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abdomen wa3 found greatly diftended with blood, which bad plainly been difcharged from the omentum, as a great number of grumes of blood were found lodg'd between its foliages. It was obferved alfo, in this fubject, that the omentum was firmly attach'd to the fundus of the uterus. The fame papers give an account alfo of another very re- markable internal Hemorrhage ; this was of the ftomach. In this cafe the patient died inftantaneoufly ; and the blood hav- ing been difcharged into the ftomach too faft, either for its being ejected upwards or downwards, when the body was opened, the ftomach was found greatly diftended, and com- pleatly filled with one great grume, or mafs, of coagulated blood. It is remarkable that, in this fubjecl, the ftomach was found in a perfectly found ftate, but the fpleen was found putrid and rotten. A£l. Petropol. vol. i. p. 382.
Hemorrhage of the Nofe. Mr. Le Dran propofes to make a feton, like that mentioned in the article Polypus, ferve for flopping Hemorrhages of the nofe ; for which purpofe he fallens two doffils to the cord, and, after drawing one out at the noftril, to bring away the clotted blood, he continues to draw the cord, and fo fills up the pofterior part of the noftril with the other, which ought to be larger, and well wet in a ftyptic liquor ; by which not only the Hemorrhage will be ftopped, but if it fhould continue, the blood and medicines will be effectually prevented from running down the throat, which commonly occafiom a cough or vomiting, that increafes the bleeding. Med. Eft. Ediu.
Unnatural Hemorrhages, a term ufed by fome medical writers to exprefs fuch difcharges of blood as are made from parts not naturally, or, in the common courfe of things, admitting fuch evacuations. Of thefe we have a very re- markable inilance, recorded in the philofophical tranfactions. It is of a young child which bled firft at the nofe and ears, and afterwards at the hinder part of the head, where there was no fore, and afterwards at the moulders, wafte, and at the fingers and toes, and the bending of the arms.
Hemorrhages from Wounds. Profufions of blood, from wounds, arifc from injuries of the veins or arteries, received in the inflicting the wound ; and the violence of the Hemorr- hage is ever in proportion to the fize of the wounded veflel : it is no wonder, therefore, that great v/eaknefs, fainting fits, and fometimes inftant death, are the dreadful confequences at- tending this fymptom, according to the fize of the wounded veftel. The furgeon ought, for this reafon, never to be without the proper remedies, to flop blood, about him ; but there are fome cafes in which it is by no means proper to flop the Hemorrhage inftantly. In a young plethoric habit, or in a wound got in a drunken fit, or even in a fit of great paflion, it is beft to let the blood run as long as it continues to do fo without inconvenience to the patient ; for, by a mode- rate lofs of blood, the inflammation, tumour, pain, and fever, are either entirely prevented, or much leffened. The ftopping of Hemorrhages is to be done by various ways : If no large veftel is wounded, dry lint alone is always fufli-. cient ; the wound is to be filled with this, and a proper com- prefs and bandage put over it. The wound mull be filled pretty clofely with the lint, and a proper degree of prefture given over the comprefs, with the hand, by which more is done fometimes than by all the bandages or violent remedies in the world. But if the He?norrhage is too large to be flopped by the application of dry lint alone, the ufe of aftrin- gent medicines is to be called in. The ufual application, in this cafe, is reclify'd fpirit of wine applied cold to the wound, filling it up with doffils dipped in the fame fpirit, and cover- ing it with large comprefTcs wrung out of the fame liquor, and making a proper prefture over all with a bandage. The other aftiiugents, ufed on this occafion, are vinegar, the ly- coperdon, or puff-ball oil, and fpirit of turpentine, alum, vitriol, or faccharum faturni, diffolved in water or vinegar, or the dry powders of bole armenic, bloodftone, dragon's blood, &c. °
When veflcls of a larger fize are divided, we are to have, re- courfe. to cauftic medicines inftead of afti ingents, the com- mon medicine, in this intention, is the Roman vitriol, which being coarfely powder'd, and fprinkled upon cotton, is to be applied to the wound, dreffing up with doffils, a comprefs and bandage. It is ufually neceflary to be very greatly cautious in the application of this, that it only be laid to the bottom of the wound, or the part where the vcflel wounded lies, other- wife the other parts will fuffcr too great an erofion from it. If thefe applications all prove fruitlefs, it will be proper wholly to divide the artery, yet only divided in part ; for, by this means alone, it will contrail and hide its end under the muf- cular flefh, and its orifice will, by that means, either be en- tirely choaked up, or at leaft it will be more ready to yield to the force of the medicines before advifed to be ufed on fuch occafions. This method of treatment is noil ufually necef- fary in wounds of the temporal arteries, and thofe of the cu- bits, and tibiae.
