DISEASES OF THE NOSE by J.G.GILCHRIST.
Epistaxis is a haemorrhage from the nose, either active (accidental) or passive (spontaneous). Usually it is of slight moment, soon ceasing of itself, but occasionally is very severe, and may, when long-continued or frequently recurring, endanger life.
Active epistaxis, is usually traumatic, due to rupture of capillaries form blows or other injuries, although in some cases, in which either morbid action or constitutional infirmity induces a sort of chronic congestion, any violence, no matter how slight, will induce bleeding; even blowing the nose, unusual laughing, or a slightly unusual physical exertion. In cases of an active character the blood may flow in a steady thin stream, or drop-by- drop, usually the former-and is also of bright color.
The treatment is usually mechanical, but in exceptional cases, those of a frequently recurring character, remedies will be called for to effect a cure. Perhaps the largest arterial distribution is from the facial artery, although the blood supply is derived from various vessels, and is very abundant; on this account pressure on the facial artery, at any point of its course, will arrest it, either with the finger, or by causing the patient to work the jaws vigorously, thus compressing the vessel by the tense masseter and other associated muscles. Elevating the arm vertically, of the affected side, will also frequently cause a cessation, but why I confess I am unable to say. Insufflation of hot water, is often curative in obstinate cases. Of course if a fracture of the nasal bones, or morbid action has opened a large vessel, it must be exposed and tied, or the nares plugged, as is laid down in other works. The remedies called for will be given in the next section of this article, and will be found very useful, almost certainly curative, and the indications definite.
Passive, or spontaneous epistaxis, may be either curative or pathological. Frequently acute congestion of the vascular membranes will be relieved in this manner, and some forms of headache, from the close relationship with intercranial vessels, will be notably benefited by a copious bleeding. In some forms of amenorrhoea, or even suppressio-mensium, epistaxis at the critical period, as a vicarious function, occurs. In a few cases menstruation is always vicarious, and epistaxis seems to be the common form. Many morbid processes may cause epistaxis, ulceration more frequently perhaps, but I think such haemorrhages will oftener be arterial and active. One of the most dangerous forms is that attendant upon that happily rare condition, known as the haemorrhagic diathesis; here death not infrequently results, and at all times the patient seems to be reduced to death’s door. Passive epistaxis, however, do matter what may be the cause, must never be lightly regarded, especially in those past the middle period of life. The bleeding differs from the active form in occurring in drops; not in a stream. In all cases, in the young and old, the cause must be sought for, and if possible removed. Polypi are very frequently unsuspected until repeated epistaxis calls attention to it; and so with many other pathological conditions.
The treatment is mostly medicinal. In addition to what has been said above, when the haemorrhage continues after all ordinary methods, seems arterial, and is causing syncope, before resorting to ligation it may be well to use some astringent applications, even persulphate of iron, in a weak solution. When venous, evidently from congestive or non-destructive pathological conditions, one of the following remedies may be used:
Erigeron can. – This is a remedy, that has been used somewhat empirically, and has rarely failed me. It has been used in all strengths, but the most satisfactory is inhalation of the tincture. The effort is speedy, and permanent.
elaps cor.- Since DR. HIGGINS called attention to this remedy, it has produced excellent results in my hands, when the blood is black, flows in a steady stream, and is copious. He used it in the 200th attenuation mainly, and gives a number of interesting and instructive cases.
Carbo veg. – DR. THAYER gives the following indications for this remedy, and like all that comes to us from that careful observer they have been frequently and fully verified. Blood thin, during convalescence from fevers, excited by mental emotion, as grief, also jarring; breath short and hot; sensation of numbness; pulse not felt the wrist; tenderness in the region of the liver; jaundice whole body much emaciated. As additional indications I have found it curative when we have frequent and continuous bleeding with pale face before and after, especially in the morning, or after straining to stool. Desire to be fanned continuously.
Crocus sat. – Blood thick, black, stringy, like tar; cold sweat on the forehead.
As remedies of secondary importance, but occasionally indispensable in particular cases, we may consult the following: Aconite.- Plethoric persons, with crampy sensation over the root of the nose.
Belladonna. – Red bloated face, and stupefying headache, but the bleeding is too long-continued; blood bright red, hot, and fluid.
China off.-Frequent epistaxis, with pale face, great weakness, and particularly coming on after blowing the nose.
Ferrum met. – Bleeding from the nose in the evening; nose constantly full of coagulated blood.
Phosphorus.- Haemorrhagic cases; the least injury produces violent and long-lasting haemorrhage.
Pulsatilla.-Dark thick blood, mostly coagulated; sore feeling of nose both externally and internally.
Rhus tox.-Epistaxis at night; no blood appears externally, but the next morning the nostrils are filled with coagulae.
Sabina.- Epistaxis preceded by dullness, and pressure in the forehead.
Sepia-Violent epistaxis; blows blood from the nose continually, but no actual haemorrhage.