Bleeding from internal parts.
By Henry Newell Guernsey, M. D.
Presented by Sylvain Cazalet
Dr H. N. Guernsey
Editor’s introduction : This essay on bleeding by this great teacher of the “keynote” system is the best essay in the literature on this topic that I have come across.
This is worth preserving, and adding some more remedies, to be referred to in emergencies.
Those remedies which are most highly characterized by BLEEDING FROM INTERNAL PARTS are : Acon., Am., Bell., Caic. c., Carb. veg., Canth., Cham., Chin., Croc., Ferrum, Hyos., Ipec., Kali c., Lach., Merc., Nitr. ac., Nux v., Phos., Plat., Puls., Sabina, Secale, Sepia, Sulphur.
As we may at any time be suddenly called upon to prescribe almost instantly for a dangerous haemorrhage, I will give the strongest points of each drug first that would facilitate our choice.
When we find with the hemorrhage an apparent mental excitement, accompanied by a fear of death (perhaps the fear of bleeding to death), we may find on investigation that the haemorrhage was brought on by a fright, by a fit of anger, or by anxiety; the patient may still be suffering from the exciting cause. The sufferer is usually lying on the back, owing to an aggravation froin lying on either side; worse on rising (becomes dizzy); blood coagulates easily; afraid to move about much, though feeling restless and anxious; thirsty, skin dry. Most generally found in dark-haired subjects, plethoric and active.
Here the bleeding has been excited from an injury; from concussion; bodily fatigue; physical exertion. We often find a bruised or sore sensation in the parts from which the blood exudes. Pulmonic or uterine haemorrhages and epistaxis, etc., are often attended with this sensation.
Hot head and a cool body are very characteristic of this remedy~
Sometimes a fright and an injury may be nearly coincident, and here great care must be observed to decide which was really the exciting cause; should fright have caused the bleeding, Arnica will not be the remedy.
The difference between Aconite and Arnica may be seen at a glance.
The blood coagu lates almost as soon as discharged and feels hot to the parts from which it escapes. If it be from the genital organs, they are usually forcing or bearing down pains: if from the chest or head, there is congestion, throbbing of the carotids1 injected eyes, flushed face. The patient wishes to be covered; cool air is unpleasant; cold shiverings frequently run through the body; photophobia; drinks little often; hot skin, plethoric habit.
Patient generally feels worse in the afternoon and evening; from draft of air; from rising; from suppressed perspiration.
Here, too, we see that Belladonna differs very essentially from either of the preceding drugs.
Here the most striking feature is the cosntitutiQn of the patient. This is leucophiegmatic; light hair. A’ little investigation may show that the menses are apt to be too profuse and t6o often; much perspiration about the head and shoulders; limbs are usually drawn up, and are cold and damp; desire for loosened I garments; amelioration from being rubbed; desire for warmth and covering; a slight draft of cool air is chilling; if the bleeding be from the chest, it is usually from the left side. CaIc. c. cannot be mistaken for or confounded with either of the above remedies.
A most striking symptom calling for the use of this remedy is found in the urinary organs, and consists of a cutting and burning pain during micturition; the urine flows in drops, or in a very scanty stream. Haematuria; uterine haemorrhage, blood usualy being very dark; haemorrhage from the lungs or nose.
We are chiefly led to the use of this remedy in very desperate cases, where there is almost an entire state of collapse; weak pulse; anguish of heart; skin cold and bluish; patient wants to be fanned very hard; and often whispers at the attendants, “Fan harder, fan me harder”.
This desire to be “fanned hard” is found in many different complaints, and may always be considered as indicative of this drug. We may sometimes be called in very late to such cases, or we may get them from the old practice.
The striking peculiarity here is mental irritability of a spiteful nature; the patient speaks quickly and sharply. Blood dark and coagulated; desire for air; restless; distressed.
Patient generally feels worse at night; from warmth; from anger; during eructations; lying on painless side; during perspiration; during sleep; from coffee. Better while fasting; while lying on painful side.
The first note of alarm here is faintness, with ringing in the ears; ringing in the ears is one of the most characteristic symptoms in the pathogenesis of China and if we do not give it soon, the pulse will become irregular, flickering, and imperceptible; skin cold and clammy; fainting and unconsciousness. Even at this stage China 2c in water, every two or three minutes, will soon work a favourable change.
Generally feels worse periodically; in the night; after drinking; while talking; can’t talk, wished others to explain: after perspiration; on touching the parts softly.
China cannot be confounded with Carb. veg. as firstly, in Carb. Veg. the patient wishes to be fanned hard, and if at all in China, very softly. Secondly, in Carb. v., the skin is dry and blue, while in China it is moist and clammy, Thirdly, in Carb. V. we find no ringing in the ears, as we do in China.
