An Account of a Polypus Found in the Heart of a Person That Died Epileptical, at Oxon. by W. G. M B. Fellow of Wadham Colledge and of the Royal Society

An account of a Polypus found in the heart of a person that died Epileptical, at Oxon. by W. G. M. B. fellow of Wadham Colledge and of the Royal Society. Several Authors that have been curious to cultivate the Anatomy of diseas'd Bodies do so frequently mention preternatural Concretions in the heart and blood-vessels especially of persons dead in lingering and chronic Diseases, that the present discourse may very well seem superfluous to those who are better instructed elsewhere. But however, Sir, since you think it worth while to furnish your papers with a thing of this nature, I will not dispute the task you have put upon me, and though the fair Figure you have bestow'd on the Polypus might excuse my farther description of the thing itself, yet since it was attended with some unusual circumstances not taken notice of by anatomical Writers, which may conduce to the determining some doubts and questions concerning the nature, growth and duration of such like concretions, it cannot be ungrateful a little to enlarge our Observations on the Subject: and that it may be done to the better purpose it will not be amiss to premise a description of the person, in whom the Polypus was found, together with the Symptoms he labour'd under, as also an account of other particulars that occur'd in the dissection, that by considering the Concomitant Irregularities in the other parts of his Body, whose causes are more apparent, we may make more probable Conjectures concerning the occasion and production of this strange and anomalous substance in his Heart. Indeed the person, whose body was the subject of our Dissection, was a poor labouring man, a meer stranger in the Town, destitute of Relations, and dy'd in the street suddenly, so that there cannot be expected so particular ticular a Relation of the Symptoms he labour'd under, as I could wish, or the thing requires: but however some things material to our purpose, as far as we could learn from the vulgar, who conversed with him in his Illness, (for he never consulted a Physician,) were such as these, namely, That he was of a swarthy, lurid Complexion, and (if we may trust the usual outward Medical Signs) of a melancholick temper. The distempers and symptoms, that afflicted him were, Fits of the falling Sickness; An obstinate Quartan Ague of above a years continuance; A deep Jaundies, even to that degree, which is call'd the black, with its constant consequent and universal settled ill habit of Body; A sense of an hard load and pressure at his stomack (meaning perhaps his Breast, or the upper part of the Region of the Liver;) he complain'd much of very great shortness of Breath, being almost constantly apprehensive of choaking; far fetcht, involuntary Sighings, and prodigious palpitations of his Heart were the continued mischiefs, that attended his miserable life a great while before death reliev'd him; he us'd to swoon very often; and at length died according to the judgment of the by-standers in the shivering fit of his Ague, with the Convulsions of an Epilepsy, not without foaming and frothing at his mouth; this is all I could credibly inform my self concerning the poor man while living. As to what was found in the Carcass, three or four Physicians of us having the fair occasion of a Body in private wholly at our own dispose, (which tho harrassed with so many Diseases yet was not wasted as to its flesh) did chiefly design a muscular Dissection, and so did not direct a very nice particular scrutiny into every part affected, but what was obvious at first sight upon opening the Abdomen and Breast was enough to raise our wonder that the poor fellow could subsist one moment with such Viscera. The Liver upon deep Incisions appear'd bloodless, stult throughout throughout like a bag of sand with a yellow gritty substance, the Gall-bladder also was furnished with the like, but of a darker hue. The Spleen was very large and of too soft and loose a texture, not much discolour'd. The Omentum rotten and wasted. The Membrane of the Stomach extremely flaccid and very thin, appearing black and mortified, and upon taking it out within twenty four hours after death (that it had both ends very close) sent forth such an intolerable sour rancid sent, that the strongest double Aquafortis (to which it might best be compar'd) could not prove so troublesome and offensive to the smell. The Lungs were distended to the uttermost with a purulent froth. The Heart much stretcht beyond its natural magnitude and of a very flat figure; the Veins of the whole Body were of an unusual and extraordinary bigness, especially the Internal Jugulars were strain'd to above an Inch diameter; polypous concretions also were found in the larger veins of the Arms, Legs and other parts, but what most engag'd our attention and wonder was that which is represented by the Figure; found in the right ventricle of the Heart, and towards its apex or tip firmly Radicated, so that no small stress was requir'd for the separation. The part by which it was fixt was nigh an Inch and half diameter when fresh taken out, irregularly rough at the