bones become carious, and the cells of the face and nose are burst up by its slow growth.

"The bones and membranes now plainly ulcerate, a foul and fetid matter, blackened with blood, distils from the nostrils, and excoriates them, and, by passing partly down the throat, occasions diarrhea: the blood vessels next give way, and sudden and impetuous hemorrhagy weakens the patient; the teeth fall from their sockets, through which a foul and fetid matter issues. from the antrum.

"Now the disease verges towards its conclusion. The patient, conscious that the tumor lately so mild and moveable, has degenerated into a mortal disease, is resigned to his fate, and no flatteries of his friends, nor soothing words from his physicians can longer deceive him. In the night he starts from his sleep in horrible dreams, and with a sense of suffocation, and fre quent hemorrhages bursting out from time to time, reduce him to such extremity of weakness, that for several days he is not able to crawl from his bed, and when he rises from it, he hangs over the fire cold from loss of blood, pale as a spectre, his lips colourless, and his face like wax, yellow and transparent: he hangs his head forward, resting it on his hand, and moving it incessantly from side to side from the intolerable pain, the saliva distilling from his mouth, and the foul matter dropping from his nose. In this state he survives a few weeks desolate and hopeless. During the last days of his illness, he lies in a state of perpetual stupor, and dies lethargic."

Such is the description given of the progress of polypi by Mr. Bell; and from the force and energy with which he writes, it is evident that he describes from nature. In speaking of the cause of polypi, he contradicts, in this book, what he said in his anatomy with respect to their sometimes being caused by picking the nose. In speaking of the spongy bones, he says, "their point forms that projection which is touched in picking the nose, and from that indecent practice very often serious consequences arise; for in many instances polypi of the lower spongy bones,

which can be fairly traced to hurts of this kind, grow so as to extend down the throat, causing suffocation and death.” Whereas, in this book, pages 102 and 103, he abuses and ridicules those "who can imagine this disease, polypus, to have any rela tion to picking the nostrils," and is at a loss to imagine how any person, writing even at a venture about surgery, could suppose any such thing! The contradiction to be sure is not material, but it shows the inattention with which Mr. B. occasionally writes. It is unnecessary to introduce his arguments to prove that polypi are never malignant; the causes which he assigns are certainly sufficient to produce all the symptoms which polypi occasion; why then suppose them malignant? He likewise contends that there is generally more than one polypus, sometimes in both nostrils, and introduces a case from Manne, in which almost the whole Schniderian membrane was covered with them.

With regard to the manner of noosing nasal polypi with Levret's tubes, or in any other manner, our author considers it as next to impossible to succeed. "I have," says he, "seen such an operation practised fifty times by men of various degrees of ingenuity and skill; some awkward, some perfectly dextrous; but never have I seen this method succeed."

But where the polypus projects backward, so as to depress the soft palate, and may be distinctly seen and felt at the back part of the fauces, then may it be noosed with absolute certainty, in a manner hereafter to be described. But in the former case, though they cannot be noosed, they may be torn out with forceps, and their recurrence prevented, by the application of caustic to their roots: so that in one of these two ways every polypus may be cured, except it has arrived at its last and fatal stage. In extracting polypi with forceps, our author is particularly careful to ascertain that the nostril is entirely free; or should it happen, that there are some excrescences so low down in the nostrils that they cannot be reached with the forceps, he then employs a knife, which is long, slender, and somewhat crooked;

