A Collection of Chirurgical Tracts

The Red Water for a Cancer

Quench unslacked Lime in boiling Water, which let stand six Hours, the clear Water poured off, put to the Fire again; to a Gallon and half of which, put Camphir ℥ß Aloes Succatrine ℥ß. Common Bole ℥ii White Copperas or Allum ℥ii all powdered, which boil in the Liquor a little while: He sometimes gave a Pill made of Deflograted Red Precipitate, which sometimes made them spit a little.

The Musilage Plaister to dissolve Schirrous Knots in the Breast

Take of the white and inward Bark of the Witch-Hasel half a Handful, cut it short and stamp it, then take of the Roots of Marsh Mallows, Holy-hock Roots two or three Roots, clean them and throw away the Pith, stamp all together, then take of Fenugreek and Linseed of each two Ounces powdered, put all in an Earthen-pot, then take a Pint of white Wine or Water, heat it scalding hot, put it to the Things aforesaid, cover it close, stirring it every Day for nine Days, then strain out the Musilage Liquor with which you make the following Plaister. Take a Pint of Salad Oyl, Cerus finely powdered 8 Ounces, boil them together, constantly stirring them, a sufficient time, which you may know by its coming clear off a Pewter Dish when dropt on, let it cool a little and put in your Musilage, which stir till it be as white as you would have it, and until almost all the Musilage be boiled away, then remove it from the Fire and put to it four Ounces of yellow Wax, probably Galbanum may be better, which when dissolved and the Plaister cold, work up for use. This Plaister is sometimes used with equal Parts of Galbanum.

THE CASE OF Dr JAMES KEIL, Represented by JOHN RUSHWORTH

I Should not have been induced to make these Papers publick, barely on account of the rash Censures, that are frequently cast upon the Practice of Surgery, not attended with Success; tho’ that Consideration alone, in the Case of a Person of such Value and Eminency in Physick, as Dr KEIL is known to have been, may be thought sufficient to have moved me to it: But being certainly informed, That several Physicians and Surgeons have before, and since his Death, given themselves the Liberty to reflect, not only upon me for Using, but also upon the Deceased for submitting to the Methods that were taken with him; I think I shall not discharge my Duty, either to my Friend, or to my Self, or indeed to the Profession, if I do not, as far as I am able, endeavour to set what was done in a True Light.

In order thereunto, it may be requisite to look back to the Time He first mentioned any Disorder in his Mouth to me, which was in August 1716. He then told me, He had preceived a Fulness in his Mouth for very many Years; but in the last Three or Four Years it was much encreased, and by the Bulk began to be troublesome to him, tho’ not in the least painful: Upon examining it, I found the Tumour not only large, but also to fluctuate, and therefore told him, until I was satisfied what was contained in it, I could not come to a Resolution, as to the manner of treating it; but, if he pleased, I would make an Incision into it, and then would tell him what I thought was fit to be done; He was very well satisfied, and resolved I should proceed accordingly.

Upon Opening it, there appeared to be nothing contained in it, but Blood; not in the least altered in Colour, Consistence, or Smell, from what is contained in the Vessels. The Tumour presently sunk very much, and I dilated the Incision with my Probe-Scissers, and pressed in some Dossels; and then told him, it was a fleshy Tumour, called a Sarcoma, and that the Blood contained in it was only accidental; and that the best way of extirpating it was by the actual Cautery; but I let him know, that I feared it would be more troublesome to him, and take longer Time to cure, than he seemed to expect.

We presently sent for the best Instrument-Maker the Country afforded, and gave him Directions: But that Night: talking with him of his Case, I desired him to consider, Whether it might not be thought a Slight, by the Learned of both Professions, if I should Perform the Operation, upon a Man of his Character, without a Consultation; there being no Reason (but the Loss of his Time) to be in haste. At first he seemed unwilling to lose so much Time, yet upon Consideration, he resolved for London the next Day, where several Physicians and Surgeons were consulted; they all agreed, it was a simple Sarcoma, and that the actual Cautery was the properest, if not the only means of curing it. This Account I received from the Doctor by Letter; as also, that the Surgeons, upon probing, found the Bone bare, and from the ill Smell concluded it was foul: “Which, said the Doctor it was impossible for you to discover; because after I left Northampton, Two Dossels of the first Dressing dropt out.” I was very glad to hear That, for those Dossels lodging so long, in that warm Part, I was in hopes might be the Occasion of the fœtid Smell; which the Surgeons, not being acquainted with, might fairly be induced to take for that of a foul Bone: Which I mentioned to the Doctor by the first return of the Post; and also, that I was farther encouraged in that Hope, by considering that the Blood, that was discharged at the first Opening, was not at all altered, neither was any Smell perceived, until after the lodging of those Dossels.

