5.) Solution of Adrenalin Chloride.
The last of these has the reputation of being the most powerful astringent known.
A solution of Perchloride of Iron is often used, but this is open to the objection of injuring the delicate living tissues.
Secondary Hæmorrhage.
Besides the bleeding which may occur immediately on the infliction of a wound, there is another variety which may take place subsequently, known as Secondary Hæmorrhage. This occurs when there is some failure in the process previously described, by which the wound heals. The coagulum is disturbed and the vessels are practically re-opened, or the coagulum becomes softened through the action of an infective agent. As a rule secondary hæmorrhage indicates some form of infection.
Often in changing the dressing there is a minute amount of hæmorrhage. This is due to injuring the developing blood vessels in the newly growing scar tissue.
Hæmorrhage due to constitutional conditions.
Some infants are born with a tendency to bleed, without any evident cause, either from the nose, bowels, or in the skin. The separation of the navel may be followed by bleeding. Many of these cases are due to hereditary disease of one character or another. Of these, there is one which requires special mention, because when fatal hæmorrhage has occurred after circumcision it has been due to it. This is Hæmophilia. Subjects of this disease are called Bleeders, and it usually only affects males. It runs in families, one or two members may be affected while the rest are free. The females in a family of “bleeders”, though they may not suffer themselves, transmit the disease to their children. In this condition the slightest injury will start profuse hæmorrhage. The use of a toothbrush may be sufficient to cause severe bleeding from the gums. If the family history of any child reveals the presence of this disease circumcision must not be performed. Should the operation have taken place in ignorance of the condition the difficulty in controlling the hæmorrhage, and its recurrence if at all relieved will at once confirm the presence of Hæmophilia. The nature of the bleeding in this condition is that referred to before as Capillary.
