122 The Nose 



gorged capillaries, in which case it comes as a relief, but it is a 

 be due to ulceration into an artery, in which case it is likely to occur 

 from the cartilage of the septum ; if so, prolonged pressure between 

 the finger and thumb may stop it at once. Pulmonary or cardiac 

 disease, by delaying the venous return, may be the cause of the 

 haemorrhage. The subject should keep erect, so as to help the venous 

 return, and he evidently should not blow his nose. Nor should he be 

 allowed to hang his head over a basin, as this attitude compresses the 

 jugular veins, and increases the venous engorgement (p. 36). The 

 vaso-motor centre may be stimulated by cold applied to the back 

 of the neck. 



Plugging the nares may have to be resorted to if the bleeding 

 become very serious. If no better apparatus be at hand, a piece of wire 

 from a soda-water bottle may be bent into a suitable loop, and, having 

 been armed with a doubled string, may be passed along the floor of the 

 nose and down against the posterior wall of the pharynx. As soon as 

 the string appears below the level of the palate the loop should be 

 caught and brought out between the teeth, the wire being withdrawn 

 from the nose. Another piece of string should be fixed in the loop for 

 the subsequent drawing out of the plug, which should consist of a 

 small roll of lint, a little larger than the last joint of the patient's 

 thumb. This, having been secured in the loop, and having been 

 helped round to the back of the soft palate by the finger in the mouth, 

 should be drawn firmly into its place by pulling on the ends of the 

 string which hang from the nostril. Then a plug is thrust into the 

 nostril and tied in position by the two strings, the single string which 

 hangs out of the mouth being also fixed to the anterior plug. 



The posterior plug, being firmly jammed in the oblong, bony frame 

 of the horizontal process of the palate bone, the internal pterygoid 

 plate, the vomer, and the body of the sphenoid, may set up necrosis if 

 it be too long retained. 



Development. The external nose is formed from a broad median 

 lappet which comes down from the cranium. Its central part forms 

 the tip of the nose, and, descending below the level of the nares, con- 

 stitutes the septum between them (the columella) and, lower down, the 

 lunula, or central part of the upper lip. The side of the nose is de- 

 veloped from the nasal process which comes down between the orbit 

 and the maxillary process. 



The depression for the eye is continuous with the mouth through 

 an oblique cleft between the fronto-nasal and external nasal processes, 

 internally and above, and the maxillary plate externally and below ; 

 rarely does the entire fissure leading into the orbit remain uneffaced. 

 As remarked on p. 76, the nasal duct is the unobliterated part of this 

 cleft. (See also pp. 105 and 123.) 