Whether the Doctor ever mentioned this my Opinion, to the Surgeons in Town, I know not; but when he returned to me, to have the Operation performed, he seemed discouraged by the Opinion the Surgeons gave of the Bones being foul. But I thought I might make bold to confirm him, in my former Opinion, the ill Smell ceasing without the Assistance of Medicines. The Consequence proved the Assertion: For when, by several Applications of the Cauteries, I had removed the whole Tumor, it was plain to me, the Bone was not affected; and the Part healed as smooth, and with as much Ease, and in as short a Time, as ever I met any thing of that Nature, and the Doctor continued well, without the least Disorder or Complaint, a Year and about Eight Months.

But then in April 1718. He shewed me a small Ulcer, near that Part of the Mouth that was before affected, and told me, He perceived it began upon eating some hot Meat, that stuck to it: At first this healed without much Trouble, but soon excoriated again; and then I could not again perfectly skin it: For as soon as it was almost healed, it would begin to excoriate a-fresh at the Edges, which is what is usual in Phagedænical Ulcers. And tho’ I could digest it, and keep it easy, yet it got ground of me, and spread towards the Teeth; and, near the Root of One of the Molares, laid the Bone bare, which appeared to me at the first not to be injured, but being long exposed became foul. It not exfoliating in due Time, with the Tincture that is commonly used, I proposed the touching of it with a small Cautery, I being able very easily to come at it without making use of a Cannula; which, by confining the Heat, very much injures the neighbouring Parts: The good Effect of which Practice, of not making use of a Cannula, where you can conveniently omit it, I had good Experience of in Doctor KEIL’s former Case: For tho’ he had several Cannulas made in London, by the best Hand, yet after Twice using of them, I told the Doctor, That if a Patient could be trusted, it would be much more easy to him, and the Surgeon would see much better to use the Cautery, than when obstructed by a Cannula. The Doctor was pleased with the Thought, and pressed me, at the next making use of the Cautery, to do it without the Cannula: The Advantage he had by it was, that it bore four Burnings, and said, It gave him not the Pain, or Trouble he had from but One before, and that the Parts were much less Disordered by it afterwards. But to return:

It will not I suppose be doubted, but that proper internal Means were all along made use of: But the Ulcer still appearing to me more threatening, his Friends pressed him, and I more than any, that he would go again to Town, and have the best Advice it could afford; and I resolved to accompany Him, in the Beginning of August 1718. And I cannot forbear saying I was surprized, when, upon a Consultation, my Brothers, Palmer and Brown, made light of it; and, without so much as hearing what I had to say, concluded, That it was chiefly owing to the Bones being foul; and that by drawing a Tooth or Two which they said were affected, and by Purging with Mercurius dulcis, all would be well; and so they took their Leave. Says the Doctor to me, “What say you to this?” I answered him, That I feared they would find themselves again mistaken as to the Surgery Part; and that as to the Mercury, though a good Medicine, He knew he had taken it already several Times, without any considerable Advantage. The Doctor smiled and said, “But since I came so far for Advice, I will not only give them a Tooth, but also try again what Effect Mercury may have.”

