H.KMATOXYLON CAMPECH1ANUM. 



H.KMOHRHAOE. 



oo 



H.EMATO-XVLON CAMPECHIA'KUM (Logwood), a tree native 

 of Campeachy, but cultivated abw in both the Wert and East Indies. 

 The finest wood is the produce of the former place. The bark and albur- 

 num bring removed, there is within a dark red coarse-fibred duramen, 

 baring a violet-like odour, and a taste at first sweetish, afterwards 

 astringent. It dye* the saliva violet-coloured, and produces a similar 

 change on many of the other secretions. Specific gravity, 1-057. Ten 

 pounds of wood yield 10-18 ounces of extract Its chief constituent* 

 are volatile oil, resinous or fatty matter, a principle termed krematory- 

 KM, which is occasionally found in the wood in the form of crystal*, 

 and a brown matter containing tannin. 



Logwood act* a* a mild astringent in hemorrhage* or increased 

 ecretions ; and in some forms of diarrhoea it often effect* a cure where 

 more powerful astringent* fail (See Abercrombie on ' Diseases of the 

 Stomach, Ac.') It may be exhibited in the form of infusion or of 

 extract : the former is preferable. It is accused of causing phlebitis, 

 or inflammation of the veins, in some cases where it had checked the 

 diarrhoea ; but this is very rarely met with. Logwood is also used 

 extensively in the art*, especially for dyeing. It gives the peculiar 

 colour to the paper in which sugar-loaves are generally wrapped. It 

 forms the basis of red ink, when Brazil wood is not used. 



H.KMATT'KIA (from O?M, blood, and ofyoy, urine), voiding of 

 bloody urine. [HJEMORKHAGE; KIDNEYS, DISEASES OF.] 



H.EMO'IT YSIS (from 01/10, blood, and WTM>, to spit), a spitting or 

 coughing of blood. [H J.UOHRHAGE ; LUNGS, DISEASES OF ; PHTHISIS 



PCLMONALIS.] 



HEMORRHAGE (from ofra, blood, and ^n^u, to break). The 

 most common cause of haemorrhage is external violence, by which the 

 TBS* Bin of a part are divided, and the blood escape* from their cavities. 

 When an artery of some calibre is wounded, a bright scarlet stream of 

 blood is propelled to a distance proportioned to the size of the vessel, 

 in a current continuous, yet increased in force at intervals corresponding 

 with the pulsations of the heart. This is called a jetting stream. If 

 a vein of some size be divided, a stream of dark crimson blood is pro- 

 jected in a perfectly continuous and equable current, and with leas 

 force than from an artery of the same calibre, in consequence of the 

 loss of power which the blood sustains in its passage through the 

 minute capillary vessels. In wounds in which no vessel of more than 

 a line in diameter has been divided, the blood flows in a constant more 

 or leas rapid oozing, but is not projected to any distance from the 

 body ; and when it issues from both kinds of vessels at once, and in 

 equal quantities, its colour is intermediate between those peculiar to 

 each of them. The same mixture of the two kinds of blood may some- 

 times, when a number of small vessels of both kinds, and a large one 

 of either kind, are simultaneously divided, make it doubtful, from the 

 colour alone, to which kind it belongs ; and the distinction becomes 

 U11 more difficult if the arterial blood be long detained in the tissues, 

 for then it assumes a venous colour. 



When a large artery, as one of the main trunks of the limbs or head, 

 is divided, the blood rushes forth with such impetuosity that life is 

 often destroyed almost instantaneously. The quantity of blood lost 

 however, and the rapidity with which death ensues, will depend in 

 some measure on the freedom of exit which the blood finds after 

 issuing from the wounded vessel, as well as on the mode in which it is 

 wounded. If there be a free external aperture, no obstacle is presented 

 to it* flow, and death speedily follows ; if, on the contrary, the aperture 

 be small, as in a punctured wound, the blood can escape but slowly, 

 and is liable to coagulate in the passage, so as partially to block it up 

 and render it still more narrow. If again the artery be completely 

 divided, itn extremities will retract into the tissues around, and be thus 

 partly covered, so that the hemorrhage will be retarded. If it be 

 cut longitudinally, the blood will flow much less rapidly than if the 

 wound be transverse, because the aperture will gape much less widely. 

 If, lastly, the wound be not cleanly made, if the edges be rough and 

 torn, as by a gun-shot, no blood at all will flow, at least for some time. 

 None of these circumstances, however, is likely to do more than retard 

 the fatal consequence of a wound of a large artery, unless immediate 

 assistance be given. 



When an arterial branch of the second magnitude, as one of the 

 primary divisions of the main trunks in the leg or fore-arm, is wounded, 

 the flow of blood is at first profuse, and a large quantity is soon lost ; 

 but after a time the patient faint* from extreme exhaustion, and then 

 the heart ceasing to act the blood no longer flows, but begins to 

 coagulate both within and around the vessel, whose extremities con- 

 tract, and further loss may thus be prevented. More frequently, 

 however, as soon as the patient recovers from his exhaustion, and the 

 heart regains some of it* power, the slight obstacles formed during the 

 fainting are forced away, and the hemorrhage recommences and con- 

 tinues till the patient is again exhausted. Thus by a succession of 

 hemorrhages and of temporary staunching!, he may at last be destroyed 

 by extreme debility. From arteries of smaller size, as those about the 

 fingers, Ac., the blood flows at first in a rapid little stream, but after a 

 few minute*, if they are exposed to the cold air, they retract ; their 

 orifice* contract and close, and the bleedjng altogether ceases, without 

 much danger of returning. 