If this method ihould fail, you mull then have rccourfe to the hot iron, or actual cautery; the orifices of veffels being burned, a emit is formed over them, and this method is fo very effeaual, that it is fcarce poffible for an Hemorrhage to happen in wounds of the external parts, which mav not ccr- 4
tainly be ftopped by it. In this cafe, two cauteries fhould be always ready, that, if one fhould be extinguifhed before the operation is finifh'd, the other may be at hand without wait- ing for it. Cauteries are made of different fhapes and fizes, according to the parts they are intended to be applied to. The great inconvenience attending the ufe of the cautery, is, that after two or three days, the efchar fometimes falls off, and then a fecond, and that commonly a fatal Hemorrhage fuc- ceeds ; to prevent this fatal accident, the wounds muff be handled very tenderly at the time of dreffing, and every time the wound is drefled, to be provided with a cautery ready heated, to repeat the operation if it fhould be neceflary. This' caution is to be obferved, in regard to the larger arteries, for fourteen days ; after this there is no great danger of a return of the complaint ; but when the crural or axillary arteries are wounded, the cautery is of ho ufe.
In. very dangerous wounds of the large arteries, fuch as the crural and axillary, and, in amputations of the limbs, the fafeft method is that of making a ligature round the veffels : If this is performed by paffing a ffrong waxed thread under , the artery, by means of a crooked needle, the blood is pre- fently ftopped, and the orifices of the' artery coalefce. Inftruments for the flopping of Hemorrhages have alfo been in ufe in all ages, which, by their forcible compreffion on the part, flop the mouths of the velfels, the moft convenient of which, is thus compofed : A brafs plate, three fingers lone:, and two fingers broad, is perforated in the middle to admit a ftrong fcrew, which is provided at the lower end with a fmall round plate ; a piece of leather is ftrongly fattened to one end of the brafs plate, of equal breadth with it. In violent Hemorrhages this inftrufnent is fitted to the wounded part. The end of the leather is brought round the part, and, by means of holes made through it, is fattened, at the proper part, to two fmall hooks made on the brafs plate, at the end, oppofite t« that where the leather is faftened ; this is to be ad jutted in fuch manner, that the fmall plate at the bottom of the fcrew is to be brought to prefs exactly upon the comprdfes' and dreffings that cover the wound ; the handle of the i'crew is then to be turned round with a gentle prefture, till it is found turned far enough to make a prefture of force, to Hop the blood : It is then to be left in this condition for a day or two, or till it may fafely be taken off. Hei/ler's Surg. p. 45.
HEMORRHOIDS (Cycl) are diftinguifhed, from the man- ner and time of their return upon the patient, into regular or periodical, and vague or irregular.
%rj/rljnoiRBoiES.' They are generally preceded by a fenfation of pain, and tenfion in the hypocondria, and vibra- tive or fpaftic motions about the ftomach, mcfentery, and fpleen ; and what is much more obvious than thefe, there is a fenfation, as it were, of a hard nucleus ftiGking in the extre- mity of the rectum ; and the more high up in that interline this is felt, the more difficult will be the eruption of the he- morrhoidal difchargc, and the longer before its appearance. With thefe fymptoms there alfo very frequently comes on a tenefmus. Thefe are the ufual antecedent figns ; but there are fome in whom they appear without any previous notice. When prefent, there is a difcharge of blood, and that ufually very pure and florid in perfons who have them frequently and regularly ; in others who have them fcldom and imperfectly, the blood appears black and grumous ; and in fome cafes, efpecially in perfons who never have had a genuine and proper flux of this kind, there is excreted a famous matter inftead of pure blood. The evacuation of the blood from them is fcldom vo- luntary, but ufually is forced out by the prefture and hardnefs oftheftools. Junior's Confp. Med. p. 47.
Perfons fuhjed to them. They equally affea both fexes, but are oftenef met with in men than in women. They are moft frequent in the middle and advanced ages of life, and when they happen to young people, they are dually hereditary.
Caufes ofthem._ Among thefe are to be reckoned a plethora, and thicknefs of the blood, for an over thinnefs and acrimony of it is feldom the caufe, tho' very often fuppofed to be fo. Violent concuffions of the abdomen, as by violent exercifes of riding or walking, will alfo bring them on, as will a fedentary life, in which, by the compreffion of the abdomen, the cir- culation is impeded at the vena porta; ; alfo an omiffion of any cuftomary evacuations of blood, an abufe of hot foods and fpirituous liquors, and the taking of aloes, or other the like medicines. In Saxony the Hemorrhoids are very frequent, from their taking great quantities of elixir proprietatis ; and in Hungary, from their eating large quantities of garlic, violent binding of the bowels, and paffions of the mind, efpeciallv anger and fear, and the venereal infection will alfo frequently bring them on ; but this laft caufe chiefly brings on the blind piles, or fuch as do not bleed.
PrognoJJicis from them. The Hemorrhoids, when they flow naturally and moderately, are very beneficial to health, and often prevent violent difeafc. They are peculiarly the moft cartain of all remedies in hypocondriacal affections ; they eafc deliriums, and very often take off fits of the gout. With afl thefe advantages in them, when moderate, they are, how- ever, attended, when immoderate, or when too long conti- nued, with bad fymptoms, and are often dangerous : They bring on great weaknefs, and, in length of time, induce ca- chectic
