601 



HAEMORRHAGE. 



HAIL, HAILSTONES, HAILSTORMS. 



603 



Many other circumstances might be adduced to show that there are 

 conditions of the smaller vessels in which they may not only more 

 easily permit haemorrhages, but are less capable of effecting those 

 changes which are necessary for arresting them, and on these con- 

 ditions the majority of the haemorrhages termed passive must be 

 supposed to depend. Such are especially those from the nose, rectum, 

 and other organs, which occur in persons of weak lax habit, and 

 which may be distinguished from the first class we have noticed 

 rather by the general appearance of the patient than by any local 

 circumstances. 



Lastly, there are cases in which the haemorrhages that take place, 

 often coiiicidently from several organs, may be presumed to depend on 

 alterations of the blood itself. Such are those that occur in scurvy, in 

 which the blood, when drawn from a vein, does not separate, as in 

 health, into a 6rm coagulum and a clear serum, but settles into a loose, 

 livid, or dark jelly-like mass, and rapidly putrefies. Such, too, are 

 probably the petechial and other effusions of blood in fever. 



Haemorrhages by exhalation may take place habitually or consti- 

 tutionally, without injuring the health ; most commonly the blood 

 flows from the nose or rectum, more rarely from the lungs or stomach, 

 or even from the skin. They are sometimes periodical ; and when 

 occurring in men, have seemed to favour the idea of a periodic action 

 of the system in the male sex as in the female, and the more so as the 

 menstrual evacuation, when suppressed in the latter, is not unfre- 

 quently compensated for by haemorrhage from some other organ. 

 Most of the cases of spontaneous bleeding from the skin are of this 

 class ; and in other instances the blood has flowed at regular periods 

 from the gums, the breasts, umbilicus, axilla;, or kidneys, but most 

 frequently from the stomach or lungs. Similar vicarious hemorrhages 

 occur in men when an habitual discharge from any organ has been 

 suppressed, or when an old ulcer has been suddenly healed. 



Of the mean* of arresting Ifcemorrhaya. When an artery is wounded, 

 unless death rapidly follow, a natural process takes place by which 

 further bleeding may be prevented. If completely divided, both 

 extremities retract into the sheath of cellular tissue in which they lie, 

 so that a considerable interval is produced between them, bounded by 

 loose and irregular walls, into which the blood as it flows infiltrates, 

 and, coagulating, tends to fill it up and obstruct the vessel. The open 

 mouths of the artery also contract, and gradually, but at last completely 

 close, either at or just above their extremities. As the stream of blood 

 is thus checked by the narrowing and closing of its canal, at the 

 same time that, by the faiutness induced by the previous loss, the 

 action of the heart is weakened and the whole circulation retarded, it 

 begins to coagulate within the vessel itself, till its tube is nearly filled 

 by a clot adhering loosely to its walls. Further changes then ensue ; 

 the divided vessel and the parts around become inflamed ; coagulating 

 lymph is effused from the edges of the wound into the artery itself and 

 over its extremities, forming a firmer plug than the blood alone had. 

 In process of time this lymph becomes organised, vessels enter it from 

 the parts around, and it becomes firmly and permanently united to 

 them and the vessel, till at length its tube is rendered impervious 

 from the point of division up to the first branch given off from it, and 

 in at last converted into a solid cord, closely connected with the sub- 

 stance of the cicatrix around it. If the artery be only partially divided, 

 the same effects follow ; though, if the cut be extensive transversely, 

 with less certainty, because retraction cannot take place, and the 

 internal coagulum, if formed, is washed away by the stream which 

 still partly passes along the vessel. The natural cessation of haemo- 

 rrhages from veins is effected in the same manner, but far more easily ; 

 for the valves prevent any bleeding from the part nearest to the heart, 

 and both orifices, instead of gaping open, fall together, and soon become 

 adherent. 



But in the human subject it is only in the veryjunall arteries that 

 the haemorrhage can be confidently expected to terminate thus natu- 

 rally, and hence various artificial means of checking bleeding from the 

 larger ones have been invented. The simplest of these is pressure : if 

 the finger be placed with moderate firmness over the mouth of a small 

 bleeding vessel for a minute or two, on removing it the orifice will be 

 found closed, and no more blood will flow. Pressure is also especially 

 useful when a number of small arteries are bleeding together, with a 

 constant oozing rather than a rapid flow of blood : in such cases, when 

 the edges of the wound are brought together, a compress should be 

 laid on, and bandaged firmly and steadily over them. The same means, 

 or a tourniquet applied a short distance above the wound, so as to 

 compress the trunk of the artery, may be useful by lessening the force 

 and volume of the current, and thus permitting the natural processes 

 to take place undisturbed. But if these means be insufficient, the 

 artery must be tied ; if it be completely divided, ligatures must be 

 pltfced on both extremities ; and if only partially cut, then on both 

 aides of the opening for, from the numerous communications of the 

 arteries, when the main current is checked, another in a retrograde 

 direction is always established into the part beyond the ligature. The 

 operation of the ligature is not merely to prevent mechanically the 

 flow of blood from the opened vessel. When a fine cord is drawn 

 tightly round an artery, something is felt to give way under it, and, on 

 removing it and opening the artery, its inner and middle membranous 

 coats are found cleanly cut through as with a knife, while the outer 

 coat remains. When the ligature is left on, it embraces this outer coat 



loosely, and thus rendering the canal impervious, completely prevents 

 further bleeding. The blood thus becoming stagnant, coagulates in the 

 lower part of the vessel and adheres to its walls ; these at the same 

 time inflame, coagulating lymph is effused from their cut edges, and 

 becoming organised, at last, as in the natural process, completely fills 

 up the canal of the vessel, while the part constricted by the ligature 

 ulcerates and gives way, permitting the cord to be safely drawn away 

 at the end of from six to sixteen days. 



