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Full text of "A treatise on cancers, with an account of a new and
successful method of operating, particularly in cancers of the breast
or testis ... "
See other formats
The Library of the _
Wellcome Institute for |
the History of Medicine a
MEDICAL SOCIE
OF 3
LONDON
‘DEPOSIT
Accession Number
3 press Mark
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PON Ck mR OR 8:
A New and Succefsful Method
ane o F
OeP oR Re Ay sEe bs Gy
PARTICULARLY IN
CANCERS of the BREAST or TESTIS,
BY WHICH THE
SuFFERINGS of the Parirenr are confiderably diminithed, the
CuReE greatly accelerated, and DEFORMITY prevented;
BY
Pee ud rt es Te ROLY ING
SURGEON to runz SURREY DISPENSARY.
eee ok De Deis Or OoUN.
In this Edition confiderable Improvements are made, and many new Cafes
given ; to which is added the Paper on the Prevention and Cure of Cancer,
without Operating, which Paper obtained the Prize Medal of the Medical
Society of London, for the Year 1788.
Eft quodam prodire tenus, fi non datur ultra.—Hor.
A A RE RESET TSE EE
LON DO N:
_ PRINTED FOR J. JOHNSON, ST. PAUL’S CHURCH-YARD.
MDCCXC,.
i
5 ti
ae cae
fa tele
TO*THE RIGHT HONOURABLE
THE PRESIDENT,
VICE PRESIDENTS ann GOVERNORS
OF THE |
SURREY DisP ENS A’ RY:
TO WHOSE BENEVOLENCE IN SUPPORTING
BoMOS TS OSE RD LD CMA RT IT ¥ 4
HE IS INDEBTED
FOR A VERY EXTENSIVE FIELD OF EXPERIENCE
IN THE CULTIVATION OF A SCIENCE,
TO WHICH HE IS MOST SINCERELY DEVOFED, |
Pe 8k,
THE FIRST FRUITS OF HIS LABOURS THEREIN,
NOW A THIRD TIME REVISED,
ARE MOST RESPECTFULLY INSCRIBED,
BY
THEIR MOST OBEDIENT,
HUMBLE SERVANT,
Ear reSTREET, ‘ewe AUTHOR,
CHATHAM-PLACE,
Noy, goth, 4784.
POR bE A GE
TO THE
THIRD EDITION.
An increafing demand proving
the continuance of that attention,
with which the public honoured
the two former editions of this
Treatife, I have been encouraged
to print a third, And in order
ta
(- vill)
to render it in fome degree more
worthy of the patronage the for-
mer ones have received, I have
not only endeavoured to make it
more perfect by the addition of
-feveral important cafes, and an
index to the whole: but have
added a paper on the prevention
and cure of cancers, which, it is
apprehended, contains an im-
| provement in practice of the ut-
moft importance to the art. Thefe
additions, it is hoped, will com-
penfate the delay which the want
-of more leifure has occafioned.
I muft
( ax")
I muft plead the fame excufe for
the many inaccuracies and defi-
ciencies, that I am fenfible ftill
remain, and for the want of me-
thod in the whole ; the daily du-
ties of my profeflzon not allowing
me' to devote any confiderable
portion of time to the fubjed at
once. Could more leifure have
been commanded, I fhould have
certainly entered rake fully into
the confideration of the origin
and nature of cancer, and the
queftion how far ‘it is hereditary. _
TI con-
(Rey }),
I continue to be favoured
with numerous letters from dif-
ferent parts of the kingdom, from
Stich I have the fatisfaGion to
learn, that the method of operat-
ing I have recommended, has been
conftantly gaining sround, from
the great fuccefs that has attended
it.
From the further experience
ot five years, fince the publication
-of the fecond edition, I am now
fully convinced, that the difeafe
is much lefs liable to return,
when
We)
when the parts have been united
by the firft intention, than when
the operation has been performed
Talithe cold way ; in which the
whole breaft was frequently fwept
off, with too little regard to the
fufferings of the patients, and
none at all to the prefervation of
kin.
Mr. SHarp, whom I had ne-
ver met, being, at the particu-
lar requeft of the patient’s rela-
tions, prefent, when I removed a
cancerous breaft, was pleafed to
fay,
¢ xi)
fay, that he regarded the improve-
ment I had introduced, in the
operation, as the ereateft that had
been made in the practice of age
gery thefe fifty years. is uni-
verfally acknowledced abilities of
this eminent furgeon ftamp a va-
-lue upon his teftimony.
In the preface to the fecond
edition, it is mentioned that I
had operated in the new method
on three patients, in each of
whom the difeafe had returned
fome months after the operation
had
(xu)
had been performed in the old
way, by the moft eminent fur-
seons in London; and that the
parts united avd {peedily healed.
I have now the fatisfaction to add,
. that they all continue well, and
without the leaft appearance of a
return of the difeafe.
By the important cafes added
to this edition, it is ftill more —
fully proved, that the practice of
keeping the wound open, as a
drain, to carry acrimony, morbid,
or cancerous matter, out of the
con-
(a ae
conftitution, having no other
foundation than a groundlefs the-
ory, unfupported by facts, fhould
in every cafe give way to the fim-
ple rational method I have de-
{cribed, which time and very ex-
tenfive experience have proved to
be deferving of more than I have
faid in it’s favour.
Ir muft be fubmitted to the
unerring judgement of sime and
experience, how far that grand
defideratum, the prevention and
cure of cancerous complaints,
without —
aa}
without operating, has been dif-
covered, in the method fet forth
in the paper, firft. publifhed in
the fecond volume of the Memoirs
of the Medical Society of Lon-
don.
WHATEVER may be the event,
I can with the ftriéeft truth
declare, that I wifh it no better
fuccefs, than it: fhall, on a fair
trial, be found to merit, and fhall
be extremely happy, to fee it, by
the aid of fuperior abilities, fur-
ther improved, or perfected ; that
fo
(o a)
fo the dreadful neceflity of having
recourfe to the knife may no
longer occur.
Intro-
Pogo, 9 Mag a Cae
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Fa ge age egy Paget Mage ays att Pigs tage Page Pigs tage tage argh oagt Feat Fags tags Mags eng
Tuer E is no difeafe to which hue
man nature is fubjeCt, confefledly, more
beyond the reach of internal medicines, or
more juftly intitled to be termed opprobrium
medicorum, than that dreadful complaint, a
Cancer. Every thing hitherto attempted,
by the moft eminent Phyficians of all
countries, has been found ineffectual; fo
that the liberal, candid, and beft informed
part of the profefiion, readily acknowledge,
they know nothing within the extenfive
: A bounds
2 INTRODUCTION.
bounds of medicine, any way to be relied
on to effect a cure. Of this candid con-
feflion, illiterate Quacks and bold Empi-
rics have ever been ready to take advan-
tage; thefe by fpecious promifes have in-
duced many unwary fufferers to have re-
courfe to them, whom they infenfibly in-
tice with the hopes of a radical cure, tel-
ling them it requires time, during which
time however they only protract the dif-
eafe, often torturing the patient with cauf-
tics or efcharotics, till matters become fo
defperate, that little or no hope can be en-
tertained even from the operation, which,
had it been performed foon enough, might
have proved effectual. Their patients,
then, too late, are convinced of their error,
when refignation to their approaching fate
is the principal alleviation their fufferings
admit of. :
Tue idea that cancer does not admit of
a radical cure, has undoubtedly been car-
ne to too great extent, and has proved
fatal to many labouring under that com-
plaint.
INTRODUCTION. 3
plamt. Writers of eminence are too of-
ten implicitly believed in every thing they
advance, to the detriment of fcience as
well as of mankind. It is with all due
deference to this eftablifhed eminence, and
at the fame time with fome reluctance,
that I humbly prefume to queftion or
doubt the authority of men of fuch high
repute in the literary world, as the late
Dr. Monro, Le Dran, Sharpe, and other
authors of note, who have fpoken of this
difeafe, in fuch difcouraging terms, as tend
only to increafe the miferies of the un-
happy fufferers, by depriving them of their
laft refource, hope; as well as of every
chance of preferving or even prolonging
life. For by reprefenting it as an in-
curable difeafe, (I mean by any internal
medicines hitherto tried) and very fubjec&
to return after the operation, numbers af-
flicted with it have too foon given way
to defpair, and thereby loft every chance
of a cure, by a timely excifion of the
difeafed part.
A 2 DO
4 : INTRODUCTION.
So far therefore as humanity, reafon,
and truth fupport me, I hope I fhall ftand
excufed in differing, both in opinion and
practice, from the very reipectable au-
thorities above mentioned, without enter-
ing too far into a medical difflertation
on the nature of cancer, which might be
thought a deviation from the ae of a
practical Surgeon.
Aut that has been advanced on this
fubject, with fuch abundant ingenuity, re-
quiring any an{wer or refutation, may, I
believe, be briefly comprifed in two frofo-
fitions or affertions; Firft, ‘* That a real
<¢ cancer does not admit of a radical cure:
‘* or more properly fpeaking, we are un-
** acquainted with any internal medicine,
** or topical application to be relied on.
<* in the cure of a cancer.” Secondly,
‘¢ That the difeafe is very apt to return
** after excifion.”” ‘Thefe two affertions
are intimately related or connected to
each other.
In
INTRODUCTION: §
\
In anfwer I would obferve, that having
granted the firft, it does not follow that
the operation fhould be rejected as ufelefs
and uncertain.
T’o the fecond J anfwer, that the oreater
number of patients have no return of the
difeafe after the part aftected has been
carefully diflected away. ‘This is clearly
proved by the cafes publifhed by Mr. Hill,
of Dumfries, in 1782; and I am fully
perfuaded, if the operation were timely
performed, in the manner I intend to ex-
_ plain and recommend, a {till {maller num-
ber would be troubled with the return of
the difeafe. Even as the operation has
hitherto been performed, it is often the
‘only alternative left, which the melan-
choly patient looks on, as a means only
to prolong exiftence a while, but not fuffi-
Cient to eradicate the difeafe; yet under.
all thefe difadvantageous circum/ftances, it
_ generally proves fuccefsful, and anfwers the
purpofes of a radical cure. For notwith-
ftanding the. difpofition to cancer, the per
Ay fon
6. INTRODUCTION.
fon who fubmits to the operation in time,
gay live afterwards to old age, or die of a
different difeafe, without the leaft return
of cancer, unlefs fome exciting caufe occur
to produce it.
WHATEVER, therefore, tends to mi-
tigate the pangs of our fellow creatures,
unremittingly tortured with this dreadful
difeafe, cannot be thought unworthy pub-
lic attention: and if, not only to mitigate
their fufferings, but to remove them en-
tirely, can by experience be proved practi-
_ eable, by an operation much lefs terrible
to the patient than that hitherto pratifed, —
and which generally anfwers the purpofes
of a radical cure; it would be wrong in
me to remain filent on a fubject fo very
important, in which great numbers of the
human race are fo deeply interefted. For
highly enlightened as the prefent age is,
yet the moft eminent praCtitioners readily
admit, that there is ftill ample room for
further improvement, in chirurgical ope-
rations. ‘Though the modern improve-~
ments
INTRODUCTION. a
ments aré very numerous and furprifingly
great, we ought by no means vainly to
‘fuppofe, that all or even the greater num-
ber of the principal operations, are brought
to the fummit of perfetion. ‘One of the
moft eminent Surgeons of this country, I
may venture to fay of the prefent age,
both as an author and operator, acknow-
ledges this. It fcarcely needs mention,
that I mean Mr. Pott, who in the Pre-
face to his Treatife on Ruptures fays, “* I
‘* would by no means be fuppofed to
‘think, that there is not large room left
*¢ for the induftry both of us and our fuc-
‘¢ ceffors, fome of the operative parts of
e
‘¢ the art are {till capable of improvement,
‘«* and the treatment of fome difeafes might
o
‘ certainly be altered for the better.”
THERE are few difeafes, I believe, that
require an alteration and improvement, in.
the general method of treatment, more
than fcirrhus and cancer of the breaft or
teftis. : 3
A 4 IN
§ INTRODUCTION.
In thefe complaints, though the opera=
ration be the only alternative to which the
patients muft have recourfe in order to
preferve life, yet it requires a greater de-
gree of refolution than moft of them can
readily f{ummon up, to fubmit toit. The
certainty of very fevere and acute pain
during the operation, as well as of that
which muft naturally follow it, the fear of
a great effufion of blood, the uncertainty
of fuccefs, the long confinement, and, in
many cafes, mutilation and deformity, are
difficulties of confiderable magnitude, and
not eafily furmounted. Whatever tends
to lefien all thefe difficulties, will, I doubt
not, be deemed of the higheft moment.
What I have to offer, if received with
candor, will, I. hope, be found not un-
worthy attention, being the refult of ob-
fervation and experience.
TH method of operating, which it is
the principal defign of this treatife to re-
commend, on account of the great and
uncommon advantages it pofleffes, and the
3 wonderful
INTRODUCTION, g
wonderful effects, I may in ftrict truth fay
I have feen refult from it, confifts in dif-
fe&ting away all the difeafed part of the
breaft or teftis, thro’ one fimple longitu-
- dinal incifion, large enough to admit of
the perfect removal of all the difeafed part
or parts, and then bringing the edges of
the wound into contact, and retaining
them in that fituation by flips of fticking
plaifter, ligature, or both if neceflary, till
they unite by what is called the Firft In-
tention, which they generally do in a few
days, without ever forming {uppuration.
The whole of this operation I fhall more
fully and diftinétly defcribe and explain in
its proper place.
HERE I beg permiffion to mention the
reafons that have got the better of that
diffidence, which otherwife might have
reftrained me from ever venturing into
the world as an author, for which under-
taking I feel and confefs myfelf not poe
defied of adequate abilities.
Ir
fo INTRODUCTION.
Ir is more than three years fince I gave
a very concife {ketch of the fuccefs of this
method of operating, in a letter to Dr.
Simmons, the Editor of a very ufeful peri-
adical publication, called the Medical Jour-
' nal, who accordingly mentioned it in the
firft fubfequent publication of that fort.
The method of operating becoming fome- ° ”
what public through that channel, I have
fince had the pleafing fatisfa€tion of find-
ing it pretty much adopted in the hofpi-
tals, as well as in private practice, efpeci-
ally in the removal of the fcirrhous or
eancerous tefticle; but not fo much in
that of the breaft, and in neither to that
extent, which I am confident it really de-
ferves. 1 fhould therefore think myfelf
exceedingly blameable to fuffer diffidence,
or an improper delicacy, to prevent me
from making as public as poflible, 2 me--
thod of operating and fubfequent treat-
ment, which on experience I have found
attended with) advantages, far excéeding
the moft favourable expectations I could
(a priori) entertain. = I only with this
So method
INTRODUCTION. : iz
method may be received with candour,
and adopted in proportion to its fuperior
advantages and gerieral utility ; and I hope
it will foon become univerfal, and the prin-
ciples on which it is founded, extended to
many other operations in furgery, befides
thofe two on the breaft and teftis. Should
it tend, even in the {malleft degree, to raife
the reputation of, or be thought in any
meafure an acquifition to a profeffional art,
truly great and noble in refpect to its
objects, viz. the relief of our fellow crea-
tures, labouring under the pains and mife-
ries attending difeafe, the prefervation of
—dife and heaith ; it will afford me inexpref-
fible happinefs. Let me, however, not be
mifunderftood, for 1 confefs my inability
to beftow, what can very fenfibly increafe
the general fund; yet I hope the contri-
bution of a mite will not be rejected, when
it proceeds from a principle, which i* is
the duty of every practitioner to have in
view, happily exprefied by a great poet in
two words >
“ MISERIS SUCCURRERE.”
ie
32 INTRODUCTION:
T'ue circumftance which led to the
difcovery of this method of operating may
not be unworthy the reader’s attention.
In the year 1778, Dr. John Sims, a
very fkilful Phyfictan, adviied a patient
under his care, to have the operation for
the trichiafis, or inverfion of the under
Seri performed; he contented, and ap-
plied to me for that purpofe. The flacci-
dity and redundance of the fkin of the
under eye-lid were fo great, that I was
_abliged to cut away a very large portion,
in order fufficiently to retraét the under
cilia, and effectually turn the hairs out-
ward, fo that they might not in future irri-
tate the eye. Having removed a fufficient
quantity, near an inch in the middle or
broadeft part, I was extremely careful to
bring the oppofite edges evenly and per-
fe&ly into contact, and to retain them in
that “aoaned by flips of adhefive plaifter,
and proper bandage. As J had taken very
great pains in applying the dreffings, and
the patient continued perfe@tly eafy, I did
. not
INTRODUCTION. 13
not attempt to remove them for three days.
On the removal, I was exceedingly pleafed
to find, that a perfect union of the edges
from one end to the other had taken place,
agreeably to my intention and withes.
‘There was a {mall ferous difcharge, but
nothing like pus or digefted matter; and -
the fecondary union was completed in a’
few days.
Tue foregoing cafe made a ftrong ims
preffion on my mind; from it I inferred,
that the principle might be applied in other
operations to very great advantage, and re-
folved to practife it the very firft oppor-
tunity. Soon after I had occafion to remove
a difeafed tefticle, very much enlargened. |
I was anxious to make the experiment,
and accordingly, inftead of following the
ufual method of filling the vod /pace, or
cavity from whence the tefticle was taken,
with dry lint, I brought the edges of the
incifed wound perfectly into contact, and
retained them in that fituation. The
event greatly exceeded my moft favourable —
i expectations ;
T4 INTRODUCTION.
expectations ; for though in this cafe there
was a confiderable cavity, and confequently
a great quantity of loofe integuments, yet.
by carefully bringing all the parts into.
contact, laying afide the interpofition of
dry lint, or any extraneous body, a perfect
union throughout the whole took place, as
in the forementioned cafe. The fuccefs
attending both thefe cafes made me refolve
to carry the principle ftill farther, by apply-
ing it in the amputation of the breaft. I
embraced the firft opportunity that offered,
and the event proved equally fuccefsful.
The patient was only two days confined to
her room, and the wound perfectly healed
in ten days. My very worthy and inge-
nious friend, Mr. Babington, of Guy’s
Hofpital, did me the favour to affift at
feveral operations performed in this way,
the uncommon fuccefs attending which |
being {poken of, I was requefted by Dr.
Skeete, Prefident of the Phyfical Society,
to give an account of it to the Society,
which I accordingly did, in a very fhort
paper, feveral months before it appeared in
the
INTRODUCTION. 13
the Medical Journal. This method of ope- .
rating being now pretty generally known,
by the paper read to that Society, by the
account of it given in the Medical Journal,
and by the relation of the patients them-
felves, it has ever fince been gaining ground,
both in public and private practice.
OBSER-
ed
» te
e
by
OBSERVATIONS
ON
Ge AUUNG Coo oR. .8:
VEE ancients gave the name fcirrhus,
to any tumor that would not admit of dif-
folution ; the moderns, with greater accu-
racy, term thofe only fcirrhous tumors,
that will not admit of fuppuration, and
bear an affinity to cancer; and, therefore,
have divided cancers into two kinds, ws.
occult-and open; thereby fully compre-
| B hending
18 OBSERVATIONS
hending all the various forts, unneceflarily
fubdivided by fome writers, and mentioned
by different technical appellations. Though
I approve of this dittinGtion, into occult
and open, as fufficiently comprehenfive,
yet I would not be thought to affert, that
this difeafe does not, at different periods,
affume very different appearances. There
are few difeafes more. fubject to variety,
both in refpect to appearance, and the
changes it undergoes from time to time.
OF
ON CANCERS. 19
OF THE GENERAL PROGRESS OF
iD LSE ASE.
Ir generally commences by a fimple
enlargement, or induration of fome glan-
| dular part, at firft moveable and free from
pain, without any inequality, apparent in-
flammation, or change of colour in the
integuments. In fome the difeafe conti-_
nues in this mild ftate for years, without
pain, inconvenience, or any vifible altera~
tion. In others, its progrefs is very rapid ;
foon after its firft appearance it increafes
in fize, becomes unequal and knotty, at-
tended with a dull heavy pain, efpecially on.
being handled ; the pain increafes with the
difeafe, and becomes lancinating and dart-
ing; the veins about the part become vari-
cous; the fkin becomes wrinkledor puckered
up in fome parts of the tumor; in others,
inflamed and fmooth; the latter appear-
ances foon terminating in what is called
B 2 the
a
20 OBSERVATIONS
the open or ulcerated cancer, attended
-with the following fymptoms :
THE ulcer is foul, ftinking, {preading,
with hard uneven edges, from whence
fungus fprouts out, of a rafpberry or cauli-
flower appearance, fubject to frequent he-
morthage. The difcharge for the moft
part, isa thin, gleety, acrid, foetid, dark
coloured ichor, and the patient complains
of an inceilant, intolerably excruciating, |
burning pain, all over the parts affected.
The neighbouring {kin feems partially
contracted with the appearance of folds or
wrinkles, as if produced by a hot iron
having been held near it,
TuHEse are the general and moft cha-
racteriftic fymptoms of cancer, to which
feveral others might be added, but I fear
without advantage, as they would render
the defcription lefs difting.
In the preceding defcription, I have
con-
ON CANCERS.’ 2I
confidered cancer as affecting a elandular
part only: but it is neceflary to obferve,
that every part of the body is fubje& to
cancer, which (except in glandular parts)
may at firft appear fomewhat like a fuper-
ficial ulcer, without any previous fcirrhous
tumor. Such cancers, however, are gene-
rally preceded by fome crufty, fcabby,
horny, or wart-like appearance of the part.
THE obfervations already given, with
others I fhall add, require minute and par-
ticular attention, as they ferve, not only as
the beft means of characterifing the difeafe,
but likewife afford fome foundation for
forming a judgment of what 1s proper to
be done, and what degree of fuccefs may
likewife attend the mode of treatment to
be adopted ; it being my intention on this
head, to enable young practioners to dif- |
tinguifh cancers from other complaints,
and vice verfa.
Bur as cancers of the breaft and teftis -
B 3. are
292 OBSERVATIONS
are by much the moft frequent and im=
portant, and as the operations I fhall des
fcribe are more applicable to thefe parts,
what I have here to offer, thall be chiefly
directed to diftinguifh other difeafes, to
which thefe parts are fubje@t, from cancer,
premifing only a general obfervation or
two. |
CANCERS, in any other part of the
body, are eafily diftinguifhed from the
various kinds of encyfted tumors; from
that {pecies called wen; and even from
{crophulous glands. Cold, indolent, tu-
mified, {crophulous glands, are not liable
to be miftaken for cancers; and in the
inflamed ferophulous gland, as well as in
phleemonic tumors, the fymptoms or ap-
pearances are {till more different; the fkin
is not uneven asin cancer, nor the veins
varicous. When the inflammation runs
high in thefe complaints, the fymptomatic.
fever keeps pace with it, the pulfe is full
and hard, as in other inflammatory com-
plaints,
ON CANCERS; NaS
plaints, and, at length, matter is formed
in the part, perceptible to the touch, but
not attended with that. degree of pain
which accompanies cancer. In the latter,
when exceffive pain quickens the pulfe,
it is at the fame time low, asin heétic
fever. But as I have juft mentioned, that
my obfervations here are principally di-
rected to cancers of the breaft and teftis,
I thail endeavour to give the beft informa-
tion I can, concerning the difference be-
tween cancerous affections of thefe parts,
and other difeafes to which they are
fubjec.
eas © FIRST
24 OBSERVATIONS
FIRST OF THE BREAST.
