PATHOLOGY. 281 
after a dated time, a habit is formed which is with diffi¬ 
culty overcome. Thefe very marked appearances do not 
always occur; but traces of fuch fymptoins may be of¬ 
ten diftinguifhed even in the moft debilitated dates. This 
fpecies has fix varieties. 
a.. H. a. nariurn, (Epifiaxis juniorum, Cull.) Bleeding 
at the nofe. In this variety the blood is difcharged 
from the nodrils, ufually preceded by a pain and heavi- 
nefs in the head, fiufhing in the face, heat and itching in 
the nodrils, a throbbing of the temporal arteries, and a 
quicknefs of the pulfe. In other hemorrhages, a coldnefs 
of the feet, and fhivering over the whole body, together 
■with a codive belly, are obferved to precede the attack. 
The intenfity of the head-aft'e£lion is often very great. 
( 3 . II. a. haemoptyfis, fpitting of blood. In this com¬ 
plaint, with the common fymptoins of fever and in- 
creafed arterial adtion, a Hurtling of the cheeks comes 
on, attended with dyfpncea and pain in the ched ; a 
cough follows, by means of which blood is copioufly 
ejedled. 
y. H. a. haematemefis, vomiting of blood. In this va¬ 
riety, dark-coloured clotted blood is thrown up from the 
domach, ufually mixed with much phlegm. The dif- 
charge is often preceded by a tenfive pricking pain in 
the domach, or the left hypochondrium ; and almod al¬ 
ways attended with a naufea, anxiety of the praecordia, a 
comprefiing pain on the fame fide, and faintnefs. 
It is. of much confequence to afcertain whether the 
blood comes from the fauces, the nofe, the domach, or 
the lungs. If from the fauces, either diredlly or dropping 
from the nofe, it is inconfiderable in quantity, and not 
alzcays attended with any hawking; and, though this is 
fometimes the cafe, the fymptorns of Haemorrhagia na- 
rium, or infpedlion of the fauces, will adid the diflinc- 
tion. Blood, however, feldom comes from the fauces, 
but in palfive hemorrhage. When a difcharge of blood 
is from the domach, it is brought up by vomiting; but 
patients can feldom didinguilh between thefe two opera¬ 
tions. In general, when from the domach, the quantity 
difcharged at once is more confiderable; it is alfo mixed 
with the contents of the domach, and not the mucus of 
the lungs; and faintnefs and naufea have generally pre¬ 
ceded. The pulmonary blood is ufually fiorid ; that of 
the domach of a darker colour. Complaints of the lungs, 
preceding the difcharge, will diow that a doubtful he¬ 
morrhage probably proceeds from thofe organs. 
The treatment of thefe hemorrhages is very fimple. 
The adtion of the heart being one of the caufes of the 
hemorrhage, this is if podible to be redrained. Blood 
fliould be taken with almod as much freedom as in Em- 
prefma ; i. e. if the pulfe and conditution of the patient 
warrant fuch a meafure. We have dated that it is ne¬ 
ceflary to take blood very quickly in inflammation, and 
this is dill more neceflary in afftive hemorrhage : a large 
orifice, or fometimes both arms, fliould be opened for this 
purpole; for it is not fo much required to deplete blood 
as to exhauft the force of the heart. This being done, 
if the hemorrhage does not dop, the next dep is to af- 
tringe the extremities of the bleeding veflels. This objedt 
is a defied in the H. nariurn by injections of fulphate of 
zinc, fulphate of copper, See. in haematemefis by dilutions 
of fulphate of zinc, but in very moderate dofes; or by the 
Tindtura Ferri muriatis, in large draughts of cold water. 
The fame treatment is applicable to the paroxyfm both 
of haemoptyfis and that of haematemefis. In the bleeding 
of the nofe, the auxiliary meafure of dalhing cold water 
over the face, head, and neck, or even the general cold 
bath, may be reforted to. We may remark, that the af- 
fufion of cold water has been ufed in haemoptyfis ; but, 
for obvious reafons, it is a dangerous expedient. Plug¬ 
ging the nafal finufes with lint may be adopted as a der¬ 
nier refort in violent hemorrhage from the nofe. 
