generally incessant, fatiguing, and is aggravated by pressure, talking, and especially by inspiring cold air and in the evening after lying down.

Ipecac. This remedy is useful in bronchial coughs, where there is great accumulation of mucus in the air passages, causing rattling respiration, but little expectoration; much wheezing, dyspnea and inclination to vomit. It is often indicated in the capillary bronchitis of children, being similar to tartar emetic, but there is less prostration and tendency to collapse. The cough is usually spasmodic and recurs in paroxysms. The same holds good in whooping cough, where we also find hæmorrhage from the nose and mouth, vomiting, loss of breath, face pale or blue, body rigid.

Antimonium Tartaricum.-This drug is very useful in coughs which are accompanied by a great accumulation of mucus in the chest, causing rattling respiration and suffocation even to cyanosis, but with little or no expectoration, relief coming promptly if expectoration occurs. It is the chief remedy in capillary bronchitis, where there is much rattling of mucus in the chest, oppressed breathing, rapid pulse, nausea, vomiting and drowsiness. It is often indicated, whooping cough, croup, asthma, broncho-pneumonia and pleuro-pneumonia, and is frequently required in the ordinary catarrhal conditions and incipient bronchitis.

Stannum. Stannum is an invaluable remedy when there is an easy, profuse mucous or muco-purulent expectoration, which is usually of greenish color. It is easily differentiated from tartar emetic by the fact that while there is a great accumulation of mucus, it is usually located in the trachea, does not cause any great amount, if any, rattling, and is very easily expectorated. Neither does it cause the cyanotic symptoms of the latter and is not accompanied by nausea and vomiting. An almost ever-present characteristic is a great weakness in the chest. The expectoration of balls of sweetish mucus is also characteristic. It is most often indicated in tracheitis, bronchitis, laryngeal phthisis and phthisis pulmonalis.

Belladonna. This drug more than any other gives a typical dry cough. It is caused by tickling in the larynx, and is usually worse in the evening after going to bed. There is great dryness in the larynx, even at times causing a husky, hoarse voice, and sometimes. threatening suffocation. It is most often indicated in acute, laryngitis or bronchitis, catarrhal croup, spasm of the glottis and whooping cough.

Nux Vomica. This drug is not as often prescribed for coughs

as it deserves. It is valuable in bronchial catarrh, with a dry cough, and accompanied by roughness, rawness and scraping in the chest, thus reminding us of rumex but being less acute in character. Violent, dry, fatiguing cough, worse early in the morning. It is quite useful in reflex coughs arising from gastric troubles and mental exertion.

Spongia. This remedy may be of value in dry, hoarse, barking cough in either children or adults, but its well-known value is in the treatment of croup, where it is often prescribed regardless of indications, and when iodine bromine or some other drug might answer a better purpose. It is not indicated when there is high fever and a dry, hot skin, but in cases where this condition is not present or has already been subdued by aconite, a dry, barking, croupy cough and anxious, wheezing, whistling, sawing respiration still remaining. It is of little value after membranes are formed.

In addition to the remedies considered we should not forget the characteristic nervous coughs of gelsemium, hyoscyamus, ignatia, kali bromatum and other drugs whose indications it is not necessary to give in detail.

A REVIEW OF THE TREATMENT OF NASAL

HEMORRHAGE.*

By C. E. TEETS, M.D.,

New York.

N selecting this title it was not for the purpose of advancing any new or original treatment for epistaxis, but to present to your attention a subject which I know you are all familiar with and which should bring out a liberal discussion.

In looking over my journals in the past, I have read with considerable interest the different suggestions in case of rebellious nasal hemorrhage, some of which I made a note of. These I will review together with some practical methods for controlling epistaxis which I have found of special value, especially after operations. In this review I shall not pass by without making mention of the home treatment which the family so often resorts to, such as a brass key down the back or a brown piece of paper under the lip. In *Read before the Homeopathic Medical Society of the County of New York.

many cases these simple means arrested the hemorrhage and was the only treatment used.

Another method, if persistently tried, will in many cases arrest the bleeding-that is, grasping the nose with the finger and thumb. so as to completely prevent any air passing through the cavity in the act of breathing. Or we may give relief by the local application of lemon juice, applied in the following manner: First, the nasal passages are cleared of all blood-clots, and then an injection of the fresh juice is made with a glass syringe into the nostril from which the blood is escaping, with the result of immediately arresting the hemorrhage. Or we may introduce into the nostril, to a considerable distance upward, a piece of fine sponge, cut to the size and shape necessary to enable it to enter without difficulty, previously soaked in lemon juice or vinegar and water. The patient is to be kept lying on the face for a length of time with the sponge in place. This is the procedure employed by Dr. Sireday for controlling epistaxis in typhoid fever patients.

Jonathan Hutchinson advocates a method of treatment for arresting nasal hemorrhage which he avers has never failed of success in his hands, and he claims to have had many very rebellious It consists in plunging the patient's feet and hands into water as hot as can be borne. A very good method, and one advocated by Dr. A. A. Philip, is to take a thin piece of oil silk, push it well back to the posterior nares by means of a smooth stick and pack the center with small pledgets of cotton.