B ESIDES the occult and open cancer,
there are three other complaints to which
it is fubject.
Frrst. A ferophulous induration and
enlargement.
SeéconpD. The milk breaft, or milk
abfcefs. 3 |
Tuirp. An induration, or fcirrhus |
from external injury.
Tue firft, or fcrophulous induration
and enlargement, is eafily diftinguithed
from a cancerous affection of the part, by
its not being attended with pain or uneafi-
nefs, even. when greatly enlarged. If it
tends to fuppurate, it has not that craggy
| | feel
ON CANCERS. Be
feel and unevennefs of {kin, peculiar to
cancer ready to burft; and when it fup-
purates, difcharges good pus, which can-
cer never does. Neither do thefe {crophu-
lous tumors, at any period, produce painful
indurations in the glands of the axilla;
but are often found to yield to cicuta inter-
nally and faturnine applications.
THE fecond, or milk breaft, in its pro-
grefs and termination, either by difper-
~ fion or fuppuration, is fo very like that of
any other phlegmonic tumor, that there
can be very little difficulty in diftinzuifh-
ing it from cancer.
I HAVE neither feen nor known an ins
ftance of a milk breaft turning to a cancer,
and cannot help thinking all apprehenfions
of that nature very groundlefs. It is not
my intention to aflert, that a breaft that
has been, or is affeéted witha milk abtcefs,
can never become cancerous ; i only intend
to give it as my humble opinion, that a
milk
26 OBSERVATIONS
milk abfcefs never is the immediate caufe
of, nor degenerates into cancer. |
Tue third or laft complaint affecting
this part, viz. an induration or {cirrhus,
from external injury, requires the moft
eareful attention. We are not pofieffed
of any means of knowing, nor can we
affert, that an induration fo occafioned will
‘not terminate in cancer, if it does not yield
to the proper treatment, in order to dif-
perfe it. Of fuch induration or {cirrhus,
it can only be faid, it is rather a favour-
able circumftance, that it was occafioned
by external injury, and a fort of prefump-
tion, that it will not terminate in cancer:
and when fuch induration or f{cirrhus im-.
mediately fucceeds the external injury, it
is a more favorable circumftance than
when it attacks the part fome confiderable
time after. But in either cafe, 1 may re-
main quiet and inoffenfive for feveral years;
or it may quickly become dangerous and
alarming, attended with all the charactee
; riftic
ON CANCERS. 29
riftic fymptoms of cancer already men-
tioned; in fuch cafe, there can be little
doubt of its being a real cancer, and that
the external injury was the exciting caufe,
without, the occurrence of which, the per-
fon might poffibly have paffed through life.
without any appearance of the difeafe: it
is, therefore, very neceffary to be guarded
in our prognofis concerning an induration
or fcirrhus thus occafioned. What has
been faid concerning external injury pro-
ducing cancer in the breaft, is equally
applicable to the teftis, of which there are
fome difeafes that require to be briefly
mentioned and diftinguifhed from cancer.
First, The hernia humoralis.
SEconD, The hydrocele.
Turtrp, The venerea! farcocéle, or en-
largement and induration of the tefticle
and epididymis.
Fourts#, The fcrophulous tefticle.
THE
28 | OBSERVATIONS
Tue firft, or hernia humoralis, is at-
tened with mflammation, pain, heat, and
moft commonly fever; the whole body of
the tefticle, as well as the epididymis, be-
coming enlarged. By evacuation, reift,
proper topical applications, and adopting
the antiphlogiftic plan, the {fymptoms foon
fubfide, and the tefticle gradually recovers
its ufual fize and fmooth feel. —
T we fecond, or hydrocele, is a collec-
tion of water in the tunica vaginalis; the
fluctuation of which, when any way con-
fiderable in quantity, may be felt very dif-
tndtly, or it may be feen by holding the
teflicle between the eye and a {trong light ;
this collection of water produces no mor-
bid change in the f{tructure, either of the
teflis or epididymis, and is not attended
with pain.
T we third, or venereal farcocele,. 1s al-
ways attended with other venereal fymp-
toms or appearances in fome part or other
of
:
ON CANCERS. 29
of the body, fufficient to characterize and
diftinguifh it from a true {cirrhus.
Bur the fourth, or fcrophulous tefticle,
is often confounded with the cancerous,
even by the moft approved writers and
practitioners, from their not. attending to
this fingle circumftance, viz. that the parts
in the courfe of abforption are not affected
by ferophula, but in cancer they always
become affected in time. In the cance-
rous tefticle the {permatic chord becomes
enlarged, indurated and knotty, but never
{o in the fcrophulous. :
THESE ought to be accurately diftin-
guifhed, as | have my doubts with refpect
to the propriety of removing a{crophulous
tefticle.
Burt whoever wifhés to be more fully
informed concerning difeafes of the tefti-
cle, may be highly gratified and inftruGed,
by the perufal of Mr. Pott’s excellent trea-
tife on the Hydrocele, efpecially the twelfth
fe€tion, to which I refer him,
OF
30 OBSERVATIONS
Ld
OFTHE VCNOS RS (OF CANCER.
AUTHORS in general have fuppofed
cancer to proceed from fome obftruction
of the fluids, in the glands, or glandular
parts, in the lymphatics, in the ladtiferous
tubes of the mamme, in the capillary
tubes, &c. by which the parts becoming
impervious, adhere together, and conftitute
the foundation of a cancer. |
VI. ExTeRNAL injury is laid down
as a caufe from whence cancer often pro-
ceeds.
Ir cannot be denied, that there are
many inftances fufficiently authenticated,
in which cancer has fucceeded contufions,
efpecially in the breafts of women. But
it is ftilla matter of doubt, whether this
difeafe would enfue, from fuch accidents,
unlefs there were in the conftitution a
natural
eS ee i
a ee ee
ON CANCERS. 31
natural predifpofition, which co-operates
with the accident and produces the effeét,
Il]. Cancer has been confidered, in
fome inftances, as proceeding from affec-
tions of the mind. |
Bur in fuch cafes, it is a queftion, whe-
ther thofe affections of the mind refult
from a particular frame, delicacy, or fuf-
ceptibility of conftitution, and if fo, are,
in like manner as the difeafe itfelf, only
effets and not caufes. 7
IV. CEssATIoNn of the menfes is a
caufe to which cancer is very often afcribed.
Ir is undoubtedly a fact that the difea
more frequently occurs at this period of
life, than at any other. And I am in-
clined to think, that change the conftitu-
tion undergoes at this time, may operate
very powerfully, or have a f¥rong tendency
to produce cancer,
V.: FHis:
a2 OBSERVATIONS
V. Tuts difeafe, like fcrophula, 2.
and many others, has been attributed, 1
terms too general, to hereditary difpot-
tion.
Tuts is a field too large for me, in the
prefent inftance, to enter upon, efpecially
as‘I muft candidly acknowledge, that I
have not yet made up my mind on the
niatter. I muft however obferve, that
thie general notion of hereditary difpofition
lias been carried a great deal too far.
VI. CANCER 1s fuppofed, in fome in-
ftances, to arife from fome peculiar acri-
mony in the habit.
Tuts, like other caufes already mention-
ed, is probably .rather to be confidered as
a fymptom or concomitant circumftance
attending cancer, than as the caufe of i it.
VII. INFLAMMATION has been af-
figned, as the caufe of cancer; and I confefs
that
ON CANCERS. 33
that in my practice for fome time paft, I
have paid more regard to this caufe than
to all the others taken together.
Ir is not my intention to enter into a
phyfiological difquifition concerning the
nature or origin of this inflammation.
The practice in which I have been un-
commonly fuccefsful is founded on the
principle or fuppofition, that inflammation 1s
the proximate caufe of the difeafe, and in-
variably and univerfally connected with it.
To avoid repetition, I muft refer the
reader to the paper I have inferted in this
treatife, taken from the 2d vol. of the
_ Memoirs of the Medical Society of Lon-
_ don.
ConcERNING the caufes of cancer, I
have only to add, that I do not yet think my-
felf adequate to the attempt of clearly illuf-
trating a fubject fo difficult and obfcure,
either to my own fatisfaction or that of
Cc the
34 OBSERVATIONS
the reader. Much more has b=" (2° on
it, than has led to ufeful and important
practice. From the moft attentive obfer-
vations I have hitherto had an opportunity
of making, cancer appears to me, generally
to arife from fome peculiarity of conftitu-
tion, which I do not profefs to underftand,
which feems offen hereditary, and predif-
pofes to the difeafe, but (I am inclined to
think) feldom produces it without the
adventitious occurrence of fome exciting
caufe.
oF
ie ON CANCERS. 35
OF THE PARTS OF THE BODY
AND THE PERIODS OF LIFE
MOST’ SUBJECT TO CANCER,
OBSERVATION and experience
{ufficiently inform us, that fome parts of
the body are more fubje&t to this difeafe
than others. The parts that diftinguifh
the fexes, and all other glandular parts,
both external and internal in both fexes,
are more fubject to it than any other part.
WoMEN are more fubje& to it than
men: whether, on account of their con-
ftitutions being weaker, or becaufe the
parts diftinguifhing them from our fex,
PVviz. the breafts, uterus, &c. are~ more
extenfive, or on account of the changes
that their conftitution undergoes, which
renders it unfit for generation, I cannot
take upon me to give an opinion. The
OaoE i as nofe,
36 OBSERVATIONS
nofe, eye-brows, chin, and other parts of
the face, as well as the lips, are more
~ fubject to it than other parts of the body. *
From forty to fifty years of age, and
upwards, is called the cancerous period.
But
* Te vifcera in general are fubject to it, even the
ftomach, and infeftines, of which | have inftances in
my poffeffion ; particularly that of the ftomach, of
‘which Dr. Sims gives an aceount, in the firft vol. of
the Medical Communications. In that colleGtion I
have given a cafe of an offified kidney, which fuggefts-
this queftion: viz. May we attempt the removal of
a difeafed kidney, affeCted with fcirrhus, or any other
difeafe that muft in time prove mortal ?
In that cafe the tumor was fo externally prominent
and circumfcribed that it might have been removed
without making any opening into the cavity of the
abdomen. It appeared to me likewife, on the removal
of it after death, that the veflels might have been
fecured in the fame manner as we pafs a ligature round
a polypus of the uterus, &c.
W HEN
ON CANCERS; 37
’
But there are inftances of the complaint
occurring at a much earlier period. I
never faw a more perfect cancer, than in
the lip of a young lady of fixteen; of
which two furgeons of the firft eminence
were fully convinced. I faw another cafe
of a young lady not twenty, who died
he€tic, from a fcirrhus of the cervex uteri,
(difcovered on opening the body) which
before her death had been accompanied
with the fymptoms of a ftone in the blad-
der ; on the fuppofition of which, fhe had
been twice examined with the found.
WueEwn a calculus in the pelvis of the kidney
becomes large, points externally, and leaves us no~
room to doubt of the nature of the complaint, I think
we ought by all means to cut upon and extract it,
ratner than fuffer our patient to drag on a miferable
exiftence, without giving him a chance for his life.—
And whoever confiders attentively the nature and func-
tions of the kidney, will fcarcely deny, that calculi are
almoft as liable to form in its pelvis as in the urinary
bladder.
1¢€ 3 W HEs
38 OBSERVATIONS
WHETHER 1s cancer a difeafe of the
fyftem, or a topical complaint only ?
Tuts is a queftion of the greateft ith-
portance ; the principal, perhaps the only
queftion, neceflary to be moft attentively
and minutely confidered and difcuffed, and,
if poffible, decided ; in order to place the
practice on a more clear and certain foun-
dation. But this grand defderatum is not
_ likely foon to be obtained. There are
authors of eminence on both fides, and
their opinions flat contradictions to each
other; fo that from what has been faid
on this important queftion, we are almoff
as much in the dark concerning it, as we
are concerning the nature and caufe of
“cancer.
‘Tue medical part of the profeffion have
been too much difpofed to confider it a dif-
eafe of the fyftem ; while chirurgical au-
thors have been equally inclined to confi-
der it as a local complaint only. The late
| Dr.
ON CANCERS. 39
Dr. Monro was of the former opinion ;
and has given a dreadful and difcouraging
account of near fixty cancers, at the extir-
pation of which he was prefent; and
thence argues againft the extirpation of
any, except thofe of the occult kind, in
young people, in other refpects healthy.
Only four of thefe remained free from the
difeafe, at the end of two years ; but more
properly {peaking none; for three had
occult cancers in the breaft, and the fourth
an ulcerated cancer on the lip. 1 fancy
from the annals of Phyfic and Surgery,
we could not felect another account, equally
dreadful and difcouraging. One would
think they were the moft defperate cafes
that could be feleted from all parts of
Great-Britain. It would be unneceflary
to mention others of a fimilar opinion.
Happily for thofe fubject to this difeafe,
later practice and experience give them
much better hopes; although men of
great eminence, both in phyfiological and
pe rgicel knowledge, as well as in prace
C 4 tice
40 OBSERVATIONS
tice and experience, have fupported the
contrary opinion.
AmoncG thefe is the late Mr. Hill, an
eminent Surgeon, at Dumfries in Scotland,
who publifhed a book on Cancers in the
year 1772, at which time he had extir-
pated from different parts of the body
eighty-four ofen, and four occu/t cancers,
and all the patients except two, recovered
from the effects of the operation.
Or the firft forty-five cafes, one only
was unfuccefsful, and in three more the
cancer broke out afrefh; all the reft of the
forty-five, viz. forty-one, continued well
as long as they lived.
OF the next thirty-three, one lived only
four months, and in five more, the cancer
broke out again. The reafon of the laft
number being more unfuccefsful than the
‘former, was, according to Mr. Hill’s ac-
count, that his extraordinary fuccefs made
: cancerous
+ Fey
ON CANCERS, At
cancerous patients flock to him from all
parts, and he was often obliged to pers
form the operation, contrary to his judg-
ment, on patients who had delayed it too
long. On the whole, after a courfe of
thirty years practice, thirty-nine of. fixty- -
three patients were all alive and found;
and of all his cancerous patients not a
feventh was threatened with a relapfe,
or remained uncured.
I HAVE been induced to make the
longer extract from this book, becaufe it
is the moft complete on the fubject of any
before the public; and from it may be
drawn the beft proofs that the diforder 1s
not originally connected with the fyitem,
but merely a local complaint, and that
the cancerous virus is abforbed into the
conftitution from the local affection ; it is
commonly fuppofed conftitutional, from
the difeafe fometimes returning, yet one
breaft being affetted, is no reafon why
| the
42 OBSERVATIONS
the other fhould not become cancerous
alfo, and the difeafe {till be local.
Or the particular nature of the cance-
rous virus I do not pretend to give an opi-
nion, but, that it is not hereditary or con-
ftitutional I am inclined to think, from
the innumerable inftances of the children
of difeafed parents never having any ap-
pearance of the difeafe. The glands, we
know, are the moft common feat of can-
cer, and that they never produce good
matter, and I fee no reafon to doubt, that
when fome peculiar irritation is applied
to them, either from an external or internal
caute, fuch a difpofition may be induced in
them, as neceffarily to occafion the form-
ation of a cancerous matter.
Peruaps the reafon that women are
fo frequently affected with cancerous
breafts, about the time of the ceffation of
the menfes, is, that there 1s a greater de-
termination of blood or fome other fluid
to
ON CANCERS. 43
to them at that period, which, from their
not being fo fufceptible of inflammation or
the formation of good pus as the other
parts, produces an indolent hard {welling,
merely by diftention of the different vef-
fels. A tumor being thus formed, it com-~
monly remains inactive until an irritation
is applied, and from the nature of the parts
a cancer generally follows.
We might likewife fupport the opinion
of the ceffation of the menfes being one
{trong pre-difpofing caufe to cancer in the
breaft, by obferving the fympathy that
always fubfifts between the uterus and
breaft. At the age of puberty the breatts
naturally fwell, and appear turgid, about
the time of the appearance of the menfes.
They ufually fill with milk, upon the
diminution of the lochia, in lying-in-wo-
men. And when they ceafe to fuckle, the
menfes commonly. return, where they had
been before obftruéted. Some women
who menftruate with difficulty, are never
fo,
44 OBSERVATIONS
fo well as when giving fuck; anatomifts
endeavour to account for all this, by the
anaftamofis of the mammary and uterine
_veffels, but further aid is certainly necef-.
fary, to account fatisfactorily for this, as
well as many other phenomena of the ani-
mal ceconomy, faid to depend folely on
the communication of blood veffels.
INDEED, the account Dr. Monro gives
of his method of treating cancerous com-
plaints fhews clearly that he could not be
fuccefsful; for by keeping the wound
made by the extirpation of the difeafe from
healing up, and by giving mercury, he
took the moft efficacious fteps to excite
and produce the complaint, while his de-
fign was to prevent it.
SoME of the moft eminent Surgeons of
the prefent time, with whom I am rather
inclined to agree, think a cancer of the
breaft and te(ticle as local as a chancre on
the glans penis, or the inflammation and
e ulceration
> oo
Reac.
Kime
ON CANCERS. 45
ulceration of the arm, from inoculation ;
and in the fame manner as in the {mall
pox, or venereal difeafe, the cancerous virus
may be abforbed, and affect the part as it
pales along; hence cancerous buboes and
affetions of the abforbent fyftem, from
cancerous as well as from venereal virus.
But in the inflammation after inoculation,
and in venereal chancres, if the parts af-
feted be removed before abforption has
taken place, a cure is effected. But in
cancer, even when abforption has taken
place, (which may be known by the ftate
of the lymphatics leading to the conftitu-
tion) the fpeedy or timely, and perfec re-
moval of all the difeafed parts, gives the
patient a fair chance of being cured.
Bur as it is not my defign (efpecially
-at prefent) in this fhort practical treatife,
to enter deeply into the difcuffion of a
{ubject, on which authors of the greateft
abilities differ fo widely in opinion; I fhall
therefore add but very little on this head.
7 Ler
46 OBSERVATIONS
Let us, fora moment, fuppofe cancer
to be a difeafe of the fyftem, and the can-
cerous virus capable of being abforbed.
When a cancer has been for fome confi-
derable time in an open ulcerated ftate, we
fhould naturally think, that from the ab-
forption conitantly carried on, the whole
fyftem muft foon become perfectly im-—
pregnated with cancerous virus; which
mui{t (as in the lues venerea) foon attack
or make its appearance in every part of the
body. But we do not find this to be the
cafe, for there are many inftances fuffi-
ciently authenticated, of open ulcerated
cancers, of fome duration, being extirpated
after the axillary glands became affected ;
and yet the patient had no return of the
difeafe. Itis probable, that nothing has
a more powerful tendency to render this
difeafe conftitutional, than neglecting to
have the part removed as early as poffible.
OF
ON CANCERS, AF
OF THE TREATMENT AND CURE
OF CANCER.
INNUMERABLE experiments and
attempts have been made by the moft emi-
nent and ingenious Phyficians, in order to
difcover an effectual remedy againft can-
cer, and their motives were undoubtedly
very commendable. But while, on the
one hand, I feel the higheft refpe for
men of great learning, genius, and profef-
fional abilities; on the other, I cannot help
regretting that their labours have turned
out fo unfuccefsful. I am indeed pretty
well convinced, that all the attempts made
to cure this complaint by internal medi-
cines, have done more harm than good,
in as much as they tend to raife the
patient’s expectation of a cure, by afford-
ing a temporary relief, till it becomes too
late for an operation. But from all that
thas been done or attempted, I fhould
think
48 OBSERVATIONS
think myfelf culpable in recommending
or relying upon the ufe of internal medi-
cines, where extirpation or removal of the
difeafed part is practicable; this being the
only remedy hitherto known on which
we can place any dependance, no cure by
medicine having been hitherto difcovered.:
Dr. Storck, in his publication on Cicuta
fome years ago, gave the world reafon to
hope, that a fpecific for cancerous difor-
ders. was difcovered; but alas! it was foon
\
found that it would not perform all the ©
wonders afcribed to it, and many declared
it would do nothing, becaufe it did not
come up to the expectation which he had
led them to form. Notwithftanding the
repeated ufe of it both externally and in-
ternally in different parts of the world for
a number of years, in the moft fkilful
hands, no fingle inftance can be produced
of its performing a cure in the cancer);
yet nobody will affirm, that it is not a
medicine of great efficacy in various obfti-.
nate complaints, that it has not mitigated
for
ON CANCERSs 49
for a while cancerous pains, checked the
progrefs of the difeafe, changed the dif-
charge for the better, in re{pect to colour,
“{mell, and confiftence, and that mankind.
is not much indebted to the Doctor for
introducing into more general ufe fo pow-
erful a remedy. From confidering its
mott ufual effeéts, that it is anodyne, cor-
rects acrimony, and promotes the formas
tion of good matter, I have made ufe of
it with fuccefs in various complaints, at-
tended with the appearance of an acrimo-
nious ftate of the juices, In the fluor
albus joined with guaiacum, it feldom
fails, and in fhort, in moft complaints
-arifing from a {trumous habit, it will often
exceed our molt fanguine expectations,
BIN thé year 1774, 48 treatife was pub-
lifhed at Paris by M. le Febure, in which
he extols arfenic given internally as a {pe-
_Cific, both in occult and open cancers.
Gooch in like manner extols corrofive
fublimate, and Juftamond the martial
: D flowers.
-
50 OBSERVATIONS
flowers. I have not only tried all thefe -
medicines myfelf fairly and for a fufficient
length of time, beimg led to place fome
bs Elen de in them from the great recom-
mendations beftowed on we by thefe
authors; but I have likewife feen them
tried. by fome of the moft eminent Phyfi-
cians in London, in cafes rea//y cancerous ;
and I can aver that I have never feen one
inftance of a radical cure by one or all of
them. Jam therefore perfuaded that the
cafes mentioned by thefe authors, where
any of thefe medicines were fuccefsful,
were not truly cancerous, but on the con-
trary were only obftinate ulcers, in fome —
inftances of a fcrophulous nature, attended
with fymptoms equally common. to fuch ©
as well as cancers.
Dr. Jaenifch, a Ruffian Phyfician, ina_
treatife lately publifhed on Cancer, fays,
that the belladona, or deadly night-fhade,
has been by much the moft faccefsful
medicine with him, in, the few inftances
where
=
“ON CANCERS, - Le
where good has been done in this difeafe s
however the trials that have been made
of it in England give us little reafon to
expe&t much from it. Still thefe unfuc-
ceisful attempts of eminent men, and
their laudable endeavours to convert poi-
fons into valuable remedies, fhould not
_difcourage others from’ perfevering in the
fame courfe, till this great defderatum in
Phyfic be found out. Our fuccefs im
curing the venereal and feveral other dif-
eafes by fpecifics, fhould ftimulate us to
go on, and leave none of the arcana of
-nature unexplored till our wifhes be an~
| perce.
