Treating Hemorrhage With Water (Aqua)

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.

Treating Hemorrhage With Acetic Acid (Acidum Aceticum)

Syringing with vinegar is frequently used as an astringent and styptic remedy for bleeding from the nose, and sponging with it for parenchymatous hemorrhage; in metrorrhagia it may be used by vaginal injection, or tampons may be soaked in it. These, however, irritate and become unpleasant in four to six hours.

Treating Hemorrhage With Sulphuric Acid (Acidum Sulphuricum, Oil Of Vitriol)

Sulphuric acid was formerly in very frequent use as an internal remedy for hemorrhage, especially of passive character, whether from the stomach, lungs, or uterus. That there is difficulty in explaining how it can exercise astringent effect after dilution and possibly combination in the blood, would be no argument against its use if this were proved efficacious; but my experience is the same as that of many modern observers (among whom I may mention Nothnagel and H. C. Wood), who give to sulphuric acid a secondary place among haemostatics, although I have known it succeed sometimes when other remedies have failed.

Treating Hemorrhage With Ammonia Gas (Ammonium)

In hemorrhage of different kinds, usually passive in character, the chloride is praised by Copland, who gave it with hydrochloric acid. It is not much used, but Warburton Begbie has seen good results from doses of 20 gr. in haematuria: in the illustrative case recorded by him, there was no definite cause for the malady (Lancet, ii., 1875).

Treating Hemorrhage With Silver (Argentum)

In cases of continued oozing from small points in the skin or mucous membranes, such as occurs after leech-bites, a finely-pointed stick of nitrate firmly pressed on the part is a good astringent. In bleeding from the mucous membrane of the bladder, such as accompanies vesical tumor, injections should be made, beginning with weak solutions, and increasing the strength by degrees if necessary. Mr. Christopher Heath speaks highly of this plan, and I have seen several instances of its successful use in his hands.

Treating Hemorrhage With Iron (Ferrum)

The astringent compounds of iron with a mineral acid are excellent local styptics in all forms of capillary hemorrhage, such as from leech-bites, wounded gums, hemorrhoids, bleeding from the nose, etc. The part should be thoroughly cleansed from clot, and then a plug or compress moistened with the solution should be firmly pressed upon it, or in cavities an injection (diluted) may suffice. Sir James Simpson strongly commended a solution of the perchloride in glycerin, used it freely for all forms of hemorrhage, and with special success in some severe cases of bleeding from the vagina and uterus (Medical Times, i., 1858, p. 79). Demarquay, Lallemand, and Deleau were using the same haemostatic with great advantage in France about the same time (Gazette des Hopitaux, 1858-59).

The liquor ferri perchloridi fortior (British Pharmacopoeia) is quite serviceable for the purpose, but is more acid, and proves often more irritating than need be, and may be well diluted with an equal part of water or glycerin. The liquor ferri sulphatis is preferred by many surgeons, and by others the liquor ferri subsulphatis, or Monsel's solution 1 of the U. S. Pharmacopoeia; this is made with sulphate of iron, sulphuric and nitric acids, and is much less caustic and irritant than our solution; it is used in rectal hemorrhage - 1 part to 4 of water (Allingham: Lancet, i., 1874) - and the "haemostatic cotton" used by Marion Sims is prepared with it. The so-called "iron alum" is probably an equally effective preparation.

Treating Hemorrhage With Magnesium

Sulphate of magnesia is a valuable adjunct to astringent remedies for hemorrhage, because it helps to lessen arterial tension and capillary congestion at the same time that it obviates constipation. In menorrhagia it may be given with sulphuric acid; in haemoptysis, with ergot, acid, and digitalis (H. Dobell); and in hoematemesis, with alum and opium (Barlow).

Treating Hemorrhage With Magnesium

The chloride of manganese and iron has been used by M. Petrequin, in preference to the simple perchloride of iron, as a local haemostatic; and in Italy it has been applied to necrosed bone, and injected into fistulous tracts and hydroceles (Practitioner, vol. v., p. 375), but it has no proved advantage over other well-known remedies.

Treating Hemorrhage With Lead (Plumbum)

The acetate of lead has decided power over many forms of internal hemorrhage, and is still in frequent use, though not so much so as formerly. Dr. Elliotson often prescribed it in 2 to 3-gr. doses; Dr. Stokes says "nothing can be more striking than its power to arrest the discharge in chronic bronchial hemorrhage," and I have more than once verified this. Dr. C. J. B. Williams recommended 3 gr. with opium every hour or half-hour in cases of hoemoptysis, taking care to give a daily dose of purgative salts (Lancet, i., 1862). In the hemorrhage of enteric fever, acetate of lead is often valuable.

In an obstinate case of hoematuria (renal), after failure of tannin, iron, and other remedies, grain doses of lead acetate, with 1/2 gr. of opium, given every six hours, soon arrested all bleeding; a blue line appeared on the gums within a week of this treatment (Gull: Lancet, i., 1866). In uterine hemorrhage, acetate of lead with opium is often suitable. Dr. Dewees used it largely in plethoric menorrhagia and in hemorrhage occurring during pregnancy.

Dr. Workman has written to advocate a novel prescription, which theory would scarcely seem to justify, though the practice is said to be advantageous; he gives the acetate in 1/2 to 1 dr. doses without any opium; this causes diarrhoea, but no other bad symptoms, and produces, he says, the best results in haemoptysis and also in uterine hemorrhage, and causes contraction of the uterus (Medical Record, 1878).