A Collection of Chirurgical Tracts

The most considerable Case that offered it self during our first Enquiries into the Nature of Cancers, was that of a Woman, who about Four Years before received a Blow on one of her Breasts, upon which it began to swell, grow painful, and after some time became all over livid, and of so prodigious a Bigness and Weight, that she was obliged to keep it suspended by a Napkin round her Neck: But in regard our Method was not put in Practice till by other Applications it was become ulcerated, we shall speak of it as such. The Patient, then, at this time complained of a very violent Pain, which extended it self to the Back and Shoulder, by the Communication of the Nerves (for those of the Breast come from the fifth Pair of the Spine, and from a Plexus about the Clavicels.) To remedy this, she had taken no small Quantity of Hypnotic Medicines, which, without Doubt, destroy the due Texture of the Blood, and so become prejudicial to the Patient, and disadvantagious to the Surgeon that proposes a Cure. But because Persons generally find some Relief by Opiates, as they retard the determined Motion of the Blood, straiten the Nerves, and check the tumultuous and disorderly Influx of the Spirits; so, probably, in these Cases, their Use will be continued. Besides the acute Pain, the Cancer was over-spread with fungous Flesh, its lower Part extreamly hard, knotty, blackish, and its Basis seemed inclinable to fix; the Matter which was discharged was thin, reddish, and stank abominably. This was the Condition of this poor Woman, when we first applied our grand Dissolvent; the Pain she was attended with the first and second Day after was inconsiderable, nor did she complain of more afterwards, than would have been procured by the most mild and easy Remedy the Dispensatory affords. In four Days Time we found a very evident Alteration for the Better; for the Consistence of the Matter was changed, and the Surface of the Cancerous Mass became somewhat soft, we continued the Use of the same Medicine, and in a few Days more some part of the Cancer came away with the dressing. In short, in about six Weeks time, the whole Substance was entirely gone, and nothing remained to be done but to heal the Ulcer, which was effected in about a Fortnight. During the time she was under Cure we gave her a proper internal Medicine, not calculated to destroy the Acidity of the Blood, but to dispose the whole Cancerous Mass, with its Appendices to come away, which might otherwise, as the Seeds of the Disease, cause it to spring again: Thus was this Patient, (after so great a Fatigue she had undergone before she came to me) perfectly cured, and has continued so to this Time, without any manner of Inconvenience as she lately told me, it being a long time since she has been well.

