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The diphtheritic process may spread from the pharynx to the nasal cavities, causing blocking of the nares, with a profuse ichorous discharge from the nostrils, and sometimes severe epistaxis. The infection may spread along the nasal duct to the conjunctiva. The lymph glands behind the angle of the jaw enlarge and become tender, and may suppurate from superadded infection.
The former takes notice only of fatal coughing of blood; the latter, besides this, notices epistaxis, hematuria, and fluxes of blood from the bowels, as symptoms of such decided and speedy mortality, that those patients in whom they were observed usually died on the same or the following day.
For it is known that vaso-motor paralysis is not of itself sufficient to induce hæmorrhage, unless the tension of the blood-current be coincidently raised. See Bouchard, Pathogenie des Hæmorrhagies. The "uterine epistaxis" of malignant fevers are evidently foreign to our subject, as also the hæmorrhages of subinvolution, or of the menopause.
A gentleman of the Court of the Emperor Ferdinand suffered epistaxis when he heard a cat mew. La Mothe Le Vayer could not endure the sounds of musical instruments, although he experienced pleasurable sensations when he heard a clap of thunder.
Gabb mentions a case of epistaxis in which the blood welled up through the lacrimal ducts and suffused into the eye so that it was constantly necessary to wipe the lower eyelid, and the discharge ceased only when the nose stopped bleeding.
Charles W. Crumb cites the case of a man, sixty-five years old, with chronic nephritis, in whom a slight bruise of the nose was followed by epistaxis lasting twenty-four hours. When the nares were plugged blood escaped freely from the eyes.
Instances of vicarious and compensatory epistaxis and hemoptysis are so common that any examples would be superfluous.
He remarks that Bartholinus has recorded the loss of 48 pounds of blood from the nose; and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an account of epistaxis without cessation for six weeks. Another writer in an old journal speaks of 75 pounds of blood from epistaxis in ten days.
The separation of the slough produced by the charring of the tissues is sometimes attended with secondary bleeding. Hæmostatics or Styptics. The local application of hæmostatics is seldom to be recommended. In the treatment of epistaxis or bleeding from the nose, of hæmorrhage from the socket of a tooth, and sometimes from ulcerating or granulating surfaces, however, they may be useful.
Highmore knew a man in whom the slightest smell of musk caused headache followed by epistaxis. Lanzonius gives an account of a valiant soldier who could neither bear the sight nor smell of an ordinary pink. There is an instance on record in which the odor coming from a walnut tree excited epilepsy.
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