The Treatment of Internal 
Hemorrhages. 
by . J 
JOHN FERGUSON, M. A., M. D., 
1. K. C. P,, L. F. P.8., 
DEMONSTRATOR OF ANATOMY, MEDICAL DEPARTMENT, 
UNIVERSITY OF TORONTO, AND LECTURER ON 
NERVOUS DISEASES TN THE SUMMER 
SESSION. 
REFR1NTRD FROM 
21 Je Neto ¥orfc fHetical Jfoumal 
for November 1, 1890. Reprinted from the New York Medical Journal 
for November 1, 1890. 
THE TREATMENT OF INTERNAL HAEMORRHAGES. 
By JOHN FERGUSON, M. A., M. D., 
L. R. C. P., L. F. P. 8., 
DEMONSTRATOR OF ANATOMY, MEDICAL DEPARTMENT, 
UNIVERSITY OF TORONTO, AND LECTURER ON NERVOUS DISEASES IN 
THE SUMMER SESSION. 
There are few more trying positions which the prac- 
titioner of medicine can find himself suddenly forced to oc- 
cupy than that of facing a severe internal haemorrhage- 
cerebral, pulmonary, gastric, intestinal, or uterine. At the 
lonely hour of midnight and far away from consultation he 
may be calle«l upon to act; and it is well to have one's mind 
already made up as to the course that should be pursued in 
the various forms of haemorrhages, for " to be forewarned is 
to be forearmed." It is with the view of summing up our 
knowledge on this subject, and with the hope of adding a 
few new points, that this contribution is offered to the medi- 
cal profession. 
In the first place, it is very apparent that the amount of 
blood that will flowthrough a rent in the wall of any vessel 
must be greatly influenced by the total amount of blood in 
the system and the amount of pressure upon the vessel 
from within. This being the case, the first step to take 
in dealing with a haemorrhage is to cut off the supply of 
liquids. In this way the amount of blood is kept down, 
while it becomes thicker in quality and better fitted for the 2 
THE TREATMENT OF INTERNAL HEMORRHAGES. 
forming of a good, firm clot in the torn or ruptured vessel. 
Another step in the same direction is to reduce the volume 
of blood by actively eliminating water from the system. 
The hypodermic injection of pilocarpine rapidly unloads 
the body of water and inspissates the blood left behind, 
lessening thereby the freeness of the flow. This would not, 
however, be suitable in cases of pulmonary bleeding. Other 
diaphoretics might be selected, according to the judgment 
of the physician, or the nature of the case and the condition 
of the patient. 
Another group of remedies is of much value in dealing 
with such cases. Those purgatives that produce copious 
watery stools, and at the same time are not irritating or de- 
pressing, must be placed high on the list of things we may 
use for the relief of the sufferer intrusted to our charge. Of 
these purgatives there is none so good as Epsom salts-the 
sulphate of magnesium. When given in saturated solu- 
tion, without water, in free doses, and oft repeated, very 
free watery evacuations are produced, the amount of fluid 
in the vascular system is speedily lessened, and the haemor- 
rhage to this extent controlled. By maintaining this action 
for some time, the ruptured vessel has time to heal, because 
the pressure is largely taken off it, and it is put into the 
condition of rest. In addition to this, however, the blood 
is thickendd. In some cases of cholera-sporadic or epi- 
demic-where the rice-water stools have been very abun- 
dant, the blood becomes so reduced in volume and so in- 
spissated as not to flow from a wound made in a large vein. 
In the event of the haemorrhage being due to the ulceration 
of typhoid fever, this plan could not be had recourse to, 
although I have used it with advantage in the bleeding of 
gastric ulcer. In the haemorrhage, often so free, from soft 
and rapidly growing uterine fibroids, it is specially useful, 
if continued long enough-say for months. THE TREATMENT OF INTERNAL HEMORRHAGES. 
