Part 6

[Sidenote: Vid. _Zacut. de Prax._ Med. admirand. _Lib._ 1. _Obs._ 15.] 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 [Sidenote: _Vid_ Sennert. _Paralipom. ad Part._ 1 _Cap._ 19.] 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 [Sidenote: _Vide_ Galen. _in_ Aph. Hip. Com. Lib. 6 Aph. 38.] 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. [Sidenote: Vide _Diemerbroeck_ de _Pest_. Page 58.]

PROBLEM III.

_Whether if the extirpating a_ Cancerous Breast _happens to be successful, it ought to be look’d upon as a Consequence of Performing the Operation better than our Predecessors._

[Sidenote: Vide _Ætius Tetrab._ 4. Ser. 4. _Cap._ 44.] By the Account we receive from Authors we cannot be positively assured, whether there was any particular established Method in the first Ages of this Art, for the Performance of this Operation: This we are only assured of that there are some Circumstances which relate to it, that have been taken Notice of; the most considerable of which is, that the actual Cautery was to be applied immediately after the Abscision; this they advised, not only to put a Stop to the Flux of Blood, but likewise to correct the ill Quality of it: It is to be observed, that they ordered always, upon such an Occasion, Defensatives to be applied to the contiguous Parts, to prevent their being inflamed; but for as much as they were sensible the actual Cautery would procure an Eschar, they recommended the Use of Digestives to separate it; after which, they proposed to heal it as [Sidenote: Vide _Arceus_, lib. 2. Cap 3. de _Curand. Vulnerib._] a common Ulcer. The very next Advance this Operation received, that we have met with, was by that Accurate Writer _Franciscus Arceus_, who obliged the World with an exact and methodical Account of the whole Method of Procedure in extirpating a _Cancer_ in the Breast; though this Author would only venture on those that were not Ulcerated, those that were he looked upon as incurable. We do not find that this Method was recommended to the World by any remarkable Histories of Cures effected by it; whether it proceeded from the Unsuccessfulness of the Attempts, or its Disuse, we cannot determine. _Fabritius Hildanus_ likewise made a considerable Step towards the Encouraging the Performing this Operation; and he assures us, he has more than once done it with Success; he did not only influence his Cotemporaries to revive an Operation, that was, perhaps, almost grown out of Date, by the Histories of some Cases he recites; but obliged them with the Figure of a Pair of Forceps, which in this Operation are very convenient to engage the Breast, and thereby prevent the Pain the Patients are sometimes put to, by piercing the Breast with Needles armed with Silk to suspend it. There are several Ways of performing the Operation, mentioned by later Practitioners, but at this Time there are few that are willing to be concerned in it. A very considerable Author speaking of extirpating a _Cancerous Breast_, advises us to take care we do not cut the Pectoral Muscle in the Operation: But we have seen a very remarkable Case of this Nature, where a Part of that Muscle was cut away, and the Cartilages of the two of the Ribs laid bare, and the Patient happened to be cured. Now if our Predecessors had so great a Respect to the avoiding the wounding of this Part, as to make their Incisions too superficial, their Operations must be in all Probability unsuccessful; for we are very well assured by Experience, that their actual Cauteries will have no good Effect here, nor will they consume the remaining Part of the _Cancerous Mass_. We have elsewhere shewed, that this Substance upon boiling becomes hard and friable; and we will here take the Liberty to give our Opinion of the Use of Cauteries in this Case. The _Cancerous Substance_ we take to be nothing more than a Transformation of the small glandulous Bodies, which form the Breast, and a Lymphatick Juice, intimately incorporated therewith, into a hard, close, whitish, and (by common Medicines) indissolvable _Mass_. In some Cases, perhaps, it may receive some Addition from some Juices, which may distil from the contiguous Fibres. This being granted, what Benefit, can we reasonably imagine, will ensue on this painful Method? Will not the Fire, by causing the more Fluid Parts of the _Mass_ to evaporate, actually dry up, torrefy, and harden it; and so dispose it for displaying a Train of mischievous Effects, on the contiguous Parts? and all this without any very apparent Decrease of it too: Nay, the very reducing of it to such a Consistence, which very much resembles a Piece of burnt Horn, is sufficient to procure a perpetual Pain, seeing Medicines can hardly soften it, so as to reduce it to its first State.

PROBLEM IV.

_Whether_ Salivation _will Cure a_ Cancer.

