HEMORRHAGE. 



Arterial, venous and capillary hsemorrhage belong almost ex- 

 clusively to the domain of surgery. Internal haemorrhages will 

 be considered in connection with the organs in which they take 

 place. 



HEMOPHIWA. 



Definition. Causes : lack of plasticity of the blood, thin walls, blood 

 tension, cardiac erethism, hypertrophy and neurosis. Sex. Heredity 

 through the female. Treatment : depletive, styptic, astringent. Transfusion .. 



This is a constitutional infirmity, usually hereditary and char- 

 acterized by the occurrence of profuse and continuous bleeding aS' 

 the result of otherwise insignificant injuries or even apart from 

 any recognizable lesion. It has been attributed to a slow coagu- 

 lation of the blood, but at the start of a hsemorrhage the blood i& 

 rich in corpuscles and coagulates firmly. It has also been as- 

 cribed to extreme tenuity of the vascular walls, but this has only 

 been met with in a certain proportion of the cases. Another po- 

 tent factor is a permanent over-filling of the blood-vessels (Im- 

 mermann, Delafield, Prudden). The same writers attach im- 

 portance to cardiac erethism, cardiac hypertrophy, and certain, 

 neurotic influences which temporarily increase the habitually con- 

 gestive diathesis. In man the majority of victims have been males, 

 perhaps because most subject to traumatisms. On the contrary 

 the hereditary transmission is mainly through the female members- 

 of the family. The families are very prolific, a condition counter- 

 balanced by the death of the majority of the victims at an early 

 age. Among the lower animals it has been observed in horses 

 consequent on castration (Siedamgrotzky, Kohne, Friedberger 

 and Frohner), setoning (Kohne, Dieckerhoff), and an ulcer of 

 the leg (Kohne). 



Treatment consists in combating plethora and constipation by 

 saline purgatives. The subject should be carefully protected from 

 injuries. Locally use styptics such as matico, adrenalin, muriate 

 of iron, tannin, alum, solution of gelatine on pledgets with press- 

 ure. Internally calcium chloride, thryoid extract, ergot, lead 

 acetate, iron chloride, or muriate, tannin, alum, acids. Pure, 

 sterilized gelatine solution, intravenously, has given good results. 

 Transfusion is a dernier resort. 

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