Читать книгу A Collection of Chirurgical Tracts - Beckett William - Страница 4

ADDRESSED TO Charles Bernard, Esq; Serjeant-Surgeon, AND Surgeon in Ordinary, to Her Majesty Queen ANNE

SIR,

I LOOK upon it as a peculiar Happiness, to live in an Age when Men of our Profession consider, that as the Art is capable of receiving daily Improvements; useful Discoveries, confirmed by Experiments, ought to receive the joint Concurrence of their good Wishes; notwithstanding, they may contradict an Opinion that has been almost universally received. These we shall always find, are the Gentlemen who in opposition to those Bigots whose Tempers discover them to be the Votaries of a few opinionative Men, endeavour to guide their Judgments by Reason, backed with judicious Observations, and whatever Arguments are produced, will never go about to controul Matters of Fact. It is a grand Truth that Necessity gave Being to Physick and Surgery, and Experience is the only Way to bring them to Perfection; but it is much to be lamented by them that are Well-Wishers to those Arts that the Persons which are perhaps capable of advancing them most, devote themselves so much to speculative Fictions (the Effects of teeming Brains) that some have pretended with a magisterial Air to dictate, even to Experience itself. In such a Case it would be needless to go about to offer Arguments sufficient to disengage their Inclinations, Time only must discover to them their Error, when it makes them sensible they have, to no Purpose, persisted in the Pursuit of frivolous Niceties; for in reality, the Benefit of Mankind in general is deduced from Practical Truths. The Thoughts of this are sufficient to inspire every generous Soul with an ardent Desire of discovering something that may be of so universal an Advantage: As for my own Part, I was not animated to concern my self in the Undertaking I have engaged in, by a Prospect of gaining that Honour that is often liberally bestowed on those that mint new Hypotheses, or make new Discoveries; my only Design was to inform my self, whether some of those Diseases, which are generally reputed incureable, are not actually in themselves curable, and by this means to wipe off a Reproach which has been cast on Nature, when in reality it proceeds only from our own Weakness, and the Infirmity of our Art. A diligent Application to those Distempers which baffle us most, has been frequently recommended by very reputable Authors, and some of those who have obliged us with the Histories of Diseased Persons, have very often mentioned considerable Cures, which have been happily performed after the Patients have been looked upon by some as incurable. Hippocrates tells us, Lib. 2 Aph. 52. Si Medico secundum rectam Rationem Facienti, Curatio non statim succedat, non est tamen mutanda Methodus, quamdiu id restat quod à Principio visum est. I am fully persuaded that most Practitioners in Surgery have at some Time or other, by an industrious Application, been successfull where Art could not warrant a Cure. As to the Disease I propose to make the chief Subject of this Letter, tho’ it be generally branded with the Character of Incurable, I must freely own I never could discover any thing essential to it in general that should make it so; it is true, there are many Diseases that are not to be cured, where certain Circumstances are conjoined, which very much contribute to the Misfortune; tho’ Others of the same Class exempt from those Adherents may, perhaps, be happily enough cured; Thus for Instance. In Cancers we have but little Reason to expect a Cure in a Person that is old, if the Cancer has been of many Years standing, and is firmly fixed to the Ribs; but if the Patient be not so far advanced in Years as to be uncapable of receiving the Benefit of Nature by the regular Discharge of the Menses and the Cancer be loose; notwithstanding, it be Ulcerated, over-spread with fungous Flesh, discharge a filthy Matter, and smell very offensively; we do upon Experience affirm that such a Patient may be cured. We must own we cannot be of the Opinion of the Paracelsians, who affirm there is no Disease but what is curable in any Patient, for the Reason we have given; nor can we with the Galenists, agree that the Gout, Dead-palsie, Stone, Cancer, &c. are Diseases absolutely incurable; because Experience discovers the contrary. We find that Mr Boyle is of the same Opinion, and thinks it were no ill Piece of Service to Mankind, if a severe Collection were made of the Cures of such Persons as have been judged irrecoverable by the Doctors; that Men might no longer excuse their own Ignorance by the Impotency of Nature, and bare the World in Hand, as if the Art of Physick and their Skill, were of the same Extent. There seems to be one very effectual Way to rescue the medicinal Art from the Aspersions of some bold Persons; and that is that of a certain Number of regular Practitioners in Physick and Surgery, each of them should apply himself to the Study of one particular Disease: By this means we should soon find they would be capable of surmounting those Difficulties that have all along baffled the most Judicious of the general Practicers. How odd, and disagreeable this Opinion may seem to some Men I know