Another Meeting was ordered, and the Tooth-Drawer to be there: Upon Drawing the Tooth, it appeared to be very sound. The First Dose he took of Mercury, whether by Cold, or any other Accident, I know not, very much disordered him. I could not conveniently be absent any longer, and therefore the next Day returned into the Country, and do not know how many more Doses the Doctor then took; but in a few Days I received a Letter from him, in which he said, “I know nothing that has succeeded right with me, since I came here: You know what State you left me in, and I was a great deal worse for some Days afterwards; though I hope the Mercury has had no ill Effect, yet I should have been loath to have been so swelled in those Parts, as I have been, willingly. The old Ulcers are not yet healed, they tell me indeed, there is no Appearance of any new Ones, and that the most effectual Methods, which have been taken here, will infallibly prevent every thing, &c.”

But by his next, which I soon received, I had the melancholy News from him, That the Ulcer was broke out again larger than ever, and therefore that he would be down with me in a Day or two, and he came accordingly, but in a worse State than ever before. And though it again digested, and did as before near heal, yet the returns were quicker, and upon every new Eruption it was larger and worse; and so continued to be, notwithstanding all the good internal Methods continually used by the concurring Advice of Dr Mead, Dr Friend, and several other Eminent Physicians; which no doubt was owing to the malignant Nature of it.

And therefore in the Beginning of February last, I could no longer forbear expressing my Fears to the Doctor that it would terminate in a raging Cancer. He was too sensible of it, and told me, “That since I thought I could keep it within Bounds no longer, He was resolved to try what a Salivation would do:” And though I could say nothing as to the Advantage he might expect from it, yet I frankly owned to him, that if it was my own Case, I should be of his Opinion, that I might make bolder with my self, than with any other Patient: But desired by all means, he would first hear if his Friends, the Physicians and Surgeons in London, had yet any other Method to propose, or else would approve of that. He wrote to them, the Answer was long in coming, which made the Doctor express himself to me with more Warmth, than I ever knew him to do before: (For he was a Man of the greatest Command of himself, as well as of the sweetest Temper) “What, says he, is not their Silence enough? And will not you, whom I take for my Friend (for fear of losing your Reputation) assist me in what I desire?” With a great deal more to assure me of his Confidence in me, and of his Opinion of my Ability to take Care of him in the Course. I am not so vain, as to mention all his kind Expressions, yet if it be desired, by any of his Friends, I will give them the Satisfaction of seeing the Letters I had from him, when he was absent from me in London.

At this Time his Brother, Doctor John Keil, came to him from Oxford; and, as I understood afterwards, had seen Dr Friend there, who was for having him salivated at London: But the Doctor being determined to the contrary, did not at that Time acquaint me with it, but began his Course, which I desired might be in the mildest Method, by small Doses of Calomel, encreased gradually, which Method pleased him very well: But Dr Friend (to whom Dr John Keil constantly sent an Account of our Proceedings) gave it as the Opinion of Mr Palmer and Mr Brown, that it should be done by Unction: I gave my Reason to the Patient against it, but they still pressed it, notwithstanding the ill Symptoms, that I thought, at that Time, forbad it; which Symptoms they had been acquainted with. They still persisting, I desired the Doctor would give me leave to write my Opinion my self to Mr Brown, which I did hastily in the following manner.

Good Brother,

I Have seen Dr Friend’s Letter to Dr Keil; and Dr Friend I understand has been so kind as to consult you, and several Others in the Case; whose Judgments, though I have all due Regard for, yet in the present Circumstances (though I give the Preference to Unction in some stubborn Cases) I dare not encourage it in this: For my Reason at first, for beginning so mildly, was, that in this uncommon Case, we might by degrees, make some Judgment of the Effects of Mercury, and then proceed accordingly: For had I not been prevented by the Accidents you have, by Dr Friend, been acquainted with, I should have been very desirous to have gone at least to the Heighth mentioned by Dr Friend. But since I find, by encreasing the Quantity of the Dose to a Scruple (of which he has taken four) it has not affected the Glands at all, or made him Spit the more; but his Stomach is much more oppressed by it, with vast Quantity of Phlegm, viscous to a degree I have not met with, and gives him more than common Disturbance, not to be relieved but by often Vomiting, to which purpose the Turpith, has answered very well for the present: My great Fear is, all things considered, that if I should proceed to Unction, and it should produce the same Effect, that it will be too many for him. If my Fears are too great, my more than common Concern and Friendship is some Excuse for me; as also I desire it may be to You, for this tedious Account from, Sir,

Yours, &c.

