SURGERY. 
bones; and produce, succesively, fistula 
lachrymalis, inflammation and ulceration of 
the Schneiderian membrane, caries of the 
bones, &c, ; some often bleed. They must 
be extracted by means of forceps ; by which 
the tumour is seized, and torn away from 
its root. This process must be repeated 
until the nostril is cleai'ed. If any pre- 
sent in the throat, they may be removed 
in the same way from that part. If ti ouble- 
some bleeding should follow, and not yield 
to a probe armed with lint, moistened in a 
strong solution of white vitriol, and applied 
to file part ; a piece of lint may be draw'll 
into the posterior opening of the nose, by 
means of a ligature iiitroduced through the 
nostril, and drawn out at the mouth; the 
front aperture being also stopped. 
Polypi of the uterus occasion at first an 
enlargement of that organ, and various 
other symptoms, as pain, hemorrhages, &c. 
The tumour escapes from the uterus, and 
by its presence in the vagina irritates the 
rectum and bladder ; causing still worse 
uterine affections, as bleedings, discharges 
of other kinds, &c. At last it descends 
through the external parts, with an aggra- 
vation of all the distressing symptoms. 
Now it must be carefully distinguished 
from the prolapsus, or inversic uteri. It 
should be removed by means of a ligature 
conveyed to its root in the uterus, by in- 
struments designed for that purpose, as 
the double caniiia of Levret, or the im- 
proved instrument of Richter, represented 
in Cooper’s “ First Lines.” 
Ulcers are consequences of wounds that 
have not united by the first intention ; or 
of a diseased process, named ulceration, in 
which a breach is made in the substance of 
the ' body by the absorbents. A healthy 
ulcer has small florid and pointed granula- 
tions, which secrete a thick white pus. 
Here any simple dressing, confined by 
means of a roller, is sufficient. 
But the ulcer may be irritable, i. e. at- 
tended with pain, a thin and discoloured 
secretion from its surface, ragged edge, no 
distinct granulations, &c. Here decoc- 
tion of poppy heads, used as a fomentation, 
emollient poultices, solution of opium 
( Jiss to ibj of water) are proper; or it may 
be indolent, i. e. not painful, having thick 
edges, flabby colour, and imperfect granu- 
lations. Irritable ulcers are brought into 
this state by too long poulticing. Stimu- 
lating applications to the sore are proper 
here ; as red precipitate, solution of lunar 
caustic, &c. combined with a roller applied 
uniformly and firmly over the whole limbw 
But the most successful treatment is that 
proposed by Mr. Baynton, of Bristol, of 
surrounding the limb, for a considerable 
extent, with straps of adhesive plaister, 
applying a roller, and keeping wet cloths 
on the part, if there be pain. Tliis prac- 
tice indeed often succeeds, where the ulcer 
is of the irritable cast : the pressure of the 
rollef is useful, and the cold water relieves 
the pain. It is most particularly beneficial 
in ulcers of the legs, attended with varicous 
veins; and, in short, is a very great im 
provement in the surgical treatment of ulce- 
rated legs, as it does not require the pati- 
ent to be confined. 
There are various ulcers, not included 
under this aivangement, having peculiari- 
ties in their appearance, discharges, &c. 
They are often connected with disordered 
chylopoietic organs. 
Encysted tumours consist of a cyst of 
various thickness, containing a matter of 
very different consistence and appearances ; 
according to which the tumour is called me- 
liceris, the contents resembling honey; 
atheroma, when of ^ pappy nature ; or 
steatoma, when of a fatty kind. They 
must be extirpated, care being taken to 
remove the whole cyst in an intire state. 
Sarcomatous tumours are fleshy masses, 
organized throughout, produced by chro- 
nic inflammation, sometimes being newly 
formed ; at others merely enlargements of 
originally existing parts, possessing a more 
or less defined cyst or capsule, which is 
formed by a condensation of the surround- 
ing cellular substance. Their structure is 
very various, sometimes consisting entirely 
of fat, at others of a fleshy vascular mass, 
in which there may be cysts, or division 
into something like lobes, &c. In the rapi- 
dity of their growth, pain, &c. they differ 
very much ; some also affect the lympha- 
tics, which others do not. As they are 
produced by chronic inflammation, local 
bleeding and cold washes will generally ar- 
rest their growth, and often reduce theiy 
size. Topical stimuli may also be employed 
with the view of discussmg them; but ex- 
tirpation is the only plan to be relied on, 
The mode of operating will be explained in 
speaking of the amputation of the breast. 
Carcinoma commences with a hard pain- 
ful tumour, termed a schirrus, which ulce- 
rating forms cancer. As several other 
swellings are both hard and painful, discri- 
mination becomes particularly necessary. 
Schirrus has an uneven feel, is attended 
