(Reprintedfrom the Therapeutic Gazette for July, 1886.) 
NOTES FROM GENERAL PRACTICE. 
BY Francis L. Haynes, M.D. 
I. Cocaine-Spray in Epistaxis, and in 
Nasal Surgery generally. 
I A., aged 20, suffering from a severe attack 
. of typhoid, was troubled by frequent epis- 
taxis. The attacks were invariably relieved by 
throwing into the nostrils, for a few moments, 
spray from a two per cent, solution of cocaine. 
On one occasion, copious bleeding was allowed 
to persist for three hours, when the spray 
checked it immediately. Until the patient 
convalesced, the spray was needed almost 
daily, and frequently several times a day, 
but the nurse never allowed more than a few 
drops of blood to be lost. 
Four per cent, solutiohs of cocaine, applied 
freely as a spray, are efficient in preventing 
pain from slighter manipulations, such as the 
removal of gelatinous polypi. Before more 
severe operations, in addition to the use of a 
four per cent, solution by the spray, a ten per 
cent, solution should be accurately applied 
on one or more pledgets of absorbent cotton 
to all surfaces about to be treated, and kept 
in position for ten minutes. Where this is 
impossible, a ten per cent, spray may be used, 
placing the tip of the atomizer as near the 
seat of the disease as may be. With these pre- 
cautions, I have made an incision through the 
whole length of the cartilaginous septum, and 
transfixed with Roberts' pin, the patient de- 
claring the procedure to be painless. Opera- 
tions under cocaine are attended with but lit- 
tle hemorrhage, thus contrasting remarkably 
with those performed under ether-ansesthesia. 
The facility with which some of the more 
remote portions of the nasal cavities may be 
examined and treated, after the complete 
shrinkage of the erectile tissues produced by 
cocaine, needs but to be mentioned here. 
Cocaine is as essential to a thorough examina- 
tion of the nose as a mydriatic to that of the eye. 
The spray, from the rapidity and diffuseness 
of its action^ is undoubtedly the best method 
of applying the drug, for this and for many 
other purposes. 
An atomizer made by the Davol Company 
("Magic, No. 25") I have found very useful 
in operations upon the pharynx and nasal 
passages. 
1924 E. Cumberland St., Philadelphia.