H^EMORRHAGIES. 231 



quently ; and as often as it appears to arise from internal 

 causes, that is, from a state of the system supposed to require 

 such evacuation. 



DCCCXX. I am however of opinion, for the reasons given 

 DCCLXXIX., that this disease is very seldom to be left to 

 the conduct of nature ; and that in all cases it should be mod- 

 erated by keeping the patient in cool air ; by giving cold drink ; 

 by keeping the body and head erect ; by avoiding any blowing 

 of the nose, speaking, or other irritation : and, when the blood 

 has flowed for some time, without showing any tendency to cease, 

 .a profuse bleeding is to be prevented by measures employed to 

 stop it ; such as pressing the nostril from which the blood flows, 

 washing the face with cold water, or applying this to other parts 

 of the body. 



DCCCXXI. Even in the case of young persons, where the 

 disease is least hazardous, and even in the first attacks, I judge 

 such measures to be proper : but they will be still more proper, 

 if the disease frequently recurs without any external violence ; 

 if the returns shall happen to persons of a habit disposed to be 

 plethoric ; and, more particularly, if the marks of a plethoric 

 state appear in the precedent symptoms. (DCCCXIII.) 



DCCCXXII. Even in young persons, if the bleeding be 

 very profuse and long continued, and more especially if the 

 pulse become weak and the face pale, I apprehend it will be 

 proper to suppress the haemorrhagy by every means in our 

 power. See DCCXCVII. and following paragraphs. 



DCCCXXIII. Further, in the same case of young persons, 

 when the returns of this haemorrhagy become frequent, and 

 especially with the marks of a plethoric habit, I think it neces- 

 sary to employ such a regimen as may prevent a plethoric state 

 (DCCL XXXIII. -DCCLXXXVIL). At the same time, 

 care should be taken to avoid all circumstances which may de- 

 termine the blood more fully to the vessels of the head, or pre- 

 vent its free return from them ; and, by keeping an open belly, 

 to make some derivation from them. 



DCCCXXIV. In adult persons, liable to frequent .re- 

 turns of the epistaxis, the whole of the measures proposed 

 DCCCXXIII., are more certainly and freely to be employed. 

 When, with the circumstances mentioned in DCCCXIII., the 