The striking feature of this haemorrhage is its black and stringy character, the blood forming long dark strings as it flows; often resembling long, black earthworms. We find this feature, whether the haemorrhage be from the uterus, lungs, or the nose. When examined in a mass the strings may be somewhat matted together, but the characteristic tendency is plainly observable. Sensation of a bounding or rolling in the abdomen, as of something alive.
Feels worse in the morning, when fasting; during pregnancy; in a warm or closed room.
Better in the open air; after eating.
We usually notice a very red face, with a full pulse; the haemorrhage is partly of a fluid, and partly of a black and clotted character. The flow may be from the lungs, stomach, nose, bowels, or uterus. If from the uterus, there are very often violent, labour-like pains in the back and abdomen; great erethism of the circulation; flushes of heat.
Feels worse at night, particularly after midnight; from change of position; from fat food.
The trouble may have been super-induced from poisoning by peruvian bark; the patient is generally very weak though having so red a face and so full a pulse.
The alarming points that appear are delirium; semi-consciousness; a constant flow of blood; jerking and twitching of the muscles; face bluish; eyes congested. The hemorrhage may have been brought on by a fit of jealously; by taking cold; by unhappy love, or some other mental affection.
Worse usually in the evening.
Better from stooping or leaning forward.
Hyos. differs from all or its companion remedies by the prompt appearance of delirium, by the semi-consciousness, by the. twitching and jerking of the muscles, and by the bluish face. The alarming kind of haemorrhage is usually uterine.
When we have an uninterrupted discharge of bright red blood from the vagina, nose or lungs. The first symptom here is usually a complaint of faintness and nausea; also, there may be a sharp cutting pain from the navel towards the uterus; later we may find cold skin, cold sweat, and a species of suffocating spells.
Hemorrhages sometimes follow suppression of eruptions; abuses of Peruvian bark; eating; coughing; while vomiting; occur periodically.
It will be perceived that Ipec. has not the ringing in the ears, nor has China the nausea. Ipec. would also be indicated in a constant flow of bright red blo~d from the nose or lungs, with the above gastric symptoms and faintness. Ipec. is more frequently indicated than any other remedy.
We are most frequently led to think of this remedy for haemor~1~ages occurring some days or weeks after parturition; also for epistaxis and haemoptysis after being overheated, and after a vexation. The sometimes accompanying symptoms are agonizing pain in the back, extending to the gluteal muscles, and down over the sacrum; stitching pains in the abdomen. abdomen often tympanitic.
Feels better from being covered up warmly; after eructations which occur quite frequently.
One of the best remedies to prevent abortion occurring about the second month, when characterized by stitching pains; pains in the back hindering walking, causing the patient to feel like stopping to lie down anywhere, in the street, on the floor, etc.; later, these pains may extend over the sacrum to the gluteal muscles.
For flooding occurring at the critical age, particularly when characterized by chills at night and hot flushes by day, or floodings at any time when thus characterized; after parturition, with pains in the right ovarian regiori always relieved by flow of blood from the vagina; in all typhus or typhoid conditions, where there is a flow of dark blood from the nose, from the lungs, or from the bowels with a sediment like charred straw. This sediment may either have a crushed appearance, or may look like distinct spears of charred straw – it really being decomposed blood.
Diarrhœa following milk-leg are sometimes accompanied with a hemorrhage of this sort, and here Lach. will be the curative agent.
Haemorrhages from the nose, lungs, or uterus when~there is a great deal of flatulence, borborygmus, and a sensation of fullness upto the throat, after taking a small quantity of water or nourishment; frequent flushes of heat; palpitation of the heart; cutting pairis from right to left in the abdomen; all symptoms worse from four to eight in the evening. Desire for air; to have the windows open; to be fanned. This remedy may often be used in the worst cases of pulmonic haemorrhage.
This remedy is particularly applicable in haemorrhages occurring in elderly females some time after the critical period has passed; light hair; scorbutic condition of the system. Cold, damp thighs and legs at night; perspiration sour and mouldy, excepting of the feet which is scentless; skin and muscles lax; thirst, even though the mouth be full of saliva; mood serious, sometimes amorous.
Feels worse at night; when blowing the nose. With the above conditions epistaxis, haemoptysis, haematemesis, haemorrhage from the bowels or uterus.
This remedy is in many respects similar to Merc. and sometimes a very close comparison is requisite to discriminate between the two.
Contrary to Merc., Nitric. Ac. has dark hair; perspiration sour and urinous; skin and muscle rigid; no thirst; blood dark; foot sweat fetid; distrust. The urine is stronger smelling, like horse urine.
