The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![two opposite conditions of the blood-vessels, in- duced by corresponding states of the body under which it occurs : in the one the extreme vessels are ruptured by the increased activity of the cir- culatory system, general and local ; in the other, from debility and relaxation their elasticity is de- stroyed, and, incapable of distension as well as of propelling their contents, their parietes readily give way ; or, from the same condition, red blood insinuates itself through the exha'ents, instead of the thinner and colourless part of this fluid proper to them. We shall proceed to consider epistaxis under these two conditions, adopting the common language of pathologists in applying to the former the term active or entonic, and to the latter pas- sive or atonic epistaxis. [Like other hemorrha- ges, epistaxis may arise from mechanical hyperae- mia—in other words, from some physical obstacle to the return of the blood from the mucous mem- brane to the heart.] Entonic epistaxis occurs occasionally in very young children, most frequently before or about the age of puberty, and in persons of a plethoric or sanguine temperament; the latter are not un- frequently the objects of it until the advances of age effect a change on the constitution, and the balance of power is transferred from the arterial to the venous system. Thus we find in early life that this hemorrhage is almost always from the arteries, and in old persons, when it does occur, that the blood flows from the venous sys- tem. The habits and exercises of males render them more liable to epistaxis than females ; but on the other hand we find in the latter that it is very often vicarious with the suppression of the menstrual discharge, and occasionally occurs with the same periodical exactness. Even in the male sex the influence of habit is often evinced in the occurrence of epistaxis, and, after other causes have been removed, it is sometimes with difficulty that its power is resisted. Local injury, inordinate exercise, exposure to heat, or increased temperature of the atmosphere; hot drinks, stimulating diet, suppressed discharges, either natural or artificial; and all other circum- stances which increase the quantity of blood, or the impetus by which it is distributed to the dif- ferent parts of the head, may occasion the occur- rence of epistaxis. In addition to these causes, it has been fre- quently preceded by various emotions of mind, terror, anger, and even a single excitement of the imagination ; hence, says Mason Good, we may •eadily trace by what means the philosophers and poets of the eastern world, and even some of those of the western, were led to regard the nose as the seat of mental irritation, the peculiar organ of heat, wrath, and anger; and discover how the same term t]X {ap or aph) came to be employed among the Hebrews to signify both the organ and Its effect, the nose, and the passion of anger to which it was supposed to give rise. In some mdividuals it is probable that there is an extraordinary delicacy of the Schneiderian membrane and its vessels, which renders the latter peculiarly easy of laceration : there appears also to be a degree of correspondence between this ex- pansion and the integuments of the face with which it is continuous, the phenomenon of blush- ing being oftei remarkable in persons subject to epistaxis, a cii cumstance which is doubtless also in great part U be referred to the identity of tem- perament predisposing to both of these affections. Excitation of the olfactory nerves, in persons of peculiar irritability of the organ of smell, has occasionally induced epistaxis ; an example of this kind has been recorded by Bruyerin, in which it was induced by smelling an apple : and another by Rhodius, in which the odour of a rose appeared to be the exciting cause. Coughing, sneezing, singing, and reading aloud for any length of time, stooping also, and particular postures of the body, have not unfrequently occasioned it. The secre- tory office of the Schneiderian membrane is liable to material interruptions from the vicissitudes of temperature to which it is necessarily exposed in the act of respiration ; and any check by cold to its natural or inordinate secretion will occasionally lead to the rupture of blood-vessels in this part. The febrile disorders which are attended with determination of blood to the head are often the precursors of epistaxis ; and this affection, from the days of Hippocrates, who pronounced it criti. cal, an expression which has been adopted through succeeding ages to the present day, has been wel- comed as a salutary effort of nature, either to reheve or bring the disorder to a favourable issue. Some nice distinctions have been drawn, by the great authority just mentioned, of the different in- dications from the occurrence of epistaxis on different days of the progress of fever ; but inde- pendently of their being inapplicable to the fevers of this country, more extended experience has shown that this is to be regarded as only one of an assemblage of symptoms from which our judg- ment of the issue of such diseases can reasonably be drawn. Epistaxis has sometimes been observed to be synchronous with the periodical returns of inter- mittents, taking place at the accession of the hot stage, when in this, as in other disorders in which fulness of blood in the vessels of the brain has been one of the morbid conditions, the greatest danger of injury to that organ, and its conse- quences, has been averted by the escape of blood from the nose. In congestions of blood in other organs of the body, whether of an acute or chronic character, as in the lungs, but particularly in the liver; or in mechanical obstructions to the free course of blood, occasioning its determination to the head, or an impediment to its free circulation in this organ, the same effect has been attended with the same salutary consequences. The suppression of the natural secretions of the body is a frequent cause of epistaxis. We see it occurring very com- monly in araenorrhoea; in those diseases in which the secretions of the other mucous or serous mem- branes are suspended ; and not unfrequently when the natural function of the skin has been checked partially or generally. Morgagni has handed down to us the record of an extraordinary, and, as far as we know, a snigular instance of the simultaneous occurrence of epistaxis in a number of persons :- It IS stated that in the year 1200 there was a great mortahty of men m the space of twentv-four hours, frol^'r^ 'r 1 ^°'V't^^' by ^ flux of blood from the nostrils; and Morgagni has -Pn^arkerf](https://iiif.wellcomecollection.org/image/b21116817_0094.jp2/full/800%2C/0/default.jpg)
