=Pathologically= the great frequency of nasal hemorrhage is due to the
great vascularity of the nasal mucous membrane. Usually in cases of
spontaneous origin, bleeding is from the region of the septal artery.
Spontaneous bleeding may also occur from posterior hypertrophies or
adenoid vegetations. The blood flowing downward into the fauces, is
expectorated in such cases, and may be mistaken for a hemorrhage from
the lungs.
=Treatment.=—The position of the individual is important. He should
assume a sitting posture, or as nearly so as possible. Holding the
nostrils tightly, or plugging them with a piece of cotton, will favor
the formation and retention of a clot, so that the hemorrhage may be
controlled. Pressure upon the carotid artery, or upon the facial artery
at the angle of the inferior maxilla, will slow the blood current
and favor the formation of a clot, also pressure on the sides of the
bridge of the nose may influence it. Correcting any lesions that may
exist in the superior cervical region, as derangement of the vertebræ
or contracted muscles, will remove obstructions or irritations to the
vasomotor system of the affected region, and thus equalize the vascular
system. Holding the arms above the head, and the application of ice to
the nose are of aid in some cases. Also, injection of cold or hot water
into the nostrils. In serious and obstinate cases, where other methods
fail, a plugging of the anterior and posterior nares should be resorted
to, using absorbent cotton or gauze.
Broncho-pulmonary Hemorrhage
(Hemoptysis)
=Osteopathic Etiology= and =Pathology=.—Pulmonary congestion; croupous
pneumonia; tuberculosis; hemorrhagic infarction; ulcers of the larynx,
trachea or bronchi; gangrene of the lung; fibrinous bronchitis,
carcinoma of the lung; lesions of the ribs or vertebræ from the second
to the seventh dorsal inclusive, may cause diseases of the bronchial
tubes or lungs, that result in hemoptysis, or the hemorrhage may be
caused directly by extreme congestion resulting from the disordered
vasomotor nerves; diseases of the heart, such as mitral disease,
causing pulmonary congestion; aneurism of the branches of the pulmonary
artery; vicarious menstruation from deranged menstrual functions;
diseases of the vessel walls, or blood, as scurvy, anemia, hemophilia,
etc.
=Pathologically= in many cases, the lesions are microscopic, consisting
of ruptured capillaries. In other cases larger vessels may be ruptured,
or are the seat of erosion. Many other lesions may be observed. After
death the bronchial mucosa is occasionally found inflamed and the lung
tissues paler than normal.
=Diagnosis.=—A differential diagnosis must be made between epistaxis,
hemoptysis and hematemesis.
In =epistaxis= the blood may flow from the posterior nares into the
pharynx; it causes coughing and a discharge of the blood may occur the
same as in hemoptysis. A careful examination of the nasal region alone
can determine the source of the bleeding.
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