3 
Some persons have a strong tendency to bleed, and any 
haemorrhage is hard to stay. The mucous membranes of 
the nose, stomach, bowels, or bronchial tubes ooze away, and 
though the flow may not be very rapid at any one time, the 
total amount los.t is very considerable. I once saw a girl 
of thirteen brought almost to death's door by such a haem- 
orrhage from the mucous membrane of her lip. In purpura 
we know how readily patients suffer from subcutaneous ex- 
travasations. For this form of slow, continuous oozing the 
following formula may be found highly serviceable : Mix 
one ounce each of absolute alcohol and oil of turpentine in a 
glass or Wedgwood mortar. To this add very slowly, stir- 
ring all the while, one ounce of sulphuric acid. When all 
chemical action is over, the mixture may be bottled. Of 
this, ten or fifteen minims may be ordered every two, three, 
or four hours as needed. I have found these "black drops" 
of very great value in some exceedingly troublesome cases. 
In the event of a very severe post-partum haemorrhage 
the medical attendant may try ergotine hypodermically, or 
hot vaginal or rectal injections ; but these may fail. It is 
a belief, not yet quite dead, that the uterine sinuses are 
closed by clots. This is quite erroneous. The uterine ves- 
sels and sinuses are interlaced by muscular fibers, and it is 
the contraction of these that arrests the haemorrhage. This 
muscular tissue, as it were, ligates the vessels that would 
bleed ; and so long as the contraction is good there is no 
danger. Now, for the maintenance of this tonic action of 
the muscular tissue in the uterus I have found the applica- 
tion of heat to the lumbar portion of the spine very useful. 
It stimulates this portion of the nervous system by bringing 
more blood to it. There is a greater influx of nerve energy 
to the uterus and contraction is brought about. It is true 
that the uterus seems to be very independent of the spinal 
cord, and labor may take place in a paraplegic. This does 4 
THE TREATMENT OE INTERNAL H/EMORRH AGES. 
not, however, invalidate the fact that heat-applied to the 
spine by a large sponge dipped into hot water-does much 
good in the way of rousing the uterus to action. But when 
all things fail, as fail they will at times; when ergotine, 
acetate of lead in large doses, hot injections, and heat to 
the spine disappoint us, we have one last resort : Tampon 
the uterus and vagina thoroughly with iodoform gauze, or. 
if this is not at hand, some cloths to which glycerin is 
added. This plan I am quite sure will not fail. The bleed- 
ing is soon arrested, the uterus begins to contract, tone in 
its walls is secured, and one can feel at ease that the patient 
is out of all immediate danger. 
As a means of arresting haemorrhages and gaining time 
for other remedies, I would suggest the following plan, one 
great feature of which is that it is always available and does 
good. It is applicable to cases of capital operations on the 
body, such as the removal of large and vascular tumors from 
the neck, the female breast, etc. The plan is simply to tie 
bands around the legs and arms close up to the body. This 
arrests the return of blood to the body, while the flow of 
blood into the limbs still goes on. By this means a very 
large amount of the blood in the body is rapidly collected 
into the four extremities and the pressure taken off the cen- 
tral vessels. One day, when in my last year as a student, in 
1879, I was walking along the streets, when I came upon 
an excited little crowd of people. I saw that one of the num- 
ber, a young man of about thirty years, was bleeding freely 
from his lungs. I had nothing with me, but had just been 
thinking about venesection and the swollen condition of 
the veins in the arm. I seized the present opportunity, tore 
up a handkerchief, and tied the strips very firmly around the 
four extremities. The results were very gratifying. Ever 
since I have made extensive use of these bands, and now feel 
a good deal of confidence in recommending them to others. THE TREATMENT OF INTERNAL HEMORRHAGES. 
5 
I have already mentioned the usefulness of the hot 
sponge to the lumbar region in post-partum haemorrhage. 
Now, in other cases of internal haemorrhage-as from the 
mucous membranes of the stomach, nose, and bowels-the 
spinal ice bag is no mean therapeutic agent. It induces 
anaemia of the spinal cord and a marked dilatation of the 
surface blood-vessels. The internal strain is reduced, and 
consequently the haemorrhage lessens. W » REASONS WHY 
Physicians Should 
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