The extraordinary Success this Method has been attended with, in some Cases of the greatest Difficulty, has so far recommended it to the World, that it is at this Time become of so great Repute, that there are few Persons but what will willingly embrace it, if proposed to them, provided they have found former Methods prove ineffectual. We once knew a Person, who laboured under an ulcerated _Cancer_ in her Breast, advised to it, and who had certainly under-gone it, though contrary to the Opinion of some Persons concerned, if in three or four Days time she had not been reduced to such a weak Condition, that it put an End to the Controversy. That a _Salivation_ has cured the most malign and spreading Ulcers, and those that have been of several Years continuance, notwithstanding their Edges have been high, inverted and assumed the Consistence of a callous Body, we have found by several Instances; but that it should cure a _Cancerous Ulcer_, an _Ulcer_ which is chiefly seated in a transformed animal Substance, and which has no Correspondence with the contiguous Parts, is what we cannot believe. One of the principal Effects of _Mercury_, if prudently given, is, that it attenuates the Juices, clears the Canals, destroys the ill Quality of that Fluid that has a Hand in causing any Obstruction, and renders the Juices temperate and sweet. By effecting this, it is, that it cures so many different Diseases, which perhaps have not so great a Diversity in their Causes, but have different Appearances, which depend upon the Variety of Parts, where the Cause operates. From hence any One may judge, that a Person who discovers a certain Method of curing _Cancers_ by Medicines only, will find that it will not consist in a Secret for purifying the Juices, which can have no Effect on the _Cancerous Mass_, so as to procure it’s Dissolution; and without a Remedy for which his Method will be always unsuccessful. _Mercklin_, in his Treatise _de Transfus Sanguinis_, page 35, tells us we have no Reason to believe we may have Success from Transfusion in a _Cancer_, nor indeed would Injections succeed better; though, perhaps, by this Means, it is possible so to alter the Fluids, that _Ulcers_, not _Cancerous_, may be cured in a short Time, as it once happened to a certain Person, who being under Cure for an inveterate Pox, had some _Rosin_ of _Scammony_ infused in the Essence of _Guaiacum_, injected into his Veins, which Vomited him excessively; but his _Ulcers_ were healed in three Days Time. From what has been hitherto said, it is evident, that a _Salivation_ can never cure a confirmed _Cancer_, because it is not capable of procuring a Dissolution of that hard Substance, which is the real _Cancer_ it self. The Glands we have observed, with the extravasated _Lympha_, and its Vessels, are perfectly changed to a different Substance to what they were before, all which make a _Mass_ of such a Nature, that it will be impossible to procure it’s Dissolution by any inward Means. If the _Cancer_ was nothing more than a Coagulation of the Juices in the Vessels, or other Canals, or Pipes, the Cure might be much more easily effected, but as the _Cancer_ is conjoined with such Circumstances as we have mentioned, we may affirm the Cure will be altogether impossible without the whole Substance with it’s Appendices or Branches (which we have found they often have) be taken away; or a perfect Dissolution of all of it be procured by some external Remedy, which is capable of operating on it after such a peculiar Manner, as to dissolve the _Cancerous Substance_, without having any such Effect on the contiguous Parts.

PROBLEM V.