Tue hiftory I have given, which might
be greatly enlarged, affords fufficient proof,
‘that very little advantage has refulted,
from any theory yet publifhed, or any
‘mode of treatment or operation hitherto
recommended. A very extenfive practice
for many years in this complaint, has
| re to my view a large field, not only
D 2 for
2 OBSERVATIONS, &c.
for obfervation and refleCtion, but like-
wife, for fair, liberal,'and prudent practical
experiments, to refrain from which, I
fhould have felt myfelf highly culpable in
neglecting and abufing a auetY favorable
opportunity.
THE sat of that experimental prac-
tice, to which I allude, I cannot more
candidly communicate to the public, than
by introducing in this place, the paper on
that fubject, verbatim as it was delivered
to the Medical Society of London, and is
‘to be found in the 2d. vol. of the Memoirs
of that Society, for the year 1788.
Obfervations
Grrggr 2}
Observations on Cancers,
By Henry Fearon, Surgeon to the
Surrey Difpenfary, amd F, M.S.
Read Sepiember 22d, 1788.
In. paper of this kind, it is naturally
expected, that fomething fhould be faid
concerning the caufe, origin, and nature
ef the difeafe. Were I capable of throw-
-ing-any light on this fubje@t, it would
give me imexpreffible pleafure to gratify
this Society with a full and minute ac-
count.» But I feel myfelf incompetent to
fuch an undertaking... Were I even to
enter into the theoretical ideas of different |
authors, I fear I fhould take up the time
ef the Society, without affording inftruc-
tions . And to recapitulate here what I
1D Tak have
$4. OBSERVATIONS
~have publifhed on this fubjeét, would be
very unneceflary, as I have there candidly
acknowledged myfelf only converfant in
the operative treatment of the difeafe, the ©
nature and fuccefsful medical treatment of
which, every modeft praétitioner in phyfic
will readily acknowledge himfelf unac-
quainted with. If, therefore, I venture to
hazard the opinion I have for fome time
been inclined to entertain, of inflammation.
being the caufe of cancer, or, in other
words, that it is always connected with
the difeafe, in a greater or lefs degree, it
is more with a defign to excite the opi-
nions of other practitioners, than from the.
vain attempt to elucidate perfectly a com-
plaint hitherto enveloped in obfcurity.
For from obftruétions, external injury,
&c. inflammation in fome degree enfues,
and I am inclined to think, that were we
to treat cancerous complaints, at an early
period, as. proceeding from inflammation,
without entering into whimfical or abftrufe
-Teveries concerning the remote, latent, or.
ae
-ON CANCERSs 5s
predifponent caufe of cancer, we would be
much more fuccefsful in pra@ice. To
this opinion and practice, I was led by the -
incident I have mentioned in the firft of
the following cafes ;. and judging, that
from the ceflation of the menftrual eva-
cuation, there would for fome time after
be a greater quantity of blood in the con-
ftitution than it had been accuftomed to
bear, I thought advantage would be de-
rived from. fubftituting an. artificial eva-
cuation inftead of that which had ceafed.
On this head I decline entering into the
doctrine of plethora, being folicitous only
to throw even the fmalleft ray of light on
the practical part, leaving the theoretical
to thofe of fuperior abilities, to.whofe de-
partment it more properly belongs*; and
| the
* That inflammation is either the proximate caufe
ef cancer, or always attends it, I am ftrongly inclined
to believe. But whether this inflammation refults
1% D 4 "4 from
56 OBSERVATIONS
the more I refle& on all the practice 1
have feen, the more it tends to confirm
me inthis opinion: for in all cafes where
Tohave feen folanum, mercury, martial
flowers, or arfenic given, they did harm;
and if from cicuta or opium any advan-
tages appeared to enfue, they were but of
fhort duration.
T'w#e cure is very fimple, and confifts in
bleeding, either topical or general, accord-
ing to the feat of the complaint or part
affected.
from plethora, from obftruction, from the ftrudture of
the part, or from. fome particular excitement therein,
I do not prefume to determine. If it can be made
appear, that bleeding has removed a cancerous difeafe,
T-fhall content myfelf with the importance of the fact,
leaving the folution to phyfiologifts.. And the more
Y reflect on all the. practice I have feen, the more it
tends to confirm me in the opinion, that it has pro-
duced, and’is capable of producing, under certain cir-
cumftances, ee very defirable effect.
WP
cant .
a
CON) CANCERS. vi
In the beginning of fcirrhous affec-
tioas of the breaft and teftis, the mode I
have adopted of taking away blood, is by
leeches repeatedly applied to, the. parts.
In this courfe, however, I have often been
interrupted by the topical inflammation,
produced by thefe animals, around the parts
where they faftened. In, delicate female
habits, I have often loft a week before I
could proceed to the re-application of them:
When the fymptoms lead me to fufpect
the ftomach, uterus, or any of the vifcera,
to be fo affected, that the complaint either
is, or moft probably foon will become can-
cerous, I then have recourfe to general
bleedings. But whether topical or gene-
ral, perfeverance for a fufficient length. of
time is neceflary... Though) the:pulfe .ne-
ver indicated fuch practice, yet the patients
have not fuffered by repeated bleedings ;
on the contrary, when they paffed a cer-
tain time of lofing blood, they felt.areturn
of their Herebialanss and. of their own/accord
defired to be bled again. To this plan or
| practice
38 OBSERVATIONS
practice of repeated bleedings, I joined a
milk and vegetable diet, avoiding wine,
{pirits, and fermented liquors, an open
- belly, and faturnine applications;.I will
give fome cafes by way of illuftrating the
practice more to the readers {atisfaction.
A PooR woman about fifty years of age, .
was admitted a patient to the Surrey Dif
- penfary; fhe faid the had long been in a bad
{tate of health, the caufe of which fhe could
not attribute to any irregularity in living,
She was of a delicate habit of body, and
not» accuftomed to the ufe of {pirituous
liquors. «She fufpected that her complaints
originated from her having been expofed
for fome time to the inclemency of the ,
weather in 1785, in an open yard, as fhe
found herfelf generally indifpofed at that
time, and went to bed, having taken fome-
thing: warm, with the view of promoting
the ufual difcharge (of which fhe had not
any appearance for fix weeks), and alfo to
relieve a fickne{s'and pain at her {tomach
i and
ON CANCERS. 59
and back, fymptoms which fhe fuppofed
to have arifen from the obftruction of her
menfes.: But in this flattering hope the
was much difappointed, as they never after
appeared, and her pains continued gradu-
ally to encreafe (and to ufe her own
words), extend all over her bowels, par-
ticularly after eating. Thefe fymptoms
continued without any intermiffion. (ex-
cept of a few days at times) for fixteen
months, during which time fhe had re-
peatedly applied to feveral regular as well
as itinerant practitioners, without meeting
with the leaft relief. Vomits, blifters,
purgatives, and every other remedy that
had been tried, only encreafed her com-
plaints.
Iw the fummer 1786, P firft faw her at
her lodgings in the Mint,’ with her head
and fhoulders raifed, refpiration: being dif-
ficult; fhe was moft amazingly | reduced
in fleth; her urine was {mall in quantity,
and high coloured; fhe complained of
| thirit,
60 OBSERVATIONS
thirft, was. coftive, her pulfe fmall and
frequent. [Her complexion was of a-can-
cerous: hue;-fhe complained of cold fits,
attended with fhiverings, and of a f{well-
ingron the right fide of her belly, on exa-
mination of which I found the abdomen
was confiderably diftended by the difeate,
which I diftin@ly felt confiderably indu-
rated... As+I.-have already obferved, , the
was very much emaciated; her. appetite
had been. on. the decline for fome time
before I-faw. her ;no folids would lie on
her. ftomach, as a-vomiting enfued. foon |
after eating, attended with a difcharge of
blood,’ and. very.,acrid_ offenfive. matter.
Purgatives had the fame unhappy effect,
fo that her body was neceflarily kept open
by clyfters only ; and fhe was nourifhed
by Jiquids. . All thefe {ymptoms encreafed
for fome time. after I faw her, when death
eafed her of the load of life, and freed her
from fufferings that exceed all defcription,
-, Jueave being obtained to open the body,
is the
ON CANCERS. | ot
the ftomach was found’ to be the part) dif
eafed; the great extremity was of a natural
appearance ; but contained a great quantity
of a chocolate coloured fluid, fo extremely
offenfive, that the fmell of it produced
immediate ficknefs, even to thofe accuf-
tomed to every kind of diflection.. "The
middle of the ftomach, {mall extremity,
and pylorus, formed a compound mafs,
which was clofely united to all the neigh-
bouring parts. On the middle and fore
part of the ftomach, there was an ulcer of
about the fize of half a crown, with un-
even ragged edges, through which fome
of the fluid was difcharged into the cavity
of the abdomen. The duodenum, ducts,
and gall bladder, all adhered ftrongly ‘to
the liver, and formed a mafs of great fize.
On being laid open, it difcovered an exten-
five cavity, with large cancerous’ knobs
appearing on its furface. But whether
this was the original cavity of the {mall
extremity of the ftomach, or of that. part
of the duodenum, running in its neigh~
bourhood,
62 OBSERVATIONS
bourhood, or of the general adhering mafé
deftroyed by internal ulceration, is difficult
to fay.
REMARKS.
The narrative of a cafe which is beyond
the reach of our art, is not a pleafing
undertaking. A cancer of the ftomach is
one of thofe melancholy cafes, which is
beyond the {kill of the moft eminent of
our profeffion ; yet, as it is the duty of
practitioners to avail themfelves of every
opportunity of determining the precife
nature of diforders by -diffe€tion, and of
communicating them to the public, this
cafe, and four other cancerous affections of
the ftomach, in my collection of difeafes,
any gentleman of the Society, who will
do me_the honour of calling at my houfe,
-may examine; they are much more ex-
tenfive than any I have met with in any
other collection, or read of, either in Mor-
gagnl,
er >
ON CANCERS. 63
gagni, Bonetus, or any other. ‘Thefe cafes,
therefore, may not be unacceptable to the
Society, efpecially as I flatter myfelf I
_ have by accident been able to throw fome
light on the nature, treatment, and pre-
vention of this loathfome difeafe; which T
fhall give in a brief ftatement, juft as the -
facts occurred.
Another reafon, I might add, that three
ladies who had apparently incipient can-
cerous affections of the ftomach, who have
by this means been cured, have requefted
that the fymptoms and treatment might
be made public.
CASE
64 OBSERVATIONS
Giese i.
| i 4 cd ‘ j paul ‘g {i 7 oe 5 A
f
In the year 1784, a lady in Clifford.
ftreet, confulted me about a lump fhe had
-juft difcovered in her right breaft; the
rt fymptoms fhe faid was a {tretching
fulnefs in the part, attended with an op-
preffion at the ftomach. As thefe com-
plaints were but flight, and exatly fimilar
to thofe the had been accuftomed to, pre-
ceding the appearance of her menfes, or
what ufually fucceeded conception, fhe
did not think it neceffary to take an opi-
nion of her cafe for a fortnight afterwards,
when an increafed hardnefs attended, with
a darting pricking pain, particularly after
being thandled, very juftly alarmed her,
LH She was forty-nine years of age, and had
no appearance of the catamenia for fix
weeks before fhe had perceived the lump,
which was clearly a {cirrhus forming that
| muft
ON CANCERS. 65
muft in a little time require an operation.
Between the feventh and eighth weck
from the former appearance, fhe had a
plentiful flow of the catamenia, which
lafted longer than vufual, during which
time the lump fubfided, and the pain went
off entirely. We were agreeably fur-
prifed, and attributed the cure to the return
of the menfes ; and we.agreed, when
thefe ceafed. entirely, if her complaints
returned afterwards, to fubftitute bleeding, .
to the amount of three or four ounces,
every fix weeks or two months, to keep
her body open, and make. her live abfte-
mioufly, by which fhe has remained free
from a relapfe thefe three years,
I have met with a great many cafes
fince, at the ceffation of the menfes, fimi- .
lar to, that mentioned, which I haye
treated with the fame fuccefs,.
66 OBSERVATIONS
HOM BB TIT! 6
i
tp 4 ff tf
ELIzABETH ROBINSON, be- |
ing admitted a patient at the Surrey Dif-
penfary, in April 1784, faid fhe kept a
coal-fhed in Bermondfey-{treet ; and that
fhe had for fix months been afflifted with
a {welling and pain in her breaft; that
fhe heard it was cancerous, and defired
my afliftance. The tumor: was incom-
preffibly hard to the touch, and gave her
very acute pain, after being handled; the
nipple was contraéted, and the veins of
the {kin varicous; the lancinating and
darting pains encreafed with the difeafe.
Being perfedtly fatisfied that it was a true
fcirrhus, I put her under a courfe of cicuta
in as large quantities as fhe could poffibly
bear, guarding againft its narcotic effects,
and applying the 4g. Veg. Min. externally.
By thefe means and a proper regimen
being
ON CANCERS. 67
being obferved, fhe thought herfelf re-
lieved for a time ;_ but at the end of eight
weeks, not receiving a cure, fhe became
tired of my prefcriptions, gave up her
letter of recommendation unknown to me,
and I heard no more of her for two
months, when fhe returned and gave me
the following account; viz. She had
been informed, that the gentlemen of the
Weftminfter Infirmary were famous for
the cure of cancerous complaints, that fhe
had been two months under the care of
Mr. Juftamond, without experiencing much
relief, and therefore was returned to fub-
mit to whatever I thought proper. I im-
mediately took her under my care, put her
upon a milk and vegetable diet, and or-
dered four leeches to be applied every
fecond day. This plan foon produced a
diminution of the fize of the difeafe, pain,
and all its concomitant fymptoms ; and
in nine weeks fhe returned thanks to Mr.
Johnfon, the Governor who recommended
her, being perfeétly cured. From the lofs
Bo 2 of
blood fhe became very..thin and pale,
infomuch that her -acquaintance appre-
hended fhe was become. confumptive, and
advifed her not to lofe any more. blood.
But the uncommon benefit the experi-
enced, induced her to perfevere, and ihe
foon recovered her health and vigor, which
the has enjoyed- without the leaft inter-
ruption ever fince.
In aconverfation with Mr. Juftamond
upon this cafe, he candidly acknowledged
he had given the martial flowers and cor-
rofive fublimate, without the withed-for
fuccefs.
; CASE
‘ON CANCERS, 69
GeaY Se ery’
TI WAS confulted by Mr. ——, aged
fifty-one, for a feirrhus of the. tefticle
which had been two. years forming, dur-
ing which time, the fize, weight and pain,
had confiderably encreafed. The fper-
matic chord was a little thickened, and -
the tefticle hard and confiderably enlarged. :
The darting pains were fo frequent at
times as to deprive him of his natural reft.
The cafe having been fufpected to be ve-
nereal, he had been put under a well-con-
ducted courfe of mercury for five weeks,
which only encreafed his complaints. Be-
ing an inhabitant of Colchefter, fea-bath-
ing was fully and fairly tried without the
leaft good effect, on the fuppofition that
_ his difeafe was {crophulous.
Ow his application to me, I did not
E 3 entertain
70 OBSERVATIONS
entertain a doubt concerning the nature of
his complaint, and therefore ordered ten
ounces of blood from the arm, and leeches
to be applied to the part at leaft thrice a
week. To this I joined an abftemtous
regimen, and kept his body open. ‘This
plan was continued only ten weeks (during
which time he was occafionally feen by
Mr. Hamilton, Mr. Beal, an India furgeon,
and Mr. Day of Colchefter) when he was
perfectly cured. |
CASE
ON CANCERS. 7k
Gra, 8 EN,
A VERY delicate female, of refpe&-
able family, only nineteen years of age,
who had not been married, was attacked
with a ficknefs at her ftomach, attended
with frequent vomitings and pain in the
region of her lois, which was encreafed
on bending her body forward. She alfo
complained of great pain about the uterus,
which fhe defcribed to be conftant, extend-
ing down her thighs, with a frequent pro-
penfity to difcharge her urine, in pafling
which, the fuffered confiderable pain ; it
alfo {topped fuddenly, the pain continuing
for {ome time after. She had likewife a
difcharge of mucus from the urethra, ac-
companied with ftraining and uneafinefs.
_ Her pulfe was quick and low (about nine-
ty) as in hedtic fever; her tongue white.
She was fometimes coftive, and at other |
E 4 times
2 OBSERVATIONS
times fubject to a diarrhoea, which core
tinued for fome days. Her phyfician, a
gentleman of the very firft eminence in
town, prefcribed for her, and defired fhe
might be examined with the found, as
the fymptoms gave reafon to fufpect there
was a ftone in the bladder. I accordingly
examined her, but no ftone was felt. The
fymptoms continuing and encreafing 1
violence, the Do&tor prevailed on the lady
to fubmit to a fecond examination, which
fhe complied with, but {till no ftone could
be found. To thefe complaints were
added, during the laft four months of our
patient’s life, the ufual fymptoms attend- ©
ing on hectic patients.
I os TAINED leave to open the body,
and, on examination, found the vifcera of
the abdomen and thorax perfely free
from the leaft appearance of difeafe. But
on viewing the peritoneum, extending over
the uterus ‘and bladder, I difcovered marks
of inflammation ; and, on further exami-
nation,
alte aeilintiie
(ON CANCERS. 73
nation, found all the contents of the pel-
vis confiderably inflamed. Having laid
-epen the urethra and bladder, I found the
inflammation general and uniform through-
out both, without the leaft appearance of
a ftone.
Ow opening the uterus, I. found a {cir-
rhus of the cervix uteri, which unravelled
the caufe of our patient’s death, and which
had produced the inflammatory appearance
throughout the contents of the pelvis.
I-wAve thought proper to record this
cafe, as a very important one; becaufe it
proves, that at a very early period indeed,
this difeafe may prove fatal. We fhould
therefore be fo far on our guard, to expect
‘the exiftence of this difeafe at any pertod
of life, when the fymptoms lead us to
form fuch opinion; which, had we done
in this cafe, we might probably have faved
- our patient, by adopting the plan I have
juft ventured to recommend. Another
| circumftance,
74 OBSERVATIONS
circumftance, in this cafe, highly deferyin es
attention 1s, that a difeafe of the uterus
may produce fymptoms, very fimilar to
thofe of a ftone in the bladder.
CONCLUSION.
TO thofe very important facts, which
prove bleeding to bea {pecific, in the early
ftages of {cirrhous complaints, I muft alfo
add, that even in apparently reduced and
fhattered conftitutions, when the difeafe
has been of long continuance, attended
with affections of the lungs, fcirrhus of the
kidnies, liver, or any of the vifcera; and
laftly, with cholicky pains in the bowels,
a cadaverous countenance, becoming yel-
low, wan, and fallow, the difeafe being
entirely beyond operation, cicutaand opium
failing in their ufual heavenly effects, {mall
| | bleedings
ON CANCERS. 7¢
bleedings have the moft happy, the moft
immediate, and the moft defirable good
effects, in mitigating the fufferings of the
patient, whofe approaching fate we are
unable to prevent.
To thofe cafes many more might be
added; but I think the facts fufficient,
in confirmation of which, I have the plea-
{ure to inform the Society, that any mem-
ber who will call on me, may have occular
demonftration of three cafes I have at pre-
fent under my care, which are yielding to
this method of cure. |
Auguft ath, 1788.
THE method laid down and recome
mended in the foregoing paper, has un--
queftionably proved fuccefsful in many
{cirrhous cafes. Yet it muft be confeffed,
7 that
76 OBSERVATIONS
that we very frequently meet with pa-
tients, fo tortured and reduced, by the
progrefs or advanced” Kate of this com-
plaint, that no time fhould be loft, in en-
deavouring to preferve life and reftore
health, by the immediate extirpal ition Or
removal of the difeafed mafs. [t mu rut alfo
be obferved, that we too clten meet witl
this difeafe, either fo i feted in refpe& to
the parts affected, or ina ftate fo nihil
ingly advanced, the habit being univerfally
tainted, and the vifcera generally affected,
that it would be madnefs to attempt either
to cure or relieve the patient by any opera-
tive means.
SPEAKING therefore of cancerous
complaints, in refpect to treatment, I think
they may very properly be divided into
two kinds, ‘namely,
First. Such as admit of extirpation
or removal by chirurgical operation.
SECOND.
ON CANCERS. | a7
SECOND. Such as from their fituation,
exceedingly advanced ftate, and con-
comitant circumftances, do not admit of
chirurgical operation, or removal.
In thofe of the firft clafs, the cure
confifts in the deftruCtion or extirpation of
the difeafed parts. The firft is effected by
chemical means, viz. the application of
cauftic, or by exciting inflammation to a
greater degree in the parts than they are
able to fupport, and they of courfe die.
Arfenic produces this effect; and the bafis
of Plunket’s Noftrum, which has made fo
much noife in the world, is arfenic. Its
virtues have been much over-rated, yet —
arfenic would appear on, the whole prefer-—
able to cauftic, on account of its action
being more confined to the difeafed parts.
The fecond, or extirpation by the knife,
is undoubtedly the. preferable mode of
cure. — But in patients who have an un-
conquerable averfion to the knife, I think
the deftruction of the difeafed parts,
ey
78 OBSERVATIONS
by chemical means, fhould not be neg-
lected.
Ir has already been mentioned, that in
this treatife, cancerous affetions of the
breaft and teftis are the chief objeéts in
view; yet I may venture to fay, that in
every topical. circumfcribed {cirrhus or
cancer, where the part is fo fituated that
it may be extirpated or removed, without
neceflarily endangering the life of the pa-
tient; the fooner fuch part is removed,
when the difeafe is characterifed, the bet-
ter chance will the patient have of a per-
fee: cure. All cancers, therefore, whe-
ther of the breaft or teftis, or in whatever
part of the body, fo fituated and circum-
ftanced, may be reckoned of that’ kind,
which admits of extirpation. But how-
ever favourably fituated, and circumftanced, —
the part affected may be, it muft be ob-
ferved, that the removal of it does not
afford any abfolute certainty, that the dif-
eafe will never after appear, either in that
: or
ON CANCERS. 79
or any other part of the body ; all that we
can venture to fay is, that (ceteris paribus)
the earlier the operation is performed, the
greater probability there will be, of the
difeafe not returning: But this confidera-
tion ought to have no weight, in difluading
any perfon from fubmitting to an opera-
tion, which appears (all circumftances con-
fidered) neceflary and proper, and which
moft frequently proves effectual; on the
contrary it ought to operate very power-
fully in perfuading the patient to have the
part extirpated at an early period ; when
the pain muft be lefs, and profpeét of fuc-
cefs greater. Befides, no one can be fe.
cure again{t the moft dreadful termination
of a complaint of this nature, who nurfes
a truly characterifed fcirrhus, in the hope
that it may remain indolent and inoffenfive
for a great many years, and, perhaps,
never produce any bad effects. It is ne-
ceffary to inform fuch, that the part affect-
ed fhould be extirpated, as foon as the
difeafe is clearly afcertained: for though
a fimple.
So OBSERVATIONS
-afimple fcirrhus may remain indolent for
many years, yet it may fuddenly change
its appearance, and rapidly prove deftruc-
tive, if not minutely attended to by a judi-
_¢lous practitioner.
