306 DISEASES OF THE NASAL CAVITIES. 



tendency to spontaneous bleeding arises, it should be these very 

 capillaries of the nasal mucous membrane which generally, and indeed 

 almost always, give way. The morbid state of the capillary walls, 

 which renders them apt to tear the haemorrhagic diathesis therefore, 

 is probably more or less diffused over the entire vascular system of 

 the body ; but it is in the nose alone, the organ whose vessels at all 

 times evince a diminished power of resistance, that the nutritive dis- 

 order of the vascular wall suffices to occasion rupture from simple pres- 

 sure of the blood. 



Predisposition to nasal bleeding is, on the whole, far greater in 

 youth than in more advanced life ; but it rarely appears before the 

 period of the second dentition, and does not occur .in very young chil- 

 dren. It is, moreover, the fragile constitutions, with slender bones, 

 relaxed muscles, delicate skin, rather than big-boned, muscular persons, 

 who are troubled by bleeding of the nose. The nutrition of the capil- 

 lary walls is especially liable to suffer from exhausting diseases, 

 whether acute or chronic, and we see epistaxis occur with striking 

 frequence, as one of the symptoms of acute or chronic marasmus, in 

 the course of typhus, of tedious intermitting fever, of the acute exan- 

 themata, pleurisy, peritonitis (particularly that insidious inflammation 

 within the abdomen, which originates in the caecum or colon), and also 

 in the course of tuberculosis, caries, etc. 



The opinion here advanced, that the capillaries of the nose are 

 more prone to rupture than those of other organs, is materially sup- 

 ported by the phenomenon that bleeding of the nose is seen nine 

 tunes ere bleeding from other organs is seen once, in diseases which 

 undoubtedly affect the condition of the entire body, and not the nasal 

 mucous membrane alone. We must also mention that, in nearly all 

 affections of the spleen, nasal haemorrhage is a common symptom, and 

 that among ancient physicians, and to this day among the people, 

 repeated bleeding of the nose, especially if from the left nostril, is 

 taken for an almost pathognomonic symptom of such diease. Affec- 

 tions of the spleen, however, occur so often in connection with exhaust- 

 ing maladies, and these maladies again, when uncomplicated by dis- 

 ease of that organ, so frequently show a tendency to epistaxis, that 

 the genetic connection between nasal haemorrhage and disease of the 

 spleen remains a matter of doubt. This is true as regards hyperaemia, 

 simple hypertrophy, and lardaceous degeneration of the spleen; and 

 it is only when diseases of this viscus give rise to leuchsemia that we 

 san consider it as demonstrated that bleeding at the nose depends 

 immediately upon an affection of the spleen, or, at all events, that it is 

 brought about by disorders of nutrition, to which disease of the latter 

 organ gives rise. 



