Blood volume tests made on a number of soldiers recovering from hemorrhage have shown that in many instances dilution of the blood occurs very slowly. The principal reasons for this seem to be (a) an initial lack of reserve fluid of the tissues, and (b) the absence of any subsequent attempt by the body to make up this fluid deficiency.

By putting such patients on a large fluid intake by mouth and rectum it has been found that their blood volume can be promptly and greatly increased. Hemorrhage cases transfused, yet still showing a low blood volume, were first treated in this way. Then the effect of forced fluids without transfusion was tried. Immediately after a hemorrhage, or as soon as the patient came under observation, he was given large quantities of water by mouth, and salt solution by rectum. Under such treatment the blood pressure soon began to show a progressive rise, the volume increased, and the red cells became more evenly redistributed, as shown by the relative hemoglobin percentages of the capillary and venous blood. These changes were often well marked after only 2 or 3 hours of the treatment.

More than this, forcing fluids in cases where the amount of bleeding is difficult to estimate on account of the presence of a high hemoglobin percentage is of distinct value, since the dilution of the blood which results serves to show the extent of the hemorrhage through the drop in hemoglobin that it entails.

In attempting to determine the condition of the patient after hemorrhage with a view to deciding the most suitable form of treatment, it is of much importance to learn the total blood loss—which is often not even indicated by the hemoglobin concentration of the remaining blood. With a total hemoglobin reduced to 25 per cent or under transfusion is needful. New blood is necessary, not only to supply more oxygen-carrying cells, but also because it actually enables the circulation to increase its volume. For, as has been pointed out in Paper I, the hemoglobin percentage must be above a certain point if a rapid restoration of the blood volume by means of the organism's own activities is to come about. With the total hemoglobin above 25 per cent the chief need is for increased blood volume, and if the patient's condition demands an immediate and large addition of circulating fluid, gum acacia solution should be given. If the condition is not so urgent, forced fluids by the alimentary tract are indicated.

The blood volume can be considerably reduced and yet a normal blood pressure maintained. It is pointed out that the vasomotor mechanism which, has adapted itself to the diminished blood bulk may in any individual case be very near the margin of its compensatory power. Increased strain in such instances may cause a failure of this mechanism with a resulting fall in blood pressure.

The beneficial results of forced fluids after secondary hemorrhage suggest the value of the early use of fluids by the alimentary tract in cases of primary hemorrhage.

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