The most considerable Case that offered it self during our first Enquiries into the Nature ofCancers, was that of a Woman, who about Four Years before received a Blow on one of her Breasts, upon which it began to swell, grow painful, and after some time became all over livid, and of so prodigious a Bigness and Weight, that she was obliged to keep it suspended by a Napkin round her Neck: But in regard our Method was not put in Practice till by other Applications it was become ulcerated, we shall speak of it as such. The Patient, then, at this time complained of a very violent Pain, which extended it self to the Back and Shoulder, by the Communication of the Nerves (for those of the Breast come from the fifth Pair of the Spine, and from aPlexusabout theClavicels.) To remedy this, she had taken no small Quantity ofHypnoticMedicines, which, without Doubt, destroy the due Texture of the Blood, and so become prejudicial to the Patient, and disadvantagious to theSurgeonthat proposes a Cure. But because Persons generally find some Relief by Opiates, as they retard the determined Motion of the Blood, straiten the Nerves, and check the tumultuous and disorderly Influx of the Spirits; so, probably, in these Cases, their Use will be continued. Besides the acute Pain, theCancerwas over-spread with fungous Flesh, its lower Part extreamly hard, knotty, blackish, and its Basis seemed inclinable to fix; the Matter which was discharged was thin, reddish, and stank abominably. This was the Condition of this poor Woman, when we first applied our grand Dissolvent; the Pain she was attended with the first and second Day after was inconsiderable, nor did she complain of more afterwards, than would have been procured by the most mild and easy Remedy the Dispensatory affords. In four Days Time we found a very evident Alteration for the Better; for the Consistence of the Matter was changed, and the Surface of theCancerous Massbecame somewhat soft, we continued the Use of the same Medicine, and in a few Days more some part of theCancercame away with the dressing. In short, in about six Weeks time, the whole Substance was entirely gone, and nothing remained to be done but to heal the Ulcer, which was effected in about a Fortnight. During the time she was under Cure we gave her a proper internal Medicine, not calculated to destroy the Acidity of the Blood, but to dispose the wholeCancerous Mass, with its Appendices to come away, which might otherwise, as the Seeds of the Disease, cause it to spring again: Thus was this Patient, (after so great a Fatigue she had undergone before she came to me) perfectly cured, and has continued so to this Time, without any manner of Inconvenience as she lately told me, it being a long time since she has been well.
A Gentlewoman near fifty Years of Age, by some Accident received a Blow on her left Breast, which in a few Days was succeeded by a considerable Tumour, whereupon she applyed herself to aSurgeon, who immediately let her Blood, ordered her to take theLap. Hibern.in Posset-Drink, and embrocated the Breast withOl. Succini: By the use of these Means the Swelling was much abated, a small Hardness only remaining, which did not exceed a small Wallnut in Bigness; in this State, with very little Pain, she continued above a Year; but being persuaded to apply anEmp. de Ran. cum Mer.to it, it encreased very apparently, was extreamly painful, and in Seven Months time became as big as a large Egg: After this she made use of a Woman who was reputed Famous for these Cases; but by One or Two of her Applications the Tumour became as big again as before: In short it continued to encrease gradually from that time, till the whole Breast, which was of a monstrous Bigness, and which was judged not to weigh less than Eight Pound, in time became entirelyCancerous. It was at this time that I saw it the Skin was very livid, looking sleek and shining, and seemed ready to open, as being scarce capable of longer containing such a prodigious hardMassas laid concealed under it, and was in all Probability as big as the Breasts of theAmmonianWomen, of whichJuvenalthus speaks,In Meroe, crasso majorem Infante Mamillam. She had been with various experienced and reputableSurgeonsbefore, among which was One not long ago deceased, who was justly looked upon as an Ornament of his Profession; but not one would willingly attempt a real Cure by cutting it off, or any other Way: They only prescribed some palliating Remedies to remove the Pain and prevent its Breaking. I was animated by my former Successes, and prevailed with my self to undertake it, not thinking I was at all blameable if my Success in so extraordinary an Affair contradicted the Prognosticks of so many worthy Gentlemen; and though it did, I shall at all times think my self obliged to pay a Deference to them. I began the Cure by removing the Integuments from the upper Part of the Cancerous Substance, but did not wait for a Separation of the Slough the Escarotick made for fear of being incommoded in my Procedure by a Fungus; For this Reason I mixed some of our Dissolvent with a digestive Ointment, by which Means I had a Part of theCancerous Masscame away with it, without any Trouble to my Patient. I continued this Method of Dressing several Days longer, with very little Alteration; but upon a Complaint of a Pain between the Shoulders, I was obliged to change my Medicine, and foment theCancerwith an Infusion of some of those Herbs that contain manyVolatileattenuating and active Particles. And here I cannot but remark, by the by, that Applications to the pained Part would have been of no Effect, as I have many times observed, and particularly in a Woman which had a Cancerated Breast, that was violently afflicted with a Pain in her Arm on the same Side, which would not be removed by any of the Applications the Person that had the Care of her made use of the affected Arm. To this I might subjoin a very pertinent Case fromGalen; but I fear I shall digress too far. The Pain of my Patient’s Back being removed, I proceeded to apply the Dissolvent, which so softened the Superficies of theCancerous Massthat in Three or Four Days Time I could take off above a Quarter of a Pound of it with the Edge or Back of my Incision Knife, and my Patient not so much as feel me, this I continued to accustom my self to, because it would have been more tedious to have waited for the coming away of theCancerous Massof it self. Sometimes I varied my Applications as I saw Occasion, but, as my Patient confessed, I scarce put her to any more Pain during the Time her Breast was dissolving (abating for the Pain of her Back) than there is in the dressing of an Issue. The prodigious Bigness of theCancerous Massmade the Cure the more tedious, for it was above Three Months before all of it was entirely dissolved and gone; but this being at length surprisingly and very happily effected theCancerous Ulcer(the last Part of theCancerthat came away left) was incarned and cicatrized by an Infusion of vulnerary Herbs, to which was added a small Quantity of Tincture of Myrrh: Thus was this Cure entirely compleated and my Success in it confirmed thatFrenchProverb, which says,It is better to be condemned to die by the Doctor, than by the Judge.I did not make use of that internal Medicine I mentioned in the former Case, because here I found no pressing Necessity for the Use of it, but some other proper Physick was taken to dispose the Ulcer to heal, as one would have done in any other Case. Upon the whole of this Cure, I cannot say whether I had more Trouble with theCancer, or in endeavouring to oblige my Patient to a strict Observance of some of the Non-Naturals she so often erred in. There is nothing can create a greater Trouble to theSurgeon, than to find Patients negligent of their Healths, by not endeavouring to prevent or regulate Miscarriages, nor taking so much Care of themselves, as they expect theSurgeonshould take of them. The Rules and Directions ofPhysiciansandSurgeons, given to their Patients, we have Reason to believe were not so often violated formerly; for in some Places they obliged themselves very strictly to the Observance of them, and some Historians give us an Account thatSelucusmade a Law; that if any of theEpizephyrian Locriansdrank Wine, contrary to thePhysician’s Direction, though they escaped the ill Consequents that might have attended it, Death was their Punishment, because they did contrary to what was prescribed them.
A Woman about Thirty Years of Age had been for a considerable Time afflicted with a hard painful Tumour under her Tongue, for the Cure of which she had applied her self to various Persons, but without Success. When I saw her I found the Swelling to be hard, painful, of a livid Appearance, and incommoded her so much in speaking, that she could not pronounce her Words articulately. I was of the Opinion of some Gentlemen that had seen it before me,viz.That it was undoubtedlyCancerous, and as such I proceeded to cure it; but I met with more Difficulties in this Case than I at first expected, for after I thought theCancerous Substancehad been entirely dissolved, and I had reduced the Ulcer to a very narrow Compass, it began to swell again, and in a short Time enlarged it self to almost the Bigness it was at first: This put me upon a Necessity of making an Incision into the Body of the Tumour, that I might commodiously come at the remaining Part, and so dispose some little Dossels of Lint, armed with our Dissolvent, that they might have their desired Effect, and this in every Respect answered what we proposed; so that we proceeded immediately to incarn the Ulcer, which we did by a Lotion prepared of an Infusion of some vulnerary Herbs, andMel. Rosar. Thus was this Woman perfectly cured, and has continued well about a Year.
