Chapter IV: Introduction: To the (3)

[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it with Success; he did not only influence his Cotemporaries to revive an Operation, that was, perhaps, almost grown out of Date, by the Histories of some Cases he recites; but obliged them with the Figure of a Pair of Forceps, which in this Operation are very convenient to engage the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._

Though this _Problem_ at first View may seem to be too near allied to that which proves the Impossibility of curing cancerous Tumours, whether ulcerated or not, by Salivation; yet in regard there are some Persons, that tell us the Disease is superable by some internal Remedies, which operate after a quite different Manner, to those generally given to procure a Salivation, we shall enquire into one of the most considerable of them, related by a Person whose Memory we have a very great Value for. And we shall the rather take Notice of this particular Remedy, because we have elsewhere spoke of the Success of it. It were no very difficult Matter for me to mention several internal Medicines, out of our Chirurgical Writers, more especially those that have been Favourers of Chemistry; but I shall purposely decline it, because to speak freely, I suspect that most of the Remedies, though much has been said in the Praise, have not been sufficiently examined by those that recommended them. To this we may add, that had the Authors of them considered the vast Difference there is to be observed in Cancers, they would not have so suddainly and positively determined, that their Medicines were of use in these Cases in general; seeing we must have regard to absolutely different Intentions, in those that are not ulcerated, and those that are, and those that are a hard Tumour, and those that are flat, and likewise when they are conjoined with Circumstances, which are often enough to be met with. The Honourable Mr _Boyle_ in his _Usefulness of experimental Philosophy_, tells us, that he was informed by credible Persons, of a certain _English_ Woman above sixty Years of Age, who had lain long indisposed with a Cancer in her Breast, in an Hospital in _Zeeland_, and was by Doctor _Harberfeld_, with one single inward Remedy perfectly cured in three Weeks; the Relation was made by a _Doctor of Physick_, who was an Eye Witness of the Cure, and another Person who not only saw the Cure, but knew the Woman before, and out of Charity, carried her to him that healed her. Our Author was informed, that the _Chemical Liquor_ the Doctor constantly made use of, does in the Dose of about a Spoonful or two, work suddainly and nimbly enough by Vomit, but hath very quickly ended it’s Operation, so that within an Hour, or less, after the Patient has taken it, he is commonly well again, and very hungry. He adds, that having some of the Liquor presented him, he found the Taste to be offensive enough, and not unlike that of _Vitriol_, which by the Taste and emetick Operation, was guessed to be it’s principal Ingredient. The Relators assured our Author they had been in _England_, as well as elsewhere partly Eye Witnesses, and partly Performers of wonderful Cures by the help of it alone, under God, in the _King’s Evil_; insomuch, that an eminent Gentleman of this Nation, hath been cured by it, when _that Distemper_ had brought his Arm to such a pass, that the Surgeons had appointed a time to cut it off. Now, who is there, that upon reading this Account would not think the Doctor a very happy Man, that was Master of so valuable a Secret; but alas! How satisfactory would it be to the World if the hundredth part of the Remedies that have been handed down to us, had a Power of effecting those things that are ascribed to them, without being attended with any ill Consequences. I assure you, Reader, I have made use of this very Remedy, for since I mentioned it as the Doctor’s having great Success from it; I met with the true Preparation of it, as it was communicated to Sir _Kenelm Digby_ by Doctor _Havervelt_, or _Haberfield_, for the Cure of _Cancers_, the _King’s Evil_, and old _Ulcers_. It is as follows. ℞ _Dantzick Vitriol, calcine it till it be yellow, then grind it with Salt, or Salt Petre, the ordinary proportion with this Sublime Mercury, which Sublime once again by it self, then take only the Cristaline part of it; of this take_ ℥i, _grind it to a Subtile Powder in a Glass Mortar with a Glass Pestle._ Put this into a Glass Bottle, and pour upon it a Quart of Fountain Water, stop the Bottle close, and let it stand thus for some Days, shaking it often; after it is well settled pour off the clear, and filtre it; take a Spoonful of this Liquor, which put into a Vial, and put to it two Spoonfuls of fair Water; shake the Vial well, and let the Patient Drink it in the Morning Fasting: As to the quickness of its Operation, and the making the Patient Hungry, I found it at first to agree with what Mr _Boyle_ says of it; but upon giving it three or four times, the Patient would afterward complain of a Languidness, which was ushered in by a Sickness at the Stomach; after this, they would be attended with a Heat or Soreness of the Throat, immoderate Thirst, convulsive Motions of the Stomach, _&c._ Some of which Inconveniencies would continue for many Hours together. It was upon Account of the Melancholy Reflections of bringing the Patients into such Disorder, and their Unwillingness to endure such Fatigues, that I had never Courage enough to proceed in this Method. I cannot but say, upon the Alteration I found in a Patient of mine, from the use of six Doses of this Medicine, that it may as well as some other churlish Remedies, cure some flat ulcerated Cancers, where there is no Tumour to dissolve, in Persons that are capable of often repeating it, which I think is sufficient to put us upon farther Enquiries, that we may be able to accomplish such Undertakings without bringing upon the Patient such a Train of mischievous Accidents.

_POSTSCRIPT._

What follows is taken from a Manuscript which at this time 1714–15, belongs to one of the Family of the _Pains_, that have for a long time pretended to cure Cancers: In the Margin is this Note, (_Used by my Father, and Grandfather, and Brothers, and known as a thing excellent by long Practice in our Family of the_ Pains:) The Book was lent me by my Brother _Dobyns_, who had it from one of the Family, a Patient of his.

_The Red Caustick._

To eat all Superfluous Cancerous and Schirrous Matters gathered hard in the Edges or Sides of any Ulcer or Cancer, breeding upon the Mouth, Face, Nose or Valva. Take of Bole Armoniac one Ounce, of yellow Arsnic three Ounces, powder them and searse them fine, pare an Apple or two and take of the Pulp and put so much of it to the Powder (beating of it together in a Mortar) as will make it of the stiffness of Dough, then make it up into round Balls of the bigness of a Walnut, dry them in a Chamber-Window till they be hard enough. When you use these Balls shave a little off from them into your Hand, and moisten the same with a little Spittle, and rub it well about the hard Foot of the _Noli me Tangere_, and all over the Head of the same, and after that you have gathered him up into the Ligature and knit him hard up (for it seems they used a Ligature smeared with the Medicine) then apply your Preparation before-mentioned, and lay fine Holland Raggs dipt in the following Red Water, all over the said Caustic, and so let it lye till it fall off its self. _Note_, The Quantity of Caustic laid on, ought not to be much, and yet sufficient to work its effect. It worketh with great Pain for twelve Hours or more, and after that by Fits, like the Tooth-Ach; as the Pain worketh off it causes great Inflammation and Swelling about those Parts it is applied to, but this does not continue above four or five Days; so meddle not with it till the Caustick comes off. Then you may for three or four Days dress the Inflammation with Diachylon Plaister, or the Red Water warm.

_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 1719[3]. Under the _Imprimatur_ of _Robert Shippen_, Vice-Can. _Oxon._

[3] Mr _Rushworth_ died 1737, and it is here inserted in Justice to
his Memory.

_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.

* * * * *

It has been likewise thought proper to preserve a _small Treatise_ of curing _Consumptions_ by a new Method, of administring _Specific-Medicines_, more especially _such_ as proceed from _Ulcers_ of the _Lungs_.

This excellent Piece was written by the late eminent Mr _Thomas Nevett_, of _Fen-Church Street_, Surgeon.

A NEW

METHOD

Of Curing

CONSUMPTIONS

BY

Specific Medicines.