H AE M 729 H AE M to which we should add, avoiding the irritations of light, heat, noise, and agitation of either mind or body. It must be remembered, that, when we spoke of cold as a means of producing haemorrhage, it was its sudden application, particularly to the extremities. In the cure of haemorrhages, its continued application is chiefly necessary. Sedatives are equally useful with the same views; but opium is, as we have said, a doubtful remedy, as supposed to unite a stimulating power. Faintness, and even that degree of it produced by nauseating doses of medicines, checks the discharge; and, perhaps, that faintness induced by injecting tobacco smoke into the rectum may have the same effect. We are confident that the digitalis has been useful chiefly in this way.

Another method of curing haemorrhages is by derivation. For this purpose, rubbing the feet with mustard, or putting them in warm water, has been advised; but the operation of the last remedy is suspicious: if the water is too warm, and the pediluvium too long continued, greater injury than advantage will result. To this head also the effects of blisters and cupping, without scarifications, may be, in part, referred.

Astringents have been liberally employed; a practice probably suggested by the benefit derived from their external application to wounds. Internally, as we have stated under the head of Haemopttsis, q. v., they are of doubtful and suspicious efficacy, unless they are such as unite a sedative power. We mean not to include in this censure astringent applications in bleedings of the nose, for these are external remedies.

Saturnine remedies are the doubtful astringents we have alluded to: they are very certainly sedatives of the most powerful kind, and an exception to the tonic powers of metals in general. Every preparation of lead is however, supposed to be deleterious, and the cause of the colicapictonum; but scarcely in any instance does lead produce this effect, except from long continuance. Dr. Reynolds' courage has been extolled in ordering a grain of acetated lead in a single dose. Five times that quantity may be given twice a day for some days, interposing only an oily laxative ever)- other day. We have often employed it in haemorrhages, sometimes with success; but it is certainly inferior in its sedative effects to nitre.

Preventing the return of the blood to the heart by means of ligatures on the extremities has been a mode of relieving haemorrhages; but the plan is injudicious, and it will scarcely in any instance succeed, unless after a few minutes trial; for the course of the blood in the arteries is soon interrupted, and an increased impetus of the whole circulating system is the consequence.

Various are the objects of superstition and horror employed for the same purpose, and probably with success; for terror annihilates every function, checks the circulation, and will even produce the deliquium which is the constant cure of the complaint.

Among the causes of haemorrhage, we have mentioned that want of energy in the arterial system which prevents the circulation being earned on to the extremities. Practitioners may often observe haemorrhages, with some appearances of activity, in the debilitated and the indolent of spare habits, without any marks of plethora. Such patients can scarcely be reduced lower; and we have found a fuller diet, exercise, a moderate quantity, or rather an additional quantity, of port wine, not only useful but necessary in such cases of haemoptysis.

Passive haemorrhages are those which are independent of fever, and in which the blood is poured out either by anastomosis or rupture of vessels. The former term is perhaps not sufficiently correct: it means a discharge of blood through the exhalants. Rupture of the vessels, however, is not uncommon in the last stage of debility, or in old age. All the appearances of catamenia in the advanced periods of life, are probably rather passive haemorrhages than the proper menstrual discharge. Perhaps, in a strict view, all ruptures should be ex -eluded from this class; but if no effort is perceivable, no increased impetus obvious, we are not authorized in supposing that any exists.

The causes of passive haemorrhages are either extreme debility, or a dissolution of the blood. The serum is dissolved in the serosity by the means of neutral salts; and an alkali, or even common salt, carried in an unusual quantity into the circulating system, will apparently produce a dissolved state of the fluids. From Dr. Stark's experiments, it is probable that sugar, used in excess as an article of diet, will have a similar effect. Some poisons will, it is said, produce this disease. The haemorrhois of Lucan may be fabulous; but the effects are peculiarly striking.

" Sanguis erant lacrymae: quaecunque foramina novit Humor, ab his largus manat cruor: ora redundant, Et patulae nares: sudor rubet -. omnia plenis Membra fluunt venis: totum est pro vulnere corpus."

