SECONDARY HEMORRHAGE.
About the time the tumor is thrown off, between the third and fourth day, and sometimes later, before the healing surface becomes strong, or should the portal circulation become obstructed and the hemorrhoidal vessels congested, secondary hemorrhage may rarely occur. It is easily controlled by the use of Monsel’s Salt, to which a little morphia should be added, carried in a small piece of wet absorbent cotton, and held on the ruptured vessel by the end of the finger until the hemorrhage ceases. A few minutes will usually suffice. Knowing where you operated will be a guide to the place of application. The injection of a strong solution of tannic acid will be sufficient in mild cases. I have never known a secondary hemorrhage, following carbolic acid injection, amount to anything more than an easily controlled venous hemorrhage. Am inclined to think secondary hemorrhage is most likely to occur when a pile breaks down from a partial injection, leaving the vessels unprotected in places, or from an injection too deeply into the substance of the bowel; yet, I have seen all these conditions time and again without the least tendency to hemorrhage.