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THE

HISTORY

OF

TWO CASES

OF

Ulcerated Cancer of the Mamma ;

ONE OF WHICH HAS BEEN CURED,

THE OTHER MUCH RELIEVED,

BY

A NEW METHOD OF APPLYING

CARBONIC ACID AIR;

ILLUSTRATED BY A COPPER-PLATE *

WITH OBSERVATIONS.

*

By JOHN EWART, M. D.

ONE OF THE PHYSICIANS OF THE BATH CITY INFIRMARY AND DISPENSARY.

BATH, PRINTED BY R. CRUTTWELL :

AND SOLD BY

C. DILLY, POULTRY, LONDON.

MDCCXCIV.

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v.

TO THE

I

DIRECTORS

OF THE

BATH CITY INFIRMARY AND DISPENSARY.

I

GENTLEMEN,

I BEG leave to dedicate thefe Sheets to you, many of whom have attended, with a benevolent Curio- lity, to the Progrefs, and have wit- neffed the Recovery of the firft Cafe which they record. I defire likewife

B to

( vi )

to offer any Profits which may arife from the Sale of this Pamphlet, to the Fund of your ufeful Inftitution, and have the honour to be,

Gentlemen,

With great regard,

Your moil obedient

/*

faithful Servant,

J. EWART.

/

PREFACE.

Xf the pradh’ce, prefented to the notice of the Public in the following pages, were fuch as could endanger the life or health, or in any degree injure the perfons, on whom it may be tried, I lliould have with¬ held what I now publilh, until I had ex¬ perience of its fuccefs in more cafes. But as it is attended neither by pain or ri(k ; as it has been fuccefsful in one cafe, and beneficial in another, under circumftances the mod defperate and deplorable; and as it feems to promife not only a hope of recovery, but immediate relief from tor¬ ture, in one of the mod excruciating and untratlable maladies incident to human nature, I have thought it would be wrong

R 2 to

Vlll

PRE FA CE .

to conceal what had occurred to me, wdhing that others might be tempted to repeat the fame experiment.

It would require much time for one indi¬ vidual to aicertain the efficacy of any new remedy, or rather of a new method of applying a remedy, the effects of which muff be fpeedily eftabhihed when tried by many. No time ought to be loft in deter¬ mining the merits of a mode of treatment, which has been found fuccefsfu! in but a fingle inftance of a very frequent,* and hitherto an incurable difeafe. This con-

I he frequency of Cancer, and of courfe the importance oi communicating any probable means of relieving it, will appear in a ffriking light, from viewing Mr, Hill’s account of the extent of his own practice in this difeafe, an author of undoubted judgment and veracity. Though his held for obfervation was by no means extenfive, in the fmall town of Dumfries, yet in the courfe of thirty years he extirpated no leis than eighty -eight genuine cancers, they being all ulce¬ rated except four. (See Cafes in Surgery.) What muft be the devaluation produced by this difeafe in London, Paris, and other populous cities !

fideration

PREFACE.

2X

fide ration will, with the candid, exculpate

in publifihing the fol¬ lowing cafes, without waiting for the cor¬ roboration of others treated in the fame manner, or from any imputation of wifh- ing to raife falfe hopes in the minds of the miferable, by attempting to impofe on the world an inralhble fpecifick for the cure of Cancer.

I cannot prefume from the limited ex¬ perience of two cafes, to promife equal fuccefs in every Similar one. I pledge

j L 'O

myfelf for no more than I have feen.

If, however, the practice which I relate Should, in the hands ol others, preferve a few of thole who are fo unfortunate as to labour under this agonizing and deftruc- tive difeafe; or if, more than any other means, it fhould foothe its anguifih where it cannot be cured, I fha.ll be Sincerely glad to have contributed to fo good an end;

but,

X

PREFACE.

but, on the other hand, Ihould my hopes in thele refpetts be fruftrated, I fhall be forry for the event, but lhali fhill think I did rivht in communicating: as foon as

O O

poffible, what I thought, by being made generally known, might be the more ex- tenlively ufeful.

HISTORY

Digitized by the Internet Archive in 2018 with funding from Wellcome Library

https://archive.org/details/b30369629

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EXPLANATION of the PLATE.

A. A circular plafter, to which the bladder is attached,

, fixed oil the bread.

B. The bladder diftended with air.

C. A flexible tube, leading from the inverted cylinder F

to the bladder.

D A bottle for the production of carbonic acid air from chalk and diluted fulphuric acid.

E. A recurved tube to convey the air under the inverted

cylinder.

F. A cylinder inverted upon water.#

G. A veflel containing water and the cylinder.

H. A cock-flop, to open and {hut the tube leading from

the cylinder.

K, A balance to fufpend the cylinder, fo that this ihall rife out of the water in proportion as air is received under it; the afeent of the cylinder thus meafuring the quantity of air obtained.

£,» A view of the infide of the plafter to be applied to the breaft, with the edges of the bladder folded back upon it.

M. The bladder.

N. The aperture through the plafter into the bladder,

correfponding to the fize of the ulcer.

O. A fmall cradle made of * wire to be placed over the

bladder when filled with air, to prevent its being * prefled upon.

ERRATA.

JAG 2

26, /. A,, for eryfepelaious , read eryfipelatOUS. 27) /• 2, for eryfepelas , read eryfipelas.

47) ^ 9 ■, for extracted, read extricated.

1

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HISTORY OF TWO CASES, &ca

CASE I.

