Haemostatics

HAEMOSTATICS, haemostatica, haemostyptica, a very large group of diverse substances whose action remains unexplained to the present time. Haemostatics are divided into 1) local or external, acting only when applied directly to the bleeding surface, and 2) general or internal, aiming to cause contraction of vessels or increased blood coagulation throughout the body. - Local haemostatics include certain salts of heavy metals and astringent substances. Most commonly among them is ferric chloride, used to stop bleeding from the surface of the skin and from the mucous membranes of the nose, oral cavity, uterus, and rectum. A 30% solution of Fe₂Cl₆ promotes clotting of blood and superficial layers of tissue, as a result of which a dense scab forms, which falls off after several days with signs of suppuration. The cauterizing action inherent in this agent is less pronounced in its preparations: ferropyrine and Gossypium haemostaticum. Of other salts of heavy metals, potassium permanganate, silver nitrate, and lead acetate are used. For bleeding from mucous membranes, astringent substances (tannin, etc.) are also used either in solutions (douches, enemas) or in powder form (insufflation of powder into the nose for nasal bleeding). For intestinal bleeding, preparations that are not changed when passing through the stomach (tannalbin, tannigen) are prescribed. At present, these agents should be abandoned, because 1) they are unreliable as haemostatics, 2) some of them, for example ferric chloride, tannin, delay tissue regeneration and impede wound healing. Some authors use suprarenin, which has a vasoconstrictive effect: a tampon soaked in a solution (1 : 1,000) of adrenaline is applied to the bleeding surface. To stop significant bleeding, this preparation is unsuitable due to the short duration of its action and the subsequent reactive dilation of vessels (see also Adrenaline). Hydrogen peroxide (Perhydrol) is most often resorted to for bleeding from the nasal and oral mucous membranes. H₂O₂ decomposes into H₂O + O, the blood foams, whips up, and clots. This method is widely used, but rarely with success. A more reliable local agent for bleeding is hypertonic solutions of glucose, NaCl. A cloth soaked in a 10% solution of NaCl and a 20-25% solution of glucose is applied to the bleeding surface and provides fairly rapid cessation of bleeding. In the Burdenko clinic during brain operations, irrigation of the bleeding surface with a 10% solution of NaCl from a rubber balloon is successfully used. The action of this agent is explained by the fact that the hypertonic solution causes the flow of tissue fluid to the surface of the wound, which is known to have the ability to significantly increase blood coagulation. The best local haemostatics are considered to be the blood of another person, blood, animal serum, tissue extracts, parenchymatous, muscle tissue, omentum. Tampons soaked in blood or normal serum are applied to the wound and cause immediate cessation of bleeding even in hemophiliacs (Freudberg). If normal serum is not at hand, any therapeutic serum can be used for this purpose. An excellent result is obtained by injecting serum with a syringe directly into a small bleeding cavity and by tamponade of the nose or bleeding socket after tooth extraction with gauze soaked in serum. Dried horse serum, which is sold under the name coagulase, can also be used. Coagulen (Kocher-Fonio), which is an extract from platelets, has strong haemostatic properties when applied locally. A good effect can be obtained by applying animal tissue fluids (Schloessmann) to the wound. Tissue fluids are obtained from resected human goiters and from parenchymatous organs of animals (lungs, spleen). Clauden, obtained from rabbit lungs, Lychkovsky's lung extract, etc., also belong to this category. Human tissues freely transplanted to the bleeding site and taken from the same patient have good local haemostatic effects. For this purpose, 1) Muscles are used; the action of this agent has been known for a long time. 2) Omentum; its action is similar to muscle tissue; used mainly for bleeding from parenchymatous organs of the abdominal cavity - liver, spleen. 3) Fascia, adipose tissue, etc. The best local haemostatic agent is vivocol (see). Blood plasma, obtained from an animal, is mixed with sodium citrate to prevent clotting and is activated with calcium chloride. To 1,000 cm³ of blood, 35 g of a 10% solution of Natr. citricum is added; the activating agent is a 4.5% solution of calcium chloride, of which V20 of the volume of plasma taken is added (Lebedenko, Cherepnina). An ampule of activator is attached to each bottle of vivocol, the quantitative relationships of which are strictly calculated. The preparation is prepared ex tempore. In this case, the bottle with vivocol is shaken until the clots completely disappear and only then mixed with the activator. A few minutes after activation, the plasma becomes sticky and viscous, solidifying into a dense mass. Methods of application: 1) pouring or dabbing onto the bleeding surface; 2) injection into the depth of the bleeding area and around it; 3) filling small bleeding wound cavities; 4) smearing the lines of sutures applied to parenchymatous organs. Internal, or general haemostatics are divided into agents that 1) cause contraction of vessels and 2) increase blood coagulation. The first group includes Sol. Adrenalini (1 : 1,000) - 0.5 subcutaneously and 20-30 drops per os 3 times a day; Histamin (1 : 25,000). The success of using these agents is very doubtful. Preparations of Secal. cornut. (Ergotin), Hydrastis canadensis, which cause contraction of the uterine vessels, give good results in uterine bleeding, but are probably useless for bleeding from other organs. - Means that increase blood coagulation. Gelatin - calf bone glue - supposedly increases blood coagulation; it was eagerly used by old authors who gave it per os, per rectum and subcutaneously. The agent is unreliable, at present it is almost not used. - Calcium preparations. No agent is used as widely for bleeding as calcium (Calc. chlor., Calc. lactic, Calc. acetic). Calcium is administered per os, per rectum and intravenously. Intravenous administration of calcium must be accompanied by great precautions so that the solution does not get into the subcutaneous tissue, as it causes tissue necrosis in this case. In such cases, Kuznetsov recommends the administration of 10.0 of a sterile 25% solution of sodium sulfate. Dosage of calcium: per os - 1.0-8.0, per rectum - 3.0-6.0 per dose, 3 times a day; intravenously - 0.1-0.25. Calcium is a favorite agent because its presence is a necessary prerequisite in the process of blood clotting and its excess in the bloodstream should supposedly increase coagulability. In reality, this is far from being the case, since calcium injected even into a vein is not retained in the blood; in addition, it should be noted that small doses of calcium have no effect on blood coagulation, while large doses sometimes cause a negative phase accompanied by a decrease in coagulability (Freudberg). - An increase in blood coagulation is also achieved by intravenous administration of a hypertonic solution of NaCl and glucose, but the effect of these agents is short-lived and just as doubtful as with calcium injection (dose: 10.0 of 10% NaCl or 20% glucose). - Extractum fluidum Polygoni hydropiperis, the liquid extract of water pepper, proposed by Krakov. Dose - 30-40 drops, 3 times a day per os. Success from this treatment was obtained in pulmonary and uterine bleeding (Kaminskaya) and in gastric bleeding (Hesse). - A good result was obtained by many authors who used the patented agent Nateina, which is a combination of various vitamins. An increase in coagulability for several hours and cessation of bleeding is sometimes achieved by irradiating the spleen with small doses (4 h) (Stephan). Further follows the parenteral administration of various protein substances: 1) Noll, Plu-mier saw good results using Pepton Witte. 2) Intramuscular injection of 5-10 cm³ of milk increases coagulability for a short time (4-8 hours); it cannot be considered an absolutely reliable agent. 3) Autogenous hemotherapy; rarely helps. 4) Human and horse blood or normal sera are more often and with greater success used, which are administered subcutaneously and intramuscularly; small doses of 5-15 cm³ do not increase blood coagulability. It is recommended to administer at least 30.0-40.0 to an adult. With repeated administration, one must remember about anaphylaxis.

