2nd. Arterial. The distinctive sign of this kind of bleeding is that it issues forth from the wound in spurts, and not in a continuous stream. Each spurt corresponds to a heart beat. This variety of hæmorrhage can only occur if an artery is cut through, i.e., a vessel which carries blood away from the heart to supply the tissues of the body.
3rd. Venous. This bleeding is due to the wound of a vessel which returns blood to the heart after it has circulated through the tissues. These vessels are called veins. The blood is dark in colour and issues from one definite spot in a continuous stream.
Treatment. For practical purposes only the first variety of hæmorrhage need be considered here. Circumcision in an infant should never interfere with an artery or vein; but in the event of this accident occurring a pledget of cotton-wool or lint must be firmly compressed with bandage around the bleeding point until the proper method can be adopted to deal with it. This consists of seizing the bleeding point with an instrument constructed for the purpose (artery forceps) and then twisting up the tissue caught in the forceps, or applying a ligature. This is a purely surgical proceeding, and as every case of hæmorrhage should without delay receive qualified medical attention nothing further need be said on this matter here.
In most cases the application of the dressing with very firm pressure suffices to arrest the inevitable bleeding of every circumcision. The bandaging cannot be considered satisfactory until the blood ceases to ooze through the dressing. In adjusting the diapers it must be seen that the thighs are tied together so that they are immovable, perfect rest being indispensable for the control of hæmorrhage. This treatment is merely a mechanical aid to the natural processes which arrest bleeding, and in the vast majority of cases is perfectly successful.
There are however certain drugs which may be applied to a bleeding surface to hasten the coagulation of the blood. These are called astringents. These are not to be used indiscriminately as many of them injure the tissues and interfere with the healing of the wound. If pressure alone is insufficient to stop the hæmorrhage and the local application of an astringent is to be tried, the part must first be carefully washed with an antiseptic solution, so as to see precisely where the bleeding is actually coming from. Strips of lint soaked in the astringent solution are then carefully applied and retained in position by the firm pressure of a bandage.
The following are the principal drugs which may be used in this way.
1.) Compound Tincture of Benzoin.
2.) Tincture of Hazeline.
3.) Strong solution of Alum in hot water.
4.) Solution of Tannic Acid (4 grains to the ounce.)