SUSAN ALFORD, aged fifty-eight years, was admitted on the 24th of Jane 1794, an out-patient of the Bath City Infirmary and Difpenfary, afflicted with an ulcer in the upper part of her left mamma. The bread: was naturally of a very large fize. The length of the ulcer, from the fuperior part of it to near the nipple, was aimoft five inches, and its breadth was between three and four. Its greateft depth was about two inches 5 and from its lower end a firms ran under the Ikin downwards, the fize and ex¬ tent of which, as well as the quantity of dif- charge from the fore, may be conceived, from her being in the habit of pre fling out of it

feveral

( 12 )

feveral times a day from a table-fpoonful to two-thirds of a fmall tea-cupful of very fetid matter. The ftench from the fore was at all times fo very offenfive both to her! elf and to by-ftanders, as fcarcely to be endured,

*1 ne whole of the ulcerated furface re- fiefied a ihining gloffy hue, without having any appearance of granulations. The ragged margins of the fore, and the fubftance of the mamma to the diftance of an inch or two around, but chiefly below it, were fwelled and indurated, forming irregular knobs, which in many places feemed to adhere to the pec¬ toral mufcle beneath. The whole was at¬ tended with a 1 molt conftant pricking pain, which (he fometimes compared to a fenfa- tion of burning ; and this frequently increafed to fuch an extreme degree of agony as to make her fcream out for hours together. Some ounces of blood were often difcharged from the fore, which happened moil gene¬ rally when fhe was warm in bed, and was

followed

( *3 )

followed by a temporary abatement of the pain. Her appetite and ftrength were much impaired, her body had been progreffively emaciating, and her fpirits were funk with long buffering, and the defpair of finding re¬ lief. She complained of attacks of fhivering, fucceeded by heat and thirft, and afterwards by cold fvveats, which particularly occurred in the night.

The following is the moft accurate ac¬ count which I have been able to learn from her, of the commencement and progrefs of her complaint.

About fourteen years ago fhe received a blow from a perfon’s hand on the affected breaft, which in confequence became painful

and difcoloured. The difcoloration foon

\ »

went off 5 but the breaft was ever afterwards fubjeft to frequent fhooting pains, particu¬ larly when (lie was over-heated, her profef- fion (that of a cook) often expofmg her to be fo. About two years after the above in-

jury,

9

( H )

juiy, fhe perceived, where it had been applied, ahard painful lump, and fome time afterwards a purling in of the Ikin over it. The uneafi- nefs from this tumour having increafed, to¬ gether with its fize, for fome years, lhe ap¬ plied to Mr. Atwood, furgeon, in Bath, who advifed an extirpation of it; which, however, was not performed. She is not accurate as to the period when fhe confulted this gentleman; but from connecting circumftances, -it ap¬ pears to have been more than fix years fmce. I mention this to fhew the opinion enter¬ tained of the complaint fo long ago, by one who will be allowed to be a competent judge.

The tumour ftill advancing, an excres¬ cence gradually began to appear on the Ikin which covered it, refembling (according to her own expreffion) “ an unripe mulberry." To this fhe applied a warm fomentation of Port grounds for about two years, which fhe thought foftened it, but gave no other relief ; afterwards flic bathed the affected part with warm milk and water only.

( T5 )

It is now more than fix years that her complaint has rendered her unable to follow her profeffion, owing to fevere pain being excited in the difeafed bread; on any motion being made with the arm of the fame fide. This may, with much probability, be afcribed to the aftion of the pedtoral mufcle 3 and it is a fymptom not much mentioned, which I have obferved in cancers of the mamma with deep adhefions. The axillary glands do not appear to have been at any time affedted.

As nearly as can be gathered from her flatement, which is fomewhat indiftindt as to dates, it is between three and four years fince her breaft began to difcharge a mixture of matter and blood. This oozed at firft from fiffures in the mulberry-like excref- cence, which was then of the circumference of <c a Jmall tea-cup” having an hardened bafe of that of cc a large tea-faucer” — I ufe her own words here. — By degrees a fcab was formed on the upper part of the above excref-

cences

4

( 16 )

cence, from under which, matter fimiiar to what has been mentioned, and not unfre- quently quantities of pure biood, flowed.

Her difeafe progreffively gaining ground, fhe applied about two years ago to Mr. Nooth, an eminent furgeon in Bath, and foon afterwards to the Surgeons of theBriftoi Infirmary, all of whom then diffuaded her from any operation, affuring her that her complaint was a cancer of too great extent and depth to be fuccefsfully extirpated. At different periods afterwards die confulted Dr. Lyfons, phyfician, and Mr. Norman, fur¬ geon, of the Cafualty Hofpital in Bath, who confirmed the opinion of the gentlemen before-named. The teftimony of fo many refpeftable and concurring judgments, can¬ not fail to have weight in fatisfying the pub- lick of the nature of the complaint, and in obviating fome poffible fufpicions of any error In my own apprehenfion of it.

I

But

( V )

*

But to proceed with the hiftory of the cafe. The fcab above-mentioned frequently falling off, expofed to view a red ulcerated furface, which gave a pain ££ as if burned by live coal •”* but a new and thicker mcruftation was foon again formed. This feparation of the fcab became more and more frequent, the ulcera¬ tion deeper, and the difcharge more abundant and more offenfive. The fwelling and hard- nels had now' occupied the greateft part of the fubftance of the mamma, and for about two months previous to her appearance at the Difpenfary, the whole tumour had been more than ulually painful and protuberant. About twelve days before fhe came to the Difpenfary, a very great difcharge of blood and matter fuddenly iffued from the breaft, carrying along with it the remains of the mulberry-like excrefcence, and leaving a deep and jagged ulcer, which continued to enlarge

* Her own exprefllon.

more

more rapidly, with increafe of the difcharge and of the pain.

I have been more minute than was per¬ haps neceffary in the foregoing detail $ but the unexpected refult of the cafe has made me felicitous to leave no circumftance un¬ mentioned, which could enable others to judge for themfelves, whether it was what ihould be confidered as a genuine Cancer or not: and that I might avoid as much as pof- fible any misftatement of the fafts, I have carefully collected and noted them, in the prefence and under the correction of feveral Phyficians and Surgeons of Bath, who have repeatedly examined the patient along with me, and who have been witneffes of the fuc- cefs of the treatment to be ddcribed.

When I firft faw the patient, I confefs I entertained no greater hopes of affording her any effential benefit, than the gentlemen had done whom fine confulted before me. I had, however, heard of feveral, and had feen feme

imperfedt

( *9 )

{

imperfect attempts to apply Carbonic Acid Air to cancers and other foul ulcers ; and although the fuccefs of fuch experiments had been fo inconfiderable as to have generally difcouraged any farther trial of them, yet fome relief which they feemed to give, pro- mifed, in my mind, more advantage from a better application of the remedy.

Confidering the foregoing cafe as a proper fubject for a fafe experiment, I gave direc¬ tions to Mr. White, apothecary to the Bath City Infirmary and Difpenfary, for the fol¬ lowing procefs, which was put in execution on the day of the patient’s admiffion.