NorwiTHsSTANDING what I have
faid of the early extirpation of the difeafed
part, I would not be underftood to infer,
that where this has been neglected, till the
difeafe is in a more advanced ftate, the
operation muft always be improper : on
the contrary, I have reafon to think, that
in cancers both of the breaft and teftis,
the operation has often been given up as
unadvifeable, when it might have been
performed with a probability of fuccefs,
Whether this was the refult of reading
and {peculative opinion without practice,
or proceeded from the bad fuccefs attend-
ing the manner of operating heretofore
practifed, I fhall not attempt to determine ;
but only mention fome fymptoms, which,
experience informs me, {hould not pro-
hibit
ON CANCERS. Sr
hibit the operation, @ as they too often have
done. )
Or this kind are enlargement of the
part, attended with frequent, or conftant,
and increafing pain ; difeafed glands in the
axilla, {mall indurated glands round the
breaft, difeated and ulcerated fkin, adhe-
fions to the pectoral muicle, and alfo to
the ribs. Thefe, we muft allow, are un-
favourable fymptoms, denoting a great
_ progrefs of the difeafe. But from the fol-
lowing cafes it will appear that they ought
by no means to prohibit the operation :
efpecially when we confider the deplorable
fituation of a patient, (which baffles all
defcription) when left a victim to the fury
of this difeafe. And if at fuch an advanced
ftate, the operation is often attended with |
fucceis, we certainly have reafon to enter-
tain far greater hopes from it, at an earlier
period. Indeed I cannot help thinking it
a matter fcarcely admitting a doubt, that
atl who have died of this excru--
F , ciating,
Sa OBSERVATIONS
ciating, loathfome difeafe, might have been
preferved to the community, as well as to
thofe relations and connections, to whom
their lives were valuable; the greater
number of them never experiencing a re-
turn of the complaint, had they fubmitted
to the operation in time.
Upon the whole, therefore, I cannot
too ftrongly urge the neceflity and advan-
tage of having recourfe to the operation
at an early period, as the only remedy ; to
defcribe which, it would be proper now to.
proceed ; but as the fuperior advantages of
that particular operation, which I am about
to recommend, depend, in a great meafure,
on Union by the Firft Intention, it may
not be improper to premife a few obferva-
tions on that fubject. |
OBSERs
ON CANCERS; 83
OBSERVATIONS ON THE DIF-+
FERENT PROCESSES OF NA+#
TURE IN HEALING WOUNDS,
MORE ESPECIALLY ON WHAT
IS CALLED: UNION BY THE
FIRST INTENTION.
‘Tue benevolent Author of Nature, for
great and good purpofes, has implanted a
law in the animal ceconomy, very preva-
lent in the living human body particularly,
whereby parts perfectly feparated or divided
by wounds, are ftrongly difpofed to unite;
efpecially if brought into contact immedi-
ately and retained in that fituation.
In freth incifed wounds, this difpofi-
fion to unite is fo great, that by bringing
the parts evenly and clofely together, and
retaining them fo, they will be flightly
glued together in the {pace of an hour or
F 2 two,
Sit? By =
:
84 OBSERVATIONS»
two, and if not difturbed and feparated by
force, conftitutional difeafe, or fome other
caufe, will perfe@tly unite and heal, with-
out inflammation or fuppuration taking
place. This may be called the firft natu-
ral procefs, or what Surgeons denominate
‘¢ Union by the Firft Intention.”
But inthis falutary defign, nature is too
often fruftrated ; for it often happens in.
large wounds, attended with great effufion of
blood, that the proper treatment of ftop-
ping the hemorrhage, by taking up the
vefiels that require it, and then bringing
the parts clofely into conta&, and retain-
ing them by ligature, if neceflary, has
not in time been adopted, and thereby the
opportunity and advantage of Union by:
the Firft Intention has been loft; yet na-
ture does not ftop here, in her efforts to
unite the parts; for when the effufion of
blood has ceafed, and the mouths of the
veflels from whence it flowed are retract-
ed or collapfe, even though inflammation
| may
ON CANCERS. - 86
may have taken place, in fome degree, if
the parts be then brought into contact and
detained, they will unite without fuppura-.
tion taking place; but neither fo foon, nor
with fo much eafe as if they had been pro-
perly treated in time.
THis may be called the Second Pro-
cefs of Nature, or the Secondary Union,
by inflammatory exudation, or adhefive
inflammation, mentioned by the late great
anatomift Dr. Hunter, by his brother Mr.
John Hunter, by O’Halloran, &c.
But in cafe this fecond opportunity
is loft, or abufed by the interpofition of any
extraneous body, which can only ferve to
keep the parts afunder, yet nature {till pro-
ceeds to accomplifh the great and falutary
purpofe intended from the beginning, of
uniting and healing the parts, but by the
different means of fuppuration, granula-
tion, &c.
F 3 Tuts
86 OBSERVATIONS
Tuts may be called the third and laft
procefs of nature. Of each of thefe na-
tural procefles, we have as infallible de-
monftration, as any mathematical theorem
can admit of.
Or the firft procefs, we have daily
proofs in the immediate union of incifed
wounds. As in blood letting, when the -
orifice becomes united a few hours after ~
the operation, when the lips have been pro-
perly brought together and kept in con-
ta&; but if this be neglected, inflamma-
tion and fuppuration are often the confe-
quence.
SucH are the indubitable proofs of the
firft procefs, which tend to illuftrate the,
dogtrine of Union by the Firft Intention,
and alfo to prove, that the parts of an ani-
mal, however diffimilar, or even parts of
_ different animals, have a {trong tendency
to unite, and become a part of the body,
fo lone as they retain life or the living
_ principle ;
ON CANCERS. - 87
principle ; but if an old extracted, or dead
tooth, or {pur were made ufe of, different
effects would follow, for they would then
att as any other extraneous body, and of
courfe, produce inflammation, fuppura-
tion, &c.
THE proofs of the fecond procefs are
equally undeniable. For inftance, if the
tefticle of a living cock be cut out and~
immediately introduced through a proper
incifion into the belly of a living fowl, the
incifion will heal up, and the tefticle ad-
here or grow to the inteftines of the
fowl.
There are other experiments of a curi-
ous nature, which more fully and exten-
fively prove the exiftence of this principle.
For inftance, if a cock’s comb be cut off,
and a found human tooth, frefh extracted,
immediately -and properly applied, and re-
tained in that pofition, they will unite and
grow together; fo that by injecting the
F 4 comb
88 OBSERVATIONS
comb, the tooth may be injected alfo. In
like manner, if a cock’s fpur be cut off,
and applied to the frefh wound, made by
cutting off the comb, it will adhere and
grow there; and fhews that it is only ne-
ceflary that one furface fhould be inflam-
ed, to throw out coagulable lymph, and
adhefion takes place.
“THERE are many other proofs of this
procefs, as the adhefion of the lungs to
the pleura, which are often confiderable
without any fenfible inconvenience; the
union of the chin tothe breaft; the adhe-
fion of the vifcera to the peritoneum. Of
this a remarkable inftance lately happened
in a perfon that was fhot through the bel-
ly, at the time of the riots in the year
1780, who died about four years after. In
confequence of the wound, inflammation
took place, and produced general adhefions
‘of the vifcera to the peritoneum through-
out the cavity of the abdomen: yet the
perfon was not fubject to any parti-
; . cular
“ON CANCERS. 89
cular pain or fenfation in confequence of
this union.
Iw all thefe cafes of inflammation of
the internal cavities, when recent, a buffy
cruft or covering is found on their furface
which isan exfudation of coagulable lymp
thrown out by the inflamed vefiels, and
which afterwards becomes the bond of uni-
on when adhefion takes place.
ANOTHER remarkable inftance came
under my care lately at the Surrey Dit-
penfary. 3
A poor lad, about ten years old, had
been afflicted by an adhefion, formed five
years before, when he had the fmall pox ;
the adhefion was at the right angle of the
roouth, which was fomewhat retracted by
it, and together with the cheek, adhered
ftrongly to the upper and under jaw ;_ his
upper jaw projected a litrle over the under,
and though he could move the latter a lit-
tle
go OBSERVATIONS
tle from fide to fide, backward and for-
ward; he could not in the leaft open his
mouth: fo that during the time mentioned
he may ftri& propriety be faid to have
lived by fuétion. He was very much
afflicted on cafting the molares which he
was forced to fwallow. On diffecting
through the adhefion, and feparating the
angle of the mouth and the cheek from
both jaws where the adhefions were form- - |
ed; he was able to open his mouth, but a
little more than before the operation; this
I attributed to the rigidity of the tempo-
ral, mafleter, and other mufcles, from fo
Jong a ftate of contraGtion; and accord-
ingly the complaint yielded to warm re-
laxing anodyne fomentations, &c. My
friend Mr. Gillefpey affifted in performing
‘this operation.
Thefe are proofs of the fecond Natural
Procefs, to which many others might be
added if neceflary.
In
ON CANCERS. or
Iw proof of the third Natural Procefs, or
union by fuppuration, granulation, &c. it
would be as abfurd to offer any arguments,
as to attempt by a tedious differtation to
prove an axiom or felf-evident truth that
what does exift does exitt.
Tue old method of amputation, deep
phagedenick ulcers, compound fractures,
and in fhort all cafes of lofs of fubftance,
are fufficient inftances of this procefs,
where nature fooner or later according to
the ftate of the conftitution, fets about
a reftoration and union of the parts by
fuppuration, granulation, &c. |
Ir is to be regretted that there are too
many inftances of this procefs in the prac-
tice of Surgery, which might have been
prevented to the great advantage of the
patient, had nature been in the leaft affift-
ed either in the firft or fecond procefs.
Sucu I humbly conceive to be the law,
and
g2 OBSERVATIONS
fuch the fleps which nature takes in the
healing art. Of thefe I have been an at-
tentive obferver, I have ftudied and admir-
ed them; and have endeavoured, as far as
a very moderate capacity, and the oppor-
tunities I have had, would permit me, to
derive from thence fome ufeful practical
knowledge. Had men of fuperior abili-
ties in the profeffion been more attentive
to the order and progrefs of thefe proceffes,
and to the operations of the vis medica-
trix nature, inftead of fabricating fine {pun
fpeculative theories, the healing art muft
before this time have been advanced to a
much greater degree of improvement.
We fhould not have feen patients fo long
tortured, by pouring ftimulating pernici-
eus balfams into wounds, or by the inter-
pofition of extraneous bodies: all which
applications tend greatly to multiply the
fufferings of the patient, and protract the
cure. for many weeks; which might have
been compleated by the firft intention or
_ Natural Procefs ina few days, 1 fancy I
a may
ON CANCERS. 93
may fafely fay, the attempts:to favour
either the firft or fecond procefs, in the
chirurgical art, would have been a hun-
dred to one more numerous, even within
the laft ten years. As all the fuperior
advantages attending, and refulting from
the following method of operating, are
derived from the firftt Natural Procefs, or
Union by the Firft Intention ; it may be
expected, I fhould fay fomething on the
nature of this Union, and the manner in
which it takes piace.
T HE manner in which this Union takes
place, feems to be as follows. In a frefh
incifed wound, there is an effufion of blood
from the vefiels divided. If thefe veffels
are fo inconfiderable, that the contractile
power of their fibres is fufficient very foon,
to put a ftop to the effufion of blood, by
retracting and clofing their mouths; it
would be very unneceffary to inflict pain
by the ufe of the needle and ligature.
However, the anatomical knowledge of
: the.
Q4. OBSERVATIONS
the part, where a wound happens, and of
the vefiel or vefiels divided, may always
prove fufficient to direct a judicious prac-
titioner : but, for the benefit of thofe who
had very little experience, I hope I hall
be excufed in obferving, that the ufe of
ftyptics fhould not be relied on, where the.
bleeding vetiel is large, or can be conve-
niently and fafely come at; but where it
cannot, as in hemorrhage from fcorbutic
fores, of the penis, mouth, nofe, &c. the
moft efficacious and fafe ftyptic we can
apply is oil of turpentine frequently re-
newed to the bleeding furface, which has
wonderfully fucceeded, where ftronger
flyptics have failed, and produced inflam-
mation and a floughing of the edges of
the wound. We fhould likewife be care-
ful not to truft to comprefs, when an ar-
tery any way confiderable happens to be
divided ; for by fuch practice I have often
' feen, at the diftance of feveral days, an
hemorrhage fo great, as to make it un-
avoidably neceffary for a Surgeon, not only —
to
ON CANCERS. - 95
to open the wound, but to make a freth
incifion, in order to get at, and take up
_ the veffel, that might and ought to have
been. fecured by ligature at firft; by neg-
le€ting which, the patient is put to unne-
ceffary pain, and the opportunity of uniting
the parts by the Firft Intention totally
loft. But to return from this digreffion,
the hemorrhage ceafing, by the vefiel or
_veflels being taken up, if neceflary, other-
wife allowed to retract, there will be fome
coagulated blood in the wound, when
brought together, which will of courfe
feparate; the ferous part will ooze out of
the wound, the red particles will be ab-
forbed, and the coagulable lymph will
become a kind of gluten or bond of Union
between the parts. This gluten or uniting
medium is at firft inorganic; but at length
becomes both vafcular and nervous. But
that change requires time, while nature
endeavours to defend the adhefion formed,
_ by uniting the fkin.or lips of the wound
by cicatrix ; fuch I imagine to be the fim-
ple,
96 OBSERVATIONS
ple, and at the fame time grand, wonder-
ful, and efficacious’ progrefs of Nature, in
forming a union of parts, by the Firft
Intention,’ by retracting and clofing the
veflels, abforbing or difcharging the re-
dundant or unneceflary fluids, glueing the
parts together by an uniting medium ; and
laftly, by cicatrizing, and even organizing
this uniting medium. If I have erred
in an humble attempt to explain this pro-
grefs, it will give me very little concern.
That fuch procefs or union takes place, is”
an indubitable fact; and it 1s of the fact
itfelf, and not of the manner in which it
1S brought about, that I with to avail my-
felf in practice. Neither do I venture to
aflert, that this union will univerfally, or
without exception, fucceed. For in a
weak conftitution, Union by the Firft Jn-
tention very feldom, or {carcely ever takes
place. This is caufed perhaps by the
blood’s being indued with lefs of the prin-
ciple of life, and in confequence of this, a
great backwardnefs to heal. But in fome
: | conftitutions
ON CANCERS. 97
conftitutions adhefion and fuppuration can-
not take place, and inflammation conti-
nues. This often happens to dropfical
patients, and mortification enfues ; but in
other cafes there is not ftrength enough to
produce inflammation, after a folution of
continuity, as in dropfical patients, alfo in
tapping, fo that the wounds keep open,
and the water 1s dif{charged through them.
- But, I believe I may venture to fay,
that in almoft all the inftances where it
does not fucceed, in a healthy conftitu-
tion, the fault may juftly be attributed to
neglect or mifmanagement. From my
own practice I can afflert, that in all the
operations I have performed, either on the
breaft or tefticle, it never once failed.
HavincG given the few prattical re-
marks that occurred to me under the head
G of
98 OBSERVATIONS
of cancers which admit of extirpation; I
am now come to mention fuch, as from
their nature, fituation, and fymptoms, do
not admit of extirpation,
OF
ON CANCERS. 99
OF THE SECOND KIND, OR SUCH
‘AS DO NOT ADMIT OF EXTIR~
PATION BY A CHIRURGICAL
OPERATION,
ile might be thought rather unnecef-
fary for me to take much notice, when
there can be no hopes of a cure, But
though I admit, that in fuch cafes we
cannot entertain hopes of a cure, yet I
fhall venture to offer fome remarks, which
I hope will not be thought unworthy at-
tention, if they anfwer the purpofe of
giving timely warning of their danger to
thofe, in whom the difeafe is only in
its infancy or early period, or have any
weight in perfuading them to’ take the
neceflary fteps in proper time, to prevent
the worft confequences. For to fuch
G 2 perfons
Loo OBSERVATIONS
perfons the obfervation of the Poet fhouid
be a lefion :
Felix quem jaciunt aliena pericula cautune
To return from this digreffion, the ex-
tirpation may be impracticable by the dif-
eafed part being fituated in, or connetted
with fome vital part, or adhering to fome
confiderable artery.
Or if the part externally affected fhould
admit of extirpation, yet there may be
other circumftances that. would render it
very imprudent in a Surgeon to recom-
mend the operation. Of fuch cafes we
have but too ‘many inftances, when the
difeafe has been of long continuance, lat-
terly attended with pains in the bowels,
and’ the pattent’s countenance is become
wan, fallow, and cadaverous. Here we
are led to fufpec a tainted habit, with
cancerous affections of the vifcera, beyond
the reach of: furgery ;. confequently, that
the
ON CANCERS. TOY
the extirpation of any part within our
reach can anfwer no good. purpofe. In
{cirrhus of the tefticle efpecially, when it
has continued fo long, that the fpermatic
chord is become indurated, knotty, pain-
ful, and uneven as far up as can be felt ;
however urgent the patient may then. be,
for the removal of the tefticle, little hopes
can be entertained from the operation.
Oi 3 OF
162 OBSERVATIONS
Of THE PALLIATIVE PLAN, O&
METHOD TO BE PURSUED IN
CASES THAT DO NOT ADMIT
OF REMOVAL BY CHIRURGICAL
OPERATION.
SUCH cafes admit of little aid, either
from the Phyfician or Surgeon; all we
can aim.-at is to mitigate, as far as in our
power, the fufferings of a patient, whofe
approaching fate we are unable to prevent.
In order to accomplifh this defirable ob-
ject, the cicuta of all the medicines now
in ufe, claims‘a preference, becaufe it is
apparently anodyne, promotes reft, and
eales pain. The powder and extract are
the moft ufual forms for giving it in.
The powder is the moft naufeous way,
but lefs liable to variation in its ftrength
than the extraét, the effects of which are
often much impaired by applying an over-
heat in its preparation, and gathering the
plant *
» ON CANCERS, 103
plant at-an improper feafon. Whichever
of thefe preparations be ufed, it fhould
always be begun in fmall dofes, and in-
creafed {tep by ftep, till we get as high as
the patient can bear, which will be known
by its producing nervous affections, fuch:
as a giddinefs of the head, a painful fenfa-
tion in the eyes, and a trembling agitation
of the body. With fuch views I have
gone fo far as to give four ounces of the
powder of hemlock in the {pace of twenty
four hours. If we ftop fhort of the full.
dofe, we fhall feldom have the fame good
effet from it, and by increafing it gra- —
dually we fhall be able to fuit it to all
conftitutions, fome bearing mach larger
dofes of it than others. In ftrumous ha-
bits it will almoft always afford a confider-
able temporary relief. |
We ought, however, every now and
then, to vary our internal and external
remedies; for the ftomach, or any other
part, which has been fome time accuftom-
G4 ed
3O4 OBSERVATIONS
ed to any particular remedy, will gradually
become infenfible of its aétion, and it will
of courfe lofe its effeét; but if there be a
proper interval, the habit will become
again as fenfible of the ftimulus as ever,
Hence it is that brandy drinkers from
continued ufe of the liquor, will require
three or four times the quantity to intox-
icate them, which would have the fame
effet when they firft began.
For the fame reafon the Turks will
bear as much opium, from ufing them-
felves to eat it, as would kill an European
unaccuftomed to its action But if either
of thef2 inebriating things be difcontinued
for a time, the fame dofe that had but lit-
tle effect when it was left off, will have
powerful ones on the recommencement of
its ufe, the ftomach by this time having
recovered its fenfibility. Therefore when
the cicuta begins to lofe its effects, we.
fhould try the ‘night-fhade, and atter that
Opiates in larger dofes, and by thus pru-
ef dently
“ON CANCERS, aes
dently changing our mode of treatment as
circumftances arife, we confiderably pal-
liate the fymptoms, and render the fufferings
of our miferable patients much more tole-
rable than they would otherwife have been.
In the mean time the patient fhould
live abftemioufly, avoiding animal food,
wines, fpirits, and fermented liquors, as
heating, ftimulating, and tending to in-
creafe pain; a milk and vegetable diet
therefore in fuch cafes is the moft proper.
The fea air, afles milk, and imall bleed-
ings, at proper intervals, contribute much
to alleviate the fufferings of our patients.
Wri refpect to the external mode of
palliation, the cicuta poultice will perhaps
claim the firft place, and then the-carrot
and linfeed meal poultice, after this opium
applied either in form of a powder, or the
lint wetted in a folution of it in warm
water.. Thus varying our external as well
as our internal plan, we may confiderably
alleviate the pangs of the miferable. fuf-
| ferer.
306 OBSERVATIONS
ferer. Dr. Jaenifch, at Peterfburgh, already
quoted, much extols the ufe of faturnine
applications in powders his manner of
preparing them is the following: Take of
white or red lead three ountes, which is
to be rubbed in a leaden mortar with a
peftle of the fame, till it doubles its weight ;
to this is to be added, by little and little,
fix ounces of Goulard’s Extract, and rub-
bed as before, till they are intimately mixed
and form a dry powder. ‘This powder
fprinkled on the parts, he fays, allays the
heat, refifts putrefaction, impedes the
growth of fungous flefh, and ftops the
hemorrhage, and oftentimes mitigates the
pains. J wifh it may be found upon trial
to merit the encomiums he beftows on it,
and that he may not have faid too much
. in its praife ; however I think it very
_ worthy of further trial. The plan here
recommended to be purfued is entirely for
thofe cafes of cancer where the operation
has. been delayed too long, or where the
part lies out of the way of an operation,
as in cancer of the uterus, liver, or any of
the
ON CANCERS. 107
the vifcera. But where there is no objec-
tion to the extirpation of the cancer from
its fituation, the fooner it is performed,
after the difeafe is difcovered, the better,
as the only certain remedy.
I am inclined to think, many cafes of
the foregoing defcription refult from mif-
management, when the furgeon has not
fufficiently recommended or urged the
operation in time; or the patient from an
imprudent dread of it, has had recourfe to
fome ignorant pretender or quack, and
has been deluded with the hopes of a
cure till the difeafe has made fuch havock
in the conftitution, as leaves us without
the leaft hope of attempting any thing
with fuccefs; thefe cafes are the more to
be lamented, when we have reafon to
think, that by extirpation of the part at an
early period, the patient might probably
never after experience a return of the com-
plaint ; or, at leaft, would have had a fair
chance from the operation.
I wouLD
108 OBSERVATIONS
I wov tp further remark, that people
in general are not fufficiently aware of
the danger, to which they are liable, from
fcirrhus or occult cancer ; for it f{ometimes
happens, that both furgeon and_ patient
think it foon enough to remove the dif-
eafed part, when forced to it, by exceffive
pain, and encreafe of fize. I cannot fuffi-
ciently warn both of the danger attending
this method of proceeding ; becaufe in
moft cancers (thofe of the breaft efpecial-
ly) internal ulceration takes place, long
before the {kin fhews any tendency to ul-
ceration ; fo that every hope and opportu-
nity of cure may be loft, and the patient
deftroyed by the deep and latent progrefs
of the difeafe, without external ulceration
ever taking place. his circumftance,
therefore, of internal abforption taking
place fo foon, not having been attended to
by any author I have read on this fubjeQ,
J} have thought proper to mention, as
highly deferving notice, and fhewing the
propriety and advantage of operating at an.
