DEP/DUA/1/23/03 (Normalised version)

Helen Young

(1780)

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Helen Young.

Disease of this patient an obvious local affection.

And if present suspicions are not ill founded of most dangerous tendency.

Consists if not entirely at least principally in fungous excrescence or tumour on [right] angle of mouth.

From even appearance of this alone very strong reason I think for presuming that is of Cancerous nature.

This suspicion corroborated by severe pains shooting to other parts.

But still more by enlargement of lymphatic glands about fauces.

For little reason to doubt that these affected in consequence of absorption from this tumour.

And now universally admitted that affection of neighbouring lymph glands one of strongest marks distinguishing tumour of cancer from those of scirrhous nature.

Is rather in favour of this supposition as otherwise that patient knows no cause to which complaint to be attributed.

Upon whole therefore, although has not yet proceeded to proper ulcerated state, yet may with some degree of confidence venture to pronounce it an example of cancer.

Here indeed but fair to mention one circumstance which may be supposed to create some doubt.

That is scrofula taint which seems to have been origin in patients constitution.

Are informed that even from infancy some marks of such an affection.

May therefore be matter of doubt whether enlarged submaxillary glands be not of this kind.

But even admitting this to be case cannot I think suppose it with regard to affection of mouth.

Appearance, pain & every other symptom, much more in favour of cancer than of scrofula.

While at same time well known that angle of mouth seldom seat of scrofula, frequently of cancer.

And upon whole greater probability that glandular swellings are as already suggested from absorption of cancer virus, than from any other cause.

Taking it for granted then that affection is cancerous prognosis cannot be favourable.

Although far from considering it as entirely incurable yet must admit that in every case a dangerous disease & in greater part even fatal.

And this especially case whether either from situation of affection from determination of patient, or other circumstances cannot admit of artificial removal.

From this circumstance consider danger in present case, as very much increased

While at same time not less to be dreaded from progress which has already made.

Has not it is true either arisen to great size or yet degenerated to ulcerated state.

But to be observed that only two months since first appeared.

A period which for a cancerous affection is proportionally very short.

Even during this period however has already proceeded so far as to create very great pain.

And if suspicions well founded to give affection of other parts from absorption of cancer virus.

To all this to be added that at present in such a state as to have even manifestly increased.

Am therefore disposed to fear that all efforts to stop progress will be ineffective.

And that patient will at length fall victim to the affection.

Begin treatment therefore without any high expectations.

Yet still case may at least affording us opportunity for trial of different medicines.

And if any found to succeed will afford stronger instance of efficacy.

In treatment of cancer in general many measures may be taken with view of alleviating symptoms.

But radical cure in general to be aimed at on one of two principles.

The total removal of diseased part.

Or the restoration of it to sound state

First of these to be effected only by mechanical means

That is either by operation or caustic.

Propriety both of one & other have among different practitioners been much subject of [debate]

And this has particularly been case with regard to extirpation by operation.

For where size considerable caustic [total] in application.

Into controversy however how far in any case is or is not advisable would here be [improper] to enter

May only observe that for my own part, consider operation which is admissible or where patient will submit to it, as being the practice of all others promising greatest success.

And notwithstanding unfavourable situation in present case as well as deformity which must necessarily give, should still [illegible] it for interest of [patient] to submit to extirpation

Of this however whatever may afterwards be case at present no probability.

And in mean time at least other measures not to be neglected.

In restoration of part to sound state where cannot be removed, two objectives to be accomplished.

1 The restoring a proper condition to vessels

2 The restoring due state of action to vessels.

Is I apprehend on these principles that to account for effect which sometimes at least has been derived from certain medicines, where affection even manifestly cancer.

Particularly from those vegetables [combined] with narcotic power that also of peculiar stimulation.

Of these none more used than the Cicuta.

Of introduction of this vegetable against cancer, or of present characteristics need offer no observations.

May only remark that notwithstanding [disease] into which has of late fallen am fully satisfied that have in many cases seen remarkable effects from it.

From this consideration then determined to give present patient that chance which it affords.

And for this purpose have begun here with internal use of it.

Is intention to employ it for some time by itself only & in this form alone.

But if thus incapable of stopping progress of affection shall use it externally as well as internally

And in both ways mean to combat it with mercury.

Externally with a solution of corrosive sublimate & internally with Calomel.

From such additions am inclined to think that in some instances have seen powers increased.

At same time will be no more than I already dread if in present instance shall in end be found unsuccessful

If this case besides attempts to alleviate symptoms may try also other measures.

Particularly if shall be able to [procure] them the verucae Equinae or Horse warts.

But as after measures must be regulated by the then state of disease as well as inclination of patient at present unnecessary to say anything respecting them.