_Whether Cancers are Curable by Causticks._

The Difficulty that those of our Predecessors who had Courage enough to attempt the Cure of _Cancers_, must unavoidably meet with, obliged them to enter upon several Methods of Practice, in order to be capable of surmounting it; and there have not been wanting for these several hundred Years last past, some Gentlemen in the Republick of Medicine that have proposed to conquer this Rebellious Disease, by the use of some particular Causticks, they have recommended. It is foreign to my Design, to give an Account of the Composition of the several Remedies, they have been big with the Expectation of Success from; I shall only take notice of one or two not very pompous Preparations, that by some Persons I know, have been looked upon as extraordinary as any that have been transmitted to us. _Guido_, who I think I may justly say is one of the best Authors of so ancient a Date, has been very lavish of his Encomiums on _Arsnick_, and after him _Fallopius_, _Rodericus a Castro_, _Ossenius_, _Penotus_, _Faber_, _Borellus_, and others, have recommended it in some particular Preparations. That of _Fuschius_, who is said to have cured abundance of Persons of _Cancers_, in _England_, _Germany_, and _Poland_, having had the most said in it’s Commendation, required our more particular Notice; _Hartman_ calls it _Pul Benedictus_, which whether it deserves that Title, we will leave to the Reader to judge, after we have faithfully recounted the Effects of it. Its Preparation is as follows: ℞ _Arsenici albi_ ℥i _subtilissime pulverisetur per dies 15 de die tertio in tertium affundatur Aq. vitæ, ut cooperiat pulverem, post triduum Aq. vitæ abjiciatur, ac nova affundatur, ac misceantur. Rad Dracunouli Major, mense julio vel Agu. collect & in taleolas scissæ ac in loco ventis perflatili exsiccatæ_ ℥ii. _Fuliginis Camini splendidi_ ℥iii _redigantur omnia in subtilissimum pulverem super lapidem marmoreum, & servetur in Vase bene clauso vitreo. Ante annum vero ad usum non erit it a commodus_. This Powder I applied to a _Cancerated_ Breast of a Woman, under thirty Years of Age, after having made a Sore by applying one of the milder _Causticks_; the first Night it was made use of, it caused a great deal of pain, and the next Day, the Breast appeared very much tumefied and inflamed, a small quantity of Gleet, having discharged on the Bolster: in short for fifteen Days she was not free from pain, she had a _Fever_, was attended with frequent _Vomitings_, _Faintings_, and several other Disorders. I could afford her but very little Relief by Internals, or the most cool and temperate Applications to the Breast; nor was it in my Power to remove the dressing, it adhered so fast to the Sore. There was a Discharge of a bloody ferous Juice for twelve Days in a moderate quantity, after which the Matter thickened, and it began to smell somewhat offensive, at the end of fifteen Days the Dressing dropped off, and with it came away about two Ounces of the _cancerous Mass_. The Reader may easily imagine that making so small a Progress in such a time, and that at the Expence of so much Pain, I could easily prevail with my self to desist from the Undertaking, for the second Application would have been attended with the same Inconveniencies as the first, which to any Persons that entertains such a concern for his Patients as he ought to do, must be very fatiguing; in short, after this I made use of that Remedy I had elsewhere mentioned, and which from its Effect was properly enough called a _Dissolvent_, with this by the Blessing of God the _Cancerous_ Substance was consumed in about three Weeks, and a perfect Cure compleated in not many Days after, the Patient which I saw lately continuing perfectly well, it being the first Case that ever Providence directed me to the use of the Remedy in. _Hildan_ has an Observation very pertinent to what we have before related; he tells us, that the _Powder_ so much celebrated by _Penotus_, and which is much the same with that just now mentioned, being applied to a _Cancer_, was succeeded by such ill Symptoms, that it killed the Patient in a few Days. We are informed in the communicated Observations of _Riverius_, that a Foreigner extirpated a Cancer, that had began to Ulcerate in the Breast of a Woman of fifty Years of Age, by the following Application: ℞ _Arsenici_ ʒi. _Salis Armoniaci_ ℥ii. _Sublimat. crud._ ℥iiii. _Aq; Fortis_ ℥i. _These were to be distill’d to Dryness, then an equal Weight of distill’d Vinegar put thereto, which was to be distilled again, till the remaining Matter, became of the Consistance of a Paste._ The Surgeon bathed the _Cancer_ with hot Wine, and rubbed it with Cloths for some time to _irritate_ it, then he spread some of his Composition on a Bolster six times less than the _Tumour_, and applied it; in twenty four Hours time, it made an _Escar_ as large as the Swelling, so that it wholly consumed the _Cancer_; after the Separation of the _Escar_ he incarned the _Ulcer_ and cicatrized it. It is very observable, that he did not engage in this painful Process, without immediately causing a Fever, which was attended with a _Vomiting_, _Loosness_, and much Provocation of _Urine_; which Symptoms lasted two or three Days, for Nature was disordered by the destructive Quality of a venemous Remedy. _Paracelsus_, _Faber_, and some others, make mention of Arsnical Preparations, that procure but little Pain in their Operation; I had a Design of making a Trial of some of these Remedies, had I not in my Enquiries met with what was very satisfactory to me, though after knowing what I have related, I should have always cautiously avoided the use of any Remedy, in which the _Arsnick_ had not undergone such a Preparation as I should have approved of, because I am assured it may procure very mischievious Symptoms, though in Substance, it do not so much as touch the Skin, witness the _Amulets_, in which it has been the chief Ingredient, and of which there have been such direful Accidents related by _Crato_, _Massaria_, and _Zacutus Lucitanus_. I do not think it impossible, but that _Arsnick_ may be prepared after such a manner as may, by the addition of some convenient Body, or depriving it of its noxious Particles, qualify it for effecting uncommon things in the Cure of this Disease, without causing the Surgeon to repent the use of it. I remember that _Helmont_ somewhere says one may easily enough correct several sorts of Poisons, so that they shall not be deprived of their Force, when we destroy their Virulency. Many Instances of this Nature we meet with in Mr _Boyle_, and some others; but that which makes most for my present purpose, is, what is mentioned by the last Honourable Gentleman, of a very ingenious Man he knew, that was famous, as well for his Writings, as for a Remedy to cure _ulcerated Cancers_ in Womens Breasts, without any considerable Pain. He assured our Author that his Medicine was indolent, and mortified the ulcerated Parts as far as they were corrupted, without disordering the Party, and this Remedy it seems partly by the Confession of the Gentleman, was reasonably enough supposed to be a Dulcification of _Arsnick_; one would think that the mention of this very Remedy, with Monsieur _Alliot’s_, and that recommended in the preceeding Letter, should be sufficient to influence the inquisitive of our Profession to farther Enquiries, which must be certainly an Undertaking, worthy the noblest Spirits. To conclude, we cannot say, but there are many Cancers that may be cured by Causticks, but the Person that is to undergo it, may very well answer, as a certain Patient did, who’s Thigh was to be cut off, _Non est tanto digna dolore Salus_. _The Preservation of Life would be too dear bought at the Price of so much Pain._ This puts me in Mind of what is related of _Galienus_ the Emperor, who it seems had for a considerable time been very grieviously afflicted with a _Sciatica_, a certain Physician undertaking to cure him, performed indeed his Promise, but nevertheless made him undergo a thousand painful Experiments; whereupon, the Emperor one Day sent for, and thus said to him, _Take_ Fabatus _two Thousand Sesterces, but withal, be informed I give them not for curing my_ Sciatica, _but that thou may’st never cure me again_.

PROBLEM VI.

_Whether Cancers are Curable by internal Medicines._