CHAPTER II

The Nose and Throat

Cold in the Head-Mouth-Breathing-Toothache-Sore Mouth -Treatment of Tonsilitis-Quinsy-Diphtheria.

NOSEBLEED.-Nosebleed is caused by blows or falls, or more frequently by picking and violently blowing the nose. The cartilage of the nasal septum, or partition which divides the two nostrils, very often becomes sore in spots, owing to irritation of dust-laden air, and these crust over and lead to itching. Then "picking the nose" removes the crusts, and frequent nosebleed results. Nosebleed also is common in both full-blooded and anæmic persons; in the former because of the high pressure within the blood vessels, in the latter owing to the thin walls of the arteries and capillaries which readily rupture.

Nosebleed is again an accompaniment of certain general disorders, as heart disease and typhoid fever. The bleeding comes usually from one nostril only, and is a general oozing from the mucous membrane, or more commonly flows from one spot on the septum near the nostril, the cause of which we have just noted. The blood may spout forth in a stream, as after a blow, or trickle away drop by drop, but is rarely dangerous

except in infants and aged persons with weak blood vessels. In the case of the latter the occurrence of bleeding from the nose is thought to indicate brittle vessels and a tendency to apoplexy, which may be averted by the nosebleed. This is uncertain. If nosebleed comes on at night during sleep, the blood may flow into the stomach without the patient's knowledge, and on being vomited may suggest bleeding from the stomach.

Treatment. The avoidance of excitement and of blowing the nose, hawking, and coughing will assist recovery. The patient should sit quietly with head erect, unless there is pallor and faintness, when he may lie down on the side with the head held forward so that the blood will flow out of the nose. There is no cause for alarm in most cases, because the more blood lost the more readily does the remainder clot and stop bleeding. As the blood generally comes from the lower part of the partition separating the nostrils, the finger should be introduced into the bleeding nostril and pressure made against this point, or the whole lower part of the nose may be simply compressed between the thumb and forefinger. If this does not suffice a lump of ice may be held against the side of the bleeding nostril, and another placed in the mouth. The injection into the nostril of ice water containing a little salt is sometimes very serviceable in stopping nosebleed. Blowing the nose must be avoided for some time after the bleeding ceases.

If none of these methods arrest the bleeding the nostril must be plugged. A piece of clean cotton cloth, about five inches square, should be pushed gently but firmly into the nostril with a slender cylinder of wood about as large as a slate pencil and blunt on the end. This substitute for a probe is pressed against the center of the cloth, which folds about the stick like a closed umbrella, and the cotton is pressed into the nostril in a backward and slightly downward direction, for two or three inches, while the head is held erect. Then pledgets of cotton wool are packed into the bag formed by the cotton cloth after the stick is withdrawn. The mouth of the bag is left projecting slightly from the nostril, so that the whole can be withdrawn in twenty-four hours.

The bleeding nostril may be more readily plugged by simply pressing into it little pledgets of cotton with a slender stick, but it would be impossible for an unskilled person to get them out again, and a physician should withdraw them inside of forty-eight hours.

FOREIGN BODIES IN THE NOSE.-Children often put foreign bodies in their nose, as shoe buttons, beans, and pebbles. They may not tell of it, and the most conspicuous symptoms are the appearance of a thick discharge from one nostril, having a bad odor, and some obstruction to breathing on the same side. If the foreign body can be seen, the nostril on the unobstructed side should be closed and the child made to blow out of the other one. If blowing does not re[Text continued on page 69.]

Plate III

THE NASAL CAVITY

In the illustration on the opposite page, the Red Portion indicates the Septum of the nose, the partition which separates the nostrils.

Inflammation of the membrane lining the nasal cavity is the condition peculiar to catarrh or "cold in the head." Deformity of the septum may obstruct the entrance of air into the nose and create suction on the walls of the nasal cavity, causing an overfilling of the blood vessels, or "congestion," with subsequent thickening of the mucous membrane.

Polypi, small growths which form in the nose, or enlargement of the glands in the upper part of the throat (just beyond dotted line at inner edge of red portion) also block the air passages and give rise to mouth-breathing and its attendant disorders.

Another cause of mouth-breathing is extreme swelling of the membrane which covers the turbinated bones of the nose.