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" 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 2) FEARON, H. my ie by aad Y r, nae ea ay Wes vp it ¥y 7 : F Fes CE ae ues eae Sa Ve. : A Beet 4 ga ORLIR Mia ns Sa. - 4 ¥ 4 ‘ ee or" ™ , re 7 ee * "2s iN we £' aie . ; as , . ‘ ae a 5 4d ha See iva Sad 2 Cie ri * " ; mate syns ti : n 4 y ‘ ; 3 ey E —# PO aa : “yy - 4 . 2 . « es * W ? . Ca by any : me Bay yt * i AN ee . aes : Ri Al a” Mar G 5 ~ rT : ¥ On . Yi) +e, 7 r . ’ Ng ‘ Pur, i b | r ~ 7 , u 4 Para? . wine ok ray y . " : es . 4 a ee o > S: ey) - - Pou — de eae a4 % 4 i ‘ yt aia ce v4, FS ie Sayers %, ea ef I ‘ : s! : ee ry 1, eee : mw ae : ; Rar ar an WARS : - a) No? at nde tt PT ange Arion * Oe Ce eh eee KE Hb : ‘ ‘ 2 gs. we ni ] t - % wi ‘ 8 t : Tae) tae 4 wes % y tA » one, a 7 ie aig A *, (te AT Ee sk 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 o 2, , Pe, Me, 38%, 0! 2% 9, en ote, Me, a Moy se aM oho, 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