2a early
t
ON CANCERS,~ 10g
early period of the complaint. It is un-
fortunately the cafe, that patients can fel-
dom be convinced, that there is any necef=
fity for an operation, while the difeafe
continues in a mild ftate; whereas that is,
beyond all doubt, the moft favourable
period for extirpating it: they too gene-
rally think, a fcirrhus of the breaft or
teftis may remain eafy through hfe: but
notwithftanding there are inflances to prove
this within the limits of poflibility, the
hope that this may be the cafe has proved
fatal to many. ‘There are very few, in-
deed, who pafs through life, with a {cir-
rhous breaft, or tefticle, without fuffering
any confiderable pain, or inconvenience ;
but there have been great numbers, - in
whom this difeafe, after continuing mild
for years, has changed fo rapidly, and put
on fuch alarming appearances, that little
hope could then be entertained, even from
the operation ; fothat they became victims
to their own inconfideratenefs and want
of timely refolution.
. OF
110 OBSERVATIONS
OF THE OPERATION OF CASTRA=
TION.
THE method of performing this opera-
tion has been defcribed by different authors
fomewhat differently : but thofe defcribed
by Mr. Pott, Mr. Bell, and Mr. Warner,
are more generally approved of and prac-
tifed than any others. In the laft edition
of Mr. Pott’s Works, vol. ii. page 485,
he gives the following direétion :
‘¢ ‘Tye void fpace in which the tefticle
“« was, is to be very flightly filled with
‘¢ dry lint, which lint fhould be fuffered
“‘to remain wnti it be perfectly loofened by
<* the fuppuration from every part of the fore ;
«¢ if it be removed fooner, 1t muft be done
“by force ; in which cafe it will give
‘* unneceflary pain, and ‘leave a crude un-
** digefted fore. If it be not removed un-
“ul
ON CANCERS. IIt
€
r
til quite loofe, it will give no pain, and
the fore will be found clean and well
digefted, and requiring no other dreffing
afterward, than mere dry lint, which
from this time fhould be-applied in fuch
quantity and manner, as to give nature
an opportunity of contracting and heal-
ing the wound as faft as fhe can; in
both which fhe may be confiderably af-
fifted by the judicious exhibition of the
¢* bark.f
&
n
é
or
é
n
6
na
é
an
&
a
<6
a
6
e
G
a
«¢ The fore ought not to be touched till
a free fuppuration takes place, which will
commonly be about the fifth or fixth
«© day; and then the dreffings fhould be
‘¢ removed, and renewed from time to
‘‘ time, once every two days, or oftener,
‘¢ according as the guantity of matter ren-
‘* ders it neceflary.”’ Bell’s Surgery, page
G
n°
6
wn
§29, vol. 1.
Mr. Warner, in his Treatife, page 89,
in
ti2 OBSERVATIONS
.in fpeaking of this operation, gives us the
following directions :
“¢ On the third or fourth day after the
operation, drefs the wound with yellow
“‘ bafilicon, or linimentum Arczi, {pread
<< upon pledgits of lint; before the pledgits
are applied, dip them in warm fallad
oil. Let this mode of drefling be re-
peated till the firft dreffings come off,
and as long afterwards as you find it
7A
6
ra
6
n
G
a)
4
ON
oN
&
&
*
neceflary to the promotion of dige/fion.
“Tr at the end of a week or ten days,
“<< or Jater, your patient complains of a lan-
“¢ouor, aud the wound fhould not pro-
<< duce good matter, but, on the contrary,
a bloody and corrofive fanies fucceeds,
foment the wound once or twice a day
‘‘ with an antifeptic fomentation, mixed
‘* with camphorated {pirits of wine or
‘¢ brandy,”
na
~~
«
6
nC
WitH all due deference to the above
re{pectable
ON CANCERS. 113
refpectable authors, and others of emi-
nence who have written on this fubject,
from whom I cannot help differing con-
cerning their principles of operating and
fubfequent treatment, I fhall now humbly
offer to the public, the operations and fub-
fequent treatment which I have for feveral
years adopted and uniformly practifed,
leaving it to the confideration and future
experience of practitioners to adopt or re-
jet them, according to their merits.
WueEn a fcirrhus or cancer of the tef-
ticle becomes fairly characterifed, and the
Operation determined on, it may be per-
formed in the following manner.
THE patient being placed on a table of
convenient height, covered with a blanket
and fheet, his head and fhoulders raifed
with a pillow, his legs and thighs are to
be feparated from each other, with his
knees a little bent, and fecured in this
fituation by proper affiftants.
| THE
rid OBSERVATIONS
T HE hairs being fhaved from the part,
the integuments over the {permatic veflels
in the groin are to be divided by an inci-
fion, beginning oppofite to the opening in
the abdominal mufcle, and continued near-
ly to the bottom of the fcrotum. This
incifion will permit the furgeon with faci-
lity to finifh the remainder of the operation.
The fpermatic chord thus laid bare, is to
be freed from its furrounding membranous
connection, and the operator is to pafs a
large crooked needle round the fpermatic
chord about half an inch below the abdo-
minal ring. The ligature ‘fhould be well
waxed and oiled, and in order that it may
be either tightened or entirely undone at
pleafure, as occafion requires, it fhould be
tied in one running knot, with fuch a mo-
derate degree of tightnefs only, as will
prevent the {permatic artery from bleed-.
ing, and not fo tight as to give pain by
bruifing the nerves. The whole chord
fhould be divided about half an inch be-
low the ligature, this done, he is to dif-
fect
ON CANCERS. | 11g
feét the tefticle out from the {crotum, be-
ginning at the upper part and going down-
wards, If any branch of an artery bleeds
freely, it is to be taken up as it fprings,
which may be done very quickly by means
of a pair of diflecting forceps, drawing out
the mouth of the veffel, and an affiftant
paffing a ligature round it. About the fe-
cond or third day the ligature may be
drawn out, without ever producing any
floughing between it and that part of the
chord that the tefticle was feparated from.
WueEn that is done, the parts from
whence the tefticle was removed are to be
gently laid together, and the edges of the
incifion to be evenly and exactly brought
into contact from one end to the other,
and retained in that fituation by flips of
adhefive plaifter, or even a future or two
if found neceflary. Should any part of
the {crotum be ulcerated, it will be necef-
fary to make a fecond incifion, beginning
a little above the ulcerated part, and con-
| HH iz tinued.
116 OBSERVATIONS
tinued in as direct a line as the inclufion
of that part will admit of, down to the ex-
tremity of the firft incifion. Thefe two
incifions will enable the operator to diffe
away the tefticle in the fame manner as
if there had been but one; nor will they
give more pain, than if the difeafed part
had been difleted away along with the
tefticle, in the manner recommended by
Mr. Sharp and Mr. Pott. The parts are
_ then to be brought together, and retained
in the fame manner as if there had been
but one incifion, that they may unite by,
the firft intention.
THE whole of this operation, and like-
wife the excifion of the cancerous breaift,
fhould be performed with a ftraight dif-
feGing knife.
OF
ON CANCERS, 117
OF THE EXCISION OR REMOVAL
OF A CANCEROUS BREAST,
THERE are two methods in ufe in the
cure of cancers; the one by cauftic, the
other by the knife.
THE former being more irritating, ex-
ceedingly more painful, lefs fubje& to
direction, and lefs certain in its effects
than the latter, is now nearly exploded, or
feldom practifed, except by Quacks, who
in all their applications or boafted fpecifics
(without exception) for the extirpation of
cancers, have a cauftic of fome kind or
other, as the bafis or principal ingredient
in their compofition. Extirpation by the
knife, therefore, being infinitely prefer-
able, I thall confider and defcribe that me-
thod, having before {poken of that by
cauitic. |
H 3 My .
ris OBSERVATIONS
My deviations from the ufual pra¢tice
confift in the mode of operating and after
treatment, of which I fhall give as clear
an account as in my power, firft giving
a few quotations from the beft modern
chirurgical writers; I will then leave the
reader to draw his own conclufions as to
the propriety. of each plan.
‘¢ Iw large tumors, it 1s very much to
be advifed to cut away great part of the
fkin, for befides that the hemorrhage will
be much lefs in this cafe, and the opera-
tion greatly fhortened, the fkin, by the
very great diftention, having been rendered
very thin, will great part of it, if not
taken away, fphacelate, and the reft be
more prone to degenerate in a cancerous
wicers?
Sharp's Surgery. Page 55.
wrs fphacelation and generation of
cancerous ulcers, mentioned by Mr. Sharp,
2ave no doubt of, becaufe they muft na-
‘3 turally
ON CANCERS, 119
turally refult from the practice of filling
the cavity from whence the tumor was
removed with dry lint, or any extraneous
fubftance that keeps up fuch an irritation,
and of courfe inflammation, that the inte-
guments are unable to bear, and fphacela-
tion confequently takes place, leaving a
large furface bare underneath, which will
require a tedious procefs of nature to cure.
Such effets never could have followed,
had the integuments at firft been brought
in contact with the parts underneath, as;
the contractile power of the fkin is fo great,
that from confiderable folds at firft, it will
foon recover a {mooth even appearance, as
I have always found to be the cafe.
Tue fame author, after defcribing the
manner of removing a fcirrhus gland, or
cancered breaft, page 140, ‘¢ The reat-
$6 ment of all thefe wounds may be with
‘6 dry lint firft, and afterwards as in com-
mon incifed wounds.”’ :
H 4 Iw
3120 OBSERVATIONS
In Mr. Warner’s Cafes, publifhed a
few months ago, page 359, after the am~
putation of a woman’s breaft in the ufual
way, and. dreffing with lint; he tells us,
‘* her wound was at the point of being
healed in zine weeks after the operation.”
‘THe circular incifion in the {kin of a |
‘¢ breaft, fhould alae) be made quite
‘* round, &c.” ,
Pott. Vol, HI. Page 492.
THE above eminent authors and moft
practitioners make it a rule to fave a con-
fiderable, or what they think a fufficient
quantity of fkin. But ftill, in this opera-
tion, as well as in others, they left a large
open wound, which by the ufual dref-
fings, became much larger by the time
they were firft removed. Thefe dreffings
give unneceflary pain, produce a very ex’
tenfive and a very ugly fore, by which the
healing of the part is greatly retarded.
The
‘ON CANCERS.: ean Ge
Tue following method is that which I
have adopted in the removal of a cance-
rous breatt, 7
. THe patient being placed in a chair of
convenient heighth, in a reclining pofture,
her head fupported with a pillow, by an
affiftant behind, and her arms fecured by
another on each fide; the Surgeon is to
place himfelf in the moft advantageous
fituation, either fitting or ftanding, as he
finds moft convenient, fo as to make one
horizontal incifion, longer than the difea-
fed mais, nearly in the direction of the rib,
and a little below the nipple, that it may
occafion the lefs deformity. An incifion
of fufficient extent, being momentary, will
give little more pain than a {mall one; and
has this great advantage, that it enables the
operator, with facility, perfectly to remove
the whole of the difeafed parts. —
THE moft painful -part of the opera-
tion being over, the affiftants who were
employed
i22 OBSERVATIONS
employed in fecuring the patient’s arms, are
now to hold afunder the integuments, and
prefs their fingers on any arteries that bleed
freely, which will enable the turgeon,
with facility and dexterity, to remove the
whole of the difeafed mafs, which fhould
be. carefully diffected from the fkin above,
and below from the pectoral mufcle and
ribs. The affiftants are now to remove their
fingers, the blood 1s to be effectually clear-
ed away, by {fponge and warm water, that
the Surgeon may examine, with the great-
eft accuracy, the furface of the wound;
and if any {mall indurated glands, or thick-
ened cellular membrane can be difcovered,
they ought to be all removed; for without.
the moft careful attention to this part of the
operation, the defign of it may be pie dee
fruftrated.
By this time, the hemorrhage will have
ceafed by the contraétion of the mufcular
fibres of the arteries; when the blood
which
ON CANCERS. © 123
which oozed out, during the examination
of the wound,.muft now be cleared away
as before, and the edges of the incifion
brought evenly and perfectly into contaét,
and retained (as in the operation of caftra+
tion) that they may unite by the firft in-
tention.
WueEN there is any ulcerated or dif-
eafed ikin, it muft be included between
two incifions, exactly in the manner re-
commended in fimilar circumftances of the
fcrotum.
Over the dreflings, a large, thick, foft,
comprefs of old linen fhould be. applied,
and gently bound on, with a flannel roller,
about five inches broad, and fix or eight
yards long. Flannel is preferable to linen
on thefe occafions, being warmer, and like-
wife more pliant, and yielding to the mo-
tions of the trunk in refpiration.
EAE
124. OBSERVATIONS
‘Tu arm on the fide affected, thould be
relaxed, by being flung in a handkerchief
~ tied round the neck.
Te ferous or bloody difcharge is gene-
-rally in fuch quantity as to appear through
all the bandages, which I remove on the
fourth day after the operation, if per-
formed in the fummer, or the fifth if
in the winter. By this time the flips of
flicking plaifter have become loofe by
the difcharge, and may. be removed
without giving the leaft pain, or affect-
ing the tender adhefion. If ligatures —
have been ufed, they muft about the
fame time be divided with {ciflars. In
my practice latterly, I never ufe ligatures,
finding the adhefive plaifter fully {ufficient
to keep the parts in contact. The adhe-
fion of the teguments are to be drefled with
fmall flips of lint fpread thin with a ce-
rate of wax and oil. Over the dreflings I
apply a few ae of adhefive plaifter, to
% ; fuppor Ct
hs
ON CANCERS. 125
fupport the tender union, and by keeping
the edges. of the fkin as clofe as poffible,
the cicatrix ‘will be very {mall, and the cure
greatly accelerated.
OBSER-
126 OBSERVATIONS
OBSERVATIONS ON THE OPE-
RATION AND SUBSEQUENT
TREATMENT,
Pa
] FIND it very neceffary from experi-
ence, to requeft the operator to be very
careful, by a gentle but fufficient preffure
to bring all the parts underneath in con-
tact with the integuments, fo as perfectly
to exclude the air when the edges of the
sncifion are laid and retained together. .
If this be not done with the greateft care,
the air remaining within the wound, and
keeping the parts afunder, fuppuration will
enfue and protract the cure, This hap-
pened tomyfelf in one cafe, and may have
eften happened to other operators, and
thereby induced them to fpeak more unfa-
vourably of this method of operating than
it deferves. But even when attended with
this difadvantage, I muft ftill think it vaft-
ly
ON CANCERS. 127
ly fuperior to the o/d method of operating,
when the whole breaft, fkin, and all is cut
away, as 1f mowed off with a /cythe.
In performing this operation, feveral
arteries bleed very freely, and are apt to
alarm a young operator, who from his
embarraffment, may make too much hafte
to finifh the operation. This hatte or ex-
pedition to finifh the bufinefs, by applying
the dreflings too foon, is a very great
error, againft which I muft ftrongly re-
commend it to every operator moft care-
fully toguard. Mr. Gafelce has had ac-
counts from the country of two cafes,
where the hzmorrhage, after the patients
were put to bed, was fo great, that the
dreflings were obliged to be removed, the
blood cleared away, and frefh dreflings ap-
plied. Such confequences muit naturally
happen, if the operator does not wait pa-
tiently till the bleeding has entirely ceafed.
The time neceflary to wait may be from
ten minutes to twenty, according to the
nature
128 OBSERVATIONS
nature of the cafe. In one where I lately
operated, atwhich Mr. Sharp, Mr. Gillef-
pey, and Mr. Wheeler were prefent, I was:
obliged to wait about fifteen minutes, be-
fore the bleeding had entirely ceafed, fo
that I might fafely apply the dreflings. It
fometimes happens that after the arteries
have retracted and entirely ceafed bleed-
ing, there will be a very inconfiderable
oozing from.the pectoral mufcle, if it has
been touched in the operation, or perhaps
from another part. In fuch cafes a gentle
preffure on the part, with the tops of the
fingers, or expofing the mouths of the
veffels to the air, will belp greatly to make
this oozing ceafe entirely. Exclufive of
the error of applying the drefiings too
foon, there is another which I cannot pafs:
unnoticed, namely, that of giving the pa-
tient a ftimulating cordial or dram, either’
before or after the operation, than which.
nothing can be more improper. This
practice or cuftom refults from the well-
meant, but very ill-timed tendernefs of the
patient's
ON CANCERS. 129
patient’s friends, to prevent which, the
Surgeon fhould take every poffible care, —
fo as to reftrain even the tender fympathizing
nurfe from giving any thing of that nature,
fecretly in his abfence. -If a ftimulating |
cordial be given before the operation with
the ill-judged defign of enabling the pa-
tient to bear it the better, it muft naturally
make the bleeding continue longer than it
would otherwife have done, by adding to |
the impetus of the circulation, and the pa-
tient will confequently be weakened or re-
duced in proportion-to the greater lofs of
blood. If given after the operation for
the abfurd purpofe of fupporting the pa-
tient againft languor or fainting, fuch a
frefh excitement to the circulation may
occafion fome veilels which had entirely
ceafed bleeding, to bleed afrefh, and there-
by not only make it neceflary to remove
all the dreflings, but ‘likewite confiderably
impair the patient’s ftrength. The pa-
tient fhould be put to bed immediately
after the dreffings have been applied, and.
1 kept
13° OBSERVATIONS
kept as quiet as poffible, the languor will
gradually go off, and the horizontal pof-
ture will be quite fufficient to prevent any
inconvenience from fainting. Even in
cate fainting takes place, no efforts fhould
be ufed to roufe the patient from it, as it
ean do no harm. I have not feen a cafe
in which fainting made it abfolutely necef-
fary that the patient fhould have even a
glafs of wine. I will admit, however,
fuch a cafe poflible, if repeated faintings
happen, againft which there is no remedy
of which I have fo good an opinion, as a
glafs of good red port. In general I order
the patient on being put to bed, to take
thirty drops of Tine. Theb. in an ounce
and a half of aq. cin. ten. with a view of
removing irritability, allaying pain, and
procuring quiet and compofure. ‘This
anodyne may be-continued for fome nights,
if occafion require, neither mutt the judi-.
cious exhibition of the bark, red: wine, and.
fuch corroborants as the patient’s. ftate.
may require, be neglected as. foon. as the
- union
ON CANCERS. 131
union has taken place. In all the onera-
tions I have performed on the breaft, I
have never had occafion to take up an ar-
tery, though I once took off a ferophulous
one, that weighed near ten pounds. There-
fore, the operator has nothing to fear in
this refpect, confidering that from the
nature of the part, no danger can entue
from diffecting freely, or even from taking
away a confiderable portion of the pectoral
muifcle, when the difeafed mafs adheres
to it. The operation is fo fimple, that
my patients have hardly complained of
pain; they generally feared they fhould
faint, but on the contrary, as foon as the
dreffings and bandage were applied, they
got up and walked to bed without any
affiftance.
SOME time after I had publifhed a fhort
and imperfe® account of this method of
operating, Mr. Bell, of Edinburgh, pub-
lifhed the fecond volume of his Sy{tem of
ae in which, page 455, in allufion
I 2 to
132 OBSERVATIONS
to the two cafes I had publifhed, he fays,
‘¢ Till of late the only means put in prac-
* tice for fecuring the fkin in its fituation,
‘< fo as to effect an adhefion between it and
‘¢ the parts underneath, was compreflion
‘¢ by the napkin and feapulary. bandage,
‘¢ excepting in a few cafes where adhefive
‘¢ plaifters were employed.”
Mr. BELL, however, ‘as appears from
his words, page 443, thinks, this method
of operating applicable only in {cirrhous
affections of the mamma, where there is.
no neceflity for taking away any of the
{kin; or where there is no adhefion to
the pectoral mufcle. When the fkin is.
ulcerated, or adhefions are formed, he
thinks the ufual method of cutting away
the fkin and dreffing with lint fhould be
followed. He alfo takes pains to deferibe
the method of fecuring the arteries, and
talks of fuppuration, matter, dreffings,
é&c. as other authors have done before
him. Jam forry, Mr. Bell has mifunder- | —
{tood
ON CANCERS. et 19 3
ftood me fo far, becaufe the method of
operating I have defcribed, ‘may be adopt-
ed, even when it is neceflary to take away
a great quantity of i{kin, either from the
breaft or {crotum, as will appear from the
following cafes.
_Iw all my practice, I have not had one
cafe, nor have I ever feen one, where
there was not {kin fufficient to cover the
wound, and unite by the firft intention,
except where cauftics had been long and
repeatedly employed. Iam confident the
following cafes are worfe than thofe that
generally occur in practice, yet in every
one of them, the Union by the Firft In-
tention fucceeded, though in fome in-
ftances, the difealed mats, together with
a large portion of the fkin, had, in the
former operation, been removed. In fome
cafes, the ulcer is fo large, that on the
firft view, one would be apt to think, that
the edges of the fkin could hardly be
brought into contact, after having taken
hag away
134 OBSERVATIONS
,away fo confiderable'a portion of it, by
including the ulcer in a double incifion.
But as there was a confiderably lefs extent
of furface to be covered after the difeaited
tumor was removed than before, there was
fkin fully fuficient for the purpote.
CAS EB
ON CANCERS. 135
In Apmil, 1779, the foreman of a hatter
in Southwark, aged thirty-eight, applied
to me on account of a complaint he had
in one of his tefticles. Both in the coun-
try and in town it had been treated as vene-
real for two years. He had been falivated
for it, and faid that the mercury always in-
ereafed his complaints; that in fize, pain, —
and weight, it was become confiderably
worfe. When I faw it, the fpermatic
chord was a little enlarged, the body of
the tefticle was very large and unequally
hard, the darting pains were fo frequent
as to deprive him of lus natural reft; his
countenance was pale and fickly: he faid
he had been been often advifed to have it
taken off, but never would confent till
lately, that his life became fuch a burthen
to him, from intolerable pain, that he did
not care if he had his head cut off.
f T 4 As
136 OBSERVATIONS
As the difeaiedid not admit of a doubt,
and he was very prefling in his entreaties to
have it- removed, I operated in this ad-
vanced {tate in the manner already defcribed.
THE parts healed ina few days, and in
lefs than a fortnight he worked at_ his
trade, and has had no complaint of the
kind ever fince, . hhh) ye
My friend and colleague, Mr. Stone-
houfe, of the Difpenfary, and the late Mr.
Blackall, Teacher of Anatomy, ‘were pre-
{ent at the operation.
CASE
ON CANCERS. 137
GuAoS. EB oi.
JAMES KELLY, formerly a failor,
about forty years of age, was admitted a
patient at the Surrey Difpenfary, in Spring,
1484. He had for two years been afflict-
ed with a fcirrhous tefticle, for which he
had taken a. great many medicines, but
without any benefit. He was then greatly
alarmed by an alteration it had undergone
a few weeks before. The tumor had been
indolent and equal, the fpermatic chord in
a natural ftate, and he had no other com-
plaint while the difeafe continued in that
ftage; but fince the change took place, —
the tefticle had increafed very confiderably,
efpecially within the two laft months, and
a fungus fore broke out on the fuperior and
anterior part, about the fize of half a
crown, which was extremely painful ;
fometimes bled, but generally produced
a gleety
/
138 OBSERVATIONS
a gleety difcharge, of a very offenfive fmell.