A Gentlewoman near fifty Years of Age, by some Accident received a Blow on her left Breast, which in a few Days was succeeded by a considerable Tumour, whereupon she applyed herself to a Surgeon, who immediately let her Blood, ordered her to take the Lap. Hibern. in Posset-Drink, and embrocated the Breast with Ol. Succini: By the use of these Means the Swelling was much abated, a small Hardness only remaining, which did not exceed a small Wallnut in Bigness; in this State, with very little Pain, she continued above a Year; but being persuaded to apply an Emp. de Ran. cum Mer. to it, it encreased very apparently, was extreamly painful, and in Seven Months time became as big as a large Egg: After this she made use of a Woman who was reputed Famous for these Cases; but by One or Two of her Applications the Tumour became as big again as before: In short it continued to encrease gradually from that time, till the whole Breast, which was of a monstrous Bigness, and which was judged not to weigh less than Eight Pound, in time became entirely Cancerous. It was at this time that I saw it the Skin was very livid, looking sleek and shining, and seemed ready to open, as being scarce capable of longer containing such a prodigious hard Mass as laid concealed under it, and was in all Probability as big as the Breasts of the Ammonian Women, of which Juvenal thus speaks, In Meroe, crasso majorem Infante Mamillam. She had been with various experienced and reputable Surgeons before, among which was One not long ago deceased, who was justly looked upon as an Ornament of his Profession; but not one would willingly attempt a real Cure by cutting it off, or any other Way: They only prescribed some palliating Remedies to remove the Pain and prevent its Breaking. I was animated by my former Successes, and prevailed with my self to undertake it, not thinking I was at all blameable if my Success in so extraordinary an Affair contradicted the Prognosticks of so many worthy Gentlemen; and though it did, I shall at all times think my self obliged to pay a Deference to them. I began the Cure by removing the Integuments from the upper Part of the Cancerous Substance, but did not wait for a Separation of the Slough the Escarotick made for fear of being incommoded in my Procedure by a Fungus; For this Reason I mixed some of our Dissolvent with a digestive Ointment, by which Means I had a Part of the Cancerous Mass came away with it, without any Trouble to my Patient. I continued this Method of Dressing several Days longer, with very little Alteration; but upon a Complaint of a Pain between the Shoulders, I was obliged to change my Medicine, and foment the Cancer with an Infusion of some of those Herbs that contain many Volatile attenuating and active Particles. And here I cannot but remark, by the by, that Applications to the pained Part would have been of no Effect, as I have many times observed, and particularly in a Woman which had a Cancerated Breast, that was violently afflicted with a Pain in her Arm on the same Side, which would not be removed by any of the Applications the Person that had the Care of her made use of the affected Arm. To this I might subjoin a very pertinent Case from Galen; but I fear I shall digress too far. The Pain of my Patient’s Back being removed, I proceeded to apply the Dissolvent, which so softened the Superficies of the Cancerous Mass that in Three or Four Days Time I could take off above a Quarter of a Pound of it with the Edge or Back of my Incision Knife, and my Patient not so much as feel me, this I continued to accustom my self to, because it would have been more tedious to have waited for the coming away of the Cancerous Mass of it self. Sometimes I varied my Applications as I saw Occasion, but, as my Patient confessed, I scarce put her to any more Pain during the Time her Breast was dissolving (abating for the Pain of her Back) than there is in the dressing of an Issue. The prodigious Bigness of the Cancerous Mass made the Cure the more tedious, for it was above Three Months before all of it was entirely dissolved and gone; but this being at length surprisingly and very happily effected the Cancerous Ulcer (the last Part of the Cancer that came away left) was incarned and cicatrized by an Infusion of vulnerary Herbs, to which was added a small Quantity of Tincture of Myrrh: Thus was this Cure entirely compleated and my Success in it confirmed that French Proverb, which says, It is better to be condemned to die by the Doctor, than by the Judge. I did not make use of that internal Medicine I mentioned in the former Case, because here I found no pressing Necessity for the Use of it, but some other proper Physick was taken to dispose the Ulcer to heal, as one would have done in any other Case. Upon the whole of this Cure, I cannot say whether I had more Trouble with the Cancer, or in endeavouring to oblige my Patient to a strict Observance of some of the Non-Naturals she so often erred in. There is nothing can create a greater Trouble to the Surgeon, than to find Patients negligent of their Healths, by not endeavouring to prevent or regulate Miscarriages, nor taking so much Care of themselves, as they expect the Surgeon should take of them. The Rules and Directions of Physicians and Surgeons, given to their Patients, we have Reason to believe were not so often violated formerly; for in some Places they obliged themselves very strictly to the Observance of them, and some Historians give us an Account that Selucus made a Law; that if any of the Epizephyrian Locrians drank Wine, contrary to the Physician’s Direction, though they escaped the ill Consequents that might have attended it, Death was their Punishment, because they did contrary to what was prescribed them.

