A Letter from Peter Templeman, M.D. to Wm. Battie, M. D. Fellow of the Royal College of Physicians, London, and F.R.S. concerning a Polypus at the Heart, and a Scirrhous Tumour of the Uterus

V. A Letter from Peter Templeman, M.D. to Wm. Battie, M.D. Fellow of the Royal College of Physicians, London, and F.R.S. concerning a Polypus at the Heart, and a Scirrhouss Tumour of the Uterus. SIR, Read Nov. 27. THE following Case appearing to me to be a remarkable Instance of a Polypus at the Heart, and of a scirrhous Uterus, I immediately determined to communicate it to you. ANN HICKS was brought to the Workhouse of St. Andrew's Holborn on Saturday the 15th of November, 1746. Her Complaints were, a Difficulty of Breathing, from a Cold she had caught about a Fortnight before, with a violent Pain and Palpitation of her Heart. The Pulse was scarce perceptible. The Surgeon, Mr. Tait, being present, I order'd him to open a Vein; but to keep his Finger on the Pulse; and if it did not rise on her losing a little Blood, immediately to desist. Upon her losing an Ounce or two of Blood, the Pulse grew more languid, and he accordingly desisted. I then order'd a large Blister to be applied to her Neck, and gave her oily Medicines with the volatile Salts. I did not visit at the Workhouse again till the Wednesday following, when I found her much much easier in her Breath, but the Pain and Palpitation of the Heart continuing. As the oily Medicines had occasioned a violent Purging, I order'd her the *Elixir asthmaticum* in Cinnamon-Water. Her Pulse was still so little discernible, that though I think it intermitted, yet I cannot be positive. Upon my telling you on Thursday my Apprehensions of a *Polypus* at her Heart, from the Pain and Palpitation of it, you desired, that, when she died, her Body might be open'd. To you therefore are we indebted for whatever curious was discover'd. She died on Friday, and her Body was open'd on Saturday. Upon exposing the Body naked on the Table, we were surprized with the Sight of a very large and hard Swelling in the hypogastric Region; concluding it at the first View to be a Child; and the more so, because the Woman had never made any Complaint of an Uneasiness in those Parts. Having open'd the Body, we found this Swelling to be of the *Uterus*, which was greatly enlarged, and extremely hard. Besides the whole Body of the *Uterus* being thus enlarged and hardened, there were two large Protuberances distinct from each other, that grew prominent out of the upper Surface of the *Uterus*, and were each of them of the Size of a large Egg. There was likewise a third Protuberance on the opposite Side, but much smaller than the other two; and another that seem'd to be but just budding. We cut down directly through one of the large Protuberances into the very Body of the *Uterus*, and found nothing but a solid Mass. Mass of a cartilaginous Substance. The Texture indeed of the Protuberance was somewhat laxer than of the Body of the Uterus. Having cut down very deep into the Uterus, and found nothing but this solid Mass, we introduced a Probe from the Os Tinceæ, to examine if there was any Cavity in the Uterus; and found a small one reaching to the Fundus, and barely large enough to admit the Probe. The Ovaries and Fallopian Tubes were in their natural State; except a small Deviation of the Fallopian Tube on the right Side. I know no Writer that has taken notice of a similar Appearance in the Uterus, but Ruysh; and his Words I beg leave to cite. They are in his Thesaurus Anatomicus Decimus, N°. CVI. "Uterus huius manus scirrhosus factus, et in majorem molem extensus, id quod in vetulis aliquoties observavi; præterea ex superficie superiore alter et exiguus scirrhus emergit, ut et ovaria, ovorum ductus (tubæ Fallopianæ dicti) satis bene disposita; et hæc omnia in liquore." He has not given any Plate or Description of the Dimensions of his enlarged Uterus; but this, which I have been describing, is, in its greatest Breadth 4 Inches and ¾; its Length from the Os Tinceæ 6 Inches; Thickness, 3 Inches and an half; and its Weight, including the Ovaries, Fallopian Tubes, &c. two Pounds twelve Ounces of Avoirdupoise Weight. Whatever Ruysh had observed of that kind were in old Women. This Woman I take to have been between 30 and 40. He does not mention having seen more than one small additional Scirrhus; whereas in ours there were three or four. And, lastly, he does not mention any thing of the hard cartilaginous Substance of the *Uterus*. There were several remarkable Adhesions in the *Abdomen* and *Thorax*; as of the *Omentum* to the *Peritoneum*, of the Lungs to the *Pleura* and Diaphragm, of the *Pericardium* to the *Pleura*. The Liver and Spleen appear'd in their natural State: The Kidneys were enlarged beyond their usual Size: The coronary Veins of the Heart were much distended with Blood, and the Lungs inflamed to a Degree of Mortification. Upon examining the Cavities of the Heart, we found in the right Ventricle a polyposè Concretion of a fleshy fibrous Substance that adhered to the Ventricle, and, in separating it from thence, was rent into two Pieces. London, Nov. 26. 1746. Your most obliged humble Servant, Peter Templeman. P. S. I have annexed two Figures, representing this præternatural *Uterus*, drawn by the ingenious Dr. Parsons. See Tab. I. and Tab. II. Represents the back Part of the *Uterus* with its scirrhous Tumours. *A* is the *Uterus*. *B*, The great *Scirrus*. *C*, One of the great Protuberances. *D*, The *Cervix Uteri*. *E*, Part of the *Vagina*. *FF*, The *Ovaries*. *GG*, The Extremities of the *Fallopian Tubes*. *H*, One of the Muscles called *Ligamenta rotunda*. *II*, Spermatic Vessels. *K*, The Edge of the *Alae Vespertilionis* on the left Side. *LL*, Two small Protuberances. **Tab. II. Fig. 1.** Represents the fore Part of the same *Uterus* laid open, by cutting through the Middle of the *Scirrus*. *A*, The Cavity of the *Uterus*. *BB*, The divided Surfaces of the great *Scirrus*. *C*, The fore Part of one of the great Protuberances. *D*, The *Cervix Uteri* laid open. *E*, The *Vagina* laid open. *F*, The divided Surface of the Protuberance that was cut through.