Feb. 22d, 1718.

J. Rushworth.

I not receiving, in due Time, an Answer to this, and the Patient being reduced to a great Weakness, and to so great a Disorder, that he could not bear Talking to, I writ these few Lines for him to consider of.

Dear Sir,

AS your Case now stands, I must own my self a Coward: Though Dr Friend is much mistaken to think I am either unacquainted with, or fear the common Accidents that often arise in Salivating: But that irregular and uncommon Effects are, in extraordinary Cases, produced by Mercury, Hale’s Case is to me a sufficient Precedent, of which I have formerly told you the Particulars; and though your Friends in Town took no Notice of the unusual Disorder in your Stomach, yet I should think myself Inexcusable if I should not. And if, upon using an Unction, any irregular Ferments should again arise, weak as you now are, I should dread the Consequence. In these Circumstances, I think it most prudent for me, to advise you, to let what is already taken, go fairly off, and if you find it not effectual, you may with much better Prospect, when you have Strength, begin de Nova, by Unction, and have an Opportunity to have it done by the infallible Men.

Upon this the Doctor no longer, at present, pressed me to use the Unction, and in a few Days, the Force of what he had taken being somewhat spent, he began to get Strength, and the very great Slough (which was one of the Accidents mentioned to Dr Friend) not only cast off, but also healed, as did also the old malignant Ulcer, and all the Parts of the Mouth looked very smooth and well; and the Doctor was very chearful, and in great Hopes of gaining the Point.

At this Time, it being eighteen Days since I wrote to Mr Brown, I received a Letter from him, in which he mentioned nothing to the Purpose. This, I must confess, did not a little warm me; and I the same Night wrote to him again, but never received any Answer: Perhaps he thought mine too hot; if so, if he desires it, both mine, and his that occasioned it, shall be produced.

The Doctor seeing what had been done to have so good Effect, and hoping what was before advised by Mr Palmer and Mr Brown, would effectually prevent any return of his Disorder, resolved to use a Mercurial Unction. He had now more Strength, and therefore I complied with him; I began with a small Quantity, and encreased it every Time, until I had used even a larger Quantity than had been proposed by Dr Friend: But it not in the least affected the Glands, or made him to spit near so much, as when he took the Calomel; neither did the Unction or Calomel produce the Smell, which generally attends Mercurial Courses; and to my great Surprize and Concern, whilst he was using the Unction, the Ulcer broke out again. And by this we were discouraged from proceeding any farther; and in due Time the Doctor endeavoured to Purge this off, but he had always so untoward a Constitution, that neither now, nor at any Time before, could he by Purges have any regular Evacuation; which was, no doubt in his Case, very Injurious to him.

Now I perfectly desponded: But a Friend and Kinsman of the Doctor’s, a Surgeon of no small Reputation, assured him, that he had known, when other Methods failed, a Mercurial Fumigation had answered: And what is it that a rational Man will not try to prevent the excruciating Pains of a Cancer? When the Doctor mentioned this to me, I confessed I knew nothing of that Practice, and always had an ill Opinion of the Fumes of Mercury: And he also owned to me, that he was wholly unacquainted with it; but satisfied in his Friend, and therefore would try it: He began the Course according to his Friend’s Directions; I never pretended to order any thing afterwards; but however still frequently visited my Good Friend, though with an aking Heart. The Fumigation not only made him spit, whilst he was using it, but also for some Hours afterwards; and the Patient continued to use it for several Days, but without any good Effect upon the Ulcer. In about ten Days after he had left off the Fumigation, a very hard Tumour began to arise, upon the Muscles of the lower Part of the Face and Neck, and increased very fast, and in a very short Time spread it self from Ear to Ear: and, by the Bulk, in a great measure prevented his Swallowing, and soon suffocated him. He was Chearful, and to all outward Appearance tolerably easy to the last, and had what he now desired, a gentle Release, July 16, 1719.

