Brian Altonen, MPH, MS

Introduction

The following text was extracted from an article written by an apprentice of Bartow White–Isaac V. Van Voorhis.  This article was published in the local medical journal, Medical Repository, and dated September 11, 1809.

The editor the letter is addressed to is Dr. Samuel Mitchell, one of the oldest and most influential physicians associated with this Journal and affiliated with the local medical school in New York City.  Dr. Mitchell had numerous articles published in natural history and medicine.  He is the primary reason many articles in this trade magazine were so different from those of Philadelphia trade magazines.  Mitchell had his own theories for disease that were locally published.  His discussions and articles at regular meetings tended to focus on weather, climate and disease, and on occasion offered special insights into the theories of evolution, nature and health and disease, offered in such forms as articles on rock types, terrain, water form, quality and disease, and even fossil records in the Hudson Valley and disease.  

ARTICLE

Fishkill, September 11th, 1809.

” Worthy Sir,

 IF you think the enclosed case of surgery, coming from a student, may afford any useful hint relative to the healing art, you are at liberty to give it a page in that very valuable work the Medical Repository.

[From] Isaac V. Van Voorhis.   [To]  Hon. Samuel L. Mitchill.

 A Case of Cancer, wherein Amputation was successful.

THE propriety of disclosing any thing which may have a tendency to add a mite to the knowledge of any medical or surgical subject, is here offered, by a student of medicine, as an apology for troubling the public with the following case of cancer.

• William Wright, Esquire, about seventy-three years of age, had been afflicted near nine years with an open cancer upon the back of his hand. The disease at first appeared in the form of an indurated tumour, about the size of a common wart. This afterwards ulcerated and spread by degrees, until it occupied and destroyed all the back part of the hand ; and, for these two years past, his whole hand has been completely disorganized, and his health greatly impaired.

A few months since, Dr. White, my preceptor, was called, and found the patient in this situation. The whole metacarpal bones were in a state of perfect curies; the back part of the hand was covered with a preternatural dark-coloured fungus  in the middle of which was a deep-seated phagedaenic ulcer, discharging a brown fetid ichor, for the most part tinged with blood. In a word, the whole hand assumed the appearance of a black disorganized mass ; from which issued an indescribable fetor, infecting every part of the house, and nauseating the strongest stomach that approached it. The patient’s general health was greatly impaired; his body emaciated ; his strength prostrated ; his nights restless ; his days painful; and he himself confined to his bed, with difficulty obtaining a little sleep by the assistance of opium.

The patient, tired of such a situation, and despairing of cure from any application, requested his physician to remove his hand. As no application whatever had at any time been used, (the patient always being opposed even to have the ulcer examined) the doctor considered it a duty first to try some milder remedy. He accordingly recommended some applications, in the form of poultice, which might in some measure palliate the disease, and render the patient’s situation less intolerable. Among them, through the advice of the consulting physician, was the root of dock, (the rumex acutus of Linn.) which has held a place among the specifics in the cure of cancer, but which did not, however, appear to possess curative powers in any degree superior to those of other similar applications.

The ravages of the disease yet progressing, and the patient’s situation becoming still less tolerable, his entreaties for the dismemberment of his hand became more earnest. Every prospect, both of palliation and cure, being now obscured, amputation was considered the only alternative; and the patient’s wishes on the 15th of July were gratified. The operation was performed in the usual manner, by Dr. White, about midway between the elbow and wrist. Nothing of a peculiar cast occurred; the pain subsequent to the operation was no greater than usual, and the anodyne immediately administered rendered the patient’s situation tolerably comfortable. In a few days, by taking 30 drops of laudanum at night, which had long been indispensably necessary, he rested perfectly easy, and continued to do so, although his opiate, at the expiration of a fortnight, was discontinued. With pleasure we add, he is now, about four weeks from the operation, well: the stump is healed, and good health restored.

Relative to the mode of treatment subsequent to the operation, we have to observe, that about the third day from amputation, no high inflammation of the stump taking place, and no symptoms of an inflammatory diathesis of the system arising, the patient was put upon bark and wine. This tonic plan was closely pursued throughout the cure ; the patient at first taking about half an ounce of Peruvian bark and half a pint of wine in the course of a day ; which quantity was found to be as great as his feeble system would bear. As the cure progressed, the dose was gradually diminished. A healthy discharge from the wound was soon induced, which shortly effected a cure.

From the success of the above treatment, may be inferred the good effects of tonics upon the systems of old people in the cure of ulcers. Their utility in these cases, when their exhibition is not contra-indicated by inflammatory symptoms, either local or general, is too great to be dispensed with. Why is it less easy to heal ulcers in old than in young subjects? Is it not because there is a deficiency of energy in the systems of the former? Then how necessary is it to supply this defect of nature by artificial means ! In the above case, it was probable that there was not much natural energy in a system, worn down by age, and reduced, by the most obstinate of all diseases, to a mere skeleton. Is it to be presumed, that under these circumstances there was natural action enough to heal the stump of an amputated arm in four weeks ? Such a supposition would be unwarrantable indeed. In healing ulcers in old persons, and especially those consequent to capital operations, the greatest attention should be paid to stimulus : no time should be lost in assisting the efforts of nature ; the powers of life in old age are languid, and unless they are artificially supported, they will sink under the discharging of extensive ulcers.

It may not be amiss to offer in this place, a few remarks upon the disease called Cancer.

This affection has justly been considered the most obstinate of human maladies, and perhaps not improperly termed the ” opprobium medicinae.” About the nature of this disease, practitioners have differed in opinion : some have asserted that it invariably proceeds from some general disorder of the system ; others contend that it always arises as a mere local affection. The former, in support of their opinion, have said that extirpation in the disease is unsuccessful ; the latter impute the failures which do take place from extirpation, to the delay in operating; and say that the disease becomes general from local absorption only. According to the former opinion, extirpation would always prove abortive; according to the latter opinion, it would prove certainly successful in the early stages only.

Theoretical opinions are only to be established by facts, and the above case stands as one, in favour of that which views cancer originally as a mere local affection. Nay, if no relapse should take place in the above case, of which at present there is not the slightest appearance, and of which, from the readiness of the stump’s healing, there is little future probability, it would seem to authorise the opinion, that a cancerous taint of the system, does not take place even from absorption; nine years being a length of time abundantly sufficient for the absorbing process to take place. Be this as it may, the above case, at present, certainly authorises the practice of extirpating cancerous affections even in the last stages of the disease; and if extirpation, or amputation, prove effectual in the advanced, what may we not expect from these remedies in the incipient stages of cancer?

We shall take the liberty of adding a few words relative to the operation of amputation.

Removing a limb is justly considered as a dreadful operation ; but it is sometimes the ultimate alternative, the only means of preserving life. From its seeming severity, and from its mutilating effect, prejudices are often imbibed against it, which prove injurious to society. It is generally considered as more dangerous and inefficacious than it really is; and many an useful life, no doubt, is sacrificed to such unjust fears and apprehensions. The operation itself is neither so hazardous nor ineffectual as is generally conceived. The danger arising from the operation alone, is trifling; and its failures, in curable diseases, are more owing to unwarrantable delays in performing it, than to any thing else. In the above case, we see a man who had passed the common age of man, whose health was extremely impaired, and whose powers of life were fast sinking under the most incurable disease, brought, by means of amputation alone, in the short time of four weeks, to the enjoyment of good health! And will it be said, that the same remedy will prove unsuccessful upon those who are strangers to old age, and whose powers of life are in full bloom? Cool and unbiassed reflection upon this subject, may be of value to the community.

[END ARTICLE]