Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. XXXIX.

Of the extirpation of a cancerous Breast.

IF notwithstanding all your en∣endeavors to cure a Cancer, the Tumor increase, and be like to ul∣cerate, you may do well to fore∣warn the Patient of the danger: and if it be loose, and in a place where it may be safely extirpated, propose it to them, lest afterwards they desire it when it is too late.

That you may be the more suc∣cessful in the operation, I shall of∣fer to your consideration these few qualifications. First, that the Pati∣ent be of a strong constitution, and of a tolerable good habit of Body, and not in a declining age, when the Menstrua are ceased. Second∣ly, that the Cancer be loose, and the axilla free from painful glands. It were also to be wisht, that the Cancer took its original from some accident, as a bruise, &c. Third∣ly, that the operation be perform∣ed in the Spring, or Autumn of the year: lest through the great heat of the Summer the spirits be resolved; or by reason of the ex∣treme cold in the winter, the na∣tive heat should be choaked.

In order to the operation you ought to have good rollers, com∣presses, restrictive powders, and defensatives, as in other amputati∣ons. The use of Chalcanthum or

other escharoticks I do not ap∣prove: for you cannot apply them so to the mouths of the Arteries, but they will corrode the adjacent parts, and cause pain, which ought not to be, especially in a Cancer. Besides, they require a strict ban∣dage, which is very troublesome on the Breasts. To avoid which in∣conveniences, I propose the stop∣ing of the Blood by a small but∣ton-cautery; which I acknow∣ledge is not done without some pain, but that is momentary, and serves to correct the indisposition of the part: whereas the other lies gnawing so long as it is upon the part, and renders it crude and indisposed. There ought to be actu∣al cauteries of different sorts ready heated in some corner of the cham∣ber, lest in the extirpation there happen to be lest some reliques of a cancerous gland behind. All things being ready, the Patient must be placed in a chair to the light, and held steady. It is then at the operators choice, whether he will make a Ligature about the basis of the cancerous Tumor, or pull it to him with one hand, while he cuts it off with the other. For the cutting into the Breast, and pulling out the cancerated knot, rarely succeeds well: nor indeed is every Breast so capable of being freed of the Cancer, when it is cut off by making a Ligature. If the Cancer be cut off clear, your business is then to stop the blood as you please: but if any scirrho∣sity remain, you shall do well to consume it by actual cautery. The Ancients used in these operations to permit them to bleed freely; nay, provoked them to it by crush∣ing out the blood; after which, the actual cautery was applied all over, then they dressed the wound as a burn: but according to my me∣thod pulv. Galeni is most proper. Then palce the Patient in bed, and give her an auodyne draught that night, to quiet the ferment. The second or third day after you may dress her with some digestive, as that ex terebinth. cum vitello ovi; or, ℞ terebinth. lotae ℥iij. syr. de ros. siccis, ℥iss. succ. plantag. so∣lani, an. ℥ij. succ. apii ℥j. co∣quantur ad dimid. succor. consum∣ptionem; dein adde far. hord. & ciceris an. ℥ss. croci ℈ij. vitell. unius ovi. Misc. But if there be no pain, dress it with Empl. è bolo. After digestion proceed with deter∣gents, and incarn and cicatrize as in wounds; remembring to keep the body soluble the while by Cly∣sters, or purge and bleed as you see occasion. And if they had no Fontanels before, make them some now: for thô the Cure may seem successful, yet if there be any evil quality in the Humors remaining, the Ulcer will scarce cicatrize.

If in cicatrizing it the Lips do grow callous, attempt the eradi∣cating timely by actual cautery, whilst it is within a narrow com∣pass, and lies in the superficies: for if you defer it till it has siezed the Musculous flesh, it will be too late, it being then scarce capable of pal∣liation. Yet some Authors have left us prescriptions, whereby they give us hopes to cure them or extirpate them. Those they have offered to us for the cure are much the same with what I have already set down, viz. ℞ ol ros. corae alb. an. ℥ij ss. succi granat

& solani. an. ℥ ij. cerussae lotae ℥ ij. plumbi usti loti & tutiae praep. an. ℥ss. thuris, mastich. an. ʒ ij. fiat imguentum s. a. Or, ℞ unguenti tutiae Vigonis ℥iiij. theriac. Venetae ℥j. sacchar. Saturni ʒ j. succ. ge∣ranii q. s. ducantur in mortario plumbeo, &c. Others commend the juice of Mullein boiled with Honey. Riverius tells you in one of his observations, that he cured one by often dressing it with aq. ros. plantag. & rhoead. with a mix∣ture of mel. rosat. Aetius proposes extract. Sumach: but that is more proper in Cancers of the Ʋterus.

Empiricks amongst us brag much of their skill in curing of them; and, by the giving of Mat∣thews's Pills, or Opium mixt with some purgative, they do now and then alleviate pain, and thereby encourage diseased people to com∣mit themselves into their hands, whom if they can perswade to an Amputation, they get some Mo∣ney in hand: but their frequent miscarriages in that work, have taught the more prudent people to avoid them.

Some eminent Chirurgeons, I suppose, after a fruitless endeavor to cure them, have attempted the extirpating of them by Escharo∣ticks. Guido has commended to us Arsnick powdered and sprinkled daily upon them, the Eschar be∣ing first pulled off. Riverius in his observations tells of a Cancer that was extirpated by this appli∣cation. ℞ aq. fort. ℥ j. sublimati crudi ℥ viij. salis Ammoniaci ℥ ij. arsenici ʒ j. These are to be di∣stilled ad siccitatem, then the ca∣put mortuum powdered, and the like weight of Vinegar to be put thereto, and distilled again to the consistence of a soft paste for use. Ol. arsenici, aq. regia, ol. vitrioli, lap. caustic, &c. have been propo∣sed. When such are applied, there will be need of good defensatives. By the Authority of some of these Authors, young Chirurgeons have been sometimes ingaged to their prejudice: and some years since an eminent Chirurgeon, since decea∣sed, undertook the eradicating of an ulcerated Cancer in the Breast of a Woman that had strength and courage to endure it. He applied the strongest of the fore-mentioned Escharoticks: they penetrated deep and made great sloughs, which he pulled off, and by repeating the Escharoticks raised new; but the use of them was not long continu∣ed: for the gleet partaking of the corrosives, ulcerated the adjacent parts; and the Cancer was so en∣raged by the Escharoticks, as shew∣ed there was no good to be done by them. Indeed if they had con∣trived Medicaments, that could have penetrated deep with little pain, there might have been some hopes of success. So cancerous ex∣crescences and Ulcers in the Mouth are increased by touching them with Oil of Vitriol, Sulphur, &c. Upon which consideration there remain but two ways, either the actual Cautery, or palliative Me∣dicines. If the Cancer be in such a place as you may hope to eradi∣cate it, the actual Cautery is then a sure help: but not by applying it lightly upon the upper parts; but by thrusting at the root with a scoop, or chisel-like Cautery, car∣rying it away before you. If there remain any rags of it, with a pro∣portionable

button-Cautery, burn it down to a crust: but if this can∣not be effected, then endeavor pal∣liation by such Medicaments as a∣bove have been proposed. And in case the Menstrua or Haemor∣rhoids be stopt, bleed by venaese∣ction or by Leeches, and make Fon∣tanels: for by such means many people live tolerably well, who have Cancers ulcerated; when others, who ailed less, by their impatience are dead.