DEP/DUA/1/15/03 (Transcript version)

Violet Mathews

(1777-1778)

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Violet Mathews.

Respecting disease to which this patient subj. little room for doubt.

Is evid subj. to an affect no less com than it is dreadful.

In diff syst. however has receivd diff appell

Yet can be no doubt that this patient subj. to a disease which in some syst. title of Cancer in others of Carcinom.

To first of these heads gen would referr it in syst of Dr C. to last in that of Sauv some other nosol.

Yet in Syst. of Sauv. may perhaps with strict prop. give it yet a diff [appel].

Mr Sauv. has formd gener. class of diseases under title dolores.

To this class from shooting pains with which patient affected would natur. be disp. to referr it her affect

This class accord to situat of pain divided into diff. orders.

And of all these disease of pres patien could alone belong to order of external pain

Under this order find a genus disting by title under title of Mastodynia.

A word of greek deriv exprss. pain of Mamma.

To this order genus Mr Sauv. has referrd no less than ten diff. gener. species.

And under each has describd very minutely affect of breast diff in essent partic from each other.

In so much that may I think with justice say that this genus does not include natur. combin.

Under this genus howevr a species describd under title of Mastodynia Cancerosa to which no doubt in referring affect of pres patient.

And indeed in hist of affect there deliv. have all sympt of pres. case.

Here as in that affect the tumour hard red & unequal.

But besides general appear charact also by pain.

These from descript given by patien are in her case of acute [Cancer.] kind.

Such however describd by Sauv. as dist. Mastod Cancerosa

And such indeed univ allowed attend of Cancer in breast.

In this affect then investig by nosol syst of Mr Sauv. leads to direct & pos. conclus. respecting disease.

And shews how far even artif. method may be serviceable for this purpose.

For can be little doubt that a genus consist of painful affect of breast [form] by no means a natur assemb.

And much less affin between these than between cancer situated in diff parts of body.

For although situat varied nature & tenden of disease the same.

And in great meas. to be combat by same remed.

Adopting cancer as genus cheif diff of disting it from scirrhus.

And princip to be done by pres. of pain.

For other marks from ineq. of tumour from varicose veins about basis &e though general yet not const.

In case before us however still farther demonstrat of cancer. tenden.

And perhaps the mark of all others the most to be relied upon.

That is affect of [axill] glands in conseq of disease of breast.

In our patient has now subsist for consid time.

And even where [cancin] pains do not occurr serves as ground for disting cancer from mere [scirrhosit].

For can be no doubt that is affect of absorpt of matter from sore.

And that this matter acting on other glands is inducing on these a simil state.

From every circum then no doubt that this affect strictly to be calld cancer.

Yet perhaps cancer placed in contra distinct to [schirrus] on an imp. foundat.

And cannot help adopting the opin of an ingen Gent. Dr Hopkins whose inag Dissert on this subj consid to be one of most accur & jud perform on cancer that [scirrhus], cancer & carcinoma to be consid merely as progr. stages of same affect.

And must own give his definit of this affect. prefer. to that of any of the nosol.

Yet not to be refused that many [schirri] which never become cancer in common accept.

That is affect stops as it were at first step

And on contrary has sometimes appar. begin from second or even third stage, without others having preceded.

Yet excepting nosol. almost every author has conjoind two last.

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In this disease two condit to [appar] at least oppos. pointed out by most pract. authors. occult & open cancer.

These Mr  Sauv has disting as two diff. gener. undernames of Cancr & Carcin

With much greatr prop howevr to be consid merely as diff. stages of same affect.

And indeed progr from one to other alter at no regul. period is yet subj of daily observat

With patient before us although disease of several months contin no doubt that still in formr of these states.

Yet must consider nature & tendency to be same as if already ulcerated.

Real nature of cancer howevr a matter much more diffic investigatd than presence in case where occurr

While at same time on prop. knowl of this rational plan of cure must in great measure proceed.

Into this subj. howevr foreign to pres course to enter at any length

When humour. pathol. prevaild supposed to depend on morbid state of general mass of fluids.

And will find many not in other respects to be reckond humor. pathol. who still contend for this doctrine.

In so much that freq. affects their practice.

Am so far howevr from being of this opin that led to believe that where such a state of fluids does occurr is conseq. not cause of affect.

Do not deny that cancr may be hered or constit affect.

But even then suppose that prin cause at least depends on fluids solids

Hold it to be at first affect of pecul inflam. or if may be allowed more gener term, pecul. action of vessels in part.

