A text-book of diseases of the nose and throat / by D. Braden Kyle ; with 175 illustrations, 24 of them in colors.

  • Kyle, D. Braden (David Braden), 1863-1916.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of diseases of the nose and throat / by D. Braden Kyle ; with 175 illustrations, 24 of them in colors. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    tissue would furnish, nor does it afford the aid of muscular con- traction in closing a wound, or in retraction of severed blood- vessel ends. The site of the hemorrhage may be any part of the mucous membrane. Certain locations are, however, especially liable, and one in particular, the so-called site of predilection, at the anterior inferior part of the septum, which has been so named from the relative frequency of occurrence there. Macroscopically, the membrane may be swollen and red, it may show varicosities or erosions, or there may be a clean, sharp cut. It may be the margins of a septal perforation that supply the points of escape, or the ragged edges of a ruptured cyst. On inspection the hem- orrhage may be seen in the form of an arterial spurt, a slower vvelling-out of blood, or a slow, steady capillary oozing. Micro- scopically, the lesion is either an overdistention of the blood- vessels, with paresis, leakage of blood into the submucous tissue, and subsequent escape upon the surface, or a rupture or wound of the vessel-walls, with exit upon the surface. The hemorrhage tends usually to stop spontaneously, and this generally is brought about by the formation of parietal thrombi. Disloelgement of these is a common cause of secondary hemorrhage. Following a profuse escape of blood, the membrane not uncommonly is pale and anemic, returning soon, however, to its normal state. Not all the cases of epistaxis must be regarded as of pathological import, as the process is in some instances evidently natural and physio- logical, and is nature's method of blood-letting. This is true of plethora, and the various renal, hepatic, and cardiac congestions. Symptoms.—The dominant symptom is, of course, loss of blood through the nose. If the lesion be in the anterior part of the nose, it escapes through the anterior nares; if in the posterior regions or if the patient be recumbent, it has exit through the choanse into the pharynx, and, from swallowing or entrance into the bronchia] and pulmonary tracts, the subsequent ejection may simulate hematemesis or hemoptysis. The amount of blood lost varies greatly. It may be a persistent and profuse flow, or it may be a slight escape, barely tinging the nasal secretion. The attacks may be irregular and isolated, they may occur with periods of varying quiescence or as daily outbreaks, and the flow may last from a few minutes to several hours. Usually the blood shows a ready ten- dency to coagulate, but such, however, is not the case in hemo- philia. Premonitory symptoms may precede the attack, such as congestive headache, fulness, roaring in the ears, vertigo, and dis- turbances of vision. In many cases, the first intimation of the hemorrhage is a bubbling of inspired air through the fluid blood in the nasal space or spaces, or the discoloration of the handkerchief used to relieve a supposedly profuse discharge of secretion. The symptoms following the epistaxis vary greatly, and are severe pro- portionately to the amount of blood lost. There .may be, and fre-