174 NASAL POLYPUS. 



pus is attached to mucous membranes, and is usually found in the nostrils, the 

 pharynx, the uterus, or the vagina. Tumours have been seen hanging loose 

 in the veins and ventricles of the heart; and in the larger blood-vessels there have 

 been accumulations of the fibrine of the blood, with peduncular attachments. 



The nasal polypus usually adheres to some portion of the superior turbinated 

 bone, or it has come from some of the sinuses connected with that cavity. It 

 escaped, while small, through the valvular opening under the superior turbi- 

 nated bone into the cavity of the nose, and there attained its full growth. 



No better account, however, can be given of the cause of their appearance 

 than that of tumours in other parts of the body. They evidently have a con- 

 stitutional origin : they are frequently hereditary, and the animal in which they 

 have once appeared is subject to a return of them. 



By some means, probably the increasing weight of the tumour, and being in 

 a dependent situation, the polypus is gradually detached from its base, and 

 forces with it the soft and easily distensible membrane of the nose. As it con- 

 tinues to descend, this portion of membrane is farther elongated, and forms 

 the pedicle or root of the tumour ; if that may be termed a root which is a 

 mere duplicate of its investing membrane. 



The polypus, when it hangs free in the nasal cavity, is usually of a pyriform 

 or pear-like shape ; and it varies in weight, from a few drachms to three or four 

 pounds. 



How is the surgeon to proceed ? Can he lay hold of the polypus by the 

 finger, or the forceps, or (for these tumours do not possess much sensibility) the 

 tenaculum ? To ascertain this, he will cast the horse, and fix the head in a 

 position to take the greatest advantage of the light. If he cannot fairly get at the 

 tumour by any of these means, he will let it alone. It will continue to grow the 

 membrane constituting the pedicle will be lengthened and the polypus will 

 at length descend, and be easily got at. Time and patience will effect wonders 

 in this and many similar cases. 



Supposing it to have grown, and the surgeon is endeavouring to extract it, he 

 must not use any great force. It must not be torn out by the root. The tumour 

 must be gently brought down, and a ligature passed round the pedicle, 

 as high up as it can conveniently be placed. If the polypus can then be 

 returned to the nose, the animal will suffer very little inconvenience ; and in a 

 few days it will slough off, and the pedicle will contract, and gradually 

 disappear. 



If the polypus is so large that it cannot be well returned after it has been 

 brought down, we must, notwithstanding, use the ligature, passing it round the 

 pedicle sufficiently tightly to cut off the supply of blood to the tumour. We 

 may then immediately excise it. Except the pedicle is exceedingly thick, there 

 will be little or no haemorrhage. Should some bleeding occur, it will probably 

 soon stop, or may be stopped by the cautery, which should however be avoided 

 if possible, for our object is to produce as little irritation as may be in the 

 membrane, and the actual cautery will be applied with considerable difficulty in 

 the cavity of the nose. 



In very bad cases, when the tumour cannot be drawn out of the nose, it may 

 be necessary to slit up the ala or side of the nostril. It. will be better, how- 

 ever, not to cut through the false nostril, for that consists of a duplicature of such 

 thin integument, that the stitches can hardly be retained in it, when the horse 

 will be continually snorting at the least inconvenience. It will also be difficult 

 to bring the edges of this thin membrane accurately together again, or, if this be 

 effected, there is scarcely life enough in it for the parts readily to unite. The 

 false nostril should be avoided, and the incision made along the lateral edge of 

 the nasal bone, beginning at its apex or point. The flap will then conveniently 



