Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Credit: Text-book of medicine / by G. Dieulafoy. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
39/1110 page 21
![urethral sound of small calibre, introduce the empty bladder into the nose, inject water through the sound, so as to distend the bladder and plug the sound. This apparatus is easily kept in place, and has often yielded me the best results. If, in spite of these means, the epistaxis continue, posterior plugging must be employed. To plug the posterior nares use Belloc's sound, or a flexible urethral bougie. Introduce the sound, smeared with vaseline, into the inferior meatus, push it horizontally till it emerges behind the soft palate, seize it with forceps, and draw it out of the mouth. By means of a strong thread of sufficient length, suspend from this end of the sound a plug of wool smeared with boric vaseline, 1 inch long and half as broad. Next pull back the sound introduced into the nose. The gauze plug may be thus fixed in the posterior opening of the nose, while the index-finger, introduced into the mouth, helps the passage of the plug behind the soft palate. The thread is fixed to the cheek by means of diachylon or collodion; it is kept in place by anterior plugging, which is usually combined with posterior plugging. The plug, however, soon becomes painful to the patient. The nose swells, breathing is impeded, and the patient can rarely tolerate the plugs for more than twenty to thirty hours. To withdraw them, moisten by injecting tepid water into the nostrils. The anterior plugs come out easily, while the posterior ones are detached by means of the injection, and are finally spat out by the patient. In some cases (erectile tumour, angioma) plugging is not the best treat- ment, and the bleeding surfaces must be cauterized with nitrate of silver, or preferably with the galvano-cautery at a dull red heat. By this means M. Luc was able at one sitting to arrest profuse epistaxis which threatened the life of one of my patients admitted for an angioma. Adrenalin must enter into the therapeutics of epistaxis. The bleeding mucosa is touched with a plug soaked in a solution of adrenalin (1 in 1,000). A plug of wool saturated with a weaker solution (say, 1 in 5,000 or 1 in 10,000) may also be left in situ. The vaso-constriction which results some- times produces paleness from the decoloration of the mucosa. When the haemorrhage has been abundant, give iced drinks, use. sub- cutaneous injections of ergotin, and administer, in tablespoonful doses, the following haemostatic draught: .ft Acid, sulphuric, dil. .. .. ,. iTl^x. Tinct. ferri perchlor. .. .. .. n]_x. Tinct. opii 11\ v. Aquam ad gss. Employ injections of serum (see Appendix on Therapeutics). If these means fail to stop the bleeding, and if the patient's life be in](https://iiif.wellcomecollection.org/image/b2150913x_0001_0039.jp2/full/800%2C/0/default.jpg)
