A Collection of Chirurgical Tracts

by William Beckett

I Should not have been induced to make these Papers publick, barely on account of the rash Censures, that are frequently cast upon the Practice of Surgery, not attended with Success; tho’ that Consideration alone, in the Case of a Person of such Value and Eminency in Physick, as Dr KEIL is known to have been, may be thought sufficient to have moved me to it: But being certainly informed, That several Physicians and Surgeons have before, and since his Death, given themselves the Liberty to reflect, not only upon me for Using, but also upon the Deceased for submitting to the Methods that were taken with him; I think I shall not discharge my Duty, either to my Friend, or to my Self, or indeed to the Profession, if I do not, as far as I am able, endeavour to set what was done in a True Light.

In order thereunto, it may be requisite to look back to the Time He first mentioned any Disorder in his Mouth to me, which was in August 1716. He then told me, He had preceived a Fulness in his Mouth for very many Years; but in the last Three or Four Years it was much encreased, and by the Bulk began to be troublesome to him, tho’ not in the least painful: Upon examining it, I found the Tumour not only large, but also to fluctuate, and therefore told him, until I was satisfied what was contained in it, I could not come to a Resolution, as to the manner of treating it; but, if he pleased, I would make an Incision into it, and then would tell him what I thought was fit to be done; He was very well satisfied, and resolved I should proceed accordingly.

Upon Opening it, there appeared to be nothing contained in it, but Blood; not in the least altered in Colour, Consistence, or Smell, from what is contained in the Vessels. The Tumour presently sunk very much, and I dilated the Incision with my Probe-Scissers, and pressed in some Dossels; and then told him, it was a fleshy Tumour, called a Sarcoma, and that the Blood contained in it was only accidental; and that the best way of extirpating it was by the actual Cautery; but I let him know, that I feared it would be more troublesome to him, and take longer Time to cure, than he seemed to expect.

We presently sent for the best Instrument-Maker the Country afforded, and gave him Directions: But that Night: talking with him of his Case, I desired him to consider, Whether it might not be thought a Slight, by the Learned of both Professions, if I should Perform the Operation, upon a Man of his Character, without a Consultation; there being no Reason (but the Loss of his Time) to be in haste. At first he seemed unwilling to lose so much Time, yet upon Consideration, he resolved for London the next Day, where several Physicians and Surgeons were consulted; they all agreed, it was a simple Sarcoma, and that the actual Cautery was the properest, if not the only means of curing it. This Account I received from the Doctor by Letter; as also, that the Surgeons, upon probing, found the Bone bare, and from the ill Smell concluded it was foul: “Which, said the Doctor it was impossible for you to discover; because after I left Northampton, Two Dossels of the first Dressing dropt out.” I was very glad to hear That, for those Dossels lodging so long, in that warm Part, I was in hopes might be the Occasion of the fœtid Smell; which the Surgeons, not being acquainted with, might fairly be induced to take for that of a foul Bone: Which I mentioned to the Doctor by the first return of the Post; and also, that I was farther encouraged in that Hope, by considering that the Blood, that was discharged at the first Opening, was not at all altered, neither was any Smell perceived, until after the lodging of those Dossels.

Whether the Doctor ever mentioned this my Opinion, to the Surgeons in Town, I know not; but when he returned to me, to have the Operation performed, he seemed discouraged by the Opinion the Surgeons gave of the Bones being foul. But I thought I might make bold to confirm him, in my former Opinion, the ill Smell ceasing without the Assistance of Medicines. The Consequence proved the Assertion: For when, by several Applications of the Cauteries, I had removed the whole Tumor, it was plain to me, the Bone was not affected; and the Part healed as smooth, and with as much Ease, and in as short a Time, as ever I met any thing of that Nature, and the Doctor continued well, without the least Disorder or Complaint, a Year and about Eight Months.

