HAEMORRHAGE FROM THE NASAL MUCOUS MEMBRANE. 3Q9 



ing from the nose, the visible mucous membranes, especially the lips 

 and the conjunctiva, assume a marked pallor ; the skin acquires a dirty- 

 white, waxy hue ; the patients are extremely prostrate, complain of 

 pain in the head and back of the neck, of uneasiness, and of palpitation 

 of the heart, and readily faint away ; and, should it not be possible to 

 arrest the bleeding, a task which, under such circumstances, is only to 

 be accomplished by the most energetic interference, death from loss of 

 blood may ensue. 



TKEATMENT. A moderate epistaxis occurring in a vigorous person, 

 particularly when preceded by symptoms which abate when the bleed- 

 ing begins, may be left to itself, as it will, generally, soon cease spon- 

 taneously. If the haemorrhage be more profuse, and begin to tell upon 

 the patient, or if the latter be already in a depressed condition, so that 

 we may dread evil consequences from even a slight loss of blood, we 

 should warn the patient against aggravating the flow by frequent 

 snuffing and wiping the nose, and should apply cold to the nose and 

 forehead in the form of cold compresses, or else cause him cautiously 

 to snuff cold water, containing a little vinegar or alum, into the nos- 

 trils. As long as the bleeding continues, we should also forbid al! 

 violent bodily motion, as also the use of coffee, tea, hot soup, and 

 other heating substances, and advise that his drink be cool and acidu- 

 lated. Should this treatment be unsuccessful if the patient, in spite 

 of it, become perceptibly weaker ; should the blood begin to assume a 

 brighter color, or coagulate slowly or incompletely, do not lose too 

 much time in the trial of other styptics, as sulphate of zinc, creasote, 

 liquor ferri sesquichlorat, but proceed at once to the simple tampon ; 

 or, if this be insufficient, to the double tamponade, by means of the 

 canula of Belloc. 



The application of ice to the testicles in men, and to the breasts in 

 women ; of dry or wet cups to the nape of the neck ; ligation of the 

 extremities ; holding up the arms over the head all procedures fol- 

 lowed by decided success in some instances are only to be resorted to 

 as long as the bleeding still remains within limits which do not threaten 

 danger. The same holds good of the internal administration of acids, 

 of secale cornutum, and of gallic acid. The longer we delay the tam- 

 ponade, not only will it be so much the harder to arrest the bleeding 

 of the nose, but, as the haemorrhagic diathesis increases with the dura 

 tion of the bleeding (see above), other haemorrhages are all the more 

 apt to complicate the epistaxis, and against these we possess less cer- 

 tain remedies than the use of the tampon. I know of several cases in 

 which a fatal result was almost indubitably owing to the too dilatory 

 employment of the tamponade. 