Bottom, insinuating many Roots into the Lacune or little cavities of the Ventricle, which again by lesser Fibres were fasten'd to the inner Membrane of the Heart. The great Branch B. which ran out into the right Auricle was nigh two Inches diameter at the largest extreme, and reach'd no farther than the insertion of the Vena Cava, and whether the current of the blood dash-ing continually against it, might hinder the progress of its growth, or what other cause I cannot determine, but this I am certain of, that nothing of the Polypus extended farther than the figure makes appear, for upon search we could find no such Concretion in the Vena Cava. As for those those Branches mark'd (G. G.) tending to the Arms; how far they grew I cannot assert, not knowing whether they were broke off or no, but the Branches H.H.II. H, &c. tending toward the Head (I well remember) could not be drawn out without some force, and 'tis very likely they were broke off at the Diverticula or two Round Sinus's where the Jugulars enter the Skull; for the like concretions were found in the Vessels of the Brain to which probably these might be adjoyn'd. The substance of the whole was plainly fibrous resembling a Nerve, and tough while moist (though upon drying, brittle) the colour white, and was cloathed with a thin Coat including (in that part which fill'd the Right Jugular Vein,) two little black specks (b. b.) of Blood (as we suppose) a long while there coagulated: as for other circumstances of the shape, extent, and largeness of the Polypus the Reader may recur to the engraven Figure drawn very near the full dimensions of the thing itself; what has already been said of it together with the Remarques on the whole dissection will I hope not be altogether useless to discover the Cause and Nature of these strange Bodys and to determine a Question much debated among learned Physicians whether a Polypus is produc't some considerable time before or always immediately after death. Those that contend for their sudden generation after death among other Reasons of less moment, insist much on the argument drawn from the tough skin spreading its self in a short time on Blood let out for the cure of Pleurisies, Peripneumonies, Rheumatisms, violent headaches, and in cases of any inward Inflammations; It seems a good consequence, that if Blood coold in a Porringer can so suddenly acquire a kind of a tough thick Membrane on its surface; the same coldness and want of motion after death might as easily make the same product in the Vessels and 'tis to be confess that suchlike Concretions have been discover'd in pleuritical Bodys dissected. Yet however on the other side in answer it may be urg'd, that the appearance is not constant in all dissections of Bodys so affected, and that very frequently nothing like it has occur'd; from whence we have reason to conjecture, the outward contact of the Air pressing the surface of the emitted Blood, or some other external Cause may have an interest in forming that skin, for else why should not the like concretion proceed constantly in the Blood-vessels, whence Air is excluded as well as when the blood is exposed in a Porringer. But moreover whoever consults the Practical Anatomy of Bonetus on the subject, will find that these pituitous Bodys scarce ever offer themselves in dissection of pleuritical persons but where the Pleurisy was complicated with some other long settled indisposition; so that the time of their growth cannot be certainly collected from such Instances; Besides when they do chance to appear in a single Pleurisy, they float loose in the mass of Blood without fixing to any part, are of a very lax texture, without any distinguishable Fibres, and like what covers pleuritical Blood in a porringer do rather resemble a stiffer sort of Jelly or Size almost dry'd, than any thing of a tough and fibrous consistence, such as was observ'd in the Polypus now describ'd. Kerkringius in the 73 of his anatomical Observations, utterly denies the existence of any such matter in a living Body, and to confirm his Opinion affirms it in his own power, to make such Concretions at pleasure by the known Experiment of Injecting Spirit of Vitriol into a dogs veins, and observing the quick coagulation so made inverts that some peccant acid in the blood occasion'd by a distaste, may as suddenly produce the same when life is gone. In answer to this argument it might be urg'd, (what frequent experience has taught us here in England, and what Kerkringius himself seems to hint by his own expressions in describing the experiment,) that this artificial Polypus is only a kind of grumous and strongly concreted blood, wholly different as to colour, texture, and firmness. firmness from that substance which these notes discourse of; but however let us suppose that Kerkringius was so lucky, as to produce one exactly like a true Polypus in all circumstances, yet it argues not that all these concretions must needs be form'd all on a sudden; it gives indeed some light into the nature of their Cause, but it does not follow that this cause must always work its effect in an instant, but a longer or shorter time will be requir'd, as the cause is more or less active. In the mean time, I do not deny that strange