Because I have always found greater Difficulty in treatingCancersof the Mouth and Lips than those of the Breast, I will here relate an Instance of one upon the lower Lip that proved extreamly troublesome. It sometimes happens that one, or more, of those Glands which are spread on the Inside of the Cheeks and Lips, calledBuccalesandLabiales, receive some Damage by a Bite or Blow; upon which they generally tumefy very much, become painful, and in Process of Time (if proper Means are not made use of) may becomeCancerous. Such was the Case of a Woman about Thirty Years of Age, who having had a Blow on her lower Lip, neglected it till it was considerably tumefied, grew very painful, and became extreamly troublesome to her. The Circumference of the Swelling when I saw it, which was many Months after the Blow was received, was very much inflamed, and a small Quantity ofIcorousMatter discharged from several small Pustules, which over-spread it; the Middle, which was the Body of theCancer, was hard, of a whitish Colour, and moveable; it’s Sides being only connected to the contiguous Parts by some small Filaments that were detached from it. The same Thing DoctorGendronhas discovered in an ulceratedCanceron the Forehead of the Servant of a certainMarquess, as he observes in his ThirdChapterof the Tract we have before mentioned. I began with my Patient by applying cool and temperate Remedies, till the Inflammation was considerably abated; after this I applied our Dissolvent, which operated so mildly that my Patient was not sensible of near so much Pain as before she was apprehensive of: In short, the Body of theCancerwas removed and a good digested Matter discharged from the Sore. Now all the Difficulty was after what Manner we should proceed to dispose the littleCancerousBranches in the Skin to come away, but this we effected after the following Manner; the Consistent of the Medicine we before applyed, was such as was no way qualified for rooting out the Cancerous Filaments, whereupon we were obliged to procure it’s Dissolution in a proper Menstruum, though it required a considerable Time to do it; by this means, we soon found, that what before was ineffectual was now capable of effecting what we desired. This being done, the Ulcer was incarned by a Sarcotick Infusion (for I never use Ointments in these Cases) and cicatrized by the common drying Plaisters. It is to be observed, that the Scar still continues hollow (it having been healed near Two Years) and not like those that are the Consequents of well ordered simple Ulcers.
The following Observation contains an Account of one that was cured of an incipientCancerin her Breast, by Internals. I was the rather inclined to set down the whole Process of this Cure, because by these, or such like Medicines, Persons under the same Circumstances may perhaps be cured, though by some they may be thought incurable. The Case is this; A Gentlewoman, Thirty Years of Age, of a thin spare Habit of Body, by some Accident received a Blow upon One of her Breasts, which put her to an immediate Pain, and that very acute; but it lessened upon her being let Blood, and the Application of a discutient Plaister: However, in a few Days, some of the glandulous Grains of the Breast became indurated, and in Process of Time, by their Increase, they were rendered painful. At this Time she sought out for fresh Advice, and continued Two Months under the Care of a Person she was recommended to; but Things not succeeding according to Expectation, she became a Patient to Three or Four more. During this Time the Lump continued to encrease but slowly, and at the Expiration of Six Months it appeared to be a very hard painful Tumour in the Middle of the Breast, but no bigger than a Hen-Egg; whereupon it was thought proper to commence her Method of Cure by exhibiting the followingPills. ℞Pill. Tartar. Quercetan.ʒß.Calomelgr. viii.F. Pill.No.5. These were likewise continued twice a Week during the whole Cure; after this, was ordered the following Infusion, ℞Vin. Rhenan.℔ii.Milleped.℥ii.Ocul. Canc.℥ßCroci.ʒii. This was not to be taken alone, but when it had stood Four and Twenty Hours, three or four Spoons-full of it was to be mixed with a Draught of the ensuing Dietetick-Drink, and taken in the Morning, and at Four of the Clock in the Afternoon. ℞Rad. Sarsaparill.℥ii.Chinæʒvi.Fig. Sassafr.℥i.Corn. Cervi, ℥Sem. Correand.℥ß.Sant. Rub.ʒii.Coq. in aq. Font. Congiis 4 per Horæ dimidium, deinde stent Clause super Cineres Calidos per Horasxii;postea ebulliant ad tertiæ Partis Consumptionem. By the Continuance of these Means about two Months, and observing a regular Method of living, the Cure of this Patient was effected; though by some she had been looked upon as incurable, unless she would submit the cutting it out, which is not often attended with Success.
Perhaps,Sir, here you may object, that it is acting disengenuously, and not like a Friend, to give you an Account of those Persons only where I have succeeded. To this I answer, that excepting one Woman, that was emaciated almost to the last Degree by the excessive Discharge of a fætid Icorous Matter from her Breast, and an Abscess under her Arm, and who was carried off by a violent Loosness, I never had a Person miscarried under my Care, where I proposed a Cure. That poor Woman I suffered my self to be persuaded to take care of, having but little Prospect of effecting it, yet my Endeavours succeeded so well, that had it been in our Power to put a Stop to her Loosness, I am of opinion she might have been cured.
What has been hitherto said, I do not question but is sufficient to satisfy you, that this formidableDiseaseis not so rebellious, but that it may be sometimes conquered by Art; and I might here relate a Case I have at this present Writing, wherein not only a Part of theCancerwas fixed, but there were hardCancerousKnots extended to the Arm-pit; and yet this seems to be almost well; the Ulcer that remains, and which heals daily, not being much broader than a Crown Piece. But in regard the Patient is not entirely cured, I shall reserve this Relation untill another Opportunity; though I will embrace the present to assure you that I am,
SIR,Your very respectful Brother,and Humble Servant,Wm. Beckett.
Hatton-Garden,July 12, 1711.
A Solution of some CuriousProblemsconcerningCancers.
PROBLEM I.
Whether the Cancerous Juice is Corrosive, or not.
WEcannot come to a certain Knowledge of the Principles of the Juice which is lodged in the Cancerous Substance, although it enjoyed the very same Properties, of that which is discharged from an ulceratedCancer, from the Account which Authors have given of the latter; for they have differed very much in determining the Nature of the Salts, with which they suppose it abounds.Helmont,Van Horne, and most of those Gentlemen that were Chymically inclined, were of Opinion they belonged to the Alkaline Family, but a far greater Number than those, have thought they are Acid.Riolan, the Father,VideRiolanus,Cap.13.Sect.2.in his Chirurgical Works, without giving his Opinion what the constituent Parts of the purulent Matter are, affirmed it to be as strong as Poison, and that no Death could be devised too cruel for such a One as should give it to a Man. This brings to my Remembrance a very unhappy Accident a Gentleman informed me of that befel MrSmith, one of theSurgeonsof StThomas’sHospital, who being so curious as to taste the Juice of a cancerated Breast presently after it was extirpated, found himself very strangely affected by it, in a very short Time; he washed his Mouth with various Things, but nothing could free him from that penetrating, malignant, and nauseous Savour, he was continually attended with; in short, he became consumptive, and in a few Months died a Martyr to the Art ofSurgery. I confess when I received this Account it did not a little surprize me, because I had several times had the Curiosity to do the very same Thing, at theHospitalwhere that unfortunate Genman made the Experiment. I never found any remarkable Sharpness in it, though it was always attended with a very unpleasant Savour. I proceeded at first very cautiously in making this Attempt; for I deluted some Drops of the Juice in several Spoons-full of fair Water, till at length, not finding any Inconvenience from it, I came to the Juice it self. We cannot imagine the Death of that Gentleman before-mentioned, was procured by the Action of any corrosive Salts, whetherAcidorAlkaline, which would have caused a Corrosion of the Parts, but that it is only accountable from the extraordinary Stench and Malignity of the Matter, which impressing its Virulency on the Animal Juices must undoubtedly disturb their regular Motions, and cause the utmost Confusion of the whole Oeconomy. It must certainly be a very tragical Scene, to observe how Nature, by so inconsiderale Means, confounds and insults, over the Animal System; but still there is nothing we are more certain of, than that her Method of Procedure is always consistent to the Rules she acts by. Since the writing of this, looking over a little Tract which informs us of the Rarities inNew-England, I met with a Relation which discovers to us the peculiar and odd Quality of the Juice of a cancerated Breast, or Wolf, as our Author calls it. He tells us that an indulgent Husband, by sucking his Wife’s sore Breast to draw out the Poison, lost all his Teeth, but was attended by no other Inconvenience. Now this does not prove that so strange an Effect should succeed the sucking the Ulcer, because of the Corrosiveness of the Matter; for had it been so, such tender Parts as the Gums, Lips, and Tongue, could not have escaped so well as to have received no Damage by it.