The neck of a bladder was cut off, fo as to make a circular aperture into it of fuch dimenfions as to correfpond nearly with the fize of the ulcer of the breaft. A round hole of the fame fize was cut in a piece of foft leather, fpread with adhefive plafter, and large enough to furround the ulcer. The cut end of the bladder was introduced through the

hole

( 20 )

hole in the leather, and its edges folded back and ft uck to the plafter on the oppofite fide; forming fomewhat of the ftiape of a round hat, the plafter refembling the rim, and the bladder, when diftended, the crown. In order the more effectually to cement the adhefion of the bladder to the plafter, and to make it air¬ tight, narrow circular ftrips of plafter were applied round their junction both infide and without. The large plafter was then fixed on the mamma, the aperture in its center with the bladder fitted to it being placed exactly over the ulcer, no part of which was touched by the plafter. A fmall orifice was made at the fundus of the bladder, fufficient to admit a tube of about a quarter of an inch diameter, which communicated with the top of an in¬ verted cylinder, fufpended upon water, which cylinder was filled with carbonic acid air. [See the plate.] The bladder being clofely fqueezed, to expel from it the atmofpheric air it contained, and the above-mentioned tube

being

( 21 )

being inferted into the orifice formed to re* ceive it, and tied by a ligature paflfed over the bladder, the inverted cylinder was prefied down in the water, fo that the carbonic acid air was made to rufh through the tube, and diftend the bladder. The tube being then withdrawn, the orifice at the fundus of the bladder was tied, to prevent the efcape of the carbonic acid air, which was thereby kept in contact with the ulcer. As often as the bladder collapfed, fo as to (hew that much of this air had got out, it was filled in the fame manner as before; and this operation was repeated fometimes twice, fometimes three times a day, according as it appeared neceffary. It is a proof of this fimple appa¬ ratus fully anfwering its purpofe, that the bladder, when filled at night, was for the mold part found to contain a confiderable quantity of its air the following morning.

When the carbonic acid air was thus applied to the fore, it fir ft occafioned a

* C fenfation

( 22 )

fenfation of coldnefs, which lafted for a few minutes, and was afterwards fucceeded by a glowing warmth, which continued more than half an hour. The fame fenfations have been uniformly exprefied by the patient, after each fucceflive application of the air.

The next morning fhe faid fhe was eafier, which was then afcribed to the ufual propen¬ sity of people to be pleafed with a new re¬ medy. But greater confidence was given to her report, when, at the expirat ion of not more than three days, the furface of the fore appeared of a better colour, and the ftench from it became lefs offenfive. Each time the bladder was removed, which for fome time was done twice a day, to evacuate the dif- charge from the fore, lhe was fenfible of immediate pain on the admiflion of the at- mofpheric air; and never failed to find eafe very foon after the carbonic acid air was again applied.

When

( 23 )

When I gave directions for the above ap¬ plication, I prefcribed likewife a cautious life of arfenic internally. The preparation of it ordered was not ready for fome days; and Mr. White, who applied the air, on whofe accuracy I can rely with much confidence, is pofitive that not only the finell from the fore was lefs fetid, but that its furface Ihewed a difpofition to granulate, before any arfenic was given. It is likewife certain that the patient’s expreffions of relief were not cold or ambiguous, but approaching to rapture. Had I feen her at this period, I fliould cer¬ tainly have given up my intention of trying the arfenic, in order to afcertain more une¬ quivocally the effedts of the air by itfelf; but as I happened to be gone to a diftance for a fhort time, Mr. White was attentive to exe¬ cute the whole of my original prefcription. The patient began at this time to take a fix- teenth part of a grain of white arfenic, dil-

C 2 folved

( 24 )

folved according to Dr. Fowler's formula, three times a day.

The ulcer continued to wear a better ap¬ pearance daily. The pain was not greater than that of a common wound of the fame fize; the difcharge gradually leiTened in quantity, and afiuraed the colour and con¬ fidence of mild pus; the circumference of the fore contracting, and its cavity filling up, its general dimenfions were on the 21ft of July (when 1 returned to my duty at the Infirmary) not quite a third part fo great as they were when I faw it on the 24th of the preceding month: and the finus at its lower part was then fo much diminifned as not to be capable of containing more than a tea- fpoonful of matter. The indurations in the mamma had become much foftened, and were evidently difperfing. The patient had recovered her appetite, her ftrength, and her deep, and was in every refpecl a renovated being.

At

( 25 )

At this period I admitted her an in-patient, that the farther progrefs of the cafe might be more conftantly obferved, and every phceno- menon faithfully defcribed for the fatisfaction of the publick. No change was made in the treatment, as I thought it would be an ill- timed experiment to run a rilk of inter¬ rupting fo fuccefsful a recovery, by omitring either the arfenic, or the application of the air, for the purpofe of afcertaining to which of them we ought chiefly to impute it.

After her admiffion into the houfe the fore continued to heal up, without interruption, without pam, or any other occurrence worth mentioning, until the 22d of Auguft, on which day the difcharge from it appeared lomewhat bloody, and the difpofition of the remaining fore (which was now very fmall) more irritable. She faid Are had hurt her breafl: the night before, by turning on her face while afleep in bed.

Some

4

( 26 )

Some days afterwards the was troubled with diarrhoea, attended by a frequent pulfe, a hot fkin, and inflamed tonfils. On the 31ft an er

itfelf over the fkin of the affefted mamma, but without materially affedting the appear¬ ance of the fore,. Thefe fymptoms feemed to be wholly unconnefted with the original complaint ; but continued more or lefs till the 13th of September. The arfenic was now left off, but the carbonic air was never removed 5 and by the 19th the fmus was en¬ tirely filled up, and the ulcer clofed.

No deep induration whatever is felt in the feat of the former fore, or in that part of the fubftance of the bread which was occu¬ pied by the finus; the whole of which bears handling and preffure without buffering the fmalleft uneafinefs; but the fkin formed by the cicatrix is fomewhat irregularly elevated and hardened. Some flight vefications have at times arifen upon it, extending no deeper

than

yfepelatous inflammation i he wed

( 27 )

than the epidermis, and apparently fome remains of the eryfepelas which lately af¬ fected her. They have now nearly vaniflied.