coagulations have suddenly happen'd, and Anatomy has often made such discoveries in cases of sudden death; yet even these generally are not to be lookt on as products after death, but rather the quick inevitable messengers and immediate forerunners of it; such are those concretions that upon dissection have been found in the heart and blood-vessels of persons kill'd by sudden frights, as also in those that have been quickly dispatch't by an unexpected fit of an Apoplexy, a Cardiacal Syncope, or a suffocating Catarrh; where the coagulative Spirit like lightning strikes through the whole mass of blood, and either fixes it and makes it unapt for the generation of fresh Spirits, or else, if a gross similitude may illustrate so abstruse a matter, (like what happens to the invisible steams of Spirit of Salt Armomiac, which will be condens'd, grow turbid and visible at the approach of the vapour of Spirit of Salt or Nitre) the animal Spirits themselves are clouded, alter'd from their natures, extinguish'd and quite destroy'd by a mixture of the foreign preternatural halitus. 'Tis not improbable that by one or both of these methods the pestilential Effluvia of an infected Air, the Arsenical Exhalation of a damp, and the nitro-fulphureous steam (much like the scent of Spirit of Nitre) arising from burning charcoal do often act such sudden and fatal Tragedies. For if we reflect on the membranous substance of the Lungs, the infinite number of Vehicles they are compos'd of, of, how that in every assignable point these vesicles are adorn'd with capillary blood-vessels, so that the point of a needle everywhere draws blood; if we calculate the inward Concave superficies of the Lungs, supposed unfolded and spread out into a plain, which must needs exceed the outward apparent Convex above an hundred times, and consequently consider the vast surface of Blood each moment expos'd to the Air: Lastly, if we allow the Ingress of the Air into the Blood upon breathing, which scarce any now deny, I say if we reflect on these things, 'tis easie to imagine how suddenly mischievous any coagulative poisonous steam may prove, since together with the Air 'twill be diffus'd through all the Blood contain'd in the Lungs at the very Instant of Inspiration, and, (whether it be austere or acid or both, or what other name Physicians may please to give it) joyns itself per minima with almost each particle of Blood, and (as steams of hot lead (they say) fix Quicksilver into a solid) presently destroys all Fluidity, stuffs the Lungs and Heart with an immoveable and almost mortify'd Mass; puts a final stop to the Circulation, and so in a moment breaks off the Series and Thred of Life. The Concretions that have such surprizing events we must allow to be suddenly produc't; and we may ascribe all perhaps to the exceeding briskness and activity of the acid, or what other quality gave their origine, but nevertheless, in the case of lingering Diseases, I think it will be no hard matter to prove, (not to contend that they differ from those already mention'd) that at least they make a slower progress in their growth as proceeding from a less active cause, and considering the nature and consistence of the bodies themselves, the Diseases and Symptoms that usually accompany them, and the circumstances of those Dissections that have discover'd them, they must needs appear a work of time, and by a daily apposition of new parts fwell into that strange Bulk and shape they sometimes obtain. What Confinement these Bodies sometimes acquire, this above described is a very instructive instance. The close fibrous texture, the tough Membrane that covered it, and the two black hard specks therein included, its strong adhesion to the heart by little capillary Roots and other larger protuberances adapted to all the little cavities of the Ventricle, are arguments that it was no small time in growing; and if it happened after death, how came it to pass that the large branch B. should stop within the Auricle, and that nothing of the like substance should be continued farther into the Vena Cava, since the Blood there must needs be as much disposed to such a sudden coagulation as in the heart; but it will be easy to account for this circumstance if we lay the first Rudiments in the heart, allow them to grow by a daily apposition of fresh parts, and that growth constantly to be circumscribed by the Appulse of Blood, or by the action and labour of the Auricle, wherein this branch so oddly shaped was contained. Lastly, if to these remarques we add the Instance Malpighius gives of a Polypus made hollow by the current of the Blood, like another new blood-vessel framed with the natural one; If also we add another round one Rorellus speaks of, bigger than a man's fist, found in the Aorta near the heart, consisting of a great many membranes lying unconnected one upon another, like the leaves of a Cabbage, (a product without doubt) of no small time) we need go no farther than the bare accidents of these odd bodies themselves to prove their long continuance before death. At least what usually offers in diffusing bodies thus affected, to demonstrates the thing, as to leave no place for doubt, and not to heap up Quotations and many Histories of what others have