The loss of blood through spontaneous hemorrhage is sometimes remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood in a few days; and there is an older record of 40 pounds being lost in four days. Horstius, Fabricius Hildanus, and Schenck, all record instances of death from hemorrhage of the gums. Tulpius speaks of hemoptysis lasting chronically for thirty years, and there is a similar record of forty years' duration in the Ephemerides. Chapman gives several instances of extreme hemorrhage from epistaxis. He remarks that Bartholinus has recorded the loss of 48 pounds of blood from the nose; and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an account of epistaxis without cessation for six weeks. Another writer in an old journal speaks of 75 pounds of blood from epistaxis in ten days. Chapman also mentions a case in which, by intestinal hemorrhage, eight gallons of blood were lost in a fortnight, the patient recovering. In another case a pint of blood was lost daily for fourteen days, with recovery. The loss of eight quarts in three days caused death in another case; and Chapman, again, refers to the loss of three gallons of blood from the bowel in twenty-four hours. In the case of Michelotti, recorded in the Transactions of the Royal Society, a young man suffering from enlargement of the spleen vomited 12 pounds of blood in two hours, and recovered.
In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost in two days; Hoffman, of 20 pounds in less than twenty-four hours, and Panaroli, of the loss of one pint daily for two years.
Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont to declare that military surgery had its origin in the treatment of wounds inflicted by darts and arrows; he used to quote Book XI of the Iliad in behalf of his belief, and to cite the cases of the patients of Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by Patroclus; he was even tempted to believe with Sextus that the name iatros, medicus, was derived from ios, which in the older times signified "sagitta," and that the earliest function of our professional ancestors was the extraction of arrows and darts. An instrument called beluleum was invented during the long Peloponnesian War, over four hundred years before the Christian era. It was a rude extracting-forceps, and was used by Hippocrates in the many campaigns in which he served. His immediate successor, Diocles, invented a complicated instrument for extracting foreign bodies, called graphiscos, which consisted of a canula with hooks. Otis states that it was not until the wars of Augustus that Heras of Cappadocia designed the famous duck-bill forceps which, with every conceivable modification, has continued in use until our time. Celsus instructs that in extracting arrow-heads the entrance-wound should be dilated, the barb of the arrow-head crushed by strong pliers, or protected between the edges of a split reed, and thus withdrawn without laceration of the soft parts. According to the same authority, Paulus Aegineta also treated fully of wounds by arrow-heads, and described a method used in his time to remove firmly-impacted arrows. Albucasius and others of the Arabian school did little or nothing toward aiding our knowledge of the means of extracting foreign bodies. After the fourteenth century the attention of surgeons was directed to wounds from projectiles impelled by gunpowder. In the sixteenth century arrows were still considerably used in warfare, and we find Pare a delineating the treatment of this class of injuries with the sovereign good sense that characterized his writings. As the use of firearms became prevalent the literature of wounds from arrows became meager, and the report of an instance in the present day is very rare.
Bill has collected statistics and thoroughly discussed this subject, remarking upon the rapidity with which American Indians discharge their arrows, and states that it is exceptional to meet with only a single wound. It is commonly believed that the Indian tribes make use of poisoned arrows, but from the reports of Bill and others, this must be a very rare custom. Ashhurst states that he was informed by Dr. Schell, who was stationed for some time at Fort Laramie, that it is the universal custom to dip the arrows in blood, which is allowed to dry on them; it is not, therefore, improbable that septic material may thus be inoculated through a wound.
Many savage tribes still make use of the poisonous arrow. The Dyak uses a sumpitan, or blow-tube, which is about seven feet long, and having a bore of about half an inch. Through this he blows his long, thin dart, anointed on the head with some vegetable poison. Braidwood speaks of the physiologic action of Dajaksch, an arrow-poison used in Borneo. Arnott has made observations relative to a substance produced near Aden, which is said to be used by the Somalies to poison their arrows. Messer of the British Navy has made inquiries into the reputed poisonous nature of the arrows of the South Sea Islanders.
Otis has collected reports of arrow-wounds from surgical cases occurring in the U. S. Army. Of the multiple arrow-wounds, six out of the seven cases were fatal. In five in which the cranial cavity was wounded, four patients perished. There were two remarkable instances of recovery after penetration of the pleural cavity by arrows. The great fatality of arrow-wounds of the abdomen is well known, and, according to Bill, the Indians always aim at the umbilicus; when fighting Indians, the Mexicans are accustomed to envelop the abdomen, as the most vulnerable part, in many folds of a blanket.
Of the arrow-wounds reported, nine were fatal, with one exception, in which the lesion implicated the soft parts only. The regions injured were the scalp, face, and neck, in three instances; the parietes of the chest in six; the long muscles of the back in two; the abdominal muscles in two; the hip or buttocks in three; the testis in one; the shoulder or arm in 13; forearm or hand in six; the thigh or leg in seven.
The force with which arrows are projected by Indians is so great that it has been estimated that the initial velocity nearly equals that of a musket-ball. At a short distance an arrow will perforate the larger bones without comminuting them, causing a slight fissure only, and resembling the effect of a pistol-ball fired through a window-glass a few yards off.
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