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November 1947


Arch Otolaryngol. 1947;46(5):684-685. doi:10.1001/archotol.1947.00690020700011

NONTRAUMATIC, nonirritant nosebleed is an early manifestation of rheumatic fever, especially in the presence of active heart disease. It may herald the onset of an acute attack, forewarn of an exacerbation of rheumatic activity or develop in a patient convalescing from active carditis. A single severe attack usually gives way to repeated episodes, increasing in frequency and severity with age and rheumatic activity. Bleeding usually arises from Little's or Kiesselbach's area, situated in the highly vascular anterior portion of the nasal septum, although other sites may be affected. Most of the rheumatic children either showed partial organization of the clot, with subsequent ulceration of the nasal septum, or, more often, a visual source of bleeding. Repeated hemorrhages may be so severe and the concern so great that cauterization and transfusion become necessary.

Hemorrhagic phenomena accompany rheumatic fever during periods of activity. There may be repeated epistaxis, easy bruising on slight

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