found, the present subject (I think) brings evidence enough in the point. For here we have the Jugular Veins (whose coat could not have been much stretch'd on a sudden, even by the wind of a Smith's Bellows) in tract of time, enlarg'd only by the gentle assiduous duous pressings of the blood, to thrice their former diameter, that is, nine times their natural cavity. Here we have a heart, (the strongest and firmest Muscle of the Body) by degrees form'd into a shape quite different from the natural; the right Auricle and Ventricle notwithstanding the strength of the Fibres of the latter and their indispositionedness to stretch easily, so prodigiously distended, that no outward force whatever without breaking it could effect the like; such hard shift did nature make to continue the vital stream and avoid the fatal stop, each moment threatened by the Polypus, that with double force she was oblig'd to maintain a Pulse, which (because it could not break or expel the unnatural load,) did By little and little stretch the sides of the ventricle, for the more easy passage of the blood, and by terrible palpitations for a long time protract a miserable life, till the monstrous body growing too big, the weakened Fibres could stretch no more, nor yet regularly contract themselves any longer; so that the Heart at last just ready to sink under the burden, is forced to collect its little remaining strength into one brisk effort, and assisted by all the spirits of the Body caus'd the poor wretch to expire in an universal Convulsion. After this Instance, it might be improper to add the more uncertain arguments drawn from the Diseases and Symptoms that are either the Effects or Causes of Polypi, but that the bare mention of such distempers does not only (as being generally chronic) farther prove their duration, but also illustrate their natures and suggest a cure (if possible) or at least a method of prevention. The Diseases wherein almost always they may be expected, are the Apoplexy, Phrensy, falling Sicknesses, Convulsions, Asthma (or difficult breathing,) Consumption, ill cur'd and lingering Fevers, Plague, venereal Diseases, Pleurifies, Peripneumonies, Green-Sicknesses, varices of the Veins, and inveterate Headaches, &c Instances in all which and many more Bonetus has industriously collected out of Platerus Wepfer, Severinus, Tulpius, Blafius, Ballonius, Ker- P 2 kyngius, kringius, Borelius, Malpighius, and others, too many to be nicely quoted, since we have among us in the University, eye-witnesses enough in most of the cases recited. The part most usually affected is the right Ventricle of the heart, and the genus venosum, where the blood returning from the habit of body, flow in motion, impoverish and dispirited more easily admits such a concretion: yet the left Ventricle and the genus arteriosum frequently breed the like, such was that Tulpius mentions, branching out into the Aorta and Vena Pulmonariae, in a person who died of a grievous Apoplexy, and such Wepfer makes one great cause of Apoplexies. The sinuses of the brain also often harbour them, as we have found in one that had an obstinate Headach, and at last died mad; and not long since in another, who once had some fits of a Frenzy, and at length died epileptical, in both which cases the sinus longitudinalis was full of a Polypus, which emitted very tough branches into all the little lateral vessels, and Blasius gives the like account in a mad-Man's brain, who at last died convult. 'Twere easy to amass together many Observations of this nature, but upon the strels of these already brought tis reasonable to assert, that a Polypus is so far from being a product at the period of a disease, that it seems rather a stated settled cause as well as an immediate occasion of the fatal symptoms which attend the most incurable distempers; thus if in the heart it grow so large as to force a Diastole beyond the due tension of the fibres, it produces a mortal Syncope; if smaller and not exceeding the confines of the Ventricles, a strong and irregular pulse succeeds, and there must be a palpitation of the Heart to maintain life; if it send branches into the larger pulmonary vessels, the motion of the blood is retarded, and the breast and lungs labour under their load in an Asthma: or if it reaches the capillaries, a Peripneumony, an Ulcer, and at last a Consumpion is at hand; if the concretion begins in the small vessels of the Pleura, then a Pleurisy follows, if it grows and fixes in the larger vessels of the arms, legs, or the like, painful varices appear, and probably Rheumatism owe much of their pain to some such concretions begun in the capillary vessels of the habit of the Body. Again, when these bodies are in the Sinus of the Brain, if small, the vessels will only be a little dilated, and so a pain in the head may suffice, but if larger, the obstruction increases, the blood and spirits are cast into an hurry, the brain is inflam'd, the senses presently are disorder'd in the apprehension of their objects and so a Frenzy seizes the man; if yet they chance to be bigger and fill the Sinus more, the blood pent up moves more furiously, and so destroys Sense and all voluntary functions, then the tumult extends beyond the limits of the