Haemorrhage

Haemorrhage (Gr. αἷμα, blood, and ῥηγνύναι, to burst), a general term for any escape of blood from a blood-vessel (see Blood). It commonly results from injury, as the tearing or cutting of a blood-vessel, but certain forms result from disease, as in scurvy and purpura. The chief varieties of haemorrhage are arterial, venous and capillary. Bleeding from an artery is of a bright red colour, and escapes from the end of the vessel nearest the heart in jets synchronous with the heart’s beat. Bleeding from a vein is of a darker colour; the flow is steady, and the bleeding is from the distal end of the vessel. Capillary bleeding is a general oozing from a raw surface. By extravasation of blood is meant the pouring out of blood into the areolar tissues, which become boggy. This is termed a bruise or ecchymosis. Epistaxis is a term given to bleeding from the nose. Haematemesis is vomiting of blood, the colour of which may be altered by digestion, as is also the case in melaena, or passage of blood with the faeces, in which the blood becomes dark and tarry-looking from the action of the intestinal fluids. Haemoptysis denotes an escape of blood from the air-passages, which is usually bright red and frothy from admixture with air. Haematuria means passage of blood with the urine.

Cessation of bleeding may take place from natural or from artificial means. Natural arrest of haemorrhage arises from (1) the coagulation of the blood itself, (2) the diminution of the heart’s action as in fainting, (3) changes taking place in the cut vessel causing its retraction and contraction. In the surgical treatment of haemorrhage minor means of arresting bleeding are: cold, which is most valuable in general oozing and local extravasations; very hot water, 130° to 160° F., a powerful haemostatic; position, such as elevation of the limb, valuable in bleeding from the extremities; styptics or astringents, applied locally, as perchloride of iron, tannic acid and others, the most valuable being suprarenal extract. In arresting haemorrhage temporarily the chief thing is to press directly on the bleeding part. The pressure to be effectual need not be severe, but must be accurately applied. If the bleeding point cannot be reached, the pressure should be applied to the main artery between the bleeding point and the heart. In small blood-vessels pressure will be sufficient to arrest haemorrhage permanently. In large vessels it is usual to pass a ligature round the vessel and tie it with a reef-knot. Apply the ligature, if possible, at the bleeding point, tying both ends of the cut vessel. If this cannot be done, the main artery of the limb must be exposed by dissection at the most accessible point between the wound and the heart, and there ligatured.

Haemorrhage has been classified as—(1) primary, occurring at the time of the injury; (2) reactionary, or within twenty-four hours of the accident, during the stage of reaction; (3) secondary, occurring at a later period and caused by faulty application of a ligature or septic condition of the wound. In severe haemorrhage, as from the division of a large artery, the patient may collapse and death ensue from syncope. In this case stimulants and strychnine may be given, but they should be avoided until it is certain the bleeding has been properly controlled, as they tend to increase it. Transfusion of blood directly from the vein of a healthy person to the blood-vessels of the patient, and infusion of saline solution into a vein, may be practised (see Shock). In a congenital condition known as haemophylia (q.v.) it is difficult to stop the flow of blood.

The surgical procedure for the treatment of an open wound is—(1) arrest of haemorrhage; (2) cleansing of the wound and removal of any foreign bodies; (3) careful apposition of its edges and surfaces—the edges being best brought in contact by sutures of aseptic silk or catgut, the surfaces by carefully applied pressure; (4) free drainage, if necessary, to prevent accumulation either of blood or serous effusion; (5) avoidance of sepsis; (6) perfect rest of the part. These methods of treatment require to be modified for wounds in special situations and for those in which there is much contusion and laceration. When a special poison has entered the wound at the time of its infliction or at some subsequent date, it is necessary to provide against septic conditions of the wound itself and blood-poisoning of the general circulation.

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