not; but I assure you, Sir, I find it of a very ancient Date; for Herodotus, a Greek Historian informs us, that before his Time, the Physicians in Egypt used to apply themselves to the Study and Advancement of one Disease in particular. Baricellus, and Lionardo di Capoa, observe the same likewise, in Relation to the Practice of Physick in that Country. Baglivi, in the Scheme he lays down for erecting of Colleges for the Improvement of Physick, tells us, that every Fellow of his Literate Society must have one Disease allotted him for the Task of his whole Life; and which elsewhere he says is not sufficient for the illustrating the Province of one Disease; but that we lie under a Necessity of taking in Materials from all Hands. But there is no Man that we know of, has spoke more agreeably of this Matter than Dr Harris, in his Pharmacologia Anti-Empirica, he owns that he took more than ordinary Pains in one particular Disease, and assures us he verily believes if learned Men, after a compleat Acquisition of the universal Method of Physick, and a necessary Search into the Nature and Cures of those manifold Infirmities and Diseases, which, with a kind of infinite Variety, do afflict Mankind, would, with their utmost Vigour and Resolution, prosecute the Knowledge of some one Disease eminently above others; they would, most certainly, find a particular Providence attending and assisting them in so good and honest a Design. He adds, a few Pages farther, that wherever a Man’s Thoughts are intent and fixed, wherever his Genius does naturally incline, and all his Aims and Application do continually tend, whether it be to pertinent or insignificant Matters; whether it be to useful, or else meerly curious Things; if he has but tolerable Parts, and Education corresponding, he can hardly ever miss; it is hardly possible he should miss the becoming Eminent, and in great Measure perfect, (I mean perfect (says he) according to the Modulum of Human Capacity) in that one Point. But there is one Thing to be recommended to the Consideration of the Person, who takes upon him the Enquiry into the Nature of one particular Disease, which perhaps he might be very liable to err in, if not cautioned against; and that is, that he be not too bold and rash in his Attempts; for, as Galen says, The Physician’s Art is not like that of an Artificer, who may make what Experiments he pleases, to satisfy his Curiosity; because if he spoils the Materials he works on, no Body is endangered by the Miscarriage: In Corpore autem humane (adds he) ea tentare quæ non sunt Experientium comprobata Periculo non vacat, cum temerariæ Experientiæ Finis sit totius Animantis internecio. I believe we shall find that one of the grand Reasons, why Persons, generally speaking, have been so negligent in making any Attempts on Cancers, has been the seeming Discouragement they have all along met with from Authors. The Caution Hypocrates has given us in his Thirty eighth Aphor. Sect. 6. has scarce been omitted by any one considerable Person that has wrote of this Subject, tho’ perhaps the Sentence has often had an Exposition put upon it, contrary to the Author’s Meaning; but of this, more in it’s proper Place. I proceed now to give an Idea of Cancers in the Breast from an external Cause; and this I shall do without concerning my self with the Opinion of the Ancients; for since we have been so happy as to live in an Age which will be remarkable for the many surprising Discoveries which have been made in Anatomy: We should be reckoned unworthy the Advantages we enjoy, if we did not study to apply them to the Benefit of Mankind in general. The more inquisitive and learned Part of the World, are at this time very well assured that the Animal Body is an exquisitely framed Machine, and that it’s Composure is little else than a Compages of branching and winding Canals, which are kept to a moderate Degree of Extention, by Fluids of different Natures; and that the Motions of these were first determined by the divine Architect: Thus in a natural State, the whole Fabrick is governed by certain Laws impressed on the Fluids; and we often find the unhappy Consequences of the Discomposure of a Part, to discover themselves first by an Interruption of the Motion of the animal Juices. Thus in a Cancer of the Breast which proceeds from a Blow or Bruise (as upon strict Enquiry we have found they most commonly do) is it not probable that by such means a Confusion of the true Order of the little Glandulous Grains and their excretory Ducts may happen? and at the same time an extravasated Lympha may lodge in such a spungy Texture, which in time becoming viscid, will coalesce with the Glandular Substance, and form a Mass considerably compact? Now this being so, it is reasonable to believe that as the Lymphatic Juice continues its Motion till it arrives at the indurated Part, its Passage must be embarrassed there; upon which, it will soon be qualified for an Union with the remaining Part of the glandulous Substance of the Breast; and so the whole be perfectly changed from what it was before. This Hypothesis is in a great Measure grounded on Experiments; for if we express a Juice from some of the Cancerous Mass, and hold some of it in a Spoon over a