This suppose to give rise to stagn. & effus. in part.

And stagn matter often assumes coag state giving pecul hardness of swelling & diff of resolut.

Forms even confused solid mass in which organ struct in great meas. destroyd.

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Hence also diffic tendency to suppur.

But even this operates as cause supporting depravd action.

And from this both the pain & separat of a pecul. fluid sometimes disch externally, but always in part taken up by absorb.

Thus the affect of other glands partic those in course of absorb.

And thus general affect of system [horripil] shivering & other febrile appear by which patients cut off.

From this view of the disease will readily imagine that not disposed to favour prognos.

Cancer notwith pomp. assert of empyr. & even of some regul. practit in by much greater number of cases termin fatally

And great reason to fear that this will happen with regard to pres patient.

Disease indeed hitherto has not had very rapid progr.

Although of above two years cont has not yet degener. into ulcer. state.

Nor does it at pres. shew any manif. signs either of this or of great absorp.

Would hope therefore that may at least have opport of trying effect of diff med.

Yet must own that look upon it to be a very unfav. case for expect much from med.

Even slow progr. against speedy cure.

Is not From firm attach size & other circum is not in condit that can be removed.

And from long contin in pres state less chance that prop circulat through it can be renewed.

On whole then suspect much that patient will leave us no better than when came under care.

This however not to deter us from at least trying most likely means of cure.

In all diseases of nature of pres. where affect merely local cure may proceed on one of two prin.

To be aimd at either by entire remov of diseased part or by restorat of that part to sound state.

No dispute that operat in as far as can be success. affords chance of most exped. cure.

Yet prop. of operating in any case of cancer among surgeons subj of much dispute.

While some contend for prop of early oper.

Others condem it in every case.

And advoc for both sides contend that found opin, not merly on reasoning but observation.

Those who are fav of the operat. contend that when diseased part can be [complety] removed patient not only speedily cured but as little chance of future cancr as if never subj to it

Those on other hand who condem it tell us that almost every patient on whom operat performd, afterwards cut off by cancr in internal viscera.

And that sympt to which subj. of most excrucit. kind.

In so much that have been told by one of oldest & most attent practit in this city that was firm resolut. never to operate on one of them.

Must howevr own that as far as my observat goes can by no means agree with him.

Know sever people still alive once afflicted with cancr who if not operatd upon in all probab. long since dead.

And cannot help thinking that on princip respecting nature of disease which can hardly be controv. prop of operat at early period may be defended.

Into the general question however not here partic our business to enter.

And [suffici] upon whole to say that am friend to operat.

Becomes howevr a second quest. how far such circum occurr in case bef. us.

And here must own that think oper not to be ventured upon.

To this indep. of other circum consider fixt state of tumour to be an unsurm object.

For hold that operat only to be performd where can be means of entirly remov. the diseasd part.

Here even swellings under axilla would give some diff.

But much greatr from [firm] attack to bones of chest.

And indeed little doubt that in sev. places insin itself between ribs.

Although therefore where considr operat advis would recommd that should not be a moment delayd [treatm] to other means of cure yet in pres is in [second] way alone that can have any expectat.

Here therfore endeav to be employd to restore as far as we are able a sound state to diseased parts.

And this to be brought about.

1 By removal of obstr. in vessels.

2 By absorpt of [effused] fluids.

3 By restoring due condit & proper action to diseasd parts.

Two first intent howevr will often be accompl if can fulfill last.

For by restorat of due condit & action to vascul. syst in [pat.] absorpt prom & circul. renewed.

And perhaps renewal of circulat is of all other means most powerful for removal of obstr.

An end indeed very diff. to accompl.

And probab. shall never be able to discov. effect means of doing it.

Yet I appreh is on this princip. [then] as far as have any affect are to acct for operat of diff veget formerly [esteemd] poisons now recom. for cure of this affect.

Is I imagine on this ground that are to acct for good effects of Cicuta Hyosci Aconitum & Belladona.

From all these plants can observe evid narcotic powers & at same time effects as pecul. stimuli.

And I appreh. on these [properties] [action] in [scirrhosit] & cancr may be acct for.

Am fully aware indeed that many who of opin that no good effect ever obt from Cicuta.

And for own part am very far from consid it as by any means entit to high charact. Dr St. gave it.

Yet that has active powers evid from obvious operat.