Problem II.
WhetherCancersare contagious, or not.
THEREhas been a very great Disagreement in the Sentiments of our Predecessors as to this Point; butZacutas Lusitanusproposes to prove it by Reason and Experience. His Reasons are,First, because in an ulceratedCancerthere is a CadaverousVid.Zacut. de Prax.Med. admirand.Lib.1.Obs.15.Stench and Rottenness, which infects the Neighbouring Parts with it’s Virulency.Secondly, Because aCanceris the sameDiseaseas anElephantiasis, andLeprosyof a particular Part. To this,Sennertusin his Posthumous Works answers, that all corrupted and fætid Substances are not contagious; for in aGangreneandSphacellus, there is the greatest Corruption and offensive Smell, yet we do not find that a Person is killed by it: He adds, though aCancerhas some Similitude to anElephantiasis, they are differentDiseases.Lusitanusdeduces his Experience from an Observation of a poor Woman, that having an ulceratedCancerin her Breast, and lying with three Children, they were affected after the same Manner by the Contagion. He says that Two of them died, but the Third, which was of a strongerVidSennert.Paralipom. ad Part.1Cap.19.Constitution, had theCancercut off by aSurgeonand was cured.Sennertusis of Opinion that these Children did not contract theDiseaseby Contagion, but that it was by Hereditary Succession. We likewise find thatCardan,Lib. de Venen. Cap.12. is of Opinion thatCancersare not contagious. However, we will not make any particular Enquiry into these Authors Reasons, when they so strenuously maintain this Point; but only relate a remarkable History, which will prove the contrary, if theCancerousMatter comes to an immediate Contract with a soft and glandulous Part. The Relation I had (some time ago) from a Gentleman not long since deceased, who, out of a pious Disposition, had devoted himself for several Years last past, to be serviceable to the greatest Objects of Charity. He informed me that a Tradesman’s Wife inNottingham, being so unhappy as to labour under aCancerin one of her Breasts, her Husband was of Opinion he could relieve her by sucking it; accordingly he put this Method in Practice, in hopes without doubt he could effect a Cure, by drawing theCancerousMatter out of the Nipple; he continued his Attempts for some Time, but found it did not answer his Design; for though a small Quantity of Matter was dischargedVideGalen.inAph. Hip. Com. Lib. 6 Aph. 38.this way, theDiseasestill became worse, and she terminated her Life soon after. Two Months were scarce expired before the Husband of the Deceased came up toLondon, upon Account of a swelling he had arose on the Inside of the upper Jaw; he applied himself to some ingeniousSurgeonsfor Advice, who assured him he must undergo the drawing of Several Teeth on that Side of the Jaw which was affected, and have the Swelling, and Part of the Jaw-Bone (if necessary) cut away; he went away very much disatisfyed with so harsh a Proposal, and became a Patient to a Person, who undertook to cure him withGargels, and such inconsiderable Remedies; however, by the Use of these Things he was of Opinion he became much better, and thought he should be cured. Upon this he retired into the Country to his Business, but in less than a Month’s Time he was obliged to come up again, and have the former Method put in Practice. But the Event was according to that Expression ofGalen,Quibus item sunt Cancri in cavitate Corporis, aut Palato, sede utero, si secentur, aut urantur, ulcera cicatrice induci non possunt. For the Sore could never be brought to cicatrize, but theCancercontinu’d to spread, till it had extended in self over most of the internal Parts of the Mouth, and to the inner Part of the Nose: In this unhappy Condition, he lived some time, but at last became so frightful an Object, and the Stench that continually proceeded from the Parts was so offensive, that he retired himself from the World, and finished his miserable Life in a Garret. Since the finishing theSolutionto the foregoingProblem, I met with a Surgeon (a Foreigner) who giving me an Account of the present State of the Practice ofSurgeryin the Country where he lived, and relating some considerable Cases which had happened within his own Knowledge, in answer to my Desire, among other things, told me, without any particular Intimation from me, he knew a very odd Accident, which happened upon a Woman’s having an ulceratedCancerin her right Breast, which was, that she being poor, for want of other Conveniences, suffered two Children she had to lie with her in that Condition; at length one of them, a Girl about five Years old, began to be afflicted with a small painful Tumour in one of her Breasts, which encreasing to near the Bigness of an Egg, became Livid, and entirelyCancerous; the Mother died some time after, and the Child did not long survive her; but the other Child continued well. Several Surgeons gave their Sentiments of this Case; some thought it to be an Hereditary Indisposition; but considering the Mother had no Appearance of aCancerbefore or at the Birth of the Child, I cannot but readily embrace the Opinion of those Gentlemen, that were inclined to believe that it was contracted by Contagion, seeing the Position of the Child’s Body was such in Bed, that that Part of it which was affected was almost always disposed to rub against the Dressings soaked in Matter, (for I understand the Mother took but very little Care to change them often.) Now it is not at all probable, that the malignantEffluvia, which continually pass off from theCancerous Mass, and the putrefied Matter, can dispose a Person at any little Distance to be affected with the likeDisease, for then the other Child would have became a Sufferer; but it may happen in some extraordinary Cases, where the corrupted Fluid has attained an exalted Pitch of Malignity, to communicate some of its more active Particles to the Blood and Spirit; and so causing a very great Disorder in their Motions produce a violent Fever, and Confusion of the whole Oeconomy, so as to occasion a Person’s Death. But see a remarkable Case inTulpius,Lib.4.Obs.8. That there are several cutaneousDiseasesthat may be propagated by Contagion, if a Person lies with another, is by all allowed of; and that the lying with a Person that has aCancermay be attended by such aDisease, from the Proofs we have brought, I suppose will be agreed to be equally as certain. But this cannot happen unless the matter be very malignant, and be suffered, by the Negligence of the Patient, to come to an immediate Contact, with a Part of the Body of the other Person; for then, without doubt, it may contuminate the Fluids, and incline them to assume a Viscidity, to which theEffluviawill immediately adhere, because they are best qualifyed for a Union with those Substances that are viscous. To this we may add, that in those Persons that are nearly related, the Malignity may be more easily communicable because of their Analogy to each other; for consonant hereto,DiemerbroeckVideDiemerbroeckdePest. Page 58.says in his Treatise ofthe Plague, thatKindred more easily receive the Infection from one another. But see more in that Author’s excellent Book where you have likewise some curious Thoughts relating to Contagion.
PROBLEM III.
Whether if the extirpating aCancerous Breasthappens to be successful, it ought to be look’d upon as a Consequence of Performing the Operation better than our Predecessors.