He had a pale unhealthy countenance.
I RECOMMENDED the operation un-
der a guarded prognoftic; he hefitated a
while, and then refufed to fubmit: but
while he was fitting in the hall, a man, on
whom I had performed the operation four
years before, came to Mr. Stonehoufe on
bufinefs, who defired him to relate his
cafe to Kelly, which he did, and affured
him the operation would give him but lit-
tle pain, and the confinement was not worth
mentioning, as he would be wellin.a few
days; at leaft that was his cafe, and he ne-
ver had a pain nor ach fince the operation ;
and laftly, that he was as good a man fince
as ever he had been before! His account
had irrefiftable influence with Kelly, par-
ticularly the /af argument, and he immedi-
ately refolved to fubmit to the operation,
Accordingly he came to the Difpenfary
next morning, where I performed the. ope-
Fation in the manner defcribed, by two
ftraight
ON CANCERS. 139
ftraight incifions, including the ulcerated
part, and having brought the edges into
contact, retained them by two ligatures and
fome adhefive plaifter, and then fupported
the fcrotum with a handkerchief. He
walked home, had no fever, and got well fo
faft, that on the ninth day he returned
thanks to the Governor who recommend-
ed him to the Difpenfary, and went to his
daily labour on the eleventh day.
Ir deferves to be mentioned, that in
the above Cafe the fkin next the feptum
{croti was about half an inch thick, and
adhered to the tefticle; yet this thicknefs
decreafed as he got well, and at laft went
off entirely.
Mr. SIMPSON, my colleague at the
Difpenfary, and Surgeon to the Magdalen
Hofpital, and Mr. Getty, a Navy Sur-
geon, were prefent, and affifted me at the
operation,
THIs
140 OBSERVATIONS
Turs cafe I] thought the moft proper to
fucceed the firft, though an_ interval of
more than five years happened between
them: but as they are both of the fame
nature, were thought unfavourable, and
were really more fo than any others I have
had, asthey prove the two different me-
thods of performing the operation, viz. by
the fingle incifion, and by two incifions ;
and as they were both fuccefsful, I thought
the orderin which they ftand the propereft
- T could fix on.
CASB
ON.CANCERS. - IAI
Cie Gok eit.
HLIZABETH TURNER wasad-
mitted a patient at the Surrey Difpenfary
about eight years ago, under the care of Dr.
Sims, who confulted me refpecting the pro-
priety of extirpating her breaft, which was
truly fcirrhous. She was about forty-fix - |
years of age, of a robuft habit, and her
breaft naturally of a large fize; but the
difeafe (which had been a year and a half
forming, without any known caufe) was
perfectly moveable and circumfcribed ;
there were no glands enlarged in the axilla,
and the cafe, upon the whole, appeared to
us to be extremely favourable for the opera-
tion, which we accordingly took great
pains to recommend, without effect. We
heard no more of her for about a fortnight,
when fhe fent for me to her apartments in
the Maze, where fhe lived. I found her
in bed, with her head and fhoulders fup-
ported
342 OBSERVATIONS
ported ; fhe breathed very quick and with:
great difficulty, her pulfe was quick and
f{mall, fhe was in the moft excruciating pain,
- ynfomuch that fhe faid fhe was tied ready
to have her breaft taken off, and would
undergo any thing to get relief. In the
above fhort time, ne Bread had increafed
confiderably, and adhered in every part to
the ribs with a firmnefs that I cannot ex-
prefs. The mufcles of the abdomen, neck
and arm, on that fide, were all enlarged,
and contracted, fo that her head and thigh
were bent towards each other. She could:
not move the armon that fide: her breaft
was not ulcerated externally. In this me~
Jancholy fituation, opium not affording her:
the leaft relict, death put an end to her tor-.
ture three days afterwards.
CASE
ON CANCERS. 143
Oro Cana ve 6p
yay LITTLE after this, I vifited one of ©
Mr. Shuter’s patients, thirty-nine years of
age, with fymptoms nearly fimilar to thofe
in the preceding cafe. When I faw her,
the breaft appeared to be very favourably
circumftanced for extirpation, which how-
ever | did not advife, the tumor being indo-
lent, and attended with very little pain ; be-
fides, fhe was feven months gone with child,
and I flattered myfelf that the complaint
would not increafe much in three months,
and that it might poflibly undergo a favour
ble change after lying-in; thefe were my
reafons for not doing more than giving the
cicuta. But to my aftonifhment, in three
weeks after fhe was as fuddenly and violent-
ly attacked, as Elizabeth Turner in the pre-
ceding cafe, except on the hand and arm,
which were covered with large oedematous
{fwellings ;
144 OBSERVATIONS
{wellings : fhe aborted that night, and died
two days afterwards.
I HAVE met with feveral fimilar cafes
fince, which fully and clearly prove the
neceflity of our operating early, and that
the lofs of a few days may be of the ut-
moft confequence. It is the fame in can-
cers of the tefticle; by deferring the ope-
ration in hopes of receiving a cure, and
lofing only a few days,.the difeafe may en-
creafe fo rapidly, and the patient become
fo much affect.d, as to render the opera-
tion unadvifeable. By an inftance of this
kind, the public were fome time ago de-
prived of a celebrated comedian.
CASE
I
ON CANCERS. 145
NEARY SMITH, aved forty, dittos
vered a lump in her breaft, about five
months before fhe applied to me, which
was in the year 1780. It was perfectly
indolent upon being handled. It had a
- ftoney incompreflible kind of hardnefs. I
told her I was of opinion, that it wasa
true {cirrhus, and accordingly recom-
mended the operation. She left me much
diffatished, and I heard no more of her for
a fortnight, during which time fhe had
ften been to an eminent furgeon, and
then returned to fubmit to the operation.
The difeafe in the above fhort time had
increafed very rapidly, and adhered to the
pectoral mufcle. The {kin was become
_fmooth and inflamed, and appeared as if
it would fhortly break out into a cancerous
fore. ‘There were little lumps round the
breaft, and-a gland enlarged in the axilla
K to
146 OBSERVATICNS
to the fize of a chefnut, which looked as
if abforption had taken place. I told her,
that from the rapid inereafe and unfavour-
able appearance of the cifeate, her chance
of a cure from the operation would be ex-
tremely uncertain. Her reply was, that
fhe fuffered fuch acute and almoft con-
ftant pain, that fhe would run any rifk.
I operated in the manner already defcribed,
removing all the indurated glands. ‘That
in the axilla was deeper feated than it had
appeared to be from the external feel.
I likewife removed all that part of the
fkin which was difcoloured. Still there
was enough left to admit of a perfect ap-
proximation of .the edges of the wound,
which healed by the firft intention. On
.cutting into the breaft after it was re-
moved, there appeared two cyfts, one of
which contained about three ounces: of fe-
rum, and the other a curdled matter
tinged with blood. Ulceration had taken
place in the infide. Mr. Walfhman, Sur-
geon, at Newington, faw this patient.
CASE
/
ON CANCERS, 147
fA peasant
PES a FOS 4
lLAnnt GAHAEY
ewe of Mae L eat ES ssesissareNUENENT
oa S EVE
SOON after this, Elizabeth Benham of
Profpect-row, Walworth, applied to me
to remove her right breaft.. The account
fhe gave of her cafe was, that as long as
fhe could remember, fhe had perceived a
{mall lump in her breaft, which had gra-
dually increafed in fize; and that about
_ ten years before I faw her, fhe had taken
the opinion of Mr. Smith, furgeon of St.
Thomas’s Hofpital, who advifed the re-
moval of the difeafed part; but that fhe
did not choofe to fubmit to an operation
ata time when fhe fuffered no inconve-
nience, except from its weight, and at
times a duli heavy pain. ‘The fize of the
tumour increafing, and the pain becoming
more acute, fhe was advifed to fee my
learned friend and colleague, Dr. Sims,
whofe opinion agreed with that of Mr.
Smith. ‘The breaft was very large, of an
Kire unequal
ey Phan
<2 ETE RY
148 OBSERVATIONS
unequal furface, very knotty, and felt
though its whole fubftance perfectly in-
durated. The veins of the {kin were
varicous, and the nipple was fhrunk out
of fight. She was forty-eight years old,
and of a delicate conftitution, but her
general health was good. The edges of
the wound were brought into contact, and
retained by flips of fticking plaifter. They
united by the firft intention, and the cica-
trix was completely formed in ten days.
She was only two days confined to her
room, and walked out on the fourth.
WHEN fhe came to the difpenfary to
return thanks to Dr. Sims, whofe opinion
and reafoning had prevailed on her to fub-
mit to the operation ; on feeing the breaft,
he expreffed himfelf much pleafed with a
method of operating, by which the cure
was fo fpeedily effected, and deformity
prevented. For the nipple having been
preferved, and the cellular membrane foon
after the operation filling with fat, it had
not
ON CANCERS. 149
‘not an appearance as if the breaft had
been removed. a
Tue breaft weighed three pounds and.
ten ounces. On cutting into it, it was
extremely hard and difeafed through its
whole fubftance, with feveral {mall cyfts,
containing a yellow, gelatinous, curdled
pus.
K 3 CASE
Tso | «-« OBSERVATIONS
CA 6 RVI.
A WIDOW applied to me, in the
year 1781, concerning her breaft, which
attended tis iat pains, (hootinen into
the axilla and adjacent parts. Mr. Grin-
dall, about half a year b:fore had recom-
mended the operation, which fhe would
‘not then confent to; I told her the remo-
val of it was the only thing from which
fhe could expect relief, to which fhe con-
fented.
THROUGH one incifion, I carefully
difle€ted away the. difeafed mafs;. which
was fo large as to leave almoft te whole
of the peétoral mufcle bare. The wound
united by the firft intention, and fhe was
perfectly -
ON CANCERS. 151
perfetly well in twelve days, and has
continued fo ever fince. ae
Mr. HaDLey (now fettled in Derby)
was prefent at the operation, and faw her
daily for the time mentioned.
Koes CA SUE
1x2 OBSERVATIONS
7 * ~ P # one
f pe rs gp 3 A a rj
OE a th A LA PPR AEE OP EE RLS me gh wetyc” Fé
4 f N A Fixe fF’ sa i?’ A EO Ge Pres PY
Ce Gn VU
SOON after the former -eafe, Elizabeth
. Auger, of Wandfworth road, about forty
-years of age, was admitted a patient at the
Surrey Difpenfary, under my care. The
whole of her right breaft was greatly en-
larged, though the-complaint had attacked
her fuddenly only three weeks before
without any external injury. Her coun-
tenance was pale and fickly, fhe was fub-
ject to indigeftion, and frequent naufea ;
the difeafe was clearly a true {cirrhus,
hard to the touch, wich frequent darting,
pricking pains; difeaied glands all round
the breaft, with a ftring of them extend-
ing into the axilla. The difeafe had in-
creafed fo rapidly, that fhe was juftly ap-
-prenenfive of the confequences, and in-
treated me in the moft earneft manner to
perform the. operation, and give her a
chance for her life; I yielded to her im-
portunate
ON CANCERS. 153
portunate folicitations quite contrary to
my judgement and opinion of the cafe,
which was that it muft end fatally. Du-
ring this operation, while I was diffecting
away the glands leading to, and thofe in
the axilla, I was very much alarmed to
find, (after the breaft and a large gland in
the axilla had been removed) that all the
cellular membrane was difeafed, and full
of hard knots in every direction. Befides
thofe that were diflefted away with the
breaft, I removed an incredible number of
them, from the fize of a pea to that of a
-filbert: the edges of the wound were
brought into contact, and healed in the
ufual time. She enjoyed perfe& health
for two months, and thought herfelf very
fortunate; but her eafe, comfort, and hap-
pinefs were then fuddenly interrupted, by
a return of the difeafe. In this lamenta-
_ ble fituation, fhe came again to me, with
her breait nearly as large. as before, and
the fymptoms nearly the fame as I have
already defcribed, all which increafed for
another
154 OBSERVATIONS
another month ; during which time, the
largeft dofes of cicuta did her no fervice 3 —
I then told her, I had not the leaft hopes —
of her obtaining a cure, by any internal
medicine, or external application; and as
I feared it would not be in my power to
remove the whole difeafed mafs, fhe had
but little reafon to expect any benefit from
having the operation repeated. She re-
plied, that fhe had feen two of my pa-_
tients, who were then in good health,
whofe breafts I had taken off; and as fhe
fuffered fuch conftant and fevere pain, fhe
was refolved to undergo the operation a
fecond time. I yielded to her intreaties,
and Mr. Babington, of (suy’s Hofpital,
did me the favour to affilt at the opera-
tion.
Tue {kin of the breaft was no way dif-
coloured ; but as the cicatrix from the
former operation, adhered to the difeafed
mafs, we made a double incifion including
it, in the fame manner as when the {kin
is
ON CANCERS. © 155
is ulcerated. We diffected away every
part that feemed in any degree difeafed ;
and carefully removed all the affetted
glands in the axilla.
Her breaft was perfectly healed in lefs
than a fortnight, and fhe appeared to en-
joy good health for three months after, at
the expiration of which, the difeafe again
appeared, and in a fhort time, fhot out in
different directions to a great fize, large
lumps or pieces frequently mortifying and
- floughing away with the poultices that
were then applied. In this miferable
fituation fhe lingered five months; in
which time opium was tried, but foon loft
its power, procuring neither fleep, nor al-
leviation of pain: thus worn out with
want of reft, inceflant pain, and hectic
fever, fhe died.
CASE
156 OBSERVATIONS
oie of . aio, 2 ca oF aN ee |
vt é PIAd O Fee LFA...
Be
CAe Sah oul Xi,
JANE BROWN was admitted a pa-
tient at the Surrey Difpenfary in the year
1782; fhe got a blow on her breaft about
ten years before, which continued to be
painful for fome days after the accident.
The pain was fucceeded by a hard tumor,
which had been gradually increafing for the
time above-mentioned, (notwithftanding —
the free ufe of hemlock,) and at the time
I faw her, extended from the clavicle to
the abdomen, and from the fternum to the
axilla; the {kin was puckered, the nipple
was retracted, and the veins were varicous.
She had taken a great many medicines,
under the care and direction of fome of the
faculty, and likewife had recourfe to
quacks, and had taken various fpecific
noftrums, but all to no purpofe. Being
tired of thefe matters, and meeting with
Elizabeth Benham (Cafe vi.) who had then
_ been
ON CANCERS. 167
been long recovered from the operation,
and gave her an account of it; fhe re-
folved to have her breaft taken off. I per-
formed the operation in the prefence of
Mr. M‘Dowell, of Shad Thames, South-
wark, removing all that was difeafed, and
bringing the edges of the wound into con-
tact. [hey were foon healed, and the re-
mains perfectly well ever fince. The fize
of this patient’s breaft_was fo enormous,
that when the edges of the wound were
laid in contact, there were feveral long and
deep wrinkles, or furrows in the fkin of
the breaft; but it foon contracted, and the |
unhandfome look from a number of loofe
flabby folds, foon went off, and fhe has
now. the appearance of a uniform round
plump breaft, fo that when fhe has her
ftayson, aftranger cannot diftinguith which
breaft has been amputated.
CA oe
158 OBSERVATIONS
po) Coa RB eX.
IN the year 1782, a widaw, about fifty —
years of age, alked my opinion concern-
ing a hard tumor in her breaft, fuppofed to
e an occult cancer, which it appeared to
be on examination, and at that time favour-
ably circumftanced for the operation; I
therefore gave it as my. opinion, that no-
thing elfe would be of the leaft fervice, and
advifed her to fubmit to it as foon as pof-
fible. To this, however, fhe would not
then confent, becaufe her furgeon (a gen-
tleman in very extentfive practice, both in
furgery and midwifery) had affured her,
that her complaint might in all human
probability, remain dormant and inoffenfive
for many years; and that if fhe even did
fubmit to the operation, the difeafe would
return with more violence than before;
that he had feen many inftances of this
kind, and that it was the opinion of the
learned
ON CANCERS. Sg
learned Dr. Monro, that the operation
would not effect a cure. I told her, that
notwithftanding it was then quiet, and
partly free from pain, yet no perfon could
pretend to fay how long it would continue
fo; I muft therefore advife her, by all
means to have it removed in its prefent fa-
vourable ftate ; and not wait till fuch alte-
ration takes place, as would induce _ her to
fubmit to the operation, when it would be
more painful, and the profpect of its prov-
ing fuccefsful not fo great as at prefent ;
- that I could not help differing from the opi-
nion of Dr. Monro, becaufe my own expe-
rience, as well as that of others who had
much practice of this kind, made it appear,
that the operation performed on proper
fubjeéts, generally proved fuccefsful, and.
that by far the greater number of thofe
who fubmitted to it in time, enjoyed general
good health for many years, or as long as
they lived, without the leaft appearance of
a return of the complaint.
Bur
160 OBSERVATIONS
Bu'r as thefe arguments did not then
convince or prevail on her to fubmit to the
operation, I heard no more of her for fix
weeks, at the end of which time fhe fent
for me. The breaft was.a good deal en-—
creafed in fize, her countenance was be-
come {allow and wan, the had no appetite,
and complained of intolerable pain; fhe
informed me that the gentleman who had
firft feen her, defired her to confult ano-
ther furgeon, who had given her mercury,
and falivated her fince I had laft feen her.
This treatment had produced in this. cafe
(as well as in’ every other I had feen fo
treated) a manifeft increafe of the difeafe,
and all its fymptoms: fhe fubmitted to
the operation, at which Mr. Charles Mon- ~
taguc, and Mr. James Stuart (then my ap-
prentice) were prefent. She was perfect-
ly well ina fortnight.
GAST
‘ON CANCERS, 161
fe,
CAS EO XI,
Wher ELIZABETH ELLIS, of
Camberwell, fent for me in the Spring.
1783, to examine her right breaft.. She
faid all the medical gentlemen that had
{een it, agreed in the opinion of it’s being
a confirmed cancer. The operation had
been recommended, but fhe never could
make up her mind to fubmit to fo horrid
and painful an operation, which in the
end might not prove fuccefsful; and to
ufe her own words, this opinion was rivet-
‘ted more firmly in her mind, from the
fufferings of a neighbour of her’s, who
had undergone the operation, under the
care of one of the firft furgeons in town,
and gave her a dreadful account of the
pain of the operation, as well as the con-
finement-and dreffings for feveral months.
Thefe confiderations had determined her
to fuffer the difeafe to carry her to the
| | Lig orave,
162 OBSERVATIONS
prave, until fhe heard of Mrs, Smith’s ©
_ cafe, before-mentioned, on this account,
(and for other reafons with which I {hall
hot trouble the reader) fhe had retracted |
her former opinion, and fent for me to
perform the operation as foon as I thought
proper; fhe thought exceflive grief was
the caufe of ker complaint ; for foon after
the death of her hufband fhe perceived a
{mall lump in her breaft, which gradually
increafed till the time I faw her, it was
‘then large and firmly attached to the pec-
toral mufcle and ribs, and had a large
cancerous fore round the nipple, attended
with lancinating pains piercing through
the tumor, which was hard, craggy, and
uneven. She was corpulent and near fixty
‘years of age. Itold her that whatever
might have been. the caufe of her com-
plaint, it was my opinion that it-was a
true cancer, and that I feared the had too
long deferred haying the operation per-
formed, and that the might not’reap any
advantage from it now, and therefore
ore Ss could.
ON CANCERS. oh EGR
could not recommend it. Her anfwer
was, that fhe was determined to have it
off, as fhe could not be worfe after the
operation than fhe was then. From her
prefling and anxious folicitations I (uffered
her to fend for the family Surgeon, Mr.
Green, of Peckham, who accordingly met
Mr, Haynes and me next morning, I
performed the operation, including the.
cancerous fore in a double incifion, and -
was obliged to cut away a confiderable
portion of the pectoral mufcle and lay two
of her ribs bare. The edges of the wound
were brought into contact, they united,
and the cicatrix was formed:in the ufual
time. 3
Lz CASE
364 OBSERVATIONS
Fa
ye fF. ? B
: EEA Eo BEBE ft
iH & £ & 8 £ i
SE XIU.
4
CoA
Me. RUMSEY, Surgeon, at Amer-
fham, in Buckinghamfhire, had removed
a {cirrhous tumor of the breaft, and drefied
the wound in the ufual way, but never
could get it to heal. The ulcer encreafed
in fize, and the whole breaft became dif-
eafed. Some time after in January 1784;
he faw me perform the operation I have
recommended on a lady in the fame coun
ty, and approving of it, acquainted me, if
he could prevail on his patient, Mrs. But-
cher, of Beacon’s-field, aged 54, to fubmit
to a fecond operation, he would try my
method. She confented, and I affifted at
‘ the operation, when Mr. Rumfey removed
the whole breaft, including a very large
ulcer (above three inches in breadth) by
the double incifion. The patient being:
corpulent, and the breaft naturally large,
there was {kin fufficient for the edges to
. be
ON CANCERS.” 165
be brought accurately into contact, which
was accordingly done by Mr. Rumfey,
with great care and nicety. The parts
healed up perfectly, in the ufual time,
nor has there been the leaft appearance of
a return of the complaint, the patient
having enjoyed a good ftate of health ever
ibe
Eo GA SE
‘166 - OBSERVATIONS
: CAS Be XII.
Soon after this a widow lady applied
to me at the Difpenfary. Her’ breaft had
been difeafed for feveral years, during
which time fhe had tried all the medicines
ufually recommended in fuch complaints,
without experiencing any real advantage
from them. About eight months before
fhe applied to me, fhe had fubmitted to
the operation, which was performed in
the old way by an eminent Surgeon, who
‘remov ed a large cancerous tumor, together
with an oval piece of fkin. The wound
had never healed up; and when I firft
faw her, there was a,foul cancerous ulcer
about tvo inches in breadth, exclufive of
which the whole breaft ‘was_ difeated ;
and, to ule her own words, was grown
out much larger than before the firft ope-.
ration, and ed larger than the breaft
that was not dileafed. She, with great
ay ‘fortitude
ON CANCERS. ay aie
fortitude of her own acco faid the. was
willing to fubmit to the operation, per- -
formed according to my method, as fhe
had no confidence in medicines. I re-
moved the whole difeafed mafs by. the
double incifion, brought the edges of the
wound together, and it. healed by the fir
intention; the has continued perfectly well
ever fince. Mr, Baxter, Surgeon of the
Oreftes frigate, and Mr. Ellifon, were
prefent at the operation,
fie, ECAS Sy
768. OBSERVATIONS
CASE XIV:
In the year 1784, a lady, at the time of
her menftrual flux becoming irregular,
but being otherwife in good health, re-
ceived a blow on her breaft, a f{mall-hard
lump was formed in the part, to which
fhe paid no regard, for a fortnight after
the accident, when it was about the fize
ofa wallnut. Inthe {pace of three months,
it increafed to the fize of an egg; and at
the end of three months more, it had in-
creafed to double the fize, or was nearly
as big as one’s fift. By this time, the pain
increafed confiderably, and, toufe her own
words, fhe felt a growing in the part, with
pains fhooting to the axilla and fhoulders,
which increafed with the tumor, till the
whole breaft became affected; notwith-
ftanding every remedy and application that
could be thought of, had been tried by re-
eular and eminent praCtitioners, as well as
aie ee + by
“ON CANCERS, ° 3 169
by itinerant pretenders, The general pro+
grefs of this difeafe is fuch as I have juft
now defcribed ; and fo far as.I have had
opportunity to obferve, I am led to believe
it takes this courfe nineteen times in
twenty. The lady finding no relief from
any thing that had been done, much lefs
any hopes of a radical cure, confented to
the operation, which, being applied to for
that purpofe, I performed. Mr. Haire,
Surgeon, at Southminfter in Effex, affitted.