A Woman about Thirty Years of Age had been for a considerable Time afflicted with a hard painful Tumour under her Tongue, for the Cure of which she had applied her self to various Persons, but without Success. When I saw her I found the Swelling to be hard, painful, of a livid Appearance, and incommoded her so much in speaking, that she could not pronounce her Words articulately. I was of the Opinion of some Gentlemen that had seen it before me, viz. That it was undoubtedly Cancerous, and as such I proceeded to cure it; but I met with more Difficulties in this Case than I at first expected, for after I thought the Cancerous Substance had been entirely dissolved, and I had reduced the Ulcer to a very narrow Compass, it began to swell again, and in a short Time enlarged it self to almost the Bigness it was at first: This put me upon a Necessity of making an Incision into the Body of the Tumour, that I might commodiously come at the remaining Part, and so dispose some little Dossels of Lint, armed with our Dissolvent, that they might have their desired Effect, and this in every Respect answered what we proposed; so that we proceeded immediately to incarn the Ulcer, which we did by a Lotion prepared of an Infusion of some vulnerary Herbs, and Mel. Rosar. Thus was this Woman perfectly cured, and has continued well about a Year.

Because I have always found greater Difficulty in treating Cancers of the Mouth and Lips than those of the Breast, I will here relate an Instance of one upon the lower Lip that proved extreamly troublesome. It sometimes happens that one, or more, of those Glands which are spread on the Inside of the Cheeks and Lips, called Buccales and Labiales, receive some Damage by a Bite or Blow; upon which they generally tumefy very much, become painful, and in Process of Time (if proper Means are not made use of) may become Cancerous. Such was the Case of a Woman about Thirty Years of Age, who having had a Blow on her lower Lip, neglected it till it was considerably tumefied, grew very painful, and became extreamly troublesome to her. The Circumference of the Swelling when I saw it, which was many Months after the Blow was received, was very much inflamed, and a small Quantity of Icorous Matter discharged from several small Pustules, which over-spread it; the Middle, which was the Body of the Cancer, was hard, of a whitish Colour, and moveable; it’s Sides being only connected to the contiguous Parts by some small Filaments that were detached from it. The same Thing Doctor Gendron has discovered in an ulcerated Cancer on the Forehead of the Servant of a certain Marquess, as he observes in his Third Chapter of the Tract we have before mentioned. I began with my Patient by applying cool and temperate Remedies, till the Inflammation was considerably abated; after this I applied our Dissolvent, which operated so mildly that my Patient was not sensible of near so much Pain as before she was apprehensive of: In short, the Body of the Cancer was removed and a good digested Matter discharged from the Sore. Now all the Difficulty was after what Manner we should proceed to dispose the little Cancerous Branches in the Skin to come away, but this we effected after the following Manner; the Consistent of the Medicine we before applyed, was such as was no way qualified for rooting out the Cancerous Filaments, whereupon we were obliged to procure it’s Dissolution in a proper Menstruum, though it required a considerable Time to do it; by this means, we soon found, that what before was ineffectual was now capable of effecting what we desired. This being done, the Ulcer was incarned by a Sarcotick Infusion (for I never use Ointments in these Cases) and cicatrized by the common drying Plaisters. It is to be observed, that the Scar still continues hollow (it having been healed near Two Years) and not like those that are the Consequents of well ordered simple Ulcers.

The following Observation contains an Account of one that was cured of an incipient Cancer in her Breast, by Internals. I was the rather inclined to set down the whole Process of this Cure, because by these, or such like Medicines, Persons under the same Circumstances may perhaps be cured, though by some they may be thought incurable. The Case is this; A Gentlewoman, Thirty Years of Age, of a thin spare Habit of Body, by some Accident received a Blow upon One of her Breasts, which put her to an immediate Pain, and that very acute; but it lessened upon her being let Blood, and the Application of a discutient Plaister: However, in a few Days, some of the glandulous Grains of the Breast became indurated, and in Process of Time, by their Increase, they were rendered painful. At this Time she sought out for fresh Advice, and continued Two Months under the Care of a Person she was recommended to; but Things not succeeding according to Expectation, she became a Patient to Three or Four more. During this Time the Lump continued to encrease but slowly, and at the Expiration of Six Months it appeared to be a very hard painful Tumour in the Middle of the Breast, but no bigger than a Hen-Egg; whereupon it was thought proper to commence her Method of Cure by exhibiting the following Pills. ℞ Pill. Tartar. Quercetan. ʒß. Calomel gr. viii. F. Pill. No. 5. These were likewise continued twice a Week during the whole Cure; after this, was ordered the following Infusion, ℞ Vin. Rhenan. ℔ii. Milleped. ℥ii. Ocul. Canc. ℥ß Croci. ʒii. This was not to be taken alone, but when it had stood Four and Twenty Hours, three or four Spoons-full of it was to be mixed with a Draught of the ensuing Dietetick-Drink, and taken in the Morning, and at Four of the Clock in the Afternoon. ℞ Rad. Sarsaparill. ℥ii. Chinæ ʒvi. Fig. Sassafr. ℥i. Corn. Cervi, ℥Sem. Correand. ℥ß. Sant. Rub. ʒii. Coq. in aq. Font. Congiis 4 per Horæ dimidium, deinde stent Clause super Cineres Calidos per Horas xii; postea ebulliant ad tertiæ Partis Consumptionem. By the Continuance of these Means about two Months, and observing a regular Method of living, the Cure of this Patient was effected; though by some she had been looked upon as incurable, unless she would submit the cutting it out, which is not often attended with Success.

