CORRESPONDENCE 771 Dear Editor Beware of Bismuth The authors thank Mr Tucker for his comments. Our senior author recalls using Whitehead’s Varnish until it was withdrawn from use at Royal North Shore Hospital some 15 years ago. It is still supplied in Australia and is described by its manufacturers as a coagulant for control of bleeding from oozing dental extraction sites. Its composition is 10% iodoform and 90% ether. Instruc- tions for application state that one is to apply liberally with a cotton swab. Warnings include the fact that it is a flammable liquid at low temperatures, can cause aspiration pneumonitis and if vapours are inhaled it can be responsible for drowsiness, vomit- ing and breathing difficulties. It is our understanding that BIPP paste has remained the mainstay of packing material in recent years in a cross section of the ENT practices we surveyed infor- mally within Sydney. We have not been able to identify any literature which confirms that BIPP paste has any particular affect on the function of cilia nor have we identified any literature regard- ing the effect of Whitehead’s Varnish on cilia. RICHARD HARRIS, FRACS ALAN POOLE, FRACS Royal North Shore Hospital St Leonards, New South Wales, Australia

Beware of Bismuth

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CORRESPONDENCE 771

Dear Editor

Beware of Bismuth

The authors thank Mr Tucker for his comments. Our seniorauthor recalls using Whitehead’s Varnish until it was withdrawnfrom use at Royal North Shore Hospital some 15 years ago. It isstill supplied in Australia and is described by its manufacturers asa coagulant for control of bleeding from oozing dental extractionsites. Its composition is 10% iodoform and 90% ether. Instruc-tions for application state that one is to apply liberally with acotton swab. Warnings include the fact that it is a flammableliquid at low temperatures, can cause aspiration pneumonitis andif vapours are inhaled it can be responsible for drowsiness, vomit-ing and breathing difficulties. It is our understanding that BIPPpaste has remained the mainstay of packing material in recentyears in a cross section of the ENT practices we surveyed infor-mally within Sydney. We have not been able to identify any liter-ature which confirms that BIPP paste has any particular affect onthe function of cilia nor have we identified any literature regard-ing the effect of Whitehead’s Varnish on cilia.

ICHARD

ARRIS

, FRACSA

LAN

OOLE

, FRACS

Royal North Shore Hospital St Leonards, New South Wales, Australia