And that these powers have been prod of good effects at least in some cases even of cancr is I think conf. by observat.

Have even in my own pract see inst where am persuaded that from use of Cicut. good effects obt.

At same time have never seen any inst where reason to suspect that cont use of it attended with bad effect.

Partic never heard it accused of precip. progr. of the disease.

A circum often affect of other meas especially external applic.

Wish therefore, hoping for some good effect from narcot & stim powers to give it fair trial in pres. case

Active prop. of Cicut. reside in diff parts of plant in various degr.

And from these may be extracted by & exhib in diff. forms

Of all parts leaves most commonly in use

And from these virtue extracted first by express of recent juice & then by evap of watery part [impress] to form of extract.

Where thus [cant.] prepared, perhaps one of best & most commod form

And easily divided into prop dose by being formd into pills.

For this purpose powder of leaves themselves to be preferrd to any other.

Of all parts of plant howevr few less active than leaves.

From acct. given of deliter. effects would seem that root most virul.

But has not as far as I know been been employd in med practice.

Seeds while less active than root more so than leaves.

Of this evid at least in having more powerful narcot effects.

And as far as my observat goes is cheifly when prod some degree of vertigo that cicuta attend with good effect.

On this acct therefore in general disp. to give pref. to extract of seeds.

Or at least to have recourse to this after extract of leaves used for some time.

For in administ of cicuta hold that obj. to be aimd at is to throw it in to such extent that affect sensib felt.

In this manner then mean to give it trial for some length of time with pres. patient.

And to avoid every extern applic except merely defending part & preserv.  gentle warm by fur.

Is with this intent that have directed her to cover mamma with soft fur.

If this course successf. with patient will I think be strongest inst I have yet met with of effic of Cicut.

But although should fail will not on that acct be disp to pronounce the med as useless one.

Shall not even think of desist. from trials of stim narcot.

But before droping cicut. have though of giving it conj. with some other of that tribe.

For this purpose have have thoughts of uniting it with the Atrop Belladona or deadly night-shade.

This partic on author of Mr Vogel told has freq. succeeded where Cicut faild.

And if from internal use no success. have thoughts of trying at same time external applic of leaves of latter.

If these meas. abort. must own shall lose hopes of cure here from tribe of Veg. poisons

There is however a miner. poison which has of late been recommended in this affect as more powerful than any of these.

That is Arsenic.

This in cases of open cancer long recom. as an extern applic.

And suppose to operate as removing the part by corros.

This pract probab. first introd by some empyr.

And according to Dr McBride is probab remed long kept secret in family of [Plunkets] in Ireland.

In prescrip which he gives Arsenic formd into mass with other artic is applied to two drams.

From sulphur indeed in compos. power may be very consid weakend.

Applic of arsenic externally of late [direct] by several regul practit.

And a surgeon of emmin in this city informs me that has often used it with consid success.

On his authority once ventured to employ it to a open cancer in Royal Infir.

In his formul. howevr one gr of the arsenic only enters.

And of this mass. I ventured only on applic of about one fourth at a time

This patient some time after cut off by [horriss] & shivering, succeeded by viol fever.

And has by some been said that he died in conseq. of the applic.

Will not pretend to affirm pos. that this not the case

At same time when consid that arsenic here used to very inconsid extent.

That death did not happen till consid time after used

That patient affected with none of those sympt which arsenic when oper. as poison induces purg. vom. or convuls.

And that cut of by sympt. fever so freq putting period to cancr. affect can see no foundat for the accus.

Arsen. howvr in this mannr applic only in case of open cancr.

But very lately are told that has been given with success not only extern but intern. also.

For this pract. are I believe indebted to Mr Le [Febure] of Paris.

At least only author who as far as I know has written upon sub.

The origin treatise will not easily [meet] with at this place

But will find an analys of it in a late numb of med. commn.

There howevr necess to observe that at end of formul an ommis of words [French] [weigt].

This med tried by one practit at this place.

But without any good affect.

From this however do not think that by any means warrantd to conclud against it.

And in a desperate case after other meas. had faild should I own be disposed to take chance it affords.

May therefore be ultim resource with this patient.

But after meas. already prop. before having recourse to it have thoughts of trying anoth med of which I own have very high opin.

That is electricit.

Of this shall at pres. say nothing as will naturally fall to be mentiond when speak of two other patients at pres. under care.

And indeed doubtful whether pres patient will remain so long under care to give [oppor] of trying it