Fire, there immediately flys off a small Vapour, and the Remainder hardens not unlike the white of an Egg boiled; this shows it to have the Properties of the Lympha; for the Chymical Analysis of that Liquor assures us it is a Composition of a great deal of fixt Sulphur, a little Volatile, some Phlegm, and much Volatile Alkalie; to which some add a little Earth: Now while the Volatile Alkalie keeps the Sulphur dissolved, the Lympha remains in a State of Fluidity; but when, by making the same Experiment, the Volatile Alkalie is evaporated, the Remainder hardens, and forms a pretty compact, whitish Substance. From hence the judicious SURGEON may easily deduce the Reason why these Sort of Tumours can never be brought to Suppuration. We shall not be so particular as to mention those Cancers which proceed from internal Causes, nor several other things which relate to the former; for what we have here said, we look upon to be commonly the Method of the Formation of them; and as such, we did endeavour to calculate Remedies that should peculiarly operate on the Mass, so as to dis-unite the firm Cohæsion of its Parts, and dispose them to separate and come away, without any great Inconvenience to the Patient; which is what we would recommend with all the Earnestness imaginable to those that are desirous of discovering a Method of curing Cancers. We were before sensible that it was possible for one Body to operate on another determinate Body, without being able to have any such Effect on innumerable Others; as Quicksilver will desolve Gold, Aqua-fortis Iron, Vinegar the Shell of an Egg, Oyl common Sulphur, &c. which will not have any such Effect on several other Bodies; for there is nothing more certain than that the Operations of Dissolvents are so determined by the various Texture of the Bodies on which they are employed, that a Liquor that is capable to corrode a more hard and solid Body, may be unable to disunite the Parts of one more soft and thin, if of a Texture indisposed to admit the small Parts of the Menstruum. It may be expected I should say something in relation to that which is generally looked upon to be the grand Cause of the Incurableness of Cancers, I mean the acid Humour in the Blood. But if those Gentlemen who are fond of entertaining this Opinion, do but consider that Cancers are often formed in a perfect State of Health; and that during the Time the Cancerous Substance dissolves, and comes away according to our Method, the Sides will run a digested Matter, and heal by the Application of dry Lint only; they will be of my Opinion, that neither the Atrabile of the Ancients, the corrosive Alkalious Salt of the Chymists, nor the predominant Acid of the Rest of the Moderns, are capable of procuring those Alterations that Cancers are sometimes attended with. If we trace the Writings of our Predecessors to their earliest Date, we shall find that many of them have made Mention of the Roots of the Cancer, which they took to be the large blew Veins that are often extended on its Surface; and the entire Removal of these they thought to be absolutely necessary, or the Patient could not be cured: But I believe there is no Body at this Time that considers the Mechanism of the Parts in such a Condition, but will agree they are the necessary Consequents of it, and that their Absence, or Presence is of no Importance; that the Cancer is sometimes attended with Adherents, or Appendices, which may very well resemble Roots, we are assured; but these generally lay deep, and not easily discovered; the most considerable One that ever we saw was very near Five Inches long, and of an unequal Bigness, some Part of it did not exceed the Largeness of a Goose’s Quill, but some others were near as big as the Top of the Thumb, which resembled so many Knots in it, it divided in the Middle, and continued separated about an Inch and a Half, and then re-united, it was of a more tender Substance than the Body of the Cancerous Mass, but of the same Colour, and was probably the Juice that was last applied to the Cancer, which assumed a Form agreeable to the Cavities it lodged it self in. Such Adherents as these are, I am more inclined to believe, are the Cause of the unsuccessful Attempts on Cancers, than any Acid in the Blood; for I am of opinion there are few Persons unacquainted with Medicines that are capable of correcting its Acidity when it happens; and had the Cure of Cancers depended on that, I am positive they would not at this Time have had such ill Character. We have before shewed that Cancers have generally their Rise from a Blow or Bruise, and that when the Body is in an healthful Condition, and the Blood and Lympha temperate and sweet: Now if there always is an Acidity of the Blood when Persons are afflicted with Cancers, the Cancers must sometimes cause it, and not the Acid in the Blood the Cancers, as is the Opinion of most of the Moderns. What has been hitherto said, is sufficient to prove that if Men will be always so sluggish as to acquiesce in the Dictates and Dogmatical Positions of their Predecessors, and not exert their Faculties in endeavouring to undeceive themselves; we must no longer expect our Art will receive any Advancements, but as Slaves to their Opinions content