When using all these protein substances, it must be kept in mind that immediately after their administration a negative phase may occur, accompanied by a decrease in blood clotting and lasting from several hours to several days. This circumstance can lead to increased bleeding. It follows that all these means are not always suitable in cases of acute bleeding, but can be successfully used for preventive purposes, for example, before operations in jaundiced patients, in septic patients, in hemorrhagic diatheses. It is only necessary in this case to ensure the disappearance of the negative phase by checking blood clotting. The best and most reliable means should be considered transfusion of whole or citrated blood. The dose is from 150.0 to 300.0. An increase in clotting occurs immediately after transfusion. The negative phase, if it occurs, is observed after 2-3 days, i.e., after a period quite sufficient for the formation of a clot. This is explained by the fact that the transfused blood acts during the first two days as a solution of thrombokinase, which gradually disappears from the bloodstream, and then as a protein, since it first gives a decrease in clotting, which is replaced after several days by increased clotting. Blood transfusion is recommended for bleeding in jaundiced patients, in septic patients, in hemorrhagic diatheses, for bleeding from the gastrointestinal tract. From all of the above, it follows that for bleeding from the skin and mucous membranes, it is best to use compresses soaked in vivocol, blood, serum; inject it into small bleeding cavities; for internal bleeding, blood should be transfused. The technique of transfusion has been simplified in recent years, determination of groups is available to any physician, and therefore this operation can be performed under any conditions. Lit..: Fonio A., Uber Koagulenzverbandstoff, Deutsch. med. Wochenschr., 1911, № 163; Scheff-1 e r, Les hemostatiques, Jour, de med. de Paris, v. XXVI, 1914; Weil P., Remarques physiologiques sur les medicaments hemostatiques, Bull, de l'Acad. de med., v. LXXXV, 1921.

S. Freydburg. "BLOOD-CLEANSING DROPS", tinctura haemocathartica, means whose action was determined by the assumption that the cause of diseases is "bad blood", the removal of harmful elements of which is possible by increasing urination and defecation. The composition of B. c. included balsams (turpentine), essential oils (juniper, dill, sassafras and many others), laxatives (jalapa, scammony, senna) and other resins (bacaouta) and etc. At present, under the name B. c., Tinctura Lignorum or Tinctura Pini compos is usually prepared - a tincture on balsamic materials (young pine cones, bacaouta and sassafras shavings, juniper berries, etc.) or an alcoholic solution of the corresponding resins and oils. Blood-cleansing drops belong to the means used on the basis of prejudices, and therefore should be excluded from use.