Definition.—Hemorrhage from the nose, arising in the cavity or in sinuses leading into it.
Etiology.—Bleeding from the nose is quite a common occurrence, especially in early life and may be due to local or constitutional conditions. The most common local cause is injury to the vessels, which in the nose are very superficial; thus a fall, a blow, or picking the nose—a very common habit in children—or even sneezing, often results in obstinate bleeding. The introduction of foreign bodies, quite common in children, may be the exciting cause. Nasal polypi and malignant growths may also be responsible for the trouble.
The constitutional cause may be due to a change in the blood itself, or it may be due to a diseased condition of the blood-vessels, or it may arise from obstruction to the pulmonary circulation, and it may possibly, at times, be vicarious. Hemophilia or the hemorrhagic diathesis often gives rise to the most severe and persistent types. Typhoid fever is often accompanied or preceded by nosebleed.
Symptoms.—In plethoric individuals there may be a sense of fullness in the head, flushing of the face, and throbbing of the carotids, as prodromes. The bleeding varies in quantity and character; thus it may slowly drip, drop by drop, for hours, or it may flow almost in a stream, passing downwards into the pharynx; the patient may swallow large quantities, to be vomited up as black coagula, which is sometimes mistaken for hematemesis.
Should the hemorrhage continue for hours, the patient becomes anxious and alarmed at his condition, the pulse becomes small and quick, and the patient shows marked depression.
Treatment.—Generally, local measures are the only ones that need to be used. Pressing the finger firmly against the affected ride for several minutes is often sufficient, or firm pressure against the facial artery for several minutes may be effective.
The use of tannin and the iron preparations I do not like, as they are apt to irritate the mucous membrane, and when the hard clot is removed, the hemorrhage often breaks out afresh. The injection of very hot water is sometimes very useful.
Pledgets of cotton in chloro-septic has given me good results.
When the bleeding persists, notwithstanding these measures, the nose should be thoroughly tamponed. A pledget of common cotton (not absorbent), to which a string is firmly tied, should be pushed far enough back to get beyond the bleeding points; then more pledgets are to be crowded in till the nostril is firmly packed. The hemorrhage ceasing, the tampon may be allowed to remain ten, twelve, or twenty-four hours, though blood in the nose very soon decomposes and becomes quite offensive.
To remove the tampon, great care must be used or the hemorrhage will be renewed. The tampon should be softened with warm water, when it will readily slip from the nostril upon slight traction of the string, which has been carried to the side of the nose and fastened by an adhesive strip.
Where the hemorrhage is passive and consists of a continued oozing, the first trituration of charcoal will give good results, three to five grains every two hours. Oil of erigeron, or cinnamon, may be used successfully, and ergot hypodermically, when the hemorrhage is very stubborn.