[Nosebleed in the history of rhinology. Images of the history of otorhinolaryngology presented by instruments from the collection of the Ingolstadt Medical History Museum].

ETIOLOGY AND ANATOMY

Up to the Middle Ages, nosebleeds were considered a natural means of purification in internal diseases. In addition injuries, extreme physical exertion, and influences from the sexual sphere were recognized causes. In the 19th century, low atmospheric pressure on mountains and in balloons was also assumed to be an etiological factor. It was only at the end of the 19th century that the importance of high blood pressure and defective coagulation were diagnosed in context with nosebleeds. In ancient times, it was known that compressing the nasal alae can often stop the bleeding, but that blood may as well run down the throat and mimick a hemorrhage coming from the trachea. Between 1874 and 1884, several authors, among them J. L. Little in USA and W. Kiesselbach in Germany, recognized the anterior part of the nasal septum as a frequent location of bleeding. GENERAL THERAPY AND ANTERIOR NASAL PLUGGING: General measures of hemostasis recommended already in ancient times were the application of cold and diverting the blood to other regions of the body by applying tourniquets to legs and arms, or by cupping. Anterior nasal plugging was already known to the ancient Assyrians and Hippocrates. Scribonus Largus (1st century) was the first to describe a nasal plugging around a tube, thus preserving a patient respiratory passage. During the Middle Ages local application of assumedly hemostatic substances of the apothecary of that time played an important part, among them "cranial moss", the lichen that grew on the skulls of hanged corpses exposed to the weather for a long time, and "mumia", a black unctuous substance made of Egyptian mummies. Plugging the nares with an inflated balloon, fabricated from animal intestines, was described first by J. P. Frank in 1807. During the second half of the 19th century, numerous varieties of rubber balloons, rubber caps, and condoms came in use for this technique. The first nasal balloon combined with a respiratory tube was presented by Dionisio in 1890. POSTERIOR NASAL PLUGGING: Plugging of the posterior nares was anticipated by Hippocrates technique of removing a pendulous polyp by pulling a sponge tied to four strings backwards through the nasal cavity. Le Dran, surgeon in Paris in 1731, was the first to adopt this technique for stopping a nasal hemorrhage. The instrument named after Belloc (or Belloq) for placing a posterior nasal plug consists of a metal tube in which a curved spring can be pushed forwards and backwards. The first description of this instrument remains a mystery. There were at least two French surgeons named Belloc and Belloq, and this has been the source of some confusion. A paper of a certain Belloq of 1757, which is generally regarded as the source, deals with means of stopping certain hemorrhages. It exists in two different printed versions with identical wording and describes the application of candle wax for stopping severe hemorrhages after tooth extraction and abdominal puncture; however, it makes no mention of nosebleeds. Bellocq's tube was made known by Deschamps' book on diseases of the nose in 1804. For about 150 years, it was one of the instruments most frequently illustrated in textbooks and most rarely used in practice because surgeons generally preferred a simple catheter for placing a posterior nasal plug. The article concludes with a short survey of the history of chemical and thermal cauterisation and ligation of blood vessels for stopping nosebleeds.