And thus, to the Misfortune of Mankind, it is manifest to me, that Mercury is not adequate to this Herculean Distemper: but however, this Case, and That I mentioned before to the Doctor, gives me good Reason to believe, that Mercurials do at least blunt the Acrimony of the Humour, and so procure Ease. For, though that Patient had most acute Pains, before he entered into a Mercurial Course, yet afterwards he was easy all a long, as he told me; for I was called in but a few Days before he died. These, and other melancholly Cases, should not however, I think, wholly discourage Surgeons from making rational Attempts upon a Distemper, which I fear is more frequently met with, than formerly, in this Part of the World: It is to be hoped, there is in Nature a Specific that may answer; and happy will that Man be who shall discover it. He will deserve to be placed next to the Great Hippocrates, and also to be rewarded, by the Publick, equally with him that shall find out the Longitude.

I will not pretend to determine, how far the Fumigation might contribute to the sudden growth of the Tumour mentioned, but I should be very glad that the Surgeon who recommended it, would be so ingenuous, as to vindicate himself, by giving Instances of it’s Innocency, and of the Advantages he has met with in the Practice of it.

And now I heartily beg Pardon of the Friends of the Deceased, who shall give themselves the Trouble of Reading this Account, that I could not bring it into a narrower Compass.

Having truly related what was done, in the Case of Dr Keil, I hope it may appear, that I have acted an honest, and not an unskilful Part in it: If what was prescribed by others of greater Fame, when it came to be tried, had not better Success, I presume I shall no longer be blamed for it. No Man would willingly lose any Reputation, who is to live by it. I question not, but the best Surgeons in the World will allow, there are Cases for which there is no Remedy: And he who frankly owns thus much, no more loses any Reputation, than the Quack, that promises greater Matters than he afterwards performs, gets any: And I think they, who have censured me, would have done more ingenuously, if they would rather have looked upon the present Case as incurable by any Surgeon, than have thrown their Aspersions upon me, as not treating it properly.

N. B. The foregoing remarkable Case of Dr Keil, was published by Mr Rushworth of Northampton, Surgeon at Oxford, in the Year 17193. Under the Imprimatur of Robert Shippen, Vice-Can. Oxon.

Some curious Observations made (by my Friend John Ranby, Esq; Surgeon to his Majesty’s Household, and F. R. S.) in the Dissection of Three Subjects, 1728.

THE first, a Man aged 70 Years, who died of a Suppression of Urine, occasioned by a Stone stopping in the Urethra, just within the Glans, of the bigness of a Horse Bean. This Appearance, with the Symptoms that had attended this miserable Man, gave me reason to expect something remarkable in the urinary Passages. The Ureters and Pelvis were very much distended; which is common where great Numbers of Stones have descended down them, from the Kidneys to the Bladder. The Bladder contained about 60 Stones, the largest of which was about the Size of a Walnut, the others smaller; and just within the Neck, was a hard Tumour, as big as a Nutmeg, which almost closed the Orifice: and indeed the Situation of this Tumour was such, that it not only made the passing the Catheter very difficult, and hindered our feeling the Stones, by directing the Instrument upwards: but likewise would alone produce the Symptoms of the Stone in the Bladder, by obstructing the free Discharge of Urine through the Urethra, the inner Membrane of which appeared as if lacerated in several Places, and the Tube filled with a glutinous Matter tinged with Blood. On the back Part of the Vesiculæ Seminales, near the Prostata, were several Stones, as large as Peas, which closely adhered to the adjacent Membranes.

The second, a Boy aged 10 Years, killed by a Blow on the Skull; whose Spleen weighed two Pounds, and possessed almost all the left Side of the abdominal Cavity. The Bladder, when distended to its greatest Capacity, would not contain an Ounce.

The third, a Man aged 25, who died of a Pocky Hectick, and some Days before complained of a painful Swelling in the Testicle, which he said came the Night before. I examined it, and found it to be a Hernia Aquosa, and would have punctured it, if I had not felt (besides the Water) a hard Body, which I could by no Means reduce. In a few Days he died, which gave me an Opportunity of being satisfied. Opening the Scrotum, and separating the common Membranes to the Processus Vaginalis, it contained about 4 Ounces of Water, besides a great Part of the Omentum; some Portions of which adhered to the Bottom of the Cavity, and the Albuginea that immediately covers the Testicle.