Perhaps, Sir, here you may object, that it is acting disengenuously, and not like a Friend, to give you an Account of those Persons only where I have succeeded. To this I answer, that excepting one Woman, that was emaciated almost to the last Degree by the excessive Discharge of a fætid Icorous Matter from her Breast, and an Abscess under her Arm, and who was carried off by a violent Loosness, I never had a Person miscarried under my Care, where I proposed a Cure. That poor Woman I suffered my self to be persuaded to take care of, having but little Prospect of effecting it, yet my Endeavours succeeded so well, that had it been in our Power to put a Stop to her Loosness, I am of opinion she might have been cured.

What has been hitherto said, I do not question but is sufficient to satisfy you, that this formidable Disease is not so rebellious, but that it may be sometimes conquered by Art; and I might here relate a Case I have at this present Writing, wherein not only a Part of the Cancer was fixed, but there were hard Cancerous Knots extended to the Arm-pit; and yet this seems to be almost well; the Ulcer that remains, and which heals daily, not being much broader than a Crown Piece. But in regard the Patient is not entirely cured, I shall reserve this Relation untill another Opportunity; though I will embrace the present to assure you that I am,

SIR,Your very respectful Brother,and Humble Servant,Wm. Beckett.

Hatton-Garden,

July 12, 1711.

A Solution of some Curious Problems concerning CancersPROBLEM IWhether the Cancerous Juice is Corrosive, or not

Vide Riolanus, Cap. 13. Sect. 2.

