On the treatment of the hemorrhagic diathesis / by James Miller.

  • Miller, James, 1812-1864.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of the hemorrhagic diathesis / by James Miller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    a remedial means in the hemorrhagic diathesis. Mr Roberts states, “ In all the cases that have come under my notice, I never saw the application of the actual cautery of much (any) service: still in extreme cases we are bound to employ it.”1 To the former part of that statement we assent, disagreeing totally, however, with its conclusion. And we think we have made out a sufficient case against the cautery, to displace it from the con- fidence of the profession, which it seems yet unworthily to hold, as a remedy in such cases. Nitrate of silver we have spoken of favourably it is true, but not as an escharotic. And if the ni- trate of mercury be employed, we should advise it to be diluted from tho form of caustic, so as to be simply styptic and astrin- gent. On pressure, we would mainly rely, as the local treatment adapted to the hemorrhagic diathesis. Having applied the ni- trate of silver gently, so as to obtain its minor effect, and thus, by a. temporary cessation of the bleeding, secure a dry bed on which the compress is to be laid, we lodge a portion of lint, ac- curately adapted to the hemorrhagic surface, and over this ano- ther and another, increasing in size, so as to make a graduated compress, whereby pressure can be applied with power, and at the same time with great accuracy. For we believe that when pressure does fail, it is because it has been inaccurately applied, i. e. not duly directed on the bleeding point, either by blood be- coming interposed, or in consequence of original mal-adjustment of the apparatus. A dry compress alone is efficient; and should we find the lint becoming saturated with blood, the oozing still continuing through the dressings, we must at once remove all, and re-adjust them with still greater attention to nicety of applica- tion. Supposing the bleeding surface to be situated on a leg or arm, the limb below the compressed point must be uniformly supported by a bandage, otherwise congestion, followed by ec- chymosis as well as oedema, will most probably result. Rut while the pressure is uniform and accurate, it must not be severe; for one of the characteristics of the disease is, that pressure is not easily borne; it is apt to occasion “ great distress, pain, throb- bing, and irritability.”2 Severe pressure, pertinaciously employ- ed, would produce inflammation, ulceration, sloughing, one or all, and of course aggravate the malady. But if the compres- sion be begun moderately, and regulated by prudence, more especially if it have been both accurately and early applied,—be- fore the part has become inflamed and swollen by other less ap- propriate and effectual remedies,—such untoward consequences need not be apprehended. On the general surface, compression can be managed by an ordinary bandage regulating and raain- e