our selves with what we know already. Were not Parisani, Riolan the Son, and Plempius, so much in the Interest of the Ancients, that when our Country-man, the assiduous Harvey, had discovered the Circulation of the Blood, they not only opposed his plain Demonstrations, but engaged in vigorous Disputes against him, tho’ at the last they were obliged shamefully to recant their Follies. Celsus tells us, Vix ulla perpetua Præcepta Ars Medicinalis recipit; scarce any of the Precepts of the Medicinal Art are perpetual. And shall we engage then in the List with a few opinionative Men, that ground their Course of Practice on those Methods only, in which they have been brought up, and implicitly assent to the Conjectures of others. No certainly, this would be to strangle Truth, and extinguish the Vigour of our Wits with precarious Authorities. Consonant to this, Dr Paxton, in his lately published Treatise, tells us, Thus Men, out of a trifling Distrust of their own Parts, will not use them; or out of Laziness of Temper, will not employ them, chusing rather to be wise or learned, by being adorned with Others Whimsies, than undergo any Labour, Fatigue, or Trouble of being really so. I believe there are some Men that would rather contradict their Senses than deny the Authority of a darling Opinion: Of this, we have a sufficient Proof in an Instance, related by an Italian Author before-mentioned. He tells us, That a certain Publick Reader long Time versed and grown Old in the Books of Aristotle being one Day present at a Dissection, and clearly seeing that the Vena Cava takes its Rise from the Liver, confessed with Astonishment what his Senses discovered to him, but that he ought not therefore, by crediting his Senses, to contradict his Master, who constantly affirms all the Veins in Man’s Body to have their Original from the Heart; because, said he, it is much more easy for our Senses to be sometimes deceived, than the Great and Sovereign Aristotle. I here seriously confess, I have as much Veneration for Antiquity as any Person whatsoever; but it would be ridiculous, if, as One says, we should so far forego our own Judgments as always to follow the Foot-steps of Others, and to be certain of nothing our selves: For this would be to see with others Eyes, to hear with others Ears, and to understand with other Men’s Intellects; so that whenever we make Quotations from the Ancients to strengthen our Opinions, we ought to do it judiciously, and fully consider, whether their Notions of Things are consonant to the Experience of these Times. To prove to you, Sir, that I have not proceeded to apply my self to the Cure of so formidable a Disease, without a Precedent, I shall instance to you that Fuschius, a learned Italian Surgeon, had such a wonderful Reputation for it formerly, that some Authors say he was distinguished by a particular Title, which discovered his Success. His Method I have made use of, and tho’ by passing thro’ several Hands (the Author being mentioned by few) it has been stampt with wonderful Encomiums, I have not hitherto found it deserves it, notwithstanding I did not omit the most minute Circumstance in preparing the Medicine, or prosecuting the Directions; but in its proper Place, I shall take particular Notice of this, and several other Remedies, that have been recommended by some Authors, as substantial and extremely useful; for if in One or Two Instances they have been crowned with Success, by Degrees they are handed down as infallible in all Diseases of the like Form. To the former Account I may add, that Monsieur Alliot, Physician to the Duke of Lorrain, has applied himself to the Cure of this Disease very successfully, as a Schedule he published at Paris some Years ago informs us; we are likewise assured by Mr Boyle that Dr Haberfield, one of the Principal Physicians of Bohemia, has had extraordinary Success in the Cure of Cancers; and the Sieur Gendron, Doctor of Physick in the University of Montpelier, has done extreamly well on that Head; the latter of these Gentlemen I cannot mention, without making an Apology for not Publishing our Annotations on his Enquiries relating to Cancers which was promised at the latter End of our Chirurgical Remarks, Printed above a Year ago; but I assure you, Sir, I was more inclined for some Reasons to offer what is therein contained, with several Observations made with the greatest Exactness, and to which, perhaps I may have an Opportunity of making several Additions, in a particular Treatise, so that the whole may conspire to finish a compleat Account of this Disease. I had at first a Design of enlarging considerably on this Subject in this Letter by adding various Things, but considering they might better find a Place in what I just now mentioned, and that you did not desire an exact History of the Disease, I resolved to omit them. I shall now proceed to give you some Instances of the Success of our Method, as being what you are most solicitous of, the Cases I shall relate shall be each of them different from the other, for I know you do not approve of that pompous Method of some Persons, that enumerate abundance of Instances of Cures when perhaps there is no great Difference in the Cases or the Method of treating them.