It is neceflary to oblerve here, concerning
what happens in many other cafes as well
as in this, that there were fome glands
behind the edge of the pectoral mufcle,
“between it and the axilla, indurated, yet
“very fmall, being only about the fize of a
horfe-bean, all which I carefully removed.
UNLEssan operator be accuftomed to
the feel of fuch glands, and know where
to fearch for them, he might readily pafs
them over, and fuppofe the parts there to
< baie found, the enlargement of
thefe
170 OBSERVATIONS
thefe glands being very inconfiderable.
{~The beft method of fearching for them, is
to raife the patient’s arm, and prefs the
points of the fingers from the poitertor
edge of the pectoral mufcle towards the
axilla. If there be any difeafed glands
they will be found in the courfe of the
lymphatics, gradually increafing and deep-
er feated as they extend into the axilla,
CASE
ON CANCERS. r7t
i2 sie ‘
~ % Bosbinesasaerren™ 4
Po $3 ‘ fi hee
DP a og ag bt hit h.a03
ws OO EF pte
A LADY, twenty-fix years of age,
who had never been married, perceived
a {welling in her right breaft, but knew
no caufe to which it could be attributed,
as the part had not been hurt by a blow,
nor injured by any external violence. The
complaint took the ufual courfe defcribed
in other cafes, till increafe of pain and fize
obliged her to apply to Mr. Pott, who at
that time (about three years ago) advifed
the immediate removal of the difeafed part.
To this fhe could not then be prevailed on
to confent. But at length, fhe was con-
vinced of the propriety of his advice, by a
neighbouring lady at Guildford, who had
been under the care of the firft’ Cancer-
Quack of the prefent time, from whofe
{pecious promifes fhe was led to expect a
radical cure in the {pace of fix months,
without undergoing any operation, Du-
ring
172 OBSERVATIONS
ring this time, inftead of receiving any re-
lief from the various noftrums and appli-
cations ufed, her complaint increafed, till
at length no hope could be entertained
from the operation. She lmgered a few
months in dreadful torture, during which
time the fent daily’ to enquire about Mifs
P—’s health, often requefting her to come
‘to town and have the operation performed,
before her cafe became fo defperate, that
fhe could entertain no hope fromit. ‘The
account of the former lady’s fufferings
and death indaced Mifs P— at length to
fubmit to the operation, but not till there
was a large cancerous ulcer formed.» Ap-
plication was made to me, to perform the
@peration in this cafe, which | did in the
prefence of Mr. Crawford, Mr. Getty,
and feveral other gentlemen of the faculty.
She recovered, and is now in good health,
without any appearance of a return of the
difeafe, |
CASE
‘ON CANCERS. 273
GAS. E, XV
In March 1785, a gentleman whofe fcros
tum was enormoufly fwelled, applied to
Mr. Shuter of Southwark. The cafe bes
ing very curious and extraordinary, Mr.
Shuter defired a confultation, to which
the patient agreeing, I was called ins On
the firft view and examination # appeared
to me to be a double hydrocele, accompa=
nied with a farcocele on one fide. On
that fide where I fuppofed the farcocele,
there was a foul ulcer on the f{crotum,
with ragged uneven edges, from which
appearances we fuppofed it to be cans
cerous. The {welling on both fides of the
fcrotum was {fo great, fo prominent, and
extended over the os pubis, that the penis
was quite buried under it, the prepuce of
which we could hardly get a fight of
and when he made water, it dribbled over
the tumor, and frequently excoriated the
{crotum,
174 ‘OBSERVATIONS
fcrotum, which was exceedingly diftended.
The tumor being fo enormous, we could
not form any clear and certain opinion
cencerning the nature of the cafe and the
true ftate of the teftes. But we agreed,
that the firft thing to be done was, to draw
off the water on both fides by the trochar,
in order to examine the ftate of the teftes,
This being done, we found the right tef-
ticle under the ulcer (the fide on which
we had fuppofed the farcocele,) to the
feel, perfectly round, and of a natural
fize within.the fack, and that the ulcer
was at a confiderable diftance from this
tefticle. On the left fide, where we fup-
pofed nothing more than a fimple hydro-
cele, the cefticle was fo difeafed, that the
~ immediate removal of it was abfolutely ne-
ceflary. To this the patient confented,
and I performed the operation. In dif-
feting it away, | found an adhefion to
the feptum {croti, through which I was
obliged to cut. This produced an inflam-
mation of the tunica vaginalis of the right
tefticle,
ON CANCERS. : i7§
tefticle, which terminated in a radical
cure of the hydrocele on that fide. The »
ulcer of the {crotum not proving cans
cerous, but having been occafioned by the
extreme diftenfion of the part, the irrita-
tion produced by the urine and rubbing
of the patient’s clothes very foon healed,
fo that the patient was perfectly well at
the end of three weeks, reckoning from |
the day I performed the operation.
CAS E
176 «OBSERVATIONS
OAS EB) SGVIT.
A FEW months after the foregoing
cafe, Thomas Bell, of King John’s Court,
Bermondifey, was admitted a patient of
the Surrey Difpenfary, under my care.
His complaint was exactly fimilar to that
IT have juft defcribed.. There was a dou-
ble hydrocele, but not quite fo large as in
the former cafe. There was alfo an ulcer
on the fcrotum, with ragged edges, ex-
tremely foul, foetid, and painful, in*every
tefpect refembling a real cancer. From
the fuccefsful treatment of the foregoing
cafe, I could not be at a lofs how to pro-
ceed in this. Having drawn off the water,
I found the tefticle under the ulcer per-
feftly found. But that on the other fide
was fo difeafed that I immediately removed
it. ‘There was no adhefion to the feptum
{croti, asin the former cafe: yet an in-
flammation of the tunica vaginalis on the
oppoiite
ON CANCERS, (177
oppofite fide took place, and produced a
radical cure. The ulcer likewife foon
healed ; the caufe which produced it
(namely a diftenfion of the fcrotum)
having been removed, the effect of courfe
ceafed. Mr. Baxter and Mr. Ellis were
prefent and affifted me at the operation.
Our patient has enjoyed an uninterrupted
{tate of good health ever fince.
178 OBSERVATIONS
OBS ER VATION,
F ROM the foregoing cafes, it is evi-
dent, that we cannot always form a clear
and juft opinion, either by the appearance,
or examination of the parts by handling,
as the tefticle we fuppofed difeafed proved
to be found, and vice verfa. Many Sur-
geons truft too much to the appearance
and a flight feel or examination of the
part, and fufpect nothing but a fimple hy-
drocele, where, by a more accurate exami-
nation, it might have been difcovered to
be complicated with a fcirrhus or difeafed
tefticle. When we can feel the body of
the tefticle enlarged in fize, hard and
uneven, there can be no doubt that it is
difeafed, and in fuch a ftate it requires a
much greater quantity of water to conceal
it entirely from the touch, than what
will conceal a found tefticle. But when
the fcrotum is fo exceedingly diftended
| with
ON CANCERS» 179
with water that the body of the tefticle
cannot be felt; the hiftory of the difeafe,-
how it was produced, and the pain attend-.
ing it, and the weight of the part, (weigh-
ing it in the hand) are the principal rules
to dire& us in forming an opinion of the
ftate of the tefticle. If doubts ftill re-
main, the fafeft practice is to treat it as a
fimple hydrocele, which is attended with
very little difadvantage, as the Surgeon
can proceed to extirpation, if the feir-
rhous or difeafed ftate of the tefticle re»
quire it,
M 2_ CASE
180 OBSERVATIONS
Gi Aor Me xav iit,
In the month of O&tober, 1785, the fol-
lowing cafe was fent by Mr. Robinfon,
affiftant to Mr. Jones of Whitchurch, in
Shropthire.
A cAsE of a fcirrhus of the mamma
eccurred to Mr. Jones above two months
ago. He had, when in London, about
patted years ago, attended Mr. Elfe,
who had peneiy infifted in his fectanee
that there was no cure for thofe infections,
and that the operation was only an addi-
tional pain given to the patient, without
a probability of fuccefs. For that very
reafon he had never ventured to perform the
operation. But having read your treatife
on cancers, juft at the time this cafe oc-
curred, it induced him to recommend the
operation, according to your method; to
which the patient fubmitting, he performed
If
| oa
“ON CANCERS. 181
at with-fuccefs. The tumor was fituated
juft under the nipple, quite indurated, but
moveable. She had violent pains in the
axilla, which extended along her arm.
She was fubject to a violent head-ach,
with ficknefs and vomiting, particularly
every morning. She laboured under all
thefe fymptoms for fome months, had
been in London, and had tried every me-
dicine in vain. Finding no relief, fhe re-
turned to the country, and applied to Mr.
Jones, who, for the reaions before men-
tioned, advifed and performed the opera-
tion according to your method. I hope
it has anfwered his expectations, as the
{hooting pain in the axilla has not re-
turned, and the head-ach and ficknefs
have left her ina great degree. Part of
the peftoral mufcle was difle@ted away,
which was unavoidable, the tumor ad-
hered fo ftrongly to it, yet notwithftande
ing fhe has perfeétly recovered the ufe of
ae arm, As fhe fometimes complains of
a lancinating pain in the part, is fubjec
M 3 ta
182 OBSERVATIONS
to complaints in her bowels, and her
complexion of a fallow hue, I fear abforp-~
tion had taken place, by her delaying to
fubmit to the operation in time. Yet I
would fondly hope I may be miftaken in
‘my apprehenfions.
I wave given the foregoing cafe in
Mr. Robinfon’s own words, from whom
J have not fince had any further informa-
tion of the patient’s ftate of health. Had
the difeafe returned, I think he would
have acquainted me of it.
CASE
ON CANCERS. _ 183
Pie teaA SB os Xiah ee
On the 26th inftant, while this pame
phlet was in the prefs, I received the fol-
lowing cafe, from Dr, Chefton, Surgeon
to the Gloucefter infirmary, and Fellow
of the Royal Society ; a gentleman as
well known in the literary world, as he is
_diftincuifhed and refpected in that part of
the kingdom where he refides, as the
moft eminent practitioner, As the accu-
racy and ingenuity with which he has
{tated it, render the leaft alteration unne-
ceflary, I give it literally in his own
words, |
Iw the fpring of 1785, Mrs. M. cons
fulted me for a very large, hard, and pain-
ful tumor in the right breaft attached to
the integuments around the nipple, im-
mediately under which there was a fuper-
ficial ulceration about the fize of a thil-
M 4 ling,
184 OBSERVATIONS
ling, from whence iflued a bloody dif-
charge in coniiderable quantity.
As the tumor was perfeétly moveable,
without the leaft affection in the axilla, or
any of the neighbouring glands, and as fhe
appeared in the moft perfec health, I
urged the immediate removal of it, as the
only chance of her avoiding the miferies
which then threatened her. It was how-
ever upwarcs of three montlis before the
could abfolutely determine to fubmit to
it; when having fixed on the 27th of
July, I performed the operation on that
day, in the prefence of Mr. Naylor, one
of the Surgeons to the Gloucefter Infir- ©
mary, aud of Mr. Browne, a Surgeon of
very extenfive practice at Minchin-Hamp-
ton, in whofe neighbourhood the patient
lived, and under whofe care fhe was to
continue.
-As my intention was to attempt the
cure by the method in which you had
| been
ON CANCERS! 18%
been fuccefsful, I began my incifion fufs
ficiently free, that I might not’ be confined
for room, and terminating it fomewhat in
the form of a triangle, included the nipple
with the whole of the difeated integu-
ments which furrounded it. Being parti-
cularly careful after the extirpation of the
tumor, to remove every fufpicious appear-
ance, the pectoral mufcle was, laid bare in
feveral places, from being obliged to carry
my diffection very high up, for the re-
moval of a kind of condenfed cellular
membrane, which however was probably
more the effect of the dragging weight of
the breaft, than any communication of
‘difeafe from the enlarged gland. Many
veflels bled very freelv in the courfe of the
difietion, but i did not think it neceflary
to ufe but one ligature. |
Avs fhe had natura'ly a very large breaft,
the quantity of the mteguments which
remained was amply fufficient to give us
‘every pro{pect of ducceis; and fecuring
them
*
386 OBSERVATIONS
them when brought together by fmall com-
prefles of cloth properly fituated for that
purpofe, the whole was confined by a cir-
cular bandage as ufual around the cheft.
VisITING my patient on the fourth
day afterwards, I had the pleafure, upon
removing the dreffing, of finding the moft
promifing union in every part, unlefs
where the ligature was fuffered to remain.
And as the fubfequent care devolved on
Mr. Browne, I had the further fatisfaGtion
of hearing from him, that a {mall dif-
charge continued a few days till the ligature
threw off, and that the cicatrix was com=
pletely formed at the end of a fortnight.
Tuus far every circumftance anfwered, _
I may fay exceeded, my moft fanguine
‘expectations, and fhe continued perfectly
well till the middle of January 1+86,
when fhe caught a fevere cold, which was
fucceeded by a troublefome cough and
tightnefs on her breath. About the latter
no end
ON CANCERS. 187
end of this month fhe found fome uneafi-
nefs in her left breaft, which upon exas
mining attentively, fhe perceived confider-
ably: fuller than formerly, and with 4.
hardnefs in every refpect fimilar to the
complaint in the right breaft when in its
incipient ftate. Soon afterwards finding
fome difagreeable fenfations about the
centre of the part, from whence the ifdu-
ration had been extirpated, fhe there found
a knot equalling a Spanifh nut, and upon a
more diligent fearch, a {mall fubftance in
the right axilla, of which fhe had never
had the leaft previous notice; as well as
-feveral enlarged glands on each fide the
neck immediately above the clavicle. ©
As fhe lived at a diftance from Glou-
cefter, and had once made a journey to
confult me on her alarming fituation,
when I happened to be from home; I
took the opportunity, when vifiting a pa-
tient in the neighbourhood on the 15th
inftant, of ¢alling on her, and found mat-
ters.
88 OBSERVATIONS
ters as above defcribed, the hardneffes not
having made much advance of late, but
the cough and tightnefs on her breath
eccafionally affecting her fo much, that
fhe could not walk upon level ground
without great inconvenience, nor up hill
without a threatning fuffocation.
THOUGH my ‘patient is at prefent in
this unfortunate fituation, I do not confi-
der it in the leaft to militate againft the
mode of operation. When we oppofe the
eafe and expedition of the cure to the ims
menfe fize of a wound after the extirpa-
tion of a tumor which weighed near three
pounds and a half, and compare it with
the pain, time, and diftrefling circum-
ftances which would neceflarily have at-
tended a large ulcerated furface in the
ufual mode of operating, the improvement
cannot but recommend itfelf in the
ftrongeft degree. . |
Il opsERVED at firft, that I did not fee —
Mrs,
‘ON CANCERS. » 189
Mrs. M. for fome time before the day of
the operation. Upon talking with her im-
mediately on my arrival at her houfe, I
found the remains of an eruption on her
fkin, which fhe attributed to a former furs
feit, but which I could not help exprefl-
ing my fears to the gentlemen in attend-
ance with me, to arife from an unfortunate
abforption, which of itfelf might poffibly |
counteract our fuccefs, as I had in feveral
inftances feen an erifipelas about the bo-
fom, with general efflorefcence, mark that
circumftance, and prove a certain fore-
runner of impending mifchief and danger,
This remark I fubmit to future attention;
as an object highly worthy of notice; for
though the glands in the neighbourhood
of acancerous tumor are often found afs
fected, without any fymptom whatever to
denote the time abforption took place, yet
J have never feen the circumftance aboves
mentioned, without an almoft immediate
change for the worfe in every re{pect.
Gloucefter, ‘June 25th, 1786.
290 , CBA aaetons
° f
Of 4 _phommeagn peers 3
OF oF & , ep 0 08 £ oe gm =} Sy Peal Prada ier» namie aay ta Oy
A Elo eke re paral Ye : OO ical Mn Manabe. WF Xe
4 & es
B Y the earneft defire and intreaty of an
individual, in the agonies of a complaint
which foon after terminated her exiftence,
who from painful and terrible experience,
wifhed to warn others again{ft the like
fatal delufion, to which fhe fell a vidtim,
I have been induced to publifh the fol-
lowing cafe.
_ Ju the month of January 1785, Mrs.
Chidley, late of Chidley Court, Pall Mall,
having been afflicted with a cancerous
tumor in her breaft, came to a refolution
to have it removed by the knife; the moft
eminent operators in town being af opi-
nion, that the immediate removal was the
only method by which fhe could expect a
cure, as no external application nor iter-
nal medicine was likely to produce any
thing more than a temporary relief, She
therefore
ON CANCERS. 191
therefore had made up her mind to fubmit
to the operation ; when, unfortunately for
her, fome officious perfon put into her
hands one of Dr. Geifler’s hand-bills,
from which, together with his incompara-
ble advertifements in the daily papers, s-
defily challenging all the Hofpital Surgeons
in London, fhe was induced to fend for
him, thinking there could be no impropri-
ety in hearing what he would fay. In his
firft vifit he foon removed all her fears, by
affuring her, that he would in a fhort time
make a perfect cure, without any sacking
or cutting infiruments, adding at the fame
time with affected aftonithment, « What
‘¢ horrid ignorant butchers they muft be, who
** auith knives, faws, and other dreadful in=
<° Lruments, disfigure the human form divine?”
Mrs. Chidley was therefore induced (the
fears of a delicate female being excited by
the idea of the knife) to put herfelf under
his care. But in fpite of all his soffrums
and infallible {pecifics, the tumor with eve-
ry concomitant fymptom, encreafed. At
leneth
192 GESERVATIONS
Jength he began to apply efcharotics, or,
as he called them, ftrong drawing plaif-
ters, afluring her, if fhe would take his
phyfic, have patience and allow him time,
he would bring away the whole difeafed
mafs by the roots, with his finger and thumd;
and as the integuments floughed away by
the * cauftic applications, it was his ufual
way to take up a clot or lump with his fin-
ger and thumb, faying, ‘* dis be van of de
‘* roots, me get dem all away in time, me
** preferve dis in {pirits.” Thus did he at-
tend and torture this unhappy patient for
fourteen months, till the tumor encreafed to
fuch an + enormous fize, as can hardly be
* The bafis of all thefe applications is a cauftic, either
arfenical or fome other kind, which is infinitely more pain-
ful than the knife, not fubjeét to limication or direction, and
much more uncerizin as to its effects. Surely there is no
other country, where the fcum of the creation, utter-
ly dettitute of every fpecies of knowledge, except that of
impofing on rhe credulous, are permitted with impunity to ©
commit fuch devaftation !
f The circumference meafured twenty-fix inches, and
the diameter in one part fourteen.
thought
ON CANCERS. 193
thought credible, every fymptom becoming
worfe and the conftitution being at length
fo tainted or affected, that no hope could
be entertained from the operation. In
this dreadful ftate fhe fent for Mr. Ireland
of Pall Mall, who had formerly been her
Apothecary. He advifed her to fend for
me, which fhe did, being then very de-
firous to undergo the operation, But as I
could not at that period of the complaint
entertain the leaft hope of fucceis, I de-
clined performing it, and was afterwards
informed that Mr. Pott and others had
done the fame;
Worw out and emaciated with excef-
five pain and the progrefs of the difeafe,
and become at laft refigned to the melan-
choly profpect of living but for a few days,
fhe thought it her duty to make her cafe
known to the public, that it might bea
warning to others, and prevent them from
being deluded by {fpecious promifes, and
in the end not only defrauded of their
N property
194. OBSERVATIONS
property but of their lives alfo. Feeling
myfelf indifpenfably bound to comply
with her wifhes, moft humanely and dif-
intereftedly directed to the good of others,
I have accordingly drawn up this concife
fketch of her cafe, without entering into
unneceflary particulars.
From the account fhe kept, it appears
the dreflings or plaifters the ufed, of which
fhe was forced to be* frugal, with fome
few internal medicines fhe took, coft her
above fifteen fhillings a week, on an aver-
age. Of the internal medicines fhe took,
fhe fhewed me the remains of a phial of
fweet fpirit of nitre, for which he had the
con{cience to charge her a guinea.
For fome time before her diffolution,
* Mere Gersier made her hang up the plaifters
(when removed) acrofs a line in the room to’ dry, and
by that contrivance applied them SERRE till perfectly
Work Out.
the
ON CANCERS. 195
the pain was at times fo exquifite, that fhe:
would ftart out of bed and run about the
houfe, up and down ftairs, like one fran-'
tic, though the* weight of the tumor
was fo great that fhe had not ftrength
even to fit up, except when feized with
one of thefe fits) The fmell at laft was
fo offenfive that it could be born only by
thofe who had been accuftomed to it from
being conftantly about Mrs. C. It -was
her earneft with that the publication of
her miferable fituation might prove at
leaft fo far ufeful as to prevent fome
others from being impofed on /o long, zill
the complaint gains ground fo far, that
nothing but death can put an end to fuf-
ferings that furpafs all defcription,
THIs may appear an extraordinary cafe,
but in this over-grown metropolis there
are great numbers affected in the fame
* Tue difeafe after her death being removed, weighed
ten pounds and three quarters.
N22 manner
1g6 OBSERVATIONS
manner Mrs. C. was originally affected,
who, by applying to itinerant pretenders
muft naturally meet a fimilar fate. For
the cafe related 1s only a plain hiftory of
the ufual progrefs of this difeafe, when
improperly treated. And as it conveys
fuch important and ufeful information to
thofe affe&ted with cancerous complaints,
I fhould think myfelf highly culpable in
withftanding the impulfe of humanity,
together with Mrs. C’s intreaties to pub-
lifh it; as it may prove effectual in re-
{cuing many out of the hands of illiterate
quacks, who to the diigrace of our legif-
lature are fuffered to {port with the pro-
perty and lives of their fellow creatures,
before they arrive at that dreadful period
which admits of no hope.
CASE
‘ON CANCERS.» 197
CAS Bo Oe a
A YOUNG woman, only twenty years
of age, received a violent blow on her right
breaft, by the handle of a pump, in the
year 1784, and a tumor fucceeded, con-
cerning which I was confulted; fhe was
then bled, took fome opening medicine,
and was ordered to live abftemioufly,
A GENERAL enlargement of the whole
breaft continued for two months, before
it began to fubfide, and then diminifhed |
about one half its fize. Buta confiderable —
induration remained, without producing
much inconvenience, except at intervals,
when fhe was afflicted with darting prick-
ing pains, from which however fhe expe-
rienced intermiflions, fometimes of two or
three days, at other times of weeks,
Occasionat bleedings, 4 light regi-
N 3 men,
4
T98 OBSERVATIONS
men, an open belly, and the cicuta, was
the plan which afforded relief, and to
which fhe ftritly adhered till the {pring
of the year 1786 (two years from the
accident) when an increafe of all the fore-
going fymptoms very juftly alarmed her.
