The causes of nose bleed may be divided into two general groups,
local and constitutional. The first group consists of trauma directly
to the nose either external or internal, from nasal operations and
other causes. The presence of a cluster of thin-walled veins on the
anterior part of the septum which readily rupture from slight cause,
constitutes perhaps the most common cause of nose bleed. The ulcers of
atrophic rhinitis or syphilis occasionally cause bleeding. Malignant
growths of the nose may cause frequent and profuse hemorrhage. The
constitutional causes of epistaxis are, the acute fevers, cardiac
and arterial diseases, which cause excessive tension; and cases of
altered composition of the blood such as the anemias, malaria, purpura,
chlorosis, hemophilia, etc.
=Diagnosis.=—Direct examination of the nose will usually reveal the
cause. If there are no signs of trauma or rupture of the anterior
group of vessels and the bleeding does not respond quickly to packing
of the affected side, there is either a rupture of a large vessel,
which requires long continued packing, or it belongs to the class of
constitutional disease.
If there is evidence of some necrotic disease of the nose or if there
are areas of exposed bone or cartilage from careless surgery, these may
usually be seen and the point of bleeding located.
=Treatment.=—Cold applications, irrigation of the nares with cold
normal salt solution and the application of an absorbent cotton or
gauze pack is usually sufficient to stop the average case of epistaxis
from any cause. The direct application of cold to the lower cervical
region will cause capillary restriction.
There are many cases in which the membranes of the nose have lost their
tone due to various irritants or from deficient nutrition to the parts.
These are cases of a wholly different type from that of the well known
necrotic diseases such as atrophic rhinitis and syphilis. Hay fever
is a result of such a cause. The treatment in such cases consists of
removing any local causes or osteopathic lesions and then normalizing
the resistance of the membranes by the methods described under the
treatment for hay fever.
The treatment for those cases of epistaxis due to constitutional
disease depends wholly upon the causative factors and the proper
treatment of these. Any local treatment in such cases will be expected
to produce only temporary results.