Epistaxis.
Synonym:—Nose-bleed.
Definition:—A condition of hemorrhage from the nasal passages, depending usually upon local causes.
Etiology:—A direct injury to the mucous membrane is the most common cause. Congestion of this membrane, with the formation of ulcers, is another common cause. The presence of polypi and other foreign bodies will induce it, and it occurs in infectious fevers, especially in exanthematous disease. It is especially liable to occur when any acute or chronic disease affects the fibrin and thus the coagulating power of the blood. It occurs in any disease in which there is a liability to sudden cerebral congestion, which is known among the laity as a "rush of blood to the head," in diseases of the heart and especially in vicarious menstruation. Severe over exertion results in nose-bleed in some plethoric patients, and children may be liable to its frequent and sudden occurrence in a severe form, with no explainable cause. With these cases there is probably a tendency to haemophilia, with some hereditary weakness and perhaps a tendency toward anemia.
Treatment:—The treatment of a case that has suddenly appeared, where there is no previous habit, should be based upon the supposition that it is due to a traumatism. If the patient is made to sit up and pressure is applied with the thumbs on the border of the inferior maxilla over the facial artery, a simple hemorrhage may be stopped. The application of cold to the back of the neck is sometimes beneficial. Continuous pressure applied against the upper lip, pressing it against the upper teeth, will control some mild cases. - I have had excellent results in recurring cases with the use of from fifteen to thirty minim doses of the compound tincture of erigeron and cinnamon, made by dissolving one dram each of the oils of erigeron and cinnamon in two ounces of alcohol, this is given internally in a tablespoonful of water every ten minutes. One physician occluded the nasal passages by drawing into them a strip of salt pork; they may be plugged with cotton saturated with a mild astringent solution, or a spray of a mild solution of the persulphate of iron or of the adrenalin chlorid are sometimes of temporary benefit. In cases where there is a sudden rush of blood to the head, the patient should have an immediate hot mustard foot bath, from twenty to forty minims of ergot internally, and cold applications to the head, and should be kept in a sitting posture, if possible.
