HEMORRHAGES
Nasal Hemorrhage
(Nose bleed; Epistaxis)
Osteopathic Etiology and Pathology.—Traumatism, such as picking the nose, blows, and surgical operations; straining when coughing; nasal tumors and ulcerations; lesions of the atlas, or any lesion of the upper cervical vertebræ, that would interfere with the vasomotor distribution to the nose and cause local congestion or weakness of the blood vessels; obstructions to the general circulation; irregularities or suppression of the menstrual flow may result in nose bleed, as a vicarious menstruation; suppression of a habitual hemorrhoidal discharge.
Pathologically the great frequency of nasal hemorrhage is due to the great vascularity of the nasal mucous membrane. Usually in cases of spontaneous origin, bleeding is from the region of the septal artery. Spontaneous bleeding may also occur from posterior hypertrophies or adenoid vegetations. The blood flowing downward into the fauces, is expectorated in such cases, and may be mistaken for a hemorrhage from the lungs.
Treatment.—The position of the individual is important. He should assume a sitting posture, or as nearly so as possible. Holding the nostrils tightly, or plugging them with a piece of cotton, will favor the formation and retention of a clot, so that the hemorrhage may be controlled. Pressure upon the carotid artery, or upon the facial artery at the angle of the inferior maxilla, will slow the blood current and favor the formation of a clot, also pressure on the sides of the bridge of the nose may influence it. Correcting any lesions that may exist in the superior cervical region, as derangement of the vertebræ or contracted muscles, will remove obstructions or irritations to the vasomotor system of the affected region, and thus equalize the vascular system. Holding the arms above the head, and the application of ice to the nose are of aid in some cases. Also, injection of cold or hot water into the nostrils. In serious and obstinate cases, where other methods fail, a plugging of the anterior and posterior nares should be resorted to, using absorbent cotton or gauze.
Broncho-pulmonary Hemorrhage
(Hemoptysis)
Osteopathic Etiology and Pathology.—Pulmonary congestion; croupous pneumonia; tuberculosis; hemorrhagic infarction; ulcers of the larynx, trachea or bronchi; gangrene of the lung; fibrinous bronchitis, carcinoma of the lung; lesions of the ribs or vertebræ from the second to the seventh dorsal inclusive, may cause diseases of the bronchial tubes or lungs, that result in hemoptysis, or the hemorrhage may be caused directly by extreme congestion resulting from the disordered vasomotor nerves; diseases of the heart, such as mitral disease, causing pulmonary congestion; aneurism of the branches of the pulmonary artery; vicarious menstruation from deranged menstrual functions; diseases of the vessel walls, or blood, as scurvy, anemia, hemophilia, etc.
Pathologically in many cases, the lesions are microscopic, consisting of ruptured capillaries. In other cases larger vessels may be ruptured, or are the seat of erosion. Many other lesions may be observed. After death the bronchial mucosa is occasionally found inflamed and the lung tissues paler than normal.
Diagnosis.—A differential diagnosis must be made between epistaxis, hemoptysis and hematemesis.
In epistaxis the blood may flow from the posterior nares into the pharynx; it causes coughing and a discharge of the blood may occur the same as in hemoptysis. A careful examination of the nasal region alone can determine the source of the bleeding.
In hemoptysis the history of the case as to pulmonary or cardiac diseases is to be considered. There is a feeling of weight and of uneasiness in the chest. A salty taste and a tickling of the throat precedes the bleeding. The blood is ejected by coughing and is bright red, frothy, very little coagula, and is alkaline in reaction.
In hematemesis the history would indicate disease of the stomach, spleen, liver or heart. Uneasiness, and occasionally nausea and faintness, precedes the bleeding. The blood is ejected by vomiting, and is dark, clotted or fluid, mixed with food, and is of acid reaction. In a few instances the blood due to hemoptysis may be swallowed, and vomited.
