On the nature and treatment of epistaxis / by Alexander Harkin.

  • Harkin, Alexander.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: On the nature and treatment of epistaxis / by Alexander Harkin. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/16 (page 9)
    fact, since the time when M. Malgaigne, some forty years since, commenced a crusade against revulsives, and particularly blisters, in the Paris Academy of Medicine, this subject has continued to prove a bone of contention. Among French practitioners the practice has still warm friends, but even so late as 1886 the use of blisters in any form, or for any purpose, was condemned and spat upon Qdespuer) by the Medical Society of Tholouse. M. Colin could not under- stand why blisters were preferably applied over the liver, as there was no vas- cular connection between the skin and that organ. He considered it was the heart that was at fault, and that epistaxis was provoked by exaggeration of the vascular system that ruptured the delicate vessels of the pituitary membrane in the nose. M. Verneuil defended the application of blisters, as it was not necessary, he said, to have any vascular connection between the organ and the part to which they were applied, and explained that the nervous system played an important role, as it was the existence of reflexogene zones that determined the point of application. Finally, he said, it mattered little whether the epistaxis had a mechanical or dyscrasic origin, as it was not his desire to formulate any Therapeutic Etiology, but simply to state interesting facts. Were I to venture on the debatable ground so carefully avoided by the Academicians, I should say that I did not attribute the curative efEects of blister- ing to any revulsive properties—this would, to a certain extent, approve the theories of the humoral pathologists of the eighteenth century—but to its counter-irritant and depletive qualities. As a counter-irritant, the blister acts by causing an irritation of the surface and of the terminal branches of the cutaneous nerves, which, through the influence of the trophic nerves, affects the calibre of the arterioles, and thus controls their congestion and hypertrophy. But, the vesicant acts as a powerful depletive by abstracting from the circu- lation in the neighbourhood of the diseased organ a quantity of white blood, highly albuminous, sojidifying on the application of moderate heat. Doubtless, wet cupping in the hypochondriac region, or free leeching from the anus, would also rapidly react on the liver, and, perhaps, as readily relieve present conges- tion ; but, irrespective of the greater inconvenience of such remedies, there is this potent objection to their use, that they must abstract from the system, already too anaemic, a quantity of red globules and fibrine, confessedly present in insufficient proportions, while the blister is as powerfully depletive, leaving untouched the haemoglobin, and not increasing the hypinotic condition. Finally, there is no organ in the body more amenable to treatment than the liver ; none whose congestions and hypertrophies yield more readily to suitable remedies ; and not another that has suffered more from heroic remedies and aggressive sur- gery. It is at present apparently a matter of competition as to who shall invent the most perfect clamp or ecraseur ; whether the ligature, the knife, or the cautery is best suited to deligate and destroy the apparatus supplied by nature for the relief of the overburdened viscus at its lowermost outlet, the hsemorr- hoidal veins ; and to crown all, the dagger or trocar is too often plunged with- out remorse into its delicate parenchyma, to tap and vivisect this most passive and illused organ in the body. The advice of M. Verneuil, in his reply to his