WE cannot come to a certain Knowledge of the Principles of the Juice which is lodged in the Cancerous Substance, although it enjoyed the very same Properties, of that which is discharged from an ulcerated Cancer, from the Account which Authors have given of the latter; for they have differed very much in determining the Nature of the Salts, with which they suppose it abounds. Helmont, Van Horne, and most of those Gentlemen that were Chymically inclined, were of Opinion they belonged to the Alkaline Family, but a far greater Number than those, have thought they are Acid. Riolan, the Father, in his Chirurgical Works, without giving his Opinion what the constituent Parts of the purulent Matter are, affirmed it to be as strong as Poison, and that no Death could be devised too cruel for such a One as should give it to a Man. This brings to my Remembrance a very unhappy Accident a Gentleman informed me of that befel Mr Smith, one of the Surgeons of St Thomas’s Hospital, who being so curious as to taste the Juice of a cancerated Breast presently after it was extirpated, found himself very strangely affected by it, in a very short Time; he washed his Mouth with various Things, but nothing could free him from that penetrating, malignant, and nauseous Savour, he was continually attended with; in short, he became consumptive, and in a few Months died a Martyr to the Art of Surgery. I confess when I received this Account it did not a little surprize me, because I had several times had the Curiosity to do the very same Thing, at the Hospital where that unfortunate Genman made the Experiment. I never found any remarkable Sharpness in it, though it was always attended with a very unpleasant Savour. I proceeded at first very cautiously in making this Attempt; for I deluted some Drops of the Juice in several Spoons-full of fair Water, till at length, not finding any Inconvenience from it, I came to the Juice it self. We cannot imagine the Death of that Gentleman before-mentioned, was procured by the Action of any corrosive Salts, whether Acid or Alkaline, which would have caused a Corrosion of the Parts, but that it is only accountable from the extraordinary Stench and Malignity of the Matter, which impressing its Virulency on the Animal Juices must undoubtedly disturb their regular Motions, and cause the utmost Confusion of the whole Oeconomy. It must certainly be a very tragical Scene, to observe how Nature, by so inconsiderale Means, confounds and insults, over the Animal System; but still there is nothing we are more certain of, than that her Method of Procedure is always consistent to the Rules she acts by. Since the writing of this, looking over a little Tract which informs us of the Rarities in New-England, I met with a Relation which discovers to us the peculiar and odd Quality of the Juice of a cancerated Breast, or Wolf, as our Author calls it. He tells us that an indulgent Husband, by sucking his Wife’s sore Breast to draw out the Poison, lost all his Teeth, but was attended by no other Inconvenience. Now this does not prove that so strange an Effect should succeed the sucking the Ulcer, because of the Corrosiveness of the Matter; for had it been so, such tender Parts as the Gums, Lips, and Tongue, could not have escaped so well as to have received no Damage by it.

Problem II Whether Cancers are contagious, or not

Vid. Zacut. de Prax. Med. admirand. Lib. 1. Obs. 15.

Vid Sennert. Paralipom. ad Part. 1 Cap. 19.

Vide Galen. in Aph. Hip. Com. Lib. 6 Aph. 38.