The ulcer would in all probability have been healed fooner than it has been, if the finus had been laid open to its bottom ; but 1 was unwilling to allow it to be touched by a knife, left more might have been attributed to it than its due; and the experiment was not neceffary in the progreffive ftate of amendment of the fore.

She was di (charged on the 30th of Sep¬ tember, with orders to return twice a day for fome time to have frefh gas applied, as the beft defence of the newly-formed fkin from any external injury.

CASE

( 28 )

CASE II.

<

M Rs. A. lady of Mr. A. banker in Bath, aged fifty -feven years, confulted me on the 27th of July 1794, in confequenee of having feen the patient whofe cafe has been de- fcribed, after the latter had been more than a month free from pain, under the above treatment, and when her ulcer was much contradted.

Mrs. A. had at this time an open ulcer in the left breaft, the appearance of which was altogether hideous. It was fame what of an elliptical figure, extending from the fternum nearly to the axilla lengthways, and laterally from at lead: two inches below where the nip¬ ple fhould be towards the clavicle. Its length, by accurate meafurement, was full fix inches, its breadth more than four and a half, and its fize conflantly increafing. Its utmofl depth

0

was

( 29 )

was about two inches; its edges uneven, hard, and dentated; its furface was very irregular, and from nearly its center arofe a prominent and very hard ulcerated tumour, immoveably fixed at its bafe, from which blood flowed on the leaft preffure being ap¬ plied to it, frequently on the mere admiffion of the atmofphere, and fometimes fpontane- oufly. A few days before I faw her, not lefs than a pint of blood had been difcharged from the fore at one evacuation. The mat¬ ter from it was in large quantity, thin, icho¬ rous, and highly offenfive to the fmell. The glands of the axilla were not then perceptibly affefted, but had at different times during her difeafe been fwelled, and again fubfided.

The pain of the ulcer was extreme, and almoft unceafing. She defcribed it by the terms pricking and J, looting . She had not enjoyed one night of quiet repofe, on account of it, for twelve months. Her body was emaciated almoft to a fkeleton, her appetite

was

( 3° )

was gone, her pulfe was at a ftandard of not lefs than 100 ftrokes in the minute, and amounting frequently to 20 more, particu¬ larly in the evenings and in the night, when fhe was fubjeft to chilly fits, fucceeded by- heat and fweating.

The following isr the hiftory of her cafe, the particulars of which have been given to me in writing by her hufband.

In May 1791, fhe difcovered a hard knob, in her left bread:, about the fize of a marble. Finding it increafe, fhe had a confultation of a phyftcian and two furgeons about three months afterwards, all of whom advifed her to have it cut out. The knob was then as large as a pigeon’s egg. Dreading an ope¬ ration by the knife, fhe applied to a country quack, who in Auguft 1791 put a cauftic to it, which kept open for three months. It was then healed, but a hardnefs was ftill left in the bread:. This having confiderably aug¬ mented, the fame perfon applied another

cauftic

( 3i )

cauftic to it in March 1792. He continued to drefs, in his own way, the wound he had thus made, till June 1799, but it was at this time fo far from being difpofed to heal, that it grew conftantly larger, and of a fouler appearance, much reducing the health and ftrength of the patient.

At this period die was recommended to apply to the fore fome noftrum which fhe received from Ireland, and to take internally drops of the terra ponderofa falita. During theufe of thefe, the ulcer appeared cleaner, and difcharged matter of a thicker confid¬ ence. Her general health too was improved. Being fome time afterwards deprived of a fupply of the Irifh application for near two months, the ulcer grew more painful, foul, and offenfive; and was again for a time cleanfed in fome degree by a repetition of the fame application. But though this, and drops of the terra ponderofa fahta , were continued till within two months of the period when I

firfi:

( 32 )

firft faw the patient, the ulcer had gradually

increafed, and her health had funk to the de~

%

gree above-mentioned. The pain during the whole time was feldom abfent, and often exceffive. She left off this application and the drops, from finding them ineffectual, and afterwards dreffed the bread: with fome Am¬ ple ointment.

On the 28th of July 1794, carbonic air was applied to the ulcer, in the fame way as in Alford’s cafe. She was fenfible of almoft an immediate abatement of pain. On the the 30th file declared her bread: quite eafy, and that fire had enjoyed a better night than for fome months. On the 31ft fhe could move the arm of the affedted fide with more cafe than formerly.

Auguft 3 d. The ulcer tolerably free of bad fmell, and its difcharge more puriform, but very abundant. Her debility and want of appetite being alarming, fire began to take an ounce and a half of a pretty ftrong decoc¬ tion

{ 33 )

lion of the broad-leaved willow bark* three oi four times a day, which I have found in hofpital practice little if at all inferior to Peruvian bark, as a tonic medicine, and grateful to many ftomachs which rejected the latter. A general reftorative regimen was likewife enjoined.

i Qth. Her appetite, having been impro¬ ving, was this day better (fhe faid) than for any time thefe two years. The fore eafy, dif- charging lefs matter, of a better confidence, and no blood fince the firft application of the carbonic air. Few or no fymptoms of pyrexia for fome days.

1 2th. Y efterday fatigued herfelf by fitting the fir ft time for many months in the garden. Became chilly, and was affifted into the houfe. Afterwards flept all night with one of the

* I was firft led to ufe this remedy, in conlequence of the favourable report of its virtues lately publillied by Mr. James, of Hoddefdon; and I have not been difappointed of fuccefs in a good many trials of it.

windows

( 34 )

windows of her chamber by accident left open. This morning was attacked by violent fhivering fits, recurring at intervals, and fucceeded by ficknefs, great reftlefihefs, third:, heat, and a quick pulfe. Saline draughts, with fmall dofes of antimonial wine, were given her, occafionally gentle opiates, and afterwards the decofilion of the willow bark, which on the firft recurrence of the fever was omitted. On the 17th this was exchanged for the decodtion of the Peruvian bark. The fe- verifh fymptoms, which were at firft imputed to the patient having caught cold, in a very few days from their commencement album ed an evident and ftrongly marked hedtic type, with a pulfe in the exacerbations of the fever rifing to 130, together with moft profufe per- fpirations, and fuch a degree of proftration of ftrength, that the patient could fcarcely bear to be gently moved in bed from one fide to the other. Yet on the 21ft, although

thefe fymptoms had not quite fubfided, the

' * >

fore

( 35 )

loie on the breaft meafured an inch and a half lefs in circumference than when the car¬ bonic air began to be applied to it; no pain had been felt in it even during fo levere a general mdifpofition, its furface looked more healthy, and it difcharged a white thick matter.