BYthe Account we receive from Authors we cannot be positively assured, whether there was any particular established Method in the first Ages of this Art, for the Performance of this Operation: This we are only assured of that there are some Circumstances whichVideÆtius Tetrab.4. Ser. 4.Cap.44.relate to it, that have been taken Notice of; the most considerable of which is, that the actual Cautery was to be applied immediately after the Abscision; this they advised, not only to put a Stop to the Flux of Blood, but likewise to correct the ill Quality of it: It is to be observed, that they ordered always, upon such an Occasion, Defensatives to be applied to the contiguous Parts, to prevent their being inflamed; but for as much as they were sensible the actual Cautery would procure an Eschar, they recommended the Use of Digestives to separate it; after which, they proposed to heal it asVideArceus, lib. 2. Cap 3. deCurand. Vulnerib.a common Ulcer. The very next Advance this Operation received, that we have met with, was by that Accurate WriterFranciscus Arceus, who obliged the World with an exact and methodical Account of the whole Method of Procedure in extirpating aCancerin the Breast; though this Author would only venture on those that were not Ulcerated, those that were he looked upon as incurable. We do not find that this Method was recommended to the World by any remarkable Histories of Cures effected by it; whether it proceeded from the Unsuccessfulness of the Attempts, or its Disuse, we cannot determine.Fabritius Hildanuslikewise made a considerable Step towards the Encouraging the Performing this Operation; and he assures us, he has more than once done it with Success; he did not only influence his Cotemporaries to revive an Operation, that was, perhaps, almost grown out of Date, by the Histories of some Cases he recites; but obliged them with the Figure of a Pair of Forceps, which in this Operation are very convenient to engage the Breast, and thereby prevent the Pain the Patients are sometimes put to, by piercing the Breast with Needles armed with Silk to suspend it. There are several Ways of performing the Operation, mentioned by later Practitioners, but at this Time there are few that are willing to be concerned in it. A very considerable Author speaking of extirpating aCancerous Breast, advises us to take care we do not cut the Pectoral Muscle in the Operation: But we have seen a very remarkable Case of this Nature, where a Part of that Muscle was cut away, and the Cartilages of the two of the Ribs laid bare, and the Patient happened to be cured. Now if our Predecessors had so great a Respect to the avoiding the wounding of this Part, as to make their Incisions too superficial, their Operations must be in all Probability unsuccessful; for we are very well assured by Experience, that their actual Cauteries will have no good Effect here, nor will they consume the remaining Part of theCancerous Mass. We have elsewhere shewed, that this Substance upon boiling becomes hard and friable; and we will here take the Liberty to give our Opinion of the Use of Cauteries in this Case. TheCancerous Substancewe take to be nothing more than a Transformation of the small glandulous Bodies, which form the Breast, and a Lymphatick Juice, intimately incorporated therewith, into a hard, close, whitish, and (by common Medicines) indissolvableMass. In some Cases, perhaps, it may receive some Addition from some Juices, which may distil from the contiguous Fibres. This being granted, what Benefit, can we reasonably imagine, will ensue on this painful Method? Will not the Fire, by causing the more Fluid Parts of theMassto evaporate, actually dry up, torrefy, and harden it; and so dispose it for displaying a Train of mischievous Effects, on the contiguous Parts? and all this without any very apparent Decrease of it too: Nay, the very reducing of it to such a Consistence, which very much resembles a Piece of burnt Horn, is sufficient to procure a perpetual Pain, seeing Medicines can hardly soften it, so as to reduce it to its first State.
PROBLEM IV.
WhetherSalivationwill Cure aCancer.
THEextraordinary Success this Method has been attended with, in some Cases of the greatest Difficulty, has so far recommended it to the World, that it is at this Time become of so great Repute, that there are few Persons but what will willingly embrace it, if proposed to them, provided they have found former Methods prove ineffectual. We once knew a Person, who laboured under an ulceratedCancerin her Breast, advised to it, and who had certainly under-gone it, though contrary to the Opinion of some Persons concerned, if in three or four Days time she had not been reduced to such a weak Condition, that it put an End to the Controversy. That aSalivationhas cured the most malign and spreading Ulcers, and those that have been of several Years continuance, notwithstanding their Edges have been high, inverted and assumed the Consistence of a callous Body, we have found by several Instances; but that it should cure aCancerous Ulcer, anUlcerwhich is chiefly seated in a transformed animal Substance, and which has no Correspondence with the contiguous Parts, is what we cannot believe. One of the principal Effects ofMercury, if prudently given, is, that it attenuates the Juices, clears the Canals, destroys the ill Quality of that Fluid that has a Hand in causing any Obstruction, and renders the Juices temperate and sweet. By effecting this, it is, that it cures so many different Diseases, which perhaps have not so great a Diversity in their Causes, but have different Appearances, which depend upon the Variety of Parts, where the Cause operates. From hence any One may judge, that a Person who discovers a certain Method of curingCancersby Medicines only, will find that it will not consist in a Secret for purifying the Juices, which can have no Effect on theCancerous Mass, so as to procure it’s Dissolution; and without a Remedy for which his Method will be always unsuccessful.Mercklin, in his Treatisede Transfus Sanguinis, page 35, tells us we have no Reason to believe we may have Success from Transfusion in aCancer, nor indeed would Injections succeed better; though, perhaps, by this Means, it is possible so to alter the Fluids, thatUlcers, notCancerous, may be cured in a short Time, as it once happened to a certain Person, who being under Cure for an inveterate Pox, had someRosinofScammonyinfused in the Essence ofGuaiacum, injected into his Veins, which Vomited him excessively; but hisUlcerswere healed in three Days Time. From what has been hitherto said, it is evident, that aSalivationcan never cure a confirmedCancer, because it is not capable of procuring a Dissolution of that hard Substance, which is the realCancerit self. The Glands we have observed, with the extravasatedLympha, and its Vessels, are perfectly changed to a different Substance to what they were before, all which make aMassof such a Nature, that it will be impossible to procure it’s Dissolution by any inward Means. If theCancerwas nothing more than a Coagulation of the Juices in the Vessels, or other Canals, or Pipes, the Cure might be much more easily effected, but as theCanceris conjoined with such Circumstances as we have mentioned, we may affirm the Cure will be altogether impossible without the whole Substance with it’s Appendices or Branches (which we have found they often have) be taken away; or a perfect Dissolution of all of it be procured by some external Remedy, which is capable of operating on it after such a peculiar Manner, as to dissolve theCancerous Substance, without having any such Effect on the contiguous Parts.
PROBLEM V.
Whether Cancers are Curable by Causticks.