Treatment.—In all these cases of hemoptysis the patient should be placed in bed and absolute rest demanded. An attempt should at once be made to correct any lesion that may be found influencing the cause of the bleeding. Correcting lesions to the vasomotor nerves of the lungs and bronchial tubes, and equalizing the disturbed vascular area, may be sufficient in a number of cases. These lesions will be found principally in the upper dorsal region. In some cases, perhaps, there is an impairment of the trophic nerves by the same lesions, thus interfering with the tone of the vessel walls and pulmonary tissues. The diet should be light, nutritious and non-stimulating. The use of hot drinks is to be avoided. The rapidity of the heart’s action should be reduced. This is best performed by thorough treatment of the dorsal spinal nerves of the left side over the heart, and by inhibition in the suboccipital region. The ice-bag to the precordia is also helpful. Iced drinks and the eating of ice is of aid. Stimulation of the systemic circulation will be of value in helping to relieve the pulmonary congestion, although the two systems are somewhat independent of each other. Also, hot foot baths and the evacuation of the bowels may be of additional value. In cases due to organic disease of the heart, the mind and body should receive absolute rest, so that the diseased areas may be strengthened as much as possible; besides a tonic treatment for the heart’s action is necessary.
After the hemorrhage has subsided care should be taken that bleeding does not occur again. All irritations of the respiratory tract should be avoided. A stimulating diet, tobacco and alcohol should be avoided. Nutritious food and a moderate amount of exercise is indicated.
Hemorrhage of the Stomach
(Hematemesis)
Osteopathic Etiology.—Injuries to the stomach; local diseases, as congestion, ulcers and cancer; vicarious menstruation; a mechanical obstruction to the portal circulation; spinal lesions to the vasomotor nerves of the stomach; alterations in the blood; perforation of the stomach walls, involving a blood vessel; disease of some neighboring organ.
Diagnosis.—A careful examination of the case and of the blood ejected will be necessary to determine the nature of the cause. The differential diagnosis as to the source of the blood, whether from the stomach or lungs, was given under hemoptysis.
Treatment.—Correction of any lesions that may influence the blood pressure in the region of the stomach, is the first requisite. Treatment of the splanchnics has the greatest influence upon the vasomotor nerves to the stomach. Treatment of the vagi nerves and of the fourth and fifth dorsals, will quiet the violent movements of the stomach, and thus aid in controlling the hemorrhage. Stimulation of the cervical sympathetics and heat applied to the feet will tend to equalize the vascular system, and thus lessen the gastric congestion. The application of a broad flat ice-bag over the stomach will be of great value. Keep the patient quiet in bed. Surgical interference may be necessary.
Intestinal Hemorrhage
Osteopathic Etiology.—An obstructed circulation of the blood through the venaporta, as in diseases of the heart, lungs and liver; lesions of the vertebræ deranging spinal nerves to the intestinal blood supply; injuries caused by corroding or cutting substances; mechanical injuries to the intestines; degeneration or erosions of the blood-vessels from ulcers of the intestines, as from typhoid fever, typhus, dysentery, etc.; disordered menstrual or hemorrhoidal discharges.
Diagnosis.—The locality of the intestines affected can be approximately determined by an examination of the discharged blood. When the blood comes from the upper part of the intestines, it is generally dark and mixed with the intestinal contents, which gives it a tarry appearance. It is generally red and fluid when it comes from the lower portion of the bowels. If from the stomach, the blood is thoroughly mixed with fecal matter. Throwing the passage into water, the water is colored red when it contains blood, and if the contents contain bile the water is colored green or yellow. Also, noting the areas of contracted muscles, as in intestinal colic, will aid in the regional diagnosis.
Treatment.—Absolute rest in all cases is necessary, the patient remaining as quiet as possible. Food, in severe cases, should not be given for ten or twelve hours. The bed-pan should be used in caring for the evacuations. Correction of the lesions along the spinal region, chiefly of the lower dorsal and lumbar regions, that are impeding the innervation to the intestines, should be attended to at once. This treatment tends to relieve any hyperemic condition of the intestinal mucosa and influences the whole vasomotor area of the mesentery. Direct treatment of the abdomen in a few cases is of great value to relieve obstructed and contracted vessels in the mesentery, but in certain pathological conditions, e. g., typhoid fever, leave the abdomen alone. Treatment (inhibition) along the spinal column from the sixth dorsal to the coccyx is helpful in all cases to quiet the peristalsis of the intestines. In severe cases cold drinks, eating of ice and an ice pack to the abdomen are of aid. In a few instances surgical measures will be necessary.
