Of the POLYPUS.
THE Polypus of the Nose, is said to be an Excresence of Flesh, spreading its Branches amongst the Laminæ of the Os Ethmoides, and through the whole Cavity of one or both Nostrils. It happens very often to both sides of the Nose at once, and in that case is very troublesome, almost suffocating the Patient, at least making Respiration very difficult. The Intent of the Operation is the Removal of this Obstacle; but as it is attended with different Events from the variety of Nature in the several sorts of Polypus's, I shall endeavour to distinguish their Species, so as to lead us into some judgment of the greater or less Probability of Success.
They all arise from the Membrane spread upon the Laminæ Spongiosæ, pretty nearly in the same manner as the Hydatids of the Abdomen, in one kind of Dropsy, do from the Surface of the Liver; or as Ganglions from the Tendons, borrowing their Coats from a Production of its Fibres and Vessels: If they appear soft, and of the Colour of the Serum of the Blood, in all likelihood they are formed of such a sort of Water contained in Cysts, which upon breaking the Membrane, leaves so little hold for the Instrument, that but a small part of it can be extracted afterwards. This Polypus is to be left to harden, before the Operation be undertaken, which in process of Time it generally will do. In the next degree of Consistence, they retain pretty nearly the same Colour, and are often partly watry, and partly of a viscid Texture, which tho' not tenacious enough to admit of drawing them out by the Roots, may at several Attempts be taken away by bits. The next Degree of Consistence, is that which is neither so soft as to be squeezed to Pieces, nor so hard and brittle as to crumble, or adhere to the Membrane with that Force as not to admit of Separation: This is the most favourable one. The last, is hard and scirrhous, adhering so tight as to tear rather than separate in the Extraction, and sometimes even tends to degenerate into a Cancer: This Polypus is very difficult of Cure.
The Polypus sometimes dilates to that degree, as not only to extend beyond the Os Palati, and hang over the Oesophagus and Trachea; but also spreading into the Sinus maxillaris, so exactly fills up every Interstice of the Nose, as to obstruct the lower Orifice of the Ductus ad Nasum, and prevent the Descent of the Tears, which necessarily must return through the Puncta Lachrymalia: and sometimes they grow so enormously large, as even to alter the Shape of the Bones of the Face.
When the Polypus appears in the Throat, it is always adviseable to extract it that way; it being found by Experience, more ready to loosen when pulled in that Direction than by the Nose. To this end, it would be right, before undertaking the Operation, to let your Patient lie supine two or three Hours, which will bring it still farther down; for the Body of the Polypus does not universally adhere, and will by its Weight stretch out the Fibres, by which it is connected to the Nose; nay, there are Instances, where by a little Effort, such as Hawking, they have dropt quite off.
The Method of extracting it, is by a Pair of Forceps, with a Slit at their Extremities for the better Hold, which must be introduced into the Nostril about an Inch and a half, to make more sure of it towards the Roots; then twisting them a little from one Side to the other, you must continue in that Action, while you pull very gradually the Body of the Polypus. If it break, you must repeat the Extraction as long as any remains, unless it is attended with a violent Hæmorrhage, which is an Accident that sometimes follows upon the Operation, and seldom fails when the Excrescence is scirrhous: However, the Surgeon is not to be alarmed at the Appearance of an immoderate Effusion the Moment after the Separation, for generally speaking, the Vessels collapse very soon again; but if they do not, dry Lint, or Lint dipt in some Styptick, will readily stop it.
After the Extirpation, it has been usual in order to prevent a Relapse, to dress with Escharotick Powders, and even to burn with the actual Cautery; but neither the one or the other can be of great Service in this Case, and both are painful and dangerous. If ever the Use of corrosive Medicines Is adviseable, it should be for destroying the remainder of a Polypus, which cannot all be taken away and then the Escharoticks may, in my Opinion, be better conveyed to the Part by a long Tent, than a Seton passed thro' the Nose and Mouth, which is difficult to do without hurting the Patient, and very nasty to bear, tho' this is the Method at present practised, and recommended by some eminent Surgeons.