Bleeding from the arteries and capillaries; bleeding from the uterus with pain in the back, running down through the hips into the legs with a sensation of pressure, as if the uterus itself would escape from the vulva. In so comparing Merc. and Nitr. Ac., we find them different from each other, and from all the preceding remedies.
It is a curious fact that in almost haemorrhages requiring NUX. V., we find an irritable condition of the rectum, which is a frequent and ineffectual desire for stool, with the sensation as if portion of faeces were in the rectum, this latter sensation remaining even after defecation; usually in dark-haired subjects.
Haemorrhage may be excited by indulgence in rich food; from much coffee, intoxicating drinks; constipa tion.
Worse in cold air, between three and four a.m.
Better in a warm place; lying on the side; in loose garments; passing wind per anum.
Particularly for tall, slim, dark-haired subjects; also in females who menstruate too often, too much, too long.
Sensation of emptiness in the abdomen; slim, dry stools, expelled with difficulty; flushes of heat.
Feels worse lying on the left side; on the back; from warm food or drinks.
Better lying on the right side; from cold food and drinks; from being rubbed; after sleep.
Small wounds bleed persistently and profusely; bleeding erectile tumors.
Haemorrhages, blood being partially fluid and partially hard, black clots; also coming out in quantities, and having a dark, tarry appearance; with sensation as if the body was growing, larger in every direction; in dark-haired, spasmodic and nervous subjects.
Intermittent haemorrhage, blood generally dark; in subjects of mild and tearful temperaments; can lie best on right side; feels worse in a close, warm room; desire for open doors and windows; no thirst; scanty urine; blood flows and stops, again flows and stops.
Blood flows freely in fluid and in clots. When from the uterus, there is very often a pain from the sacrum to the pubis or vice versa; for violent after-pains of the above na ture, w;th the above characteristic bleeding; especially applicable to miscarriages coming on about the third month; blood pale from the nose; blood from the vagina pale, or red, dark, or mixed with light red; much soreness in the hypogastric region.
Feels worse in a close, warm room. Better in the open air.
We see that Puls. and Sabina agree in the aggravation from warmth, but Sabina has that peculiar pain. Puls. has a different disposition, and the character of haemorrhage differs.
The flow is passive and may be dark or red, mostly red; in subjects who are naturally feeble and cachetic; tingling in the limbs and prostration; desire for air; aversion to being covered; cool skin with no desire for covering.
Better when lying with limbs extended. (In CaIc. c., the patient feels better with the limbs drawn up.)
With abdominal plethora or congestion; pain in the right groin; sensation of weight in the anus; painful sensation of emptiness in the pit of the stomach.
Feels better from drawing up the limbs.
Disposition to abort from the fifth to the seventh month, especially when there is uterine congestion; cold hands and feet; hot flashes; particularly where she complains of little, fine, darting pains up the neck of the uterus. The difference must be remembered among Kali. C. which has abortion about the second month of pregnancy, Sabina, with abortion about the tenth month and Sepia, with abortion after the fifth month.
Sensation of heat in any part previous to as well as during the hemorrhage, particularly when from the lungs. This sensation of heat may be in the inner part of the nose, uterus, rectum, etc.
Worse when warm in bed; when exposed to any heat, as of fire, etc.
In giving these remedies for bleeding from internal parts, I think it proper to remark upon the so-called adjuvants which some physicians resort to for the arrest of hemorrhages.
As we passed over a variety of haemorrhages, and have observed how each has its own peculiar character, each one differing from all the others, it will be useful to inquire “why does the patient bleed in this manner or that. Why these bleedings occur each of its own peculiar type, from the nose, from the lungs, or from the dried up uterus of the aged female?” We know that in all these haemorrhagic conditions there were no open blood vessels from which blood could flow.
What other cause then can be assigned but that a peculiar morbific condition exists in each case, which, having induced a flux of blood to the parts concerned, caused the bleeding? In apoplexia, in the various conges tions, in the erethisni of blood which causes flashes of heat, there is a morbific agent at work which is not unlike in principle, other morbid conditions causing other forms of disease which are perfectly amenable to the remedies of our materia med ica.
And why then might we not as well employ the so-called adjuvants in almost any other form of disease, as in bleeding from inner parts?
As in the pathogenesis of a peculiar morbific influence which we see manifested in the various forms of haemorrhages, so the pathogenesis of some peculiar drug must indicate its use in arresting the forms of bleeding to which it is adapted.
As we know our remedies, we can succeed with their use as destined by the Creator without the aid of any cumbersome, and often injurious, so called adjuvants.
The Homœopathic Heritage, March, 1993. p. 151-7.
H. N. Guernsey, M.D.