but its cutting edge short, to prevent injuring the narrow pasinto which it is introduced. As to hemorrhagy, he says, sages there is little danger of its proving troublesome. Should this happen, it may be suppressed in the same manner that other hemorrhages from the nose are, that is, by drawing up a plug behind the palate, so as to stop the posterior openings, of the nostrils, at the same time that the anterior are closed. After having done as much with the knife and forceps as they can do, Mr. B. proceeds to apply caustic to the roots of the polypi which have been removed, which he does with great boldness, little solicitous about destroying a portion of the membrane of the nose, or even some of the bone. His manner of applying it is as follows: "First I fold," says he, "a piece of lint twice or thrice, and give it a triangular form, and after pounding the caustic, I mix it with water into a paste, and spread it on the lint,* and then bend it over the point of a probe, or directory rather, the big obtuse point of which carries it and deposits it upon the precise point you wish, fairly and without getting entangled in it. In passing so big a caustic along the nostril the parts would be cruelly excoriated, were we not careful of the canal, which I do by cutting a stripe of sheep's leather, and conveying it high into the nostril with the probe, and laying it flat and smooth along the surface to be cauterised; I leave it there, and turning the caustic towards it, I run it up to the point I design to burn. Upon the slightest sense of disappointment, I withdraw both, and begin anew; but being conscious that I have succeeded, I withdraw the sheath of leather at the same moment that I push up the caustic to the part, and I impress the caustic very firmly upon the part, for the instant it touches the naked surface, the eyes fill with tears, the patient draws a long breath, and sneezes tremendously, and instantly displaces it; but if you press firmly, this first irritation goes off: if you have passed it

* The size we suppose must be proportionate to the space the polypus occupied. Mr. B. refers to a plate which is left out of our copy. Ed.

far beyond the strait of the nostril, and up to that point where always I conceive the roots of the tumor to lie, it seldom is driven away by any future paroxysm of sneezing. It does sometimes happen that the profuse secretion of mucus carries it down, and the operation being performed at ten o'clock, for example, the caustic is discharged by two or three o'clock; but often I have found the caustic in both nostrils the next day at dressing. It will add to your assurance and confidence when Ì tell you, that deep as you may appear to yourself to have in troduced the caustic, rather beyond the nostril as you would imagine, and on the very verge of its posterior opening, just over the palate, it never falls backward into the throat, nor ever is swallowed; of the many hundred times I have used the caustic, no such accident has ever happened.

"The caustic," he continues, "I apply every second or third day; and I often continue this severe process during a whole month, with occasional intermissions ;" previously wiping the nostril perfectly clean, with a large iron probe well armed with lint. The event he declares to be almost uniformly suc eessful.

'But though it is so difficult to noose an incipient or nasal po. lypus, our author, positively asserts, that every polypus extending downwards so as to become guttural, may be noosed, “and that no person of common dexterity can fail to perform it." For this purpose he prefers silver wire about the size of harp. sichord wire. The manner in which it is to be done is as fol.

lows:

"First. How to pass the wire through the nostril to the throat.-You have already felt the tumor depressing the palate, and estimated its size; you have repeatedly placed the patient before you, and made him open his throat, and depressed his

* Certainly Mr. B. would not deposit his caustic upon supposition merely, but would ascertain the part to which it was to be applied. Ed.

tongue so as to occasion straining and retching, which unfolds all the parts, and shows you their size and relations; you now place him before you, opposite to a light, supported by assist ants, resolute to bear whatever you do, and reconciled to it, by seeing that you have only a piece of silver wire in your hand; you take the piece of wire, about three feet long, double it, and smooth and arrange the double part, by pressing and modelling it in your fingers into a neat noose, a little open, and ready to expand when it gets into the throat, but small enough to pass through the nostril, and taking this loop betwixt your fore finger and thumb, you enter it into the nostril, and push it gently along. However big the polypus, you find the loop of silver wire glides easily and smoothly along; find it sometimes stopped, and then it bends and resists; but withdraw it a little, and then push it, and it will go on. I have never found occasion to use any instrument for conveying the loop to the throat, except when the bones were destroyed, a case in which I can hardly counsel you to attempt the cure." Should an instrument be required, a catheter, cut open so as to be converted into a canula, will answer the purpose of pushing the loop into the throat.

When the loop has passed into the fauces you can easily see it, and taking hold of it with a hook, or a pair of dressing forceps, you pull it out of the mouth with one hand, and push it into the nostril with the other: this is a short but painful struggle, until you have drawn the loop without the mouth. "Often you will find the loop of your wire passing actually down into the glottis; the patient instantly cries, coughs, and strains violently, while the face becomes turgid, and the eyes stand in tears; instantly knowing what kind of an accident has happened, you withdraw the wire a little towards the nostril; by this motion you retract it from within the glottis, and you keep it carefully there until the straining ceases; then you push it gently on again, keeping the mouth open, and catching the