740 



NOSE. 



The vesicular polypi, or, as they have been 

 called, fiydutid fjolypi, are composed of masses 

 of large, pellucid' vesicles, filled by a trans- 

 parent and slightly viscid fluid, or consist of a 

 substance somewhat like the vitreous humour. 

 They can be broken by a very slight force, and 

 after they have discharged their fluid nothing 

 remains but shreds of fine membrane, like 

 films of washed fibrine. They commonly grow 

 from the upper and side walls of the nasal 

 fossae, and their growth is very rapid. They 

 frequently also burst spontaneously, discharge 

 their contents, and are reproduced ; and their 

 reproduction is almost always very rapid when 

 they are artificially destroyed, and the patient 

 is not in other respects effectually treated. The 

 thin membrane investing them is easily per- 

 meable, and their size varies according to the 

 rapidity with which evaporation can take place 

 from them, so that they may serve as a sort of 

 hygrometer, indicating by their size the relative 

 quantity of moisture in the atmosphere. Their 

 nature is as yet unknown; they are probably 

 entirely new productions, and not, as some 

 think, distended mucous follicles. 



Gelatinous polypi are more common than 

 those of any other kind, and are those which 

 are commonly called mucous polypi, though, 

 under this term, Boyer and some others in- 

 clude both these and the preceding variety. 

 They are much firmer than the vesicular polypi, 

 and grow in one or more distinct and circum- 

 scribed masses. They are of a dull white or 

 yellowish colour, soft and easily torn, com- 

 posed of a fine tissue with fluid infiltrated in 

 it, like anasarcous cellular membrane. Gene- 

 rally they appear to have a few opaque white 

 filaments running through their substance, and 

 their surface and interior are traversed by long 

 meandering bloodvessels. When small, they 

 are nearly round and elongated ; but as they 

 increase they adapt themselves, as the other 

 kinds also do, to the form of the nasal cavities, 

 spreading towards their apertures, but rarely 

 having sufficient force of growth to expand the 

 firmer parts of the nose. They almost always 

 grow nearer the anterior than the posterior 

 nares, from about the middle of the outer wall 

 of the nose, or from the middle tuibinated 

 bone, to which they are fixed by a narrow base 

 more or less deeply rooted in the tissue of the 

 Schneiderian membrane, and sometimes tightly 

 adherent to the bone. It is only very rarely 

 that this or either of the other innocent forms 

 of polypus grows from the septum ; but Mr. 

 Hawkins has seen one example. Sometimes 

 one only grows at a time, but more often there 

 are several crammed together. They are co- 

 vered by a fine membrane, like a thin con- 

 tinuation of the mucous membrane of the nose, 

 like which, also, it is said to be covered by 

 ciliary epithelium and appears to produce 

 mucus. A polypus of this kind, which I re- 

 cently examined, was composed throughout of 

 a tough interlacement of fine, crooked, pale 

 filaments like those composing a fibrinous coat 

 of blood, in which there were thickly em- 

 bedded a vast number of flat, circular, granu- 

 cells, or cells with granulated nuclei. 



Each cell was about s^th of an inch in di- 

 ameter, and in each, three or four of the gra- 

 nules appeared much darker than the rest. The 

 whole presented on dissection a tough fibrous 

 grain, and appeared to the naked eye much 

 more highly organized than the microscope 

 proved it to be. From its minute structure, 

 which resembled in its general characters 

 that of many other kinds of tumours, it is 

 evident that these polypi, as well as the last, 

 are not mere changes or out-growths of the 

 mucous membrane, but are altogether new pro- 

 ductions and belong to the class of tumours 

 rather than to that of degenerated tissues. 



librous, surcoMutous, or fleshy polypi are 

 masses of firm, well organized, and vascular 

 tissue, growing like the others from a com- 

 paratively small base. Their substance is of a 

 pale reddish or brownish colour, and they are 

 invested by a thin smooth membrane. In dif- 

 ferent examples their degrees of firmness differ, 

 so that, on the one hand, it is not easy to draw 

 a line between this and the preceding variety, 

 and, on the other, some specimens of this are 

 found nearly as hard as the denser fibrous 

 tissues. The base, or pedicle, of these growths 

 is usually firmer and more fibrous than the rest 

 of their substance, and parts of them are com- 

 posed sometimes of tissues like cartilage or 

 bone. Like the preceding they grow from the 

 outer wall of the fossae, but from the posterior, 

 more often than from the anterior, part. Some- 

 times one only is produced, sometimes several; 

 and their force and rapidity of growth are suf- 

 ficient to stretch, if unchecked, all the parts 

 around them, to expand and destroy the bones, 

 and protrude through the skin of the face, 

 where ulcerating they may present nearly all 

 the characters of malignant diseases. And 

 this resemblance to malignant growths becomes 

 the greater from the polypus itself softening 

 and growing more vascular on its surface or 

 even throughout its substance. 



The apparent transition from the preceding 

 to this variety of polypus makes it probable 

 that these also are new formations ; and though 

 they are sometimes firm and apparently fibrous 

 even when they are very small, yet perhaps 

 they are often produced by the further deve- 

 lopement of the gelatinous variety. Mr. Haw- 

 kins says that, in general, when the polypus 

 grows from the surface only of the mucous 

 membrane it is soft and gelatinous; but if the 

 whole thickness of the membrane, including 

 also the periosteum, be its seat, or if it grow 

 from a part where there is much fibrous tissue, 

 as for example, near the posterior nares, it is 

 fibrous; and this, no doubt, is generally true; 

 yet the frequency with which portions of the 

 turbinated bones are pulled away in extracting 

 gelatinous polypi proves that these also have 

 often deep attachments. 



What are called malignant polypi of the 

 nose do not truly deserve the generic name. 

 They are cancerous diseases of the mucous 

 membrane or of the parts situated on its ex- 

 terior, from which they gradually make their 

 way into the nasal cavities. In general cha- 

 racters they do not differ from the similar dis- 