THEDifficulty that those of our Predecessors who had Courage enough to attempt the Cure ofCancers, must unavoidably meet with, obliged them to enter upon several Methods of Practice, in order to be capable of surmounting it; and there have not been wanting for these several hundred Years last past, some Gentlemen in the Republick of Medicine that have proposed to conquer this Rebellious Disease, by the use of some particular Causticks, they have recommended. It is foreign to my Design, to give an Account of the Composition of the several Remedies, they have been big with the Expectation of Success from; I shall only take notice of one or two not very pompous Preparations, that by some Persons I know, have been looked upon as extraordinary as any that have been transmitted to us.Guido, who I think I may justly say is one of the best Authors of so ancient a Date, has been very lavish of his Encomiums onArsnick, and after himFallopius,Rodericus a Castro,Ossenius,Penotus,Faber,Borellus, and others, have recommended it in some particular Preparations. That ofFuschius, who is said to have cured abundance of Persons ofCancers, inEngland,Germany, andPoland, having had the most said in it’s Commendation, required our more particular Notice;Hartmancalls itPul Benedictus, which whether it deserves that Title, we will leave to the Reader to judge, after we have faithfully recounted the Effects of it. Its Preparation is as follows: ℞Arsenici albi℥isubtilissime pulverisetur per dies 15 de die tertio in tertium affundatur Aq. vitæ, ut cooperiat pulverem, post triduum Aq. vitæ abjiciatur, ac nova affundatur, ac misceantur. Rad Dracunouli Major, mense julio vel Agu. collect & in taleolas scissæ ac in loco ventis perflatili exsiccatæ℥ii.Fuliginis Camini splendidi℥iiiredigantur omnia in subtilissimum pulverem super lapidem marmoreum, & servetur in Vase bene clauso vitreo. Ante annum vero ad usum non erit it a commodus. This Powder I applied to aCanceratedBreast of a Woman, under thirty Years of Age, after having made a Sore by applying one of the milderCausticks; the first Night it was made use of, it caused a great deal of pain, and the next Day, the Breast appeared very much tumefied and inflamed, a small quantity of Gleet, having discharged on the Bolster: in short for fifteen Days she was not free from pain, she had aFever, was attended with frequentVomitings,Faintings, and several other Disorders. I could afford her but very little Relief by Internals, or the most cool and temperate Applications to the Breast; nor was it in my Power to remove the dressing, it adhered so fast to the Sore. There was a Discharge of a bloody ferous Juice for twelve Days in a moderate quantity, after which the Matter thickened, and it began to smell somewhat offensive, at the end of fifteen Days the Dressing dropped off, and with it came away about two Ounces of thecancerous Mass. The Reader may easily imagine that making so small a Progress in such a time, and that at the Expence of so much Pain, I could easily prevail with my self to desist from the Undertaking, for the second Application would have been attended with the same Inconveniencies as the first, which to any Persons that entertains such a concern for his Patients as he ought to do, must be very fatiguing; in short, after this I made use of that Remedy I had elsewhere mentioned, and which from its Effect was properly enough called aDissolvent, with this by the Blessing of God theCancerousSubstance was consumed in about three Weeks, and a perfect Cure compleated in not many Days after, the Patient which I saw lately continuing perfectly well, it being the first Case that ever Providence directed me to the use of the Remedy in.Hildanhas an Observation very pertinent to what we have before related; he tells us, that thePowderso much celebrated byPenotus, and which is much the same with that just now mentioned, being applied to aCancer, was succeeded by such ill Symptoms, that it killed the Patient in a few Days. We are informed in the communicated Observations ofRiverius, that a Foreigner extirpated a Cancer, that had began to Ulcerate in the Breast of a Woman of fifty Years of Age, by the following Application: ℞Arseniciʒi.Salis Armoniaci℥ii.Sublimat. crud.℥iiii.Aq; Fortis℥i.These were to be distill’d to Dryness, then an equal Weight of distill’d Vinegar put thereto, which was to be distilled again, till the remaining Matter, became of the Consistance of a Paste.The Surgeon bathed theCancerwith hot Wine, and rubbed it with Cloths for some time toirritateit, then he spread some of his Composition on a Bolster six times less than theTumour, and applied it; in twenty four Hours time, it made anEscaras large as the Swelling, so that it wholly consumed theCancer; after the Separation of theEscarhe incarned theUlcerand cicatrized it. It is very observable, that he did not engage in this painful Process, without immediately causing a Fever, which was attended with aVomiting,Loosness, and much Provocation ofUrine; which Symptoms lasted two or three Days, for Nature was disordered by the destructive Quality of a venemous Remedy.Paracelsus,Faber, and some others, make mention of Arsnical Preparations, that procure but little Pain in their Operation; I had a Design of making a Trial of some of these Remedies, had I not in my Enquiries met with what was very satisfactory to me, though after knowing what I have related, I should have always cautiously avoided the use of any Remedy, in which theArsnickhad not undergone such a Preparation as I should have approved of, because I am assured it may procure very mischievious Symptoms, though in Substance, it do not so much as touch the Skin, witness theAmulets, in which it has been the chief Ingredient, and of which there have been such direful Accidents related byCrato,Massaria, andZacutus Lucitanus. I do not think it impossible, but thatArsnickmay be prepared after such a manner as may, by the addition of some convenient Body, or depriving it of its noxious Particles, qualify it for effecting uncommon things in the Cure of this Disease, without causing the Surgeon to repent the use of it. I remember thatHelmontsomewhere says one may easily enough correct several sorts of Poisons, so that they shall not be deprived of their Force, when we destroy their Virulency. Many Instances of this Nature we meet with in MrBoyle, and some others; but that which makes most for my present purpose, is, what is mentioned by the last Honourable Gentleman, of a very ingenious Man he knew, that was famous, as well for his Writings, as for a Remedy to cureulcerated Cancersin Womens Breasts, without any considerable Pain. He assured our Author that his Medicine was indolent, and mortified the ulcerated Parts as far as they were corrupted, without disordering the Party, and this Remedy it seems partly by the Confession of the Gentleman, was reasonably enough supposed to be a Dulcification ofArsnick; one would think that the mention of this very Remedy, with MonsieurAlliot’s, and that recommended in the preceeding Letter, should be sufficient to influence the inquisitive of our Profession to farther Enquiries, which must be certainly an Undertaking, worthy the noblest Spirits. To conclude, we cannot say, but there are many Cancers that may be cured by Causticks, but the Person that is to undergo it, may very well answer, as a certain Patient did, who’s Thigh was to be cut off,Non est tanto digna dolore Salus.The Preservation of Life would be too dear bought at the Price of so much Pain.This puts me in Mind of what is related ofGalienusthe Emperor, who it seems had for a considerable time been very grieviously afflicted with aSciatica, a certain Physician undertaking to cure him, performed indeed his Promise, but nevertheless made him undergo a thousand painful Experiments; whereupon, the Emperor one Day sent for, and thus said to him,TakeFabatustwo Thousand Sesterces, but withal, be informed I give them not for curing mySciatica,but that thou may’st never cure me again.
PROBLEM VI.
Whether Cancers are Curable by internal Medicines.