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

A Gentlewoman near fifty Years of Age, by some Accident received a Blow on her left Breast, which in a few Days was succeeded by a considerable Tumour, whereupon she applyed herself to a Surgeon, who immediately let her Blood, ordered her to take the Lap. Hibern. in Posset-Drink, and embrocated the Breast with Ol. Succini: By the use of these Means the Swelling was much abated, a small Hardness only remaining, which did not exceed a small Wallnut in Bigness; in this State, with very little Pain, she continued above a Year; but being persuaded to apply an Emp. de Ran. cum Mer. to it, it encreased very apparently, was extreamly painful, and in Seven Months time became as big as a large Egg: After this she made use of a Woman who was reputed Famous for these Cases; but by One or Two of her Applications the Tumour became as big again as before: In short it continued to encrease gradually from that time, till the whole Breast, which was of a monstrous Bigness, and which was judged not to weigh less than Eight Pound, in time became entirely Cancerous. It was at this time that I saw it the Skin was very livid, looking sleek and shining, and seemed ready to open, as being scarce capable of longer containing such a prodigious hard Mass as laid concealed under it, and was in all Probability as big as the Breasts of the Ammonian Women, of which Juvenal thus speaks, In Meroe, crasso majorem Infante Mamillam. She had been with various experienced and reputable Surgeons before, among which was One not long ago deceased, who was justly looked upon as an Ornament of his Profession; but not one would willingly attempt a real Cure by cutting it off, or any other Way: They only prescribed some palliating Remedies to remove the Pain and prevent its Breaking. I was animated by my former Successes, and prevailed with my self to undertake it, not thinking I was at all blameable if my Success in so extraordinary an Affair contradicted the Prognosticks of so many worthy Gentlemen; and though it did, I shall at all times think my self obliged to pay a Deference to them. I began the Cure by removing the Integuments from the upper Part of the Cancerous Substance, but did not wait for a Separation of the Slough the Escarotick made for fear of being incommoded in my Procedure by a Fungus; For this Reason I mixed some of our Dissolvent with a digestive Ointment, by which Means I had a Part of the Cancerous Mass came away with it, without any Trouble to my Patient. I continued this Method of Dressing several Days longer, with very little Alteration; but upon a Complaint of a Pain between the Shoulders, I was obliged to change my Medicine, and foment the Cancer with an Infusion of some of those Herbs that contain many Volatile attenuating and active Particles. And here I cannot but remark, by the by, that Applications to the pained Part would have been of no Effect, as I have many times observed, and particularly in a Woman which had a Cancerated Breast, that was violently afflicted with a Pain in her Arm on the same Side, which would not be removed by any of the Applications the Person that had the Care of her made use of the affected Arm. To this I might subjoin a very pertinent Case from Galen; but I fear I shall digress too far. The Pain of my Patient’s Back being removed, I proceeded to apply the Dissolvent, which so softened the Superficies of the Cancerous Mass that in Three or Four Days Time I could take off above a Quarter of a Pound of it with the Edge or Back of my Incision Knife, and my Patient not so much as feel me, this I continued to accustom my self to, because it would have been more tedious to have waited for the coming away of the Cancerous Mass of it self. Sometimes I varied my Applications as I saw Occasion, but, as my Patient confessed, I scarce put her to any more Pain during the Time her Breast was dissolving (abating for the Pain of her Back) than there is in the dressing of an Issue. The prodigious Bigness of the Cancerous Mass made the Cure the more tedious, for it was above Three Months before all of it was entirely dissolved and gone; but this being at length surprisingly and very happily effected the Cancerous Ulcer (the last Part of the Cancer that came away left) was incarned and cicatrized by an Infusion of vulnerary Herbs, to which was added a small Quantity of Tincture of Myrrh: Thus was this Cure entirely compleated and my Success in it confirmed that French Proverb, which says, It is better to be condemned to die by the Doctor, than by the Judge. I did not make use of that internal Medicine I mentioned in the former Case, because here I found no pressing Necessity for the Use of it, but some other proper Physick was taken to dispose the Ulcer to heal, as one would have done in any other Case. Upon the whole of this Cure, I cannot say whether I had more Trouble with the Cancer, or in endeavouring to oblige my Patient to a strict Observance of some of the Non-Naturals she so often erred in. There is nothing can create a greater Trouble to the Surgeon