*♦

2 Jth. She began to take, inftead of the decoftion of bark, Dr. Griffiths’s well-known mix Line, compoied of fait or fteel, myrrh, and vegetaole alkali, m doles of four grains of the fir ft article twice a day.

Sept, 2 d. The ulcer has for Ibme davs difchaiged very little matter, which is of a thinner conliftence. Her appetite is better, her pullb 1 educed to a ftandard of between So and 90, and her ftrength returning.

6 th. Complains to-day of being chilly, but has no fymptoms of fever in the pulfe. The ulcer growing drier.

13//6. The whole furface of the ulcer having become fo dry as to approach almofl:

to

( 36 )

to a fcab, fhe complains of an uneafy fenfa- tion of ftiffnefs in it, particularly on drawing a full infpiration, but has none of the for¬ mer (hooting or pricking pain. She gains ftrength rapidly.

1 6 th. A fmall difcharge of thick white matter from the bread, which has removed

the uneafy ftiffnefs of the fore, and foftened

*

its furface.

2 jth. Has continued perfeftly eafy. Is ftronger, and walks more ere£t than for two years paft. Appetite perfe£tly good, and fleep undifturbed. Although the depth of the ulcer has filled up confiderably, and its

diameter has been contracting, yet in neither

*

of thefe refpects has it mended near fo ra¬ pidly as Alford's fore did. Its dimenfions are now one inch lefs in length, and half an inch lefs in breadth, than when fhe began to apply the gas.

The carbonic air is kept conftantly applied, the bladder being removed only once a day,

when,

( 37 )

N

when, as in Alford’s cafe, the patient is im¬ mediately fenfible of the irritation of the atmofphere. She continues to take Dr. Griffiths’s mixture.

How far her recovery may proceed, I do

•v>

not prefume to conjedture. But it is no fmall recommendation of what has been ap¬ plied, that it has kept a perfon in eafe and comfort for two months, who for fo great a length of time before had known only agony and torture; and who in the fame in¬ terval has to a moft furprifing degree reco¬ vered her general health.*

* Since the above was written , Mrs. A. had for two days (the 3 d and \th of October) feme return of pain in her ulcer , ivhich of late has difeharged a more ichorous matter , and has Jhewn lefs difpofition to heal than formerly. Sufpefting that the difeharge , by infinuating itfelf between the plafter and the jkin , had opened an outlet for the carbonic air , and an entrance for ■ the atmofphere , 1 directed the application of the carbonic air to . be more frequently renewed . TShe pain has fence fubftded , and the difeharge from the fere has been diminijhed. — Oft. qth.

*

D

OBSER-

( 3§ )

V

OBSERVATIONS, &c.

*

I.T is fometimes not a little difficult to dif- tinguifh carcinomatous ulcers from others of a more benign nature, but of fufpicious af- pcct. When the former difeafe is in its incipient Rate of fchirrus, many tumours of a very different charadter have been miftaken for it, and extirpated improperly. But the cafes which have been defcribed, are fo ftrongly marked by every feature of the moil formidable ftate of malignant cancer, that I am perfuaded no two experienced phyficians oi furgeons could any where be found, who Oil ffeing them would have differed in opi¬ nion about them. The convidlion, however, which would have followed examination, may hot be fo certainly produced by defcription. It will not, therefore, be amifs to brin°-to<m-

ther

*

( 39 )

ther and compare the leading circumftances of both cafes, to fhew their correfpondence with one another, and with the received cha¬ racters of confirmed cancer in every material point.

In both cafes we find the tumor fchirrodeus, agre fuppurans, in ulcus depafcens mail moris abiens. In both were felt fevere lancinating pains, with a violence and for a continuance unknown in other ulcers. In both the dif- eafe was progrejjive , a fymptom not peculiar to cancerous ulcers, (as it likewife takes place in fyphilis) but diftinguifhing them from fcrophulous, fcorbutic, and other fores, which are often flationary or retrogrefiive. In Mrs. A.’s cafe, indeed, the ulcer for a time, during the ufe of the Irifh application, and of the terra ponder of a fdlita , was fomewhat cleaned on its furface, yet the pain did not abate, and the decline of the conftitution fliewed the continued progrefs of the difeafe,

D 2

In

( 4° )

In both cafes there was an highly offen- five, ichorous, bloody difcharge; both ulcers had the labia dura , everfa, fchirrofa-, and both patients were hectic.

The difference of the two cafes confided in the fchirrous tumour in Alford’s cafe fuc~ ceeding to a blow, and that of Mrs. A’s fupervening fpontaneoufly; and in Alford’s tumour proceeding (lowly to fuppuration, while the other was nrft converted into an ulcer by the application of a cauftic. A few obfervations are fuggefted by thefe circum- ftances.

i/I. As the tumour in Alford’s cafe was not perceived for two years after the blow, al¬ though fhe differed pains of the bread in the interval, it is by no means certain that the blow was the occafion of the tumour.

2 dly. Suppofing the blow to have been in- drumental in producing the tumour, it does not follow that this tumour was not origi¬ nally of a fchirrous nature, leading to cancer,

or

( 4i )

or was otherwife differing from Mrs. A’s cale, except in the accidental circumftance of its remote caufe. If a difeafe, by whatever external caufe firft excited, fhall affume the fame appearances and purfue the fame courfe as another which arifes fpontaneoufly, muft we not give it the fame name, and confider it of the fame nature and tendency? We are unacquainted with the laws of operation either of the vifible or occult occafions of the malady. Has not every practitioner known Inftances of the moft untraftable cancers being traced, or at lead afcribed, to external injuries?