THOUGHthisProblemat first View may seem to be too near allied to that which proves the Impossibility of curing cancerous Tumours, whether ulcerated or not, by Salivation; yet in regard there are some Persons, that tell us the Disease is superable by some internal Remedies, which operate after a quite different Manner, to those generally given to procure a Salivation, we shall enquire into one of the most considerable of them, related by a Person whose Memory we have a very great Value for. And we shall the rather take Notice of this particular Remedy, because we have elsewhere spoke of the Success of it. It were no very difficult Matter for me to mention several internal Medicines, out of our Chirurgical Writers, more especially those that have been Favourers of Chemistry; but I shall purposely decline it, because to speak freely, I suspect that most of the Remedies, though much has been said in the Praise, have not been sufficiently examined by those that recommended them. To this we may add, that had the Authors of them considered the vast Difference there is to be observed in Cancers, they would not have so suddainly and positively determined, that their Medicines were of use in these Cases in general; seeing we must have regard to absolutely different Intentions, in those that are not ulcerated, and those that are, and those that are a hard Tumour, and those that are flat, and likewise when they are conjoined with Circumstances, which are often enough to be met with. The Honourable MrBoylein hisUsefulness of experimental Philosophy, tells us, that he was informed by credible Persons, of a certainEnglishWoman above sixty Years of Age, who had lain long indisposed with a Cancer in her Breast, in an Hospital inZeeland, and was by DoctorHarberfeld, with one single inward Remedy perfectly cured in three Weeks; the Relation was made by aDoctor of Physick, who was an Eye Witness of the Cure, and another Person who not only saw the Cure, but knew the Woman before, and out of Charity, carried her to him that healed her. Our Author was informed, that theChemical Liquorthe Doctor constantly made use of, does in the Dose of about a Spoonful or two, work suddainly and nimbly enough by Vomit, but hath very quickly ended it’s Operation, so that within an Hour, or less, after the Patient has taken it, he is commonly well again, and very hungry. He adds, that having some of the Liquor presented him, he found the Taste to be offensive enough, and not unlike that ofVitriol, which by the Taste and emetick Operation, was guessed to be it’s principal Ingredient. The Relators assured our Author they had been inEngland, as well as elsewhere partly Eye Witnesses, and partly Performers of wonderful Cures by the help of it alone, under God, in theKing’s Evil; insomuch, that an eminent Gentleman of this Nation, hath been cured by it, whenthat Distemperhad brought his Arm to such a pass, that the Surgeons had appointed a time to cut it off. Now, who is there, that upon reading this Account would not think the Doctor a very happy Man, that was Master of so valuable a Secret; but alas! How satisfactory would it be to the World if the hundredth part of the Remedies that have been handed down to us, had a Power of effecting those things that are ascribed to them, without being attended with any ill Consequences. I assure you, Reader, I have made use of this very Remedy, for since I mentioned it as the Doctor’s having great Success from it; I met with the true Preparation of it, as it was communicated to SirKenelm Digbyby DoctorHavervelt, orHaberfield, for the Cure ofCancers, theKing’s Evil, and oldUlcers. It is as follows. ℞Dantzick Vitriol, calcine it till it be yellow, then grind it with Salt, or Salt Petre, the ordinary proportion with this Sublime Mercury, which Sublime once again by it self, then take only the Cristaline part of it; of this take℥i,grind it to a Subtile Powder in a Glass Mortar with a Glass Pestle.Put this into a Glass Bottle, and pour upon it a Quart of Fountain Water, stop the Bottle close, and let it stand thus for some Days, shaking it often; after it is well settled pour off the clear, and filtre it; take a Spoonful of this Liquor, which put into a Vial, and put to it two Spoonfuls of fair Water; shake the Vial well, and let the Patient Drink it in the Morning Fasting: As to the quickness of its Operation, and the making the Patient Hungry, I found it at first to agree with what MrBoylesays of it; but upon giving it three or four times, the Patient would afterward complain of a Languidness, which was ushered in by a Sickness at the Stomach; after this, they would be attended with a Heat or Soreness of the Throat, immoderate Thirst, convulsive Motions of the Stomach,&c.Some of which Inconveniencies would continue for many Hours together. It was upon Account of the Melancholy Reflections of bringing the Patients into such Disorder, and their Unwillingness to endure such Fatigues, that I had never Courage enough to proceed in this Method. I cannot but say, upon the Alteration I found in a Patient of mine, from the use of six Doses of this Medicine, that it may as well as some other churlish Remedies, cure some flat ulcerated Cancers, where there is no Tumour to dissolve, in Persons that are capable of often repeating it, which I think is sufficient to put us upon farther Enquiries, that we may be able to accomplish such Undertakings without bringing upon the Patient such a Train of mischievous Accidents.
POSTSCRIPT.
What follows is taken from a Manuscript which at this time 1714–15, belongs to one of the Family of thePains, that have for a long time pretended to cure Cancers: In the Margin is this Note, (Used by my Father, and Grandfather, and Brothers, and known as a thing excellent by long Practice in our Family of thePains:) The Book was lent me by my BrotherDobyns, who had it from one of the Family, a Patient of his.
The Red Caustick.
To eat all Superfluous Cancerous and Schirrous Matters gathered hard in the Edges or Sides of any Ulcer or Cancer, breeding upon the Mouth, Face, Nose or Valva. Take of Bole Armoniac one Ounce, of yellow Arsnic three Ounces, powder them and searse them fine, pare an Apple or two and take of the Pulp and put so much of it to the Powder (beating of it together in a Mortar) as will make it of the stiffness of Dough, then make it up into round Balls of the bigness of a Walnut, dry them in a Chamber-Window till they be hard enough. When you use these Balls shave a little off from them into your Hand, and moisten the same with a little Spittle, and rub it well about the hard Foot of theNoli me Tangere, and all over the Head of the same, and after that you have gathered him up into the Ligature and knit him hard up (for it seems they used a Ligature smeared with the Medicine) then apply your Preparation before-mentioned, and lay fine Holland Raggs dipt in the following Red Water, all over the said Caustic, and so let it lye till it fall off its self.Note, The Quantity of Caustic laid on, ought not to be much, and yet sufficient to work its effect. It worketh with great Pain for twelve Hours or more, and after that by Fits, like the Tooth-Ach; as the Pain worketh off it causes great Inflammation and Swelling about those Parts it is applied to, but this does not continue above four or five Days; so meddle not with it till the Caustick comes off. Then you may for three or four Days dress the Inflammation with Diachylon Plaister, or the Red Water warm.
The Red Water for a Cancer.
Quench unslacked Lime in boiling Water, which let stand six Hours, the clear Water poured off, put to the Fire again; to a Gallon and half of which, putCamphir℥ßAloes Succatrine℥ß.Common Bole℥iiWhite Copperas or Allum℥ii all powdered, which boil in the Liquor a little while: He sometimes gave a Pill made of Deflograted Red Precipitate, which sometimes made them spit a little.
The Musilage Plaister to dissolve Schirrous Knots in the Breast.
Take of the white and inward Bark of the Witch-Hasel half a Handful, cut it short and stamp it, then take of the Roots of Marsh Mallows, Holy-hock Roots two or three Roots, clean them and throw away the Pith, stamp all together, then take of Fenugreek and Linseed of each two Ounces powdered, put all in an Earthen-pot, then take a Pint of white Wine or Water, heat it scalding hot, put it to the Things aforesaid, cover it close, stirring it every Day for nine Days, then strain out the Musilage Liquor with which you make the following Plaister. Take a Pint of Salad Oyl, Cerus finely powdered 8 Ounces, boil them together, constantly stirring them, a sufficient time, which you may know by its coming clear off a Pewter Dish when dropt on, let it cool a little and put in your Musilage, which stir till it be as white as you would have it, and until almost all the Musilage be boiled away, then remove it from the Fire and put to it four Ounces ofyellow Wax, probablyGalbanummay be better, which when dissolved and the Plaister cold, work up for use. This Plaister is sometimes used with equal Parts ofGalbanum.
IShould not have been induced to make these Papers publick, barely on account of the rash Censures, that are frequently cast upon the Practice ofSurgery, not attended with Success; tho’ that Consideration alone, in the Case of a Person of such Value and Eminency inPhysick, as DrKEILis known to have been, may be thought sufficient to have moved me to it: But being certainly informed, That severalPhysiciansandSurgeonshave before, and since his Death, given themselves the Liberty to reflect, not only upon me for Using, but also upon the Deceased for submitting to the Methods that were taken with him; I think I shall not discharge my Duty, either to my Friend, or to my Self, or indeed to the Profession, if I do not, as far as I am able, endeavour to set what was done in a True Light.
In order thereunto, it may be requisite to look back to the Time He first mentioned any Disorder in his Mouth to me, which was inAugust1716. He then told me, He had preceived a Fulness in his Mouth for very many Years; but in the last Three or Four Years it was much encreased, and by the Bulk began to be troublesome to him, tho’ not in the least painful: Upon examining it, I found the Tumour not only large, but also to fluctuate, and therefore told him, until I was satisfied what was contained in it, I could not come to a Resolution, as to the manner of treating it; but, if he pleased, I would make an Incision into it, and then would tell him what I thought was fit to be done; He was very well satisfied, and resolved I should proceed accordingly.
Upon Opening it, there appeared to be nothing contained in it, but Blood; not in the least altered in Colour, Consistence, or Smell, from what is contained in the Vessels. The Tumour presently sunk very much, and I dilated the Incision with my Probe-Scissers, and pressed in someDossels; and then told him, it was a fleshy Tumour, called aSarcoma, and that the Blood contained in it was only accidental; and that the best way of extirpating it was by the actualCautery; but I let him know, that I feared it would be more troublesome to him, and take longer Time to cure, than he seemed to expect.
