawn attention to the value of hot water as a haemostatic, and quotes a case of thigh-amputation, where a sudden drenching with water at 120° F. stopped the bleeding after cold water had failed to do so. He suggests that in such cases it acts as an excitant to the nerves of the small vessels, and perhaps directly irritates the muscles themselves (Practitioner, February, 1879). Dr. Paul Brown found water at 150° F. succeed well in staying hemorrhage after an amputation when Esmarch's bandage was removed (Medical Record, 1879).

Mr. Keetley has also found hot water efficacious in epistaxis, though he acknowledges that "it is powerless against it if of a certain grade of severity," and I have myself seen its use in a very severe case followed by serious results. During one attack the attendant had applied it for some time, though the bleeding continued, and the patient became alarmingly prostrate. I stayed the flow quickly with cold water, but in a second attack, some weeks afterward, I heard the hot water treatment was again employed, and the patient died of syncope.

In Uterine Hemorrhage the results of hot water injections have been more satisfactory. Windelband used it at 117°, 120°, 124° F. (Medical Times, 1876). Emmet (New York) and Whitwell found it very safe, efficient, and disinfectant in post-partum hemorrhage (Lancet, i., 1878, p. 920). Lombe Atthill uses it constantly (at 110° F.) in his practice at the Rotunda, not only in hemorrhage, but also in chronic uterine congestions. Ricord finds a hot uterine douche, 122° F.,"almost infallible" in menor-rhagia. C. Richter uses hot douches for hemorrhage in childbed, and reports 105 cases occurring in the Charite (Berlin) where they had been employed with excellent results; he recommends injections of three to five pints at 122° F. into the uterine cavity through a catheter, and for the sake of disinfection adds a proportion of 1 per cent. of carbolic acid; he says that the hot water coming in continued contact with the inner surface of the uterus causes a soaking and swelling of the tissues, particularly of the peri-vascular connective tissue, and thus checks the hemorrhage (Zeitschrift fur Geburtshulfe und Gynoecologie).

Peter recommends it for cases of non-puerperal hemorrhage; his theory is that through the irritation of the lumbar ganglia the vaso-motor nerves get into a state of "over-activity," and that the vessels contract accord-ingly (Centralblatt fur Gynoecologie). I have myself ordered hot water injections in several cases of uterine hemorrhage, directing a stream at 122° F. into the uterine cavity, and the effects have been various. When hemorrhage arose from cancer, sometimes there was immediate relief, which lasted for some days, but in others the bleeding was increased; when the bleeding arose from a retained portion of the placenta a larger flow occurred; when caused by an atonic state of the uterus the hot water injection alone did little good, but when alternated with cold injections, 60° to 70° F., the result was excellent. In all other cases of hemorrhage the effect was beneficial. I am satisfied that the water should be as hot as possible, otherwise success cannot be secured; and I agree with Runge in calling it "a non-infallible but an important remedy." It is already largely used in London practice, with very general satisfaction. Hot water bags applied to the lower part of the spine also prove useful in uterine hemorrhage.