I fhould not have thought thefe obferva- tions neceffary, in what I believe to be the prefent date of opinion on the fubjedt, if a gentleman whofe judgment I refpecf, but who never faw the cafes in queftion, had not lately obferved to me, when fpeaking of them, that he coniiders ulcers apparently cancerous, arifing from external caufes, as

efientially

( 42 )

i

\

dTentially different from fpontaneous can- cers, which he fuppofes to be owing to a conftitutional taint. The fuccefs attending excifion in both cafes, if fufficiently foon per¬ formed, as the experience of a Bell, of a Hill, and of many other great names, has evinced, proves to a demonftration that cancer in all cafes is primarily a local difeafe.

3 dly. One circumftance in Mrs. A’s cafe deferves particular notice. Not only the ulcer was firft made by a cauftic, but the wound made by the firft cauftic was afterwards healed. A confirmed fchirrus, however, preceded this application, which, it cannot I think be doubted, would have fooner or later ulce¬ rated of its. own accord. From every en¬ quiry I have made of the patient, I am fatis- fied that the cauftic which was firft applied had not penetrated fo deep as to corrode any part of the fchirrous tumour j of courfe the fuperficial fore produced by it clofed as foon as the efcharotic dreffings were removed.

But

( 43 )

But the fecond application of the cauftic feems to have been more powerful, and to have reached the fubftance of the fchirrus, which, being once brought into a ftate of ulcer, continued to fuppurate and extend,, with every mark of the moil inveterate cancer.

4 thly. The drying up of the difcharge in Mrs. A’s cafe, during one period of the appli¬ cation of the carbonic air, is fmgular, and dif¬ ferent from what happened to Alford, whole ulcer continued to pour out a confiftent pus, though in moderate quantity, till it doled,

I cannot ftate with confidence what this dif¬ ference was owing to ; but it was likewife remarked in Alford’s cafe, that when the gas was moft frequently renewed, the dif¬ charge was the moft diminifhed. Perhaps in the period alluded to, Mrs. A’s bladder may have been more accurately filled than ufual.

$thly* No

( *4 )

§thly . No fymptoms occurred during Al¬ ford’s ufe of the arfenic, to fhew that it had any perceptible effefts in contributing to her cure. I have been informed, however, that in America it has been lately tried with ad¬ vantage in cancers; but this is not con¬ firmed by the experience of Mr. Pearfon, and

i

of other perfons in our own country.

It would doubtlefs be a matter of much importance, as well as of laudable curiofity, to inveftigate and afcertain the mode of ope¬ ration of carbonic air on the foregoing cafes, as a fuccefsful refuit of the enquiry might lead to new applications and modifications of the remedy. It is long fince it has been propofed for the cure of cancers and other ulcers. Dr. Percival, in his E flays, mentions fome trials he had made with it on the former of thefe difeafes, which were attended at leafl; by temporary relief. Dr. Dobfon, in his book on fixed air, fpeaks of his having failed of

fuccefs

( 45 )

fuccefs in applying it to cancerous ulcers 5 but gives cafes, on the authority of the gen¬ tleman laft named, of Dr. Haygarth, Mr. White, and himfelf, in which gangrenous and phagedenic fores, and particularly the ulcerated fore-throat, were much benefited by fumigating them with this acid gas. My friend Sir George Colebrooke informs me, that twenty years ago a furgeon of the Mid- dlefex Hofpital, whofe name he does not recoiled, (hewed him a patient who had been cured of a fuppofed cancer of the lip, by ex- pofmg it to a ftream of carbonic air ; and that a relation of his own, who had a can¬ cerous ulcer on the nofe, kept it from advan¬ cing by the fame means.

It is probable that M. de Fourcroy alludes, in the flrft part of the following quotation, to fome of thefe inftances ; and no doubt can be entertained of the truth of the fads after¬ wards mentioned by him. He obferves, [fee Fourcroy’sElemens deChimie, tom, i. p. 449]

4 4 Les

( 46 )

“ Les papiers publics ont annonce 1’hif- “ toire de plufieurs cures de cancer, faites “ en Angleterre, par 1’applicaiion de 1’acide “ carbonique. Nous pouvons affurer avoir “ vu employer ce moyen plufieurs fois, & “ 1’avoir employe nous-meme fans fucces. “ Dans les premieres applications, 1’ulcere “ cancereux femble prendre un meilleur ca- u radere ; la fame qui en decoule ordinaire- “ merit, devient blanche, confidante, & puri- “ forme; les chairs prennent une couleur “ vive et animee; mais ces apparences flat- “ teufes de mieux ne fe foutierment pas; “ l’ulcere revient bientot a l’etat ou il etoit “ auparavant, & parcourt enfuite fes peri- “ odes avec la meme ddivite.”

To account for the difference of the refult of M. de Fourcroy’s experiments, and of the other unfuccefsful trials which have been made with carbonic air upon cancers, from that of the firft cafe I have related, it is to be remarked, that this remedy has heretofore

been

( 47 )

V

been applied to fores, either by holding them over the fteam of fermenting mixtures in open velfels; or by pointing a tube to them, leading from a veffel in which carbonic air was generated; or by means of fermenting poultices. It is likewife probable that the carrot poultice, and the poultices of frefh animal dungs, which have been in ufe, a<5t in confequence of carbonic acid being extracted from them. In the latter way its application muft be uncertain, on account of the inter¬ vention of the fuhftance of the poultice itfelf, and of the variable fupply of the air from it; and in either of the two former ways, the carbonic air, by its fpecific gravity, will fall from the part on which it is poured, or be fpeedily wafted away by every breeze of the furrounding atmofphere. It is no inconfider- able proof, therefore, of the efficacy of this gas on ulcerated furfaces, that fuch momen¬ tary and imperfedl methods of applying it ffiould produce even a temporary benefit.

May

( 48 )

May not much more be reafonably expected

*

from its continued and accurate application?