Hematuria
Osteopathic Etiology.—Congestion and acute inflammation of the kidneys, exacerbations of pyelitis, renal calculi, chronic nephritis, traumatism, tuberculosis, etc.; affections of the urinary tract, as calculi or lacerations of the ureter; calculi, cystitis, ulcerations, etc., of the bladder; calculi, gonorrhoea, parasites, etc., of the urethra; general diseases, chiefly the acute specific fevers and blood diseases; blows, wounds and traumatic influences, external to the kidneys; lesions of the renal splanchnics.
Diagnosis of the locality of the hemorrhage in the urinary tract: In hemorrhage from the kidney the blood is thoroughly mixed with the urine, giving a uniform color. Blood casts and leucocytes are present. In hemorrhage from the ureters the blood is usually molded in clots which conform to the shape of the ureter. The clots appear like small dark worms. In hemorrhage from the bladder the blood is not thoroughly mixed with the urine and large clots form upon standing. In hemorrhage from the urethra the blood often discharges without micturition. When urine is passed the blood precedes the passage of urine.
Treatment.—Rest is essential. A correction of the lesions to the renal splanchnics is necessary to control the congestion and inflammation of the kidneys. When the ureters, bladder or urethra is involved, attention must be given to the condition of the spinal column below the renal splanchnics. In all cases the inhibitory treatment to the lower spinal column and ice to the loins are of value. If surgery is indicated, do not delay operation.
Uterine Hemorrhage
Most of the causes of uterine hemorrhage come under the subject of obstetrics; others under menorrhagia and metrorrhagia. Such will be found in obstetrical and gynecological works.
Treatment.—The patient should assume the dorsal position with the buttocks raised. If any displacement of the uterus is present or if there is any foreign material in the uterus, usually such should be corrected or removed at once. Stimulation of the clitoris is a most effectual means to control uterine hemorrhage; it contracts the circular fibres of the uterus. Stimulation of the uterus directly through the vagina, and over the abdomen, and stimulation of the upper wall of the vagina, will aid in contracting the uterus. A quick, unexpected pull of the hair on the mons veneris will have the effect of closing the capillaries by shock to the nervous control (Dr. Still). Before closing the os, however, it is well to know that there is no irritating foreign material within the body of the uterus. Correction of obstructions of the vasomotor nerves of the uterus through the splanchnic and lumbar region is important. Compression of the abdominal aorta, and vaginal injections of hot water may be of aid, as will also a hot water bag at the lumbar region and ice water bag over symphysis. In severe cases inversion of the body, if it can be done with safety, may be performed. Packing the vagina is a method resorted to occasionally in severe cases.
Hiccoughs
Occasionally there is a case of hiccoughs that has been continuous for hours or even days and that all efforts have failed to stop. They are caused by an irritation to the peripheral distribution of the phrenic nerve from some gastric disturbance or a local irritant acting upon the center in the medulla. It may follow fright or great emotion and be associated in persistent form in rheumatism, typhoid fever and other febrile diseases. It follows abdominal operations at times and is very distressing. When occurring in elderly people with pneumonia and in peritonitis with distention it usually marks the end. The same may be said in case of carcinoma of the stomach and bowels.
Treatment.—Go first to the origin of the phrenic nerve at the third, fourth and fifth cervical and, if there is a lesion as there will probably be, adjust it and note results. This will be sufficient in many cases. Failing, bring direct pressure on the nerve just above the clavicle and anterior to the sternomastoid muscle and release the scaleni muscles. After this examine and treat at the fifth and twelfth dorsals. Correct any lesions but best results will be had from inhibition at these points. Another method is to stand beside the patient and insert the fingers of both hands under the costal end of the ribs and lightly pull. Firm pressure over the solar plexus with flat of the hand is sometimes beneficial. In hysterical cases, drawing out the tongue will often be effective and it has been suggested that standing the patient on the head will stop them in short order. Tickling the nose to produce violent sneezing is an ancient remedy. Some one of these will cure the case, as osteopathy has never failed so far as recorded.
The stomach should be emptied of all irritating matter to prevent recurrence.