We presently sent for the bestInstrument-Makerthe Country afforded, and gave him Directions: But that Night: talking with him of his Case, I desired him to consider, Whether it might not be thought a Slight, by the Learned of both Professions, if I should Perform the Operation, upon a Man of his Character, without a Consultation; there being no Reason (but the Loss of his Time) to be in haste. At first he seemed unwilling to lose so much Time, yet upon Consideration, he resolved forLondonthe next Day, where severalPhysiciansandSurgeonswere consulted; they all agreed, it was a simpleSarcoma, and that the actualCauterywas the properest, if not the only means of curing it. This Account I received from the Doctor by Letter; as also, that theSurgeons, upon probing, found the Bone bare, and from the ill Smell concluded it was foul: “Which, said the Doctor it was impossible for you to discover; because after I leftNorthampton, TwoDosselsof the first Dressing dropt out.” I was very glad to hear That, for thoseDosselslodging so long, in that warm Part, I was in hopes might be the Occasion of the fœtid Smell; which theSurgeons, not being acquainted with, might fairly be induced to take for that of a foul Bone: Which I mentioned to the Doctor by the first return of the Post; and also, that I was farther encouraged in that Hope, by considering that the Blood, that was discharged at the first Opening, was not at all altered, neither was any Smell perceived, until after the lodging of thoseDossels.
Whether the Doctor ever mentioned this my Opinion, to theSurgeonsin Town, I know not; but when he returned to me, to have the Operation performed, he seemed discouraged by the Opinion theSurgeonsgave of the Bones being foul. But I thought I might make bold to confirm him, in my former Opinion, the ill Smell ceasing without the Assistance of Medicines. The Consequence proved the Assertion: For when, by several Applications of theCauteries, I had removed the whole Tumor, it was plain to me, the Bone was not affected; and the Part healed as smooth, and with as much Ease, and in as short a Time, as ever I met any thing of that Nature, and the Doctor continued well, without the least Disorder or Complaint, a Year and about Eight Months.
But then inApril1718. He shewed me a smallUlcer, near that Part of the Mouth that was before affected, and told me, He perceived it began upon eating some hot Meat, that stuck to it: At first this healed without much Trouble, but soon excoriated again; and then I could not again perfectly skin it: For as soon as it was almost healed, it would begin to excoriate a-fresh at the Edges, which is what is usual inPhagedænical Ulcers. And tho’ I could digest it, and keep it easy, yet it got ground of me, and spread towards the Teeth; and, near the Root of One of theMolares, laid the Bone bare, which appeared to me at the first not to be injured, but being long exposed became foul. It not exfoliating in due Time, with the Tincture that is commonly used, I proposed the touching of it with a smallCautery, I being able very easily to come at it without making use of aCannula; which, by confining the Heat, very much injures the neighbouring Parts: The good Effect of which Practice, of not making use of aCannula, where you can conveniently omit it, I had good Experience of in DoctorKEIL’s former Case: For tho’ he had severalCannulasmade inLondon, by the best Hand, yet after Twice using of them, I told the Doctor, That if a Patient could be trusted, it would be much more easy to him, and the Surgeon would see much better to use theCautery, than when obstructed by aCannula. The Doctor was pleased with the Thought, and pressed me, at the next making use of theCautery, to do it without theCannula: The Advantage he had by it was, that it bore four Burnings, and said, It gave him not the Pain, or Trouble he had from but One before, and that the Parts were much less Disordered by it afterwards. But to return:
It will not I suppose be doubted, but that proper internal Means were all along made use of: But theUlcerstill appearing to me more threatening, his Friends pressed him, and I more than any, that he would go again to Town, and have the best Advice it could afford; and I resolved to accompany Him, in the Beginning ofAugust1718. And I cannot forbear saying I was surprized, when, upon a Consultation, my Brothers,PalmerandBrown, made light of it; and, without so much as hearing what I had to say, concluded, That it was chiefly owing to the Bones being foul; and that by drawing a Tooth or Two which they said were affected, and by Purging withMercurius dulcis, all would be well; and so they took their Leave. Says the Doctor to me, “What say you to this?” I answered him, That I feared they would find themselves again mistaken as to theSurgeryPart; and that as to theMercury, though a good Medicine, He knew he had taken it already several Times, without any considerable Advantage. The Doctor smiled and said, “But since I came so far for Advice, I will not only give them a Tooth, but also try again what EffectMercurymay have.”
Another Meeting was ordered, and the Tooth-Drawer to be there: Upon Drawing the Tooth, it appeared to be very sound. The First Dose he took ofMercury, whether by Cold, or any other Accident, I know not, very much disordered him. I could not conveniently be absent any longer, and therefore the next Day returned into the Country, and do not know how many more Doses the Doctor then took; but in a few Days I received a Letter from him, in which he said, “I know nothing that has succeeded right with me, since I came here: You know what State you left me in, and I was a great deal worse for some Days afterwards; though I hope theMercuryhas had no ill Effect, yet I should have been loath to have been so swelled in those Parts, as I have been, willingly. The oldUlcersare not yet healed, they tell me indeed, there is no Appearance of any new Ones, and that themost effectualMethods, which have been taken here, willinfalliblyprevent every thing,&c.”
But by his next, which I soon received, I had the melancholy News from him, That theUlcerwas broke out again larger than ever, and therefore that he would be down with me in a Day or two, and he came accordingly, but in a worse State than ever before. And though it again digested, and did as before near heal, yet the returns were quicker, and upon every new Eruption it was larger and worse; and so continued to be, notwithstanding all the good internal Methods continually used by the concurring Advice of DrMead, DrFriend, and several other EminentPhysicians; which no doubt was owing to the malignant Nature of it.
And therefore in the Beginning ofFebruarylast, I could no longer forbear expressing my Fears to the Doctor that it would terminate in a ragingCancer. He was too sensible of it, and told me, “That since I thought I could keep it within Bounds no longer, He was resolved to try what aSalivationwould do:” And though I could say nothing as to the Advantage he might expect from it, yet I frankly owned to him, that if it was my own Case, I should be of his Opinion, that I might make bolder with my self, than with any other Patient: But desired by all means, he would first hear if his Friends, thePhysiciansandSurgeonsinLondon, had yet any other Method to propose, or else would approve of that. He wrote to them, the Answer was long in coming, which made the Doctor express himself to me with more Warmth, than I ever knew him to do before: (For he was a Man of the greatest Command of himself, as well as of the sweetest Temper) “What, says he, is not their Silence enough? And will not you, whom I take for my Friend (for fear of losing your Reputation) assist me in what I desire?” With a great deal more to assure me of his Confidence in me, and of his Opinion of my Ability to take Care of him in the Course. I am not so vain, as to mention all his kind Expressions, yet if it be desired, by any of his Friends, I will give them the Satisfaction of seeing the Letters I had from him, when he was absent from me inLondon.
At this Time his Brother, DoctorJohn Keil, came to him fromOxford; and, as I understood afterwards, had seen DrFriendthere, who was for having him salivated atLondon: But the Doctor being determined to the contrary, did not at that Time acquaint me with it, but began his Course, which I desired might be in the mildest Method, by small Doses ofCalomel, encreased gradually, which Method pleased him very well: But DrFriend(to whom DrJohn Keilconstantly sent an Account of our Proceedings) gave it as the Opinion of MrPalmerand MrBrown, that it should be done byUnction: I gave my Reason to the Patient against it, but they still pressed it, notwithstanding the ill Symptoms, that I thought, at that Time, forbad it; which Symptoms they had been acquainted with. They still persisting, I desired the Doctor would give me leave to write my Opinion my self to MrBrown, which I did hastily in the following manner.
Good Brother,
I Have seen DrFriend’sLetter to DrKeil;and DrFriendI understand has been so kind as to consult you, and several Others in the Case; whose Judgments, though I have all due Regard for, yet in the present Circumstances (though I give the Preference toUnctionin some stubborn Cases) I dare not encourage it in this: For my Reason at first, for beginning so mildly, was, that in this uncommon Case, we might by degrees, make some Judgment of the Effects ofMercury,and then proceed accordingly: For had I not been prevented by the Accidents you have, by DrFriend,been acquainted with, I should have been very desirous to have gone at least to the Heighth mentioned by DrFriend.But since I find, by encreasing the Quantity of the Dose to aScruple(of which he has taken four) it has not affected the Glands at all, or made him Spit the more; but his Stomach is much more oppressed by it, with vast Quantity of Phlegm, viscous to a degree I have not met with, and gives him more than common Disturbance, not to be relieved but by often Vomiting, to which purpose theTurpith,has answered very well for the present: My great Fear is, all things considered, that if I should proceed toUnction,and it should produce the same Effect, that it will be too many for him. If my Fears are too great, my more than common Concern and Friendship is some Excuse for me; as also I desire it may be to You, for this tedious Account from, Sir,
Yours,&c.