I wAs again fent for, when I found the
difeafe had increafed, the nipple was con-
tracted, and the fkin ulcerated, with hard
uneven edges, from whence fungus {j prouted
out; her pains were very acute, with lit-
tle intermiffion. I then exprefled my ap-
prehenfions refpecting the event of the cafes
and recommended the removal of the
breaft ; which however was not confented
to till fhe had confulted feveral Surgeons,
and receiving no encouragement from them,
fhe confented to fubmit to the operation,
which I performed in the prefence of Mr.
“Turnbull, Surgeon to the Eaftern Difpen-
fary, and Mr. Cummings, of Queen-{treet,
Cheapfide. She recovered in a few days,
and has had no complaint ever fince. ©
CASE
ON CANCERS, 199
A, SE EL
A LADY in Alderfgate-ftreet, thirty-
eight years of age, applied to me in the
Summer, 1786, by the defire of Dr. John
Sims, on account of a cancer in her breaft,
THE complaint had been of three years
ftanding, and extended from the breaft
into the axilla,
THE difeafe, upon the whole, was fo
far advanced, that I recommended the im-
mediate removal of the part, as the only
remedy to free her from pain, and fave her
life. She however would not then con-
fent, and her friends recommended Mr, |
Sharp, under whofe care fhe remained two
months, During this time fhe had taken
every medicine that had been known of
wf in fuch cafes, and at the fame time
| N 4 was
; by
200 OBSERVATIONS
was under an alterative courfe of mercury,
but all to no purpofe.
SHE took Mr. Pott’s opinion, and at
length confented to my performing the
operation, at which Mr. Sharp, and Mr.
Wheeler the Botanift attended.
Tue diffection from the breaft into the
axilla was tedious and difficult; however
all the difeafed glands were removed, and
the integuments brought into contact, and
they united by the Firt Intention. She
has experienced no return of the complaint,
CASE
ON CANCERS, 201
GAS E XXL
I WAS defired by Dr. Cooper of Nor-
folk-ftreet, to attend a lady in Saint John’s
{quare. She was corpulent and about
forty years of age. There was no doubt
about the nature of the cafe. It was a
truly {cirrhous affection of the breaft, ar-
rived at fo advanced a ftate, without any
known caufe, that I did not hefitate im-
mediately to urge the operation, to which
fhe would not then confent; but during
the {pace of more than two months, took
the opinions of the moft eminent of the
profeffion, and tried various medicines
without receiving any benefit. At length
fhe confented to the operation, and a day
being appointed Dr. Cooper attended,
There was nothing particular occurred
during the operation, after which fhe was
put to bed, felt very faint and cold, ‘The
nurfe gave a cordial, and loaded the bed
with
202 OBSERVATIONS
with clothes, which foon encreafed the
impetus of the circulation, and a hemor-
rhage enfued. I was fent for ina hurry,
and was under the neceflity of removing
the whole of the dreflings, and a much
greater quantity of blood, than had been
lot during’ the operation, The coagulate
blood being entirely removed, T did not
think it neceflary to fecure any of the vef-
fels that had bled, but drefied the patient,
ftriGly guarding againft the repetition of
every thing fimilar to what had occafioned
the former hemorrhage. Every thing
went on well, and the lady has enjoyed
fuch perfect health, that fhe has fince the
operation prefented her hufband with two
fine epi:
Dr. CueEston faw this lady in Glou- -
cefter fome time after fhe had recovered
frem the operation; and about twelve
months ago, when he was in London, he
called to fee her, and exprefled himfelf
highly pleafed with the event.
CASE
ON CANCERS. 203
GAS E” XXtv,
A. B. A poor man in the tin bufinefs,
of a thin habit and fallow complexion,
forty-two years of age, was admitted a
patient at the Surrey Difpenfary, in the
Autumn, 1787,
THE account which he gave was, that
two years before, he perceived an enlarge- |
ment of one of his tefticles. But as it
gave him little trouble for*near a year,
except fome darting pains once or twice
a week, he did not think of applying for
advice. Soon after this, it had encreafed
prodigioufly in fize, and the pain became
very acute and frequent, fo as to prevent
his having reft without the affiftance of an
opiate-—In this fituation he was admitted
into one of the firft hofpitals in town,
where he remained feveral months, and
after
204 OBSERVATIONS
after different confultations he was ditt
charged incurable.
Ow the firft view of the difeafe, I was
fhocked at the appearance of it. In fize it
was largerthan his head, extending from the
ring 12 the abdomen all over the pelvis,
burying the penis and the other tefticle, and
extending down to the anus; his breeches
were obliged to be made fo large to contain
this huge mafs, that delicacy di€tated to this
poor man the propriety of conftantly wear-
ing an apron to cover it. There were
ulcers on different parts of the tumor.—My
prognoftic was very unfavourable ; which
the poor fellow faid, was no more than he
expected, and an operation he was deter-
mined on, if he fhould die under it: for
though it aiforded a very diftant hope,
yet he had no with left but an attempt to
remove the difeafe, and that afterwards he
would die more contented, that he had
fubmitted to every thing that could poffi-
bly be done for him, Under thefe cir
| cumftances,
ON CANCERS. 208
cumflances, and being fo frongly preffed
by the poor man, I performed the opera-
tion, at which Mr. Gaielie of the Borough,
Mir. Day, Mr. Hadley, Mr. Dawfon, and
Mr. Simpfon attended.—After I laid the
fpermatic chord bare, by the firft ftroke
of my knife, it was fo thickened into the
abdomen, (but not hardened and knotty
as in fcirrhus of the part) that it occurred
to me that there might be either omentum
ot inteftine down. This idea rendered
the remainder of the operation more tedi-
ous, but the event proved neither to be
the cafe. It was only an enlargement of
the chord, probably occafioned by the
weight of the difeafed mafs. To the
aftonifhment, not only of all who were
prefent at the operation, but likewife of
all who had ever feen this cafe; the
patient recovered, and enjoys an uninter-
rupted ftate of good health to the prefent
moment.
CASE
206 OBSERVATIONS
, , 0 en gi . A ‘
GENS UY
THE following cafe I received from
Mr. Ingham, Surgeon to the Infirmary at
Newcattle upon Tyne. ;
Newca/tle, April 28th, 1787.
SR:
APPROVING very highly
of your method of extirpating difeafed |
breafts, and the attendant fuccefs in feve-
ral cafes, I determined the very firft oppor
tunity to operate in fuch difeafes, accord-
ing to the plan defcribed in your publication
on that fubjec&t; I therefore on the 2d of
February laft removed three painful {cir-
thi in the left mammary ry gland, each of
them rather Jarger than a common-fized
chefnut, by a He incifion through the
integus
ON CANCERS. 20%
integuments, upwards of five inches in
leneth, difle@ting out the indurated parts $
the lips of the wouhd were then united by
flicking piaifter ; and on the fifth day
from the operation I took off the dreffing
and had the fatisfaction of finding the
whole completely healed.—My patient had
no complaint after the operation, and fhe
continues perfectly well, the breaft has
{carcely the appearance of having been
operated upon.—In juftice to your merit
in communicating fo important an ime
provement in Surgery to the world, I fend
you the hiftory of this cafe, and 1 fhall
whenever any thing material on this fub-
ject occurs give you every information in
my power.
I am, Sir,
Your obedient
humble Servant,
Wn. INGHAM.
To
208 ~ OBSERVATIONS
To the cafes already given, I might:
add many others received from different
parts of the kingdom, But this pamphlet
has already fo much exceeded the bounds
I intended, that I am obliged to ftop here,
fupprefling many fuccefsful cafes. This, _
I hope, will be accepted as a fufficient
apology, by thofe gentlemen, who have
favoured me with cafes,
‘THESE two I have felected froma great
number, it being my wifh and intention
not to conceal from the public any one
that had the leaft appearance of terminating —
unfavourably.
R E-
ON CANCERS: 209
REMARKS.
THE foregoing cafes are f{elected, being
the worft in which I have operated, and.
fhewing at what an advanced ftate of the
difeafe the operation may be attended
with fuccefs. Many others might be
added of milder nature, which of courfe
were all fuccefsful. But thofe I have
given fufficiently prove the advantages of
the methods of operating I have defcribed,
and juftify the manner in which I have
fpoken of them, in the former part of this
treatife. I have given two cates which
quickly proved fatal, though no operation
was performed.
~ 'Tuess cafes thew the propriety of hav-
ing recourfe to the operation in time. I
have likewife given an unfuccefsful cafe in
which | performed the operation, viz. that
of Elizabeth Auger ; and even from that
O | cafe,
Z16 OBSERVATIONS
cafe, the practicability and advantage of
uniting the parts by the firft intention ap
pears, which {ucceeded in the feeond ope-
ration, as well as in the firft, though a
eonfiderable portion of the integuments
was removed by the double incifion: |
venture fo fay, that this and one other
fince the firft edition of this pamphlet;
are the only unfuccefsful cafes; as: the
other patients are all at this time ‘living,
and, without exception, free from any
appearance of a relapfe. ‘e
Upon the whole, I cannot help regard+
ing this tmmediate unton of the parts’ by
the firft intention, and the fpeedy-cicatri-
zation of the wound in ten or twelve days,
as the two great effects -refulting from:
thefe operations, and the advantages arifing,
therefrom as invaluable. |
WHETHER among other good effects
they have a tendency to prevent a return
-of the difeafe, time and experience muft,
| deters
ON CANCERS, eit
determine. This we know for certain,
that in the ufual method of amputating
the breaft, a wound of 4 large furface is
made, which by the application of lint,
and the {Kin being allowed to retraét, be-
tomes confiderably larger by the time it is
firt dreffed, than it was se Firs it, after
the peceates sath A a
~
om
i: aires “the greater fufferings of. the
patient, much time is loft in the healing
up of this wound, generally three months
or more $ in many cafes it never can be
healed intirely ; but when it comes to the
breadth of a fhilling, fpreads out afrefh,
and the difeafe returns, or perhaps is
thereby reproduced,
O 2 CASE
2132 OBSERVATIONS
CASE XXVI.
M Y friend Dr. Squire, one of the a :
ficians to the lying-in charity, and a'moft
attentive and obfervant practitioner, has
been fo kind to fend me the following
cafe, fo ftrongly in favor of the method I
have laid down, in the paper of the 2d
vol. of the Memoirs of the Medical So-
ciety.
Tuts and the following cafe were acci-
dentally miflaid by the printer, and not
found till it was too late to introduce them
in their proper place. . Their importance;
however, will juftify me in adding them
by way of Appendix, and in faying that
though laft they are not leaft.
DEAR
ON. CANCERS 213
DEAR SIR,
I HAVE great pleafure in
communicating to you the following cafe
of a fcirrhous affection of the breaft, in
which the treatment you firft fuggefted,
was ufed with great fuccefs, In the be-
ginning of March laft, Mrs. G. in her
forty-fixth year, who menftruates irregu-
Jarly, applied to me on account of a come
plaint in her left breaft, which was gene-
rally enlarged to a confiderable fize, indu-
rated, and extremely tender, the had fharp
fhooting pains through the fubftance of it,
and the pains extended to the axilla, and
fometimes to the other breaft. I thought
there was every reafon to fufpect a cancer,
amore efpectally as fhe had been fenfible of
enlargement, and uneafinefS for near two
years, 1 advifed four leeches to be applied
upon the breaft, and to be repeated every.
O 3 7 other
214 OHSERVATIONS
other day; that it fhould be covered
with a folded cloth, frequently wetted
with aqua lithargyri acetati, compofita ;
and that fhe fhould take the cictta’ in
‘powder three times every day, gradually
increaflhe the quantity, fill it amounted
to. one hundred and twenty grains daily;
which was as much as fhe could bear.
LENIENT purgatives were occafionally
piven, the breait was fufpended and guarded
from preffure, arid her diet was ftridtly
reoulated. In lefs than three weeks, the
breaft began to leffen in its fize, and the
pain to abate. About this titre you were
defired to feé her, and recommended het
perievering in the fame method, All the
complaiits gradually leflened, the breaft
-18 fiow reduced to its natural fize, the
itiduration is removed, and fhe is wholly
free from pain. Her général health has
not fuffered in any way froth, i rethied,
fhe has purfaed,
DuRING
|
.@N CANCERS. (BIg
Dvurinc the whole of her complaint,
the nipple was fhrivelled and contracted, |
from whence a thin fanious difcharge
iffued, which gradually diminifhed as fhe |
became better, and entirely ceafed when
fhe was cured, the nipple having reco>
-vered its natural found appearance,
I am, |
Dear Sir,
With great regard,
Your's moft fincerely,
I, Squire,
Naffau-fireet, 13th Fuly, 1789.
Gf CAGE
216 OBSERVATIONS
Co Aid Ee CV Lh
AC MAN about fifty years old was ad-
mitted a patient at the Surrey Difpenfary,
by the recommendation of his mafter, Mr.
Buckley, of Bermondfey-ftreet, in January
1788. |
He had a difeafed tefticle of the fcir-
rhous kind, it was hard and unequal. The
{permatic procefs was not in a natural
ftate, He had a morbid afpeét, and his
reft had been frequently difturbed by pain,
for the {pace of two years. He had been
advifed, during that time, to have it
removed: but he was averfe to, the ope-
ration. He was put upon a light diet,
and his belly kept open; the cicuta was
eiven, and leeches to the tefticle, three
times aweek. But it being in the winter,
when they were fcarce and dear, and the
patient poor, the young men who attended
ok my
ON CANCERS. 217
my practice, on whom J depended, and.
who had feen repeated proofs of the good
effets of topical bleediags, very impru-
dently bled him largely from the arm,
twice a week, and at intervals they opened
{mall arteries on the fcrotum. This eva-
cuation removed the complaint, but the
effet was very alarming. His abdomen
and legs fweiled very much, and he had
all the {fymptoms of a dropfy of the cheft.
Unpver thefe fymptoms I transferred
my patient to the care of my colleagues,
Dr. Dale and Thompfon, from whom I
afterwards underftood, that the poor man
recovered his health perfectly.
Ir may not be unworthy of remark,
‘that in cafes fimilar to that juft recited,
where the’ lots of fo much blood was ne-
ceflary, in order tq difperfe the tumor, I
have often found in practice, (part:cularly
in a {eirrhous cafe lately, where Mr. Jones
of Gracechurch-ftreet attended with me)
as
218 OBSERVATIONS
as the patient recovers from the original
difeafe, the fymptomatic or concomitant
fymptoms of dropfy gradually erished
and at length totally vanifh,
C:G NeCsr Sw @. FeO. SN.
TLuave now only to add, that I hum-
bly offer the operations I. have defcribed -
to the ‘public under no patronage whatever,
but truft to the advantages which by
experience may be found to refult from
them. Should they be thought any way
conducive to the improvement of the
chirurgical art, and by being brought into
general ufe, prove beneficial to my fellow
creatures, i diminifhing pain, sreatly
| fhortening
ON CANCERS, 219
fhortening confinement, accelerating the
healing of the part, and thereby adding
confiderably to the hopes of a cure; [I
- fhall think myfelf amply recompentfed for
the trouble taken in drawing up this little
treatife ; and fhall ever refle& on the time
, employed in this humble attempt as the
beft {pent time of my whole life.
INDEX.
a ee ee ented
hey
ch
ee
oN oe "
: A:
APOLOGY to thofe Gentlemen whofe
communications have not been inferted in
this work - - - P. 208
Aputsion of the vifcera to the peritoneum . 88
B.
Banpacs forthe chet - - =. 123.
Bopy, the parts of, moft fubje€t to cancer 35
Breast, difeafes of, diftinguifhed from can-
cer ~ . - - : 24
—~ milk abfcefs of, never turns to a can-
cer ma pies i = ai 25
BLEEDING,
922 INDE Xa
BLEEDING, experimental practice in the dure
of Sancer = - + > 52
rca cafes cured by; 64, 66, pe 212, 216
—— . mode of taking away blood fan
: — frequency of, never attended with
danger = it othe 57s 68, 217
a— ufeful in the-more advaneed flages
of the complaint —- i 7h
BELLADONNA, general effects of this medicine 50
Bert, Mr. quotation from, on the operation
of caftration oe aa s Raat Oy 3s 3
ieee Of the removal of a cancerous
breaft “ &) An yi > 13t
€.
Cancer, danger of reprefenting it an incurable
difeafe, 2, 107, 109—Cafes, 141, 143;
152, 190——Obfervations on, 17—Defcription
and progrefs of; 1g—Occult and open, des
fcription of; 19, 20—Diftinguifhed from
_ other complaints, 22—Whether a difeafe of
the fyftem or a topical complaint, confidered;
- 38—Particular nature of, 42—-Caufes of, 30
—Not fo liable to return after an operation
as formerly, 5, 44—Not hereditary, 42—A
local complaint, 44, 46—-Treatment of, 47
CHESTON,
Creston, Dr. cafe of a fcirrhous breaft from,
| 180
CastRaATIon, review of the feveral methods
of performing it - - + - 110
: method of performing the ope-
ration - - - - <. 113
«——_——-— when performed on a proper fubjeG,
produces a radical cure, 135, 173, 176—
- With obfervations, 178, 203
‘De’
Dropsicat Symptoms, occafioned by repeated
bleedings, never attended with danger 68,
217
E.
Excision, or removal of a cancerous. breaft,
T175 112i
i Tublequent treatment: 4iyiio5 2G
effeéts a radical cure; 2—Cafes of,
146, 147, 160, 156, 158, 161, 166, 163,
171, 197, 199, 201—Remarks on the fore-
tp
_ going cafes, 209
M. Le
224. INDEX. .
F..
M. Le Fesure, his method by arfenic cons
fidered - ~ Sthaeia ciaaR™ 49
G.
Guatacum, joined with cicuta, good effeéts of,
in the fluor albus - - z 49
Goucn, on corrofive fublimate, confidered 49
GuMs AND CHEEK, adhefion of, with a cafe and
method of cure - ~ ~ - 89
GLANDS DISEASED, extending under the edge of
the pectoral mufcle and into the axilla, how
to difcover them - - 169
H.
Hitt, quotations from, concerning the fuccefs
attending operations = > 5
on the difeafe being local - 40
Hmmorruace, recurring feveral days after the
accident, g4, 127—-Fault of the attendants,
127—-How to proceed infuch cafes - 427
| HERNIA
oo
ae oe | 229
Hernta Humoratis diftinguifhed from a feir-
thus = - ~ - 28
Hyproce ce, its diftinéion from a fcirrhous
teftis - - on meta 28, ARS
vache When combined with {cirrhus,
how to rotacd - > 174, 176.
HEmLock, its ufe confidered sa ii 48
=———-— mode of giving it - we 102
L art
InfLameED: fcrophulous gland diftinguithed from
{cirrhous . ihe - 22
Incurazie cases of cancer, plan to be adopted
en \.y ‘1902—External made of palliation in in-
curable cafes of cancer z 7 105
INFLAMMATION, caufe of cancer 325555
InGHAM, cafe of cancer from, * 206
JUSTAMOND, on martial flowers, confidered, 49,
bs ris ? higier sal:
JAENISCH, Dr, his method of treating cancer-—
ous complaints 7 - 50, 108
Jonzs, cafe of {cirrhous breaft from ss 18Q_
+
yrs Kipyey,
x
y
226 IND Ee
Kos
Kipney, fcirrhous, removal of — - ~ 36
M,
Mewses, ceflation of, a ufual period of the dif.
eafe appearing =— = - - 42
Mercury of no ufe in fchirrhous aoe 56
N.
Nature, different proceties of, in healing
wounds ° fe 83; 92
O.
Opzration for a fcirrhous breaft, improved
method, advantages attending Mr hoi Oy ey
29, 126, 2TO
ealbssits i) circumftances which led to
this met! vod of operating ~ - 12
seaamatoen Progrefs of ie * 10, 13
——-——— diferent methods of performing
ee - = r ; os 77
| Operation,
INDEX, Ce.
Operation, Want of refolution to fubmit to
it, caufe of | - - - 8
—— Reafons for fubmitting to it, 4, 78,
81—Danger of delaying it, 107, 141, 143—
Such cafes as are curable byit, 75 —-Thatdo net
admit of cure, 99—Refult from mifmanage-
ment, 107—Plan to be adopted in fuch
cafes, 102—Fxternal mode of treatment in
incurable cafes of cancer SPCR: 105
Opium, effects of a ~ - 104
P,
Porr, Mr. quotation from, on the operation of
‘caftration —_ + “ - -110
— on the removal of a fchirrhous breaft
120
Psriops of life moft fubjeét to cancer, 36—~
Reafons of, 42—Cafes that have occurred
ata much more early period than is gene-
rally imagined ~ = Pir Pving f
PLuNKgt?’s NostRUM, compofition of - 77
Pea ~ Quwacxs,
228 INDE Xe
La ‘ ; Tat ys
©.
“Quacxs, artifices of, expofed 2, 107, 117,
Posie 190
R.
‘Romsey, a cafe of a fcirrhous breaft from 164
Reeimen tobe obferved ~ < 58, 10g
s,
‘SeropuxtLovs Tumors diftinguifhed from feir-
rhus - - = nore»
‘Sarcocers, diftinguifhed from cancer 28
STOMACH AND VISCERA, in general, fubject to
cancer (note) — = - “ 36
een mene we Cancer of, with re-
marks - - ~ ~ * 53
Spirits, effects of, on the ftomach - 104
SoLanum, character of - - 56
STONE, fymptoms of, occafioned by a fcirrhus of
the cervix uteri - os ay 995 Fe
SATURNINE
END 235 229.
a
SATURNINE APPLICATIONS ok a ots
STYPTICs, not to be relied on ~ - 94
SKIN, always fufficient for union by the firft
intention - | - - - - 133
a \
SHARP, quotations from on the removal of
fcirrhous tumors with obfervations 118
Squire, Dr. cafe from, on the cure of {cirrhus
bleedin - - - - 112
dy & ‘ r, m
Ty,
TRICHIASIS, operation for, defcribed 12
TREATMENT and cure of cancer - 47
not underftood arr 5t
Testis, fcrophulous, diftinguifhed from {fcir-
thous ~ - ° - 29
cr
Urervs, cancer of, 71—With obfervations, 73
—Bleeding in - - - 73
Union by the firft Intention, obfervations on
83, 133
om always fucceeds - - Of
_ULcERATION,
-
230 : DN DE Hie
UnceraTion, internal, taking place at an early
period a the complaint, danger a” 108
2 ca ite ail «
Ww OMEN more fubject ro ca
Wounps, obfervations o on the healing of 83, 92
& Wanier, quotations from, on ae operation
of caftration - > 7. TIE
sisutiin on the removal of a cancerous breaft
; 120
-"
Beng ia h
} 7 Mek
has BM
yee, Toe BO! a Pi Sih es HEA Sa kt ea
# ; : ral oe
*
Ty
es
ane
ries ae
”
i
Ped, a
thn Hiya