Epistaxis as a primary and secondary affection. Causes—mechanical,
over-exertion, blood pressure, new formations, diseased mucosa,
disease of the nasal venous plexus, disease of heart or lungs, in
blood diseases, in hæmorrhagic constitution, in bacteridian diseases
of the respiratory organs. Symptoms. Often one nostril, blood bright,
red, clotted, sneezing, (not retching, acid, nor cough). _Treatment._
Mechanical, astringent, cold, plugging in solipedes and other animals:
hæmostatics.
As a primary affection this occurs more frequently in the horse than in
any other domestic animal, though as a symptomatic disease it is common
in all farm animals.
_Causes._ The most common causes are mechanical injury of the
Schneiderian membrane, violent congestion of this membrane during
extraordinary excitement or exertions, as in coughing, in a closely
contested race, in a trying hunt, in drawing heavy loads, especially if
uphill and with a tight collar. It may coincide with congestion of the
brain acting to some extent as a vicarious discharge, or with the
formation of new structures as polypus, or cancer, in which, from the
looseness and friability of their texture, the vessels readily give way.
The softened membrane is equally liable to laceration or rupture during
the progress of inflammation and particularly when fibrinous (croupous)
exudations are being detached. In all these cases animals of a strong,
vigorous constitution and with a full or plethoric habit are most liable
to be attacked. Various congestions of the mucosa in diseases of the
heart or lungs are additional causes. Disease or injury of the cervical
branch of the sympathetic nerve, and varicosity of the pituitary venous
plexus must be accepted as occasional causes.
Epistaxis is also met with in states of general weakness and with
deteriorated blood, as in anæmia, in the course of various fevers and in
those hemorrhagic constitutions in which the altered blood appears to
find an easy passage through the debilitated or ruptured coats of the
bloodvessels. Thus it is seen in the so-called _purpura hemorrhagica_ in
the horse, in _small-pox_ in sheep, in anthrax, and in _swine plague_
and hog cholera. _Hering_ records the case of a number of pigs suffering
from a scorbutic affection and which bled profusely from the nose. In
bleeders (hæmophilia) and in leucocythæmia it is liable to appear.
The ulcerations of the mucous membrane occurring in _glanders_ and
_chronic catarrh_ have proved exciting causes of the hemorrhage. Lastly
the intense heats of summer and prolonged exposure to the direct rays of
the sun induce a general relaxation and a determination of blood to the
surface which rouses to activity the latent tendency.
_Symptoms._ The bleeding, usually from one nostril only, falls in a
succession of drops, (rarely in a stream), collects in clots around the
nostril, and bespatters surrounding objects as it is expelled forcibly
in sneezing. It is usually of a bright crimson hue or, in fevers or
poisoned conditions of the blood, of a dark or blackish color. It is
distinguished from pulmonary hemorrhage by the absence of cough and of a
frothy condition, and from bleeding from the stomach by the absence of
the blackened clots and acid odor which indicate the presence of the
gastric juice.
It is usually to be further distinguished from these in all animals,
save solipedes, by the absence of blood in the mouth.
_Treatment._ Nasal hemorrhage often stops spontaneously, but if the
discharge is profuse or long continued, and especially in weak or anæmic
conditions it must be treated energetically. Care should be taken,
however, to ascertain first, whether it is not vicarious of some other
and more dangerous condition like cerebral congestion.
The head should be placed in an elevated position by tying it up to the
rack, and cold water or ice kept applied over the head and neck. Matico
powder may be blown into the affected nostril during inspiration, or a
solution of alum (4 drachms to 1 pint of water) or other astringent may
be thrown in by means of a syringe. A tablespoonful of peroxide of
hydrogen thrown into the nose with an ordinary syringe will give
immediate relief. (Gillette.)
Plugging the affected nostril with a pellet of tow covered with matico,
tannin, tincture of chloride of iron (1:10 or 20) or other astringent
may be employed when other means fail. By means of a cord attached to
the plug it may be withdrawn after all danger is past. In solipedes, if
both nostrils must be plugged, wrap the tow around two elastic
caoutchouc tubes and introduce these, or in the absence of these perform
tracheotomy.
Any tendency to recurrence may be met by the internal administration of
gallic acid (horse and cow ½–1 drachm), acetate of lead (horse and cow
½–1 drachm) or, in anæmic conditions, tincture of the perchloride of
iron (horse and cow ½ oz.) in water.