LXXXIII Significance of Epistaxis

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Abstract
Epistaxis is the most common form of bleeding that happens without apparent reason or cause. The theory is advanced that such bleeding, wherever it occurs and regardless of the lesions which permit its escape or the numerous diseases with which it is associated, is the result of a hormonal imbalance analogous to that which precipitates the bleeding phase of the menstrual cycle. The lesions are considered the source and not the case of bleeding. The term, spontaneous hemorrhage, is apropos but not accurate. The author maintained the disease has a higher morbidity and mortality than any other human affliction. Epistaxis as well as other forms of spontaneous hemorrhage must be initiated by an inherent and hence a hereditary stimulus. This stimulus starts the progression of events, easily seen in the nose, that prepares a bleeding state, creates a lesion for bleeding and then dissipates this whole process regardless of whether the bleeding stops by itself or is arrested. Cardiovascular disease, and particularly coronary occlusion, is, in the vast majority of cases, preceded by silent bleeding into the walls of arteries. The blood flows from a vascular ization process in the intima, which is the bleeding lesion preparedfor this purpose, and starts without apparent reason or cause; and it can be prevented to some degree by the same hormonal therapy that controls epistaxis. The connection between estrogen deprivation and the vascular system is established by the fact that the administration of this hormone will abolish hot flushes. So many patients who have had coronary occlusion also had earlier epistaxis or other forms of spontaneous bleeding that it is possible such bleeding can be the herald of cardiovascular disease in later life. Epistaxis signifies the organism possesses a mechanism that can promote bleeding episodes without any abnormality of the blood or the hemostatic factors as far as these are known now.