The above remarks apply principally to the treatment 
of a fudden eruption of blood. When this is flopped, 
the treatment fliould be condudled dill with the fame 
view of leflening the momentum of the blood by vene- 
fedlion and abflinent diet. We fliould avoid all circum- 
ftances capable of dimulating the heart, or increafing the 
impetus of blood in the aifedted organ. Animal food 
fliould therefore be withheld, quietude enjoined, cool 
drinks and purgatives adminidered. In haematemefis, 
and dill more in haemoptyfis, digitalis and the fuperace- 
tate of lead are very ufeful medicines. The former is 
given in various dofes (ufually from five to-twenty 
drops), according to its effedls ; and the latter in a quan¬ 
tity varying from one to three or more grains. The fu- 
garof lead is ufually combined with opium.; but we have 
found it more fuccefsful when given alone. The fears 
of fome pradlitioners as to this fubdance producing colic 
fliould not arrefl its exhibition, its conflipating effedts 
being eafily corredled by purgatives. 
H. a. haematuria, bloody urine: evacuated at the 
urethra ; preceded by pain in the region of the bladder 
or kidneys ; and accompanied with faintnefs. 
A difcharge of blood by urine, when proceeding from 
the kidneys or ureter, is commonly attended with an 
acute pain in the back, and fome difficulty of making 
water, the urine which comes away firfl being muddy 
and high coloured, but towards the clofe of its flowing 
becoming tranfparent and of a natural appearance. 
When the blood proceeds immediately from the bladder, 
it is ufually accompanied with a fenfe of heat and pain at 
the bottom of the belly. The voiding of bloody urine 
is always attended with fome danger, particularly when 
mixed with purulent matter. When it arifes in the 
courfe of any malignant difeafe, it indicates a fatal ter¬ 
mination. 
When the difeafe occurs in a plethoric habit, it may 
be proper to take blood, and purfue the general anti- 
phlogiflic plan, opening the bowels occafionally with 
caftor-oil, &c. When owing to calculi which cannot be 
removed, we mud be chiefly content with palliative 
meafures, giving alkalies or acids according to the qua¬ 
lity of the urine; likewife mucilaginous drinks and 
clyders; and opium, fomentations, &c. to relieve pain ;‘ 
uva urfi alfo has been found ufeful under thefe circum- 
ftances; but more decidedly where the hemorrhage is 
purely palfive ; in which cafe alfo fome of the terebinthate 
remedies may be cautioufly tried ; and means of flrength- 
ening the conditution mud not be negiedted. 
£. H. a. uterina, uterine hemorrhage: blood difcharged 
from the uterus; with a fenfe of weight in the loins, and 
of preflu re upon the vagina. See Paramenia, and the ar¬ 
ticle Parturition, vol. xviii. p. 706-9. 
£. II. a. prodtica, (Hemorrhois, Cull.) blood difchar¬ 
ged from the anus fpontaneoufly ; with a fenfe of weight 
and pain within the reef urn ; and often of load in the 
head. See the genus Prodica, p. 166. 
z. Haemorragia pafliva, palfive haemorrhage : accom¬ 
panied with general laxity or debility ; and weak vaf'eu- 
lar adlion ; blood attenuate, and of a Modena red. 
Palfive hemorrhages are much more difficult to cure 
than the adlive fpecies before detailed. Their chief 
fymptom, as in the active hemorrhages, is a dilcharge of 
blood, which however is faid to be of a darker colour, 
longer in coagulating, and the coagulum when formed 
lefs firm, than in adlive hemorrhages. The fymptorns of 
fever are alfo abfent; and, above all, the pulfe is foft and 
fmall. The palfive hemorrhages refult fometimes from 
ruptured arteries ; but fometimes the blood is actually 
fecreted. They are not neceflarily accompanied with 
plethora, but they are fo very generally. They are al¬ 
ways connected with alteration in the blood ; and are 
confequently never met with except in old perfons, in 
dyfpeptics or debilitated habits, or in thofe who have 
fuftered from bad modes of living. The fame local treat¬ 
ment is neceflary in both fpecies; but bleeding, fo im¬ 
portant in the firfl, is of no avail towards relieving the 
fanguine 