What ftrikes us, in the two preceding cafes, with the greateft* aftonhhment, is the almoft inftantaneous relief of pain, which never failed to follow the application of the gas s and the return of it to a certain degree on its removal. Does this fudden relief imply the exclufion of a hurtful caufe, or the operation of an aftive agent? Did the carbonic air, therefore, aft merely by excluding the atmo- phere, or more properly the oxygen of the atmofphere, which is known to be highly ftimulant to the living folid, and has been fuppofed, by fome modern theorifts, to be the principle of , irritability, and of life itfelf? If fo, the fuccefs of the praftice muft have been owing to the mode of applying the gas, by which every particle of oxygen in a difen- gaged ftate, or in a ftate capable of combining with or afting upon the ulcer, qua oxygen, was accurately removed. For it is very im¬ probable

*

( 49 )

bable that the carbonic add could be decorn- pofed by being kept in contact with the ulcer or with the matter which it difcharged. Of all the compounds of cnemiftry, it is perhaps that which is the moft difficultly decompofed, owing to the charcoal and oxygen of which it is conftituted having a ftronger attradion to one another, than either of thefe fubftan- ces have for any other known body. Its decompofition has not been yet accomplifhed but by means of double affinities; and we cannot reafonably imagine any unknown matter in the difcharge from a cancer capable of effeding a difunion of principles, which no other lingle chemical agent has produced.

Suppofmg the carbonic air, therefore, to have operated in the way above fuggefted, we fhould be led to exped the fame effeds from nitrogene or inflammable airs applied in a fimilar manner. Do the Ample dreffings of furgeons ad otherwife than by excluding the atmofphere? It is well known that all ulcers

are

( 5° )

are injured by being expofed to the common air; and that abfceffes, until opened, do not in general caufe hedlic fever. From the lat¬ ter fa£t it has been fuggefted to me, in a

letter from Mr. Watt of Birmingham, (the

%

celebrated improver of the fleam-engine, and one of the moft accurate experimentalifts of the age, who I am happy to find has of late applied the vigour of his mind to difcove- ries in pneumatic chemiftry) that, as in Dr. Beddoes’s cafe,* a continued infpiration of oxygene air produced hedlic fymptoms, fo the abforption of oxygen by the humours of an ulcer, and of thefe by the fyftem, may be the caufe of the heflic fever which attends fup- puration. On this account it may be of the laid importance to exclude the atmofphere as much as poffible from all fores. Mr. x4ber- jiethy’s late experiments appear to prove, what may give fome fupport to this idea,

* See his letter to Dn Darwin.

that

( 51 )

that oxygene air is abforbed by the furface of our bodies. After expofing his hand for five hours to fome atmofpheric air, contained in ajar inverted on quickfilver, and throwing up lime-water to abforb the carbonic air which had perfpired from his hand; he found that the remaining air, on being tried by the teft of nitrous air, had ioft nearly one- fixth of the oxygen it contained before the experiment. To this I am aware it may be objected tnat tne dilappearance of oxygen was here owing to its becoming fat u rated with carbone derived from the fkin, and forming the carbonic air afterwards fixed by tae lime-water. His previous experiments,

’ however, demonftrate that carbonic air al¬ ready formed is perfpired by the fkin s and others of them feem to fhew that the abforb- ents take up oxygene in preference to other airs.*

Had

* See Surgical and Phyfiological Effays.

( J* )

Had the carbonic air in the foregoing cafes any pofitive or aftive operation?

It does not appear to poffefs an efcharoti c power, for in neither of the preceding cafes did it give pain, or produce an efchar. It does not feem to meliorate the nature of the difcharge by attrafting any principle from it, which al¬ ters the chemical properties of the acid itfelf: I have collected fome of the acid air which had been in contadl with Alford’s fore for feveral hours, and found that it extinguiihed flame, precipitated lime-water, and reddened the infuiion of turnfole.

Has the carbonic air any direft fedative effedt upon ulcers, by deftroying their fen- fibility ? ,

Bergmann thought that it fuffocates, by immediately deftroying irritability ; but the improved dodtrine of refpiration accounts for its producing fuffocation in a more fatis- factory manner. The Chevalier Landriani affirms that it extinguifties irritability, even

when

( 53 )

when applied to the fkin. By tying a blad¬ der full of this gas to the neck of a fowl, in fuch a manner that only the head of the ani¬ mal was in the open air, and the whole body inclofed in the bladder, the fowl (he afferts) immediately perifned. The Abbe Fontana, however, denies the truth of this experiment; but he does not feem to have ufed pure car¬ bonic air.

Or, was the carbonic air abforbed by the ulcers, in the preceding cafes, or combined in its ftate of a compound acid with the matter of the fores?

I have not been able to determine whether any part, or what quantity, of this air was abforbed by the ulcers. It is true that fome of it difappeared during its application, as the bladder in which it was contained col- lapfed the more the longer it was fixed on the bread. I am inclined, however, to be¬ lieve, that part of it efcaped, becaufe it was impoffible to make the bladder and plafter

E perfectly

( 54 )

perfectly air-tight; and hecaufe the bladder Ihrunk, both when the ulcer in Alford’s cafe was diminifhed in fize, and when it was largeft. At the fame time, Mr. Abernethy, in the Effays already quoted, proves in a very clear manner, not only that carbonic gas is thrown forth from the (kin, but that it is like wife capable of being abforbed by it in very considerable quantity. By expofing his hand tor nine hours to fix ounces of carbonic gas, the quantity of the latter was reduced to lefs than three ounces.* flow far a fimilar abforption may have contributed to the relief of the ulcers which I have defcribed, rfmft be decided by the refill t of future experiments.

With reipect to the poilible combination of the carbonic acid with the matter of can-

# E carbonic air be abiorbed by the furface of the body fo largely, and if Dr. Beddoes’s fpeculations on phthifis be found to have validity, may we not carbonize the fyftem by aerial baths, inftead of the infpiration of airs of a low ftan- dard, and thereby reduce the excefs of oxygen in the blood and folids, if fuch really takes place in that difeafe ?

cerous

ccrous ulcers, I have very little to add. The difcharge from cancers has been fuppofed to be corrofive. 1 do not know that this is a fact. If it be true, and if the acrimony of the difcharge be of an alkaline nature, the carbonic acid may neutralize it, and deprive it of its caufticity. This fuppoiition was fuggeited to me by my friend Dr. Mailer, when it was too late to examine it by expe¬ riments on the matter of the ulcers above defer i bed, owing to the di min idled quantity of their difcharge. Very obvious tells, how¬ ever, will occur to every one, who may have opportunities and inclination to i live (ligate the fubject.

