EPISTAXIS.
The bleeding may be a conservative phenomenon when not due to local injuries or ulcerations, and if slight it should not be meddled with; thus in plethoric subjects, and in those suffering from congestive headaches, the discharge gives relief, and measures for its arrest should not be under taken unless the flow has already been plentiful. In cases occurring in renal disease, purpura, hepatic cirrhosis, &c., attention must be paid to the general condition, and Chloride of Calcium given in 2 o gr. doses, repeated every 3 or 4 hours.
The patient being placed on his back, with the shoulders and head elevated and the arms raised as high as possible above the head, pressure is made upon the nostrils by pinching them between the finger and thumb, when usually the leernorrhage will be found to cease. Should this fail, cold compresses or ice to the temples and occiput, and sinapisms to the calves of the legs, may be tried,or I furchinson's plan of seating thepatient upright in a chair with his feet in a deep pail of hot water may be resorted to. The reflex action following these applications often speedily causes closure of the bleeding vessels through the vasomotor supply.
If bleeding continues the nostrils should be washed out with saline solution, and a careful examination made for the discovery of the bleeding spot. This may be touched with the electric cautery at a low heat when found in its most common site on the lower part of the septum at its anterior aspect. A probe dipped in strong Chromic Acid may he applied to the spot. Adrenalin Solution is sufficient in most cases, a pledget of lint or gauze being soaked in the liquid is to be used as a plug for the anterior nares. This drug has displaced all other local astringents. as tannin, perchloride of iron, &c. Cocaine is also efficacious, but recurrences are more common after its use. The writer's routine method was to pauk the nostril with Puff Ball, which always succeeds, hut it is difficult to keep the parts aseptic, and the adrenalin is therefore preferable when at hand.
Of recent remedies a piece of gauze steeped in normal Horse Serum will be found a convenient and effective haemostatic. A rubber bag in the form of a penny balloon which is placed iu. situ in the nostril in the collapsed state and afterwards inflated with air is a painless and efficient method; it should, like the adrenalin plug, he removed after 24. hours and reinserted if necessary.
When repeated haemorrhages follow the forcible detachment of hard crusts or scabs from the anterior portion of the nostril in rhinitis sicca. the bleeding points should be touched with the cautery at a low heat, and the membrane kept oiled by a thin unguent consisting of i dr. ('itrine Oint
ment in 7 drs. Almond Oil. The crusts may be detached by a stream of saline or alkaline solution made to pass through the nasal cavity and out of the opposite nostril, if the palate he elevated by keeping the mouth wide open, and hot water may be so employed with advantage when the haemorrhage continues.
Where notwithstanding the above measures the epistaxis continues, the bleeding spot being situated posteriorly, there will be no resource left to the surgeon but to plug the posterior flares. This is one of the simplest and least painful of operations in the eyes of the practitioner= till he has tried it. Having once performed it, he will hesitate to repeat or recommend it. It should never he undertaken unless the loss of blood is serious, and all other means of checking it have failed. By means of a Bellocq's canula, a thin double whipcord or hempen ligature is passed through the nostril, and one end brought out through the mouth. To this end a compact roll of lint, about the size of the terminal joint of the little finger, is attached. 'fraction upon the cord in the nostril hauls the lint tightly against or into the aperture of the posterior nares, where it is held in position by a plug of lint packed into the nostril in front. Over this plug the ends of the cord may be tied so as to render displacement impossible. It is advisable to leave a piece of string attached to the plug behind; this may he left hanging in the pharynx, or from the mouth. By pulling upon it, the posterior plug can be easily removed at any time through the mouth.
Some operators discard the canula and other paraphernalia and insert the left forefinger into the mouth till it blocks the posterior nares, after a thin long strip of gauze is introduced anteriorly through the nostril. and by a probe packed Molly against the left finger till which is kept in situ till the entire nostril is tightly plugged. Another and simpler plan is to insert the nasal rubber bog as far back as the and then inflate it strongly to obliterate the .ther the removal of the plug in 2.1 or 36 hours it is not advisable to resort to syringing or dourhing, as these may start the bleeding again, hut it there should he much ftetor a stream of cold saline containing adrenalin may he cautiously used to wash out the nasal cavity, and the patient should be forbidden to How his nose. A short course of Calcium Chloride may be advantageously resorted to to diminish the risk of a recurrence. When the ha•morrhage has been excessive the usual remedies indicated in anaemia must be employed, and the hypodermic administra tion of a large quantity of normal saline or transfusion may he required.