Strange, however, as it may appear, we have seen even this picture realized, in a stout young farmer, without any known cause. We have seen it in a less degree in a delicate woman from excess of nourishment, taken for a supposed weakness. Each recovered: the first by the most active exhibition of the bark and mineral acids, the other by regulation of diet. In the former the muscular strength was apparently not impaired.

The cure of passive haemorrhages chiefly depends on tonics; and of these, as we have said, the bark and the mineral acids are the most effectual; but even passive haemorrhages are often relieved by refrigerants, particularly by nitre.

In externa] haemorrhages the blood chiefly proceeds from the arteries; for even the bleeding from a large vein, if divided, ceases, from fainting coming on. When the wound or the size of the artery is considerable, a tourniquet above the wound is necessary; but in slight cases a compress of lint, or of lint mixed with the powder of vitriolated copper, confined with a proper bandage, is sufficient. The needle and ligature are sometimes necessary. See Wounds of the arteries.

Haemorrhagia nasi, epistaxis of Cullen, in the class pyrexia, and order hemorrhagiae. He defines it pain or load of the head, flushing of the face, with a flow of blood from the nose, of which he names one idiopathic species, haemorrhagia plethorica, and six symptomatic; four from internal, and two from external, causes. Hippocrates means by epistaxis, repeated distillations of blood from the nose; and Fernelius observes, that"persons whose viscera and liver are weak

H AE M 730 H AE M and scirrhous are subject to frequent haemorrhages of the nose, as well as dropsical patients;" but, in general, it is the disease of the young and the plethoric.

The causes, in general, are the same as in other morbid haemorrhages.

Epistaxis is often preceded by some degree of quickness in the pulse, flushing in the face, pulsation in the temporal arteries, heaviness in the head, dimness of sight, heat and itching in the nostrils; preceded, like other haemorrhages, by a stricture of the skin, chilliness, lassitude, and often costiveness.

In many instances the loss of blood by the nose is salutary, as in fevers, vertigo, headach, epilepsy, dimness of sight. Those who in childhood often bleed at the nose when older become subject to haemoptysis, rheumatism, and haemorrhoids. When considerable headach has preceded, or the patient been subject to vertigo, or other diseases proceeding from too great an accumulation of blood in the vessels of the brain, bleeding at the nose should not be rashly checked. In fevers, when there is a load in the head, the same caution has been given; and it is, perhaps, the safest general rule: but we think even in the beginning of fevers we have found it lower the strength in too great a degree; and it should be apparently regulated rather than permitted to proceed till the patient faints. The nose is peculiarly adapted to deplete the arteries of the brain, as its vessels are numerous, their coats thin, and they are supplied with blood both from the external and internal carotids, which freely anastomose in this organ.

When it is to be checked, the remedies, mentioned under haemorrhage, will be proper; but particularly nitre and the neutral laxatives. A cold wet napkin, or a sponge full of cold vinegar, with water, may be applied to the forehead and nose; and any thing very cold put down the back will occasion a shiver, during which the bleeding is checked. Dossils of lint, wetted with water, or oxymel, are often advantageously introduced into the nostrils.

When, notwithstanding every medicine and application, the blood continues to flow from the nose, the following method is often effectual. The hint of this method of stopping up the nostrils and passage to the throat is taken from Ledran's Operations, case vi. in the Remarks, and easily cures the complaint."take a piece of strong sewing silk, wax it well, and to one end of it fasten a dossil of lint; then take a piece of catgut (about the size of the second string of a violin,) and introduce it up the bleeding nostril: when you perceive it in the mouth, take hold of its end with the forceps, and draw it out from thence, make a knot upon it, and fasten the end of the waxed silk to it; then withdraw the catgut back again by the nostril, take hold of the silk, and pull the dossil of lint into the posterior nostril; after which stuff the anterior nostril full of lint, and thus you certainly stop the bleeding. After a few days the lint may be taken away." See Hoffman; and Van Swieten's Commentary on Boerhaave's Aphorisms; Cullen's First Lines, edit. 4. vol. ii. p. 256; Bell's Surgery, vol. iv. p. 70; London Medical Transactions, vol. iii. p. 217; White's Surgery, p. 263.

Haemorrhagia uterina. See Menorrhagia.

Haemorrhagia hepatis, vel intestinorum. See Mi.laina, and Morbus niger.

Haemorrhagia renum, vel vesicae. See Urina.