If the carbonic air afled, in the cafes under review, by combining with and chemically changing the difcharge from the ulcers, other airs may perhaps be applied to fimilar fores with even more advantage. If their pain be caufed by the flimulus of oxygen, hydrogene air is capable of immediately combining with

E 2 it;

( 56 )

it; and the accurate Mr. Watt aiTures me that this air has a powerful effect in allaying the pain of external inflammation and fores. Whether the union of the oxygene and hydro¬ gene airs may not, however, render the dis¬ charge from cancers more thin and watery, a circumftance not to be wifhed, muft be deter¬ mined by trials. But this is only a furmife, as I know no fafts to be depended upon, that prove this combination to produce water without a more rapid combuftion than can be expected in the degree of heat of the fur- face of ulcers.

Mr. Watt obligingly informs me,* that in his experiments he has found the inflamma¬ ble airs from charcoal, iron, and zinc, fpeci-

* For a full account of Mr. Watt’s ingenious experi¬ ments and difcoveries upon different kinds of airs, and for a defcription of the apparatus which he has invented for pro¬ curing them, I beg leave to refer to an interefting publica¬ tion of Dr. Beddoes’s, now in the prefs, which will be given tb the world about the fame time as this pamphlet,

fically

( 57 )

fically different, agreeing in nothing but their inflammability; that they all contain a quantity of the (olid by means of which they are produced; and he fuggefts, that as the inflammable air produced by charcoal and water, contains a quantity of the former in an aeriform ftate, we may in its application to ulcers, expe6f its antifeptic virtues as well as from carbonic acid air. He thinks it more likely to carbonize the blood, or the humors of the fores, as it may be abforbed by oxygen; whereas the carbonic acid air is already faturated with this principle.

He farther alludes to the ufe of zinc ap¬ plied in fubftance to ulcers ; and fuggefts the poffibility of its being conveyed to them with advantage, either on the furface of the body or in the lungs, by means of the inflammable air produced from zinc by heat and water. What feems to obviate the objedlion ftarted above to the application of the hydrogene gas to cancers, as capable of diluting their dif-

chargc.

( 58 )

♦

charge* is an obfervation of this gentleman, that a few infpirations of this air from zinc very fenfibly thickened the mucus of the lungs.

I beg once for all to obferve that the fore¬ going fpeculations have arifen out of the cafes before defcribed; and that no preconceived theory has had any fiiare in biaffing my judg¬ ment of the pradlice which I have related. I have no partiality for any of the fuppofi- tions which I have ftated, and place no value upon them, but in fo far as they may lead others and myfelf to obtain a knowledge of more fabts by experiment.

Experiments, with the different faftitious airs mentioned, may with perfedt fafety be made not only on cancerous, but on many other ulcers, which it is unneceffary to par¬ ticularize. Where furgeons ufe merely fimple dreffings, which they feem to Amplify more and more every day, it appears impoffible that they can a£t otherwife than by excluding the

atmofphere.

( 59 )

atmofphere. As every fubftance applied to a raw fore mu ft irritate more or lefs, the irri¬ tation of the dreffings commonly employed, may be avoided by applying airs of a low ftandard. Hence an obvious indication of their ufe in incifed wounds, and after fur- gical operations, fuch as the amputation of the mamma, of the extremities, &c.

Another fubjedt for their trial is in all cafes where furgeons open cavities. In the lumbar abfcefs, fo*r inftance, it is well known that the cyft is tolerably free of inflammation in general, until opened either by ulceration or the hand of a furgeon,when a fuddenand great inflammation takes place; and the fuccefs of the cure is commonly in proportion to the care with which the atmofphere is excluded. The fame thing happens in evacuating col¬ lections of matter from the Burfae Mucofe, or from the capfular ligaments of the joints; in the operations of the trepan, for the hernia, empyema, fuppurations in the liver, and in

the

( 6o )

the Caefarean operation itfelf. 1 In moft or all of thefe cafes, airs of a low ftandard may be applied with convenience and eafe. Their em¬ ployment isthemore clearly indicated here, be- caufe when the common air is once admitted into cavities, the ufual drefllngs confine what has already entered, without abforbing or expelling it. The application of a quantity of carbonic, nitrogene, or hydrogene airs, however, would either fimply mix with and dilute the atmofphere fo admitted, or chemi¬ cally combine with its oxygen, and render it in either cafe innoxious. On an oppofite principle they fhould not be applied after the operation for the hydrocele, where the objedt is to excite inflammation by the admiflion of the common air. Would the injedtion of oxygene air into the fcrotum be of ufe in this cafe?

Would the application of the former airs be beneficial to inflamed as well as ulcerated furfaces, fuch as eryflpelas or opthalmia?

They

( 6i )

They appear deferving of atrial in burns; and it would be no very difficult matter to envelope the whole body in any of them

when fcalded, the mouth and noftrils ex-

*

cepted. If the Chevalier Landriani’s expe¬ riment, formerly mentioned, be well founded, I would prefer nitrogene or hydrogene airs, in this cafe, to the carbonic.

If factitious airs are to be applied to large furfaces or in large quantity, where a bladder would be too frnall to confine them, pieces of filk, varnifhed with amber or cobalt varnifh, fitted to the fize and fliape of the part, and their edges accurately fixed to the fid n by adhefive plafter, ought to be employed. Var¬ nifhed filk, it is well known, is ufed in bal¬ loons for confining inflammable air, the mod fugitive of all the permanently eiaftic va¬ pours •, and it will therefore more eafily re¬ tain carbonic air, which is a much lefs fub- tile fluid. For the application of airs to the extremities, bags may be made of this filk,

F refembling

( 62 )

refembling wide ftockings, which will require being fixed by plafters, or tied by firings, only where they are open at top. Other modes of fliaping and applying pouches of {ilk to whatever parts we chufe, wifi occur to every perfon of the moft moderate capacity for invention.

It is enough to mention a few, in order to fuggefl many familiar cafes, in which the ex¬ ternal ufe of airs may be tried. I abftain, therefore, from multiplying examples.

I truft, however, that I do not altogether flatter myfelf with a vain hope, when, in addition to what Bacon faid of the difcove- ries in his time, <c that a new philofophy has <c iffued from the furnaces of the chemifts, cc which has confounded the reafonings of the <c ancients,” I lubjoin, that a new Medicine likewife, with healing on its wings, may be expected to arife out of the old, from the application of the late difcoveries in chemiflry to pra£tice.

FINIS.