CUTANEOUS HEMORRHAGE: BLOODY SWEAT: HÆMATIDROSIS. HÆMATOPEDESIS.
Forms of cutaneous hæmorrhage; in specific diseases; in parasitism; in insect bites; in congestions of sweat glands; in deranged innervation; in hæmophilia. Section of sympathetic. Salt on sciatic. Hysteria. Sclerosis of cord. Inflammation. Symptoms: drops, crusts. Hæmorrhagic nodules. Treatment: styptics, cold, ice, snow, tannin, matico, iron chloride, alum, gelatine, atropine, ergot, lead acetate, quinia. Gravitation.
The escape of the blood by the skin is seen in a variety of morbid conditions, due it may be to profound changes in the blood and capillary walls, as in petechial fever, anthrax, scorbutus, septicæmia, swine erysipelas, etc., in which this is only a subsidiary phenomenon of a general disorder:—to the presence of parasites (Filaria hæmorrhagica,) in the skin:—to insect bites:—to violent congestions implicating the sweat glands (bloody sweat):—or to deranged innervation of the part as in cases of trauma of the sympathetic or sciatic nerve, or disease of the nerve centres. It may further be a manifestation of hæmophilia in which any slight lesion becomes the occasion of persistent hæmorrhage.
Cases that appear in the course of specific contagious diseases and those dependent on filaria will be considered under these headings, and we may confine our attention here to the forms of sweating and oozing of blood from independent causes. German writers draw attention to its frequency in eastern horses, attributing it to the great development of the vascular system especially of the skin, but its comparative infrequency in the English racer and American trotter would throw doubt on this doctrine. It may be questioned whether the frequency of the disease in Oriental horses is not to be ascribed rather to filariasis. This idea is not contradicted by the especial prevalence of the bleeding in summer when the filaria is most active, but when also the skin is the most vascular and its tissues most relaxed.
Of nervous hæmorrhages we have the experimental examples of Bouchard and Simon from section of the sympathetic nerve in animals, also those of Glen and Mathieu from irritation of the sciatic in dogs with common salt. In man the nervous causation has been seen in hysteria, under profound nervous shock, in sclerosis of the cord, and even as the result of auto-suggestion. This influence is constantly operative in violent inflammations in which diapedesis and minute hæmorrhages into the affected tissues are marked phenomena, and under such a cause the gland ducts especially are the seat of transudation. When the skin is abraded, cracked, or blistered it occurs also on the surface of the exposed derma.
Symptoms. With active local congestion or inflammation the blood usually oozes in drops from the surface, and drying concretes into dark red crusts. In other instances, however, it drops from the surface, or even flows, producing anæmia and even death. Into such cases hæmophilia presumably enters. Hæmorrhagic swellings like wheat kernels or beans also form in the skin.
Treatment. Apart from the contagious and parasitic diseases, and scurvy, the general treatment will be styptic. Cold water, ice, snow, a stream from a hose, solutions of tannin, matico, iron chloride or sulphate, alum or gelatine may be employed. Internally the iron salts, gelatine, atropine, ergot, lead acetate, or quinia may be given. In hæmophilia the gelatine especially should be tried both locally and generally. When it is possible, as in the case of the head, gravitation should be availed of. Elsewhere a compress bandage may be used.
ULCERATION. GANGRENE. BED SORES.
Causes: inflammation, exudation, obstructed circulation, lesions in trophic nerve centres, sclerosis, toxins, ergot, caustics, freezing, gangrene, microbes, cryptogams, spoiled fodder, white skins, buckwheat, insolation. Symptoms: inflammation, molecular disintegration, dry sloughs. Treatment: camphorated spirit or vaseline, antiseptics, phenol, salicylic acid, iodoform, iodine, creolin, lysol, tar, detach sloughs.
In all cases in which the skin is violently inflamed, and particularly when the seat of an abundant exudation or infiltration which blocks circulation and retards nutrition, the tissues are especially liable to death, molecular or by sloughing, and formation of bedsores. As a general cause lesions of the trophic centres in the medulla and cord must be accepted as a cause of the imperfect nutrition and lack of vitality. This is seen in sclerosis of the cord, but may appear as the result of poisoning of the myelon as well as the gangrenous tissues by absorbed toxins. Again a common cause of circumscribed cutaneous gangrene is the capillary contraction and obstruction of ergotism. This usually involves all the tissues, soft and hard, at the distal end of a member or organ, causing the separation of all at one common level, but in less severe forms the skin only sloughs, in the form of round or irregular masses, usually around the coronet, and the resulting sores heal up under an appropriate diet. Cauterization and freezing may be a further occasion of gangrene. Finally, the local operation of the microbes of gangrene, determines both ulceration and sloughing. Cryptogams on spoiled fodders (trefoil, lupins, vetches, rusty gramineæ) are also charged with developing gangrene.