2 lleiiiorrliayc from I lie Nose. 



E])iHtaxis niially occurs not iiit r(M|iu'iitly in the course of 

 f^eiicral acute infectious diseases (antlirax, purpura luenior- 

 rlia^ica, scorlnitus, smallpox) ; also in blood diseases (leukemia, 

 anemia). 



Symptoms. There is a discharge of blood from one or both 

 nares, I'itlier in the form of drops (epistaxis) or in a continuous 

 thin stream or in laro-er amounts (rhinorrhagia) ; the blood is 

 usually bright red, not foamy, perhaps mixed with a few large 

 air bubbles. If nasal catarrh exists simultaneously, the blood 

 may appear in the form of fine streaks in a mucoid or purulent 

 discharge. If there is a more severe loss of blood, the patient 

 is frightened, the pulse is small and frequent, the mucosae are 

 very pale and a fatal issue due to loss of blood may occur under 

 intensification of the symptoms within eight to twelve hours, 

 or only after five to eight days. In the majority of cases, 

 however, hemorrhage ceases spontaneously after a time. We 

 generally need consider only such hemorrhages as dangerous 

 which occur frequently in anemic animals or which are due to 

 serious underlying infections. 



Diagnosis. It is generally easy to recognize the nasal cavi- 

 ties or the accessor}^ nasal cavities as the source of a hemor- 

 rhage. However, the cause of such hemorrhage can only be 

 determined after a consideration' of all concomitant circum- 

 stances and after a careful inspection of the nasal cavities, 

 with the rliinolaryngoscope when possible. If there is a 

 more severe hemorrliage such inspection must, however, be 

 postponed, and the stopping of the flow of blood is the first 

 requirement. In hemorrliage from the lungs the blood is like- 

 wise bright red; but it is finely foamy and there is cough and 

 frequently dyspnea. Exclusion of hemorrhage from the lungs 

 may be difficult in those cases in which portions of blood get 

 into the pharynx and from there into the trachea or bronchi, 

 causing cough and becoming more or less foamy. In hem- 

 orrhage from the stomach the blood is dirty brown, has an acid 

 reaction and may in horses, and occasionallj^ in cattle, be ex- 

 pelled from the nose with vomitory movements. Blood oozing 

 out of ulcers is mixed with mucoid, purulent or ichorous dis- 

 charges. 



Treatment. Hemorrhage frequently stops soon and spon- 

 taneously if the animal is taken to a quiet place. If it persists, 

 cold applications to the frontal region and to the nose are 

 indicated, also astringent irrigations of the bleeding nasal cav- 

 ity (alum, tannic acid, iron sulphate, chloride of iron in 3-5% 

 solutions). In severe hemorrhage, which cannot be controlled 

 otherwise, one or both nasal cavities must be tainponed; this 

 may be done with al)sorbent cotton soaked in an 8-1 O^o solution 

 of chloride of iron, or with oil of turpentine or with a 0.01-0.02% 