Feb. 22d, 1718.
J. Rushworth.
I not receiving, in due Time, an Answer to this, and the Patient being reduced to a great Weakness, and to so great a Disorder, that he could not bear Talking to, I writ these few Lines for him to consider of.
Dear Sir,
AS your Case now stands, I must own my self a Coward: Though DrFriendis much mistaken to think I am either unacquainted with, or fear the common Accidents that often arise in Salivating: But that irregular and uncommon Effects are, in extraordinary Cases, produced byMercury, Hale’s Case is to me a sufficient Precedent, of which I have formerly told you the Particulars; and though your Friends in Town took no Notice of the unusual Disorder in your Stomach, yet I should think myself Inexcusable if I should not. And if, upon using anUnction,any irregular Ferments should again arise, weak as you now are, I should dread the Consequence. In these Circumstances, I think it most prudent for me, to advise you, to let what is already taken, go fairly off, and if you find it not effectual, you may with much better Prospect, when you have Strength, beginde Nova,byUnction,and have an Opportunity to have it done by theinfallibleMen.
Upon this the Doctor no longer, at present, pressed me to use theUnction, and in a few Days, the Force of what he had taken being somewhat spent, he began to get Strength, and the very great Slough (which was one of the Accidents mentioned to DrFriend) not only cast off, but also healed, as did also the old malignantUlcer, and all the Parts of the Mouth looked very smooth and well; and the Doctor was very chearful, and in great Hopes of gaining the Point.
At this Time, it being eighteen Days since I wrote to MrBrown, I received a Letter from him, in which he mentioned nothing to the Purpose. This, I must confess, did not a little warm me; and I the same Night wrote to him again, but never received any Answer: Perhaps he thought mine too hot; if so, if he desires it, both mine, and his that occasioned it, shall be produced.
The Doctor seeing what had been done to have so good Effect, and hoping what was before advised by MrPalmerand MrBrown, would effectually prevent any return of his Disorder, resolved to use aMercurial Unction. He had now more Strength, and therefore I complied with him; I began with a small Quantity, and encreased it every Time, until I had used even a larger Quantity than had been proposed by DrFriend: But it not in the least affected the Glands, or made him to spit near so much, as when he took theCalomel; neither did theUnctionorCalomelproduce the Smell, which generally attendsMercurialCourses; and to my great Surprize and Concern, whilst he was using theUnction, theUlcerbroke out again. And by this we were discouraged from proceeding any farther; and in due Time the Doctor endeavoured to Purge this off, but he had always so untoward a Constitution, that neither now, nor at any Time before, could he by Purges have any regular Evacuation; which was, no doubt in his Case, very Injurious to him.
Now I perfectly desponded: But a Friend and Kinsman of the Doctor’s, aSurgeonof no small Reputation, assured him, that he had known, when other Methods failed, aMercurial Fumigationhad answered: And what is it that a rational Man will not try to prevent the excruciating Pains of aCancer?When the Doctor mentioned this to me, I confessed I knew nothing of that Practice, and always had an ill Opinion of the Fumes ofMercury: And he also owned to me, that he was wholly unacquainted with it; but satisfied in his Friend, and therefore would try it: He began the Course according to his Friend’s Directions; I never pretended to order any thing afterwards; but however still frequently visited my Good Friend, though with an aking Heart. The Fumigation not only made him spit, whilst he was using it, but also for some Hours afterwards; and the Patient continued to use it for several Days, but without any good Effect upon theUlcer. In about ten Days after he had left off the Fumigation, a very hard Tumour began to arise, upon the Muscles of the lower Part of the Face and Neck, and increased very fast, and in a very short Time spread it self from Ear to Ear: and, by the Bulk, in a great measure prevented his Swallowing, and soon suffocated him. He was Chearful, and to all outward Appearance tolerably easy to the last, and had what he now desired, a gentle Release,July 16, 1719.
And thus, to the Misfortune of Mankind, it is manifest to me, thatMercuryis not adequate to thisHerculeanDistemper: but however, this Case, and That I mentioned before to the Doctor, gives me good Reason to believe, thatMercurialsdo at least blunt the Acrimony of the Humour, and so procure Ease. For, though that Patient had most acute Pains, before he entered into aMercurialCourse, yet afterwards he was easy all a long, as he told me; for I was called in but a few Days before he died. These, and other melancholly Cases, should not however, I think, wholly discourageSurgeonsfrom making rational Attempts upon a Distemper, which I fear is more frequently met with, than formerly, in this Part of the World: It is to be hoped, there is in Nature a Specific that may answer; and happy will that Man be who shall discover it. He will deserve to be placed next to the GreatHippocrates, and also to be rewarded, by the Publick, equally with him that shall find out theLongitude.
I will not pretend to determine, how far the Fumigation might contribute to the sudden growth of the Tumour mentioned, but I should be very glad that theSurgeonwho recommended it, would be so ingenuous, as to vindicate himself, by giving Instances of it’s Innocency, and of the Advantages he has met with in the Practice of it.
And now I heartily beg Pardon of the Friends of the Deceased, who shall give themselves the Trouble of Reading this Account, that I could not bring it into a narrower Compass.
Having truly related what was done, in the Case of DrKeil, I hope it may appear, that I have acted an honest, and not an unskilful Part in it: If what was prescribed by others of greater Fame, when it came to be tried, had not better Success, I presume I shall no longer be blamed for it. No Man would willingly lose any Reputation, who is to live by it. I question not, but the bestSurgeonsin the World will allow, there are Cases for which there is no Remedy: And he who frankly owns thus much, no more loses any Reputation, than the Quack, that promises greater Matters than he afterwards performs, gets any: And I think they, who have censured me, would have done more ingenuously, if they would rather have looked upon the present Case as incurable by anySurgeon, than have thrown their Aspersions upon me, as not treating it properly.
N. B.The foregoing remarkableCaseof DrKeil, was published by MrRushworthofNorthampton, Surgeon atOxford, in the Year17193. Under theImprimaturofRobert Shippen, Vice-Can.Oxon.
Somecurious Observationsmade(by my FriendJohn Ranby,Esq;Surgeon to his Majesty’s Household,and F. R. S.)in theDissectionofThree Subjects, 1728.
THEfirst, a Man aged 70 Years, who died of a Suppression of Urine, occasioned by a Stone stopping in theUrethra, just within theGlans, of the bigness of a Horse Bean. This Appearance, with the Symptoms that had attended this miserable Man, gave me reason to expect something remarkable in the urinary Passages. TheUretersandPelviswere very much distended; which is common where great Numbers of Stones have descended down them, from the Kidneys to the Bladder. The Bladder contained about 60 Stones, the largest of which was about the Size of a Walnut, the others smaller; and just within the Neck, was a hardTumour, as big as a Nutmeg, which almost closed the Orifice: and indeed the Situation of this Tumour was such, that it not only made the passing theCathetervery difficult, and hindered our feeling the Stones, by directing the Instrument upwards: but likewise would alone produce the Symptoms of the Stone in the Bladder, by obstructing the free Discharge of Urine through theUrethra, the inner Membrane of which appeared as if lacerated in several Places, and the Tube filled with a glutinous Matter tinged with Blood. On the back Part of theVesiculæ Seminales, near theProstata, were severalStones, as large as Peas, which closely adhered to the adjacent Membranes.