brain through the whole system of the spirits, and whereas in a frenzy, sense, though mistaken did direct their paths, now they run quada porta ungovern'd and impetuous through the nerves and muscles causing the involuntary motions and convulsions of an epilepsy, which continue till the spirits are spent, the blood quiet, and the blood-vessels by the very agony enlarged equal to their burden; and indeed in epilepsies, dissections seldom miss of a polypus, neither can we deny this convulsive power of a concretion in the brain, since the great Lower's experiment tells us that a Dog died in terrible convulsions by injected milk coagulated only in his heart; but lastly, if the sinews prove almost totally obstructed, the blood instantly overflows the brain, and without much previous notice (except perhaps of giddiness, loss of sight, or the like) an apoplexy ensues; which disease will also more dangerously happen, when some particles of a polypus in the left ventricle of the heart broken off by the violent stream of blood, shall be impacted into the carotid arteries at their insertion into the brain, whence all intercourse of spirits will irrecoverably be stopt. Now tho' in some of these cases a polypus does only by fits disquiet the man it possesses, yet it is in being when it does not produce such sensible effects, for exercise, passions, diet and other external causes will so affect the quantity and motion of the blood, that the obstruction may be more insupportable than when the stream was calm, and 'tis as easy to imagine the disorders thus caus'd in an animal body, as that a large swift river dam'd up from quietly pursuing its own channel, must needs impetuously overflow all the country about; and thus we have consider'd those symptoms of which a polypus may rationally be thought (at least occasionally) the next and immediate cause. As for others before mention'd, namely, the plague, venereal diseases, lingering fevers, and the like, they are not the effects of a polypus but causes that dispose the blood of some persons to such putrid concretions. But to discover their cause more nicely we may observe with we fer, that persons thus afflicted are never well, breath hardly, have frequent palpitations of the heart, unequal pulses, are dull to all action, stupid, luxurious and slothful, of a livid leaden or sallow complexion or a saturated red in hands and face, because there is either very little blood in the capillaries of their skin, or at best a slow circulation; their blood has usually a thickness and peculiar lentor in it, or abundance of serum, the latter for want of volatile salts to digest the bile into a laudable red, and the former happens, either because the heart, destitute of spirits for its pulse, cannot duly agitate the mass or (as experiments on blood emitted seem to prove) by reason of the mixture of a preternatural acid, whence may infer this conjunct cause. cause of a Polypus, that the Fibres of the blood not being sufficiently sustain'd and kept asunder by a due motion of the intercepted fluid parts, may either barely upon the account by itself cling together, or else may be by degrees connected to an austere affringent acid (always to be found in cachectical Bodies) for the same reason as (an analogous liquor) milk is curdled, only with this difference that in this, the coagulation is brittle, because the Fibres are weak and short, whereas it may be very tough in blood, because its Fibres are strong and of a greater length. Upon the whole we may conclude that whatever maintains the fluidity, motion, spirit, and texture of the blood promises a cure (though not of a confirm'd Polypus) yet of the first Rudiments of it. All these indications are answered by medicines of volatile, brisk active parts, which destroy acids, exalt and ferment the blood, and do not only hinder, but also dissolve the first beginnings of coagulation and probably tis by affecting the blood and not immediately the nerves, that they do such feats in diseases before mention'd. Lastly, the effects of bleeding in some cases can never enough be admir'd, thus Riverius tells us of a Girl 12 years old, being bled plentifully for a Pleurify, was cured of her failing Sickness, a disease never without the suspicion of a Polypus. But Sir, the importunity and surprise of the Press must put a stop to these Speculations, and gives me leave only to beg yours and the readers favor for all the defaults of Your humble Servant W. Gould. The explication of the Figure of the Polypus according as it appear'd, when fresh expanded on a Board. A. That part of the Polypus which was firmly rooted in the right Ventricule of the Heart. B. The Branch terminated in the right Auricle. C. D. D. D. The part tending toward the Lungs. E. E. The Branch running out of the ventricles into the pulmonary Artery. e.e.e.e. &c. The several lesser Ramifications distributed according to the several divisions of the pulmonary Artery. F. F. F. The branch belonging to the descending Vena Cava. G. G. The branches began in the Axillary veins. H. H. H. H. H. &c. The two branches that ran up the Internal Jugulars even to their entrance into the Skull. k. k. Two little black specks of concreted blood contain within the Coat of the Polypus.