Previous to the general use of the ligature, introduced by Ambrose 

 Pare' in the 16th century, numberless means for checking 

 haemorrhages, then so frequently fatal, were resorted to by surgeons, 

 under the names of styptics, astringents, &c. They were in the habit 

 of applying hot irons to the stumps of amputated limbs to stop 

 the bleeding, which it is probable the eschar thus formed would 

 generally effect. At present however the use of the actual cautery is 

 nearly abolished in this country ; it can only be justifiable in the few 

 cases where, from peculiarity of situation, the vessel can neither be 

 tied nor compressed, and for such cases it is certainly the most effectual 

 styptic known. Cold air or ice is nearly as useful, and far ofteuer 

 applicable : it is quite sufficient in all common cases where only small 

 vessels are divided. In the very few cases where any astringents are 

 required, as in some of external bleeding from diseased surfaces or 

 from tumours, the best are solutions of sulphate of copper and of 

 alum. Another class of remedies that may be usefully employed are 

 those which act mechanically as sponge, agaric, lint, and other light 

 very porous bodies, which placed over a small bleeding orifice will 

 soon completely obstruct it by favouring the coagulation of the 

 blood. 



Such are the principal modes of treatment applicable in cases of 

 external or surgical haemorrhage in which vessels are divided by 

 external injury, and are within reach of the eye or fingers. In internal 

 haemorrhages however it is obvious that mechanical means can rarely 

 be employed. From the varied nature of the cases from which they 

 arise it is evident that different means may be required in the several 

 kinds of cases. In those so closely related to inflammation, in which 

 there is accumulation of blood from local or general excitement, the 

 haemorrhage is itself a naturally curative means of its cause, and need 

 not be checked unless it implicates some important organ, as the brain, 

 and then the most advisable means of arresting it is to bleed from the 

 arm. So, too, in cases of habitual or vicarious haemorrhages, if not 

 dangerous or very inconvenient from locality, it will seldom be advisable 

 to check them, for they are generally outlets by which a plethoric 

 condition that would else be highly injurious is cured ; at any rate 

 they should be arrested gradually and cautiously. Where external 

 means are applicable none are so useful as cold, or, as a last resource, 

 pressure ; as by plugs put in the nostrils, &c. Where a mechanical 

 obstacle to the passage of the blood exists, medicine can often do 

 nothing for the permanent cure of the haemorrhage that it produces. 

 For the time, the most effectual means are cool air, cold water or ice. 

 applied as near as convenient to the seat of bleeding, iced drinks, 

 perfect quietude, and the avoidance of all stimuli ; the body should be 

 placed in that position in which blood may gravitate from the affected 

 part, and if there be any indication of plethora or accelerated circula- 

 tion blood should be drawn from the arm to an amount to be 

 determined by the circumstances of the case. In many cases great 

 benefit results from exciting the vessels, of and near the part, to a 

 copious secretion of the usual fluids, as in some cases of hrematemesis, 

 by administering purgatives. If astringent remedies be deemed 

 advisable, and in many cases they are highly useful, the acetate of lead 

 will generally be preferable, and next to it the different vegetable 

 compounds of gallic acid. [ASTRINGENTS.] The treatment of the 

 peculiar class of haemorrhages from alteration of the blood is con- 

 sidered under FEVER, Ac. Bleeding from the nose is treated under 

 EFISTAXIS. (J. F. D. Jones, On Hemorrhage and the Liyature ; 

 T. Watson, Cyclop&dia of Medicine, art. ' Hiemorrhage.') 



HEMORRHOIDS (from aZ/ua blood, and fia, to flow), varicose 

 tumours of the veins of the rectum. [ANDS, DISEASES OF THE.] 



H^ERETICO COMBURENDO, WRIT DE. [HERESY.] 



HAGUE, ALLIANCE OF THE. [TREATIES, CHRONOLOGICAL 

 TABLE OF.] 



HAIL, HAILSTONES, HAILSTORMS. The conversion of the 

 aqueous vapour which is an essential constituent of the atmosphere, by 

 the depression of its temperature, either successively into water and ice, 

 or immediately into the latter without the sensible intervention of the 

 former state ; and whether in the atmosphere itself, or on the ground, 

 or against the surfaces of bodies resting upon it or extended into the 

 air, presents several subjects for philosophical investigation, all of them 

 having important relations to the welfare of man and of the various 

 beings of organic nature he associates around him, as well as to the 

 operations of human life. Water in the solid state is produced from 

 the atmosphere in several ways, and in different forms. When a 

 portion of the vapour in the air at certain elevations freezes, by the 

 sudden reduction in temperature of its entire mass, it becomes con- 

 verted into innumerable separate congeries of minute perfect crystals 

 of ice, which are called flakes of snow ; when that in contact with 

 solid bodies forming part of the surface of the earth, or immersed in 

 the atmosphere, becomes sufficiently lowered in temperature by then 

 loss of heat by radiation, hoar-frost appears ; and under other physical 