THERE has been a very great Disagreement in the Sentiments of our Predecessors as to this Point; but Zacutas Lusitanus proposes to prove it by Reason and Experience. His Reasons are, First, because in an ulcerated Cancer there is a Cadaverous Stench and Rottenness, which infects the Neighbouring Parts with it’s Virulency. Secondly, Because a Cancer is the same Disease as an Elephantiasis, and Leprosy of a particular Part. To this, Sennertus in his Posthumous Works answers, that all corrupted and fætid Substances are not contagious; for in a Gangrene and Sphacellus, there is the greatest Corruption and offensive Smell, yet we do not find that a Person is killed by it: He adds, though a Cancer has some Similitude to an Elephantiasis, they are different Diseases. Lusitanus deduces his Experience from an Observation of a poor Woman, that having an ulcerated Cancer in her Breast, and lying with three Children, they were affected after the same Manner by the Contagion. He says that Two of them died, but the Third, which was of a stronger Constitution, had the Cancer cut off by a Surgeon and was cured. Sennertus is of Opinion that these Children did not contract the Disease by Contagion, but that it was by Hereditary Succession. We likewise find that Cardan, Lib. de Venen. Cap. 12. is of Opinion that Cancers are not contagious. However, we will not make any particular Enquiry into these Authors Reasons, when they so strenuously maintain this Point; but only relate a remarkable History, which will prove the contrary, if the Cancerous Matter comes to an immediate Contract with a soft and glandulous Part. The Relation I had (some time ago) from a Gentleman not long since deceased, who, out of a pious Disposition, had devoted himself for several Years last past, to be serviceable to the greatest Objects of Charity. He informed me that a Tradesman’s Wife in Nottingham, being so unhappy as to labour under a Cancer in one of her Breasts, her Husband was of Opinion he could relieve her by sucking it; accordingly he put this Method in Practice, in hopes without doubt he could effect a Cure, by drawing the Cancerous Matter out of the Nipple; he continued his Attempts for some Time, but found it did not answer his Design; for though a small Quantity of Matter was discharged this way, the Disease still became worse, and she terminated her Life soon after. Two Months were scarce expired before the Husband of the Deceased came up to London, upon Account of a swelling he had arose on the Inside of the upper Jaw; he applied himself to some ingenious Surgeons for Advice, who assured him he must undergo the drawing of Several Teeth on that Side of the Jaw which was affected, and have the Swelling, and Part of the Jaw-Bone (if necessary) cut away; he went away very much disatisfyed with so harsh a Proposal, and became a Patient to a Person, who undertook to cure him with Gargels, and such inconsiderable Remedies; however, by the Use of these Things he was of Opinion he became much better, and thought he should be cured. Upon this he retired into the Country to his Business, but in less than a Month’s Time he was obliged to come up again, and have the former Method put in Practice. But the Event was according to that Expression of Galen, Quibus item sunt Cancri in cavitate Corporis, aut Palato, sede utero, si secentur, aut urantur, ulcera cicatrice induci non possunt. For the Sore could never be brought to cicatrize, but the Cancer continu’d to spread, till it had extended in self over most of the internal Parts of the Mouth, and to the inner Part of the Nose: In this unhappy Condition, he lived some time, but at last became so frightful an Object, and the Stench that continually proceeded from the Parts was so offensive, that he retired himself from the World, and finished his miserable Life in a Garret. Since the finishing the Solution to the foregoing Problem, I met with a Surgeon (a Foreigner) who giving me an Account of the present State of the Practice of Surgery in the Country where he lived, and relating some considerable Cases which had happened within his own Knowledge, in answer to my Desire, among other things, told me, without any particular Intimation from me, he knew a very odd Accident, which happened upon a Woman’s having an ulcerated Cancer in her right Breast, which was, that she being poor, for want of other Conveniences, suffered two Children she had to lie with her in that Condition; at length one of them, a Girl about five Years old, began to be afflicted with a small painful Tumour in one of her Breasts, which encreasing to near the Bigness of an Egg, became Livid, and entirely Cancerous; the Mother died some time after, and the Child did not long survive her; but the other Child continued well. Several Surgeons gave their Sentiments of this Case; some thought it to be an Hereditary Indisposition; but considering the Mother had no Appearance of a Cancer before or at the Birth of the Child, I cannot but readily embrace the Opinion of those Gentlemen, that were inclined to believe that it was contracted by Contagion, seeing the Position of the Child’s Body was such in Bed, that that Part of it which was affected was almost always disposed to rub against the Dressings soaked in Matter, (for I understand the Mother took but very little Care to change them often.) Now it is not at all probable, that the malignant Effluvia, which continually pass off from the Cancerous Mass, and the putrefied Matter, can dispose a Person at any little Distance to be affected with the like Disease, for then the other Child would have became a Sufferer; but it may happen in some extraordinary Cases, where the corrupted Fluid has attained an exalted Pitch of Malignity, to communicate some of its more active Particles to the Blood and Spirit; and so causing a very great Disorder in their Motions produce a violent Fever, and Confusion of the whole Oeconomy, so as to occasion a Person’s Death. But see a remarkable Case in Tulpius, Lib. 4. Obs. 8. That there are several cutaneous Diseases that may be propagated by Contagion, if a Person lies with another, is by all allowed of; and that the lying with a Person that has a Cancer may be attended by such a Disease, from the Proofs we have brought, I suppose will be agreed to be equally as certain. But this cannot happen unless the matter be very malignant, and be suffered, by the Negligence of the Patient, to come to an immediate Contact, with a Part of the Body of the other Person; for then, without doubt, it may contuminate the Fluids, and incline them to assume a Viscidity, to which the Effluvia will immediately adhere, because they are best qualifyed for a Union with those Substances that are viscous. To this we may add, that in those Persons that are nearly related, the Malignity may be more easily communicable because of their Analogy to each other; for consonant hereto, Diemerbroeck says in his Treatise of the Plague, that Kindred more easily receive the Infection from one another. But see more in that Author’s excellent Book where you have likewise some curious Thoughts relating to Contagion.