Hemorrhage from wounded veins is of less importance. It is much 

 more stow, for the blood is prevented by the valves from flowing from 

 that part of the vein which is between the heart and the orifice, and in 



the part which ia beyond the orifice it has only the force of that in the 

 smaller arteries. Hence it is seldom immediately fatal, and when the 

 patient become* faint the edge* of the vessel fall together, instead of 

 remaining open as those of arteries. Thus a coagulum forms within 

 and around them, and, except from the largest trunks, prevent* any 

 further flow. Other cases in which bleeding takes place from large 

 vessels are those in which they are burst by sudden efforts, as some- 

 times happens in the aorta, especially when it or the heart is diseased ; 

 those in which the walls of an aneurism or otherwise diseased artery 

 or vein burst or ulcerate ; those in which ulceration, whether in 

 internal or external organs, spreads from surrounding parts, and at 

 last (though they always resist for a long time) invade* the wall* of 

 arteries and veins. The bleeding so common from ulcerated surfaces, 

 and from various vascular morbid growths, probably depends on 

 rupture of the very delicate vessels which they contain ; and the same 

 delicacy of the walls of its vessels, with their great liability to diooose 

 in advanced life, may be assigned for many cases of haemorrhage in the 

 more vascular part* of the brain producing apoplexy. 



But bleeding to a great extent may take place without visible rupture 

 of any vessel. This form of hemorrhage, which may take place in 

 various parts of the body, is that popularly supposed to arise from the 

 " bursting of a blood-vessel ; " but in the large majority of case* where 

 blood is poured forth in the interior of the body, the most careful 

 examination can discover no aperture through which it had flowed. 

 It is therefore called haemorrhage by exhalation, from the idea that the 

 vessels which in health ore traversed only by the fluids of the exhala- 

 tions or secretions, now permit the passage of the blood. The only 

 instances in which the blood has been seen flowing in these coses are 

 those extremely rare ones of hemorrhage from the skin of the face, 

 hands, feet, &c. In these the mi-face is covered by a dew of blood ; if 

 this be wiped away no unnatural appearance is perceptible, but the 

 blood soon exudes again. From this the process would appear to be 

 very similar to that of menstruation. When internal organs from 

 which haemorrhage has taken place are examined after death, they are 

 sometimes found loaded with blood, but at others quite pale, their 

 vessels having been completely emptied ; when pressed, small clots of 

 blood like grains of sand sometimes ooze out on the surface, as if 

 proceeding from the orifices of secreting ducU. From these and other 

 circumstances it is probable that the blood does pas* through the 

 vessels which naturally ore permeated by the secretions, though the 

 minute details of neither process are yet wholly explicable. It cannot 

 however be certainly affirmed that the minute blood-vessels ore not 

 ruptured, for neither the apertures nor the cicatrices in them could be 

 in any way visible. 



The circumstances under which these hemorrhages take place are 

 various. In some cases they arise from distension of the vessels in 

 consequence of some local excitement, either with or without increased 

 activity of the circulation generally ; and in these the flow of blood is 

 preceded by a sensation of fullness and throbbing in the port, which, if 

 visible, appears red and swollen. Such are those which take place in 

 bronchitis, producing some rare cases of hemoptysis ; in dysentery and 

 acute inflammation of the intestines ; from the membrane of the nose, 

 producing the epistaxis so common in young persons in robust health ; 

 in the brain, producing some forms of apoplexy, especially those con- 

 nected with hypertrophy of the heart ; and occasionally in the acute 

 inflammations of nearly all the tissues. In other cases the main cause 

 of the hemorrhage is the existence of some obstacle to the free passage 

 of the blood through the vessels. Such ore those very frequent cases 

 in which hemoptysis, or spitting of blood, takes place in consumption, 

 where the blood is obstructed in it* passage through the pulmonary 

 arteries by the masse* of tuberculous matter deposited around them ; 

 those of hematemesis, or vomiting of blood, which arise from obstruc- 

 tion of the splenic or portal vein, by coagula, or by disease of the liver 

 or other adjacent organs, and the consequent congestion of the vessels 

 of the stomach ; many of those which occur from the stomach, uterus, 

 and other organs, in the early stages of various structural diseases ; 

 those which depend on disease of the heart, producing obstruction in 

 the large vessels, and which may take place in the brain, lungs, and 

 various other organs ; and those arising from obstacles in the veins, as 

 in hanging, or even from the influence of gravitation. 



But a simply mechanical distension of the vessels, whether from an 

 increased afflux of blood into them, or a retarded removal of it from 

 them, cannot explain all the phenomena of these spontaneous hemo- 

 rrhage*. In many cases a peculiar condition of the vessels, or of the 

 blood itself, must be assumed, and is indeed nearly proved. To these 

 must be referred many case* of what is called idiopathic hemorrhage, 

 as in some instances of hematemeais, hematuria, Ac. In some ]>cr- 

 sons, indeed, there appears to be a peculiar disposition to bleeding, a 

 hemorrhage diathesis. Mr. Abcrnethy ('Surgical Lectures') used to 

 speak of a bleeding family, in all of whom it was extremely difficult to 

 staunch the blood from even the slightest wound ; and among other 

 similar case* are not a few in which fatal hemorrhage has followed the 

 extraction of a tooth, or, in children, the application of leeches. Every 

 surgeon, also, must have observed that in the same operatic 

 different persons the number of vessels requiring to be tied varies 

 greatly ; in some amputations, for example, it is not necessary to 

 secure more than the main artrry, while in others eight or more must 

 be tied, and this not admitting of any explanation from local differences 



