Medicine: Operation for Nosebleed

As a girl in Hartford, Conn., Ruth Siegel suffered severe and frequent nosebleeds. As she grew older they got worse, sometimes occurring daily and costing her a cupful or more of blood. Last week, to stop her nosebleeds. Ruth Siegel Ribicoff, 51, wife of the Secretary of Health, Education and Welfare, underwent a new operation—the first effective treatment that medical science has been able to devise in half a century of trying.

Mrs. Ribicoff suffers from a rare disease called hereditary hemorrhagic telangiectasia. It is inherited, like brown eyes, in a Mendelian dominant pattern; some of Mrs. Ribicoff’s cousins have it, but her own two children apparently do not. In this disorder, the blood itself is normal. But in some parts of the body, there are abnormal swellings of the ends of minute arteries and veins. These “end-vessel swellings” (telangiectases) burst and bleed.

One of the commonest sites for them is in the mucous lining of the nose, where Mrs. Ribicoff had them. Doctors have tried to help similar patients with cauteries and radium, but always unsuccessfully, and Mrs. Ribicoff refused these treatments. Then she heard of the new operation devised by Ohio State University’s Dr. William Howerton Saunders.

Explains Nebraska-born Surgeon Saunders, 41: “I reasoned that if you could replace the fragile membrane of the nose with skin, even though you might not remove all the telangiectases, they still would not bleed because of the skin covering.” Dr. Saunders has done 40 such operations since 1958, all on adults.

Last week Mrs. Ribicoff went to the operating room in University Hospital. Columbus, under heavy sedation and local anesthetics. From the thigh. Surgeon Saunders took a “split-thickness graft”—a piece of skin about two by three inches less than 1/50 inch thick. Then he cut loose both sides of the nose so that he could lift them like flaps to get at the lower part of the septum, the gristly central partition. He scraped the mucous lining off this, removing many of the telangiectases with the membrane. Finally, Dr. Saunders put patches of the graft skin on each side of the septum, sewed the nose together again, and packed it. The grafts, inside the nostrils, should take by early this week.

Ruth Ribicoff can look forward to relief from severe nosebleeds. If she still has any, they should be no more troublesome than those of people who are free of hereditary hemorrhagic telangiectasia.