Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
After a severe hæmorrhage into the cellular tissue or into a joint, the
patient becomes pale and anæmic, the temperature may rise to 102° or
103° F., the pulse become small and rapid, and hæmic murmurs are
sometimes developed over the heart and large arteries. The swelling is
tense, fluctuating, and hot, and there is considerable pain and
tenderness.
In exceptional cases, blisters form over the seat of the effusion, or
the skin may even slough, and the clinical features may therefore come
to simulate closely those of an acute suppurative condition. When the
skin sloughs, an ulcer is formed with altered blood-clot in its floor
like that seen in scurvy, and there is a remarkable absence of any
attempt at healing.
The acute symptoms gradually subside, and the blood is slowly absorbed,
the discoloration of the skin passing through the same series of changes
as occur after an ordinary bruise. The patients seldom manifest the
symptoms of the bloodless state, and the blood is rapidly regenerated.
The _diagnosis_ is easy if the patient or his friends are aware of the
family tendency to hæmorrhage and inform the doctor of it, but they are
often sensitive and reticent regarding the fact, and it may only be
elicited after close investigation. From the history it is usually easy
to exclude scurvy and purpura. Repeated hæmorrhages into a joint may
result in appearances which closely simulate those of tuberculous
disease. Recent hæmorrhages into the cellular tissue often present
clinical features closely resembling those of acute cellulitis or
osteomyelitis. A careful examination, however, may reveal ecchymoses on
other parts of the body which give a clue to the nature of the
condition, and may prevent the disastrous consequences that may follow
incision.
These patients usually succumb sooner or later to hæmorrhage, although
they often survive several severe attacks. After middle life the
tendency to bleed appears to diminish.
_Treatment._--As a rule the ordinary means of arresting hæmorrhage are
of little avail. From among the numerous means suggested, the following
may be mentioned: The application to the bleeding point of gauze soaked
in a 1 in 1000 solution of adrenalin; prolonged inhalation of oxygen;
freezing the part with a spray of ethyl-chloride; one or more
subcutaneous injections of gelatin--5 ounces of a 2½ per cent.
solution of white gelatin in normal salt solution being injected at a
temperature of about 100° F.; the injection of pituitary extract. The
application of a pad of gauze soaked in the blood of a normal person
sometimes arrests the bleeding.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account