On epistaxis and the haemorrhoidal flux : their pathogenic unity and identity of cure / by Alexander Harkin.

  • Harkin, Alexander.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: On epistaxis and the haemorrhoidal flux : their pathogenic unity and identity of cure / 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.

    4/20 (page 4)
    terror, suffered from frequent discharge from the nostrils. Dr. Girod, of Clement Ferrand, relates the case of a young man under a^e, his companion in travel, who suffered from intractable and daily epistaxis ; suspecting the cause, and gaining the young man's confidence, he confessed that it was due to daily malpractices. Acting on his advice, the young man relinquished the habit, and the haemorrhage ceased; and Hippocrates, in his De Morbis Vul- garibus, writes: Timochari hieme distillatione in nares praecipio vexata post veneris usum cuncta resiccata sunt. Epistaxis also sometimes presents itself as a symptom or con- comitant of cardiac and hepatic, of renal and febrile affections, and of acute rheumatism with pronounced endocarditis or hypertrophy of the left ventricle. It is seldom that the malady can be regarded as of idiopathic origin, the outbreak being generally indicative of constitutional disorder and disturbance of the physiological equili- brium of the blood-current; often, after the successful suppression of the haemorrhage, should the systemic cause be overlooked, the periodical return of the flux frequently occurs. While Morell Mackenzie attributes the frequency of nasal haemorrhage in grow- ing youths to plethora, Germain See, on the contrary, charges its inroads to anaemia, and censures parents and physicians for not recognising the condition as indicative of general debility. Possibly first attacks may be due to a hyperaemic condition of the blood, their frequent repetition, by draining the system of its normal amount of fibrin and red corpuscles, may induce an anaemic change; in this case, the passive haemorrhage from the delicate lining of the nostrils shows an absence of the buflfy coat, imperfect coagula- tion, and a soft clot, with often a diseased and impaired texture of the capillary vessels in the Schneiderian membrane. When, how- ever, the nasal discharge is of an active character, the blood is surcharged with red globules and fibrin in increased proportion. As to the aetiology and pathology of epistaxis, the result of my observation and experience leads me to attribute its causation, in the first instance, to functional and often to structural disease of the liver, the haemorrhagic diathesis being a dyscrasia—a secondary affection due to chronic hepatic derangement, and this theory should not appear unreasonable if we take into account the role of the liver in the constitution and distribution of the blood, its metabolic activity, its power of transforming haemoglobin into bile pigment, its capacity for storing up glucose under the form of glycogen to pour into the blood when it is needed, and its double