I have used many times, with excellent results, a five-per-cent. solution of antipyrine in sterilized water in the form of a spray or applied by saturating strips of lintine with the solution. But Dr. Roswell Park relates in the Medical News his discovery of a new styptic, consisting of a combination of antipyrine and tannic acid in solution. From this combination is precipitated an intensely agglutinative and cohesive substance, which he claims offers the most ideal styptic for certain purposes ever dreamed of. This combination is an alcoholic solution of tannin with antipyrine in powder. There is formed at once a gumma mass, at first flocculent, which quickly coheres, the result being a combination, the stickiness and adhesiveness of which surpasses any other styptic known. They may be united in almost any proportion with the formation of the gumma mass. There is but one difficulty, that it is so remarkably cohesive that when the time comes for detachment or separation of the tampon it is difficult to remove it. It may be even necessary to

wait for sufficient times for the formation of granulations and separation by natural processes.

This is a styptic I can recommend and one worth remembering, as it is much cleaner than the Monsel's solution so often used to control nasal hemorrhage.

A very novel method which was advocated by Prof. Hodgen, of St. Louis twenty years ago called by him the Dr. McDowell's method, has been fully described by Dr. H. D. Wood. It is to introduce into the nasal cavity a condom and fill it with air or water. Dr. Wood describes the method he has used as follows: Cut off two or three inches of the open end of the condom, as may be thought necessary, and introduce a No. 5 or 6 soft rubber catheter, leaving the bag to project almost half an inch beyond the end of the catheter, as it will shorten when distended. Hold the cut end of the bag evenly around the catheter and take a few turns with a sewing thread, and tie securely to prevent it from leaking, but not so tight as to obstruct the lumen of the catheter.

Now dip this simple instrument a few times in clean water to which a few drops of carbolic acid have been added, hold the bag between the thumb and finger of one hand and twist the catheter with the other until it is brought in contact with the end of the bag. While holding the instrument in this way ask your patient to forcibly blow the nose so as to free it of all blood clots. Now introduce the instrument into the bleeding nostril until it lies just within the cavity. Then give the catheter a turn in the opposite direction and fill it with air or water and plug the end so the rubber bag will remain distended. The catheter can then be fastened to the head with a bandage, or a cord may be tied tightly around it near the nose and cut off.

In making this apparatus two condoms might be used, slipping one bag into another, so as to prevent, after operations, sharp spiculæ of bone from cutting through and spoiling the bag.

Dr. Wood considers this the simplest and safest as well as the cleanest method that he has seen described. It is very easy to remove; all you have to do is to let the air or water out, twist slightly and withdraw the bag. Cooper Rose has designed an instrument for plugging the nasal cavities on the principle described by Dr. Wood. It consists of an india-rubber bag connected with a tube which is provided with a stop-cock. The bag is introduced into the nostril in a flaccid state and then distended by blowing it up through the tube. Other methods of anterior plugging have been described,

and various astringents have been recommended for the purpose of saturating the plugs, e. g., turpentine, tincture of hamamelis, trilleum, perchloride of iron or a solution of tannic or gallic acid.

In a case of epistaxis, the first thing to do would be to make a rhiniscopic examination, and if possible find the source of the hemorrhage. If, as is usually the case, the bleeding is seen to come from a point on the anterior part of the septum, the flow may be arrested by a pledget of iodoform gauze. Or by applying to the bleeding point chromic or trichloracetic acid, or the nitrate of silver if ulceration is discovered. The most certain plan of effecting a radical cure is by the use of the galvano-cautery. First a ten or twenty-per-cent. solution of cocaine is applied to the affected part by means of a strip of lintine, and allowed to remain for a few minutes so as to render the mucous membrane anesthetic. Then a flat platinum electrode should be heated to a dull red heat and applied carefully to the seat of the hemorrhage, the outer wall of the nose being protected by a suitable speculum. After cauterization the cavity should be sprayed with glynol and eucalyptol.

Supposing, however, that a careful rhinoscopic examination fails to reveal the immediate source of the hemorrhage or that the loss of blood is so excessive as to prevent us making a satisfactory examination, then recourse must be had to plugging.

In addition to the methods I have already described I wish to suggest two others which I have used with the most satisfactory result.

The first is, to take a strip of plain gauze about three-quarters of an inch wide and after saturating it with hamamelis or fluid extract of geranium maculalum pass it up the nostril through a speculum, and carefully plug every part of the nasal chambers.

The second method is to take a cork and shape it so as to conform to the nasal passage to be treated. This is then dipped into iodoform and collodion and when dry introduced into the nasal cavity with the result of immediate cessation of the hemorrhage. This undoubtedly is the most cleanly and least objectionable of any method I have seen described; furthermore it can be removed with the least difficulty. In some cases, after the most careful plugging the hemorrhage continues, and then recourse must be had to the method of posterior plugging.

This may be accomplished with the Bellocq's canula or with a soft rubber catheter. In the absence of both, a strong piece of twine which has previously been dipped in collodium or a piece of