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.