HAEMORRHAGE FROM THE NASAL MUCOUS MEMBRANE. 30? 



The exciting causes of epistaxis are usually of so trifling a char- 

 acter as generally to escape detection. Haemorrhage from the nose, 

 indeed, sometimes occurs in consequence of blows, or other injuries 

 sustained by that organ, and is a frequent concomitant of catarrh, 

 ulceration, and the development of morbid growths in the nasal pas- 

 sages ; but such haemorrhages occurring in subjects exempt from mor- 

 bid predisposition are rarely of great magnitude, and scarcely ever 

 require any active treatment. On the other hand, in individuals 

 afflicted by a morbid tendency to bleeding, the plethora arising after a 

 full meal often gives rise to epistaxis. Sometimes the use of spirits, 

 or of coffee, tea, or other hot drink, as well as violent bodily efforts, 

 acute mental excitement, and other influences which excite the action 

 of the heart, may have the same effect. In another series of cases, 

 rupture of the capillaries is induced by some trifling obstacle to the 

 outflow of the blood from the head ; but, as we have already remarked, 

 in predisposed individuals, the exciting cause of the bleeding is not 

 generally determinable ; and although theoretically we may classify 

 the causes of nasal haemorrhages into plethoric, fluxionary, and obstruc- 

 tive, it is often difficult to decide, in particular instances, to which of 

 these three categories a case belongs. 



The frequent occurrence of instances where patients with habitual 

 epistaxis always bleed from one and the same nostril, from which nos- 

 tril a brisk haemorrhage may always be made to spring by thrusting 

 any thing into it, while no such result is obtained by a similar proce- 

 dure at the other nostril, makes it seem likely that bleedings of this 

 kind proceed from dilatation of some small blood-vessel in the lower 

 and anterior part of the nasal cavity. If we consider that the vascular 

 net-work of the lower turbinated bones and their mucous membrane is 

 extremely well developed, there being a vascular plexus there of some 

 magnitude, containing both arteries and veins ; and if we reflect that, 

 in some persons, such haemorrhages come on with suddenness and vio- 

 lence, a continuous jet of blood spirting all at once from the nose, there 

 can hardly be any doubt (in spite of our lack of anatomical proof of the 

 fact) that the source of the epistaxis, from which some people suffer 

 upon every trifling occasion, consists in a varicose dilatation and thin- 

 ning of one or more of these blood-vessels. The remarkable fact that 

 very violent haemorrhage can often be stanched by merely plugging 

 the nose in front, and that it is not often necessary also to tampon the 

 posterior nares, would likewise seem to indicate that the source of the 

 bleeding lies low down and in front (/Seitz). 



ANATOMICAL APPEABANCES. The bodies of persons who have 

 died of epistaxis putrefy very rapidly, and upon autopsy exhibit signs 

 of the most complete anaemia. In other respects, the results of post- 



