Polypi.—The mucous membrane of the nose is more subject than any other part to the growth of polypi, which may occur in either one or both of the nasal fossze, or in the cavi ties adjacent to the ,nose. Those which grow in the fossze, and which alone will be con sidered here, are of several kinds, and, though the lines of distinction cannot be clearly drawn between them, are commonly arranged as vesicular, gelatinous, fibrous, and malignant polypi.
The vesicular polypi, or, as they have been called, hydatitl polypi, 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 fossw, 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 rnoisture 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, frorn about the middle of the outer wall of the riose„or from the middle turbinated 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 lated cells, or cells with granulated nuclei.
Each cell was about 2-61011 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.
Fibrous, sarcomatous, 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, of pedicle, of these growths is usually firmer and more tibrous 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 fossm, but frnm 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 a the characters of malignant diseases. An this resemblance to malignant growths becom the greater from the polypus itself softeni and growing more vascular on its surface even throughout its substance.