It is established that in toxiinfective and obstructive forms of jaundice there
commonly develops a state characterised by an undue
liability to haemorrhage.
The bleeding may occur from a mucous or
serous surface or into the skin. It commonly gives
rise to epistaxis, haematemesis, melaena, purpura.
The danger of haemorrhage is greatest in the period
immediately after operation, and herein lies its
special importance from the surgical standpoint.
The usual experience is that no excessive bleeding
is noticed during the operation, and haemostasis is
generally secured without difficulty; the bleeding
takes place a few days later, and the period of
greatest danger lies between the third and the
sixth day. Such post- operative bleeding may occur
at the sites already mentioned, but more commonly
it takes place from the raw surfaces in the operative field. It is very apt to take the form of a slow ooze into the depths of the wound, forming a haematoma there or perhaps leaking to the surface
at the incision.
Haemorrhage in jaundice is thus a condition of no little surgical importance. In the
investigation reported here I have aimed at the
solution of three problems related to the subject,
the cause of the bleeding tendency, its recognition
and its prevention or treatment.
The work is based upon a study of 50
cases of jaundice under treatment in the Edinburgh
Western Hospital and the Edinburgh Royal Infirmary,
including 12 cases in which spontaneous or postoperative haemorrhages developed. It comprises
clinical and laboratory investigations, with special
reference to the coagulability of the blood and
other factors concerned in the arrest of haemorrhage
Special attention has been directed to the
prothrombin content of the blood, and evidence is
presented in support of the view that a prothrombin
deficiency is an important factor predisposing to
haemorrhage in jaundice. The results of prothrombin estimations on 34 jaundiced cases are given,'
and the value of this test as a method of gauging
the risk of haemorrhage is discussed. The cause of
the prothrombin deficiency is considered, and the
evidence attributing it to faulty absorption or
faulty utilisation of a vitamin is studied. Finally
observations are recorded on the effect of
administering preparations containing the vitamin
to jaundiced patients.