But then in April 1718. He shewed me a small Ulcer, near that Part of the Mouth that was before affected, and told me, He perceived it began upon eating some hot Meat, that stuck to it: At first this healed without much Trouble, but soon excoriated again; and then I could not again perfectly skin it: For as soon as it was almost healed, it would begin to excoriate a-fresh at the Edges, which is what is usual in Phagedænical Ulcers. And tho’ I could digest it, and keep it easy, yet it got ground of me, and spread towards the Teeth; and, near the Root of One of the Molares, laid the Bone bare, which appeared to me at the first not to be injured, but being long exposed became foul. It not exfoliating in due Time, with the Tincture that is commonly used, I proposed the touching of it with a small Cautery, I being able very easily to come at it without making use of a Cannula; which, by confining the Heat, very much injures the neighbouring Parts: The good Effect of which Practice, of not making use of a Cannula, where you can conveniently omit it, I had good Experience of in Doctor KEIL’s former Case: For tho’ he had several Cannulas made in London, by the best Hand, yet after Twice using of them, I told the Doctor, That if a Patient could be trusted, it would be much more easy to him, and the Surgeon would see much better to use the Cautery, than when obstructed by a Cannula. The Doctor was pleased with the Thought, and pressed me, at the next making use of the Cautery, to do it without the Cannula: The Advantage he had by it was, that it bore four Burnings, and said, It gave him not the Pain, or Trouble he had from but One before, and that the Parts were much less Disordered by it afterwards. But to return:

It will not I suppose be doubted, but that proper internal Means were all along made use of: But the Ulcer still appearing to me more threatening, his Friends pressed him, and I more than any, that he would go again to Town, and have the best Advice it could afford; and I resolved to accompany Him, in the Beginning of August 1718. And I cannot forbear saying I was surprized, when, upon a Consultation, my Brothers, Palmer and Brown, made light of it; and, without so much as hearing what I had to say, concluded, That it was chiefly owing to the Bones being foul; and that by drawing a Tooth or Two which they said were affected, and by Purging with Mercurius dulcis, all would be well; and so they took their Leave. Says the Doctor to me, “What say you to this?” I answered him, That I feared they would find themselves again mistaken as to the Surgery Part; and that as to the Mercury, though a good Medicine, He knew he had taken it already several Times, without any considerable Advantage. The Doctor smiled and said, “But since I came so far for Advice, I will not only give them a Tooth, but also try again what Effect Mercury may have.”

Another Meeting was ordered, and the Tooth-Drawer to be there: Upon Drawing the Tooth, it appeared to be very sound. The First Dose he took of Mercury, whether by Cold, or any other Accident, I know not, very much disordered him. I could not conveniently be absent any longer, and therefore the next Day returned into the Country, and do not know how many more Doses the Doctor then took; but in a few Days I received a Letter from him, in which he said, “I know nothing that has succeeded right with me, since I came here: You know what State you left me in, and I was a great deal worse for some Days afterwards; though I hope the Mercury has had no ill Effect, yet I should have been loath to have been so swelled in those Parts, as I have been, willingly. The old Ulcers are not yet healed, they tell me indeed, there is no Appearance of any new Ones, and that the most effectual Methods, which have been taken here, will infallibly prevent every thing, &c.”

But by his next, which I soon received, I had the melancholy News from him, That the Ulcer was broke out again larger than ever, and therefore that he would be down with me in a Day or two, and he came accordingly, but in a worse State than ever before. And though it again digested, and did as before near heal, yet the returns were quicker, and upon every new Eruption it was larger and worse; and so continued to be, notwithstanding all the good internal Methods continually used by the concurring Advice of Dr Mead, Dr Friend, and several other Eminent Physicians; which no doubt was owing to the malignant Nature of it.

And therefore in the Beginning of February last, I could no longer forbear expressing my Fears to the Doctor that it would terminate in a raging Cancer. He was too sensible of it, and told me, “That since I thought I could keep it within Bounds no longer, He was resolved to try what a Salivation would do:” And though I could say nothing as to the Advantage he might expect from it, yet I frankly owned to him, that if it was my own Case, I should be of his Opinion, that I might make bolder with my self, than with any other Patient: But desired by all means, he would first hear if his Friends, the Physicians and Surgeons in London, had yet any other Method to propose, or else would approve of that. He wrote to them, the Answer was long in coming, which made the Doctor express himself to me with more Warmth, than I ever knew him to do before: (For he was a Man of the greatest Command of himself, as well as of the sweetest Temper) “What, says he, is not their Silence enough? And will not you, whom I take for my Friend (for fear of losing your Reputation) assist me in what I desire?” With a great deal more to assure me of his Confidence in me, and of his Opinion of my Ability to take Care of him in the Course. I am not so vain, as to mention all his kind Expressions, yet if it be desired, by any of his Friends, I will give them the Satisfaction of seeing the Letters I had from him, when he was absent from me in London.