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Show 150 or PULYI'US IN THE nose. ~-their arteries continue their action---and the blood flows unin~ terruptedly from them, until the system is drained. Successive attacks bring on great weakness, and in the end prove fatal. I have no hesitation in saying, that these polypi ought to or roryrus IN THE nose. 151 cceded to the operation, pain in the face, head-ache, and fe- ver. On the fourth day, the patient became insensible, and died on the sixth day. During dissection, there was observed an effusion of coagulable lymph on the lower surface of be taken away as well as the looser and more membranous the anterior and middle lobes of the brain, and the cribri- polypi; for in the end, they are fatal by successive bleeding, If surgeons make no distinction in polypi, they may, I con- form plate of the ethmoid bone was away ! Now, I do not say that the horizontal plate of the ethmoid bone was torn away by the forceps; but merely judge by the circumstances of the ceive, commit very terrible mistakes. For the looser tumour, the polypus forceps is best; and, by what I have seen of its case, that whether there was disease here, and the bones were eroded ; or whether the bones taken away during the opera- use, little delicacy is observed in its application, membranes and bones being promiscuously brought away. Nay, some of our London surgeons seem to think they have not done enough until the bones are brought away as a trophy, and a proof that tion, (as we are constrained unwillii gly to call it) consisted of the cribriform plate, as well as the perpendicular plates of the or by pressing upon and destroying the bones of the face. they have gone to the root of the evil, and have eradicated the disease. When this has a good effect, I have already said that I conceive it is by inducing a new action, and bringing on an in- flammation, to destroy this unnatural relaxation in the menr brane. \Wll" But the disease is not in the bones! and it is much easier to bring the bones away than the membranes; and the brine» ing away of the lower or upper turoinated bone, is no proof ethmoid bone, there is good reason for our avoiding violence with the forceps directed upwards in the nose. When a polypus tumour is growing in the nose, let it in- crease while harmless; whilst it does not press upon the bones to the effect of occasroning a fcctid discharge, or, if not, dan- gerous from lizemorrhagies, until it becomes pendulous inn to the fauees, or so as to press forward the cclumpalati.-- Then it can be nooscd with very perfect effect, and with little trouble. But any operation with the wire or ligature, before the tumour has become thus pendulous, is very troublesome of the membrane being brought away, far less of the roots of the tumour being removed. This practice may do well and precarious : for if the tumour be moved, it is but in part, and before that which is included beyond the ligature has where the tumour is of a soft and membranous nature; but when it is firm and fibrous at the roots, as I have seen it t, and dropt oil‘, other portions will have taken their place. when it has run its connexions up among the delicate lamina: of the ethmoid bone, the tearing away of the tumour may be fatal, by breaking up the cribriform plate. I am unwilling to let this rest on conjecture. The following instance I saw a few years ago, in confirmation of the dan- ger of pulling polypi rudely away. It is evident, that a Before this state of pendulous enlargement, the forceps are our only resource. But some years ago, I found this tearing of the membrane of the nose, productive of pain and hzemorrhagies so great, compared with the advantage gained, that I resolved to persevere in a less painful and troublesome way. I made a slender pair of steel forceps, with teeth to shut close; but the The polypus forchq handles I made to separate from the blades, just behind the hinge; with this instrument I grasped the roots of the tu- were buried three inches in a direction obliquely upwards; mour in the nostrils, and then with a screw, fixed them to- nothing was brought away but blood and loose membranes, and bones : the nostrils were, however, cleared. There sue gether, and withdrew the handles, fig. ]. spectator can judge only from the circumstances of the case. and the motions of the surgeon's hand. |